Fla. Admin. Code Ann. R. 69O-149.031 - Applicability and Scope; Penalties

(1) Except as otherwise provided, the provisions of the rules in this part shall apply, to the extent provided in Section 627.6699, F.S., and this rule, to small employer health benefit plans delivered or issued for delivery in this state by an authorized insurer, a health maintenance organization, or any other person providing a health benefit plan subject to insurance regulation in this state to a small employer group.

(2) The rules in this part shall apply to any health benefit plan, whether provided on a group or individual basis, which:

(a) Satisfies Section 627.6699(4), F.S.; and,

(b) Provides coverage to one or more employees of a small employer located in this state, without regard to whether the policy or certificate was issued in this state.

(3) The Office shall impose penalties for non-compliance with the act or for abusive market conduct practices in accordance with Rule 69O-142.011, F.A.C. Such non-compliance or abusive market conduct practices are divided into three levels based on severity and intent.

(a) Level 1. This level will be treated as a violation under Category IV in Rule 69O-142.011, F.A.C., upon its becoming effective. Inadvertent miscommunications on the part of an agent or carrier. These are practices which evidence no bad faith on the carrier's or agent's part. Such practices include omissions, and "one time" actions without any consequences. All parties involved shall take necessary steps to clear up the miscommunication once the situation is brought to their attention.

(b) Level 2. This level will be treated as a violation under Category II in Rule 69O-142.011, F.A.C., upon its becoming effective. Deliberate action on the part of a carrier or agent that is in violation of the Act. These include repetitive acts and omissions. The violation must be corrected within 30 days, once it is brought to the carrier's or agent's attention in order to avoid being considered a Level 3 violation.

(c) Level 3. This level will be treated as a violation under Category I in Rule 69O-142.011, F.A.C., upon its becoming effective. Deliberate practice which has a severe economic impact on the insured or the policyholder and is clearly in violation of the Act.

Notes

Fla. Admin. Code Ann. R. 69O-149.031

Rulemaking Authority 624.308(1), 627.6699(16) FS. Law Implemented 624.418, 624.4211, 627.6699(4)(a), (5), (5)(g)1., (7) FS.

New 3-1-93, Amended 11-7-93, 4-23-95, 8-4-02, Formerly 4-149.031.

New 3-1-93, Amended 11-7-93, 4-23-95, 8-4-02, Formerly 4-149.031.