reglab/statecodes huggingface dataset:
Illinois Administrative Code › Title 50 - INSURANCE › Part 2008 - MINIMUM STANDARDS FOR INDIVIDUAL AND GROUP MEDICARE SUPPLEMENT INSURANCE › Subpart G - MISCELLANEOUS PROVISIONS › Appendix T - Notice of Medicare Changes

Current through Register Vol. 48, No. 28, July 12, 2024
(Company Name)
NOTICE ON CHANGES IN MEDICARE AND YOUR
				  MEDICARE SUPPLEMENT INSURANCE
The following outline briefly describes the modifications in
				  Medicare and in your Medicare supplement coverage. Please read
				  carefully!
(A) brief description of the revisions to Medicare Parts A
				  & B with a parallel description of supplemental benefits with subsequent
				  changes, including dollar amounts, provided by the Medicare supplement coverage
				  in substantially the following format).
Services
Medicare Benefits
Your Medicare
Supplement Coverage
Effective (insert current calendar year)
							 Medicare Will Pay
Effective (insert current calendar year) Your
							 Coverage Will Pay
MEDICARE PART A SERVICES AND SUPPLIES
Inpatient Hospital Services
All but _______ for first 60 days/benefit
							 period
Semi-Private Room & Board
All but _______ a day for
							 61st-90th days/benefit period
Miscellaneous Hospital Service & Supplies, such
							 as Drugs, X-Rays, Lab Tests & Operating Room
All but _____ a day for
							 91st-150th days (if
							 individual chooses to use 60 nonrenewable lifetime reserve days)
BLOOD
Pays all costs except nonreplacement fees (blood
							 deductible) for first 3 pints in each calendar year
SKILLED NURSING FACILITY CARE
100% of costs for first 20 days (after a 3 day prior
							 hospital/ confinement/
benefit period)
All but ______ a day for
							 21st-100th days /benefit
							 period
Beyond 100 days - Nothing /benefit period
MEDICARE PART B SERVICES AND
SUPPLIES
80% of allowable charges (after ____
							 deductible/calendar year)
PRESCRIPTION DRUGS
Inpatient prescription drugs 80% of allowable charges
							 for immunosuppressive drugs during the first year following a covered
							 transplant (after ____ deductible/
calendar year)
BLOOD
80% of costs except nonreplacement fees (blood
							 deductible) for first 3 pints (after ___ deductible/calendar year
(Any other policy benefits not mentioned in this chart should
				  be added to the chart in the order prescribed by the outline of coverage. If
				  there are corresponding Medicare benefits, they should be shown.)
(Describe any coverage provisions changing due to Medicare
				  modifications.)
(Include information about when premium adjustments that may
				  be necessary due to changes in Medicare benefits will be effective.)
THIS CHART SUMMARIZING THE CHANGES IN YOUR MEDICARE BENEFITS
				  AND IN YOUR MEDICARE SUPPLEMENT PROVIDED BY (COMPANY) ONLY BRIEFLY DESCRIBES
				  SUCH BENEFITS. FOR INFORMATION ON YOUR MEDICARE BENEFITS CONTACT YOUR SOCIAL
				  SECURITY OFFICE OR THE HEALTH CARE FINANCING ADMINISTRATION. FOR INFORMATION ON
				  YOUR MEDICARE SUPPLEMENT (POLICY) CONTACT: (COMPANY AND FOR AN INDIVIDUAL
				  POLICY-NAME OF AGENT) (ADDRESS/PHONE NUMBER).
Illinois Administrative Code › Title 50 - INSURANCE › Part 2008 - MINIMUM STANDARDS FOR INDIVIDUAL AND GROUP MEDICARE SUPPLEMENT INSURANCE › Subpart G - MISCELLANEOUS PROVISIONS › Appendix U - Medicare Supplement Policies Report

Current through Register Vol. 48, No. 28, July 12, 2024
Company Name:
				  _______________________________________________________
Address:
				  _____________________________________________________________
Phone Number:
				  ________________________________________________________
Due: March 1, annually
The purpose of this report is to provide information on each
				  resident of this State who has more than one Medicare supplement policy or
				  certificate in force. The information is to be grouped by individual
				  policyholder.
Policy and Certificate
							 #
Date of Issuance
___________________________________
Signature
___________________________________
Name and Title (please type)
___________________________________
Date
Illinois Administrative Code › Title 50 - INSURANCE › Part 2009 - COORDINATION OF BENEFITS › Section 2009.10 - Purpose and Applicability

