62S.08 COVERAGE OUTLINE.
    Subdivision 1. Delivery. An outline of coverage must be delivered to a prospective
applicant for long-term care insurance at the time of initial solicitation through means that
prominently direct the attention of the recipient to the document and its purpose. In the case of
agent solicitations, an agent must deliver the outline of coverage before the presentation of an
application or enrollment form. In the case of direct response solicitations, the outline of coverage
must be presented in conjunction with an application or enrollment form.
    Subd. 2. Requirements. The outline of coverage must be a freestanding document, using no
smaller than ten-point type, and may not contain material of an advertising nature. Text which is
capitalized or underscored in the standard format outline of coverage may be emphasized by other
means which provide prominence equivalent to the capitalization or underscoring.
    Subd. 3. Mandatory format. The following standard format outline of coverage must be
used, unless otherwise specifically indicated:
ADDRESS - CITY AND STATE
TELEPHONE NUMBER
LONG-TERM CARE INSURANCE
OUTLINE OF COVERAGE
Policy Number or Group Master Policy and Certificate Number
(Except for policies or certificates which are guaranteed issue, the following caution
statement, or language substantially similar, must appear as follows in the outline of coverage.)
CAUTION: The issuance of this long-term care insurance (policy) (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 you applied). If your answers are incorrect or
untrue, the company 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 company at this address: (insert address).
(1) This policy is (an individual policy of insurance) (a group policy) which was issued in
the (indicate jurisdiction in which group policy was issued).
(2) PURPOSE OF OUTLINE OF COVERAGE. This outline of coverage provides a very
brief description of the important features of the policy. You should compare this outline of
coverage to outlines of coverage for other policies available to you. This is not an insurance
contract, but only a summary of coverage. Only the individual or group policy contains governing
contractual provisions. This means that the policy or group policy sets forth in detail the rights
and obligations of both you and the insurance company. Therefore, if you purchase this coverage,
or any other coverage, it is important that you READ YOUR POLICY (OR CERTIFICATE)
CAREFULLY.
(3) THIS PLAN IS INTENDED TO BE A QUALIFIED LONG-TERM CARE
INSURANCE CONTRACT AS DEFINED UNDER SECTION 7702(B)(b) OF THE INTERNAL
REVENUE CODE OF 1986.
(4) TERMS UNDER WHICH THE POLICY OR CERTIFICATE MAY BE CONTINUED
IN FORCE OR DISCONTINUED.
(a) (For long-term care health insurance policies or certificates describe one of the following
permissible policy renewability provisions:)
(1) (Policies and certificates that are guaranteed renewable shall contain the following
statement:) RENEWABILITY: THIS POLICY (CERTIFICATE) IS GUARANTEED
RENEWABLE. This means you have the right, subject to the terms of your policy, (certificate)
to continue this policy as long as you pay your premiums on time. (Company name) cannot
change any of the terms of your policy on its own, except that, in the future, IT MAY INCREASE
THE PREMIUM YOU PAY.
(2) (Policies and certificates that are noncancelable shall contain the following statement:)
RENEWABILITY: THIS POLICY (CERTIFICATE) IS NONCANCELABLE. This means that
you have the right, subject to the terms of your policy, to continue this policy as long as you pay
your premiums on time. (Company name) cannot change any of the terms of your policy on its
own and cannot change the premium you currently pay. However, if your policy contains an
inflation protection feature where you choose to increase your benefits, (company name) may
increase your premium at that time for those additional benefits.
(b) (For group coverage, specifically describe continuation/conversion provisions applicable
to the certificate and group policy.)
(c) (Describe waiver of premium provisions or state that there are not such provisions.)
(5) TERMS UNDER WHICH THE COMPANY MAY CHANGE PREMIUMS.
(In bold type larger than the maximum type required to be used for the other provisions of
the outline of coverage, state whether or not the company has a right to change the premium and,
if a right exists, describe clearly and concisely each circumstance under which the premium
may change.)
(6) TERMS UNDER WHICH THE POLICY OR CERTIFICATE MAY BE RETURNED
AND PREMIUM REFUNDED.
(a) (Provide a brief description of the right to return -- "free look" provision of the policy.)
(b) (Include a statement that the policy either does or does not contain provisions providing
for a refund or partial refund of premium upon the death of an insured or surrender of the policy
or certificate. If the policy contains such provisions, include a description of them.)
