Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 20 - ADVERTISEMENTS OF HEALTH INSURANCE › Section 836-020-0225 - Advertisements of Benefits Payable, Losses Covered, or Premiums Payable

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Deceptive
			 Words, Phrases, or Illustrations Prohibited:
(a) No advertisement shall omit particular
			 information or use particular 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 prospective purchasers as to the nature or
			 extent of any policy benefit payable, loss covered, or premium payable. The
			 fact that the offered policy is made available to a prospective insured for
			 inspection prior to consummation of sale, or that an offer is made to refund
			 the premium if the purchaser is not satisfied, does not remedy misleading
			 statements;
(b) No advertisement
			 shall 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 in reference to loss-of-time benefits), or similar words or
			 phrases, in a manner which exaggerates any benefit beyond the terms of the
			 policy;
(c) No advertisement shall
			 contain descriptions of a policy limitation, exception, or reduction worded in
			 a positive manner to imply that it is a benefit. Examples of this are
			 describing a waiting period as a "benefit builder", or stating that "even
			 pre-existing conditions are covered after two years". Words and phrases used in
			 an advertisement to describe policy limitations, exceptions, or reductions
			 shall fairly and accurately describe the negative features of the limitation,
			 exception, or reduction;
(d) 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 in a manner which has the capacity, tendency, or effect of misleading
			 prospective purchasers into believing that the policy advertised will in some
			 way enable them to make a profit from being hospitalized. This rule does not
			 prohibit the use of complete and accurate terminology explaining the federal
			 Internal Revenue Service rules applicable to the taxation of various types of
			 health insurance benefits. It is noted that such rules provide that premiums
			 paid for and benefits received from hospital indemnity policies are subject to
			 the same rule as loss-of-time premiums and benefits, and are not afforded the
			 same favorable tax treatment as expense-incurred hospital, medical, and
			 surgical benefit coverages;
(e) No
			 advertisement of a hospital or 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 on a daily pro rata
			 basis relating to the number of days of confinement. When the policy contains a
			 limit on the number of days of coverage provided, the limit must appear in the
			 advertisement;
(f) No advertisement
			 of a policy covering only one or more specified diseases shall imply coverage
			 beyond the terms of the policy. Several synonymous terms shall not be used to
			 refer to any one disease so as to imply broader coverage than is the
			 fact;
(g) 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;
(h) An advertisement of an
			 insurance policy sold by direct mail shall not imply that, because "no
			 insurance agent will call and no commission will be paid to agents", it is a
			 "low cost plan", or use similar phrases. A statement that "no agent will call"
			 is not of itself misleading.