(1) An outline of coverage must be delivered to a prospective applicant for supplemental 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.
(a) The commissioner must prescribe a standard format, including style, arrangement, overall appearance, and the content of an outline of coverage. The outline of coverage must also include a disclosure:
(i) Of how the supplemental long-term care insurance interacts with benefits provided in chapter
50B.04 RCW and any potential gaps in coverage or discontinuities of care between benefits provided under chapter
50B.04 RCW and the policy;
(ii) That the premiums may increase over time and an explanation of the conditions that may result in an increase in premiums;
(iii) If the policyholder's circumstances change or premiums increase and the policyholder is unable or unwilling to pay the increased premiums, the options available to the consumer, including a reduction in benefits and nonforfeiture of premiums;
(iv) That premiums continue after retirement;
(v) When premium payments are no longer required under the policy, known as a waiver of premiums; and
(vi) That the purchase of the policy does not qualify the policyholder to apply to be exempt from premium assessments under RCW
50B.04.085.
(b) When an insurance producer makes a solicitation in person, the insurance producer must deliver an outline of coverage before presenting an application or enrollment form.
(c) In a direct response solicitation, the outline of coverage must be presented with an application or enrollment form. The disclosures required under (a) of this subsection are required in any marketing materials.
(d) If a policy is issued to a group as defined in RCW
48.212.020(5)(a), an outline of coverage is not required to be delivered, if the information that the commissioner requires to be included in the outline of coverage is in other materials relating to enrollment. Upon request, any such materials must be made available to the commissioner.
(2) If an issuer approves an application for a supplemental long-term care insurance contract or certificate, the issuer must deliver the contract or certificate of insurance to the applicant within 30 days after the date of approval. A policy summary must be delivered with an individual life insurance policy that provides supplemental long-term care benefits within the policy or by rider. In a direct response solicitation, the issuer must deliver the policy summary, upon request, before delivery of the policy, if the applicant requests a summary.
(a) The policy summary must include:
(i) An explanation of how the supplemental long-term care benefit interacts with other components of the policy, including deductions from any applicable death benefits;
(ii) An illustration of the amount of benefits, the length of benefits, and the guaranteed lifetime benefits if any, for each covered person;
(iii) Any exclusions, reductions, and limitations on benefits of supplemental long-term care;
(iv) A statement that any supplemental long-term care inflation protection option required by RCW
48.212.140 is not available under this policy; and
(v) If applicable to the policy type, the summary must also include:
(A) A disclosure of the effects of exercising other rights under the policy;
(B) A disclosure of guarantees related to long-term care costs of insurance charges; and
(C) Current and projected maximum lifetime benefits.
(b) The provisions of the policy summary may be incorporated into a basic illustration required under chapter
48.23A RCW, or into the policy summary which is required under rules adopted by the commissioner.
