reglab/statecodes huggingface dataset:
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-149.031 - Applicability and Scope; Penalties

Current through Reg. 50, No. 138; July 16, 2024
(1) Except
				as otherwise provided, the provisions of the rules in this part shall apply, to
				the extent provided in Section
				627.6699, F.S., and this rule,
				to small employer health benefit plans delivered or issued for delivery in this
				state by an authorized insurer, a health maintenance organization, or any other
				person providing a health benefit plan subject to insurance regulation in this
				state to a small employer group.
(2) The rules in this part shall apply to any
				health benefit plan, whether provided on a group or individual basis, which:
(a) Satisfies Section
				627.6699(4),
				F.S.; and,
(b) Provides coverage to
				one or more employees of a small employer located in this state, without regard
				to whether the policy or certificate was issued in this
				state.
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-149.032 - Requirement to Insure Entire Groups

Current through Reg. 50, No. 138; July 16, 2024
(1) A
				small employer carrier which offers coverage to a small employer shall offer
				coverage to each eligible employee and to each of the dependents of the
				employees who elect coverage. The small employer carrier shall offer the same
				health benefit plans to each employee and dependent.
(2) A small employer carrier is permitted to
				offer the small employer the option of choosing among one or more health
				benefit plans, provided that each employee is permitted to choose any of the
				offered plans.
(3) New entrants to
				a small employer group shall be offered coverage under the health benefit plan
				provided to the group. If a small employer carrier has offered more than one
				health benefit plan to a small employer group, new entrants shall be offered
				the same choice of health benefit plans.
Rulemaking Authority 624.308(1), 627.6699(16) FS. Law
					 Implemented 627.6699(5), (12) FS.
New 3-1-93, Amended 11-7-93, 4-23-95, 8-4-02, Formerly
					 4-149.032.
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-149.033 - Consideration of Industry

Current through Reg. 50, No. 138; July 16, 2024
A small employer carrier shall not consider the occupation of
				  the employees of a small employer or the industry or type of business in which
				  the small employer is engaged in determining whether to issue or continue to
				  provide coverage to the small employer.
Rulemaking Authority 624.308(1), 627.6699(15) FS. Law
					 Implemented 627.6699(12) FS.
New 3-1-93, Amended 11-7-93, Formerly
					 4-149.033.
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-149.037 - Calculation of Premium Rates

Current through Reg. 50, No. 138; July 16, 2024
(1) This
				rule is applicable for all health benefit plans subject to Section
				627.6699, F.S., and is in
				addition to Parts I and II.
(2)
(a) A group's rate shall not be changed due
				to employee age changes which occur during the period when a premium schedule
				is guaranteed.
(b) The rate
				applicable to new or terminating enrollees or any change in dependent status
				shall be made at the premium schedule in effect at the employer's
				policy/certificate anniversary.
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-149.038 - Employee Health Care Access Act Statement Reporting Requirement

Current through Reg. 50, No. 138; July 16, 2024
(1) Pursuant to Section
				627.6699, F.S., each carrier
				that provides health benefit plans in this state shall file an actuarial
				certification, pursuant to paragraph
				69O-149.044(2)(b),
				F.A.C., on or before March 15 of each year that the carrier is in compliance
				with the provisions of section
				627.6699(6),
				F.S., as required by Section
				627.6699(8)(b),
				F.S., for the prior calendar year and that the current rating methods of the
				carrier are actuarially sound. The actuary shall provide a detailed explanation
				if this certification cannot be made.
(2) Quarterly Reports: Within 45 days
				following each calendar quarter each small employer carrier shall file,
				pursuant to paragraph
				69O-149.044(2)(b),
				F.A.C., a report on Form OIR-B2-1117, Florida Employee Health Care Access Act
				Enrollment Report, adopted in Rule
				69O-149.044, F.A.C.
(3)
(a)
1. All small employer carriers utilizing
				rating adjustments pursuant to subsection
				69O-149.037(6),
				F.A.C., shall make semiannual reports that reflect their experience from
				January 1 through June 30 and from July 1 through December 31 of each year. The
				reports shall be filed with the Office, pursuant to paragraph
				69O-149.044(2)(b),
				F.A.C., within 45 days following the last day of the reporting period using
				Form OIR-B2-1575, "Small Employer Group Underwriting Experience Report Form"
				adopted in Rule 69O-149.044, F.A.C.
2. The experience of any group category that
				is not subject to underwriting, pursuant to subsection
				69O-149.037(6),
				F.A.C., such as 1-life groups, shall not be included in the
				report.
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-149.039 - Designation of Election to Become a Risk-Assuming or Reinsuring Carrier Under Section 627.6699, Florida Statutes, the Employee Health Care Access Act

