Florida Insurance Laws - Study Notes

Florida Insurance Laws - Study Notes

• Free Look Period (Life Insurance): A required provision in Florida life insurance policies, allowing the policyholder a specific timeframe to review the policy and return it if dissatisfied.

• Pre-existing Conditions (Health Insurance): Florida law prohibits insurers from denying coverage outright due to pre-existing conditions. Insurers may impose a waiting period, but cannot deny coverage.

• Loan Option (Life Insurance): A life insurance policy provision that permits borrowing against the policy's cash value.

• Claims for Pre-existing Conditions (First Two Years): If a pre-existing condition is undisclosed, insurers can deny claims within the first two policy years based on misrepresentation.

• Florida Guaranty Fund (Health Insurance): The fund covers up to $250,000 in medical benefits for policyholders when a Florida insurer declares bankruptcy.

• Florida Guaranty Fund (Life Insurance): The fund provides up to $300,000 in coverage for medical claims to policyholders if the insurer goes bankrupt.

• Group Health Policy Termination: If a group health policy terminates due to financial reasons, Florida law mandates that insurers provide coverage continuation at group rates.

• Insurance Agent Continuing Education: Florida insurance agents need 30 hours of continuing education every two years.

• Misrepresentation After Two Years (Life Insurance): Insurers cannot cancel policies based on misrepresentations discovered after two years, though they can deny claims arising from the misrepresentation.

• Guaranteed Renewable (Insurance Policies): Policies with the "guaranteed renewable" feature permit the insurer to adjust policy terms but cannot cancel coverage as long as premiums are paid.

• Policy Cancellation After Two Years (Misrepresentation): Policies cannot be canceled after the first two years for a misrepresentation that is not considered fraudulent.

• HIPAA (Health Insurance): Florida law reinforces HIPAA's purpose: maintaining the privacy and confidentiality of health records and medical information.

• Small Employer Group Health Insurance: Florida law mandates that insurance be provided for the entire group, pre-existing conditions included, when a small employer purchases group health insurance. Minimum employees for group coverage is 2.

• Medicare Supplement Policies: They are in Florida, and must contain minimum benefit standards.

• Individual Health Policy Cancellation: Insurers must provide a written notice 45 days before canceling or refusing to renew an individual policy.

• Long-Term Care Insurance: A primary function of long-term care insurance: covers custodial care, not elective surgery or temporary disabilities.

• PPO Health Plans: PPO plans, compared to HMOs, permit patients to see out-of-network providers, but at a higher cost.

• POS (Point of Service) Health Plans: A health plans that blend aspects of HMOs and PPOs, offering flexibility in selecting providers and potentially lower costs compared to HMOs but higher costs compared to PPOs.

• Prepaid Service Organization (Health Plan): Prepaid service organizations (PSOs) predetermine payment of medical services before they're needed.

• Florida Health Insurance Guaranty Association: covers up to $300,000 in health insurance claims for bankrupt insurers.

• Outline of Coverage (Health Insurance): Insurers must provide an "Outline of Coverage" to prospective policyholders at the time of policy application in Florida.

• Pre-existing Condition Exclusions (Waiting Period): The maximum waiting period for pre-existing conditions, to be excluded from a group health insurance policy, is six months in Florida.

• HMO vs. PPO Plans: HMOs restrict patient choices to in-network providers, PPOs permit patients to utilize any provider, though it may cost more.

• Waiver of Premium (Rider): The waiver of premium rider waives premiums for a life insurance policy if the insured becomes totally disabled.

• Prohibited Provisions (Health Insurance): Florida law forbids gender-based pricing in health insurance policies.

• Group Health Policies (Required Provisions): All group health insurance policies must include coverage for preventive services.

• Guaranteed Renewable Health Policies: These policies aren't permanent. The issuer can change plan terms with notice.

• Medicare Advantage Plans: Medicare Advantage plans in Florida are coordination plans between Medicare and other insurers to provide additional benefits.

• Florida Guaranty Fund (Bankruptcy Coverage): The fund covers a maximum of $250,000 in individual health claims if a Florida health insurer declares bankruptcy.

• Misrepresentation (After Two Years): After two years, insurers cannot deny claims based on the policyholder's prior health representations. They can deny claims if the representation is fraudulent.

Explore key provisions and regulations in Florida insurance laws with this quiz. Topics include the Free Look Period, handling of pre-existing conditions, and the Florida Guaranty Fund for both life and health insurance. Test your knowledge on essential legal aspects of insurance in Florida.