§431:10H-112  Outline of coverage required.  (a)  An outline of coverage shall 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.  The commissioner shall prescribe a standard format, including style, arrangement, and overall appearance, and the content of an outline of coverage.  In the case of producer solicitations, a producer shall deliver the outline of coverage prior to the presentation of an application or enrollment form.  In the case of direct response solicitation, the outline of coverage shall be presented in conjunction with any application or enrollment form.  In the case of a policy issued to a group defined in paragraph (1) of the definition of “group long-term care insurance” in § 431:10H-104, an outline of coverage shall not be required to be delivered; provided that the information described in subsection (b) is contained in other materials relating to enrollment.  Upon request, these other materials shall be made available to the commissioner.

Terms Used In Hawaii Revised Statutes 431:10H-112

  • Applicant: means :

         (1)  In the case of an individual long-term care insurance policy, the person who seeks to contract for benefits; and

         (2)  In the case of a group long-term care insurance policy, the proposed certificate holder. See Hawaii Revised Statutes 431:10H-104

  • Certificate: means , for the purposes of this article, any certificate issued under a group long-term care insurance policy, which policy has been delivered or issued for delivery in this State. See Hawaii Revised Statutes 431:10H-104
  • Contract: A legal written agreement that becomes binding when signed.
  • federally tax-qualified long-term care insurance contract: means an individual or group insurance contract that meets the requirements of § 7702B(b) of the Internal Revenue Code of 1986, as amended, as follows:

         (1)  The only insurance protection provided under the contract is coverage of qualified long-term care services. See Hawaii Revised Statutes 431:10H-104

  • Long-term care insurance: means any insurance policy or rider advertised, marketed, offered, or designed to provide coverage for not less than twelve consecutive months for each covered person on an expense incurred, indemnity, prepaid, or other basis, 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. See Hawaii Revised Statutes 431:10H-104
  • Policy: means , for the purposes of this article, any policy, contract, subscriber agreement, rider, or endorsement delivered or issued for delivery in this State by an insurer; fraternal benefit society; nonprofit health, hospital, or medical service corporation; prepaid health plan; health maintenance organization; or any similar organization. See Hawaii Revised Statutes 431:10H-104

     (b)  The outline of coverage shall include:

     (1)  A description of the principal benefits and coverage provided in the policy;

     (2)  A statement of the principal exclusions, reductions, and limitations contained in the policy;

     (3)  A statement of the terms under which the policy or certificate, or both, may be continued in force or discontinued, including any reservation in the policy of a right to change premium.  Continuation or conversion provisions of group coverage shall be specifically described;

     (4)  A statement that the outline of coverage is a summary only, not a contract of insurance, and that the policy or group master policy contains governing contractual provisions;

     (5)  A description of the terms under which the policy or certificate may be returned and premium refunded;

     (6)  A brief description of the relationship of costs of care and benefits; and

     (7)  A statement that discloses to the policyholder or certificate holder whether the policy is intended to be a federally tax-qualified long-term care insurance contract under § 7702B(b) of the Internal Revenue Code of 1986, as amended.