Louisiana Administrative Code › Title 37 - INSURANCE › Part XI - Rules › Chapter 1 - Rule Number 3A-Advertisement of Medicare Supplement Insurance › Section XI-105 - Definitions

Current through Register Vol. 50, No. 6, June 20, 2024
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.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:2 and
				  22:224.