reglab/statecodes huggingface dataset:
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-154 - HEALTH INSURANCE POLICIES › Section 69O-154.304 - Notice of Occurrence of a Qualifying Event

Current through Reg. 50, No. 138; July 16, 2024
Each contract, policy, certificate and handbook must contain
				  a Notice of Occurrence of a Qualifying Event provision. This provision must
				  include the information required by Section 627.6692(5)(d)1., F.S. The
				  beneficiary shall notify the carrier in writing within sixty-three (63) days,
				  as evidenced by postmark, after the occurrence of the qualifying event or the
				  termination of coverage whichever is later.
Rulemaking Authority 624.308(1), 627.6692(9) FS. Law
					 Implemented 624.307(1), 627.6692(5)
					 FS.
New 4-24-97, Formerly 4-154.304, Amended
					 5-4-06.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-154 - HEALTH INSURANCE POLICIES › Section 69O-154.305 - Election and Premium Notice Form

Current through Reg. 50, No. 138; July 16, 2024
(1)
				Within 14 days of the date that the carrier receives the notice of occurrence
				of a qualifying event from the qualified beneficiary the carrier must send to
				the employee, covered spouse and covered dependents, by certified mail, the
				Election and Premium Notice Form OIR-B2-1261 (REV 8/03), which is hereby
				adopted and incorporated by reference. Copies of the forms are available and
				may be printed from the Office's website:
				http://www.floir.com/iportal.
(2)
				Carriers may develop a similar form which must include the information in Form
				OIR-B2-1261. Any similar form must be filed and approved before use pursuant to
				the requirements of Section
				627.410, F.S. Any filing shall
				be submitted to the Office electronically through
				http://www.floir.com/iportal.
Rulemaking Authority 624.308(1), 627.6692(9) FS. Law
					 Implemented 624.307(1), 624.424, 627.6692(5)
					 FS.
New 4-24-97, Formerly 4-154.305, Amended 5-4-06,
					 7-30-17.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-154 - HEALTH INSURANCE POLICIES › Section 69O-154.306 - Election, Billing and Payment of Premium

Current through Reg. 50, No. 138; July 16, 2024
(1) The employee, covered spouse and covered
				dependents have until the 30th day, as evidenced by postmark, after receiving
				the Election and Premium Notice form described in Rule
				69O-154.305, F.A.C., to elect
				coverage continuation in writing and pay the premium to the carrier.
(2) The carrier or its designee must process
				all elections, within 30 days and provide coverage retroactively to the day
				coverage would have otherwise terminated due to the qualifying event. The first
				premium payment must include the coverage paid to the end of the month in which
				the first payment of premium is made.
Rulemaking Authority 624.308(1), 627.6692(9) FS. Law
					 Implemented 624.307(1), 627.6692(5)
					 FS.
New 4-24-97, Formerly 4-154.306, Amended
					 5-4-06.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-154 - HEALTH INSURANCE POLICIES › Section 69O-154.410 - Withdrawal From the Group Market

Current through Reg. 50, No. 138; July 16, 2024
(1) If
				a health insurance issuer elects to withdraw from the group market, the issuer
				must provide 180 days' written notice to the Office and to all policyholders,
				certificateholders and beneficiaries provided coverage by the issuer in that
				market.
(2) A notice of withdrawal
				from the group market means an issuer may then non-renew coverage upon the next
				renewal date of policies affected by the withdrawal.
(3) A policy may not be terminated except at
				the next renewal date following the 180 day notice period.
(4) Notice to the Office must include a copy
				of all forms issued in that market.
(5) With respect to notice to policyholders,
				certificateholders, beneficiaries, a mailing to one household constitutes a
				mailing to all covered persons residing in the household.
(6) A separate mailing is required for each
				separate household.
(7) If the
				issuer elects to exit or withdraw from the group market, re-entry into that
				market is prohibited for five years from the last date of coverage provided in
				that market.
(8) The filing shall
				be submitted to the Office electronically through
				http://www.floir.com/iportal.
Rulemaking Authority 624.308(1), 641.36 FS. Law Implemented
					 624.424, 627.410, 627.6571(3)(b), 641.31074
					 FS.
New 3-1-98, Formerly 4-154.410, Amended
					 7-30-17.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-154 - HEALTH INSURANCE POLICIES › Section 69O-154.512 - Withdrawal From the Small Group Market

Current through Reg. 50, No. 138; July 16, 2024
(1) If a small employer carrier elects to
				withdraw from the small group health insurance market, the carrier must provide
				180 days' written notice to the Office and to all policyholders,
				certificateholders and beneficiaries provided coverage by the carrier in that
				market.
(2) A notice of withdrawal
				from the small group market means an issuer may then non-renew coverage upon
				the next renewal date of policies affected by the withdrawal.
(3) A policy may not be terminated except at
				the next renewal date following the 180 day notice period.
(4) Notice to the Office must include a copy
				of all forms issued in that market.
(5) With respect to notice to policyholders,
				certificateholders, beneficiaries, a mailing to one household constitutes a
				mailing to all covered persons residing in the household.
(6) A separate mailing is required for each
				separate household.
(7) If the
				small employer carrier elects to exit or withdraw from the small group market,
				re-entry into that market is prohibited for five years from the last date of
				coverage provided in that market.
(8) The filing shall be submitted to the
				Office electronically through
				http://www.floir.com/iportal.
Rulemaking Authority 624.308(1) FS. Law Implemented
					 624.424, 627.410, 627.6571 FS.
New 3-1-98, Formerly 4-154.512, Amended
					 7-30-17.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-154 - HEALTH INSURANCE POLICIES › Section 69O-154.530 - Renewal of Group Health Insurance

