Department Communication
The Communications Director manages the Department of Communications. The Insurance Commissioner appointed Florida’s Communications Director in March 2014. According to the Insurance Commissioner, the department’s Director (aka “Commissioner”) of Communications is responsible for: “… the day-to-day activities of the communications business unit. He will serve as the key spokesperson for the OIR, and advise on overall communication strategies.”
[Source: OIR Press Release]
The CFO and Insurance Commissioner are proponents of transparency for its citizens. Managing communications and making them public (as appropriate) enforces the transparency process. The Newsroom on the floir.com/office/newsroom.aspx website makes the Director available, provides access to OIR actions, and ensures related news is current. Citizens are invited to follow them @FLOIR_comm on Twitter© and Facebook© and sign up for the weekly newsletter Dollars & Sense.
Guaranty Association
Florida Insurance Guaranty Association (FIGA) is part of a non-profit, state-based, statutorily-created system that pays certain outstanding claims of insolvent insurance companies. By paying these claims, guaranty associations protect policyholders and claimants. Guaranty associations are active in every state, the District of Columbia, Puerto Rico and the Virgin Islands.
Guaranty associations ease the burden on policyholders and claimants of the insolvent insurer by immediately stepping in to assume responsibility for most policy claims following liquidation. The coverage guaranty associations provide is fixed by the policy or state law; they do not offer a "replacement policy."
By virtue of the authority given to the guaranty associations by state law, they are able to provide two important benefits: prompt payment of covered claims and payment of the full value of covered claims up to the limits set by the policy or state law.
Specifically, when a member insurer is found to be insolvent and is ordered liquidated, a receiver takes over the insurer under court supervision and processes the assets and liabilities through liquidation. Upon liquidation, FLAHIGA automatically becomes liable for the policy obligations the liquidated insurer owed to its Florida policyholders. [Chapter 631]
Life and Health Insurance Guaranty of Payments [§631.711]
What follows applies to direct life insurance, health insurance, annuity contracts, and supplemental contracts issued by those licensed to transact insurance in Florida. Coverage is provided to:
· Those who are the beneficiaries, assignees, or payees of covered persons; and
· Those who are owners of policies or contracts, and who:
o Are residents of Florida; or
o Are residents of other states, IF:
* The insurer is in Florida;
* The insurers were not licensed in the states in which the individuals reside at the time specified in a state’s guaranty association law (necessary for coverage);
* Such other states have associations similar to the association created by Florida; and
* Such persons are not eligible for coverage by those associations.
* Notwithstanding any other provisions this part applies to coverage of a person who is a payee under a structured settlement annuity, or a beneficiary if the payee is deceased, with a coverage limit of $300,000 by the association, if:
· The payee is a resident of Florida.
· The payee, the beneficiary, or the contract owner is eligible for coverage by the association of the state in which the contract owner resides.
Administration and Assessment [§631.715(2)(a)]
For purposes of administration and assessment, the association maintains three accounts:
· The health insurance account;
· The life insurance account; and
· The annuity account.
Borrowing between accounts for payment of policyholder and contract holder claims and other obligations of the association is authorized at the discretion of the board of directors, provided that the amounts are restored to the appropriate accounts not less than annually.
The association is under the immediate supervision of the department and subject to the applicable provisions of the insurance laws of Florida.
Florida HMO Consumer Assistance Plan [§631.811 and §631.828]
There is a nonprofit legal entity known as the Florida HMO Consumer Assistance Plan. All HMOs must remain members of the plan as a condition of their authority to transact business in Florida. The plan performs its functions under the plan of operations established and approved under the provisions and exercise its powers through a board of directors. The plan comes under the immediate supervision of the department and is subject to the applicable laws of Florida.
INSURANCE LAW AND UPDATES
New Florida Law Updates
The following are summaries of new Florida laws and their effective date:
2019 UPDATES
HB 29—Active Military Members, Veterans, and Their Spouses
House Bill 29 waives the prelicensing education requirement for active military members, veterans, and their spouses who are currently in good
standing with the military or have been honorably discharged. These individuals are also exempt from license application fees if they are currently in good standing with the military or have been honorably discharged within 24 months of application.