Current through Register Vol. 48, No. 28, July 12, 2024
a) The
			 purpose of this regulation is to:
1) Permit,
			 but not require, plans to include a coordination of benefits (COB)
			 provision;
2) Establish an order in
			 which plans pay their claims;
3)
			 Provide the authority for the orderly transfer of information needed to pay
			 claims promptly;
4) Reduce
			 duplication of benefits by permitting a reduction of the benefits paid by a
			 plan when the plan, pursuant to rules established by this Part, does not have
			 to pay its benefits first;
5)
			 Reduce claims payment delays; and
6) Make all contracts that contain a COB
			 provision consistent with this Part.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2009 - COORDINATION OF BENEFITS › Section 2009.30 - Model COB Contract Provision

Current through Register Vol. 48, No. 28, July 12, 2024
a)
			 Exhibit A contains a model COB provision for use in contracts. That use is
			 subject to subsections (b) and (c) and Section
			 2009.40.
b) A contract's COB provision does not have
			 to use the words and format shown at Exhibit A. Changes may be made to fit the
			 language and style of the rest of the contract or to reflect the differences
			 among plans that provide services, pay benefits for expenses incurred, and
			 indemnify. No other substantive changes are allowed. (The Department will
			 determine compliance with this subsection (b) under Section 143 of the
			 Code.)
c) Prohibited Coordination
			 and Benefit Design
1) A contract may not
			 reduce benefits on the basis that:
A) Another
			 plan exists;
B) A person is or
			 could have been covered under another plan, except with respect to Part B of
			 Medicare; or
C) A person has
			 elected an option under another plan providing a lower level of benefits than
			 another option that could have been elected.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2009 - COORDINATION OF BENEFITS › Section 2009.40 - Standards for Coordination of Benefits

Current through Register Vol. 48, No. 28, July 12, 2024
a) General
The general order of benefits is as follows:
1) The primary plan must pay or provide its
			 benefits as if the secondary plan or plans do not exist. A plan that does not
			 include a coordination of benefits provision may not take the benefits of
			 another plan into account when it determines its benefits. There is one
			 exception: a contract holder's coverage that is designed to supplement a part
			 of a basic package of benefits may provide that the supplementary coverage is
			 excess to any other parts of the plan provided by the contract
			 holder.
2) A secondary plan may
			 take the benefits of another plan into account only when, under these
			 standards, it is secondary to that other plan.
3) The benefits of the plan that covers the
			 person as an employee, member or subscriber (that is, other than as a
			 dependent) are determined before those of the plan that covers the person as a
			 dependent; except that, if the person is also a Medicare beneficiary, Medicare
			 is:
A) Secondary to the plan covering the
			 person as a dependent; and
B)
			 Primary to the plan covering the person as other than a dependent, for example
			 a retired employee.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2009 - COORDINATION OF BENEFITS › Section 2009.50 - Procedure to be followed by Secondary Plan

Current through Register Vol. 48, No. 28, July 12, 2024
a) When it is determined, pursuant to Section
			 2009.40,
			 that this Plan is a Secondary Plan, it may reduce its benefits so that the
			 total benefits paid or provided by all plans during a Claim Determination
			 Period are not more than total Allowable Expenses. The amount by which the
			 Secondary Plan's benefits have been reduced shall be used by the Secondary Plan
			 to pay Allowable Expenses, not otherwise paid, which were incurred during the
			 Claim Determination Period by the person for whom the claims is made. As each
			 claim is submitted, the Secondary Plan determines its obligation to pay for
			 Allowable Expenses based on all claims which were submitted up to that point in
			 time during the Claim Determination Period.
b) The benefits of the Secondary Plan will be
			 reduced when the sum of the benefits that would be payable for the Allowable
			 Expenses under the Secondary Plan in the absence of this COB provision and the
			 benefits that would be payable for the Allowable Expenses under the other
			 plans, in the absence of provisions with a purpose like that of this COB
			 provision, whether or not claim is made, exceeds those Allowable Expenses in a
			 Claim Determination Period. In that case, the benefits of the Secondary Plan
			 will be reduced so that they and the benefits payable under the other plans do
			 not total more than those Allowable Expenses.
1) When the benefits of this Plan are reduced
			 as described above, each benefit is reduced in proportion. It is then charged
			 against any applicable benefit limit of this Plan.
2) Subsection (b)(1) above may be omitted if
			 the plan provides only one benefit (i.e. dental only), or may be altered to
			 suit the coverage provided.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2009 - COORDINATION OF BENEFITS › Exhibit A - Model COB Provisions

