Code of Massachusetts Regulations
211 CMR - DIVISION OF INSURANCE
Title 211 CMR 146.00 - Specified Disease Insurance
Section 146.04 - Definitions

Agent means an insurance producer licensed under M.G.L. c. 175, § 162I or an agent of a fraternal benefit society licensed in accordance with M.G.L. c. 176, § 35.

Carrier means a commercial insurance company licensed to issue accident and sickness policies under M.G.L. c. 175 or a fraternal benefit society licensed under MGL. c. 176.

Cold-lead Advertising means making use directly or indirectly of any method of marketing which fails to disclose in a conspicuous manner that one of the purposes of the method of marketing is the solicitation of insurance and that contact will be made by a carrier or its agent.

Commissioner means the commissioner of insurance or his/her designee.

Disease means a medical condition as identified in the most recent edition of the International Classification of Diseases or succeeding document.

Employment-based Group Policy means a certificate issued to an insured who is enrolled in a group policy issued to one or more employers or labor organizations, or to the trustees of a fund established by one or more employers or labor organizations, or combination thereof, for employees or former employees, or a combination thereof, or for members or former members, or a combination thereof, of the labor organizations.

Group Policy means the certificate issued to an insured who is enrolled through a group trust or association to which the carrier has issued a specified disease insurance policy. For the purposes of 211 CMR 146.00, this does not include an employment-based group policy.

Guaranteed Renewable means a policy feature that guarantees the insured's right to continue the policy in force by the timely payment of premiums. A carrier cannot cancel, cannot decline to renew, and cannot make any unilateral change in any provision of a guaranteed renewable policy without the agreement of the insured, but subject to the approval of the commissioner, a carrier may revise premium rates for guaranteed renewable policies on a class basis.

Health Plan means any individual, general, blanket or group policy of health, accident or sickness insurance issued by an insurer licensed under M.G.L. c. 175 or the laws of any other jurisdiction; a hospital service plan issued by a non-profit hospital service corporation pursuant to M.G.L. c. 176A or the laws of any other jurisdiction; a medical service plan issued by a medical service corporation pursuant to M.G.L. c. 176B or the laws of any other jurisdiction; a health maintenance contract issued by a health maintenance organization pursuant to M.G.L. c. 176G or the laws of any other jurisdiction; and an insured health benefit plan that includes a preferred provider arrangement issued pursuant to M.G.L. c. 176I or the laws of any other jurisdiction.

High-Pressure Tactics means employing any method of marketing that has the effect of or tends to induce or recommend the purchase of any insurance policy through force, fright, threat (whether explicit or implied) or undue pressure.

Individual Policy means a policy issued by a carrier directly to an insured.

Insured means the named policyholder or certificate-holder under a specified disease policy.

Noncancelable means the policy feature that guarantees the insured's right to continue the policy in force at the same premium level by the timely payment of premiums. A carrier cannot cancel, cannot decline to renew, cannot make any unilateral change in any provision of coverage and cannot revise premium rates for a non cancelable policy without the agreement of the insured.

Policymeans an individual specified disease policy or a certificate of a group specified disease policy that is not employment-based, as well as the policy applications, riders, amendments or other provisions that are attached to the policy to identify the contractual provisions of the insured's coverage.

Pre-existing Condition means a medical condition for which an insured received diagnosis or treatment during the six-month period prior to the effective date of coverage.

Specified Disease Coverage means a policy which pays benefits on an indemnity or lump sum basis for the diagnosis and/or treatment of the disease or diseases.