211 ADVERTISEMENTS: ACCIDENT AND SICKNESS INSURANCE

211.1 It is the purpose of this section to establish specific guidelines for advertisements relating to individual, group, blanket, and franchise accident and sickness insurance. The provisions of this section shall be applicable to all persons and entities authorized to transact accident and sickness insurance in the District of Columbia, and to agents and brokers to the extent that they are responsible for the advertisement of any such policy.211.2 To facilitate compliance with this section the Commissioner may issue interpretations which shall be consistent to the extent possible with the interpretations recommended by the National Association of Insurance Commissioners, adopted December 2, 1971.211.3 Advertisements shall be truthful and not misleading in fact or in implication. No words or phrases the meaning of which is clear only by implication or by familiarity with insurance terminology shall be used.211.4 No words, phrases, or illustrations shall be used in a manner which misleads or has the capacity and tendency to deceive as to the extent of any policy benefit payable, loss covered, or premium payable. An advertisement relating to any policy benefit payable, loss covered, or premium payable shall be sufficiently complete and clear as to avoid deception or the capacity and tendency to deceive.211.5 The words and phrases 'all,' 'full,' 'complete,' 'total,' 'comprehensive,' 'unlimited,' 'up to,' 'as high as,' 'extra cash,' 'this policy will pay your hospital and surgical bills' or 'this policy will replace your income,' or similar words and phrases shall not be used so as to exaggerate any benefit beyond the terms of the policy, but shall be used only in a manner as fairly to describe the benefit.211.6 Phrases such as 'this policy pays \$5,000 for hospital room and board expenses' shall be considered incomplete without indicating the maximum daily benefit and the maximum time limit for hospital room and board expenses.211.7 No policy covering only one disease or a list of specified diseases shall be advertised so as to imply coverage beyond the terms of the policy. No synonymous terms shall be used to refer to any disease so as to imply broader coverage than is fact.211.8 No advertisement covered by the provisions of this section shall do any of the following:- (a) Shall state or imply that an insurer or a policy has been approved or an insurer's financial condition has been examined and found to be satisfactory by a governmental agency;

- (b) State or imply that an insurer or a policy has been approved or endorsed by any individual, group of individuals, society, association or other organization, unless that is the fact;

- (c) Contain untrue statements with respect to the time within which claims are paid or statements which imply that claim settlements will be liberal or generous beyond the terms of the policy;

- (d) Contain statements which are untrue in fact or by implication misleading with respect to the insurer's assets, corporate structure, financial standing, age or relative position in the insurance business;

1. (e) Directly or indirectly make unfair or incomplete comparisons of policies or benefits or otherwise falsely disparage competitors, their policies, services or business methods;
2. (f) Imply licensing beyond the limits of the jurisdiction in which the insurer is licensed;
3. (g) State or imply that prospective policyholders become group or quasi-group members and as such enjoy special rates or underwriting privileges, unless that is the fact; and
4. (h) State or imply that enrollment in a plan or under a policy is limited to a specific period unless the period of time to enroll is disclosed, or that a particular policy or combination of policies is an introductory, initial or special offer and that the applicant will receive advantages by accepting the offer, if the insurer has offered, or plans to repeat such offer for the same or substantially the same product.211.9 The benefits of a policy which pays varying amounts or the same loss occurring under different conditions or which pays benefits only when a loss occurs under certain conditions shall not be advertised without disclosing the limited conditions under which the benefits referred to are provided by the policy.211.10 When an advertisement refers to any dollar amount, period of time for which any benefit is payable, cost of policy, or specific benefit or the loss for which such benefit is payable, it shall also disclose those exceptions, reductions and limitations affecting the basic provisions of the policy without which the advertisement would have the capacity and tendency to mislead or deceive.211.11 When a policy contains a time period between the effective date of the policy and the effective date of coverage under the policy or a time period between the date a loss occurs and the date benefits begin to accrue for that loss, an advertisement covered by §211.10 shall disclose the existence of those periods.211.12 An advertisement covered by §211.10 shall disclose the extent to which any loss is not covered if the cause of the loss is traceable to a condition existing prior to the effective date of the policy.211.13 When a policy does not cover losses traceable to pre-existing conditions no advertisement of the policy shall state or imply that the applicant's physical condition or medical history will not affect the issuance of the policy or payment of a claim under the policy, and this shall limit the use of the phrase 'no medical examination required' and phrases of similar import.211.14 An advertisement which refers to renewability, cancellability, or termination of a policy, or which refers to a policy benefit, or which states or illustrates time or age in connection with eligibility of applicants or continuation of the policy, shall disclose the provisions relating to renewability, cancellability, and termination and any modification of benefits, losses covered, or premiums because of age or for other reasons, in a manner which shall not minimize or render obscure the qualifying conditions.211.15 All information required to be disclosed by this section shall be set out conspicuously and in close conjunction with the statements to which such information relates or under appropriate captions of such prominence that it shall not be minimized, rendered obscure, or presented in an ambiguous fashion or intermingled with the context of the advertisement so as to be confusing or misleading.211.16 Testimonials used in advertisements shall be genuine, represent the current opinion of the author, be applicable to the policy advertised, and be accurately reproduced. The insurer, in using a testimonial, shall make as its own all of the statements contained therein, and the advertisement, including those statements, shall be subject to all of the provisions of this section.

