Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 90 - RULES GOVERNING ADVERTISEMENT OF ACCIDENT AND SICKNESS INSURANCE › Section 14VAC5-90-30 - Definitions

Current through Register Vol. 40, No. 24, July 15, 2024
The following words and terms when used in this chapter shall
				  have the following meanings unless the context clearly indicates
				  otherwise:
"Advertisement" means
(i) printed and published material, audio
				visual material, and descriptive literature of an insurer used in direct mail,
				newspapers, magazines, radio scripts, television scripts, web sites and other
				Internet displays or communications, other forms of electronic communications,
				billboards, and similar displays;
(ii) descriptive literature and sales aids of
				all kinds issued by an insurer or agent for presentation to the
				insurance-buying public, including but not limited to circulars, leaflets,
				booklets, depictions, illustrations, and form letters; and
(iii) prepared sales talks, presentations and
				material for use by agents. "Advertisement" shall not include:
1. Material used in-house by
				insurers;
2. Communications within
				an insurer's own organization not intended for dissemination to the
				insurance-buying public; however, to the extent any communications are in fact
				disseminated to the insurance-buying public or utilized in a sales presentation
				to the insurance-buying public, the materials shall be considered to fall
				within the definition of "advertising";
3. Individual communications of a personal
				nature with current policyholders other than material urging the policyholder
				to increase, expand, terminate or purchase new coverages;
4. Correspondence between a prospective group
				or policyholder and an insurer in the course of negotiating a group contract
				other than material urging the policyholder to increase or expand
				coverages;
5. Court-approved
				material ordered by a court to be disseminated to policyholders;
6. A general announcement from a group
				policyholder to eligible individuals on an employment or membership list that a
				contract or program has been written or arranged, provided that the
				announcement clearly indicates that it is preliminary to the issuance of a
				booklet and that the announcement does not describe specific benefits under the
				contract or program nor describe advantages as to the purchase of the contract
				or program. This does not prohibit a general endorsement of the program by the
				sponsor;
7. Electronic
				communications devoted to electronic business transactions between existing
				members, providers, employers, and the insurer containing no materials relating
				to increasing, decreasing, terminating, or expanding coverages; or
8. Member newsletters or educational material
				sent to existing members, providers, or employers containing no materials
				relating to increasing, decreasing, terminating, or expanding coverages.
"Commission" means the Virginia State Corporation
				  Commission.
"Exception" means 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" 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 an individual, corporation, association,
				  partnership, reciprocal exchange, inter-insurer, Lloyds, fraternal benefit
				  society, health maintenance organization, and any other legal entity that is
				  defined as an "insurer" in Title 38.2 of the Code of Virginia.
"Invitation to contract" means an advertisement that includes
				  in any manner an application for insurance. It is not 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 and does not contain an application for coverage,
				  but may contain (i) the dollar amount of benefits payable, and (ii) the period
				  of time during which benefits are payable. An invitation to inquire may not
				  refer to cost, except as otherwise permitted by this chapter.
"Limitation" means any provision that restricts coverage
				  under the policy other than an exception or a reduction.
"Policy" means a policy, plan, certificate, contract,
				  agreement, statement of coverage, rider or endorsement that provides accident
				  or sickness benefits or medical, surgical or hospital expense benefits, whether
				  on an indemnity, reimbursement, service or prepaid basis, except (i) when
				  issued in connection with another kind of insurance other than life; and (ii)
				  disability, waiver of premium, and double indemnity benefits included in life
				  insurance and annuity contracts.
"Reduction" means any provision that reduces the amount of
				  the benefit; a risk of loss is assumed but payment upon the occurrence of the
				  loss is limited to some amount or period less than would be otherwise payable
				  had such reduction not been used.