New York Codes, Rules and Regulations
Title 11 - INSURANCE
Chapter IX - Unfair Trade Practices
Part 215 - Advertisements Of Accident And Health Insurance
Section 215.6 - Advertisements of benefits payable, losses covered or premiums payable
Universal Citation: 11 NY Comp Codes Rules and Regs ยง 215.6
Current through Register Vol. 46, No. 12, March 20, 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 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
policy.
(3) No advertisement shall
contain any description 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 such policy limitations, exceptions and reductions shall fairly and
accurately describe the negative features of such limitations, exceptions and
reductions of the policy offered.
(4) 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 because such words and phrases
have the capacity, tendency or effect of misleading the public into believing
that the policy advertised will, in some way, enable persons to make a profit
from being hospitalized.
(5) 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. When the policy
contains a limit on the number of days of coverage provided, such limit must
appear in the advertisement.
(6) No
advertisement of a direct response insurance product shall imply that because
"no insurance agent will call and no commissions will be paid to agents" it is
"a low cost plan," or use other similar words or phrases because the cost of
advertising and servicing such policies is a substantial cost in the marketing
of a direct response insurance product.
(7) The terms Medicare supplement, Medigap
and words of similar import shall not be used in any advertisement of a policy,
nor shall such advertisement otherwise imply or state that the policy is
supplemental to Medicare unless that policy is issued in compliance with
section
52.11
and Part 58 of this Title.
(b) Exceptions, reductions and limitations.
(1) When an advertisement refers to either a
dollar amount, a period of time for which any benefit is payable, the cost of
the policy, a specific policy benefit, or the loss for which such 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 such
loss, an advertisement which is subject to the requirements of the preceding
paragraph 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 subject to the
requirements of section 215.6(b) of this Part 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 term preexisting condition 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 the policy or
payment of a claim thereunder. This rule 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 to be completed by the applicant and returned by mail for a direct
response insurance product, such application shall be identical except for size
to the application form approved for the policy being offered.
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