Current through Reg. 50, No. 138; July 16, 2024
An insurer or health maintenance organization that issues a
				  group health insurance policy must renew or continue in force such coverage at
				  the option of the policyholder. Employers are eligible to renew that exact
				  coverage, subject to the participation requirement provisions of Sections
				  627.6571(2) and
				  641.31074(2),
				  F.S.
Rulemaking Authority 624.308(1), 627.6699(16) FS. Law
					 Implemented 624.307, 627.6571, 641.31074
					 FS.
New 3-12-01, Formerly
					 4-154.530.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-156 - MEDICARE SUPPLEMENT INSURANCE › Section 69O-156.001 - Purpose

Current through Reg. 50, No. 138; July 16, 2024
The purpose of this chapter is to provide for the reasonable
				  standardization and simplification of terms and benefits of Medicare supplement
				  policies; to facilitate public understanding and comparison of such policies;
				  to eliminate provisions contained in such policies which may be misleading or
				  confusing in connection with the purchase of such policies or with the
				  settlement of claims; and to provide for full disclosure in the sale of
				  accident and sickness insurance coverage to persons eligible for
				  Medicare.
Specific Authority 624.308(1) FS. Law Implemented
					 624.307(1), 627.674 FS.
New 1-1-81, Formerly 4-51.01, Amended 11-7-88, 9-4-89,
					 Formerly 4-51.001, Amended 1-1-92, Formerly
					 4-156.001.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-156 - MEDICARE SUPPLEMENT INSURANCE › Section 69O-156.002 - Scope

Current through Reg. 50, No. 138; July 16, 2024
(1)
(a)
				These rules shall apply to all Medicare supplement insurance policies,
				including certificates issued or delivered in this state under a group Medicare
				supplement policy which has been effectuated within or outside this state, and
				other Medicare supplement health benefit plans offered by private entities and
				issued, delivered or issued for delivery in this state on and after January 1,
				1992.
(b) For Medicare supplement
				policies and certificates issued before January 1, 1992, only Rules
				69O-156.006,
				69O-156.010,
				69O-156.011,
				69O-156.014 and
				69O-156.018, F.A.C., shall
				apply.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-156 - MEDICARE SUPPLEMENT INSURANCE › Section 69O-156.003 - Definitions

Current through Reg. 50, No. 138; July 16, 2024
For purposes of this rule:
(1) "Applicant" means:
(a) In the case of an individual Medicare
				supplement policy, the person who seeks to contract for insurance benefits,
				and
(b) In the case of a group
				Medicare supplement policy, the proposed certificate
				holder.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-156 - MEDICARE SUPPLEMENT INSURANCE › Section 69O-156.004 - Policy Definitions and Terms

Current through Reg. 50, No. 138; July 16, 2024
No policy or certificate may be advertised, solicited or
				  issued for delivery in this state as a Medicare supplement policy or
				  certificate unless such policy or certificate contains definitions or terms
				  which conform to the requirements of this section.
(1) "Accident," "accidental injury" and
				"accidental means" shall be defined to employ "result" language and shall not
				include words which establish an accidental means test or use words such as
				"external, violent, visible wounds" or similar words of description or
				characterization.
(a) The definition shall not
				be more restrictive than the following: "Injury or injuries for which benefits
				are provided means accidental bodily injuries sustained by the insured person
				which are the direct result of an accident, independent of disease or bodily
				infirmity or any other cause, and occurs while insurance is in
				force".
(b) Such definition may
				provide that injuries shall not include injuries for which benefits are
				provided or available under any workers' compensation, employers' liability or
				similar law, or motor vehicle no-fault plan, unless prohibited by
				law.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-156 - MEDICARE SUPPLEMENT INSURANCE › Section 69O-156.005 - Policy Provisions

