TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE
SUBCHAPTER z: ACCIDENT AND HEALTH INSURANCE
PART 2002
ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE
SECTION 2002.10 AUTHORITY
Section 2002.10 Authority
This Part is issued by the
Director of Insurance pursuant to Section 401 of the Illinois Insurance Code
which empowers the Director " . . . to make reasonable rules and
regulations as may be necessary for making effective . . ." the
insurance laws of this State. This Part implements Article XXVI and Section
149 of the Illinois Insurance Code by establishing minimum standards,
guidelines, and interpretations for the form, content, practice and method of
advertising policies of accident and sickness insurance offered for sale in
Illinois.
 | TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE
SUBCHAPTER z: ACCIDENT AND HEALTH INSURANCE
PART 2002
ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE
SECTION 2002.20 PURPOSE
Section 2002.20 Purpose
The purpose of this Part is to
assure truthful and adequate disclosure of all material and relevant
information in the advertising of accident and sickness insurance. This
purpose is intended to be accomplished by the establishment of, and adherence
to, certain minimum standards and guidelines of conduct in the advertising of
accident and sickness insurance in a manner which prevents unfair competition
among insurers and is conducive to the accurate presentation and description to
the insurance buying public of a policy of such insurance offered through
various advertising media. The Guideline for this Section is found in Appendix
A, Illustration A.
| TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE
SUBCHAPTER z: ACCIDENT AND HEALTH INSURANCE
PART 2002
ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE
SECTION 2002.30 APPLICABILITY
Section 2002.30
Applicability
a) This Part shall apply to any accident and sickness insurance
"advertisement" as that term is hereinafter defined in Section
2002.40, unless otherwise specified in this Part, intended for presentation,
distribution or dissemination in this State when such presentation,
distribution or dissemination is made either directly or indirectly by or on
behalf of an insurer, agent or broker as those terms are defined in the
Insurance Code of this State and this Part. The Guideline for this subsection
(a) is found in Appendix A, Illustration B.
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 such advertisements, regardless of by whom
written, created, designed or presented, shall be the responsibility of the
insurer whose policies are so advertised. The Guideline for this subsection
(b) is found in Appendix A, Illustration C.
c) This Part shall apply to advertisements both inside and outside
the Illinois Health Insurance Marketplace. Policies and rates shall not
be constructed or marketed in a way that discourages use of the Illinois Health
Insurance Marketplace. A certificate of compliance with this Part must be
submitted annually to the Illinois Department of Insurance (Department) in
accordance with Section 2002.180.
(Source: Amended at 38 Ill.
Reg. 2124, effective January 2, 2014)
| TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE
SUBCHAPTER z: ACCIDENT AND HEALTH INSURANCE
PART 2002
ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE
SECTION 2002.40 DEFINITIONS
Section 2002.40 Definitions
An "advertisement," for the purpose of this Part,
shall include:
printed and published material, audio-visual material, and
descriptive literature of an insurer used in direct mail, email,
internet pages, blogs, social media, newspapers, magazines, radio scripts, TV
scripts, billboards and similar displays; and
descriptive literature and sales aids of all kinds issued by
an insurer, agent or broker for presentation to members of the insurance buying
public, including but not limited to circulars, leaflets, booklets, depictions,
illustrations, and form letters; and
prepared sales talks, presentations and material for use by
agents, brokers and solicitors. The Guideline for this definition is found in
Appendix A, Illustration D.
"Exception," for the purpose of this Part, shall
mean 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.
"Health Insurance Marketplace" means the Illinois
Health Benefits Exchange established in accordance with 215 ILCS 122/5-5 and 42
USC 18031.
"Institutional Advertisement", for the purpose of
this Part, shall mean an advertisement having as its sole purpose the promotion
of the reader's or viewer's interest in the concept of accident and sickness
insurance or the promotion of the insurer.
"Insurer", for the purpose of this Part, shall
include any individual, corporation, association, partnership, reciprocal
exchange, inter-insurer, Lloyds, fraternal benefit society, health maintenance
organization, and any other legal entity that is defined as an
"insurer" in the Insurance Code of Illinois and is engaged in the
advertisement of a policy, as "policy" is defined in this Section.
"Invitation to Contract", for the purpose of this
Part, shall mean an advertisement that is neither an invitation to inquire nor
an institutional advertisement.
"Invitation to Inquire", for the purpose of this
Part, shall mean an advertisement having as one of its objectives, but not
necessarily the main objective, the creation of a desire to inquire further
about the product or products and that is limited to a brief description of the
loss or losses for which the benefit is payable, and that may contain the
dollar amount of benefit payable and/or the period of time during which the
benefit is payable, provided the advertisement does not refer to cost. An ad that
is an invitation to inquire and that contains a dollar amount of benefit
payable, and/or the period of time during which a benefit is payable, shall
contain a provision in effect as follows:
"For costs and further details of the coverage, including
exclusions, any reductions or limitations and the terms under which the policy
may be continued in force, see your agent or write to the company."
"Limitation", for the purpose of this Part, shall
mean any provision that restricts coverage under the policy other than an
exception or a reduction.
"Policy", for the purpose of this Part, shall
include any policy, plan, certificate, contract, agreement, statement of
coverage, rider or endorsement that provides accident or sickness benefits, or
medical, surgical or hospital expense benefits, whether on an indemnity,
reimbursement, 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. The Guideline for this definition is found in Appendix A,
Illustration E.
"Reduction", for the purpose of this Part, shall
mean 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.
(Source: Amended at 38 Ill.
Reg. 2124, effective January 2, 2014)
| TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE
SUBCHAPTER z: ACCIDENT AND HEALTH INSURANCE
PART 2002
ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE
SECTION 2002.50 METHOD OF DISCLOSURE OF REQUIRED INFORMATION
Section 2002.50 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 such 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
advertisement so as to be confusing or misleading. The Guideline for this
Section is found in Appendix A, Illustration F.
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CHAPTER I: DEPARTMENT OF INSURANCE
SUBCHAPTER z: ACCIDENT AND HEALTH INSURANCE
PART 2002
ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE
SECTION 2002.60 FORM AND CONTENT OF ADVERTISEMENTS
Section 2002.60 Form and
Content of Advertisements
a) The format and content of an advertisement of an accident or
sickness insurance policy shall be sufficiently complete and clear to avoid
deception or the capacity or tendency to mislead or deceive. Whether an
advertisement has a capacity or tendency to mislead or deceive shall be
determined by the Director of Insurance from the 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.
The Guideline for this paragraph (a) is found in Appendix A, Illustration G.
b) Advertisements shall be truthful and not misleading in fact or
in implication. Words or phrases, the meaning of which is clear only by
implication or by familiarity with insurance terminology, shall not be used.
The Guideline for this paragraph (b) is found in Appendix A, Illustration H.
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CHAPTER I: DEPARTMENT OF INSURANCE
SUBCHAPTER z: ACCIDENT AND HEALTH INSURANCE
PART 2002
ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE
SECTION 2002.70 ADVERTISEMENTS OF BENEFITS PAYABLE, LOSSES COVERED OR PREMIUMS PAYABLE
Section 2002.70
Advertisements of Benefits Payable, 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 such information or
use of such words, phrases, statements, references or illustrations has the
capacity, tendency or effect of misleading or deceiving purchasers or
prospective purchasers as to the nature or extent of any policy benefit
payable, loss covered or premium payable. The fact that the policy offered is
made available to a prospective insured for inspection prior to consummation of
the sale or an offer is made to refund the premium if the purchaser is not
satisfied, does not remedy misleading statements. The Guideline for this
paragraph (a) (1) is found in Appendix A, Illustration I.
2) No advertisement shall contain or use words or phrases such
as: "all"; "full"; "complete";
"comprehensive"; "unlimited"; "up to"; "as
high as"; "this policy will help pay your hospital and surgical
bills"; "this policy will help fill some of the gaps that Medicare
and your present insurance leave out"; "this policy will help to
replace your income" (when used to express loss of time benefits); or
similar words and phrases, in a manner which exaggerates any benefits beyond
the terms of the policy. The Guideline for this paragraph (a) (2) is found in
Appendix A, Illustration J.
