Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-230 - GENERAL ETHICS AND DISCLOSURE REQUIREMENTS › Section 69O-230.033 - Reporting Requirements for Licensees Concerning Unlicensed Insurance Activity

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 Office to submit to the Office information of which they
				become aware concerning unlicensed insurance activity in this State. Such
				information will assist the Office 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, Florida Statutes. The term also includes
				any person licensed or registered by the Office 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
				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 (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) "Office" means the Florida Office of
				Insurance Regulation.
(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 multiple-employer welfare
				arrangement (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 Office.
(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 Office 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 Office
				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 Office 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.
(m) "Department"
				means the Florida Department of Financial Services.