New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 15 - LONG-TERM CARE INSURANCE › Section 13.10.15.26 - SOLICITATIONS OTHER THAN DIRECT RESPONSE

Current through Register Vol. 35, No. 13, July 16, 2024
Upon determining that a sale will involve replacement, an
				  insurer, other than an insurer using direct response solicitation methods, or
				  its agent, shall furnish the applicant, prior to issuance or delivery of the
				  individual long-term care insurance policy, a notice regarding replacement of
				  accident and sickness or long-term care coverage. One copy of such notice shall
				  be retained by the applicant and an additional copy signed by the applicant
				  shall be retained by the insurer. The required notice shall be provided in the
				  following manner:
NOTICE TO APPLICANT REGARDING REPLACEMENT OF INDIVIDUAL
						  ACCIDENT AND SICKNESS OR LONG-TERM CARE INSURANCE [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 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 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 which 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
						  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 your 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: ______________ (Date)
						  _______________________________ (Applicant's Signature)