Iowa Administrative Code › Agency 191 - Insurance Division › Unfair Trade Practices › Chapter 15 - Unfair Trade Practices › Rule 191-15.2 - Definitions

Current through Register Vol. 47, No. 3, July 24, 2024
"Advertisement"
for the purpose of these
				  rules means material designed to create public interest in insurance or an
				  insurer, or to induce the public to purchase, increase, modify, reinstate or
				  retain a policy including:
1. Printed
				and published material, audio and visual material, and descriptive literature
				of an insurer or producer used in direct mail, newspapers, magazines, radio
				scripts, TV scripts, billboards, computer online networks and similar displays
				and descriptive literature and sales aids of all kinds issued by an insurer or
				producer for presentation to members of the public.
2. However, for the purpose of these rules
				"advertisement" shall not include: communications or materials used within an
				insurer's own organization and not intended for dissemination to the public;
				communications with policyholders other than material urging policyholders to
				purchase, increase, modify, reinstate, or retain a policy; and a general
				announcement from a group or blanket policyholder to eligible individuals on an
				employment or membership list that a policy or program has been written or
				arranged, provided the announcement clearly indicates that it is preliminary to
				the issuance of a booklet explaining the proposed coverage.
"Aftermarket crash parts"
means replacement
				  parts as defined in Iowa Code section
				  537B.4.
"Certificate"
means a statement of the
				  coverage and provisions of a policy of group accident and sickness insurance
				  that has been delivered or issued for delivery in this state and includes
				  riders, endorsements and enrollment forms, if attached.
"Duplicate Medicare supplement insurance"
means the sale or the attempt to knowingly sell to an individual a policy of
				  insurance designed to supplement Medicare benefits as provided in Title XVIII,
				  Health Insurance for the Aged and Disabled, of the Social Security Amendments
				  of 1965 as then constituted or later amended, when the individual is already
				  insured under such a policy.
"Duplication"
means policies of the same
				  coverage type according to minimum standards classifications outlined in rule
				  191-36.6 (514D) that overlap to
				  the extent that a reasonable individual would not consider the ownership of the
				  policies to be beneficial.
"Exception"
for the purpose of these rules
				  shall mean 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.
"Illustrated scale"
means a scale of
				  nonguaranteed elements currently being illustrated that is not more favorable
				  to the policyholder than the lesser of the disciplined current scale or the
				  currently payable scale as defined in rule
				  191-14.4 (507B).
"Institutional advertisement"
means an
				  advertisement having as its sole purpose the promotion of the reader's,
				  viewer's or listener's interest in the concept of accident and sickness
				  insurance, or the promotion of the insurer as a seller of accident and sickness
				  insurance.
"Insurer"
means any corporation,
				  association, partnership, reciprocal exchange, interinsurer, Lloyd's, fraternal
				  benefit society, and any other legal entity engaged in the business of
				  insurance.
"Invitation to contract"
means an
				  advertisement for accident and sickness insurance that is neither an invitation
				  to inquire nor an institutional advertisement.
"Invitation to inquire"
means an
				  advertisement having as its objective the creation of a desire to inquire
				  further about accident and sickness insurance and that is limited to a brief
				  description of the loss for which benefits are payable. An invitation to
				  inquire must not refer to cost but may contain the dollar amount of benefits
				  payable and the period of time during which benefits are payable.
"Limitation"
for the purpose of these rules
				  means any provision that restricts coverage under the policy other than an
				  exception or a reduction.
"Limited benefit health coverage"
means the
				  same as defined in 191-subrule 36.6(10).
"Person"
means any individual, corporation,
				  association, partnership, reciprocal exchange, interinsurer, fraternal benefit
				  society, and any other legal entity engaged in the business of insurance,
				  including insurance producers and adjusters. "Person" also means any
				  corporation operating under the provisions of Iowa Code chapter 514 and any
				  benevolent association as defined and operated under Iowa Code chapter 512A.
				  For purposes of this chapter, corporations operating under the provisions of
				  Iowa Code chapters 514 and 512A shall be deemed to be engaged in the business
				  of insurance.
"Policy"
includes any policy, plan,
				  certificate, contract, agreement, statement of coverage, rider, or endorsement
				  that provides for insurance benefits.
"Preneed funeral contract or prearrangement"
means an agreement by or for an individual before the individual's death
				  relating to the purchase or provision of specific funeral or cemetery
				  merchandise or services.
"Producer"
means a person who solicits,
				  negotiates, effects, procures, delivers, renews, continues or binds policies of
				  insurance for risks residing, located or to be performed in this state.
"Prominently"
or
"conspicuously"
means that the information to be disclosed
				  will be presented in a manner that is noticeably set apart from other
				  information or images in the advertisement.
"Reduction"
for the purpose of these rules
				  means any provision that 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.
"Twisting"
means any action by a producer or
				  insurer to induce or attempt to induce any individual to lapse, forfeit,
				  surrender, terminate, retain, assign, borrow, or convert a policy or an annuity
				  in order that such individual procure another policy or annuity, when such
				  action would operate to the overall detriment of the interests of the
				  individual.