Current through Reg. 50, No. 138; July 16, 2024
(1) A small employer carrier shall file,
				pursuant to paragraph
				69O-149.044(1)(b),
				F.A.C., a final designation of election to become either a risk-assuming
				carrier or a reinsuring carrier using Form OIR-B2-1093, "State of Florida/Small
				Employer Carrier's Application to Become a Risk Assuming Carrier or a
				Reinsuring Carrier, as Required by Section
				627.6699(9),
				F.S.," adopted in Rule
				69O-149.044, F.A.C.
(2) The Office shall provide notice by
				publication of a small employer carrier's designation of election to become a
				risk assuming carrier and shall provide 21 days from publication for comment
				prior to making a decision on the election. The Office shall hold a hearing on
				the election if requested by the carrier.
(3) The Office shall approve or disapprove
				any application within 60 days after filing, based on the criteria in Section
				627.6699(10),
				F.S.
(4) The filing shall be
				submitted to the Office electronically through
				http://www.floir.com/iportal.
Rulemaking Authority 627.6699(17) FS. Law Implemented
					 624.424, 627.6699(9), (10) FS.
New 3-1-93, Amended 11-7-93, 8-4-02, Formerly 4-149.039,
					 Amended 7-30-17.
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-149.040 - Change of Status of Small Employer Carrier's Election to Become Risk-Assuming Carrier or Reinsuring Carrier

Current through Reg. 50, No. 138; July 16, 2024
(1) Any
				small employer carrier seeking to change the election made by the carrier under
				Section 627.6699(9)(a),
				F.S., to become either a risk-assuming carrier or a reinsuring carrier shall
				request a change of status, pursuant to paragraph
				69O-149.044(2)(b),
				F.A.C., on Form OIR-B2-1095, State of Florida/Small Employer Carrier's
				Application to Modify Previous Election to Become a Risk Assuming or a
				Reinsuring Carrier, As Required by Section
				627.6699(9),
				F.S., adopted in Rule
				69O-149.044, F.A.C.
(2) Within 60 days after the form and its
				attached information is filed with the Office, the Office will hold a hearing
				on the request. Within 30 days after the conclusion of the hearing and the
				submission of any post-hearing documentation or argument, the Office will
				approve or disapprove the request, based on the criteria in Section
				627.6699(10)(b),
				F.S.
(3) The filing shall be
				submitted to the Office electronically through
				http://www.floir.com/iportal.
Rulemaking Authority 627.6699(9)(b), (17) FS. Law
					 Implemented 624.424, 627.6699(9), (10), (11)
					 FS.
New 3-1-93, Amended 11-7-93, 8-4-02, Formerly 4-149.040,
					 Amended 7-30-17.
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-149.043 - Small Employer Health Reinsurance Program

Current through Reg. 50, No. 138; July 16, 2024
(1) Beginning January 1, 1994, the board of
				the "Florida Small Employer Health Reinsurance Program," as established in
				Section 627.6699(11),
				F.S., shall consist of the Director or his designee, who shall serve as
				chairman, and eight (8) additional members who are representatives of carriers
				and who are appointed by the commissioner in accordance with the requirements
				of Sections 627.6699(11)(b)3. and 6., F.S., with the restrictions in Section
				627.6699(11)(b)3.a., F.S., and with this rule.
(2) Of the 8 additional members of the board,
				subsequently amended to 13 in the 2000 legislative session, 5 shall be selected
				from individuals recommended by small employer carriers. Any small employer
				carrier wishing to do so may submit a list of recommended appointees to the
				commissioner either on its own behalf or through its trade organization. The
				list shall be submitted to: Insurance Commissioner, Office of Insurance
				Regulation, Larson Building, Tallahassee, FL 32399-0328, or submitted
				electronically to InsuranceCommissioner@floir.com. The carrier or trade
				organization submitting the list shall include the following information about
				the persons it is recommending:
(a) Name,
				present affiliation, business address and business phone number.
(b) Educational background to the extent the
				small employer carrier deems it relevant to the selection process.
(c) Work experience to the extent the small
				employer carrier deems it relevant to the selection process.
(d) Professional qualifications not addressed
				in paragraphs (b) and (c), above, such as membership in professional societies
				and publications, to the extent the small employer carrier deems it relevant to
				the selection process.
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-149.044 - Forms

