69O-230.033. Reporting Requirements for Licensees Concerning Unlicensed Insurance Activity by Multiple Employer Welfare Arrangements, Labor Leasing Organizations, and Purportedly Collectively Bargained Plans


Effective on Monday, July 23, 2001
  • 1(1) Purpose. The purpose of this rule section is to require licensed insurers, managed care entities, agents, brokers, third-party administrators, adjusters, and other licensees of the Office to submit to the Office information of which they become aware concerning unlicensed insurance activity in this State. Such information will assist the Office in identifying unlicensed insurance activity in advance of its occurrence and will therefore aid in protecting the public from such activity.

    73(2) Definitions. For purposes of this rule, the following definitions shall apply.

    85(a) “Agent” means and includes any person holding any type and class of licensure, whether limited or unlimited, issued by the Office under chapter 626, Florida Statutes. The term also includes any person licensed or registered by the Office as an agent, sales representative, sales agent, salesperson, runner, or bail bondsman, under any of the following statutes: section 143632.634, F.S., 145(fraternal benefit agents); section 149634.031, F.S., 151(warranty association sales person); section 156635.051, F.S., 158(mortgage guaranty insurance agent); section 637.141, F.S., (optometric service plan sales representative); section 637.301, F.S., (pharmaceutical service plan sales representative); section 638.181, F.S., (ambulance service association or insurer sales representative); section 639.185, F.S., (pre-need funeral merchandise or services contract sales agent); section 200641.386, F.S., 202(health maintenance organization sales agent); section 208642.036, F.S., 210(legal expense insurance sales representative); or section 217648.30, F.S., 219(bail bondsman or bail runner). The term includes such persons whether residents of Florida or not.

    235(b) “Arrangement” means a fund, trust, plan, instrument, program, association, union, or other entity or mechanism, any portion of which does, or purports to, provide for the transfer of the risk of loss, damage, or expense resulting from a fortuitous event, from the person or entity having incurred the loss, damage, or expense, to another.

    290(c) “Collectively bargained arrangement” means an arrangement (as defined in paragraph (b), hereof), that exists pursuant to one or more bona fide labor agreements, including arrangements that are sponsored by a union or a union local. For purposes of the reporting requirements of this rule, the term also includes arrangements in which both union members and non-members do or may participate. For purposes of this rule, a collectively bargained arrangement does not include an arrangement which is fully insured by a licensed insurer for so long as the arrangement stays fully insured.

    382(d) “Office” means the Florida Office of Insurance Regulation.

    391(e) “Employee” means any individual employed by an employer.

    400(f) “Employee leasing” means a relationship whereby an employee leasing company assigns its employees to a client and allocates the direction of and control over the leased employees between the leasing company and the client. The definition includes, and is subject to the conditions, exclusions and limitations of chapter 468, part XI, F.S., and rules promulgated in accordance therewith. Notwithstanding, for as long as an employee leasing company makes available insurance benefits only through licensed insurers, such employee leasing company shall not be a subject of the reporting requirements of this rule.

    492(g) “Welfare benefit plan” means any plan, fund or program maintained by an employer or by an employee organization, or by both, to the extent that such plan, fund or program was established or is maintained in whole or in part for the purpose of providing for its participants or their beneficiaries, through the purchase of insurance or otherwise, medical, surgical or hospital care or benefits, or benefits in the event of sickness, accident, disability, death or unemployment.

    570(h) “Employee organization” means any labor union or any organization of any kind, or any agency or employee representation committee, association, group, or plan, in which employees participate and which exists for the purpose, in whole or in part, of dealing with employers concerning an employee benefit plan, or other matters incidental to employment relationships; or any employees’ beneficiary association organized for the purpose in whole or in part, of establishing such a plan.

    644(i) “Employer” means any person acting directly as an employer, or indirectly in the interest of an employer, in relation to an employee benefit plan; and includes a group or association of employers acting for an employer in such capacity.

    684(j) “Reportable MEWA,” for purposes of this rule, means a person that provides or offers insurance benefits or coverage to the employees of two or more employers, whether alone or with other benefits. “Reportable MEWA” does not include:

    7231. A licensed insurer;

    7272. An arrangement which is fully insured by a licensed insurer for so long as the arrangement stays fully insured;

    7473. An employee welfare benefit plan established or maintained by a rural electric cooperative or a rural telephone cooperative; or

    7674. A MEWA licensed by the Office.

    774(k) “Third party administrator” or “TPA” means “administrator” under section 784626.88, F.S., 786and includes, but is not limited to, all persons licensed by the department as administrators.

    801(l) “Unlicensed insurer” is any insurer as defined in section 811624.03, F.S., 813including self-insurers, which has not been licensed to transact insurance by the Office under the provisions of the Florida Insurance Code; except that any person or group authorized to self-insure for workers’ compensation coverage pursuant to sections 850440.38(1), 851440.57, and 440.575, F.S., and the rules of the Office is not an “unlicensed insurer” for purposes of this rule. The term includes any plan required to be licensed under the provisions of chapter 632 or chapters 634-651, F.S.

    890(3) Information Required to Be Reported.

    896(a) Any agent, third party administrator or insurer with knowledge of an unlicensed insurer doing business in the State of Florida, shall report the activities of the insurer to the Office and, if known, shall provide the following information:

    9351. Organizational information concerning the reportable MEWA, employee leasing arrangement, welfare benefit plan, employee organization, collectively bargained arrangement, or other unlicensed insurer;

    9572. Information on any insurance or reinsurance contracts, benefits or coverage offered by the reportable MEWA, employee leasing arrangement, welfare benefit plan, employee organization, collectively bargained arrangement, or other unlicensed insurer;

    9883. The names, addresses, and phone numbers of any officers or agents of the reportable MEWA, employee leasing arrangement, welfare benefit plan, employee organization, collectively bargained arrangement, or other unlicensed insurer;

    10194. The names, addresses, and phone numbers of any employers, employees, or individuals who may be enrolled by, or who will be receiving services from the reportable MEWA, employee leasing arrangement, welfare benefit plan, employee organization, collectively bargained arrangement, or other unlicensed insurer;

    1062(4) The report shall be made with the Office at the following address: Attn: Unlicensed Entity Coordinator, Office of Insurance Regulation, Division of Insurance Fraud. The report can be made by phone, (850)413-4000, or by mail to 2020 Capital Circle, S. E., Alexander Building, Tallahassee, FL 32301.

    1109Rulemaking Authority 1111624.308(1), 1112624.33(2), 1113624.401(1), 1114624.4431, 1115629.989(6) FS. Law Implemented 1119624.09, 1120624.44, 1121624.307, 1122624.317, 1123624.437, 1124624.442, 1125624.446, 1126626.901, 1127626.910, 1128626.9571, 1129626.9581, 1130626.9591, 1131626.9601 FS. 1133History–New 6-15-92, Amended 9-7-93, 7-23-01 Formerly 4-230.033.