Current through Register Vol. 48, No. 28, July 12, 2024
COORDINATION OF THE CONTRACT'S BENEFITS
WITH OTHER BENEFITS
I. APPLICABILITY
A. This Coordination of Benefits ("COB")
			 provision applies to This Plan when an enrollee or the enrollee's covered
			 dependent has health care coverage under more than one Plan. "Plan" and "This
			 Plan" are defined in Section II.
B.
			 If this COB provision applies, the order of benefit determination rules should
			 be looked at first. Those rules determine whether the benefits of This Plan are
			 determined before or after those of another plan. The benefits of This Plan:
(1) Shall not be reduced when, under the
			 order of benefit determination rules, This Plan determines its benefits before
			 another plan; but
(2) May be
			 reduced when, under the order of benefits determination rules, another plan
			 determines its benefits first. The reduction is described in Section IV "Effect
			 on the Benefits of This Plan."
Illinois Administrative Code › Title 50 - INSURANCE › Part 2010 - ADVERTISEMENTS OF MEDICARE SUPPLEMENT INSURANCE › Section 2010.10 - Purpose

Current through Register Vol. 48, No. 28, July 12, 2024
The purpose of this Part is to provide prospective purchasers
				with clear and unambiguous statements in the advertisement of Medicare
				supplement insurance; to assure the clear and truthful disclosure of the
				benefits, limitations and exclusions of policies sold as Medicare supplement
				insurance. This purpose is intended to be accomplished by the establishment of
				guidelines and permissible and impermissable standards of conduct in the
				advertising of Medicare supplement insurance in a manner which prevents unfair,
				deceptive and misleading advertising and is conducive to accurate presentation
				and description to the insurance-buying public through the advertising media
				and material used by insurance agents and companies.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2010 - ADVERTISEMENTS OF MEDICARE SUPPLEMENT INSURANCE › Section 2010.20 - Applicability

Current through Register Vol. 48, No. 28, July 12, 2024
a) This Part shall
			 apply to any "advertisement" of Medicare supplement insurance as that term is
			 defined herein, unless otherwise specified in this Part, which the insurer
			 knows or reasonably should know is intended for presentation, distribution or
			 dissemination in this State when such presentation, distribution or
			 dissemination is made either directly or indirectly by or on behalf of an
			 insurer or producer of this State.
b) Every insurer shall establish and at all
			 times maintain a system of control as required by this Part over the content,
			 form and method of dissemination of all of its Medicare supplement insurance
			 advertisements. All such advertisements, regardless of by whom written,
			 created, designed or presented, shall be the responsibility of the insurers
			 benefiting directly or indirectly from their dissemination.
c) Advertising materials which are reproduced
			 in a quantity of 50 or more copies shall be identified by form numbers. Such
			 identification shall distinguish an advertisement from any other advertising
			 materials, policies, applications or other materials used by the
			 insurer.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2010 - ADVERTISEMENTS OF MEDICARE SUPPLEMENT INSURANCE › Section 2010.30 - Definitions

Current through Register Vol. 48, No. 28, July 12, 2024
a) Advertisement
1) "Advertisement" shall include:
A) printed and published material, audio
			 visual material and descriptive literature used by or on behalf of an insurer
			 in direct mail, newspapers, magazines, radio scripts, television scripts,
			 billboards and similar displays;
B)
			 descriptive literature and sales aids of all kinds issued by an insurer or an
			 insurance producer as that term is defined in Section 491.1 of the Illinois
			 Insurance Code (Ill. Rev. Stat. 1989, ch. 73, par. 1065.38 -1), for
			 presentation to members of the insurance-buying public; including, but not
			 limited to, circulars, leaflets, booklets, depictions, illustrations, form
			 letters and lead generating devices of all kinds as herein defined; and
C) prepared sales talks,
			 presentations and material for use by the insurer or the producer;
			 and
D) advertising material
			 included with a policy when the policy is delivered and material used in the
			 solicitation of renewals and reinstatements.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2010 - ADVERTISEMENTS OF MEDICARE SUPPLEMENT INSURANCE › Section 2010.40 - Methods of Disclosure of Required Information

Current through Register Vol. 48, No. 28, July 12, 2024
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 manner
				or fashion or intermingled with the context of the advertisement so as to be
				confusing or misleading.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2010 - ADVERTISEMENTS OF MEDICARE SUPPLEMENT INSURANCE › Section 2010.50 - Form and Content of Advertisements

