California Legislature—2013–14 Regular Session

Assembly Bill No. 1234

Introduced by Assembly Member Levine

February 22, 2013

An act to amend Section 10234.93 of the Insurance Code, relating to insurance.

LEGISLATIVE COUNSEL’S DIGEST

AB 1234, as introduced, Levine. Insurance: long term care insurance.

Existing law provides for the regulation of insurers by the Department of Insurance, including insurers issuing policies of long-term care insurance. Existing law regulates the marketing or solicitation of long-term care insurance policies and, in that regard, requires specified disclosures to prospective applicants or enrollees. Existing law requires an insurer of long-term care insurance to clearly post on its Internet Web site and provide written notice at the time of solicitation that a specimen individual policy form or group master policy and certificate form for each policy form offered by the insurer is available upon request and to provide that form within 15 calendar days upon request.

This bill would additionally require an insurer to clearly post on its Internet Web site, and include on its policy application, information about an Internet Web site provided by the Department of Health Care Services, known as www.rureadyca.org.

Vote: majority. Appropriation: no. Fiscal committee: no. State-mandated local program: no.

The people of the State of California do enact as follows:

SECTION 1.  

Section 10234.93 of the Insurance Code is
amended to read:

10234.93.  

(a) Every insurer of long-term care in California
shall:

(1) Establish marketing procedures to assure that any comparison
of policies by its agents or other producers will be fair and accurate.

(2) Establish marketing procedures to assure excessive insurance
is not sold or issued.

(3) Submit to the commissioner within six months of the
effective date of this act, a list of all agents or other insurer
representatives authorized to solicit individual consumers for the
sale of long-term care insurance. These submissions shall be
updated at least semiannually.

(4) Provide the following training and require that each agent
or other insurer representative authorized to solicit individual
consumers for the sale of long-term care insurance shall
satisfactorily complete the following training requirements that,
for resident licensees, shall count toward the licensee’s continuing
education requirement, but may still result in completing more
than the minimum number of continuing education hours set forth
in this section:

(A) For licensees issued a license after January 1, 1992, eight
hours of training in each of the first four 12-month periods
beginning from the date of original license issuance and thereafter
eight hours of training prior to each license renewal.

(B) For licensees issued a license before January 1, 1992, eight
hours of training prior to each license renewal.

(C) For nonresident licensees that are not otherwise subject to
the continuing education requirements set forth in Section 1749.3,
the evidence of training required by this section shall be filed with
and approved by the commissioner as provided in subdivision (g)
of Section 1749.4.

Licensees shall complete the initial training requirements of this
section prior to being authorized to solicit individual consumers
for the sale of long-term care insurance.

The training required by this section shall consist of topics related
to long-term care services and long-term care insurance, including,
but not limited to, California regulations and requirements,
available long-term care services and facilities, changes or
improvements in services or facilities, and alternatives to the
purchase of private long-term care insurance. On or before July
1, 1998, the following additional training topics shall be required:
differences in eligibility for benefits and tax treatment between
policies intended to be federally qualified and those not intended
to be federally qualified, the effect of inflation in eroding the value
of benefits and the importance of inflation protection, and NAIC
consumer suitability standards and guidelines.

(5) Display prominently on page one of the policy or certificate
and the outline of coverage: “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.”

(6) 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.

(7) Every insurer or entity marketing long-term care insurance
shall establish auditable procedures for verifying compliance with
this subdivision.

(8) Every insurer shall provide to a prospective applicant, at the
time of solicitation, written notice that the Health Insurance
Counseling and Advocacy Program (HICAP) provides health
insurance counseling to senior California residents free of charge.
Every agent shall provide the name, address, and telephone number
of the local HICAP program and the statewide HICAP number,
1-800-434-0222.

(9) Provide a copy of the long-term care insurance shoppers
guide developed by the California Department of Aging to each
prospective applicant prior to the presentation of an application or
enrollment form for insurance.

(10) Clearly post on its Internet Web site and provide written
notice at the time of solicitation that a specimen individual policy
form or group master policy and certificate form for each policy
form offered in this state is available to a prospective applicant
upon request. The individual specimen policy form or group master
policy and certificate form shall be provided to a requesting party
within 15 calendar days or receipt of a request.

begin insert

(11) Clearly post on its Internet Web site, and include on its
policy application, information about an Internet Web site provided
by the Department of Health Care Services, known as
www.rureadyca.org.

end insert

(b) In addition to other unfair trade practices, including those
identified in this code, the following acts and practices are
prohibited:

(1) Twisting. Knowingly making any misleading representation
or incomplete or fraudulent comparison of any insurance policies
or insurers 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.

(2) High pressure tactics. Employing any 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.

(3) Cold lead advertising. Making use directly or indirectly of
any 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.