CHAPTER Ins 2600
ADVERTISEMENTS OF INSURANCE
Statutory Authority: RSA 400-A:15, I.; RSA 417:4
PART
Ins 2601
ADVERTISEMENTS OF ACCIDENT AND HEALTH INSURANCE
Ins 2601.01 Purpose. The purpose of the advertisements of accident
and health insurance part is to establish minimum criteria to assure proper and
accurate description and to protect prospective purchasers with respect to the
advertisement of accident and health insurance in the same manner as the rule
governing advertisements of Medicare supplement insurance. This part assures the clear and truthful
disclosure of the benefits, limitations and exclusions of policies sold as
accident and health insurance by the establishment of standards of conduct in
the advertising of accident and health insurance in a manner that prevents
unfair, deceptive and misleading advertising and is conducive to accurate
presentation and description to the insurance-buying public through the
advertising media and material used by insurance agents and companies.
Source. #1900, eff 1-1-82; ss by #4287, eff 7-1-87;
ss by #5655, eff 7-1-93; ss by #6971, eff 4-1-99, EXPIRED: 4-1-07
New. #9333, eff 12-5-08; ss
by #11173, eff 12-5-16
Ins 2601.02 Applicability.
(a) This part shall apply to individual and group
accident and health insurance (except Medicare supplement insurance or any
other insurance that is covered by a separate state statute)
"advertisement," as that term is defined in Ins 2601.03 (b), (g), (h)
and (i) unless otherwise specified in this part,
which the insurer knows or reasonably should know is intended for presentation,
distribution or dissemination in this state when the presentation, distribution
or dissemination is made either directly or indirectly by or on behalf of an
insurer or producer, as those terms are defined in Title XXXVII.
(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. All of
the insurer's advertisements, regardless of by whom written, created, designed
or presented, shall be the responsibility of the insurer whose policies are
advertised.
(c)
Advertising materials that are reproduced in quantity shall be
identified by form numbers or other identifying means. The identification shall be sufficient to
distinguish an advertisement from any other advertising materials, policies,
applications or other materials used by the insurer.
Source. #1900, eff 1-1-82; ss by #4287, eff 7-1-87;
ss by #5655, eff 7-1-93; ss by #6971, eff 4-1-99, EXPIRED: 4-1-07
New. #9333, eff 12-5-08; ss
by #11173, eff 12-5-16
Ins 2601.03 Definitions.
(a)(1)
"Accident and health insurance policy" means a policy, plan,
certificate, contract, agreement, statement of coverage, rider or endorsement
that provides accident or health benefits or medical, surgical or hospital
benefits, whether on an indemnity, reimbursements, service or prepaid basis,
except when issued in connection with another kind of insurance other than life
and except disability, waiver of premium and double indemnity benefits included
in life insurance and annuity contracts.
An accident and health insurance policy does not include a Medicare
supplement policy, or any other type of accident and
health insurance with advertising guidelines covered by a separate statute or
rule.
(2)
The language "except disability, waiver of premium and double
indemnity benefits included in life insurance and annuity contracts" means
it does not include disability, waiver of premium or double indemnity benefits
included in life insurance, endowment or annuity contracts or contracts
supplemental to the above contracts that contain only provisions that:
a. Provide
additional benefits in case of death or dismemberment or loss of sight by accident;
or
b. Operate
to safeguard the contracts against lapse or to give a special surrender value,
special benefit or an annuity in the event that the insured or annuitant shall
become totally and permanently disabled as defined by the contract or supplemental
contract.
(b)(1)
"Advertisement" means:
a. Printed and published material, audio visual
material, and descriptive literature of an insurer used in direct mail,
newspapers, magazines, radio scripts, TV scripts, websites and other Internet
displays or communications, other forms of electronic communications,
billboards and similar displays;
b. Descriptive literature and sales aids of all
kinds issued by a producer for presentation to members of the insurance-buying
public, such as circulars, leaflets, booklets, depictions, illustrations, form
letters and lead-generating devices of all kinds; and
c. Prepared
sales talks, presentations and material for use by producers whether prepared
by the insurer or the producer.
(2) The definition of "advertisement"
includes advertising material included with a policy when the policy is
delivered and material used in the solicitation of renewals and reinstatements.
(3) The definition of advertisement extends to
the use of all media for communications to the general public, to the use of
all media for communications to specific members of the general public, and to
the use of all media for communications by producers.
(4) The definition of advertisement does not
include:
a. Material
used solely for the training and education of an insurer's employees and
producers;
b. Material
used in-house by insurers;
c.
Communications within an insurer's own
organization not intended for dissemination to the public;
d. Individual
communications of a personal nature with current policyholders other than
material urging the policyholders to increase or expand coverages;
e.
Correspondence between a prospective group or
blanket policyholder and an insurer in the course of negotiating a group or
blanket contract;
f. Court-approved
material ordered by a court to be disseminated to policyholders; or
g. A
general announcement from a group or blanket policyholder to eligible
individuals on an employment or membership list that a contract or program has
been written or arranged; provided that the announcement clearly indicates that
it is preliminary to the issuance of a booklet and that the announcement does
not describe the specific benefits under the contract or program nor describe
advantages as to the purchase of the contract or program. This does not prohibit a general endorsement
of the program by the sponsor.
(c)
"Certificate" means a statement of the coverage and provisions
of a policy of group accident and sickness insurance, which has been delivered
or issued for delivery in this state and includes riders, endorsements and
enrollment forms, if attached.
(d)
"Exception" means any provision in a policy whereby coverage
for a specified hazard is entirely eliminated; it is a statement of a risk not
assumed under the policy.
(e)
"Insurer" means an individual, corporation, association,
partnership, reciprocal exchange, inter-insurer, Lloyds, fraternal benefits
society, health maintenance organization, hospital service
corporation, medical service corporation, prepaid health plan and any
other legal entity that is defined as an insurer under Title XXXVII, and is
engaged in the advertisement of itself or an accident and health insurance
policy.
(f)
"Institutional advertisement" means an advertisement having as
its sole purpose the promotion of the reader's, viewer's or listener's interest
in the concept of accident and health insurance, or the promotion of the
insurer as a seller of accident and health insurance.
(g)
"Invitation to contract" means an advertisement
that is neither an invitation to inquire nor an institutional advertisement.
(h)
"Invitation to inquire" means:
(1) An advertisement having as its objective the
creation of a desire to inquire further about accident and health insurance and
that is limited to a brief description of the loss for which benefits are
payable but may contain:
a. The
dollar amount of benefits payable; and
b. The
period of time during which benefits are payable.
(2) An invitation to inquire may not refer to cost.
(3) An invitation to inquire shall contain a
provision in the following or substantially similar form:
"This
policy has [exclusions] [limitations] [reduction of benefits] [terms under
which the policy may be continued in force or discontinued]. For costs and complete details of the
coverage, call [or write] your insurance producer or
the company [whichever is applicable]."
(i) "Lead-generating device" means any
communication directed to the public that, regardless of the 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 accident and health insurance.
(j)
"Limitation" means a provision that restricts coverage under
the policy other than an exception or a reduction.
(k)
"Limited benefit health coverage" is health insurance that
provides certain health related benefits, including income replacement coverage
for certain health related events, that is not health coverage under RSA
420-G:2,IX.
(l)
"Person" means a natural person, association, organization,
partnership, trust, group, discretionary group, corporation or any other
entity.
(m) "Prominently" or
"conspicuously" means that the information to be disclosed
prominently or conspicuously shall be presented in a manner that is noticeably
set apart from other information or images in the advertisement.
(n)
"Reduction" means a provision that 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 and
the reduction has not been used.
Source. #9333, eff 12-5-08; ss
by #11173, eff 12-5-16
Ins 2601.04 Method of Disclosure of
Required Information.
(a)
All information, exceptions, limitations, reductions and other
restrictions required to be disclosed by this part shall be set out
conspicuously and in close conjunction to the statements to which the information
relates or under appropriate captions of such prominence that it shall not be
minimized, rendered obscure or presented in an ambiguous fashion or
intermingled with the context of the advertisements so as to be confusing or
misleading. This part permits, but is
not limited to, the use of either the following methods of disclosure:
(1) Disclosure in the description of the related
benefits or in a paragraph set out in close conjunction with the description of
the policy benefits; or
(2) Disclosure not in conjunction with the
provisions describing policy benefits but under appropriate captions of such
prominence that the information shall not be minimized, rendered obscure or
otherwise made to appear unimportant.
The phrase "under appropriate captions" means that the title
shall be accurately descriptive of the captioned material. Appropriate captions include the
following: "Exceptions,"
"Exclusions," "Conditions Not Covered,"
and "Exceptions and Reductions."
The use of captions such as the following are prohibited because they do
not provide adequate notice of the significance of the material: "Extent of Coverage," "Only
these Exclusions," or "Minimum Limitations."
Source. #9333, eff 12-5-08; ss
by #11173, eff 12-5-16
Ins 2601.05 Form
and Content of Advertisements.
(a)
The format and content of an advertisement of an accident or health
insurance policy shall be sufficiently complete and clear to avoid deception or
the capacity or tendency to mislead or deceive.
Format means the arrangement of the text and the captions.
(b) Distinctly different
advertisements are required for publication in different media, such as
newspapers or magazines of general circulation as compared to scholarly,
technical or business journals and newspapers.
Where an advertisement consists of more than one piece of material, each
piece of material shall, independent of all other pieces of material, conform
to the disclosure requirements of this part.
(c)
Whether an advertisement has a capacity or tendency to mislead or
deceive shall be determined by the commissioner from the overall impression
that the advertisement may be reasonably expected to create within the segment
of the public to which it is directed.
Exceptions, reductions and limitations shall be in the same size and
type as benefit features.
(d)
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.
(e)
An insurer shall clearly identify its accident and health insurance
policy as an insurance policy. A policy
trade name shall be followed by the words "insurance policy" or
similar words clearly identifying the fact that an insurance policy or health
benefits product (in the case of health maintenance organizations, prepaid
health plans and other direct service organizations) is being offered.
(f)
An insurer, producer or other person shall not solicit a resident of
this state for the purchase of accident and health insurance in connection with
or as the result of the use of advertisement by the person or any others
persons, where the advertisement:
(1) Contains any misleading representations or
misrepresentations, or is otherwise untrue, deceptive or misleading with regard
to the information imparted, the status, character or representative capacity
of the person or the true purpose of the advertisement; or
(2) Otherwise violates the provisions of this
part.
(g)
An insurer, producer or other person shall not solicit residents of this
State for the purchase of accident and health insurance through the use of a
true or fictitious name that is deceptive or misleading with regard to the
status, character or proprietary or representative capacity of the person or
the true purpose of the advertisement.
Source. #9333, eff 12-5-08; ss
by #11173, eff 12-5-16
Ins 2601.06 Advertisements
of Benefits Payable, Losses Covered or Premiums Payable.
(a)
Covered benefits.
(1) The use of deceptive words, phrases or
illustrations in advertisements of accident and health insurance is prohibited.
(2) An advertisement that fails to state clearly
the type of insurance coverage being offered is prohibited.
(3) An advertisement shall not omit information
or use words, phrases, statements, references or illustrations if the omission
of information or use of words, phrases, statements, references or
illustrations has the capacity, tendency or effect of misleading or deceiving
purchases 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.
(4) 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 that Medicare and your present insurance leave out,"
"the policy will help to replace your income," (when used to express
loss of time benefits), or similar words and phrases, in a manner that
exaggerates a benefit beyond the terms of the policy.
(5) An advertisement of a hospital or other
similar facility confinement benefit that makes reference to the benefit being
paid directly 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 an assignment of
benefits is made by the policyholder. An
advertisement of medical and surgical expense benefits shall comply with this
part in regard to the disclosure of assignments of benefits to providers of
services. 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
that it is payable to the insured or someone designated by the insured.
(6)
a. An
advertisement for basic hospital expense coverage, basic medical-surgical
expense coverage, basic hospital/medical-surgical expense coverage, hospital
confinement indemnity coverage, accident only coverage, specified disease
coverage, specified accident coverage or limited benefit health coverage or for
coverage that covers only a certain type of loss is prohibited if:
1. The advertisement refers to a total benefit
maximum limit payable under the policy in any headline, lead-in or caption
without also in the same headline, lead-in or caption specifying the applicable
daily limits and other internal limits;
2. The advertisement states a total benefit
limit without stating the period benefit payment, if any, and the length of
time the period benefit would be payable to reach the total benefit limit; or
3. The advertisement prominently displays a
total benefit limit that would not, as a general rule, be payable under an
average claim.
b. This
paragraph does not apply to individual major medical expense coverage,
individual basic medical expense coverage, or disability income insurance.
(7) Advertisements that emphasize total amounts
payable under hospital, medical or surgical accident and health 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.
(8) Advertisements that include examples of
benefits payable under a policy shall not use examples in a way that implies
that the maximum payable benefit payable under the policy will be paid, when less than maximum benefits are paid in an average
claims.
(9) When a range of benefit levels is set forth
in an advertisement, it shall be clear that the insured will receive only the
benefit level written or printed in the policy selected and issued. Language that implies that the insured may
select the benefit level at the time of filing claims is prohibited.
(10) Language in an advertisement that implies
that 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.
(11) Advertisements for policies with premiums
that are modest because of their limited coverage or limited amount 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 are prohibited.
(12) Advertisements that state or imply that
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.
(13) 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.
(14) An advertisement that exaggerates the effects
of statutorily mandated benefits or required policy provisions or that implies
that the provisions are unique to the advertised policy is prohibited.
(15) An advertisement that implies 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.
(16) Language in an advertisement that states or
implies that each member under a family contract is covered as to the maximum
benefits advertised, where that is not the fact, is prohibited.
(17) An advertisement that contains 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 that the policy is issued
within a reasonable period of time after the application is received by the
insurer, is prohibited.
(18) An advertisement that states or implies
immediate coverage of a policy is prohibited unless administrative procedures
exist so that the policy is issued within 15 working days after the insurer
receives the completed application.
(19) An advertisement that contains statements
such as "here is all you do to apply," or "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 or approval by the insurer.
(20) An advertisement of accident and health
insurance sold by direct response shall not state or imply that because no
insurance producer will call and no commissions will be paid to producers 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.
(21) 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 that implies that 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.
(22) An advertisement that implies in any manner
that the prospective insured may realize a profit from obtaining hospital,
medical or surgical insurance coverage is prohibited.
(23) An advertisement that uses 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 that the
policy advertised will, in some way, enable them to make a profit from being
hospitalized.
(24) 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 in juxtaposition with equally prominent statements of the benefit
payable on a daily basis. The term
"juxtaposition" means side by side or immediately above or
below. When the policy contains a limit
on the number of days of coverage provided, the limit shall appear in the
advertisement.
(25) An advertisement of a policy covering only
one disease or a list of specified diseases shall not 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.
(26) 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.
(27) 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 that does not create the misleading
impression that there is full coverage for expenses.
(28) An advertisement that describes any benefits
that vary by age shall disclose that fact.
(29) An advertisement that uses 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.
(30) A television, radio, mail or newspaper
advertisement or lead-generating device that is 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 a producer may contact the applicant.
(31) 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.
(32) An advertisement, including invitations to
inquire or invitations to contract, shall not employ devices that are designed
to create undue fear or anxiety in the minds of those to whom they are
directed. Examples of prohibited devices
are:
a. The
use of phrases such as "cancer kills somebody every two minutes" and
"total number of accidents" without reference to the total population
from which the statistics are drawn;
b. The
exaggeration of the importance of diseases rarely or seldom found in the class
of persons to whom the policy is offered;
c. The
use of phrases such as "the finest kind of treatment," implying that
the treatment would be unavailable without insurance;
d. The
reproduction of newspaper articles, magazine articles, information from the
Internet or other similar published material containing irrelevant facts and
figures;
e. The use of images that unduly emphasize
automobile accidents, disabled persons or persons confined in beds who are in
obvious distress, persons receiving hospital or medical bills or persons being
evicted from their homes due to their medical bills;
f. The use of phrases as "financial
disaster," "financial distress," "financial shock," or
another phrase implying that financial ruin is likely without insurance is only
permissible in an advertisement for major medical expense coverage, individual
basic medical expense coverage or disability income coverage, and only if the
phrase does not dominate the advertisement;
g. The
use of phrases or devices that unduly excite fear of dependence upon relatives
or charity; and
h. The
use of phrases or devices that imply that long sicknesses or hospital stays are
common among the elderly.