Current through Reg. 50, No. 138; July 16, 2024
(1) Except for
				permitted preexisting condition clauses as described in paragraphs
				69O-156.006(1)(b),
				69O-156.007(1)(a),
				and 69O-156.0075(1)(a),
				F.A.C., of this chapter, no policy or certificate may be advertised, solicited
				or issued for delivery in this State as a Medicare supplement policy if such
				policy or certificate contains limitations or exclusions on coverage that are
				more restrictive than those of Medicare.
(2) No Medicare supplement policy or
				certificate may use waivers to exclude, limit or reduce coverage or benefits
				for specifically named or described preexisting diseases or physical
				conditions.
(3) No Medicare
				supplement policy or certificate in force in the State shall contain benefits
				which duplicate benefits provided by Medicare.
(4)
(a)
				Subject to paragraphs
				69O-156.006(1)(e), (f), and
				(h), and paragraphs
				69O-156.007(1)(d) and
				(e), F.A.C., a Medicare supplement policy
				with benefits for outpatient prescription drugs in existence prior to January
				1, 2006, shall be renewed for current policyholders who do not enroll in Part D
				at the option of the policyholder.
(b) A Medicare supplement policy with
				benefits for outpatient prescription drugs shall not be issued after December
				31, 2005.
(c) After December 31,
				2005, a Medicare supplement policy with benefits for outpatient prescription
				drugs may not be renewed after the policyholder enrolls in Medicare Part D
				unless:
1. The policy is modified to eliminate
				outpatient prescription coverage for expenses of outpatient prescription drugs
				incurred after the effective date of the individual's coverage under a Part D
				plan; and
2. Premiums are adjusted
				to reflect the elimination of outpatient prescription drug coverage at the time
				of Medicare Part D enrollment, accounting for any claims paid, if
				applicable.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-156 - MEDICARE SUPPLEMENT INSURANCE › Section 69O-156.008 - Standard Medicare Supplement Benefit Plans for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or After January 1, 1992, and with an Effective Date for Coverage Prior to June 1, 2010

Current through Reg. 50, No. 138; July 16, 2024
The following applies to all 1990 Standardized Medicare
				  Supplement Benefit Plan Policies or Certificates issued for delivery on or
				  after January 1, 1992, and with an effective date for coverage prior to June 1,
				  2010.
(1) An issuer shall make
				available to each prospective policyholder and certificateholder a policy form
				or certificate form containing only the basic "core" benefits, as defined in
				subsection 69O-156.007(2),
				F.A.C., of this chapter.
(2) No
				groups, packages or combinations of Medicare supplement benefits other than
				those listed in this section shall be offered for sale in this state, except as
				may be permitted in subsection
				69O-156.008(7)
				and Rule 69O-156.030, F.A.C., of this
				chapter.
(3)
(a)
1.
				Benefit plans shall be uniform in structure, language, designation and format
				to the standard benefit plans "A" through "L" as provided in Form OIR-B2-MSC
				(Rev. 11/04), "Outline of Medicare Supplement Coverage", and shall conform to
				the definitions in Rule
				69O-156.003, F.A.C.
2. Form OIR-B2-MSC (Rev. 11/04), "Outline of
				Medicare Supplement Coverage", is hereby adopted and incorporated by reference,
				is available and may be printed from the Office's website:
www.floir.com
.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-156 - MEDICARE SUPPLEMENT INSURANCE › Section 69O-156.0085 - Standard Medicare Supplement Benefit Plans for 2010 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery with an Effective Date for Coverage on or After June 1, 2010

Current through Reg. 50, No. 138; July 16, 2024
The following standards are applicable to all Medicare
				  supplement policies or certificates delivered or issued for delivery in this
				  state with an effective date for coverage on or after June 1, 2010. No policy
				  or certificate may be advertised, solicited, delivered or issued for delivery
				  in this state as a Medicare supplement policy or certificate unless it complies
				  with these benefit plan standards. Benefit plan standards applicable to
				  Medicare supplement policies and certificates issued with an effective date for
				  coverage before June 1, 2010, remain subject to the requirements of Rules
				  69O-156.006,
				  69O-156.007, and
				  69O-156.008, F.A.C.
(1)
(a) An
				issuer shall make available to each prospective policyholder and
				certificateholder a policy form or certificate form containing only the basic
				(core) benefits, as defined in subsection
				69O-156.0075(2),
				F.A.C.
(b) If an issuer makes
				available any of the additional benefits described in subsection
				69O-156.0075(3),
				F.A.C., or offers standardized benefit Plans K or L as described in paragraphs
				69O-156.0085(5)(h) and
				(i), F.A.C., then the issuer shall make
				available to each prospective policyholder and certificateholder, in addition
				to a policy form or certificate form with only the basic (core) benefits as
				described in paragraph (1)(a) above, a policy form or certificate form
				containing either standardized benefit Plan C as described in paragraph
				69O-156.0085(5)(c),
				F.A.C., or standardized benefit Plan F as described in paragraph
				69O-156.0085(5)(e),
				F.A.C.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-156 - MEDICARE SUPPLEMENT INSURANCE › Section 69O-156.0086 - Standard Medicare Supplement Benefit Plans for 2020 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery to Newly Eligible Medicare Beneficiaries with an Effective Date for Coverage on or After January 1, 2020

