Insurance ch 10

In Florida, what is the maximum percentage rate that may be charged on a fixed rate loan?

10%

Maximum penalty for failure to comply with a subpoena?

1000 per violation

You cannot as an agent, Mail order insurance without an agent

True

What is the maximum fine for being guilty of an unfair trade practice?

$3500

What is the penalty for committing an unintentional act of twisting?

$5000

The outline of coverage shall contain:

A statement identifying the applicable category of coverage afforded by the policy, based on the minimum basic standards. A brief description of the principal benefits and coverage provided in the policy. A summary statement of the principal exclusions and limitations or reductions contained in the policy, including, but not limited to, preexisting conditions, probationary periods, elimination periods, deductibles, coinsurance, and any age limitations or reductions. A summary statement of the renewal and cancellation provisions, including any reservation of the insurer of a right to change premiums. A statement that the outline contains a summary only of the details of the policy as issued or of the policy as applied for and that the issued policy should be referred to for the actual contractual governing provisions. When home health care coverage is provided, a statement that such benefits are provided in the policy.

Eligible individuals must be Florida residents who meet all of the following requirements:

Age 19 to 64 Do not have health insurance coverage under an individual health insurance policy Are ineligible for coverage under Medicare, Medicaid or Kidcare Have not had health insurance coverage for the past 6 months - exception: Job loss in which health insurance was provided by the employer COBRA benefits ran out The limiting age was met under a health insurance policy The individual's spouse, who was covered under a employer-sponsored heatlh insurance plan, dies or divorces the individual The individual applicant must complete an application for a Cover Florida health insurance plan, and make timely premium payments

Fiduciary Responsibility

All premiums belonging to insurers or others received by an agent are trust funds received by the licensee in a fiduciary capacity.

Cover Florida

Cover Florida is administered by the Agency for Health Care Administration and the Florida Office of Insurance Regulation. Cover Florida offers economical heatlh insurance plans, offering basic or catastrophic coverage. Cover Florida plans are not required to provide inpatient care (except the catastrophic plan option provides coverage for inpatient hospital visits), nor many of the other mandatory provisions requisite of other health plans offered in the traditional health insurance market.

How often is the Office of Insurance Regulation entitled to perform a financial examination of an insurer?

Once every 3 years

Florida Comprehensive Health Association

The Florida Comprehensive Health Association allows individuals otherwise uninsurable by traditional open market health insurers due to preexisting conditions to receive health insurance coverage through the association (high risk pool).

True or False: Insurance transactions requiring agents perform them must occur within the physical presence of the charge agent.

True

Twisting

making misleading representations or incomplete or fraudulent comparison of any insurance policies or insurers for the purpose of inducing, or tending to induce, any person to lapse, forfeit, surrender, terminate, retain, or convert any insurance policy, or to take out a policy of insurance in another insurer.

Churning

the fraudulent and misleading replacement of life insurance policies. Churning is an unfair and deceptive practice.

Florida Health Care and Insurance Reform Act of 1993

CHPAs create managed competition by pooling small health insurance purchasers. CHPAs became nonexistent after the law establishing them was repealed in 2000. Insurers can now issue group policies to any nonprofit corporation Small Employer Health Alliance. These alliances are groups formed for the purpose of obtaining insurance.

Florida Health Insurance Coverage Continuation Act

The Florida Health Insurance Coverage Continuation Act requires employers with fewer than 20 employees offer continuation of coverage to their employees without requiring employees to provide proof of insurability. Employees and their dependents will be eligible to receive continuation of coverage for up to 18 months after coverage would have been discontinued.

Penalty for act of Churning?

an intentional act of churning is guilty of a misdemeanor of the first degree and subject to a fine in an amount up to $75,000.

Sliding

Representing to the applicant that a specific ancillary coverage or product is required by law in conjunction with the purchase of insurance when such coverage or product is not required; Representing to the applicant that a specific ancillary coverage or product is included in the policy applied for without an additional charge when such charge is required; or Charging an applicant for a specific ancillary coverage or product, in addition to the cost of the insurance coverage applied for, without the informed consent of the applicant.

Florida Health Insurance Plan

The Florida Health Insurance Plan is to make coverage available to individuals who have no other option for similar coverage, at a premium that is commensurate with the risk and benefits provided, and with benefit designs that are reasonable in relation to the general market.

Small Employers Access Program

The Legislature finds that increased access to health care coverage for small employers with up to 25 employees could improve employees' health and reduce the incidence and costs of illness and disabilities among residents in this state.