Sec. 31.14.01.18. Outline of Coverage

A. An insurer or the agent soliciting long-term care coverage shall deliver to a prospective applicant, at the time of the initial solicitation, an outline of coverage in a manner which prominently directs the attention of the recipient to the document and its purpose.

B. Time of Delivery. In the case of:

(1) Solicitation by an agent, the agent shall deliver the outline of coverage before presenting an applicant or enrollment form to the prospective applicant;

(2) Direct response solicitations, the insurer shall deliver the outline of coverage in conjunction with any application or enrollment form.

C. The outline of coverage shall include:

(1) A description of the principal benefits and coverage provided under the policy or certificate;

(2) A statement of the principle exclusions, reductions, and limitations under the policy or certificate;

(3) A statement of the renewal provisions, including any reservation of the insurer's right to change the schedule of premiums;

(4) A statement of probable or expected premium increases, or additional premiums to pay for automatic or optional benefit increases, with these being presented in tabular form together with a graphic demonstration of the magnitude of potential premiums the applicant will need to pay from the effective date of the coverage up to age 75;

(5) A statement that the outline of coverage is a summary of the coverage applied for and that the individual policy or the group master policy should be consulted to determine the governing contractual provisions;

(6) A statement of the terms under which the policy or certificate may be returned for a refund of the premium;

(7) A brief description of the relationship of cost of care and benefits; and

(8) 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.

D. The format of the outline of coverage shall comply with the following:

(1) The outline of coverage shall be a free-standing document printed in at least 12-point or larger type;

(2) The outline of coverage may not contain any material of an advertising nature;

(3) Text which is capitalized or underscored in the standard format outline of coverage may be emphasized by other means which provide prominence equivalent to capitalization or underscoring;

(4) Use of the text and sequence of the standard format outline of coverage is mandatory, unless otherwise specifically indicated.

E. The insurer shall use the standard format and the required text of the outline of coverage shown in Regulation .21 of this chapter.