N.D. Admin. Code 45-06-04-03

Current through Supplement No. 395, January, 2025
Section 45-06-04-03 - Definitions

1. An "advertisement" for the purpose of this chapter includes:

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

b. Descriptive literature, identification cards, and sales aids of all kinds used by an insurer, agent, or broker for presentation to members of the insurance buying public, including, but not limited to, circulars, business calling cards, lead cards, surveys, leaflets, booklets, depictions, illustrations, and form letters; and

C- Prepared sales talks, presentations, and material for use by agents, brokers, and solicitors.

2. "Exception" for the purpose of this chapter means any provision in a policy whereby coverage for a specified hazard is entirely eliminated; it is a statement or a risk not assumed under the policy.

3. "Institutional advertisement" for the purpose of this chapter means an advertisement having as its sole purpose the promotion of the reader's or viewer's interest in the concept of accident and sickness insurance, or the promotion of the insurer.

4. "Insurer" for the purposes of this chapter includes any individual, corporation, association, partnership, reciprocal exchange, interinsurer, Lloyds, fraternal benefit society, nonprofit health service corporation, 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 an insurance policy as "policy" is defined in this section.

5. "Invitation to contract" for the purpose of this chapter means an advertisement which is neither an invitation to inquire nor an institutional advertisement.

6. "Invitation to inquire" for the purpose of this chapter means an advertisement having as its objective the creation of a desire to inquire further about the product and which is limited to a brief description of the loss for which the benefit is payable, and which may contain:

3- The dollar amount of benefit payable, and/or

b. The period of time during which the benefit is payable; provided the advertisement does not refer to cost. An advertisement which specifies either the dollar amount of benefit payable or the period of time during which the benefit is payable must contain a provision in effect as follows:

"For costs and further details of the coverage, including exclusions, any reductions or limitations and the terms under which the policy may be continued in force, see your agent or write to the company."

7. "Limitation" for the purpose of this chapter means any provision which restricts coverage under the policy other than an exception or a reduction.

8. "Policy" for the purpose of this chapter includes 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 an indemnity, reimbursement, service, or prepaid basis, nursing home benefits, long-term care insurance benefits, and medicare supplement benefits.

9. "Reduction" for the purpose of this chapter means 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.

N.D. Admin Code 45-06-04-03

Effective March 1, 1988.

General Authority: NDCC 26.1-04-08, 28-32-02

Law Implemented: NDCC 26.1-04-03(1), 26.1-04-03(2), 26.1-04-07