Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 40.00 - Marketing of insured health plans › Section 40.03 - Definitions

Current through Register 1525, July 5, 2024
As used in
				211 CMR 40.00 the following
				mean:
Carrier
, shall include, but not be
				limited to, an insurer licensed or otherwise authorized to transact accident
				and health insurance under M.G.L. c. 175, a fraternal benefit society licensed
				under M.G.L. c. 176, a hospital service corporation organized under M.G.L. c.
				176A, a medical service corporation organized under M.G.L. c. 176B, a dental
				service corporation organized under M.G.L. c. 176E, an optometric service
				corporation organized under M.G.L. c. 176F, and a health maintenance
				organization licensed under M.G.L. c. 176G.
Exception
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.
Insured health plan
shall include any
				individual, blanket, association, or group policy of health, accident or
				sickness insurance offered by a carrier.
Limitation
shall mean any provision
				which restricts coverage under the policy other than an exception or a
				reduction.
Marketing or marketing methods
shall
				include any of the following including, but not limited to advertisements, when
				they are used by any person with the intent of soliciting an offer to contract
				for an insured health plan:
(a) Printed and published material, audio-visual material and
				descriptive literature used in direct mail, newspapers, magazines, radio or TV
				scripts, billboards, computer or electronic transmissions and similar
				displays;
(b) Descriptive literature and sales aids of all kinds issued
				for presentation to members of the insurance-buying public, including but not
				limited to circulars, leaflets, booklets, depictions, illustrations and form
				letters;
(c) Prepared sales talks, presentations and material;
				and
(d) All oral and written solicitations and
				presentations.
Medicare
shall mean Title XVIII of the
				Social Security Act, "Health Insurance for the Aged Act," 42 USCS §1396
et seq
., as amended.
Person
shall mean any individual,
				carrier, or any other legal entity engaged in the marketing or advertising of a
				policy, including agents, brokers, and advisors.
Policy
shall include any policy, plan,
				certificate, contract, agreement, statement of coverage, rider, or endorsement
				which provides insured health benefits, including surgical or hospital expense
				benefits and disability or loss of time benefits, whether such are issued
				individually or on a general or blanket basis, whether such are issued on an
				indemnity, reimbursement, service or prepaid basis, except when issued in
				connection with another kind of insurance other than life and except
				disability, waiver of premium and double indemnity benefits included in life
				insurance and annuity contracts.
Reduction
shall mean 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.