OAR 836-052-0576
Prohibition Against Post-Claims Underwriting, Applications


(1)

Each application for a long-term care insurance policy, rider or certificate, except those that are guaranteed issue, shall contain clear and unambiguous questions designed to ascertain the health condition of the applicant.

(2)

If an application for long-term care insurance contains a question asking whether the applicant has had medication prescribed by a physician, it must also ask the applicant to list the medication that has been prescribed;

(3)

If the medications listed in the application were known by the insurer, or should have been known by the insurer at the time of application, to be directly related to a medical condition for which coverage would otherwise be denied, the policy, rider or certificate shall not be rescinded for that condition.

(4)

Except for policies or certificates that are guaranteed issue:

(a)

The following language shall be set out conspicuously and in close conjunction with the applicant’s signature block on an application for a long-term care insurance policy, rider or certificate: Caution: If your answers on this application are incorrect or untrue, (insurer) has the right to deny benefits or rescind your policy.

(b)

The following language, or language substantially similar to the following, shall be set out conspicuously on the long-term care insurance policy, rider or certificate at the time of delivery: Caution: The issuance of this long-term care insurance (policy) (rider) (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 your applied). If your answers are incorrect or untrue, the insurer 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 insurer at this address: (insert address).

(5)

Prior to issuance of a long-term care policy, rider or certificate to an applicant age 80 or older, the insurer shall obtain one or more of the following:

(a)

A report of physical examination;

(b)

An assessment of functional capacity;

(c)

An attending physician’s statement;

(d)

Copies of medical records.

(6)

A copy of the completed application or enrollment form, whichever is applicable, shall be delivered to the insured not later than the time of delivery of the policy, rider or certificate unless it was retained by the applicant at the time of application.

(7)

Every insurer or other entity selling long-term care insurance benefits shall maintain a record of all rescissions of policies, riders and certificates, both state- and country-wide, except those that the insured voluntarily effectuated, and shall annually furnish this information to the Director in the format prescribed in Exhibit 1 or similar form approved by the Director.
[ED. NOTE: Exhibits referenced are available from the agency.]

Source: Rule 836-052-0576 — Prohibition Against Post-Claims Underwriting, Applications, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=836-052-0576.

836–052–0103
Purpose
836–052–0107
Authority
836–052–0114
Applicability and Scope
836–052–0119
Definitions
836–052–0124
Policy Definitions and Terms
836–052–0129
Policy Provisions
836–052–0132
Benefit Standards for 2010 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery with an Effective Date of Coverage on or After June 1, 2010
836–052–0133
Benefit Standards for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or After July 1, 1992 and with an Effective Date of Coverage Prior to June 1, 2010
836–052–0134
Minimum Benefit Standards for Policies or Certificates Issued for Delivery Prior to July 1, 1992
836–052–0136
Standard Medicare Supplement Benefit Plans for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or After July 1, 1992 and with an Effective Date of Coverage Prior to June 1, 2010
836–052–0138
Open Enrollment
836–052–0139
Medicare Select Policies and Certificates
836–052–0140
Standards for Claims Payment
836–052–0141
Standard Medicare Supplement Benefit Plans for 2010 Standardized Medicare Supplement Benefit Plan Policies or Certificates with an Effective Date of Coverage on or After June 1, 2010
836–052–0142
Guaranteed Issue for Eligible Persons
836–052–0143
Annual Opportunity to Select Another Medicare Supplement Policy or Certificate
836–052–0144
Standard Medicare Supplement Benefit Plans for 2020 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery to Individuals Newly Eligible for Medicare on or after January 1, 2020.
836–052–0145
Loss Ratio Standards and Refund or Credit of Premium
836–052–0151
Filing and Approval of Policies and Certificates and Premium Rates
836–052–0156
Permitted Compensation Arrangements
836–052–0160
Required Disclosure Provisions
836–052–0165
Requirements for Application Forms, Replacement Coverage
836–052–0170
Filing Requirements for Advertising
836–052–0175
Standards for Marketing
836–052–0180
Appropriateness of Recommended Purchase and Excessive Insurance
836–052–0185
Reporting of Multiple Policies
836–052–0190
Prohibition Against Preexisting Conditions, Waiting Periods, Elimination Periods and Probationary Periods in Replacement Policies and Certificates
836–052–0192
Prohibition Against Use of Genetic Information and Requests for Genetic Testing
836–052–0194
Separability
836–052–0225
Durational Limits for Health Maintenance Organizations
836–052–0230
Provider Services Limits for Insurers and Health Care Contractors
836–052–0500
Statutory Authority
836–052–0508
Definitions
836–052–0516
Policy Definitions
836–052–0526
Policy Practices and Provisions
836–052–0531
Long Term Care Insurance Partnership Program
836–052–0546
Required Policy Provisions
836–052–0556
Required Disclosure of Rating Practices to Consumers
836–052–0566
Initial Rate Filing Requirements
836–052–0576
Prohibition Against Post-Claims Underwriting, Applications
836–052–0586
Minimum Standards for Home Health and Community Care Benefits in Long-Term Care Insurance Policies
836–052–0596
Standards for Covered Services
836–052–0606
Use and Definition of “Home” or Similar Wording
836–052–0616
Requirement to Offer Inflation Protection
836–052–0626
Requirements for Application Forms and Replacement Coverage
836–052–0636
Reporting Requirements
836–052–0637
Annual Rate Certification Requirements
836–052–0639
Training for Insurance Producers
836–052–0646
Benefits Provided Through Advancement of Life Insurance Proceeds
836–052–0656
Reserve Standards
836–052–0666
Loss Ratio
836–052–0676
Premium Rate Schedule Increases
836–052–0680
Premium Rate Schedule Increases for Policies Subject to Loss Ratio Limits Related to Original Filings
836–052–0686
Filing Requirements for Out-of-State Group Policies
836–052–0696
Filing Requirements for Advertising
836–052–0706
Standards for Marketing
836–052–0716
Disclosure Statement
836–052–0726
Suitability
836–052–0736
Prohibition Against Preexisting Conditions, Waiting Periods and Probationary Periods in Replacement Policies and Certificates
836–052–0738
Availability of New Services or Providers
836–052–0740
Right to Reduce Coverage and Lower Premiums
836–052–0746
Nonforfeiture Benefit Requirement
836–052–0756
Standards for Benefit Triggers
836–052–0766
Additional Standards for Benefit Triggers for Qualified Long-Term Care Insurance Contracts
836–052–0768
Appealing An Insurer’s Determination That The Benefit Trigger Is Not Met
836–052–0770
Prompt Payment of Clean Claims
836–052–0776
Standard Format Outline of Coverage
836–052–0786
Requirement to Deliver Shopper’s Guide
836–052–0790
Disclosure of Benefits Paid
836–052–0800
Purpose
836–052–0810
Replacement Upon Termination
836–052–0840
Termination of Coverage
836–052–0850
Multiple Employer Trusts
836–052–0860
Form of Notice to Group Policyholder
836–052–1000
Prosthetic and Orthotic Devices
Last Updated

Jun. 8, 2021

Rule 836-052-0576’s source at or​.us