Illinois Administrative Code
Title 50 - INSURANCE
Part 2010 - ADVERTISEMENTS OF MEDICARE SUPPLEMENT INSURANCE
Section 2010.60 - Advertisements of Benefits, Losses Covered or Premiums Payable
Universal Citation: 50 IL Admin Code ยง 2010.60
Current through Register Vol. 48, No. 12, March 22, 2024
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.
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 fill some of the gaps that Medicare and your present insurance leave
out," "this policy pays all that Medicare doesn't" or similar words and
phrases, in a manner which exaggerates any benefit beyond the terms of the
policy.
3) 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 separate signatures for each application. The insurance program must
be presented so as not to mislead or deceive the prospective members that they
are purchasing insurance as well as applying for membership, if that is the
case.
4) 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 preexisting conditions are
covered after 6 months." 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.
5) An
advertisement of Medicare supplement insurance sold by direct response shall
not state or 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 a advertising and servicing such
policies is a substantial cost in marketing by direct response.
b) Exceptions, Reductions and Limitations
1) An advertisement which is an
invitation to contract shall disclose those exceptions, reductions and
limitations affecting benefits provided by the policy.
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 subsection
(b)(1) shall disclose the existence of such periods.
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."
c) Preexisting Conditions
1) An advertisement which is an invitation to
contract 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 use of the term "preexisting condition"
without an appropriate definition or description shall not be used.
2) When a Medicare supplement insurance
policy does not cover losses resulting from preexisting 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 subsection 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 shall disclose that a
medical examination is required.
3)
When an advertisement contains an application form to be completed by the
applicant and returned by mail, such application form shall contain a question
or statement which reflects the preexisting condition provisions of the policy
immediately preceding the blank space for the applicant's signature. For
example, such an application form shall contain a question or statement
substantially as follows:
A) Do you
understand that this policy will not pay benefits during the first six (6)
months after the issue date for a disease or physical condition for which
medical advice was given or treatment was recommended by or received from a
physician within six (6) months before the policy issue date? 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 six (6) months after the issue date due to a disease
or physical condition for which I received medical advice or for which
treatment was recommended by or received from a physician within six (6) months
before the issue date.
Disclaimer: These regulations may not be the most recent version. Illinois may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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