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85 Cards in this Set
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- Back
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Who administers the insurance laws of the State of Florida? |
The chief financial officer (CFO),the Financial Services Commission and the Commissioner of the Office of Insurance Regulation |
Page 402 |
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The Financial Services Commission is composed of? |
The Governor, the CFO, Attorney General, & the Commissioner of Agriculture |
Page 402 |
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What does the Office of Insurance Regulation (OIR) do? |
They are responsible for all activities of the Financial Services Commission relating to regulation of insurers and other risk-bearing and entities |
Page 402 |
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What does the Office of Financial Regulation (OFR) do? |
They are responsible for all activities of the Financial Services Commission relating to regulation of banks, credit unions, financial institutions etc. |
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What office includes the Bureau of Financial Investigations that may investigate suspected wrong doing? |
OFR. Office of Financial Regulation |
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What parts of state government are involved in the regulation of insurance business in Florida? |
Legislature. Department of Financial Services. Commissioner of the Office of Insurance Regulation. The state court system. |
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Florida insurance laws deal with what four areas? |
* The organization of Department of Financial Services & the duties of the CFO, the Financial Services Commission, and the Office of Insurance Regulation * the organization of insurance companies * qualifications licensing and appointment of agents * the rights of policyowners and beneficiaries |
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Rules beginning with 69O are adopted by who? |
The Office of Insurance Regulation |
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Rules beginning with 69B adopted by? |
The Department of Financial Services |
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Who regulates agents? |
The Department of Financial Services |
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Who regulates insurers? |
The Office of Insurance Regulation |
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What are the general powers/duties of the chief financial officer CFO and the Office of Insurance Regulation OIR? |
* enforce the Insurance Code * conduct investigation of insurance matters and determine if a person has violated the code * they can collect, propose or publish information regarding the duties set upon by the code |
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Where are the major areas of which the CFO and the OIR are involved in regulating insurance companies? |
* Organizing and licensing of companies * Regulation of insurance company activities like forms, provisions and rates * supervising licensing of agents and advertising practices * monitoring the financial condition of insurers (insurance companies) |
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Can the CFO and the OIR carry out an examination of records? |
Yes
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How long does Florida law require agents to keep records pertaining to premium payments? |
3 years |
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What is an "admitted" health insurance company |
A company which the OIR has licensed to transact business in Florida under state laws |
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Can an insurer deny coverage to someone who owns a gun? |
No. |
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Can an insurer increase premiums someone who owns a gun? |
No. The insurer can not discriminate against an insured or applicant on the basis of them owning a firearm |
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What does ERISA stand for? |
Employee Retirement Income Security Act |
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How did ERISA, Employee Retirement Income Security Act come about? |
Problems with unauthorized health insurance entities. |
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Employee Retirement Income Security Act ,which came about when there was problems with unauthorized health insurance entities, started in or about what year? |
1974 |
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ERISA deals with what matters? |
Matters relating to employer-sponsored health insurance type plans |
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One of the goals of ERISA was to encourage individual employers to establish employee health plans. One of those plans is a self insured plan. What is a self insured plan? |
A health plan in which the employer would pay with his own funds and bear the financial responsibility for the covered health claims of its own participating employees. |
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What is a fully insured health plan? |
A plan an employer establishes within a licensed insurer who would, in turn, bear the financial risk for the payment of claims. |
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What ACT began the federal law when the state regulation of the business of insurance is in the public interest? |
The MCCARRAN-FEGLRGUSON ACT, 1945 |
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What is ERISA "pre-exemption" concept? |
The primary legal and factual issues involved in the unauthorized health insurance problem is the claim that a health plan and an entity sponsoring it or not subject to state insurance regulations. |
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What ERISA provision/clause states that nothing in ERISA should be construed to exempt or leave any person from any law of any state which regulates insurance? This provision makes clear that ERISA does not pre exempt any state law that regulates insurance. |
Savings Clause. |
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What ERISA clause provides that "no employee benefit plan shall be deemed to be an insurance company or any other insurer or to be engaged in the business of insurance"? |
Deemer Clause |
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What does MEWA stand for? |
Multiple Employer Welfare Arrangement |
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What is MEWA? |
Regulated risk-bearing entities who provide welfare benefit plan that is established or maintain to provide health insurance to the employees of two or more employers |
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Can Union plans be an exception to MEWA? |
Yes. |
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Our association plans exempt to to State Insurance Regulation? |
No. There is no employer-employee relationship and they must be fully insured which Association Plans are not. |
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What does PEO stand for? |
