Sample Long Term Care Insurance Policy, Page 22

SAMPLE LONG TERM CARE INSURANCE POLICY
The Claim Appeals Review Board will make one of two determinations:
• overturn the initial claim determination and pay any benefits due; or
• uphold the initial claim determination.

Misstatement of Age
If Your age has been misstated, We may either reduce Your Policy benefits or rescind Your Policy. In the event of a reduction of benefits, Your Policy benefits will be amended to be those that the premium paid would have purchased at Your correct age. If as a result of such misstatement, We issued a Policy which would not have been issued to You had such misstatement not occurred, Your Policy will be rescinded. In that case, Our liability under any such Policy will be limited to refund of the premium paid.

Legal Action
You may not bring suit against Us to recover benefits under this Policy until at least 60 days has
expired after written Proof of Loss has been given to Us. Also, You cannot bring suit against Us to recover benefits under this Policy after four years from the date a claim is denied.

SAMPLE LONG TERM CARE INSURANCE POLICY
PART 5 - PREMIUMS AND REINSTATEMENT
This part explains what happens if You do not pay the premium for this Policy when it is due.

WHEN AND WHERE PREMIUMS ARE PAYABLE
Payment of Premiums
Payment of the First Premium will keep this Policy in effect for the first premium payment period. This period starts at 12:01 a.m., Eastern Standard Time on the Effective Date of Coverage. It ends at midnight of the day before the next premium due date, subject to the Grace Period provision below. Each premium, after the first, is due at the end of the period for which the preceding premium was paid. Policy years, months and anniversaries are measured from the Effective Date of Coverage. Your first premium must be paid at Our LTC Administrative Office or to any of Our duly authorized agents. Any subsequent premium payment must be paid to Our LTC Administrative Office. If a premium is paid to an agent, We will provide a receipt in exchange for such payment. To be valid, it must also be countersigned by the agent shown on the receipt. Payment of a premium will not keep this Policy in effect beyond the period for which it is paid, except as may be otherwise provided in this Policy. You may elect to pay Your premium on an annual, semi-annual, quarterly or monthly basis. You may change Your mode of premium payment by making a written request to Us at Our LTC Administrative Office. Please note that the more often you pay, the higher your premium amount will be per year. Additional premium charges are included for semi-annual, quarterly, and monthly premiums. These
charges are called “modal fees”. These fees are based upon the following modal factors and are used to determine the premium amount for all payment options. The modal factors are 1.00 for annual, .52 for semi-annual, .27 for quarterly and .09 for monthly. To calculate Your approximate total annual premium payment based on Your current policy selection:
• multiply the “Base Policy Premium” as shown on the Policy Schedule by the factor associated
with Your selected mode of payment, and then
• multiply that result by the number of payments required in a year based upon Your selected payment mode.

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