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Florida Administrative Code (Last Updated: June 27, 2024) |
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69. Department of Financial Services |
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69O. OIR – Insurance Regulation |
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69O-154. Health Insurance Policies |
1(1) An outline of coverage, as required by Section 10627.642, F.S., 12shall be delivered either at the time the application for the policy is taken or at the time such policy is delivered. Such outline of coverage shall be clearly identified as such and accurately describe the policy or contract and its provisions in a clear and concise manner. If the outline is delivered at the time the application is taken, there must be either a certification of delivery by the agent, or an acknowledgement of receipt by the applicant. Such certification or acknowledgement may be a separate document or by certification in the application.
106(2) The requirement of the outline of coverage as set forth in Section 119627.642, F.S., 121shall include the following information:
126(a) The name and principal address of the insurer or service association.
138(b) A statement of identification of the policy or contract as described in Rule 15269O-154.106, 153F.A.C., of this rule.
157(c) A description of each of the principal benefits and coverages, including the benefit amounts, duration or limits, elimination periods, inner limits and any other items appropriate to the coverage provided.
188(d) A description of the terms and conditions or renewability of the policy or contract, including any limitations by age, time or event, rights to change premium, status requirements and any other matters appropriate to the terms and conditions of renewability (including any rights of cancellation reserved to the insurer).
238(e) A description of the principal exceptions, reductions and limitations contained in the policy or contract, including the pre-existing conditions, if any, and the circumstances under which any reduction provisions become operative.
270(f) A statement that the Outline of Coverage is only a brief summary of the policy and is not the contract of insurance. The policy or contract itself sets forth the rights and obligations of the insured and insurer.
309Rulemaking Authority 311627.643, 312624.308 FS. 314Law Implemented 316624.307(1), 317627.642, 318627.643 FS. 320History–New 1-1-75, Formerly 4-37.07, 4-37.007, 4-154.107.
