W. Va. Code R. § 114-17-2

Current through Register Vol. XLI, No. 50, December 13, 2024

Section 114-17-2 - Definitions

2.1. "Applicant" shall mean:

(a) In the case of an individual Medicare Supplement or Limited Benefit Medicare Supplement policy or subscriber contract, the person who seeks to contract for insurance benefits; and

(b) In the case of a group Medicare Supplement or Limited Benefit Medicare Supplement policy or subscriber contract, the proposed certificate holder.

2.2. "Certificate" shall mean any certificate issued under a group Medicare Supplement or Limited Benefit Medicare Supplement policy which policy has been delivered or issued for delivery in this State.

2.3. "Duplication of Insurance" shall mean a transaction involving the purchase of accident and/or sickness insurance where it is known or should be known to the agent or, in the case of direct response solicitation, to the insurer, that the new insurance will provide some of the benefits or coverages to which the proposed insured is already entitled under an existing policy or contract of insurance.

2.4. "Limited Benefit Medicare Supplement Policy" shall mean any policy or subscriber contract or accident and/or sickness insurance which is issued to a person eligible for Medicare by reason of age, which is designed to supplement Medicare coverage or which is advertised, marketed or otherwise purported to be a supplement to Medicare coverage and which includes terms and benefits which do not meet the requirements of Section 4.2 of this regulation.

2.5. "Medicare Supplement Policy" shall mean a group or individual policy or contract of accident and sickness insurance which is designed primarily to supplement Medicare coverage or which is advertised, marketed or otherwise purported to be a supplement to Medicare coverage and which includes terms and benefits which meet the requirements of Section 4 of this regulation.

2.6. "Replacement of Insurance" shall mean a transaction involving the purchase of accident and/or sickness insurance where it is known or should be known to the agent or, in the case of direct response solicitation, to the insurer, that previously existing accident and/or sickness insurance has been or will be lapsed, canceled or otherwise terminated as a result of the transaction.

2.7. "Sales Materials" shall mean any and all promotional materials, replacement forms, duplication forms or any other forms or informational material used in connection with the promotion, solicitation or sale of accident and/or sickness insurance.

W. Va. Code R. § 114-17-2