The rule amendment provides penalties for violations of section 626.9957, F.S., regarding the conduct of health insurance navigators. “Navigator” is a new category of insurance professional created by Ch. 2013-101, Laws of Florida to help health ...  

  • Division of Insurance Agents and Agency Services

    RULE NOS.:              RULE TITLES:

    69B-231.010              Purpose

    69B-231.020              Scope

    69B-231.030              Definitions

    69B-231.040              Calculating Penalty

    69B-231.070              Prosecutorial Discretion

    69B-231.100              Penalties for Violation of Subsection 626.9541(1), F.S.

    69B-231.110              Penalties for Violation of Other Specific Provisions of the Florida Insurance Code

    69B-231.115              Penalties for Violation of Section 626.9957, Florida Statues

    69B-231.160              Aggravating/Mitigating Factors

    PURPOSE AND EFFECT: The rule amendment provides penalties for violations of Section 626.9957, F.S., regarding the conduct of health insurance navigators. “Navigator” is a new category of insurance professional created by Ch. 2013-101, Laws of Florida to help health insurance consumers to understand the options available under the Patient Protection and Affordable Care Act. Additionally, “section” is replaced with “subsection” to conform to the present convention.

    The new penalties are listed in Rule 69B-231.115, F.A.C., and are analogous to penalties for similar violations by other insurance licensees.

    SUMMARY: The rule amendment provides penalties for violations of Section 626.9957, F.S., regarding the conduct of health insurance navigators. “Navigator” is a new category of insurance professional created by Ch. 2013-101, Laws of Florida to help health insurance consumers to understand the options available under the Patient Protection and Affordable Care Act. Additionally, “section” is replaced with “subsection” to conform to the present convention.

    SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS AND LEGISLATIVE RATIFICATION:

    The Agency has determined that this will not have an adverse impact on small business or likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule. A SERC has been prepared by the Agency.

    The Agency has determined that the proposed rule is not expected to require legislative ratification based on the statement of estimated regulatory costs or if no SERC is required, the information expressly relied upon and described herein: This rule deals with the penalties being imposed on individuals for failing to comply with the Florida insurance code. Individuals are required to maintain records for the transactions they discuss with Florida consumers under the Florida Statutes and the Patient Protection and Affordable Care Act. However, if a person were to be charged with an allegation of violating the law, then that person will need to retrieve their records and spend time developing a defense to the allegations. They may also incur attorney fees to try to defend their position and maintain their registration.

    Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.

    RULEMAKING AUTHORITY: 624.308, 626.9957(12), 626.9958 FS.

    LAW IMPLEMENTED: 624.307(1), 624.308, 624.308(2), 626.207(2), 626.611, 626.621, 626.631, 626.631(1), 626.641, 626.681, 626.691, 626.9521, 626.9541(1), 626.9561, 626.9571, 626.9581, 626.9954, 626.9957, 626.9957(4)(a), (b), (g), 627.9957(4)(g), 631.155 FS.

    IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW (IF NOT REQUESTED, THIS HEARING WILL NOT BE HELD):

    DATE AND TIME: Wednesday, May 7, 2014, 10:30 a.m.

    PLACE: 116 Larson Building, 200 East Gaines Street, Tallahassee, Florida

    Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 5 days before the workshop/meeting by contacting: Barry Lanier, (850)413-5601 or Barry.Lanier@myfloridacfo.com. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).

    THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Barry Lanier, Chief, Bureau of Investigation, Division of Insurance Agent & Agency Services, Department of Financial Services, 200 E. Gaines Street, Room 416A, Larson Building, Tallahassee, FL 32399-0320, (850)413-5601 or Barry.Lanier@myfloridacfo.com

     

    THE FULL TEXT OF THE PROPOSED RULE IS:

     

    69B-231.010 Purpose.

    The purpose of this rule chapter is to implement the Department’s duty under subsections Sections 624.307(1), and 626.207(2), and Section 626.9954, F.S., to enforce Sections 626.611, 626.621, 626.631, 626.641, 626.681, and 626.691, and 626.9954, F.S., by establishing standards for penalties described in those statutory sections, and interpreting provisions in those sections as they relate to penalties imposed upon licensees specified in Rule 69B-231.020, F.A.C.

    Rulemaking Specific Authority 624.308, 626.9957(12), 626.9958 626.207(2) FS. Law Implemented 624.307(1), 624.308(2), 626.207(2), 626. 9957 FS. History–New 7-13-93, Amended 9-23-02, Formerly 4-231.010, Amended 8-15-06,_________.

     

    69B-231.020 Scope.

