Current through Register Vol. 48, No. 18,
September 15, 2023
PURPOSE: This rule effectuates or aids in the
interpretation of and carries out the provisions of sections
376.777, 376.850-376.890 and 379.922, RSMo.
PUBLISHER'S NOTE: The secretary of state has
determined that the publication of the entire text of the material which is
incorporated by reference as a portion of this rule would be unduly cumbersome
or expensive. Therefore, the material which is so incorporated is on file with
the agency who filed this rule, and with the Office of the Secretary of State.
Any interested person may view this material at either agency's headquarters or
the same will be made available at the Office of the Secretary of State at a
cost not to exceed actual cost of copy reproduction. The entire text of the
rule is printed here. This note refers only to the incorporated by reference
(A) These rules shall apply to
any accident and sickness insurance advertisement, as that term is defined in
this rule, intended for presentation, distribution, dissemination or other
advertising use in this state, when this use is made either directly or
indirectly by or on behalf of that insurer.
(B) Every insurer shall establish and at all
times maintain a system of control over the content, form and method of
dissemination of all advertisements of its policies. The insurer whose policies
are so advertised shall be deemed responsible for all these advertisements,
regardless of by whom written, created, presented or distributed.
(C) Each health service corporation licensed
under Chapter 354, RSMo shall be considered within the full scope of this rule
and consider itself an insurer issuing policies when doing any advertising as
defined in this rule.
(A) An advertisement for the purpose of these
rules shall include:
1. Printed or published
material, audiovisual material and descriptive literature used by or on behalf
of an insurer in direct mail, newspapers, magazines, radio scripts, television
scripts, billboards and similar displays;
2. Descriptive literature and sales aids of
all kinds issued by an insurer, insurance producer for presentation to members
of the insurance buying public, including, but not limited to, circulars,
leaflets, booklets, depictions, illustrations, form letters and lead-generating
devices of all kinds as defined in this rule; and
3. Prepared sales talks, presentations and
material for use by insurance producers whether prepared by the insurer or the
Exception for the purpose of these rules shall mean any provision in a policy
where coverage for a specified hazard is entirely eliminated; it is a statement
of risk not assumed under the policy.
(C) Institutional advertisement for the
purpose of these rules shall mean an advertisement having as its sole purpose
and presentation the promotion of the reader's interest in the concept of
accident and sickness insurance or the promotion of the insurer as a name in
the field of accident and sickness insurance.
(D) Insurer for the purpose of these rules
shall include any individual, corporation, association, partnership, reciprocal
exchange, interinsurer, Lloyd's, fraternal benefit society, health maintenance
organization, health service corporation, prepaid dental plan and any other
legal entity which is regulated as an insurer in this state and is engaged in
the advertisement of itself or a policy as policy is defined in this
(E) Invitation to contract
for the purpose of these rules shall mean any advertisement which is neither
clearly an invitation to inquire nor clearly an institutional
(F) Invitation to
inquire for the purpose of these rules shall mean an advertisement having as
its objective the creation of a desire to inquire further about the product and
which is limited to a brief description of the loss for which the benefit is
payable and which may contain the dollar amount of benefit payable or the
period of time during which the benefit is payable, or both. The advertisement
shall not refer to cost. An advertisement which specifies either the dollar
amount of benefit payable or the period of time during which the benefit is
payable shall conspicuously contain a provision substantially as follows: "For
costs and further details of the coverage, including exclusions, any reductions
or limitations and the terms under which the policy may be continued in force,
see your insurance producer or write the company."
(G) Lead-generating device, for the purpose
of these rules, shall mean any communication directed to the public which,
regardless of form, content or stated purpose, is intended to result in the
compilation or qualification of a list containing names and other personal
information to be used to solicit residents of this state for the purchase of a
(H) Limitation for the
purpose of these rules shall mean any provision which restricts coverage under
the policy other than an exception or a reduction.
(I) Policy for the purpose of these rules
shall include any policy, plan, certificate, contract, agreement, statement of
coverage, rider or endorsement which provides accident or sickness benefits or
medical, surgical or hospital expense benefits, whether, on an indemnity,
reimbursement, health service or prepaid basis, except when issued in
connection with another type of insurance other than life and except
disability, waiver of premium and double indemnity benefits included in life
insurance and annuity contracts.
