The Florida Senate

627.411  Grounds for disapproval.--

(1)  The department 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.

(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 health insurance, and provides benefits which are unreasonable in relation to the premium charged, contains provisions which are unfair or inequitable or contrary to the public policy of this state or which encourage misrepresentation, or which apply rating practices which result in premium escalations that are not viable for the policyholder market or result in unfair discrimination in sales practices.

(f)  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 department, 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.

History.--s. 460, ch. 59-205; ss. 13, 35, 69-106; s. 3, ch. 76-168; s. 1, ch. 77-457; ss. 2, 3, ch. 81-318; ss. 366, 377, 809(2nd), ch. 82-243; s. 79, ch. 82-386; s. 48, ch. 88-380; s. 114, ch. 92-318; s. 63, ch. 93-129.