Requirements for application forms and replacement coverage

1. The following language shall be set out conspicuously and in close conjunction with the applicant's signature block on an application for a short-term care insurance policy or certificate: "Caution: If your answers on this application are incorrect or untrue, [company] has the right to deny benefits or rescind your policy." 2. Application forms shall include the following questions designed to elicit information as to whether, as of the date of the application, the applicant has another short-term care or long-term care insurance policy or certificate in force or whether a short-term care policy or certificate is intended to replace any other accident and sickness or short-term care policy or certificate presently in force. A supplementary application or other form to be signed by the applicant and agent, except when the coverage is sold without an agent, containing the questions may be used. With regard to a replacement policy issued to a group, the following questions may be modified only to the extent necessary to elicit information about health or short-term care insurance policies other than the group policy being replaced, provided that the certificate holder has been notified of the replacement. a. Do you have another short-term care or long-term care insurance policy or certificate in force, including health care service contract, health maintenance organization contract? b. Did you have another short-term care or long-term care insurance policy or certificate in force during the last twelve months? (1) If so, with which company? (2) If that policy lapsed, when did it lapse? c. Are you covered by Medicaid? d. Do you intend to replace any of your medical or health insurance coverage with this policy [certificate]? 3. Agents shall list any other health insurance policies they have sold to the applicant. a. List policies sold that are still in force. b. List policies sold in the past five years that are no longer in force. 4. Replacements - Solicitations other than direct response. Upon determining that a sale will involve replacement, an insurer, other than an insurer using direct response solicitation methods, or its agent shall furnish the applicant, prior to issuance or delivery of the individual short-term care insurance policy, a notice regarding replacement of accident and sickness or short-term care coverage. One copy of the notice shall be retained by the applicant and an additional copy signed by the applicant shall be retained by the insurer. The required notice shall be provided as referenced in appendix A. 5. Direct response solicitations. Insurers using direct response solicitation methods shall deliver a notice regarding replacement of accident and sickness, short-term care or long-term care coverage to the applicant upon issuance of the policy. The required notice shall be provided as referenced in appendix B.