Section R20-6-1018. Suitability

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

B.       Every insurer or other person marketing long-term care insur- ance, including an insurance producer or managing general agent, (the “issuer”) 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 the Director’s request.

C.      To determine whether an applicant meets an issuer’s suitability standards, the insurance producer and issuer shall develop pro- cedures that take the following into consideration:

1.        The applicant’s ability to pay for the proposed coverage and other pertinent financial information related to the purchase of the coverage;

2.        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

3.        The values, benefits, and costs of the applicant’s existing insurance, if any, when compared to the values, benefits, and costs of the recommended purchase or replacement.

D.      The issuer shall make reasonable efforts to obtain the informa- tion set out in subsection (C)(1), including giving the applicant the “Long-Term Care Insurance Personal Worksheet” pre- scribed in Appendix A, to complete before or at the time of application. The issuer shall use a personal worksheet that contains, at a minimum, the information contained in Appen- dix A, in substantially the same text and format, in not less than 12 point type. The issuer may ask the applicant to provide additional information to comply with its suitability standards. An issuer shall file a copy of its personal worksheet with the Director.

E.       An issuer shall not consider an applicant for coverage until the issuer has received the applicant’s completed personal work- sheet, except the personal worksheet need not be returned for sales of employer group long-term care insurance to employ- ees and their spouses.

F.       No one shall sell or disseminate information obtained through the personal worksheet outside the issuer that obtains the worksheet.

G.      The issuer shall use its suitability standards to determine whether issuance of long-term care insurance coverage to a particular applicant is appropriate.

H.      An insurance producer shall use the suitability standards developed by the issuer in marketing long-term care insurance.

I.        When giving an applicant a personal worksheet, the issuer shall also provide the applicant with a disclosure form entitled “Things You Should Know Before You Buy Long-Term Care Insurance.” The form shall be in substantially the same format and text contained in Appendix H, in not less than 12 point type.

J.        If the issuer determines that the applicant does not meet its financial suitability standards, or if the applicant has declined to provide the information, the issuer may reject the applica- tion. In the alternative, the issuer shall send the applicant a let- ter that is substantially similar to Appendix I. However, if the applicant has declined to provide financial information, the issuer may use some other method to verify the applicant’s intent to purchase the long-term care policy. The issuer shall have either the applicant’s returned Appendix I letter or a record of the alternative method of verification as part of the applicant’s file.

K.      The issuer shall report annually to the Director the total num- ber of applications received from residents of this state, the number of those who declined to provide information on the personal worksheet, the number of applicants who did not meet the suitability standards, and the number of those who chose to confirm after receiving a suitability letter as pre- scribed in subsection (J).

Historical Note

New Section made by final rulemaking at 10 A.A.R.

4661, effective January 3, 2005 (Supp. 04-4).