4550287, 69O-125.003 - Florida Administrative Rules, Law, Code, Register

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Notice: 4550287

Notice of Meeting/Workshop Hearing

Department:

DEPARTMENT OF FINANCIAL SERVICES

Division:

OIR – Insurance Regulation

Chapter:

UNFAIR DISCRIMINATION

Overview

RULE:

69O-125.003

Unfair Discrimination Because of Travel Plans

The Financial Services Commission, Office of Insurance Regulation announces a hearing to which all persons are invited.

DATE AND TIME:

PLACE:

Subject:

This is the Final Public Hearing on the adoption of proposed amendments to Rule 69O-125.003, Florida Administrative Code, published on June 15, 2007 in Vol. 33, No. 24, of the Florida Administrative Weekly, No notice of change was published.

THE FULL TEXT OF THE PROPOSED RULE IS:
69O-125.003 Unfair Discrimination Because of Travel Plans.
(1) No insurer nor person authorized to engage in the business of insurance in the State of Florida shall refuse to issue or refuse to continue any policy, contract or certificate of insurance of any individual, or limit the amount, extent or kind of insurance coverage offered to an individual, any policy, contract or certificate of life insurance, annuity contract, an accident, disability or health insurance policy or certificate, because of the intent of the applicant to engage in future lawful foreign travel or based upon past lawful foreign travel, unless the insurer can demonstrate that insureds who have traveled or intend to travel are a separate actuarially supportable class whose risk of loss is different from those insureds who have not traveled and do not intend to travel.  
(2) No insurer nor person authorized to engage in the business of insurance in the State of Florida, shall, in determining the rates charged an applicant for coverage under any policy, contract or certificate of life insurance, annuity contract, accident, disability or health insurance, issued or to be issued to be delivered to any resident of this state, consider the intent of the applicant to engage in future lawful foreign travel or past lawful travel of the applicant, unless the insurer can demonstrate that insureds who have traveled or intend to travel are a separate actuarially supportable class whose risk of loss is different from those insureds who have not traveled and do not intend to travel.  
(3) No insurer nor person authorized to engage in the business of insurance in the State of Florida shall refuse to issue any policy, contract or certificate of life insurance to or refuse to continue any policy, contract or certificate of life insurance of any individual or limit the amount, extent or kind of life insurance coverage offered to an individual based solely on the individual’s past lawful foreign travel.  Violation of this rule constitutes unfair discrimination prohibited by Section 626.9541(1)(g), F.S.
(4) No insurer nor person authorized to engage in the business of insurance in the State of Florida shall refuse to issue any policy, contract or certificate of life insurance to or refuse to continue any policy, contract or certificate of life insurance of an individual, or limit the amount, extent or kind of life insurance coverage offered an individual based solely on the individual’s future lawful foreign travel plans unless the insurer can demonstrate that individuals who travel are a separate actuarially supportable class whose mortality risk is different from that of individuals who do not travel, and that such risk classification is based on sound actuarial principles and actual or reasonably anticipated experience that correlates to the risk of travel to a specific destination.
(5) An insurer shall file for approval information demonstrating that individuals who travel to a specific destination constitute a separate actuarially supportable class.  The insurer shall not utilize such information within any underwriting decision resulting in a refusal to issue, refusal to continue, limitation on amount, extent or kind of life insurance coverage available to an individual until the Office has first approved the filing and determined that the insurer has demonstrated that the underwriting proposed meets compliance with the standards of Section 626.9541(1)(dd), F.S.  Nothing in this rule prevents an insurer from asking questions about foreign travel on an application in order to compile information provided such information is not used in any underwriting decision unless the insurer has received prior approval from the Office.  
(6) In determining individuals who travel are a separate actuarially supportable class whose risk of loss is different from those individuals who do not travel based on sound actuarial principles and actual or reasonably anticipated experience that correlates to the risk of travel to a specific destination, insurers shall:
(a) Have performed a detailed actuarial analysis detailing the specific impact of the proposed risk;
(b) Demonstrate that all similar risks with similar risk exposure are similarly treated and that the risk is outside of the underwriting parameters that the insurer is accepting for its maximum rated risks;
(c) Use statistically credible data that is specific and relevant to the analysis and risk being evaluated, that is, using a country population death rate is not relevant to the analysis of the risk of short-term travel.  In the absence of actual experience, an actuary may submit for the Office’s consideration clear actuarial evidence, including clinical experience or expert opinion relied upon by the actuary that demonstrates to the Office that differences in risk are related to the travel;
(d) Disclose the range of underwriting and rating options and how each is supported by the analysis;
(e) Maintain a report prepared by the actuary providing the information used and relied upon by the actuary in preparing his conclusions, including but not limited to: summarizing the source, basis and relevancy of data used, the impact of the risk on expected loss, the range of expected loss within the underwriting class and how the proposed travel risk falls inside or outside of such underwriting range, the analysis performed and the basis of any conclusions reached.  Such report shall disclose how compliance with all appropriate actuarial standards of practice is met and specifically detail any standards that are not.
 (7)  In accordance with s. 626.9541(1)(dd)3., an insurer may file a petition for a variance or waiver with the Office for a limited exception from the statute and this rule.  The petition shall contain supporting information demonstrating that the requested limited exception(s) are based upon national or international emergency conditions that affect the public health, safety, and welfare and are consistent with public policy.  
(8)(a) Insurers are required to maintain the following data.  The data for each calendar year shall be submitted to the Office annually by January 31 of the following year:
1. The number of applications under which a policy or certificate of life insurance or an annuity contract was denied;
2. The number of applications under which a policy or certificate of life insurance or an annuity contract’s continuation was refused; and
3. The number of applications under which a policy or certificate of life insurance or an annuity contract’s coverage was limited.
(b) For each specific case, the insurer shall provide the reason for taking such action.
(c) For each case the insurer shall provide a brief summary, prepared by an actuary, of the supporting data and analysis used in taking such action for such specific destination.  Such underlying data and analysis shall be available upon request of the Office.
(9)(a) Violation of this rule constitutes unfair discrimination prohibited by Sections 626.9541(1)(g) & (dd), F.S.
(b) An insurer that uses past travel or future lawful travel in underwriting decisions without having first filed and received approval of the Office shall, among other administrative penalties:
1. Provide restitution to all applicants or insureds that were negatively acted upon by the insurer;
2.  Issue the coverage applied for which was rejected, subject to the applicants option of the effective date being the date of application or the current date; and
3. Pay any valid claim of an applicant incurred subsequent to the initial application date. 
(10) “Travel” shall not include “residency” or relocation for employment.  An individual who is absent from the United States for more than one hundred eighty [180] consecutive days and has established a residence in a foreign country during that period is considered to be residing in that country.  Residency in a foreign country is not considered "foreign travel" for purposes of this Rule.
Specific Authority 626.9541(1)(dd)3., 626.9611 FS. Law Implemented 626.951, 626.9521, 626.9541(1)(g), and (dd), FS. History–New 7-6-06, Amended ______________.

A copy of the agenda may be obtained by contacting: The Governor and Cabinet Website at http://www.myflorida.com/myflorida/cabinet/mart.html. The agenda should be available approximately one week before the cabinet meeting.

PRINT PUBLISH DATE:

8/31/2007 Vol. 33/35

REFERENCE MATERIALS:

No reference(s).

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