OAR 836-052-0626
Requirements for Application Forms and Replacement Coverage

(1)

An application form for long-term care insurance shall include the questions set forth in this section designed to elicit information as to whether, as of the date of the application, the applicant has another long-term care insurance policy, rider or certificate in force or whether a long-term care insurance policy, rider or certificate is intended to replace any other health or long term care insurance policy, rider or certificate currently in force. A supplementary application or other form to be signed by the applicant and insurance producer, except when the coverage is sold without an insurance producer, containing the questions may be used. With regard to a replacement policy issued to a group defined by ORS 743.652 (Definitions for ORS 743.650 to 743.665)(3)(a), the following questions may be modified only to the extent necessary to elicit information about health or long-term care insurance policies other than the group policy being replaced, but only if the certificate holder has been notified of the replacement. The questions are as follows:

(a)

Do you have another long-term care insurance policy, rider or certificate in force (including health care service contract, health maintenance organization contract)?

(b)

Did you have another long-term care insurance policy, rider or certificate in force during the last 12 months?

(A)

If so, with which insurer?

(B)

If that policy lapsed, when did it lapse?

(C)

Are you covered by a state assistance program (Medicaid)?

(d)

Do you intend to replace any of your medical or health insurance coverage with this policy, rider or certificate?

(2)

An insurance producer shall list any other health insurance policies that the insurance producer has sold to the applicant:

(a)

List such policies sold that are still in force, and;

(b)

List such policies sold in the past five years that are no longer in force.

(3)

Solicitations other than direct response. Upon determining that a sale will involve replacement of long-term care insurance coverage, the insurer, other than an insurer using direct response solicitation methods, or its producer, shall furnish the applicant, prior to issuance or delivery of the individual long-term care insurance policy, a notice regarding replacement of accident and sickness or long-term care coverage. One copy of the notice shall be retained by the applicant and an additional copy signed by the applicant shall be retained by the insurer. The required notice shall be provided in the form shown in Exhibit 1 to this rule.

(4)

Direct Response Solicitations. An insurer using direct response solicitation methods shall deliver a notice regarding replacement of accident and sickness or long-term care coverage to the applicant upon issuance of the policy. The required notice shall be provided in the form shown in Exhibit 2 to this rule.

(5)

When replacement is intended, the replacing insurer shall notify, in writing, the existing insurer of the proposed replacement. The existing policy shall be identified by the insurer, name of the insured and policy number or address including zip code. Notice shall be sent within five working days from the date the application is received by the insurer or the date the policy is issued, whichever is sooner.

(6)

Life insurance policies that accelerate benefits for long-term care shall comply with this section if the policy being replaced is a long-term care insurance policy. If the policy being replaced is a life insurance policy, the insurer shall comply with the replacement requirements of OAR 836-080-0001 (Statutory Authority; Purpose; Applicability) to 836-080-0043 (Violations and Penalties). If a life insurance policy that accelerates benefits for long-term care is replaced by another such policy, the replacing insurer shall comply with both the long-term care and the life insurance replacement requirements.

(7)

Sections (1) through (6) do not apply when the application is to the existing insurer that issued the existing policy, certificate or rider when the transaction meets the following:

(a)

A contractual change or a conversion privilege is being exercised, or

(b)

When the existing policy, certificate or rider is being replaced by the same insurer and unearned premium is credited toward the new coverage.
[ED. NOTE: Exhibits referenced are available from the agency.]

Source: Rule 836-052-0626 — Requirements for Application Forms and Replacement Coverage, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=836-052-0626.

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 836-052-0626’s source at or​.us