§ 22:1260.7 — Marketing restrictions and disclosure requirements

Louisiana § 22:1260.7

• Jurisdiction: Louisiana
• Title 22: Insurance

Text

§1260.7. Marketing restrictions and disclosure requirements
A.(1) The name of the discount medical plan and the address shall be prominently
displayed on all of its advertisements, marketing materials and brochures.
(2) All advertisements, marketing materials, brochures, discount medical plan cards
and any other communications of a discount medical plan organization provided to
prospective members and members shall be truthful and not misleading in either fact or
implication.
(3) Upon request, a discount medical plan organization shall submit to the
commissioner all advertising, marketing materials and brochures regarding a discount
medical plan.
B. A discount medical plan organization shall not do any of the following:
(1) Except as otherwise provided in this Subpart or as a disclaimer of any
relationship between discount medical plan benefits and insurance, or as a description of an
insurance product connected with a discount medical plan, use in its advertisements,
marketing material, brochures and discount medical plan cards the term "insurance."
(2) Except as otherwise provided in the laws of this state, describe or characterize
the discount medical plan as being insurance whenever a discount medical plan is bundled
with an insured product and the insurance benefits are incidental to the discount medical plan
benefits.
(3) Use in its advertisements, marketing material, brochures and discount medical
plan cards the terms "health plan," "coverage," "copay," "copayments," "deductible,"
"preexisting conditions," "guaranteed issue," "premium," "PPO," "preferred provider
organization," or other terms in a manner that could mislead an individual into believing that
the discount medical plan is health insurance.
(4) Use language in its advertisements, marketing material, brochures and discount
medical plan cards with respect to being "registered" by the department in a manner that
could mislead an individual into believing that the discount medical plan is insurance or has
been endorsed by this state.
(5) Make misleading, deceptive or fraudulent representations regarding the discount
or range of discounts offered by the discount medical plan card or the access to any range of
discounts offered by the discount medical plan card or the access to any range of discounts
offered by the discount medical plan card.
(6) Have restrictions on access to health care providers who have contracted with a
discount medical plan, except for hospital services.
C.(1) Each discount medical plan organization shall, in writing that is not less than
twelve-point font, disclose on the first content page of any advertisements, marketing
materials or brochures made available to the public relating to a discount medical plan and
any enrollment forms given to a prospective member:
(a) That the plan is a discount plan and is not insurance coverage.
(b) That the range of discounts for medical services provided under the plan will vary
depending on the type of provider and medical service received.
(c) That the plan member is obligated to pay for all medical services, but will receive
a discount from those providers that have contracted with the discount medical plan
organization.
(d) The toll-free telephone number and Internet website address for the registered
discount medical plan organization for prospective members to obtain information about and
assistance on the discount medical plan and up-to-date list of providers participating in the
discount medical plan.
(2) If the initial contact with a prospective member is made by telephone, the
disclosures required under Paragraph (1) of this Subsection shall be made orally and included
in the written materials that describe the benefits under the discount medical plan provided
to the prospective or new member.
D.(1) In addition to the general disclosures required under Subsection C of this
Section, each discount medical plan shall provide the following:
(a) To each new member, at the time of enrollment, information that describes the
terms and conditions of the discount medical plan, including any limitations or restrictions
on the refund of any processing fees or periodic charges associated with the discount medical
plan.
(b) To each new member a written document that contains the terms and conditions
of the discount medical plan.
(2) The written document required under Subparagraph (1)(b) of this Subsection
shall include information on the following:
(a) The name of the member.
(b) The benefits to be provided under the discount medical plan.
(c) Any processing fees and periodic charges associated with the discount medical
plan, including any limitations or restrictions on the refund of any processing fees and
periodic charges.
(d) The mode of payment of any processing fees and periodic charges and procedure
for changing the mode of payment.
(e) Any limitations, exclusions or exceptions regarding the receipt of discount
medical plan benefits.
(f) Any waiting periods for certain medical services under the discount medical plan.
(g) Procedures for obtaining discounts under the discount medical plan, such as
requiring members to contact the discount medical plan organization to make an appointment
with a provider on the member's behalf.
(h) Cancellation procedures, including information on the member's thirty-day
cancellation rights and refund requirements and procedures for obtaining refunds.
(i) Renewal, termination and cancellation terms and conditions.
(j) Procedures for adding new members to a family discount medical plan, if
applicable.
(k) Procedures for filing complaints under the discount medical plan organization's
complaint system and information that, if the member remains dissatisfied after completing
the organization's complaint system, the plan member may contact his state insurance
department.
(l) The name and mailing address of the registered discount medical plan
organization or other entity where the member can make inquiries about the plan, send
cancellation notices and file complaints.

Legislative History

Acts 2008, No. 442, §1, eff. Jan. 1, 2009; Redesignated by Acts 2009, No. 503, §3.