Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter Y - STANDARDS FOR LONG-TERM CARE INSURANCE, NON-PARTNERSHIP AND PARTNERSHIP LONG-TERM CARE INSURANCE COVERAGE UNDER INDIVIDUAL AND GROUP POLICIES AND ANNUITY CONTRACTS, AND LIFE INSURANCE POLICIES THAT PROVIDE LONG-TERM CARE BENEFITS WITHIN THE POLICY › Division 2 - NON-PARTNERSHIP AND PARTNERSHIP LONG-TERM CARE INSURANCE › Section 3.3839 - Standards for Marketing

Current through Reg. 49, No. 28; July 12, 2024
(a) Each insurer,
					 health care service plan, or other entity marketing long-term care insurance
					 coverage in this state, directly or through its agents, shall establish and
					 implement marketing procedures to assure that:
(1) any comparison of policies by its agents
					 or other producers will be fair and accurate;
(2) excessive insurance is not sold or
					 issued;
(3) every reasonable effort
					 is made 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;
(4) no person shall, in selling or offering
					 to sell a long-term care policy, misrepresent a material fact;
(5) the policy shall be delivered no later
					 than 30 days after the application for the long-term care insurance policy or
					 certificate is approved;
(6) the
					 terms non-cancellable and level premium are used only to describe a policy or
					 certificate that conforms to §
												3.3810
					 of this subchapter (relating to Policy or Certificate Standards for
					 Noncancellability);
(7) auditable
					 procedures are established to verify compliance with this subsection;
(8) at time of solicitation, the insurer
					 provides written notice to the prospective policyholder and certificate holder
					 that a senior insurance counseling program is available from the department and
					 the name, address and telephone number of the program;
(9) at the time of application, an
					 explanation is provided to the applicant of the contingent nonforfeiture
					 benefit upon lapse provided for in §
												3.3844(g)(1)
					 of this subchapter (relating to Nonforfeiture and Contingent Nonforfeiture
					 Benefits) and, if applicable, an explanation of the additional contingent
					 nonforfeiture benefit upon lapse provided for policies or certificates with
					 fixed or limited premium payment periods as specified in §
												3.3844(g)(2)
					 of this subchapter;
(10) at the
					 time of application, copies of the disclosure forms (Form Number LHL560(LTC)
					 Long-Term Care Insurance Personal Worksheet as specified in Figure: 28 TAC
					 §
												3.3829(b)(8)(H)
					 andForm Number LHL561(LTC) Long-Term Care Insurance Potential Rate Increase
					 Disclosure Form as specified in Figure: 28 TAC §
												3.3829(b)(8)(I)
					 are provided to the applicant; and
(11) the notice required in subparagraph (A)
					 or (B) of this paragraph, as appropriate, is prominently displayed by type,
					 stamp, or other appropriate means on the first page of both the policy (or
					 certificate) and the outline of coverage.
(A)
					 For any policy or certificate which contains inflation protection provisions,
					 the notice shall read as follows: "Notice to buyer: This policy (or
					 certificate) may not cover all of the costs associated with long-term care
					 incurred by the policyholder (or certificate holder) during the period of
					 coverage. The policyholder (or certificate holder) is advised to review
					 carefully all policy limitations."
(B) For any policy or certificate which does
					 not contain inflation protection provisions, the notice shall read as follows:
					 "Notice to buyer: This policy (or certificate) may not cover all of the costs
					 associated with long-term care incurred by the policyholder (or certificate
					 holder) during the period of coverage. The policyholder (or certificate holder)
					 is advised to review carefully all policy limitations. In addition, the
					 policyholder (or certificate holder) is advised that based on current health
					 care cost trends, the benefits provided by this policy (or certificate) may be
					 significantly diminished in terms of real value to the policyholder (or
					 certificate holder), depending on the amount of time which elapses between the
					 date of purchase and the date upon which the policyholder (or certificate
					 holder) first becomes eligible for those benefits."