All licensed property and casualty insurers with a COA. All licensed life and health insurers with a COA.-- HOWEVER, A HEALTH INSURER THAT WRITES MEDICARE PART D ONLY IS EXEMPT FROM THE RULE UNTIL SUCH TIME THAT THEIR LINE OF BUSINESS CHANGES TO EMCOMPASS OTHER LINES OF COVERAGE. All licensed Health Maintenance Organizations with a COA-- HOWEVER, AN HMO THAT WRITES MEDICARE PART D ONLY IS EXEMPT FROM THE RULE UNTIL SUCH TIME THAT THEIR LINE OF BUSINESS CHANGES TO EMCOMPASS OTHER LINES OF COVERAGE. All title companies with a COA. All surety and bonding companies with a COA. All mortgage guaranty companies with a COA. All Risk Retention Groups with COA. All Captive insurers with a COA. Any licensee that holds a certificate of authority pursuant to the authority of Florida Statutes should check its statutory site section in the Florida Statutes for "Applicability of Other Laws". If the "applicability of other laws" section refers to Chapter 626, Part IX, F.S. (unfair trade practices), your company is required to comply with Rule 69D-2. EXEMPT COMPANIES: Self Insured employers are exempt. Surplus lines non admitted companies are exempt. Reinsurance companies are exempt. Pre-paid legal service organizations are exempt. Third party administrators (TPA)are exempt. Premium Finance companies are exempt. Service Warranty companies are exempt. Continuing Care Facilities are exempt. Non-profit organizations are exempt.

Yes, FL DIF requires that the SIU descriptions or anti-fraud plan filings be made on our forms. DFS-L1-1689 (SIU Descriptions - over $10 million in FL direct annual premium) or DFS-L1-1690 (Anti-fraud plans - less than $10 million in Florida annual direct written premium). These are found at the www.fldfs.com/fraud website. THE DIVISION WILL NOT ACCEPT MANUAL FILINGS. THE DIVISION WILL ONLY ACCEPT THE FORMS INDICATED ABOVE.

The rule is effective October 5, 2006. All licensees that are required to make the filing must submit their updated SIU descriptions or anti-fraud plans by October 5, 2006. The SIU description and anti-fraud plan filings due date is October 5, 2006.

Yes. Rule 69D-2 and the Florida Insurance Code provide for the following penalties for failing to comply with the rule component requirements: 1) A carrier that is out of compliance with any component requirement of the rule, assuming DIF has approved the carrier's SIU description or anti-fraud plan filing, would be subject to a maximum fine of $10,000 for willful violations and up to $2,500 for non-willful violations. This type of non-compliance could be construed as a willful violation. 2) A carrier that fails to submit an anti-fraud plan or a SIU description, pursuant to section 626.9891, FS and Rule 69D-2, is subject to a fine of up to $2,000 per day. A carrier that fails to file an approved filing or correct their filing with acceptable acknowledgements to the division could be subject to a fine of up to $2,000 per day. 3) A carrier that fails to report any suspected claim/fraud referrals, again assuming that DIF approved the SIU description or anti-fraud plan filing where the carrier acknowledged that it would report suspected fraud activity to the division, is considered in violation of the SIU description/anti-fraud plan acknowledgments. This constitutes a failure to follow/implement the plan/description, and thus would be punishable up to $2,500 (non-willful violation) and up to $10,000 (willful violation) per occurrence. Additionally, the Office of Insurance Regulation has the ability to suspend a Certificate of Authority (COA) for failure to comply with items #1 or #2 above.

No, only one type of filing should be made. The type of filing, either a SIU description (form DFS-L1-1689) or anti-fraud plan (form DFS-L1-1690) depends on the company's latest available (2005) FL annual direct written premium volume. This is detailed at the www.fldfs.com/fraud website. If you have a group of insurers, you use the aggregate or total of all Florida annual direct written premium volume to determine if you would file a SIU description filing for over $10 million premium or an anti-fraud plan filing for less than $10 million premium. Only one filing is necessary.

Once the SIU description or anti-fraud plan filings have been "uploaded" to the IFPR database, a message will show that the filing has been "successfully submitted and received". The division will review the SIU description filings and anti-fraud plan filings for any deficiencies. If deficiencies are found, the division will contact the company via an email. The company will have two weeks to respond to the email request and upload a filing to correct the deficiencies. The filer will upload the corrected filing using the ?Filing workbench?.

The company will access the IFPR (Insurance Fraud Plan Report) site from www.fldfs.com/fraud. First, select the REPORT FILINGS "SIU Description and Anti-fraud Plan Report Filings Pursuant to Rule 69D-2, FAC" icon in the center of the fraud main page. Next select "Instructions for Filing SIU Descriptions or Anti-fraud Plans to IFPR". This provides the instructions for making a filing. Lastly, select the "Insurance Fraud Plan Report IFPR to make filing" link site. This is where you will activate a new account, start a new filing, select your company (s) and upload the filing.

You may submit questions or problems to IFPRRPT@myfloridacfo.com. Someone will regularly review this email address.

An acknowledgement in the SIU description and/or anti-fraud plan filing must be made in exact accordance with the language found in Rule 69D-2. By changing the verbiage in the responses/answers to the acknowledgements, the insurer would NOT be swearing to implement what is required by Rule 69D-2. This would be unacceptable and a violation of Rule 69D-2. An acknowledgement is a written commitment that the company is acknowledging it has established criteria, procedures and/or policies that will be utilized in its special investigative units or anti-fraud operations. It does not have to be divulged in the descriptions or plans filed with the division. The SIU descriptions and anti-fraud plan filings that fail to state a declaratory acknowledgement of each of the component requirements of the rule will be considered deficient filings. The company's actual procedures, criteria and/or policies required by the rule should be utilized by the SIU or anti-fraud operations and should be made available to the FL OIR Market Investigations upon examination.

The company user should access the "Filing workbench" in order to proceed with making their filing. From the "filing workbench" the user can review the companies that have been selected to be certain that they are correct. If they are correct, the user will "begin upload" to proceed with the filing. A "reserved" filing status means that the user initiated a new account, attempted to start a filing, selected a company, but failed to continue uploading the filing. The company user must go to "Filing workbench" to complete the filing. THE COMPANY WILL BE CONSIDERED IN NON COMPLIANCE OF RULE 69D-2 IF THEY DO NOT COMPLETE THE FILING BY UPLOADING IT INTO THE IFPR DATABASE.

This is to clarify what is meant by "defined and supported"-- an allegation of suspicious activity is defined if, accepting all factual allegations as true and assuming their subsequent proof beyond a reasonable doubt, the conduct alleged to have occurred amounts to insurance fraud or an insurance related crime. An allegation of suspicious activity is supported simply by a demonstration that the allegation is supported by a modicum of evidence that the activity was criminal in nature. It is something tangible that makes the suspicion reasonable, and beyond mere speculation.