415-I:11 Marketing Restrictions and Disclosure Requirement. –
I. 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 fact or in implication.
II. An advertisement, any marketing material, brochure, discount medical plan card, or other communication is misleading in fact or in implication if it has a capacity or tendency to mislead or deceive based on the overall impression that it is reasonably expected to create within the segment of the public to which it is directed.
III. A discount medical plan organization shall not:
(a) Except 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.
(b) 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.
(c) Use language in its advertisements, marketing material, brochures, and discount medical plan cards with respect to being registered by the state insurance department in a manner that could mislead an individual into believing that the discount medical plan is insurance or has been endorsed by the state.
(d) Make misleading, deceptive, or fraudulent representations regarding the discount or range of discounts offered by the discount medical plan or the access to any range of discounts offered by the discount medical plan.
(e) Have restrictions on access to discount medical plan providers, including, except for hospital services, waiting periods and notification periods.
(f) Pay providers any fees for medical or ancillary services or collect or accept money from a member to pay a provider for medical or ancillary services provided under the discount medical plan, unless the discount medical plan organization has an active certificate of authority to act as a health carrier or as a third party administrator in accordance with RSA 402-H:11.
IV. (a) Each discount medical plan organization shall make the following disclosures to prospective members.
(1) That the plan is not insurance.
(2) That the discounts for medical or ancillary services provided under the plan are available only from participating providers and will vary depending on the provider and medical or ancillary service received.
(3) That the discount medical plan organization does not make payments to providers for the medical or ancillary services received under the discount medical plan.
(4) That the plan member is obligated to pay for all medical or ancillary services, but will receive a discount from those providers that have contracted with the discount medical plan organization.
(5) The toll-free telephone number and Internet website address for the licensed discount medical plan organization for prospective members and members to obtain additional information about and assistance on the discount medical plan and up-to-date list of providers participating in the discount medical plan.
(6) Information that generally describes or summarizes 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) The disclosures required under subparagraph IV(a) shall be in writing in at least 12-point font and shall be provided along with any enrollment forms given to a prospective member and on the first content page of any advertisements, marketing materials, or brochures made available to the public relating to the discount medical plan. If the initial contact with a prospective member is by telephone, the disclosures required under subparagraph IV(a) shall be made orally and included in the initial written materials that describe the benefits under the discount medical plan provided to the prospective or new member.
(c) Each discount medical plan organization shall provide to each new member a written document that contains the terms and conditions of the discount medical plan. This written document shall be clear and include the following information:
(1) The name of the member.
(2) The benefits to be provided under the discount medical plan.
(3) 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.
(4) The mode of payment for any processing fees and periodic charges and procedures for changing the mode of payment.
(5) Any limitations, exclusions, or exceptions regarding the receipt of discount medical plan benefits.
(6) 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.
(7) Cancellation procedures, including information on the member's 30-day cancellation rights and refund requirements and procedures for obtaining refunds.
(8) Renewal, termination, and cancellation terms and conditions.
(9) Procedures for adding new members to a family discount medical plan, if applicable.
(10) 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 or her local state insurance department.
(11) The name and mailing address of the licensed discount medical plan organization or other entity where the member can make inquiries about the plan, send cancellation notices, and file complaints.