Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-154 - HEALTH INSURANCE POLICIES › Section 69O-154.105 - Standards for Policy Provisions

Current through Reg. 50, No. 138; July 16, 2024
(1)
				Terms of renewability - Each individual or family policy of accident and health
				insurance shall include a renewal, continuation or nonrenewal provision. The
				language or specifications of such provision must be consistent with the type
				of contract to be issued (e.g., noncancellable and guaranteed renewable,
				guaranteed renewable, renewable at the option of the insurer, single term
				nonrenewable, etc.). Such provision must be appropriately captioned and
				commence or be referenced on the first page of the policy and must clearly
				state the duration, where limited, of renewability and the duration of the term
				of coverage for which the policy is issued and for which it may be renewed.
(a) Noncancellable and Guaranteed Renewable
				Policy - A renewal provision of a policy characterized as "noncancellable and
				guaranteed renewable" must be consistent with the minimum requirements as
				adopted and set forth in Rule
				69O-154.004, F.A.C. In a family
				policy covering both husband and wife the age of the younger spouse must be
				used as the basis for fulfilling the age (at least to age 50) or durational
				(for at least 5 years if issued after age 44) requirements of the definitions
				of "noncancellable" and "guaranteed renewable" policies for the purpose of
				defining the period of guaranteed renewability of the policy. This requirement
				shall not prevent termination of coverage of the older spouse upon attainment
				of the state age limit (e.g., age 65) so long as the policy may be continued in
				force as to the younger spouse to the age or for the durational period as
				specified in said definition.
(b)
				Guaranteed Renewable Policy - The renewal provision used in a policy which is
				characterized as a "guaranteed renewable policy" must be consistent with the
				minimum requirements of Rule
				69O-154.004, F.A.C. The renewal
				provision of a "guaranteed renewable policy" will be the same as that contained
				in a "noncancellable and guaranteed renewable policy" except for the
				reservation of the right to the insurer to change premium on a class basis.
				Such right shall be clearly expressed within the renewal provision and
				referenced in the caption of such provision.
(c) Renewable Subject to Consent of Company
				and Variants Thereof.
1. The renewal
				provision of a policy characterized as "renewable subject to the consent of the
				company" shall be appropriately captioned as:
a. Renewable Subject to Consent of Company;
				or
b. Renewable Subject to Company
				Consent; or
c. Renewable at Option
				of Company.
The designated captions are without prejudice to the right of
				  the insurer to submit another caption, subject to the approval of the Director,
				  which it believes is equally clear or more definitive as to the subject matter
				  of said provision. The provision shall clearly declare that renewal of the
				  policy is subject to the consent of the insurer and that the premium rate
				  applicable to such policy shall be that currently in use on each renewal date
				  of the policy. If the insurer reserves the right of cancellation, notice of the
				  existence of the provision shall be cross-referenced in the renewal
				  provision.
2.
				Conditional or limited continuance - A policy which provides a qualified right
				of continuance after expiration of the period during which such policy is
				"noncancellable and guaranteed renewable" or "guaranteed renewable" must
				clearly specify the conditions, such as continued gainful employment, which
				must be fulfilled to permit continuance of the policy. If premiums are to be
				based on an attained age or on a step-rate basis, such must be declared in the
				renewal provision. The age limit, if any, to which any policy is renewed shall
				be declared in the renewal provision.
3. Qualified right of renewal - A renewal
				provision, other than enumerated above, may grant to the insured the right of
				renewal by timely payment of premium up to a stated age, if any, subject to the
				reserved right of the insurer to terminate all such policies on a specified
				basis upon the giving of a specified period of notice, which shall be set forth
				in the appropriate provision of the policy. The right of the insured to renew
				the policy may be conditioned upon the continuation of a specified status
				(e.g., an employee or a named employer, member of a named organization, while
				engaged in a specific occupation associated with such employment or such
				organization, residence in a given state or geographic area, insured under a
				given form of insurance having like form number identification). The rights of
				the insured and of the insurer shall be clearly set forth in the renewal
				provision. Such shall include the specified age limit, if any, requirements as
				to the professional or occupational status, if any, and requirements as to the
				continuing relationship, if any, of the employee or member. Continuance of
				insurance after the insured ceases to be eligible for coverage under the plan
				may be at the option of the insurer. In the event a different table of premium
				rates is to be applicable with respect to renewals occurring thereafter, such
				fact shall be declared in the renewal provision.
4. Single term nonrenewable policy - A policy
				characterized as a "single term nonrenewable policy" shall include a provision
				appropriately captioned (e.g., "this policy is not renewable" or words of
				similar import). Such provision must identify or reference the proper part of
				the contract within which the term (duration) of the coverage is
				specified.
(d) Renewable
				at the option of the insured - A policy which may not be characterized as
				"noncancellable and guaranteed renewable" or "guaranteed renewable" under
				existing definitional requirements solely because such policy may not be
				continuable to age 50 or for a minimum period of five years, may use a renewal
				provision caption, subject to the approval of the Director, which states that
				the right of the renewal is vested in the insured (e.g., policies issued to
				afford coverage for family income protection mortgage payments or temporary
				debt obligations) for a stated period of years, to a stated age, to the
				occurrence of a stated event or during the continuance of a given status (e.g.,
				employment, membership).