§ 10601
292 words·~1 min read·
/ca/insurance-code/10601A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
As used in this chapter:
(a)“Benefits and coverage” means the accident, sickness or disability indemnity available under a policy of disability insurance.
(b)“Exception” means any provision in a policy whereby coverage for a specified hazard or condition is entirely eliminated.
(c)“Reduction” means any provision in a policy which reduces the amount of a policy benefit to some amount or period less than would be otherwise payable for medically authorized expenses or services had such a reduction not been used.
(d)“Limitation” means any provision other than an exception or a reduction which restricts coverage under the policy.
(e)“Presenting for examination or sale” means either
(1)publication and dissemination of any brochure, mailer, advertisement, or form which constitutes a presentation of the provisions of the policy and which provides a policy enrollment or application form, or
(2)consultations or discussions between prospective beneficiaries or their contract agents and employees or agents of disability insurers, when such consultations or discussions include presentation of formal, organized information about the policy which is intended to influence or inform the prospective insured or beneficiary, such as brochures, summaries, charts, slides, or other modes of information in lieu of or in addition to the policy itself.
(f)“Disability insurance” means every policy of disability insurance, self-insured employee welfare benefit plan, and nonprofit hospital service plan issued, delivered, or entered into pursuant to or described in Chapter 1 (commencing with Section 10110), Chapter 4 (commencing with Section 10270), or Chapter 11A (commencing with Section 11491) of this part.
(g)“Insurer” means every insurer transacting disability insurance, every self-insured employee welfare plan, and every nonprofit hospital service plan specified in subdivision (e).
(h)“Disclosure form” means the standard supplemental disclosure form required pursuant to Section 10603.