Current through Reg. 50, No. 138; July 16, 2024
(1) The following forms are hereby adopted
				and incorporated by reference:
(a)
				OIR-B2-1117, Rev. 1/05, Florida Employee Health Care Access Act Enrollment
				Report.
(b) OIR-B2-1093, Rev. 5/02,
				State of Florida/Small Employer Carrier's Application to Become a Risk Assuming
				Carrier or a Reinsuring Carrier, as Required by Section
				627.6475(5),
				F.S.
(c) OIR-B2-1095, Rev. 5/02,
				State of Florida/Small Employer Carrier's Application to Modify Previous
				Election to Become a Risk Assuming or a Reinsuring Carrier, as Required by
				Section 627.6699(9),
				F.S.
(d) OIR-B2-1575, Rev. 10/03,
				Small Employer Group Underwriting Experience Report Form.
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-149.052 - Establishing a Self-Funded Health Benefit Plan

Current through Reg. 50, No. 138; July 16, 2024
(1) Prior to establishing a Self-Funded
				Health Benefit Plan, the local governmental unit shall submit the following:
(a) A copy of its Plan, including a list of
				its offered benefits;
(b) Form
				OIR-B2-570, "General Information on Self-Funded Health Benefit Plans"; as
				adopted in Rule 69O-149.054, F.A.C.;
(c) Form OIR-B2-571 "New Plan Operating
				Projections for Self-Funded Health Benefit Plans"; as adopted in Rule
				69O-149.054, F.A.C.;
(d) Form OIR-B2-573, "Operating Projections
				for Self-Funded Health Benefit Plans"; as adopted in Rule
				69O-149.054, F.A.C.;
				and,
(e) A certification as to the
				actuarial soundness of the Plan prepared by an actuary who is a member of the
				Society of Actuaries or the American Academy of Actuaries accompanied by an
				explanation or basis of how the certification was made.
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-149.053 - On-Going Review of the Self-Funded Health Benefit Plan

Current through Reg. 50, No. 138; July 16, 2024
(1) Once the Plan has been approved by the
				Office and has commenced operations, the local governmental unit shall submit
				the following, no later than 90 days after the close of the Plan's fiscal year:
(a) Form OIR-B2-570, "General Information on
				Self-Funded Health Benefit Plans," as adopted in Rule
				69O-149.054, F.A.C.;
(b) Form OIR-B2-572, "Annual Report of
				Self-Funded Health Benefit Plans," as adopted in Rule
				69O-149.054, F.A.C.;
(c) Form OIR-B2-573, "Operating Projections
				for Self-Funded Health Benefit Plans," as adopted in Rule
				69O-149.054, F.A.C.;
(d) Form OIR-B2-574, "General Information and
				Surplus Statement for Self-Funded Health Benefit Plans," as adopted in Rule
				69O-149.054, F.A.C.;
				and,
(e) A certification as to the
				actuarial soundness of the Plan prepared by an actuary who is a member of the
				Society of Actuaries or the American Academy of Actuaries accompanied by an
				explanation or basis of how the certification was made.
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-149.054 - Forms Incorporated by Reference

Current through Reg. 50, No. 138; July 16, 2024
(1) The
				following forms are hereby adopted and incorporated by reference:
(a) Form OIR-B2-570 (12/03) "General
				Information on Self-Funded Health Benefit Plans";
(b) Form OIR-B2-571 (12/03) "New Plan
				Operating Projections for Self-Funded Health Benefit Plans";
(c) Form OIR-B2-572 (12/03) "Annual Report of
				Self-Funded Health Benefit Plans";
(d) Form OIR-B2-573 (12/03) "Operating
				Projections for Self-Funded Health Benefit Plans";
(e) Form OIR-B2-574 (12/03) "General
				Information and Surplus Statement for Self-Funded Health Benefit
				Plans";
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-149.200 - Purpose

Current through Reg. 50, No. 138; July 16, 2024
The purpose of this part is to establish the standard annual
				  risk rates pursuant to Section
				  627.6675(3),
				  F.S., to be used as the maximum rate for group conversion insurance forms and
				  by the Florida Comprehensive Health Association ("FCHA") in establishing rates
				  for coverages issued by the association.
Rulemaking Authority 624.308, 627.6675(3)(c) FS. Law
					 Implemented 624.307(1), 627.6498(4), 627.6675(3), 627.6498(4), 641.3922(3),
					 FS.
New 3-2-00, Formerly
					 4-149.200.
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-149.201 - Scope

