This review will assist the Legislature in determining whether mandating a particular coverage is in the public interest. A prospective purchaser, purchaser, or beneficiary of, or applicant for, any product or service regulated under the Florida Insurance Code, and a family member or dependent of a consumer. An employee seeking assistance from the Employee Assistance and Ombudsman Office under s. I of the State Constitution.
This exemption applies to personal financial and health information held by the department or office before, on, or after the effective date of this exemption. Before the department or office provides the record, the person must affirm his or her request to receive the record. If the office determines that a form does not comply with PPACA, the office shall inform the insurer or organization of the reason for noncompliance.
If the office determines that a form ultimately used by an insurer or organization does not comply with PPACA, the office may report such potential violation to the federal Department of Health and Human Services. The review of forms by the office under this subsection does not include review of the rates, rating practices, or the relationship of benefits to the rates. If the insurer or organization does not take action to comply with PPACA, the office may report such potential violation to the federal Department of Health and Human Resources.
The act of entering into a direct health care agreement does not constitute the business of insurance and is not subject to the Florida Insurance Code. The agreement may provide for immediate termination due to a violation of the physician-patient relationship or a breach of the terms of the agreement. This agreement does not qualify as minimum essential coverage to satisfy the individual shared responsibility provision of the Patient Protection and Affordable Care Act, 26 U.
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The Office of Insurance Regulation shall establish and maintain offices in Tallahassee and in such other places throughout the state as it designates. The office shall have the powers and authority expressly conferred upon it by, or reasonably implied from, the provisions of this code.
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The cost of such investigations shall be borne by the state. Actuaries employed pursuant to this paragraph shall be members of the Society of Actuaries or the Casualty Actuarial Society and shall be exempt from the Career Service System established under chapter The salaries of the actuaries employed pursuant to this paragraph shall be set in accordance with 1 s. When process documents are made available electronically, the Chief Financial Officer shall send a notice of receipt of service of process to the person last designated by the regulated person or unauthorized insurer to receive legal process.
Receive inquiries and complaints from consumers. Prepare and disseminate information that the department deems appropriate to inform or assist consumers. Provide direct assistance to and advocacy for consumers who request such assistance or advocacy. With respect to apparent or potential violations of law or applicable rules committed by a person or entity licensed by the department or office, report apparent or potential violations to the office or to the appropriate division of the department, which may take any additional action it deems appropriate.
Designate an employee of the division as the primary contact for consumers on issues relating to sinkholes. The response must address the issues and allegations raised in the complaint. A director, officer, employee, trustee, committee member, or controlling stockholder of a licensee or a subsidiary or service corporation of the licensee, other than a controlling stockholder which is a holding company, or an agent of a licensee or a subsidiary or service corporation of the licensee;.
A person who has filed or is required to file a statement or any other information required to be filed under s. A stockholder, other than a stockholder that is a holding company of the licensee, who participates in the conduct of the affairs of the licensee;. An independent contractor who: a. Renders a written opinion required by the laws of this state under her or his professional credentials on behalf of the licensee, which opinion is reasonably relied on by the department or office in the performance of its duties; or.
A third-party marketer who aids or abets a licensee in a violation of the insurance code relating to the sale of an annuity to a person 65 years of age or older. If it appears that any person has violated any provision of this code for which criminal prosecution is provided, the department or office shall provide the appropriate state attorney or other prosecuting agency having jurisdiction with respect to such prosecution with the relevant information in its possession.
An act that demonstrates a lack of fitness or trustworthiness to engage in the business of insurance, is hazardous to the insurance buying public, or constitutes business operations that are a detriment to policyholders, stockholders, investors, creditors, or the public;.
A violation of any provision of the Florida Insurance Code;. A violation of any rule of the department or commission;. A violation of any order of the department or office; or. A breach of any written agreement with the department or office. An uncontested cease and desist order is effective as agreed. The emergency order is effective immediately upon service of a copy of the order upon the licensee or affiliated party named therein and remains effective for 90 days. If the department or office begins nonemergency cease and desist proceedings under this subsection, the emergency order remains effective until the conclusion of the proceedings under ss.
Any emergency order entered under this subsection is exempt from s. All emergency cease and desist orders that are not made permanent are available for public inspection 1 year from the date the emergency cease and desist order expires; however, portions of an emergency cease and desist order remain confidential and exempt from the provisions of s. Jeopardize the integrity of another active investigation;. Impair the safety and financial soundness of the licensee or affiliated party;. Reveal personal financial information;.
Reveal the identity of a confidential source;. Defame or cause unwarranted damage to the good name or reputation of an individual or jeopardize the safety of an individual; or. Reveal investigative techniques or procedures. An act that demonstrates a lack of fitness or trustworthiness to engage in the business of insurance through engaging in illegal activity or mismanagement of business activities;.
A willful violation of any law relating to the business of insurance; however, if the violation constitutes a misdemeanor, no complaint shall be served as provided in this section until the affiliated party is notified in writing of the matter of the violation and has been afforded a reasonable period of time, as set forth in the notice, to correct the violation and has failed to do so;.
