Florida Regulations 69B-150.206: Marketing Communications of Benefits Payable, Losses Covered, and Premiums Payable
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(1) Deceptive Words, Phrases, or Illustrations Prohibited.
(a) A marketing communication shall not omit information or use words, phrases, statements, references, or illustrations that have the capacity, tendency, or effect of misleading or deceiving purchasers or prospective purchasers as to the nature or extent of any health benefit payable, loss covered, or premium payable. The fact that the plan offered is made available to the prospective plan purchaser for inspection prior to consummation of the sale, or that an offer is made to refund the premium if the purchaser is not satisfied, does not remedy misleading statements.
(b) A marketing communication shall not contain or use words or phrases such as “”all,”” “”full,”” “”complete,”” “”comprehensive,”” “”unlimited,”” “”up to,”” “”high as,”” “”this plan will help pay your hospital and surgical bills,”” “”this plan will help fill some of the gaps that your present insurance leaves out,”” or similar words and phrases, in a manner that exaggerates any benefits beyond the terms of the plan.
(c) A marketing communication shall not contain descriptions of a plan limitation or exclusion worded in a positive manner to imply that it is a benefit, such as, “”even pre-existing conditions are covered after a limited period of time.”” Words and phrases used in a marketing communication to describe plan limitations and exclusions shall fairly and accurately describe the negative features of the limitations and exclusions of the plan offered.
(d) A marketing communication of a benefit for which payment is conditional upon confinement in a hospital or similar facility shall not use words or phrases such as “”tax free,”” “”extra cash,”” “”extra income,”” “”extra pay,”” or substantially similar words or phrases in a manner that would have the capacity, tendency, or effect of misleading the public into believing that the plan marketed will in some way enable them to make a profit from being hospitalized or disabled.
(e) When the plan marketed contains a limit on the number of days of coverage provided, the limit must appear in the marketing communication.
(f) A marketing communication of a plan covering only one disease or a list of specified diseases shall not imply coverage beyond the terms of the plan. Synonymous terms shall not be used to refer to any disease in order to imply broader coverage than is the fact.
(g) A marketing communication that is an invitation to contract and is intended to be used in the marketing of a standard, basic, or limited health benefit plan in this state must contain the disclosures stated in section 627.6699(9)(d)1., F.S.
(h)1. A marketing communication for a plan providing benefits for either a basic or standard health benefit plan shall state clearly and conspicuously in a prominent type the kind of plan marketed.
2. A marketing communication for a health benefit plan providing limited benefits, such as specified diseases or specified accidents, shall state clearly and conspicuously in prominent type the limited nature of the plan.
3. The statement shall be worded in language identical to, or substantially similar to the following: “”THIS IS A LIMITED SMALL EMPLOYER HEALTH BENEFIT PLAN””, “”THIS IS A BASIC SMALL EMPLOYER HEALTH BENEFIT PLAN””, “”THIS IS A STANDARD SMALL EMPLOYER HEALTH BENEFIT PLAN””, whichever is applicable.
(i) A marketing communication of a health benefit plan sold by direct response shall not use in a misleading manner the phrases, “”no salesman will call””, “”no agent will call””, “”by eliminating the agent and/or commission, we can offer this low cost plan”” or similar wording.
(2) Exclusions and Limitations.
(a) A marketing communication that is an invitation to contract shall disclose those exclusions and limitations that affect the benefit provisions of the plan.
(b) A marketing communication shall not use the words “”only,”” “”just,”” “”merely,”” “”minimum,”” or similar words or phrases to describe the applicability of any exclusions, reductions, or limitations, such as, “”This plan is subject to the following minimum exclusions and reductions.””
(3) Pre-Existing Conditions.
(a) A marketing communication that is an invitation to contract for health benefits shall, in negative terms, 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 plan. The term “”pre-existing condition”” without an appropriate definition or description shall not be used.
(b) When coverage is in any way limited for pre-existing conditions, any application attached to the marketing communication shall contain immediately preceding the blank space for the applicant’s signature a statement of the pre-existing condition provisions of the plan.
