2002 Minnesota Statutes

     62S.08 Coverage outline. 

    Subdivision 1.    Delivery.  An outline of coverage must 
 be delivered to a prospective applicant for long-term care 
 insurance at the time of initial solicitation through means that 
 prominently direct the attention of the recipient to the 
 document and its purpose.  In the case of agent solicitations, 
 an agent must deliver the outline of coverage before the 
 presentation of an application or enrollment form.  In the case 
 of direct response solicitations, the outline of coverage must 
 be presented in conjunction with an application or enrollment 
 form. 

    Subd. 2.    Requirements.  The outline of coverage must 
 be a freestanding document, using no smaller than ten-point 
 type, and may not contain material of an advertising nature.  
 Text which is capitalized or underscored in the standard format 
 outline of coverage may be emphasized by other means which 
 provide prominence equivalent to the capitalization or 
 underscoring. 

    Subd. 3.    Mandatory format.  The following standard 
 format outline of coverage must be used, unless otherwise 
 specifically indicated: 

                           COMPANY NAME 
                     ADDRESS - CITY AND STATE 
                         TELEPHONE NUMBER 
                     LONG-TERM CARE INSURANCE 
                       OUTLINE OF COVERAGE 

 Policy Number or Group Master Policy and Certificate Number 

    (Except for policies or certificates which are guaranteed 
 issue, the following caution statement, or language 
 substantially similar, must appear as follows in the outline of 
 coverage.) 

    CAUTION:  The issuance of this long-term care insurance 
 (policy) (certificate) is based upon your responses to the 
 questions on your application.  A copy of your (application) 
 (enrollment form) (is enclosed) (was retained by you when you 
 applied).  If your answers are incorrect or untrue, the company 
 has the right to deny benefits or rescind your policy.  The best 
 time to clear up any questions is now, before a claim arises.  
 If, for any reason, any of your answers are incorrect, contact 
 the company at this address:  (insert address). 

    (1) This policy is (an individual policy of insurance) (a 
 group policy) which was issued in the (indicate jurisdiction in 
 which group policy was issued). 

    (2) PURPOSE OF OUTLINE OF COVERAGE.  This outline of 
 coverage provides a very brief description of the important 
 features of the policy.  You should compare this outline of 
 coverage to outlines of coverage for other policies available to 
 you.  This is not an insurance contract, but only a summary of 
 coverage.  Only the individual or group policy contains 
 governing contractual provisions.  This means that the policy or 
 group policy sets forth in detail the rights and obligations of 
 both you and the insurance company.  Therefore, if you purchase 
 this coverage, or any other coverage, it is important that you 
 READ YOUR POLICY (OR CERTIFICATE) CAREFULLY. 

    (3) THIS PLAN IS INTENDED TO BE A QUALIFIED LONG-TERM CARE 
 INSURANCE CONTRACT AS DEFINED UNDER SECTION 7702(B)(b) OF THE 
 INTERNAL REVENUE CODE OF 1986. 

    (4) TERMS UNDER WHICH THE POLICY OR CERTIFICATE MAY BE 
 RETURNED AND PREMIUM REFUNDED. 

    (a) (Provide a brief description of the right to return -- 
 "free look" provision of the policy.) 

    (b) (Include a statement that the policy either does or 
 does not contain provisions providing for a refund or partial 
 refund of premium upon the death of an insured or surrender of 
 the policy or certificate.  If the policy contains such 
 provisions, include a description of them.) 

    (5) THIS IS NOT MEDICARE SUPPLEMENT COVERAGE.  If you are 
 eligible for Medicare, review the Medicare Supplement Buyer's 
 Guide available from the insurance company. 

    (a) (For agents) neither (insert company name) nor its 
 agents represent Medicare, the federal government, or any state 
 government. 

    (b) (For direct response) (insert company name) is not 
 representing Medicare, the federal government, or any state 
 government. 

    (6) LONG-TERM CARE COVERAGE.  Policies of this category are 
 designed to provide coverage for one or more necessary or 
 medically necessary diagnostic, preventive, therapeutic, 
 rehabilitative, maintenance, or personal care services, provided 
 in a setting other than an acute care unit of a hospital, such 
 as in a nursing home, in the community, or in the home. 

    This policy provides coverage in the form of a fixed dollar 
 indemnity benefit for covered long-term care expenses, subject 
 to policy (limitations), (waiting periods), and (coinsurance) 
 requirements.  (Modify this paragraph if the policy is not an 
 indemnity policy.) 

    (7) BENEFITS PROVIDED BY THIS POLICY. 

    (a) (Covered services, related deductible(s), waiting 
 periods, elimination periods, and benefit maximums.) 

    (b) (Institutional benefits, by skill level.) 

    (c) (Noninstitutional benefits, by skill level.) 

    (Any benefit screens must be explained in this section.  If 
 these screens differ for different benefits, explanation of the 
 screen should accompany each benefit description.  If an 
 attending physician or other specified person must certify a 
 certain level of functional dependency in order to be eligible 
 for benefits, this too must be specified.  If activities of 
 daily living (ADLs) are used to measure an insured's need for 
 long-term care, then these qualifying criteria or screens must 
 be explained.) 

    (8) LIMITATIONS AND EXCLUSIONS: 

    Describe: 

    (a) preexisting conditions; 

    (b) noneligible facilities/provider; 

    (c) noneligible levels of care (e.g., unlicensed providers, 
 care or treatment provided by a family member, etc.); 

    (d) exclusions/exceptions; and 

    (e) limitations. 

    (This section should provide a brief specific description 
 of any policy provisions which limit, exclude, restrict, reduce, 
 delay, or in any other manner operate to qualify payment of the 
 benefits described in paragraph (6).) 

    THIS POLICY MAY NOT COVER ALL THE EXPENSES ASSOCIATED WITH 
 YOUR LONG-TERM CARE NEEDS. 

    (9) RELATIONSHIP OF COST OF CARE AND BENEFITS.  Because the 
 costs of long-term care services will likely increase over time, 
 you should consider whether and how the benefits of this plan 
 may be adjusted.  As applicable, indicate the following: 

    (a) that the benefit level will not increase over time; 

    (b) any automatic benefit adjustment provisions; 

    (c) whether the insured will be guaranteed the option to 
 buy additional benefits and the basis upon which benefits will 
 be increased over time if not by a specified amount or 
 percentage; 

    (d) if there is such a guarantee, include whether 
 additional underwriting or health screening will be required, 
 the frequency and amounts of the upgrade options, and any 
 significant restrictions or limitations; and 

    (e) whether there will be any additional premium charge 
 imposed and how that is to be calculated. 

    (10) ALZHEIMER'S DISEASE AND OTHER ORGANIC BRAIN DISORDERS. 
 (State that the policy provides coverage for insureds clinically 
 diagnosed as having Alzheimer's disease or related degenerative 
 and dementing illnesses.  Specifically, describe each benefit 
 screen or other policy provision which provides preconditions to 
 the availability of policy benefits for such an insured.) 

    (11) PREMIUM. 

    (a) State the total annual premium for the policy. 

    (b) If the premium varies with an applicant's choice among 
 benefit options, indicate the portion of annual premium which 
 corresponds to each benefit option. 

    (12) ADDITIONAL FEATURES. 

    (a) Indicate if medical underwriting is used. 

    (b) Describe other important features. 

    Subd. 4.    Outline of coverage.  The outline of 
 coverage must include the inflation protection information 
 required under section 62S.23, subdivision 3, and the notice to 
 buyer requirements specified under section 62S.29, subdivision 
 1, clause (3). 

    HIST: 1997 c 71 art 1 s 8