Current through Reg. 50, No. 138; July 16, 2024
No policy or certificate that provides coverage of the
				  Medicare Part B deductible may be advertised, solicited, delivered or issued
				  for delivery in this state as a Medicare supplement policy or certificate to
				  Newly Eligible Medicare Beneficiary. In accordance with the Medicare Access and
				  CHIP Reauthorization Act of 2015 (Pub. L. No. 114-10, 129 Stat. 87
				  (2015)), all policies must comply with the following benefit standards:
(1) Benefit Requirements. The standards and
				requirements of this rule apply to all Medicare supplement policies or
				certificates delivered or issued for delivery to Newly Eligible Medicare
				Beneficiary. Standardized Medicare supplement benefit Plans C, F, and F with
				High Deductible, as defined in paragraphs
				69O-156.0085(5)(c), (e), and
				(f), F.A.C., may not be offered to Newly
				Eligible Medicare Beneficiaries.
(2) An issuer shall make available to each
				prospective policyholder and certificateholder a policy form or certificate
				form containing the basic (core) benefits, as defined in paragraph
				(6)(a).
(3) If an issuer makes
				available any of the additional benefits described in paragraphs (6)(b)-(i),
				then the issuer shall make available to each prospective policyholder and
				certificateholder, in addition to a policy form or certificate form with only
				the basic (core) benefits as described in subsection (2) above, a policy form
				or certificate form containing either standardized Medicare supplement benefit
				Plan D as described in paragraph (6)(c) or standardized Medicare supplement
				benefit Plan G as described in paragraph (6)(d).
(4) Applicability to Certain Individuals.
				This rule applies only to Newly Eligible Medicare Beneficiaries who are
				enrolled in Medicare Part B:
(a) By reason of
				attaining age 65 on or after January 1, 2020; or
(b) By reason of entitlement to benefits
				under Part A pursuant to sections 226(b) or 226A of the Social Security Act
				(42 U.S.C. §§
											426(b),
				426-1) or who are deemed to be
				eligible for benefits under section 226(a) of the Social Security Act on or
				after January 1, 2020.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-156 - MEDICARE SUPPLEMENT INSURANCE › Section 69O-156.009 - Open Enrollment

Current through Reg. 50, No. 138; July 16, 2024
(1) No issuer shall
				deny or condition the issuance or effectiveness of any Medicare supplement
				policy or certificate available for sale in this State, nor discriminate in the
				pricing of such a policy or certificate because of the health status, claims
				experience, receipt of health care, or medical condition of an applicant in the
				case of an application for a policy or certificate that is submitted prior to
				or during the six (6) month period beginning with the first day of the first
				month in which an individual is both 65 years of age or older and is enrolled
				for benefits under Medicare Part B. Each Medicare supplement policy and
				certificate currently available from an insurer shall be made available to all
				applicants who qualify under this rule without regard to age.
(2)
(a) If
				an applicant qualifies under subsection (1) and submits an application during
				the time period referenced in subsection (1) and, as of the date of
				application, has had a continuous period of creditable coverage of at least six
				(6) months, the issuer shall not exclude benefits based on a pre-existing
				condition.
(b) If the applicant
				qualifies under subsection (1) and submits an application during the time
				period referenced in subsection (1) and, as of the date of application, has had
				a continuous period of creditable coverage that is less than six (6) months,
				the issuer shall reduce the period of any pre-existing condition exclusion by
				the aggregate of the period of creditable coverage applicable to the applicant
				as of the enrollment date. The Secretary shall specify the manner of the
				reduction under this subsection.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-156 - MEDICARE SUPPLEMENT INSURANCE › Section 69O-156.0095 - Guaranteed Issue for Eligible Persons

Current through Reg. 50, No. 138; July 16, 2024
(1) Guaranteed Issue.
(a) Eligible persons are those individuals
				described in subsection (2) who:
1. Seek to
				enroll under the policy during the period specified in subsection (3);
				and
2. Submit evidence of the date
				of termination, disenrollment, or Medicare Part D enrollment with the
				application for a Medicare supplement policy.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-156 - MEDICARE SUPPLEMENT INSURANCE › Section 69O-156.010 - Standards for Claims Payment

Current through Reg. 50, No. 138; July 16, 2024
(1) An
				issuer shall comply with Section 1882(c)(3) of the Social Security Act (as
				enacted by Section 4081(b)(2)(C), of the Omnibus Budget Reconciliation Act of
				1987 (OBRA) 1987, Pub. L. No. 100-203) by:
(a)
				Accepting a notice from a Medicare carrier on dually assigned claims submitted
				by participating physicians and suppliers as a claim for benefits in place of
				any other claim form otherwise required and making a payment determination on
				the basis of the information contained in that notice;
(b) Notifying the participating physician or
				supplier and the beneficiary of the payment determination;
(c) Paying the participating physician or
				supplier directly;
(d) Furnishing,
				at the time of enrollment, each enrollee with a card listing the policy name,
				number and a central mailing address to which notices from a Medicare carrier
				may be sent;
(e) Paying user fees
				for claim notices that are transmitted electronically or otherwise;
				and
(f) Providing to the Secretary
				of Health and Human Services, at least annually, a central mailing address to
				which all claims may be sent by Medicare carriers.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-156 - MEDICARE SUPPLEMENT INSURANCE › Section 69O-156.011 - Loss Ratio Standards and Refund or Credit of Premium

