044-21 Wyo. Code R. §§ 21-3 - Definitions

As used in these rules and regulations:

(a) "Accident and sickness insurance policy" means a policy, plan, certificate, contract, agreement, statement of coverage, rider, or endorsement providing accident or sickness benefits or medical surgical or hospital benefits on an indemnity, reimbursement, service, or prepaid basis, except when issued in connection with insurance other than life insurance and annuities. An accident and sickness insurance policy includes a Medicare supplement insurance policy.

(i) "Accident and sickness insurance policy" does not apply to disability income insurance, waiver of premium, and double indemnity benefits included in life insurance, endowment, or annuity contracts containing only provisions that:

(A) Provide additional benefits in case of death, dismemberment, or loss of sight by accident; or

(B) Operate to safeguard the contracts against lapse or to give a special surrender value, special benefit, or an annuity in the event the insured or annuitant becomes totally and permanently disabled as defined by the contract or supplemental contract.

(b) "Advertisement" means:

(i) Printed and published material, audio visual material, and descriptive literature of an insurer used in direct mail, newspapers, magazines, radio scripts, TV scripts, websites, and other Internet displays or communications, other forms of electronic communications, social media, billboards, and similar displays;

(ii) Descriptive literature and sales aids of all kinds issued by an insurer or producer for presentation to members of the insurance-buying public, such as circulars, leaflets, booklets, depictions, illustrations, form letters, and lead-generating devices of all kinds;

(iii) Prepared sales talks, presentations, and material for use by producers, whether prepared by the insurer or the producer;

(iv) Advertising material included with policies delivered and material used to solicit renewals and reinstatements; and

(v) All media communications by producers to the general public and specific members of the general public.

(vi) The definition of advertisement does not include:

(A) Material used solely for training and educating an insurer's employees or producers;

(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) 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 regarding a contract or program having been written or arranged; provided the announcement clearly indicates it is preliminary to issuing a booklet and the announcement does not describe the specific contract or program benefits nor advantages of purchasing the contract or program. This does not prohibit a sponsor's general endorsement of the program.

(c) "Certificate" means a statement of the coverage and provisions of a group accident and sickness insurance policy which has been delivered or issued for delivery in Wyoming and includes riders, endorsements, and enrollment forms, if attached.

(d) "Exception" means any provision in a policy whereby coverage for a specified hazard is entirely excluded; it is a statement of a risk not assumed under the policy.

(e) "Insurer" means an individual, corporation, association, partnership, reciprocal exchange, inter-insurer, Lloyds, fraternal benefit society, hospital service corporation, prepaid health plan, and any other legal entity defined as an insurer in the Wyoming insurance code and engaged in advertising itself or an accident and sickness insurance policy.

(f) "Institutional advertisement" means an advertisement whose sole purpose is promoting the reader's, viewer's, or listener's interest in accident and sickness insurance, or promoting the insurer as a seller of accident and sickness insurance.

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

(h) "Invitation to inquire" means:

(i) An advertisement aimed at creating a desire to inquire about accident and sickness insurance, limited to a brief description of the loss for which benefits are payable but may contain:

(A) The dollar amount of benefits payable; and

(B) The period of time during which benefits are payable.

(ii) An invitation to inquire may not refer to cost.

(iii) An invitation to inquire 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 of the company [whichever is applicable]."

(i) "Lead generating device" means any communication directed to the public, regardless of form, content, or stated purpose, intended to result in compiling or qualifying a list containing names and other personal information to solicit Wyoming residents to purchase accident and sickness insurance.

(j) "Limitation" means a provision restricting policy coverage other than an exception or reduction.

(k) "Limited benefit health coverage" is insurance offered and marketed as supplemental health insurance and not as a substitute for hospital or medical insurance or major medical expense insurance.

(l) "Person" as defined by W.S. § 26-1-102(a)(xx).

(m) "Producer" means an insurance producer as defined by W.S. § 26-1-102(a)(xxxv).

(n) "Prominently" or "conspicuously" means presented in a manner noticeably set apart from other information or images in the advertisement.

(o) "Reduction" means a provision reducing the benefit amount; a risk of loss is assumed but payment upon occurrence of the loss is limited to some amount or period less than would be otherwise payable and such reduction has not been used.

Notes

044-21 Wyo. Code R. §§ 21-3

Amended, Eff. 7/16/2019.