Mich. Admin. Code R. 500.651 - Definitions

Rule 1. As used in these rules:

(a) "Accident and sickness insurance" means disability insurance as defined in section 606 of the code, coverage comparable to that defined in section 606 of the code offered by multiple employer welfare arrangements, and credit accident and health insurance as defined in section 3 of Act No. 173 of the Public Acts of 1958, as amended, being S550.603 of the Michigan Compiled Laws.

(b) "Advertisement" means all of the following:

(i) Printed and published material, audiovisual material, and descriptive literature used by or on behalf of an insurer in any of the following:

(A) Direct mail.

(B) Newspapers.

(C) Magazines.

(D) Radio scripts.

(E) Television scripts.

(F) Billboards.

(G) Other similar displays.

(ii) Descriptive literature and sales aids of all kinds issued or used by an insurer, agent, or other person for presentation to members of the public, including any of the following:

(A) Circulars.

(B) Leaflets.

(C) Booklets.

(D) Depictions.

(E) Illustrations.

(F) Form letters.

(G) Lead-generating devices of all kinds.

(iii) Prepared sales talks, presentations, and material for use by agents or other persons, whether prepared for or by the insurer, agent, or other person.

(iv) Advertising material included with a policy when the policy is delivered.

(v) Advertising material used in the solicitation of renewals, reinstatements, and alterations.

(c) "Bureau" means the insurance bureau of the department of licensing and regulation.

(d) "Code" means Act No. 218 of the Public Acts of 1956, as amended, being S500.101 et seq. of the Michigan Compiled Laws.

(e) "Exception" means a 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.

(f) "Institutional advertisement" means an advertisement that has as its sole or primary 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.

(g) "Insurer" means an entity that is defined as an insurer or a multiple employer welfare arrangement in the code.

(h) "Invitation to contract" means an advertisement which is neither an invitation to inquire nor an institutional advertisement.

(i) "Invitation to inquire" means an advertisement which is limited to a brief description of coverage, which has as its objective the creation of a desire to inquire further about accident and sickness insurance, and which shall contain a provision in the following or substantially similar form: "This policy has exclusions, reduction of benefits or 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 insurance company."

(j) "Lead-generating device" means 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 accident and sickness insurance.

(k) "Limitation" means a provision which restricts coverage under a policy, other than an exception or a reduction.

(l) "Person" means any of the following entities:

(i) A natural person.

(ii) An association.

(iii) An organization.

(iv) A partnership.

(v) A trust.

(vi) A group.

(vii) A discretionary group.

(viii) A corporation.

(ix) Any other entity.

(m) "Policy" means a policy, plan, certificate, contract, agreement, statement of coverage, rider, or endorsement which provides accident or sickness benefits or medical, surgical, or hospital expense benefits, whether on an indemnity, reimbursement, service, or prepaid basis, except when issued in connection with another kind of insurance other than life and except for disability, waiver of premium, and double indemnity benefits included in life and annuity contracts.

(n) "Reduction" means a provision which reduces the amount of the benefit; a risk of loss is assumed, but payments upon the occurrence of the loss are limited to some amount or period less than would be otherwise payable had the reduction not been used.

Notes

Mich. Admin. Code R. 500.651

1979 AC; 1991 AACS