Subchapter A. REQUIRED DISCLOSURES IN THE
SOLICITATION OF LIFE INSURANCE
Sec.
83.1. Purpose.
83.2. Applicability.
83.3. Disclosure statement.
83.4. Time of delivery.
83.4a. Certification of disclosure statement delivery.
83.4b. Maintenance of disclosure statement delivery certification.
83.4c. Certification of disclosure statement delivery by direct-response or mail-order insurers.
83.5. Effect on other insurance laws or regulations.
83.6. Penalties.
Cross References This subchapter cited in 31 Pa. Code § 90c.18 (relating to applications intended for use in mail order solicitations of life insurance); 31 Pa. Code § 90f.15 (relating to disclosure and benefit payment notice); and 31 Pa. Code § 90g.15 (relating to disclosure and benefit payment notice).
§ 83.1. Purpose.
(a) This subchapter protects the purchaser from misrepresentation, unfair comparison and deceptive and misleading sales methods in the solicitation of life insurance by setting standards for disclosure of minimal information pertinent to a life insurance contract.
(b) This subchapter is not intended to prohibit a life insurance agent or insurer from using additional solicitation material which is not in violation of this chapter, applicable Commonwealth statutes or other applicable provisions of this title.
§ 83.2. Applicability.
(a) This subchapter applies to insurance companies authorized to transact the business of life insurance in this Commonwealth as regards solicitation of the sale of insurance on the life of a Commonwealth resident unless excluded in subsection (b). This subchapter equally applies to fraternal benefit societies authorized to transact the business of life insurance in this Commonwealth and employing representatives licensed as agents or brokers or selling life insurance on a direct-response or mail-order basis. When the cost of life insurance coverage is borne in part by the employer of the insured, the required disclosures may be made at representative ages of not to exceed 10-year age intervals in lieu of a disclosure at all applicable ages.
(b) This subchapter is not applicable to the following kinds of insurance:
(1) Annuities.
(2) Group life insurance.
(3) Credit life insurance.
(4) Life insurance of $1,000 or less.
(5) Substandard solicitations to the extent the agent or company do not reasonably know the pertinent information at the time the presentation is made to a prospective insured.
(6) Life insurance issued in connection with qualified funded pension plans and qualified retirement plans.
(7) Life insurance issued as a result of a contractual policy change or conversion provision.
(8) Life insurance where the cost is borne in whole by the employer of the insured.
(9) Variable life insurance.
Source The provisions of this § 83.2 amended through December 28, 1979, effective March 1, 1980, 9 Pa.B. 4251. Immediately preceding text appears at serial page (42666).
§ 83.3. Disclosure statement.
(a) Required written disclosure. A life insurance agent, broker or insurer soliciting the type of business to which this subchapter applies shall provide a prospective purchaser with a written disclosure statement clearly labeled as such. An acceptable disclosure statement is attached as Appendix A. If the Appendix A disclosure statement will be used, a letter to that effect, prior to use, is adequate notification to the Department. However, if a statement different than Appendix A will be used, the statement shall be filed with the Department for review prior to use. If an insurer desires to use an advertisement as its disclosure statement, the portion of the advertisement containing the disclosure statement shall be filed for review prior to use. A disclosure statement shall be a document which shall describe the purpose and importance of the disclosure and describe the significant elements of the policy and riders being offered.
(1) A statement that the disclosure is for the insured’s protection, provides basic information about the cost and coverage of the insurance and should be read carefully.
(2) A statement that the disclosure statement may not be considered as an offer to contract or as altering or modifying any policy or rider that might be issued.
(3) The name, age and sex of the proposed insured, to the extent that each is known or can reasonably become known to the company, broker or agent at the time of presentation.
(4) Source of insurance, including the following:
(i) If applicable, the name of the agent or broker, home address or agency address and the home or agency telephone number of the insurance agent or broker making the solicitation.
(ii) The name and home address (city and state) of the insurer to whom applications will be made and a mailing address of the insurer’s home, executive or administrative office to which correspondence should be addressed.
(5) Information about the basic policy, rider or supplemental benefit built into the policy, such as descriptive title, as ‘‘whole life, 20 year decreasing term, endowment at age 65,’’ and the like.
(6) Amount of coverage and benefits offered.
(i) Separately for each basic policy, rider and supplemental benefit built into the policy.
(A) The face amount of coverage; if not applicable, a description of the coverage.
(B) If the face amount of coverage changes (other than through the exercise of dividend options), an explanation as to what changes will occur and when, as ‘‘coverage reduces $100 per month till age 65 when the coverage expires.’’
(ii) Retirement income. If the policy is one primarily designated to pay a guaranteed income, the monthly income payable for life with a ten-year period certain at the appropriate age.
(iii) Cash surrender value.
(A) In policies which develop such values, the applicable amount of cash surrender value per $1,000 or face amount at the end of 5, 10 and 20 policy years and at age 65.
(B) If a loan option is available, the annual percentage loan interest charge.
(7) Premiums.
(i) Separately for each basic policy and rider:
(A) Annual premium; if not known, premium for mode quoted to prospect.
(B) If the premium quoted in clause (A) changes other than by the exercise of an option contained in the policy such as a right of renewal of a term life insurance policy or the exercise of a dividend option:
(I) If one premium changes, the ultimate premium and the effective time.
(II) If more than one premium changes, two representative premiums and the ultimate premium and the effective time of each such change; or an explanation as to what changes will occur, as ‘‘Amount of premium increases 3% each year’’ and the ultimate premium and the effective time.
(C) If the policy contains supplemental built-in benefits, a statement that the cost for such benefits is included in the premium for the policy.
(ii) Total initial annual premium for the policy and rider. If not known, total initial premium for the policy and rider for the payment mode quoted to prospect.
