Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 146.00 - Specified Disease Insurance › Section 146.04 - Definitions

Current through Register 1525, July 5, 2024
Agent
means an insurance producer
				licensed under M.G.L. c. 175, § 162I or an agent of a fraternal benefit
				society licensed in accordance with M.G.L. c. 176, § 35.
Carrier
means a commercial insurance
				company licensed to issue accident and sickness policies under M.G.L. c. 175 or
				a fraternal benefit society licensed under MGL. c. 176.
Cold-lead Advertising
means making use
				directly or indirectly of any method of marketing which fails to disclose in a
				conspicuous manner that one of the purposes of the method of marketing is the
				solicitation of insurance and that contact will be made by a carrier or its
				agent.
Commissioner
means the commissioner of
				insurance or his/her designee.
Disease
means a medical condition as
				identified in the most recent edition of the International Classification of
				Diseases or succeeding document.
Employment-based Group Policy
means a
				certificate issued to an insured who is enrolled in a group policy issued to
				one or more employers or labor organizations, or to the trustees of a fund
				established by one or more employers or labor organizations, or combination
				thereof, for employees or former employees, or a combination thereof, or for
				members or former members, or a combination thereof, of the labor
				organizations.
Group Policy
means the certificate
				issued to an insured who is enrolled through a group trust or association to
				which the carrier has issued a specified disease insurance policy. For the
				purposes of
				211
				CMR 146.00, this does not include an employment-based
				group policy.
Guaranteed Renewable
means a policy
				feature that guarantees the insured's right to continue the policy in force by
				the timely payment of premiums. A carrier cannot cancel, cannot decline to
				renew, and cannot make any unilateral change in any provision of a guaranteed
				renewable policy without the agreement of the insured, but subject to the
				approval of the commissioner, a carrier may revise premium rates for guaranteed
				renewable policies on a class basis.
Health Plan
means any individual,
				general, blanket or group policy of health, accident or sickness insurance
				issued by an insurer licensed under M.G.L. c. 175 or the laws of any other
				jurisdiction; a hospital service plan issued by a non-profit hospital service
				corporation pursuant to M.G.L. c. 176A or the laws of any other jurisdiction; a
				medical service plan issued by a medical service corporation pursuant to M.G.L.
				c. 176B or the laws of any other jurisdiction; a health maintenance contract
				issued by a health maintenance organization pursuant to M.G.L. c. 176G or the
				laws of any other jurisdiction; and an insured health benefit plan that
				includes a preferred provider arrangement issued pursuant to M.G.L. c. 176I or
				the laws of any other jurisdiction.
High-Pressure Tactics
means employing
				any method of marketing that has the effect of or tends to induce or recommend
				the purchase of any insurance policy through force, fright, threat (whether
				explicit or implied) or undue pressure.
Individual Policy
means a policy
				issued by a carrier directly to an insured.
Insured
means the named policyholder
				or certificate-holder under a specified disease policy.
Noncancelable
means the policy feature
				that guarantees the insured's right to continue the policy in force at the same
				premium level by the timely payment of premiums. A carrier cannot cancel,
				cannot decline to renew, cannot make any unilateral change in any provision of
				coverage and cannot revise premium rates for a non cancelable policy without
				the agreement of the insured.
Policy
means an individual specified
				disease policy or a certificate of a group specified disease policy that is not
				employment-based, as well as the policy applications, riders, amendments or
				other provisions that are attached to the policy to identify the contractual
				provisions of the insured's coverage.
Pre-existing Condition
means a medical
				condition for which an insured received diagnosis or treatment during the
				six-month period prior to the effective date of coverage.
Specified Disease Coverage
means a
				policy which pays benefits on an indemnity or lump sum basis for the diagnosis
				and/or treatment of the disease or diseases.