Florida Laws and Rules Flashcards
Appointment:
the authority given to an agent to transact business on behalf of the insurer is called appointment. No person may act as an insurance agent unless currently licensed by the department and appointed by the insurer.
- New appointments will expire 24 months on the last day of the licensee’s birth month
- An appointing entity may terminate its appointment of any appointee at any time with at least 60 days’ notice
- Within 30 days after terminating the appointment, the entity must file written notice with the department including the reasons and facts involved in the termination
- An agent’s license will terminate if the agent allows 48 months to elapse without being appointed for the class or classes of insurance listed on the license
Renewing or Maintaining a license (Continuing Education):
an agent needs to abide by the following guidelines every two years to maintain their license:
- 24 hours of continuing education every two years for agents licensed less than 6 years
- 20 hours of continuing education for every two years for agents licensed more than 6 years
- Any continuing education must include minimum 4 hours in law and ethics
- Pay license fees, appointment and renewal fees
- Continue to be appointed with an insurance company
Unfair Trade Practices
any of various deceptive, fraudulent, or otherwise injurious (as to a consumer) practices or acts that are declared unlawful by statute (as a consumer protection act) or recognized as actionable at common law.
Unfair Claims Settlements:
the improper avoidance of a claim by an insurer or an attempt to reduce the size of the claim. By engaging in unfair claims practices an insurer tries to reduce its costs. However, this is illegal in many jurisdictions.
Domestic, Foreign, and Alien:
insurance companies are classified according to the location of its corporation. Regardless of where the insurance company is incorporated, it still has to get a Certificate of Authority before transacting insurance within a state.
The following definitions apply:
• Domestic insurance company: a company that resides and is incorporated under the laws of the state in which its home office is located. For example, a company chartered in Florida would be a domestic company in Florida.
• Foreign insurance company: a company whose home office is located in another state. It is considered to be a foreign company in all states except for its home state. For example, a company chartered in Texas would be a foreign company in Florida.
• Alien insurance company: is one that is chartered and organized in any country other than the United States. It is considered an alien insurance company in all states. For example, a company chartered in Canada would be an alien company in Florida.
Free-Look:
also known as the “Right to Examine”. Health insurance policies must provide a minimum free-look period of 10 days upon policy delivery. This allows the policyowner time to decide whether or not to keep it. If the policyowner decides not to keep the policy within the 10 days allowed, a full refund will be given.
Grace Period:
life insurance policies must provide a grace period of 31 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.
Replacement:
s strictly regulated and requires full disclosure by both the agent and the replacing insurance company. Replacement regulations exists to assure that purchasers receive specified information and it also reduces the opportunity for misrepresentation. Policy replacement is defined as a transaction in which a new policy or contract is to be purchased, and the agent is aware that an existing policy or contract has been, or will be:
- Lapsed, forfeited, surrendered or partially surrendered, assigned to the replacing insurer or otherwise terminated
- Converted to reduced paid-up insurance, continued as extended term insurance, or otherwise reduced in value by the use of nonforfeiture benefits or other policy values
- Modified to cause a reduction in benefits or length of policy term
- Subjected to loans exceeding 25% of the cash value
- Reissued with a reduction in cash value
- Used in a financed purchase
Entire Contract:
a provision that the policy, application, and all attachments shall constitute the entire contract between the parties.
• States that the agent does NOT have the authority to change the policy or waive any of its provisions.
Notice of Claim:
written notice of a claim must be given within 20 days after a covered loss starts or as soon as reasonably possible.
Reinstatement:
an insurance company that requires an application for reinstatement has style 45 days to reject the application before reinstatement is automatic. In other words, if the insurer takes no action within 45 days, the policy is considered reinstated automatically.
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.
• If the insurer takes no action within 45 days after receiving the reinstatement application, the policy is considered automatically reinstated.
Pre-existing Conditions:
is any condition for which the patient has already received medical advice or treatment prior to enrollment in a new medical insurance plan.
COBRA:
The Consolidated Omnibus Budget Reconciliation Act (COBRA) is a federal law that requires employers with 20 or more employees to include a continuation of benefits provision for former employees and their dependents. COBRA guarantees that the participant can continue the group coverage (at their own expense) at group rates if their participation in the group plan is terminated because of a qualifying event. Qualifying events: include the death of the employee, termination of employment (except for termination because of gross misconduct) or a reduction in work hours, which results in the participant no longer qualifying for group coverage.
Note: It is important to remember that COBRA benefits apply only to group health insurance, not group life insurance.
Long-Term Care
long-term care insurance is designed to provide coverage for diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services in a setting other than an acute care unit of a hospital.
Medicare
is the federal health insurance program for:
- People who are 65 or older
- Certain younger people with disabilities
- People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)
The different parts of Medicare help cover specific services:
- Medicare Part A (Hospital Insurance)
- Medicare Part B (Medical Insurance)
- Medicare Part C (Medicare Advantage Plans)
- Medicare Part D (prescription drug coverage)
