69B-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 Section 626.9541(1)(b)1. through 4., Florida Statutes.

(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.

Specific Authority 624.308(1), 626.9611 FS. Law Implemented 624.307(1), 626.9541(1)(a), (b), (e), (k), (l), 626.9641(1) FS. History–Revised 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.