(1) Every issuer, health service corporation,
health maintenance organization or other entity marketing long-term care
insurance coverage in this state, directly or through its producers, shall:
(a) Establish marketing procedures to assure
that any comparison of policies by its producers or other producers will be
fair and accurate;
(b) Establish marketing procedures to assure
excessive insurance is not sold or issued;
(c) Display prominently by type, stamp or other
appropriate means, on the first page of the outline of coverage and policy or
certificate the following:
"Notice
to buyer: This policy or certificate 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."
(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;
(e) Establish auditable procedures for verifying
compliance with this rule;
(f) The issuer must at solicitation, provide
written notice to the prospective policyholder and certificate holder that a
senior insurance counseling program is available and the name, address and
telephone number of the program; and
(g) For long-term care health insurance
policies and
certificates,
use the terms "noncancelable" or "level premium" only when
the insured has the right to continue the long-term care insurance in
force by the timely payment of premiums during which period the issuer has no
right to unilaterally make any change in any provision of the insurance or in
the premium rate.
(2) In addition to the practices prohibited in
Title 33, chapter 18, Montana Code Annotated, the following acts and practices
are prohibited:
(a) Twisting or knowingly making any misleading
representation or incomplete or fraudulent comparison of any insurance policies
or issuers 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 certificate or to take out a policy of insurance or
certificate with another issuer;
(b) High pressure tactics such as 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; and
(c) Cold lead advertising such as 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.
(3) (a) With respect to the obligations set forth in
this subsection, the primary responsibility of an association, as defined in 33-22-1107,
MCA, when endorsing 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 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;
(b) The issuer shall file with the insurance
department the following material:
(i) the policy and certificate;
(ii) a corresponding outline of coverage; and
(iii) all advertisements requested by the insurance department.
(c) The association shall disclose in any long-term
care insurance marketing materials developed by the association:
(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 of the policy or certificate to its members; and
(ii) a brief description of the process under
which such policies and the issuer issuing such policies were selected.
(d) If the association and the issuer have
interlocking directorates or trustee arrangements, the association shall
disclose such fact to its members.
(e) The board of directors of associations
endorsing long-term care insurance policies or certificates shall review and
approve such insurance policies as well as the compensation arrangements made
with the issuer.
(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 issuer to conduct an examination of the
policies, including its benefits, features, and rates and update such
examination thereafter in the event of material change;
(ii) actively monitor the marketing efforts of
the issuer and its producers; and
(iii) review and approve all marketing materials
or other insurance communications used to promote sales or sent to members
regarding such policies or certificates.
(g) No group long-term care insurance
policy or certificate may be issued to an association unless the issuer files
with the state insurance department the information required in this rule.
(h) The issuer shall not issue a long-term
care policy or certificate to an association or continue to market such a
policy or certificate unless the issuer 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 Title 33, chapter 18, Montana Code Annotated.