Section R590-285-13 - Requirements for Application Forms and Replacement Coverage(1)(a) An application or enrollment form shall include questions to elicit information as to whether, as of the date of the application, the applicant: (i) currently has: (A) a limited long-term care insurance policy or certificate; or(B) a long-term care insurance policy or certificate; and(ii) whether the policy or certificate is intended to replace any other accident and health insurance policy or certificate currently in force.(b) The questions in Subsection (1)(a) shall include:(i) "Do you currently have limited long-term care insurance or long-term care insurance?";(ii) "Did you have limited long-term care insurance or long-term care insurance in force during the last twelve (12) months? If so, with which company?
If the policy lapsed, when did it lapse?";
(iii) "Are you covered by Medicaid?; and(iv) "Do you intend to replace any of your medical or health insurance coverage with this policy or certificate?"(c) A supplementary application signed by the applicant and producer may be used, except when the coverage is sold without a producer.(d) For a replacement policy issued to a group, the questions may be modified to the extent necessary to elicit information about other health insurance or limited long-term care insurance other than the group policy being replaced, provided the certificate holders have been notified of the replacement.(2) A producer shall list other accident and health insurance policies they sold to the applicant, identifying policies sold:(a) that are still in force; and(b) in the past five years that are no longer in force.(3)(a)(i) An insurer using a direct response solicitation method shall deliver a notice regarding replacement of accident and health insurance, limited long-term care insurance, or long-term care insurance to the applicant when the policy or certificate is issued.(ii)(A) If replacement is intended, the replacing insurer shall notify the existing insurer in writing of the proposed replacement identifying the insurer, the insured, and the policy number or address including zip code.(B) The notice shall be made within five working days from the date the application is received by the insurer or the date the policy or certificate is issued, whichever is sooner.(b)(i) An insurer using a solicitation method other than direct response shall, upon determining that a sale will involve a replacement, provide to the applicant, before issuance or delivery of the individual policy, a notice regarding replacement of accident and health insurance, limited long-term care insurance, or long-term care insurance.(ii) A copy of the notice shall be provided to the applicant and an additional copy signed by the applicant shall be retained by the insurer.(c) A replacement notice shall be provided in a manner substantially similar to the following NAIC Limited Long-Term Care Insurance Model Regulation form:(i) "NOTICE TO APPLICANT REGARDING REPLACEMENT OF INDIVIDUAL ACCIDENT AND SICKNESS OR LIMITED LONG-TERM CARE INSURANCE OR LONG-TERM CARE INSURANCE"; or(ii) "NOTICE TO APPLICANT REGARDING REPLACEMENT OF ACCIDENT AND SICKNESS OR LIMITED LONG-TERM CARE INSURANCE OR LONG-TERM CARE INSURANCE".Utah Admin. Code R590-285-13
Adopted by Utah State Bulletin Number 2021-05, effective 2/23/2021Adopted by Utah State Bulletin Number 2024-21, effective 10/22/2024