[Sec. 626.171, 732, 7851, 8311, 8417, 927 F.S.; effective July 1, 2018]
HB483—Advertising and Promotional Gifts
This bill modifies Florida’s unfair trade practices law regarding advertising
and promotional gifts. Insurers and agents may give insureds, prospective insureds, and others merchandise, gift cards, event tickets, or other items valued at $100 or less per individual in any calendar year. For title insurance agents and agencies, a $25 limit applies. Insurers and agents may also make charitable contributions on behalf of insureds or prospective insureds of up to $100 per individual in any calendar year.
[Sec. 626.9541 F.S.; effective July 1, 2018]
2020 UPDATES
HB 7065 – Assignment Of Benefits Reform
Provides for substantial changes in the way insurance benefits may be assigned to third parties. Defines “assignment agreement” and establishes requirements for the execution, validity, and effect of such an agreement; Transfers certain pre-lawsuit duties under the insurance contract to the assignee and shifts the burden to the assignee to prove that any failure to carry out such duties has not limited the insurer’s ability to perform under the contract; Requires each insurer to report specified data on claims paid in the prior year under assignment agreements by Jan. 30, 2022, and each year thereafter; allows an insurer to make available a policy prohibiting assignment, in whole or in part, under certain conditions; Revises the state’s one-way attorney fee statute to incorporate an attorney fee structure in determining the fee amount awarded in suits by an assignee against an insurer; requires service providers to give an insurer and the consumer prior written notice of at least 10 business days before filing suit on a claim. Takes Effect: July 1, 2019
HB 1393 – Modifies Areas Regulated by the Florida Department of Financial Services
· Allows applicants that have committed certain felonies to obtain a license on a probationary basis once the applicant has served at least half of the disqualifying period if the applicant, during that time, has not been found guilty of or has not pleaded guilty or nolo contendere to a crime;
·Provides the DFS the discretion to deny, suspend, revoke, or refuse to continue an insurance agency license on the grounds that another jurisdiction has taken an adverse action against a professional license held by a majority owner, partner, manager, director, officer or other controlling person of the agency Takes Effect: July 1, 2019
2021 UPDATES
SB 292: Insurance Claims Data
Insurance Claims Data; Defining the terms “loss run statement” and “provide”; requiring authorized insurers to provide insureds a loss run statement within 15 days after receipt of the insured’s written request and provide notice to the agent of record. No fees can be charged for providing this information once, annually.
This section defines a loss runs statement as a report that contains the following information about an insurance policy:
· The policy number
· The period of coverage
· The number of claims
· The paid losses on all claims
· The date of each loss
Loss run statements do not include supporting claim file documentation such as the following:
· Copies of claim files
· Investigation reports
· Evaluation statements
· Insureds’ statements
· Documents protected by a common law or statutory privilege
The loss run statement that will be given to an insured is required to contain a claims history with the insurer that covers the past five years or the complete claims history if it is less than five years. Insurers are not required to provide loss reserve information. Effective Date: 1/1/2021
SB 540: Insurance Guaranty Associations
Insurance Guaranty Associations; Authorizing certain guaranty association employees to adjust losses for the Florida Insurance Guaranty Association if certain conditions are met; redefining the term “net direct written premiums” as “direct written premiums” and revising the definition of that term; deleting a calculation of initial estimated assessments levied by the Office of Insurance Regulation on insurers in the Florida Insurance Guaranty Association; deleting a calculation of initial estimated assessments levied by the office on insurers in the Florida Workers’ Compensation Insurance Guaranty Association.
The bill establishes that assessment installment payments made by FIGA member insurers may be made quarterly rather than monthly.The bill clarifies the method by which assessments are levied against insurers and collected by FWCIGA related to policy deductibles and to retrospectively rated policies. Effective date: July 1, 2020.
HB 1189: Genetic Information for Insurance Purposes
Now, insurers who provide health, life, and long-term care insurance, in the absence of a diagnosis of a condition related to genetic information, cannot cancel, limit, or deny coverage, or establish differentials in premium rates, based on that kind of genetic information.
