Chapter Ins 3

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)1. 1. War or act of war.

Ins 3.27(10)(j)2. 2. While in armed services.

Ins 3.27(10)(j)3. 3. Territorial restriction or coverage within United States and Canada.

Ins 3.27(10)(j)4. 4. Complete aviation exclusion.

Ins 3.27(10)(j)5. 5. Self-inflicted injury.

Ins 3.27(10)(j)6. 6. Injury inflicted by another person.

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)8. 8. Pre-existing sickness or disease or other bodily infirmity.

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)11. 11. Waiting, elimination, probationary or similar periods.

Ins 3.27(10)(j)12. 12. Reduction in benefits because of age.

Ins 3.27(10)(j)13. 13. Any reduction in benefit during a period of disability.

Ins 3.27(10)(j)14. 14. Workers’ compensation or employers’ liability law exclusion.

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.