{"data":{"id":"us-ok/okla.-stat.-tit.-36-36-4426","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 36, § 36-4426","heading":"Requirements of policies","body":"A. No long-term care insurance policy shall:\n\n1. Be canceled, nonrenewed, or otherwise terminated on the\n\ngrounds of age or the deterioration of the mental or physical health\n\nof the insured individual or certificate holder;\n\n2. Contain a provision establishing a new waiting period in the\n\nevent existing coverage is converted to or replaced by a new or\n\nother form within the same company, except with respect to an\n\nincrease in benefits voluntarily selected by the insured individual\n\nor group policyholder; or\n\n3. Provide coverage for skilled nursing care only or provide\n\nsignificantly more coverage for skilled care in a facility than\n\ncoverage for lower levels of care.\n\nB. 1. No long-term care insurance policy or certificate shall\n\nuse a definition of \"preexisting condition\" which is more\n\nrestrictive than the following: Preexisting condition means a\n\ncondition for which medical advice or treatment was recommended by,\n\nor received from a provider of health care services, within six (6)\n\nmonths preceding the effective date of coverage of an insured\n\nperson.\n\n2. No long-term care insurance policy or certificate shall\n\nexclude coverage for a loss or confinement which is the result of a\n\npreexisting condition unless such loss or confinement begins within\n\nsix (6) months following the effective date of coverage of an\n\ninsured person.\n\n3. The definition of \"preexisting condition\" does not prohibit\n\nan insurer:\n\na. from using an application form designed to elicit the\n\ncomplete health history of an applicant, and\n\nb. from underwriting, on the basis of the answers on that\n\napplication, in accordance with that insurer's\n\nestablished underwriting standards.\n\n4. Unless otherwise provided in the policy or certificate, a\n\npreexisting condition, regardless of whether it is disclosed on the\n\napplication, need not be covered until the waiting period described\n\nin paragraph 2 of subsection B of this section expires. No long-\n\nterm care insurance policy or certificate may exclude or use waivers\n\nor riders of any kind to exclude, limit or reduce coverage or\n\nbenefits for specifically named or described preexisting diseases or\n\nphysical conditions beyond the waiting period described in paragraph\n\n2 of subsection B of this section.\n\nC. Prior hospitalization/institutionalization:\n\n1. No long-term care insurance policy may be delivered or\n\nissued in this state if such policy:\n\na. conditions eligibility for any benefits on a prior\n\nhospitalization requirement,\n\nb. conditions eligibility for benefits provided in an\n\ninstitutional care setting on the receipt of a higher\n\nlevel of institutional care, or\n\nc. conditions eligibility for any benefits other than\n\nwaiver of premium, post-confinement, post-acute care\n\nor recuperative benefits on a prior\n\ninstitutionalization requirement.\n\n2. a. A long-term care insurance policy containing post-\n\nconfinement, post-acute care or recuperative benefits\n\nshall clearly label in a separate paragraph of the\n\npolicy or certificate entitled \"Limitations or\n\nConditions on Eligibility for Benefits\" such\n\nlimitations or conditions, including any required\n\nnumber of days of confinement.\n\nb. A long-term care insurance policy or rider which\n\nconditions eligibility of noninstitutional benefits on\n\nthe prior receipt of institutional care shall not\n\nrequire a prior institutional stay of more than thirty\nof the\n\npolicy or certificate entitled \"Limitations or\n\nConditions on Eligibility for Benefits\" such\n\nlimitations or conditions, including any required\n\nnumber of days of confinement.\n\nb. A long-term care insurance policy or rider which\n\nconditions eligibility of noninstitutional benefits on\n\nthe prior receipt of institutional care shall not\n\nrequire a prior institutional stay of more than thirty\n\n(30) days.\n\nD. No law, rule or regulation shall establish loss ratio\n\nstandards for long-term care insurance policies unless a specific\n\nreference to long-term care insurance policies is contained in such\n\nlaw, rule or regulation.\n\nE. Long-term care insurance applicants shall have the right to\n\nreturn the policy or certificate within thirty (30) days after its\n\ndelivery and to have the premium refunded if, after examination of\n\nthe policy or certificate, the applicant is not satisfied with the\n\npolicy, for any reason. Long-term care insurance policies and\n\ncertificates shall have a notice prominently printed on the first\n\npage of the policy or attached thereto, stating in substance, that\n\nthe applicant shall have the right to return the policy or\n\ncertificate within thirty (30) days after its delivery and to have\n\nthe premium refunded if, after examination of the policy, or\n\ncertificate, the applicant is not satisfied with the policy, for any\n\nreason. If an application for a qualified long-term care contract\n\nis denied, the issuer shall refund to the applicant any premium and\n\nany other fees submitted by the applicant within thirty (30) days of\n\nthe date of the denial. If the insurer does not return any premiums\n\nor moneys paid therefor within thirty (30) days from the date of\n\ncancellation, the insurer shall pay interest on the proceeds which\n\nshall be the same rate of interest as the average United States\n\nTreasury Bill rate of the preceding calendar year, as certified to\n\nthe Insurance Commissioner by the State Treasurer on the first\n\nregular business day in January of each year, plus two (2)\n\npercentage points, which shall accrue from the date of cancellation\n\nuntil the premiums or moneys are returned. In such event, the long-\n\nterm care policy shall be deemed to have been canceled on the date\n\nthe policy was placed in the United States mail in a properly\n\naddressed, postpaid envelope, or, if not so posted, on the date of\n\ndelivery of such policy or annuity to the insurer.