(A) Purpose
The purpose of this rule is to safeguard the interests of
medicare-eligible persons in the solicitation and sale of any type of medicare
supplemental sickness and accident health insurance
policy by
providing for the regulation of the solicitation and sale of medicare
supplemental accident and health insurance policies; and to assure that
medicare-eligible persons are not subjected to unfair or deceptive acts or
practices in the solicitation and sale of medicare supplemental accident and
health insurance policies by defining additional unfair or deceptive acts or
practices in this rule.
(B)
Authority
This rule is promulgated pursuant to the authority vested in
the superintendent under section
3901.041 of the Revised Code,
providing that the superintendent of insurance shall adopt, amend and rescind
rules and make adjudications necessary to discharge the superintendent's duties
and exercise the superintendent's powers under Title 39 of the Revised Code;
section 3923.332 of the Revised Code,
providing that the superintendent shall adopt reasonable rules to establish
minimum standards for advertising and marketing practices for medicare
supplemental policies and certificates; and section
3901.21 of the Revised Code,
providing that the enumeration in sections
3901.19 to
3901.26 of the Revised
Codeof specific unfair or deceptive acts
or practices in the business of insurance is not exclusive or restrictive or
intended to limit the powers of the superintendent of insurance to adopt rules
to implement said section, or to take action under other sections of the
Revised Code.
(C)
Definitions
(1) "Medicare-eligible person"
means any person eligible for either medicare part A or medicare part B,
pursuant to Title XVIII
of the federal Social Security Act (
42 U.S.C.
1395 et seq.).
(2) "Medicare program" refers to the benefits
available to medicare-eligible persons, pursuant to Title XVIII of the Social
Security Act, codified in Title XVIII of the federal Social Security
Act (
42 U.S.C.
1395 et seq.).
(D) Unfair or deceptive acts or practices
defined
It shall be deemed an unfair or deceptive act or practice to
commit or perform any of the following:
(1) Any implication, either verbal or
written, which conveys the impression that any medicare supplemental insurance
program being offered by a companyor agent
is affiliated with or sponsored by the federal government, the social security
administration, the centers for medicare and medicaid services, or the
department of health and human services. No solicitation, advertisement, or
marketing material shall be used in the state that fails to include the
following or a substantially similar disclaimer: "Not connected with or
endorsed by the U.S. government or the federal medicare program."
(2) Any of the following unsolicited contacts
with a medicare-eligible person:
(a)
Door-to-door solicitation including leaving information such as a leaflet,
flyer, or door hanger at a residence, or leaving information such as a leaflet
or flyer on someone's car;
(b)
Approaching individual prospective applicants in common areas (e.g., parking
lots, hallways, lobbies, sidewalks, etc.);
(c) Telephonic or
electronic solicitation including leaving electronic voicemail
messages, text messages or direct social media
messages;
(d) These
prohibitions on marketing through unsolicited contacts do not extend to
advertisements through mass
communications including direct mail, or unsolicited contacts with
prospective applicants with whom the entity or insurance agent has a business
relationship, regardless of the method of
communication.
(3)
Any representation by an agent to
the effect that such person is a "counselor," "advisor" or
similar designation, for any association or group of medicare-eligible persons,
which obscures the actual role of such agent with respect to the solicitation or sale of such insurance.
(4) Any act for the purpose of
inducing an applicant or prospective applicant to sign any form, application or
document in blank.
(5) Failure by
the agent to state affirmatively,
verbally and in writing, the following:
(a)
That the person making the solicitation or sale is, in fact, an insurance agent
;
(b) That the agent is making the solicitation or sale on
behalf of an insurance company or insurance companies, which company or
companies must be identified to the medicare-eligible
persons;
(c) That the
medicare-eligible person may verify the information required to be stated in
paragraphs (D)(5)(a) and (D)(5)(b) of this rule by contacting the Ohio
department of insurance;
(d) That
the medicare-eligible person may contact the agent making the solicitation or sale at both
an address and telephone number provided by the agent
;
(e) That the medicare-eligible person may
contact the insurance company or insurance companies on behalf of which the
solicitation or sale was made at an address and telephone number provided by
the agent ;
(f) That the agent and the insurance company have no connection or affiliation with, and are
not in any way sponsored by, the federal or state government, the social
security administration, the centers for medicare and medicaid services, or the
department of health and human services;
(g) That the medicare-eligible person has the
option, if he or she purchases a medicare supplemental insurance policy, of
paying his or her premium(s) directly to the insurance company.
(6) Any inaccurate or misleading
description of the benefits provided by either the medicare program or the
medicare supplemental policy being offered for sale.
(7) Any attempt by an insurance
company
or
agent to arrange a solicitation
or sales interview with an applicant or prospective applicant by implying or
conveying in any way the impression that such insurance company
or agent
has been authorized by the
federal government, the medicare program or the social security administration
to contact said applicant or prospective applicant for the purpose of
reviewing, modifying or discussing his or her existing insurance program. Such
prohibition is also extended to any statement or act which implies or conveys
in any way the impression that such insurance company
or agent
has access to official records of
the federal government, medicare program or social security administration,
pertaining to the applicant's or prospective applicant's insurance
program.
(8) Use of any title or
initials by the agent which
imply or convey the impression that such agent
is affiliated with or sponsored
by the federal government, medicare program or social security administration.
Such prohibition also applies to the use of trade names by individual agents
.
(9)
Any misrepresentation or incomplete
comparison by the insurance company
or agent , by commission or omission, for the purpose of inducing or
tending to induce a medicare-eligible person to purchase, amend, lapse,
forfeit, change or surrender insurance.
(E) Severability
If any paragraph, term or provision of this rule is adjudged
invalid for any reason, the judgment shall not affect, impair or invalidate any
other paragraph, term or provision of this rule, but the remaining paragraphs,
terms and provisions shall be and continue in full force and effect.