W. Va. Code R. § 114-17-10

Current through Register Vol. XLI, No. 50, December 13, 2024

Section 114-17-10 - Replacement of Insurance

No Medicare Supplement or Limited Benefit Medicare Supplement policy or contract shall be delivered or issued for delivery in this State to any person eligible for Medicare by reason of age unless issued in compliance with this section.

10.1. Question in application. -- Medicare Supplement and Limited Benefit Medicare Supplement application forms shall include a question designed to elicit information as to whether the insurance to be issued is intended to replace any other accident and/or sickness insurance presently in force. A supplementary application or other form to be signed by the applicant containing such a question may be used.

10.2. Notice required. -- Upon determining that a sale will involve replacement, an insurer, other than a direct response insurer, or its agent shall furnish to the applicant, prior to issuance or delivery of the policy, the notice described in Subsection 10.3 of these rules. One (1) copy of such notice shall be retained by the applicant and an additional copy signed by the applicant shall be retained by the insurer for the period of time in which the policy or contract is in force. A direct response insurer shall deliver to the applicant upon issuance of the policy, the notice described in Subsection 10.4 of these rules. In no event, however, will such a notice be required in the solicitation of "Single Premium Nonrenewable" policies.

10.3. Form of notice. -- The notice required by Subsection 10.2 of these rules for an insurer, other than a direct response insurer, shall provide, in substantially the following form:

NOTICE TO APPLICANT REGARDING REPLACEMENT

OF ACCIDENT AND/OR SICKNESS INSURANCE

According to your application (information you have furnished), you intend to lapse or otherwise terminate existing accident and/or sickness insurance and replace it with a policy to be issued by (Company Name) Insurance Company. Your new policy provides ten (10) days within which you may decide without cost whether you desire to keep the policy. For your own information and protection, you should be aware of and seriously consider certain facts which may affect the insurance protection available to you under the new policy.

(1) Health conditions which you may presently have (preexisting conditions) may not be immediately or fully covered under the new policy. This could result in denial or delay of a claim for benefits under the new policy, whereas a similar claim might have been payable under your present policy.

(2) You may wish to secure the advice of your present insurer or its agent regarding the proposed replacement of your present policy. This is not only your right, but it is also in your best interests to make sure you understand all the relevant factors involved in replacing your present coverage.

(3) If, after due consideration, you still wish to terminate your present policy and replace it with new coverage, be certain to truthfully and completely answer all questions on the application concerning your medical/health history. Failure to include all material medical information on an application may provide a basis for the company to deny any future claims and to refund your premium as though your policy had never been in force. After the application has been completed and before you sign it, reread it carefully to be certain that all information has been properly recorded.

The above "Notice to Applicant" was delivered to me on:

___________________________

(Date)

___________________________

(Applicant's Signature)

10.4. Form of notice for direct response insurers. -- The notice required by Subsection 10.2 of these rules for a direct response shall be as follows:

NOTICE TO APPLICANT REGARDING

REPLACEMENT

OF ACCIDENT AND/OR SICKNESS INSURANCE

According to your application (information you have furnished), you intend to lapse or otherwise terminate existing accident and/or sickness insurance and replace it with the policy delivered herewith issued by (Company Name) Insurance Company. Your new policy provides thirty (30) days within which you may decide without cost whether you desire to keep the policy. For your own information and protection, you should be aware of and seriously consider certain factors which may affect the insurance protection available to you under the new policy.

(1) Health conditions which you may presently have (preexisting conditions) may not be immediately or fully covered under the new policy. This could result in denial or delay of a claim for benefits under the new policy, whereas a similar claim might have been payable under your present policy.

(2) You may wish to secure the advice of your present insurer or its agent regarding the proposed replacement of your present policy. This is not only your right, but it is also in your best interests to make sure you understand all the relevant factors involved in replacing your present coverage.

(3) If, after due consideration, you still wish to terminate your present policy and replace it with new coverage, read the copy of the application attached to your new policy and be sure that all questions concerning your medical/health history are answered truthfully and completely. Material omissions or misstatements in the application could cause an otherwise valid claim to be denied. Carefully check the application and write to (Company Name and Address) within ten (10) days if any information is not correct and complete, or if any past medical history has been left out of the application.

___________________

(Company Name)

W. Va. Code R. § 114-17-10