\n\nF. An outline of coverage shall be delivered to a prospective\n\napplicant for long-term care insurance at the time of initial\n\nsolicitation through means which prominently direct the attention of\n\nthe recipient to the document and its purpose. The Insurance\n\nCommissioner shall prescribe a standard format, including style,\n\narrangement and overall appearance, and the content of an outline of\n\ncoverage. In the case of agent solicitations, an agent must deliver\n\nthe outline of coverage prior to the presentation of an application\n\nor enrollment form. In the case of direct response solicitations,\n\nthe outline of coverage must be presented in conjunction with any\n\napplication or enrollment form. Such outline of coverage shall\n\ninclude, but not be limited to:\n\n1. A description of the principal benefits and coverage\n\nprovided in the policy;\n\n2. A statement of the principal exclusions, reductions and\n\nlimitations contained in the policy;\n\n3. A statement of the terms under which the policy or\n\ncertificate, or both, may be continued in force or discontinued,\n\nincluding any reservation in the policy of a right to change\n\npremiums. Continuation or conversion provisions of group coverage\n\nshall be specifically described;\n\n4. A statement that the outline of coverage is a summary only,\n\nnot a contract of insurance, and that the policy or group master\n\npolicy contains governing contractual provisions;\n\n5. A description of the terms under which the policy or\n\ncertificate may be returned and premium refunded;\nto change\n\npremiums. Continuation or conversion provisions of group coverage\n\nshall be specifically described;\n\n4. A statement that the outline of coverage is a summary only,\n\nnot a contract of insurance, and that the policy or group master\n\npolicy contains governing contractual provisions;\n\n5. A description of the terms under which the policy or\n\ncertificate may be returned and premium refunded;\n\n6. A brief description of the relationship of cost of care and\n\nbenefits; and\n\n7. If the policy or certificate is intended to be a qualified\n\nlong-term care insurance contract, a statement that discloses to the\n\npolicyholder or certificate holder that the policy is intended to be\n\na qualified long-term care insurance contract.\n\nG. The issuer of a qualified long-term care insurance contract\n\nshall deliver to the applicant, policyholder, or certificate holder\n\nthe contract or certificate no later than thirty (30) days after the\n\ndate of approval.\n\nH. At the time of policy delivery, a policy summary shall be\n\ndelivered for an individual life insurance policy which provides\n\nlong-term care benefits within the policy or by rider. In the case\n\nof direct response solicitations, the insurer shall deliver the\n\npolicy summary upon the applicant's request, but regardless of\n\nrequest shall make such delivery no later than at the time of policy\n\ndelivery. In addition to complying with all applicable\n\nrequirements, the summary shall also include:\n\n1. An explanation of how the long-term care benefit interacts\n\nwith other components of the policy, including deductions from death\n\nbenefits;\n\n2. An illustration of the amount of benefits, the length of\n\nbenefit, and the guaranteed lifetime benefits if any, for each\n\ncovered person;\n\n3. Any exclusions, reductions and limitations on benefits of\n\nlong-term care; and\n\n4. If applicable to the policy type, the summary shall also\n\ninclude:\n\na. a disclosure of the effects of exercising other rights\n\nunder the policy,\n\nb. a disclosure of guarantees related to long-term care\n\ncosts of insurance charges, and\n\nc. current and projected maximum lifetime benefit.\n\nI. Any time a long-term care benefit, funded through a life\n\ninsurance vehicle by the acceleration of the death benefit, is in\n\nbenefit payment status, a monthly report shall be provided to the\n\npolicyholder. Such report shall include:\n\n1. Any long-term care benefits paid out during the month;\n\n2. An explanation of any changes in the policy, e.g. death\n\nbenefits or cash values, due to long-term care benefits being paid\n\nout; and\n\n3. The amount of long-term care benefits existing or remaining.\n\nJ. If a claim under a qualified long-term care insurance\n\ncontract is denied, the issuer shall, within sixty (60) days of the\n\ndate of a written request by the policyholder or certificate holder,\n\nor a representative thereof:\n\n1. Provide a written explanation of the reasons for the denial;\n\nand\n\n2. Make available all information directly related to such\n\ndenial.\n\nK. No policy shall be advertised, marketed or offered as long-\n\nterm care insurance unless it complies with the provisions of the\n\nLong-Term Care Insurance Act.\n\nL. Policies or contracts issued by life care communities which\n\nare not licensed insurers in this state shall contain the following\n\nstatement in conspicuous bold-face type on the front of the policy\n\nor contract: \"The financial condition of the entity issuing this\n\ncontract is not subject to review by or the jurisdiction of the\n\nOklahoma Insurance Commissioner. This contract is not subject to\n\nthe protection of any guaranty association.\"","path":["OK Code","Title 36"],"source_url":"https://www.oklegislature.gov/OK_Statutes/CompleteTitles/os36.pdf","current_through":"2026-08-14","vintage":"open-us-law v2026.08, retrieved 2026-09-14","retrieved_at":"2026-09-14T18:32:36Z","sha256":"cceeaddb74d522edddeb0d331cfeb9a3167b02d6c70f77ed31122b29f9cb6895","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-36-36-4424","next":"us-ok/okla.-stat.-tit.-36-36-4426.1"},"notice":"GroundRules: Original legal text. Not legal advice."}