50 Ill. Adm. Code 2010.APPENDIX A
A Interpretive Guidelines
Section 2010
Section 2010.APPENDIX A
Interpretive Guidelines
Section 2010.ILLUSTRATION G Guideline
to Section 2010.60(a)(1)
This Section prohibits the use
of incomplete statements and words or phrases which create deception by
omission or commission. The following examples are illustrations of the
prohibitions created by this Section:
a) An advertisement which describes any benefits that vary by age
must disclose the fact.
b) An advertisement that uses a phrase such as "no age
limit" must disclose that premiums may vary be age or that benefits may
vary by age if such is the case.
c) 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
in fact the advertisement is directed to all persons in a group or to all
persons whose names appear on a mailing list.
d) Advertisements for group or franchise group 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.
e) It is unacceptable to use terms such as "enroll" or
"join" with reference to group or blanket insurance coverage when
such is not the case.
f) An advertisement, which states or implies immediate coverage
is provided, is unacceptable unless suitable administrative procedures exist so
that the policy is issued within fifteen working days after the application is
received by the insurer.
g) Applications, request forms for additional information, and
similar related materials are unacceptable if they resemble paper currency,
bonds or stock certificates; or use any name, service mark, slogan, symbol or
any device in such a manner that implies that the insurer or the policy
advertised is connected with a government agency, such as the Social Security
Administration or the Department of Health and Human Services.
h) An advertisement which uses the word "plan" without
identifying it as a Medicare supplement insurance policy is not permissible.
i) An advertisement which implies in any manner that the
prospective insured may realize a profit from obtaining Medicare supplement
insurance is not permissible.
j) An advertisement which fails to disclose any waiting or
elimination periods is unacceptable.
k) Examples of benefits payable under a policy shall not disclose
only maximum benefits unless such maximum benefits are paid for loss from
common or probable illnesses or accidents, rather than exceptional or rare
illnesses or accidents or periods of confinement for such exceptional or rare
accidents or illnesses.
l) 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.
m) Advertisements for policies whose premiums are modest because
of their limited amount of benefits shall not describe premiums as
"low," "low-cost," "budget" or use qualifying
words of similar import. This Section also prohibits the use of words such as
"only" and "just" in conjunction with statements of premium
amounts when used to imply a bargain.
n) An advertisement which exaggerates the effects of statutorily
mandated benefits or required policy provisions or which 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 thirty-day right to examine the policy and is not acceptable.
o) 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."
p) An advertisement may not omit the word "covered"
when referring to benefits payable under its policy. Continued reference to
"covered" is not necessary where this fact has been prominently
disclosed in the advertisement.
q) An advertisement must state that benefits payable under the
policy are based upon Medicare eligible expenses, if such is the case.
r) An advertisement 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.
s) A television, radio, mail or newspaper advertisement, or lead
generating device which is designed to produce leads either by use of a coupon,
a request to write or to call the company, or a subsequent advertisement prior
to contact must include information disclosing that an insurance agent may
contact the applicant if such is the fact.
t) Advertisements for policies designed to supplement Medicare
shall not employ devices which are designed to create undue anxiety in the
minds of the elderly. Such phrases as "here is where most people over 65
learn about the gaps in Medicare," or "Medicare is great, but ..."
or which otherwise exaggerate the gaps in Medicare coverage are unacceptable.
Phrases or devices which unduly excite fear of 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.
u) An advertisement which is an invitation to contract implying
that the coverage is supplemental to Medicare, if it does not explain the
manner in which it is supplemental to Medicare coverage, is not acceptable.
v) An advertisement which is an invitation to contract for
Medicare supplement insurance is unacceptable if the advertisement:
1) Fails to disclose in clear language which of the Medicare
benefits the policy is not designed to supplement or if it otherwise implies
that Medicare provides only those benefits which the policy is designed to
supplement;
2) Describes the in-patient hospital coverage of Medicare as
"Medicare hospital," or "Medicare Part A" when the policy
does not supplement the non-hospital or the psychiatric hospital benefits of
Medicare Part A;
3) Fails to describe clearly the operation of the Part or Parts
of Medicare which the policy is designed to supplement; or
4) Describes those Medicare benefits not supplemented by the
policy in such a way as to minimize their importance relative to the Medicare
benefits which are supplemented.
w) Advertisements which indicate that a particular coverage or
policy is exclusively for "preferred risks" or a particular segment
of the population, or that particular segments of the population are acceptable
risks, when such distinctions are not maintained in the issuance of policies,
are not acceptable.
x) 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.
y) 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.
z) Advertisements which state or imply that premiums will not be
changed in the future are not acceptable unless the advertised policies so
provide.
aa) An advertisement which does not require the premium to
accompany the application must not overemphasize that fact and must make the
effective date of the coverage clear.
bb) 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 not acceptable.