Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 65.00 - Long-term Care Insurance › Section 65.101 - Outline of Coverage

Current through Register 1525, July 5, 2024
[
CARRIER NAME
]
[
ADDRESS - CITY & STATE
], [
TELEPHONE
				NUMBER
]
LONG-TERM CARE INSURANCE
-
OUTLINE OF
				COVERAGE
Policy Number
:
[The following three paragraphs must be included in
				substantially similar language at the top of the policy.]
FEDERAL INCOME TAX EXEMPTIONS:
This policy
						  (
IS)
(
IS NOT
) intended to be a federally qualified
						  long-term care insurance contract under section 7702B(b) of the Internal
						  Revenue Code of 1986, as amended.
STATE MASSHEALTH (MEDICAID) EXEMPTIONS:
This policy
(IS)(IS NOT)
intended to satisfy Massachusetts'
						  minimum long-term care insurance coverage requirements as of the policy's
						  effective date for certain asset and liability exemptions under the
						  Massachusetts MassHealth (Medicaid) Program. Please note that there may be
						  other MassHealth (Medicaid) requirements to qualify for these
						  exemptions.
Please read
Your Options for Financing
						  Long-Term Care: A Massachusetts Guide
for important information about
						  the federal and state exemptions. PLEASE NOTE THAT STATE AND FEDERAL LAWS ARE
						  SUBJECT TO CHANGE AND THAT FEDERAL AND STATE EXEMPTIONS MAY NOT APPLY TO THIS
						  POLICY AT A FUTURE DATE.
1. This policy is
			 [an individual policyofinsurance/a group policy which was issued in (indicate
			 jurisdiction in which group policy was issued)]. THIS IS A LIMITED POLICY. This
			 policymaynot cover all the expenses associated with your long-term care needs.
[Except for policies or certificates that are guaranteed issue,
				the following cautionstatement, orlanguage substantially similar, must appear
				as follows in the outline of coverage.]
Caution:
The issuance of this long-term care
				insurance [policy] [certificate] is based upon your responses to the questions
				on your application. A copy of your [application] [enrollment form] [is
				enclosed] [was retained by you when you applied]. If your answers are incorrect
				or untrue as of the date you signed the applications, the carrier has the right
				to deny benefits or rescind your policy subject to the [Time Limit on Certain
				Defenses, Incontestable] section of your policy. The best time to clear up any
				questions is now, before a claim arises! If, for any reason, any of your
				answers were incorrect, contact the carrier at this address: [insert
				address]
2.
SUMMARY
			 OF POLICY FEATURES
This policy
:
1. is not a Medicare Supplement
			 policy.
2. [is guaranteed
			 renewable/is noncancelable] for your lifetime.
3. [is/is not] subject to automatic premium
			 increases as you get older.
4. [may
			 be/is not] subject to across the board premium increases for all policyholders
			 in your class.
5. [does/does not]
			 offeranoption to purchase inflation protection after the policy is issued
			 without any medical underwriting.
6. [does/does not] offer an option to
			 purchase nonforfeiture protection after the policy is issued without any
			 medical underwriting.
7. [does/does
			 not] contain special age limitations for purchase.
8. [does not cover services due to
			 pre-existing conditions (existing health problems) for a period of __ months
			 from policy issue][does not have a waiting period before pre-existing
			 conditions (existing health problems) are covered].
9. [may have/has] an elimination period of __
			 days before benefits are payable by policy.
10. [offers a waiver of premium after __ days
			 of __ benefits][does not offer a waiver of premium].