Section 3 AAC 28.558 - Prohibition against post-claims underwriting(a) All applications for long-term care insurance policies or certificates, except those that are guaranteed issue, must contain clear and unambiguous questions designed to ascertain the health condition of the applicant.(b) If an application for long-term care insurance contains a question that 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. If the medications listed in the 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related to a medical condition for which coverage would otherwise be denied, then the policy or certificate may not be rescinded for that condition.(c) Except for policies or certificates that are guaranteed issue; (1) the following language must be set out conspicuously and in close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, must 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]; and
(3) before issuance of a long-term care policy or certificate to an applicant 80 years of age or older, the insurer shall get 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) The completed application or enrollment form, whichever is applicable, is part of the policy and shall be delivered to the insured with the policy or certificate unless it was retained by the applicant at the time of application.(e) Every insurer or other entity selling or issuing long-term care insuranee benefits shall maintain a record of all policy or certificate rescissions, both state and nation wide, except those that the insured voluntarily effectuated and shall annually furnish this information to the director in the format prescribed by the director.Eff. 3/27/2022, Register 241, April 2022Authority:AS 21.06.090
AS 21.53.020
AS 21.53.030
AS 21.53.050
AS 21.53.090