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)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)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)(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)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 Ins 3.27(13)(c)8.8. If it contains a description of benefit payments which does not disclose the true nature of the insurance coverage under which the benefits were paid. Ins 3.27(13)(d)(d) An advertisement shall not state or imply that an insurer or a policy has been approved or endorsed by an individual, group of individuals, society, association or other organization, unless such is the fact. Any proprietary relationship between such society, association or other organization and the insurer shall be disclosed. If such society, association or other organization has been formed by the insurer or is owned or controlled by the insurer or the person or persons who own or control the insurer, the advertisement shall clearly disclose such a fact. Ins 3.27(13)(e)(e) When a testimonial refers to benefits received under a policy, a summary of the pertinent claim information including claim number and date of loss shall be retained by the insurer with the advertisement in the advertising file required by sub. (28). Ins 3.27(13)(f)(f) An advertisement shall not state or imply that a government publication has commended or recommended the insurer or its policy. Ins 3.27(14)(14) Jurisdictional licensing; approval by governmental agency. Ins 3.27(14)(a)(a) An advertisement which may be seen or heard beyond the limits of the jurisdiction in which the insurer is licensed shall not imply licensing beyond those limits. Ins 3.27(14)(b)(b) An advertisement shall not state or imply, or otherwise create the impression directly or indirectly, that the insurer, its financial condition or status, the payment of its claims, its policy forms or the merits or desirability of its policy forms or kinds or plans of insurance are approved, endorsed or accredited by any agency of this state or the federal government. Ins 3.27(14)(c)(c) In any advertisement any reference to licensing shall contain an appropriate disclaimer that such reference is not to be construed as an endorsement or implied endorsement of the insurer or its products by any agency of this state or the commissioner of insurance. Ins 3.27(14)(d)(d) An advertisement shall not contain a reproduction of a portion of a state insurance department report of examination. Ins 3.27(15)(15) Introductory, initial or special offers and limited enrollment periods. Ins 3.27(15)(a)(a) An advertisement shall not state or imply that a policy or combination of policies is an introductory, initial or special offer and that the applicant will receive advantages not available at a later date by accepting the offer, that only a limited number of policies will be sold, that a time is fixed for the discontinuance of the sale of the policy advertised because of special advantages available in the policy, or that an individual will receive special advantages by enrolling within an open enrollment period or by a deadline date, unless such is the fact. Ins 3.27(15)(b)(b) An advertisement shall not state or imply that enrollment under a policy is limited to a specific period unless the period of time permitted to enroll, which shall be not less than 10 days and not more than 40 days from the date of the advertisement, is disclosed. Ins 3.27(15)(c)(c) If the insurer making an introductory, initial or special offer has previously offered the same or similar policy on the same basis or intends to repeat the current offer for the same or similar policy, the advertisement shall so indicate. Ins 3.27(15)(d)(d) An insurer shall not establish for residents of this state a limited enrollment period within which an individual policy may be purchased less than 6 months after the close of an earlier limited enrollment period for the same or similar policy. Such restriction shall apply to all advertisements in newspapers, magazines and other periodicals circulated in this state, all mail advertisements sent to residents of this state and all radio and TV advertisements broadcast in this state. Such restriction shall not apply to the solicitation of enrollments under individual policies issued on a group basis. Ins 3.27(15)(e)(e) Where an insurer is an affiliate of a group of insurers under common management and control, the word “insurer” for the purposes of this subsection means the insurance group. The requirements and restrictions applicable to an insurer shall apply to the insurance group. Ins 3.27(15)(f)(f) Similar policies for the purposes of this subsection include policies which provide similar benefits even though there may be differences in benefit amounts, elimination periods, renewal terms or ancillary benefits. Ins 3.27(16)(16) Mail order refusal form. An insurer shall not use a mail order advertisement which requires the recipient, in order to refuse a policy, to sign a refusal form and return it to the insurer. Ins 3.27(17)(17) Group, quasi-group or special class implications. An advertisement shall not state or imply that prospective policyholders or members of a particular class of individuals become group or quasi-group members or are uniquely eligible for a special policy or coverage and as such will be subject to special rates or underwriting privileges or that a particular coverage or policy is exclusively for preferred risks, a particular segment of people, or a particular age group or groups, unless such is the fact. Ins 3.27(18)(a)(a) An offer in an advertisement of free inspection of a policy or an offer of a premium refund shall not be a cure for misleading or deceptive statements contained in such advertisement. Ins 3.27(18)(b)(b) An advertisement which refers to the provision in the policy advertised regarding the right to return the policy shall disclose the time limitation applicable to such right. Ins 3.27(19)(19) Identification of plan or number of policies. Ins 3.27(19)(a)(a) When an advertisement refers to a choice regarding benefit amounts, it shall disclose that the benefit amounts provided will depend upon the plan selected and that the premium will vary with the amount of the benefits. Ins 3.27(19)(b)(b) When an advertisement refers to various benefits which may be contained in 2 or more policies, other than group policies, it shall disclose that such benefits are provided only through a combination of such policies. Ins 3.27(20)(a)(a) An advertisement which sets out the dollar amounts of claims paid, the number of persons insured or other statistical information shall identify the source of such statistical information and shall not be used unless it accurately reflects all of the relevant facts. Irrelevant statistical data shall not be used. Ins 3.27(20)(b)(b) An advertisement shall not imply that the statistical information given is derived from the insurer’s experience under the policy advertised unless such is the fact. The advertisement shall specifically so state if such information applies to other policies or plans. Ins 3.27(20)(c)(c) If a loss ratio is to be shown in an advertisement, it shall be derived from either premiums received and benefits paid or premiums earned and losses incurred. Ins 3.27(20)(d)(d) If loss ratios are to be compared between insurers in an advertisement, comparison shall be limited to policies or plans of the same type issued to similar classes of risks. Ins 3.27(20)(e)(e) An advertisement which sets out the dollar amounts of claims paid shall also indicate the period during which such claims have been paid. Ins 3.27(21)(21) Service facilities. An advertisement shall not: Ins 3.27(21)(a)(a) Contain untrue statements with respect to the time within which claims are paid. Ins 3.27(21)(b)(b) State or imply that claim settlements will be liberal or generous or use words of similar import. Ins 3.27(21)(c)(c) State or imply that claim settlements will be beyond the actual terms of the policy, or Ins 3.27(21)(d)(d) Contain a description of a claim which involves unique or highly unusual circumstances. Ins 3.27(22)(22) Statements about an insurer. An advertisement shall not contain statements which are untrue in fact or are by implication misleading with respect to the insurer’s assets, corporate structure, financial standing, age, experience or relative position in the insurance business.
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Office of the Commissioner of Insurance (Ins)
administrativecode/Ins 3.27(11)(f)
administrativecode/Ins 3.27(11)(f)
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