Md. Code Regs. 31.14.01.29
Reporting Form for Long-Term Care Policies. The following form is to be used for reporting rescissions made by each insurer as required by Regulation .09C of this chapter: RESCISSION REPORTING FORM FOR LONG-TERM CARE POLICIES FOR THE STATE OF FOR THE REPORTING YEAR 20[ ] Company Name: _____________________ Address: _________________ Phone Number: _____________________ Due: March 1 annually Instructions: The purpose of this form is to report all rescissions of long-term care insurance policies or certificates. Those rescissions voluntarily effectuated by an insured are not required to be included in this report. Please furnish one form per rescission.
| Policy Form# | Policy and Certificate # | Name of Insured | Date of Policy Issuance | Date/s Claim/s Submitted | Date of Rescission |
|---|---|---|---|---|---|
| Detailed reason for rescission: _______________________________ |
| ______________________________________________________ |
| ___________________________ Signature |
| ___________________________ Name and Title (please type) |
| ___________________________ Date |
Authority: Health-General Article, §19-705; Insurance Article, §§2-109, 14-124, Title 18, Subtitle 1, and Title 27; Annotated Code of Maryland
Effective date: September 1, 1994 (21:13 Md. R. 1156)
Chapter recodified from COMAR 09.30.88 to COMAR 31.14.01 effective September 7, 1998 (25:18 Md. R. 1439)
Chapter revised effective April 1, 2002 (29:6 Md. R. 570)
Chapter revised effective September 10, 2007 (34:18 Md. R. 1581)
Regulation .01 amended effective September 1, 2014 (41:17 Md. R. 972)
Regulation .13E amended effective February 27, 2017 (44:4 Md. R. 256)
Regulation .24H—J adopted effective February 27, 2017 (44:4 Md. R. 256)
Regulation .36 amended effective February 27, 2017 (44:4 Md. R. 256)