Current through Reg. 50, No. 138; July 16, 2024
(1) Loss Ratio Standards.
(a) A Medicare Supplement policy form or
				certificate form shall not be delivered or issued for delivery unless the
				policy form, certificate form, or block of pooled forms, can be expected, as
				estimated for the lifetime of the policy, to return to policyholders and
				certificateholders in the form of aggregate benefits (not including anticipated
				refunds or credits) provided under the policy form, certificate form, or block
				of pooled forms:
1. At least seventy-five
				percent (75%) of the aggregate amount of premiums earned in the case of group
				policies, or
2. For individual
				policies issued or renewed prior to July 1, 1989, at least 60% of the aggregate
				amount of premiums earned, and for individual policies issued on or after July
				1, 1989, at least sixty-five percent (65%) of the aggregate amount of premiums
				earned, calculated on the basis of incurred claims experience or incurred
				health care expenses where coverage is provided by a health maintenance
				organization on a service rather than reimbursement basis and earned premiums
				for such period and in accordance with accepted actuarial principles and
				practices. Policies and certificates which were marketed and issued as Medicare
				Supplement policies and which have been redefined as limited benefit policies
				shall have the same loss ratio requirements as if they were still defined as
				Medicare Supplement policies. Incurred health care expenses where coverage is
				provided by a health maintenance organization shall not include:
a. Home office and overhead costs;
b. Advertising costs;
c. Commissions and other acquisition
				costs;
d. Taxes;
e. Capital costs;
f. Administrative costs; and
g. Claims processing
				costs.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-156 - MEDICARE SUPPLEMENT INSURANCE › Section 69O-156.012 - Filing and Approval of Policies and Certificates and Premium Rates

Current through Reg. 50, No. 138; July 16, 2024
(1) An issuer shall not deliver or issue for
				delivery a policy or certificate to a resident of this State unless the policy
				form or certificate form has been filed with and approved by the Office
				including any riders or amendments to policy or certificate forms to delete
				outpatient prescription drug benefits as required by the Medicare Prescription
				Drug, Improvement, and Modernization Act of 2003, in accordance with Sections
				627.410,
				627.411,
				627.674, F.S.
(2) An issuer shall not use or change premium
				rates for a Medicare supplement policy or certificate unless the rates, rating
				schedule and supporting documentation have been filed with and approved by the
				Office in accordance with Sections
				627.410,
				627.411,
				627.674, F.S.
(3)
(a)
				Except as provided in paragraph
				69O-156.012(3)(b),
				F.A.C., an issuer shall not file for approval more than one form of a policy or
				certificate of each type for each standard Medicare supplement benefit
				plan.
(b) An issuer may offer, with
				the approval of the Office, up to four (4) additional policy forms or
				certificate forms of the same type for the same standard Medicare supplement
				benefit plan, one for each of the following cases:
1. The inclusion of new or innovative
				benefits;
2. The addition of either
				direct response or agent marketing methods;
3. The addition of either guaranteed issue or
				underwritten coverage;
4. The
				offering of coverage to individuals eligible for Medicare by reason of
				disability.
(c) For the
				purposes of this rule, a "type" means an individual policy, a group policy, an
				individual Medicare Select policy, or a group Medicare Select policy.
(d) Acceptable rate classification criteria
				within a form include only age, gender, area and smoker status or tobacco
				usage.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-156 - MEDICARE SUPPLEMENT INSURANCE › Section 69O-156.013 - Permitted Compensation Arrangements

Current through Reg. 50, No. 138; July 16, 2024
(1) An
				insurer or other entity may provide commission or other compensation to an
				agent or other representative for the sale of a Medicare supplement policy or
				certificate only if the first year commission or other first year compensation
				is no more than 200 percent (200%) of the commission or other compensation paid
				for selling or servicing the policy or certificate in the second year or
				period. However, an issuer on entry, who restricts first agent commission or
				compensation to 15% or less of the policy premium, may elect not to pay any
				commission or other compensation to an agent or other representative for the
				renewal or replacement of a Medicare supplement policy or
				certificate.
(2) The commission or
				other compensation provided in subsequent (renewal) years must be the same as
				that provided in the second year or period and must be provided for no fewer
				than five (5) renewal years.
(3) No
				issuer or other entity shall provide compensation to its agents or other
				producers and no agent or producer shall receive compensation greater than the
				renewal compensation payable by the replacing insurer on renewal policies or
				certificates if an existing policy or certificate is replaced.
(4) For purposes of this rule, "compensation"
				includes pecuniary or non-pecuniary remuneration of any kind relating to the
				sale or renewal of the policy or certificates including but not limited to
				bonuses, gifts, prizes, awards and finders fees.
Rulemaking Authority 627.6742(1) FS. Law Implemented
					 627.6742 FS.
New 12-9-90, Formerly 4-51.022, Amended 1-1-92, Formerly
					 4-156.013.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-156 - MEDICARE SUPPLEMENT INSURANCE › Section 69O-156.016 - Standards for Marketing

