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to all advertisements as defined in §21.102(1) of this title
(relating to Scope)). This subparagraph is inapplicable to solicitation
of employees or members of a particular group, except that this subparagraph
does apply to the solicitation of members of an association group
that otherwise would be eligible under specific provisions of the
Insurance Code for group, blanket, or franchise insurance. This section
applies to all affiliated companies under common management or control.
The phrase "a particular insurance product" is used here to describe
an insurance policy that provides substantially different benefits
than those contained in any other policy. Different terms of renewability,
an increase or decrease in the dollar amounts of benefits, or an increase
or decrease in any elimination period or waiting period from those
available during an enrollment period for another policy are not sufficient
to constitute the product being offered as a different product eligible
for concurrent or overlapping enrollment periods.
(B) There may be no statement or implication to the
effect that only a specific number of policies will be sold, or that
a time is fixed for the discontinuance of the sale of the particular
policy advertised because of special advantages available in the policy.
(C) An invitation to contract Medicare supplement advertisement
must describe complete information regarding all available "open enrollment"
opportunities or prominently disclose a means of obtaining complete
information regarding such opportunities.
(l) Acknowledgment of nonduplication; notice to consumer.
(1) Acknowledgment of nonduplication; notice to consumer.
(A) Acknowledgment of nonduplication--The document
that contains and is limited to the language set forth in item (6)
of Figure: 28 TAC §21.113(l)(5).
(B) Duplication--Policies of the same coverage type
according to minimum standard classifications outlined in Chapter
3, Subchapter S and Subchapter Y of this title (relating to 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). For example, two cancer insurance policies
or two long-term care policies would be duplicative. Duplication is
also present when two policy coverages overlap to the extent that
a reasonable person would not consider the ownership of two such policies
to be cost efficient in light of the consumer's needs and income level.
Group health coverage obtained through an employer-sponsored plan,
conversion from a group employer-sponsored health plan, short-term
travel accident coverage, short-term nonrenewable coverage, Medicare
risk contracts, and retired-employee group plans will not be considered
duplication of other coverage.
(C) Notice to consumer--The document that contains
and is limited to the language set forth in item (7) of Figure: 28
TAC §21.113(l)(5).
(2) All insurers, other than direct response insurers,
or their agents or other intermediaries, must obtain an acknowledgment
of nonduplication with all applications for health insurance sold
to an individual who is 65 years of age or older, other than group
health coverage obtained through an employer-sponsored plan, conversion
from a group employer-sponsored health plan, short-term travel accident
coverage, short-term nonrenewable coverage, Medicare risk contracts,
and retired-employee group plans. This acknowledgment must be obtained
at the same time as the application and must be submitted to the insurer
with the application. One copy of the acknowledgment must be left
with the insured and one copy kept on file with the company. The form
of the acknowledgment or notice must be printed on a separate piece
of paper and must contain the specific language and must be in the
format set forth in item (6) of Figure: 28 TAC §21.113(l)(5).
(3) To obtain this acknowledgment, all insurers or
their agents or other intermediaries must offer to examine all health
insurance policies and health care coverage owned by a prospective
insured and advise the insured as to whether the purchase of the proposed
policy will result in any duplication of benefits.
(4) Direct response insurers that market to the consumer
without agents or other intermediaries are exempt from the requirement
to deliver the acknowledgment contained in item (6) of Figure: 28
TAC §21.113(l)(5), but must deliver the notice to consumers set
forth in item (7) of Figure: 28 TAC §21.113(l)(5).
(5) Failure to comply with paragraphs (1) - (4) of
this subsection is an unfair business practice as defined by Insurance
Code Chapter 541, concerning Unfair Methods of Competition and Unfair
or Deceptive Acts or Practices.
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| Source Note: The provisions of this §21.113 adopted to be effective February 1, 1981, 5 TexReg 3336; amended to be effective February 15, 1991, 16 TexReg 557; amended to be effective October 6, 1997, 22 TexReg 9677; amended to be effective December 9, 2007, 32 TexReg 8830; amended to be effective September 8, 2010, 35 TexReg 8117; amended to be effective June 27, 2023, 48 TexReg 3409 |
