Louisiana Administrative Code › Title 37 - INSURANCE › Part XI - Rules › Chapter 13 - Rule Number 3-Advertisements of Accident and Sickness Insurance › Section XI-1311 - Advertisements of Benefits Payable, Losses Covered or Premiums Payable

Current through Register Vol. 50, No. 6, June 20, 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
				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, or which may lead the policyholder to expect payment of benefits
				which he is not likely to derive, except in very unusual
				circumstances.
3. An advertisement
				shall not contain descriptions of a policy limitation, exception, or reduction,
				worded in a positive manner to imply that 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.
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
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.
5. No advertisement of a hospital or other
				similar facility confinement benefit shall advertise that the amount of the
				benefit is payable on a monthly or weekly basis when, in fact, the amount of
				the benefit payable is based upon a daily pro rata basis relating to the number
				of days of confinement unless such statements of such monthly or weekly benefit
				amounts are followed immediately by equally prominent statements of the benefit
				payable on a daily basis; for example, either of the following statements is
				acceptable: "$1,000.00 a month ($33.33 a day) or $33.33 a day ($1,000.00 a
				month)". When the policy contains a limit on the number of days of coverage
				provided, such limit must appear in the advertisement.
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.
9. An
				advertisement for a policy specifically designed to augment benefits available
				under the Federal Medicare Act shall not exaggerate the policy benefits and
				shall clearly disclose in unmistakable language what Medicare benefits the
				policy is designed to complement, and what Medicare benefits the policy will
				not complement. No such advertisement shall use the term
Medicare
				Supplement
, or similar term, to describe the policy being offered
				unless the policy provides a benefit for those items that make up the
				deductible and related coinsurance amounts of Part A and Part B of the Federal
				Medicare Act.
10. An advertisement
				that makes a reference to the policy benefits being paid directly to an insured
				is prohibited unless, in making such a reference, the advertisement includes a
				statement that the benefits will be paid directly to a hospital or any other
				provider of health care services if an assignment of the policy benefits has
				been made.