New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter IX - Unfair Trade Practices › Part 215 - Advertisements Of Accident And Health Insurance › Section 215.5 - Form and content of advertisements

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The format and content of an
				advertisement of an accident and health 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 superintendent from the overall impression
				that the advertisement may be reasonably expected to create upon a person of
				average education and intelligence, unique to the particular type of audience
				to which the advertisement is directed, and whether it may be reasonably
				comprehended by 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, the meaning of which is
				clear only by implication or by familiarity with insurance terminology, shall
				not be used.
(c) An advertisement
				of a policy shall contain in a prominent place and style the appropriate
				statement for the coverage provided, as determined by the definitions in 11
				NYCRR 52.5-52.11 (Regulation No. 62), as follows:
(1) This policy meets the minimum standards
				for basic hospital insurance as defined by the New York State Insurance
				Department. It does NOT provide basic medical or major medical insurance. The
				expected benefit ratio for this policy is ________ percent. This ratio is the
				portion of future premiums which the company expects to return as benefits,
				when averaged over all people with this policy.
(2) This policy meets the minimum standards
				for basic medical insurance as defined by the New York State Insurance
				Department. It does NOT provide basic hospital or major medical insurance. The
				expected benefit ratio for this policy is ________ percent. This ratio is the
				portion of future premiums which the company expects to return as benefits,
				when averaged over all people with this policy.
(3) This policy meets the minimum standards
				for major medical insurance as defined by the New York State Insurance
				Department. It does NOT provide basic hospital or basic medical insurance. The
				expected benefit ratio for this policy is ________ percent. This ratio is the
				portion of future premiums which the company expects to return as benefits,
				when averaged over all people with this policy.
(4) This policy provides limited benefits
				health insurance only. It does NOT provide basic hospital, basic medical or
				major medical insurance as defined by the New York State Insurance Department.
				The expected benefit ratio for this policy is ________ percent. This ratio is
				the portion of future premiums which the company expects to return as benefits,
				when averaged over all people with this policy.
(5) This policy provides disability income
				insurance only. It does NOT provide basic hospital, basic medical or major
				medical insurance as defined by the New York State Insurance Department. The
				expected benefit ratio for this policy is ________ percent. This ratio is the
				portion of future premiums which the company expects to return as benefits,
				when averaged over all people with this policy.
(6) This policy provides ACCIDENT insurance
				only. It does NOT provide basic hospital, basic medical or major medical
				insurance as defined by the New York State Insurance Department. The expected
				benefit ratio for this policy is ________ percent. This ratio is the portion of
				future premiums which the company expects to return as benefits, when averaged
				over all people with this policy.
IMPORTANT NOTICE--THIS POLICY DOES NOT PROVIDE COVERAGE FOR
				  SICKNESS.
(7) This policy
				provides DENTAL insurance only. The expected benefit ratio for this policy is
				________ percent. This ratio is the portion of future premiums which the
				company expects to return as benefits, when averaged over all people with this
				policy.
(8) This policy meets the
				minimum standards for MEDICARE SUPPLEMENT INSURANCE as defined by the New York
				State Insurance Department. The expected benefit ratio for this policy is
				________ percent. This ratio is the portion of future premiums which the
				company expects to return as benefits, when averaged over all people with this
				policy.
IMPORTANT NOTICE--A CONSUMER'S GUIDE TO HEALTH INSURANCE FOR
				  PEOPLE ELIGIBLE FOR MEDICARE MAY BE OBTAINED FROM YOUR LOCAL SOCIAL SECURITY
				  OFFICE OR FROM THIS INSURER.
Such statements may be made to conform to the actual
				  insurance provided where such insurance complies with more than one of the
				  definitions contained in such sections
				  52.5
				  through
				  52.11.
				  The requirements for disclosure of the expected benefit ratios of policies as
				  provided in this section shall not apply to group policies as defined in
				  sections 221 and 253(6) of the Insurance Law.