Insurance Code section 10233.5
(a)
An outline of coverage shall be delivered to a prospective applicant for long-term care insurance at the time of initial solicitation through means which prominently direct the attention of the recipient to the document and its purpose.(b)
In the case of agent solicitations, an agent shall deliver the outline of coverage prior to the presentation of an application or enrollment form.(c)
In the case of direct response solicitations, the outline of coverage shall be presented in conjunction with any application or enrollment form.(d)
The outline of coverage shall be a freestanding document, using no smaller than 10-point type.(e)
The outline of coverage shall contain no material of an advertising nature.(f)
Use of the text and sequence of the text of the outline of coverage set forth in this section is mandatory, unless otherwise specifically indicated.(g)
Text which is capitalized or underscored in the outline of coverage may be emphasized by other means which provide prominence equivalent to capitalization or underscoring.(h)
The outline of coverage shall be in the following form:(a)
Provide a brief description of the right to return—“free look” provision of the policy.(b)
Include a statement that the policy either does or does not contain provisions providing for a refund or partial refund of premium upon the death of an insured or surrender of the policy or certificate. If the policy contains those provisions, include a description of them.(a)
(For agents) Neither (insert company name) nor its agents represent Medicare, the federal government or any state government.(b)
(For direct response) (insert company name) is not representing Medicare, the federal government or any state government.(a)
(Covered services, related deductible(s), waiting periods, elimination periods, and benefit maximums.)(b)
(Institutional benefits, by skill level.)(c)
(Noninstitutional benefits, by skill level.)(a)
Preexisting conditions.(b)
Noneligible facilities/provider.(c)
Noneligible levels of care (e.g., unlicensed providers, care or treatments provided by a family member, etc.).(d)
Exclusions/exceptions.(e)
Limitations.)(a)
That the benefit level will NOT increase over time.(b)
Any automatic benefit adjustment provisions.(c)
Whether the insured will be guaranteed the option to buy additional benefits and the basis upon which benefits will be increased over time if not by a specified amount or percentage.(d)
If there is a guarantee, include whether additional underwriting or health screening will be required, the frequency and amounts of the upgrade options, and any significant restrictions or limitations.(e)
And finally, describe whether there will be any additional premium charge imposed, and how that is to be calculated.)(a)
Describe the policy renewability provisions.(b)
For group coverage, specifically describe continuation/conversion provisions applicable to the certificate and group policy.(c)
Describe waiver of premium provisions or state that there are no waiver of premium provisions.(d)
State whether or not the company has a right to change premium, and if that right exists, describe clearly and concisely each circumstance under which the premium may change.(a)
State the total annual premium for the policy.(b)
If the premium varies with an applicant’s choice among benefit options, indicate the portion of annual premium which corresponds to each benefit option.(a)
Indicate if medical underwriting is used.(b)
Describe other important features.
Source:
Section 10233.5, https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=INS§ionNum=10233.5.
(updated Jan. 1, 2000; accessed Jun. 30, 2025).