Rules & Regulations of the State of Tennessee
Title 0780 - Commerce and Insurance
Subtitle 0780-01 - Insurance Division
Chapter 0780-01-61 - Long-Term Care Insurance
Section 0780-01-61-.23 - STANDARDS FOR MARKETING
Universal Citation: TN Comp Rules and Regs 0780-01-61-.23
Current through September 24, 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 and
insurance producer training requirements.
1.
Any marketing activities, including any comparison of policies by its insurance
producers or other producers will be fair and accurate; and
2. 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 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 as required by Rule 0780-1-61-.09 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 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.
(e) Every insurer or
entity marketing long-term care insurance shall establish auditable procedures
for verifying compliance with Paragraph (1) of this rule.
(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 the program is available and the name, address and
telephone number of the program.
(g) For long-term care insurance policies and
certificates, use the terms "non-cancelable" or "level premium" only when the
policy or certificate conforms to Rule 0780-1-61-.06(1)(c).
(h) Provide copies of the disclosure forms
required in Rule 0780-1-61-.09 and to the applicant.
(i) Provide an explanation of contingent
benefit upon lapse provided for in Rule 0780-1- 61-.26(6).
(2) In addition to the practices prohibited in T.C.A. §§ 56-8-101, et seq., 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
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.
(d) Misrepresentation. Misrepresenting a
material fact in selling or offering to sell a long-term care insurance
policy.
(3)
(a) With respect to the obligations set forth
in this paragraph, the primary responsibility of an association, as defined in
T.C.A. §
56-42-103, 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.
(b) The insurer
shall file with the Commissioner the following material:
1. The policy and certificate,
2. A corresponding outline of coverage,
and
3. All advertisements requested
by the Department of Commerce and Insurance.
(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 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 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.
(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 the
examination thereafter in the event of material change.
2. Actively monitor the marketing efforts of
the insurer and its insurance producer.
3. Review and approve all marketing materials
or other insurance communications used to promote sales or sent to members
regarding the policies or certificates.
4. Subparts 1. through 3. of this
subparagraph shall not apply to qualified long-term care insurance
contracts.
(g) No group
long-term care insurance policy or certificate may be issued to an association
unless the insurer files with the Commissioner the information required in this
rule.
(h) 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 this
rule.
(i) Failure to comply with
the filing and certification requirements of this rule constitutes an unfair
trade practice in violation of T.C.A. §§
56-8-101, et
seq.
Authority: T.C.A. §§ 56-6-124, 56-8-104(1), 56-8-113, 56-42-105.
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