3) An advertisement shall not contain descriptions of a policy
limitation, exception or reduction, worded in a positive manner to imply that
it is a benefit, such as, describing a waiting period as a "benefit
builder," or stating "even pre-existing conditions are covered after
two years." Words and phrases used in an advertisement to describe such
policy limitations, exceptions and reductions shall fairly and accurately
describe the negative features of such limitations, exceptions and reductions
of the policy offered. The Guideline for this paragraph (a) (3) is found in
Appendix A, Illustration K.
4) No advertisement of a benefit for which payment is conditional
upon confinement in a hospital or similar facility shall use words or phrases
such as "tax free"; "extra cash"; "extra income";
"extra pay"; or substantially similar words or phrases because such
words and phrases have the capacity, tendency or effect of misleading the
public into believing that the policy advertised will, in some way, enable them
to make a profit from being hospitalized. The Guideline for this paragraph (a)
(4) is found in Appendix A, Illustration L.
5) No advertisement of a hospital or other similar facility
confinement benefit shall advertise that the amount of benefit is payable on a
monthly or weekly basis when, in fact, the amount of the benefit payable is
based upon a daily pro rata basis relating to the number of days of
confinement. When the policy contains a limit on the number of days of coverage
provided, such limit must appear in the advertisement. The Guideline for this
paragraph (a) (5) is found in Appendix A, Illustration M.
6) No advertisement of a policy covering only one disease or a
list of specified diseases shall imply coverage beyond the terms of the policy.
Synonymous terms shall not be used to refer to any disease so as to imply
broader coverage than is the fact.
7) An advertisement for a policy providing benefits for specified
illnesses only, such as cancer, or for specified accidents only, such as
automobile accidents, shall clearly and conspicuously in prominent type state
the limited nature of the policy. The statement shall be worded in language
identical to, or substantially similar to the following: "THIS IS A
LIMITED POLICY"; "THIS IS A CANCER ONLY POLICY"; "THIS IS
AN AUTOMOBILE ACCIDENT ONLY POLICY."
8) An advertisement of a direct response insurance product shall
not imply that because "no insurance agent will call and no commissions
will be paid to agents," that it is "a low cost plan," or use
other similar words or phrases because the cost of advertising and servicing
such policies is a substantial cost in the marketing of a direct response
insurance product. The Guideline for this paragraph (a) (8) is found in
Appendix A, Illustration N.
b) Exceptions, Reductions and Limitations
1) When an advertisement which is an invitation to contract
refers to either a dollar amount, or a period of time for which any benefit is
payable, or the cost of the policy, or specific policy benefit, or the loss for
which such benefit is payable, it shall also disclose those exceptions,
reductions and limitations affecting the basic provisions of the policy without
which the advertisement would have the capacity or tendency to mislead or
deceive. The Guideline for this paragraph (b) (1) is found in Appendix A,
Illustration O.
2) When a policy contains a waiting, elimination, probationary or
similar time period between the effective date of the policy and the effective
date of coverage under the policy or a time period between the date a loss
occurs and the date benefits begin to accrue for such loss, an advertisement
which is subject to the requirements of the preceding paragraph shall disclose
the existence of such periods. The Guideline for this paragraph (b) (2) is
found in Appendix A, Illustration P.
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." The Guideline for this paragraph (b) (3) is found in
Appendix A, Illustration Q.
c) Pre-Existing Conditions
1) An advertisement which is subject to the requirements of
Section 2002.70 (b) shall, in negative terms, disclose the extent to which any
loss is not covered if the cause of such loss is traceable to a condition
existing prior to the effective date of the policy. The term
"pre-existing condition" without an appropriate definition or
description shall not be used. The Guideline for this paragraph (c) (1) is
found in Appendix A, Illustration R.
2) When a policy does not cover losses resulting from
pre-existing conditions, no advertisement of the policy shall state or imply
that the applicant's physical condition or medical history will not affect the
issuance of the policy or payment of a claim thereunder. This 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. The Guideline for this paragraph (c)
(2) is found in Appendix A, Illustration S.
3) When an advertisement contains an application form to be
completed by the applicant and returned by mail for a direct response insurance
product, such application form shall contain a question or statement which
reflects the pre-existing condition provisions of the policy immediately
preceding the blank space for the applicant's signature.
A) For example, such an application form shall contain a question
as follows:
"Do you
understand that this policy will not pay benefits during the first _____
year(s) after the issue date for a disease or physical condition which you now
have or have had in the past?"
Yes
B) Or substantially the following statement:
"I
understand that the policy applied for will not pay benefits for any loss
incurred during the first _____ year(s) after the issue date on account of
disease or physical condition which I now have or have had in the past."
C) The Guideline for this paragraph (c) (3) is found in Appendix
A, Illustration T.
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CHAPTER I: DEPARTMENT OF INSURANCE
SUBCHAPTER z: ACCIDENT AND HEALTH INSURANCE
PART 2002
ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE
SECTION 2002.80 NECESSITY FOR DISCLOSING POLICY PROVISIONS RELATING TO RENEWABILITY, CANCELLABILITY AND TERMINATION
Section 2002.80 Necessity
for Disclosing Policy Provisions Relating to Renewability, Cancellability and
Termination
When an advertisement, which is
an invitation to contract, refers to either a dollar amount or a period of time
for which any benefit is payable, or the cost of the policy, or specific policy
benefit, or the loss for which such benefit is payable, it 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. The Guideline for this Section is found in Appendix A,
Illustration U.
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CHAPTER I: DEPARTMENT OF INSURANCE
SUBCHAPTER z: ACCIDENT AND HEALTH INSURANCE
PART 2002
ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE
SECTION 2002.90 TESTIMONIALS OR ENDORSEMENTS BY THIRD PARTIES
Section 2002.90 Testimonials
or Endorsements by Third Parties
a) Testimonials used in advertisements must be genuine, represent
the current opinion of the author, be applicable to the policy advertised and
be accurately reproduced. The insurer, in using a testimonial, makes as its
own all of the statements contained therein, and the advertisement, including
such statements, is subject to all the provisions of this Part. The Guideline
for this paragraph (a) is found in Appendix A, Illustration V.
b) If the person making a testimonial, an endorsement or an
appraisal has a financial interest in the insurer or a related entity as a
stockholder, director, officer, employee, or otherwise, such fact shall be
disclosed in the advertisement. If a person is compensated for making a
testimonial, endorsement or appraisal, such fact shall be disclosed in the
advertisement by language substantially as follows: "Paid
Endorsement." This Part does not require disclosure of union
"scale" wages required by union rules if the payment is actually for
such "scale" for TV or radio performances. The payment of substantial
amounts, directly or indirectly, for "travel and entertainment" for
filming or recording of TV or radio advertisements remove the filming or
recording from the category of an unsolicited testimonial and require
disclosure of such compensation. This subsection does not apply to an
institutional advertisement which has as its sole purpose the promotion of the
insurer. The Guideline for this paragraph (b) is found in Appendix A,
Illustration W.
c) An advertisement shall not state or imply that an insurer or a
policy has been approved or endorsed by an individual, group of individuals,
society, association or other organizations, 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, such fact shall be disclosed in the
advertisement. The Guideline for this paragraph (c) is found in Appendix A,
Illustration X.
d) When a testimonial refers to benefits received under a policy,
the specific claim data, including claim number, date of loss, and other
pertinent information shall be retained by the insurer for inspection for a
period of four years or until the filing of the next regular report of
examination of the insurer, whichever is the longer period of time. The
Guideline for this paragraph (d) is found in Appendix A, Illustration Y.
| TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE
SUBCHAPTER z: ACCIDENT AND HEALTH INSURANCE
PART 2002
ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE
SECTION 2002.100 USE OF STATISTICS
Section 2002.100 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 such statistics are derived from the policy
advertised unless such is the fact, and when applicable to other policies or
plans shall specifically so state. The Guideline for this paragraph (a) is
found in Appendix A, Illustration Z.
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. The Guideline
for this paragraph (b) is found in Appendix A, Illustration AA.
c) The source of any statistics used in an advertisement shall be
identified in such advertisement. The Guideline for this paragraph (c) is
found in Appendix A, Illustration BB.
