Penn Treaty Network America Insurance Company, Inc.

November 18, 2015Dear [redacted]Thank you for your letter regarding the above-referenced policyholder. We are taking this opportunity to address your correspondence of November 5, 2015 regarding [redacted]'s policy.We would like to respond to [redacted]'s comments indicating that the agent of...

record misled him regarding the coverage provided by his Penn Treaty policy. It should be noted that all agents that sold our policies were independent agents and were not captive agents of our Company and their contracts as an agent to sell PTNA specifically stated that they cannot "Bind the company to any coverage risk”. The policy [redacted] purchased was for in-home care only. We have enclosed a copy of his application which shows the policy he applied for was a Home Health Care policy.In addition, his policy contains a "NOTICE TO BUYER- 30 DAY RIGHT TO EXAMINER, POLICY” one page one which states:"Although this Policy covers a wide variety of Long Term Care services and providers, its benefits are subject to limits as further described inside this Policy. If you require Long Term Care services, this Policy may not cover all of the costs you incur. We recommend that you review the Policy, including its benefits and limitations, as soon as you receive it.If you are not completely satisfied with the coverage you have purchased, you can receive a refund of the entire premium paid if you return this Policy by mailing it to us at the address listed above within 30 days of your receiving it. If you return this policyfor a refund within its 30 day Examination. Period, we will mail a refund of the entire premium paid directly to you within 30 days and the Policy will immediately be considered void from the beginning, as if it had never been issued.”Our records indicate that we did not receive any request to refund the premiums and his policy remained active.It should be noted that the premium paid on his policy while in force is considered earned and any claim that met the terms and conditions of the policy would have been honored. Based on that information, we are unable to honor his request for a full refund of the premium paid on the policy.We have received a cancellation request for [redacted]'s policy which was forwarded to our Premium Services Department. The policy was cancelled and the enclosed letter was sent on November 9, 2015 confirming the cancellation,We trust that we have provided you with the necessary information to complete your review of this matter. Should you have any further questions or require additional information, please do not hesitate to contact me at ###-###-####, ext: [redacted],Sincerely,Brandice M.Review Specialist Customer Dispute Resolution

November 18, 2015
Dear [redacted]
Thank you for your letter regarding the above-referenced policyholder. We are taking this opportunity to address your correspondence of November 5, 2015 regarding [redacted]'s policy.
We would like to respond to [redacted]'s comments...

indicating that the agent of record misled him regarding the coverage provided by his Penn Treaty policy. It should be noted that all agents that sold our policies were independent agents and were not captive agents of our Company and their contracts as an agent to sell PTNA specifically stated that they cannot "Bind the company to any coverage risk”. The policy [redacted] purchased was for in-home care only. We have enclosed a copy of his application which shows the policy he applied for was a Home Health Care policy.In addition, his policy contains a "NOTICE TO BUYER- 30 DAY RIGHT TO EXAMINER, POLICY” one page one which states:"Although this Policy covers a wide variety of Long Term Care services and providers, its benefits are subject to limits as further described inside this Policy. If you require Long Term Care services, this Policy may not cover all of the costs you incur. We recommend that you review the Policy, including its benefits and limitations, as soon as you receive it.
If you are not completely satisfied with the coverage you have purchased, you can receive a refund of the entire premium paid if you return this Policy by mailing it to us at the address listed above within 30 days of your receiving it. If you return this policyfor a refund within its 30 day Examination. Period, we will mail a refund of the entire premium paid directly to you within 30 days and the Policy will immediately be considered void from the beginning, as if it had never been issued.”
Our records indicate that we did not receive any request to refund the premiums and his policy remained active.It should be noted that the premium paid on his policy while in force is considered earned and any claim that met the terms and conditions of the policy would have been honored. Based on that information, we are unable to honor his request for a full refund of the premium paid on the policy.
We have received a cancellation request for [redacted]'s policy which was forwarded to our Premium Services Department. The policy was cancelled and the enclosed letter was sent on November 9, 2015 confirming the cancellation,
We trust that we have provided you with the necessary information to complete your review of this matter. Should you have any further questions or require additional information, please do not hesitate to contact me at ###-###-####, ext: [redacted],
Sincerely,
Brandice M.
Review Specialist Customer Dispute Resolution