    (1) This rule chapter shall apply to all resident and nonresident insurance agents, customer representatives, adjusters, navigators, and service representatives licensed under Chapter 626, F.S., who are subject to discipline under Sections 626.611 and 626.621, F.S.

    (2) No change.

    Rulemaking Specific Authority 624.308, 626.9957(12), 626.9958 626.207(2) FS. Law Implemented 624.307(1), 624.308(2), 626.207(2), 626.611, 626.621, 626.9957 FS. History–New 7-13-93, Amended 8-15-00, 9-23-02, Formerly 4-231.020, Amended 8-15-06,__________.

     

    69B-231.030 Definitions.

    The following definitions shall apply for purposes of this rule chapter.

    (1) through (7) No change.

    (7) “Final penalty” means the penalty imposed on a licensee by the Department.

    (8) “License” shall have the meaning set forth in subsection 120.52(10), Florida Statutes which includes registrations.

    (9) “Licensee” means one who holds a license.

    (8) through (10) No change.

    Rulemaking Authority 624.308, 626.9957(12), 626.9958 626.207(2) FS. Law Implemented 624.307(1), 624.308(2), 626.207(2), 626.611, 626.621, 626.9957 FS. History–New 7-13-93, Amended 9-23-02, Formerly 4-231.030, Amended 8-15-06, 8-12-10, _________.

     

    69B-231.040 Calculating Penalty.

    (1) Penalty Per Count.

    (a) The Department is authorized to find that multiple grounds exist under Sections 626.611, and 626.621 and 626.9957, F.S., for disciplinary action against the licensee based upon a single count in an administrative complaint based upon a single act of misconduct by a licensee. However, for the purpose of this rule chapter, only the violation specifying the highest stated penalty will be considered for that count. The highest stated penalty thus established for each count is referred to as the “penalty per count”.

    (b) No change.

    (2) No change.

    (3) Final Penalty.

    (a) No change.

    (b) The Department may convert the total penalty to an administrative fine and probation if the licensee has not previously been subjected to an administrative penalty and the current action does not involve a violation of Section 626.611, F.S.;

    (c) through (d) No change.

    Rulemaking Specific Authority 624.308, 626.9957(12), 626.9958 626.207(2) FS. Law Implemented 624.307(1), 624.308(2), 626.207(2), 626.611, 626.621, 626.641, 626.681, 626.691, 626.9957 FS. History–New 7-13-93, Formerly 4-231.040, Amended 8-15-06,___________.

     

    69B-231.070 Prosecutorial Discretion.

    (1) through (2) No change.

    (3) Cease and Desist Actions. This rule chapter shall not preclude the Department from initiating an administrative action against licensed or unlicensed individuals for the purpose of imposing cease and desist and penalty orders authorized by Section 626.9581, F.S.

    (4) No change.

    Rulemaking Specific Authority 624.308, 626.9957(12), 626.9958 626.207(2) FS. Law Implemented 624.307(1), 624.308, 626.207(2), 626.611, 626.621, 626.681, 626.691, 626.9521, 626.9561, 626.9571, 626.9581, 626.9957 FS. History–New 7-13-93, Formerly 4-231.070, Amended 8-15-06,___________.

     

    69B-231.100 Penalties for Violation of Subsection Section 626.621(6), or Section 626.9541, F.S.

    If a licensee is found to have violated subsection Section 626.621(6), or Section 626.9541, F.S., by engaging in unfair methods of competition or in unfair or deceptive acts or practices as defined in any of the following paragraphs of subsection Section 626.9541(1), F.S., the following stated penalty shall apply:

    (1) Paragraph Section 626.9541(1)(a), F.S. – suspension 12 months

    (2) Paragraph Section 626.9541(1)(b), F.S. – suspension 6 months

    (3) Paragraph Section 626.9541(1)(c), F.S. – suspension 3 months

    (4) Paragraph Section 626.9541(1)(d), F.S. – suspension 3 months

    (5) Paragraph Section 626.9541(1)(e), F.S. – suspension 6 months; except that the penalty for a violation of subparagraph Section 626.9541(1)(e)1., F.S., shall be a suspension of 12 months.