Current through Register Vol. 48, No. 28, July 12, 2024
a) The format and content of a Medicare
			 supplement insurance advertisement shall 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 from the
			 overall impression that the advertisement may be reasonably expected to create
			 upon a person of average education or intelligence, within the segment of the
			 public to which it is directed.
b)
			 Advertisements shall be truthful and not misleading in fact or in implication.
			 Words or phrases whose meanings are clear only by implication or by the
			 consumer's familiarity with insurance terminology shall not be used.
c) An insurer must clearly identify its
			 Medicare supplement insurance policy as an insurance policy. A policy trade
			 name must be followed by the words "Insurance Policy" or similar words clearly
			 identifying the fact that an insurance policy or health benefits product (in
			 the case of health maintenance organizations, prepaid health plans and other
			 direct service organizations) is being offered.
d) No insurer, producer or other person shall
			 solicit a resident of this State for the purchase of Medicare supplement
			 insurance in connection with or as the result of the use of any advertisement
			 by such person or any other person, where the advertisement:
1) Contains any misleading representations or
			 misrepresentations, or is otherwise untrue, deceptive or misleading with regard
			 to the information imparted, the status, character or representative capacity
			 of such person or the true purpose of the advertisement; or
2) Otherwise violates the provisions of this
			 Part.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2010 - ADVERTISEMENTS OF MEDICARE SUPPLEMENT INSURANCE › Section 2010.60 - Advertisements of Benefits, Losses Covered or Premiums Payable

Current through Register Vol. 48, No. 28, July 12, 2024
a) Deceptive Words,
			 Phrases or Illustrations Prohibited
1) No
			 advertisement shall omit information or use words, phrases, statements,
			 references or illustrations if the omission of such information or use of such
			 words, phrases, statements, references or illustrations has the capacity,
			 tendency or effect of misleading or deceiving purchasers or prospective
			 purchasers as to the nature or extent of any policy benefit payable, loss
			 covered or premium payable. The fact that the policy offered is made available
			 to a prospective insured for inspection prior to consummation of the sale or an
			 offer is made to refund the premium if the purchaser is not satisfied, does not
			 remedy misleading statements.
2) No
			 advertisement shall contain or use words or phrases such as "all," "full,"
			 "complete," "comprehensive," "unlimited," "up to," "as high as," "this policy
			 will help fill some of the gaps that Medicare and your present insurance leave
			 out," "this policy pays all that Medicare doesn't" or similar words and
			 phrases, in a manner which exaggerates any benefit beyond the terms of the
			 policy.
3) An advertisement which
			 also is an invitation to join an association, trust or discretionary group must
			 solicit insurance coverage on a separate and distinct application which
			 requires separate signatures for each application. The insurance program must
			 be presented so as not to mislead or deceive the prospective members that they
			 are purchasing insurance as well as applying for membership, if that is the
			 case.
4) An advertisement shall not
			 contain descriptions of policy limitations, exceptions or reductions, worded in
			 a positive manner to imply that it is a benefit, such as describing a waiting
			 period as a "benefit builder" or stating "even preexisting conditions are
			 covered after 6 months." Words and phrases used in an advertisement to describe
			 such policy limitations, exceptions and reductions shall fairly and accurately
			 describe the negative features of such limitations, exceptions and reductions
			 of the policy offered.
5) An
			 advertisement of Medicare supplement insurance sold by direct response shall
			 not state or imply that "because no insurance agent will call and no
			 commissions will be paid to 'agents' that it is a low cost plan" or use other
			 similar words or phrases because the cost of a advertising and servicing such
			 policies is a substantial cost in marketing by direct response.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2010 - ADVERTISEMENTS OF MEDICARE SUPPLEMENT INSURANCE › Section 2010.70 - Necessity for Disclosing Policy Provisions Relating to Renewability, Cancellability and Termination

Current through Register Vol. 48, No. 28, July 12, 2024
An advertisement which is an invitation to contract shall
				disclose the provisions relating to renewability, cancellability and
				termination and any modification of benefits, losses covered or premiums
				because of age or for other reasons, in a manner which complies with the
				standards for disclosure set forth in Section
				2010.40
				of this Part.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2010 - ADVERTISEMENTS OF MEDICARE SUPPLEMENT INSURANCE › Section 2010.80 - Testimonials or Endorsements by Third Parties

