West Virginia Code of State Rules
Agency 114 - Insurance Commission
Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER
Series 114-83 - Discount Medical Plan Organizations And Discount Prescription Drug Plan Organizations
Section 114-83-4 - Marketing Restrictions
Universal Citation: 114 WV Code of State Rules 114-83-4
Current through Register Vol. XLI, No. 38, September 20, 2024
4.1. Upon request, the Discount Medical Plan Organization or Discount Prescription Drug Plan Organization shall submit to the Commissioner all advertising, marketing materials and brochures regarding a discount medical plan.
4.2.
4.2.a. All
advertisements, marketing materials, brochures, discount medical plan cards and any
other communications of a Discount Medical Plan Organization or Discount
Prescription Drug Plan Organization that are provided to prospective members and
members shall be truthful and not misleading in fact or in implication.
4.2.b. An advertisement, any marketing material,
brochure, discount medical plan card or other communication is misleading in fact or
in implication if it has a capacity or tendency to mislead or deceive based on the
overall impression that it is reasonably expected to create within the segment of
the public to which it is directed.
4.3.
4.3.a. A
Discount Medical Plan Organization or Discount Prescription Drug Plan Organization
must prominently display in their advertising, marketing materials, brochures,
discount medical plan cards, or other communication provided to members or
prospective members, the website address where a list of participating providers can
be accessed.
4.3.b. The website address
provided to members of a Discount Medical Plan Organization or Discount Prescription
Drug Plan Organization must (i) prominently display on such website the e-mail
address of the organization where a plan member may cancel a discount medical plan,
or (ii) allow the member to cancel a plan by sending an e-mail to the organization
through the website.
4.4. A Discount Medical Plan Organization or Discount Prescription Drug Plan Organization shall not:
4.4.a. Use in its advertisements,
marketing material, brochures and discount medical plan cards the term "insurance,"
except as a disclaimer of any relationship between discount medical plan benefits
and insurance or as a description of an insurance product connected with a discount
medical plan;
4.4.b. Describe or
characterize the discount medical plan as being insurance whenever a discount
medical plan is bundled with an insured product and the insurance benefits are
incidental to the discount medical plan benefits;
4.4.c. Use in its advertisements, marketing
material, brochures and discount medical plan cards the terms "health plan,"
"coverage," "copay," "copayments," "deductible," "preexisting conditions,"
"guaranteed issue," "premium," "PPO," "preferred provider organization," or other
terms in a manner that could reasonably mislead an individual into believing that
the discount medical plan is health insurance;
4.4.d. Make misleading, deceptive or fraudulent
representations regarding the discount or range of discounts offered by the discount
medical plan card or the access to any range of discounts offered by the discount
medical plan card;
4.4.e. Have
restrictions on access to discount medical plan providers, including, except for
hospital services, waiting periods and notification periods; or
4.4.f. Pay providers any fees for medical or
ancillary services or collect or accept money from a member to pay a provider for
medical or ancillary services provided under the discount medical plan, unless the
Discount Medical Plan Organization has an active certificate of authority to act as
a third party administrator in accordance with W. Va. Code §
33-46-1, et
seq.
4.5. The marketing restrictions found in this subsection shall not go into effect until July 1, 2008 in order to allow Discount Medical Plan Organizations or Discount Prescription Drug Plan Organizations the necessary time to change marketing materials to comply with the provisions of this section.
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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