New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 4 - ADVERTISING ACCIDENT AND HEALTH INSURANCE › Section 13.10.4.11 - ADVERTISEMENTS OF BENEFITS PAYABLE, LOSSES COVERED OR PREMIUMS PAYABLE

Current through Register Vol. 35, No. 13, July 16, 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 this information or use of these 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," "the 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.
(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
				separate and distinct applications required need not be on a separate document
				or contained in a separate mailing. 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 six months." Words and phrases used in an advertisement to
				describe these policy limitations, exceptions and reductions shall fairly and
				accurately describe the negative features of the limitations, exceptions and
				reductions of the policy offered.
(5) An advertisement of accident and health
				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 advertising and servicing these policies is a substantial cost in the
				marketing by direct response.
(6)
				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 these words and phrases have the capacity, tendency or
				effect of misleading the public into believing that the policy advertised will,
				in some way, enable them to make a profit from being hospitalized.
(7) 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 these statements of monthly or weekly benefit
				amounts are in juxtaposition with equally prominent statements of the benefit
				payable on a daily basis. The term "juxtaposition" means side by side or
				immediately above or below. When the policy contains a limit on the number of
				days of coverage provided, the limit must appear in the
				advertisement.
(8) 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.
(9) 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," or
				"THIS IS AN AUTOMOBILE ACCIDENT ONLY POLICY."
(10) To facilitate the insured's right of
				freedom of choice in the selection of insurance coverage, any advertisement or
				sales material furnished an applicant relating to any policy which provides
				limited coverage in terms of the practitioners whose services are covered shall
				clearly disclose the practitioner limitations.