(b)
Exceptions, Reductions and Limitations.
(1) An advertisement shall not contain
descriptions of policy limitations, exceptions or reductions, 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 shall fairly and accurately describe the
negative features of the limitations, exceptions and reductions of the policy
offered.
(2) An advertisement that is an invitation to
contract shall disclose those exceptions, reductions and limitations affecting
the basic provisions of the policy in the same size and type as benefit
features.
(3) 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 at a time period between
the date a loss occurs and the date benefits begin to accrue for the loss, an
advertisement that is subject to the requirements of the preceding paragraph
shall prominently disclose the existence of the periods.
(4) An advertisement shall not use the words
"only," "just," "merely," "minimum,"
"necessary" or similar words or phrases to describe the applicability
of any exceptions, reductions, limitations or exclusions such as: "This policy is subject to the following
minimum exceptions and reductions."
(5) 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.
(6) An advertisement for loss-of-time coverage
that is an invitation to contract that sets forth a range of amounts of benefit
levels is prohibited unless it also states that 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.
(7) 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 this fact has been prominently
disclosed in the advertisement and where the description of sicknesses or
injuries not covered is prominently set forth.
(8) An advertisement that fails to disclose that
the definition of "hospital" does not include certain facilities that
provide institutional care such as a nursing home, convalescent home or
extended care facility, when the facilities are excluded under the definition
of hospital in the policy, is prohibited.
(9) An advertisement that fails to disclose any
waiting or elimination periods for specific benefits is prohibited.
(10) 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," or "THIS IS AN
AUTOMOBILE ACCIDENT ONLY POLICY."
(c)
Preexisting Conditions.
(1) 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 the loss is traceable to a condition existing prior to the
effective date of the policy. The use of
the term "preexisting condition" without an appropriate definition or
description shall not be used.
(2) When an accident and health 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 the issuance of the policy or payment of a
claim under the policy. This part 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 if it is an invitation to contract shall disclose
that a medical examination is required.
(3) 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 that reflects the preexisting
condition provisions of the policy immediately preceding the blank space for
the applicant's signature. For example,
the application form shall contain a question or statement substantially as
follows:
"Do
you understand that this policy will not pay benefits during the first [insert
number] [years, months] after the issue date for a disease or physical
condition that you now have or have had in the past? YES"
Or
substantially the following statement:
"I
understand that the policy applied for will not pay benefits for any loss incurred
during the first [insert number] [years, months] after the issue date on
account of disease or physical condition that I now have or have had in the
past."
Source. #9333, eff 12-5-08; ss
by #11173, eff 12-5-16
Ins 2601.07 Necessity
for Disclosing Policy Provisions Relating to Renewability, Cancellability
and Termination.
(a)
An advertisement that is an invitation to contract shall disclose the
provisions relating to renewability, cancellability
and termination and any modification of benefits, losses covered, or premiums
because of age or for other reasons, in a manner that shall not minimize or
render obscure the qualifying conditions.
(b)
Advertisements of cancellable accident and health insurance policies
shall state that the contract is cancellable or renewable at the option of the
company, as the case may be, in language substantially similar to the
following: A policy that is renewable at
the option of the insurance company shall be advertised in a manner similar to,
"This policy is renewable at the option of the company," or "The
company has the right to refuse renewal of this policy," or
"Renewable at the option of the insurer," or "This policy can be
cancelled by the company at any time."
(c)
Advertisements of insurance policies that are guaranteed renewable,
cancelable or renewable at the option of the company shall disclose that the
insurer has the right to increase premium rates if the policy so provides.
(d)
Qualifying conditions that constitute limitations on the permanent nature
of the coverage shall be disclosed in advertisements of insurance policies that
are guaranteed renewable, cancelable or renewable at the option of the
company. Examples of qualifying
conditions are:
(1) Age limits;
(2) Reservation of a right to increase premiums;
and
(3) The establishment of aggregate limits.
a. Provisions
for reduction of benefits at stated ages shall be set forth. For example, a policy may contain a provision
that reduces benefits 50 percent after age 60 although it is renewable to age
65. Such a reduction shall be set
forth. Also, a provision for the
elimination of certain hazards at any specific ages or after the policy has
been in force for a specified time shall be set forth.
b. An advertisement for a policy that provides
for step-rated premium rates based upon the policy year or the insured's
attained age shall disclose the rate increases and the times or ages at which
the premiums increase.
Source. #9333, eff 12-5-08; ss
by #11173, eff 12-5-16
Ins 2601.08 Standards
for Marketing.
(a)
An insurer, directly or through its producers, shall:
(1) Establish marketing procedures to assure that
any comparison of policies by its producers will be fair and accurate;
(2) Establish marketing procedures assuring excessive
insurance is not sold or issued, except this requirement does not apply to
group major medical expense coverage and disability income coverage; and
(3) Establish auditable procedures for verifying
compliance with this subsection.
(b)
In addition to the practices prohibited in RSA 417, the following acts
and practices are prohibited:
(1) Twisting.
Knowingly making any misleading representation or incomplete or
fraudulent comparison of insurance policies or insurers for the purpose of
inducing, or tending to induce, a person to lapse, forfeit, surrender,
terminate, retain, pledge, assign, borrow on, or convert an insurance policy,
or to take out a policy of insurance with another insurer;
(2) High Pressure Tactics. Employing a method of marketing that has the
effect of inducing the purchase of insurance, or tends to induce the purchase
of insurance through force, fright, threat, whether explicit or implied, or
undue pressure to purchase or recommend the purchase of insurance; and
(3) Cold Lead Advertising. Making use directly or indirectly of any
method of marketing that fails to disclose in a conspicuous manner that a
purpose of the method of marketing is solicitation of insurance and that
contact will be made by an insurance agent or insurance company.
Source. #9333, eff 12-5-08; ss
by #11173, eff 12-5-16
Ins 2601.09 Testimonials
or Endorsements by Third Parties.
(a)
Testimonials and endorsements used in advertisements shall 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 or endorsement, makes as its own all
of the statements contained in it, and the advertisement, including the statement,
is subject to all the provisions of this part.
When a testimonial or endorsement is used more than one year after it
was originally given, a confirmation shall be obtained.
(b)
A person shall be deemed a "spokesperson" if the person making
the testimonial or endorsement:
(1) Has a financial interest in the insurer or a
related entity as a stockholder, director, officer, employee or otherwise;
(2) Has been formed by the insurer, is owned or
controlled by the insurer, its employees, or the person or persons who own or
control the insurer;
(3) Has any person in a policy-making position
who is affiliated with the insurer in any of the above described capacities; or
(4) Is in any way directly or indirectly
compensated for making a testimonial or endorsement.
(c)
The fact of a financial interest or the proprietary or representative
capacity of a spokesperson shall be disclosed in an advertisement and shall be
accomplished in the introductory portion of the testimonial or endorsement in
the same form and with equal prominence.
If a spokesperson is directly or indirectly compensated for making a
testimonial or endorsement, the fact shall be disclosed in the advertisement by
language substantially as follows:
"Paid Endorsement." The
requirement of this disclosure may be fulfilled by use of the phrase "Paid
Endorsement" or words of similar import in a type style and size at least
equal to that used for the spokesperson's name or the body of the testimonial
or endorsement, whichever is larger. In
the case of television or radio advertising, the required disclosure shall be
accomplished in the introductory portion of the advertisement and shall be
given prominence.
(d)
The disclosure requirements of this regulation shall not apply where the
sole financial interest or compensation of a spokesperson, for all testimonials
or endorsements made on behalf of the insurer, consists of the payment of union
scale wages required by union rules, and if the payment is actually the scale
for TV or radio performances.
(e)
An advertisement shall not state or imply that an insurer or an accident
and health insurance policy has been approved or endorsed by any individual,
group of individuals, society, association or other organizations, unless that
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 person or persons who own or
control the insurer, the fact shall be disclosed in the advertisement. If the insurer or an officer of the insurer
formed or controls the association, or holds any policymaking position in the
association, that fact shall be disclosed.
(f)
When a testimonial refers to benefits received under an accident and
health insurance policy, the specific claim data, including claim number, date
of loss and other pertinent information shall be retained by the insurer for
inspection for the period required under RSA 400-B or until the filing of the
next regular report of examination of the insurer, whichever is the longer
period of time. The use of testimonials
that do not correctly reflect the present practices of the insurer or that are
not applicable to the policy or benefit being advertised is not permissible.
Source. #9333, eff 12-5-08; ss
by #11173, eff 12-5-16
Ins 2601.10 Use
of Statistics.
(a)
An advertisement relating to the dollar amounts of claims paid, the
number of persons insured, or similar statistical information relating to an insurer
or policy shall not use irrelevant facts, and shall not be used unless it
accurately reflects all of the current and relevant facts. The advertisement shall not imply that the
statistics are derived from the policy advertised unless that is the fact, and
when applicable to other policies or plans shall specifically so state.
(1) An advertisement shall specifically identify
the accident and health insurance policy to which statistics relate and where
statistics are given that are applicable to a different policy, it shall be
stated clearly that the data do not relate to the policy being advertised.
(2) An advertisement using statistics that
describe an insurer, such as assets, corporate structure, financial standing,
age, product lines or relative position in the insurance business, may be
irrelevant and, if used at all, shall be used with extreme caution because of
the potential for misleading the public.
As a specific example, an advertisement for accident and health
insurance that refers to the amount of life insurance which the company has in
force or the amounts paid out in life insurance benefits is not permissible
unless the advertisement clearly indicates the amount paid out for each line of
insurance.
(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 source of any statistics used in an advertisement shall be
identified in the advertisement.
Source. #9333, eff 12-5-08; ss
by #11173, eff 12-5-16
Ins 2601.11 Identification
of Plan or Number of Policies.
(a)
An advertisement that uses the word "plan" without prominently
identifying it as an accident and sickness insurance policy is prohibited.
(b)
When a choice of the amount of benefits is referred to, an advertisement
that is an invitation to contract shall disclose that the amount of benefits
provided depends upon the plan selected and that the premium will vary with the
amount of the benefits selected.
(c)
When an advertisement that is an invitation to contract refers to
various benefits that may be contained in 2 or more policies, other than group
master policies, the advertisement shall disclose that the benefits are
provided only through a combination of policies.
Source. #9333, eff 12-5-08; ss
by #11173, eff 12-5-16
Ins 2601.12 Disparaging
Comparisons and Statements. An advertisement shall not directly or
indirectly make unfair or incomplete comparisons of policies or benefits or
comparisons or non-comparable policies of other insurers, and shall not
disparage competitors, their policies, services or business methods, and shall
not disparage or unfairly minimize competing methods of marketing insurance.
(a)
An advertisement shall not contain statements such as "no red
tape" or "here is all you do to receive benefits."
(b)
Advertisements that state or imply that competing insurance coverages customarily contain certain exceptions,
reductions or limitations not contained in the advertised policies are
prohibited unless the exceptions, reductions or limitations are contained in a
substantial majority of the competing coverages.
(c)
Advertisements that state or imply that an insurer's premiums are lower
or that its loss ratios are higher because its organizational structure differs
from that of competing insurers are prohibited.
Source. #9333, eff 12-5-08; ss
by #11173, eff 12-5-16
Ins 2601.13 Jurisdictional
Licensing and Status of Insurer.
(a)
An advertisement that is intended to be 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 the merits, desirability, or advisability of its policy forms or
kinds or plans of insurance are approved, endorsed or accredited by any
division or agency of this state or the federal government. Terms such as "official" or words
of similar import, used to describe any policy or application form are
prohibited because of the potential for deceiving or misleading the public.
(c)
An advertisement shall not imply that approval, endorsement or
accreditation of policy forms or advertising has been granted by any division
or agency of the state or federal government.
Approval of either policy forms or advertising shall not be used by an
insurer to imply or state that a governmental agency has endorsed or
recommended the insurer, its policies, advertising or its financial condition.
Source. #9333, eff 12-5-08; ss
by #11173, eff 12-5-16
Ins 2601.14 Identity
of Insurer.
(a)
The name of the actual insurer shall be stated in all of its
advertisements. The form number or
numbers of the policy advertised shall be stated in an advertisement that is an
invitation to contract. An advertisement
shall not use a trade name, an insurance group designation, name of the parent
company of the insurer, name of the particular division of the insurer, service
mark, slogan, symbol or other device that 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 insurer.
(b)
An advertisement shall not use any combination of words, symbols, or
physical materials that by their content, phraseology, shape, color or other
characteristics are so similar to 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.
(c)
Advertisements, envelopes or stationery that employ words, letters,
initials, symbols or other devices that are similar to those used in
governmental agencies or by other insurers are not permitted if they may lead
the public to believe:
(1) That the advertised coverages
are somehow provided by or are endorsed by the governmental agencies or the other
insurers;
(2) That the advertiser is the same as is
connected with or is endorsed by the governmental agencies or the other
insurers.
(d)
An advertisement shall not use the name of a state or political
subdivision of a state in a policy name or description.
(e)
An advertisement in the form of envelopes or stationery of any kind may
not use any name, service mark, slogan, symbol or any device in a manner that
implies that the insurer or the policy advertised, or that any producer who may
call upon the consumer in response to the advertisement, is connected with a
governmental agency, such as the Social Security Administration.
(f)
An advertisement may not incorporate the word "Medicare" in
the title of the plan or policy being advertised unless, whenever it appears,
the word is qualified by language differentiating it from Medicare. The advertisement, however, shall not use the
phrase "[ ] Medicare Department of the [ ] Insurance Company," or language
of similar import.
(g)
An advertisement may not imply that the reader may lose a right or
privilege or benefit under federal, state or local law if he or she fails to
respond to the advertisement.
(h)
The use of letters, initials or symbols of the corporate name or
trademark that would have the tendency or capacity to mislead or deceive the
public as to the true identity of the insurer is prohibited unless the true,
correct and complete name of the insurer is in close conjunction and in the
same size type as the letters, initials or symbols of the corporate name or
trademark.
(i) The use of the name of an agency or
"Underwriters" or "Plan" in type, size and location so as
to have the capacity and tendency to mislead or deceive as to the true identity
of the insurer is prohibited.
(j)
The use of an address so as to mislead or deceive as to true identity of
the insurer, its location or licensing status is prohibited.
(k)
An insurer shall not use, in the trade name of its insurance policy, any
terminology or words so similar to the name of a
governmental agency or governmental program as to have the tendency to confuse,
deceive or mislead the prospective purchaser.
(l)
Advertisements used by producers of an insurer shall have prior written
approval of the insurer before they may be used.
(m)
A producer who makes contact with a consumer, as a result of acquiring
that consumer's name from a lead-generating device, shall disclose that fact in
the initial contact with the consumer. A
producer or insurer may not use names produced from lead-generating devices
that do not comply with the requirements of this part.
Source. #9333, eff 12-5-08; ss
by #11173, eff 12-5-16
Ins 2601.15 Group
or Quasi-Group Implications.
(a)
An advertisement of a particular policy shall not state or imply that
prospective insureds become group or quasi-group
members covered under a group policy, and as members, enjoy special rates or
underwriting privileges, unless that is the fact.