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CHAPTER I: DEPARTMENT OF INSURANCE
SUBCHAPTER z: ACCIDENT AND HEALTH INSURANCE
PART 2002
ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE
SECTION 2002.110 IDENTIFICATION OF PLAN OR NUMBER OF POLICIES
Section 2002.110
Identification of Plan or Number of Policies
a) When a choice of the amount of benefits is referred to, an
advertisement which is an invitation to contract shall disclose that the amount
of benefits provided depends upon the plan selected and that the premium will
vary with the amount of the benefits selected.
b) When an advertisement which is an invitation to contract
refers to various benefits which may be contained in two or more policies,
other than group master policies, the advertisement shall disclose that such
benefits are provided only through a combination of such policies.
c) The Guideline for paragraphs (a) and (b) is found in Appendix
A, Illustration CC.
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CHAPTER I: DEPARTMENT OF INSURANCE
SUBCHAPTER z: ACCIDENT AND HEALTH INSURANCE
PART 2002
ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE
SECTION 2002.120 DISPARAGING COMPARISONS AND STATEMENTS
Section 2002.120 Disparaging
Comparisons and Statements
An advertisement shall not
directly or indirectly make unfair or incomplete comparisons of policies or
benefits or 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. The Guideline for this Section is found in Appendix A, Illustration
DD.
| TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE
SUBCHAPTER z: ACCIDENT AND HEALTH INSURANCE
PART 2002
ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE
SECTION 2002.130 JURISDICTIONAL LICENSING AND STATUS OF INSURER
Section 2002.130
Jurisdictional Licensing and Status of Insurer
a) An advertisement which 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. The Guideline for this paragraph (a) is found
in Appendix A, Illustration EE.
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 United States Government. The
Guideline for this paragraph (b) is found in Appendix A, Illustration FF.
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CHAPTER I: DEPARTMENT OF INSURANCE
SUBCHAPTER z: ACCIDENT AND HEALTH INSURANCE
PART 2002
ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE
SECTION 2002.140 IDENTITY OF INSURER
Section 2002.140 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 which is an invitation to contract. An
advertisement shall not use a trade name, any insurance group designation, name
of the parent company of the insurer, name of a particular division of the
insurer, service mark, slogan, symbol or other device which without disclosing
the name of the actual insurer would have the capacity and tendency to mislead
or deceive as to the true identity of the insurer.
b) No advertisement shall use any combination of words, symbols
or physical materials which by their content, phraseology, shape, color or
other characteristics are so similar to 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) The Guideline for paragraphs (a) and (b) is found in Appendix
A, Illustration GG.
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CHAPTER I: DEPARTMENT OF INSURANCE
SUBCHAPTER z: ACCIDENT AND HEALTH INSURANCE
PART 2002
ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE
SECTION 2002.150 GROUP OR QUASI-GROUP IMPLICATIONS
Section 2002.150 Group or
Quasi-Group Implications
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 such is the fact. The Guideline for
this Section is found in Appendix A, Illustration HH.
| TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE
SUBCHAPTER z: ACCIDENT AND HEALTH INSURANCE
PART 2002
ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE
SECTION 2002.160 INTRODUCTORY, INITIAL OR SPECIAL OFFERS
Section 2002.160
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 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 accident and sickness insurance. The Guideline
for this paragraph (a) (1) is found in Appendix A, Illustration II.
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 six 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 must mail the application which shall be not
less than ten days and not more than forty days from the date that such
enrollment period is advertised for the first time. This Part applies to all
advertising media: i.e., mail, newspapers, radio, television, magazines and
periodicals, by any one insurer. It is inapplicable to solicitations of
employees or members of a particular group or association which otherwise would
be eligible under specific provisions of the Insurance Code for group or
blanket insurance. The phrase "any one insurer" includes all the
affiliated companies of a group of insurance companies under common management
or control. The Guideline for this paragraph (a) (2) is found in Appendix A,
Illustration JJ.
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 the particular policy advertised because
of special advantages available in the policy, unless such is the fact.
4) The phrase "a particular insurance product" in
paragraph (a)(2) of this Section means an insurance policy which provides substantially
different benefits than those contained in any other policy. Different terms
of renewability; an increase or decrease in the dollar amounts of benefits; an
increase or decrease in any elimination period or waiting period from those
available during an enrollment period for another policy shall not be
sufficient to constitute the product being offered as a different product
eligible for concurrent or overlapping enrollment periods. The Guideline for
this paragraph (a)(4) is found in Appendix A, Illustration KK.
b) An advertisement shall not offer a policy which utilizes a
reduced initial premium rate in a manner which overemphasizes the availability
and the amount of the initial reduced premium. When an insurer charges an
initial premium that differs in amount from the amount of the renewal premium
payable on the same mode, the advertisement shall not display the amount of the
reduced initial premium either more frequently or more prominently than the
renewal premium, and both the initial reduced premium and the renewal premium
must be stated in juxtaposition in each portion of the advertisement where the
initial reduced premium appears. The Guideline for this paragraph (b) is found
in Appendix A, Illustration LL.
c) Special awards, such as a "safe drivers' award,"
shall not be used in connection with advertisements of accident or accident and
sickness insurance. The Guideline for this paragraph (c) is found in Appendix
A, Illustration MM.
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CHAPTER I: DEPARTMENT OF INSURANCE
SUBCHAPTER z: ACCIDENT AND HEALTH INSURANCE
PART 2002
ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE
SECTION 2002.170 STATEMENTS ABOUT AN INSURER
Section 2002.170 Statements
About an Insurer
An advertisement shall not
contain statements which are untrue in fact, or by implication misleading, with
respect to the assets, corporate structure, financial standing, age or relative
position of the insurer in the insurance business. An advertisement shall not
contain a recommendation by any commercial rating system unless it clearly
indicates the purpose of the recommendations and the limitations of the scope
and extent of the recommendation. The Guideline for this Section is found in
Appendix A, Illustration NN.
| TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE
SUBCHAPTER z: ACCIDENT AND HEALTH INSURANCE
PART 2002
ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE
SECTION 2002.180 ENFORCEMENT PROCEDURES
Section 2002.180 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 that 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 subject to regular and periodic
inspection by the Department. All such advertisements shall be maintained in the
file for a period of either four 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. With respect to those health
insurance policies offered on the Illinois Health Insurance Marketplace, each insurer
shall prepare and maintain a certificate of compliance that will be filed with
the Department annually on or before March 15 of the year immediately following
the year pertaining to the certificate. With respect to those health insurance
policies not offered on the Illinois Health Insurance Marketplace, each insurer
shall prepare and maintain a certificate of compliance that will be placed on
file with the insurer, together with the materials identified in subsection (a).
The certificates shall be executed by an authorized officer of the insurer.
The certificate shall state that, to the best of the authorized officer's
knowledge, information and belief, the advertisements 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: Amended at 38 Ill.
Reg. 2124, effective January 2, 2014)
| TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE
SUBCHAPTER z: ACCIDENT AND HEALTH INSURANCE
PART 2002
ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE
SECTION 2002.190 SEVERABILITY PROVISION
Section 2002.190
Severability Provision
If any Section or portion of a
Section of this Part or the applicability thereof to any person or circumstance
is held invalid by a court, the remainder of the Part, or the applicability of
such provision to other persons or circumstances, shall not be affected
thereby.
Section 2002.APPENDIX A Guidelines
| TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE
SUBCHAPTER z: ACCIDENT AND HEALTH INSURANCE
PART 2002
ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE
SECTION 2002.APPENDIX A GUIDELINES
Section 2002.APPENDIX A Guidelines
Section 2002.ILLUSTRATION A Guideline
to Section 2002.20
Disclosure is one of the
principal objectives of this Part and this Section states specifically that the
Part shall assure "truthful and adequate disclosure of all material and
relevant information." This Part specifically prohibits some previous
advertising techniques.
| TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE
SUBCHAPTER z: ACCIDENT AND HEALTH INSURANCE
PART 2002
ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE
SECTION 2002.APPENDIX A GUIDELINES
Section 2002.APPENDIX A
Guidelines
Section 2002.ILLUSTRATION B Guideline
to Section 2002.30(a)
a) If an advertisement is circulated in Illinois from a medium
published in a locality bordering Illinois, which has substantial circulation
in Illinois, the advertisement must either comply with this Part, disclaim the
availability of the product advertised for Illinois residents or the company
must decline issue of the policy explaining to the applicant that the
advertisement does not meet Illinois advertising standards.
b) If an advertisement appears in a regional publication which
has a substantial amount of its circulation in Illinois, the ad will be
considered "intended" for use in Illinois and it must either comply
with this Part, disclaim the availability of the product advertised for
Illinois residents or the company must decline issue of the policy explaining
to the applicant that the advertisement does not meet Illinois advertising
standards.
c) This Part applies to group and blanket as well as individual
accident and sickness insurance. Certain distinctions, however, are applicable
to these categories. Among them is the level of conversance with insurance, a
factor which is covered by Section 2002.60(a) of this Part.
| TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE
SUBCHAPTER z: ACCIDENT AND HEALTH INSURANCE
PART 2002
ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE
SECTION 2002.APPENDIX A GUIDELINES
Section 2002.APPENDIX A
Guidelines
Section 2002.ILLUSTRATION C Guideline
to Section 2002.30(b)
a) This Section holds a company responsible for the actions of an
agent or employee unless the company can demonstrate that it had no prior
knowledge of the actions and unless the company can demonstrate to the
satisfaction of the Director of Insurance that it has an adequate system of
control as described in Section 2002.30(b) of this Part.
b) It is recognized that there are three kinds of
advertisements:
1) offer to contract,
2) offer to inquire, and
3) institutional advertisements.
