Oklahoma's senior-market rules come mainly from two statutes: the Long-Term Care Insurance Act (36 O.S. 4421 et seq., with suitability rules in 4429 and the Partnership in 4400) and the Medicare supplement statute (36 O.S. 3611.1). Expect questions on free looks, outlines of coverage, preexisting-condition limits, premium-increase notices, LTC suitability and Partnership inflation protection. How Medicare works (Parts A-D, enrollment periods, Medigap plan letters, Medicaid, LTC benefit triggers) is in the national Senior and Special Needs guide.

Medicare supplement (36 O.S. 3611.1)

• A Medicare supplement policy helps pay Original Medicare's deductibles and coinsurance (3611.1(A)).
• Outline of coverage: a policy can't be delivered unless the outline was given to the applicant at the time the application was made (3611.1(F)(1)).
• Free look: the policyholder may return the policy for a premium refund within 30 days of delivery (3611.1(G)).
• Preexisting conditions: a claim can't be denied for a preexisting condition for losses incurred more than 6 months after coverage begins (3611.1(C)).
• Premium increases (3611.1(D)):
  • An approved increase must be communicated at least 45 days before it takes effect.
  • Increases may be put in place no more than once a year.
• Disability open enrollment: the Commissioner must provide by regulation an open enrollment period for people who qualify for Medicare because of disability (3611.1(B)).
• Medicare Part C and Part D plans aren't covered by the Oklahoma Life and Health Insurance Guaranty Association (36 O.S. 2025(B)(2)(l)).

Long-term care insurance: policy standards

What counts as LTC (36 O.S. 4424(1))

• Long-term care insurance must be designed to cover at least 12 consecutive months.

Policy standards (36 O.S. 4426)

• No cancellation for age or health: a policy can't be canceled or nonrenewed because of the insured's age or declining health (4426(A)(1)).
• Not skilled care only: a policy may not cover skilled nursing care only, or give significantly more coverage for skilled care than for lower levels of care (4426(A)(3)).
• Replacement by the same insurer: a new form can't start a new waiting period for benefits the insured already had (4426(A)(2)).
• Preexisting conditions: the look-back is limited to conditions for which advice or treatment was recommended or received within 6 months before coverage began (4426(B)).
• Prior hospital stay: if noninstitutional benefits depend on a prior institutional stay, the required stay can't exceed 30 days (4426(C)(2)(b)).

Free look, outline and delivery (36 O.S. 4426)

• Free look: 30 days after delivery, for a full premium refund (4426(E)).
• Outline of coverage: when an agent solicits, it must be delivered before the application is presented (4426(F)).
• Qualified LTC contracts: delivered within 30 days after approval (4426(G)).
• Denied claims: a written explanation is due within 60 days of a written request (4426(J)).

LTC benefits on life policies (36 O.S. 4426(H)-(I))

• When a life policy provides LTC benefits, a policy summary is delivered with the policy.
• While accelerated death benefits are being paid for LTC, the policyholder gets a monthly report.

LTC suitability (36 O.S. 4429)

• Every LTC insurer must have suitability standards and must train its agents in them (4429(B)).
• The applicant must receive a personal worksheet and disclosure form at or before application (4429(C)).
• The agent and insurer must consider:
  • The applicant's ability to pay.
  • The applicant's long-term care goals or needs.
  • The values, benefits and costs of existing insurance compared with the recommendation.
• Information on the worksheet may not be sold or disseminated outside the company or agency (4429(C)(4)).

Oklahoma Long-Term Care Partnership (36 O.S. 4400)

A Partnership-qualified policy must include inflation protection that depends on the buyer's age at purchase:

Common exam traps

• Free looks: Medicare supplement is 30 days and LTC is 30 days. The ordinary individual life and annuity free look is 10 days.
• Medigap preexisting limit is 6 months. Medigap premium increases need 45 days' notice and can come at most once a year.
• LTC outline timing: before the application is presented in an agent sale. The Medigap outline is due at the time of application.
• LTC prior-stay requirement: no more than 30 days.
• LTC must cover at least 12 consecutive months. Skilled-only policies are prohibited.