Current through Reg. 50, No. 138; July 16, 2024
(1) An issuer,
				directly or through its producers, shall:
(a)
				Establish marketing procedures to assure that any comparison of policies by its
				agents or other producers will be fair and accurate.
(b) Establish marketing procedures to assure
				excessive insurance is not sold or issued.
(c) Display prominently by type, stamp or
				other appropriate means, on the first page of the policy the following: "Notice
				to buyer: This policy may not cover all of your medical expenses."
(d) Inquire and otherwise make every
				reasonable effort to identify whether a prospective applicant or enrollee for
				Medicare supplement insurance already has accident and sickness insurance and
				the types and amounts of any such insurance.
(e) Establish auditable procedures for
				verifying compliance with subsection
				69O-156.016(1),
				F.A.C.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-156 - MEDICARE SUPPLEMENT INSURANCE › Section 69O-156.017 - Appropriateness of Recommended Purchase and Excessive Insurance

Current through Reg. 50, No. 138; July 16, 2024
(1) In recommending the purchase or
				replacement of any Medicare supplement policy or certificate an agent shall
				make reasonable efforts to determine the appropriateness of a recommended
				purchase or replacement.
(2) Any
				sale of Medicare supplement policy or certificate that will provide an
				individual with more than one Medicare supplement policy or certificate is
				prohibited.
(3) An issuer shall not
				issue a Medicare supplement policy or certificate to an individual enrolled in
				Medicare Part C unless the effective date of the coverage is after the
				termination date of the individual's Part C coverage.
Rulemaking Authority 627.674 FS. Law Implemented 627.6744
					 FS.
New 12-9-90, Formerly 4-51.019, Amended 1-1-92, Formerly
					 4-156.017, Amended 9-15-05.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-156 - MEDICARE SUPPLEMENT INSURANCE › Section 69O-156.018 - Reporting of Multiple Policies

Current through Reg. 50, No. 138; July 16, 2024
(1) On or
				before March 1 of each year, an issuer shall report the following information
				for every individual resident of this State for which the issuer has in force
				more than one Medicare supplement policy or certificate:
(a) Policy and certificate number,
				and
(b) Date of
				issuance.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-156 - MEDICARE SUPPLEMENT INSURANCE › Section 69O-156.019 - Prohibition Against Preexisting Conditions, Waiting Periods, Elimination Periods and Probationary Periods in Replacement Policies or Certificates

Current through Reg. 50, No. 138; July 16, 2024
(1) If a Medicare supplement policy or
				certificate replaces another Medicare supplement policy or certificate, the
				replacing issuer shall waive any time periods applicable to preexisting
				conditions, waiting periods, elimination periods and probationary periods in
				the new Medicare supplement policy or certificate to the extent such time was
				spent under the original policy.
(2) If a Medicare supplement policy or
				certificate replaces another Medicare supplement policy or certificate which
				has been in effect for at least six (6) months, the replacing policy shall not
				provide any time period applicable to preexisting conditions, waiting periods,
				elimination periods and probationary periods for benefits similar to those
				contained in the original policy or certificate.
Rulemaking Authority 627.674 FS. Law Implemented 627.6741
					 FS.
New 12-9-90, Formerly 4-51.021, Amended 1-1-92, Formerly
					 4-156.019.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-156 - MEDICARE SUPPLEMENT INSURANCE › Section 69O-156.020 - Prohibition Against Use of Genetic Information and Requests for Genetic Testing

Current through Reg. 50, No. 138; July 16, 2024
(1) An issuer of a
				Medicare supplement policy or certificate;
(a)
				Shall not deny or condition the issuance or effectiveness of the policy or
				certificate (including the imposition of any exclusion of benefits under the
				policy based on a preexisting condition) on the basis of the genetic
				information with respect to such individual; and
(b) Shall not discriminate in the pricing of
				the policy or certificate (including the adjustment of premium rates) of an
				individual on the basis of the genetic information with respect to such
				individual.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-156 - MEDICARE SUPPLEMENT INSURANCE › Section 69O-156.030 - Medicare Select

Current through Reg. 50, No. 138; July 16, 2024
(1)
(a) This rule applies to Medicare Select
				policies and certificates, as defined in this rule.
(b) No policy or certificate may be
				advertised as a Medicare Select policy or certificate unless it meets the
				requirements of this rule.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-156 - MEDICARE SUPPLEMENT INSURANCE › Section 69O-156.050 - Separability

Current through Reg. 50, No. 138; July 16, 2024
If any provision of this regulation or the application
				  thereof to any person or circumstance is for any reason held to be invalid, the
				  remainder of the regulation and the application of such provision to other
				  persons or circumstances shall not be affected thereby.
Rulemaking Authority 624.308(1) FS. Law Implemented
					 624.307(1), 627, Part VIII FS.
New 12-9-90, Formerly 4-51.030,
					 4-156.050.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-156 - MEDICARE SUPPLEMENT INSURANCE › Section 69O-156.101 - Purpose