    (6) Paragraph Section 626.9541(1)(f), F.S. – suspension 3 months

    (7) Paragraph Section 626.9541(1)(g), F.S. – suspension 6 months

    (8) Paragraph Section 626.9541(1)(h), F.S. – suspension 6 months

    (9) Paragraph Section 626.9541(1)(i), F.S. – suspension 6 months

    (10) Paragraph Section 626.9541(1)(j), F.S. – suspension 3 months

    (11) Paragraph Section 626.9541(1)(k), F.S. – suspension 9 months

    (12) Paragraph Section 626.9541(1)(l), F.S. – suspension 12 months

    (13) Paragraph Section 626.9541(1)(m), F.S. – suspension 3 months

    (14) Paragraph Section 626.9541(1)(n), F.S. – suspension 6 months

    (15) Paragraph Section 626.9541(1)(o), F.S. – suspension 6 months

    (16) Paragraph Section 626.9541(1)(p), F.S. – suspension 3 months

    (17) Paragraph Section 626.9541(1)(q), F.S. – suspension 3 months

    (18) Paragraph Section 626.9541(1)(r), F.S. – suspension 3 months

    (19) Paragraph Section 626.9541(1)(s), F.S. – suspension 3 months

    (20) Paragraph Section 626.9541(1)(t), F.S. – suspension 3 months

    (21) Paragraph Section 626.9541(1)(u), F.S. – suspension 9 months

    (22) Paragraph Section 626.9541(1)(v), F.S. – suspension 3 months

    (23) Paragraph Section 626.9541(1)(w), F.S. – suspension 6 months

    (24) Paragraph Section 626.9541(1)(X), F.S. – suspension 6 months

    (25) Paragraph Section 626.9541(1)(y), F.S. – suspension 6 months

    (26) Paragraph Section 626.9541(1)(z), F.S. – suspension 6 months

    (27) Paragraph Section 626.9541(1)(aa), F.S. – suspension 9 months

    (28) Paragraph Section 626.9541(1)(bb), F.S. – suspension 3 months

    (29) Paragraph Section 626.9541(1)(cc), F.S. – suspension 6 months

    (30) Paragraph Section 626.9541(1)(ee), F.S.  – suspension 12 months

    (31) Paragraph Section 626.9541(1)(ff), F.S. – suspension 12 months.

    Rulemaking Authority 624.308, 626.9957(12), 626.9958 626.207(2) FS. Law Implemented 624.307(1), 624.308(2), 626.207(2), 626.621, 626.9541(1), 626.9957(4)(a) FS. History–New 7-13-93, Formerly 4-231.100, Amended 8-15-06, 8-12-10,___________.

     

    69B-231.110 Penalties for Violation of Other Specific Provisions of the Florida Insurance Code.

    If the licensee is found to have violated any of the following provisions of the Insurance Code, the following stated penalty shall apply:

    (1) Subsection Section 624.318(2), F.S. – suspension 3 months

    (2) Subsection Section 626.112(2), F.S. – suspension 3 months

    (3) Subsection Section 626.342(1), F.S. – suspension 3 months

    (4) through (7) No change.

    (8) Subsection Section 626.561(1), F.S. – suspension 9 months

    (9) Subsection Section 626.561(2), F.S. – suspension 3 months

    (10) through (12) No change.

    (13) Subsection Section 626.601(2), F.S. – suspension 3 months

    (14) Subsection Section 626.631(1), F.S. – revocation

    (15) Subsection Section 626.641(4), F.S. – revocation

    (16) No change.

    (17) Subsection Section 626.741(3), F.S. – suspension 3 months

    (18) Subsection Section 626.741(4), F.S. – suspension 6 months

    (19) through (23) No change.

    (24) Subsection Section 626.792(3), F.S. – suspension 3 months

    (25) Subsection Section 626.792(6), F.S. – revocation

    (26) through (29) No change.

    (30) Subsection Section 626.835(3), F.S. – suspension 3 months

    (31) Subsection Section 626.835(6), F.S. – revocation

    (32) through (34) No change.

    (35) Subsection Section 626.901(1), F.S. – suspension 12 months

    (36) Subsection Section 626.901(2), F.S. – suspension 12 months

    (37) through (39) No change.

    Rulemaking Authority 624.308, 626.9957(12), 626.9958 626.207(2) FS. Law Implemented 624.307(1), 624.308(2), 626.207(2), 626.611, 626.621, 626.681, 626.691, 626.9957(4)(a), 631.155 FS. History–New 7-13-93, Formerly 4-231.110, Amended 8-15-06, 8-12-10,___________.

     

    69B-231.115 Penalties for Violation of Section 626.9957, Florida Statutes.

