NDAC 45-06-04-07
Preexisting conditions
Cite as N.D. Admin. Code ยง 45-06-04-07
1.
An advertisement which is subject to the requirements of section 45-06-04-06 must, in
negative terms, disclose the extent to which any loss is traceable to a condition existing prior
to the effective date of the policy. The use of the term "preexisting condition" without an
appropriate definition or description may not be used.
2.
When a policy does not cover losses resulting from preexisting conditions, no advertisement
of the policy may state or imply that the applicant's physical condition or medical history will
not affect the issuance of the policy or payment of a claim thereunder. This rule prohibits the
use of the phrase "no medical examination required" and phrases of similar import, but does
not prohibit explaining "automatic issue". If an insurer requires a medical examination for a
specified policy, the advertisement if it is an invitation to contract must disclose that a medical
examination is required.
3.
When an advertisement contains an application form to be completed by the applicant and
returned by mail for a direct response insurance product, such application form must contain a
question requiring a response by the applicant or a statement in prominent type, all in capital
letters, which reflects the preexisting condition provisions of the policy immediately preceding
the blank space for the applicant's signature. For example, such an application form must
contain a question substantially as follows:
"Do you understand that this policy will not pay benefits during the first ----- year(s) after
the issue date for a disease or physical condition which you now have or have had in the
past?" -------- Yes
Or a statement in prominent type, all capitalized, substantially as follows:
"I UNDERSTAND THAT THE POLICY APPLIED FOR WILL NOT PAY BENEFITS FOR
ANY LOSS INCURRED DURING THE FIRST ------- YEAR(S) AFTER THE ISSUE DATE
ON ACCOUNT OF DISEASE OR PHYSICAL CONDITION WHICH I NOW HAVE OR
HAVE HAD IN THE PAST."