Ins 3.46(6) (6) Nursing home and home health care coverage forms may not use the term “long-term care”. Only a form for a long-term care policy, life insurance-long-term care coverage or certificate which provides substantial coverage of care in both an institutional setting and in a community-based setting may use the term “long-term care” or a substantially similar term.

Ins 3.46(7) (7) Misrepresentations prohibited.

Ins 3.46(7)(a) (a) No insurer or intermediary may use the term “long-term care” or similar terminology in an advertisement or offer of a policy, coverage or certificate unless the policy, coverage or certificate advertised or offered:

Ins 3.46(7)(a)1. 1. Covers care in both institutional and community-based settings;

Ins 3.46(7)(a)2. 2. Complies with this section; and

Ins 3.46(7)(a)3. 3. Is approved as a long-term care policy or certificate covering care in both institutional and community settings and as appropriately using the term “long-term care” by the office.

Ins 3.46(7)(b) (b) No insurer may file a form under s. 631.20, Stats., for a long-term care policy, life insurance-long-term care coverage or certificate, unless the form complies with this section.

Ins 3.46(8) (8) Outline of coverage.

Ins 3.46(8)(a) (a) An outline of coverage for a long-term care policy, life insurance-long-term care coverage or certificate shall:

Ins 3.46(8)(a)1. 1. Have captions printed in 18-point bold letters and conspicuously placed;

Ins 3.46(8)(a)2. 2. Be printed in an easy to read type and written in easily understood language; and

Ins 3.46(8)(a)3. 3. Comply with s. Ins 3.27 (5) (L) and (9) (zh).

Ins 3.46(8)(b) (b) No insurer or intermediary may use an outline of coverage to comply with sub. (9) or advertise, market or offer a long-term care policy, life insurance-long-term care coverage or certificate, unless prior to the use, advertising, marketing or offer the outline of coverage is approved in writing by the office.

Ins 3.46(8)(c) (c) Display prominently by type, stamp or other appropriate means, on the first page of the outline of coverage and policy all of the following:

Ins 3.46(8)(c)1. 1. “Notice to Buyer: This policy may not cover all of the costs associated with long-term care incurred by the buyer during the period of coverage. The buyer is advised to review carefully all policy limitations.”

Ins 3.46(8)(c)2. 2. A statement of the terms under which the policy or certificate, or both, may be continued in force or discontinued, including any reservation by the insurer of the right to change premium. Continuation or conversion provisions of group coverage shall be specifically described.

Ins 3.46(8)(d) (d) This par. does not apply to a group that is offered coverage as a result of collective bargaining and has guaranteed issue.

Ins 3.46(9) (9) Disclosure when soliciting.

Ins 3.46(9)(a) (a) An insurer or intermediary at the time the insurer or intermediary contacts a person to solicit the sale of a long-term care policy, life insurance-long-term care coverage or certificate shall deliver to the person:

Ins 3.46(9)(a)1. 1. A copy of the current edition of the guide to long-term care; and

Ins 3.46(9)(a)2. 2. An outline of coverage.

Ins 3.46(9)(b) (b) Other than a policy for which no applicable premium rate or rate schedule increases can be made, an insurer shall provide all of the following information to the applicant at the time of application or enrollment:

Ins 3.46(9)(b)1. 1. A statement that the policy may be subject to rate increases in the future.

Ins 3.46(9)(b)2. 2. An explanation of potential future premium rate revisions and the policyholder’s or certificateholder’s option in the event of a premium rate revision.

Ins 3.46(9)(b)3. 3. The premium rate or rate schedules applicable to the applicant that will be in effect until a request is made for an increase.

Ins 3.46(9)(b)4. 4. A general explanation for applying premium rate or rate schedule adjustments that shall include a description of when premium rate or rate schedule adjustments will be effective, such as next anniversary date or next billing date, and the right to a revised premium rate or rate schedule as provided in subd. 2. if the premium rate or rate schedule is changed.

Ins 3.46(9)(b)5. 5. Information regarding each premium rate increase on this policy form or similar policy forms over the past 10 years for this state or any other state that, at a minimum, identifies the policy forms for which premium rates have been increased; the calendar years when the form was available for purchase; and the amount or percentage of each increase. The percentage may be expressed as a percentage of the premium rate prior to the increase and may also be expressed as minimum and maximum percentages if the rate increase is variable by rating characteristics.

Ins 3.46(9)(c) (c) The insurer may as part of the disclosure under par. (b) in a fair manner, provide additional explanatory information related to the rate increases.

Ins 3.46(9)(d) (d) For purposes of the disclosure requirement under par. (b), an insurer shall have the right to exclude from the disclosure premium rate increases that only apply to blocks of business acquired from other nonaffiliated insurers or the long-term care policies acquired from other nonaffiliated insurers when those increases occurred prior to the acquisition.