Kansas Administrative Regulations

Agency 40. Insurance Department

Article 4. Accident and Health Insurance

40-4-37j Long-term care insurance; outline of coverage; content; format.

(a)(1) An outline of coverage shall be delivered to a prospective applicant for long-term care insurance at the time of initial solicitation. The outline of coverage shall prominently direct the attention of the recipient to such outline of coverage and explain its purpose.

(A)  The commissioner shall prescribe a standard format, including style, arrangement, and overall appearance, and the content of the outline of coverage.

(B)  In the case of agent solicitations, the 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.

(2)  The outline of coverage shall display prominently by type, stamp or other appropriate means, on the first page of the outline of coverage and policy the following:

”Notice to buyer: This policy may not cover all of the costs associated with long-term care incurred by the buyer during the period of coverage. The buyer is advised to review carefully all policy limitations.''

(3)  The outline of coverage shall 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 premium. Continuation or conversion provisions of group coverage shall be specifically described;

(D)  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;

(E)  a description of the terms under which the policy or certificate may be returned and premium refunded;

(F)  a brief description of the relationship of cost of care and benefits;

(G)  a graphic comparison of the benefit levels of a policy that increases benefits over the policy period with a policy that does not increase benefits. The graphic comparison shall show benefit levels over at least a 20 year period; and

(H)  any expected premium increases or additional premiums to pay for automatic or optional benefit increases.

(b)(1)  A long-term care insurance shopper's guide in the format developed by the national association of insurance commissioners, or a guide developed or approved by the commissioner, shall be provided to all prospective applicants of a long-term care insurance policy or certificate.

(A)  In the case of agent solicitations, an agent must deliver the shopper's guide prior to the presentation of an application or enrollment form.

(B)  In the case of direct response solicitations, the shopper's guide must be presented in conjunction with any application or enrollment form.

(2)  Life insurance policies or riders containing accelerated long-term care benefits are not required to furnish the above referenced guide, but shall furnish the policy summary required under K.A.R. 40-2-20.

(Authorized by K.S.A. 40-103, K.S.A. 1991 Supp. 40-2228; implementing K.S.A. 1991 Supp. 40-2228; effective Jan. 4, 1993.)