Under the Affordable Care Act, state-based health insurance exchanges must actively
monitor and regulate marketing practices and step in to promptly stop any
misleading or deceptive marketing; ensure that incentives brokers and agents receive are
appropriate to guide consumers to good enrollment choices; and ensure that consumers
who use brokers or agents will also be informed about how to contact their state’s
exchange and get further information from the exchange’s website.
The Silver State Health Insurance Exchange (“Exchange”) incorporates values of honesty,
integrity, fairness, impartiality and transparency on the foundation of which the
Exchange’s Brokers/Agents Code of Conduct was formed. All Brokers/Agents must
respect and obey all federal, state laws and regulations. 45 CFR 155.220
The Exchange has zero tolerance for noncompliant marketing behavior. Over and above
compliance, the Exchanges’ Brokers/Agents are expected to act with the highest ethical
standards in all of their business dealings.
All Brokers/Agents representing the Exchange and its carrier partners are required to
abide by this Brokers/Agents Code of Conduct. Those who violate standards in this Code
will be subject to termination. After reading each section initial in the space provided
before signing the document.
Brokers/Agents must be persons of high integrity. Without honesty and integrity, there is
no foundation of trust. Unequivocal honesty is what leads to creating the trust of a
consumer. Consumers must never be provided with information that is false or
misleading. Brokers/Agents must not engage in misrepresentation, fraud and/or deceit
cannot be tolerated; either act should lead to immediate termination by the Exchange.
The Exchange expects Brokers/Agents to perform fairly and honestly, not through
unethical or illegal business practices. Brokers/Agents must endeavor to respect the rights
of and deal fairly with the consumers and carrier partners and may not take unfair
advantage of anyone through manipulation, concealment, abuse of privileged
information, misrepresentation of material facts, or any other intentional unfair-dealing
The Exchange is firmly committed to providing equal opportunity in all aspects of
it’s business practices and will not tolerate illegal discrimination or harassment of any
kind. In dealings with consumers and the general public, Brokers and Agents must
always be mindful to act in accordance with the highest standards of professionalism and
ethics, and avoid conduct that could be construed as discrimination or harassment.
Brokers/Agents may not disparage the Exchange, its carrier partners, competitors or their
products or plans, nor shall make unsubstantiated comparisons or seek to influence the
cancellation of any contract that may exist between competitors and consumers.
Participating Brokers/Agents must have prior approval of their marketing materials and
web site representation by the Exchange and follow the Exchange’s co-branding
Brokers/Agents will clearly identify themselves as such and their relationship to the
Exchange, disclose they are a licensed insurance agent, and never imply in any manner
that they are an employee of any carrier, health plan, the Exchange or the U.S.
Brokers/Agents will conduct themselves with courtesy, dignity, and respect for the rights
and reasonable requests of consumers and potential consumers at all times.
The business of health insurance is declared to be a public trust in which all
Brokers/Agents of all companies have a common obligation to work together in serving
the best interests of the insuring public. Consistent with that, Brokers/Agents must
understand and observe the laws governing insurance in spirit by presenting accurately
and completely every fact essential to a consumer’s decision, and by always placing the
consumer’s best interests first.
Brokers/Agents will not engage in activities that could mislead or confuse consumers or
potential consumers or misrepresent the Exchange, its carrier partners or their products or
Inducements are a violation of law and are unethical. Except as otherwise expressly
provided by law, Brokers/Agents will not knowingly make or offer any agreement
pertaining to any insurance contract other than as plainly provided in the contract itself.
Except as expressly provided by law, Brokers/Agents will not give or provide
anything of value to a consumer, directly or indirectly, as an inducement to any insurance
transaction. In addition, to tangible items having value, inducements include special
favors and offers to pay or rebate any portion of premiums or charges, or to share
commissions or bonuses.
Misrepresentations are a violation of law and are unethical. Brokers/Agents will not make
any statement concerning any insurance product or plan that is untrue, deceptive or
misleading. Brokers/Agents will not make false or misleading statements as to the
financial condition of any carrier, or use any name or title of any insurance product or
class of products misrepresenting the true nature thereof.
Brokers/Agents will ensure that all information on any application is completely filled in
by the consumer or the consumer’s authorized representative, at the direction of the
consumer and/or the consumer’s authorized representative, and in the presence of the
consumer and/or the consumer’s authorized representative. Brokers/Agents will never
sign any application on behalf of any consumer, even if directed by the consumer to do
so. Brokers/Agents will verify that all information on the application is correct, and
confirm the consumer’s intent to make application for that product or plan.
In recommending any product to a consumer, Brokers/Agents will first make reasonable
efforts to obtain information concerning the consumer’s health status to evaluate the
suitability of the recommendation. Before initiating the purchase or exchange of a health
insurance product resulting from a recommendation to a consumer, regardless of whether
the transaction will involve replacement or exchange of any other product or plan, you
will objectively consider all information provided by the consumer to ensure that the
transaction is suitable.
Brokers/Agents will not use any form of scare tactic, coercion, deception, sympathy
appeal, false sense of urgency or other high pressure tactic to cause a consumer or
potential consumer to enter into any transaction. Brokers/Agents will always give clear
and accurate information regarding their relationship with the Exchange and its carrier
partners, and avoid the use of false, contextually misleading, or exaggerated statements.
During every health plan review, Brokers/Agents will take steps to fully explain all
benefits and exceptions as it pertains to each carrier.
It is inevitable that Brokers/Agents will sometimes commit mistakes or make initial
decisions on claims which are not the right ones. These situations will generate consumer
complaints. The important consideration is that when a complaint is received, the Broker/
Agent treats it seriously, responds to the complaint with promptness and courtesy, and
advises the consumer of his/her options when he/she is not satisfied with the response to
In dealings with consumers and other insurance professionals, Brokers/Agents will learn
information about policyholders and other interested parties that is sensitive. Such
information must be protected at all time. It must be kept strictly confidential and not
passed on to other parties without advance notice to the consumer or other individuals
Brokers/Agents must be able to demonstrate that they have taken proactive steps to
maintain their professional knowledge at levels that would equal currently recognized
“best practice” standards.
The Exchange may terminate Brokers/Agents for cause based on a specific finding of
noncompliance or a sufficiently severe pattern of noncompliance with regard to a
federal law, state law, applicable regulations, or the Broker/Agent Code of Conduct. In
instances of termination for cause, the Exchange will issue a notice to the Broker/Agent
identifying the specific finding or pattern of noncompliance and indicating that, if the
matter is not resolved to the satisfaction of the Exchange within 30 days of the date of
the notice, the Exchange may terminate the Broker/Agent agreement and the Broker/
Agent’s ability to enroll consumers on the marketplace.
Brokers/Agents may request reconsideration of termination for cause within 30
calendar days of the date of the written termination notice from the Exchange. The
Exchange will respond within 30 days of receiving the request for reconsideration, and
this response will constitute a final determination. The Exchange retains the right to
bypass the termination process described above and terminate a Broker/Agent
immediately when noncompliance is sufficiently egregious.
I have read and understand the Exchange’s Brokers/Agents Code of Conduct. I
understand that, should I be found in violation of any of the provisions of this Code
during my association with the Exchange, my contact and appointment are subject to
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