R590-126-9. Replacement of Accident and Health Insurance Requirements  


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  • (1) Upon determining that a sale will involve replacement, an insurer, other than a direct response insurer, or its producer, shall furnish the applicant, prior to issuance or delivery of the policy, the notice described in Subsection (2). The insurer shall retain a copy of the notice. A direct response insurer shall deliver to the applicant, upon issuance of the policy, the notice described in Subsection (3). In no event, however, will the notices be required in the solicitation of the following types of policies: accident-only and single-premium nonrenewable policies.

    (2) The notice required by Subsection (1) for an insurer, other than a direct response insurer, shall provide, in substantially the following form:


    TABLE XII


    NOTICE TO APPLICANT REGARDING REPLACEMENT

    OF ACCIDENT AND HEALTH INSURANCE


    According to (your application) (information you have

    furnished), you intend to lapse or otherwise terminate

    existing accident and health insurance and replace it with a

    policy to be issued by (insert company name) Insurance Company.

    For your own information and protection, you should be aware of

    and seriously consider certain factors that may affect the

    insurance protection available to you under the new policy.

    Health conditions which you may presently have, (preexisting

    conditions) may not be immediately or fully covered under the

    new policy. This could result in denial or delay of a claim for

    benefits under the new policy, whereas a similar claim might have

    been payable under your present policy.

    You may wish to secure the advice of your present insurer or its

    producer regarding the proposed replacement of your present policy.

    This is not only your right, but it is also in your best interests

    to make sure you understand all the relevant factors involved in

    replacing your present coverage.

    If, after due consideration, you still wish to terminate your

    present policy and replace it with new coverage, be certain to

    truthfully and completely answer all questions on the application

    concerning your medical/health history. Failure to include all

    material medical information on an application may provide a basis

    for the company to deny any future claims and to refund your

    premium as though your policy had never been in force. After the

    application has been completed and before you sign it, reread it

    carefully to be certain that all information has been properly

    recorded.

    The above "Notice to Applicant" was delivered to me on:

    ...........................

    (Date)

    ...........................

    (Applicant's Signature)


    (3) The notice required by Subsection (1) for a direct response insurer shall be as follows:


    TABLE XIII


    NOTICE TO APPLICANT REGARDING REPLACEMENT

    OF ACCIDENT AND HEALTH INSURANCE


    According to (your application) (information you have

    furnished), you intend to lapse or otherwise terminate

    existing accident and health insurance and replace it with the

    policy delivered herewith issued by (insert 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 that may affect the

    insurance protection available to you under the new policy.

    Health conditions that you may presently have (preexisting

    conditions) may not be immediately or fully covered under the new

    policy. This could result in denial or delay of a claim for

    benefits under the new policy, whereas a similar claim might

    have been payable under your present policy.

    You may wish to secure the advice of your present insurer or

    its producer regarding the proposed replacement of your present

    policy. This is not only your right, but it is also in your best

    interests to make sure you understand all the relevant factors

    involved in replacing your present coverage.

    (To be included only if the application is attached to the

    policy). If, after due consideration, you still wish to terminate

    your present policy and replace it with new coverage, read the

    copy of the application attached to your new policy and be sure

    that all questions are answered fully and correctly. Omissions

    or misstatements in the application could cause an otherwise valid

    claim to be denied. Carefully check the application and write to

    (insert company name and address) within ten days if any

    information is not correct and complete, or if any past medical

    history has been left out of the application.

    COMPANY NAME