Florida Administrative Code

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 …

These rules supersede and constitute a revision of all prior rules pertaining to solicitation and sale of Life Insurance and Annuity Contracts. 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. History-Ne…

(1) The purpose of these rules is to provide small employers with clear and unambiguous statements in the marketing of health benefit plans issued pursuant to the Employee Health Care Access Act, as set forth in Section 627.6699, F.S., and to assure the clear, truthful, and adequ…

(1) These rules shall apply to any health benefit plan marketing communication in this state that a small employer carrier knows or reasonably should know is intended for presentation, distribution, or dissemination in this state either directly by a small employer carrier or ind…

For purposes of these rules, the terms below are defined as follows: (1) "Application" means the form that must be filled in by the person seeking to effectuate a health benefit plan. (2) "Application Period" includes any enrollment period. (3)(a) "Carrier" means a person that pr…

All information required to be disclosed by these rules shall be set out conspicuously and in close conjunction with the statements to which the information relates or under appropriate captions of such prominence that the information shall not be minimized, rendered obscure, or …

(1) The form and content of a health benefit plan marketing communication shall be sufficiently complete and clear to avoid deception or the capacity or tendency to mislead or deceive, as determined by the Department from the overall impression that the marketing communication ma…

(1) Deceptive Words, Phrases, or Illustrations Prohibited. (a) A marketing communication shall not omit information or use words, phrases, statements, references, or illustrations that have the capacity, tendency, or effect of misleading or deceiving purchasers or prospective pur…

A marketing communication that is an invitation to contract shall disclose, in a manner that shall not minimize or render obscure the qualifying conditions, the provisions relating to renewability, cancellability, and termination and any modification of benefits, losses covered, …

Rulemaking Authority 624.308(1), 626.9611, 627.6699(12) FS. Law Implemented 624.307(1), 626.062, 626.830, 626.9541(1)(a), (b), (e), (k), (l), 626.9641(1), 627.6699(9)(d)4., 624.307(1) FS. History-New 2-25-93, Formerly 4-150.208, Repealed 11-15-22.

(1) A marketing communication relating to the dollar amount of claims paid, the number of persons insured, or similar statistical information relating to any small employer carrier or plan shall not use irrelevant facts, and shall not be used unless it accurately reflects all of …

A marketing communication for a basic, standard, or limited health benefit plan or any combination thereof that refers to a choice of the amount of benefits shall disclose that the amount of benefits provided depends upon the plan selected, and that the premium will vary with the…

(1) A marketing communication shall not: (a) Directly or indirectly make unfair or incomplete comparisons of plans or benefits, or comparisons of non-comparable policies or contracts of other small employer carriers; (b) Disparage competitors, their plans, policies, contracts, se…

(1) A marketing communication shall not create the impression directly or indirectly that the small employer carrier, its financial condition or status, payment of claims, or the merits, desirability, or advisability of its plan or policy forms or kinds of plans of insurance are …

(1)(a) The name of the actual small employer carrier shall be stated in all of the small employer carrier's marketing communications. (b) The form number or numbers of the plan marketed shall be stated in any marketing communication that describes a particular plan's benefits. (c…

(1) A marketing communication of an individual health benefit plan shall not directly or by implication represent that a plan or combination of plans is an introductory, initial, or special offer, or that applicants will receive substantial advantages not available at a later dat…

(1) A marketing communication shall not contain statements that are untrue in fact, or misleading by implication, with respect to the assets, corporate structure, financial standing, age, or relative position of the small employer carrier in the insurance business. (2) A marketin…

If any section or portion of a section of these rules, or any amendment, or the applicability to any person or circumstance is held invalid by a court, the remainder of the rules or the applicability of the provision to other persons or circumstances shall not be affected. Rulema…

The purpose of this rule chapter is: (1) To implement the provisions of sections 626.9521, 626.9541, 626.9611 and 626.9641, F.S., and such other laws of this state as may be applicable, with respect to the replacement of life insurance and related matters; (2) To regulate the act…

"Replacement" means any transaction in which new life insurance is to be purchased, and it is known or should be known to the proposing agent that by reason of such transaction existing life insurance has been or is to be: (1) Lapsed, forfeited, surrendered, or otherwise terminat…

(1) "Existing Insurer" means the insurance company whose policy is or will be changed or terminated in such a manner as described within the definition of "replacement." (2) "Existing Life Insurance" means any life insurance in force including life insurance under a binding or co…

Rulemaking Authority 624.308, 626.9611, 626.9641 FS. Law Implemented 624.307(1), 626.9521, 626.9541, 626.9641 FS. History-New 7-9-81, Formerly 4-24.03, Amended 2-2-83, Formerly 4-24.13, 4-24.013, 4-151.004, Repealed 12-31-15.

Each agent shall submit to the insurer with or as a part of each application for life insurance: (1) A statement signed by the applicant as to whether or not such insurance will replace existing life insurance; and, (2) A signed statement as to whether or not the agent knows repl…

Where replacement is or may be involved, the agent shall: (1) Present to the applicant, not later than at the time of taking the application, a Form OIR-B2-312 "Notice to Applicant Regarding Replacement of Life Insurance" rev. 1-91 as described in Exhibit A adopted in rule 69B-15…

Rulemaking Authority 624.308, 626.9611, 626.9641 FS. Law Implemented 624.307(1), 626.9521, 626.9541, 626.9641 FS. History-New 7-9-81, Formerly 4-24.06, 4-24.19, 4-24.019, 4-151.009, Repealed 12-31-15.

