Oregon Administrative Rules
Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION
Division 52 - INSURANCE POLICIES
Section 836-052-0706 - Standards for Marketing
Universal Citation: OR Admin Rules 836-052-0706
Current through Register Vol. 63, No. 9, September 1, 2024
(1) Every insurer, health care service plan or other entity marketing long-term care insurance coverage in this state, directly or through its insurance producers, shall:
(a) Establish marketing procedures and
insurance producer training requirements to assure that:
(A) Any marketing activities, including any
comparison of policies by its insurance producers, will be fair and accurate;
and
(B) Excessive insurance is not
sold or issued.
(b)
Display prominently by type, stamp or other appropriate means, on the first
page of the outline of coverage and policy, or certificate if a group, 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."
(c) Provide
copies of the disclosure forms required in OAR
836-052-0556(4)
(Exhibits 1 and 2) to the applicant.
(d) Inquire and otherwise make every
reasonable effort to identify whether a prospective applicant or enrollee for
long-term care insurance already has health 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 health insurance is not
required.
(e) Establish auditable
procedures for verifying compliance with this section.
(f) At solicitation, provide written notice
to the prospective policyholder and certificate holder that a senior insurance
counseling program approved by the Director is available and the name, address
and telephone number of the program.
(g) For long-term care insurance policies,
certificates and riders, use the terms "noncancellable" or "level premium" only
when the policy, certificate or rider conforms to OAR
836-052-0526(1)(c).
(h) Provide an explanation of contingent
benefit upon lapse provided for in OAR
836-052-0746(4)(c)
and, if applicable, the additional contingent benefit upon lapse provided to
policies with fixed or limited premium paying periods in
836-052-0746(4)(d).
(2) In addition to the practices prohibited under ORS Chapter 746, the following acts and practices are prohibited:
(a) Twisting, which includes
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 insure.
(b) High pressure tactics, which include the
employing of any method of marketing having the effect of inducing or tending
to induce the purchase of insurance through force, fright or threat, whether
explicit or implied, or undue pressure to purchase or recommend the purchase of
insurance.
(c) Cold lead
advertising, which is 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 insurer or insurance producer.
(d) Misrepresentation of a material fact in
selling or offering to sell a long-term care insurance policy.
(3) An association, as defined in ORS 743.652(3)(b), and the insurer endorsing or selling long-term care insurance are subject to the following requirements and obligations:
(a) The primary responsibility of an
association, 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. An association shall provide objective
information regarding long term care insurance policies or certificates
endorsed or sold by the association to ensure that its members receive a
balanced and complete explanation of the features in the policies or
certificates that are being endorsed or sold.
(b) The insurer shall file with the Director
the following material:
(A) The policy,
certificate, and riders;
(B) A
corresponding outline of coverage; and
(C) All advertisements requested by the
Director.
(c) 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.
(d) If the
association and the insurer have interlocking directorates or trustee
arrangements, the association shall disclose that fact to its
members.
(e) The board of directors
of an association 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.
(f) The association shall also:
(A) 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;
(B) Actively monitor the marketing efforts of
the insurer and its producers; and
(C) Review and approve all marketing
materials or other insurance communications used to promote sales or sent to
members regarding the policies, certificates, or riders.
(g) Subsection (f) of this section does not
apply to qualified long-term care insurance contracts.
(h) A group long term care insurance policy,
certificate or rider may not be issued to an association unless the insurer
files with the director the information required in this section.
(i) The insurer may not issue a long term
care insurance policy or certificate to an association or continue to market
the policy or certificate or certificate unless the insurer certifies annually
that the association has complied with the requirements of this
section.
(j) Failure to comply with
the filing and certification requirements of this rule is an unfair trade
practice in violation of ORS
746.240.
.: Exhibits referenced are available from the agency.
Stat. Auth.: ORS 731, 742 & 743
Stats. Implemented: ORS 743.655(1)(a) & 746.240
Disclaimer: These regulations may not be the most recent version. Oregon 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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