(b)
This part prohibits the solicitations of a particular class, such as
governmental employees, by use of advertisements which state or imply that
their occupational status entitles them to reduced rates on a group or other
basis when, in fact, the policy being advertised is sold only on an individual
basis at regular rates.
(c)
Advertisements that indicate that a particular coverage or policy is
exclusively for "preferred risks" or a particular segment of the
population or that a particular segment of the population is an acceptable
risk, when the distinctions are not maintained in the issuance of policies, are
prohibited.
(d)
An advertisement to join an association, trust or discretionary group
that is also an invitation to contract for insurance coverage shall clearly
disclose that the applicant will be purchasing both membership in the
association, trust or discretionary group and insurance coverage. The insurer shall solicit insurance coverage
on a separate and distinct application that requires a separate signature. The separate and distinct applications
required need not be on separate documents or contained in a separate
mailing. The insurance program shall be
presented so as not to conceal the fact that the prospective members are
purchasing insurance as well as applying for membership, if that is the
case. Similarly, it is prohibited to use
terms such as "enroll" or "join" to imply group or blanket
insurance coverage when that is not the fact.
(e)
Advertisements for group or franchise group plans that provide a common
benefit or a common combination of benefits shall not imply that the insurance
coverage is tailored or designed specifically for that group, unless that is
the fact.
Source. #9333, eff 12-5-08; ss
by #11173, eff 12-5-16
Ins 2601.16 Introductory,
Initial or Special Offers.
(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 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 the enrollment periods as the
usual method of marketing accident and health insurance.
(2) This part 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
that is the fact.
(b)
An advertisement shall not offer a policy that utilizes a reduced
initial premium rate in a manner that 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 shall 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
and health insurance.
Source. #9333, eff 12-5-08; ss
by #11173, eff 12-5-16
Ins 2601.17 Statements
About an Insurer. An
advertisement shall not contain statements that 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 recommendation and the limitations of the scope
and extent of the recommendations.
Source. #9333, eff 12-5-08; ss
by #11173, eff 12-5-16
Ins 2601.18 Enforcement
Procedures.
(a)
Advertising File. Each insurer
shall maintain at its home or principal office 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 this or any other state, whether
or not licensed in another state, with a notation attached to each
advertisement that indicates the manner and extent of distribution and the form
number of any policy advertised. The
file shall be subject to regular and periodical inspection by the
commissioner. All of these
advertisements shall be maintained in a file for the period required pursuant
to RSA 400-B or until the filing of the next regular report on examination of
the insurer, whichever is the longer period of time.
(b)
Certificate of Compliance. Each
insurer required to file an annual statement shall file with the commissioner,
with its annual statement, a certificate of compliance executed by an
authorized officer of the insurer that states that, to the best of the
officer's knowledge, information and belief, the advertisements that were
disseminated by the insurer during the preceding statement year complied or
were made to comply in all respects with the provisions of this part and the
insurance laws of this state as implemented and interpreted by this part.
Source. #9333, eff 12-5-08; ss
by #11173, eff 12-5-16
Ins 2601.19 Filing
for Prior Review. The
commissioner may, at his or her discretion, require filing of any accident and
health insurance advertising material for review prior to use. The advertising material shall be filed by
the insurer with the commissioner not less than 30 days prior to the date the
insurer desires to use the advertisement.
Source. #9333, eff 12-5-08; ss
by #11173, eff 12-5-16
Ins 2601.20 Penalties. An insurer or its officers, directors,
producers or employees that violate any of the provisions of this part, or
knowingly participate in or abet such violation, shall be subject to the
penalty provisions of RSA 400-A:15, III.
Source. #9333, eff 12-5-08; ss
by #11173, eff 12-5-16
PART Ins 2602 ADVERTISEMENTS OF LIFE INSURANCE AND
ANNUITIES
Ins 2602.01 Purpose. The purpose of this part is to set forth
minimum standards and guidelines to assure a full and truthful disclosure to
the public of all material and relevant information in the advertising of life
insurance policies and annuity contracts.
Source. #6971, eff 4-1-99, EXPIRED: 4-1-07
New. #9333, eff 12-5-08; ss
by #11173, eff 12-5-16
Ins 2602.02 Applicability.
(a)
This part shall apply to any life insurance or annuity advertisement
intended for dissemination in this state.
In variable contracts where disclosure requirements are established
pursuant to federal regulation, this part shall be interpreted so as to
eliminate conflict with federal regulations.
(b)
All advertisements, regardless of by whom written, created, designed or
presented, shall be the responsibility of the insurer, as well as the producer
who created or presented the advertisement.
Insurers shall establish and all times maintain a system of control over
the content, form and method of dissemination of all advertisements of its
policies. A system of control shall
include regular and routine notification, at least once a year, to producers
and others authorized by the insurer to disseminate advertisements of the
requirement and procedures for company approval prior to the use of any
advertisements that is not furnished by the insurer and that clearly sets forth
within the notice the most serious consequence of not obtaining the required
prior approval.
Source. #9333, eff 12-5-08; ss
by #11173, eff 12-5-16
Ins 2602.03 Definitions. For the purposes of this part:
(a)(1) "Advertisement" means material
designed to create public interest in life insurance or annuities or in an
insurer, or in an insurance producer; or to induce the public to purchase,
increase, modify, reinstate, borrow on, surrender, replace or retain a policy
including:
a. Printed and published material, audiovisual
material and descriptive literature of an insurer or insurance producer used in
direct mail, newspapers, magazines, radio and
television scripts, billboards and similar displays, and the Internet or
any other mass communication media;
b. Descriptive literature and sales aids of all
kinds, authored by the insurer, its insurance producers, or third parties,
issued, distributed or used by the insurer or insurance producer; including but
not limited to circulars, leaflets, booklets, web pages, depictions,
illustrations and form letters;
c. Material used for the recruitment, training
and education of an insurer's insurance producers which is designed to be used
or is used to induce the public to purchase, increase, modify, reinstate,
borrow on, surrender, replace or retain a policy; and
d. Prepared
sales talks, presentations and materials for use by insurance producers.
(2) "Advertisement" for the purposes of
this part shall not include:
a.
Communications or materials used within an
insurer's own organization and not intended for dissemination to the public;
b. Communications with policyholders other than
material urging policyholders to purchase, increase, modify, reinstate or
retain a policy; and
c. A general announcement from a group or
blanket policyholder to eligible individuals on an employment or membership
list that a policy or program has been written or arranged; provided the
announcement clearly indicates that it is preliminary to the issuance of a
booklet explaining the proposed coverage.
(b)
"Determinable policy elements" means elements that are derived
from processes or methods that are guaranteed at issue and not subject to
company discretion, but where the values or amounts cannot be determined until
some point after issue. These elements
include the premiums, credited interest rates (including any bonus), benefits,
values, non-interest based credits, charges or elements of formulas used to
determine any of these. These elements
may be described as guaranteed but not determined at issue. An element is considered determinable if it
was calculated from underlying determinable policy elements only, or from both
determinable and guaranteed policy elements.
(c)
"Guaranteed policy elements" means the premiums, benefits,
values, credits or charges under a policy, or elements of formulas used to
determine any of these that are guaranteed and determined at issue.
(d)
"Insurance producer" means a person required to be licensed
under RSA 402-J to sell, solicit or negotiate insurance, including annuities.
(e)
"Insurer" means any individual, corporation, association,
partnership, reciprocal exchange, inter-insurer, Lloyd's, fraternal benefit
society, and any other legal entity which is defined as an "insurer"
in Title XXXVII or issues life insurance or annuities in this state and is
engaged in the advertisement of a policy.
(f)
"Nonguaranteed elements" means the premiums, credited interest
rates (including any bonus), benefits, values, non-interest based credits,
charges or elements of formulas used to determine any of these, that are
subject to company discretion and are not guaranteed at issue. An element is considered nonguaranteed if any
of the underlying nonguaranteed elements are used in its calculation.
(g)
"Policy" means any policy, plan, certificate, including a
fraternal benefit certificate, contract, agreement,
statement of coverage, rider or endorsement which provides for life insurance
or annuity benefits.
(h)
"Preneed funeral contract or prearrangement" means an
arrangement by or for an individual before the individual's death relating to
the purchase or provision of specific funeral or cemetery merchandise or
services.
Source. #9333, eff 12-5-08; ss
by #11173, eff 12-5-16
Ins 2602.04 Form
and Content of Advertisements.
(a)
Advertisements shall be truthful and not misleading in fact or by
implication. The form and content of an
advertisement of a policy shall be sufficiently complete and clear so as to
avoid deception. It shall not have the
capacity or tendency to mislead or deceive.
Whether an advertisement has the capacity or tendency to mislead or deceive
shall be determined by the commissioner from the overall impression that the
advertisement may be reasonably expected to create upon a person of average
education or intelligence within the segment of the public to which it is
directed.
(b)
No advertisement shall use the terms "investment,"
"investment plan," "founder's plan," "charter
plan," "deposit," "expansion plan,"
"profit," "profits," "profit sharing,"
"interest plan," "savings," "savings plan,"
"private pension plan," "retirement plan" or other similar
terms in connection with a policy in a context or under such circumstances or
conditions as to have the capacity or tendency to mislead a purchaser or
prospective purchaser of such policy to believe that he will receive, or that
it is possible that he will receive, something other than a policy or some
benefit not available to other persons of the same class and equal expectation
of life.
Source. #9333, eff 12-5-08; ss
by #11173, eff 12-5-16
Ins 2602.05 Disclosure
Requirements.
(a)
The information required to be disclosed by this part shall not be
minimized, rendered obscure, or presented in an ambiguous fashion or
intermingled with the text of the advertisement so as to be confusing or
misleading.
(b)
An advertisement shall not omit material 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, premium payable, or state or federal tax consequences. 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 that the policy or contract includes a "free look"
period that satisfies or exceeds regulatory requirements, does not remedy
misleading statements.
(c)
In the event an advertisement uses "non-medical," "no
medical examination required," or similar terms where issue is not
guaranteed, terms shall be accompanied by a further disclosure of equal
prominence and in juxtaposition thereto to the effect that issuance of the
policy may depend upon the answers to the health questions set forth in the
application.
(d)
An advertisement shall not use as the name or title of a life insurance
policy any phrase that does not include the words "life insurance"
unless accompanied by other language clearly indicating it is life
insurance. An advertisement shall not
use as the name or title of an annuity contract any phrase that does not
include the word "annuity" unless accompanied by other language
clearly indicating it is an annuity. An
annuity advertisement shall not refer to an annuity as a CD annuity, or
deceptively compare an annuity to a certificate of deposit.
(e)
An advertisement shall prominently describe the type of policy
advertised.
(f)
An advertisement of an insurance policy marketed by direct response
techniques shall not state or imply that because there is no insurance producer
or commission involved there will be a cost saving to prospective purchasers
unless that is the fact. No cost savings
may be stated or implied without justification satisfactory to the commissioner
prior to use.
(g)
An advertisement for a life insurance policy containing graded or
modified benefits shall prominently display any limitation of benefits. If the premium is level and coverage
decreases or increases with age or duration, that fact shall be commonly
disclosed. An advertisement of or for a
life insurance policy under which the death benefit varies with the length of
time the policy has been in force shall accurately describe and clearly call
attention to the amount of minimum death benefit under the policy.
(h)
An advertisement for the types of policies described in (f) and (g)
above shall not use the words "inexpensive," "low cost," or
other phrases or words of similar import when the policies being marketed are
guaranteed issue.
(i) Premiums.
(1) An advertisement for a policy with non-level
premiums shall prominently describe the premium changes.
(2) An advertisement in which the insurer
describes a policy where it reserves the right to change the amount of the
premium during the policy term, but which does not prominently describe this
feature, is deemed to be deceptive and misleading and is prohibited.
(3) An advertisement shall not contain a
statement or representation that premiums paid for a life insurance policy can
be withdrawn under the terms of the policy.
Reference may be made to amounts paid into an advance premium fund,
which are intended to pay premiums at a future time, to the effect that they
may be withdrawn under the conditions of the prepayment agreement. Reference may also be made to withdrawal
rights under any unconditional premium refund offer.
(4) An advertisement that represents that a pure
endowment benefit has a "profit" or "return" on the premium
paid, rather than a policy benefit for which a specified premium is paid is
deemed to be deceptive and misleading and is prohibited.
(5) An advertisement shall not represent in any
way that premium payments will not be required for each year of the policy in
order to maintain the illustrated death benefits, unless that is the fact.
(6) An advertisement shall not use the term
"vanish" or "vanishing premium," or a similar term that
implies the policy becomes paid up, to describe a plan using nonguaranteed
elements to pay a portion of future premiums.
(j)
Analogies between a life insurance policy or annuity contract's cash
values and savings accounts or other investments and between premium payments
and contributions to savings accounts or other investments shall be complete
and accurate. An advertisement shall not
emphasize the investment or tax features of a life insurance policy to such a
degree that the advertisement would mislead the purchaser to believe the policy
is anything other than life insurance.
(k)
An advertisement shall not state or imply in any way that interest
charged on a policy loan or the reduction of death benefits by the amount of
outstanding policy loans is unfair, inequitable or in any manner an incorrect
or improper practice.
(l)
If nonforfeiture values are shown in any
advertisement, the values shall be shown either for the entire amount of the
basic life policy death benefit or for each $1,000 of initial death benefit.
(m)
The words "free," "no cost," "without
cost," "no additional cost," "at no extra cost," or
words of similar import shall not be used with respect to any benefit or
service being made available with a policy unless true. If there is no charge to the insured, then
the identity of the payer shall be prominently disclosed. An advertisement may specify the charge for a
benefit or a service or may state that a charge is included in the premium or
use other appropriate language.
(n)
No insurance producer may use terms such as "financial
planner," "investment adviser," "financial
consultant," or "financial counseling" in such a way as to imply
that he or she is generally engaged in an advisory business in which
compensation is unrelated to sales unless that actually is the case. This provision is not intended to preclude
persons who hold some form of formal recognized financial planning or consultant
designation from using this designation even when they are only selling
insurance. This provision also is not
intended to preclude persons who are members of a recognized trade or
professional association having such terms as part of its name from citing
membership, providing that a person citing membership, if authorized only to
sell insurance products, shall disclose that fact. This provision does not permit persons to
charge an additional fee for services that are customarily associated with the
solicitation, negotiation or servicing of policies.
(o)
Nonguaranteed Elements.
(1) An advertisement shall not utilize or
describe nonguaranteed elements in a manner that is misleading or has the
capacity or tendency to mislead.
(2) An advertisement shall not state or imply
that the payment or amount of nonguaranteed elements is guaranteed. Unless otherwise specified in life
illustrations, if nonguaranteed elements are illustrated, they shall be based
on the insurer's current scale and the illustration shall contain a statement
to the effect that they are not to be construed as guarantees or estimates of
amounts to be paid in the future.
(3) Unless otherwise specified in life
illustrations, an advertisement that includes any illustrations or statements
containing or based upon nonguaranteed elements shall set forth, with equal
prominence comparable illustrations or statements containing or based upon the
guaranteed policy elements.
(4) An advertisement shall not use or describe
determinable policy elements in a manner that is misleading or has the capacity
or tendency to mislead.
(5) Advertisement may describe determinable
policy elements as guaranteed but not determinable at issue. This description should include an
explanation of how these elements operate, and their limitations, if any.
(6) If an advertisement refers to any
nonguaranteed policy element, it shall indicate that the insurer reserves the
right to change any such element at any time and for any reason. However, if an insurer has agreed to limit
this right in any way; such as, for example, if it has agreed to change these
elements only at certain intervals or only if there is a change in the
insurer's current or anticipated experience, the advertisement may indicate any
such limitation on the insurer's right.
(7) An advertisement shall not refer to dividends
as "tax-free" or use words of similar import, unless the tax
treatment of dividends is fully explained and the nature of the dividend as a
return of premium is indicated clearly.