Current through Register Vol. 48, No. 28, July 12, 2024
a) Testimonials and endorsements 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 or endorsement, 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. When a testimonial or endorsement is used
			 more than one year after it was originally given, a current written
			 confirmation from the author of such testimonial or endorsement must be
			 obtained and maintained for three years in the insurer's advertising
			 file.
b) A person shall be deemed a
			 "spokesperson" if the person making the testimonial or endorsement:
1) Has a financial interest in the insurer or
			 an affiliate as that term is defined in Section 131.1 of the Illinois Insurance
			 Code as a stockholder, director, officer, employee or otherwise; or
2) Has any person in a policy-making position
			 who is affiliated with the insurer in any of the above described capacities;
			 or
3) Has been formed by the
			 insurer, is owned or controlled by the insurer, its employees, or the person or
			 persons who own or control the insurer; or
4) Is in any way directly or indirectly
			 compensated for making a testimonial or endorsement.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2010 - ADVERTISEMENTS OF MEDICARE SUPPLEMENT INSURANCE › Section 2010.90 - Use of Statistics

Current through Register Vol. 48, No. 28, July 12, 2024
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 such statistical information unless it pertains to the
			 insurer's Medicare supplement insurance business. Such an advertisement shall
			 not imply that such statistics are derived from a policy advertised unless such
			 is the fact, and when applicable to other policies or plans shall specifically
			 so state.
1) An advertisement shall
			 specifically identify the Medicare supplement insurance policy to which
			 statistics relate and, where statistics are given which are applicable to a
			 different policy, it must be stated clearly that the data do not relate to the
			 policy being advertised.
2) An
			 advertisement using statistics which describe an insurer, such as assets,
			 corporate structure, financial standing, age, product lines or relative
			 position in the insurance business, may be irrelevant and, if used at all, must
			 be used with extreme caution because of the potential for misleading the
			 public. As a specific example, an advertisement for Medicare supplement
			 insurance 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 permissable
			 unless the advertisement clearly indicates the amount paid out for each line of
			 business.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2010 - ADVERTISEMENTS OF MEDICARE SUPPLEMENT INSURANCE › Section 2010.100 - Disparaging Comparisons and Statements

Current through Register Vol. 48, No. 28, July 12, 2024
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.
a) An advertisement shall not contain
			 statements such as "no red tape" or "here is all you do to receive
			 benefits."
b) 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 not less than 50 percent of such competing coverages.
c) 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.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2010 - ADVERTISEMENTS OF MEDICARE SUPPLEMENT INSURANCE › Section 2010.110 - Jurisdictional Licensing and Status of Insurer

Current through Register Vol. 48, No. 28, July 12, 2024
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.
b) An advertisement shall not create the
			 impression directly or indirectly that the insurer, its financial condition or
			 status; or the payment of its claims; or the merits, desirability or
			 advisability of its policy forms or kinds of plans of insurance are approved,
			 endorsed or accredited by any division or agency of this State or the United
			 States Government.
c) An
			 advertisement shall not imply that approval, endorsement or accreditation of
			 policy forms or advertising has been granted by any division or agency of the
			 state or federal government. "Approval" of either policy forms or advertising
			 shall not be used by an insurer to imply or state that a governmental agency
			 has endorsed or recommended the insurer, its policies, advertising or its
			 financial conditions.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2010 - ADVERTISEMENTS OF MEDICARE SUPPLEMENT INSURANCE › Section 2010.120 - Identity of Insurer

Current through Register Vol. 48, No. 28, July 12, 2024
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 destination, name of the parent company of the
			 insurer, name of a particular division of the insurer, service mark, slogan,
			 symbol or other device which with or without disclosing the name of the actual
			 insurer would have the capacity and tendency to mislead or deceive as to the
			 true identity of the insurer.
b) No
			 advertisement shall use any combination of words, symbols or physical materials
			 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) 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 are not
			 permitted if they may lead the public to believe:
1) that the advertised coverages are somehow
			 provided by or are endorsed by such governmental agencies or such other
			 insurers;
2) that the advertiser is
			 the same as, is connected with or is endorsed by such governmental agencies or
			 such other insurers.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2010 - ADVERTISEMENTS OF MEDICARE SUPPLEMENT INSURANCE › Section 2010.130 - Group or Quasi-Group Implications

Current through Register Vol. 48, No. 28, July 12, 2024
a) An advertisement of a particular policy
			 shall not state or imply that prospective insureds become group or quasi-group
			 members covered under a group policy and as such enjoy special rates or
			 underwriting privileges, unless such is the fact.
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.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2010 - ADVERTISEMENTS OF MEDICARE SUPPLEMENT INSURANCE › Section 2010.150 - Statements About an Insurer

Current through Register Vol. 48, No. 28, July 12, 2024
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
				recommendation and the limitations of the scope and extent of the
				recommendation.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2010 - ADVERTISEMENTS OF MEDICARE SUPPLEMENT INSURANCE › Section 2010.160 - Enforcement Procedures