These distinctions
are made since, historically, different provisions in a policy were required or
not required to be disclosed depending on the kind of advertisement; the
company's attention is directed to Sections 2002.40, 2002.70(b)(1), and Section
2002.80 in determining those provisions that must be disclosed.
| TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE
SUBCHAPTER z: ACCIDENT AND HEALTH INSURANCE
PART 2002
ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE
SECTION 2002.APPENDIX A GUIDELINES
Section 2002.APPENDIX A
Guidelines
Section 2002.ILLUSTRATION D Guideline
to Section 2002.40(a)
a) The scope of the term "advertisement" extends to the
use of all media for communication to the general public (Section 2002.40(a))
and to the use of all media for communication by agents, brokers and
solicitors.
b) 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.
c) The definition of "advertisement" does not include:
1) material to be used solely for the training and education of
an insurer's employees, agents or brokers unless such training or educational
materials are for the presentation to the public of accident and health
policies;
2) material in house organs of insurers;
3) communications within an insurer's own organization not
intended for dissemination to the public;
4) individual communications of a personal nature with current
policyholders other than material urging such policyholders to increase or
expand coverages;
5) court approved material ordered by a court to be disseminated
to policyholders;
6) 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 clearly
indicates that it is preliminary to the issuance of a booklet or certificate;
or
7) correspondence between an insurer and prospective group or
blanket policyholder which follows the initial presentation of a group or
blanket policy to the prospective policyholder, as long as such correspondence
relates to the same program as initially presented.
| TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE
SUBCHAPTER z: ACCIDENT AND HEALTH INSURANCE
PART 2002
ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE
SECTION 2002.APPENDIX A GUIDELINES
Section 2002.APPENDIX A
Guidelines
Section 2002.ILLUSTRATION E Guideline
to Section 2002.40(h)
In Section 2002.40(h), the
language "except disability, waiver of premium and double indemnity
benefits included in life insurance and annuity contracts" means except
disability, waiver of premium and double indemnity benefits included in life
insurance, endowment or annuity contracts or contracts supplemental thereto
which contain only such provisions which:
a) provide additional benefits in case of death or dismemberment
or loss of sight by accident, or as
b) operate to safeguard such contracts against lapse or to give a
special surrender value or 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.
| TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE
SUBCHAPTER z: ACCIDENT AND HEALTH INSURANCE
PART 2002
ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE
SECTION 2002.APPENDIX A GUIDELINES
Section 2002.APPENDIX A
Guidelines
Section 2002.ILLUSTRATION F Guideline
to Section 2002.50
a) This Section 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 such 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 must be accurately descriptive of the
captioned material. Appropriate captions include the following:
"Exceptions," "Exclusions," "Conditions Not Covered"
and "Exceptions and Reduction." 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."
b) In considering whether an advertisement complies with the
disclosure requirements of this Section, the Section must be applied in
conjunction with the form and content standards in Section 2002.60.
| TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE
SUBCHAPTER z: ACCIDENT AND HEALTH INSURANCE
PART 2002
ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE
SECTION 2002.APPENDIX A GUIDELINES
Section 2002.APPENDIX A
Guidelines
Section 2002.ILLUSTRATION G Guideline
to Section 2002.60(a)
a) This Section must be applied in conjunction with Sections
2002.20 and 2002.50 of this Part. This Section refers 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 captions.
b) The Part requires distinctly different advertisements for
publication in newspapers or magazines of general circulation as compared to
scholarly, technical or business journals or newspapers. Where an
advertisement consists of more than one piece of material, each piece of
material must, independent of all other pieces of material, conform to the
disclosure requirements applicable to the appropriate form of advertisement as
defined in Section 2002.40 of this Part.
| TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE
SUBCHAPTER z: ACCIDENT AND HEALTH INSURANCE
PART 2002
ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE
SECTION 2002.APPENDIX A GUIDELINES
Section 2002.APPENDIX A
Guidelines
Section 2002.ILLUSTRATION H Guideline
to Section 2002.60(b)
This Section prohibits the use
of incomplete statements and words or phrases which 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 must 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 Section 2002.60(a), distinctly different levels
of comprehension may be anticipated of the subscribers of various publications.
| TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE
SUBCHAPTER z: ACCIDENT AND HEALTH INSURANCE
PART 2002
ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE
SECTION 2002.APPENDIX A GUIDELINES
Section 2002.APPENDIX A Guidelines
Section 2002.ILLUSTRATION I Guideline
to Section 2002.70(a)(1)
This Section prohibits words,
phrases or illustrations which create deception to the reader by omission or
commission. The following examples are illustrations of the prohibitions
created by the Section:
a) An advertisement which describes any benefits that vary by age
must disclose that fact in a manner as described in this Part. (See also
ILLUSTRATION O.)
b) An advertisement which uses a phrase such as "no age
limit," if benefits or premiums vary by age or if age is an underwriting
factor, must disclose that fact in a manner as described in this Part. (See
also ILLUSTRATION O.)
c) "Individualized" 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 such 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.
d) Advertisements which 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 are acceptable
risks, when such distinctions are not maintained in the issuance of policies,
are not acceptable.
e) Advertisements for group or franchise plans which 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.
f) It is unacceptable to use terms such as "enroll" or
"join" to imply group or blanket insurance coverage when such is not
the fact.
g) Any advertisement which 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.
h) An advertisement which states or implies immediate coverage or
guaranteed issuance of a policy is unacceptable unless suitable administrative
procedures exist so that the policy is issued within a reasonable period of
time for such immediate coverage or guaranteed issuance coverage after the
application is received by the insurer.
i) Any advertisement which uses any 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 which 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.
j) Applications, request forms for additional information, and
similar related materials are unacceptable if they resemble paper currency,
bonds, stock certificates, etc.
k) An advertisement may employ devices which are designed to
create reasonable concern in the minds of those to whom they are directed.
Unacceptable examples of devices which may create undue concern are:
1) 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 such statistics are drawn (As an example of
a permissible device, data prepared by the American Cancer Society is
acceptable provided the source is noted and it is not overemphasized.);
2) the use of phrases such as "the finest kind of
treatment," implying that such treatment would be unavailable without
insurance;
3) the reproduction of newspaper articles, etc., containing
irrelevant facts and figures;
4) the use of illustrations which unduly emphasize automobile
accidents, disabled persons or persons confined in beds who are in obvious
distress or receiving hospital or medical bills or persons being evicted from
their homes due to their hospital bills;
5) the use of phrases such as "financial disaster,"
"financial distress," "financial shock," or other phrases
implying that financial ruin is likely without the insurance advertised where
used in an advertisement which comes within Section 2002.70(a)(7) relating to
policies covering specified illnesses or specified accidents only and other
accident and health insurance designed primarily for supplementing an insured's
basic insurance program.
l) An advertisement which uses the word "plan" without
identifying it as an "insurance plan" is not permissible.
m) An advertisement which implies in any manner that the
prospective insured may realize a profit from obtaining hospital, medical or
surgical insurance coverage is not acceptable.
n) An advertisement shall not state or imply by word, phrase or
illustration that the benefits being offered will supplement any other
insurance policy, insurance-type concept, or governmental plan if such is not
the fact.
o) An advertisement of a hospital or other similar facility
confinement benefit that makes reference to the benefit being paid directly to
the policyholder is misleading unless, in making such a 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 are acceptable so long as the advertisement indicates that it is
payable to the insured or someone designated by the insured.
