Ill. Admin. Code tit. 50, § 2002.70 - Advertisements of Benefits Payable, Losses Covered or Premiums Payable
a) Deceptive words,
phrases or illustrations prohibited.
1) 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. The Guideline for this paragraph (a) (1) is found
in Appendix A, Illustration I.
2)
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"; "this
policy will help to replace your income" (when used to express loss of time
benefits); or similar words and phrases, in a manner which exaggerates any
benefits beyond the terms of the policy. The Guideline for this paragraph (a)
(2) is found in Appendix A, Illustration J.
3) An advertisement shall not contain
descriptions of a policy limitation, exception or reduction, 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 two years." 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 and
reductions of the policy offered. The Guideline for this paragraph (a) (3) is
found in Appendix A, Illustration K.
4) No advertisement of a benefit for which
payment is conditional upon confinement in a hospital or similar facility shall
use words or phrases such as "tax free"; "extra cash"; "extra income"; "extra
pay"; or substantially similar words or phrases because such words and phrases
have the capacity, tendency or effect of misleading the public into believing
that the policy advertised will, in some way, enable them to make a profit from
being hospitalized. The Guideline for this paragraph (a) (4) is found in
Appendix A, Illustration L.
5) No
advertisement of a hospital or other similar facility confinement benefit shall
advertise that the amount of benefit is payable on a monthly or weekly basis
when, in fact, the amount of the benefit payable is based upon a daily pro rata
basis relating to the number of days of confinement. When the policy contains a
limit on the number of days of coverage provided, such limit must appear in the
advertisement. The Guideline for this paragraph (a) (5) is found in Appendix A,
Illustration M.
6) No advertisement
of a policy covering only one disease or a list of specified diseases shall
imply coverage beyond the terms of the policy. Synonymous terms shall not be
used to refer to any disease so as to imply broader coverage than is the
fact.
7) An advertisement for a
policy providing benefits for specified illnesses only, such as cancer, or for
specified accidents only, such as automobile accidents, shall clearly and
conspicuously in prominent type state the limited nature of the policy. The
statement shall be worded in language identical to, or substantially similar to
the following: "THIS IS A LIMITED POLICY"; "THIS IS A CANCER ONLY POLICY";
"THIS IS AN AUTOMOBILE ACCIDENT ONLY POLICY."
8) An advertisement of a direct response
insurance product shall not imply that because "no insurance agent will call
and no commissions will be paid to agents," that it is "a low cost plan," or
use other similar words or phrases because the cost of advertising and
servicing such policies is a substantial cost in the marketing of a direct
response insurance product. The Guideline for this paragraph (a) (8) is found
in Appendix A, Illustration N.
b) Exceptions, Reductions and Limitations
1) When an advertisement which is an
invitation to contract refers to either a dollar amount, or a period of time
for which any benefit is payable, or the cost of the policy, or specific policy
benefit, or the loss for which such benefit is payable, it shall also disclose
those exceptions, reductions and limitations affecting the basic provisions of
the policy without which the advertisement would have the capacity or tendency
to mislead or deceive. The Guideline for this paragraph (b) (1) is found in
Appendix A, Illustration O.
2) When
a policy contains 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 a time period between the date a loss occurs and the date
benefits begin to accrue for such loss, an advertisement which is subject to
the requirements of the preceding paragraph shall disclose the existence of
such periods. The Guideline for this paragraph (b) (2) is found in Appendix A,
Illustration P.
3) 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, such
as: "This policy is subject to the following minimum exceptions and
reductions." The Guideline for this paragraph (b) (3) is found in Appendix A,
Illustration Q.
c)
Pre-Existing Conditions
1) An advertisement
which is subject to the requirements of Section
2002.70(b)
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" without an
appropriate definition or description shall not be used. The Guideline for this
paragraph (c) (1) is found in Appendix A, Illustration R.
2) 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
Part prohibits the use of the phrase "no medical examination required" and
phrases of similar import, but does not prohibit explaining "automatic issue."
If an insurer requires a medical examination for a specified policy, the
advertisement, if it is an invitation to contract, shall disclose that a
medical examination is required. The Guideline for this paragraph (c) (2) is
found in Appendix A, Illustration S.
3) When an advertisement contains an
application form to be completed by the applicant and returned by mail for a
direct response insurance product, such application form shall contain a
question or statement which reflects the pre-existing condition provisions of
the policy immediately preceding the blank space for the applicant's signature.
A) For example, such an application form
shall contain a question as follows:
"Do you understand that this policy 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
B) Or
substantially the following statement:
"I understand that the policy applied for will not pay benefits for any loss incurred during the first _____ year(s) after the issue date on account of disease or physical condition which I now have or have had in the past."
C) The Guideline for
this paragraph (c) (3) is found in Appendix A, Illustration T.
Notes
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