N.M. Code R. § 13.10.4.7 - DEFINITIONS
The following definitions apply for purposes of this rule:
A.
"Accident and health
insurance policy" means any policy, plan, certificate, contract,
agreement, statement of coverage, rider or endorsement which provides accident
or health benefits, medical, surgical or hospital expense benefits, or dental
or vision 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 disability, waiver of premium, double indemnity or
accelerated death benefits included in life insurance and annuity
contracts.
B.
"Advertisement:"
(1)
Advertisement means:
(a) printed and published
material, audio visual material, and descriptive literature of an insurer used
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;
(c)
prepared sales talks, presentations and material for use by agents, brokers,
producers and solicitors whether prepared by the insurer or the agent, broker,
producer or solicitor; and
(d)
advertising material included with a policy when the policy is delivered and
material used in the solicitation of renewals and reinstatements.
(2) Advertisement does not mean:
(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 the 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 clearly indicates that it is preliminary to the
issuance of a booklet.
C.
"Certificate" means any
certificate issued under a group accident and health insurance policy which has
been delivered or issued for delivery in this state.
D.
"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.
E.
"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 health
insurance, or the promotion of the insurer as a seller of accident and health
insurance.
F.
"Insurer" means 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 and is engaged in the
advertisement of itself, or an accident and health insurance policy.
G.
"Invitation to contract"
means an advertisement which is neither an invitation to inquire nor an
institutional advertisement.
H.
"Invitation to inquire" means an advertisement having as its
objective the creation of a desire to inquire further about accident and health
insurance and 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] [reduction 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]."
I.
"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 health
insurance.
J.
"Limitation" means any provision which restricts coverage under
the policy other than an exception or a reduction.
K.
"Person" means any natural
person, association, organization, partnership, trust, group, discretionary
group, corporation or any other entity.
L.
"Reduction" means any
provision which 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 and the reduction has not been
used.
Notes
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