Florida Statutes 627.411 – Grounds for disapproval
Current as of: 2023 | Check for updates
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(1) The office shall disapprove any form filed under s. 627.410, or withdraw any previous approval thereof, only if the form:
(a) Is in any respect in violation of, or does not comply with, this code.
Terms Used In Florida Statutes 627.411
- Contract: A legal written agreement that becomes binding when signed.
- Policy: means a written contract of insurance or written agreement for or effecting insurance, or the certificate thereof, by whatever name called, and includes all clauses, riders, endorsements, and papers that are a part thereof. See Florida Statutes 627.402
(b) Contains or incorporates by reference, where such incorporation is otherwise permissible, any inconsistent, ambiguous, or misleading clauses, or exceptions and conditions which deceptively affect the risk purported to be assumed in the general coverage of the contract.
(c) Has any title, heading, or other indication of its provisions which is misleading.
(d) Is printed or otherwise reproduced in such manner as to render any material provision of the form substantially illegible.
(e) Is for residential property insurance and contains provisions that are unfair or inequitable or encourage misrepresentation.
(f) Is for health insurance, and:
1. Provides benefits that are unreasonable in relation to the premium charged.
2. Contains provisions that are unfair or inequitable or contrary to the public policy of this state or that encourage misrepresentation.
3. Contains provisions that apply rating practices that result in unfair discrimination pursuant to s. 626.9541(1)(g)2.
(g) Excludes coverage for human immunodeficiency virus infection or acquired immune deficiency syndrome or contains limitations in the benefits payable, or in the terms or conditions of such contract, for human immunodeficiency virus infection or acquired immune deficiency syndrome which are different than those which apply to any other sickness or medical condition.
(2) In determining whether the benefits are reasonable in relation to the premium charged, the office, in accordance with reasonable actuarial techniques, shall consider:
(a) Past loss experience and prospective loss experience within and without this state.
(b) Allocation of expenses.
(c) Risk and contingency margins, along with justification of such margins.
(d) Acquisition costs.