Okla. Stat. tit. 36, § 36-4426

A. No long-term care insurance policy shall:

1. Be canceled, nonrenewed, or otherwise terminated on the

grounds of age or the deterioration of the mental or physical health

of the insured individual or certificate holder;

2. Contain a provision establishing a new waiting period in the

event existing coverage is converted to or replaced by a new or

other form within the same company, except with respect to an

Oklahoma Statutes - Title 36. Insurance Page 969

increase in benefits voluntarily selected by the insured individual

or group policyholder; or

3. Provide coverage for skilled nursing care only or provide

significantly more coverage for skilled care in a facility than

coverage for lower levels of care.

B. 1. No long-term care insurance policy or certificate shall

use a definition of "preexisting condition" which is more

restrictive than the following: Preexisting condition means a

condition for which medical advice or treatment was recommended by,

or received from a provider of health care services, within six (6)

months preceding the effective date of coverage of an insured

person.

2. No long-term care insurance policy or certificate shall

exclude coverage for a loss or confinement which is the result of a

preexisting condition unless such loss or confinement begins within

six (6) months following the effective date of coverage of an

insured person.

3. The definition of "preexisting condition" does not prohibit

an insurer:

a. from using an application form designed to elicit the

complete health history of an applicant, and

b. from underwriting, on the basis of the answers on that

application, in accordance with that insurer's

established underwriting standards.

4. Unless otherwise provided in the policy or certificate, a

preexisting condition, regardless of whether it is disclosed on the

application, need not be covered until the waiting period described

in paragraph 2 of subsection B of this section expires. No long-

term care insurance policy or certificate may exclude or use waivers

or riders of any kind to exclude, limit or reduce coverage or

benefits for specifically named or described preexisting diseases or

physical conditions beyond the waiting period described in paragraph

2 of subsection B of this section.

C. Prior hospitalization/institutionalization:

1. No long-term care insurance policy may be delivered or

issued in this state if such policy:

a. conditions eligibility for any benefits on a prior

hospitalization requirement,

b. conditions eligibility for benefits provided in an

institutional care setting on the receipt of a higher

level of institutional care, or

c. conditions eligibility for any benefits other than

waiver of premium, post-confinement, post-acute care

or recuperative benefits on a prior

institutionalization requirement.

2. a. A long-term care insurance policy containing post-

confinement, post-acute care or recuperative benefits

Oklahoma Statutes - Title 36. Insurance Page 970

shall clearly label in a separate paragraph of the

policy or certificate entitled "Limitations or

Conditions on Eligibility for Benefits" such

limitations or conditions, including any required

number of days of confinement.

b. A long-term care insurance policy or rider which

conditions eligibility of noninstitutional benefits on

the prior receipt of institutional care shall not

require a prior institutional stay of more than thirty
of the

policy or certificate entitled "Limitations or

Conditions on Eligibility for Benefits" such

limitations or conditions, including any required

number of days of confinement.

b. A long-term care insurance policy or rider which

conditions eligibility of noninstitutional benefits on

the prior receipt of institutional care shall not

require a prior institutional stay of more than thirty

(30) days.

D. No law, rule or regulation shall establish loss ratio

standards for long-term care insurance policies unless a specific

reference to long-term care insurance policies is contained in such

law, rule or regulation.

E. Long-term care insurance applicants shall have the right to

return the policy or certificate within thirty (30) days after its

delivery and to have the premium refunded if, after examination of

the policy or certificate, the applicant is not satisfied with the

policy, for any reason. Long-term care insurance policies and

certificates shall have a notice prominently printed on the first

page of the policy or attached thereto, stating in substance, that

the applicant shall have the right to return the policy or

certificate within thirty (30) days after its delivery and to have

the premium refunded if, after examination of the policy, or

certificate, the applicant is not satisfied with the policy, for any

reason. If an application for a qualified long-term care contract

is denied, the issuer shall refund to the applicant any premium and

any other fees submitted by the applicant within thirty (30) days of

the date of the denial. If the insurer does not return any premiums

or moneys paid therefor within thirty (30) days from the date of

cancellation, the insurer shall pay interest on the proceeds which

shall be the same rate of interest as the average United States

Treasury Bill rate of the preceding calendar year, as certified to

the Insurance Commissioner by the State Treasurer on the first

regular business day in January of each year, plus two (2)

percentage points, which shall accrue from the date of cancellation

until the premiums or moneys are returned. In such event, the long-

term care policy shall be deemed to have been canceled on the date

the policy was placed in the United States mail in a properly

addressed, postpaid envelope, or, if not so posted, on the date of

delivery of such policy or annuity to the insurer.

