Florida Insurance Laws - Study Notes

Florida Insurance Laws - Study Notes

• Policy Delivery Requirements: A "free look period" is required when a Florida life insurance policy is delivered to the policyholder.

• Pre-existing Conditions (Health Insurance): Insurers in Florida cannot deny coverage for pre-existing conditions. Waiting periods are permitted, but denial based solely on the condition isn't allowed.

• Policy Loan Options: Life insurance policies often have a "loan option" that lets policyholders borrow against the cash value.

• Claims for Pre-existing Conditions: If a claim for a pre-existing condition is filed within the first two years, and the condition wasn't disclosed during the application, the claim will likely be denied due to misrepresentation.

• Florida Guaranty Fund (Health Claims): If a Florida insurer goes bankrupt, the Florida Guaranty Fund covers up to $250,000 in medical benefits for an individual's claims.

• Insurer Bankruptcy (Life Claims): In case of an insurer bankruptcy, the Florida Guaranty Fund will provide coverage for medical expenses from the policies issued in Florida, up to $300,000.

• Group Health Policy Termination: If a group health policy is terminated due to financial reasons, the insurer must provide continuation of coverage at group rates to the eligible policyholders.

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

• Misrepresentation in Life Insurance (After 2 Years): After two years, if a significant misrepresentation in a life insurance application is discovered, the insurer can deny the claim, but cannot retroactively cancel the policy.

• Guaranteed Renewable Policies: A "guaranteed renewable" policy in health insurance means the insurer can change terms, but the contract can't be canceled.

• Policy Cancellation After Two Years: After two years, an insurer cannot cancel a policy in Florida, based on misrepresentation discovered later.

• HIPAA (Health Insurance Portability & Accountability Act): HIPAA focuses primarily on the confidentiality of health records and medical information, not health insurance access or cost control for Floridians in general.

• Small Group Health Insurance: Florida allows small employers with at least two employees to apply for group health insurance.

• Medicare Supplement Minimum Benefits: All Medicare Supplement policies in Florida must meet minimum benefit standards.

• Small Employer Group Health Coverage: In Florida, small employers are legally obligated to provide coverage in group health plans to all employees, regardless of pre-existing conditions. Policies are meant to support the entire group.

• Health Insurance Policy Cancellation Notice: Before canceling an insurance policy for an individual, insurers must provide a written notice to the policyholder 45 days in advance.

• Long-Term Care Coverage: Long-term care insurance primarily covers custodial care.

• Preferred Provider Organization (PPO) Plans: PPO plans allow the insured access to non-network healthcare providers, but at a potentially higher cost.

• Prepaid Service Organization (PSO) Plans: In a PSO plan, medical services are typically paid upfront.

• Florida Life and Health Insurance Guaranty Association (Limits): The Florida Life and Health Insurance Guaranty Association provides coverage up to $300,000 in case of health-related issues or claims in the event of an insurer bankruptcy.

• Outline of Coverage (Group Health): Insurers must provide a summary of coverage at the time of application.

• Pre-Existing Condition Exclusion Waiting Period (Group Health): The maximum waiting period permitted for pre-existing conditions in group health policies in Florida is six months.

• HMO vs. PPO Differences: HMO plans generally limit choices of providers; PPOs offer more flexibility.

• Waiver of Premium Riders: A waiver of premium rider typically waives premiums if the insured becomes totally disabled.

• Prohibited Provisions (Health Insurance): Gender-based pricing, limitations for mental health coverage, are not permitted. Pre-existing conditions aren't inherently prohibited.

• Group Health Policies (Preventive Services): Preventative health care services are required in all group health policies.

• Guaranteed Renewable Insurance: A policy deemed "guaranteed renewable" means an insurer can still change the policy terms, and does not guarantee the same rates or continuation of benefits over time.

• Medicare Advantage Plan: It's essentially a coordinated health insurance plan that works with Medicare. (Supplemental/alternative Medicare coverage)

• Guaranty Fund Coverage Limits (Insurer Bankruptcy): The Guaranty Fund provides up to $250,000 in claims in Florida.

• Misrepresentation After Two Years: For claims based on misrepresentation, an insurance company cannot cancel or deny a claim or claim payments after two years. However, they can still deny a claim based on fraud.