Chapter Ins 3

Ins 3.27(10)(j)15. 15. Occupational exclusion.

Ins 3.27(10)(j)16. 16. Violation of law.

Ins 3.27(10)(j)17. 17. Automatic benefit in lieu of another benefit.

Ins 3.27(10)(j)18. 18. Confinement in government hospital.

Ins 3.27(10)(j)19. 19. Pregnancy.

Ins 3.27(10)(j)20. 20. Miscarriage in sickness or accident and sickness policy.

Ins 3.27(10)(j)21. 21. Restrictions relating to organs not common to both sexes.

Ins 3.27(10)(j)22. 22. Restrictions on number of hospital hours before benefit accrues.

Ins 3.27(10)(j)23. 23. Insanity, mental diseases or disorders or nervous disorder.

Ins 3.27(10)(j)24. 24. Dental treatment, surgery or procedures.

Ins 3.27(10)(j)25. 25. Cosmetic surgery.

Ins 3.27(10)(j)26. 26. While intoxicated or under the influence of narcotics, or other language not substantially the same as the uniform individual policy provision regarding the use of intoxicants and narcotics.

Ins 3.27(10)(j)27. 27. Unemployed persons.

Ins 3.27(10)(j)28. 28. Retired persons.

Ins 3.27(10)(j)29. 29. While handling explosives or chemical compounds.

Ins 3.27(10)(j)30. 30. While or as a result of participating in speed contests.

Ins 3.27(10)(j)31. 31. While or as a result of riding a motorcycle or motorcycle attachment.

Ins 3.27(10)(j)32. 32. While or as a result of participating in professional athletics.

Ins 3.27(10)(j)33. 33. While or as a result of participating in certain specified sports.

Ins 3.27(10)(j)34. 34. While or as a result of serving as a volunteer firefighter or in other hazardous occupations.

Ins 3.27(10)(j)35. 35. Riot or while participating in a riot.

Ins 3.27(10)(j)36. 36. Ptomaine poisoning.

Ins 3.27(10)(j)37. 37. Gas or poisonous vapor.

Ins 3.27(10)(j)38. 38. Sunstroke or heat prostration.

Ins 3.27(10)(j)39. 39. Freezing.

Ins 3.27(10)(j)40. 40. Poison ivy or fungus infection.

Ins 3.27(10)(j)41. 41. Requirement of permanent disability.

Ins 3.27(10)(j)42. 42. Reduction because of other insurance.

Ins 3.27(10)(j)43. 43. Limitations on the choice of providers or geographical area served.

Ins 3.27(10)(k) (k) The following are examples of exceptions, reductions and limitations which generally do not affect the basic policy provisions to such an extent that their absence would cause the advertisement to have the capacity and tendency to mislead or deceive.

Ins 3.27(10)(k)1. 1. Suicide or attempted suicide, while sane or insane.

Ins 3.27(10)(k)2. 2. Intentional self-inflicted injury.

Ins 3.27(10)(k)3. 3. Territorial restriction with no limitation of coverage while in United States and Canada.

Ins 3.27(10)(k)4. 4. Aviation exclusion under which passage on commercial airlines is covered.

Ins 3.27(10)(k)5. 5. Felony or illegal occupation.

Ins 3.27(10)(k)6. 6. All uniform individual policy provisions, both required and optional, other than those relating to other insurance.

Ins 3.27(10)(k)7. 7. Requirement for regular care by a physician.

Ins 3.27(10)(k)8. 8. Definition of total disability.

Ins 3.27(10)(k)9. 9. Definition of partial disability.

Ins 3.27(10)(k)10. 10. Definition of hospital.

Ins 3.27(10)(k)11. 11. Definition of specific total loss.

Ins 3.27(10)(k)12. 12. Definition of injury.

Ins 3.27(10)(k)13. 13. Definition of physician or surgeon.

Ins 3.27(10)(k)14. 14. Definition of nurse.

Ins 3.27(10)(k)15. 15. Definition of recurrent disability.

Ins 3.27(10)(k)16. 16. Definition of commercial air travel.

Ins 3.27(10)(k)17. 17. Provision that hernia will be considered a sickness.

Ins 3.27(10)(k)18. 18. Rest cure.

Ins 3.27(10)(k)19. 19. Diagnosis.

Ins 3.27(10)(k)20. 20. Prosthetics.

Ins 3.27(10)(k)21. 21. Cosmetic surgery exclusion under which such surgery which results from injury is covered.

Ins 3.27(10)(k)22. 22. Dental treatment, surgery or procedures exclusion under which such treatment which results from injury to sound natural teeth is covered.

Ins 3.27(10)(k)23. 23. Bacterial infection exclusion under which pyogenic infection which results from injury is covered.

Ins 3.27(10)(k)24. 24. Eye examination for fitting of glasses.

Ins 3.27(10)(k)25. 25. Hearing aid.

Ins 3.27(10)(k)26. 26. Exclusion of sickness or disease in a policy providing only accident coverage.

Ins 3.27(10)(k)27. 27. Exclusion for miscarriage in policy providing only accident coverage.

Ins 3.27(11) (11) Renewability, cancelability and termination. An advertisement shall disclose, as required below, the provisions relating to renewability, cancelability and termination and any modification of benefits, losses covered or premiums because of age or for other reasons, in a manner which shall not minimize or render obscure the qualifying conditions.

Ins 3.27(11)(a) (a) Any advertisement which refers to renewability, cancelability or termination of a policy shall be subject to the disclosure requirements of this subsection.

Ins 3.27(11)(b) (b) An advertisement which refers to a policy benefit and which is an invitation to apply shall be subject to the disclosure requirements of this subsection.

