Florida Administrative Code

(1)(a) Testimonials and endorsements used in marketing communications must: 1. Be genuine; 2. Represent the current opinion of the author; 3. Be applicable to the health benefit plan marketed; and, 4. Be accurately reproduced. (b) The small employer carrier in using a testimonial…

(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…

(1) Marketing File. (a) Each small employer carrier shall maintain at its home or principal office a complete file, available for inspection by the Office, containing: 1. Every printed, published, or prepared marketing communication; 2. A notation attached to each marketing commu…

(1) Any marketing of health benefit plans as defined in subsections 69O-150.203(7), (8), (9), and (10), F.A.C., of this rule chapter shall be filed by the small employer carrier with the Office for review not less than 30 days prior to the date the small employer carrier desires …

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…

Rulemaking Authority 624.308, 626.9611, 626.9641 FS. Law Implemented 624.307(1), 626.9521, 626.9541 FS. History-New 7-9-81, Formerly 4-24.01, 4-24.10, 4-24.010, 4-151.001, Repealed 1-4-24.

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

(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…

Unless otherwise specifically included, paragraph 69O-151.007(3)(b) and subsection 69O-151.008(1), F.A.C., shall not apply to: (1) Industrial Insurance; (2) Group, franchise, and individual credit life insurance; (3) Group life insurance and life insurance policies issued in conn…

Rulemaking Authority 624.308, 626.9611, 626.9641 FS. Law Implemented 624.307(1), 626.9521, 626.9541, 626.9641 FS. History-New 7-8-81, Formerly 4-24.04, 4-24.14, 4-24.014, 4-151.005, Repealed 1-4-24.

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 4-24.04, Amended 2-2-83, Formerly 4-24.15, 4-24.015, 4-151.006, Repealed 1-4-24.

Each replacing insurer shall: (1) Inform its field representatives of the requirements of these rules. (2) Require with or as part of each completed application for life insurance: (a) A statement signed by the applicant as to whether or not such insurance will replace existing l…

Each existing insurer shall inform its responsible personnel of the requirements of these rules. Each existing insurer shall: (1) Within ten (10) days from the date it receives the Form OIR-B2-312, rev. 07/23, as adopted in Rule 69O-151.010, F.A.C., furnish the policyowner, when …

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 1-4-24.

(1) Form OIR-B2-312, "Notice to Applicant Regarding Replacement of Life Insurance," rev. 07/23, hereby incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-16290. The form may be obtained from https://www.floir.com. (2) Form OIR-B2-313, "…

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 1-4-24.

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 4-44.01, 4-44.001, 4-151.101, Repealed 1-4-24.

Rules 69O-151.102 through 69O-151.104, F.A.C., 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…

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…

(1) Upon determining that a sale will involve replacement, an insurer, other than a direct response insurer, shall furnish the applicant, upon issuance or delivery of the policy, or prior thereto, the notice described below. Once copy of such notice shall be given to the applican…

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 1-4-24.

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 1-4-24.

(1) Rules 69O-151.201, and 69O-151.202, F.A.C., apply to any and all types of policies which include a policy value feature, irrespective of the marketing method by which such policies or contracts are sold. (2) Rules 69O-151.201, and 69O-151.202, F.A.C., shall not apply to: (a) …

(1) Each insurer shall adopt written procedures to reasonably avoid and discourage the practice of churning, as defined in Section 626.9541(1)(aa), F.S. (2)(a) Form OIR-D0-1180, "Policy Disclosure Form and Instructions," rev. 07/23, hereby incorporated by reference and available …

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), 627.4554 FS., History-New 2-19-96, Formerly 4-151.203, Repealed 1-4-24.

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…

A health care provider shall disclose a pre-provision of services agreement by one of the following methods: (1) Attaching a copy of the agreement to the claim form; (2) Attaching a statement that discloses the agreement and the specific terms thereof; (3) Attaching a copy of the…

(1) It is the opinion of the Insurance Commission that purchasers of disability insurance in this state should realize the importance of the application for insurance, therefore, no policy of disability insurance shall be delivered to any person in this state unless a notice stat…

It is the opinion of the Director that the citizens of this state should be aware and should have full knowledge of the meaning of the terms, "This policy is renewable at the option of the company," "This policy is cancellable by the company," or similar captions on renewable ter…

It is the opinion of the Director that it will be in the public interest and of benefit to all if the person to whom the policy is issued has the opportunity to return the policy if he is not satisfied with it, provided such return is made within a reasonable length of time after…

The terms "non-cancellable" or "non-cancellable and guaranteed renewable" may be used only in a policy which the insured has the right to continue in force by the timely payment of premiums set forth in the policy until at least age 50, or in the case of a policy issued after age…

Every company writing disability insurance in this state shall complete and file with its annual statement a questionnaire concerning its course of training and instruction given its agents. Such questionnaire forms shall be supplied by the Director. Rulemaking Authority 624.308 …

Rules 69O-154.001-.003, F.A.C., do not apply to group, franchise, or blanket disability insurance. Rulemaking Authority 624.308 FS. Law Implemented 624.307(1), 624.424, 627.601 FS. History-New 12-24-74, Formerly 4-8.06, 4-8.006, 4-154.006.

(1) These rules shall apply to all individual and family accident and health insurance policies, subscriber contracts of medical, surgical, or health maintenance organizations and to franchise insurance policies issued or issued for delivery in this state on and after the effecti…

(1) Accident, accidental injury, accidental means: (a) The definition shall employ "result" language and shall not include words which establish an "accidental means" test or use words such as "external, violent, visible wounds" or similar words of description or characterization…

(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., noncancel…

An individual policy of accident and health insurance or nonprofit, medical, surgical, or hospital service corporation contract shall not be delivered or issued for delivery in this state unless the outline of coverage required by Section 627.642, F.S., labels and describes the p…

(1) An outline of coverage, as required by Section 627.642, F.S., shall be delivered either at the time the application for the policy is taken or at the time such policy is delivered. Such outline of coverage shall be clearly identified as such and accurately describe the policy…

Rulemaking Authority 624.308, 627.6561(8)(e), 641.31071(8)(a), (e), (10)(b) FS. Law Implemented 624.307(1), 627.64871, 627.6561(8), 641.31071 FS. History-New 9-19-00, Formerly 4-154.110, Repealed 11-21-17.

Rulemaking Authority 624.308, 627.6561(5)(b), (7)(b), (8)(a), (e), (9)(b), 641.31071(8)(a), (e), (10)(b) FS. Law Implemented 624.307(1), 627.64871, 641.31071 FS. History-New 9-19-00, Formerly 4-154.111, Repealed 11-21-17.

(1)(a) Each health insurance issuer that offers individual health insurance coverage shall make available to eligible individuals the two policy forms with the largest and the next to largest premium volume of all such policy forms offered by the issuer in the state or a particul…