Wyoming Administrative Code
Agency 044 - Insurance Dept
Sub-Agency 0002 - General Agency, Board or Commission Rules
Chapter 21 - Rules Governing Advertisements of Accident and Sickness Insurance
Section 21-6 - Advertisements of Benefits Payable, Losses Covered or Premiums Payable

(i) The use of deceptive words, phrases, or illustrations in accident and sickness insurance advertisements is prohibited.

(ii) An advertisement that fails to state clearly the type of insurance coverage being offered is prohibited.

(iii) An advertisement shall not omit information or use words, phrases, statements, references, or illustrations if the omission or use 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 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.

(iv) An advertisement shall not 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 Medicare and your present insurance leave out," "this policy will help replace your income," (when used to express loss of time benefits), or similar words and phrases, in a manner that exaggerates any benefits beyond the policy's terms.

(v) An advertisement of a hospital or other similar facility confinement benefit referencing direct payment of the benefit to the policyholder is prohibited unless, in making the reference, the advertisement includes a statement that the benefits may be paid directly to the hospital or other health care facility if the policyholder assigns their benefits. An advertisement of medical and surgical expense benefits shall comply with this regulation. Phrases such as "you collect," "you get paid," "pays you," or other words or phrases of similar import may be used so long as the advertisement indicates it is payable to the insured or someone designated by the insured.

(vi) An advertisement for limited benefit health coverage or coverage of only certain types of loss is prohibited if:

(vii) Section 6(a)(vi) does not apply to individual major medical expense coverage, individual basic medical expense coverage, or disability income insurance.

(viii) Advertisements emphasizing total amounts payable under hospital, medical, or surgical accident and sickness insurance coverage or other benefits in a policy, such as benefits for private duty nursing, are prohibited unless the actual amounts payable per day for the indemnity or benefits are stated.

(ix) Advertisements examples of benefits payable under a policy shall not use examples in a way that implies the maximum payable benefit under the policy will be paid when less than maximum benefits are paid in an average claim.

(x) When an advertisement sets forth a range of benefit levels, it shall be clear the insured will receive only the benefit level written or printed in the policy selected and issued. Language implying the insured may select the benefit level at the time of filing claims is prohibited.

(xi) Language in an advertisement implying the amount of benefits payable under a loss-of-time policy may be increased at the time of claim or disability according to the needs of the insured is prohibited.

(xii) Advertisements for policies with modest premiums due to limited coverage or limited amounts of benefits shall not describe premiums as "low," "low cost," "budget," or use qualifying words of similar import. The use of words such as "only" and "just" in conjunction with statements of premium amounts when used to imply a bargain is prohibited.

(xiii) Advertisements stating or implying premiums will not be changed in the future are prohibited unless the advertised policies expressly provide that the premiums will not be changed in the future.

(xiv) An advertisement for a policy that does not require the premium to accompany the application shall not overemphasize that fact and shall clearly indicate under what circumstances coverage will become effective.

(xv) An advertisement exaggerating the effects of statutorily mandated benefits or required policy provisions or implying the provisions are unique to the advertised policy is prohibited.

(xvi) An advertisement implying that a common type of policy or a combination of common benefits is "new," "unique," "a bonus," "a breakthrough," or is otherwise unusual is prohibited. The addition of a novel method of premium payment to an otherwise common plan of insurance does not render it new.

(xvii) Language in an advertisement stating or implying that each member under a family contract is covered as to the maximum benefits advertised where that is not the fact is prohibited.

(xviii) An advertisement containing statements such as "anyone can apply," or "anyone can join," other than with respect to a guaranteed issue policy for which administrative procedures exist to assure the policy is issued within a reasonable period of time after the application is received by the insurer, is prohibited.

(xix) An advertisement stating or implying immediate coverage of a policy is prohibited unless administrative procedures exist so the policy is issued within fifteen (15) working days after the insurer receives the completed application.

(xx) An advertisement containing statements such as "here is all you do to apply," "simply," or "merely" to refer to the act of applying for a policy that is not a guaranteed issue policy is prohibited unless it refers to the fact that the application is subject to acceptance of approval by the insurer.

(xxi) An advertisement of accident and sickness 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 advertising and servicing the policies is a substantial cost in the marketing by direct response.

(xxii) Applications, request forms for additional information, and similar related materials are prohibited if they resemble paper currency, bonds, stock certificates, etc., or use any name, service mark, slogan, symbol, or device in a manner implying the insurer or the policy advertised is connected with a government agency, such as the Social Security Administration or the Department of Health and Human Services.

(xxiii) An advertisement implying in any manner that the prospective insured may realize a profit from obtaining hospital, medial, or surgical insurance coverage is prohibited.

(xxiv) An advertisement using words such as "extra," "special," or "added" to describe a benefit in the policy is prohibited. No advertisement of a benefit for which payment is conditioned 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 these words and phrases have the capacity, tendency, or effect of misleading the public into believing the policy advertised will, in some way, enable them to make a profit from being hospitalized.

(xxv) An advertisement of a hospital or other similar facility confinement benefit shall not 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 the monthly or weekly benefit amounts are juxtaposed with equally prominent statements of the benefit payable on a daily basis. The term "juxtaposed" means side by side or immediately above or below. When the policy contains a limit on the number of days of coverage provided, such limit must appear in the advertisement.

(xxvi) An advertisement of a policy covering only one disease or a list of specified diseases shall not imply coverage beyond the policy terms. Synonymous terms shall not be used to refer to any disease so as to imply broader coverage than is the fact.

(xxvii) An advertisement that is an invitation to contract for a specified disease policy that provides lesser benefit amounts for a particular subtype of disease, shall clearly disclose the subtype and its benefits. This provision shall not apply to institutional advertisements.

