WAC 284-212-063. Notice to applicant regarding replacement of individual accident and sickness, supplemental long-term care insurance, or long-term care insurance marketed by an insurance producer

The following notice is required in WAC 284-212-060 (3): notice to applicant regarding replacement of individual [accident and sickness] [health] [SUPPLEMENTAL LONG-TERM CARE INSURANCE] OR [LONG-TERM CARE INSURANCE] [Insurance company's name and address] SAVE THIS NOTICE! IT MAY BE IMPORTANT TO YOU IN THE FUTURE. According to [your application] [information you have furnished], you intend to lapse or otherwise terminate existing [accident and sickness] [health], [supplemental long-term care], or [long-term care] insurance and replace it with an individual supplemental long-term care insurance policy to be issued by [company name] insurance company. Your new policy provides 30 days within which you may decide, without cost, whether you desire to keep the policy. For your own information and protection, you should be aware of and seriously consider certain factors which may affect the insurance protection available to you under the new policy. You should review this new coverage carefully, comparing it with all [accident and sickness] [health], [supplemental long-term care], or [long-term care] insurance coverage you now have, and terminate your present policy only if, after due consideration, you find that purchase of this supplemental long-term care coverage is a wise decision. STATEMENT TO APPLICANT BY [INSURANCE PRODUCER OR OTHER REPRESENTATIVE]: (Use additional sheets, as necessary.) I have reviewed your current medical or health insurance, and/or supplemental long-term care insurance coverage. I believe the replacement of insurance involved in this transaction materially improves your position. My conclusion has taken into account the following considerations, which I call to your attention: _____ (Signature of [Insurance Producer] or Other Representative) [Typed Name and Address of [Insurance Producer]] The above "Notice to Applicant" was delivered to me on: _____ (Applicant's Signature) _____ (Date) _____ (Applicant's Signature) _____ (Date)