California Code of Regulations
Title 10 - Investment
Chapter 5 - Insurance Commissioner
Subchapter 3 - Insurers
Article 12 - Disability Insurance Advertisements
Section 2535.3 - Definitions

Universal Citation: 10 CA Code of Regs 2535.3

Current through Register 2024 Notice Reg. No. 38, September 20, 2024

(a) An advertisement for the purpose of these regulations shall include:

(1) 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; and

(2) 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

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

GUIDELINE 2535.3(a)

The scope of the term "advertisement" extends to the use of all media for communication to the general public (Section 2535.3(a)(1), to the use of all media for communication to specific members of the general public (Section 2535.3(a)(2) and to the use of all media for communication by agents, brokers and solicitors.

The definition of "advertisement" includes advertising material included with a policy when the policy is delivered and material used in the solicitation of renewals and reinstatements.

The definition of "advertisement" does not include:

(1) material to be used solely for the training and education of an insurer's employees, agents or brokers;

(2) material in house organs of insurers;

(3) communications within an insurer's own organization not intended for dissemination to the public;

(4) individual communications of a personal nature with current policyholders other than material urging such policyholders to increase or expand coverages;

(5) correspondence between a prospective group or blanket policyholder and an insurer in the course of negotiating a group or blanket contract;

(6) court approved material ordered by a court to be disseminated to policyholders; or

(7) 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.

(b) "Policy" for the purpose of these regulations shall include 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, 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.

GUIDELINE 2535.3(b)

In Section 2535.3(b), the language "except disability, waiver of premium and double indemnity benefits included in life insurance and annuity contracts" means except disability, waiver of premium and double indemnity benefits included in life insurance, endowment or annuity contracts or contracts supplemental thereto which contain only such provisions which:

(a) provide additional benefits in case of death or dismemberment or loss of sight by accident or as

(b) operate to safeguard such contracts against lapse or to give a special surrender value or special benefit or an annuity in the event that the insured or annuitant shall become totally and permanently disabled as defined by the contract or supplemental contract.

The term "disability benefits" includes benefits for death or dismemberment or loss of sight by accident.

(c) "Insurer" for the purpose of these regulations shall include any individual, corporation, association, partnership, reciprocal exchange, inter-insurer, Lloyd's, fraternal benefit society, 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 defined in these regulations.

(d) "Exception" for the purpose of these regulations 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.

(e) "Reduction" for the purpose of these regulations 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.

(f) "Limitation" for the purpose of these regulations shall mean any provision which restricts coverage under the policy other than an exception or a reduction.

(g) "Institutional Advertisement" for the purpose of these regulations shall mean 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.

(h) "Invitation to Inquire" for the purpose of these regulations shall mean 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:

(1) The dollar amount of benefit payable, and/or

(2) 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 shall 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."

(i) "Invitation to Contract" for the purpose of these regulations shall mean an advertisement which is neither an invitation to inquire nor an institutional advertisement.

GUIDELINES 2535.3(c) THROUGH 2535.3(i)

These subsections are self-explanatory.

1. Amendment and new subsections (g), (h), and (i) filed 11-29-74; effective thirtieth day thereafter (Register 74, No. 48).

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