Sec. 31.14.01.25. Suitability

A. This regulation does not apply to life insurance policies that accelerate the death benefits for long-term care.

B. Each insurer shall:

(1) Develop and use suitability standards to determine whether the purchase or replacement of long-term care insurance is appropriate for the needs of the applicant;

(2) Train its insurance producers in the use of its suitability standards; and

(3) Maintain a copy of its suitability standards and make them available for inspection upon request by the Commissioner.

C. Procedures.

(1) To determine whether the applicant meets the standards developed by the insurer, the insurance producer and insurer shall develop procedures that take the following into consideration:

(a) The ability to pay for the proposed coverage and other pertinent financial information related to the purchase of the coverage;

(b) The applicant's goals or needs with respect to long-term care and the advantages and disadvantages of insurance to meet these goals or needs; and

(c) The values, benefits, and costs of the applicant's existing insurance, if any, compared to the values, benefits, and costs of the recommended purchase or replacement.

(2) Collection of Information from Applicant.

(a) The insurer, and if an insurance producer is involved, the insurance producer shall make reasonable efforts to obtain the information described in §C(1) of this regulation.

(b) The efforts to obtain the information described in §C(1) of this regulation shall include presentation to the applicant, at or prior to application, the "Long-Term Care Insurance Personal Worksheet".

(c) The personal worksheet used by the insurer shall contain, at a minimum, the information in the format contained in COMAR 31.14.02.08, in not less than 12-point type.

(d) The insurer may request the applicant to provide additional information to comply with its suitability standards.

(e) A copy of the insurer's personal worksheet shall be filed with the Commissioner.

(3) A completed personal worksheet shall be returned to the insurer prior to the insurer's consideration of the applicant for coverage, except the personal worksheet is not required to be returned for sales of employer group long-term care insurance to employees and their spouses.

(4) An insurer or insurance producer may not sell or disseminate outside the company or agency any information obtained through the personal worksheet set forth in COMAR 31.14.02.08.

D. The insurer shall use the suitability standards it has developed under this regulation in determining whether issuing long-term care insurance coverage to an applicant is appropriate.

E. Insurance producers shall use the suitability standards developed by the insurer in marketing long-term care insurance.

F. Disclosure Form.

(1) At the same time as the personal worksheet is provided to the applicant, the disclosure form entitled "Things You Should Know Before You Buy Long-Term Care Insurance" shall be provided.

(2) The form described in §F(1) of this regulation shall be in the format contained in Regulation .30 of this chapter, in not less than 12-point type.

G. Procedure to Follow if Applicant Does Not Meet Suitability Standards.

(1) If the insurer determines that the applicant does not meet its financial suitability standards, or if the applicant has declined to provide the information, the insurer may reject the application.

(2) As an alternative to rejecting the application as described in §G(1) of this regulation, the insurer shall send the applicant a letter similar to that found in Regulation .31 of this chapter.

(3) If the applicant has declined to provide financial information, the insurer may use some other method than the method described in this regulation to verify the applicant's intent.

(4) The insurer shall make either the applicant's returned letter or a record of the alternative method of verification a part of the applicant's file.

H. The insurer shall report annually by March 31 to the Commissioner the:

(1) Total number of applications received from residents of this State;

(2) Number of those who declined to provide information on the personal worksheet;

(3) Number of applicants who did not meet the suitability standards; and

(4) Number of those who chose to confirm after receiving a suitability letter.