Current through Register Vol. 48, No. 28, July 12, 2024
a)
			 Advertising File: Each insurer shall maintain at its home or principal office a
			 complete file containing every printed, published or prepared advertisement of
			 its individual policies and typical printed, published or prepared
			 advertisements of its blanket, franchise and group policies hereafter
			 disseminated in this or any other state, whether or not licensed in such other
			 state, with a notation attached to each such advertisement which shall indicate
			 the manner and extent of distribution and the form number of any policy
			 advertised. Such file shall be available for inspection by this Department. All
			 such advertisements shall be maintained in said 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: Each insurer
			 which is required to file an Annual Statement with this Department and which is
			 now or hereafter becomes subject to the provisions of this Part must file with
			 this Department, with its Annual Statement, a Certificate of Compliance
			 executed by an authorized officer of the insurer wherein it is stated that, to
			 the best of his knowledge, information and belief, the advertisements which
			 were disseminated by the insurer during the preceding statement year complied
			 or were made to comply in all respects with the provisions of this Part and the
			 Insurance Laws of this State.
c) If
			 the Director or Insurance finds that any advertisement subject to this Part has
			 materially failed to comply with the provisions of this Part, the Director may,
			 by order, require the insurer responsible for such non-compliance to publish in
			 the same or similar medium, an approved correction or retraction of any untrue,
			 misleading, or deceptive statement contained in the advertising and may
			 prohibit such insurer from publishing or distributing, or allowing to be
			 published or distributed on its behalf such advertisement or any new materially
			 revised advertisement without first having filed a copy thereof with the
			 Director 30 days prior to the publication or distribution thereof, or any
			 shorter period specified in such order.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2010 - ADVERTISEMENTS OF MEDICARE SUPPLEMENT INSURANCE › Section 2010.170 - Filing Requirements for Advertising

Current through Register Vol. 48, No. 28, July 12, 2024
Every insurer shall provide a copy of any Medicare supplement
				advertisement intended for use in this State whether through written, radio or
				television medium to the Director of Insurance of this State. Such
				advertisement shall comply with Sections 149 and 363a of the Illinois Insurance
				Code.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2010 - ADVERTISEMENTS OF MEDICARE SUPPLEMENT INSURANCE › Appendix A - Interpretive Guidelines › ILLUSTRATION A - Guideline to Section 2010.30

Current through Register Vol. 48, No. 28, July 12, 2024
This Part applies to any "advertisement" as that term is
				  defined in Section
				  2010.30(a),
				  (h), (i), and (j) unless otherwise specified
				  in this Part. This Part applies to group, blanket and individual Medicare
				  supplement insurance advertisements. Certain distinctions, however, are
				  applicable to these categories. Among them is the level of conversance with
				  insurance, a factor which is covered by Section
				  2010.50(a).
Illinois Administrative Code › Title 50 - INSURANCE › Part 2010 - ADVERTISEMENTS OF MEDICARE SUPPLEMENT INSURANCE › Appendix A - Interpretive Guidelines › ILLUSTRATION B - Guideline to Section 2010.30(a)(1)

Current through Register Vol. 48, No. 28, July 12, 2024
The scope of the term "advertisement" extends to the use of
				  all media for communications to the general public, to the use of all media for
				  communications to specific members of the general public, and to use of all
				  media for communications by producers.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2010 - ADVERTISEMENTS OF MEDICARE SUPPLEMENT INSURANCE › Appendix A - Interpretive Guidelines › ILLUSTRATION C - Guideline to Section 2010.30(i)

Current through Register Vol. 48, No. 28, July 12, 2024
A "brief description of coverage" in an invitation to inquire
				  may consist of an explanation of Medicare benefits, minimum benefits, standards
				  for Medicare supplement policies, the manner in which the advertised Medicare
				  supplement insurance policy supplements the benefits of Medicare and meets or
				  exceeds the minimum benefit requirements. An invitation to inquire shall not
				  refer to cost or the maximum dollar amount of benefits payable.
As with all Medicare supplement insurance advertisements, an
				  invitation to inquire must not:
1)
				Employ devices which are designed to create undue anxiety in the minds of the
				elderly or excite fear of dependence upon relatives or charity;
2) Exaggerate the gaps on Medicare
				coverage;
3) Exaggerate the value
				of the benefits available under the advertised policy.
4) Otherwise violate the provisions of this
				Part.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2010 - ADVERTISEMENTS OF MEDICARE SUPPLEMENT INSURANCE › Appendix A - Interpretive Guidelines › ILLUSTRATION D - Guideline to Section 2010.40

