DECEPTIVE MARKETING AND ADVERTISING PRACTICES

ST ATE OF NEW MEXICO OFFICE OF SUPERINTENDENT OF INSURANCE SUPERINTENDENT OF INSURANCE Russell Toal =4551 DEPUTY SUPERINTENDENT Robert E. Doucette, Jr. OiIICE O} NEW MEXICO iutipi+iitxotiit 01 INlUllAltC[ BULLETIN 2020-013 i(a'< ' - -r .-Wl' -=t. MAY 20, 2020 - .l = ) T%) TO: ALL INSURERS AND PRODUCERS AUTHORIZED TO SELL EXCEPTED BENEJIT PLANS 11 f' -71 :ll,." i-l RE: DECEPTIVEMARKETINGANDADVERTISINGPRACTICES The New Mexico Office of Superintendent of Insurance ("OSr') is charged with protecting New Mexicans from misleading and deceptive practices connected to the marketing and advertising of excepted health benefit plans, i.e., limited benefit plans that do not offer the full coverage required by the Affordable Care Act ("ACA"). In Docket No. 20-00017-COMP-LH, OSI ordered companies that issue certain excepted benefit products to infon'n current and prospective purchasers that those products do not provide major medical coverage. Any marketing or advertising practice that suggests otherwise is deceptive, misleading and, thus, prohibited by Sections 59A-16-4, 59A-16-5 and 59A-16-20, NMSA 1978. This bulletin identifies some specific deceptive and misleadingmarketing and advertisingpractices of which OSI has become aware and will take action against. These include: * Representing that an excepted benefit plan provides benefits that it does not. @ Selling, or offering to sell, multiple excepted benefit plans to an individual as part of a single transaction without providing a written disclosure that the combined products are not a substitute for major medical coverage. * Using terms such as "bronze," "silver," "gold," "platinum" or "essential health benefits" to describe the coverage or benefits included in an excepted benefit plan that are associated with an ACA-compliant plan,. * Using teri'ns to describe the coverage or benefits included in an excepted benefit plan that are associated with comprehensive major medical coverage, such as "PPO", "network," "copay," "coinsurance," "direct pay to providers" or "dollar first plan". Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NA4 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110 Main Phone: (505) 827-4601 Satellite Phone: (505) 322-2186 Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us B U L I. E T I N 2 0 2 0 - 0 1 3 P a g e 12 * Selling an excepted benefit plan through an association or group, unless the group is in compliance with Sections 59A-23-3, 59A-23-8 and 59A- 23-9, NMSA 1978 and approved by OSI, or selling association or group memberships in conjunction with the sale of excepted benefit products. * Failing to explain to a prospective purchaser the difference between comprehensive major coverage and tlie limited coverage provided by an excepted benefit plan. * Failing to deliver to each prospective purchaser of an excepted benefit product (excluding excepted benefit products offered to members of groups identified in Sections 59A-23-(A)(1)-(3), NMSA 1978) the Coverage Options Flyer attached hereto. * "Spoofing" phone numbers on a call recipient's caller ID display to pose as another caller to market insurance, especially if the number spoofed appears to be from another carrier, healthcare provider, or gover'mnent agency. @ Providing a false name or National Producer Number (NPN). * Soliciting sales of excepted benefit products through a website, printed advertisement, text message, or phone call without identifying the producer. * Using printed advertising media that has not been approved by OSI. To aid OSI's monitoring and enforcement operations, the superintendent directs every producer or producer representative offering excepted benefit products (excluding products offered to members of groups identified in Sections 59A-23-(A)(1)-(3), NMSA 1978) to include the producer's name and NPN on every advertisement for health insurance or an excepted benefit product. In such advertisements or other printed materials, the producer's name and NPN must be clearly visible in no less than 12-point font type or in print type equal to the second largest print type in the advertisement. These disclosure and font requirements also apply to any text message, emailorwebsiteintendedtosolicitsalesinNewMexico. Anyproducerwhocontactsaprospective purchaser of any health insurance or excepted benefit product shall disclose this infon'nation at the startofthecontact. Aproducerwhocontactsaprospectivepurchaserbyphone,butfailstoconnect with that contact, shall leave a voice message, if that option is available, that includes the producer's name and NPN. Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110 Main Phone: (505) 827-4601 i Satellite Phone: (505) 322-2186i Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us B U L L E T I N 2 0 2 0 - 0 1 3 P a g '-i' 3 Any producer who markets an excepted benefit product using a form of advertisement previously approved by OSI shall include the producer's name and NPN on that advertisement, but shall not make any other change to the advertisement. For previously approved print advertisements, a producer can comply with tl'iis requirement by affixing the required disclosure to the printed material in anymanner that is likelyto remain attached, and include the associated SERFF tracking number. Insurers have a duty to ensure that the advertising and marketing of tlieir excepted benefit plans are not deceptive or misleading. OSI deems all unapproved fonns to be deceptive and misleading and will hold plan issuers responsible for both direct marketing and indirect marketing through producers of such forms as well as misrepresentation of the coverage and benefits provided under approved forms. The marketing or sale of any plan using a deceptive practice subjects both the producer and issuer to fines and penalties, including the revocation of a producer license or certificate of authority. If you have questions regarding this bulletin, please contact the Life and Health Product Filing Bureau at (505) 827-4601 or LHRFF.osi@state.ni'n.us. ISSUED this !day of May, 2020. Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110 Main Phone: (505) 827-4601 i Satellite Phone: (505) 322-2186i Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us In these difficult times, you can get health coverage. We are here to help. During the Pandemic, EVERYONE QUALIFIES for coverage. We will help you get covered for free or at a low-cost to you. Start Here Do you qualify for Medicaid? Depending on yourincome and family size you may quaklfy for Mgdlc;ild To apply call 1-855-637-65% or apply online at the YES New Me+iise @ertal, Are you eligible to enroll in a plan through beWellnm? If you don t qualify for Medicaid, you may now qualify for no or low-cosk private insurancethroughbeWellnm Ifyouhave recentlylostyou2ob orseena reduction in your income, call 1-833-862-3935 tosee ifyou qualifyforcoverage. 1-855-637-6574 yes.state.nm.us 1-833-862-3935 bewellnm.com No matter what, you can get covered. MEDICAID I nm" New Mexico* Medical € le H6'm-to qualify r6i"66verage. Federal Poverty Level [FPL), is a measure ofincome used to determine eligibility for Medicaid and the Childrenas Health Insurance Program [CHIP], aswell as premium subsidies and cost-sharing reductions [cost-sharing subsidies) in the exchange, and otherfederal programs. Light Blue = Could qualify for a discounted premium. Blue = Could qualify for a premium tax credit and cost-sharing reduction. Dark Blue = Could qualify for Medicaid coverage. New !vtexii:o"j> Medical € Pool 2)E) hpNnm' MEDICAID HUMAN SERVICES Individuals Family of 2 Family of 3 Family of 4 Family of 5 O-IOO% FPL $1,064 $1437 $1,81CI $2,184 $2,557 138% FPL $1,468 $1,983 $2,498 $3,013 $3,529 l39'i(i FPL $1,469 $1,984 $2,499 $3,€15 $3 530 240% FPL $2,552 $3,449 $4,344 $5,240 $6,137 300% FPL $3,190 $4,311 $5,430 $6,550 $7,671 400% FPL $4256 $5,748 $7,240 $8,736 $10,228 Over 400% FPL $4,256+ $5,748+ $8,736+ $10,228+ Family of 6 $2,930 $4,045 $7,032 $8,790 $11,72CI $11,720+ The FPL amounts are valid through March 31, 2021. Ifyou think you qualify or are unsure what you qualify for, give us a call so we can help: MEDICAID € X- New Mexicol Medical ,eole 1-855-637-6574 1-833-862-3935 1-844-728-7896 yes.state.nm.us bewellnm.com nmmip.org NMllXOCn [14/2 € En estos tiempos dificiles, puede ob-tener cobertura de salud. Estamos aqui para ayudar. Durante la pandemia, TODOS CALIFICAN para la cobertura. Le ayudaremos obtener una cobertura gratuita o de bajo costo para usted. Com:ience aqui ,;Califica para Medicaid? Dependiendo de sus ingresos y el tamario de su famili,i puede calificar para Medicaid Para aplicar, llame all-855-637-65% o llene una solicitud en la pagina web de YES New Mexico ,;Es usted elegible para inscribirse en un plan a trav6s de beWellnm? Si no califica para Medicaid ahora puede calificar para un seguro privado gratuito odebajocostoatravesdebeWellnm Si recientemente perdi6 su trabajo o vio una reduccion en sus ingresas, llame al 1-833-862-3935 para versi califica para cobertura. ',)'O'tr;:6p6i6m,r':'.:'-.=,',:'5;," :,' .- The New Mexico -:' ,lMedical Irisurarice".- -Pool- =..; Si;oo 'calif:tJpara Medicai'd o cob4rtui:a -: ,,."' '.satravesdebeWellnm,todosenNu;vo ' " Mexico pue'deri.6b€e.ner.cobertQa h €rav6saf (' de T.he New Mexico M'edicallnsurance-..' ;." a= Pool Paraobteneruna.solicitudlllameal,l:. ',.1-%A-.728-7896ovi4itewww'rirrimiporg : 1-855-637-6574 yes.state.nm.us 1-833-862-3935 bewellnm.com Pase lo que pase, usted puede estar cubierto. MEDICAID New Mexicog3aa Medical € le r,, 1y+';Y4i:l::Jy%b%i,,IF:71,,,s. J, , 'e6mo calificar para la cobertura. El Nivel Federal de Pobreza [FPL) es una medida de ingresos utilizada para determinar la ekegibilidad para Medicaid y ek Programa de Seguro Medico para Nirios (CHIP), asi como subsidios de primas y reducciones de costos compartidos [subsidios de costos compartidos) en el intercambio, y otros programas federales. Azul claro = Podria calificar para una prima con descuento. Azul = Podria cakificar para un cr6dito fiscal premium y una reducci6n de costos compartidos. Azul Oscuro = Podria calificar para ka cobertura de Medicaid. New Miixi4' M='-',,;':-')2) bpMnm' MEDICAID I -NG i HUMAN SERVICES Individuos Familia de 2 Familia de 3 Familia de 4 Familia de 5 O-100% FPL $1 ,064 $1,437 $i8l0 $2184 $2,557 138o/o FPL $1,468 $1,983 $2,498 $3,013 $3,529 139% FPL $1,469 $1,984 $2,499 $3,015 $3,530 240% FPL $2,552 $3,449 $5,240 $6,137 300% FPL $3, 190 $4,311 $5,430 $6,550 $7,671 400% FPL $4,256 $5,748 $7,24 €) $8,736 $IO 228 OVer 400 % FPL $4,256+ $5,7 48+ $7,240+ $8;736+ $10,228+ Familia de 6 $2,930 $4,045 $7,032 $8,790 $11,72 € Los montos de FPL son validos hasta el31 de marzo del 2021 Si cree que califica o no esta seguro para qu6 califica, 116menos para que podamos ayudarlo! MEDICAID H U M A N m SERVICES nm' New Mexico* Medical <le 1-855-637-6574 7eS.State.nm.uS 1-833-862-3935 bewellnm.com 1-844-728-7896 nmmtp.Org NMHXDm 04/20