Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 755 - HEALTH INSURANCE CLASSIFICATIONS, DISCLOSURE, AND MINIMUM STANDARDS › Section 031-755-8 - Requirements for Replacement of Individual Health Insurance

Current through 2024-29, July 17, 2024
A. An application form for individual health
				insurance shall include a question designed to elicit information as to whether
				the insurance to be issued is intended to replace any other health insurance
				presently in force. A supplementary application or other form to be signed by
				the applicant containing the question may be used.
B. Upon determining that a sale will involve
				replacement, an insurer, other than a direct response insurer, or its agent
				shall furnish the applicant, prior to issuance or delivery of the policy, the
				notice described in Subsection C below. The insurer shall retain a copy of the
				notice. A direct response insurer shall deliver to the applicant upon issuance
				of the policy, the notice described in Subsection D below. In no event,
				however, will the notices be required in the solicitation of the following
				types of policies: accident-only and single-premium nonrenewable
				policies.
C. The notice required by
				Subsection B above for an insurer, other than a direct response insurer, shall
				provide, in substantially the following form:
NOTICE TO APPLICANT REGARDING REPLACEMENT
OF HEALTH INSURANCE
According to [your application] [information you have
				  furnished], you intend to lapse or otherwise terminate existing health
				  insurance and replace it with a policy to be issued by [insert company name]
				  Insurance Company. For your own information and protection, you should be aware
				  of and seriously consider certain factors that may affect the insurance
				  protection available to you under the new policy.
(1) Health conditions that you may presently
				have, (preexisting conditions) may not be immediately or fully covered under
				the new policy. This could result in denial or delay of a claim for benefits
				present under the new policy, whereas a similar claim might have been payable
				under your present policy. [This subsection may be modified or omitted if
				preexisting conditions are covered under the new policy.]
(2) You may wish to secure the advice of your
				present insurer or its agent regarding the proposed replacement of your present
				policy. This is not only your right, but it is also in your best interests to
				make sure you understand all the relevant factors involved in replacing your
				present coverage.
(3) Do not cancel
				your present policy until you have actually received your new policy and are
				sure you want to keep it.
(4) If,
				after due consideration, you still wish to terminate your present policy and
				replace it with new coverage, be certain to truthfully and completely answer
				all questions on the application concerning your medical/health history.
				Failure to include all material medical information on an application may
				provide a basis for the company to deny any future claims and to refund your
				premium as though your policy had never been in force. After the application
				has been completed and before you sign it, reread it carefully to be certain
				that all information has been properly recorded.
The above "Notice to Applicant" was delivered to me
				  on:
____________________________
(Date)
____________________________
(Applicant's Signature)