The Form OIR-B2-312 "Notice to Applicant Regarding Replacement of Life Insurance," rev. 1-91, set forth in Exhibit A is hereby incorporated by reference and adopted herein. Copies of the above-mentioned form is available to the public through the Office of Insurance Regulation, B…

Rulemaking Authority 624.308, 626.9611, 626.9641 FS. Law Implemented 624.307(1), 626.9521, 626.9541, 626.9641 FS. History-New 7-9-81, Formerly 4-24.20, 4-24.020, 4-151.012, Repealed 12-31-15.

The purpose of these rules is to safeguard the interests of persons covered by accident and health insurance policies or plans who are considering replacement of their insurance by making available to them information regarding replacement, thereby reducing the opportunity for mi…

These rules apply to the solicitation of accident and health insurance covering residents of this state. They do not apply to the solicitation of the following accident and health insurance: (1) Group, blanket or franchise; (2) Accident only; (3) Single premium nonrenewable; (4) …

As used in these rules: (1) "Replacement" is any transaction wherein new accident and health insurance is to be purchased and it is known to the agent, broker or insurer at the time of application that, as a part of the transaction, existing accident and health insurance has been…

An application form for insurance subject to these rules shall contain a question to elicit information as to whether the insurance to be issued is to replace any insurance presently in force. If replacement of existing coverage is indicated the application shall state the Compan…

Rulemaking Authority 624.308(1), 626.9611, 626.9641 FS. Law Implemented 624.307(1), 626.9521, 626.9541, 626.9641 FS. History-New 2-1-79, Formerly 4-44.05, 4-44.005, 4-151.105, Repealed 12-31-15.

Rulemaking Authority 624.308(1), 626.9611, 626.9641 FS. Law Implemented 624.307(1), 626.9521, 626.9541, 626.9641 FS. History-New 2-1-79, Formerly 4-44.06, 4-44.006, 4-151.106, Repealed 12-31-15.

Rulemaking Authority 624.308(1), 626.9611, 626.9641 FS. Law Implemented 624.307(1), 626.9521, 626.9541, 626.9641 FS. History-New 2-1-79, Formerly 4-44.07, 4-44.007, 4-151.107, Repealed 12-31-15.

(1) The purpose of rules 69B-151.201 and 69B-151.202, F.A.C., is to implement the provisions of section 626.9541(1)(aa), F.S., with respect to churning rules 69B-151.201 and 69B-151.202, F.A.C., apply to all types of policies and annuity contracts which include a policy value fea…

(1)(a) Forms required to be completed by the insurer by its licensed and appointed agent and provided to the applicant prior to or contemporaneous with the time the applicant signs any application for the purchase of an additional life insurance policy or annuity contract to be f…

Rulemaking Authority 624.308(1), 626.9541(1)(aa)2. FS., Chapter 95-219, Laws of Florida. Law Implemented 624.307(1), 626.9541(1)(aa) FS., Chapter 95-219, Laws of Florida. History-New 2-19-96, Formerly 4-151.203, Repealed 6-4-18.

For purposes of this chapter: (1) The term "False Claim" means any written statement which is a part of or supports a claim for payment or other benefit pursuant to an insurance policy or health maintenance organization coverage document for commercial or personal insurance or he…

The preparation of a false claim for presentation to an insurer, health maintenance organization, or third party and the presentation of a false claim to an insurer, health maintenance organization, or third party by an agent, physician, claimant or other person are deceptive act…

The submission or presentation for payment to an insurer, health maintenance organization or third party of a claim form, bill, or other statement for services rendered, prepared or signed by a health care provider or health care facility which does not disclose a pre-provision o…

Rulemaking Authority 627.6742(1) FS. Law Implemented 627.6742 FS. History-New 12-9-90, Formerly 4-51.022, Amended 1-1-92, Formerly 4-156.013, Repealed 11-11-18.

Rulemaking Authority 624.308(1), 627.674(2) FS. Law Implemented 624.307(1), 627.674 FS. History-New 1-1-81, Formerly 4-51.06, Amended 9-4-89, 3-13-90, 12-9-90, Formerly 4-51.006, Amended 1-1-92, 7-14-96, 12-17-96, 7-26-99, Formerly 4-156.014, Repealed 11-11-18.

Rulemaking Authority 624.308(1), 627.674(2) FS. Law Implemented 624.307(1), 627.674 FS. History-New 1-1-81, Formerly 4-51.07, Amended 9-4-89, 12-9-90, Formerly 4-51.007, Amended 1-1-92, 7-14-96, Formerly 4-156.015, Repealed 11-11-18.

(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…

(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 coverage that will provide an ind…

Rulemaking Authority 624.308(1) FS. Law Implemented 624.307(1), 627, Part VIII FS. History-New 12-9-90, Formerly 4-51.030, 4-156.050, Repealed 11-11-18.

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 exclusion…

(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 suc…

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, T…

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 …