    If it is found that the navigator has violated any of the following subsections of Section 626.9957, F.S., the following stated penalty shall apply:

    (1) Paragraph 626.9957(2)(a), F.S. – suspension 6 months

    (2) Paragraph 626.9957(2)(b), F.S. – suspension 6 months

    (3) Paragraph 626.9957(3)(a), F.S. – suspension 6 months

    (4) Paragraph 626.9957(3)(b), F.S. – suspension 6 months

    (5) Paragraph 626.9957(3)(c), F.S. – suspension 6 months

    (6) Paragraph 626.9957(4)(c), F.S. – suspension 6 months

    (7) Paragraph 626.9957(4)(d), F.S. – cancellation upon failure to meet statutory requirements

    (8) Paragraph 626.9957(4)(e), F.S. –

    (a) Suspension 12 months if, had the license application been accurate, the application would have been granted, based on the statutes and Department licensing rules applicable to the application at the time the Department issued the license, and the documentation in the applicant’s file at the time the Department issued the license,

    (b) Revocation if, had the license application been accurate, the application would have been denied, based on the statutes and Department licensing rules applicable to the application at the time the Department issued the license.

    (9) Paragraph 626.9957(4)(f), F.S. – revocation

    (10) Paragraph 626.9957(4)(g), F.S. – see Rule 69B-231.150

    (11) Paragraph 626.9957(4)(h), F.S. – revocation

    (12) Paragraph 626.9957(4)(i), F.S. – suspension 6 months

    (13) Paragraph 626.9957(4)(j), F.S. – revocation

    Rulemaking Authority 626.9957(12), 626.9958 FS. Law Implemented 626.9957 FS. History–New_________.

     

    69B-231.160 Aggravating/Mitigating Factors.

    The Department shall consider the following aggravating and mitigating factors and apply them to the total penalty in reaching the final penalty assessed against a licensee under this rule chapter. After consideration and application of these factors, the Department shall, if warranted by the Department’s consideration of the factors, either decrease or increase the penalty to any penalty authorized by law.

    (1) For penalties other than those assessed under Rule 69B-231.150, F.A.C.:

    (a) through (l) No change.

    (m) Violation of any part of Sections 626.9541, and 627.4554. F.S., in relation to the sale of a life insurance policy or annuity to a senior citizen; and

    (n) No Change.

    (2) For penalties assessed under Rule 69B-231.150, F.A.C., for violations of subsections Sections 626.611(14) and 626.621(8), F.S.:

    (a) through (i) No change.

    Rulemaking Authority 626.308, 626.9957(12), 626.9958 626.207(2), 627.4554(9) FS. Law Implemented 624.307(1), 624.308(2), 626.207(2), 626.611, 626.621, 626.631, 626.681, 626.9541, 627.4554, 626.9954, 627.9957(4)(g) FS. History–New 7-13-93, Formerly 4-231.160, Amended 8-15-06, 8-12-10,___________.

     

    NAME OF PERSON ORIGINATING PROPOSED RULE: Barry Lanier, Chief, Bureau of Investigation, Division of Insurance Agent & Agency Services, Department of Financial Services

    NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Jeff Atwater, Chief Financial Officer, Department of Financial Services

    DATE PROPOSED RULE APPROVED BY AGENCY HEAD: April 4, 2014

    DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: January 6, 2014

Document Information

Comments Open:
4/10/2014
Summary:
The rule amendment provides penalties for violations of section 626.9957, F.S., regarding the conduct of health insurance navigators. “Navigator” is a new category of insurance professional created by Ch. 2013-101, Laws of Florida to help health insurance consumers to understand the options available under the Patient Protection and Affordable Care Act. Additionally, “section” is replaced with “subsection” to conform to the present convention.
Purpose:
The rule amendment provides penalties for violations of section 626.9957, F.S., regarding the conduct of health insurance navigators. “Navigator” is a new category of insurance professional created by Ch. 2013-101, Laws of Florida to help health insurance consumers to understand the options available under the Patient Protection and Affordable Care Act. Additionally, “section” is replaced with “subsection” to conform to the present convention. The new penalties are listed in Rule 69B-231....
Rulemaking Authority:
624.308, 626.9957(12), 626.9958, F.S.
Law:
624.307(1), 624.308, 624.308(2), 626.207(2), 626.611, 626.621, 626.631, 626.631(1), 626.641, 626.681, 626.691, 626.9521, 626.9541(1), 626.9561, 626.9571, 626.9581, 626.9954, 626.9957, 626.9957(4)(a), (b), (g),627.9957(4)(g), 631.155, F.S.
Contact:
Barry Lanier, Chief, Bureau of Investigation, Division of Insurance Agent & Agency Services, Department of Financial Services, 200 E. Gaines Street, Room 416A, Larson Building, Tallahassee, FL 32399-0320, (850) 413-5601 or Barry.Lanier@myfloridacfo.com.
Related Rules: (9)
69B-231.010. Purpose
69B-231.020. Scope
69B-231.030. Definitions
69B-231.040. Calculating Penalty
69B-231.070. Prosecutorial Discretion
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