760 IAC 1-18-3 Definitions

Sec. 3. Section A. DEFINITIONS. (1) The term "advertisement" for the purpose of these regulations [ 760 IAC 1-18] shall include: (a) printed and published material and descriptive literature of an insurer used in newspapers, magazines, radio, and television scripts, billboards and similar displays; and (b) descriptive literature and sales aids of all kinds issued by an insurer for presentation to members of the public, including but not limited to circulars, leaflets, booklets, depictions, illustrations, and form letters; and (c) prepared sales talks, presentations and material for use by agents and brokers, and representations made by agents and brokers in accordance therewith. (2) The term "policy" for the purpose of these regulations shall include 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 a cash indemnity, reimbursement, or service basis, except when issued in connection with another kind of insurance other than life, and except disability and double indemnity benefits included in life insurance and annuity contracts. (3) The term "insurer" for the purpose of these regulations shall include any individual, corporation, association, partnership, reciprocal exchange, inter-insurer, Lloyds, fraternal benefit society, and any other legal entity engaged in the advertisement of a policy as herein defined. (4) The term "exception" shall mean any provision in a policy whereby coverage for a specified hazard is entirely eliminated; it is a statement of risk not assumed under the policy. (5) The term "reduction" shall mean any provision which reduces the amount of the benefit; 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 clause not been used. (6) The term "limitation" shall mean any provision which restricts coverage under the policy other than an exception or a reduction. Interpretation of Section A 1 (a) Advertisements for the sole purpose of obtaining employees, agents, agencies or brokers are among those not to be considered within the definition of an advertisement. Interpretation of Section A 1 (b) The definition of the word "Advertisement" is intended to include material used in the solicitation of renewals and reinstatements except for communications or notices which mention the cost of the insurance but do not describe benefits. It does not include: material in house organs of insurers; communications within an insurer's own organization not intended for dissemination to the public; individual communications of a personal nature; nor correspondence between a prospective group policyholder and an insurer in the course of negotiating a group contract. With respect to existing groups, reprints of group booklets after the effective date of the Rules [ 760 IAC 1-18] shall be considered within the definition of an advertisement however, until January 1, 1973, insurance companies shall not be prohibited from distributing already printed group booklets. A general announcement from a group policyholder to eligible individuals that a contract has been written is not intended to be an advertisement within the meaning of the Rules [ 760 IAC 1-18] if it clearly indicates that it is preliminary to a booklet. Interpretation of Section A 1 (c) Materials to be used solely for the training and education of its employees, agents or brokers are not within the purview of the Rules [ 760 IAC 1-18]. Interpretation of Section A 2 The language in Section A 2 "except disability and double indemnity benefits included in life insurance and annuity contracts" shall be interpreted to mean, "except disability and double indemnity benefits included in life insurance endowment or annuity contract or contracts supplemental thereto which contain only such provisions relating to accident and sickness insurance as (a) provide additional benefits in case of death or dismemberment or loss of sight by accident, or as (b) operate to safeguard such contracts against lapse, or to give a special surrender value or special benefit or an annuity in the event that the insured or annuitant shall become totally and permanently disabled, as defined by the contract or supplemental contract." Interpretation of Section A 3 An insurer is not responsible for an advertisement which is not under its direct or indirect control.