Professional employer organization |
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What doess a professional employer organization (PEO) do? |
Referred to as an employee leasing company (similar to temp agencies) they perform administrative functions such as payroll |
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Is a PEO sponsored health plan exempt from state insurance regulation under ERISA? |
No because there is no true employer-employee relationship between the employee and the PEO |
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What is a mail order insurance company? |
A mail order insurance company operates principally by mail without personal agent interaction with prospects |
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Can a mail-order insurance company solicit in Florida? |
No. Florida law states that the transaction of insurance and clean the application for insurance must be taken by and the policy delivered through a licensed and appointed Florida agent |
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What is a solicitation of insurance? |
The attempt to persuade any person to purchase an insurance product. |
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What are some ways someone can solicit insurance? |
* describing the benefits or terms of insurance coverage * distributing an invitation to contract perspective insureds * making general or specific recommendations * comparing insurance products |
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Are financial institutions allowed to sell insurance? |
Yes. |
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When financial institutions are selling insurance what are some Prohibitions? |
* prohibits misinterpretations regarding the insured or guarantees status * prohibit the release of insurance information to third parties without the consumer consent * the institution cannot tie insurance products to loan arrangements * Prohibits inclusion of insurance premiums in a credit transaction without the express consent of the customer * prohibits the use of the name or logo of the financial institution when marketing to prospective customers |
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Does an insurance agency have to be licensed in the state of Florida? |
Yes. Per Florida Statute when one possessing an insurance agency license for each place of business at which it engages an activity may be performed by a licensed insurance agent. Per Florida Statute each agency must have a license and appoint an agent in full time charge of each location. |
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When did Florida require insurance agencies be licensed? |
January 1 2003 |
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Prior to January 1st 2003 how did one have an insurance agency as a business in the state of Florida? |
Prior to January 1st 2003 an agency had to register with the state of Florida by filing an application. Failure to continue to file an application will be fined $5,000. |
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How much will an agency be fined if they do not file an application for licensure? |
$10,000 |
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Does an agent have to report a guilty verdict or no contest to a felony or crime? |
Yes. Florida law provides the each licensee shall advise the department in writing within 30 days after having been found guilty or pleaded no contest to a felony or a crime punishable by imprisonment of one year more |
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Can an agent write business for a company for which the agent is not appointed? |
Usually no unless it is excess or rejected business or a single case agreement |
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What is the Florida law requiring insurance agents to obtain continuing education? |
State law requires 24 hours every two years of continued education |
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What is twisting? |
Misrepresentation made by an insurance agent to induce a policyholder to lapse a policy in order to switch insurance |
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What is sliding and does it apply to all insurance products? |
Florida law states that sliding is the act or practice of representing to the applicant that * a specific coverage is required by law in conjunction with the purchase of insurance when such coverage is not required. * representing to the applicant that is specific coverage is included in the policy without a charge when such a charge is required * or charging an applicant for a specific coverage in addition to the cost of insurance coverage apply for without the consent of the applicant |
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What is misrepresentation? |
A situation where one fails to clearly bring to mind a fact or condition (innocent or intent to deceive) |
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Can an agent advertise for health policies? |
Yes. Agents must secure company or approval prior to use of any advertisement not furnished by the insurer. |
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What is defamation? |
Defamation of character includes both written (libel) in spoken (slander). |
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What is rebating? |
Act of refunding part of the commission or premium as inducement to buy an insurance policy. The act, if not done strictly according to Florida Statute, is in violation of the Code of Ethics and Florida law |
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What does NAIFA stand for? |
The National Association of Insurance and Financial Advisors |
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If an application for insurance is not attach the policy may the insurance company claim that application contains fault answers and void the policy |
No the application only becomes part of the policy is subject to legal contest by the insurance company when it's attached the policy |
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For what reason my insurance company within two years after the date of the issue return all premiums instead of paying a claim when the application is attached to any part of a policy |
Misrepresentation omission concealment |
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What is the free look period for Florida |
* Health and disability 10 day * Medicare and long term 30 day * No period for short-term single premium policies like aviation accident policy |
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My health insurance agency refuse coverage or require a higher premium because a person has sickle cell , gender or marital status |
No this would violate Florida Rules of discrimination |
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My health insurance agency refuse coverage or require a higher premium because a person has sickle cell , gender or marital status |
No this would violate Florida Rules of discrimination |
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Can provisions of the charter or by laws of the insurance company be used in any legal proceedings are in the policy? |
