Current through Register Vol. 46, No. 12, March 20, 2024
(a) The format and content of an
advertisement of an accident and health 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 superintendent from the overall impression
that the advertisement may be reasonably expected to create upon a person of
average education and intelligence, unique to the particular type of audience
to which the advertisement is directed, and whether it may be reasonably
comprehended by the segment of the public to which it is directed.
(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.
(c) An advertisement
of a policy shall contain in a prominent place and style the appropriate
statement for the coverage provided, as determined by the definitions in 11
NYCRR 52.5-52.11 (Regulation No. 62), as follows:
(1) This policy meets the minimum standards
for basic hospital insurance as defined by the New York State Insurance
Department. It does NOT provide basic medical or major medical insurance. The
expected benefit ratio for this policy is ________ percent. This ratio is the
portion of future premiums which the company expects to return as benefits,
when averaged over all people with this policy.
(2) This policy meets the minimum standards
for basic medical insurance as defined by the New York State Insurance
Department. It does NOT provide basic hospital or major medical insurance. The
expected benefit ratio for this policy is ________ percent. This ratio is the
portion of future premiums which the company expects to return as benefits,
when averaged over all people with this policy.
(3) This policy meets the minimum standards
for major medical insurance as defined by the New York State Insurance
Department. It does NOT provide basic hospital or basic medical insurance. The
expected benefit ratio for this policy is ________ percent. This ratio is the
portion of future premiums which the company expects to return as benefits,
when averaged over all people with this policy.
(4) This policy provides limited benefits
health insurance only. It does NOT provide basic hospital, basic medical or
major medical insurance as defined by the New York State Insurance Department.
The expected benefit ratio for this policy is ________ percent. This ratio is
the portion of future premiums which the company expects to return as benefits,
when averaged over all people with this policy.
(5) This policy provides disability income
insurance only. It does NOT provide basic hospital, basic medical or major
medical insurance as defined by the New York State Insurance Department. The
expected benefit ratio for this policy is ________ percent. This ratio is the
portion of future premiums which the company expects to return as benefits,
when averaged over all people with this policy.
(6) This policy provides ACCIDENT insurance
only. It does NOT provide basic hospital, basic medical or major medical
insurance as defined by the New York State Insurance Department. The expected
benefit ratio for this policy is ________ percent. This ratio is the portion of
future premiums which the company expects to return as benefits, when averaged
over all people with this policy.
IMPORTANT NOTICE--THIS POLICY DOES NOT PROVIDE COVERAGE FOR
SICKNESS.
(7) This policy
provides DENTAL insurance only. The expected benefit ratio for this policy is
________ percent. This ratio is the portion of future premiums which the
company expects to return as benefits, when averaged over all people with this
policy.
(8) This policy meets the
minimum standards for MEDICARE SUPPLEMENT INSURANCE as defined by the New York
State Insurance Department. The expected benefit ratio for this policy is
________ percent. This ratio is the portion of future premiums which the
company expects to return as benefits, when averaged over all people with this
policy.
IMPORTANT NOTICE--A CONSUMER'S GUIDE TO HEALTH INSURANCE FOR
PEOPLE ELIGIBLE FOR MEDICARE MAY BE OBTAINED FROM YOUR LOCAL SOCIAL SECURITY
OFFICE OR FROM THIS INSURER.
Such statements may be made to conform to the actual
insurance provided where such insurance complies with more than one of the
definitions contained in such sections
52.5
through
52.11.
The requirements for disclosure of the expected benefit ratios of policies as
provided in this section shall not apply to group policies as defined in
sections 221 and 253(6) of the Insurance Law.
(d) Every insurer providing Medicare
supplement insurance as defined in 11 NYCRR 52.11 (Regulation 62) shall
provide, prior to its use, a copy of any advertisement for a Medicare
supplement insurance policy intended for use in this State whether through
written, radio, or television medium to the superintendent. Such advertisement
shall comply with all applicable regulations and laws of this State.