Current through Reg. 50, No. 138; July 16, 2024
The provisions of this part shall apply to all group
				  conversion coverage issued or renewed in Florida on or after the effective date
				  of this rule for coverage issued:
(1)
				As an individual policy; or
(2) As
				a certificate under a group policy; including group policies issued or
				delivered outside of this state.
Rulemaking Authority 624.308, 627.6675(3)(c) FS. Law
					 Implemented 624.307(1), 627.6498(4), 627.6675(3), 641.3922(3)
					 FS.
New 3-2-00, Amended 4-2-01, Formerly
					 4-149.201.
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-149.202 - Standard Risk Rate

Current through Reg. 50, No. 138; July 16, 2024
(1) Standard risk
				rates, pursuant to the provisions of Section
				627.6675(3),
				F.S., are provided for the following "categories of coverages":
(a) Indemnity policies;
(b) Preferred provider organization
				("PPO")/exclusive provider organization ("EPO") policies; and,
(c) Health maintenance organization ("HMO")
				contracts.
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-149.203 - Group Conversion Premium

Current through Reg. 50, No. 138; July 16, 2024
(1) The
				maximum group conversion rates to be charged an insured shall not exceed the
				standard risk rate times 2.0.
(2)
				All rate filings shall provide a comparison table clearly identifying benefit
				differences from those benefits listed in rule
				69O-149.204, F.A.C., from which
				the standard risk rates contained in this part were derived.
(3) The maximum group conversion rate
				determined in subsection (1), above, shall be adjusted for benefit differences
				from those benefits used for the standard risk rates based on a common
				morbidity basis of all other individual major medical forms of the company, or
				if none, other major medical group forms for the same category of coverage.
				Such adjustment factor shall be included in the comparison table of subsection
				(2), above, for each benefit difference identified. For purposes of this
				subsection, "common morbidity" means a set of values for the frequency and
				intensity of claims from which claim costs for a set of benefits may be
				calculated.
(4) A company providing
				coverage issued on a family basis may file a family factor for approval. Any
				such factor proposed for approval may be no greater than that used by the
				company for other individual major medical products, or if none, other similar
				products.
(5) Terminating employees
				or members shall be offered the same "category of coverage" (see subsection
				69O-149.202(1),
				F.A.C.) as the underlying group policy form from which they are being offered
				conversion coverage.
(6) The
				following benefit adjustment factors to reflect the benefit difference from the
				$1,000 deductible plan provided in this part will be accepted without further
				justification required by subsection (8):
(a)
				1.171, for $250 deductible;
(b)
				1.107, for $500 deductible;
(c)
				1.050, for $750 deductible;
(d)
				0.914, for $1,500 deductible;
(e)
				0.847, for $2,000 deductible;
(f)
				0.797, for $2,500 deductible;
(g)
				0.632, for $5,000 deductible.
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-149.204 - Outline of Coverage (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 624.308, 627.6675(3)(c) FS. Law
					 Implemented 624.307(1), 627.6498(4), 627.6675(3), 641.3922(3)
					 FS.
New 3-2-00, Amended 4-2-01, 4-17-02, Formerly 4-149.204,
					 Amended 5-18-04, Repealed 11-21-17.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-150 - LIFE AND HEALTH ADVERTISING REQUIREMENTS › Section 69O-150.001 - 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 of health
				  insurance, and to assure the clear, truthful and adequate disclosure of the
				  benefits, limitations and exclusions of policies sold as health insurance. This
				  purpose is intended to be accomplished by the establishment of guidelines and
				  standards of permissible and impermissible conduct in the advertising of health
				  insurance to assure that product descriptions are presented in a manner which
				  prevents unfair, deceptive and misleading advertising and is conducive to the
				  accurate presentation and description of health insurance to 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), 626.9541(1)(a), (b), (e), (k), (l), 626.9641
					 FS.
New 1-19-73, Repromulgated 12-24-74, Formerly 4-6.01,
					 Amended 6-13-88, Formerly 4-6.001,
					 4-150.001.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-150 - LIFE AND HEALTH ADVERTISING REQUIREMENTS › Section 69O-150.002 - Applicability