(8) Dividends payable.
(i) If the company chooses to show illustrations, a statement that illustrated dividends are not a guarantee of what future dividends will be.
(ii) If a payment of a dividend is contingent upon the payment of the next premium due, a statement to this effect.
(iii) Dividend illustrations used shall be for policy years 10 and 20 per $1,000 or face amount. A statement that the dividend illustrations will be based on current interest, mortality, and expense experience of the company as reflected in the dividends currently paid and will pertain to the policy or rider being solicited.
(9) Surrender comparison index for policies.
(i) A disclosure that a surrender comparison index will be provided upon delivery of the policy or earlier if requested. If requested earlier, the index disclosure must be provided as soon as reasonably possible. This requirement is not applicable to the following kinds of insurance:
(A) Annuities.
(B) Group life insurance.
(C) Credit life insurance.
(D) Life insurance of less than $5,000.
(E) Life insurance on substandard risks.
(F) Life insurance issued in connection with qualified funded pension plans and qualified retirement plans.
(G) Life insurance issued as a result of a contractual policy change or conversion provision.
(H) Life insurance where the cost is borne in whole or in part by the employer of the insured.
(I) Policies having a varying face amount (resulting from other than the application of dividends).
(J) Variable life insurance.
(K) Family policies.
(L) Term policies.
(M) Riders.
(ii) A provision for the election of earlier delivery.
(iii) A brief explanation of what the surrender comparison index is.
(10) Upon request, the company, fraternal benefit society, or agent, if applicable, will furnish the prospective insured with additional information about the insurance described.
(b) Appendix A. Italicized material in the Appendix A disclosure statement has been included for explanatory purposes only and shall not appear in copies of Appendix A used by insurers. Insurer’s Appendix A form should only indicate applicable terminology or designation in lieu of italicized material.
Source The provisions of this § 83.3 amended through December 28, 1979, effective March 1, 1980, 9 Pa.B. 4251. Immediately preceding text appears at serial pages (42667) to (42669).
Cross References This section cited in 31 Pa. Code § 81.6 (relating to duties of insurers that use agents or brokers); and 31 Pa. Code § 90c.18 (relating to applications intended for use in mail order solicitations of life insurance).
§ 83.4. Time of delivery.
Except as otherwise provided herein, the written disclosure statement shall be given no later than the time that the application form is signed by the applicant.
§ 83.4a. Certification of disclosure statement delivery.
The agent shall submit to the insurer with or as a part of the application for life insurance a statement, signed by him, certifying that the written disclosure statement was given no later than the time that the application was signed by the applicant.
Source The provisions of this § 83.4a adopted August 24, 1979, effective March 1, 1980, 9 Pa.B. 2885; amended December 28, 1979, effective March 1, 1980, 9 Pa.B. 4251. Immediately preceding text appears at serial page (42670).
§ 83.4b. Maintenance of disclosure statement delivery certification.
The insurer shall maintain the agent’s certification of disclosure statement delivery in its appropriate files for at least 3 years or until the conclusion of the next succeeding regular examination by the Insurance Department of its domicile, whichever is later. The absence of the agent’s certification from the appropriate files of the insurer shall constitute prima facie evidence that no disclosure statement was provided to the prospective purchaser of life insurance.
Source The provisions of this § 83.4b adopted August 24, 1979, effective March 1, 1980, 9 Pa.B. 2885; amended December 28, 1979, effective March 1, 1980, 9 Pa.B. 4251. Immediately preceding text appears at serial page (42670).
§ 83.4c. Certification of disclosure statement delivery by direct-response or mail-order insurers.
The appropriate officer of each direct-response or mail-order insurer shall certify, in conjunction with the annual statement of the insurer, that all written disclosure statements have been provided in accordance with this subchapter. Failure to so certify shall constitute prima facie evidence that written disclosure statements have not been provided to prospective purchasers of life insurance.
Source The provisions of this § 83.4c adopted August 24, 1979, effective March 1, 1980, 9 Pa.B. 2885; amended December 28, 1979, effective March 1, 1980, 9 Pa.B. 4251. Immediately preceding text appears at serial page (42671).
§ 83.5. Effect on other insurance laws or regulations.
This subchapter does not limit the authority of the Commissioner or the responsibilities of an individual or entity selling insurance under another chapter or law, unless such is specifically stated in the body of that chapter or law.
§ 83.6. Penalties.
(a) For failing to make adequate disclosure of basic information about the product being sold, after an administrative hearing as provided by law, an agent or broker may be subject to the penalties provided in section 639 of The Insurance Department Act of one thousand nine hundred and twenty-one (40 P. S. § 279) for conduct that would disqualify an agent or broker from the initial issuance of a license under section 603 or section 622 of that act (40 P. S. § 233 or § 252).
(b) For failing to insure adequate disclosure of basic information about the product being sold, after a hearing as provided by law, a company may be subject to the penalties provided in section 350 of The Insurance Company Law of 1921 (40 P. S. § 475) for violations of sections 347—349 of The Insurance Company Law of 1921 (40 P. S. § § 472—474).
(c) For failing to insure adequate disclosure of basic information about the product being sold, after a hearing as provided by law, a fraternal benefit society may be subject to the penalties provided in sections 817(b) and 904(d) of the Fraternal Benefit Society Code (40 P. S. § § 1141-817(b) and 1141-904(d)).
(d) In addition to subsections (a)—(c), failure to make the disclosure outlined in this subchapter may be considered a violation of the Unfair Insurance Practices Act (40 P. S. § § 1171.1—1171.15).
Source The provisions of this § 83.6 amended through December 28, 1979, effective March 1, 1980, 9 Pa.B. 4251. Immediately preceding text appears at serial pages (42671) to (42672).
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