North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-15 - Short-Term Care Insurance › Appendix A - NOTICE TO APPLICANT REGARDING REPLACEMENT OF INDIVIDUAL ACCIDENT AND SICKNESS, SHORT-TERM CARE OR LONG-TERM CARE INSURANCE

Current through Supplement No. 393, July, 2024
[Insurance company's name and address]
SAVE THIS NOTICE! IT MAY BE IMPORTANT TO YOU IN THE FUTURE.
According to [your application] [information you have
				  furnished], you intend to lapse or otherwise terminate existing accident and
				  sickness, short-term care or long-term care insurance and replace it with an
				  individual long-term care insurance policy to be issued by [company name]
				  Insurance Company. Your new policy provides thirty (30) days within which you
				  may decide, without cost, whether you desire to keep the policy. For your own
				  information and protection, you should be aware of and seriously consider
				  certain factors which may affect the insurance protection available to you
				  under the new policy.
You should review this new coverage carefully, comparing it
				  with all accident and sickness, short-term care or long-term care insurance
				  coverage you now have, and terminate your present policy only if, after due
				  consideration, you find that purchase of this long-term care coverage is a wise
				  decision.
STATEMENT TO APPLICANT BY AGENT [BROKER OR OTHER
				  REPRESENTATIVE]:
(Use additional sheets, as necessary.)
I have reviewed your current medical or health insurance
				  coverage. I believe the replacement of insurance involved in this transaction
				  materially improves your position. My conclusion has taken into account the
				  following considerations, which I call to your attention:
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 in payment of benefits under
				the new policy, whereas a similar claim might have been payable under your
				present policy.
2. State law
				provides that your replacement policy or certificate may not contain new
				preexisting conditions or probationary periods. The insurer will waive any time
				periods applicable to preexisting conditions or probationary periods in the new
				policy (or coverage) for similar benefits to the extent such time was spent
				(depleted) under the original policy.
3. If you are replacing existing short-term
				care or long-term care insurance coverage, 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
				interest to make sure you understand all the relevant factors involved in
				replacing your present coverage.
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.
(Signature of Agent, Broker, or Other Representative)
[Typed Name and Address of Agent or Broker]
The above "Notice to Applicant" was delivered to me
				  on:
(Applicant's Signature) (Date)