Fla. Admin. Code Ann. R. 69B-156.108 - Advertisements of Benefits Payable, Losses Covered or Premiums Payable

(1) Deceptive Words, Phrases, or Illustrations Prohibited.

(a) No advertisement shall omit information or use words, phrases, statements, references or illustrations if the omission of such information or use of such words, phrases, statements, references, or illustrations has the capacity, tendency, or effect of misleading or deceiving purchasers or prospective purchasers as to the nature or extent of any policy benefit payable, loss covered or premium payable. The fact that the policy offered is made available to a prospective insured for inspection prior to consummation of the sale or an offer is made to refund the premium if the purchaser is not satisfied, does not remedy misleading statements.

(b) No advertisement shall contain or use words or phrases such as "all," "full," "complete," "comprehensive," "unlimited," "up to," "as high as," "this policy will help pay your hospital and surgical bills," "this policy will help fill some of the gaps that Medicare and your present insurance leave out," or similar words and phrases, in a manner which exaggerates any benefits beyond the terms of the policy.

(c) An advertisement which also is an invitation to join an association, trust, or discretionary group must solicit insurance coverage on a separate and distinct application which requires signatures for each application. The insurance program must be presented so as not to mislead or deceive the prospective members regarding the fact that they are purchasing insurance as well as applying for membership, if that is the case.

(d) An advertisement shall not contain descriptions of policy limitations, exceptions, or reductions, worded in a positive manner to imply that it is a benefit, such as describing a waiting period as a "benefit builder" or stating "even pre-existing conditions are covered after a limited period of time." Words and phrases used in an advertisement to describe such policy limitations, exceptions and reductions shall fairly and accurately describe the negative features of such limitations, exceptions, or reductions of the policy offered.

(e) An advertisement of medicare supplement insurance sold by direct response shall not use the phrases, "no salesman will call," or "no agent will call," or "by eliminating the agent and/or commission we can offer this low cost plan" or similar wording in a misleading manner.

(2) Exceptions, Reductions, and Limitations.

(a) An advertisement which is an invitation to contract shall disclose those exceptions, reductions, and limitations affecting the basic provisions of the policy.

(b) An advertisement which is subject to the requirements of the preceding paragraph shall disclose the existence of a waiting, elimination, probationary, or similar time period between the effective date of the policy and the effective date of coverage under the policy, or the existence of a time period between the date a loss occurs and the date benefits begin to accrue for such loss in a manner as prominent as the benefit amount or benefit time period advertised.

(c) An advertisement shall not use the words "only," "just," "merely," "minimum," or similar words or phrases to describe the applicability of any exceptions and reductions or limitations, such as: "This policy is subject to the following minimum exceptions and reductions."

(3) Pre-Existing Conditions.

(a) An advertisement which is an invitation to contract for Medicare Supplement benefits shall, in negative terms, disclose the extent to which any loss is not covered if the cause of such loss is traceable to a condition existing prior to the effective date of the policy. The term "pre-existing condition" shall not be used without an appropriate definition or description.

(b) When a policy does not cover losses resulting from pre-existing conditions, no advertisement of the policy shall state or imply that the applicant's physical condition or medical history will not affect the issuance of the policy or payment of a claim thereunder. This rule prohibits the use of the phrase "no medical examination required" and phrases of similar import, in a misleading manner. If an insurer requires a medical examination for a specified policy, the advertisement shall disclose that a medical examination is required.

(c) When coverage is in any way limited for pre-existing conditions, the application shall contain a statement which reflects the pre-existing condition provisions of the policy immediately preceding the blank space for the applicant's signature. For example, such an application form shall contain a statement substantially as follows:

This policy has a pre-existing condition limitation and if a physician has provided treatment or recommended treatment for any injury or illness or other condition within the 6-month period prior to issuance of the (policy/certificate) for which I am applying, no coverage will be provided for that illness or injury or other condition until 6 months after the (policy/certificate) has been issued.

Notes

Fla. Admin. Code Ann. R. 69B-156.108

Rulemaking Authority 624.308(1), 626.9611 FS. Law Implemented 624.307(1), 626.9541(1)(a), (b), (e), (k), (l), 626.9641(1) FS.

New 6-12-88, Formerly 4-46.007, 4-156.108.

New 6-12-88, Formerly 4-46.007, 4-156.108.