Md. Code Regs. 31.14.01.33

Current through Register Vol. 51, No. 22, November 1, 2024

Section 31.14.01.33 - Incontestability Period

A. Except as provided in §G of this regulation, §§B-F of this regulation apply to each qualified long-term care insurance policy.

B. Policies In Force Less Than 6 Months.

(1) This section applies to a long-term care insurance policy that has been in force for less than 6 months.

(2) Unless the insurer demonstrates that the applicant misrepresented information on the application for the long-term insurance policy that is material to the acceptance for coverage, an insurer may not:

(a) Rescind the policy described in §B(1) of this regulation; or

(b) Deny an otherwise valid long-term care insurance claim under the policy described in §B(1) of this regulation.

C. Policies in Force at Least 6 Months, but Less than 2 Years.

(1) This section applies to a long-term care insurance policy that has been in force for at least 6 months, but less than 2 years.

(2) Unless the insurer demonstrates that the applicant misrepresented information on the application for the long-term insurance policy that is material to the acceptance for coverage and that pertains to the condition for which benefits are sought, an insurer may not:

(a) Rescind a long-term care insurance policy described in §C(1) of this regulation; or

(b) Deny an otherwise valid long-term care insurance claim under a policy described in §C(1) of this regulation.

D. Policies In Force 2 Years or More.

(1) After a long-term care insurance policy has been in force for 2 years it is not contestable upon the grounds of misrepresentation alone.

(2) An insurer may not contest a policy described in §D(1) of this regulation, unless the insurer can demonstrate that the insured knowingly and intentionally misrepresented relevant facts relating to the insured's health.

E. A long-term care insurance policy may be field issued, if the compensation to the field issuer is not based on the number of policies or certificates issued.

F. If an insurer has paid benefits under the long-term care insurance policy, the insurer may not recover the benefit payments if the policy is rescinded.

G. Life Insurance Policy That Accelerates Benefits for Long-Term Care.

(1) In the event of the death of the insured, this regulation may not be applied to the remaining death benefit of a life insurance policy that accelerates benefits for long-term care.

(2) In the situation described in §G(1) of this regulation, the remaining death benefits under the life insurance policy that accelerates the benefits for long-term care shall be governed by Insurance Article, § 16-203, Annotated Code of Maryland.

(3) Except as described in §G(1)-(2) of this regulation, this regulation shall apply to life insurance policies that accelerate benefits for long-term care.

Md. Code Regs. 31.14.01.33