Additional language was added to establish that this does not prevent a life or long-term care insurer from looking at an individual’s medical record as part of the application process. The statute also does not prohibit these kinds of insurers from considering a medical diagnosis included in a medical record, even if the diagnosis was based on the results of a genetic test.
Effective Date: July 1, 2020
HB 1409: Records of Insurers
Exempts from public records requirements certain records made or received by DFS acting as receiver pursuant to specified provisions; provides that such records comprise consumer personal financial & health information, certain underwriting files, insurer personnel & payroll records, consumer claim files, certain reports & documents submitted to OIR relating to insurer own-risk, corporate governance annual disclosures, & certain information received from NAIC or governments; provides retroactive applicability; provides for future legislative review & repeal of exemptions; provides statements of public necessity.
Effective Date: July 1, 2020
SB 1606: Insurance Administration
Prohibits the DFS and the Office of Insurance Regulation (OIR) from disseminating aggregated information if it contains trade secret information that can be individually extrapolated;
Requires authorized insurers to file with the Department of Financial Services (DFS) the name and email address of the person who will receive civil remedy notices and requires the DFS to provide civil remedy notices to the designated e-mail address;
Changes the amount of time the applicable statute of limitations for statutory bad faith actions is tolled pursuant to the civil remedy notice from 65 days after mailing of the notice to 60 days after the insurer receives the notice from the DFS.
Effective Date: July 1, 2020.
HB 607: Direct Care Workers
Health insurance policies, including major medical, group, blanket, or franchise policies and health maintenance contracts, which are delivered, issued, or renewed in Florida by January 1, 2021, cannot require an insured to receive services from a registered advanced practice registered nurse in place of a physician. Effective Date: July 1, 2020
2022 UPDATES
HB 1209 - Department of Financial Services
The bill modifies several areas regulated by the Department of Financial Services including:
- Division of Public Assistance Fraud: establishes DPAF as a criminal justice agency.
-Changes the mandatory continuing education (CE) update course for all insurance agents, customer representatives, and insurance adjusters from a five-hour course every two years to a four-hour course every two years. This language does not change the total number of CE hours that insurance agents, customer representatives, and adjusters must obtain every two years during their compliance period. This provision is effective for compliance periods that end January 1, 2022, or later, and for any agent/customer representative with such a compliance period who has already taken the five-hour course, credit will be given for the four-hour course plus one hour of elective credit.
-Protecting Proprietary Business Information: prohibits a person from requiring an insurance agent or agency to provide the replacement cost estimator or other proprietary underwriting information as a condition to extending credit secured by real property, nor may an insurance agent or agency provide this information.
Effective Date: July 1, 2021.
Senate Bill 1598 - Agency Package - PROTECTING INSURANCE POLICYHOLDERS
-Requires an entity that is licensed or issued a certificate of authority by the Department of Financial Services (DFS) or the Florida Office of Insurance Regulation (OIR) to respond to document requests from the DFS Division of Consumer Services.
-Revises the Licensing Procedures Law's prohibition against unlicensed activity to include knowingly aiding or abetting an unlicensed person in transacting insurance or otherwise engaging in insurance activities in this state without a license. A person who does so commits a thirddegree felony.
-Authorizes DFS to suspend, revoke, or refuse to issue the license of an insurance agent, adjuster, customer representative, service representative, or managing general agent that makes a consumer's personal financial or medical information available to the public, or initiates in-person or telephone solicitation with a prospective customer
after 9 p.m. or before 8 a.m., unless the customer requests otherwise.
-Prohibits the sale of industrial life insurance policies, effective July 1, 2021.
-Expands the definition of sliding, a practice that violates the Unfair Insurance Trade Practices.
-Requires insurance agencies whose name contains the word “Medicare” or Medicaid” to delete those words from the agency name no later than June 30, 2023.
Effective Date: Upon becoming law (06/16/2021, unless otherwise noted).
Senate Bill 1120 - PUSHING BACK AGAINST UNSOLICITED TELEMARKETNG
-Requires all sales telephone calls, text messages, and direct-to-voicemail transmissions to have the receiving consumer's prior express written consent if the call will be made using an automated machine to dial the recipient's phone number or will play a recorded message upon connection with the recipient.
