LAW
Writer®
Ohio Laws and Rules
(A) Authority
This rule is promulgated pursuant to section 3901.041 of the Revised Code, providing that the superintendent of insurance shall adopt, amend and rescind rules and make adjudications necessary to discharge his duties and exercise his powers under Title 39 of the Revised Code; and section 3901.21 of the Revised Code, providing that the enumeration in sections 3901.19 to 3901.26 of the Revised Code, of specific unfair or deceptive acts or practices in the business of insurance is not exclusive or restrictive or intended to limit the powers of the superintendent of insurance to adopt rules to implement said section, or to take action under other sections of the Revised Code.
(B) Purpose
The purpose of this rule is to safeguard the interests of medicare-eligible persons in the solicitation and sale of any type of individual medicare supplemental accident and health insurance policies by providing for the regulation of the solicitation and sale of individual medicare supplemental accident and health insurance policies; and to assure that medicare-eligible persons are not subjected to unfair or deceptive acts or practices in the solicitation and sale of individual medicare supplemental accident and health insurance policies by defining additional unfair or deceptive acts or practices in this rule. This rule shall not apply to the solicitation of group, blanket, or franchise accident and health insurance.
(C) Definitions
(1) “Medicare-eligible person” means any person eligible for either medicare part A or medicare part B, pursuant to Title XVIII, U.S. Code.
(2) “Medicare program” refers to the benefits available to medicare-eligible persons, pursuant to Title XVIII of the Social Security Act, codified in 42 U.S.C. 1395 ff.
(D) Unfair or deceptive acts or practices defined
It shall be deemed an unfair or deceptive act or practice to commit or perform any of the following:
(1) Any implication, either verbal or written, which conveys the impression that any medicare supplemental insurance program being offered by a company, agent or broker is affiliated with the federal government, the social security administration, the centers for medicare and medicaid services, or the department of health and human services.
(2) Any implication, either verbal or written, which conveys the impression that any medicare supplemental insurance program being offered by a company, agent, solicitor, or broker, is sponsored by the federal government, the social security administration, the centers for medicare and medicaid services, or the department of health and human services.
(3) Any representation by an agent or broker to the effect that such person is a “counselor”, “advisor” or similar designation, for any association or group of medicare-eligible persons, which obscures the actual role of such agent or broker with respect to the solicitation or sale of such insurance.
(4) Any act for the purpose of inducing an applicant or prospective applicant to sign any form, application or document in blank.
(5) Failure by the agent or broker to state affirmatively, verbally and in writing, the following:
(a) That the person making the solicitation or sale is, in fact, an insurance agent or broker;
(b) That the agent or broker is making the solicitation or sale on behalf of an insurance company or insurance companies, which company or companies must be identified to the senior citizens;
(c) That the medicare-eligible person may verify the information required to be stated in paragraph (D)(5)(a) and paragraph (D)(5)(b) by contacting the Ohio department of insurance;
(d) That the medicare-eligible person may contact the agent or broker making the solicitation or sale at both an address and telephone number provided by the agent or broker;
(e) That the medicare-eligible person may contact the insurance company or insurance companies on behalf of which the solicitation or sale was made at an address and telephone number provided by the agent or broker;
(f) That the agent or broker, and the insurance company, have no connection or affiliation with, and are not in any way sponsored by, the federal or state government, the social security administration, the centers for medicare and medicaid services, or the department of health and human services.
(g) That the medicare-eligible person has the option, if he or she purchases a medicare supplemental insurance policy, of paying his or her premium(s) directly to the insurance company.
(6) Any inaccurate or misleading description of the benefits provided by either the medicare program or the medicare supplemental policy being offered for sale.
(7) Any attempt by an insurance company, agent or broker to arrange a solicitation or sales interview with an applicant or prospective applicant by implying or conveying in any way the impression that such insurance company, agent or broker has been authorized by the federal government, the medicare program or the social security administration to contact said applicant or prospective applicant for the purpose of reviewing, modifying or discussing his or her existing insurance program. Such prohibition is also extended to any statement or act which implies or conveys in any way the impression that such insurance company, agent or broker has access to official records of the federal government, medicare program or social security administration, pertaining to the applicant’s or prospective applicant’s insurance program.
(8) Use of any title or initials by the agent or broker which implies or conveys the impression that such agent or broker is affiliated with or sponsored by the federal government, medicare program or social security administration. Such prohibition also applies to the use of trade names by individual agents or brokers.
(9) The making of any misrepresentation or incomplete comparison by the insurance company, agent or broker, by commission or omission, for the purpose of inducing or tending to induce a medicare-eligible person to purchase, amend, lapse, forfeit, change or surrender insurance.
(E) Severability
If any section, term or provision of this rule or the application thereof to any person or situation be adjudged invalid for any reason such invalidity shall not affect, impair or invalidate any other section, term or provision of this rule or the application thereof which can be given effect without the invalid provision or application and to this end the provisions of this rule are declared to be severable.
Effective: 04/05/2007
R.C. 119.032 review dates: 12/29/2006 and 12/30/2011
Promulgated Under: 119.03
Statutory Authority: 3901.041; 3901.21
Rule Amplifies: 3901.19 to 3901.26
Prior Effective Dates: 05/14/1979