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.

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. History–New 2-25-93, Amended 1-4-00, Formerly 4-150.203.