Florida laws and rules pertinent to insurance 18/8
Change of Beneficiary Provision
(required) applies to death benefit policies. policyowner has the right to change beneficiaries only if he or she has been designated revocable
Unfair Discrimination
- Prohibited from showing any type of partiality to individuals in regard to their premium and benefits
Notice of Claim
- The policyowner's obligation to the insurer to provide notification of loss within 20 days after the occurrence (or as soon as is reasonably possible). - 20 days
Mutual Life Insurance Companies
- owned by the policyholders - 5% of policies are from this type of company - participating policy premiums are higher than non-participating policies
Insurance Transaction
-Solicitation; -Negotiations; -Sale (effectuation of a contract of insurance); -Advising an individual concerning coverage or claims
eligibility requirements for associations
-must be a natural group - minimum of 100 participants is required for a contributory plan - the group must have been in existence for two years - the group must hold regular meetings at least on an annual basis -
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
A company whose home office is located in another state.
Twisting
A form of misrepresentation in which an agent persuades an insured/owner to cancel, lapse, or switch policies, even when it's to the insured's disadvantage.
Risk Retention Group
A liability insurance company owned by its members, which are exposed to similar liability risks by virtue of being in the same business or industry.
Fraternal Benefit Society
A life or health insurance company formed to provide insurance for members of an affiliated lodge, religious, or fraternal organization with a representative form of government.
Adjuster
A representative of an insurance company who investigates and acts on the behalf of the company to obtain agreements for the amount of the insurance claim.
Stock Insurance Company
A type of insurance company owned by stockholders.
Defamation
Act of harming or ruining another's reputation
Alien Insurance Company
An insurance company incorporated outside the country
Unauthorized Insurer
An insurance company that has not applied, or has applied and been denied a Certificate of Authority.
Authorized Insurer
An insurance company that has qualified and received a Certificate of Authority from the Department of Insurance to transact insurance in the state.
COBRA
Consolidated Omnibus Budget Reconciliation Act; law to provide terminated employees or those who lose insurance coverage because of reduced work to be able to buy group insurance for themselves and their families for a limited amount of time.
Reinstatement
If a health policy is reinstated after it had lapsed for nonpayment, there is a waiting period of 10 days before a claim covering sickness will be covered. Injuries sustained from an accident, however, will be covered immediately.
Commingling
Illegally mixing deposits or monies, collected from a client, with one's personal or business account. Taking money out too soon or putting it into escrow too late (10 banking days).
claim forms provision
Insurer is required to send you a claim form within 15 days after notice is received
domestic, foreign, alien
Insurers are classified according to their domicile. What are the three types of insurers?
Office of Financial Regulation
Responsible for all activities concerning insurers. Office of Financial Regulation: • Regulation of banks • Credit unions • Finance companies • Security industry • Includes the Bureau of Financial Investigations - ruination a as a criminal justice agency • The Office of Financial Regulations
Grace Period
The grace period for health and accident insurance is required to be no less than 7 days for weekly premiums policies, 10 days for monthly premium policies and 31 days for all other policies. if premium is paid within the grace period, coverage shall remain in effect.
physical exams and autopsies
The insurer has the right to examine the insured during the claim process and to make an autopsy when death is involved and where it is not forbidden by law.
a pre-existing conditions waiver.
The policy describing a period of non-coverage for conditions diagnosed prior to the issuance of an insurance benefit plan is called
Variable Products
Variable insurance products do not guarantee contract cash values, and it is the policyowner who assumes the investment risk. Variable life insurance contracts do not make any promises as to either interest rates or minimum cash values. What these products do offer is the potential to realize investment gains that exceed those available with traditional life insurance policies. This is done by allowing policyowners to direct the investment of the funds that back their variable contracts through separate account options. By placing their policy values into separate accounts, policyowners can participate directly in the account's investment performance, which will earn a variable (as opposed to a fixed) return. Functioning on much the same principle as mutual funds, the return enjoyed-or loss suffered-by policyowners through their investment in a separateaccount is directly related to the performance of the assets underlying the separate account. Separate accounts arenot insured by the insurer and the returns on their investments are not guaranteed
financial services commission
Within the Department of Financial Services, what is the Commission that oversees the office of financial regulation and the office of insurance regulation?
Free Look Provision
a 30 day free look period is required for long term care policies
Entire Contract
a provision that the policy application and all attachments shall constitute the entire contract between the parties
false advertising
advertising that is misleading in some important way, including the failure to reveal facts about possible results from using the advertised products
Notice of Replacement
agent must present to applicant not later than at the time of taking the application a "notice to applicant regarding replacement of life insurance, must be signed by applicant and agent and left with applicant. Also the original or a copy of all sales proposals. Both of these also must be turned in to the replacing insurer.
