Department Communication
The Communications Director manages the Department of Communications. The CFO and Insurance Commissioner are proponents of transparency for its citizens. Managing communications and making them public (as appropriate) enforces the transparency process.
The Newsroom on the floir.com website makes the Director available, provides access to OIR actions, and ensures related news is current. Citizens are invited to follow them on social media and sign up for the weekly newsletter Dollars & Sense. [Source: OIR Press Release]
Guaranty Association
Florida Insurance Guaranty Association (FIGA) is part of a non-profit, state-based, statutorily-created system that pays certain outstanding claims of insolvent insurance companies. By paying these claims, guaranty associations protect policyholders and claimants. Guaranty associations are active in every state, the District of Columbia, Puerto Rico, and the Virgin Islands.
Guaranty associations ease the burden on policyholders and claimants of the insolvent insurer by immediately stepping in to assume responsibility for most policy claims following liquidation. They provide two important benefits: prompt payment of covered claims and payment of the full value of covered claims up to the limits set by the policy or state law. [Chapter 631]
Coverage applies to direct life insurance, health insurance, annuity contracts, and supplemental contracts issued by those licensed to transact insurance in Florida. Coverage is provided to:
- Those who are the beneficiaries, assignees, or payees of covered persons
- Those who are owners of policies or contracts and who are residents of Florida
- Residents of other states if the insurer is domiciled in Florida, the insurers were not licensed in the states in which the individuals reside, and such other states have associations similar to FIGA
- A payee under a structured settlement annuity (or beneficiary if the payee is deceased) with a coverage limit of $300,000, if the payee is a resident of Florida
For purposes of administration and assessment, the association maintains three accounts: the health insurance account, the life insurance account, and the annuity account. Borrowing between accounts for payment of claims is authorized at the discretion of the board of directors, provided that the amounts are restored to the appropriate accounts not less than annually. [§631.715(2)(a)]
There is a nonprofit legal entity known as the Florida HMO Consumer Assistance Plan. All HMOs must remain members of the plan as a condition of their authority to transact business in Florida. The plan comes under the immediate supervision of the department and is subject to the applicable laws of Florida. [§631.811 and §631.828]
New Florida Law Updates
Waives the prelicensing education requirement for active military members, veterans, and their spouses who are currently in good standing with the military or have been honorably discharged. These individuals are also exempt from license application fees if they are currently in good standing or have been honorably discharged within 24 months of application.
Effective July 1, 2018 [Sec. 626.171, 732, 7851, 8311, 8417, 927 F.S.]
Modifies Florida’s unfair trade practices law regarding advertising and promotional gifts. Insurers and agents may give insureds, prospective insureds, and others merchandise, gift cards, event tickets, or other items valued at $100 or less per individual in any calendar year. For title insurance agents and agencies, a $25 limit applies. Insurers and agents may also make charitable contributions on behalf of insureds or prospective insureds of up to $100 per individual in any calendar year.
Effective July 1, 2018 [Sec. 626.9541 F.S.]
Provides for substantial changes in the way insurance benefits may be assigned to third parties. Key provisions:
- Defines “assignment agreement” and establishes requirements for execution, validity, and effect
- Transfers certain pre-lawsuit duties under the insurance contract to the assignee
- Requires each insurer to report data on claims paid under assignment agreements by January 30, 2022, and each year thereafter
- Revises the state’s one-way attorney fee statute to incorporate an attorney fee structure
- Requires service providers to give an insurer and the consumer prior written notice of at least 10 business days before filing suit on a claim
Takes Effect: July 1, 2019
Requires authorized insurers to provide insureds a loss run statement within 15 days after receipt of the insured’s written request. No fees can be charged for providing this information once annually. A loss run statement contains: policy number, period of coverage, number of claims, paid losses on all claims, and date of each loss. The loss run statement must cover the past five years or the complete claims history if less than five years. Insurers are not required to provide loss reserve information.
Effective Date: 1/1/2021
Insurers who provide health, life, and long-term care insurance, in the absence of a diagnosis of a condition related to genetic information, cannot cancel, limit, or deny coverage, or establish differentials in premium rates, based on that genetic information. This does not prevent life or long-term care insurers from considering a medical diagnosis included in a medical record, even if the diagnosis was based on the results of a genetic test.
Effective Date: July 1, 2020
Exempts from public records requirements certain records made or received by DFS acting as receiver, including consumer personal financial & health information, certain underwriting files, insurer personnel & payroll records, consumer claim files, certain reports & documents submitted to OIR relating to insurer own-risk, corporate governance annual disclosures, and certain information received from NAIC or governments.
Effective Date: July 1, 2020
- Establishes the Division of Public Assistance Fraud (DPAF) as a criminal justice agency
- Changes the mandatory CE update course from a five-hour course to a four-hour course every two years, effective for compliance periods ending January 1, 2022 or later
- Prohibits a person from requiring an insurance agent or agency to provide the replacement cost estimator or other proprietary underwriting information as a condition to extending credit secured by real property
Effective Date: July 1, 2021
- Requires entities licensed by DFS or OIR to respond to document requests from the DFS Division of Consumer Services
- Revises the prohibition against unlicensed activity to include knowingly aiding or abetting an unlicensed person — a third-degree felony
- Authorizes DFS to suspend or revoke the license of an agent that makes a consumer’s personal financial or medical information available to the public
- Prohibits in-person or telephone solicitation with a prospective customer after 9 p.m. or before 8 a.m., unless the customer requests otherwise
- Prohibits the sale of industrial life insurance policies, effective July 1, 2021
- Expands the definition of sliding, a practice that violates Unfair Insurance Trade Practices
- Requires insurance agencies whose name contains “Medicare” or “Medicaid” to delete those words from the agency name no later than June 30, 2023
Effective Date: Upon becoming law (06/16/2021, unless otherwise noted)
- Requires all sales telephone calls, text messages, and direct-to-voicemail transmissions to have the receiving consumer’s prior express written consent if the call will be made using an automated machine or will play a recorded message
- Prohibits telephone sellers from calling consumers outside of the hours between 8 a.m. and 8 p.m. in the consumer’s time zone
- Prohibits contact with consumers on the same subject matter more than three times in a 24-hour period
Effective Date: July 1, 2021
Prohibits insurers of life insurance policies, industrial life policies, group life policies, credit life and credit disabilities policies, and long-term care policies from discrimination against living organ donors or prospective living organ donors in coverage or eligibility solely on their status as a living organ donor.
