Cal. Code Regs. tit. 22 § 58052

Current through Register 2025 Notice Reg. No. 1, January 3, 2025

Section 58052 - Marketing and Disclosure Requirements

(a) Every Issuer shall submit a copy of any advertisements, educational and/or sales materials intended for use with Partnership Policies or Certificates to the Department of Health Services for review and approval at least thirty (30) days before dissemination. These materials are deemed approved unless the Department of Health Services formally disapproves them within thirty (30) days of receipt.

(b) Policies or Certificates deemed to meet the requirements of this Chapter shall be designated by the presence of the official logo of the California Partnership for Long-Term Care. The official logo shall be printed on every Partnership Policy or Certificate, and all application forms, sales materials, and other information used by the Issuer in conjunction with the sales and marketing of Partnership Policies and Certificates. Subject to the conditions in this Section, all materials bearing this logo must be reviewed and approved by the Department of Health Services.

(c) No long-term care insurance Policy or Certificate may be advertised, solicited, or issued for delivery in this state as a Partnership Long-Term Care Insurance Policy or Certificate unless the Issuer does the following:

(1) provides the Department of Health Services with a written summary of the methods the Issuer will use to alert the consumer, prior to presentation of an application for a Partnership Policy or Certificate, of the availability of consumer information and public education provided by the California Department of Aging's Health Insurance Counseling and Advocacy Program;

(2) uses applications to be signed by the applicant which indicates, that the applicant;

(A) received, prior to the presentation of an application or enrollment form, a complete description of the California Partnership for Long-Term Care in a form and format prepared by the Department of Health Services, including an explanation of Asset Protection provided by the program and how it is achieved and the Health Insurance Counseling and Advocacy Program's toll free consumer information number; and

(B) received, prior to the presentation of an application or enrollment form, a copy of a long-term care insurance shoppers guide approved by the California Partnership for Long-Term Care; and

(C) received a statement regarding Medi-Cal eligibility and benefits that shall be in the following format:

"NOTICE TO APPLICANT REGARDING MEDI-CAL ELIGIBILITY

I understand that eligibility for Medi-Cal is not automatic; an application is necessary. Once my long-term care insurance begins paying benefits, the insurer will send me quarterly statements showing how much asset protection I have earned. This permanent asset protection is in addition to any asset exemptions available to any Californian applying for Medi-Cal. I understand that should I want to apply for Medi-Cal it is my responsibility to complete the application process. I further understand that before receiving Medi-Cal I will first have to use any additional assets I have not protected. If I become a Medi-Cal beneficiary, I understand that I may have to apply a portion of my income toward the cost of my care, and that Medi-Cal services at that time may not be the same services I was receiving under my private long-term care insurance.

______________________________

(Signature of Applicant(s))"

(D) agrees to the release of information by the Issuer to the State as may be needed to evaluate the California Partnership for Long-Term Care and to provide the necessary verification to document the applicant's Medi-Cal Property Exemption, in the following format:

"CONSENT AND AUTHORIZATION TO RELEASE INFORMATION

I hereby agree to the release of all records and information pertaining to this long-term care insurance policy or certificate to the State of California for the purposes of documenting my Medi-Cal asset disregard under the Medi-Cal program, evaluating the California Partnership for Long-Term Care, and meeting Department of Health Services or Department of Insurance audit or quality control requirements.

As part of the evaluation of the California Partnership for Long-Term Care, the State is trying to determine how well this program is reaching people with varying amounts of income and assets. You will therefore be asked to fill out a brief survey, prepared by the State, and indicate what range your income and assets fall into.

I understand that the information contained in these records will be used for no purpose other than those stated above, and will be kept strictly confidential by the State of California.

______________________________

(Signature of Applicant(s))"

(E) Received a graphic comparison in a form provided by the California Partnership for Long-Term Care showing the benefit levels of a Policy or Certificate that increases benefits at a compounded annual rate of not less than five percent (5%) over the Policy or Certificate period with a policy or certificate that does not increase benefits. The graphic comparison shall show benefit levels over at least a twenty (20) year period.

The comparison will also illustrate the costs the Policy or Certificate holder would pay out of their own income or assets for nursing home care between a Policy or Certificate that does not increase benefits and;

1. an expense reimbursable Policy or Certificate that increases benefits but not premiums over the Policy or Certificate period; and

2. an expense incurred Policy or Certificate that increases premiums and benefits over the Policy or Certificate period.

(F) Received a statement regarding the absence of a Medi-Cal residential care facility benefit if the application is for a Nursing Facility and Residential Care Facility Only Policy or Certificate with the following features:

1. Benefit Eligibility is based on deficiencies in two Activities of Daily Living; and

2. the lifetime maximum benefit is less than seven hundred thirty (730) times the Nursing Facility per diem benefit.

(G) Issuers that market by direct mail response without sales agents will meet the requirements of Subsections (c)(2)(A) and (B), above, by using applications, to be signed by the applicant, that indicate the applicant received the specified publications and information prior to completing the application or enrollment form.

Cal. Code Regs. Tit. 22, § 58052

1. New section filed 8-30-93 as an emergency; operative 8-30-93 (Register 93, No. 36). Submitted for printing only pursuant to section 22009, Welfare and Institutions Code.
2. Certificate of Compliance as to 8-30-93 order, including amendments of subsections (a), (c)(2)(A) and (c)(2)(C) and new subsection (c)(2)(G) transmitted to OAL 12-30-93 and filed 1-28-94 (Register 94, No. 4).
3. Repealer of subsection (c)(2)(E), redesignation of former subsection (c)(2)(F), and amendment of subsection (c)(2)(F02 filed 10-26-94 as an emergency; operative 10-26-94 (Register 94, No. 43). Submitted for printing only pursuant to section 22009, Welfare and Institutions Code.
4. Certificate of Compliance as to 10-26-94 order transmitted to OAL 2-22-95 and filed 3-30-95 (Register 95, No. 13).
5. Amendment filed 10-1-98 as an emergency; operative 10-1-98. Submitted to OAL for printing only pursuant to Welfare and Institutions Code section 22009(d) (Register 98, No. 41). A Certificate of Compliance must be transmitted to OAL by 1-29-99 or emergency language will be repealed by operation of law on the following day.
6. Certificate of Compliance as to 10-1-98 order transmitted to OAL 1-28-99 and filed 3-15-99 (Register 99, No. 12).

Note: Authority cited: Sections 22005 and 22009(a), Welfare and Institutions Code. Reference: Sections 22001, 22003, 22004 and 22006, Welfare and Institutions Code.