Selected Florida Statues and Rules Quiz 1
What does the Florida Statute state about ethics?
While the statute does not define ethical behavior, it does state the agent or customer representative should be acting in the public interest.
Why are "Association Plans" not exempt from state regulation?
"Association Plans" are not exempt from state regulation as 1) there is no employer-employee relationship (usually the relationship is a member and the association); and 2) the "association plan" must be fully insured so the insurer is subject to state regulation.
When is a "Union Plan" exempt from state regulation?
A "Union Plan", may receive an express finding (in writing) from the U.S. Department of Labor that the collective bargaining agreements between that union and the employers are bona fide and be exempt from state regulation.
Are Professional Employer Organizations (PEO) or employee leasing companies exempt from state regulation?
A PEO sponsored health plan is not exempt from state insurance regulation under ERISA as 1) even though a purported "co-employer" relationship exist, the state does not recognize an employee/employer relationship with the employee and the PEO since the PEO does not control the hiring and firing of employees, evaluation of employee performance, discipline, determine compensation, or determine the hours, location, nature and method of work to be performed; and 2) Florida Statute 468.529 prohibits PEOs from sponsoring self-insured health plans.
What are examples of core values?
A code of ethics generally emphasizes what people who have subjected themselves to and measure themselves by are supposed to do. Examples of core values include but are not limited to: 1) Honesty and truth; 2) Responsibility and accountability; 3) Respect and tolerance; 4) Fairness and justice; 5) Compassion and caring.
What are the possible consequences for acting as an insurer without a Certificate of Authority?
Any person acting as an insurer without a Certificate of Authority may be convicted of a third-degree felony (F.S. 624.401) and liable for all unpaid claims of the unauthorized insurer (F.S. 629.901) as well as subject to suspension or revocation of all insurance licenses (F.S. 626-621, F.S. 626.611 and F.S. 626.6215).
Describe ethics.
Ethical behavior is a positive goal; to do what is right. The Greek word ethos meaning custom generally refers to proper modes of conduct. Ethical behavior is the product of ingrained attitudes, personal respect, and ideals of service to others in an unselfish manner. Ethical behavior is hard to define although ethical behavior is of ultimate importance in maintaining the integrity of our industry.
What is altruism and how is it involved with ethics?
Ethics may involve altruism ("doing what is right for others") because it is the right thing to do and not because of notoriety or recognition.
Describe a MEWA (Multiple-Employer Welfare Arrangement.
MEWAs require a Certificate of Authority from the Department of Financial Services. MEWAs are defined as an arrangement that is established or maintained to provide one or more various insurance benefits (health insurance) to the employees of two or more employers. * Both of these Neither of these MEWAs (Multiple-Employer Welfare Arrangement) are regulated as risk-bearing entities by the Florida Insurance Code.
What are the possible consequences for aiding and abetting an unauthorized insurer?
Possible consequences for aiding and abetting an unauthorized insurer include conviction of a third-degree felony (F.S. 624.401) and liability for all unpaid claims of the unauthorized insurer (F.S. 629.901) as well as subject to suspension or revocation of all insurance licenses (F.S. 626-621, F.S. 626.611 and F.S. 626.6215).
What are some factors making ethical behavior a dilemma?
Representing multiple insurers with the volume commitments from insurers, trips and other contests, and contingent commissions (additional payments to the agency based on total premium volume and loss ratios) all add the ethical dilemmas. Personal desires including family expectations, expectations of superiors, emotional pressures, personal financial dilemmas, and moral and religious views of the agent all add to the ethical dilemmas.
What are the rules that allow for state regulation of MEWAs?
Special rules allow for state regulation of MEWAs that are employee welfare benefit plans and meet the ERISA definition: 1) If fully insured, the MEWA remains subject to state regulation; 2) If not fully insured, the MEWA is subject to all state insurance laws not inconsistent with ERISA; or 3) A MEWA that is not an employee benefit plan is subject to state insurance regulation.
What is the common note of most codes of ethics?
The common note of most codes of ethics developed by professionals is the spirit of placing the interest of others before the interest of self. While the insurance industry demands a certain level of skill, an agent will become professional by acting in a professional manner.
Why the increased regulatory concern with unauthorized insurers?
There is increased regulatory concern with unauthorized insurers due to 1) ongoing instances of such activity; 2) the potential for criminal activity within the business of insurance; 3) the potential for adverse economic impact upon authorized insurers; 4) the potential for quantities of unpaid claims due to dishonesty along with the absence of state or federal guaranty funds to cover unpaid claims; 5) the potential for adverse economic impact on the future insurability of participants under statutes mandating guaranteed-issue health coverage; 6) the potential for adverse economic impact on health-care providers from unpaid claims; 7) lack of comprehensive federal oversight, including licensure and regulation similar to that of state insurance codes; and 8) the adverse impact on public perception that foresee the role of state regulations as protecting them from illicit insurance schemes, ensuring benefits are paid as contracted, and that legitimate insurance is available and affordable.