Current through Reg. 50, No. 138; July 16, 2024
The purpose of these rules is to provide prospective
				  purchasers with clear and unambiguous statements in the advertisement and
				  direct solicitation and sale of Medicare Supplement Insurance, and to assure
				  the clear and truthful disclosure of the benefits, limitations and exclusions
				  of policies sold as Medicare Supplement Insurance. This purpose is intended to
				  be accomplished by the establishment of guidelines and standards of permissible
				  and impermissible conduct in the advertising of Medicare Supplement Insurance
				  to assure that product descriptions are presented in a manner which prevents
				  unfair, deceptive and misleading advertising and is conducive to accurate
				  presentation and description of Medicare Supplement Insurance to the segment of
				  the insurance buying public through the advertising media and material used by
				  insurance agents and companies.
Rulemaking Authority 624.308(1), 626.9611 FS. Law
					 Implemented 624.307(1), 626.830, 626.9541(1)(a), (b), (e), (k), (l),
					 626.9641(1) FS.
New 7-1-79, Formerly 4-46.01, Amended 6-12-88, Formerly
					 4-46.001, 4-156.101.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-156 - MEDICARE SUPPLEMENT INSURANCE › Section 69O-156.102 - Applicability

Current through Reg. 50, No. 138; July 16, 2024
(1) These rules shall apply to any Medicare
				Supplement Insurance "advertisement" or direct solicitation and sale made or
				disseminated in this State which the insurer knows or reasonably should know is
				intended for presentation, distribution or dissemination in this State when
				such presentation, distribution or dissemination is made either directly by an
				insurer or indirectly on behalf of an insurer, by an agent, broker, producer or
				solicitor or any other person who has either actual or apparent authority to
				act on behalf of the insurer; provided the insurer shall not be responsible for
				advertisements that are published in violation of written procedures or
				guidelines of the insurer.
(2)
				Every insurer shall establish and at all times maintain a system of control
				over the content, form, and method of dissemination of all of its Medicare
				Supplement Insurance advertisements. All such advertisements, regardless of by
				whom written, created, designed or presented, shall be the responsibility of
				the insurers benefiting directly or indirectly from their dissemination;
				provided the insurer shall not be responsible for advertisements that are
				published in violation of written procedures or guidelines of the
				insurer.
(3) Advertising materials
				which are reproduced in quantity shall be identified by form numbers or other
				identifying means. Such identification shall be sufficient to distinguish an
				advertisement from any other advertising materials, policies, applications or
				other materials used by the insurer.
Rulemaking Authority 624.308(1), 626.9611 FS. Law
					 Implemented 624.307(1), 626.9541(1)(a), (b), (e), (k), (l), 626.9641(1)
					 FS.
New 6-12-88, Formerly 4-46.0021,
					 4-156.102.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-156 - MEDICARE SUPPLEMENT INSURANCE › Section 69O-156.103 - Definitions

Current through Reg. 50, No. 138; July 16, 2024
For the purpose of these rules, the terms below are defined
				  as follows:
(1) An "Advertisement"
				includes:
(a) Printed and published material,
				audio visual material and descriptive literature used by or on behalf of an
				insurer in direct mail, newspapers, magazines, radio scripts, TV scripts,
				billboards, and similar displays; and
(b) Descriptive literature and sales aids of
				all kinds issued by an insurer, agent, producer, broker, or solicitor or any
				other person who has either actual or apparent authority to act on behalf of
				the insurer for presentation to members of the insurance buying public,
				including, but not limited to, circulars, leaflets, booklets, depictions,
				illustrations, form letters, and lead-generating devices as herein defined;
				and
(c) Prepared sales talks,
				presentations, and material for use by agents, brokers, producers, solicitors,
				announcers, celebrities, and other persons, whether prepared by agents,
				brokers, producers, solicitors, announcers, spokesperson, celebrities, or any
				other person who has either actual or apparent authority to act on behalf of
				the insurer; and
(d) Advertising
				material included with a policy when the policy is delivered and material used
				in the solicitation of any policy.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-156 - MEDICARE SUPPLEMENT INSURANCE › Section 69O-156.104 - Method of Disclosure of Required Information

Current through Reg. 50, No. 138; July 16, 2024
All information required to be disclosed by these rules shall
				  be set out conspicuously and in close conjunction with the statements to which
				  such information relates or under appropriate captions of such prominence that
				  it shall not be minimized, rendered obscure or presented in an ambiguous manner
				  or fashion or intermingled with the context of the advertisement so as to be
				  confusing or misleading.
Rulemaking Authority 624.308(1), 626.9611 FS. Law
					 Implemented 624.307(1), 626.9541(1)(a), (b), (e), (k), (l), 626.9641(1)
					 FS.
New 6-12-88, Formerly 4-46.0023,
					 4-156.104.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-156 - MEDICARE SUPPLEMENT INSURANCE › Section 69O-156.105 - Unfair or Deceptive Acts or Practices Defined