Ins 3.27(11)(c) (c) An advertisement which refers to a policy benefit and which is an invitation to inquire shall not be subject to the disclosure requirements of this subsection unless:

Ins 3.27(11)(c)1. 1. Paragraph (a) or (f) applies or

Ins 3.27(11)(c)2. 2. Such an advertisement mentions benefits, benefit periods or premiums for the purpose of doing more than identifying the policy.

Ins 3.27(11)(d) (d) A booklet, summary or explanation of coverage issued to insured persons shall be subject to the disclosure requirements of this subsection.

Ins 3.27(11)(e) (e) An advertisement which refers to a policy benefit and which is an institutional advertisement shall not be subject to the disclosure requirements of this subsection unless par. (a) or (f) applies.

Ins 3.27(11)(f) (f) An advertisement which states or illustrates time or age in connection with eligibility of applicants or continuation of the policy and which implies permanency shall be subject to the disclosure requirements of this subsection.

Ins 3.27(11)(g) (g) The actual policy language concerning renewability, cancelability or termination need not be used in an advertisement subject to the disclosure requirements of this subsection. However, all pertinent information shall be disclosed.

Ins 3.27(11)(h) (h) The qualifying conditions applicable to a non-cancellable policy and to a guaranteed renewable policy shall include age limits, aggregate benefit limits and modifications of benefits because of age, other than such modifications occurring at or about the time the policy terminates. A qualifying condition applicable to a guaranteed renewable policy shall be the insurer’s reservation of the right to change premiums.

Ins 3.27(11)(i) (i) The qualifying conditions shall be set forth with the language describing renewability.

Ins 3.27(11)(j) (j) An advertisement of a group or blanket policy which would otherwise be subject to the disclosure requirements of this subsection need not disclose the policy’s provisions relating to renewability, cancelability and termination. Such advertisement shall provide, however, as a minimum, that an insured person’s coverage is contingent upon continued membership in the group and the continuation of the plan.

Ins 3.27(11)(k) (k) An advertisement of a non-cancellable policy or of a guaranteed renewable policy shall also be subject to sub. (25).

Ins 3.27(11)(L) (L) An advertisement of a franchise, wholesale, collectively renewable, or non-renewable for stated reasons only policy, or any other policy under which the insurer has by policy provision limited its right to terminate to one or more reasons, shall accurately set forth the policy’s renewal provisions if disclosure of such renewal provisions is required by par. (a), (b), (c), (d) or (e). Such advertisement shall not state or imply renewal terms which are more favorable than those actually contained in the policy. Such advertisement shall not state or imply that the policy is guaranteed renewable or warranted renewable or that renewal is guaranteed or warranted or use other variations of such expressions.

Ins 3.27(12) (12) Identity of insurer.

Ins 3.27(12)(a) (a) The identity of the insurer shall be made clear in all of its advertisements.

Ins 3.27(12)(b) (b) An advertisement shall not use a trade name, an insurance group designation, the name of the parent company of the insurer, the name of a government agency or program, the name of a department or division of an insurer, the name of an agency, the name of any other organization, a service mark, a slogan, a symbol or any other device which has the capacity and tendency to mislead or deceive as to the identity of the insurer.

Ins 3.27(12)(c) (c) An advertisement shall not use any combination of words, symbols or materials which, by its content, phraseology, shape, color, nature or other characteristics, is so similar to combinations of words, symbols or materials used by federal, state or local government agencies that it tends to confuse or mislead prospective buyers into believing that the solicitation is in some manner connected with such a government agency.

Ins 3.27(12)(d) (d) An advertisement shall not refer to an affiliate of the insurer without disclosing that the 2 organizations are separate legal entities.

Ins 3.27(12)(e) (e) An advertisement shall not indicate an address for an insurer in such a way as to mislead or deceive as to its identity or licensing status. An advertisement which indicates an address for an insurer other than that of its home office shall clearly identify such address and clearly disclose the actual city and state of domicile of the insurer.

Ins 3.27(13) (13) Testimonials, endorsements or commendations by third parties.

Ins 3.27(13)(a) (a) An advertisement shall not contain a testimonial, endorsement or other commendatory statement concerning the insurer, its policies or activities by any person who receives any pay or remuneration, directly or indirectly, from the insurer in connection with such testimonial, endorsement or statement. Any advertisement containing a testimonial, endorsement or statement not prohibited by the foregoing, shall include a full and prominent disclosure therein of the relationship, direct or indirect, including but not limited to financial interest and remuneration, between the insurer and the person making such testimonial, endorsement or statement. The provisions of this paragraph do not apply to any person holding a Wisconsin insurance agent’s license nor to any radio or television announcer or other person employed or compensated on a salaried or union wage scale basis.

Ins 3.27(13)(b) (b) A testimonial or endorsement used in an advertisement shall be genuine, represent the current opinion of the author, be applicable to the policy advertised and be accurately reproduced.

Ins 3.27(13)(c) (c) An insurer shall not use a testimonial or endorsement:

Ins 3.27(13)(c)1. 1. Which is fictional,

Ins 3.27(13)(c)2. 2. Where the insurer has information indicating a substantial change of view on the part of the author,

Ins 3.27(13)(c)3. 3. Where it is reasonable to conclude that the views expressed do not correctly reflect the current opinion of the author,

Ins 3.27(13)(c)4. 4. For more than 2 years after the date on which it was originally given or 2 years after the date of a prior confirmation without obtaining a confirmation that the statement represents the author’s current opinion,

Ins 3.27(13)(c)5. 5. Which does not accurately reflect the present practices of the insurer,

Ins 3.27(13)(c)6. 6. To advertise a policy other than the one for which such statement was given, unless the statement clearly has some reasonable application to the second policy,

Ins 3.27(13)(c)7. 7. In which a change or omission has been effected which alters or distorts its meaning or intent as originally written, or