211.17 No advertisement relating to the dollar amounts of claims paid, the number of persons insured, or similar statistical information relating to any insurer or policy shall be used unless it accurately reflects all of the relevant facts. That advertisement shall not imply that the statistics are derived from the policy advertised unless that is the fact.

211.18 An offer in an advertisement of inspection of a policy or offer of a premium refund shall not be a cure for misleading or deceptive statements contained in that advertisement.

211.19 When a choice of the amount of benefits is referred to, an advertisement shall disclose that the amount of benefits provided depends upon the plan selected and that the premium will vary with the amount of the benefits.

211.20 When an advertisement refers to various benefits which may be contained in two (2) or more policies, other than group master policies, the advertisement shall disclose that those benefits are provided only through a combination of such policies.

211.21 The identity of the insurer shall be made clear in all of its advertisements. No advertisement shall use a trade name, service mark, slogan, symbol, or other device which has the capacity and tendency to mislead or deceive as to the true identity of the insurer.

211.22 No insurer shall use an introductory offer of a reduced or deviated initial premium for the first month or months of coverage under a renewable policy, unless actuarial soundness was established.

211.23 A limited enrollment period within which a particular insurance product may be purchased on an individual basis shall not be offered to residents of the District unless there has been a lapse of not less than ninety (90) days between the close of the immediately preceding enrollment period for the same or substantially same product and the opening of the new enrollment period. This ninety (90) day period shall apply to all advertising media, including mail, newspapers, radio, television, magazines, and periodicals by any one insurer. It is inapplicable to solicitations of employees or members of a particular group or association which otherwise would be eligible under existing contractual provisions.

211.24 Advertising in magazines, periodicals, and newspapers printed and published in other states for circulation in the District shall comply with the ninety (90) day period applicable to publications originating in the District.

211.25 Each insurer shall maintain at its home or principal office a complete file containing every printed, published, or prepared advertisement of individual policies and typical printed, published or prepared advertisements of blanket, franchise, and group policies disseminated in the District or in any state whether or not licensed in that state, with a notation attached to each such advertisement which shall indicate the manner and extent of distribution and the form number of any policy advertised. This file shall be subject to inspection by the Department. All advertisements shall be maintained in this file for a period of not less than three (3) years.

211.26 Each insurer required to file an annual statement shall file with the Department, together with its annual statement, a certificate executed by an authorized officer of the insurer wherein it is stated that to the best of his or her knowledge, information, and belief the advertisements which were disseminated by the insurer during the preceding statement year complied or were made to comply in all respects with the provisions of this section.