23 CAR § 100-103. Definitions

As used in this part: (1)(A) An "advertisement" shall include: (i) Printed and published material, audio visual material, and descriptive literature used by or on behalf of an insurer in: (a) Direct mail; (b) Newspapers; (c) Magazines; (d) Radio scripts; (e) TV scripts; (f) Billboards; and (g) Similar displays; (ii) Descriptive literature and sales aids of all kinds issued by an insurer, agent, producer, broker, or solicitor for presentation to members of the insurance buying public, including but not limited to, circulars, leaflets, booklets, depictions, illustrations, form letters, and lead generating devices as herein defined; and (iii) Prepared sales talks, presentations, and material for use by agents, brokers, producers, and solicitors, whether prepared by the: (a) Insurer; (b) Agent; (c) Broker; (d) Producer; or (e) Solicitor. (B) “Advertisement” includes advertising material included with a policy when the policy is delivered and material used in the solicitation of renewals and reinstatements. (C) “Advertisement” does not include: (i) Material to be used solely for the training and education of an insurer's employees, agents, or brokers; (ii) Material used in-house by insurers; (iii) Communications within an insurer's own organization not intended for dissemination to the public; (iv) Individual communications of a personal nature with current policyholders other than material urging such policyholders to increase or expand coverages; (v) Correspondence between a prospective group or blanket policyholder and an insurer in the course of negotiating a group or blanket contract; (vi) Court-approved material ordered by a court to be disseminated to policyholders; or (vii) A general announcement from a group or blanket policyholder to eligible individuals on an employment or membership list that a contract or program has been written or arranged, provided the announcement clearly indicates that it is preliminary to the issuance of a booklet; (2) "Certificate" means any certificate issued under a group Medicare supplement policy, which certificate has been delivered or issued for delivery in this state; (3)(A) "Exception" means any provision in a policy whereby coverage for a specified hazard is entirely eliminated. (B) It is a statement of a risk not assumed under the policy; (4) "Institutional advertisement" means an advertisement having as its sole purpose the promotion of the: (A) Reader’s, viewer's, or listener's interest in the concept of Medicare Supplement Insurance; or (B) Insurer as a seller of Medicare Supplement Insurance; (5) "Insurer" includes any individual, corporation, association, partnership, reciprocal exchange, interinsurer, Lloyd’s, fraternal benefit society, health maintenance organization, hospital medical service corporation, prepaid health plan, and any other legal entity that is: (A) Defined as an "insurer" in the Insurance Code of this state; and (B) Engaged in the advertisement of itself or Medicare Supplement Insurance; (6) "Invitation to contract" means an advertisement that is neither an institutional advertisement nor an invitation to inquire; (7) "Invitation to inquire" means an advertisement having as its objective the creation of a desire to inquire further about Medicare Supplement Insurance that is limited to a brief description of coverage and that shall contain 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 the company (whichever is applicable).”; (8) "Lead-generating device" means any communication directed to the public that, regardless of form, content, or stated purpose, is intended to result in the compilation or qualification of a list containing names and other personal information to be used to solicit residents of this state for the purchase of Medicare Supplement Insurance; (9) "Limitation" means any provision that restricts or limits coverage under the policy other than an exception or a reduction; (10) "Medicare" means "The Health Insurance For the Aged Act, Title XVIII of The Social Security Amendments of 1965 as Then Constituted or Later Amended" or Title I, Part 1, of Public Laws 89-97, as enacted by the Eighty-Ninth Congress of the United States of America and popularly known as the "Health Insurance for the Aged Act", as then constituted and any later amendments or substitutes thereof or words of similar import; (11) "Medicare Supplement Insurance" means a group or individual policy of disability insurance or a subscriber contract of a hospital and medical service corporation or health maintenance organization that is advertised, marketed, or designed primarily as a supplement to reimbursements under Medicare for the hospital, medical, or surgical expenses of persons eligible for Medicare by reason of age; (12) "Person" means any: (A) Natural person; (B) Association; (C) Organization; (D) Partnership; (E) Trust; (F) Group; (G) Discretionary group; (H) Corporation; or (I) Other entity; and (13)(A) "Reduction" means any provision that reduces the amount of the benefits. (B) 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.