§ 8090. Outline of coverage for applicant; certificate
(a) An outline of coverage shall be delivered 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. The Commissioner
shall prescribe a standard format, including style, arrangement, overall appearance,
and the content of an outline of coverage.
(b) In the case of agent solicitations, an agent shall deliver the outline of coverage
prior to the presentation of an application or enrollment form.
(c) In the case of direct response solicitations, the outline of coverage shall be presented
in conjunction with any application or enrollment form.
(d) In the case of a policy issued to a group defined in subdivision 8082(4)(A) of this
chapter, an outline of coverage shall not be required to be delivered, provided that
the information described in subsection (e) of this section is contained in other
materials relating to enrollment. Upon request, these other materials shall be made
available to the Commissioner.
(e) The outline of coverage shall include all of the following:
(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 or certificate, or both, may be continued
in force or discontinued, including any reservation in the policy of a right to change
premium. Continuation or conversion provisions of group coverage shall 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 or certificate may be returned and
the premium refunded.
(6) A brief description of the relationship of cost of care and benefits.
(7) 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 under
Subsection 7702B(b) of the Internal Revenue Code of 1986, as amended.
(f) A certificate issued pursuant to a group long-term care insurance policy delivered
or issued for delivery in this State shall 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 determines governing contractual provisions.
(g) If an application for a long-term care insurance contract or certificate is approved,
the issuer shall deliver the contract or certificate of insurance to the applicant
not later than 30 days after the date of approval. (Added 2003, No. 124 (Adj. Sess.), § 2, eff. Jan. 1, 2005; amended 2021, No. 105 (Adj. Sess.), § 267, eff. July 1, 2022; 2023, No. 6, § 75, eff. July 1, 2023.)