§431:10H-218  Prohibition against
post-claims underwriting.  (a)  All applications for long-term care
insurance policies or certificates except those that are guaranteed issue shall
contain clear and unambiguous questions designed to ascertain the health condition
of the applicant.



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



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rescinded for that condition.



(d)  Except for policies or certificates which
are guaranteed issue:



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



"CAUTION:  If your answers on this
application are incorrect or untrue, the (company) has the right to deny
benefits or rescind your policy.";



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



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



(3)  Prior to issuance of a long-term care policy or
certificate to an applicant age eighty or older, the insurer shall obtain one
of 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 or
enrollment form, whichever is applicable, shall be delivered to the insured no
later than at the time of delivery of the policy or certificate unless it was
retained by the applicant at the time of application.



(f)  Every insurer or other entity selling or
issuing long-term care insurance benefits shall maintain a record of all policy
or certificate rescissions, both state and countrywide, except those that the
insured voluntarily effectuated.  Every insurer shall annually furnish this information
to the insurance commissioner in the format prescribed by the National
Association of Insurance Commissioners in Appendix A to the April, 2002, NAIC
Long-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).