Kansas Administrative Regulations

Agency 40.  Insurance Department

Article 4.  Accident and Health Insurance

 

 40-4-37l Long-term care insurance; applications.

 

All applications for long-term care insurance policies or certificates, except those which are guaranteed issue, shall contain clear and unambiguous questions designed to ascertain the health condition of the applicant.

(a)(1)  If an application for long-term care insurance contains a question which 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.

(2)  If the medications listed in such 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to a medical condition for which coverage would otherwise be denied, then the policy or certificate shall not be rescinded for that condition.

(3)  Application forms shall include the following questions designed to elicit information as to whether, as of the date of the application, the applicant has another long-term care insurance policy or certificate in force or whether a long-term care policy or certificate is intended to replace any other accident and sickness or long-term care policy or certificate presently in force. A supplementary application or other form to be signed by the applicant and agent, except where the coverage is sold without an agent, containing such questions may be used. With regard to a replacement policy issued to a group defined by K.S.A. 1991 Supp. 40-2209(3), if the certificateholder has been notified of the replacement, the following questions may be modified only to the extent necessary to elicit information about health or long-term care insurance policies other than the group policy being replaced.

(A)  Do you have another long-term care insurance policy or certificate in force (including health care service contract, health maintenance organization contract)?

(B)  Did you have another long-term care insurance policy or certificate in force during the last 12 months?

(i)  If so, with which company?

(ii)  If that policy lapsed, when did it lapse?

(C)  Are you covered by medicaid?

(D)  Do you intend to replace any of your medical or health insurance coverage with this policy (certificate)?

(b)  Agents shall list any other health insurance policies they have sold to the applicant:

(1)  Which are still in force; and

(2)  in the past five years which are no longer in force.

(c)  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, (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).

(3)  Prior to issuance of a long-term care policy or certificate to an applicant age 80 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.

(d)  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.

 

(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.)