Current through Register Vol. 48, No. 28, July 12, 2024
This Section permits the use of either of the following
				  alternative methods of disclosure:
a)
				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.
b) 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 Reductions." The use of captions such as, or similar to, the
				following are not acceptable because they do not provide adequate notice of the
				significance of the material: "Extent of Coverage," "Only these Exclusions," or
				"Minimum Limitations."
In considering whether an advertisement complies with the
				  disclosure requirements of this Section, the requirements of this Section must
				  be applied in conjunction with the form and content standards contained in
				  Section
				  2010.50.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2010 - ADVERTISEMENTS OF MEDICARE SUPPLEMENT INSURANCE › Appendix A - Interpretive Guidelines › ILLUSTRATION E - Guideline to Section 2010.50(a)

Current through Register Vol. 48, No. 28, July 12, 2024
The requirements of Section
				  2010.50(a)
				  must be applied in conjunction with Sections
				  2010.10
				  and
				  2010.40.
				  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 the captions.
This Section requires distinctly different advertisements for
				  publication in newspapers or magazines of general circulation, as compared to
				  scholarly, technical or business journals and newspapers. Where an
				  advertisement consists of more than one piece of material, each piece of
				  material must, independent of all other pieces of material, conform to the
				  disclosure requirements of this Section.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2010 - ADVERTISEMENTS OF MEDICARE SUPPLEMENT INSURANCE › Appendix A - Interpretive Guidelines › ILLUSTRATION F - Guideline to Section 2010.50(b)

Current through Register Vol. 48, No. 28, July 12, 2024
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 Illustration
				  E, distinctly different levels of comprehension of the subscribers of various
				  publications may be anticipated.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2010 - ADVERTISEMENTS OF MEDICARE SUPPLEMENT INSURANCE › Appendix A - Interpretive Guidelines › ILLUSTRATION H - Guideline to Section 2010.60(a)(2)

Current through Register Vol. 48, No. 28, July 12, 2024
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," or "pays for financial needs." Other
				  phrases may or may not be acceptable depending upon the nature of the coverage
				  being advertised.
This Section also prohibits words or phrases which exaggerate
				  the effect of benefit payment on the insured's general well-being, such as
				  "worry-free savings plan," "guaranteed savings," "financial peace of mind," and
				  "you will never have to worry about hospital bills again."
Advertisements which are an invitation to contract for
				  policies designed to supplement Medicare benefits are unacceptable if they fail
				  to disclose that no hospital confinement benefits will be payable for that
				  portion of a Medicare benefit period for which Medicare pays all hospital
				  confinement expenses (currently sixty days) other than the initial deductible
				  if the policy so provides. The length of said period must be stated in
				  days.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2010 - ADVERTISEMENTS OF MEDICARE SUPPLEMENT INSURANCE › Appendix A - Interpretive Guidelines › ILLUSTRATION I - Guideline to Section 2010.60(a)(4)

Current through Register Vol. 48, No. 28, July 12, 2024
Explanations must not minimize nor describe restrictive
				  provisions in a positive manner. Negative features must be accurately set
				  forth. Any limitation on benefits precluding preexisting conditions must also
				  be restated under a caption concerning exclusions or limitations,
				  notwithstanding that the preexisting condition exclusion has been disclosed
				  elsewhere in the advertisement. (See Illustration L for additional comments on
				  preexisting conditions.)
Illinois Administrative Code › Title 50 - INSURANCE › Part 2010 - ADVERTISEMENTS OF MEDICARE SUPPLEMENT INSURANCE › Appendix A - Interpretive Guidelines › ILLUSTRATION J - Guideline to Section 2010.60(a)(5)

Current through Register Vol. 48, No. 28, July 12, 2024
This Section should be applied in conjunction with Section
				  2010.110.
				  Phrases such as "we cut cost to the bone" or "we deal direct with you so our
				  costs are lower" shall not be used.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2010 - ADVERTISEMENTS OF MEDICARE SUPPLEMENT INSURANCE › Appendix A - Interpretive Guidelines › ILLUSTRATION K - Guideline to Section 2010.60(b)(1)