(8) An advertisement may not state or imply that
illustrated dividends under either or both a participating policy or pure
endowment will be or can be sufficient at any future time to assure without the
future payment of premiums, the receipt of benefits, such as a paid-up policy,
unless the advertisement clearly and precisely explains the benefits or
coverage provided at that time and the conditions required for that to occur.
(p)
An advertisement shall not state that a purchaser of a policy will share
in or receive a stated percentage or portion of the earnings on the general
account assets of the company.
(q)
Testimonials, Appraisals, Analysis, or Endorsements by Third Parties.
(1) Testimonials, appraisals or analysis used in
advertisements shall be genuine; represent the current opinion of the author;
be applicable to the policy advertised, if any; and be accurately reproduced
with sufficient completeness to avoid misleading or deceiving prospective insureds as to the nature or scope of the testimonial,
appraisal, analysis or endorsement. In
using testimonials, appraisals or analysis, the insurer or insurance producer
makes as its own all the statements contained therein, and these statements are
subject to all the provisions of this part.
(2) If the individual making a testimonial,
appraisal, analysis or an endorsement has a financial interest in the insurer
or related entity as a stockholder, director, officer, employee or otherwise,
or receives any benefit directly or indirectly other than required union scale
wages, that fact shall be prominently disclosed in the advertisement.
(3) An advertisement shall not state or imply
that an insurer or a policy has been approved or endorsed by a group of
individuals, society, association or other organization unless such is the fact
and unless any proprietary relationship between an organization and the insurer
is disclosed. If the entity making the
endorsement or testimonial is owned, controlled or managed by the insurer, or
receives any payment or other consideration from the insurer for making an
endorsement or testimonial, that fact shall be disclosed in the advertisement.
(4) When an endorsement refers to benefits
received under a policy for a specific claim, the claim date, including claim
number, date of loss and other pertinent information shall be retained by the
insurer for inspection for the period required pursuant to RSA 400-B after the
discontinuance of its use or publication.
(r)
An advertisement shall not contain statistical information relating to
any insurer or policy unless it accurately reflects recent and relevant
facts. The source of any statistics used
in advertisement shall be identified.
(s)
Policies Sold to Students.
(1) The envelope in which insurance solicitation
material is contained may be addressed to the parents of students. The address may not include any combination
of words which imply that the correspondence is from a
school, college, university or other education or training institution nor may
it imply that the institution has endorsed the material or supplied the insurer
with information about the student unless such is a correct and truthful
statement.
(2) All advertisements including, but not limited
to, informational flyers used in the solicitation of insurance shall be
identified clearly as coming from an insurer or insurance producer, if such is
the case, and these entities shall be clearly identified as such.
(3) The return address on the envelope may not
imply that the soliciting insurer or insurance producer is affiliated with a
university, college, school or other educational or training institution,
unless true.
(t)
Introductory, Initial or Special Offers and Enrollment Periods.
(1) An advertisement of an individual policy or
combination of policies shall not state or imply that the policy or combination
of policies 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
describe an enrollment period as "special" or "limited" or
use similar words or phrases in describing it when the insurer uses successive
enrollment periods as its usual method of marketing its policies.
(2) An advertisement shall not state or imply
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.
(3) An advertisement shall not offer a policy
that utilizes a reduced initial premium rate in a manner that overemphasizes
the availability and the amount of the reduced initial premium. A reduced initial or first year premium may
not be described as constituting free insurance for a period of time. When an insurer charges an initial premium
that differs in amount from the amount of the renewal premium payable on the
same mode, all references to the reduced initial premium shall be followed by
an asterisk or other appropriate symbol that refers the reader to that specific
portion of the advertisement that contains the full rate schedule for the
policy being advertised.
(u)
An advertisement of a particular policy shall not state or imply that
prospective insureds shall be or become members of a
special class, group, or quasi-group and as such enjoy special rates, dividends
or underwriting privileges, unless that is the fact.
(v)
An advertisement shall not make unfair or incomplete comparisons of
policies, benefits, dividends or rates of other insurers. An advertisement shall not disparage other
insurers, insurance producers, policies, services or methods of marketing.
(w)
For individual deferred annuity products or deposit funds, the following
shall apply:
(1) Any illustrations or statements containing or
based upon nonguaranteed interest rates shall likewise set forth with equal
prominence comparable illustrations or statements containing or based upon the
guaranteed accumulation interest rates.
The nonguaranteed interest rate shall not be greater than those
currently being credited by the company unless the nonguaranteed rates have
been publicly declared by the company with an effective date for new issues not
more than 3 months subsequent to the date of declaration;
(2) If an advertisement states the net premium
accumulation interest rate, whether guaranteed or not, it shall also disclose
in close proximity thereto and with equal prominence, the actual relationship
between the gross and the net premiums;
(3) If the contract does not provide a cash
surrender benefit prior to commencement of payment of annuity benefits, an
illustration or statement concerning the contract shall prominently state that
cash surrender benefits are not provided; and
(4) Any illustrations, depictions or statements
containing or based on determinable policy elements shall likewise set forth
with equal prominence comparable illustrations, depictions or statements
containing or based on guaranteed policy elements.
(x)
An advertisement of a life insurance policy or annuity that illustrates
nonguaranteed values shall only do so in accordance with current applicable
state law relative to illustrating such values for life insurance policies and
annuity contracts.
(y)
An advertisement for the solicitation or sale of a preneed funeral
contract or prearrangement as defined in Ins 2602.03 (h) that is funded or to
be funded by a life insurance policy or annuity contract shall adequately
disclose the following:
(1) The fact that a life insurance policy or
annuity contract is being used to fund a prearrangement as defined in Ins
2602.03 (h); and
(2) The nature of the relationship among the
soliciting agent or agents, the provider of the funeral or cemetery merchandise
services, the administrator and any other person.
Source. #9333, eff 12-5-08; ss
by #11173, eff 12-5-16
Ins 2602.06 Identity
of Insurer.
(a)
The name of the insurer shall be clearly identified in all
advertisements about the insurer or its products, and if any specific
individual policy is advertised it shall be identified either by form number or
other appropriate description. If an
application is a part of the advertisement, the name of the insurer shall be
shown on the application. However, if an
advertisement contains a listing of rates or features that is a composite of
several different policies or contracts of different insurers, the
advertisement shall so state, shall indicate, if applicable, that not all
policies or contracts on which the composite is based may be available in all
states, and shall provide a rating of the lowest rated insurer and reference
the rating agency, but need not identify each insurer. If an advertisement identifies the issue
insurers, insurance issuer ratings need not be stated.
(b)
An advertisement shall not use a trade name, an insurance group
designation, name of the parent company of the insurer, name of a particular
division of the insurer, a reinsurer of the insurer, service mark, slogan,
symbol or other device or reference without disclosing the name of the insurer,
if the advertisement would have the capacity or tendency to mislead or deceive
as to the true identity of the insurer or create the impression that a company
other than the insurer would have any responsibility for the financial
obligation under a policy.
(c)
An advertisement shall not use any combination of words, symbols or
physical materials that by their content, phraseology, shape, color or other
characteristics are so similar to a combination of words, symbols or physical
materials used by a governmental program or agency or otherwise appear to be of
such a nature that they tend to mislead prospective insureds
into believing that the solicitation is in some manner connected with a
governmental program or agency.
Source. #9333, eff 12-5-08; ss
by #11173, eff 12-5-16
Ins 2602.07 Jurisdictional
Licensing and Status of Insurer.
(a)
An advertisement that is intended to be 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 may state that an insurer or insurance producer is
licensed in a particular state or states, provided it does not exaggerate that
fact or suggest or imply that competing insurers or insurance producers may not
be so licensed.
(c)
An advertisement shall not create the impression that the insurer, its
financial condition or status, the payment of its claims or the merits,
desirability, or advisability of its policy forms or kinds of plans of
insurance are recommended or endorsed by any governmental entity. However, where a governmental entity has
recommended or endorsed a policy form or plan, that fact may be stated if the
entity authorizes its recommendation or endorsement to be used in an
advertisement.
Source. #9333, eff 12-5-08; ss
by #11173, eff 12-5-16
Ins 2602.08 Statements
About the Insurer.
An advertisement shall not contain statements, pictures or illustrations
that are false or misleading, in fact or by implication, with respect to the
assets, liabilities, insurance in force, corporate structure, financial
condition, 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
defines the scope and extent of the recommendation including, but not limited
to, the placement of insurer's rating in the hierarchy of the rating system
cited.
Source. #9333, eff 12-5-08; ss
by #11173, eff 12-5-16
Ins 2602.09 Enforcement
Procedures.
(a)
Each insurer shall maintain at its home or principal office a complete
file containing a specimen of every printed, published or prepared
advertisement of its individual policies and specimen copies of typical printed,
published or prepared advertisements of its blanket, franchise and group
policies, hereafter disseminated in this state, with a notation indicating the
manner and extent of distribution and the form number of any policy advertised. The file shall be subject to inspection by
the department. All advertisements shall
be maintained in the file for the period required pursuant to RSA 400-B after
discontinuance of its use or publication.
(b)
If the commissioner determines that an advertisement has the capacity or
tendency to mislead or deceive the public, the commissioner may require an
insurer or insurance producer to submit all or any part of the advertising
material for review or approval prior to use.
(c)
Each insurer subject to the provisions of this part shall file with the
commissioner with its annual statement a certificate of compliance executed by
an authorized officer of the insurer stating that to the best of his or her
knowledge, information and belief the advertisements that were disseminated by or
on behalf of the insurer in this state during the preceding statement year, or
during the portion of the year when these rules were in effect, complied or
were made to comply in all respects with the provisions of these parts and the
insurance laws of the state as implemented and interpreted by this part.
Source. #9333, eff 12-5-08; ss
by #11173, eff 12-5-16
Ins 2602.10 Penalties. An insurer or its officers, directors,
producers or employees that violate any of the provisions of this part, or
knowingly participate in or abet such violation, shall be subject to the
penalty provisions of RSA 400-A:15, III.
Source. #9333, eff 12-5-08; ss
by #11173, eff 12-5-16
Ins 2602.11 Conflict
With Other Laws or Rules. It
is not intended that this part conflict with or supersede any rules currently
in force or subsequently adopted in this state governing specific aspects of
the sale or replacement of life insurance including, but not limited to, laws
or rules dealing with life insurance cost comparison indices, deceptive
practices in the sale of life insurance, replacement of life insurance
policies, illustration of life insurance policies, and annuity disclosure. Consequently, no disclosure pursuant to or
required under those rules shall be deemed to be an advertisement within the
meaning of this part.
Source. #9333, eff 12-5-08; ss
by #11173, eff 12-5-16
PART Ins 2603 ADVERTISEMENTS
OF MEDICARE SUPPLEMENT INSURANCE WITH INTERPRETIVE GUIDELINES
Statutory
Authority: RSA 400-A:15,
I.; RSA 417:4; RSA 415-F:3,III-IV; RSA 415-F:7
Ins 2603.01 Purpose. The purpose of this part is to provide
prospective buyers with clear and unambiguous statements in the advertisement of
Medicare supplement insurance, to assure the clear and truthful disclosure of
the benefits, limitations and exclusions of policies sold as Medicare
supplement insurance. This purpose is
intended to be accomplished by the establishment of guidelines and permissible
and impermissible standards of conduct in the advertising of Medicare
supplement insurance in a manner which prevents unfair, deceptive and
misleading advertising and is conducive to accurate presentation and
description to the insurance-buying public through the advertising media and
material used by insurance producers and companies.
Source. #9398, eff 3-1-09; ss
by #11173, eff 12-5-16
Ins 2603.02 Applicability.
(a)
This part shall apply to any "advertisement" of Medicare
supplement insurance as that term is defined herein, unless otherwise specified
in this part, that the insurer knows or reasonably should know is intended for
presentation, distribution or dissemination in this state when the
presentation, distribution or dissemination is made either directly or
indirectly by or on behalf of an insurer, agent, broker, producer or solicitor,
as those terms are defined in Title XXXVII.
(b)
Every insurer shall establish and at all times maintain a system of control over the content, form and
method of dissemination of all of its Medicare supplement insurance
advertisements. All such advertisements,
regardless of by whom written, created, designed or
presented, shall be the responsibility of the insurers benefiting directly or
indirectly from their dissemination.
(c)
Advertising materials that are reproduced in quantity shall be
identified by form numbers or other identifying means. The identification shall be sufficient to
distinguish an advertisement from any other advertising materials, policies,
applications or other material used by the insurer.
Source. #9398, eff 3-1-09; ss
by #11173, eff 12-5-16
Ins 2603.03 Definitions.
(a)(1) " Advertisement" for
the purpose of this part shall include:
a. Printed and published material, audio visual
material and descriptive literature used by or on behalf of an insurer in
direct mail, newspapers, magazines, radio scripts, TV scripts, billboards,
internet displays and websites, and similar displays;
b. Descriptive literature and sales aids of all
kinds issued by an insurer, agent, producer, broker or solicitor 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 part; and
c. Prepared sales talks, presentations and
material for use by agents, brokers, producers and solicitors, whether prepared
by the insurer or the agent, broker, producer or solicitor.
(2) The definition of "advertisement"
includes advertising material included with a policy when the policy is delivered
and material used in the solicitation of renewals and reinstatements.
(3) The definition of "advertisement"
does not include:
a. Material to be used solely for the
training and education of an insurer's employees, agents or brokers;
b. Material used in-house by insurers;
c. Communications within an
insurer's own organization not intended for dissemination to the public;
d. Individual communications
of a personal nature with current policyholders other than material urging the
policyholders to increase or expand coverages;
e. Correspondence between a
prospective group or blanket policyholder and an insurer in the course of
negotiating a group or blanket contract;
f. Court approved material ordered by a
court to be disseminated to policyholders; or
g. A general announcement from a group or
blanket policyholder to eligible individuals on an employment or membership
list that a contract or program has been written or arranged; provided, the
announcement shall clearly indicate that it is preliminary to the issuance of a
booklet.
(b)
"Medicare supplement insurance" means a group or individual
policy of accident and health insurance or a subscriber contract of hospital
and medical service associations or health maintenance organizations that is
advertised, marketed or designed primarily as a supplement to reimbursements
under Medicare for the hospital, medical or surgical expenses of persons
eligible for Medicare by reason of age.
(c)
"Certificate" means, for the purposes of this part, any
certificate issued under a group Medicare supplement policy, which certificate
has been delivered or issued for delivery in this state.
(d)
"Insurer" means, for the purposes of this part, any
individual, corporation, association, partnership, reciprocal exchange,
inter-insurer, Lloyds, fraternal benefit society, health maintenance
organization, hospital service corporation, medical service corporation,
prepaid health plan and any other legal entity which is defined as an
"insurer" in Title XXXVII and is engaged in the advertisement of
itself, or Medicare supplement insurance.
(e)
"Exception" means, for the purpose of this part, any provision
in a policy whereby coverage for a specified hazard is entirely eliminated; it
is a statement of a risk not assumed under the policy.
(f)
"Reduction" means, for the purpose of this part, any provision
that 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 reduction not been used.
(g)
"Limitation" means, for the purposes of this part, any
provision that restricts coverage under a policy other than an exception or a
reduction.
(h)
“Institutional advertisement” means, for purposes of this part, an
advertisement having as its sole purpose the promotion of the reader’s,
viewer’s, or listener’s interest in the concept of Medicare supplement
insurance or the promotion of the insurer as a seller of Medicare supplement
insurance.
(i) "Invitation to inquire" means, for
the purposes of this part, an advertisement having as its objective the
creation of a desire to inquire further about Medicare supplement insurance
that is limited to a brief description of coverage, and that shall contain a
provision in the following or substantially similar form:
"This
policy has [exclusions] [limitations] [reductions of benefits] [terms under
which the policy may be continued in force or discontinued]. For costs and complete details of the coverage,
call [or write] your insurance agent or the company
[whichever is applicable]."