p) An advertisement which refers to "hospitalization for
injury or sickness" omitting the word "covered" when the policy
excludes certain sicknesses or injuries is unacceptable. 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 are prominently set forth.
q) An advertisement which refers to "whenever you are
hospitalized" or "while you are confined in the hospital"
omitting the phrase "for covered injury or sickness," if the policy
excludes certain injuries or sicknesses, is unacceptable. 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 are prominently set forth.
r) Advertisements which state that benefits are provided when
"you go to the hospital" are unacceptable unless the advertisement
clearly sets forth the extent of the coverage.
s) An advertisement which is an invitation to contract and which
fails to disclose that the definition of "hospital" does not include
a nursing home, convalescent home or extended care facility, as the case may
be, is unacceptable.
t) An advertisement which is an invitation to contract and which
fails to disclose any waiting or elimination periods for specific benefits is
unacceptable.
u) An advertisement for a limited policy, or a plan of insurance
which covers only certain causes of loss (such as dread disease) or which
covers only a certain type of loss is unacceptable if:
1) the advertisement refers to a total benefit maximum limit
payable under the policy in a prominent manner;
2) the advertisement states any total benefit limit without
stating the periodic benefit payment, if any, and the length of time the
periodic benefit would be payable to reach the total benefit limit;
3) the advertisement prominently displays a benefit which would
not, as a general rule, be payable under an average claim.
v) Advertisements which utilize total amounts payable under
hospital room and board, medical or surgical coverage or other benefits in a
policy, such as benefits for private duty nursing, are unacceptable unless the
actual amounts payable per day for such indemnity or benefits are stated. (See
also ILLUSTRATION M.)
w) Examples of claims that may be paid under a policy shall not
disclose only maximum benefits unless such maximum benefits are paid for loss
from common and probable illnesses or accidents rather than exceptional or rare
illnesses or accidents or periods of confinement for such exceptional or rare
accidents or illnesses.
x) When a range of benefit levels is set forth in an
advertisement, it must be made clear that the insured will receive only the
benefit level written or printed in the policy selected and issued. Language
which implies that the insured may select the benefit level at the time of
filing claims is unacceptable.
y) Language which 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 unacceptable.
z) An advertisement for loss-of-time coverage which is an
invitation to contract which sets forth a range of amounts of benefit levels is
unacceptable unless it also states that eligibility for the benefits is based
upon condition of health, income, other economic conditions, or other
underwriting standards of the insurer if such is the fact.
aa) The term "confining sickness" is an abbreviated
expression and must be explained in an advertisement containing the term. Such
an explanation might be as follows:
"Benefits
are payable for total disability due to confining sickness only so long as the
insured is necessarily confined and under the care of a physician."
Statements
such as "Lifetime Sickness Benefits" or "Five-Year Sickness
Benefits" are incomplete if such benefits are subject to confinement
requirements.
bb) Advertisements for policies whose premiums 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. 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.
cc) Advertisements which state or imply that premiums will not be
changed in the future are not acceptable unless the advertised policies so
provide.
dd) An advertisement which does not require the premium to accompany
the application must not overemphasize that fact and must make the facts
concerning effective date of coverage clear.
ee) An advertisement which exaggerates the effect of statutorily
mandated benefits or required policy provisions or which exaggerates the
provisions or implies that such provisions are unique to the advertised policy,
is unacceptable. For example, the phrase "Money Back Guarantee" is
an exaggerated description of the ten-day right to examine the policy and is
not acceptable.
ff) An advertisement which 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."
gg) An advertisement which is an invitation to contract which fails
to disclose the amount of any deductible and/or the percentage of any
co-insurance factor is unacceptable.
hh) An advertisement which fails to state clearly the type of
insurance coverage being offered is not acceptable.
ii) Language which states or implies that each member under a
"family" contract is covered as to the maximum benefits advertised,
when such is not the fact, is unacceptable.
jj) The importance of diseases rarely or seldom found in the
class of persons to whom the policy is offered shall not be exaggerated in an
advertisement.
kk) An advertisement, regardless of the media used, which is
designed to produce leads in any manner or subsequent advertisement prior to
contact must include information disclosing that an agent may contact the
applicant if such is the fact.
ll) Advertisements for policies designed to supplement Medicare
or which are otherwise designed for issue to the elderly shall not employ
devices which are designed to create undue anxiety in the minds of such
persons. Such phrases as "here is where most people over 65 learn about
the gaps in Medicare," or "Medicare is great, but..." which
otherwise exaggerate the gaps in Medicare coverage, are unacceptable. Phrases
or devices which unduly excite fear or concern, dependence upon relatives or
charity are unacceptable. Phrases or devices which imply that long sicknesses
or hospital stays are common among the elderly are unacceptable.
mm) An advertisement implying that the coverage is supplemental to
Medicare may show the extent it supplements Medicare, but must not refer to the
Medicare Program and the proposed coverage to imply that with the coverage and
Medicare, the patient will have no uncovered expenses unless that is in fact
true.
(Source: Amended at 28 Ill.
Reg. 4595, effective March 1, 2004)
| TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE
SUBCHAPTER z: ACCIDENT AND HEALTH INSURANCE
PART 2002
ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE
SECTION 2002.APPENDIX A GUIDELINES
Section 2002.APPENDIX A
Guidelines
Section 2002.ILLUSTRATION J Guideline
to Section 2002.70(a)(2)
a) This Section 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, such terms (and those
specified in this Part do not represent a comprehensive list but only examples)
must be used with caution to avoid any tendency to exaggerate benefits and must
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 must 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," "pays for financial needs," "provides
for replacement of your lost paycheck," "replaces income" or
"emergency paycheck." Other phrases may or may not be acceptable
depending upon the nature of the coverage being advertised. For example, the
phrase "this policy will help to replace your income" is acceptable
in advertising for loss of time coverage, but is unacceptable in advertising
for hospital confinement (including "hospital indemnity") coverage.
b) This Section also prohibits words or phrases which exaggerate
the effect of a 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."
c) Advertisements 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 said
period must be stated in days.
| TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE
SUBCHAPTER z: ACCIDENT AND HEALTH INSURANCE
PART 2002
ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE
SECTION 2002.APPENDIX A GUIDELINES
Section 2002.APPENDIX A
Guidelines
Section 2002.ILLUSTRATION K Guideline
to Section 2002.70(a)(3)
Explanations must not minimize
nor describe restrictive provisions in a positive manner. Negative features
must be accurately set forth. Any limitation on benefits precluding
pre-existing conditions also must be restated under a caption concerning exclusions
or limitations, notwithstanding that the pre-existing condition exclusion has
been disclosed elsewhere in the advertisement. (See ILLUSTRATIONS R, S and T
for additional comments on pre-existing conditions.)
| TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE
SUBCHAPTER z: ACCIDENT AND HEALTH INSURANCE
PART 2002
ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE
SECTION 2002.APPENDIX A GUIDELINES
Section 2002.APPENDIX A
Guidelines
Section 2002.ILLUSTRATION L Guideline
to Section 2002.70(a)(4)
a) The words, phrases, illustrations and concepts listed are
illustrations of the words, phrases, illustrations and concepts prohibited by
the Part which create the impression of a profit or gain to be realized by the
insured when hospitalized.
b) Any illustration which depicts paper currency or checks
showing an amount payable is deceptive and misleading and is not permissible.
c) A hospital indemnity advertisement shall not include language
such as "pay for a trip to Florida," "buy a new television"
or otherwise imply that the insured will make a profit on hospitalization.
d) An advertisement which uses words such as "extra,"
"special" or "added" to describe any benefit in the policy
is unacceptable.
e) Although the Part prohibits the use of the phrase "tax
free," it does not prohibit the use of complete and accurate terminology
explaining the Internal Revenue Service Rules applicable to the taxation of
accident and sickness benefits. The IRS Rules provide that the premiums paid
for the benefits received from hospital indemnity policies are subject to the
same rules as loss of time premiums and benefits and are not afforded the same
favorable tax treatment as premiums for expense incurred hospital, medical and
surgical benefit coverages. (Rev. Rul. 68-451 and Rev. Rul. 69-154.) Prominence
either by caption, lead-in, boldface or large type shall not be given in any
manner to any statements relating to the tax status of such benefits.
| TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE
SUBCHAPTER z: ACCIDENT AND HEALTH INSURANCE
PART 2002
ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE
SECTION 2002.APPENDIX A GUIDELINES
Section 2002.APPENDIX A
Guidelines
Section 2002.ILLUSTRATION M Guideline
to Section 2002.70(a)(5)
This paragraph requires that
benefits payable on a daily basis be stated as such and not on the basis of
weekly or monthly equivalents. It also requires disclosure of the time period
of coverage provided by the policy.
| TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE
SUBCHAPTER z: ACCIDENT AND HEALTH INSURANCE
PART 2002
ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE
SECTION 2002.APPENDIX A GUIDELINES
Section 2002.APPENDIX A
Guidelines
Section 2002.ILLUSTRATION N Guideline
to Section 2002.70(a)(8)
a) This Section should be applied in conjunction with Section
2002.120.
b) Phrases such as "we cut costs to the bone" or
"we deal direct with you so our costs are lower" shall not be used.
| TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE
SUBCHAPTER z: ACCIDENT AND HEALTH INSURANCE
PART 2002
ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE
SECTION 2002.APPENDIX A GUIDELINES
Section 2002.APPENDIX A
Guidelines
Section 2002.ILLUSTRATION O Guideline
to Section 2002.70(b)(1)
a) 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.
b) Some advertisements disclose exceptions, reductions and
limitations as required, but the advertisement is so lengthy as to obscure the
disclosure. Where the length of an advertisement has this effect, special
emphasis must be given by changing the format to show the restrictions in a
manner which does not minimize, render obscure or otherwise make them appear
unimportant.
c) This Section provides that those invitations to contract
advertisements for a policy with any reduction of benefits at a particular age
will disclose with the display of usual benefits that the reduction is
applicable.
d) This interpretation is primarily aimed toward those policies
which reduce benefits at a particular attained age.
| TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE
SUBCHAPTER z: ACCIDENT AND HEALTH INSURANCE
PART 2002
ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE
SECTION 2002.APPENDIX A GUIDELINES
Section 2002.APPENDIX A
Guidelines
Section 2002.ILLUSTRATION P Guideline
to Section 2002.70(b)(2)
a) This Section imposes the same disclosure standards as the
preceding paragraph with respect to policy provisions providing for waiting,
elimination, probationary or similar time periods between the effective date of
the policy and the effective date of coverage under the policy or a time period
between the date a loss occurs and the date benefits begin to accrue for such
loss. The comments under Section 2002.70(b)(1) are equally applicable to this
Section. Where a policy has waiting, elimination, probationary or other such
time periods, such provisions must be stated in negative terms.
b) This Section provides that those advertisements which are
invitations to contract for a policy with any waiting periods for coverage, at
any time, will disclose such fact in a manner as prescribed by Section 2002.50
of this Part.
c) An advertisement for a policy designed to supplement Medicare
benefits is unacceptable if it fails to disclose prominently that no hospital
confinement benefits will be payable for that portion of a Medicare benefit
period, currently 60 days, for which Medicare pays all Medicare eligible
hospital confinement expenses other than the initial deductible, if the policy
so provides. The length of said period must be stated in days.
| TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE
SUBCHAPTER z: ACCIDENT AND HEALTH INSURANCE
PART 2002
ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE
SECTION 2002.APPENDIX A GUIDELINES
Section 2002.APPENDIX A
Guidelines
Section 2002.ILLUSTRATION Q Guideline
to Section 2002.70(b)(3)
a) This Section is similar to Section 2002.70(a)(3) and requires
a fair and accurate description of exceptions, limitations and reductions in a
manner which does not minimize, render obscure or otherwise make them appear
unimportant.
b) Advertisements must state exceptions, limitations and
reductions in the negative and must not understate any exception, limitation or
reduction or qualify any exception, limitation or reduction to emphasize
coverage described elsewhere: e.g., "Does not pay for ______; HOWEVER,
MEDICARE PAYS THIS" is not acceptable, nor is "Does not pay for the
first four days in HOSPITAL FOR SICKNESS, BUT PAYS FOR ACCIDENT FROM FIRST
DAY." (Capitalization indicates the manner in which statements are
sometimes emphasized.)
c) This Section prohibits the use of any term, such as
"just," "only," "merely," "necessary"
or "minimum" to describe any exclusion, limitation, reduction or
exception.
| TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE
SUBCHAPTER z: ACCIDENT AND HEALTH INSURANCE
PART 2002
ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE
SECTION 2002.APPENDIX A GUIDELINES
Section 2002.APPENDIX A
Guidelines
Section 2002.ILLUSTRATION R Guideline
to Section 2002.70(c)(1)
a) This Section imposes the same disclosure standards with
respect to pre-existing conditions' provisions as noted in ILLUSTRATION 0. The
comments under that Illustration are equally applicable to this Section of the
Part since the pre-existing conditions' provision is an exception under the
Part.
b) This Part implements the objective of Section 2002.70(a)(3) by
requiring in negative terms a description of the effect of a pre-existing
condition exclusion because such an exclusion is a restriction on coverage.
The Subdivision also prohibits the use of the phrase "pre-existing
condition" without an appropriate definition or description of the term
and prohibits stating a reduction in the statutory time limit (such as a
reduction from two years to one year) as an affirmative benefit. The words
"appropriate definition or description" mean that the term
"pre-existing condition" must be defined as it is used by the
company's claims department.
| TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE
SUBCHAPTER z: ACCIDENT AND HEALTH INSURANCE
PART 2002
ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE
SECTION 2002.APPENDIX A GUIDELINES
Section 2002.APPENDIX A
Guidelines
Section 2002.ILLUSTRATION S Guideline
to Section 2002.70(c)(2)
a) The phrase "no health questions" or words of similar
import shall not be used if the policy excludes pre-existing conditions.
b) Use of a phrase such as "guaranteed issue" or
"automatic issue," if the policy excludes pre-existing conditions for
a certain period, must 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 Section 2002.50.
| TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE
SUBCHAPTER z: ACCIDENT AND HEALTH INSURANCE
PART 2002
ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE
SECTION 2002.APPENDIX A GUIDELINES
Section 2002.APPENDIX A
Guidelines
Section 2002.ILLUSTRATION T Guideline
to Section 2002.70(c)(3)
The Department requires approval
of the application forms even when the application is not attached to the
policy when issued. This Part does not change such a requirement.
| TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE
SUBCHAPTER z: ACCIDENT AND HEALTH INSURANCE
PART 2002
ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE
SECTION 2002.APPENDIX A GUIDELINES
Section 2002.APPENDIX A
Guidelines
Section 2002.ILLUSTRATION U Guideline
to Section 2002.80
a) This Section imposes the same disclosure standards with
respect to policy provisions relating to renewability, cancelability and
termination, modification of benefits, losses or premiums because of age or
otherwise as stated in ILLUSTRATION O. The comments in that Illustration are
equally applicable to this Section.
b) Advertisements of cancelable policies must state that the
contract is cancelable or renewable at the option of the company as the case
may be. For example, the following represent illustrations: A policy which is
cancelable shall be advertised in a manner similar to "This policy can be
cancelled by the company at any time"; a policy which 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." Advertisements of such policies must
indicate that the insurer has the right to increase premium rates.
c) With respect to non-cancelable policies and
guaranteed-renewable policies, the Part requires that a summary of the policy
provisions with respect to renewability must be set forth and defined where
appropriate. The disclosure of provisions relating to renewability requires
the use of language such as "non-cancelable," "non-cancelable
and guaranteed renewable," or "guaranteed renewable."
d) The Part also requires a statement of the qualifying
conditions which constitute limitations of the permanent nature of the
coverage. These customarily fall into three categories: age limits,
reservation of right to increase premiums and the establishment of aggregate
limits. For example, "non-cancelable and guaranteed renewable" does
not fulfill the requirement of the Part if the policy contains a terminal age
of 65. In such a case, a proper statement would be "non-cancelable and
guaranteed renewable to age 65." If a guaranteed renewable policy
reserves the right to increase premiums, the statement must be expanded into
language similar to "guaranteed renewable to age 65, but the company
reserves the right to increase premium rates on a class basis." A policy
may have one or more of the three basic limitations and an advertisement must
describe each of those which the policy contains. Most new individual policy
issues are guaranteed renewable; therefor, the fact that a policy is guaranteed
renewable shall not be exaggerated.