Current through Register Vol. 48, No. 28, July 12, 2024
An advertisement which is an invitation to contract as
				  defined in Section
				  2010.30(j)
				  must recite the exceptions, reductions and limitations as required by this
				  Section and in a manner consistent with Section
				  2010.40.
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 must be referred to in the advertisement.
Some advertisements disclose exceptions, reductions and
				  limitations as required, but the advertisement is so lengthy that it obscures
				  the disclosure. Where the length of an advertisement has this effect, special
				  emphasis 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.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2010 - ADVERTISEMENTS OF MEDICARE SUPPLEMENT INSURANCE › Appendix A - Interpretive Guidelines › ILLUSTRATION L - Guideline to Section 2010.60(c)(1)

Current through Register Vol. 48, No. 28, July 12, 2024
This Section implements the objective of Section
				  2010.60(a)(4)
				  by requiring in negative terms a description of the effect of a preexisting
				  condition exclusion because such a exclusion is a restriction on coverage. The
				  Section also prohibits the use of the phrase "preexisting condition" without an
				  appropriate definition or description of the term and prohibits stating a
				  reduction in the statutory time limit as an affirmative benefit. The words
				  "appropriate definition or description" means that the term "preexisting
				  condition" must be defined as it is used by the company's claims
				  department.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2010 - ADVERTISEMENTS OF MEDICARE SUPPLEMENT INSURANCE › Appendix A - Interpretive Guidelines › ILLUSTRATION M - Guideline to Section 2010.60(c)(2)

Current through Register Vol. 48, No. 28, July 12, 2024
The phrase "no health questions" or words of similar import
				  shall not be used if the policy excludes preexisting conditions.
Use of a phrase such as "guaranteed issue," or " automatic
				  issues," if the policy excludes preexisting conditions for a certain period,
				  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
				  2010.40.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2010 - ADVERTISEMENTS OF MEDICARE SUPPLEMENT INSURANCE › Appendix A - Interpretive Guidelines › ILLUSTRATION N - Guideline to Section 2010.70

Current through Register Vol. 48, No. 28, July 12, 2024
Advertisements of cancellable Medicare supplement policies
				  must state that the contract is cancellable or renewable at the option of the
				  company as the case may be. With respect to noncancellable policies and
				  guaranteed renewable policies, the policy provisions, with respect to
				  renewability, must be set forth and defined where appropriate.
This Section also requires a statement of the qualifying
				  conditions which constitute limitations on the permanent nature of the
				  coverage. These customarily fall into three categories:
(1) age limits,
(2) reservation of a right to increase
				premiums, and
(3) the
				establishment of aggregate limits. For example, "noncancellable and guaranteed
				renewable" does not fulfill the requirements of this Section if the policy
				contains a terminal age. In such a case, a proper statement would be
				"Noncancellable and guaranteed renewable to age _____." If a guaranteed
				renewable policy reserves the right to increase premiums, the statement must be
				expanded into language similar to "guaranteed renewable to age ______, but the
				company reserves the right to increase premium rates on a class basis." If the
				contract contains an aggregate limit after which no further benefits are
				payable, the above statement must be amplified with the phrase "subject to a
				maximum aggregate amount of $50,000" or similar language. A Medicare supplement
				insurance policy may have one or more of the three basic limitations and an
				advertisement must describe each of those which the policy contains. Over fifty
				percent of new individual policy issues are guaranteed renewable; therefore,
				the fact that a policy is guaranteed renewable shall not be
				exaggerated.
An advertisement for a Medicare supplement insurance policy
				  which provides for age step-rated premium rates based upon the policy year or
				  the insured's attained age must disclose such rate increases and the times or
				  ages at which such premium increases.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2010 - ADVERTISEMENTS OF MEDICARE SUPPLEMENT INSURANCE › Appendix A - Interpretive Guidelines › ILLUSTRATION O - Guideline to Section 2010.80

Current through Register Vol. 48, No. 28, July 12, 2024
This Section must be applied in conjunction with Section
				  2010.90 and
				  requires that all such statements must be genuine and not fictitious. 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.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2010 - ADVERTISEMENTS OF MEDICARE SUPPLEMENT INSURANCE › Appendix A - Interpretive Guidelines › ILLUSTRATION P - Guideline to Section 2010.80(c)

Current through Register Vol. 48, No. 28, July 12, 2024
The rule requires that both approval or endorsement of a
				  policy by an individual, group of individuals, society, association, or other
				  organization be factual and that any proprietary relationship between the
				  sponsoring or endorsing organization and the insurer be disclosed. For example,
				  if the dividend under an association group case is payable to the association,
				  disclosure of that fact is required. Also, if the insurer or an officer of the
				  insurer formed or controls the association, that fact must be disclosed. This
				  guideline also applies to Section
				  2010.80(e).