North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .1000 - LONG TERM CARE INSURANCE › Section 12 .1010 - REQUIREMENTS FOR REPLACEMENT

Current through Register Vol. 39, No. 2, July 15, 2024
(a)
				Individual and direct response solicited long-term care insurance application
				forms shall include a question designed to elicit information as to whether the
				proposed policy is intended to replace any other accident and health or
				long-term care insurance policy presently in force. A supplementary applicant
				or other form to be signed by the applicant containing such a question may be
				used.
(b) 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 policy, a notice regarding
				replacement of accident and health 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 HEALTH OR LONG-TERM CARE
				  INSURANCE
According to [your application] [information you have
				  furnished], you intend to lapse or otherwise terminate existing accident and
				  health or long-term care insurance and replace it with an individual long-term
				  care insurance policy to be issued by [company name]. 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 that 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.
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
				pre-existing conditions or probationary periods. The insurer will waive any
				time periods applicable to pre-existing conditions or probationary periods in
				the new policy or certificate for similar benefits to the extent such time was
				spent under the original plan.
3.
				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)
The above Notice to Applicant was delivered to me on:
______________________________________________
(Date)
______________________________________________
(Applicant's Signature) "