(j)
"Invitation to contract" means, for the purposes of this part,
an advertisement that is neither an institutional advertisement nor an
invitation to inquire.
(k)
"Person" means, for the purposes of this part, a natural
person, association, organization, partnership, trust, group, discretionary
group, corporation or any other entity.
(l)
"Medicare" means "The Health Insurance for the Aged Act,
Title XVIII of the Social Security Amendments of 1965 as Then Constituted or
Later Amended," or Title I, art I of Public Law 89-97, as enacted by the
Eighty-Ninth Congress of the United States of America, and popularly known as
the "Health Insurance for the Aged Act, as then constituted and any later
amendments or substitutes thereof," or words of similar import.
(m)
"Lead-generating device" means, for the purposes of this part,
any communication directed to the public that, 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 Medicare supplement insurance.
Source. #9398, eff 3-1-09; ss
by #11173, eff 12-5-16
Ins 2603.04 Method of Disclosure of
Required Information. All
information required to be disclosed by this part shall be set out
conspicuously and in close conjunction with the statements to which the
information relates or under appropriate captions of such prominence that it
shall not be minimized, rendered obscure or presented in an ambiguous manner or
fashion or intermingled with the context of the advertisement so as to be
confusing or misleading.
Source. #9398, eff 3-1-09; ss
by #11173, eff 12-5-16
Ins 2603.05 Form and Content of
Advertisements.
(a)
The format and content of a Medicare supplement insurance advertisement
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 commissioner of insurance from the overall impression that
the advertisement may be reasonably expected to create upon a person of average
education or intelligence, within 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 whose
meanings are clear only by implication or by the consumer's familiarity with insurance
terminology shall not be used.
(c)
An insurer shall clearly identify its Medicare supplement insurance
policy as an insurance policy. A policy
trade name shall be followed by the words..."Insurance Policy" or
similar words clearly identifying the fact that an insurance policy or health
benefits product (in the case of health maintenance organizations, prepaid
health plans and other direct service organizations) is being offered.
(d)
No insurer, agent, broker, producer, solicitor or other person shall
solicit a resident of this state for the purchase of Medicare supplement
insurance in connection with or as the result of the use of any advertisement
by such person or any other person, where the advertisement:
(1) Contains any misleading representations or
misrepresentations, or is otherwise untrue, deceptive or misleading with regard
to the information imparted, the status, character or representative capacity
of such person or the true purpose of the advertisement; or
(2) Otherwise violates the provisions of this
part.
(b)
No insurer, agent, broker, solicitor or other person shall solicit
residents of this state for the purchase of Medicare supplement insurance
through the use of a true or fictitious name that is deceptive or misleading
with regard to the status, character, or proprietary or representative capacity
of the person or the true purpose of the advertisement.
Source. #9398, eff 3-1-09; ss
by #11173, eff 12-5-16
Ins 2603.06 Advertisements of Benefits,
Losses Covered or Premiums Payable.
(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
the 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 fill some of the gaps that Medicare
and your present insurance leave out," "this policy pays all that
Medicare doesn't" or similar words and phrases, in a manner which
exaggerates any benefit beyond the terms of the policy.
(3) An advertisement that also is an invitation
to join an association, trust or discretionary group shall solicit insurance
coverage on a separate and distinct application that requires separate
signature for each application. The
separate and distinct application required for an advertisement which is also
an invitation to join an association, trust or discretionary group need not be
on a separate document or contained in a separate mailing. The insurance program shall 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.
(4) An advertisement shall not contain
descriptions of policy limitations, exceptions or reductions, worded in a
positive manner to imply that is a benefit, such as describing a waiting period
as a "benefit builder' or stating "even preexisting conditions are
covered after 6 months." Words and
phrases used in an advertisement to describe the policy limitations, exceptions
and reductions shall fairly and accurately describe the negative features of
the limitations, exceptions and reductions of the policy offered.
(5) An advertisement of Medicare supplement
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
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 marketing by
direct response.
(b)
Exceptions, Reductions and Limitations.
(1) An advertisement that is an invitation to
contract shall disclose those exceptions, reductions and limitations affecting
the basic provisions of the policy.
(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 the
loss, an advertisement that is subject to the requirements of the preceding
paragraph shall disclose the existence of these 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 that is an invitation to
contract shall, in negative terms, disclose the extent to which any loss is not
covered if the cause of the loss is traceable to a condition existing prior to
the effective date of the policy. The
use of the term "preexisting condition" without an appropriate
definition or description shall not be used.
(2) When a Medicare supplement insurance 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 under the policy. This part
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
form to be completed by the applicant and returned by mail, the application
form shall contain a question or statement that reflects the preexisting
condition provisions of the policy immediately preceding the blank space for
the applicant's signature. For example,
such an application form shall contain a question or statement substantially as
follows:
Do you
understand that this policy will not pay benefits during the first 6 months
after the issue date for a disease or physical condition for which medical
advice was given or treatment was recommended by or received from a physician
within 6 months before the policy issue date?
YES
Or substantially
the following statement:
I understand
that the policy applied for will not pay benefits for any loss incurred during
the first 6 months after the issue date due to a disease or physical condition
for which I received medical advice or for which treatment was recommended by
or received from a physician within 6 months before the issue date.
Source. #9398, eff 3-1-09; ss
by #11173, eff 12-5-16
Ins 2603.07 Necessity for Disclosing
Policy Provisions Relating to Renewability, Cancellability
and Termination. An advertisement
that is an invitation to contract shall disclose the provisions relating to
renewability, cancellability and termination and any
modification of benefits, losses covered or premiums because of age or for
other reasons, in a manner which shall not minimize or render obscure the
qualifying conditions.
Source. #9398, eff 3-1-09; ss
by #11173, eff 12-5-16
Ins 2603.08 Testimonials or Endorsements
by Third Parties.
(a)
Testimonials and endorsements used in advertisements shall 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 or endorsement, makes as its own all
of the statements contained therein, and the advertisement, including the
statement, is subject to all he provisions of this part. When a testimonial or endorsement is used
more than one year after it was originally given, a confirmation shall be
obtained.
(b)
A person shall be deemed a "spokesperson" if the person making
the testimonial or endorsement:
(1) Has a financial interest in the insurer or a
related entity as a stockholder, director, officer, employee or otherwise;
(2) Has been formed by the insurer, is owned or
controlled by the insurer, its employees, or the person or persons who own or
control the insurer;
(3) Has any person in a policy-making position
who is affiliated with the insurer in any of the above described capacities; or
(4) Is in any way directly or indirectly
compensated for making a testimonial or endorsement.
(c)
The fact of a financial interest or the proprietary or representative
capacity of a spokesperson shall be disclosed in an advertisement and shall be
accomplished in the introductory portion of the testimonial or endorsement in
the same form and with equal prominence thereto. If a spokesperson is directly or indirectly
compensated for making a testimonial or endorsement, that fact shall be
disclosed in the advertisement by language substantially as follows: "Paid Endorsement." The requirement of this disclosure may be
fulfilled by use of the phrase "Paid Endorsement" or words of similar
import in a type style and size at least equal to that used for the
spokesperson's name or the body of the testimonial or endorsement; whichever is
larger. In the case of television or
radio advertising, the required disclosure shall be accomplished in the
introductory portion of the advertisement and shall be given prominence.
(d)
The disclosure requirements of this part shall not apply where the sole
financial interest or compensation of a spokesperson, for all testimonials or
endorsements made on behalf of the insurer, consists of the payment of union
scale wages required by union rules, and if the payment is actually for the
scale for TV or radio performances.
(e)
An advertisement shall not state or imply that an insurer or a Medicare
supplement insurance policy has been approved or endorsed by any individual,
group of individuals, society, association or other organization, unless such
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 person or persons who own or
control the insurer, that fact shall be disclosed in the advertisement. If the insurer or an officer of the insurer formed
or controls the association, or holds any policymaking position in the
association, that fact shall be disclosed.
(f)
When a testimonial refers to benefits received under a Medicare
supplement insurance policy, the specific claim data, including claim number,
date of loss, and other pertinent information shall be retained by the insurer
for inspection for a period of 4 years or until the filing of the next regular
report of examination of the insurer, whichever is the longer period of time. The use of testimonials that do not correctly
reflect the present practices of the insurer or that are not applicable to the
policy or benefit being advertised is not permissible.
Source. #9398, eff 3-1-09; ss
by #11173, eff 12-5-16
Ins 2603.09 Use of Statistics.
(a)
An advertisement relating to the dollar amounts of claims paid, the
number of persons insured, or similar statistical information relating to any
insurer or policy shall not use irrelevant facts, and shall not be used unless
it accurately reflects all of the relevant facts. Such an advertisement shall not imply that
the statistics are derived from a policy advertised unless such is the fact,
and when applicable to other policies or plans shall specifically so state.
(1) An advertisement shall specifically identify
the Medicare supplement insurance policy to which statistics relate and, where
statistics are given which are applicable to a different policy, it shall be
stated clearly that the data do not relate to the policy being advertised.
(2) An advertisement using statistics that
describe an insurer, such as assets, corporate structure, financial standing,
age, product lines or relative position in the insurance business, may be
irrelevant and, if used at all, shall be used with extreme caution because of
the potential for misleading the public.
As a specific example, an advertisement for Medicare supplement
insurance that refers to the amount of life insurance that the company has in
force or the amounts paid out in life insurance benefits is not permissible
unless the advertisement clearly indicates the amount paid out for each line of
insurance.
(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 state or imply 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 source of any statistics used in an advertisement shall be
identified in the advertisement.
Source. #9398, eff 3-1-09; ss
by #11173, eff 12-5-16
Ins 2603.10 Disparage Comparisons and
Statements. An advertisement shall
not directly or indirectly make unfair or incomplete comparisons of
non-comparable policies of other insurers, and shall not disparage competitors,
their policies, services or business methods, and shall not disparage or
unfairly minimize competing methods of marketing insurance.
(a)
An advertisement shall not contain statements such as "no red
tape" or "here is all you do to receive benefits."
(b)
Advertisements that state or imply that competing insurance coverages customarily contain certain exceptions,
reductions or limitations not contained in the advertised policies are
unacceptable unless the exceptions, reductions or limitations are contained in
a substantial majority of the competing coverages.
(c)
Advertisements that state or imply that an insurer's premiums are lower
or that its loss ratios are higher because its organizational structure differs
from that of competing insurers are unacceptable.
Source. #9398, eff 3-1-09; ss
by #11173, eff 12-5-16
Ins 2603.11 Jurisdictional Licensing and
Status of Insurer.
(a)
An advertisement that is intended to be 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 the 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 government.
(c)
An advertisement shall not imply that approval, endorsement or
accreditation of policy forms or advertising has been granted by any division
or agency of this state or the federal government. "Approval" of either policy forms
or advertising shall not be used by an insurer to imply or state that a
governmental agency has endorsed or recommended the insurer, its policies,
advertising or its financial conditions.
Source. #9398, eff 3-1-09; ss
by #11173, eff 12-5-16
Ins 2603.12 Identity of Insurer.
(a)
The name of the actual insurer shall be stated in all of its
advertisements. The form number or
numbers of the policy advertised shall be stated in an advertisement that is an
invitation to contract. An advertisement
shall not use a trade name, an 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 that with or 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 insurer.
(b)
No advertisement shall use any combination of words, symbols or physical
materials that by their content, phraseology, shape, color or other
characteristics are so similar to combinations 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.
(c)
Advertisements, envelopes or stationery that employ words, letters,
initials, symbols or other devices that are so similar to those used by
governmental agencies or other insurers are not permitted if they may lead the
public to believe:
(1) That the advertised coverages
are somehow provided by or are endorsed by the governmental agencies or the
other insurers; or
(2) That the advertiser is the same as, is connected with or is endorsed by the governmental
agencies or the other insurers.
(d)
No advertisement shall use the name of a state or political subdivision
thereof in a policy name or description.
(e)
No advertisement in the form of envelopes or stationary of any kind may
use any name, service mark, slogan, symbol or any device in such a manner that
implies that the insurer or the policy advertised, or that any agent who may
call upon the consumer in response to the advertisement is connected with a
governmental agency, such as the Social Security Administration.
(f)
No advertisement may incorporate the word "Medicare" in the
title of the plan or policy being advertised unless, whenever it appears, the
word is qualified by language differentiating it from Medicare. Such an advertisement,
however shall not use the phrase "__________Medicare Department of the
_______________Insurance Company," or language of similar import.
(g)
No advertisement shall be used that fails to include the disclaimer to
the effect of "Not Connected with or endorsed by
the U.S. government or the federal Medicare program."
(h)
No advertisement may imply that the reader may lose a right or privilege
or benefit under federal, state or local law if he fails to respond to the
advertisement.
(i) The use of letters, initials or symbols of
the corporate name or trademark that would have the tendency or capacity to
mislead or deceive the public as to the true identity of the insurer is
prohibited unless the true, correct and complete name of the insurer is in
close conjunction and in the same size type as the letters, initials or symbols
of the corporate name or trademark.
(j)
The use of the name of any agency or "__________Underwriters"
or "_____________ Plan" in type, size and location so as to have the
capacity and tendency to mislead or deceive as to the true identity of the
insurer is prohibited.
(k)
The use of an address so as to mislead or deceive as to the true
identity of the insurer, its location or licensing status is prohibited.
(l)
No insurer may use, in the trade name of its insurance policy, any
terminology or words so similar to the name of a
governmental agency or governmental program as to have the tendency to confuse,
deceive or mislead the prospective purchaser.
(m)
All advertisements used by agents, producers, brokers or solicitors of
an insurer shall have prior written approval of the insurer before they may be
used.
(n)
An agent who makes contact with a consumer, as a result of acquiring
that consumer's name from a lead generating device, shall disclose that fact in
the initial contact with the consumer.
Source. #9398, eff 3-1-09; ss
by #11173, eff 12-5-16
Ins 2603.13 Group or Quasi-Group
Implications.
(a)
An advertisement of a 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 or
underwriting privileges, unless that is the fact.
(b)
This part prohibits the solicitation of a particular class, such as
governmental employees, by use of advertisements that state or imply that their
occupational status entitles them to reduced rates on a group or other basis
when, in fact, the policy being advertised is sold only on an individual basis at
regular rates.
Source. #9398, eff 3-1-09; ss
by #11173, eff 12-5-16
Ins 2603.14 Introductory, Initial or
Special Offers.
(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 Medicare supplement 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 6
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 shall mail the application, which shall be not less than 10
days and not more than 40 days from the date that the enrollment period is advertised
for the first time. This part applies to
all advertising media, i.e., mail, newspapers, radio, television, magazines,
internet displays, and periodicals, by any one insurer. It is not applicable to solicitations of
employees or members of a particular group or association that otherwise would
be eligible under specific provisions of RSA 415. The phrase "any one insurer"
includes all the affiliated companies of a group of insurance companies under
common management or control.
(3) This part 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 a particular
policy advertised because of special advantages available in the policy, unless
that is the fact.
(4) The phrase "a particular insurance
product" in (2) of this subsection means an insurance policy that 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, or 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 that utilizes a reduced
initial premium rate in a manner that 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 shall be stated in juxtaposition in
each portion of the advertisement where the initial reduced premium
appears. The term
"juxtaposition" means side by side or immediately above or below.
(c)
Special awards, such as a "safe driver’s award" shall not be
used in connection with advertisements of Medicare supplement insurance.
Source. #9398, eff 3-1-09; ss
by #11173, eff 12-5-16
Ins 2603.15 Statements About an Insurer. An advertisement shall not contain statements
that 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 recommendation and
the limitations of the scope and extent of the recommendation.
Source. #9398, eff 3-1-09; ss
by #11173, eff 12-5-16
Ins 2603.16 Enforcement Procedures.
