Utah Admin. Code R590-130-6 - Advertisements of Benefits Payable, Losses Covered, or Premiums Payable

(1) Deceptive words, phrases, and illustrations are prohibited.

(a) An advertisement may not omit information or use words, phrases, statements, references, or illustrations that may mislead or deceive a purchaser or potential purchaser regarding:

(i) the nature or extent of a policy benefit payable;

(ii) the loss covered; or

(iii) the premium payable.

(b) The requirements in Subsection (a) must be satisfied even if:

(i) the prospective insured could review the policy before the sale; or

(ii) an unsatisfied purchaser is offered a refund of the premium.

(c) An advertisement may not contain or use words or phrases in a manner that exaggerates a policy benefit when viewing the policy as a whole, including:

(i) all;

(ii) full;

(iii) complete;

(iv) comprehensive;

(v) unlimited;

(vi) up to;

(vii) as high as;

(viii) this policy will help fill some of the gaps that Medicare and your present insurance leave out;

(ix) the policy will help to replace your income; or

(x) similar words and phrases.

(d) An advertisement that is also an invitation to join an association, trust, or discretionary group shall:

(i) solicit insurance coverage on a separate and distinct application that requires separate signatures for each application;

(ii) have separate and distinct applications on separate documents;

(iii) disclose:

(A) that the prospective members are purchasing insurance;

(B) applying for membership;

(C) membership refundability; and

(D) the underwriter.

(e)

(i) An advertisement may not describe policy limitations, exceptions, or reductions in a positive manner to imply that policy limitations, exceptions, and reductions are benefits.

(ii) The following are examples of prohibited uses:

(A) describing a waiting period as a "benefit builder"; or

(B) stating "even preexisting conditions are covered after two years."

(iii) Words and phrases used in an advertisement to describe the advertised policy's limitations, exceptions, and reductions shall fairly and accurately describe the negative features of the limitations, exceptions, and reductions.

(f)

(i) An advertisement for a benefit that conditions payment on confinement in a hospital or similar facility may not use words or phrases that could mislead an individual to believe that the advertised policy enables an individual to profit from being hospitalized.

(ii) The following are prohibited phrases:

(A) tax-free;

(B) extra cash;

(C) extra income;

(D) extra pay; or

(E) substantially similar words or phrases.

(g) An advertisement for a fixed indemnity benefit that advertises weekly or monthly benefits shall explain in the advertisement, with equal prominence, that the benefits are based on an accumulated daily pro rata benefit.

(h) An advertisement for a policy covering one disease or a list of specified diseases may not:

(i) imply coverage beyond the policy's terms; or

(ii) use synonymous terms to refer to a disease that may imply broader coverage than is in the policy.

(i) An advertisement for a policy providing benefits for a specified illness, such as cancer, shall:

(i) state the policy's limited nature; and

(ii) use language identical or substantially similar to the following:

(A) "THIS IS A LIMITED POLICY"; or

(B) "THIS IS A CANCER ONLY POLICY".

(j) An advertisement for a policy providing benefits for a specified accident, such as an automobile accident, shall:

(i) state the policy's limited nature; and

(ii) use language identical or substantially similar to "THIS IS AN AUTOMOBILE ACCIDENT ONLY POLICY".

(k) An advertisement for a preneed funeral contract that is funded by a life insurance policy or annuity contract shall adequately disclose that a life insurance policy or annuity contract is:

(i) involved in the arrangement; or

(ii) being used to fund the arrangement.

(l) An advertisement for a life insurance policy may not use a phrase in the policy's name or title that does not include the words "life insurance," unless other accompanying language clearly indicates that the policy is life insurance.

(2) Exceptions, Reductions, and Limitations.

(a) An advertisement that is an invitation to contract shall disclose the policy's exceptions, reductions, and limitations that affect the policy's basic provisions.

(b) An advertisement that is an invitation to contract shall disclose a policy's waiting, elimination, probationary, or similar time period regarding:

(i) the policy's effective date and the effective date of coverage under the policy; or

(ii) the date of loss and the date benefits begin to accrue for the loss.

(c) An advertisement may not use words or phrases in a way that may minimize the effects of a policy's exceptions, reductions, limitations, or exclusions, including:

(i) only;

(ii) just;

(iii) merely;

(iv) necessary; or

(v) similar words or phrases.

(3) Preexisting Conditions.

(a) An advertisement that is an invitation to contract shall disclose in a negative tone any loss that is not covered if the cause of the loss is traceable to a condition existing prior to the policy's effective date.

(b) A description or definition must accompany the use of the term "preexisting condition."

(c) An advertisement may not state or imply that an applicant's physical condition or medical history will not affect the issuance of a policy or a claim being paid when an accident and health insurance policy does not cover losses resulting from a preexisting condition.

(d) An advertisement is prohibited from using the phrase "no medical examination required" or similar phrases.

(e) An advertisement is not prohibited from using the phrase "guaranteed issue" or "automatic issue."

(f) An advertisement that is an invitation to contract regarding a specified disease policy shall disclose if a medical examination is required.

(g)

(i) When an advertisement contains an application form to be completed and returned, the application form shall contain a question or statement regarding the policy's preexisting condition provision, which shall be located:

(A) immediately preceding the blank space for the applicant's signature; or

(B) preceding the statement regarding the truthfulness of information provided in the application.

(ii) The following are examples of the question or statement required under Subsection (g)(i):

(A) Do you understand that this policy will not pay benefits during the first (insert period of time) after the issue date for a disease or physical condition that you now have or have had in the past? YES; or

(B) I understand that the policy applied for will not pay benefits for any loss incurred during the first (insert period of time) after the issue date on account of a disease or physical condition that I now have or have had in the past.

Notes

Utah Admin. Code R590-130-6

Adopted by Utah State Bulletin Number 2022-24, effective 12/8/2022