33-22-1111. Outline of coverage. (1) (a) An insurer shall deliver an outline of coverage as approved by the commissioner to a prospective applicant for long-term care insurance at the time of initial solicitation through means that prominently direct the attention of the recipient to the document and its purpose.
(b) The commissioner shall prescribe a standard format, including style, arrangement, and overall appearance, and the content of the outline of coverage.
(c) In the case of insurance producer solicitations, an insurance producer shall deliver the outline of coverage prior to the presentation of an application or enrollment form.
(d) In the case of direct response solicitations, the insurer shall deliver the outline of coverage upon the earlier of the applicant's request or the delivery of the policy.
(2) The outline of coverage must include:
(a) a description of the principal benefits and coverage provided in the policy;
(b) a statement of the principal exclusions, reductions, and limitations contained in the policy;
(c) a statement of the terms under which the policy or certificate, or both, may be continued in force or discontinued, including any reservation in the policy of a right to change premiums. Continuation or conversion provisions of a group policy must be specifically described.
(d) a statement that the outline of coverage is only a summary of the policy issued or applied for, not a contract of insurance, and that the policy or group master policy contains governing contractual provisions;
(e) a description of the terms under which the policy or certificate may be returned and the premium refunded;
(f) a brief description of the relationship of cost of care and benefits; and
(g) a statement that discloses to the policyholder or certificate holder whether the policy is intended to be a federally tax-qualified long-term care insurance contract.
(3) The outline of coverage:
(a) must prominently display the name of the insurer;
(b) must be a freestanding document not dependent for purposes of reader comprehension upon any other document;
(c) must use no smaller than 12-point type; and
(d) may not contain material of an advertising nature.
History: En. Sec. 11, Ch. 355, L. 1989; amd. Sec. 1, Ch. 713, L. 1989; amd. Sec. 12, Ch. 416, L. 1997; amd. Sec. 5, Ch. 32, L. 2007.
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