Current through Reg. 50, No. 138; July 16, 2024
(1) These rules shall apply to any Health
				Insurance "advertisement," 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) 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.
(3) Except where specifically provided
				otherwise, these rules shall apply to advertisements for long-term care
				policies issued pursuant to Sections 627.9401-.9408, F.S.
Rulemaking Authority 624.308(1), 626.9611, 627.9407(1), (2)
					 FS. Law Implemented 624.307(1),
					 626.451(3),
					 626.9541(1)(a), (b), (e), (k),
					 (l),
					 626.9641(1),
					 627.9407(1),
					 (2)
					 FS.
New 1-19-73, Repromulgated 12-24-74, Formerly 4-6.02,
					 Amended 6-13-88, 5-17-89, Formerly 4-6.002, Amended 1-4-00, Formerly
					 4-150.002.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-150 - LIFE AND HEALTH ADVERTISING REQUIREMENTS › Section 69O-150.003 - 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 any method of communicaton listed in Sections 626.9541(1)(b)1. through
				4., F.S.
(2) The definition of
				"Advertisement" does not include:
(a) Material
				to be used solely for the training and education of an insurer's employees,
				agents, or brokers;
(b) Material
				used exclusively in-house by insurers;
(c) Communications within an insurer's own
				organization not intended for dissemination to the public;
(d) Individual communications of a personal
				nature with current policyholders regarding existing coverage other than
				material urging such policyholders to renew, increase or expand
				coverages;
(e) Correspondence
				between a prospective group or blanket policyholder and an insurer in the
				course of negotiating a group or blanket contract;
(f) Court approved material ordered by a
				court to be disseminated to policyholders; or
(g) A general announcement from a group or
				blanket policyholder to eligible individuals on an employment or membership
				list which may include a brief description of coverage and is primarily a
				notification that a contract or program has been written or arranged; provided,
				the announcement must clearly indicate that it is preliminary to the issuance
				of a booklet, pamphlet, brochure or other similar paper preliminary to coverage
				by the insurer.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-150 - LIFE AND HEALTH ADVERTISING REQUIREMENTS › Section 69O-150.004 - 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
				  fashion or intermingled with the context of the advertisement so as to be
				  confusing or misleading.
Rulemaking Authority 624.308, 626.9611 FS. Law Implemented
					 624.307(1), 626.9541(1), (2) FS.
New 1-19-73, Repromulgated 12-24-74, Formerly 4-6.04,
					 4-6.004, 4-150.004.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-150 - LIFE AND HEALTH ADVERTISING REQUIREMENTS › Section 69O-150.005 - Form and Content of Advertisements

Current through Reg. 50, No. 138; July 16, 2024
(1) The
				form and content of a Health 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 Director 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)
(a) An
				insurer must clearly identify its health insurance policy as an insurance
				policy in its advertisements.
(b)
				The name of any policy shall be followed by or include the words "Insurance
				Policy" or similar words clearly identifying, the fact that an insurance policy
				is being offered, through the use of the full generic name of the product;
				e.g., long term care insurance policy, major medical insurance policy, limited
				benefit health insurance policy, or disability insurance
				policy.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-150 - LIFE AND HEALTH ADVERTISING REQUIREMENTS › Section 69O-150.007 - Necessity for Disclosing Policy Provisions Relating to Renewability, Cancellability, and Termination

Current through Reg. 50, No. 138; July 16, 2024
An advertisement which is an invitation to contract shall
				  disclose the provisions relating to renewability, cancellability and
				  termination and any modification of benefits, losses covered or premiums
				  because of age or for other reasons, in a manner which shall not minimize or
				  render obscure the qualifying conditions.
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 1-19-73, Repromulgated 12-24-74, Formerly 4-6.07,
					 Amended 6-13-88, Formerly 4-6.007,
					 4-150.007.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-150 - LIFE AND HEALTH ADVERTISING REQUIREMENTS › Section 69O-150.008 - Testimonials or Endorsements by Third Parties

Current through Reg. 50, No. 138; July 16, 2024
(1) Testimonials and endorsements used in
				advertisements must be genuine, represent the current opinion of the author, be
				applicable to the policy advertised and be accurately reproduced. The insurer,
				in using a testimonial or endorsement, makes as its own all of the statements
				contained therein, and the advertisement, including such statement is subject
				to all the provisions of these rules. When a testimonial or endorsement is used
				more than one year after it was originally given, a confirmation must be
				obtained.
(2) A person shall be
				deemed a "spokesperson" if the person making the testimonial or endorsement:
(a) Has a financial interest in the insurer
				or a related entity as a stockholder, director, officer, employee or otherwise;
				or
(b) Is an entity formed by the
				insurer, is owned or controlled by the insurer, its employees, or the person or
				persons who own or control the insurer; or
(c) Is in a policy-making position who is
				affiliated with the insurer in any of the above described capacities;
				or
(d) Is in any way directly or
				indirectly compensated for making a testimonial or
				endorsement.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-150 - LIFE AND HEALTH ADVERTISING REQUIREMENTS › Section 69O-150.009 - Use of Statistics