Only if the charter or by laws are incorporated in full into the policy |
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Can insurer refuse coverage because of being diagnosed with fibrocystic condition? |
No unless the condition is diagnosed through a breast biopsy the demonstrates an increase to position to develop breast cancer |
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Can ensure exclude covered for bone marrow transplants |
No... only if it is not used as experimental |
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How is health insurance for mental or nervous disorders treated under Florida law |
Group health insurance policies are required to make available to the policyholder coverage for mental and nervous disorders |
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Is health insurance coverage for alcoholism or drug dependency required by law |
Yes group health insurance policies are required to offer coverage for alcohol and drug dependency for the policyholder |
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Does Florida law provide for the continuation of coverage for handicapped children |
Both individual and group insurance policies cover a handicapped child even after the age of 18 if they have mental retardation or physical handicap this room plies even though the family policy with normal and terminate covered for a child who reaches a specific age |
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Can a health insurance policy be cancelled |
Florida law provides that the individual and group health insurance policies and HMO contract must be renewed at the option of the individual or a policyholder except for Failure to pay Fraud Failure to meet minimum participation When the insurance company ceases offering coverage - they must give 90 days notice an offer alternative couragous it's all covered in the individual group market if this continues this sure must have 180 days notice and they are banned from issuing coverage of Florida for 5 years |
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Are bones and joints of the jaw and facial region covered under health insurance policies and HMO plan |
Yes. Diagnostic procedures including the bones and joints of the skeleton, surgical procedures deemed medically necessary |
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Our individual and group insurance policy in ancient no contract requires provide coverage for treatment of diabetes |
Yes. Coverage for all medically necessary equipment supplies and services to treat diabetes including self management training and educational services if medically necessary |
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Is health insurance a national coverage for osteoporosis covered in Florida |
Yes most individual and group health insurance required by law except Medicare Supplement long term care insurance in Florida State Employee Health Program |
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what are Florida laws concerning breast cancer and mastectomy |
* covered for process devices and reconstructive surgery Prohibits impatient coverage for being limited for less than what is determined to be in a medically necessary For heaven's a person from being denied her litter from coverage for breast cancer if the person has remained breast cancer free for 2 years Prohibits breast cancer follow-up care for being considered an evaluation for pre-existing condition and left breast cancer is found |
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Is health insurance coverage for cleft lip and cleft palate required under Florida law |
Yes until a child turns 18. Covers medical dental speech therapy and nutritional services |
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When using health insurance policy do the word physician or medical doctor include dentists? |
Yes the law requires that the word position a medical doctor include Dennis when the policy covers surgical procedure |
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What are the requirements for Florida companies to cover chiropractic treatment |
Florida law requires insurance companies to provide or offer chiropractic coverage under individual and health insurance policies |
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What is the length of the grace period in a health insurance policy |
Not lesson 7 days for weekly premium policies 10 days for monthly 31 days for all other |
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How long after a lapse disability policy does reinstatement become effective |
10 days after reinstatement, illness only insured is entitled to full benefit from an accident as soon as the policy is reinstated |
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What are the key factors when evaluating health insurance underwriting process |
Age occupation physical conditions medical history financial status and hobbies |
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What is a non cancel policy |
Continual at the option of the policyowner at the premium stated in the policy the insured may continue until is stated to termination date by timely payment of the fixed premium |
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What must the insurance company do when it receives Notice of Claim |
The company must furnish the claimant with proof of loss forms within 15 days if it does not the claimant has his own forms and may present proof under written manner |
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What must the insurance company do when it receives Notice of Claim |
The company must furnish the claimant with proof of loss forms within 15 days if it does not the claimant has his own forms and may present proof under written manner |
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What is the time limit for giving notice of claim |
Written notice must be given within 20 days giving the name of the policyowner nature of the loss and other information to identify the claimant |
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Can insurance company demand independent medical examination during the pendency of a claim |
Yes it may request examination as often as reasonably requires |
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Can a policyowner do the insurance company to to recover under a policy |
Yes provided that The suit is filed at least 60 days after proof of loss has been given
The loss is not paid within 120 days from the filing date
The suit is brought within five years after proof of loss to the insurance company |
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Are maternity benefits required health insurance policies by the state of Florida |
Individual policies do not have to offer maternity benefits but group medical expenses must provide maternity benefits |
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Florida law for group insurance how many employees have to be a member in order to qualify for insurance |
There is no specific minimum number of participants for the issuance of a group health policy |
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