§ 23-97-312 — Outline of coverage

(a) (1) An outline of coverage shall be delivered to a prospective applicant for long-term care insurance at the time of initial solicitation through means that prominently direct the attention of the recipient to the outline of coverage and its purpose. (2) The Insurance Commissioner shall prescribe a standard format for the outline, including style, arrangement, overall appearance, and content. (3) In the case of agent solicitations, an agent shall deliver the outline of coverage prior to the presentation of an application or enrollment form. (4) In the case of direct response solicitations, the outline of coverage shall be presented in conjunction with any application or enrollment form. (5) (A) In the case of a policy issued to a group approved by the commissioner under § 23-97-304(6)(B) , an outline of coverage shall not be required to be delivered if the information described in subsection (b) of this section is provided to applicants in other materials relating to enrollment. (B) Materials relating to enrollment shall be made available to the commissioner upon request. (b) The outline of coverage shall include: (1) A description of the principal benefits and coverage provided in the policy; (2) A statement of the principal exclusions, reductions, and limitations contained in the policy; (3) (A) A statement of the terms under which the policy or certificate, or both, may be continued in force or discontinued, including any reservation in the policy of a right to change premium. (B) Continuation or conversion provisions of group coverage shall be specifically described; (4) A statement that the outline of coverage is a summary only, not a contract of insurance, and that the policy or group master policy contains governing contractual provisions; (5) A description of the terms under which the policy or certificate may be returned and premium refunded; (6) A brief description of the relationship between cost of care and benefits; and (7) A statement that discloses to the policyholder or certificate holder whether the policy is intended to be a federally tax-qualified long-term care insurance contract under section 7702B(b) of the Internal Revenue Code of 1986.

Legislative History

Acts 2005, No. 1697, § 31; 2007, No. 496, § 21.