Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-149 - FILING OF FORMS AND RATES FOR LIFE/HEALTH INSURANCE › Section 69O-149.041 - Marketing Communication Material and Marketing Guidelines

Current through Reg. 50, No. 138; July 16, 2024
(1) Any marketing communication shall comply
				with the requirements of rule Chapter 69O-150, Part III, F.A.C.
(2) Any insurer marketing small group health
				plans shall comply with the following guidelines:
(a) The small group health history or size
				shall not be used to direct the small group to a particular small group plan
				except as permitted by the provisions of Section
				627.6699, F.S.
(b)
1. In
				determining eligibility for small group coverage an employer/employee income
				may not be used.
2. A carrier may
				request information and documentation to determine whether an individual
				qualifies as an active business that is eligible for coverage.
3. The following information, records, or
				documents may be requested or considered in determining whether an employer
				meets the definition of small employer pursuant to Section
				627.6699(3)(v),
				F.S. If the employer was required by applicable law to maintain the
				information, record or documents or to file the document with a local, state or
				federal governmental agency or authority; maintains the information in the
				normal course of business; or was issued the information, records, or documents
				by a local, state, or deferral agency or authority:
a. IRS form 1040, Schedule C or F.
b. IRS 941 (quarterly wage and tax
				form).
c. IRS 1065 (for partnership
				income).
d. IRS 1120 (corporate
				income).
e. IRS 1099 (which may
				include payments to independent contractors).
f. IRS 2106 (employee business
				expenses).
g. IRS 990 (for
				non-profits with annual receipts over $25,000).
h. Occupational Licenses.
i. State Licenses.
j. Florida UT 6 (unemployment compensation
				tax form).
k. Articles of
				incorporation.
l. Partnership
				agreements.
m. Affidavits from the
				customers or suppliers of the small employer.
n. Auditable personal records of receipts,
				expenditures, invoices.
o. Leases
				and other contracts.
4.
a. Refusal to insure an eligible small
				employer because of the employer's refusal or unwillingness to provide
				information, records or documents which are not necessary to reasonably
				establish that the employer meets the definition of Section
				627.6699(3)(v),
				F.S., violates Section
				627.6699(5)(a),
				F.S.
b. Any statement that requires
				information not necessary for determining eligibility be provided for coverage
				to be issued shall constitute an unfair method of competition in violation of
				Section 626.9541(1)(b),
				F.S.
(c) In the
				instance where a company splits to become two or more corporations, with each
				corporation employing less than 50 employees, they are considered an eligible
				small employer if:
1. The group is not
				splitting solely with the intent of providing health insurance coverage to a
				separate class of employees;
2. The
				new company can produce signed documentation (i.e., articles of incorporation)
				that substantiates that there is a legitimate business with business
				activity;
3. All eligible employees
				are working 25 hours or more per week.
(d) New and renewal policies for the Basic
				and Standard policies issued on or after May 1, 1995, must include the 1995
				Basic and Standard Health Benefit Plans (OIR-B2-95) pursuant to Section
				627.6699(12),
				F.S., which is incorporated herein by reference and can be obtained from the
				Bureau of Life and Health Forms and Rates.
(e)
1.
				Pursuant to Section 626.9611, F.S., the Office
				identifies the following as being prohibited by Section
				626.9541(1)(b),
				F.S., for a small employer carrier in reflecting any of the permitted rate
				adjustments in subsection
				69O-149.037(6),
				F.A.C.:
a. To quote a rate which does not
				reflect the actual characteristics of the individual group; or
b. Where necessary underwriting information
				has not been analyzed, to quote a rate other than the approved community rate.
				Any such quote of the community rate shall include a disclosure that the rate
				will be affected by the results of underwriting by up to 15 percent up or down
				for new groups, or up to a 10 percent increase for renewal
				groups.
2. This does not
				restrict carriers from quoting rates to groups based on estimated enrollment or
				demographics provided by the employer.
(f) Any practice that results in the
				declination of an application from an eligible small employer, other than for
				statutorily permitted reasons, constitutes a failure to comply with the
				guaranteed-issue requirements of Section
				627.6699(5),
				F.S.; for example, imposing standards for eligibility that are not required by
				law, such as:
1. Requiring the small employer
				to be a domestic entity; or
2.
				Requiring the group to have prior group coverage; or
3. Requiring payment of premiums with
				business checks instead of personal
				checks.