Current through Reg. 50, No. 138; July 16, 2024
(1) An advertisement
				relating to the dollar amount of claims paid, the number of persons insured, or
				similar statistical information relating to any insurer or policy or contract
				shall not use irrelevant facts, and shall not be used unless it accurately
				reflects all of the relevant facts. Such an advertisement shall not imply that
				such statistics are derived from the policy or contract advertised unless such
				is the fact, and when applicable to other policies or contracts or plans shall
				specifically so state.
(a) An advertisement
				shall specifically identify the policy to which statistics relate and, where
				statistics are given which are applicable to a different policy, it must be
				stated clearly that the data do not relate to the policy being
				advertised.
(b) An advertisement
				shall not contain statements which are untrue in fact, or by implication
				misleading, with respect to the assets, corporate structure, financial
				standing, age or relative position of the insurer in the insurance
				business.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-150 - LIFE AND HEALTH ADVERTISING REQUIREMENTS › Section 69O-150.010 - Identification of Plan or Number of Policies

Current through Reg. 50, No. 138; July 16, 2024
(1) When a choice of the amount of benefits
				is referred to, an advertisement shall disclose that the amount of benefits
				provided depends upon the plan selected and that the premium will vary with the
				amount of the benefits selected.
(2) When an advertisement refers to various
				benefits which may be contained in two or more policies, other than group
				master policies, the advertisement shall disclose that such benefits are
				provided only through a combination of such policies.
Rulemaking Authority 624.308, 626.9611 FS. Law Implemented
					 624.307(1), 626.9541(1), (2) FS.
New 1-19-73, Repromulgated 12-24-74, Formerly 4-6.10,
					 4-6.010, 4-150.010.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-150 - LIFE AND HEALTH ADVERTISING REQUIREMENTS › Section 69O-150.011 - Disparaging Comparisons and Statements

Current through Reg. 50, No. 138; July 16, 2024
(1) An advertisement shall not directly or
				indirectly make unfair or incomplete comparisons of policies or contracts or
				benefits or comparisons of non-comparable policies or contracts of other
				insurers, and shall not disparage competitors, their policies, or contracts,
				services or business methods, and shall not disparage or unfairly minimize
				competing methods of marketing insurance.
(2) An advertisement should not contain
				statements such as "no red tape" or "here is all you do to receive
				benefits."
(3) Advertisements which
				state or imply that competing insurance coverage customarily contain certain
				exceptions, reductions or limitations not contained in the advertised policies
				are unacceptable unless such exceptions, reductions or limitations are
				contained in a substantial majority of such competing coverages.
(4) Advertisements which state or imply in a
				misleading or incomplete manner that an insurer's premiums are lower or that
				its loss ratios are higher because its organizational structure differs from
				that of competing insurers shall not be used.
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 1-19-73, Repromulgated 12-24-74, Formerly 4-6.11,
					 Amended 6-13-88, Formerly 4-6.011,
					 4-150.011.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-150 - LIFE AND HEALTH ADVERTISING REQUIREMENTS › Section 69O-150.012 - Jurisdictional Licensing and Status of Insurer

Current through Reg. 50, No. 138; July 16, 2024
(1) An advertisement which is intended to be
				seen or heard beyond the limits of the jurisdiction in which the insurer is
				licensed shall not imply licensing beyond those limits.
(2) An advertisement shall not create the
				impression directly or indirectly that the insurer, its financial condition or
				status, or the payment of its claims, or the merits, desirability, or
				advisability of its policy forms or kinds of plans of insurance are approved,
				endorsed, or accredited by any division or agency of this State or the United
				States Government or if such relationship exists, such advertisement shall not
				exaggerate or otherwise be misleading with respect to the nature or extent of
				such relationship.
(3) An
				advertisement shall not imply in a misleading manner that approval,
				endorsement, or accreditation of policy forms or advertising has been granted
				by any division or agency of the state or federal government. "Approval" of
				either policy forms or advertising shall not be used by an insurer to imply or
				state that a governmental agency has endorsed or recommended the insurer, its
				policies, advertising or its financial conditions.
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 1-19-73, Repromulgated 12-24-74, Formerly 4-6.12,
					 Amended 6-13-88, Formerly 4-6.012,
					 4-150.012.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-150 - LIFE AND HEALTH ADVERTISING REQUIREMENTS › Section 69O-150.013 - Identity of Insurer