F. An outline of coverage shall be delivered to a prospective

applicant for long-term care insurance at the time of initial

solicitation through means which prominently direct the attention of

the recipient to the document and its purpose. The Insurance

Commissioner shall prescribe a standard format, including style,

arrangement and overall appearance, and the content of an outline of

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coverage. In the case of agent solicitations, an agent must deliver

the outline of coverage prior to 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 any

application or enrollment form. Such outline of coverage shall

include, but not be limited to:

1. A description of the principal benefits and coverage

provided in the policy;

2. A statement of the principal exclusions, reductions and

limitations contained in the policy;

3. A statement of the terms under which the policy or

certificate, or both, may be continued in force or discontinued,

including any reservation in the policy of a right to change

premiums. Continuation or conversion provisions of group coverage

shall be specifically described;

4. A statement that the outline of coverage is a summary only,

not a contract of insurance, and that the policy or group master

policy contains governing contractual provisions;

5. A description of the terms under which the policy or

certificate may be returned and premium refunded;
to change

premiums. Continuation or conversion provisions of group coverage

shall be specifically described;

4. A statement that the outline of coverage is a summary only,

not a contract of insurance, and that the policy or group master

policy contains governing contractual provisions;

5. A description of the terms under which the policy or

certificate may be returned and premium refunded;

6. A brief description of the relationship of cost of care and

benefits; and

7. If the policy or certificate is intended to be a qualified

long-term care insurance contract, a statement that discloses to the

policyholder or certificate holder that the policy is intended to be

a qualified long-term care insurance contract.

G. The issuer of a qualified long-term care insurance contract

shall deliver to the applicant, policyholder, or certificate holder

the contract or certificate no later than thirty (30) days after the

date of approval.

H. At the time of policy delivery, a policy summary shall be

delivered for an individual life insurance policy which provides

long-term care benefits within the policy or by rider. In the case

of direct response solicitations, the insurer shall deliver the

policy summary upon the applicant's request, but regardless of

request shall make such delivery no later than at the time of policy

delivery. In addition to complying with all applicable

requirements, the summary shall also include:

1. An explanation of how the long-term care benefit interacts

with other components of the policy, including deductions from death

benefits;

2. An illustration of the amount of benefits, the length of

benefit, and the guaranteed lifetime benefits if any, for each

covered person;

3. Any exclusions, reductions and limitations on benefits of

long-term care; and

Oklahoma Statutes - Title 36. Insurance Page 972

4. If applicable to the policy type, the summary shall 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 benefit.

I. Any time a long-term care benefit, funded through a life

insurance vehicle by the acceleration of the death benefit, is in

benefit payment status, a monthly report shall be provided to the

policyholder. Such report shall include:

1. Any long-term care benefits paid out during the month;

2. An explanation of any changes in the policy, e.g. death

benefits or cash values, due to long-term care benefits being paid

out; and

3. The amount of long-term care benefits existing or remaining.

J. If a claim under a qualified long-term care insurance

contract is denied, the issuer shall, within sixty (60) days of the

date of a written request by the policyholder or certificate holder,

or a representative thereof:

1. Provide a written explanation of the reasons for the denial;

and

2. Make available all information directly related to such

denial.

K. No policy shall be advertised, marketed or offered as long-

term care insurance unless it complies with the provisions of the

Long-Term Care Insurance Act.

L. Policies or contracts issued by life care communities which

are not licensed insurers in this state shall contain the following

statement in conspicuous bold-face type on the front of the policy

or contract: "The financial condition of the entity issuing this

contract is not subject to review by or the jurisdiction of the

Oklahoma Insurance Commissioner. This contract is not subject to

the protection of any guaranty association."