Or. Admin. R. 836-020-0270

Current through Register Vol. 63, No. 8, August 1, 2024

Section 836-020-0270 - Introductory, Initial, or Special Offers

(1)

(a) An advertisement shall not directly or by implication represent that a policy or combination of policies is an introductory, initial, or special offer, that applicants will receive substantial advantages not available at a later date, or that the offer is available only to a specified group of individuals, unless such is the fact. An advertisement shall not contain phrases describing an enrollment period as "special" or "limited", or similar words or phrases, if the insurer uses such enrollment periods as its usual method of marketing health insurance;

(b) An enrollment period during which a particular insurance coverage may be purchased on an individual basis shall not be offered unless there has been a lapse of not less than three months between the close of the immediately preceding enrollment period for the same coverage and the opening of the new enrollment period. The advertisement shall indicate the date by which the applicant must mail the application, which shall be not less than ten days and not more than forty days from the date that such enrollment period is advertised in this state for the first time. This requirement applies to all advertising media used by the insurer. It does not apply to solicitations of employees or members of a group or association who are eligible under the Insurance Code for group, blanket, or franchise health insurance. All affiliated insurers in a group of insurers under common management or control are considered as one insurer for the purpose of this paragraph. "A particular insurance coverage" refers for the purpose of this paragraph to an insurance policy which provides substantially different benefits than those contained in any other policy of the insurer. Different terms of renewability, an increase or decrease in the dollar amount of benefits or an increase or decrease in any elimination period or waiting period from those available during an enrollment period for another policy shall not be considered sufficient to constitute a different coverage which is eligible for concurrent or overlapping enrollment periods.

(2) An advertisement shall not offer a policy which utilizes a reduced initial premium rate in a manner which overemphasizes the availability and the amount of the initial reduced premium. When an insurer charges an initial premium that differs in amount from the amount of the renewal premium payable on the same mode, the advertisement shall not display the amount of the reduced initial premium either more frequently or more prominently than the renewal premium, and both the initial reduced premium and the renewal premium shall be stated in a juxtaposition in each portion of the advertisement where the initial reduced premium appears.

(3) An advertisement shall not offer special awards such as a "safe driver's award".

(4)

(a) If benefits are less for a particular age group, the reduced benefits for that group must be prominently set out in a separate section of an advertisement in such a manner that it would normally come to the attention of a casual reader;

(b) An advertisement for a policy covering accidental injury only must prominently state that illness or disease is not covered;

(c) An insurer soliciting business from customers, employees, or members of a particular company, employer, union, or other person must display the name of the insurer as prominently as that of the company, employer, union, or such other person, and must clearly indicate that there is no affiliation between the insurer and such person unless some significant affiliation does in fact exist.

(5)

(a) An advertisement of an individual policy which provides for a direct response by including an application or enrollment form shall contain a "policy summary" setting out the essential features of the policy that will be issued upon acceptance of an application by the insurer;

(b) The policy summary shall be prominently displayed and readily distinguishable from all other portions of the advertisement. The policy summary shall explain the essential features of the policy in simple, concise, and readily understandable language, as in the following example:

POLICY SUMMARY

(or other descriptive title)

-A- This policy provides $16.27 daily hospital benefits.

-B- This policy is guaranteed renewable to age 65.

-C- The insurance company can change the premium.

-D- Pre-existing conditions are not covered for the first two years.

-E- Benefits are payable from the first day of accidents and the eighth day of sickness. -F- Benefits are reduced at age 65.

-G- This policy does not cover mental illness, alcoholism, or drug addiction.

-H- (Other significant policy provisions).

Or. Admin. R. 836-020-0270

IC 53, f. 3-5-73, ef. 3-15-73; ID 2-1987, f. & ef. 3-3-87

Stat. Auth.: ORS 731, ORS 743 & ORS 746

Stats. Implemented: IC 53, f. 3-5-73, ef. 3-15-73; ID 2-1987, f. & ef. 3-3-87