e) This Part also requires the disclosure of any modification of
benefits or losses covered because of age or for other reasons. Provisions for
reduction of benefits at stated ages must be set forth. For example, a policy
may contain a provision which reduces benefits 50% after age 60 although it is
renewable to age 65. Such a reduction would have to 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 would have to be set forth.
f) An advertisement for a policy which provides for step-rated
premium rates based upon the policy year of the insured's attained age must
disclose such rate increases and the times or ages at which such premiums
increase.
g) This Section requires that the qualifying conditions of
renewability must be disclosed in a manner which does not minimize or render
obscure the qualifying conditions of renewal.
| TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE
SUBCHAPTER z: ACCIDENT AND HEALTH INSURANCE
PART 2002
ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE
SECTION 2002.APPENDIX A GUIDELINES
Section 2002.APPENDIX A
Guidelines
Section 2002.ILLUSTRATION V Guideline
to Section 2002.90(a)
a) This Section requires that all such statements must be genuine
and not fictitious. Under this Section, 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 which
would be unacceptable under this Part must be edited out of a testimonial.
b) A testimonial must also represent the current opinion of the
author. While an insurer is not required in each instance to check with the
author each time the testimonial is used to ascertain that the views expressed
have not altered, a testimonial should be checked before use in those instances
when a change in views might be probable or reasonable to assume. When a
testimonial is used more than one year after it was originally given, a
confirmation must be obtained.
c) Testimonials or Endorsements by Third Parties. A
"testimonial" is defined as a statement from a typical policyowner,
group policyholder or beneficiary as to either benefits received in a claim
payment or comments relating to the policyowner, group policyholder or
beneficiary expressions of appreciation relating to those usual policyowner,
group policyholder or beneficiary-company relationships.
d) An endorsement differs from a testimonial only through the
fact that an endorsement includes any comments from any person except those of
a typical policyowner, group policyholder or beneficiary who is commenting only
on those usual policyowner, group policyholder or beneficiary-company
relationships. A typical policyowner, group policyholder or beneficiary is not
any person well known to the general public or who is classifiable as a
celebrity.
e) There are two types of testimonials: Solicited and
Unsolicited.
1) Solicited Testimonials are those in which the company has in
any way contacted the policyowner, group policyholder or beneficiary requesting
information about claims handling, policyowners service, etc. A solicited
testimonial used in an advertisement must be clearly labeled with a statement
such as, "These comments from policyowners, group policyholders or
beneficiaries were received as a result of our questioning policyowners, group
policyholders, or beneficiaries as to their thoughts about our service,"
or other language which indicates that the testimonial was solicited.
2) Unsolicited Testimonials are those sent to a company without
the company contacting the policyowner, group policyholder or beneficiary.
| TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE
SUBCHAPTER z: ACCIDENT AND HEALTH INSURANCE
PART 2002
ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE
SECTION 2002.APPENDIX A GUIDELINES
Section 2002.APPENDIX A
Guidelines
Section 2002.ILLUSTRATION W Guideline
to Section 2002.90(b)
a) This Section requires the disclosure of any financial interest
of a person making a testimonial, endorsement or appraisal. Any payment,
direct or indirect, whether specifically for the testimonial or endorsement or
for any other services or relationship, is required to be disclosed.
Reimbursement for substantial travel and entertainment expenses is also
required to be disclosed; however, union scale wages required by union rules
are not required to be disclosed. Travel away from the home of the person giving
the testimonial or endorsement to a distant location involving transportation
expenses, lodging expenses or expenses for meals constitutes payment and must
be reflected as a paid endorsement. The requirement of disclosure may be
fulfilled by use of the phrase "Paid Endorsement" or words of similar
import in a type style and size that is identical to the endorser's name. In
the case of television or radio advertising, the paid nature of the
advertisement must be given prominence.
b) The word "person," as used in this subsection,
includes a human person, body of persons or any legal entity recognized by law
as the subject of rights and duties.
c) A person making an endorsement cannot comment upon his
evaluation either of the merits of an administrative process of a company or of
the value of the insurance product unless he has adequate experience within the
area he is evaluating. In the absence of such experience, either the level of
expertise of the person or the relevant facts forming the basis for such an
endorsement must be disclosed.
| TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE
SUBCHAPTER z: ACCIDENT AND HEALTH INSURANCE
PART 2002
ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE
SECTION 2002.APPENDIX A GUIDELINES
Section 2002.APPENDIX A
Guidelines
Section 2002.ILLUSTRATION X Guideline
to Section 2002.90(c)
This Section requires both that
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 must be disclosed.
| TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE
SUBCHAPTER z: ACCIDENT AND HEALTH INSURANCE
PART 2002
ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE
SECTION 2002.APPENDIX A GUIDELINES
Section 2002.APPENDIX A
Guidelines
Section 2002.ILLUSTRATION Y Guideline
to Section 2002.90(d)
a) This Section provides the Department of Insurance the means to
verify the authenticity of testimonials used in advertising efforts.
b) The use of testimonials which do not correctly reflect the
present practices of the insurer or which are not applicable to the policy or
benefit being advertised is not permissible.
| TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE
SUBCHAPTER z: ACCIDENT AND HEALTH INSURANCE
PART 2002
ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE
SECTION 2002.APPENDIX A GUIDELINES
Section 2002.APPENDIX A
Guidelines
Section 2002.ILLUSTRATION Z Guideline
to Section 2002.100(a)
Section
2002.ILLUSTRATION AA Guideline to Section 2002.100(b)
Section
2002.ILLUSTRATION BB Guideline to Section 2002.100(c)
Section
2002.ILLUSTRATION CC Guideline to Section 2002.110(a) and (b)
Section
2002.ILLUSTRATION DD Guideline to Section 2002.120
Section
2002.ILLUSTRATION EE Guideline to Section 2002.130(a)
Section
2002.ILLUSTRATION FF Guideline to Section 2002.130(b)
Section
2002.ILLUSTRATION GG Guideline to Section 2002.140(a) and (b)
Section
2002.ILLUSTRATION HH Guideline to Section 2002.150
Section
2002.ILLUSTRATION II Guideline to Section 2002.160
Section
2002.ILLUSTRATION JJ Guideline to Section 2002.160(a) and (b)
Section
2002.ILLUSTRATION KK Guideline to Section 2002.160(a)(4)
Section
2002.ILLUSTRATION LL Guideline to Section 2002.160(b)
Section
2002.ILLUSTRATION MM Guideline to Section 2002.160(c)
Section 2002.ILLUSTRATION NN Guideline to Section 2002.170(c)
a) This Section prohibits the use of statistics in a manner which
is misleading and deceptive. It requires the disclosure of all relevant facts
and prohibits the use of irrelevant facts. An advertisement shall specifically
identify the policy to which statistics relate and, where statistics are given
which are applicable to a different policy, it must be stated clearly that the data
does not relate to the policy being advertised.
b) Statistics which describe the 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, must
be used with extreme caution because of their potential for misleading the
public. As a specific example, an advertisement for a health insurance policy
which 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.
c) An advertisement which states the dollar amount of claims paid
must also indicate the period over which such claims have been paid. The total
dollar amount of claims paid must not be overemphasized.
d) If the term "loss ratio" is used, it shall be
properly explained in the context of the advertisement, and it shall be
calculated on the basis of premiums earned to losses incurred and shall not be
on a yearly run-off basis.
Section 2002.APPENDIX A
Guidelines
Section 2002.ILLUSTRATION AA
Guideline to Section 2002.100(b)
This Section prohibits deceptive
or misleading statements in an advertisement regarding an insurer's claim
settlement practices. It also prohibits the use of an unusual amount paid for
a unique claim or an unusual claim whether actual or hypothetical.
Section 2002.APPENDIX A
Guidelines
Section 2002.ILLUSTRATION BB
Guideline to Section 2002.100(c)
This Section requires any
advertisement which uses statistics to cite the source. The Part does not
require that statistics for a state be used since such statistics as hospital
charges and average stays may vary from state to state. When nationwide
statistics are used, such fact should be noted as such unless the statistics on
the particular point are substantially the same in a state to which the
advertisement is directed. Statistics may be used only if they are credible.
Section 2002.APPENDIX A
Guidelines
Section 2002.ILLUSTRATION CC
Guideline to Section 2002.110(a) and (b)
This Section imposes the same
disclosure standards as stated in ILLUSTRATION O. The comments in that
Illustration are equally applicable to this Section.
