North Dakota Administrative Code
Title 45 - Insurance, Commissioner of
Article 45-06 - Accident and Health Insurance
Chapter 45-06-05 - Long-Term Care Insurance Model Regulation
Section 45-06-05-09.2 - Standards for marketing
Universal Citation: ND Admin Code ยง 45-06-05-09.2
Current through Supplement No. 394, October, 2024
1. Every insurer, health care service plan, or other entity marketing long-term care insurance coverage in this state, directly or through its producers, shall:
a. Establish marketing procedures to assure
that any comparison of policies by its agents or other producers will be fair
and accurate.
b. Establish
marketing procedures to assure excessive insurance is not sold or issued.
c. 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."
d. 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.
e. Every insurer or
entity marketing long-term care insurance shall establish auditable procedures
for verifying compliance with this subsection.
f. 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
certificate holder that such a program is available and the name, address, and
telephone number of the program.
g. For long-term care health insurance
policies and certificates, use the terms "noncancelable" or "level premium"
only when the policy or certificate conforms to subdivision c of subsection 1
of section
45-06-05-04.
2. In addition to the practices prohibited in North Dakota Century Code section 26.1-04-03, the following acts and practices are prohibited:
a. 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.
b.
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.
c. Cold
lead advertising. Making use directly or indirectly of any method of marketing
that 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 agent or insurance company.
3.
a. With
respect to the obligations set forth in this subsection, the primary
responsibility of an association, as defined in subdivision b of subsection 3
of North Dakota Century Code section 26.1-45-01, when endorsing long-term care
insurance is 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 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.
b. The insurer shall file with the insurance
department the following material:
(1) The
policy and certificate;
(2) A
corresponding outline of coverage; and
(3) All advertisements requested by the
insurance department.
c. The association shall disclose in any
long-term care insurance solicitation:
(1)
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
(2) A brief description of the process under
which such policies and the insurer issuing such policies were selected.
d. If the association
and the insurer have interlocking directorates or trustee arrangements, the
association shall disclose such fact to its members.
e. The board of directors of associations
selling or endorsing long-term care insurance policies or certificates shall
review and approve such insurance policies as well as the compensation
arrangements made with the insurer.
f. The association shall also:
(1) 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 such
examination thereafter in the event of material change;
(2) Actively monitor the marketing efforts of
the insurer and its agents; and
(3) Review and approve all marketing
materials or other insurance communications used to promote sales or sent to
members regarding such policies or certificates.
g. A group long-term care insurance policy or
certificate may not be issued to an association unless the insurer files with
the insurance department the information required in this subsection.
h. The insurer may 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 this subsection.
i. Failure to comply with the
filing and certification requirements of this section constitutes an unfair
trade practice under North Dakota Century Code section 26.1-04-03.
General Authority: NDCC 28-32-02
Law Implemented: NDCC 26.1-45
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