Subchapter A. GENERAL PROVISIONS
Sec.
51.1. Definitions.
51.2. Filings of advertisements.
51.3. Company’s responsibility and control.
51.4. Advertising file.
51.5. Certificate of compliance.
51.6. Compliance standards.
51.7. Sanctions.§ 51.1. Definitions.
The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:
Advertisement—Printed and published material, audio visual material and descriptive literature of a company used in direct mail, newspapers, magazines, radio scripts, TV scripts, billboards and similar displays; descriptive literature and sales aids of all kinds issued by a company, agent or broker for presentation to members of the insurance buying public, including but not limited to circulars, leaflets, booklets, depictions, illustrations and form letters; and prepared sales talks, presentations and material for use by agents, brokers or solicitors, and any representations made in connection therewith.
Commissioner—The Commissioner of the Pennsylvania Insurance Department.
Company—An association, individual, corporation, partnership, reciprocal or interinsurance exchange, Lloyds, hospital plan corporation, professional health services plan corporation, fraternal benefit society, beneficial society, voluntary nonprofit health service plan and any other legal entity issuing to Commonwealth residents a contract of insurance as defined in this chapter and subject to appropriate regulation by the Department.
Compliance standards—The criteria by which an advertisement would be judged acceptable by the Department as not being deceptive, misleading or otherwise in violation of the Unfair Insurance Practices Act (40 P. S. § § 1171.1—1171.15) or other applicable law or regulation.
Contract—A policy, plan, certificate issued by a fraternal benefit society, agreement, statement of coverage, binder, rider or endorsement which provides insurance or service benefits.
Department—The Insurance Department of the Commonwealth.
Exception—A provision in a contract whereby coverage for a specified risk is entirely eliminated.
Invitation to inquire—An advertisement which is designed to attract the reader’s interest in the contract advertised so that he will inquire for further details and information.
Limitation—A provision other than an exception or reduction which restricts coverage or benefits under the contract.
Mail-order solicitation—An advertisement which is designed specifically to market a contract to a prospective insured where the application for the contract is made by mail. A mail-order solicitation does not include the following:(i) Material which relates to the renewal of an existing contract, when the renewal does not affect the benefits available, coverage included or rates payable under the contract.
(ii) An invitation to inquire.
Publication—The circulation of an advertisement by any means, whereby the advertisement may reasonably be expected to reach prospective or present policyholders in this Commonwealth.
Reduction—A provision which reduces the amount of the benefit which would otherwise be payable either by limitation as to dollar amount or by limitation as to period of time.
Source The provisions of this § 51.1 amended May 21, 1976, effective May 22, 1976, 6 Pa.B. 1135. Immediately preceding text appears at serial pages (15132) and (13286).
Cross References This section cited in 31 Pa. Code § 89.1 (relating to definitions); and 31 Pa. Code § 154.16 (relating to information for enrollees).
§ 51.2. Filings of advertisements.
(a) Required filing. Mail-order solicitations of individual accident and health contracts or franchise accident and health contracts shall be filed as follows:
(1) A mail-order solicitation for an individual accident and health contract or a franchise accident and health contract shall be properly filed with the Department as an ‘‘Initial Filing of a Mail-order Solicitation,’’ not later than the day of first publication of the advertisement.
(2) A mail-order solicitation which has been properly filed with the Department in accord with this subsection and advertisement for which has subsequently been changed in any way, shall be filed in its changed form as an ‘‘Amended Filing of a Mail-order Solicitation’’ not later than the day of first publication of that changed advertisement.
(3) Once a mail-order solicitation has been properly filed with the Department as an ‘‘Initial Filing of a Mail-order Solicitation’’ or an ‘‘Amended Filing of a Mail-order Solicitation,’’ that same mail-order solicitation need not be filed with the Department upon each subsequent use for a period of 2 years from the date of that filing. An advertisement shall be refiled as a ‘‘Renewed Filing of a Mail-order Solicitation’’ not later than the date of first publication after the expiration of this 2-year period.
