Florida Insurance Laws, Rules, and Regulations

Comprehensive practice flashcards covering Florida insurance regulations, life and health insurance statutes, trade practices, and the Affordable Care Act based on the lecture notes.

Office of Insurance Regulation (OIR)

An entity whose mission is to promote public welfare by maintaining the solvency of insurance companies and is responsible for regulation, compliance, enforcement of statutes, and monitoring industry markets.

Chief Financial Officer (CFO)

Independently elected official who serves as the head of the Department of Financial Services and oversees the Bureau of Unclaimed Property.

Bureau of Unclaimed Property

An entity overseen by the CFO that holds unclaimed property accounts valued at more than $\$1 \text{ Billion}$, mostly from dormant financial, insurance, and utility accounts.

Continuing Education (Licensed < 6 years)

Requires agents licensed less than $6 \text{ years}$ to complete $24 \text{ hours}$ of continuing education every two years, including a minimum of $5 \text{ hours}$ in ethics.

Continuing Education (Licensed > 6 years)

Requires agents licensed more than $6 \text{ years}$ to complete $20 \text{ hours}$ of continuing education every two years, including a minimum of $5 \text{ hours}$ in ethics.

Agent

An individual authorized by an insurer to solicit applications, collect premiums, render services to prospects, and perform field underwriting.

Appointment

The authority given to an agent to transact business on behalf of the insurer; a licensee cannot transact insurance business in Florida until this is granted by an insurer.

Change of Address/Reporting of Actions

Agents must notify the Department of Financial Services within $30 \text{ days}$ for a residence address change or if found guilty of a felony.

Insurance Transaction

Includes the solicitation or inducement to purchase insurance, negotiations toward the sale, executing or issuing a contract, and advising on coverages and claims.

Twisting

The illegal practice of using misrepresentations or incomplete comparisons to convince a policyowner to cancel their current policy to purchase a new one with another company.

Churning

The practice of replacing one policy for another with the same company for the sole purpose of making more commission, usually via misrepresentation or deception.

Sliding

The act of telling an applicant that an additional product is required by law to get the product they want, or falsely representing that specific coverage is included at no extra charge.

Coercion

Using physical or mental force with the intent of convincing an applicant to buy insurance.

Defamation

Making malicious oral or written statements intended to injure a person in the insurance business or mislead about the financial condition of a person or company.

Controlled Business

Insurance coverage written by an agent on their own life, health, property, immediate family, or business associates.

Rebating

Refunding part of a commission or exchanging items of value to induce a purchase; allowed in Florida only if offered to insureds in the same actuarial class.

Domestic Insurance Company

A company that resides and is incorporated under the laws of the state in which its home office is located.

Foreign Insurance Company

An insurance company whose home office is located in another state.

Alien Insurance Company

An insurance company chartered and organized in any country other than the United States.

Stock Insurance Company

An insurance company owned and controlled by stockholders (shareholders) who provide capital and share in profits or losses.

Mutual Life Insurance Company

An insurance company owned and controlled by its policyowners, who elect a board of directors and receive profits as dividends or retained surplus.

Advertising Gift Limit

An agent is permitted to give advertising gifts to a prospective customer provided the value does not exceed $\$25$.

Florida Life and Health Insurance Guaranty Association

An organization established to provide funds to protect insureds in the event of an insurer's insolvency.

Free Look Period (Life Insurance)

A provision allowing an insured a period of $14 \text{ days}$ from delivery to return a policy for a full refund.

Grace Period (Life Insurance)

A period of $31 \text{ days}$ after the due date; in Florida, individuals over the age of $64$ receive an additional $21 \text{ days}$.

Maximum Policy Loan Interest Rate

The maximum fixed rate an insurer can charge for a policy loan in Florida is $10\%$.

Suicide Provision

If an insured commits suicide within $2 \text{ years}$ of policy issue, the beneficiary receives only a refund of premiums; after $2 \text{ years}$, the face amount is paid.

Excess Business

Portion of a risk above the limits of what an agent’s own insurer will accept; agents may place this with other authorized insurers without a new appointment.

Conservation

The term for an agent’s attempt to stop the replacement of an existing life insurance policy or annuity.

Viatical Settlement

An arrangement where a terminally ill insured sells their life insurance policy to a third party for a percentage of the face value.

Time Limit on Certain Defenses

A health policy provision stating it is incontestable after $2 \text{ years}$, except for fraudulent misstatements.

Grace Period (Health Insurance)

Required to be no less than $7 \text{ days}$ for weekly premium, $10 \text{ days}$ for monthly premium, and $31 \text{ days}$ for all other policies.

Notice of Claim (Health)

Written notice must be given within $20 \text{ days}$ after a covered loss starts or as soon as reasonably possible.

Proof of Loss (Health)

Written proof for any health insurance loss must be provided to the company within $90 \text{ days}$.

Legal Actions (Health)

Cannot be initiated within $60 \text{ days}$ of proof of loss submission and no later than $5 \text{ years}$ thereafter.

Newborn Child Coverage

Health plans must cover an insured’s newborn child from the moment of birth for a period of $18 \text{ months}$.

Small Employer

Under Florida law, an employer who employs not more than $50 \text{ employees}$; carriers must offer at least the standard plan.

COBRA (Consolidated Omnibus Budget Reconciliation Act)

Federal law requiring employers with $20$ or more employees to offer continuation of group health benefits after a qualifying event.

Florida Healthy Kids

Offers affordable health insurance for children ages $5-18$ for families not eligible for Medicaid.

Medicare Supplement Open Enrollment

A period that begins $3 \text{ months}$ before one's $65\text{th}$ birthday and lasts for $7 \text{ months}$; policies must be issued regardless of health status.

Bronze Plan Actuarial Level

A qualifying health plan under the ACA that provides a $60\%$ actuarial level of coverage.

Silver Plan Actuarial Level

A qualifying health plan under the ACA that provides a $70\%$ actuarial level of coverage.

Gold Plan Actuarial Level

A qualifying health plan under the ACA that provides an $80\%$ actuarial level of coverage.

Platinum Plan Actuarial Level

A qualifying health plan under the ACA that provides a $90\%$ actuarial level of coverage.

ACA Dependent Coverage

Provisions allowing parents to insure dependent adult children up to their $26\text{th}$ birthday, regardless of marital status or living situation.