Texas Administrative Code
Title 28 - INSURANCE
Part 1 - TEXAS DEPARTMENT OF INSURANCE
Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES
Subchapter Y - STANDARDS FOR LONG-TERM CARE INSURANCE, NON-PARTNERSHIP AND PARTNERSHIP LONG-TERM CARE INSURANCE COVERAGE UNDER INDIVIDUAL AND GROUP POLICIES AND ANNUITY CONTRACTS, AND LIFE INSURANCE POLICIES THAT PROVIDE LONG-TERM CARE BENEFITS WITHIN THE POLICY
Division 2 - NON-PARTNERSHIP AND PARTNERSHIP LONG-TERM CARE INSURANCE
Section 3.3839 - Standards for Marketing
Universal Citation: 28 TX Admin Code § 3.3839
Current through Reg. 50, No. 13; March 28, 2025
(a) Each insurer, health care service plan, or other entity marketing long-term care insurance coverage in this state, directly or through its agents, shall establish and implement marketing procedures to assure that:
(1) any comparison of policies by its agents
or other producers will be fair and accurate;
(2) excessive insurance is not sold or
issued;
(3) every reasonable effort
is made 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;
(4) no person shall, in selling or offering
to sell a long-term care policy, misrepresent a material fact;
(5) the policy shall be delivered no later
than 30 days after the application for the long-term care insurance policy or
certificate is approved;
(6) the
terms non-cancellable and level premium are used only to describe a policy or
certificate that conforms to §
3.3810 of this subchapter
(relating to Policy or Certificate Standards for Noncancellability);
(7) auditable procedures are established to
verify compliance with this subsection;
(8) at time of solicitation, the insurer
provides written notice to the prospective policyholder and certificate holder
that a senior insurance counseling program is available from the department and
the name, address and telephone number of the program;
(9) at the time of application, an
explanation is provided to the applicant of the contingent nonforfeiture
benefit upon lapse provided for in §
3.3844(g)(1) of
this subchapter (relating to Nonforfeiture and Contingent Nonforfeiture
Benefits) and, if applicable, an explanation of the additional contingent
nonforfeiture benefit upon lapse provided for policies or certificates with
fixed or limited premium payment periods as specified in §
3.3844(g)(2) of
this subchapter;
(10) at the time
of application, copies of the disclosure forms (Form Number LHL560(LTC)
Long-Term Care Insurance Personal Worksheet as specified in Figure: 28 TAC
§
3.3829(b)(8)(H)
andForm Number LHL561(LTC) Long-Term Care Insurance Potential Rate Increase
Disclosure Form as specified in Figure: 28 TAC §
3.3829(b)(8)(I)
are provided to the applicant; and
(11) the notice required in subparagraph (A)
or (B) of this paragraph, as appropriate, is prominently displayed by type,
stamp, or other appropriate means on the first page of both the policy (or
certificate) and the outline of coverage.
(A)
For any policy or certificate which contains inflation protection provisions,
the notice shall read as follows: "Notice to buyer: This policy (or
certificate) may not cover all of the costs associated with long-term care
incurred by the policyholder (or certificate holder) during the period of
coverage. The policyholder (or certificate holder) is advised to review
carefully all policy limitations."
(B) For any policy or certificate which does
not contain inflation protection provisions, the notice shall read as follows:
"Notice to buyer: This policy (or certificate) may not cover all of the costs
associated with long-term care incurred by the policyholder (or certificate
holder) during the period of coverage. The policyholder (or certificate holder)
is advised to review carefully all policy limitations. In addition, the
policyholder (or certificate holder) is advised that based on current health
care cost trends, the benefits provided by this policy (or certificate) may be
significantly diminished in terms of real value to the policyholder (or
certificate holder), depending on the amount of time which elapses between the
date of purchase and the date upon which the policyholder (or certificate
holder) first becomes eligible for those benefits."
(b) The marketing of a long-term care insurance policy or certificate which includes benefits provisions under § 3.3818(b) of this subchapter (relating to Standards for Eligibility for Benefits) shall disclose within a common location and in equal prominence a description of all benefit levels payable for coverage described in § 3.3818(b) of this subchapter.
(c) In addition to the practices prohibited in the Insurance Code Chapter 541, the following acts and practices are unfair methods of competition or unfair or deceptive acts or practices in the marketing of long-term care policies or certificates in this state and are prohibited under § 541.003 of the Insurance Code.
(1) Twisting--Knowingly making
any misleading representation or incomplete or fraudulent comparisons 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.
(2)
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.
(3) 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 agent or insurance company.
(4) Misrepresentation--Selling, marketing,
offering, or advertising any insurance policy, certificate, or rider to such
policy or certificate, which substantially meets the definition of long-term
care insurance found in the Insurance Code §
1651.003, but which
provides benefits for a period of fewer than 12 months.
Disclaimer: These regulations may not be the most recent version. Texas 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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