フロリダ州議会が2010年3月2日に2010年通常会期を開始した際、保険業界とその支持者はいくつかの野心的な目標の達成を望んでいた。しかし2010年4月30日に会期が終了するまでに、業界はわずかな小規模な成果で妥協せざるを得なかった。
フロリダ州のチャーリー・クリスト知事が、特定の資本力のある企業を対象に住宅保険の保険料率設定を規制緩和する2009年法案を拒否権で否決した後、規制緩和推進派は2010年に知事の反対意見の一部に対応した保険料率規制緩和案を可決できると期待した。 他の保険会社は、州内で急増する自動車保険金請求詐欺に対処する法案を求めた。立法タスクフォースは、権利保険を規制する法律の全面的な改正を提言した。これらの取り組みはいずれも成功しなかった。
The Legislature did, however, enact measures affecting solvency, regulatory authority over affiliates, property insurance claims, rate deregulation for commercial insurance, guaranty funds, and other important matters. This article describes the highlights of these and other insurance-related enactments.
Property Insurance
SB 2044 includes several issues that were sought by the Florida Office of Insurance Regulation, including increased surplus requirements and increased regulatory authority over managing general agents and other affiliates. The bill also contains provisions sought by insurers, including restrictions on public adjusters. The major changes in the bill include:
- Minimum surplus: The bill requires new residential property insurers to maintain at least $15 million in surplus as to policyholders. For existing residential property insurers, the minimum surplus is raised to $5 million through July 1, 2015, $10 million from that date through July 1, 2020, and $15 million thereafter. Under current law, residential property insurers must maintain minimum surplus of $4 million.
- Affiliates and managing general agents: When a residential property insurer sustains a loss of surplus of 15 percent or more in a year, it will be required to provide the regulator with detailed financial information about all affiliates. The bill also expands regulatory authority by allowing the regulator to examine any managing general agent as if it were an insurer and requires any insurer to change the accounting firm used to prepare its annual report once every five years.
- Claims: The bill requires all claims for residential windstorm or hurricane losses to be filed within three years after the date the windstorm caused the loss or the hurricane made landfall. The bill also provides that under replacement cost coverage, the insurer may hold back a portion of the payment for dwelling losses, but it does not change the current prohibition on hold-backs for replacement cost coverage of personal property.
- Public adjusters: SB 2044 imposes several new restrictions on public adjusters, who assist claimants in the settlement of claims. The bill prohibits public adjusters from making certain statements in the course of soliciting business. Public adjusters also are prohibited from preventing insurers’ access to an insured person or property. The bill requires public adjuster contracts to include specified information and limits commissions on supplemental or reopened claims to 20 percent of the additional claims payment.
- Ratemaking: The bill continues the prohibition against property insurer implementing a rate change before it is approved by the regulator (“use-and-file” rates) through December 31, 2011. It also revises provisions for expedited rate review to allow expedited review of filings that reflect only adjustments in reinsurance costs, financing products used in lieu of reinsurance, and inflation trend factors. The bill also prohibits the regulator from using the ratemaking process to directly or indirectly affect an insurer’s decisions regarding agent compensation or appointment.
- CEO/CFO/chief actuary certification: The requirement that an insurer’s CEO or CFO and the insurer’s chief actuary attest to the truthfulness of a rate filing is modified to provide that the certification is not rendered false if the insurer later submits additional information to the regulator, provided the additional information is submitted in response to a request from the regulator.
- Hurricane loss mitigation: In response to controversies about the size of mandatory hurricane loss mitigation discounts and the quality of mitigation inspections, the bill provides that a rate increase may be justified when the aggregate value of the discounts exceeds the reduction in expected losses from mitigation. The bill also adds restrictions on who may conduct mitigation inspections, requires that the authorized inspector personally inspect the property, and provides that violations may result in disciplinary actions by the appropriate licensing agencies.
- Citizens Property Insurance Corporation (Citizens): The bill delays for two years a mandated reduction in the size of the area in which Citizens writes windstorm-only policies and other insurers are allowed to write homeowners’ policies that exclude windstorm coverage.
- Notice of cancellation or nonrenewal: The bill changes the notice periods for cancellations and nonrenewals to allow a Citizens policy to be replaced with a policy issued by another insurer upon 45 days’ advance notice and to allow any property insurer to cancel or nonrenew a policy after 45 days’ notice, if the regulator finds that the action is necessary to protect other policyholders or the public. The bill also provides that an insurer may renew a residential policy with a change in policy terms after appropriate notice; currently, a change in policy terms may require the nonrenewal and replacement of the policy.
SB 2044 has not yet been presented to the governor. If it becomes a law, it will take effect on July 1, 2010.
SB 1460 revises the Florida Hurricane Catastrophe Fund contract year. The 2010 bill was enacted in response to the unintended consequences of 2009 legislation that changed the start date of the fund’s contract year from June 1 to January 1 and provided for a contract period of seven months, beginning on June 1, 2010 and ending on December 31, 2010, to provide for a transitional period. The accounting consequences of the transitional contract “year” resulted in a reduction to insurers’ surplus. SB 1460 restores the June 1 – May 31 contract year and does away with the transitional period.