Current through Reg. 50, No. 138; July 16, 2024
(1)
(a) The name of the actual insurer shall be
				stated in all of the insurer's advertisements.
(b) The form number or numbers of the policy
				advertised shall be stated in any invitation to contract.
(c) An advertisement shall not use a trade
				name, any insurance group designation, name of the parent company of the
				insurer, name of a particular division of the insurer, name of any reinsurere
				or any other party, service mark, slogan, symbol or other device which would be
				misleading as to the true identity of the insurer or create the false
				impression that the parent company or reinsurer or any other party would have
				any responsibility for the finacial obligation of the
				insurer.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-150 - LIFE AND HEALTH ADVERTISING REQUIREMENTS › Section 69O-150.014 - Group or Quasi-Group Implications

Current through Reg. 50, No. 138; July 16, 2024
(1) An
				advertisement of a particular policy shall not state or imply that prospective
				insureds become group or quasi-group members covered under a group policy and
				as such enjoy special rates or underwriting privileges, unless such is the
				fact.
(2) No solicitation of a
				particular class, such as governmental employees, shall state or imply that the
				occupational status of group members entitles them to reduced rates on a group
				or other basis when, in fact, the policy being advertised is sold only on an
				individual basis at regular rates.
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 1-19-73, Repromulgated 12-24-74, Formerly 4-6.14,
					 Amended 6-13-88, Formerly 4-6.014,
					 4-150.014.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-150 - LIFE AND HEALTH ADVERTISING REQUIREMENTS › Section 69O-150.016 - Statements About an Insurer

Current through Reg. 50, No. 138; July 16, 2024
(1) An
				advertisement shall not contain statements which are untrue in fact, or by
				implication misleading, with respect to the assets, corporate structure,
				financial standing, age or relative position of the insurer in the insurance
				business.
(2) An advertisement
				shall not contain a recommendation by any commercial rating system unless the
				advertisement clearly indicates the purpose of the recommendation and the
				limitations of the scope and extent of the recommendation.
(3) An advertisement shall not refer to a
				holding company or subsidiary of an insurer unless the advertisement fully
				discloses that the holding company or subsidary is a separate entity and not
				responsible for the insurer's financial condition or contractual
				obligations.
Rulemaking Authority 624.308, 626.9611 FS. Law Implemented
					 624.307(1), 626.9541(1), (2) FS.
New 1-19-73, Repromulgated 12-24-74, Formerly 4-6.16,
					 4-6.016, Amended 1-4-00, Formerly
					 4-150.016.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-150 - LIFE AND HEALTH ADVERTISING REQUIREMENTS › Section 69O-150.018 - Enforcement Procedures

Current through Reg. 50, No. 138; July 16, 2024
(1) Each insurer
				shall maintain at its home or principal office a complete file containing:
(a) Every printed, published or prepared
				advertisement of its individual policies;
(b) Typical printed, published or prepared
				advertisements of its blanket, franchise and group policies hereafter
				disseminated in this; and,
(c) A
				notation attached to each advertisement indicating the manner and extent of
				distribution and the form number of any policy advertised.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-150 - LIFE AND HEALTH ADVERTISING REQUIREMENTS › Section 69O-150.019 - Filing for Review

Current through Reg. 50, No. 138; July 16, 2024
(1) An insurer
				shall file with the Office all long-term care insurance advertising material
				intended for use in this state at least thirty (30) days prior to use of the
				advertisement in this state as required by Section
				627.9407(2),
				F.S.
(2) Only advertisements that
				are required by law to be filed will be routinely received and reviewed by the
				Office.
Rulemaking Authority 624.308(1), 626.9611, 627.9407(1), (2)
					 FS. Law Implemented 624.307(1),
					 626.9541(1)(a), (b), (e), (k),
					 (l),
					 626.9641,
					 627.9407(1),
					 (2)
					 FS.
New 6-13-88, Amended 5-17-89, Formerly 4-6.0185, Amended
					 4-21-98, 1-4-00, 12-5-00, Formerly
					 4-150.019.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-150 - LIFE AND HEALTH ADVERTISING REQUIREMENTS › Section 69O-150.020 - Severability Provision

