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Florida health insurance agents can now lawfully enter into a contract with a consumer and charge a flat fee in lieu of receiving commissions from the insurer for individual health policies. The law went into effect when Senate Bill 1386 was signed by Governor Scott on April 8, 2016.
Introduction of the legislation was spurred by the elimination or significant reduction of commission payments to agents by a number of health insurers for some individual health policies.
As with contracts for fee-based compensation for group health policies, it is critical that all requirements of the law be met in order for an agent to lawfully charge a fee to a consumer. Requirements include effectuating a written contract between the agent and the party to be charged, and stating the fee and the services that will be provided in consideration of the fee. The contract must also inform the consumer that any commission or compensation paid to the agent or agency by an insurer or other persons or entities in consideration for the policy written will be promptly rebated to the party (consumer) named in the contract.
Lawful compensation is limited to specific services by the licensee, such as giving or offering advice, counsel, recommendation, or information in respect to the terms, conditions, benefits, coverage, or premium of insurance policies.
[The relevant Florida Statute, s.626.593, has not been updated at Online Sunshine as of publication.]
Effective April 1, 2016, new and renewal policies with an effective date on or after April 1, 2016 will incur a FSLSO Service Office fee of 0.15% of the total gross premium as defined in Florida Statute 626.9325. The fee percentage charged on the premium is based on the effective date of the policy. The fee is applicable to Florida single state policies only.
The FSLSO Service Office fee for all subsequent endorsements applicable to policies effective prior to April 1, 2016 will be the same percentage as the inception date of the policy being endorsed.
Again, the FSLSO Service Office fee percentage charged on the premium is based on the effective date of the policy. Click here for an electronic copy of the bulletin referencing this change.
The Centers of Medicare & Medicaid Services (CMS) will host a “Protection Requirements and Appropriate Usage of Consumer’s Personally Identifiable Information (PII)” webinar on Wednesday, May 11, 2016 from 1:00 PM to 2:30 PM Eastern Time. The webinar will review:
The webinar will also highlight new requirements for protecting PII as documented in the Department of Health & Human Services' Notice of Benefit and Payment Parameters for 2017 Final Rule (Payment Notice) and the Final 2017 Letter to Issuers in the Federally-facilitated Marketplaces (Letter to Issuers) that will be effective starting for plan year 2017.
To register for the webinar, please log in to www.REGTAP.info. If you have questions on the webinar registration process, visit the new “Upcoming Agent and Broker Webinars” section of the Agents and Brokers Resources webpage for more information.
For claims that are based on events that are the subject of a declaration of a state of emergency by the Governor, and during the year after the declaration of emergency:
The following are excerpts of the standards of conduct that define ethical behavior, and are included in the code of ethics:
Please refer to Section 69B-220.201, Florida Administrative Code for the full Adjuster Code of Ethics.
The Florida Statutes can be viewed at Online Sunshine - Title XXXVII Insurance.