Rule 20:06:10:05.01 Health insurance advertisements or solicitations of benefits payable, losses covered, or premiums payable.
insurance advertisements or solicitations of benefits payable, losses covered,
or premiums payable. In addition to the requirements of § 20:06:10:05,
health insurance advertisements or solicitations must meet the following
(1) No advertisement or
solicitation may contain or 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 to
express loss of time benefits)," or similar words and phrases in a manner
which exaggerates any benefits beyond the terms of the policy;
(2) An advertisement or
solicitation may not contain descriptions of a policy limitation, exception, or
reduction worded in a positive manner to imply that it is a benefit, such as
describing a waiting period as a "benefit builder" or stating
"even preexisting conditions are covered after two years." Words and
phrases used in an advertisement to describe such policy limitations,
exceptions, and reductions must fairly and accurately describe the negative
features of such limitations, exceptions, and reductions of the policy offered;
(3) No advertisements or
solicitations of a benefit for which payment is conditional on confinement in a
hospital or similar facility may use words or phrases such as "tax
free," "extra cash," extra income," "extra pay,"
or substantially similar words or phrases which may mislead the public into
believing that the policy advertised will, in some way, enable them to make a
profit from being hospitalized;
(4) No advertisement or
solicitation of a benefit for confinement in a hospital or similar facility may
advertise that the amount of the benefit is payable monthly or weekly when, in
fact, the amount of the benefit payable is calculated daily and is based on the
number of days of confinement, unless the monthly or weekly benefit amount is
immediately adjacent to and in equal prominence with the daily benefit amount.
If the policy contains a limit on the number of days of coverage provided, the
limit must clearly and prominently appear in the advertisement or solicitation;
(5) No advertisement or
solicitation of a policy covering only one disease or a list of specified
diseases may imply coverage beyond the terms of the policy or imply that
current coverage will not indemnify the specific disease so covered. Synonymous
terms may not be used to refer to any disease so as to imply broader coverage
than is the fact;
(6) An advertisement or
solicitation for a policy providing benefits for specified illnesses only, such
as cancer, or for specified accidents only, such as automobile accidents, must
clearly and conspicuously in prominent type state the limited nature of the
policy. The statement must be worded in language identical to or substantially
similar to the following: "THIS IS A LIMITED POLICY"; "THIS IS A
CANCER ONLY POLICY"; "THIS IS AN AUTOMOBILE ACCIDENT ONLY
Failure to comply with any of the
provisions of this section creates a presumption that an advertisement or
solicitation is deceptive, misrepresentative, or misleading.
15 SDR 143, effective March 29, 1989; 27 SDR 54, effective December 4, 2000; 38
SDR 116, effective January 10, 2012.
Authority: SDCL 58-33A-7.
Implemented: SDCL 58-33-5, 58-33-6, 58-33-7, 58-33A-8, 58-33A-10.
Back to 20:06:10