760 IAC 2-5-2 Language of application; supplemental information

Sec. 2. Except for policies, certificates, or subscriber agreements which are guaranteed issue, the following apply: (1) The following language shall be set out conspicuously and in close conjunction with the applicant's signature block on an application for a long term care insurance policy, certificate, or subscriber agreement: "Caution: If your answers on this application are incorrect or untrue, [company] has the right to deny benefits or rescind your [policy] [certificate] [subscriber agreement].". (2) The following language, or language substantially similar to the following, shall be set out conspicuously on the long term care insurance policy, certificate, or subscriber agreement at the time of delivery: "Caution: The issuance of this long term care insurance [policy] [certificate] [subscriber agreement] is based upon your responses to the questions on your application. A copy of your [application] [enrollment form] [is enclosed] [was retained by you when you applied]. If your answers are incorrect or untrue, the company has the right to deny benefits or rescind your [policy] [certificate] [subscriber agreement]. The best time to clear up any questions is now, before a claim arises! If, for any reason, any of your answers are incorrect, contact the company at this address: [insert address].". (3) Prior to issuance of a policy, certificate, or subscriber agreement to an applicant eighty (80) years of age or older, the insurer shall obtain one (1) of the following: (A) A report of a physical examination. (B) An assessment of functional capacity. (C) An attending physician's statement. (D) Copies of medical records.