Ga. Comp. R. & Regs. R. 120-2-16-.23 - Standards for Marketing
(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 agent training requirements to assure that:
(i) Any marketing activities, including any
comparison of policies, by its agents or other producers will be fair and
accurate; and
(ii) 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 required in Section
120-2-16-.09(3)
(Appendices B and F) 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 this subsection (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.
(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 Section
120-2-16-.06(1)(c)
of this Regulation.
(h) Provide an
explanation of contingent benefit upon lapse provided for in Section
120-2-16-.28(6)(c)
and, if applicable, the additional contingent benefit upon lapse provided to
policies with fixed or limited premium paying periods in Section
120-2-16-.28(6)(d).
(2) In addition to the practices
prohibited in O.C.G.A. Chapter 33-6, 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 agent 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 subsection, the primary responsibility of an association, as defined in
O.C.G.A. Section
33-42-4(as a valid
group), 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 Georgia
Insurance Department the following material:
(i) The policy and certificate,
(ii) A corresponding outline of coverage,
and
(iii) All advertisements
requested by the Georgia Insurance Department.
(c) The association shall disclose in any
long-term care insurance solicitation:
(i)
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
(ii) 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:
(i) 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;
(ii) Actively monitor the marketing efforts
of the insurer and its agents; and
(iii) Review and approve all marketing
materials or other insurance communications used to promote sales or sent to
members regarding the policies or certificates.
(iv) Subparagraphs (i) through (iii) 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 Georgia Insurance Department the information required in this subsection
(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
(3).
(i) Failure to comply with the
filing and certification requirements of this section constitutes an unfair
trade practice in violation of O.C.G.A. Chapter 33-6.
Notes
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