(J) Reduction for the purpose of these rules
shall mean any provision which reduces the amount of the benefit; a risk of
loss is assumed but payment upon the occurrence of the loss is limited to some
amount or period less than would be otherwise payable had the reductions not
(3) Method of
Disclosure of Required Information. All information required to be disclosed by
these rules shall be set out conspicuously and in close conjunction with the
statements to which this information relates or under appropriate captions of
such prominence that it shall not be minimized, obscured or presented in an
ambiguous fashion or intermingled with the context of the advertisement so as
to be confusing or misleading.
Form and Content of Advertisements.
format and content of an advertisement of an accident or sickness insurance
policy shall be sufficiently complete and clear to avoid deception or the
capacity or tendency to mislead or deceive. Whether an advertisement has a
capacity or tendency to mislead or deceive shall be determined by the director
of insurance from the basic overall impressions that the advertisement may
create reasonably upon those persons of average education and intelligence for
that segment of the public to which it appears on its face to be
(B) Advertisements shall
be truthful and not misleading in fact or in implication. Words or phrases, the
meaning of which is clear only by implication or by familiarity with insurance
terminology, shall not be used.
(5) Advertisements of Benefits Payable,
Losses Covered or Premiums Payable.
Deceptive words, phrases or illustrations are prohibited.
1. No advertisement shall omit information or
use words, phrases, statements, references or illustrations if the omission of
this information or use of these 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 or does not remedy misleading statements or
omissions of pertinent fact. No advertisements may employ devices which create
undue fear or anxiety in the minds of its readers judged by the standards in
2. Policies advertised
as Medicare supplements or as providing additional benefits not provided by
Medicare or similar government programs must not create any illusion of greater
coverage or undue anxiety in the minds of those purchasing the coverage than is
actually provided. Any advertisement is unacceptable which-
A. Exaggerates the gaps in Medicare
B. Promotes fear of
dependence upon relatives or charity;
C. Implies that long periods of sickness or
hospital stays are common among the elderly;
D. Does not explain the manner in which any
advertised policy is supplemental to Medicare coverage or fails to disclose the
exact benefits it is designed to supplement;
E. Describes the inpatient hospital coverage
of Medicare as "hospital Medicare" or "Medicare Part A" when the policy does
not supplement the nonhospital or the psychiatric hospital benefits of Medicare
Part A (phrases to the effect of the "inhospital portion of Medicare Part A"
F. Fails to
clearly describe the operation of the part(s) of Medicare which the policy is
designed to supplement; and G. Describes those Medicare benefits not
supplemented by the policy in a way as to minimize their importance relative to
the Medicare benefits which are supplemented.
3. 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
4. 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 preexisting conditions
are covered after two years." Words and phrases used in an advertisement to
describe the policy limitations, exceptions and reductions fairly and
accurately shall describe the negative features of these limitations,
exceptions and reductions of the policy offered.
5. 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 in a manner which has the
capacity, tendency or effect of misleading the public into believing that the
policy advertised, in some way, will enable them to make a profit from being
6. No advertisement
of a hospital or other similar facility confinement benefit shall advertise
that the amount of the 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 unless the
statements of these monthly or weekly benefit amounts are followed immediately
by equally prominent statements of the benefit payable on a daily basis. For
example, either of the following statements is acceptable: "$1000 a month at
($33.33 per day)" or "$33.33 per day ($1000 per month)." When the policy
contains a limit on the number of days of coverage provided, this limit must
appear in the advertisement.
advertisement of a policy covering only one (1) 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.
8. 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 substantially as follows: "THIS IS A LIMITED POLICY," "THIS
IS A CANCER POLICY ONLY," "THIS IS AN AUTOMOBILE ACCIDENT ONLY
9. An advertisement which
is also 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; provided, however, that a
separate and distinct application which requires signatures for each
application need not be made where the advertisement is an invitation to join a
discretionary group approved under section 376.421.2., RSMo, which has as its
sole purpose the provision of group health insurance benefits. 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.
Exceptions, Reductions and Limitations.
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 specified policy benefit or the loss for which the 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.
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 this
loss, an advertisement as stated shall disclose the existence of these
3. An advertisement shall
not use the words "only", "just", "merely", "minimum" or similar words or
phrases to imply a minimal applicability of any exceptions and reductions such
as "This policy is subject only to the following minimum exceptions and
1. An advertisement
which is subject to the requirements of subsection (5)(B), in negative terms,
shall disclose the extent to which any loss is not covered if the cause of the
loss manifested itself prior to the effective date of the policy. The term
"preexisting condition" or any similar phrase without an appropriate definition
or description shall not be used.