本法案はまた、保険会社が災害基金との契約を、契約の6月1日発効日より3か月前（かつ年次議会会期の開始前）に締結しなければならないと規定している。この変更の目的は、災害基金契約の条件を保険会社に早期に通知することで、安定性を高め、保険会社が経済的に再保険を調達する能力を向上させることにある。
本法案は、州管理委員会が基金が2つの170億ドル契約年度分をカバーする十分な保険金支払い能力を有すると判断するまで、当該契約年度における基金の「基本」層の規模を170億ドルに制限する。この規定は、基金の成長をリスクの増加に連動させていた規定に代わるものである。
SB 1460は2010年4月15日に知事により承認され、同日に発効した。
HB 7217 amends a provision relating to Florida Hurricane Catastrophe Fund emergency assessments. Under current law, medical malpractice insurance premiums are exempt from assessment, but the exemption expires on May 31, 2010. HB 7127 extends the exemption for an additional three years. SB 2044 also includes this three-year extension of the exemption.
HB 7127 has not yet been presented to the governor. If it becomes a law, it will take effect upon becoming a law.
Commercial Insurance Ratemaking and Warranty Associations
SB 2176 deregulates ratemaking for most forms of commercial insurance other than workers’ compensation. The bill also includes provisions addressing several other areas, including warranty associations, workers’ compensation, health insurance, and life insurance. The workers’ compensation, health insurance, and life insurance aspects of the bill are discussed below under those respective headings.
The bill allows an insurer to implement rates for most forms of commercial insurance without the approval of the Office of Insurance Regulation, provided that the insurer notify the regulator of any rate changes no later than 30 days after the effective date of the change. The regulator may subsequently review the rates to determine whether they are excessive, inadequate, or unfairly discriminatory. The affected lines of insurance include commercial motor vehicle insurance covering a fleet of 20 or more self-propelled vehicles, excess or umbrella coverage, surety and fidelity, boiler and machinery, errors and omissions, directors and officers, intellectual property liability, advertising and Internet liability, property risks rated under a highly protected risks rating plan, and other similar commercial lines as determined by the Office of Insurance Regulation.
SB 2176はまた、自動車サービス契約会社、住宅保証協会、サービス保証協会を規制する法律を大幅に改正する。主な改正点として、これら3種類の保証協会に対する料金・書式届出義務を廃止し、非消費者向け商用自動車サービス契約を規制対象から除外し、無免許活動に対する軽犯罪罰則を規定し、必要な財務報告書の数を削減し、保証協会に対する検査を義務から任意に変更する。
SB 2176 has not yet been presented to the governor. If it becomes a law, the provisions relating to commercial insurance rates will take effect January 1, 2011, and the provisions relating to warranty associations will take effect upon the bill becoming a law.
労働者災害補償
HB 5603 addresses an issue that some workers’ compensation carriers have identified as a major cost driver. According to the carriers, some pharmaceutical providers repackage or relabel drugs in an effort to avoid fee schedules. HB 5603 provides that statutory limitations on reimbursement for prescription drugs apply regardless of the location or provider from which the claimant receives the medication. The bill specifies a formula for calculating the reimbursement amount for a drug that has been repackaged or relabeled and provides that the maximum price for relabeled or repackaged drugs is the amount that would have been otherwise payable had the drugs not been repackaged or relabeled.
HB 5603 has not yet been presented to the governor. If it becomes a law, it will take effect July 1, 2010.
SB 2176は、法執行官の労災補償適用に関する複数の規定を含む。本法案は、矯正保護観察官に対し、結核、心臓疾患、高血圧症に関して、現行の法執行官、矯正官、消防士に適用されている「職務遂行中」の推定を同様に適用する資格を与える。 本法案はさらに、従業員が所定の治療方針から著しく逸脱した場合、当該疾病が職務中に発生したとは推定されない旨を規定するとともに、法執行官、矯正官及び矯正保護観察官が、退職後180日以内に給付請求を行わない限り、結核、 また、退職後180日以内に給付請求を行わない限り、職務中に結核、心臓病、高血圧を罹患したとの推定を適用しない旨を規定している。
If SB 2176 becomes a law, these provisions will take effect January 1, 2011.
SB 2046 revises provisions governing licensure of employee-leasing companies to remove certain restrictions on change of ownership. Prior approval for the acquisition of a company is no longer required if a controlling person of the company being acquired also is a controlling person of the acquiring company. Existing stockholders or partners no longer need board approval to acquire control from other stockholders or partners, and the Department of Business and Professional Regulation is no longer authorized to conduct an investigation prior to the acquisition of control. SB 2046 also changes the sanctions for failure to pay late fees for license renewals. The failure to pay the late fee will now be grounds for disciplinary action, rather than automatically voiding the license.
SB 2046 has not yet been presented to the governor. If it becomes a law, it will take effect July 1, 2010.