(xxviii) An advertisement of a specified disease policy providing expense benefits shall not use the term "actual" when the policy only pays up to a limited amount for expenses. Instead, the term "charges" or substantially similar language should be used which does not create the misleading impression that there is full coverage for expenses.

(xxix) An advertisement describing any benefits which vary by age shall disclose that fact.

(xxx) An advertisement using a phrase such as "no age limit" if benefits or premiums vary by age or if age is an underwriting factor shall disclose that fact.

(xxxi) A television, radio, mail, or newspaper advertisement, or lead-generating device designed to produce leads either by use of a coupon, a request to write or to call the company, or a subsequent advertisement prior to contact shall include information disclosing that an agent may contact the applicant.

(xxxii) Advertisements, applications, requests for additional information, and similar materials are prohibited if they state or imply that the recipient has been individually selected to be offered insurance or has had his or her eligibility for the insurance individually determined in advance when the advertisement is directed to all persons in a group or to all persons whose names appear on a mailing list.

(xxxiii) An advertisement, including invitations to inquire or invitations to contract, shall not employ devices designed to create undue fear or anxiety in those to whom they are directed. Examples of prohibited devices are:

(i) An advertisement shall not contain descriptions of policy limitations, exceptions, or reductions, worded in a positive manner implying it is a benefit, such as describing a waiting period as a "benefit builder" or stating "even pre-existing conditions are covered after two years." Words and phrases used in an advertisement describing the policy limitations, exceptions, and reductions shall fairly and accurately describe the negative features of the limitations, exceptions, and reductions of the offered policy.

(ii) An advertisement that is an invitation to contract shall disclose exceptions, reductions, and limitations affecting the basic policy provisions.

(iii) An advertisement subject to the requirements of the preceding paragraph shall prominently disclose 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 the loss.

(iv) An advertisement shall not use the words "only," "just," "merely," "minimum," "necessary," or similar words or phrases to describe applicability of any exceptions, reductions, limitations, or exclusions such as: "This policy is subject to the following minimum exceptions and reductions."

(v) An advertisement that is an invitation to contract that fails to disclose the amount of any deductible or the percentage of any coinsurance factor is prohibited.

(vi) An advertisement for loss-of-time coverage that is an invitation to contract which sets forth a range of amounts of benefit levels is prohibited unless it also states eligibility for the benefits is based upon condition of health, income, or other economic conditions, or other underwriting standards of the insurer if that is the fact.

(vii) An advertisement that refers to "hospitalization for injury or sickness" omitting the word "covered" when the policy excludes certain sicknesses or injuries, or that refers to "whenever you are hospitalized," "when you go to the hospital," or "while you are confined in the hospital" omitting the phrase "for covered injury or sickness," if the policy excludes certain injuries or sickness, is prohibited. Continued reference to "covered injury or sickness" is not necessary where the advertisement has prominently disclosed this fact and where the description of sicknesses or injuries not covered is prominently set forth.

(viii) An advertisement that fails to disclose that the definition of "hospital" does not include certain facilities providing institutional care such as a nursing home, convalescent home, or extended care facility, when the facilities are excluded under the policy's definition of hospital is prohibited.

(ix) The term "confining sickness" or "homebound status" shall be explained in an advertisement containing the term.

(x) An advertisement that fails to disclose any waiting or elimination periods for specific benefits is prohibited.

(xi) An advertisement for a policy providing benefits for specified illnesses only, such as cancer, or for specified accidents only, such as automobile accidents, or other policies providing benefits that are limited in nature shall clearly and conspicuously in prominent type state the limited nature of the policy. The statement shall be worded in language identical to, or substantially similar to, the following: "THIS IS A LIMITED POLICY," "THIS POLICY PROVIDES LIMITED BENEFITS," "THIS IS A CANCER ONLY POLICY," "THIS IS A MEDICARE SUPPLEMENT POLICY," or "THIS IS AN AUTOMOBILE ACCIDENT ONLY POLICY."

(i) An advertisement that is an invitation to contract shall, in negative terms, disclose the extent to which any loss is not covered if the cause of loss is traceable to a condition existing prior to the policy's effective date. The term "pre-existing condition" shall not be used without an appropriate definition or description complying with Wyoming Statutes.

(ii) Under no circumstance shall the definition of "preexisting condition" be based upon "prudent person" or similar language, meaning the average layperson would have sought treatment or advice for the given condition or symptom. Preexisting conditions shall only relate to conditions for which medical advice, diagnosis, care, or treatment was actually recommended or received.

(iii) When an accident and sickness insurance policy does not cover losses resulting from preexisting conditions, an advertisement of the policy shall not state or imply that the applicant's physical condition or medical history will not affect issuance of the policy or payment of a claim under the policy. The phrase "no health questions" or words of similar import shall not be used if the policy excludes preexisting conditions. Use of a phrase such as "guaranteed issue or "automatic issue," if the policy excludes preexisting conditions for a certain period, must be accompanied by a statement disclosing that fact in a manner that does not minimize, render obscure, or otherwise make it appear unimportant and is otherwise consistent with Section 4.

(iv) When an advertisement contains an application form to be completed by the applicant and returned by mail, the application form shall contain a question or statement reflecting the pre-existing condition provisions of the policy immediately preceding a blank space for the applicant's signature. The application form shall contain a question or statement substantially as follows:

"I understand the policy applied for will not pay benefits for any loss incurred during the first twelve (12) months after the issue date on account of disease or physical conditions for which medical advice, diagnosis, care, or treatment was actually recommended or received in the last six (6) months."