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What Consumer Protections Apply to Long-Term Care Insurance Sold in California? California has a long list of consumer protections, some of which are listed here. Renewability: Every individual long-term care policy must be either guaranteed renewable or non-cancelable. Guaranteed Renewable means that the insurer may not cancel your coverage unless you do not pay premiums on time. Your coverage may not be cancelled because of your age or your health, but the company retains the right to increase premiums if the Department of Insurance approves the increase. 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 agents 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.
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