Section 376.1124

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS

Chapter 376

Effective - 28 Aug 2002   

  376.1124.  Rescinding of a long-term care policy, permitted when — grounds for contesting — no field issuance, when. — 1.  For a policy or certificate that has been in force less than six months, an insurer may rescind a long-term care insurance policy or certificate, or deny an otherwise valid long-term care insurance claim upon a showing of misrepresentation that is material to the acceptance for coverage.

  2.  For a policy or certificate that has been in force for at least six months but less than two years, an insurer may rescind a long-term care insurance policy or certificate, or deny an otherwise valid long-term care insurance claim upon a showing of misrepresentation that is both material to the acceptance of coverage and which pertains to the conditions for which benefits are sought.

  3.  After a policy or certificate has been in force for two years, such policy or certificate is not contestable upon the grounds of misrepresentation alone.  Such policy or certificate may be contested only upon a showing that the insured knowingly and intentionally misrepresented relevant facts relating to the insured's health.

  4.  No long-term care insurance policy or certificate shall be field issued based on medical or health status.  For purposes of this subsection, "field issued" means a policy or certificate issued by an agent or third-party administrator pursuant to the underwriting authority granted to the agent or third-party administrator by an insurer.

  5.  If an insurer has paid benefits under the long-term care insurance policy or certificate, the benefit payments shall not be recovered by the insurer if such policy or certificate is rescinded.

  6.  In the event of the death of the insured, this section shall not apply to the remaining death benefit of a life insurance policy that accelerates benefits for long-term care.  In this situation, the remaining death benefits under these such policies shall be governed by the contestability provisions otherwise applicable in the policy to life insurance benefits.  In all other situations, this section shall apply to life insurance policies that accelerate benefits for long-term care.

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(L. 2002 H.B. 1568 merged with S.B. 1009)