-Amends the Florida Telemarketing Act to prohibit telephone sellers or salespersons from calling consumers outside of the hours between 8 a.m. and 8 p.m. in the consumer's time zone and prohibits telephone sellers or salespersons from contacting consumer on the same subject matter more than three times in a 24-hour period. The bill also clarifies that calls made through an automated dialer or recorded message are subject to the same prohibitions.
Effective Date: July 1, 2021
House Bill 7017 - PROTECTING CONSUMERS
-Requires specified entities that apply for or receive any gift or grant with a value of $50,000 or more from any foreign source to disclose such gift or grant to the appropriate agency, along with additional specified information.
-Requires the Department of Financial Services (DFS) to manage a website to publish required disclosures and maintain an active and current list of ineligible entities on the website, and requires DFS to investigate an allegation of a disclosure violation.
Effective Date: July 1, 2021.
HB 701 - Behavioral Health Care Services Coverage and Access
Behavioral Health Care Services Coverage and Access: Requires DFS to submit report relating to behavioral health care services & benefits to Governor & Legislature by specified date; specifies minimum information report must contain; requires department to make certain information
available on its website; requires health insurers & health maintenance organizations to disclose specified information on their websites; requires health insurers & health maintenance organizations to annually provide certain written notices to insureds or subscribers.
Effective Date: October 1, 2021
UPDATES 2023
SB-156 – Loss Run Statements
Reduces from 5 years to 3 years the claims history that must be included within a loss run statement; requires an admitted and a non-admitted personal lines insurer to provide loss run statements within 15 days of an insureds request after first providing information on how to obtain a loss run statement from a consumer reporting agency; excludes admitted and non-admitted life insurers from the requirement to provide a loss run statement.
Effective June 24, 2022
HB-357 - Pharmacies and Pharmacy Benefit Managers
Transfers the oversite of Pharmacy audits from Florida Department of Health to OIR; institutes a $10,000 fine for Pharmacy Benefits Managers that fail to register with OIR.
Effective July 1, 2022
HB458 – Step-therapy Protocols
Requires an insurer or Health Maintenance Organization to publish on its website, and provide to an insured in writing, a procedure for an insured patient and health care provider to request a protocol exemption; requires an insurer or HMO granting a protocol exemption to specify the prescription drug, medical procedure or course of treatment approved; requires an insurer or HMO denying a protocol exemption request must provide a written explanation of denial, including the clinical rational supporting the denial.
Effective July 1, 2022
HB1099 – Living Organ Donors in Insurance Policies
Prohibits insurers of life insurance policies, industrial life policies, group life policies, credit life and credit disabilities policies, and long-term care policies from discrimination against living organ donors or prospective living organ donors, in coverage or eligibility solely on their status as a living organ donor.
Effective July 1, 2022
UPDATES 2024
HB1185 - Consumer Protection
Living Organ Donors in Insurance Policies
Prohibits insurers of life insurance policies, industrial life policies, group life policies, credit life and credit disabilities policies, and long-term care policies from discrimination against living organ donors or prospective living organ donors, in coverage or eligibility solely on their status as a living organ donor.
Effective July 1, 2022
Annuity Investments:
CS/CS/HB1185 covers regulations related to annuity investments. The bill adopts the National Association of Insurance Commissioners (NAIC) Suitability in Annuity Transactions Model Regulation (2020), which broadens the scope of requirements for sales or recommendations of annuities. The bill places a duty on insurers and agents to act in the best interest of consumers, emphasizing care, disclosure, conflict of interest, and recordkeeping. Certain exceptions are provided, and the bill introduces training requirements for agents involved in annuity sales.
Insurance Provisions:
The bill addresses unfair trade practices by requiring agents to disclose third-party remuneration for health insurance marketing practices.
SB 312 - Telehealth
SB 312, aims to amend existing regulations related to telehealth practices in the state of Florida. The bill addresses the prescribing of controlled substances through telehealth services and introduces specific criteria under which telehealth providers can prescribe certain controlled substances. This summary provides an overview of the key provisions within the bill and their implications for telehealth providers, patients, and controlled substance prescriptions.
