La. Admin. Code tit. 37 § XI-105

Current through Register Vol. 50, No. 11, November 20, 2024
Section XI-105 - Definitions

Advertisement-

1.

a. printed and published material, audiovisual 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;

b. 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 of all kinds as herein defined; and

c. prepared sales talks, presentations, and material for use by agents, brokers, producers, and solicitors whether prepared by the insurer of the agent, broker, producer, or solicitor.

2.advertisement includes advertising material included with a policy when the policy is delivered and material used in the solicitation of renewals and reinstatements;

3.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 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 other than material urging such policyholders to 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 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.

Certificate- any certificate issued under a group Medicare supplement policy, which certificate has been delivered or issued for delivery in this state.

Exception- 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.

Institutional Advertisement- an advertisement having as its sole purpose the promotion of the reader's, viewer's, or listener's interest in the concept of Medicare supplement insurance, or the promotion of the insurer as a seller of Medicare supplement insurance.

Insurer- shall include any individual, corporation, association, partnership, reciprocal exchange, inter-insurer, Lloyds, fraternal benefit society, health maintenance organization, hospital service corporation, medical service corporation, prepaid health plan, and any other legal entity which is defined as an insurer in the Insurance Code of this state and is engaged in the advertisement of itself, or Medicare supplement insurance.

Invitation to Contract- an advertisement which is neither an institutional advertisement nor an invitation to inquire.

Invitation to Inquire- an advertisement having as its objective the creation of a desire to inquire further about Medicare supplement insurance which 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)."

Lead-Generating Device- any communication directed to the public which, 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.

Limitation- any provision which restricts coverage under the policy, other than an exception or a reduction.

Medicare- the Health Insurance for the Aged Act, Title XVIII of The Social Security Amendments of 1965 as Then Constituted or Later Amended, or Title 1, 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 "Health Insurance for the Aged Act, as then constituted and any later amendments or substitutes thereof" or words of similar import.

Medicare Supplement Insurance- a group or individual policy of accident and sickness insurance or a subscriber contract of hospital and medical service associations or health maintenance organizations which 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.

Person- any natural person, association, organization, partnership, trust, group, discretionary group, corporation, or any other entity.

Reduction- 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 not been used.

La. Admin. Code tit. 37, § XI-105

Promulgated by the Department of Insurance, Commissioner of Insurance, LR 17:67 (January 1991).
AUTHORITY NOTE: Promulgated in accordance with R.S. 22:2 and 22:224.