§431:10H-218  Prohibition againstpost-claims underwriting.  (a)  All applications for long-term careinsurance policies or certificates except those that are guaranteed issue shallcontain clear and unambiguous questions designed to ascertain the health conditionof the applicant.

(b)  If an application for long-term careinsurance contains a question that asks whether the applicant has hadmedication prescribed by a physician, it must also ask the applicant to listthe medication that has been prescribed.

(c)  If the medications listed in theapplication were known by the insurer, or should have been known at the time ofapplication, to be directly related to a medical condition for which coveragewould otherwise be denied, then the policy or certificate shall not berescinded for that condition.

(d)  Except for policies or certificates whichare guaranteed issue:

(1)  The following language shall be set outconspicuously and in close conjunction with the applicant's signature block onan application for a long-term care insurance policy or certificate:

"CAUTION:  If your answers on thisapplication are incorrect or untrue, the (company) has the right to denybenefits or rescind your policy.";

(2)  The following language, or language substantiallysimilar to the following, shall be set out conspicuously on the long-term careinsurance policy or certificate at the time of delivery:

"CAUTION:  The issuance of thislong-term care insurance (policy) (certificate) is based upon your responses tothe questions on your application.  A copy of your (application) (enrollmentform) (is enclosed) (was retained by you when you applied).  If your answersare incorrect or untrue, the (company) has the right to deny benefits orrescind your policy.  The best time to clear up any questions is now, before aclaim arises!  If, for any reason, any of your answers are incorrect, contactthe (company) at this address: (insert address)."; and

(3)  Prior to issuance of a long-term care policy orcertificate to an applicant age eighty or older, the insurer shall obtain oneof the following:

(A)  A report of a physical examination;

(B)  An assessment of functional capacity;

(C)  An attending physician's statement; or

(D)  Copies of medical records.

(e)  A copy of the completed application orenrollment form, whichever is applicable, shall be delivered to the insured nolater than at the time of delivery of the policy or certificate unless it wasretained by the applicant at the time of application.

(f)  Every insurer or other entity selling orissuing long-term care insurance benefits shall maintain a record of all policyor certificate rescissions, both state and countrywide, except those that theinsured voluntarily effectuated.  Every insurer shall annually furnish this informationto the insurance commissioner in the format prescribed by the NationalAssociation of Insurance Commissioners in Appendix A to the April, 2002, NAICLong-Term Care Insurance Model Regulation. [L 1999, c 93, pt of §2; am L 2007,c 233, §15]

 

Revision Note

 

  Subsections (e) and (f) redesignated pursuant to §23G-15(1).