(a)
Advertising File. Each insurer
shall maintain at its home or principal office 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 this or any other state, whether
or not licensed in such other state, with a notation attached to each
advertisement that shall indicate the manner and extent of distribution and the
form number of any policy advertised.
The file shall be available for inspection by this department. All such advertisements shall be maintained
in the file for a period of either 4 years or until the filing of the next
regular report of examination of the insurer, whichever is the longer period of
time.
(b)
Certificate of Compliance. Each
insurer required to file an annual statement which is now or which hereafter
becomes subject to the provisions of this part shall file with this department,
with its annual statement, a certificate of compliance executed by an
authorized officer of the insurer wherein it is stated that, to the best of his/her
knowledge, information and belief, the advertisements that were disseminated by
the insurer during the preceding statement year complied or were made to comply
in all respects with the provisions of this part and the insurance laws of this
state as implemented and interpreted by this part.
Source. #9398, eff 3-1-09; ss
by #11173, eff 12-5-16
Ins 2603.17 Filing for Prior Review. The commissioner may, at his or her
discretion, require the filing with this department, for review prior to use,
of any Medicare supplement insurance advertising material. The advertising material shall be filed by
the insurer with this department not less than 30 days prior to the date the
insurer desires to use the advertisement.
Source. #9398, eff 3-1-09; ss
by #11173, eff 12-5-16
Appendix
INTERPRETIVE GUIDELINES
FOR RULES GOVERNING ADVERTISEMENTS OF
MEDICARE SUPPLEMENT INSURANCE
Guideline 1
Disclosure is
one of the principal objectives of this part and this section states
specifically that the rules shall assure truthful and adequate disclosure of
all material and relevant information.
This part specifically prohibits some previous advertising techniques.
Guideline 2
This part
applies to any "advertisement" as that term is defined in Ins 2603.03
(a), (h), (i) and (j) unless otherwise specified in
this part. This part applies to group, blanket and individual Medicare supplement insurance
advertisements. Certain distinctions,
however, are applicable to these categories.
Among them is the level of conversance with insurance, a factor which is
covered by Ins 2603.05 (a).
Guideline 3-A
The scope of the
term "advertisement" extends to the use of all media for
communications to the general public, to the use of all media for
communications to specific members of the general public, and to use of all
media for communications by agents, brokers, producers and solicitors.
Guideline 3-I
A "brief
description of coverage" in an invitation to inquire may consist of an
explanation of Medicare benefits, minimum benefits, standards for Medicare
supplement policies, and the manner in which the advertised Medicare supplement
insurance policy supplements the benefits of Medicare and meets or exceeds the
minimum benefit requirements. An
invitation to inquire shall not refer to cost or the maximum dollar amount of
benefits payable.
As with all Medicare
supplement insurance advertisements, an invitation to inquire shall not:
(1) Employ devices that are designed to create
undue anxiety in the minds of the elderly or excite fear of dependence upon
relatives or charity;
(2) Exaggerate the gaps
in Medicare coverage;
(3) Exaggerate the value
of the benefits available under the advertised policy;
(4) Otherwise violate the provisions of this
part.
Guideline 4
This part
permits the use of either of the following alternative methods of disclosure:
(1) The first alternative provides for the
disclosure of exceptions, limitations, reductions and other restrictions
conspicuously and in close conjunction with the statements to which the
information relates. This may be
accomplished by disclosure in the description of the related benefits or in a
paragraph set out in close conjunction with the description of policy benefits.
(2) The second alternative provides for the
disclosure of exceptions, limitations, reductions and other restrictions not in
conjunction with the provisions describing policy benefits but under
appropriate captions of such prominence that the information shall not be
minimized, rendered obscure or otherwise made to appear unimportant. The phrase "under appropriate
captions" means that the title shall be accurately descriptive of the
captioned material. Appropriate captions
include the following:
"Exceptions," "Exclusions," "Conditions Not Covered," and "Exceptions and
Reductions." The use of captions
such as, or similar to, the following are not acceptable because they do not
provide adequate notice of the significance of the material: "Extent of Coverage," "Only
these Exclusions," or "Minimum Limitations."
In
considering whether an advertisement complies with the disclosure requirements
of this part, this rule must be applied in conjunction with the form and
content standards contained in Ins 2603.05.
Guideline 5-A
This part shall
be applied in conjunction with Ins 2603.01 and Ins 2603.05. These parts refer specifically to "format
and content" of the advertisement and the "overall" impression
created by the advertisement. This
involves factors such as, but not limited to, the size, color and prominence of
type used to describe benefits. The word
"format" means the arrangement of the text and the captions.
This part
requires distinctly different advertisements for publication in newspapers or
magazines of general circulation, as compared to scholarly, technical or
business journals and newspapers. Where
an advertisement consists of more than one piece of material, each piece of
material shall, independent of all other pieces of material, conform to the
disclosure requirements of this part.
Guideline 5-B
This part
prohibits the use of incomplete statements and words or phrases that have the
tendency or capacity to mislead or deceive because of the reader's
unfamiliarity with insurance terminology.
Therefore, words, phrases and illustrations used in an advertisement
shall be clear and unambiguous, if the advertisement uses insurance
terminology, sufficient description of a word, phrase or illustration shall be
provided by definition or description in the context of the advertisement. As implied in Guideline 5-A, distinctly
different levels of comprehension to the subscribers of various publications
may be anticipated.
Guideline 6-A(1)
This part
prohibits the use of incomplete statements and words or phrases that create
deception by omission or commission. The
following examples are illustrations of the prohibitions created by the rule:
(1) An advertisement that describes any benefits
that vary by age shall disclose the fact.
(2) An advertisement that uses a phrase such as
"no age limit" shall disclose that premiums may vary by age or that
benefits may vary by age if such is the case.
(3) Advertisements, applications, requests for
additional information and similar materials are unacceptable if they state or
imply that the recipient has been individually selected to be offered
insurance, or has had his eligibility for insurance individually determined in
advance, when in fact the advertisement is directed to all persons in a group
or to all persons whose names appear on a mailing list.
(4) Advertisements for group or franchise group
plans that provide a common benefit or a common combination of benefits shall
not imply that the insurance coverage is tailored or designed specifically for
that group, unless such is the fact.
(5) It is unacceptable to use terms such as
"enroll" or "join" with reference to group or blanket insurance
coverage when such is not the case.
(6) An advertisement that states or implies
immediate coverage is provided is unacceptable unless suitable administrative
procedures exist so that the policy is issued within 15 working days after the
application is received by the insurer.
(7) Applications, request forms for additional
information, and similar related materials are unacceptable if they resemble
paper currency, bonds or stock certificates; or use any name, service mark,
slogan, symbol or any device in such a manner that implies that 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.
(8) An advertisement that uses the word "plan"
without identifying it as a Medicare supplement insurance policy is not
permissible.
(9) An advertisement that implies in any manner
that the prospective insured may realize a profit from obtaining Medicare
supplement insurance is not permissible.
(10) An advertisement that fails to disclose any
waiting or elimination periods is unacceptable.
(11) Examples of benefits payable under a policy
shall not disclose only maximum benefits unless the maximum benefits are paid
for loss from common or probable illnesses or accidents, rather than
exceptional or rare illnesses or accidents or periods of confinement for these
exceptional or rare accidents or illnesses.
(12) When a range of benefit levels is set forth
in an advertisement, it shall be made clear that the insured will receive only
the benefit level written or printed in the policy selected and issued.
(13) Advertisements for policies whose premiums
are modest because of their limited amount of benefits shall not describe
premiums as "low, "low-cost," "budget" or use
qualifying words of similar import. This
part also prohibits the use of words such as "only" and
"just" in conjunction with statements of premium amounts when used to
imply a bargain.
(14) An advertisement that exaggerates the effects
of statutorily mandated benefits or required policy provisions or that implies
that these provisions are unique to the advertised policy is unacceptable. For example, the phrase, "Money Back
Guarantee," is an exaggerated description of the 30 day right to examine
the policy and is not acceptable.
(15) An advertisement that implies that a common
type of policy or a combination of common benefits is "new,"
"unique," "a bonus," "a breakthrough," or is
otherwise unusual is unacceptable. Also,
the addition of a novel method of premium payment to an otherwise common plan
of insurance does not render it "new."
(16) An advertisement may not omit the word
"covered" when referring to benefits payable under its policy. Continued reference to "covered" is
not necessary where this fact has been prominently disclosed in the
advertisement.
(17) An advertisement shall state that benefits
payable under the policy are based upon Medicare eligible expenses, if such is
the case.
(18) An advertisement that fails to disclose that
the definition of "hospital" does not include a nursing home,
convalescent home or extended are facility, as the case may be, is
unacceptable.
(19) A television, radio, mail, internet, or
newspaper advertisement, or lead generating device that is 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 insurance agency may contact the applicant if such is the fact.
(20) Advertisements for policies designed to
supplement Medicare shall not employ devices that are designed to create undue
anxiety in the minds of the elderly.
Such phrases as "here is where most people over 65 learn about the
gaps in Medicare," or "Medicare is great, but..." or which
otherwise exaggerate the gaps in Medicare coverage are unacceptable. Phrases or devices that unduly excite fear of
dependence upon relatives or charity are unacceptable. Phrases or devices that imply that long
sicknesses or hospital stays are common among the elderly are unacceptable.
(21) An advertisement that is an invitation to
contract implying that the coverage is supplemental to Medicare, if it does not
explain the manner in which it is supplemental to Medicare coverage, is not
acceptable.
(22) An advertisement that is an invitation to
contract for Medicare supplement insurance is unacceptable if the
advertisement:
(a) Fails to disclose in clear language which of
the Medicare benefits the policy is not designed to supplement or if it
otherwise implies that Medicare provides only those benefits that the policy is
designed to supplement;
(b) Describes the in-patient hospital coverage of
Medicare as "Medicare hospital," or "Medicare Part A" when
the policy does not supplement the non-hospital or the psychiatric hospital
benefits of Medicare Part A;
(c) Fails to describe clearly the operation of
the part or parts of Medicare that the policy is designed to supplement; or
(d) Describes those Medicare benefits not
supplemented by the policy in such a way as to minimize their importance
relative to the Medicare benefits that are supplemented.
(23) Advertisements that indicate that a
particular coverage or policy is exclusively for "preferred risks" or
a particular segment of the population, or that particular segments of the
population are acceptable risks, when such distinctions are not maintained in
the issuance of policies, are not acceptable.
(24) An advertisement that contains 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 that the policy is issued
within a reasonable period of time after the application is received by the
insurer, is unacceptable.
(25) An advertisement that uses a phrase or term
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 unacceptable unless it refers to the fact that the
application is subject to acceptance or approval by the insurer.
(26) Advertisements that state or imply that
premiums will not be changed in the future are not acceptable unless the
advertised policies so provide.
(27) An advertisement that does not require the
premium to accompany the application shall not overemphasize that fact and
shall make the effective date of that coverage clear.
(28) An advertisement that is an invitation to
contract that fails to disclose the amount of any deductible or the percentage
of any co-insurance factor is not acceptable.
Guideline 6-A(2)
This part
recognizes that certain words and phrases in advertising may have a tendency to
mislead the public as to the extent of benefits under an advertised
policy. Consequently, the terms (and
those specified in this part do not represent a comprehensive list but only
examples) shall be used with caution to avoid any tendency to exaggerate
benefits and shall not be used unless the statement is literally true in every
instance. The use of the following
phrases based on such terms or having the same effect shall be similarly
restricted: "pays hospital,
surgical, etc., bills," "pays dollars to offset the cost of medical
care," "safeguards your standard of living," "pays full coverage,"
"pays complete coverage," or "pays for financial
needs." Other phrases may or may
not be acceptable depending upon the nature of the coverage being advertised.
This part also
prohibits words or phrases that exaggerate the effect of benefit payment on the
insured's general well-being, such as "worry-free savings plan,"
"guaranteed savings," "financial peace of mind," and
"you will never have to worry about hospital bills again."
Advertisements
that are an invitation to contract for policies designed to supplement Medicare
benefits are unacceptable if they fail to disclose that no hospital confinement
benefits will be payable for that portion of a Medicare benefit period for
which Medicare pays all hospital confinement expenses (currently 60 days) other
than the initial deductible if the policy so provides. The length of the period shall be state in
days.
Guideline 6-A(4)
Explanations
shall not minimize nor describe restrictive provisions in a positive
manner. Negative features shall be
accurately set forth. Any limitation on
benefits precluding preexisting conditions shall also be restated under a
caption concerning exclusions or limitations, notwithstanding that the
preexisting condition exclusion has been disclosed elsewhere in the advertisement. (See Guideline 6-C for additional comments on
preexisting conditions.)
Guideline 6-A(5)
This part should
be applied in conjunction with Ins 2603.10.
Phrases such as "we cut cost to the bone" or "we deal
direct with you so our costs are lower" shall not be used.
Guideline 6-B(1)
An advertisement
that is an invitation to contract as defined in Ins 2603.03 (j) shall recite
the exceptions, reductions and limitations as required by this part and in a
manner consistent with Ins 2603.04.
If an exception,
reduction or limitation is important enough to use in a policy, it is of
sufficient importance that its existence in the policy should be referred to in
the advertisement regardless of whether it may also be the subject matter of a
provision of the Uniform Individual Accident and Sickness Policy Provision Law.
Some
advertisements disclose exceptions, reductions and limitations as required, but
the advertisement is so lengthy that it obscures the disclosure. Where the length of an advertisement has this
effect, special emphasis shall be given by changing the format to show the
restrictions in a manner that does not minimize, render obscure or otherwise
make them appear unimportant.
Guideline 6-C(1)
This part
implements the objective of Ins 2603.06(a)(4) by
requiring in negative terms a description of the effect of a preexisting
condition exclusion because such an exclusion is a restriction on
coverage. The subdivision also prohibits
the use of the phrase "preexisting condition" without an appropriate
definition or description of the term and prohibits stating a reduction in the
statutory time limit as an affirmative benefit.
The words "appropriate definition or description" mean that
the term "preexisting condition" shall be defined as it is used by the
company's claims department.
Guideline 6-C(2)
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 issues," if the
policy excludes preexisting conditions for a certain period, shall be
accompanied by a statement disclosing that fact in a manner which does not
minimize, render obscure or otherwise make it appear unimportant and is
otherwise consistent with Ins 2603.04.
Guideline 6-C(3)
Some states
require approval of the application even when the application is not attached
to the policy when issued. This part
does not change such a requirement. The
text of this guideline should be modified to reflect the rule applicable in the
particular state.
Guideline 7
Advertisements
of cancellable Medicare supplement policies shall state that the contract is
cancellable or renewable at the option of the company as the case may be. With respect to noncancellable
policies and guaranteed renewable policies, the policy provisions, with respect
to renewability, shall be set forth and defined where appropriate.
This part also
requires a statement of the qualifying conditions that constitute limitations
on the permanent nature of the coverage.
These customarily fall into 3 categories (1) age limits, (2) reservation
of a right to increase premiums, and (3) the establishment of aggregate
limits. For example, "noncancellable and guaranteed renewable" does not
fulfill the requirements of this part if the policy contains a terminal
age. In such a case, a proper statement
would be "Noncancellable and guaranteed renewal
to age ____." If a guaranteed
renewable policy reserves the right to increase premiums, the statement shall
be expanded into language similar to "guaranteed renewable to age,"
but the company reserves the right to increase premium rates on a class
basis." If the contract contains an
aggregate limit after which no further benefits are payable, the above
statement shall be amplified with the phrase "subject to a maximum
aggregate amount of $50,000" or similar language. A Medicare supplement insurance policy may
have one or more of the 3 basic limitations and an advertisement shall describe
each of those which the policy contains.
Over 50 percent of new individual policy issues are guaranteed
renewable; therefore, the fact that a policy is guaranteed renewable shall not
be exaggerated.