Schedule II Controlled Substances Through Telehealth:
Under the provisions of SB 312, telehealth providers are permitted to use telehealth services for the prescription of controlled substances classified as Schedule II, but only if the prescription fulfills certain criteria. The bill outlines four specific circumstances under which Schedule II controlled substances can be prescribed through telehealth:
· Psychiatric Disorder Treatment
· Hospice Services
· Medication management for patients in hospital settings.
· Nursing Home Residents
Schedule III, IV, V Controlled Substances Through Telehealth:
The bill provides more flexibility for controlled substances classified as Schedule III, IV, or V according to section 893.03 of the Florida Statutes. Telehealth providers are permitted to issue renewal prescriptions for these controlled substances through telehealth within the scope of their practice and in compliance with state and federal laws.
CS/CS/HB 487 - Department of Financial Services
CS/CS/HB 487 is a legislative bill aimed at revising various programs and provisions within the Florida Department of Financial Services (DFS). The bill encompasses a wide range of changes that impact different aspects of financial regulation, insurance, and related areas. This summary provides an overview of the key provisions within the bill and their implications.
Investigations and Prosecutions:
The bill amends existing provisions to empower the Division of Investigative and Forensic Services (DIFS) within the DFS to conduct investigations when there is reason to believe a violation of Florida or federal criminal law has occurred. This expansion includes the authority to initiate investigations, rather than merely conduct them. Moreover, it extends the jurisdiction of the Chief Financial Officer (CFO) and State Fire Marshal to initiate investigations. Additionally, the DFS gains the authority to refer both state and federal criminal violations for prosecution.
Anti-Fraud Reward Program:
The bill introduces changes to the Anti-Fraud Reward Program by expanding the list of insurance fraud violations for which the DFS can offer rewards of up to $25,000. The expanded list includes violations related to nursing homes, forgery, racketeering, theft, false insurance claims, money laundering, and more. Importantly, the bill eliminates the requirement for a conviction to award a reward under this program, potentially encouraging more individuals to report fraudulent activities.
CS/CS/HB 487 Workers' Compensation:
revises provisions concerning the Workers' Compensation Three Member Panel. The bill eliminates the physician reimbursement manual and directs the DFS to annually publish maximum reimbursement allowances for medical providers. Additionally, the bill ratifies specific rules related to the Florida Workers' Compensation Law.
-Health Care Ministries:
The bill addresses health care ministries and stipulates that nonprofit religious organizations cannot market or sell health plans through agents licensed by the DFS. This aims to regulate the sale of health plans by such organizations.
-Funerals and Cemeteries:
The bill introduces changes to the regulation of funeral, cemetery, and consumer services. It defines terms like "preneed" and "transportation protection agreement," and clarifies that the Florida Insurance Code does not apply to certain transportation protection agreements.
CS/CS/HB 487 Division of Insurance Agents and Agencies:
includes multiple modifications related to the licensure of insurance agents and agencies. It eliminates certain application filing fees, changes the rules for taking fingerprints of applicants, and empowers the DFS to adopt rules for specific violations and penalties. The bill also revises definitions, adds license categories, and alters grounds for disciplinary actions against insurance representatives.
CS/CS/HB 487 Insurer Insolvency? Rehabilitation and Liquidation:
provides the DFS with authority in receivership proceedings to transfer an insolvent insurer's book of business to a solvent assuming insurer and allows the sharing of records with prospective assuming insurers.
Florida Prescription Drug Reform Legislation
The Florida Prescription Drug Reform Act has introduced changes to the state's existing prescription drug price portal, MyFloridaRX.com. This portal, which includes a Prescription Drug Price Locator, now requires prescription drug manufacturers to reveal reportable price increases. These increases will be made available on Florida's official website.
Florida Family and Medical Leave Act (FMLA):
The Family and Medical Leave Act (FMLA) provides eligible employees with up to 12 weeks of unpaid leave per year for family or medical reasons. While the law doesn't mandate paid sick leave, it safeguards employees' jobs during their absence.
Employment law attorneys can assist employees in understanding and asserting their FMLA rights, particularly if an employer fails to comply with the law or discriminates against them for utilizing FMLA benefits.
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