(7) THIS IS NOT MEDICARE SUPPLEMENT COVERAGE. If you are eligible for
Medicare, review the Medicare Supplement Buyer's Guide available from the insurance company.
(a) (For agents) neither (insert company name) nor its agents represent Medicare, the federal
government, or any state government.
(b) (For direct response) (insert company name) is not representing Medicare, the federal
government, or any state government.
(8) LONG-TERM CARE COVERAGE. Policies of this category are designed to provide
coverage for one or more necessary or medically necessary diagnostic, preventive, therapeutic,
rehabilitative, maintenance, or personal care services, provided in a setting other than an acute
care unit of a hospital, such as in a nursing home, in the community, or in the home.
This policy provides coverage in the form of a fixed dollar indemnity benefit for covered
long-term care expenses, subject to policy (limitations), (waiting periods), and (coinsurance)
requirements. (Modify this paragraph if the policy is not an indemnity policy.)
(9) BENEFITS PROVIDED BY THIS POLICY.
(a) (Covered services, related deductible(s), waiting periods, elimination periods, and
benefit maximums.)
(b) (Institutional benefits, by skill level.)
(c) (Noninstitutional benefits, by skill level.)
(d) (Eligibility for payment of benefits.)
(Activities of daily living and cognitive impairment shall be used to measure an insured's
need for long-term care and must be defined and described as part of the outline of coverage.)
(Any benefit screens must be explained in this section. If these screens differ for different
benefits, explanation of the screen should accompany each benefit description. If an attending
physician or other specified person must certify a certain level of functional dependency in order
to be eligible for benefits, this too must be specified. If activities of daily living (ADLs) are
used to measure an insured's need for long-term care, then these qualifying criteria or screens
must be explained.)
(10) LIMITATIONS AND EXCLUSIONS:
Describe:
(a) preexisting conditions;
(b) noneligible facilities/provider;
(c) noneligible levels of care (e.g., unlicensed providers, care or treatment provided by a
family member, etc.);
(d) exclusions/exceptions; and
(e) limitations.
(This section should provide a brief specific description of any policy provisions which
limit, exclude, restrict, reduce, delay, or in any other manner operate to qualify payment of the
benefits described in paragraph (8).)
THIS POLICY MAY NOT COVER ALL THE EXPENSES ASSOCIATED WITH YOUR
LONG-TERM CARE NEEDS.
(11) RELATIONSHIP OF COST OF CARE AND BENEFITS. Because the costs of
long-term care services will likely increase over time, you should consider whether and how the
benefits of this plan may be adjusted. As applicable, indicate the following:
(a) that the benefit level will not increase over time;
(b) any automatic benefit adjustment provisions;
(c) whether the insured will be guaranteed the option to buy additional benefits and the basis
upon which benefits will be increased over time if not by a specified amount or percentage;
(d) if there is such a guarantee, include whether additional underwriting or health screening
will be required, the frequency and amounts of the upgrade options, and any significant
restrictions or limitations; and
(e) whether there will be any additional premium charge imposed and how that is to be
calculated.
(12) ALZHEIMER'S DISEASE AND OTHER ORGANIC BRAIN DISORDERS. (State
that the policy provides coverage for insureds clinically diagnosed as having Alzheimer's disease
or related degenerative and dementing illnesses. Specifically, describe each benefit screen or
other policy provision which provides preconditions to the availability of policy benefits for
such an insured.)
(13) PREMIUM.
(a) State the total annual premium for the policy.
(b) If the premium varies with an applicant's choice among benefit options, indicate the
portion of annual premium which corresponds to each benefit option.
(14) ADDITIONAL FEATURES.
(a) Indicate if medical underwriting is used.
(b) Describe other important features.
(15) CONTACT THE STATE DEPARTMENT OF COMMERCE OR SENIOR LINKAGE
LINE IF YOU HAVE GENERAL QUESTIONS REGARDING LONG-TERM CARE
INSURANCE. CONTACT THE INSURANCE COMPANY IF YOU HAVE SPECIFIC
QUESTIONS REGARDING YOUR LONG-TERM CARE INSURANCE POLICY OR
CERTIFICATE.
    Subd. 4. Outline of coverage. The outline of coverage must include the inflation protection
information required under section 62S.23, subdivision 3, and the notice to buyer requirements
specified under section 62S.29, subdivision 1, clause (3).
History: 1997 c 71 art 1 s 8; 2006 c 255 s 37; 2006 c 282 art 17 s 3