230 R.I. Code R. 230-RICR-20-30-1.6

Current through December 3, 2024
Section 230-RICR-20-30-1.6 - Statements in the Application for Health Benefit Contracts
A. No application designed to elicit information regarding the applicant's physical condition or that of his dependents shall be used in this state in connection with any health benefit contract which by its terms permits the insurer to reduce or deny a claim or avoid the contract on the grounds that misstatements were made by the insured in the application unless a statement is made which satisfies the requirements of § 1.6(A)(1) or (2) of this Part.
1. A statement contained in the application to be signed by the applicant which states that he has read or has had read to him all questions and answers contained in the application and that any misstatements made by him may allow the insurer to reduce or deny a claim or avoid the contract within the contestable period.
a. The following statement is acceptable:
(1) I hereby certify that I have read the above statements or that they have been read to me and that the above statements are true and complete to the best of my knowledge and belief. I understand that any misrepresentation contained herein relied on by the Company may be used to reduce or deny a claim or void the contract within the contestable period if such misrepresentation materially affects the acceptance of the risk.
b. The Director may approve any other statement that clearly expresses the same intent as the above statement.
2. A statement furnished to the applicant, within ten (10) days of the issuance of a contract or amendment of a contract, in the form of a sticker to be attached to the first page of the contract, a letter or other form containing substantially the following:
a. Please read the copy of the application attached to this notice or to your contract. Omissions or misstatements in the application could cause an otherwise valid claim to be denied or cause your contract to be voided or reformed. Carefully check the application and write to the insurer within ten (10) days if any information shown on the application is not correct and complete or if any medical history has not been included. The application is part of the insurance contract. The insurance contract was issued on the basis that the answers to all questions and any other material information shown on the application are correct and complete.
B. Each insurer shall instruct its agents that such agents must ascertain whether each applicant is able to read and understand the English language. When questions or answers on such application are written in English and the applicant is unable to read and/or understand English, the agent must read or interpret or have someone else interpret all questions and answers in such manner that they could reasonably be expected to be understood by the applicant.
1. Each insurer shall file with the Director a description of the procedure it will follow and the form or forms it will use to meet the requirements of § 1.6 of this Part.

230 R.I. Code R. 230-RICR-20-30-1.6