Florida Regulations 69O-156.103: Definitions
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For the purpose of these rules, the terms below are defined as follows:
(1) An “”Advertisement”” includes:
(a) Printed and published material, audio visual material and descriptive literature used by or on behalf of an insurer in direct mail, newspapers, magazines, radio scripts, TV scripts, billboards, and similar displays; and
(b) Descriptive literature and sales aids of all kinds issued by an insurer, agent, producer, broker, or solicitor or any other person who has either actual or apparent authority to act on behalf of the insurer 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
(c) Prepared sales talks, presentations, and material for use by agents, brokers, producers, solicitors, announcers, celebrities, and other persons, whether prepared by agents, brokers, producers, solicitors, announcers, spokesperson, celebrities, or any other person who has either actual or apparent authority to act on behalf of the insurer; and
(d) Advertising material included with a policy when the policy is delivered and material used in the solicitation of any policy.
(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 clearly indicates 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 medicare supplement 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) “”Institutional Advertisement”” means an advertisement having as its sole purpose the promotion of the readers’, viewers’ or listeners’ interest in the concept of Medicare Supplement Insurance or the promotion of the insurer as a seller of Medicare Supplement Insurance.
(8) “”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.
(9) “”Invitation to Contract”” means an advertisement which is neither an institutional advertisement nor an invitation to inquire.
(10) “”Invitation to Inquire”” means an advertisement having as its objective the creation of a desire to inquire further about a Medicare Supplement Insurance Policy which advertisement is limited to a brief description of coverage and which 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]
A “”brief description of coverage”” in an invitation to inquire may consist of an explanation of Medicare benefits, minimum benefits, standards for Medicare supplement policies, the manner in which the advertised Medicare supplement insurance policy supplements the benefits of Medicare and meets or exceeds the minimum benefit requirements. An invitation to inquire shall not refer to cost or the maximum dollar amount of benefits payable.
As with all Medicare supplement insurance advertisements, an invitation to inquire must not:
(a) Employ devices which are designed to create undue anxiety in the minds of the elderly or excite fear of dependence upon relatives or charity;
(b) Exaggerate the gaps in Medicare coverage;
(c) Exaggerate the value of the benefits available under the advertised policy;
(d) Otherwise violate the provisions of these rules.
(11) “”Lead Generating Device”” means any communication directed to the public which, regardless of form, content, or stated purpose, invites or elicits a response on the subject of insurance and thereby results in the compilation or qualification of a list containing names of, or other personal information regarding persons who have expressed a specific interest in an insurance product or coverage and which is to be used to solicit residents of this State for the purchase of Medicare Supplement Insurance or other insurance.
(12) “”Limitation”” means any provision which restricts coverage under the policy other than an exception or a reduction.
(13) “”Medicare”” is defined as “”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 I, of Public Law 89-97, as enacted by the Eighty-Ninth Congress of the United States of America and popularly known as the “”Medicare Act””, as then constituted and any later amendments or substitutes thereof or words of similar import.
(14) “”Medicare Supplement Insurance Policy”” means a group or individual policy of accident and sickness insurance or a subscriber contract of hospital and medical service associations which is advertised, marketed or designed primarily as a supplement to reimbursements under the Medicare program for the hospital, medical or surgical expenses of persons eligible for Medicare.
(15) “”Person”” means any natural person, association, organization, partnership, trust, group, discretionary group, corporation or any other entity.
(16) “”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.
Rulemaking Authority 624.308(1), 626.9611 FS. Law Implemented 624.307(1), 626.9541(1)(a), (b), (c), (e), (k), (l), 626.9641(1) FS. History-New 6-12-88, Formerly 4-46.0022, 4-156.103.
Terms Used In Florida Regulations 69O-156.103
- Charity: An agency, institution, or organization in existence and operating for the benefit of an indefinite number of persons and conducted for educational, religious, scientific, medical, or other beneficent purposes.
- Contract: A legal written agreement that becomes binding when signed.
- Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
- Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
- Public law: A public bill or joint resolution that has passed both chambers and been enacted into law. Public laws have general applicability nationwide.
(a) Printed and published material, audio visual material and descriptive literature used by or on behalf of an insurer in direct mail, newspapers, magazines, radio scripts, TV scripts, billboards, and similar displays; and
(b) Descriptive literature and sales aids of all kinds issued by an insurer, agent, producer, broker, or solicitor or any other person who has either actual or apparent authority to act on behalf of the insurer 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
(c) Prepared sales talks, presentations, and material for use by agents, brokers, producers, solicitors, announcers, celebrities, and other persons, whether prepared by agents, brokers, producers, solicitors, announcers, spokesperson, celebrities, or any other person who has either actual or apparent authority to act on behalf of the insurer; and
(d) Advertising material included with a policy when the policy is delivered and material used in the solicitation of any policy.
(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 clearly indicates 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 medicare supplement 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) “”Institutional Advertisement”” means an advertisement having as its sole purpose the promotion of the readers’, viewers’ or listeners’ interest in the concept of Medicare Supplement Insurance or the promotion of the insurer as a seller of Medicare Supplement Insurance.
(8) “”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.
(9) “”Invitation to Contract”” means an advertisement which is neither an institutional advertisement nor an invitation to inquire.
(10) “”Invitation to Inquire”” means an advertisement having as its objective the creation of a desire to inquire further about a Medicare Supplement Insurance Policy which advertisement is limited to a brief description of coverage and which 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]
A “”brief description of coverage”” in an invitation to inquire may consist of an explanation of Medicare benefits, minimum benefits, standards for Medicare supplement policies, the manner in which the advertised Medicare supplement insurance policy supplements the benefits of Medicare and meets or exceeds the minimum benefit requirements. An invitation to inquire shall not refer to cost or the maximum dollar amount of benefits payable.
As with all Medicare supplement insurance advertisements, an invitation to inquire must not:
(a) Employ devices which are designed to create undue anxiety in the minds of the elderly or excite fear of dependence upon relatives or charity;
(b) Exaggerate the gaps in Medicare coverage;
(c) Exaggerate the value of the benefits available under the advertised policy;
(d) Otherwise violate the provisions of these rules.
(11) “”Lead Generating Device”” means any communication directed to the public which, regardless of form, content, or stated purpose, invites or elicits a response on the subject of insurance and thereby results in the compilation or qualification of a list containing names of, or other personal information regarding persons who have expressed a specific interest in an insurance product or coverage and which is to be used to solicit residents of this State for the purchase of Medicare Supplement Insurance or other insurance.
(12) “”Limitation”” means any provision which restricts coverage under the policy other than an exception or a reduction.
(13) “”Medicare”” is defined as “”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 I, of Public Law 89-97, as enacted by the Eighty-Ninth Congress of the United States of America and popularly known as the “”Medicare Act””, as then constituted and any later amendments or substitutes thereof or words of similar import.
(14) “”Medicare Supplement Insurance Policy”” means a group or individual policy of accident and sickness insurance or a subscriber contract of hospital and medical service associations which is advertised, marketed or designed primarily as a supplement to reimbursements under the Medicare program for the hospital, medical or surgical expenses of persons eligible for Medicare.
(15) “”Person”” means any natural person, association, organization, partnership, trust, group, discretionary group, corporation or any other entity.
(16) “”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.
Rulemaking Authority 624.308(1), 626.9611 FS. Law Implemented 624.307(1), 626.9541(1)(a), (b), (c), (e), (k), (l), 626.9641(1) FS. History-New 6-12-88, Formerly 4-46.0022, 4-156.103.