Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69B - Division of Insurance Agent and Agency Services › Chapter 69B-230 - GENERAL ETHICS AND DISCLOSURE REQUIREMENTS FOR INSURANCE REPRESENTATIVES › Section 69B-230.033 - Reporting Requirements for Licensees Concerning Unlicensed Insurance Activity by Multiple Employer Welfare Arrangements, Labor Leasing Organizations, and Purportedly Collectively Bargained Plans

Current through Reg. 50, No. 138; July 16, 2024
(1) Purpose. The purpose of this rule section
				is to require licensed insurers, managed care entities, agents, brokers,
				third-party administrators, adjusters, and other licensees of the Department to
				submit to the Department information of which they become aware concerning
				unlicensed insurance activity in this State. Such information will assist the
				Department in identifying unlicensed insurance activity in advance of its
				occurrence and will therefore aid in protecting the public from such
				activity.
(2) Definitions. For
				purposes of this rule, the following definitions shall apply.
(a) "Agent" means and includes any person
				holding any type and class of licensure, whether limited or unlimited, issued
				by the Department under Chapter 626, F.S. The term also includes any person
				licensed or registered by the Department as an agent, sales representative,
				sales agent, salesperson, runner, or bail bondsman, under any of the following
				statutes: Section  632.634, F.S., (fraternal
				benefit agents); Section
				 634.031, F.S., (warranty
				association sales person); Section
				 635.051, F.S., (mortgage
				guaranty insurance agent); Section
				 637.141, F.S., (optometric
				service plan sales representative); Section
				 637.301, F.S., (pharmaceutical
				service plan sales representative); Section
				 638.181, F.S., (ambulance
				service association or insurer sales representative); Section
				 639.185, F.S., (pre-need funeral
				merchandise or services contract sales agent); Section
				 641.386, F.S., (health
				maintenance organization sales agent); Section
				 642.036, F.S., (legal expense
				insurance sales representative); or Section
				 648.30, F.S., (bail bondsman or
				bail runner). The term includes such persons whether residents of Florida or
				not.
(b) "Arrangement" means a
				fund, trust, plan, instrument, program, association, union, or other entity or
				mechanism, any portion of which does, or purports to, provide for the transfer
				of the risk of loss, damage, or expense resulting from a fortuitous event, from
				the person or entity having incurred the loss, damage, or expense, to
				another.
(c) "Collectively
				bargained arrangement" means an arrangement (as defined in paragraph (2)(b),
				hereof), that exists pursuant to one or more bona fide labor agreements,
				including arrangements that are sponsored by a union or a union local. For
				purposes of the reporting requirements of this rule, the term also includes
				arrangements in which both union members and non-members do or may participate.
				For purposes of this rule, a collectively bargained arrangement does not
				include an arrangement which is fully insured by a licensed insurer for so long
				as the arrangement stays fully insured.
(d) "Department" means the Florida Department
				of Financial Services.
(e)
				"Employee" means any individual employed by an employer.
(f) "Employee leasing" means a relationship
				whereby an employee leasing company assigns its employees to a client and
				allocates the direction of and control over the leased employees between the
				leasing company and the client. The definition includes, and is subject to the
				conditions, exclusions and limitations of Chapter 468, Part XI, F.S., and rules
				promulgated in accordance therewith. Notwithstanding, for as long as an
				employee leasing company makes available insurance benefits only through
				licensed insurers, such employee leasing company shall not be a subject of the
				reporting requirements of this rule.
(g) "Welfare benefit plan" means any plan,
				fund or program maintained by an employer or by an employee organization, or by
				both, to the extent that such plan, fund or program was established or is
				maintained in whole or in part for the purpose of providing for its
				participants or their beneficiaries, through the purchase of insurance or
				otherwise, medical, surgical or hospital care or benefits, or benefits in the
				event of sickness, accident, disability, death or unemployment.
(h) "Employee organization" means any labor
				union or any organization of any kind, or any agency or employee representation
				committee, association, group, or plan, in which employees participate and
				which exists for the purpose, in whole or in part, of dealing with employers
				concerning an employee benefit plan, or other matters incidental to employment
				relationships; or any employees' beneficiary association organized for the
				purpose in whole or in part, of establishing such a plan.
(i) "Employer" means any person acting
				directly as an employer, or indirectly in the interest of an employer, in
				relation to an employee benefit plan; and includes a group or association of
				employers acting for an employer in such capacity.
(j) "Reportable MEWA," for purposes of this
				rule, means a person that provides or offers insurance benefits or coverage to
				the employees of two or more employers, whether alone or with other benefits.
				"Reportable MEWA" does not include:
1. A
				licensed insurer;
2. An arrangement
				which is fully insured by a licensed insurer for so long as the arrangement
				stays fully insured;
3. An employee
				welfare benefit plan established or maintained by a rural electric cooperative
				or a rural telephone cooperative; or
4. A MEWA licensed by the
				Department.
(k) "Third
				party administrator" or "TPA" means "administrator" under Section
				 626.88, F.S., and includes, but
				is not limited to, all persons licensed by the department as
				administrators.
(l) "Unlicensed
				insurer" is any insurer as defined in Section
				 624.03, F.S., including
				self-insurers, which has not been licensed to transact insurance by the
				Department under the provisions of the Florida Insurance Code; except that any
				person or group authorized to self-insure for workers' compensation coverage
				pursuant to Sections  440.38(1),
				 440.57, and
				 440.575, F.S., and the rules of
				the Florida Department of Financial Services, Division of Workers'
				Compensation, is not an "unlicensed insurer" for purposes of this rule. The
				term includes any plan required to be licensed under the provisions of Chapter
				632 or 634-651, F.S.