D.C. Mun. Regs. tit. 26, r. 26-A299

Current through Register 71, No. 45, November 7, 2024

Rule 26-A299 - DEFINITIONS

299.1

For the purposes of § 211, the following words and phrases shall have the meanings ascribed:

Advertisement - any of the following:

(1) printed and published material and descriptive literature of an insurer used in newspapers, magazines, radio and TV scripts, billboards and similar displays;

(2) descriptive literature and sales aids of all kinds issued by an insurer for presentation to members of the public, including but not limited to circulars, leaflets, booklets, depictions, illustrations, and form letters; and

(3) prepared sales talks, presentations and material for use by agents and brokers, and representations made by agents and brokers in accordance therewith.

Policy - any policy, plan, certificate, contract, agreement, statement of coverage, rider or endorsement which provides disability benefits, or medical, surgical or hospital expense benefits, whether on a cash indemnity, reimbursement, or service basis, except when issued in connection with another kind of insurance other than life, and except disability and double indemnity benefits included in life insurance and annuity contracts.

Insurer - any individual, corporation, association partnership, reciprocal exchange, inter-insurer, Lloyds, fraternal benefit society, and any other legal entity engaged in the advertisement of a policy as herein defined.

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.

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 of period less than would be otherwise payable had such reduction clause not be used.

Limitation - any provision which restricts coverage under the policy other than an exception or a reduction.

Department - Department of Consumer and Regulatory Affairs.

D.C. Mun. Regs. tit. 26, r. 26-A299