Effective July 1, 2022
Adopts the NAIC Suitability in Annuity Transactions Model Regulation (2020), broadening the scope of requirements for sales or recommendations of annuities. The bill places a duty on insurers and agents to act in the best interest of consumers, emphasizing care, disclosure, conflict of interest, and recordkeeping. Introduces training requirements for agents involved in annuity sales. Also requires agents to disclose third-party remuneration for health insurance marketing practices.
- Investigations: Expands authority of the Division of Investigative and Forensic Services (DIFS) to initiate investigations when there is reason to believe a violation of Florida or federal criminal law has occurred
- Anti-Fraud Reward Program: Expands the list of insurance fraud violations for which DFS can offer rewards of up to $25,000, and eliminates the requirement for a conviction to award a reward
- Insurer Insolvency: Provides DFS with authority in receivership proceedings to transfer an insolvent insurer’s book of business to a solvent assuming insurer
Authorizes emergency refill of insulin and insulin-related supplies or equipment not to exceed three non-consecutive times per calendar year.
Effective Date: July 1, 2024
Prohibits a contract between a health insurer and a dentist from containing certain restrictions on payment methods. Prohibits a health insurer from charging a fee to transmit a payment to a dentist through ACH transfer unless the dentist has consented to such fee. Prohibits a health insurer from denying claims for procedures included in a prior authorization.
Effective Date: 1/1/2025
Codifies FUFIPA into ch. 738, F.S., replacing FUPIA as the law governing the allocation of trust and estate receipts and disbursements. Key provisions: allows for total-return investing under the “modern portfolio theory,” provides for conversion of an existing trust into a unitrust, and provides a governing law provision to reduce jurisdictional disputes.
Effective Date: January 1, 2025
Creates a new section of law authorizing Nonprofit Agricultural Organizations (Farm Bureaus) to establish medical benefit plans that are exempt from state insurance laws, as is permitted in several other states. Section 624.4032 is added to Part III of Chapter 624 of the Insurance Code.
Effective Date: July 1, 2025
Reduces from 30 months to 12 months the timeframe for a health insurer or HMO to submit claims for overpayment to a licensed psychologist, aligning psychologists with the same 12-month look-back period applicable to other health care providers. Applies to claims for services provided on or after January 1, 2026.
Effective Date: July 1, 2025 [Statutes Affected: 627.6131, 641.3155]
Requires health care practitioners, facilities, providers, and anyone who accepts payment from insurance for services rendered, to refund any overpayment made by the patient no later than 30 days after determining that the patient made an overpayment.
Effective Date: January 1, 2026
Removes the definition of “diligent effort” for surplus lines insurance and removes all existing eligibility criteria for surplus lines exporting, including the diligent effort requirement, layering allowances, and documentation standards. The only provisions retained are updates to the disclosure form required for surplus lines placements — specifically adding that surplus lines insurers’ policy rates and forms are not approved by any Florida regulatory agency.
Effective July 1, 2025
Pertinent Federal Law Review
Each state’s insurance director manages most insurance issues and products at the state level. There are, however, instances in which the state and federal governments work together — for example, Medicaid is a state and federally funded program.
The Federal Insurance Office (FIO) was created by the Dodd-Frank Wall Street Reform and Consumer Protection Act (DFA), which has allowed states the same freedoms as before creation of the FIO. The FIO’s authorities extend to all lines of insurance except health and LTC insurances (except those lines of insurance included with life or annuity components).
This bill requires the Securities and Exchange Commission (SEC) to create a new form for the registration of index-linked annuities to ensure that a purchaser can make a knowledgeable decision. The bill defines a registered index-linked annuity as an annuity that:
- Is deemed a security that must be registered with the SEC
- Is issued by an insurance company subject to state supervision
- Has returns based on the performance of a specified benchmark index or rate
- May be subject to a market value adjustment if amounts are withdrawn early
Money laundering is the process of disguising the source of funds obtained through criminal activity — such as fraud, drug trafficking, or terrorist financing — so they appear to come from legitimate sources. The USA PATRIOT Act authorized the Financial Crimes Enforcement Network (FinCEN) — a bureau of the U.S. Treasury Department — to extend Anti-Money Laundering (AML) obligations to insurance companies. These requirements are codified at 31 CFR Part 1025 and apply nationwide, including in Florida.
The rule applies to life insurers that issue permanent (cash-value) life insurance policies, annuities (fixed, indexed, and variable), and other investment-type contracts. Term life and property-casualty products are generally excluded.
Although insurers file the official Suspicious Activity Reports (SARs), agents are obligated to identify and escalate red flags, including:
- A client insisting on paying large premiums with cash or money orders
- A request for early surrender or refund shortly after issue
- Frequent changes of ownership or beneficiary with no clear reason
- Reluctance to provide identification or financial information
- Foreign transfers of funds or policy loans with suspicious destinations
When the insurer’s compliance department concludes that a transaction is suspicious and involves at least $5,000, a SAR must be filed electronically with FinCEN within 30 days of detection.
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