New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 4 - ACTUARIAL SERVICES
Subchapter 34 - LONG-TERM CARE INSURANCE
Section 11:4-34.21 - Standards for marketing
Universal Citation: NJ Admin Code 11:4-34.21
Current through Register Vol. 56, No. 6, March 18, 2024
(a) Every carrier marketing long-term care insurance coverage in this State, directly or through its producers, shall:
1. Establish
marketing procedures and agent training requirements to assure that:
i. Any marketing activities, including any
comparison of policies, by its agents or other producers will be fair and
accurate; and
ii. 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, policy
and certificate the following:
"Notice to buyer: This [policy] [certificate] 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] [certificate] limitations."
3. Provide copies of the disclosure forms
required in
11:4-34.7(c)
(subchapter 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 this subsection.
6. At solicitation, provide written notice to
the prospective policyholder and certificateholder that the New Jersey State
Health Insurance Program is available to provide counseling to seniors
interested in purchasing long-term care insurance and shall provide the 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
11:4-34.4(a)3
and 4; and
8. Provide an
explanation of the contingent benefit upon lapse provided for in
11:4-34.2 4(c)2.
(b) In addition to the practices prohibited in 17B:30-1 et seq., the following acts and practices are prohibited:
1. High
pressure tactics, which means 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; and
2.
Cold lead advertising, which means making use directly or indirectly of any
method of marketing which fails to disclose in a conspicuous manner that a
purpose of the marketing is solicitation of the purchase of insurance and that
contact will be made by an agent or carrier.
(c) The following shall apply with respect to associations that endorse or make available long-term care insurance to members:
1. The association shall 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 made
available 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 made available.
2. The carrier shall file with the Department
the following material:
i. The policy and
certificate;
ii. A corresponding
outline of coverage; and
iii. All
advertisements requested by the Department.
3. The association shall disclose in any
long-term care insurance solicitation:
i. 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 availability of the policy or
certificate to its members; and
ii.
A brief description of the process under which the policies and the carrier
issuing the policies were selected.
4. If the association and the carrier have
interlocking directorates or trustee arrangements, the association shall
disclose that fact to its members.
5. The boards of directors of associations
endorsing or making available long-term care insurance policies or certificates
shall review and approve the insurance policies as well as the compensation
arrangements made with the carrier.
6. The association shall also, except for
qualified long-term care insurance contracts:
i. At the time of the association?s decision
to endorse the coverage, engage the services of a person with expertise in
long-term care insurance not affiliated with the carrier to conduct an
examination of the policies, including their benefits, features, and rates and
update the examination thereafter in the event of material change;
ii. Actively monitor the marketing efforts of
the carrier and its agents; 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.
7. No group long-term care insurance policy
may be issued to an association unless the carrier files with the Department
the information required in this subsection.
8. The carrier shall not issue a long-term
care policy or certificate to an association or member of an association or
continue to market such a policy or certificate unless the carrier certifies
annually that the association has complied with the requirements set forth in
this subsection.
9. Failure to
comply with the filing and certification requirements of this section
constitutes an unfair trade practice in violation of
17B:30-1 et seq.
Disclaimer: These regulations may not be the most recent version. New Jersey may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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