Current through Register Vol. 50, No. 9, September 20, 2024
A.
1. An
advertisement of an individual policy shall not directly or by implication
represent that a contract or combination of contracts is an introductory,
initial or special offer, or that applicants will receive substantial
advantages not available at a later date, or that the offer is available only
to a specified group of individuals, unless such is the fact. An advertisement
shall not contain phrases describing an enrollment period as
special, limited, or similar words or phrases
when the insurer uses such enrollment periods as the usual method of
advertising accident and sickness insurance.
2. An enrollment period during which a
particular insurance product may be purchased on an individual basis shall not
be offered within this state unless there has been a lapse of not less than
three months between the close of the immediately preceding enrollment period
for the same product and the opening of the new enrollment period. The
advertisement shall indicate the date by which the applicant must mail the
application which shall be not less than 10 days and not more than 40 days from
the date that such enrollment period is advertised for the first time. This
rule applies to all advertising media, i.e., mail, newspapers, radio,
television, magazines and periodicals, by any one insurer. It is inapplicable
to solicitation, of employees or members of a particular group or association
which otherwise would be eligible under specific provisions of the
Insurance Code for group, blanket or franchise insurance. The
phrase any one insurer includes all the affiliated companies
of a group of insurance companies under common management or control.
3. This rule prohibits any statement or
implication to the effect that only a specific number of policies will be sold,
or that a time is fixed for the discontinuance of the sale of the particular
policy advertised because of special advantages available in the policy, unless
such is the fact.
4. The phrase
a particular insurance product in
§1329. A.2 means an
insurance policy which provides substantially different benefits than those
contained in any other policy. Different terms of renewability; an increase or
decrease in the dollar amounts of benefits; an increase or decrease in any
elimination period or waiting period from those available during an enrollment
period for another policy shall not be sufficient to constitute the product
being offered as a different product eligible for concurrent or overlapping
enrollment periods.
B.
An advertisement shall not offer a policy which utilizes a reduced initial
premium rate in a manner which overemphasizes the availability and the amount
of the initial reduced premium. When an insurer charges an initial premium that
differs in amount from the amount of the renewal premium payable on the same
mode, the advertisement shall not display the amount of the reduced initial
premium either more frequently or more prominently than the renewal premium and
both the initial reduced premium and the renewal premium must be stated in
juxtaposition in each portion of the advertisement where the initial reduced
premium appears.
C. Special awards,
such as a safe drivers' award shall not be used in connection with
advertisements of accident or accident and sickness insurance.
D. An advertisement using terminology to
indicate that a particular form of coverage is unlike any other form of
coverage presently in existence is prohibited if similar plans and offers are
available.
E.
1. An advertisement of an individual policy
which provides an application or enrollment form shall contain a policy summary
setting out the essential features of the policy that will be issued upon
acceptance of an application by the insurer. Essential features must include
language describing:
a. benefits;
b. renewability of policy;
c. right of company to change
premium;
d. liability of company
for pre-existing conditions;
e.
waiting periods for which no benefits are payable;
f. reduction (if any) of benefits;
g. exclusions.
2. The policy summary shall be prominently
displayed and readily distinguishable from all other portions of the
advertisement. The policy summary shall explain the essential features of the
policy in simple, concise and readily understandable language, as in the
following example:
POLICY SUMMARY
(or other descriptive title)
A. This policy provides $16.27 daily hospital
benefits.
B. This policy is guaranteed renewable to age 65.
C. The insurance company can change the premium.
D. Pre-existing conditions are not covered for the
first two years.
E. Benefits are payable from the first day of
accidents and the eighth day of sickness.
F. Benefits are reduced at age 65.
G. This policy does not cover mental illness,
alcoholism or drug addiction.
H. (Other significant policy provisions.)
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AUTHORITY NOTE:
Promulgated in accordance with
R.S.
22:2.