Pennsylvania Code › Title 31 - INSURANCE › Part I - General Provisions › Subpart E - Advertising of Insurance › Chapter 51 - GENERAL PROVISIONS › Subchapter B - COMPLIANCE STANDARDS › SPECIFIC COMPLIANCE STANDARDS FOR ACCIDENT AND HEALTH INSURANCE › Section 51.41 - Benefits payable

Current through Register Vol. 54, No. 28, July 13, 2024
(a) An
						advertisement of a benefit for which payment is conditional upon confinement in
						a hospital or similar facility may not use words or phrases such as "tax free";
						"extra cash"; "extra income"; "extra pay"; or substantially similar words or
						phrases because the 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. An advertisement may
						use complete and accurate terminology explaining the IRS rules applicable to
						the taxation of types of accident and sickness benefits.
(b) An advertisement which represents
						benefits which may be payable under a contract shall provide in close
						conjunction therewith, either a statement of applicable limitation of time over
						which the benefits will be paid, or a statement of the number of payments which
						will be made if by the terms of the contract payment of benefits is limited in
						time or number. The statement shall be made each time the benefit is so listed,
						if the failure to do so would result in the capacity or tendency to mislead or
						deceive.
(c) An advertisement of a
						hospital or other similar facility confinement benefit may not represent or
						imply 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.
(d) An advertisement of a hospital indemnity
						shall state that the benefits are payable during hospital confinement
						only.
(e) Words or phrases such as
						"up to" or "as high as" which are descriptive of upper limits of dollar amounts
						payable for represented loss or expenses may not be used in an advertisement
						unless the contract provides benefit payments up to such an amount in all cases
						for such losses or expenses actually sustained by a policyholder, or unless
						there is full and conspicuous disclosure in close conjunction with such words
						or phrases of either of the following:
(1) The
						complete schedule of payments provided by the contract.
(2) The specific loss or expense for which
						the advertised dollar amount is provided by the contract, and an equally
						prominent disclosure that benefits provided by the contract for losses or
						expenses of the kind advertised vary in amount depending on the particular kind
						of loss or expense incurred, and where the advertisement refers to specific
						dollar amounts in connection with surgical benefits, it shall set forth at
						least six surgical procedures for which benefits are provided by the contract,
						including the operations which pay the minimum and maximum benefits, and
						additional operations representative of the more frequently performed surgical
						procedures.