NDAC 45-06-05.1-21
Standards for marketing
Cite as N.D. Admin. Code ยง 45-06-05.1-21
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:
a.
Establish marketing procedures and agent training requirements to assure that:
(1)
Any marketing activities, including any comparison of policies, by its agents or other
producers will be fair and accurate; and
(2)
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 subsection 3 of section 45-06-05.1-07
(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 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 certificate holder
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
"noncancelable" or "level premium" only when the policy or certificate conforms to
subdivision c of subsection 1 of section 45-06-05.1-04.
h.
Provide an explanation of contingent benefit upon lapse provided for in subdivision c of
subsection 4 of section 45-06-05.1-24 and, if applicable, the additional contingent benefit
upon lapse provided to policies with fixed or limited premium payment periods in
subdivision d of subsection 4 of section 45-06-05.1-24.
2.
In addition to the practices prohibited in North Dakota Century Code section 26.1-04-03, 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 subdivision b of subsection 3 of North Dakota Century Code
section 26.1-45-01, 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 insurance department the following material:
(1)
The policy and certificate;
(2)
A corresponding outline of coverage; and
(3)
All advertisements requested by the insurance department.
c.
The association shall disclose in any long-term care insurance solicitation:
(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
(2)
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:
(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;
(2)
Actively monitor the marketing efforts of the insurer and its agents; and
(3)
Review and approve all marketing materials or other insurance communications
used to promote sales or sent to members regarding the policies or certificates.
(4)
Paragraphs 1 through 3 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 state insurance department the information required in
this subsection.
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.
i.
Failure to comply with the filing and certification requirements of this section constitutes
an unfair trade practice in violation of North Dakota Century Code section 26.1-04-03.