1. (1) Upon determining that a sale will involve replacement, an insurer, other than a direct response insurer, shall furnish the applicant, upon issuance or delivery of the policy, or prior thereto, the notice described below. Once copy of such notice shall be given to the applicant and an additional copy signed by the applicant shall be retained by the insurer in its home office for at least three years or until the conclusion of the next succeeding regular examination by the Insurance Department of its state of domicile, whichever is later. This notice required for an insurer, other than a direct response Insurer, shall be provided in substantially the following form:

   NOTICE TO APPLICANT REGARDING REPLACEMENT OF ACCIDENT AND SICKNESS INSURANCE

   According to (your application) (information you have furnished), you intend to lapse or otherwise terminate existing accident and sickness insurance (insert policy number) you have with (insert Company name) and replace it with a policy to be issued by (insert Company name). For your information and protection, you should be aware of and seriously consider certain factors which may affect the insurance protection available to you under the new policy.

2. (1) Health conditions which you may presently have, (pre-existing conditions) may not be immediately or fully covered under the new policy. This could result in denial or delay of a claim for benefits under the new policy, whereas a similar claim might have been payable under your present policy (to be included if pre-existing conditions are not covered under the replacement policy).
3. (2) You may wish to secure the advice of your present insurer or its agent regarding the proposed replacement of your present policy. This is not only your right, but it is also in your best interests to make sure you understand all the relevant factors involved in replacing your present coverage.
4. (3) If, after due consideration, you still wish to terminate your present policy and replace it with new coverage, be certain that all questions on the application concerning your medical/health history are truthfully and completely answered. Failure to include all material medical information on an application may provide a basis for the company to deny any future claims and to refund your premium as though your policy had never been in force. After the application has been completed it should be carefully reviewed before being signed to be certain that all information has been properly recorded.
5. (4) New policies may be issued at an older age than that used for issuance of your present policy; therefore, the cost of the new policy, depending upon the benefits, may be higher than you are paying for your present policy.

6. (5) The renewal provisions of the new policy should be reviewed so as to make sure of your rights to periodically renew the policy.

   The above “Notice to Applicant” was delivered to me on:

   ______________________________________________

7. (date) Witness _______________________________________

   (Writing Agent)

   ______________________________________________

   (Applicant’s Signature)

8. (2) A direct response insurer shall deliver to the applicant upon issuance of the policy, or within five working days from receipt of the application, whichever date occurs earlier, the notice described below. This notice required for a direct response insurer shall be in a form substantially as follows:

   NOTICE TO APPLICANT REGARDING REPLACEMENT OF ACCIDENT AND SICKNESS INSURANCE

   According to (your application) (information you have furnished), you intend to lapse or otherwise terminate existing accident and sickness insurance (insert policy number) you have with (insert Company name) and replace it with the policy delivered herewith issued by (insert Company name). Your new policy provides 10 days within which you may decide without cost whether you desire to keep the policy. For your own information and protection you should be aware of and seriously consider certain factors which may affect the insurance protection available to you under the new policy.

9. (1) Health conditions which you may presently have, (pre-existing conditions) may not be immediately or fully covered under the new policy. This could result in denial or delay of a claim for benefits under the new policy, whereas a similar claim might have been payable under your present policy.
10. (2) You may wish to secure the advice of your present insurer or its agent regarding the proposed replacement of your present policy. This is not only your right, but it is also in your best interests to make sure you understand all the relevant factors involved in replacing your present coverage.

11. (3) (To be included only if the application is attached to the policy.) If, after due consideration, you still wish to terminate your present policy and replace it with new coverage, read the copy of the application attached to your new policy and be sure that all questions are answered fully and correctly. Omissions or misstatements in the application could cause an otherwise valid claim to be denied. Carefully check the application and write to (insert Company Name and Address) within 10 days if any information is not correct and complete, or if any past medical history has been left out of the application.

    ____________________________

    Company Name)

12. (3) An insurer, within five working days from the receipt of an application at its policy issuance office, shall furnish a copy of such notice to the insurer whose policy is being replaced.

Rulemaking Authority 624.308(1), 626.9611, 626.9641 FS. Law Implemented 624.307(1), 626.9521, 626.9541, 626.9641 FS. History–New 2-1-79, Formerly 4-44.05, 4-44.005, 4-151.105.