(b) Voluntary review of advertisements. Voluntary review shall occur as follows:
(1) Prior to first publication, a mail-order solicitation may be submitted to the Department as a ‘‘Voluntary Submission of an Advertisement’’ for voluntary review in regard to compliance with existing statutory requirements. In such cases, submission should be made at least 30 days prior to first publication.
(2) A mail-order solicitation submitted for voluntary review shall still be appropriately filed in accord with subsection (a).
(3) An advertisement submitted for the voluntary review will not be protected or insulated from an action that might be taken by the Department under existing statutory provisions of the law.
(c) Department right of review for all advertisements. Advertisements, whether or not actually filed or required to be filed with the Department under this chapter, may be reviewed at the discretion of the Department.
(d) Filing procedures. Advertisements filed or submitted shall be sent by certified mail and shall be accompanied by the following:
(1) Three copies of the advertisement.
(2) A stamped, self-addressed envelope to facilitate communication with the company.
(3) A cover letter submitted in duplicate which shall include the following:
(i) Proper designation of filing, as ‘‘Initial Filing of Mail-order Solicitation,’’ ‘‘Amended Filing of Mail-order Solicitation,’’ ‘‘Renewed Filing of Mail-order Solicitation’’ or ‘‘Voluntary Submission of an Advertisement.’’
(ii) The reference number or other approved identification of the contract form to which the advertisement refers or relates shall be stated.
(iii) The date of first publication and the specific newspaper or other means of public circulation shall be stated.
(iv) If it is an amended or renewed mail-order filing, the date of filing of the last filed form of the advertisement shall be stated. Further, there shall be a clear identification of changes made, if any, from the last filed form of the advertisement.
(v) If an enrollment is to be employed, a statement shall be included with the filing indicating the minimum and maximum length of the enrollment period that will be used.
(vi) If a testimonial is to be used in a mail-order solicitation, a statement by the company shall be submitted to the Department stating all relevant facts concerning any arrangement with the company for the providing of the testimonial, including any financial interest of the provider of the testimonial in the company. Further, the company shall submit copies of correspondence or other documentation from which any recommendations, favorable comments or other forms of testimonials appearing in a mail-order solicitation were taken.
§ 51.3. Company’s responsibility and control.
(a) Every company shall maintain complete control over the content, form and method of dissemination of advertisements of its contracts. The advertisements, regardless of by whom written, created or designed, shall be the responsibility of the company whose contracts are being advertised.
(b) Advertisements prepared by persons other than the company for which the advertisement is intended to be used shall, prior to its use, be approved in writing by an officer of the company or another person the company may designate for this purpose.
§ 51.4. Advertising file.
(a) A company shall maintain at its home or principal office a complete file containing every printed, published or prepared advertisement of its individual contracts and typical printed, published or prepared advertisements of its blanket, franchise and group contracts hereafter disseminated in this or another state whether or not licensed in the other state.
(b) An advertisement included in this advertising file shall be annotated as to the manner and extent of distribution and the form number of the contract advertised.
(c) The advertising file kept in accordance with this section shall be subject to inspection by the Department.
(d) Advertisements and related material shall be maintained in the file for a period of either 4 years or until the filing of the next regular report of examination of the company, whichever is the longer period.
§ 51.5. Certificate of compliance.
A company required to file an annual statement which is now or which hereafter becomes subject to this chapter shall file with the Department with its Annual Statement a Certificate of Compliance executed by an authorized officer of the company wherein it is stated that to the best of his knowledge, information and belief the advertisements which were disseminated by the company during the preceding statement year complied or were made to comply in all respects with the provisions of the insurance laws and regulations of this Commonwealth.
§ 51.6. Compliance standards.
The Commissioner may adopt compliance standards relating to the enforcement of statutory requirements regulating the advertisement of insurance.
§ 51.7. Sanctions.
Failure to properly file or maintain material in accord with the requirements of this chapter shall constitute a refusal to produce or maintain records as required by the Department, and shall subject an individual or company so failing to the appropriate sanctions provided by law.
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