LONG TERM CARE 15
California Department of Insurance
Protecting California Consumers
Toll Free 800-927-HELP
Non-cancelable
means that the insurer cannot cancel your coverage or increase
your premiums, as long as you continue to pay your premiums
on time. No company currently offers this type of coverage
in California.
Group Coverage Renewability
If you purchase a long-term care certificate through a group,
you have the right to either continuation or conversion if
your coverage terminates.
Continuation
means you maintain the same coverage
if you continue to pay the premium on time.
Conversion
means you will be issued an individual
policy containing identical or equivalent coverage regardless
of your health or your age. The premium will be calculated
on your age at the time the group certificate was issued.
Duty of Honesty, Good Faith and Fair
Dealing
Every long-term care insurer and insurance agent owes every
applicant and policyholder a duty of honesty, good faith and
fair dealing. Among other things, this duty means that advertisements
and other marketing materials may not be misleading. Applicants
must be given fair and accurate comparisons of policies. No
excessive insurance or inappropriate replacement policies
may be sold. High pressure tactics are expressly forbidden,
and insurance agents must receive special training in order
to sell long-term care insurance.
30-Day Free Look
Purchasers of individual long-term care
insurance (except purchasers through employer groups or trade
associations) have the right to review the policy or certificate
for 30 days after they receive it. If they decide not to buy
the insurance, for any reason, they may return the policy
to the insurer or the agent without explanation, and all the
money they paid will be refunded to them. (Note: Always keep
a record of the date you receive the policy and the date you
return it, or return it by certified mail.)
Outline of Coverage
An outline of coverage is a summary of
the terms of a policy or certificate that you can use to compare
different policies. An Outline of Coverage must be delivered
to you at the time of an insurance agent’s first presentation.
If you are purchasing insurance through the mail, then the
Outline of Coverage must be delivered to you at the time you
receive the application or enrollment form. You do not need
to fill out an application in order to get the Outline of
Coverage.
An agent or insurance company should
be willing to give you an Outline of Coverage. If a company
or an agent refuses to give you one, do business with someone
else.
Changing Your Benefits
If you find that you cannot afford to
continue paying the same amount of premiums for the coverage
you bought, you have the right to reduce your benefits in
return for a lower premium. Companies must, at a minimum,
let you reduce the daily benefit or change the number of years
the company will pay benefits so the lower premium is an amount
that is more affordable.
Shoppers Guide
Companies and agents are required to
give a copy of the long-term care insurance shoppers guide
developed by the California Department of Aging to each person
who applies for a long-term care insurance policy. This guide
is titled “Taking Care of Tomorrow” and covers many issues
related to long-term care, as well as long-term care insurance.
Checklist and Counseling Information
Agents are required to leave a number of documents with you
when they sell a long-term care insurance policy. Among the
items you should get is a copy of a “Personal Worksheet” that
helps you understand some of the issues related to purchasing
long-term care insurance, and the name, address, and local
phone number of the HICAP office nearest you where you can
receive, free of charge, information and counseling about
long-term care insurance.
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