Ins 3.27(9)(r)6.6. A workers’ compensation or employers’ liability or occupational disease law exception, reduction, or limitation; Ins 3.27(9)(r)7.7. A reduction based on social security benefits or other disability benefits; or Ins 3.27(9)(s)(s) An advertisement shall not state a policy’s benefits are tax free unless an explanation of the rules applicable to the taxation of such types of accident and sickness benefits is clearly shown with equal prominence and in close conjunction with such statement. An advertisement of a benefit for which payment is conditioned upon confinement in a hospital or similar facility shall not state that such benefit is tax free. Ins 3.27(9)(t)(t) An advertisement shall not use the expressions “extra cash,” “cash income,” “income,” “cash,” or similar words or phrases in such a way as to imply that the insured will receive benefits in excess of the expenses incurred while being sick, injured or hospitalized. Ins 3.27(9)(u)(u) The description in advertisements of government insurance programs, including Medicare, and of changes in such program shall be accurate and not give an incorrect impression as to the need for supplementary coverage. If gaps in such programs are referred to, they shall be described fairly so that the reader or listener can determine how the policy being advertised covers such gaps. Ins 3.27(9)(v)(v) An invitation to apply advertisement which refers to a policy as being a Medicare supplement shall: Ins 3.27(9)(v)1.1. Contain a prominent statement indicating which Medicare benefits the policy is intended to supplement (for example, hospital benefits) and which Medicare benefits the policy will not supplement (for example, medical-surgical benefits) and shall clearly disclose any gaps in Medicare coverage for which the policy does not provide benefits; and Ins 3.27(9)(v)2.2. Clearly indicate the extent of the benefits if the policy bases benefits on expenses incurred beyond what Medicare covers and thus provides somewhat limited benefits for short term hospital confinements. Ins 3.27(9)(w)(w) An advertisement may refer to immediate coverage or guaranteed issuance of a policy only if suitable administrative procedures exist so that the policy is issued within a reasonable time after the application is received. Ins 3.27(9)(x)(x) If an advertisement indicates an initial premium which differs from the renewal premium on the same mode, the renewal premium shall be disclosed with equal prominence and in close conjunction with any statement of the initial premium. Any increase in premium or reduction in coverage because of age shall be clearly disclosed. Ins 3.27(9)(y)(y) An advertisement shall not state that the policy contains no waiting period unless pre-existing conditions are covered immediately or unless the status of pre-existing conditions is disclosed with equal prominence and in close conjunction with such statement. Ins 3.27(9)(z)(z) An advertisement shall not state that no age limit applies to a policy unless applications from applicants of any age are considered in good faith and such statement clearly indicates the date or age to which the policy may be renewed or that the company may refuse renewal. Ins 3.27(9)(za)(za) An advertisement shall not state that no medical, doctor’s or physical examination is required or that no health, medical or doctor’s statements or questions are required or that such examination, statements or questions are waived or otherwise state or imply that the applicant’s physical condition or medical history will not affect the policy unless: Ins 3.27(9)(za)1.1. The statement indicates with equal prominence that it applies only to the issuance of the policy or to both the issuance of the policy and the payment of claims, and Ins 3.27(9)(za)2.2. Pre-existing conditions are covered immediately under the policy or the period of time following the effective date of the policy during which pre-existing conditions are not covered is disclosed with equal prominence and in close conjunction with such statement. Ins 3.27(9)(zb)(zb) An advertisement of a limited policy as defined in s. Ins 3.13 (2) (h) shall prominently indicate that the policy provided limited coverage with an appropriate statement such as “THIS IS A CANCER ONLY POLICY” or “THIS IS AN AUTOMOBILE ACCIDENT ONLY POLICY,” and shall clearly disclose what injuries or sicknesses and what losses are covered. Ins 3.27(9)(zc)(zc) An advertisement of a policy which provides benefits for injuries only or for sickness only shall prominently indicate that the policy covers injuries only or sickness only. Ins 3.27(9)(zd)(zd) An advertisement shall not refer to a policy or coverage as being “special” unless it can be shown that there is a reasonable basis for the use of such a term. Ins 3.27(9)(ze)(ze) An advertisement shall not set out exceptions, reductions or limitations from a policy worded in a positive manner to imply that they are beneficial features such as describing a waiting period as a benefit builder. Words and phrases used to disclose exceptions, reductions or limitations shall fairly and accurately describe their negative features. The words “only” or “minimum” or similar words or phrases shall not be used to refer to exceptions, reductions or limitations. Ins 3.27(9)(zf)(zf) An advertisement shall not state or imply, or use similar words or phrases to the effect, that because no insurance agent will call and no commissions will be paid to agents the policy is a low cost