2635 STANDARDS FOR MARKETING — GENERAL

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2635.1 An insurer, health care service plan, or other entity marketing long-term care insurance or benefits in the District of Columbia, directly or through its producers, shall:

(a) Establish marketing procedures and agent training requirements to assure the following:

1. (1) Marketing activities, including comparison of policies, by its agents or other producers will be fair and accurate; and
2. (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 by subsections 2618.3 through 2618.8 (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 shall not be required;

- (e) Establish auditable procedures for verifying compliance with this subsection;

- (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 state’s insurance commissioner, provide, at solicitation, written notice to the prospective policyholder and certificateholder 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 “noncancellable” or “level premium” only when the policy or certificate conforms to subsections 2602.5 and 2602.6; and

- (h) Provide an explanation of contingent benefit upon lapse provided for in subsection 2639.6.

2635.2 The following acts and practices are prohibited:

(a) Twisting. Knowingly making a misleading representation or incomplete or fraudulent comparison of an insurance policy or insurer 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 a 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 a 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; and

(d) Misrepresentation. Misrepresenting a material fact in selling or offering to sell a long-term care insurance policy.

SOURCE: Final Rulemaking published at 55 DCR 3759 (April 11, 2008).