Current through Reg. 50, No. 138; July 16, 2024
If any section or portion of a section of these rules, or any
				  amendment thereto, or the applicability thereof to any person or circumstance
				  is held invalid by a court, the remainder of the rules, or the applicability of
				  such provision to other persons or circumstances shall not be affected
				  thereby.
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 1-19-73, Repromulgated 12-24-74, Formerly 4-6.19,
					 Amended 6-13-88, Formerly 4-6.019,
					 4-150.020.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-150 - LIFE AND HEALTH ADVERTISING REQUIREMENTS › Section 69O-150.021 - Prior Rules

Current through Reg. 50, No. 138; July 16, 2024
These rules supersede and constitute a revision of all prior
				  rules pertaining to solicitation and sale of Health Insurance
				  policies.
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 1-19-73, Repromulgated 12-24-74, Formerly 4-6.20,
					 Amended 6-13-88, Formerly 4-6.020,
					 4-150.021.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-150 - LIFE AND HEALTH ADVERTISING REQUIREMENTS › Section 69O-150.101 - 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 of Life
				  Insurance and Annuity Contracts, and to assure the clear, truthful and adequate
				  disclosure of the benefits, limitations and exclusions of policies sold as Life
				  Insurance and Annuity Contracts. This purpose is intended to be accomplished by
				  the establishment of guidelines and standards of permissible and impermissible
				  conduct in the advertising of Life Insurance and Annuity Contracts 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 Life Insurance and Annuity Contracts 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), 626.9541(1)(a), (b), (e), (k), (l), 626.9641
					 FS.
New 9-1-73, Formerly 4-35.01, Amended 6-12-88, Formerly
					 4-35.001, 4-150.101.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-150 - LIFE AND HEALTH ADVERTISING REQUIREMENTS › Section 69O-150.102 - Applicability

Current through Reg. 50, No. 138; July 16, 2024
(1) These rules shall apply to any Life
				Insurance Policy and Annuity Contract "advertisement," 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. Further, provided, that in variable contracts where
				disclosure requirements are established pursuant to Federal regulation, these
				rules shall be interpreted so as to minimize or eliminate conflict with such
				Federal Regulation wherever possible.
(2) 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, 627.805 FS. Law
					 Implemented 624.307(1), 626.9541(1)(a), (b), (e), (g), (k), (l), 626.9641(1),
					 626.99, 627.460 FS.
New 9-1-73, Formerly 4-35.02, Amended 6-12-88, Formerly
					 4-35.002, Amended 5-27-96, 1-4-00, Formerly
					 4-150.102.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-150 - LIFE AND HEALTH ADVERTISING REQUIREMENTS › Section 69O-150.103 - 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 any method of communication listed in Sections 626.9541(1)(b)1.
				through 4., F.S.
(2) The definition
				of "Advertisement" does not include:
(a)
				Material to be used solely for the training and education of an insurer's
				employees, agents, or brokers;
(b)
				Material used exclusively in-house by insurers;
(c) Communications within an insurer's own
				organization not intended for dissemination to the public;
(d) Individual communications of a personal
				nature with current policyholders regarding existing coverage other than
				material urging such policyholders to renew, increase or expand
				coverages;
(e) Correspondence
				between a prospective group policyholder and an insurer in the course of
				negotiating a group contract;
(f)
				Court approved material ordered by a court to be disseminated to policyholders;
				or
(g) A general announcement from
				a group policyholder to eligible individuals on an employment or membership
				list which may include a brief description of coverage and is primarily a
				notification that a contract or program has been written or arranged; provided,
				the announcement must clearly indicate that it is preliminary to the issuance
				of a booklet, pamphlet, brochure or other similar paper preliminary to coverage
				by the insurer.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-150 - LIFE AND HEALTH ADVERTISING REQUIREMENTS › Section 69O-150.104 - 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, in the same size type as that used in the body of the
				  advertisement, 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 fashion,
				  or intermingled with the context of the advertisement so as to be confusing or
				  misleading.
Rulemaking Authority 624.308 FS. Law Implemented
					 624.307(1), 626.9541(1) FS.
New 9-1-73, Formerly 4-35.04, Amended 2-26-92, Formerly
					 4-35.004, 4-150.104.