Utah Administrative Code (Current through November 1, 2019) |
R590. Insurance, Administration |
R590-233. Health Benefit Plan Insurance Standards |
R590-233-9. 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).
(2) The notice required by Subsection (1) for an insurer, other than a direct response insurer, shall provide, in substantially the following form:
TABLE IV
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 V
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