plan. Ins 3.27(9)(zg)(zg) Devices such as a safe drivers’ award and other such awards shall not be used in connection with an advertisement. Ins 3.27(9)(zh)(zh) An advertisement which describes or offers to provide information concerning the federal Medicare program or any related government program or changes in such programs shall: Ins 3.27(9)(zh)1.1. Include no reference to such program on the envelope, the reply envelope or to the address side of the reply postal card, if any, Ins 3.27(9)(zh)2.2. Include on any page containing a reference to such program an equally prominent statement to the effect that in providing supplemental coverage the insurer and agent involved in the solicitation is not in any manner connected with such program, Ins 3.27(9)(zh)3.3. Contain a statement that it is an advertisement for insurance or is intended to obtain insurance prospects, Ins 3.27(9)(zh)4.4. Prominently identify the insurer or insurers which issues the coverage, and Ins 3.27(9)(zh)5.5. Prominently state that any material or information offered will be delivered in person by a representative of the insurer, if such is the case. Ins 3.27(10)(a)(a) When an advertisement refers to any dollar amount of benefits payable, period of time for which any benefit is payable, cost of policy, specific policy benefit or the loss for which such benefit is payable, it shall also disclose those exceptions, reductions and limitations (including waiting, elimination, probationary or similar periods and pre-existing condition exceptions) affecting the basic provisions of the policy without which the advertisement would have the capacity and tendency to mislead or deceive subject to the following. Ins 3.27(10)(b)(b) An invitation to apply shall be subject to the disclosure requirements of this subsection. Ins 3.27(10)(c)(c) An invitation to inquire shall not be subject to the disclosure requirements of this subsection unless: Ins 3.27(10)(c)1.1. Such an advertisement mentions benefits, benefit periods or premiums for the purpose of doing more than identifying the policy or Ins 3.27(10)(c)2.2. Such an advertisement makes any reference to the policy’s exceptions, reductions and limitations. Ins 3.27(10)(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(10)(e)(e) An institutional advertisement shall not be subject to the disclosure requirements of this subsection. Ins 3.27(10)(f)(f) If the policy advertised does not provide immediate coverage for pre-existing conditions, an application or enrollment form contained in or included with an advertisement to be completed by the applicant and returned to the insurer shall contain a question or statement immediately preceding the applicant’s signature line which summarizes the pre-existing condition provisions of the policy. The following are a suggested question and statement; however, an insurer shall use wording which is appropriate to the actual pre-existing condition provisions of the policy advertised: “Do you understand that the policy applied for will not pay benefits during the first - - - - - year(s) after the issue date for a disease or physical condition which you now have or have had in the past? Yes - - - - - -” or “I understand that the policy applied for will not pay benefits during the first - - - - - year(s) after the issue date for a disease or physical condition which I now have or have had in the past.” Ins 3.27(10)(g)(g) An advertisement which is subject to the disclosure requirements of this subsection shall in negative terms disclose the extent to which any loss is not covered if the cause of the loss is a condition which exists prior to the effective date of the policy. The expression “pre-existing conditions” shall not be used unless appropriately defined. Ins 3.27(10)(h)(h) If a medical examination is required for a policy, an invitation to apply advertisement of such policy shall disclose such requirement. Ins 3.27(10)(i)(i) The exceptions, reductions and limitations referred to in this subsection shall include: Ins 3.27(10)(i)1.1. Those which are set out in the policy under captions referring to exceptions, reductions, limitations or exclusions or are otherwise designated as such, and Ins 3.27(10)(i)2.2. Those which are not so captioned or designated contained in other portions of the policy such as a benefit provision, definition or uniform provision. Ins 3.27(10)(j)(j) The following are examples of exceptions, reductions and limitations which generally do 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)(j)3.3. Territorial restriction or coverage within United States and Canada. Ins 3.27(10)(j)7.7. Time limitation on death, dismemberment or commencement of disability or medical treatment following an accident. Ins 3.27(10)(j)9.9. Exclusion or reduction for loss due to specific diseases, classes of diseases or types of injuries. Ins 3.27(10)(j)10.10. Confinement restrictions in disability policies such as house confinement, bed confinement and confinement to the premises. 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)31.31. While or as a result of riding a motorcycle or motorcycle attachment. 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)(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.
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administrativecode
/code/admin_code/ins/3/27/10
Office of the Commissioner of Insurance (Ins)
administrativecode/Ins 3.27(10)
administrativecode/Ins 3.27(10)
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