Rulemaking Authority 624.308(1), 626.9611, 627.6699(12) FS. Law Implemented 624.307(1), 626.9541(1)(a), (b), (e), (k), (l), 626.9641(1), 627.6699(9)(d)1., 4. FS. History-New 2-25-93, Formerly 4-150.206.
Terms Used In Florida Regulations 69B-150.206
- Contract: A legal written agreement that becomes binding when signed.
(b) A marketing communication shall not contain or use words or phrases such as “”all,”” “”full,”” “”complete,”” “”comprehensive,”” “”unlimited,”” “”up to,”” “”high as,”” “”this plan will help pay your hospital and surgical bills,”” “”this plan will help fill some of the gaps that your present insurance leaves out,”” or similar words and phrases, in a manner that exaggerates any benefits beyond the terms of the plan.
(c) A marketing communication shall not contain descriptions of a plan limitation or exclusion worded in a positive manner to imply that it is a benefit, such as, “”even pre-existing conditions are covered after a limited period of time.”” Words and phrases used in a marketing communication to describe plan limitations and exclusions shall fairly and accurately describe the negative features of the limitations and exclusions of the plan offered.
(d) A marketing communication of a benefit for which payment is conditional upon confinement in a hospital or similar facility shall not use words or phrases such as “”tax free,”” “”extra cash,”” “”extra income,”” “”extra pay,”” or substantially similar words or phrases in a manner that would have the capacity, tendency, or effect of misleading the public into believing that the plan marketed will in some way enable them to make a profit from being hospitalized or disabled.
(e) When the plan marketed contains a limit on the number of days of coverage provided, the limit must appear in the marketing communication.
(f) A marketing communication of a plan covering only one disease or a list of specified diseases shall not imply coverage beyond the terms of the plan. Synonymous terms shall not be used to refer to any disease in order to imply broader coverage than is the fact.
(g) A marketing communication that is an invitation to contract and is intended to be used in the marketing of a standard, basic, or limited health benefit plan in this state must contain the disclosures stated in section 627.6699(9)(d)1., F.S.
(h)1. A marketing communication for a plan providing benefits for either a basic or standard health benefit plan shall state clearly and conspicuously in a prominent type the kind of plan marketed.
2. A marketing communication for a health benefit plan providing limited benefits, such as specified diseases or specified accidents, shall state clearly and conspicuously in prominent type the limited nature of the plan.
3. The statement shall be worded in language identical to, or substantially similar to the following: “”THIS IS A LIMITED SMALL EMPLOYER HEALTH BENEFIT PLAN””, “”THIS IS A BASIC SMALL EMPLOYER HEALTH BENEFIT PLAN””, “”THIS IS A STANDARD SMALL EMPLOYER HEALTH BENEFIT PLAN””, whichever is applicable.
(i) A marketing communication of a health benefit plan sold by direct response shall not use in a misleading manner the phrases, “”no salesman will call””, “”no agent will call””, “”by eliminating the agent and/or commission, we can offer this low cost plan”” or similar wording.
(2) Exclusions and Limitations.
(a) A marketing communication that is an invitation to contract shall disclose those exclusions and limitations that affect the benefit provisions of the plan.
(b) A marketing communication shall not use the words “”only,”” “”just,”” “”merely,”” “”minimum,”” or similar words or phrases to describe the applicability of any exclusions, reductions, or limitations, such as, “”This plan is subject to the following minimum exclusions and reductions.””
(3) Pre-Existing Conditions.
(a) A marketing communication that is an invitation to contract for health benefits shall, in negative terms, 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 plan. The term “”pre-existing condition”” without an appropriate definition or description shall not be used.
(b) When coverage is in any way limited for pre-existing conditions, any application attached to the marketing communication shall contain immediately preceding the blank space for the applicant’s signature a statement of the pre-existing condition provisions of the plan.
Rulemaking Authority 624.308(1), 626.9611, 627.6699(12) FS. Law Implemented 624.307(1), 626.9541(1)(a), (b), (e), (k), (l), 626.9641(1), 627.6699(9)(d)1., 4. FS. History-New 2-25-93, Formerly 4-150.206.