West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-17 - Medicare Supplement Insurance Coverage › Section 114-17-10 - Replacement of Insurance

Current through Register Vol. XLI, No. 28, July 12, 2024
No Medicare Supplement or Limited Benefit Medicare Supplement
				  policy or contract shall be delivered or issued for delivery in this State to any
				  person eligible for Medicare by reason of age unless issued in compliance with this
				  section.
10.1. Question in application. --
				Medicare Supplement and Limited Benefit Medicare Supplement 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/or sickness insurance presently
				in force. A supplementary application or other form to be signed by the applicant
				containing such a question may be used.
10.2. Notice required. -- Upon determining that a
				sale will involve replacement, an insurer, other than a direct response insurer, or
				its agent shall furnish to the applicant, prior to issuance or delivery of the
				policy, the notice described in Subsection 10.3 of these rules. 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 for the period of time in which the
				policy or contract is in force. A direct response insurer shall deliver to the
				applicant upon issuance of the policy, the notice described in Subsection 10.4 of
				these rules. In no event, however, will such a notice be required in the
				solicitation of "Single Premium Nonrenewable" policies.
10.3. Form of notice. -- The notice required by
				Subsection 10.2 of these rules for an insurer, other than a direct response insurer,
				shall provide, in substantially the following form:
NOTICE TO APPLICANT REGARDING REPLACEMENT
OF ACCIDENT AND/OR SICKNESS INSURANCE
According to your application (information you have furnished),
				  you intend to lapse or otherwise terminate existing accident and/or sickness
				  insurance and replace it with a policy to be issued by (Company Name) Insurance
				  Company. Your new policy provides ten (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 facts which may affect the
				  insurance protection available to you under the new policy.
(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 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
				interests 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, 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)