W. Va. Code R. § 114-10-3

Current through Register Vol. XLI, No. 50, December 13, 2024

Section 114-10-3 - Definitions

3.1. Advertisement. -- "Advertisement" for the purpose of this regulation shall include:

(a) Printed and published material, audio visual material and descriptive literature of an insurer used in direct mail, newspapers, magazines, radio scripts, television scripts, billboards and similar displays;

(b) Descriptive literature and sales aids of all kinds issued by an insurer, agent or broker for presentation to members of the insurance buying public, including, but not limited to, circulars, leaflets, booklets, depictions, illustrations and form letters; and

(c) Prepared sales talks, presentations and material for use by agents, brokers and solicitors.

3.2. Policy. -- "Policy" for the purpose of this regulation shall include any 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 disability, waiver of premium and double indemnity benefits included in life insurance and annuity contracts.

3.3. Insurer. -- "Insurer" for the purpose of this regulation shall include any individual, corporation, association, partnership, reciprocal exchange, inter-insurer, Lloyds, fraternal benefit society, health maintenance organization and any other legal entity which is defined as an "Insurer" in the Insurance Code of this State and is engaged in the advertisement of a policy as "Policy" is herein defined.

3.4. Exception. -- "Exception" for the purpose of this regulation shall mean 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.

3.5. Reduction. -- "Reduction" for the purpose of this regulation shall mean 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 or period less than would be otherwise payable had such reduction not been used.

3.6. Limitation. -- "Limitation" for the purpose of this regulation shall mean any provision which restricts coverage under the policy other than an exception or a reduction.

W. Va. Code R. § 114-10-3