New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 52 - Minimum Standards For Form, Content And Sale Of Health Insurance, Including Standards Of Full And Fair Disclosure › Section 52.29 - Rules relating to the replacement of accident and health insurance coverage with individual long term care insurance, nursing home insurance only, home care insurance only, or nursing home and home care insurance policies and the purchase of multiple accident and health policies

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Application forms shall include a
				  question designed to elicit information as to whether a long term care
				  insurance, nursing home insurance only, home care insurance only, or nursing
				  home and home care insurance policy is intended to replace any other accident
				  and health insurance policy presently in force. The application form must
				  require a list of all existing accident and health insurance policies and
				  require identification of those being replaced.
(b) The application for long term care
				  insurance, nursing home insurance only, home care insurance only, or nursing
				  home and home care insurance, taken by an agent shall include, or have attached
				  thereto, a statement signed by the agent as follows:
"I have reviewed the current accident and health insurance
					 coverage of the applicant and find that the indicated replacement, or the
					 additional coverage of the type and amount applied for, is appropriate for the
					 applicant's needs."
(c)
				  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 long term care insurance, nursing home insurance
				  only, home care insurance only, or nursing home and home care insurance policy,
				  a notice regarding replacement of accident and health insurance coverage. One
				  copy of such notice shall be provided to 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 at the time of the issuance of the
				  policy the notice regarding replacement of accident and health insurance
				  coverage.
(d) The notice required
				  by subdivision (c) of this section for an insurer, other than a direct response
				  insurer, shall be provided in substantially the following form:
NOTICE TO APPLICANT REGARDING REPLACEMENT OF ACCIDENT AND
					 HEALTH INSURANCE
AND THE PURCHASE OF MULTIPLE ACCIDENT AND HEALTH
					 POLICIES
According to (your application) (information you have
					 furnished), you intend to lapse or otherwise terminate existing accident and
					 health insurance and replace it with a policy to be issued by (Company Name)
					 Insurance Company.
Your new policy provides (insert appropriate number) 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.
1. Health
				  conditions which you may presently have may be considered preexisting
				  conditions and 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 (this paragraph may be modified if preexisting conditions are covered
				  under the new policy).
2. You
				  should be aware that the premium rate for the replacement policy may be higher
				  than what you are paying for the existing policy that you plan to replace. If
				  the premium for your existing policy is based on your age when it was issued,
				  you have built up equity in that policy which may be lost if you terminate
				  it.
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 requested 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)
I have reviewed the current health insurance coverage of
					 the applicant and find that replacement and/or additional coverage of the type
					 and amount applied for is appropriate for the applicant's needs.
__________
(Agent's Signature)