California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 8 - CALIFORNIA PARTNERSHIP FOR LONG-TERM CARE › Article 2 - CONDITIONS OF ISSUER PARTICIPATION › Section 58052 - Marketing and Disclosure Requirements

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Every Issuer shall submit a copy of any
					 advertisements, educational and/or sales materials intended for use with
					 Partnership Policies or Certificates to the Department of Health Services for
					 review and approval at least thirty (30) days before dissemination. These
					 materials are deemed approved unless the Department of Health Services formally
					 disapproves them within thirty (30) days of receipt.
(b) Policies or Certificates deemed to meet
					 the requirements of this Chapter shall be designated by the presence of the
					 official logo of the California Partnership for Long-Term Care. The official
					 logo shall be printed on every Partnership Policy or Certificate, and all
					 application forms, sales materials, and other information used by the Issuer in
					 conjunction with the sales and marketing of Partnership Policies and
					 Certificates. Subject to the conditions in this Section, all materials bearing
					 this logo must be reviewed and approved by the Department of Health
					 Services.
(c) No long-term care
					 insurance Policy or Certificate may be advertised, solicited, or issued for
					 delivery in this state as a Partnership Long-Term Care Insurance Policy or
					 Certificate unless the Issuer does the following:
(1) provides the Department of Health
					 Services with a written summary of the methods the Issuer will use to alert the
					 consumer, prior to presentation of an application for a Partnership Policy or
					 Certificate, of the availability of consumer information and public education
					 provided by the California Department of Aging's Health Insurance Counseling
					 and Advocacy Program;
(2) uses
					 applications to be signed by the applicant which indicates, that the applicant;
(A) received, prior to the presentation of an
					 application or enrollment form, a complete description of the California
					 Partnership for Long-Term Care in a form and format prepared by the Department
					 of Health Services, including an explanation of Asset Protection provided by
					 the program and how it is achieved and the Health Insurance Counseling and
					 Advocacy Program's toll free consumer information number; and
(B) received, prior to the presentation of an
					 application or enrollment form, a copy of a long-term care insurance shoppers
					 guide approved by the California Partnership for Long-Term Care; and
(C) received a statement regarding Medi-Cal
					 eligibility and benefits that shall be in the following format:
"NOTICE TO APPLICANT REGARDING MEDI-CAL
						ELIGIBILITY
I understand that eligibility for Medi-Cal is not
						automatic; an application is necessary. Once my long-term care insurance begins
						paying benefits, the insurer will send me quarterly statements showing how much
						asset protection I have earned. This permanent asset protection is in addition
						to any asset exemptions available to any Californian applying for Medi-Cal. I
						understand that should I want to apply for Medi-Cal it is my responsibility to
						complete the application process. I further understand that before receiving
						Medi-Cal I will first have to use any additional assets I have not protected.
						If I become a Medi-Cal beneficiary, I understand that I may have to apply a
						portion of my income toward the cost of my care, and that Medi-Cal services at
						that time may not be the same services I was receiving under my private
						long-term care insurance.
______________________________
(Signature of
						Applicant(s))"
(D)
					 agrees to the release of information by the Issuer to the State as may be
					 needed to evaluate the California Partnership for Long-Term Care and to provide
					 the necessary verification to document the applicant's Medi-Cal Property
					 Exemption, in the following format:
"CONSENT AND AUTHORIZATION TO RELEASE
						INFORMATION
I hereby agree to the release of all records and
						information pertaining to this long-term care insurance policy or certificate
						to the State of California for the purposes of documenting my Medi-Cal asset
						disregard under the Medi-Cal program, evaluating the California Partnership for
						Long-Term Care, and meeting Department of Health Services or Department of
						Insurance audit or quality control requirements.
As part of the evaluation of the California Partnership
						for Long-Term Care, the State is trying to determine how well this program is
						reaching people with varying amounts of income and assets. You will therefore
						be asked to fill out a brief survey, prepared by the State, and indicate what
						range your income and assets fall into.
I understand that the information contained in these
						records will be used for no purpose other than those stated above, and will be
						kept strictly confidential by the State of California.
______________________________
(Signature of
						Applicant(s))"
(E)
					 Received a graphic comparison in a form provided by the California Partnership
					 for Long-Term Care showing the benefit levels of a Policy or Certificate that
					 increases benefits at a compounded annual rate of not less than five percent
					 (5%) over the Policy or Certificate period with a policy or certificate that
					 does not increase benefits. The graphic comparison shall show benefit levels
					 over at least a twenty (20) year period.
The comparison will also illustrate the costs the Policy
						or Certificate holder would pay out of their own income or assets for nursing
						home care between a Policy or Certificate that does not increase benefits
						and;
1. an expense reimbursable Policy
					 or Certificate that increases benefits but not premiums over the Policy or
					 Certificate period; and
2. an
					 expense incurred Policy or Certificate that increases premiums and benefits
					 over the Policy or Certificate period.
(F) Received a statement regarding the
					 absence of a Medi-Cal residential care facility benefit if the application is
					 for a Nursing Facility and Residential Care Facility Only Policy or Certificate
					 with the following features:
1. Benefit
					 Eligibility is based on deficiencies in two Activities of Daily Living;
					 and
2. the lifetime maximum benefit
					 is less than seven hundred thirty (730) times the Nursing Facility per diem
					 benefit.
(G) Issuers that
					 market by direct mail response without sales agents will meet the requirements
					 of Subsections (c)(2)(A) and (B), above, by using applications, to be signed by
					 the applicant, that indicate the applicant received the specified publications
					 and information prior to completing the application or enrollment
					 form.