Arizona Laws 20-1691.10. Contestable periods
A. If a policy or certificate has been in force for less than six months, an insurer may rescind a long-term care insurance policy or certificate or deny an otherwise valid long-term care insurance claim only on a showing of misrepresentation that is material to the acceptance for coverage.
Terms Used In Arizona Laws 20-1691.10
- Certificate: means a certificate issued under a group long-term care insurance policy, which has been delivered or issued for delivery in this state. See Arizona Laws 20-1691
- Long-term care insurance: means an individual or group insurance policy or rider issued by insurers, fraternal benefit societies, nonprofit health, hospital and medical service corporations, prepaid health plans, health care services organizations or any similar organization and advertised, marketed, offered or designed to provide coverage for each covered person on an expense-incurred, indemnity, prepaid or other basis for one or more necessary or medically necessary diagnostic, preventive, therapeutic, rehabilitative, maintenance, personal or custodial care services provided in a setting other than an acute care unit of a hospital. See Arizona Laws 20-1691
- Policy: means an individual or group policy, contract, subscriber agreement, rider or endorsement delivered or issued for delivery in this state by an insurer, fraternal benefit society, nonprofit health, hospital or medical service corporation, prepaid health plan or health care services organization or any similar organization. See Arizona Laws 20-1691
B. If a policy or certificate has been in force for at least six months but less than two years, an insurer may rescind a long-term care insurance policy or certificate or deny an otherwise valid long-term care insurance claim only on a showing of misrepresentation that is both material to the acceptance for coverage and that pertains to the condition for which benefits are sought.
C. After a policy or certificate has been in force for two years it is not contestable solely for misrepresentation, but the insurer may contest the policy or certificate on a showing that the insured knowingly and intentionally misrepresented relevant facts relating to the insured’s health.
D. An insurance producer or third party administrator shall not issue a long-term insurance policy or certificate pursuant to the underwriting authority granted to the insurance producer or third party administrator by an insurer that is based on medical or health status.
E. If an insurer paid benefits under the long-term care insurance policy or certificate, the insurer shall not recover the benefit payments if the insurer rescinds the policy or certificate.
F. If an insured dies, this section does not apply to the remaining death benefit of a life insurance policy that accelerates benefits for long-term care. Section 20-1204 applies to the remaining death benefits.