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A violation of any other law involving fraud or moral turpitude that constitutes a felony;. A willful violation of any rule of the department or commission;. A willful violation of any order of the department or office;. A material misrepresentation of fact, made knowingly and willfully or made with reckless disregard for the truth of the matter; or.
An act of commission or omission or a practice which is a breach of trust or a breach of fiduciary duty. The licensee has suffered or will likely suffer loss or other damage;.
The interests of the policyholders, creditors, or public are, or could be, seriously prejudiced by reason of the violation or act or breach of fiduciary duty;. The affiliated party has received financial gain by reason of the violation, act, or breach of fiduciary duty; or. The violation, act, or breach of fiduciary duty is one involving personal dishonesty on the part of the affiliated party or the conduct jeopardizes or could reasonably be anticipated to jeopardize the financial soundness of the licensee,.
An uncontested order of removal, restriction, or prohibition is effective as agreed. The chief executive officer, or the person holding the equivalent office, of a licensee shall promptly notify the department or office that issued the license if she or he has actual knowledge that any affiliated party is charged with a felony in a state or federal court.
Whenever any affiliated party is charged with a felony in a state or federal court or with the equivalent of a felony in the courts of any foreign country with which the United States maintains diplomatic relations, and the charge alleges violation of any law involving fraud, theft, or moral turpitude, the department or office may enter an emergency order suspending the affiliated party or restricting or prohibiting participation by the affiliated party in the affairs of the particular licensee or of any other licensee upon service of the order upon the licensee and the affiliated party charged.
The order shall contain notice of opportunity for a hearing pursuant to ss. In accordance with applicable rules, the department or office shall notify the affiliated party whether the order suspending or prohibiting the person from participation in the affairs of a licensee will be rescinded or otherwise modified. The emergency order remains in effect, unless otherwise modified by the department or office, until the criminal charge is disposed of. The acquittal of the person charged, or the final, unappealed dismissal of all charges against the person, dissolves the emergency order, but does not prohibit the department or office from instituting proceedings under paragraph a.
If the person charged is convicted or pleads guilty or nolo contendere, whether or not an adjudication of guilt is entered by the court, the emergency order shall become final. Any affiliated party who is removed, restricted, or prohibited from participation in the affairs of a licensee pursuant to this section may petition the department or office for modification or termination of the removal, restriction, or prohibition. No proceeding shall be initiated and no fine shall accrue until after the person has been notified in writing of the nature of the violation and has been afforded a reasonable period of time, as set forth in the notice, to correct the violation and has failed to do so.
In any administrative or judicial proceeding arising under this section, a party may elect to correct the violation asserted by the department or office, and, upon doing so, any fine shall cease to accrue; however, the election to correct the violation does not render any administrative or judicial proceeding moot. All fines collected under this section shall be paid to the Insurance Regulatory Trust Fund. Any service required or authorized to be made by the department or office under this code shall be made: a 1.
By certified mail, return receipt requested, delivered to the addressee only; or. If service by certified mail cannot be obtained at the last address provided to the department by the recipient, then by e-mail, delivery receipt required, sent to the most recent e-mail address provided to the department by the applicant or licensee in accordance with s.
The procedures set forth in s. Such authorization by the department or office may not be provided unless the affiliated party or the licensee has made restitution, if applicable, to all parties damaged by the actions of the affiliated party or the licensee which served as the basis for the removal or prohibition of the affiliated party or the suspension or revocation of the rights and privileges of the licensee. Any person who violates the provisions of this subsection commits a felony of the third degree, punishable as provided in s. Duly certified or authenticated reproductions of such photographs, microphotographs, or other reproductions from an electronic recordkeeping system shall be as admissible in evidence as the originals.
The office shall determine the most appropriate ratio or ratios for quantifying complaints. All moneys so deposited and all funds hereafter transferred to the Insurance Regulatory Trust Fund are appropriated for the uses and purposes above mentioned.
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Any such publication may be printed, revised, or reprinted upon the basis of the original low bid. The examination shall be pursuant to a written order of the office. Such order shall expire upon receipt by the office of the written report of the examination.
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To facilitate uniformity in examinations, the commission may adopt, by rule, the Market Conduct Examiners Handbook and the Financial Condition Examiners Handbook of the National Association of Insurance Commissioners, , and may adopt subsequent amendments thereto, if the examination methodology remains substantially consistent. The examination shall cover the preceding 5 fiscal years of the insurer and shall be commenced within 12 months after the end of the most recent fiscal year being covered by the examination. The examination may include examination of events subsequent to the end of the most recent fiscal year and the events of any prior period that affect the present financial condition of the insurer.
The rules shall provide: 1. That the rates charged to the insurer being examined are consistent with rates charged by other firms in a similar profession and are comparable with the rates charged for comparable examinations. That the firm selected by the office to perform the examination has no conflicts of interest that might affect its ability to independently perform its responsibilities on the examination.
That the insurer being examined must make payment for the examination pursuant to s.
https://mumgenbsufcomp.ml The examination must cover the preceding fiscal year or the period since the last examination of the insurer. The office may limit the scope of the examination. The examination shall be for the purpose of ascertaining compliance by the person examined with the applicable provisions of chapters , , , , and Such claims-handling practices and procedures are public records and are not trade secrets or otherwise exempt from the provisions of s. A domestic insurer;.
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