Fla. Admin. Code Ann. R. 69O-150.203 - Definitions
For purposes of these rules, the terms below are defined as follows:
(1) "Application" means the
form that must be filled in by the person seeking to effectuate a health
benefit plan.
(2) "Application
Period" includes any enrollment period.
(3)
(a)
"Carrier" means a person that provides a health benefit plan in this state,
including any authorized carrier, health maintenance organization,
multiple-employer welfare arrangement, or any other person providing a health
benefit plan that is subject to insurance regulation in this state and as set
forth in Section 627.6699, F.S.
(b) "Carrier" does not include a
multiple-employer welfare arrangement established by an association of members
of the same profession that:
1. Operates
solely for the benefit of the members or the members and employees of the
members;
2. Was in existence on
January 1, 1992; and,
3. Provides
coverage upon the member's request for any member of the association with
eleven (11) or more employees, or any eleven (11) members and dependents of
members.
(4)
"Certificate" means any certificate that has been delivered or issued for
delivery in this state and issued under a health benefit plan.
(5) "Exclusion" means any provision in a plan
or policy that entirely eliminates coverage for a specified hazard; it is a
statement of a risk not assumed under the plan or policy.
(6) "Health Benefit Plan" or "Plan" includes
any policy, plan, certificate, contract, agreement, statement of coverage,
rider, or endorsement that provides basic, standard, or limited benefit
coverage to a small employer as described in Section
627.6699(3)(r),
F.S.
(7) "Institutional Marketing
Communication" means a marketing communication having as its sole purpose the
promotion of the readers', viewers', or listeners' interest in the concept of
health benefit plans or the promotion of the small employer carrier as a seller
of health benefit plans.
(8)
"Invitation to Contract" means a marketing communication that is neither an
institutional marketing communication, a lead generating device nor an
invitation to inquire.
(9)
(a) "Invitation to Inquire" means a marketing
communication that:
1. Has as its objective
the creation of a desire to inquire further about a health benefit
plan;
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.
3. Contains a provision in the following or
substantially similar form: "This plan has (exclusions) (limitations) (terms
under which the plan may be continued in force or discontinued). For costs and
complete details of the coverage call (or write) your insurance agent or
company (carrier)." (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 and invitation to contact pursuant to this
rule chapter; or
4. Otherwise
violate these rules or the Insurance Code.
(10) "Limitation" means any provision, other
than an exclusion, that restricts coverage under a health benefit
plan.
(11) "Marketing
Communication" includes any method of communication listed in Sections
626.9541(1)(b)1. through 4., F.S.
(12) "Small Employer Carrier" means a carrier
that offers health benefit plans covering eligible employees of one or more
small employers.
Notes
Rulemaking Authority 624.308, 626.9611 FS. Law Implemented 624.307(1), 626.9541(1)(a), (b), (e), (k), (l), 626.9641(1), 627.6699(9)(d)4. FS.
New 2-25-93, Amended 1-4-00, Formerly 4-150.203.
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