N.Y. Comp. Codes R. & Regs. tit. 11 § 215.5

Current through Register Vol. 46, No. 50, December 11, 2024

Section 215.5 - Form and content of advertisements

(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.

(d) Every insurer providing Medicare supplement insurance as defined in 11 NYCRR 52.11 (Regulation 62) shall provide, prior to its use, a copy of any advertisement for a Medicare supplement insurance policy intended for use in this State whether through written, radio, or television medium to the superintendent. Such advertisement shall comply with all applicable regulations and laws of this State.

N.Y. Comp. Codes R. & Regs. Tit. 11 § 215.5