W. Va. Code R. § 114-17-8

Current through Register Vol. XLI, No. 50, December 13, 2024

Section 114-17-8 - Prohibited Acts or Practices

8.1. Solicitation or sale. -- No person shall engage in any unfair, deceptive, misleading or unreasonably confusing act or practice in the promotion, solicitation or sale of accident and health insurance delivered or issued for delivery in this State to persons eligible for Medicare by reason of age.

8.2. Prima facie violations. -- The following acts and practices shall be deemed prima facie evidence of a violation of this section:

(a) Any act which encourages an applicant to omit pertinent underwriting information from an application;

(b) Any act which induces a prospective insured to sign a blank or incomplete application, acknowledgment or form;

(c) Failure to disclose, during initial solicitation to a prospective insured, any affiliation with an insurer;

(d) Any representations, expressed or implied, unless specifically authorized in writing by the organization, of affiliation with or authorization by any civic, social or other nongovernmental organization;

(e) Any representation, expressed or implied, of affiliation with or authorization by any governmental agency or of access to any information from any such agency which is not generally available to the public;

(f) The making of any false or misleading statements as to the length of time an insurance policy or contract may or may not be available;

(g) The issuance of any policy or contract, which has not been submitted to and approved by the Commissioner;

(h) The sale of Medicare Supplement or Limited Benefit Medicare Supplement insurance to any person not eligible for Medicare;

(i) The sale of any accident and/or sickness insurance policy or contract to any person without ascertaining whether the person is eligible for Medicare by reason of age;

(j) The sale of any accident and sickness insurance policy or contract to any person who indicates eligibility for Medicare by reason of age, without strict adherence to the disclosure requirements of this regulation;

(k) Falsely answering any question or signing any certification in any application or form required to be completed by the prospective insured;

(l) Failure by an agent to deliver, within seven (7) business days, any policy sent to the agent for delivery to an applicant;

(m) The taking of an application, except by direct response, without inquiring and recording the reply as to whether the proposed insurance will duplicate any insurance then enforce; or

(n) Making any inquiry in such manner as to invite a response contrary to fact.

W. Va. Code R. § 114-17-8