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.

Test your knowledge with flashcards on Florida Laws and Rules pertinent to insurance, focusing on Chapter 8. This quiz covers essential elements included in health insurance policies and their implications for policyholders. Ideal for those preparing for licensing or exams in the insurance field.