An advertisement
for a Medicare supplement insurance policy that provides for age step-rated premium
rates based upon the policy year or the insured's attained age shall disclose
the rate increases and the times or ages at which the premium increases.
Guideline 8-A
This part shall
be applied in conjunction with Ins 2603.08 and requires that all such
statements shall be genuine and not fictitious.
Under this part, the manufacturing, substantive editing or
"doctoring up" of a testimonial is clearly prohibited as being false
and misleading to the insurance-buying public.
However, language that would be unacceptable under this part shall be
edited out of a testimonial.
Guideline 8-C
This part
requires that both approval or endorsement of a policy
by an individual, group of individuals, society, association or other
organization be factual and that any proprietary relationship between the
sponsoring or endorsing organization and the insurer be disclosed. For example, if the dividend under an
association group case is payable to the association, disclosure of that fact
is required. Also, if the insurer or an
officer of the insurer formed or controls the association, that fact shall be
disclosed. This guideline also applies
to Ins 2603.08(e).
Guideline 9-A
An advertisement
shall specifically identify the Medicare supplement insurance policy to which
statistics relate and, where statistics are given that are applicable to a
different policy, it shall be stated clearly that the data does not relate to
the policy being advertised.
An advertisement
that states the dollar amount of claims paid shall also indicate the period
over which the claims have been paid.
If the term
"loss ratio" is used, it shall be properly explained in the context
of the advertisement and, unless the state has issued a rule otherwise defining
the term, it shall be calculated on the basis of premiums earned to losses
incurred and shall not be on a yearly run-off basis.
Guideline 9-C
This part does
not require that statistics for this state be used since such statistics as
hospital charges and average stays may vary from state to state. When nationwide statistics are used, that
fact should be noted, unless the statistics on the particular point are
substantially the same in a state to which the advertisement is directed. Statistics may only be used if they are
current and credible.
Guideline 10
This part
prohibits disparaging, unfair or incomplete comparisons of policies or benefits
that would have a tendency to decline or mislead the public. This part does not preclude the use of
comparisons by health maintenance organizations, prepaid health plans and other
direct service organizations that describe the difference between their prepaid
health benefits coverage and indemnity insurance coverage.
Guideline 11-A
This part
prohibits advertisements that imply that an insurer is licensed beyond the
limits of those jurisdictions where it is actually licensed. An advertisement that contains testimonials
from persons who reside in a state in which the insurer is not licensed or that
refers to claims of persons residing in states in which the insurer is not
licensed implies licensing in those states and, therefore, is in violation of
this part unless the advertisement states that the insurer is not licensed in
those states.
Guideline 11-B
Although this
part permits a reference to an insurer being licensed in a state where the
advertisement appears, it does not allow exaggeration of the fact of that
licensing nor does it permit the suggestion that competing insurers may not be
so licensed because, in most states, an insurer must be licensed in the state
to which it directs its advertising.
Terms such as
"official," or words of similar import, used
to describe any policy or application form are not permissible because of the
potential for deceiving or misleading the public. This guideline also applies to Ins
2603.11(c).
Guideline 14-A(1)
This part
prohibits advertising representing that a product is offered on an
introductory, initial or special offer basis or otherwise which (a) will not be
available later; or (b) is available only to certain individuals, unless such
is the fact. This part prohibits the
repetitive use of such advertisements.
Where an insurer uses enrollment periods as the usual method of advertising
these policies, this part prohibits describing an enrollment period as a
special opportunity or offer for the applicant.
Guideline 14-A(2)
This part
restricts the repetitive use of enrollment periods. The requirement of reasonable closing dates
and waiting periods between enrollment periods was adopted to eliminate the
abuses that formerly existed. This part
does not limit just the use of enrollment periods. It requires that a particular insurance
product offered in an enrollment period through any advertising media,
including the prepared presentations of agents, cannot be offered again in the
state until 6 months from the close of the enrollment period. Thus, an insurer shall choose whether to use
enrollment periods or open enrollment for a product. (See Ins 2603.14(a)(4)
for the definition of "a particular insurance product.")
This part does
not prohibit multiple advertising during an enrollment period through any and
all media published or transmitted within this state as long as the enrollment
periods for all such advertisements have the same expiration date.
This part does
not prohibit the solicitation of members of a group or association for the same
product even though there has not been a lapse of 6 months since the close of a
preceding enrollment period that was open to the general public for the same
product.
This part does
not require separation by 6 months
of enrollment periods for the same insurance product in this state if the
advertising material is directed by an admitted insurer to persons by direct
mail on the basis that a common relationship exists with an entity. Examples would be a bank and its depositors,
a department store to its charge account customers, or an oil company to its
credit card holders, and more than one of these organizations is sponsoring an
insurance product at different times if providing the insurance under such
methods is not otherwise prohibited by law.
However, the 6 month rule
does apply to one specific sponsor to the same persons in this state on the
basis of their status as customers of that one specific entity only.
Guideline 14-A(4)
This part
defines the meaning of "a particular insurance product" in Ins
2603.14(a)(2) and prohibits advertising of products
having minor variations such as different periods or different amounts of daily
hospital indemnity benefits, in a succession of enrollment periods.
Guideline 15
This part is
closely related to the requirement of Ins 2603.09 concerning the use of
statistics. This part prohibits
insurances that have been organized for only a brief period of time advertising
that they are "old" and also prohibits emphasizing the size and
magnitude of the insurer. Also, the occupations of the persons comprising the insurer's board of
directors or the public's familiarity with their names or reputations is
irrelevant and shall not be emphasized.
The preponderance of a particular occupation or profession among the
board of directors of an insurer does not justify the advertisement of a plan
of insurance offered to the general public as insurance designed or recommended
by members of that occupation or profession.
For example, it is unacceptable for an insurance company to advertise a
policy offered to the general public as "the physicians' policy" or
the "the doctors' plan" simply because there is a preponderance of
physicians or doctors of the insurer.
This part prohibits the use of recommendation of a commercial rating
system unless the purpose, meaning and limitations of the recommendation are
clearly indicated.
Guideline 16
The text of Ins
2603.16(a) is identical to the text of the first paragraph of the enforcement
section of previous drafts of this part except the last sentence of the
subsection has been revised to require that the advertising file be maintained
either for a period of 4 years (rather than 3 as previously) or until the next
regular examination of the insurer, whichever is the longer period of time.
Guideline 17
Filing of all
Medicare supplement advertisements is required by this part.
PART Ins 2604 ALL OTHER ADVERTISEMENTS OF LIFE,
ACCIDENT, AND HEALTH INSURANCE
Ins 2604.01 Purpose. The purpose of this part is to ensure that all
advertisements that relate to life, accident or health insurance policies sold
in this state that are not regulated under Ins 2601, Ins 2602, or Ins 2603,
present clear and accurate information to the public and do not mislead
consumers about the characteristics or operations of any insurance plan or
product.
Source. #6971, eff 4-1-99, EXPIRED: 4-1-07
New. #9333, eff 12-5-08; ss
by #11173, eff 12-5-16
Ins 2604.02 Applicability
and Scope. This
part shall apply to life, accident or health insurance policies that are not
regulated under Ins 2601, Ins 2602, or Ins 2603 and to
any entity which holds a license to sell, issue or administer these policies in
this state.
Source. #6971, eff 4-1-99, EXPIRED: 4-1-07
New. #9333, eff 12-5-08; ss
by #11173, eff 12-5-16
Ins 2604.03 Definitions. For the purpose of this part, the following
definitions shall apply:
(a) “Advertisement” means:
(1) Printed and published material and literature
an insurer uses in newspapers, magazines, radio and TV scripts, billboards and
similar displays to describe its
plans and products;
(2) Descriptive literature and sales aids issued
by an insurer for presentation to members of the public, including but not
limited to circulars, leaflets, booklets, depictions, illustrations, and form
letters;
(3) Prepared sales talks, presentations and
material for use by producers; and
(4) Product descriptions, illustrations, web
pages and other materials available on the internet.
(b) “Exception” means any provision in a policy
which eliminates coverage for a specified hazard through a statement of a risk
the policy does not assume.
(c)
“Insurer” means any individual, producer, corporation, association, partnership,
health maintenance organization, reciprocal exchange, interinsurer,
fraternal benefit society, and any other legal entity engaged in the
advertisement of a policy as herein defined.
(d) “Limitation” means any provision in a policy
which restricts coverage under the policy that is not an exception or a
reduction.
(e) “Policy” means any, plan, certificate,
contract, agreement, statement of coverage, rider or endorsement that provides
life, accident or health benefits or medical, surgical or hospital expense
benefits whether on a cash indemnity, reimbursement, or service basis. “Policy”
does not include the disability and double indemnity benefits included in insurance
lines defined in RSA 401:1, III, or any policy that is regulated by Ins 2601, Ins 2602, Ins 2603, or Ins 3600.
(f)
“Policy elimination period” means any period between the policy’s
effective date and the effective date of coverage for specified illness if such
illness is not covered as of the policy’s effective date, or any period between
the time loss occurs and the time coverage begins.
(g)
“Reduction” means any provision in a policy that reduces a benefit
amount wherein the policy does assume some risk of loss, but the insurer limits
payment to an amount or period of time that is less than the policy would cover
if the contract did not include the reduction provision.
Source. #9333, eff 12-5-08; ss
by #11173, eff 12-5-16
Ins 2604.04 Reference
to Policy Form Numbers. All
printed advertisements except general invitations to inquire about the details
of policies shall carry a reference number for any contract form mentioned in
the advertisement.
Source. #9333, eff 12-5-08; ss
by #11173, eff 12-5-16
Ins 2604.05 Advertisements
in General.
(a) Advertisements shall be truthful and not
misleading in fact or in implication.
(b) Advertisements shall use words or phrases whose meaning is direct and unambiguous and not
words or phrases whose meaning is clear only by implication.
(c) Advertisements shall not use words or phrases
that are clear only to people who understand insurance terminology.
(d)
Advertisements containing disclosures required pursuant to this part
shall present:
(1) Required disclosures in close proximity to
the information to which they relate so that the information to which a
disclosure relates is clear to consumers;
(2) Disclosures shall be set out under
appropriate captions of sufficient prominence so that the disclosures appear
clear and conspicuous and do not become intermingled with other text; and
(3) Disclosures shall be set out in full and
complete, in a manner that does not render the information unclear, confusing,
ambiguous, or obscure.
(e)
An advertisement shall not directly or indirectly make unfair or
incomplete comparisons of policies or benefits.
Advertisements shall not falsely or maliciously disparage competitors,
their policies, services or business methods.
(f)
A policy advertisement shall not state or imply that prospective
policyholders become group or quasi-group members, and as such enjoy special
rates or underwriting privileges, unless such is the fact.
(g) An advertisement shall not contain untrue
statements about the time within which claims are paid, or the number of claims
paid. An advertisement shall not contain
statements that imply that claim settlements will be liberal or generous beyond
the terms of the policy.
(h)
An advertisement shall not contain statements about the insurer’s
assets, corporate structure, financial standing, age or relative position in
the insurance industry that are untrue or misleading.
(i) Insurers shall maintain complete control over
the content, form and method of dissemination of its advertisements at all
times. The sponsoring insurer shall be
responsible for all advertisements, regardless of whether another party has
written, created, or designed the advertisement.
(j)
Disclosed information shall be set out in type size at least as large as
the statements to which the information relates, and in a font style the same
as or comparable with the font style used for the statements to which the
information relates.
Source. #9333, eff 12-5-08; ss
by #11173, eff 12-5-16
Ins 2604.06 Advertisements
of Benefits Payable, Losses Covered or Premiums Payable.
(a)
An insurer shall not use misleading
words, phrases, statements, references or illustrations, or omit
information that might mislead or deceive the consumer as to:
(1) Any policy benefit
payable;
(2) Any loss covered; or
(3) Any premium payable.
(b)
When an advertisement describes any policy benefit payable, loss covered
or premium payable, the insurer shall use only words and phrases in the
advertisement that give complete and clear information and do not mislead or
deceive, as follows:
(1) An advertisement shall not use the following words and phrases:
"all," "full," "complete,"
"comprehensive," "unlimited," "this policy will pay
your hospital and surgical bills," or "this policy will replace your
income," or similar words and phrases to refer to any coverage that is, in
fact, subject to any exception, reduction or limitation, unless the
advertisement includes appropriate disclosure;
(2) An advertisement shall not use words or phrases such as "up
to," "as high as," or similar words or phrases to describe the
dollar amount payable for any losses or expenses except:
a. When
the contract provides benefit payments for such losses or expenses actually
sustained by a policyholder in all cases; or
b. When
the advertisement includes appropriate disclosure of either:
1. The complete schedule of payments provided by
the contract; or
2. The specific loss or expense for which the
contract pays the represented dollar amount, as well as a statement indicating
that the actual benefit will vary in amount depending on the particular kind of
loss or expense incurred; and
(3) When an insurer advertises a policy that
provides surgical benefits, and the advertisement refers to specific dollar
amounts for coverage of surgical procedures, the insurer shall:
a. Derive a list of 6 commonly performed
surgical procedures for which the advertised policy provides coverage, and the
insurer shall periodically review and update this list, to ensure its
continuing validity; and
b. Disclose
this list of procedures, along with the relevant maximum and minimum benefit
limits from the insurer’s surgical schedule for each of the listed procedures.
(c)
An advertisement shall list the surgical procedures in terms that the
average reader understands easily. An
advertisement for a policy that covers only one disease or a list of specified
diseases shall not imply coverage beyond the terms of the policy. The advertisement shall not use a synonymous
term for any disease to imply broader coverage than is the fact.
(d)
Advertisements shall not refer to policy benefits when the benefits paid
vary for the same loss occurring under different conditions, or when the
benefits are paid only when a loss occurs under certain conditions, unless the
advertisement discloses these conditions.
(e)
An advertisement shall not use phrases
that indicate that the policy pays a specific amount for hospital room and
board expenses without disclosing
the maximum daily benefit and the maximum time limit for hospital room and
board expenses.
(f)
An advertisement shall not represent the weekly, monthly, or other
periodic benefits payable under a contract without disclosing:
(1) Any limits on the time period over which such
benefits will be paid; or
(2) The number of payments that will be made if the
contract limits such benefits
in time or number.
(g)
No advertisement shall use the following words or phrases "extra
cash," "extra income," "extra pay," or substantially
similar words or phrases that could lead the public to believe that the contract
advertised will enable them to financially profit from being hospitalized.
(h)
No advertisement shall represent or imply that a contract may continue
indefinitely or for any period of time, when:
(1) The contract permits the insurer to non-renew
or cancel the policy; or
(2) The contract permits the insurer to terminate
the policy under any circumstances over which the insured has no control,
during the period of time represented.
(i) An advertisement that refers to any coverage
as being limited to a certain age group shall disclose such limitation. When applicable, such advertisement shall
state clearly that the insured will receive reduced benefits upon attaining a
certain age.
(j)
An advertisement that refers to a contract that may be renewed,
cancelled, or terminated shall disclose any and all related provisions,
including possible modification of policy terms relating to benefits, coverages or premiums, and any qualifying conditions.
(k)
No insurer shall state or imply that a consumer shall obtain coverage, or guaranteed issuance of a
policy, unless the insurer has maintained administrative procedures and
sufficient staff to ensure that it will issue the policy within a maximum of 15
days after receiving the
application.
(l)
An advertisement of a hospital indemnity policy that includes words or
phrases describing the policy’s benefits shall disclose:
(1) The actual amounts payable per day; and
(2) The fact that the insurer will pay such
benefits during hospital confinement only.
(m)
No advertisement shall depict scenes that could scare a reader into
purchasing a policy. Such scenes include
but shall not be limited to scenes of hospital operating rooms, disabled
persons, bed patients in or out of the hospital,
doctors' offices, accident scenes, or scenes of other tragedies.