2. When a 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 a policy or payment of a claim. If an insurer
requires a medical examination for a specified policy, the advertisement if it
is an invitation to contract must disclose that a medical examination is
3. When an advertisement
contains an application form to be completed by the applicant and returned by
mail for a direct response insurance product, the application form shall
contain a question or statement which reflects the preexisting condition
provisions of the policy which immediately precedes the blank space for the
applicant's signature. For example, this application form shall contain
substantially the following question or statement: "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" or substantially the following statement: "I understand 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."
(6) Necessity for Disclosing Policy
Provisions Relating to Renewability, Cancellability and Termination. 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 a specific policy benefit or the loss for which the benefit is
payable, it shall disclose the provisions relating to renewability,
can-cellability, termination and any modification of benefits, losses covered
or premiums in a manner which shall not minimize or render obscure the
Testimonials or Endorsements by Third Parties.
(A) Testimonials used in advertisements must
be genuine, represent the current opinion of the author, be applicable to the
policy advertised and be accurately reproduced. The insurer, in using a
testimonial, makes as its own all of the statements contained in the
testimonial and the advertisement, including this statement, is subject to all
the provisions of these rules.
If the person making a testimonial, an endorsement or an appraisal has a
financial interest in the insurer or a related entity as a stockholder,
director, officer, employee or otherwise, this fact shall be disclosed in the
advertisement. If a person is compensated for making a testimonial, endorsement
or appraisal, this fact shall be disclosed in the advertisement by language
substantially as follows: "Paid Endorsement." The payment of substantial
amounts, directly or indirectly, for "travel and entertainment" for filming or
recording of television or radio advertisements requires disclosure of such
compensation. This rule does not apply when payment is union scale.
(C) An advertisement shall not state or imply
that an insurer or a policy has been approved or endorsed by any individual,
group of individuals, society, association or other organizations, unless this
is the fact and unless any proprietary relationship between an organization and
the insurer is disclosed. If the entity making the endorsement or testimonial
has been formed by the insurer or is owned or controlled by the insurer or the
per-son(s) who owns or controls the insurer, this fact shall be disclosed in
(D) When a
testimonial refers to benefits received under a policy, the specific claim
data, including claim number, date of loss and other pertinent information,
shall be retained and made available by the insurer for inspection for a period
of four (4) years or until the next regular report of examination of the
insurer, whichever is the longer period of time.
(8) Use of Statistics.
(A) An advertisement relating to any insurer
or policy shall not use irrelevant facts or statistics and shall accurately
reflect all of the relevant facts. This advertisement shall not imply that the
statistics are derived from the policy advertised unless this is the fact and
when applicable to other policies or plans shall specifically so
(B) An advertisement shall
not represent or imply that claim settlements by the insurer are "liberal" or
"generous" or use words of similar import or that claim settlements are or will
be beyond the actual terms of the contract. An unusual amount paid for a unique
claim for the policy advertised is misleading and shall not be used.
(C) The specific source of any statistics
used in an advertisement shall be clearly identified in the
Identification of Plan or Number of Policies.
(A) When a choice of the amount of benefits
is referred to, an advertisement which is an invitation to contract shall
disclose that the-
1. Amount of benefits
provided depends upon the plan selected; and
2. Premium will vary with the plan and
When an advertisement which is an invitation to contract refers to various
benefits which may be contained in two (2) or more policies, other than group
master policies, the advertisement shall disclose that these benefits are
provided only through a combination of those policies.
(10) Disparaging Comparisons and Statements.
An advertisement shall not, directly or indirectly, make unfair or incomplete
comparisons of policies or benefits or comparisons of noncomparable policies of
other insurers and shall not disparage competitors, their policies, services or
business methods. It shall not disparage or unfairly minimize competing methods
of marketing insurance.
Jurisdictional Licensing and Status of Insurer.
(A) An advertisement which is seen or heard
beyond the limits of the jurisdiction in which the insurer is licensed shall
not imply licensing beyond those limits.
(B) An advertisement shall not create the
impression directly or indirectly that the insurer, its financial condition or
status or the payment of its claims or merits, desirability or advisability of
its policy forms or kinds of plans of insurance are approved, endorsed or
accredited by any division or agency of this state or the United States
Identity of Insurer.
