BROKER/AGENT CODE OF CONDUCT

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.

HONESTY, INTEGRITY AND TRUSTWORTHINESS

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.

COMPETITION AND FAIR DEALING

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 practice.

ANTI-DISCRIMINATION

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.

NON-DISPARAGEMENT

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.

USE OF APPROVED MARKETING MATERIALS

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 standards.

IDENTIFICATION

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. Government.

RIGHTS OF CONSUMERS

Brokers/Agents will conduct themselves with courtesy, dignity, and respect for the rights and reasonable requests of consumers and potential consumers at all times.

BEST INTERESTS OF THE CONSUMER

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.

DECEPTIVE ACTIVITIES

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 plans.

UNLAWFUL INDUCEMENTS

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.

MISREPRESENTATION

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.

DUTY TO VERIFY CLIENT INFORMATION AND INTENT

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.

DUTY TO ENSURE SUITABILITY OF PRODUCT RECOMMENDATION

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.

HIGH PRESSURE SALES TACTICS

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.

PRODUCT/PLAN REVIEW

During every health plan review, Brokers/Agents will take steps to fully explain all benefits and exceptions as it pertains to each carrier.

PROMPT CONSIDERATION OF CONSUMER COMPLAINTS

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 his/her complaint.

RESPECT FOR CONFIDENTIALITY

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 concerned.

PROFESSIONAL CONDUCT

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.

CERTIFICATION AND TERMINATION

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.

APPEAL OF TERMINATION

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 termination.

Name: Agree: Date:

State of Nevada

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