376.1115. Coverage outline to be delivered to applicants, when, content.
Coverage outline to be delivered to applicants, when, content.
376.1115. 1. An outline of coverage shall be delivered to a prospectiveapplicant for long-term care insurance at the time of initial solicitationthrough means which prominently direct the attention of the recipient to thedocument and its purpose. The director shall prescribe a standard format,including style, arrangement and overall appearance, and the content of anoutline of coverage. In the case of agent solicitations, an agent shalldeliver the outline of coverage prior to the presentation of an application orenrollment form. In the case of direct response solicitations, the outline ofcoverage shall be presented in conjunction with any application or enrollmentform. In the case of a policy issued to a group defined in section 376.1100,an outline of coverage shall not be required to be delivered; provided thatthe information described in subdivisions (1) to (6) of subsection 2 of thissection is contained in other materials relating to enrollment. Upon request,such other materials shall be made available to the director.
2. The outline of coverage shall include:
(1) A description of the principal benefits and coverage provided in thepolicy;
(2) A statement of the principal exclusions, reductions, and limitationscontained in the policy;
(3) A statement of the terms under which the policy or certificate, orboth, may be continued in force or discontinued, including any reservation inthe policy of a right to change the premium. Continuation or conversionprovisions of group coverage shall be specifically described;
(4) A statement that the outline of coverage is a summary only, not acontract of insurance, and that the policy or group master policy containsgoverning contractual provisions;
(5) A description of the terms under which the policy or certificate maybe returned and premium refunded;
(6) A brief description of the relationship of cost of care andbenefits; and
(7) A statement that discloses to the policyholder or certificate holderwhether the policy is intended to be a federally tax-qualified long-term careinsurance contract under Section 7702B(b) of the Internal Revenue Code of1986, as amended.
3. A certificate issued pursuant to a group long-term care insurancepolicy which policy is delivered or issued for delivery in this state shallinclude:
(1) A description of the principal benefits and coverage provided in thepolicy;
(2) A statement of the principal exclusions, reductions and limitationscontained in the policy; and
(3) A statement that the group master policy determines governingcontractual provisions.
4. If an application for a long-term care insurance contract orcertificate is approved, the issuer shall deliver the contract or certificateof insurance to the applicant no later than thirty days after the date ofapproval.
5. At the time of policy delivery, a policy summary shall be deliveredfor an individual life insurance policy which provides long-term care benefitswithin the policy or by rider. In the case of direct response solicitations,the insurer shall deliver the policy summary upon the applicant's request, butregardless of request shall make such delivery no later than at the time ofpolicy delivery. In addition to complying with all applicable requirements,the summary shall also include:
(1) An explanation of how the long-term care benefit interacts withother components of the policy, including deductions from death benefits;
(2) An illustration of the amount of benefits, the length of benefit,and the guaranteed lifetime benefits, if any, for each covered person;
(3) Any exclusions, reductions and limitations on benefits of long-termcare;
(4) A statement that any long-term care inflation protection option thatmay be required by the laws of this state is not available under the policy;and
(5) If applicable to the policy type, the summary shall also include:
(a) A disclosure of the effects of exercising other rights under thepolicy;
(b) A disclosure of guarantees related to long-term care costs ofinsurance charges;
(c) Current and projected maximum lifetime benefits; and
(d) The provisions of the policy summary listed in paragraphs (a) to (c)of this subdivision may be incorporated into a basic illustration required tobe delivered in accordance with sections 375.1509, RSMo, or into the lifeinsurance policy summary required to be delivered in accordance with section376.706.
(L. 1990 S.B. 765 § 6 subsecs. 2 to 5, A.L. 2002 H.B. 1568 merged with S.B. 1009)*Transferred 2002; formerly 376.957