Fla. Admin. Code Ann. R. 69O-150.003 - Definitions
For the purpose of these rules, the terms below are defined as follows:
(1) An "Advertisement"
includes any method of communicaton listed in Sections 626.9541(1)(b)1. through
4., F.S.
(2) The definition of
"Advertisement" does not include:
(a) Material
to be used solely for the training and education of an insurer's employees,
agents, or brokers;
(b) Material
used exclusively in-house by insurers;
(c) Communications within an insurer's own
organization not intended for dissemination to the public;
(d) Individual communications of a personal
nature with current policyholders regarding existing coverage other than
material urging such policyholders to renew, increase or expand
coverages;
(e) Correspondence
between a prospective group or blanket policyholder and an insurer in the
course of negotiating a group or blanket contract;
(f) Court approved material ordered by a
court to be disseminated to policyholders; or
(g) A general announcement from a group or
blanket policyholder to eligible individuals on an employment or membership
list which may include a brief description of coverage and is primarily a
notification that a contract or program has been written or arranged; provided,
the announcement must clearly indicate that it is preliminary to the issuance
of a booklet, pamphlet, brochure or other similar paper preliminary to coverage
by the insurer.
(3)
"Application" means the form which must be filled in by the person seeking to
effectuate an insurance policy.
(4)
"Application Period" also includes any enrollment period.
(5) "Certificate" means any certificate
issued under a group health policy which certificate has been delivered or
issued for delivery in this state.
(6) "Exception" means any provision in a
policy whereby coverage for a specified hazard is entirely eliminated; it is a
statement of a risk not assumed under the policy.
(7) "Health Insurance Policy" includes any
policy, plan, certificate, contract, agreement, statement of coverage, rider or
endorsement which provides accident or sickness benefits, or medical, surgical
or hospital expense benefits, whether on an indemnity, reimbursement, service
or prepaid basis, except when issued in connection with another kind of
insurance other than life, and except disability, waiver of premium and double
indemnity benefits included in life insurance annuity contracts, and, except
medicare supplement policies.
(8)
"Institutional Advertisement" means an advertisement having as its sole purpose
the promotion of the readers', viewers' or listeners' interest in the concept
of Health Insurance or the promotion of the insurer as a seller of Health
Insurance.
(9) "Insurer" includes
any individual, corporation, association, partnership, reciprocal exchange,
inter-insurer, Lloyds, fraternal benefit society, hospital service corporation,
medical service corporation, and any other legal entity which is defined as an
"insurer" in the Insurance Code of this state.
(10) "Invitation to Contract" means an
advertisement which is neither an institutional advertisement nor an invitation
to inquire.
(11)
(a) "Invitation to Inquire" means an
advertisement that:
1. Has as its objective
the creation of a desire to inquire further about a health insurance
policy;
2. Is limited to a brief
description of coverage that shall include only:
a. A brief description of the loss for which
benefits are payable;
b. The dollar
amount of benefits payable; and,
c.
The period of time during which benefits are payable; and,
3. Contains a provision in the following or
substantially similar form: "This policy has (exclusions) (limitations)
(reductions of benefits) (terms under which the policy may be continued in
force or discontinued). For costs and complete details of the coverage call (or
write) your insurance agent or company." (whichever is
applicable)
(b) An
invitation to inquire shall not:
1. Employ
devices that are designed to create undue anxiety;
2. Exaggerate the value of the benefits
available under the marketed health benefit plan;
3. State premium cost. If an advertisement
which would otherwise be considered an invitation to inquire does state a cost,
it shall be considered an invitation to contract pursuant to this rule chapter;
or
4. Otherwise violate these rules
or the Insurance Code.
(12) "Limitation" means any provision which
restricts coverage under the policy other than an exception or a
reduction.
(13) "Person" means any
natural person, association, organization, partnership, trust, group,
discretionary group, corporation or any other entity.
(14) "Reduction" means any provision which
reduces the amount of the benefit; this term includes a situation where a risk
of loss is assumed, but payment upon the occurrence of such loss is limited to
some amount or period less than would be otherwise payable had such reduction
not been used.
Notes
Rulemaking Authority 624.308(1), 626.9611 FS. Law Implemented 624.307(1), 626.9541(1)(a), (b), (e), (k), (l), 626.9641(1) FS.
New 1-19-73, Repromulgated 12-24-74, Formerly 4-6.03, Amended 6-13-88, Formerly 4-6.003, Amended 1-4-00, Formerly 4-150.003.
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