Guaranty Funds
HB 159 revises various provisions relating to the Florida Insurance Guaranty Association (FIGA), the Florida Life & Health Insurance Guaranty Association (FLAHIGA), and the Florida Workers’ Compensation Insurance Guaranty Association (FWCIGA). Several provisions of the bill are intended to make Florida’s guaranty fund laws more closely conform to NAIC model laws.
本法案は、保険会社がFIGA賦課金を保険契約者に転嫁する手続きを改正する。現行法では、承認済み保険料率届出にFIGA費用が組み込まれるまで、保険会社はFIGA賦課金の回収が認められていない。HB 159により、保険会社は監督当局に情報通知を行った後、保険料請求書に回収率を適用できる。また本法案は、自動車保険の2つの勘定を単一勘定に統合することでFIGAの効率化を図る。
HB 159は、積立段階における繰延年金について、FLHIGAの適用限度額を25万ドルに引き上げ、代理店や保険会社が契約見込み者にFLHIGAの保護について言及することを禁じる規定を撤廃し、フロリダ州非居住者に対するFLHIGAの適用条件を規定するとともに、メディケア・アドバンテージ保険契約及び各種指数連動型商品をFLHIGAの適用対象から除外する。
本法案は、雇用者賠償責任保険に基づく補償をFIGAの対象外とし、当該請求をFWCIGAの対象とする。補償額は30万ドルまたは保険契約の限度額のうち低い方の金額を上限とする。
HB 159 was approved by the governor on May 11 and will take effect July 1, 2010.
健康保険
House Joint Resolution 37 proposes an amendment to the Florida Constitution that would add a section on health care services to the Declaration of Rights if approved by 60 percent of the voters in the 2010 general election.
憲法改正案は、いかなる法律または規則も、個人、雇用主、または医療提供者を直接的または間接的にいかなる医療制度への参加を強制してはならないと規定する。 また、個人は医療サービスを直接支払う権利を有し、医療提供者は医療サービスに対する直接支払を受け入れる権利を有すると規定している。さらに、「個人の選択肢を実質的に制限しない合理的かつ必要な規則」に従うことを条件として、民間医療保険の購入または販売を禁止してはならないと規定している。これらの規定は、州議会の各院の議員総数の3分の2以上の賛成により可決された法律によって優先されることがある。
有権者の承認を得た場合、この改正案は2011年1月4日に発効する。
SB 2176には、メディケア補足保険会社が入院施設ネットワークを利用することを認める規定が含まれている。本法案の下では、メディケア補足保険会社は、自社のネットワーク内の入院施設を利用する被保険者に対して保険料クレジットを付与することができる。 また本法案は、保険会社がメディケアパートAの自己負担額免除に同意する施設とネットワーク契約を締結することを認める。保険料割引と自己負担額免除の両方は、保険会社の損害率計算および保険料算定に反映されなければならない。
If SB 2176 becomes a law, these provisions will take effect January 1, 2011.
Life Insurance
HB 885 amends several life insurance provisions. The bill exempts certain transactions from the requirement that the current insurer be notified of the replacement of a policy. The notice requirement will not apply in transactions involving an application to the current insurer when a contractual change or conversion privilege is being exercised, when a current contract is being replaced by the same insurer with regulatory approval, or when a term-conversion privilege is being exercised among corporate affiliates.
本法案は、従業員が加入する団体生命保険契約において、配偶者及び扶養家族を被保険者として、当該従業員の保険金額全額を上限として加入することを認める。また、雇用主の団体健康保険計画に加入する従業員のみで構成される従業員クラスを、団体生命保険契約の目的で創設することを禁止する。さらに、メディケア二次支払者要件を満たすための和解の一環として取得された年金を、第三者に売却または譲渡することを禁止する。
HB 885 was approved by the governor on May 11 and took effect on that date.
SB 2176には「高齢者保護法」として知られる一連の生命保険関連規定も含まれている。本法案は固定年金または変額年金の販売に関する開示要件を改正し、65歳以上の購入者に対しては他の購入者に適用される14日間ではなく、21日間の「クーリングオフ期間」を付与する。 また、高齢者消費者向けに販売される年金契約については、一部の例外を除き、解約手数料または繰延販売手数料が10％を超えることを禁止し、保険代理店による不正流用被害を受けた高齢者消費者に対し、金融サービス局が代理店に賠償金の支払いを命じることを認めています。 高齢者消費者以外にも適用される規定として、本法案は「ツイスト」及び「チャーン」禁止規定への故意違反に対する罰則を75,000ドルに引き上げるとともに、当該行為が詐欺的である場合にのみ刑事罰を科すという要件を削除する。
If SB 2176 becomes a law, these provisions will take effect January 1, 2011.
Legal News Alert is part of our ongoing commitment to providing up-to-the-minute information about pressing concerns or industry issues affecting our insurance industry clients and colleagues. If you have any questions about this alert or would like to discuss this topic further, please contact your Foley attorney or any of the following individuals:
Leonard E. Schulte
Tallahassee, Florida
850.5133380
[email protected]
Thomas J. Maida
Tallahassee, Florida
850.513.3377
[email protected]
