(a) A long-term care insurance applicant may return a policy within 30 days after delivery and have the premium refunded if, after examination of the policy, the applicant is not satisfied with the policy. A long-term care insurance policy must have a notice prominently printed on the first page of the policy or separately attached stating that the applicant has the right to return the policy within 30 days of its delivery and to have the premium refunded if, after examination of the policy, the applicant is not satisfied with the policy for any reason. This subsection also applies to application denials, and any refund must be made within 30 days after return or denial.
(b) An insurer, hospital or medical service corporation, or fraternal benefit society shall deliver an outline of coverage to a prospective applicant for long-term care insurance at the time of initial solicitation by a means that prominently directs the attention of the recipient to the document and its purpose. In the case of agent solicitations, an agent shall deliver the outline of coverage before the presentation of an application or enrollment form. In the case of direct response solicitations, the outline of coverage must be presented in conjunction with an application or enrollment form. The outline of coverage must include
(1) a description of the principal benefits and coverage provided in the policy;
(2) a statement of the principal exclusions, reductions, and limitations contained in the policy;
(3) a statement of the terms under which the policy may be continued in force or discontinued, including a reservation in the policy of a right to change the premium; continuation or conversion provisions of group coverage must be specifically described;
(4) a statement that the outline of coverage is a summary only, not a contract of insurance, and that the policy or group master policy contains governing contractual provisions;
(5) a description of the terms under which the policy may be returned and premium refunded;
(6) a brief description of the relationship between the cost of care and benefits; and
(7) a statement that discloses to the policyholder whether the policy is intended to be a federal qualified long-term care insurance contract under 26 U.S.C. 7702B(b) (Internal Revenue Code).
(c) A certificate issued under a group long-term care insurance policy that is delivered or issued for delivery in this state must include
(1) a description of the principal benefits and coverage provided in the policy;
(2) a statement of the principal exclusions, reductions, and limitations contained in the policy; and
(3) a statement that the group master policy establishes the governing contractual provisions.
(d) For a policy issued to a group defined in AS 21.53.200(3)(A), an insurer, hospital or medical service corporation, or fraternal benefit society is not required to provide an outline of coverage if the information required on the outline of coverage under (b) of this section is contained in other enrollment materials. An insurer, hospital or medical service corporation, and fraternal benefit society shall provide the enrollment materials to the director on request.
(e) If an application for a long-term care insurance policy is approved, the insurer shall deliver the policy to the applicant not later than 30 days after the date of approval.
Section: Previous 21.53.010 21.53.020 21.53.030 21.53.040 21.53.050 21.53.060 21.53.062 21.53.064 21.53.066 21.53.068 21.53.070 21.53.080 21.53.090 21.53.200 NextLast modified: November 15, 2016