Florida Insurance Laws Chapter 8

Outline of Coverage

• Projection of future costs is not required in the Outline of Coverage for health insurance policies.

Notice of Claim

• Insured individuals must notify the insurance company of a claim within twenty days following a covered loss.

Dread Disease Policies

• These policies specifically cover one disease or illness, rather than all diseases.

Types of Insurance Companies

• An alien insurance company is domiciled in another country, such as England, but does business in Florida.

Multiple Employer Welfare Arrangement (MEWA)

• MEWAs provide insurance benefits to members.

Legal Entities for Selling Insurance

• Risk management advisers are not recognized as a legal entity for selling life insurance in Florida.

Group Life Insurance Conversion

• Conversion privileges do not require evidence of insurability.

Admitted Mail Order Insurance Companies

• These companies can solicit insurance without needing a licensed agent's assistance.

Group Life Coverage Conversion

• Coverage can be converted to an individual policy at regular rates based on attained age within six months.

Buyer's Guide

• A buyer's guide aids prospective clients in understanding and choosing the right insurance product.

Controlled Business Limit

• Florida law states an agent's controlled business must not exceed fifty percent of their total business.

Association Plans Regulation

• Health benefit plans for associations are regulated because they are insured by authorized insurers.

Consequences of Unauthorized Insurer Business

• Third-degree felonies, insurance license revocations, and responsibility for claims may ensue for business with unauthorized insurers.

Florida Insurance Law Areas

• An agent's commission does not fall under the four principal areas of Florida insurance law.

Conversion Rights Under Group Life Policy

• An employee has the right to convert to an individual policy upon employment termination.

Life Insurance Replacement Definition

• Defined as a transaction where a new policy is bought, leading to the termination of an old one.

Viatical Settlement Provider

• A policyowner can sell their life insurance policy for a portion of its value to a viatical settlement provider.

Licensing and Replacement Notifications

• Agents must submit a notice to existing insurers when replacing a policy.

Insurance Company Plans

• A mixed plan involves issuing both participating and non-participating insurance policies.

Premium Payment Grace Period

• Policyowners have a grace period during which they can pay overdue premiums.

Florida Employee Health Care Access Act

• Established to provide group health insurance options for employers with up to fifty employees.

Health Insurance Coverage Continuation Act (Mini COBRA)

• Applies to employers with less than twenty employees.

Free-Look Period for Life Insurance

• Florida allows a 14-day free-look period starting from the delivery date of the policy.

Continuing Education for Agents

• Agents in Florida must complete five hours of law and ethics continuing education every two years.

Coordination of Benefits (COB)

• COB exists to prevent duplicate benefit payments from multiple insurance policies.

Long-term Care Lapse Notice

• Required to be delivered to both the applicant and a secondary addressee.

Advertising Gifts Regulations

• Agents can give prospective clients gifts up to $25 in value.

Annuity Replacement Disclosures

• Agents must inform annuitants about potential tax implications when replacing or exchanging an annuity.

Financial Services Commission Hearings

• May conduct hearings for any reason deemed necessary.

Agent-in-Charge Location Allowance

• Can have more than one location only if present during insurance activity.

Agent's Authority Limitations

• Agents cannot authorize claim payments on behalf of an insurer.

Grounds for License Denial

• A license may be suspended or revoked following a finding of misrepresentation.

Claims Time Requirement

• Under an Individual Disability policy, claims must be filed at least monthly.

Misrepresentation Practice

• Involves incorrectly stating that dividends from a policy are guaranteed.

False Advertising Example

• Exaggerating dividend amounts in advertisements constitutes false advertising.

Rebate Definition

• Referring to returning premium as an inducement for purchasing is considered rebating.

Replacement Regulation

• Replacement of policies is strictly regulated and requires full disclosure to involved parties.

Entire Contract Provision

• States the agent has no authority to change or waive the terms of the policy.

Coercion by Agents

• An agent suggesting rights may be impaired without a signed release form could be guilty of coercion.

Foreign Insurance Company Definition

• A foreign insurance company is formed under laws of another state and operates in Florida.

Domestic Insurance Company Definition

• A company incorporated in the state where its home office is located.

Interest Rates on Life Policy Loans

• Florida caps interest rates on life policy loans at 10%.

Coverage for Handicapped Children

• Coverage under family health policies may end if premiums for the child are not paid.

Unfair Trade Practices

• Material misrepresentation by an agent is classified as an unfair trade practice.

Corrective Actions for Agents

• Agents may be required to pay monetary restitution if improper sales occur.

Address Change Notification Timeline

• Licensees in Florida must notify the Department of Financial Services within thirty days of an address change.

Situations Not Under Life Insurance Laws

• Day-to-day operations of insurance companies are generally not governed by Florida life insurance laws.

Nonforfeiture Options

• Automatic Premium Loan Option is not classified under Nonforfeiture Options.

Grace Period for Quarterly Health Policies

• Health insurance policies requiring quarterly payments must allow a 31-day grace period.

Medicare Supplement Application Guidelines

• Agents must deliver the Outline of Coverage to Medicare Supplement applicants at the time of application.

Approval of Insurance Policy Forms

• The Office of Insurance Regulation (OIR) approves all insurance policy forms used in Florida.

Group Life Policy Conversion Privilege

• Required to allow conversion to an individual policy for a specified time frame without insurability proof.

Selling Life Insurance Policy

• Policyowners can sell policies to viatical settlement providers for a percentage of the face value.