Section 2002.APPENDIX A
Guidelines
Section 2002.ILLUSTRATION DD
Guideline to Section 2002.120
a) This Section prohibits unfair or incomplete comparisons of
products, insurers or business methods. It specifically prohibits comparisons
of non-comparable policies and provides that advertisements shall not unfairly
minimize nor disparage competing types of insurance coverages or competing
methods of marketing insurance, including any federal or state program.
b) An advertisement should not contain statements such as
"no red tape" or "here is all you do to receive benefits."
c) Advertisements which state or imply that competing insurance
coverages customarily contain certain exceptions, reductions or limitations not
contained in the advertised policies are unacceptable unless such exceptions,
reductions or limitations are contained in a substantial majority of such
competing coverages.
d) Advertisements which 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.
Section 2002.APPENDIX A
Guidelines
Section 2002.ILLUSTRATION EE Guideline
to Section 2002.130(a)
This Section prohibits
advertisements which imply that an insurer is licensed beyond the limits of
those jurisdictions where it is actually licensed. An advertisement which
contains testimonials from persons who reside in a state in which the insurer
is not licensed or which 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.
Section 2002.APPENDIX A
Guidelines
Section 2002.ILLUSTRATION FF
Guideline to Section 2002.130(b)
a) This Section prohibits advertisements implying that approval,
endorsement or accreditation of policy forms or advertising has been granted by
any division or agency of the state or federal governments.
"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.
b) This prohibits prominent statements such as "licensed by
the State of Illinois" or any other statements which imply endorsements by
a governmental agency. The insurer is not prohibited to disclose the fact that
a company is licensed in the State of Illinois in the body or majority of the
advertisement.
c) Although the Section permits a reference to an insurer being
licensed in a state where the advertisement appears, it does not allow
exaggeration of the fact of such 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.
d) 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.
Section 2002.APPENDIX A
Guidelines
Section 2002.ILLUSTRATION GG
Guideline to Section 2002.140(a) and (b)
a) This Section prohibits the use of an advertisement which has
the capacity or tendency to mislead or deceive as to the true identity of the
insurer. The Section recognizes the existence of holding companies. The
requirement that the advertisement refer to the policy form number is
applicable to advertisements of individual and franchise policies only.
However, the requirement of the policy form number is not applicable to those
advertisements for individual and franchise policies not required to disclose
information under Sections 2002.70(b)(1) and (8). Subsection (a) and
subsection (b) prohibit misleading practices of insurers in connection with the
sale of insurance to supplement federal Medicare benefits and confusion by
insurers with advertising material used by hospital service corporations or
pre-paid health plans.
b) This Section prohibits advertisements, envelopes or stationery
which employ words, letters, initials, symbols or other devices which are so
similar to those used by governmental agencies or other insurers, including
hospital service corporations and pre-paid health plans, that the public may be
confused into believing:
1) that the advertised coverages are somehow provided by or are
endorsed by such governmental agencies or such other insurers;
2) that the advertised coverages are the same as those provided
by such governmental agencies or such other insurers;
3) that the advertiser is the same as, is connected with or is
endorsed by such governmental agencies or such other insurers.
c) It is unacceptable for an advertisement to use the name of a
state or a political subdivision thereof in a policy name or description. For
example, "XYZ insurance company's (name of state) hospital confinement
policy" is unacceptable.
d) This Section prohibits an insurer from using envelopes or
stationery which have printed thereon any name, service mark, slogan or symbol
or using any other device in such a manner that it implies that the insurer or
the policy advertised is connected with a governmental agency such as the
Social Security Administration or the Veterans Administration.
e) Policies advertised to supplement Medicare benefits are
unacceptable if they incorporate the word "MEDICARE" in the title of
the plan or policy being advertised unless, wherever it appears, said word is
qualified by language differentiating it from Medicare. Such phrases as
"Medicare Insurance Supplement" or "insurance to supplement
Medicare" are acceptable. Such an advertisement, however, shall not use
the phrase "_________ Medicare Department of the XYZ Insurance
Company," or language of similar import.
f) Advertisements for policies designed to supplement Medicare
benefits are unacceptable if they fail to clearly show that the company or the
plan being advertised is not endorsed by the U.S. Government or the federal
Medicare program.
g) This Section prohibits an advertisement which implies that the
reader may lose a right, privilege or benefit under federal, state or local law
if he fails to respond to the advertisement.
h) If the use of letters, initials or symbols of the corporate
name or trademark would have the capacity or tendency to mislead or deceive the
public as to the true identity of the insurer, this Section prohibits the use
of such letters, initials, or symbols without disclosing in close conjunction
the true and correct complete name of the insurer which will issue the policy.
i) This Part prohibits 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 and also prohibits an insurer from using an
address so as to mislead or deceive as to its true identity, location or
licensing status.
Section 2002.APPENDIX A
Guidelines
Section 2002.ILLUSTRATION HH
Guideline to Section 2002.150
a) This Section prohibits the use of representations to any
segment of the population that a particular policy or coverage is available
only to that or similar segments of the population as preferred risks when
actually such policy or coverage is available to members of the public at large
at the same rates. This Part prohibits an advertisement labeled "Now for
Readers of X Magazine."
b) This Section prohibits the solicitation 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.
Section 2002.APPENDIX A
Guidelines
Section 2002.ILLUSTRATION II
Guideline to Section 2002.160(a)(1)
This Section prohibits
advertising representing that a product is offered on an introductory, initial,
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 in the advertising of its policies, the Part prohibits
describing an enrollment period as a special opportunity or offer for the
applicant.
Section 2002.APPENDIX A
Guidelines
Section 2002.ILLUSTRATION JJ
Guideline to Section 2002.160(a)(2)
a) This Section restricts the repetitive use of enrollment
periods. 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 entire state until six months from the close of
the enrollment periods have expired. Thus, an insurer must choose whether to
use enrollment periods or open enrollment for a product.
b) This Section 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 such advertisements have the
same expiration date.
c) The six month limitation applies to the offering of the
product in any advertising media and the entire State of Illinois is considered
one geographic area. For example, if an enrollment period was used in the
solicitation of a product in the Chicago area, it could not be offered in any
section of Illinois until six months expire from the closing date of the
enrollment period.
Section 2002.APPENDIX A
Guidelines
Section 2002.ILLUSTRATION KK
Guideline to Section 2002.160(a)(4)
a) This Section defines the meaning of "a particular
insurance product" in Section 2002.160(a)(2) and prohibits advertising of
products having minor variations, such as different elimination periods or
different amounts of daily hospital indemnity benefits, in a succession of
enrollment periods.
b) To determine if one product is substantially different than
another, the products must be compared as to primary benefits offered. For
example, if one hospital indemnity policy has a $30/day benefit and a return of
premium benefit, it is substantially similar to one having a $100/day benefit
with no return of premium benefit. A hospital expense policy as compared with
a hospital indemnity plan is substantially different.
Section 2002.APPENDIX A
Guidelines
Section 2002.ILLUSTRATION LL
Guideline to Section 2002.160(b)
This Section prohibits
advertising which overemphasizes an initial reduced premium. The Part requires
the renewal premium to appear as frequently as, as prominently as, and in
juxtaposition with the initial reduced premium wherever and as often as it
appears. The term "juxtaposition" means side by side or immediately
above or below.
Section 2002.APPENDIX A
Guidelines
Section 2002.ILLUSTRATION MM Guideline
to Section 2002.160(c)
a) This subsection prohibits the use in advertisements of
so-called awards as an inducement to the purchase of insurance.
b) This subsection prohibits those marketing techniques which
imply that the person is being offered an opportunity to purchase a policy due
to a minor qualification which has little to do with the underwriting
requirements for the benefits provided by the policy.
Section 2002.APPENDIX A
Guidelines
Section 2002.ILLUSTRATION NN Guideline
to Section 2002.170
This Section is closely related
to the requirements of Section 2002.100 concerning the use of statistics. The
Part prohibits insurers which have been organized for only a brief period of
time advertising that they are "old" and also prohibits the use of
illustrations of a "home office" building in a manner which is
misleading with respect to the actual 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 must
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 doctors'
plan" simply because there is a preponderance of physicians or doctors on
the board of directors of the insurer. The Part prohibits the use of a
recommendation of a commercial rating system unless the purpose, meaning and
limitations of the recommendation are clearly indicated.
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