West Virginia Code of State Rules
Agency 114 - Insurance Commission
Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER
Series 114-32 - Long-Term Care Insurance
Section 114-32-21 - Standards for Marketing
Universal Citation: 114 WV Code of State Rules 114-32-21
Current through Register Vol. XLI, No. 38, September 20, 2024
21.1. Every insurer, health care service plan or other entity marketing long-term care insurance coverage in this state, directly or through its producers, shall:
21.1.a. Establish marketing procedures and
producer training requirements to assure that:
21.1.a.1. Any marketing activities, including any
comparison of policies by its producers or other producers will be fair and
accurate; and
21.1.a.2. Excessive
insurance is not sold or issued.
21.1.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."
21.1.c. Provide copies of the disclosure forms
required in subsection 7.3 of this rule (Appendices B and F) to the
applicant.
21.1.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.
21.1.e. Every insurer or entity marketing
long-term care insurance shall establish auditable procedures for verifying
compliance with this Subsection.
21.1.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 certificateholder that the program is available and the name,
address and telephone number of the program.
21.1.g. For long-term care health insurance
policies and certificates, use the terms "noncancellable" or "level premium" only
when the policy or certificate conforms to subdivision c, subsection 4.1 of this
rule.
21.1.h. Provide an explanation of
contingent benefit upon lapse provided for in subdivision c, subsection 26.4 of this
rule and, if applicable, the additional contingent benefit upon lapse provided to
policies with fixed or limited premium paying periods in subdivision d, subsection
26.4 of this rule.
21.2. In addition to the practices prohibited in this state's Unfair Trade Practices Act [W. Va. Code § 33-11-1et seq.], the following acts and practices are prohibited:
21.2.a. 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.
21.2.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.
21.2.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.
21.2.d. Misrepresentation.
Misrepresenting a material fact in selling or offering to sell a long-term care
insurance policy.
21.3
21.3.a. With respect to the obligations set forth
in this subsection, the primary responsibility of an association, as defined in W.
Va. Code §
33-15A-4(e)(2),
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.
21.3.b. The insurer shall file with the
Commissioner the following material:
21.3.b.1. The
policy and certificate,
21.3.b.2. A
corresponding outline of coverage, and
21.3.b.3. All advertisements requested by the
Commissioner.
21.3.c. The
association shall disclose in any long-term care insurance solicitation:
21.3.c.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
21.3.c.2. A brief description of the process under
which the policies and the insurer issuing the policies were selected.
21.3.d. If the association and the
insurer have interlocking directorates or trustee arrangements, the association
shall disclose that fact to its members.
21.3.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.
21.3.f. The
association shall also:
21.3.f.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;
21.3.f.2. Actively monitor the marketing efforts
of the insurer and its producers; and
21.3.f.3. Review and approve all marketing
materials or other insurance communications used to promote sales or sent to members
regarding the policies or certificates.
21.3.f.4. Paragraphs 1 through 3 of this
subdivision shall not apply to qualified long-term care insurance
contracts.
21.3.g. No group
long-term care insurance policy or certificate may be issued to an association
unless the insurer files the information required in this subsection with the
Commissioner.
21.3.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
subsection.
21.3.i. Failure to comply
with the filing and certification requirements of this section constitutes an unfair
trade practice in violation of this state's Unfair Trade Practices Act [W. Va. Code
§
33-11-1et
seq.].
Disclaimer: These regulations may not be the most recent version. West Virginia 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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