Current through Reg. 50, No. 138; July 16, 2024
It shall be deemed an unfair or deceptive act or practice in
				  the direct solicitation or sale of Medicare supplement insurance policies,
				  to:
(1) Make any representation by an
				agent to the effect that such person is a "Counselor," "Advisor" or similar
				designation, for any association or group of Medicare eligible persons, which
				fails to reflect the actual role of such agent with respect to the solicitation
				or sale of such insurance.
(2) Make
				any misrepresentation or incomplete comparison by the insurance company or
				agent, by commission or omission, for the purpose of inducing or which would
				reasonably be expected to induce Medicare eligible persons to purchase, amend,
				lapse, forfeit, non-renew, change, duplicate coverage already in force, replace
				a policy that is only technically at variance with the policy or policies being
				offered, or otherwise surrender existing insurance.
(3) Do any act which causes an applicant to
				sign any form, application or document in blank.
(4) Use any sales material or presentation
				which does not disclose that an insurance product is involved.
(5) Effect the sale of Medicare supplemental
				insurance to any person not eligible for the Medicare
				Program.
Rulemaking Authority 624.308(1), 626.9611 FS. Law
					 Implemented 624.307(1), 626.830, 626.9541(1)(a), (b), (e), (k), (l),
					 626.9641(1) FS.
New 7-1-79, Formerly 4-46.03, Amended 6-12-88, Formerly
					 4-46.003, 4-156.105.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-156 - MEDICARE SUPPLEMENT INSURANCE › Section 69O-156.106 - Certification Form Required

Current through Reg. 50, No. 138; July 16, 2024
It shall be the responsibility of each agent directly
				  soliciting a policy of Medicare supplemental insurance to complete a form as
				  indicated by Exhibit "A" herein. Substantially equivalent forms may be adopted
				  with the prior approval of the Director. The original copy of such form shall
				  be furnished to the applicant upon the taking of the application and a copy
				  shall be maintained in the files of the company for a period of three
				  years.
"EXHIBIT A"
CERTIFICATION
I, the undersigned insurance agent certify:
THAT, I have taken an application for Policy Form No.
				  ________ offered by the ________ (Name of Insurance Company) to ________
				  (Applicant).
THAT, I have explained the provisions of the policy being
				  applied for, including specifically, all the different benefits, exceptions and
				  limitations of the plan.
THAT, I am a licensed agent of this insurance company and
				  have given a company receipt for an initial premium in the amount of $________
				  (Insert zero if no premium received) which has been paid to me by () Check ()
				  Cash () Money Order (Check appropriate method of payment).
THAT, I have clearly explained any benefits of this plan are
				  a supplement to any benefits that the applicant may be entitled to receive from
				  the Medicare Program of the Federal Government.
THAT, I have not made any representation to the applicant
				  that there is any endorsement whatsoever by the Social Security Administration
				  or the Health Care Financing Administration of the Federal Government in
				  connection with this insurance policy being applied for.
________
____________________________
Date
Signature of Agent
________________________________
____________________________
I, the undersigned
Name of Agency
applicant, have
received a copy of
this form
____________________________
Address of Agent or
Agency
________________________________
________
Applicant's
Phone No.
signature
Rulemaking Authority 624.308(1), 626.9611, 626.9641 FS. Law
					 Implemented 624.307(1), 626.830, 626.9541(1), (2), (3), (5), (11), (12),
					 626.9641(1)(a), (c), (e), (h) FS.
New 7-1-79, Formerly 4-46.04, 4-46.004,
					 4-156.106.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-156 - MEDICARE SUPPLEMENT INSURANCE › Section 69O-156.107 - Form and Content of Advertisements

Current through Reg. 50, No. 138; July 16, 2024
(1) The
				form and content of a Medicare Supplement Insurance advertisement shall be
				sufficiently complete and clear to avoid deception or the capacity or tendency
				to mislead or deceive. Whether an advertisement has a capacity or tendency to
				mislead or deceive shall be determined by the Commissioner of Insurance from
				the overall impression that the advertisement may be reasonably expected to
				create upon a person of average education or intelligence, within the segment
				of the public to which it is directed.
(2) Advertisements shall be truthful and not
				misleading in fact or in implication. Words or phrases whose meanings are clear
				only by implication or by the consumer's familiarity with insurance terminology
				shall not be used.
(3) An insurer
				must clearly identify its Medicare Supplement Insurance policy as an insurance
				policy. With respect to any product first filed to be offered to Florida
				residents on or after the effective date of these rules, a policy trade name
				must be followed by the words "Insurance Policy" or similar words clearly
				identifying the fact that an insurance policy is being offered.
(4) No insurer, agent, broker, producer,
				solicitor or other person shall solicit a resident of this State for the
				purchase of Medicare Supplement Insurance in connection with or as the result
				of the use of any advertisement which:
(a)
				Contains any misleading representations, misrepresentations, or is otherwise
				untrue, deceptive or misleading with regard to the information imparted, the
				status, character or representative capacity of such person or the true purpose
				of the advertisement; or
(b)
				Otherwise violates the provisions of these rules; or
(c) Otherwise violates the provisions of the
				Florida Insurance Code.