Section Ins 2604.06 - Advertisements of Benefits Payable, Losses Covered or Premiums Payable(a) An insurer shall not use misleading words, phrases, statements, references or illustrations, or omit information that might mislead or deceive the consumer as to: (1) Any policy benefit payable;(b) When an advertisement describes any policy benefit payable, loss covered or premium payable, the insurer shall use only words and phrases in the advertisement that give complete and clear information and do not mislead or deceive, as follows: (1) An advertisement shall not use the following words and phrases: "all," "full," "complete," "comprehensive," "unlimited," "this policy will pay your hospital and surgical bills," or "this policy will replace your income," or similar words and phrases to refer to any coverage that is, in fact, subject to any exception, reduction or limitation, unless the advertisement includes appropriate disclosure;(2) An advertisement shall not use words or phrases such as "up to," "as high as," or similar words or phrases to describe the dollar amount payable for any losses or expenses except: a. When the contract provides benefit payments for such losses or expenses actually sustained by a policyholder in all cases; orb. When the advertisement includes appropriate disclosure of either: 1. The complete schedule of payments provided by the contract; or2. The specific loss or expense for which the contract pays the represented dollar amount, as well as a statement indicating that the actual benefit will vary in amount depending on the particular kind of loss or expense incurred; and(3) When an insurer advertises a policy that provides surgical benefits, and the advertisement refers to specific dollar amounts for coverage of surgical procedures, the insurer shall:a. Derive a list of 6 commonly performed surgical procedures for which the advertised policy provides coverage, and the insurer shall periodically review and update this list, to ensure its continuing validity; andb. Disclose this list of procedures, along with the relevant maximum and minimum benefit limits from the insurer's surgical schedule for each of the listed procedures.(c) An advertisement shall list the surgical procedures in terms that the average reader understands easily. An advertisement for a policy that covers only one disease or a list of specified diseases shall not imply coverage beyond the terms of the policy. The advertisement shall not use a synonymous term for any disease to imply broader coverage than is the fact.(d) Advertisements shall not refer to policy benefits when the benefits paid vary for the same loss occurring under different conditions, or when the benefits are paid only when a loss occurs under certain conditions, unless the advertisement discloses these conditions.(e) An advertisement shall not use phrases that indicate that the policy pays a specific amount for hospital room and board expenses without disclosing the maximum daily benefit and the maximum time limit for hospital room and board expenses.(f) An advertisement shall not represent the weekly, monthly, or other periodic benefits payable under a contract without disclosing: (1) Any limits on the time period over which such benefits will be paid; or(2) The number of payments that will be made if the contract limits such benefits in time or number.(g) No advertisement shall use the following words or phrases "extra cash," "extra income," "extra pay," or substantially similar words or phrases that could lead the public to believe that the contract advertised will enable them to financially profit from being hospitalized.(h) No advertisement shall represent or imply that a contract may continue indefinitely or for any period of time, when: (1) The contract permits the insurer to non-renew or cancel the policy; or(2) The contract permits the insurer to terminate the policy under any circumstances over which the insured has no control, during the period of time represented.(i) An advertisement that refers to any coverage as being limited to a certain age group shall disclose such limitation. When applicable, such advertisement shall state clearly that the insured will receive reduced benefits upon attaining a certain age.(j) An advertisement that refers to a contract that may be renewed, cancelled, or terminated shall disclose any and all related provisions, including possible modification of policy terms relating to benefits, coverages or premiums, and any qualifying conditions.(k) No insurer shall state or imply that a consumer shall obtain coverage, or guaranteed issuance of a policy, unless the insurer has maintained administrative procedures and sufficient staff to ensure that it will issue the policy within a maximum of 15 days after receiving the application.(l) An advertisement of a hospital indemnity policy that includes words or phrases describing the policy's benefits shall disclose: (1) The actual amounts payable per day; and(2) The fact that the insurer will pay such benefits during hospital confinement only.(m) No advertisement shall depict scenes that could scare a reader into purchasing a policy. Such scenes include but shall not be limited to scenes of hospital operating rooms, disabled persons, bed patients in or out of the hospital, doctors' offices, accident scenes, or scenes of other tragedies.(n) All printed advertisements for policies that include certain exceptions, reductions or limitations shall display and use a separate box clearly distinguishable from the remainder of the advertisement to set forth the required disclosures.(o) The box required in (n) above shall be as follows:(1) For black and white advertisements, the box shall carry a border that stands out due to its size from the remainder of the advertisement; and(2) For color advertisements, the box shall carry a border that stands out due to its color from the remainder of the advertisement.(p) An advertisement may omit a schedule, chart or a detailed explanation, otherwise required by this part, from the box if the box includes a reference to the exact location where the schedule, chart or explanation appears elsewhere in the advertisement.(q) The box required in (n) above shall include a statement that indicates the policy might contain exceptions, reductions or limitations in addition to those set forth in the box.(r) The box required in (n) above shall only use negative language to describe policy limitations and exclusions, so that the language indicates what the policy does not cover, rather than what the policy does cover.(s) Exceptions, reductions, or limitations of benefits described in the box required in (n) above shall include: (1) Treatment of preexisting conditions;(2) Policy elimination periods;(3) The fact that indemnity is payable only when the insured is confined to a hospital;(4) The fact that confinement in rest homes, nursing homes, V.A. hospitals, or other types of extended care in a facility are not covered;(5) The fact that the policy does not cover certain deductibles;(6) The fact that the policy does not duplicate benefits provided by federal or state legislation, such as workers compensation; and(7) The fact that the policy covers hospital bills and not doctors' bills or vice versa.(t) When an advertisement refers to terms or conditions of the policy, including but not limited to specific dollar amounts, or policy benefits, and times or ages in connection with coverage eligibility, it shall also disclose any related exception, reduction or limitation.(u) Advertisements for policies that include any exception, reduction or limitation related to a preexisting condition, shall: (1) Disclose the extent to which any loss is not covered if the cause of such loss is traceable to a condition existing prior to the effective date of the policy;(2) Not state or imply that the insurer will issue a policy or pay claims under the policy regardless of the applicant's physical condition or medical history, when the policy does not cover losses traceable to preexisting conditions;(3) Not use the phrase "no medical examination required" or phrases of similar meaning when the policy does not cover losses traceable to preexisting conditions; and(4) For policies that do not require a medical examination, disclose any conditions pertaining to or involving the insured's health that would limit benefits paid under the contract.N.H. Admin. Code § Ins 2604.06
Amended by Volume XXXVI Number 36, Filed September 8, 2016, Proposed by #11173, Effective 12/5/2016, Expires 12/5/2026.