Current through Register Vol. 50, No. 9, September 20, 2024
A. Every insurer, health care service plan,
or other entity marketing long-term care insurance coverage in this state,
directly or through its producers, shall:
1.
establish marketing procedures and producer training requirements to assure
that:
a. any marketing activities, including
any comparison of policies by its producers or other producers will be fair and
accurate; and
b. excessive
insurance is not sold or issued;
2. display prominently by type, stamp, or
other appropriate means, on the first page of the outline of coverage and
policy the following:
Notice to Buyer: This policy may not cover all of the costs
associated with long-term care incurred by the buyer during the period of
coverage. The buyer is advised to review carefully all policy
limitations.
3. provide
copies of the disclosure forms required in
§1915. D (Appendices B
and F) to the applicant;
4.
inquire, and otherwise make every reasonable effort to identify, whether a
prospective applicant or enrollee for long-term care insurance already has
accident and sickness, or long-term care insurance and the types and amounts of
any such insurance, except that in the case of qualified long-term care
insurance contracts, an inquiry into whether a prospective applicant or
enrollee for long-term care insurance has accident and sickness insurance is
not required;
5. establish
auditable procedures for verifying compliance with
§1945 A;
6. if the state in which the policy or
certificate is to be delivered or issued for delivery has a senior insurance
counseling program, approved by the commissioner, the insurer shall, at
solicitation, provide written notice to the prospective policyholder and
certificateholder that such a program is available and the name, address and
telephone number of the program;
7.
for long-term care health insurance policies and certificates, use the terms
noncancellable or level premium only when the
policy or certificate conforms to
§1909. A.3 of this
regulation;
8. provide an
explanation of contingent benefit upon lapse provided in
§1955. D.3 and, if
applicable, the additional contingent benefit upon lapse provided to policies
with fixed or limited premium paying periods in
§1955. D.4
B. In addition to the practices
prohibited in
R.S. 22:1961
et seq., the following acts and practices are prohibited.
Cold Lead Advertising-making use directly,
or indirectly, of any method of marketing which fails to disclose, in a
conspicuous manner, that a purpose of the method of marketing is solicitation
of insurance and that contact will be made by an insurance producer or
insurance company.
High Pressure Tactics-employing any method
of marketing having the effect of or tending to induce the purchase of
insurance through force, fright, threat, whether explicit or implied, or undue
pressure to purchase or recommend the purchase of insurance.
Misrepresentation-misrepresenting a material
fact in selling or offering to sell a long-term care insurance policy.
Twisting-knowingly making any misleading
representation or incomplete or fraudulent comparison of any insurance policies
or insurers for the purpose of inducing, or tending to induce, any person to
lapse, forfeit, surrender, terminate, retain, pledge, assign, borrow on, or
convert any insurance policy or to take out a policy of insurance with another
insurer.
C.
1. With respect to the obligations set forth
in §1945.
C 1, the primary responsibility of an
association, as defined in
R.S.
22:1184(4)(b), when
endorsing or selling long-term care insurance shall be to educate its members
concerning long-term care issues, in general, so that its members can make
informed decisions. Associations shall provide objective information regarding
long-term care insurance policies or certificates endorsed or sold by such
associations to ensure that members of such associations receive a balanced and
complete explanation of the features in the policies or certificates that are
being endorsed or sold.
2. The
insurer shall file with the insurance department the following material:
a. the policy and certificate;
b. a corresponding outline of coverage;
and
c. all advertisements requested
by the insurance department.
3. The association shall disclose in any
long-term care insurance solicitation:
a. the
specific nature and amount of the compensation arrangements (including all
fees, commissions, administrative fees and other forms of financial support)
that the association receives from endorsement or sale of the policy or
certificate to its members; and
b.
a brief description of the process under which the policies, and the insurer
issuing the policies, were selected.
4. If the association and the insurer have
interlocking directorates or trustee arrangements, the association shall
disclose that fact to its members.
5. The board of directors of associations
selling or endorsing long-term care insurance policies or certificates shall
review and approve the insurance policies as well as the compensation
arrangements made with the insurer.
6.
a. The
association shall also:
i. at the time of the
association's decision to endorse, engage the services of a person with
expertise in long-term care insurance, not affiliated with the insurer, to
conduct an examination of the policies, including its benefits, features, and
rates and update the examination thereafter in the event of material
change;
ii. actively monitor the
marketing efforts of the insurer and its producers; and
iii. review and approve all marketing
materials or other insurance communications used to promote sales or sent to
members regarding the policies or certificates.
b. Clauses 1945.C.6.a.i-iii shall not apply
to qualified long-term care insurance contracts.
7. No group long-term care insurance policy
or certificate may be issued to an association unless the insurer files with
the state insurance department the information required in
§1945. C
8. The insurer shall not issue a long-term
care policy or certificate to an association or continue to market such a
policy or certificate unless the insurer certifies annually that the
association has complied with the requirements set forth in
§1945. C
9. Failure to comply with the filing and
certification requirements of
§1943 constitutes an unfair trade
practice in violation of
R.S. 22:1961
et seq.
AUTHORITY NOTE:
Promulgated in accordance with
R.S.
22:1186(A),
22:1186(E),
22:1188(C),
22:1189,
and
22:1190.