Change of Address
agent must report to the department of financial services within 30 days
substance abuse
all health plans must provide benefits when an insured is confined for in patient treatment of mental illness in a licensed medical care facility
inflation protection
all insurers issuing long term care insurance policies must offer, as an optional benefit an inflation protection feature which provides for automatic future increases in th level of benefits without evidence of insurability.
long-term care insurance
any policy designed to provide coverage for at least 12 consecutive months for each covered person on an expense insured indemnity prepaid of other basis
Fraternal life insurance organizations
are nonprofit providers of life insurance that is covered by a special section of the florida insurance code
Converted policy
at the option of the insurer a separate converted policy may be issued to cover a dependent
Dread disease policies
cover a single disease or illness only
Contributory Group Plan
employees covered by employee group health insurance.
record keeping
every resident agent must have and maintain at their place of business the usual and customary records pertaining to transactions under their license for at least 5 years following the final settlement or final adjudication of a criminal proceeding, civil litigation, or an administrative proceeding.
Free Look Period
free look period provision allows an insured a period 14 days from the delivery date of the policy to look over the new policy and return it for a full premium refund if dissatisfied for any reason
Group Health Insurance
health insurance consisting of contracts written between a group, (employer, union, etc.) and the health care provider
Right to Examine (Free Look)
health insurance policies must provide a minimum free look period of 10 days upon policy delivery. this allows the policy owner timer to decide wether or not to keep it if the policy owner decides not to keep the policy within the 10 days allowed a full refund will be given
Criminal and administrative actions
if an agent is found guilty of. felony, he or she is require to notify the department of insurance within 30 days
senior citizen grace period
in Florida anyone over the age of 64 will receive an additional 21 days beyond the normal policy grace period.
noncontributory group
in a noncontributory group the policy must cover 100% of eligible persons.
Suicide Clause
in florida if an insured commits suicide within 2 years of policy issue the beneficiary will only receive a refund of premiums paid after two years the face amount will be paid in the event of suicide
Named Beneficiary
in florida, if a policy is made payable to a named beneficiary, a creditor can make no claim on the proceeds.
communicating with the department
insurance companies must respond to consumer complaint within 20 days
outline coverage
it is basically a summery of coverage. In health insurance, document explaining the coverage purchased and the names of the insurer and agent.
false statements and entries
it is prohibited to knowingly make any false statments or false entry of a material fact - deliver to any person or publish false statement or facts -file or place false statements with the public officials.
admitted mail order insurance
it may solicit insurance Bussiness by mail without the assistance of a license agent
Exclusive Provider Organization (EPO)
managed care plan that provides benefits to subscribers if they receive services from network providers.
Lapse Notice
must mail a long term care lapse notice at least 30 days prior to the effective date of cancellation to both the policyholder and a specified secondary addressee
New born child coverage
must provide coverage for the insureds newborn child from the moment of birth for a period of 18 months
churning
occurs when an agent has a policyholder replace one policy for a other with the same company for the sole purpose of making more commission.
sliding
occurs when an agent tells an applicant that in order to get the product they want, they are required by law to get ab additional product as well. it can also mean falsely representing to an applicant that specific coverage is included in the policy applied for with no additional charge.
Mutual Insurance Company
owned by policyholders/ also allows their policy owners to elect a governing body
exclusion
part time employees, seasonal workers, and full time employees before the probationary period may be excluded from a group life plan. - full time employees may be included after probationary period.
Certificate Authority
permits an insurance company to transact business in that state
contestable period in life and health policies
policy terms shall be incontestable after it has been in force for a period of 2 years from its date of issue unless the purpose for taking out the coverage was fraud
Life and Health Guaranty Association
protects insureds against an insurer's inability to meet contractual obligations due to impairment or insolvency. The Association provides coverage for people with direct, non-group life, health, or annuity policies by: providing payment of covered claims under certain insurance policies avoiding excessive delays in payment minimizing financial loss to claimants assisting in the detection and prevention of insurer insolvencies providing an association to assess the cost of this protection among insurers. All insurers, as a condition of their ability to write insurance, are required to be members of the Fund.
Grace Period Provision
provide a grace period of 30 days after the due date. if the insured dies during the grace period the insurance company may deduct any premium due from the death benefit.
Buyer's Guide
provides general information about the types of life insurance policies available, in language that can be understood by the average person.
Office of Insurance Regulation
regulation, compliance, and enforcement of statutes related to the business of insurance and the monitoring of industry markets (regulatory oversight of company solvency, policy forms and rates, market conduct performance, and new company entrants in the FL market
minimum age
the minimum age at which an individual can sign a life insurance application is 15 years
Rebating
the practice of giving an individual a premium reduction or some other financial advantage not stated in the policy as an inducement to purchase the policy
coercion
the practice of persuading someone to do something by using force or threats
Guaranty Fund
the purpose of the guaranty fund is to ensure that claims filed against insolvent insurance companies will be paid
vatical settlement
the sale of a life insurance policy by a terminally ill insured to another party, typically to investors or investor groups, who hope to profit by the insured's early death
ERISA
the savings clause in ERISA protects the (insurance, banking, and securities
Proof of Loss
written proof for any loss must be given to the insurance company within 90 days
Duties of the replacing insurance company
• Require from the producers list of the applicants life insurance contracts to be replaced. • A copy of the replacement notice provided by the applicant. • Send each existing insurance company a written communication advising of proposed replacement within the specified time frame which starts at the time the application is received in the replacing insurers home or admin office. • A policy summary or ledger statement containing policy data on the prosper life insurance or annuity must be included.
