Marketing Communication Material and Marketing Guidelines

 

DEPARTMENT OF FINANCIAL SERVICES
OIR – Insurance Regulation

RULE NO: RULE TITLE
69O-149.041: Marketing Communication Material and Marketing Guidelines

NOTICE OF CHANGE

Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 34, No. 25, June 20, 2008 issue of the Florida Administrative Weekly.

69O-149.041 Marketing Communication Material and Marketing Guidelines.

(1) Any marketing communication shall comply with the requirements of Rule Chapter 69O-150, Part III, F.A.C.

(2) Any insurer marketing small group health plans shall comply with the following guidelines:

(a) The small group health history or size shall not be used to direct the small group to a particular small group plan except as permitted by the provisions of Section 627.6699, F.S.

(b)1. In determining eligibility for small group coverage an employer/employee income may not be used.

2. A carrier may request information and documentation to determine whether an individual qualifies as an active business that is eligible for coverage.

3. The following information, records, or documents may be requested or considered in determining whether an employer meets the definition of small employer pursuant to Section 627.6699(3)(v), F.S. If the employer was required by applicable law to maintain the information, record or documents or to file the document with a local, state or federal governmental agency or authority; maintains the information in the normal course of business; or was issued the information, records, or documents by a local, state, or deferral agency or authority:

a. IRS form 1040, Schedule C or F.

b. IRS 941 (quarterly wage and tax form).

c. IRS 1065 (for partnership income).

d. IRS 1120 (corporate income).

e. IRS 1099 (which may include payments to independent contractors).

f. IRS 2106 (employee business expenses).

g. IRS 990 (for non-profits with annual receipts over $25,000).

h. Occupational Licenses.

i. State Licenses.

j. Florida UT 6 (unemployment compensation tax form).

k. Articles of incorporation.

l. Partnership agreements.

m. Affidavits from the customers or suppliers of the small employer.

n. Auditable personal records of receipts, expenditures, invoices.

o. Leases and other contracts.

4.a. Refusal to insure an eligible small employer because of the employer’s refusal or unwillingness to provide information, records or documents which are not necessary to reasonably establish that the employer meets the definition of Section 627.6699(3)(v), F.S., violates Section 627.6699(5)(a), F.S.

b. Any carrier statement that knowingly requires the submission of information not necessary for determining eligibility as a condition of the issuance of coverage engages in an unfair method of competition in violation of Section 626.9541(1)(b), F.S. information not necessary for determining eligibility be provided for coverage to be issued shall constitute an unfair method of competition in violation of Section 626.9541(1)(b), F.S.

(c) In the instance where a company splits to become two or more corporations, with each corporation employing less than 50 employees, they are considered an eligible small employer if:

1. The group is not splitting solely with the intent of providing health insurance coverage to a separate class of employees;

2. The new company can produce signed documentation (i.e., articles of incorporation) that substantiates that there is a legitimate business with business activity;

3. All eligible employees are working 25 hours or more per week.

(d) New and renewal policies for the Basic and Standard policies issued on or after May 1, 1995, must include the 1995 Basic and Standard Health Benefit Plans (OIR-B2-95) pursuant to Section 627.6699(12), F.S., which is incorporated herein by reference and can be obtained from Life and Health Product Review the Bureau of Life and Health Forms and Rates.

(e)1. Pursuant to Section 626.9611, F.S., the Office identifies the following as being prohibited by Sections 626.9541(1)(b) or 626.9541(1)(g), F.S., for a small employer carrier in reflecting any of the permitted rate adjustments in subsection 69O-149.037(6), F.A.C.:

a. Knowingly quoting To quote a rate which does not reflect the actual characteristics of the individual group; or

b. Where necessary underwriting information has not been analyzed, knowingly quoting to quote a rate other than the approved community rate. Any such quote of the community rate shall include a disclosure that the rate will be affected by the results of underwriting by up to 15 percent up or down for new groups, or up to a 10 percent increase for renewal groups.

2. This does not restrict carriers from quoting rates to groups based on estimated enrollment or demographics provided by the employer.

(f) Any practice that results in the declination of an application from an eligible small employer, other than for statutorily permitted reasons, constitutes a failure to comply with the guaranteed-issue requirements of Section 627.6699(5), F.S.; for example, imposing standards for eligibility that are not required by law, such as:

1. Requiring the small employer to be a domestic entity; or

2. Requiring the group to have prior group coverage; or

3. Requiring payment of premiums with business checks instead of personal checks.

(g) All applications used by carriers to obtain information to offer and issue a small employer health benefit plan to an eligible small employer shall be on a form which the eligible small employer shall complete. Forms that require employees to complete application information or provide additional health details to the eligible small employer as a condition for the eligible small employer to obtain coverage are prohibited.

Specific Authority 626.9611, 627.6699(13)(i), (17) FS. Law Implemented 626.9541(1)(b), (g)2., (x)3., 627.6699(3)(g), (v), (5)(a), (5)(c), (7), (12), (12)(c), (13), (13)(b) FS. History–New 3-1-93, Amended 11-7-93, 4-23-95, 8-4-02, 6-19-03, Formerly 4-149.041.