Florida Administrative Code

"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 History-New 7-8-81, Formerly 4-24.04, 4-24.14, 4-24.014, 4-151.005, Repealed 1-4-24.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 History-New 7-9-81, Formerly 4-24.04, Amended 2-2-83, Formerly 4-24.15, 4-24.015, 4-151.006, Repealed 1-4-24.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 History-New 7-9-81, Formerly 4-24.06, 4-24.19, 4-24.019, 4-151.009, Repealed 1-4-24.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…

If an issuer elects to discontinue an individual health insurance policy form by consolidation with another policy form, the rate for the benefits shall be actuarially justified and approved by the Office for the consolidated group. Rulemaking Authority 624.308(1) FS. Law Impleme…

(1) If a health insurance issuer elects to withdraw from the individual health insurance market, the issuer must provide 180 days' written notice to the Office and to all policyholders, certificateholders and beneficiaries provided coverage by the issuer in that market. (2) A not…

(1)(a) All individual health insurance issuers shall file a designation with the Office of their election to become either a risk-assuming or a reinsuring carrier. (b) The individual issuer desiring to be a risk-assuming or reinsuring carrier shall use Form OIR-B2-1311 (rev. 8/03…

(1) Any individual issuer seeking to change the election made by the carrier under Section 627.6475(5)(a), F.S., to become either a risk-assuming carrier or a reinsuring carrier shall request a change of status on Form OIR-B2-1304, "Individual Carrier's Application To Modify Prev…

(1)(a) This rule chapter applies to all individual and group health insurance policies, including single premium credit disability insurance. All other credit insurance is not subject to this rule chapter. Credit disability is defined under Section 627.677(2), F.S. (b) This rule …

As used in this rule chapter, the following terms have the following meaning: (1) Annual Claim Cost. The net annual cost per unit of benefit before the addition of expenses, including claim settlement expenses, and a margin for profit or contingencies. For example, the annual cla…

Adequacy of an insurer's health insurance reserves shall be determined on the basis of all three categories combined. However, these standards emphasize the importance of determining appropriate reserves for each of the three categories separately. (1) Claim Reserves. (a) General…

Specific minimum standards for morbidity, mortality and interest which apply to claim reserves according to year of incurral and to contract reserves according to year of issue: (1) Morbidity. (a) Minimum morbidity standards for valuation of specified individual contract health i…

Waiver of premium reserves involve several special considerations. (1) The disability valuation tables promulgated by the National Association of Insurance Commissioners are based on exposures that include contracts on premium waiver as in-force contracts. Therefore, contract res…