Disclosure

Question 1

Advertising

Answer 1

Advertising rules aim to ensure truthful and adequate disclosure of relevant information to consumers and prevent unfair competition among insurers.
All insurance companies must maintain control over the content, form, and method of dissemination of their advertising materials.
Advertisements include any printed or published material, descriptive literature, sales aids, prepared sales talks, and materials included with a policy.

Question 2

Outline of Coverage:

Answer 2

An outline of coverage must be provided at the time of application or policy delivery to ensure full and fair disclosure to the applicant.
The outline should include a statement identifying the coverage category, a brief description of benefits and coverages, major exclusions and limitations, renewal and cancellation provisions, and a statement that it contains a summary of the policy.
Home health care coverage provision must be included if applicable.

Question 3

Policy Cancellation or Nonrenewal

Answer 3

Individual health insurance coverage must be renewed or continued at the option of the insured, except for specific reasons such as nonpayment of premium, fraud, or noncompliance with insurer’s requirements.
Insurers must provide a 90-day notice before canceling or nonrenewing a policy

Question 4

Certificate of Coverage:

Answer 4

Group insurance plans issue certificates of coverage to insured individuals, detailing coverage, claims filing procedures, duration, and conversion options.
Certificates must not contain unfair, misleading, or deceptive provisions.

Question 5

Group Blanket Health:

Answer 5

Blanket policies cover specific groups during particular activities, such as students, campers, or sports teams.
Unlike group health insurance, blanket policies automatically cover individuals without issuing certificates.
Policies cannot contain provisions less favorable to insured individuals than those required for individual health insurance policies.

Question 6

Unfair Trade Practices - Genetic Testing

Answer 6

Genetic testing for underwriting purposes is prohibited by insurers.
Genetic information alone cannot be considered a pre-existing condition, nor can the refusal to undergo genetic testing be used against the applicant.
Genetic Information Nondiscrimination Act of 2008 (GINA) prevents denial or discrimination in health plan pricing based on genetic information.

Question 7

Application Responsibilities and Marketing Methods and Practices:

Answer 7

Insurance applications must accurately disclose relevant information about the applicant’s health history and other factors.
Agents cannot make changes to applications without written consent from the insured.
Insurers may investigate an applicant’s health history for eligibility and premium determination.
Insurers must provide a free-look period allowing applicants to review policies and return them for a refund if unsatisfied.
An Outline of Coverage must accompany every individual or family accident and health insurance policy or be delivered to the applicant at the time of application.
Refusal of coverage based on sickle-cell trait, sex, or marital status is prohibited.
Health benefits must be reasonable for the premium charged, with criteria established by the Department to prevent overcharging.
The Florida Comprehensive Health Association guaranteed health insurance to residents unable to obtain coverage due to poor health until June 30, 1991, when enrollments ceased due to financial deficits. All health insurers must be part of the association and share in losses.