Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 5 - Minimum Standards; Contract Guidelines › Part 1 - MINIMUM STANDARDS AND BENEFITS FOR ACCIDENT AND HEALTH INSURANCE › Section 365:10-5-7 - Requirements for replacement

Current through Vol. 41, No. 20, July
				  1, 2024
(a) Application
				  forms shall include a question designed to elicit information as to whether the
				  insurance to be issued is intended to replace any other accident and sickness
				  insurance presently in force. A supplementary application or other forms 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 a direct response insurer, or its agent
				  shall furnish the applicant, prior to issuance or delivery of the policy, the
				  notice described in 365:10-5-7(c). One (1) copy of such notice shall be
				  retained by the applicant and an additional copy signed by the applicant shall
				  be retained by the insurer. A direct response insurer shall deliver to the
				  applicant upon issuance of the policy, the notice described in 365:10-5-7(d).
				  In no event, however, will such a notice be required in the solicitation of the
				  following types of policies: accident only and single premium nonrenewable
				  policies.
(c) The notice required
				  by (2) of this paragraph for an insurer, other than a direct response insurer,
				  shall provide, in substantially the following form:
NOTICE TO APPLICANT REGARDING
REPLACEMENT OF ACCIDENT AND SICKNESS
INSURANCE
According to (your application)
								(information you have furnished), you intend to lapse or otherwise terminate
								existing accident and sickness insurance and replace it with a policy to be
								issued by (Company Name) Insurance Company. 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.
1.
Health conditions which you may presently have,
								(pre-existing conditions) may not be immediately or fully covered under the new
								policy. This could result in denial or delay of a claim for benefits under the
								new policy, whereas a similar claim might have been payable under your present
								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 interest to make sure
								you understand all the relevant factors involved in replacing your present
								coverage.
3.
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,
								re-read 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)
(d) The notice required by 365:10-5-7(b) for
				  a direct response insurer shall be as follows:
NOTICE TO APPLICANT REGARDING
REPLACEMENT OF ACCIDENT AND SICKNESS
INSURANCE
According to (your application)
								(information you have furnished), you intend to lapse or otherwise terminate
								existing accident and sickness insurance and replace it with the policy
								delivered herewith issued by (insert Company Name) Insurance Company. Your new
								policy provides 10 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 you should be aware of an seriously consider certain
								factors which may affect the insurance protection available to you under the
								new policy.
1.
Health conditions which you may presently have,
								(pre-existing conditions) may not be immediately or fully covered under the new
								policy. This could result in denial or delay of a claim for benefits under the
								new policy whereas a similar claim might have been payable under your present
								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 interest to make sure
								you understand all the relevant factors involved in replacing your present
								coverage.
3.
(To be included only if the application is attached
								to the policy.) If, after due consideration, you still wish to terminate your
								present policy and replace it with new coverage, read the copy of the
								application attached to your new policy and be sure that all questions are
								answered fully and correctly. Omissions or misstatements in the application
								could cause an otherwise valid claim to be denied. Carefully check the
								application and write to (insert Company Name and Address) within 10 days if
								any information is not correct and complete, or if any past medical history has
								been left out of the application.
______________________
(Company Name)
Amended at 11 Ok Reg
					 1839, eff 5-15-94