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HEARING - U.S. Senate Special Committee on Aging

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176<br />

The above "Notice to Applicant" was delivered to me On:<br />

DATE<br />

(Applicants Signature)<br />

C_ Insurers using direct resp<strong>on</strong>se solicitati<strong>on</strong> methods shall deliver the<br />

notice regarding replacement of accident and sickness or l<strong>on</strong>g-term care<br />

coverage to the applicant up<strong>on</strong> issuance of the policy. The required<br />

notice shall be provided in substantially the following form<br />

NOTICE TO APPLICANT REGARDING REPLACEMENT<br />

OF ACCIDENT AND SICKNESS OR LONG-TERM CARE INSURANCE<br />

According to (your applicati<strong>on</strong>) (informati<strong>on</strong> you have furnished) you intend to<br />

lapse or otherwise terminate existing accident and sickness or l<strong>on</strong>g-term care<br />

insurance and replace it with the l<strong>on</strong>g-term care insurance policy delivered<br />

herewith issued by (Company Name) Insurance Company. Your new policy provides<br />

thirty (30) days within which you may decide without cost whether you desire<br />

to keep the policy. For your own informati<strong>on</strong> and protecti<strong>on</strong>. you should be<br />

aware of and seriously c<strong>on</strong>sider certain factors which may affect the insurance<br />

protecti<strong>on</strong> available to you under the new policy.

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