(A) The name of the
actual insurer shall be stated in all of its advertisements. The form number(s)
of the policy advertised shall be stated in an advertisement which is an
invitation to contract. An advertisement shall not use a trade name, any
insurance group designation, name of the parent company of the insurer, name of
a particular division of the insurer, service mark, slogan, symbol or other
device which without disclosing the name of the actual insurer would have the
capacity and tendency to mislead or deceive as to the true identity of the
(B) No advertisement shall
use any combination of words, symbols or physical materials which by their
content, phraseology, shape, color or other characteristics are so similar to a
combination of words, symbols or physical materials used by agencies of the
federal government or of this state or otherwise appear to be of such a nature
that it tends to confuse or mislead prospective insureds into believing that
the solicitation is in some manner connected with an agency of the municipal,
state or federal government.
advertisement in the form of envelopes or stationery of any kind may use any
name, service mark, slogan or symbol or any device in a manner that implies
that the insurer or the policy advertised, or that any insurance producer who
may call upon the consumer in response to the advertisement is connected with a
governmental agency, such as the Social Security Administration.
(D) An insurance producer who makes contact
with a consumer, as result of acquiring that consumer's name from a
lead-generating device must disclose this fact in the initial contact with the
(13) Group or
Quasi-Group Implications. An advertisement of particular policy shall not state
or imply that prospective insureds become group or quasi-group members covered
under a group policy and as such enjoy special rates and underwriting
privileges, unless that is the fact.
(14) Introductory, Initial or Special Offers.
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 that 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 these enrollment periods as the usual method of advertising accident and
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 (3) months between the close of the
immediately preceding enrollment period for substantially 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 not be less
than ten (10) days and not more than forty (40) days from the date that the
enrollment period is advertised for the first time. This rule applies to all
advertising media-that is, mail, newspapers, radio, television, magazines and
periodicals-by any one (1) insurer. It is inapplicable to solicitations 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
3. This rule prohibits
any statement of 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 this is the fact.
4. The phrase "a particular insurance
product" in paragraph (14)(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 award, such as a "safe drivers'
award" shall not be used in connection with advertisements of accident or
accident and sickness insurance.
(15) Statements About an Insurer. An
advertisement shall not contain statements which are untrue in fact, or by
implication misleading, with respect to the assets, corporate structure,
financial standing, age or relative position of the insurer in the insurance
business. An advertisement shall not contain a recommendation by any commercial
rating system unless it clearly indicates the purpose of the recommendations
and the limitations of the scope and extent of the recommendation.
(16) Enforcement Procedures.
(A) Advertising File. Each insurer shall
maintain at its home or principal office and at its main office in this state,
if any, a complete file containing every printed, published or prepared
advertisement of its individual policies and typical printed, published or
prepared advertisements of its blanket, franchise and group policies hereafter
disseminated in or into this state, with a notation attached to each
advertisement which shall indicate the manner and extent of distribution and
the form number of any policy advertised. This file shall be subject to regular
inspection by this department. All these advertisements shall be maintained in
this file for a period of four (4) years.
(B) Preapproval of Advertising Required on
Noncompliance. Any person violating any provision of this rule shall be subject
to the penalties prescribed by law. The director may also require the insurer
to file all its advertising intended for use in the state no later than twenty
(20) days before the use, the filings to be examined and approved by the
accident and health section of the Missouri Department of Commerce and
Insurance before use in this state. On these disapproved filings, the insurer
may request a hearing, as under section 376.777.7., RSMo, Approval of
Guidelines Adopted. The National Association of Insurance Commissioners'
Interpretive Guidelines predating this rule are declared to be the official
interpretation of this rule except where inconsistent with this rule.
(18) Severability Provision. If any section
or portion of a section of these rules or the applicability of them to any
person or circumstance is held invalid by a court, the remainder of the rules
or the applicability of that provision to other persons or circumstances, shall
not be affected by it.
RSMo 2000.* This rule was previously filed as 4 CSR 190-13.070. Original rule
filed Jan. 2, 1970, effective Jan. 15, 1970. Amended: Filed June 12, 1970,
effective July 1, 1970. Amended: Filed Aug. 5, 1974, effective Aug. 15, 1974.
Amended: Filed July 12, 2002, effective Jan. 30, 2003. Non-substantive change
filed Sept. 11 , 2019, published Oct. 31, 2019.
**Original authority: 354.120, RSMo 1973, amended 1983,
1993; 374.045, RSMo 1967, 1995; 375.936, RSMo 1959, amended 1967, 1969, 1971,
1976, 1978, 1983, 1991; and 376.405, RSMo 1959, amended 1984; and 376.777, RSMo
1959, amended 1984.