(n)
All printed advertisements for policies that include certain exceptions,
reductions or limitations shall display and use a separate box clearly distinguishable from the
remainder of the advertisement to set forth the required disclosures.
(o)
The box required in (n) above shall be as follows:
(1) For black and white advertisements, the box
shall carry a border that stands out due to its size from the remainder of the
advertisement; and
(2) For color advertisements, the box shall carry
a border that stands out due to its color from the remainder of the
advertisement.
(p)
An advertisement may omit a schedule, chart or a detailed explanation,
otherwise required by this part, from the box if the box includes a reference
to the exact location where the schedule, chart or explanation appears
elsewhere in the advertisement.
(q)
The box required in (n) above shall include a statement that indicates
the policy might contain exceptions, reductions or limitations in addition to
those set forth in the box.
(r)
The box required in (n) above shall only use negative language to
describe policy limitations and exclusions, so that the language indicates what
the policy does not cover, rather than what the policy does cover.
(s) Exceptions, reductions, or limitations of
benefits described in the box required in (n) above shall include:
(1) Treatment of preexisting conditions;
(2) Policy elimination periods;
(3) The fact that indemnity is payable only when
the insured is confined to a hospital;
(4) The fact that confinement in rest homes,
nursing homes, V.A. hospitals, or other types of extended care in a facility
are not covered;
(5) The fact that the policy does not cover
certain deductibles;
(6) The fact that the policy does not duplicate
benefits provided by federal or state legislation, such as workers
compensation; and
(7) The fact that the policy covers hospital
bills and not doctors’ bills or vice versa.
(t)
When an advertisement refers to terms or conditions of the policy,
including but not limited to specific dollar amounts, or policy benefits, and
times or ages in connection with coverage eligibility, it shall also disclose
any related exception, reduction or limitation.
(u)
Advertisements for policies that include any exception, reduction or
limitation related to a preexisting condition, shall:
(1) 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;
(2) Not state or imply that the insurer will
issue a policy or pay claims under the policy regardless of the applicant’s
physical condition or medical history, when the policy does not cover losses
traceable to preexisting conditions;
(3) Not use the phrase “no medical examination
required” or phrases of similar meaning when the policy does not cover losses
traceable to preexisting conditions; and
(4) For policies that do not require a medical
examination, disclose any conditions pertaining to or involving the insured’s
health that would limit benefits paid under the contract.
Source. #9333, eff 12-5-08; ss
by #11173, eff 12-5-16
Ins 2604.07 Testimonials.
(a)
When an advertisement
uses a testimonial, the testimonial shall:
(1) Be genuine;
(2) Apply to the policy advertised;
(3) Be accurately reproduced; and
(4) Disclose:
a. When
the author of a testimonial has received compensation for the testimonial; and
b. When
the author of a testimonial has a financial interest in the company or a
related entity as a stockholder, director, compensated employee, or any other
interest.
(b)
The insurer shall be responsible for all of the statements contained in
any testimonial as if such testimonials were stated directly by the insurer.
Source. #9333, eff 12-5-08; ss
by #11173, eff 12-5-16
Ins 2604.08 Use
of Statistics.
(a)
An advertisement shall not use statistics unless the advertisement
accurately reflects all the relevant facts related to the stated statistic.
(b)
Statistics shall include, but not be limited to:
(1) The dollar amounts of claims paid;
(2) The time within which claims are paid;
(3) The number of claims paid; or
(4) The number of persons insured.
(c)
An advertisement that uses statistics shall not imply that the
statistics are derived from the policy advertised unless such is the fact.
Source. #9333, eff 12-5-08; ss
by #11173, eff 12-5-16
Ins 2604.09 Inspection
of Policy. An advertisement
shall not attempt to cure misleading or deceptive statements by offering the
consumer a free policy inspection or premium refund.
Source. #9333, eff 12-5-08; ss
by #11173, eff 12-5-16
Ins 2604.10 Identification
of Plan or Number of Policies.
(a)
When an advertisement refers to a choice in the amount of benefits, it
shall disclose that the amount of benefits and the premium depend upon the
selected plan.
(b)
When an advertisement refers to various benefits, that might be
contained in 2 or more policies, the advertisement shall disclose that the
insured can obtain such benefits only by combining these policies. This requirement shall not apply to group
master policies.
Source. #9333, eff 12-5-08; ss
by #11173, eff 12-5-16
Ins 2604.11 Jurisdictional
Licensing.
(a)
An advertisement that appears or airs in New Hampshire beyond the limits
of the jurisdiction in which the insurer is licensed, or which originates in
New Hampshire and appears or airs beyond the limits of the jurisdiction in
which the insurer is licensed, shall not imply in the advertisement that the
insurer is licensed beyond those limits.
(b)
Direct mail advertisements that appear in New Hampshire from beyond the
limits of the licensure jurisdiction, and direct mail advertisements that
originate in New Hampshire and are sent beyond the limits of the licensure jurisdiction, shall indicate that the insurer is licensed in
a specified state or states only, or is not licensed in a specified state or
states. Direct mail advertisements shall
use language such as "This Company is licensed only in State "A"
or "This Company is not licensed in State B", or "This policy is
not available to residents of .......".
(c)
Any advertisement that originates outside the state of New Hampshire,
but that can reasonably be expected to be seen or heard in this state, shall
comply with this part, except when the advertisement prominently sets forth an appropriate disclaimer such
as: "This policy is not available
to residents of New Hampshire."
Source. #9333, eff 12-5-08; ss
by #11173, eff 12-5-16
Ins 2604.12 Identity
of Insurer.
(a) All advertisements shall make the
insurer’s identity clear. An
advertisement shall not use a trade name, service mark, slogan, symbol or other
device that could mislead or deceive as to the true identity of the insurer.
(b)
An advertisement that uses an address other than the insurer's home
office shall properly identify such address as a district office, branch
office, or other office. An advertisement
that uses a designation such as "Disability Division" shall not give
such designation greater prominence than the name of the insurer. An advertisement shall not use such a
designation except in connection with any address other than the insurer’s
actual office address.
(c)
No advertisement or sales solicitation material shall use any combination of words and/or physical materials that
resemble combinations or words and/or physical materials used by agencies of
the federal government or the state of New Hampshire, in any manner that might
confuse and/or mislead prospective insureds to
believe that the solicitation
relates to an agency of the state or federal government.
Source. #9333, eff 12-5-08; ss
by #11173, eff 12-5-16
Ins 2604.13 Introductory,
Initial or Special Offers.
(a)
An advertisement shall not falsely state or imply that a particular
policy or combination of policies is an introductory, initial, special or
limited enrollment policy.
(b)
An advertisement shall not contain phrases such as "special
enrollment," "special limited enrollment," "enrollment
deadline," "acceptance period," or similar words or phrases that
falsely imply:
(1) That an interested party shall apply by a specific deadline to obtain the
particular contract advertised, or to obtain any contract of the same insurer
which offers substantially similar coverage;
(2) That the insurer shall receive an interested
party’s application by a prescribed date and that it will not accept the
application thereafter;
(3) That the policy shall not be available at a
future date; and
(4) That an applicant shall receive advantages
not available at a later date if he or she applies immediately.
(c)
An advertisement shall not state that the insurer requires an enrollment
period, when less than 90 days separates the ending date of one enrollment
period and the beginning date of the next enrollment period for the same
contract, or any substantially similar contract the insurer offers in the
state.
(d)
An insurer shall not advertise or use a first month premium rate of less
than 1/12 of the annual premium for any contract, except when the insurer
substantiates that it reduces benefits paid during the first month of the
contract in proportion to the
premium it charges during that period.
Source. #9333, eff 12-5-08; ss
by #11173, eff 12-5-16
Ins 2604.14 Third
Party Approval and Endorsement.
(a)
An advertisement shall not state or imply that a governmental agency has
approved an insurer or a policy, or has examined an insurer's financial condition and found it satisfactory, unless
such is the fact.
(b)
An advertisement shall not state or imply that any individual, group,
society, association, or other organization
has approved or endorsed an insurer or a policy unless such is the fact.
Source. #9333, eff 12-5-08; ss
by #11173, eff 12-5-16
Ins 2604.15 Advertising
File.
(a)
Each insurer shall
maintain at its home or principal office a complete file that contains:
(1) Every printed, published or prepared
advertisement of individual policies; and
(2) Typical printed, published or prepared
advertisements for blanket, franchise and group policies that the insurer has
published.
(b)
The required file shall
include such advertisements appearing in this state or any other state, whether
or not the insurer carriers a license in such other state.
(c)
The insurer shall attach a notation to each advertisement that indicates
the manner and extent of distribution and the form number of any policy advertised.
(d)
The insurer shall
maintain all advertisements in the
file for a period of not less than 3 years.
(e) The insurer shall make the advertising file
available to the commissioner or his or her designee for
inspection.
Source. #9333, eff 12-5-08; ss
by #11173, eff 12-5-16
Ins 2604.16 Soliciting
Names of Prospective Insureds. Any advertisement which the insurer uses to
solicit leads for prospective applicants shall disclose that an agent for the insurer will contact the applicant if such
is the fact.
Source. #9333, eff 12-5-08; ss
by #11173, eff 12-5-16
Ins 2604.17 Penalty
Provisions. Any insurer who
knowingly violates any requirement of
this part shall be subject to the penalty provisions of RSA 400-A:15.
Source. #9333, eff 12-5-08; ss
by #11173, eff 12-5-16
APPENDIX
|
Rule |
Statute |
|
Ins
2601.01 |
RSA
400-A:15, I; 406-A:1, I; 406-A:3; 417:3; 417:4, I, III |
|
Ins
2601.02 |
RSA
400-A:15, I; 406-A:1, I; 406-A:3; 417:3; 417:4, I, III; 402-H:5 |
|
Ins
2601.03 |
RSA
400-A:15, I; 406-A:1, I; 406-A:3; 417:3; 417:4, I, III |
|
Ins
2601.04 |
RSA
400-A:15, I; 417:4, I, III |
|
Ins
2601.05 |
RSA
417:4, I |
|
Ins
2601.06 |
RSA
406-A:1; 406-A:3; 417:1; 417:3; 417:4, I, III, XIII |
|
Ins
2601.07 |
RSA
417:4, I, III |
|
Ins
2601.08 |
RSA
417:4, I, III |
|
Ins
2601.09 |
RSA
417:4, I, II, III, IV, VI |
|
Ins
2601.10 |
RSA
417:4, I, II, III, IV, VI |
|
Ins
2601.11 |
RSA
417:4, I, III, XIII |
|
Ins
2601.12 |
RSA
417:4, I, III, IV |
|
Ins
2601.13 |
RSA
406-A:1; 406-A:3; 417:1; 417:3; 417:4, I, III |
|
Ins
2601.14 |
RSA
406-A:1; 406-A:3; 417:1; 417:3; 417:4, I, III |
|
Ins
2601.15 |
RSA
417:4, I, III |
|
Ins
2601.16 |
RSA
417:4, I, III, IX |
|
Ins
2601.17 |
RSA
417:4, IV, VI |
|
Ins
2601.18 |
RSA
400-B |
|
Ins
2601.19 |
RSA
400-A:15, I; 406-A:1, I; 406-A:3 |
|
Ins
2601.20 |
RSA
400-A:15, III; 417:10; 417:13 |
|
|
|
|
Ins
2602.01 |
RSA
400-A:15, I; 406-C:8; 417:3; 417:4, III |
|
Ins
2602.02 |
RSA
400-A:15, I; 406-C:8; 417:3; 417:4, III |
|
Ins
2602.03 |
RSA
400-A:15, I; 406-C:8; 417:3; 417:4, III |
|
Ins
2602.04 |
RSA
400-A:15, I; 406-C:8; 417:4, I, III, VIII |
|
Ins
2602.05 |
RSA
400-A:15, I; 406-C:8; 417:4, I, III, VIII |
|
Ins
2602.06 |
RSA
406-C:8; 417:3; 417:4, I, III |
|
Ins
2602.07 |
RSA
406-C:8; 417:3; 417:4, I, III |
|
Ins
2602.08 |
RSA
417:4, IV, VI |
|
Ins
2602.09 |
RSA
400-A:15, I; 400-B; 406-C:8; 417:1; 417:3; 417:4, I, II, III |
|
Ins
2602.10 |
RSA
400-A:15, III; 417:10; 417:13 |
|
Ins
2602.11 |
RSA
400-A:15, III |
|
|
|
|
Ins
2603.01 |
RSA
415-F:3, III, IV; 415-F:7 |
|
Ins
2603.02 |
RSA
415-F:3, III, IV; 415-F:7 |
|
Ins
2603.03 |
RSA
415-F:3, III, IV; 415-F:7 |
|
Ins
2603.04 |
RSA
415-F:3, III, IV; 415-F:7 |
|
Ins
2603.05 |
RSA
415-F:3, III, IV; 415-F:7 |
|
Ins
2603.06 |
RSA
415-F:3, III, IV; 415-F:7 |
|
Ins
2603.07 |
RSA
415-F:3, III, IV; 415-F:7 |
|
Ins
2603.08 |
RSA
415-F:3, III, IV; 415-F:7 |
|
Ins
2603.09 |
RSA
415-F:3, III, IV; 415-F:7 |
|
Ins
2603.10 |
RSA
415-F:3, III, IV; 415-F:7 |
|
Ins
2603.11 |
RSA
415-F:3, III, IV; 415-F:7 |
|
Ins
2603.12 |
RSA
415-F:3, III, IV; 415-F:7 |
|
Ins
2603.13 |
RSA
415-F:3, III, IV; 415-F:7 |
|
Ins
2603.14 |
RSA
415-F:3, III, IV; 415-F:7 |
|
Ins
2603.15 |
RSA
415-F:3, III, IV; 415-F:7 |
|
Ins
2603.16 |
RSA
415-F:3, III, IV; 415-F:7 |
|
Ins
2603.17 |
RSA
415-F:3, III, IV; 415-F:7 |
|
|
|
|
Ins
2604.01 |
RSA
406-A:1; 406-A:3; 406-C:8; 417:1; 417:3; 417:4, I, III |
|
Ins
2604.02 |
RSA
406-A:1; 406-A:3; 406-C:8; 417:1; 417:3; 417:4, I, III |
|
Ins
2604.03 |
RSA
406-A:1; 406-A:3; 406-C:8; 417:1; 417:3; 417:4, I, III |
|
Ins
2604.04 |
RSA
417:4, I, III |
|
Ins
2604.05 |
RSA
406-A:1; 406-A:3; 406-C:8; 417:1; 417:3; 417:4, I, III, XIII, XIV |
|
Ins
2604.06 |
RSA
417:4, I, III, VIII, IX, XII, XIII, XIV |
|
Ins
2604.07 |
RSA
417:4, I, II, III, IV, VI |
|
Ins
2604.08 |
RSA
417:4, I, II, III, IV, VI |
|
Ins
2604.09 |
RSA
406-A:1, 406-A:3, 406-C:8; 417:4, I, II, III, IX, XII, XV |
|
Ins
2604.10 |
RSA
417:1; 417:3; 417:4 |
|
Ins
2604.11 |
RSA
406-A:1; 406-A:3; 406-C:8; 417:1; 417:3; 417:4, I, III |
|
Ins
2604.12 |
RSA
406-A:1; 406-A:3; 406-C:8; 417:1; 417:3; 417:4, I, III |
|
Ins
2604.13 |
RSA
406-A:1; 406-A:3; 406-C:8; 417:1; 417:3; 417:4 I, II, III, XII |
|
Ins
2604.14 |
RSA
417:4, I, II, III, IV, VI |
|
Ins
2604.15 |
RSA
400-B:3 |
|
Ins
2604.16 |
RSA
406-A:1; 406-A:3; 406-C:8; 417:1; 417:3; 417:4, I, II, III |
|
Ins
2604.17 |
RSA
400-A:15, III; 417:10; 417:13 |