Every insurance company marketing long-term care insurance coverage must establish marketing procedures to assure that any comparison of policies by its agents or other producers will be fair and accurate. Insurance companies must have marketing guidelines to ensure excessive insurance is not sold or issued.

The insurance company must retain all advertisements for at least 3 years from the date that the advertisement was first used.

When recommending the purchase or replacement of any long-term care policy, an agent must make reasonable efforts to determine the appropriateness of a recommended purchase or replacement.

Every insurer marketing long-term care insurance coverage must establish marketing procedures to ensure that:

• Any comparison of policies will be fair and accurate;
• Excessive insurance will not be sold; and
• Every reasonable effort is made to identify whether a prospective applicant for long-term care insurance already has accident and health or long-term care insurance, and the types and amounts of any such insurance.

Long-term care insurance policies are also subject to the same marketing requirements regarding twisting, high-pressure tactics, and cold lead advertising as Medicare supplement policies.

In the state of Ohio, all long-term care policies must offer each policyholder an inflation protection feature that provides, as a minimum, one of the following benefits:

• Increase of 5% for the annual benefit level;
• The right of the insured to periodically increase benefit levels without providing evidence of insurability or health status (as long as the option has not been declined for the previous period); and/or
• Coverage for a specified percentage of actual or reasonable charges.

If a long-term care insurance policy or certificate replaces another, the replacing insurance company must waive any time periods applicable to pre-existing conditions, waiting periods and probationary periods in the new long-term care policy or certificate for similar benefits to the extent that similar exclusions have been satisfied under the original policy or certificate.

An individual long-term care policy cannot be issued until the insurer has received from the applicant either a written designation of at least one person, in addition to the applicant, who is to receive notice of lapse or termination of the policy for nonpayment of premium, or a written waiver dated and signed by the applicant reflecting their decision not to designate additional people. This is also known as the secondary addressee provision.

The outline of coverage must follow the standard format set out in the insurance regulations including information about the insurance company, the policy number and important features of the policy. The outline of coverage must be a separate document, and must be delivered to the insured prior to the application or enrollment form.

A long-term care insurance Shopper’s Guide must be provided in the format developed by the National Association of Insurance Commissioners (NAIC). The shopper’s guide must be presented to the applicant prior to completing the application (in the case of producer solicitation), or in conjunction with the application (in the case of direct response solicitations).

The term pre-existing condition means a condition for which medical advice or treatment was recommended (or received) from a health care services provider within 6 months of the effective date of coverage. The definition of a pre-existing condition, however, does not prohibit an insurer from using an application form designed to elicit the complete health history of an applicant.