624.438 General eligibility. ---
(1) To meet the requirements for issuance of a certificate of
authority and to maintain a multiple-employer welfare arrangement, an
arrangement:
(a) Must be nonprofit.
(b)
1. Must be established by a trade association, industry association,
or professional association of employers or professionals which has a
constitution or bylaws specifically stating its purpose and which has been
organized and maintained in good faith for a continuous period of 1 year for
purposes other than that of obtaining or providing insurance.
2. Must not combine member employers from disparate trades,
industries, or professions as defined by the appropriate licensing agencies,
and must not combine member employers from more than one of the employer
categories defined in sub-subparagraphs a.-c.
a. A trade association consists of member employers who are in the
same trade as recognized by the appropriate licensing agency.
b. An industry association consists of member employers who are in
the same major group code, as defined by the Standard Industrial
Classification Manual issued by the federal Office of Management and Budget,
unless restricted by sub-subparagraph a. or sub-subparagraph c.
c. A professional association consists of member employers who are
of the same profession as recognized by the appropriate licensing
agency.
The requirements of this subparagraph do not apply to an arrangement
licensed prior to April 1, 1995, regardless of the nature of its business.
However, an arrangement exempt from the requirements of this subparagraph may
not expand the nature of its business beyond that set forth in the articles of
incorporation of its sponsoring association as of April 1, 1995, except as
authorized in this subparagraph.
(c) Must be operated pursuant to a trust agreement by a board of
trustees which shall have complete fiscal control over the arrangement and
which shall be responsible for all operations of the arrangement. The trustees
selected shall be owners, partners, officers, directors, or employees of one
or more employers in the arrangement. A trustee may not be an owner, officer,
or employee of the administrator or service company of the arrangement. The
trustees shall have the authority to approve applications of association
members for participation in the arrangement and to contract with an
authorized administrator or service company to administer the day-to-day
affairs of the arrangement.
(d) Must be neither offered nor advertised to the public
generally.
(e) Must be offered only to eligible employers who have been members
of the sponsoring association for at least 2 consecutive months. The
requirements of this paragraph shall not apply to an arrangement that has been
operating under a certificate for at least 3 years.
(f) Must be operated in accordance with sound actuarial
principles.
(g) May, notwithstanding the provisions of paragraph (e), be offered
to eligible physician employers. An eligible physician employer may
participate in an arrangement's employer health benefit plans without being a
member of the arrangement's sponsoring association if:
1. The physician has more than one employee.
2. The physician employer enters into a contract to render medical
services to the arrangement's plan participants.
3. The physician employer agrees to waive any fee due from the
arrangement in the event that the arrangement becomes insolvent.
4. The physician employer agrees to be subject to the same
assessments and surcharges as apply to arrangement
members.
(2) The arrangement shall issue to each covered employee a
policy, contract, certificate, summary plan description, or other evidence of
the benefits and coverages provided. This evidence of the benefits and
coverages provided shall contain in boldfaced print and in at least 12-point
type in a conspicuous location, the following statement: "The benefits
and coverages described herein are provided through a trust fund established
and funded by a group of employers. It is not an insurance company and it is
not protected by a guaranty fund in the event of insolvency. Participating
employers are assessable for any losses incurred by the trust."
(3) Each arrangement shall maintain specific excess insurance
with a retention level determined in accordance with s. 624.439(6) and sound
actuarial principles.
(4) Each arrangement shall establish and maintain appropriate
loss reserves determined in accordance with sound actuarial
principles.
(5) The department shall not grant or continue a certificate of
authority for any arrangement if the department determines any trustee,
manager, or administrator to be incompetent, untrustworthy, or so lacking in
insurance expertise as to make the operations of the arrangement hazardous to
potential and existing insureds; that any trustee, manager, or administrator
has been found guilty of, or has pled guilty or no contest to a felony, a
crime involving moral turpitude, or a crime punishable by imprisonment of 1
year or more under the law of any state, territory, or country, whether or not
a judgment or conviction has been entered; that any trustee, manager, or
administrator has had any type of insurance license revoked in this or any
other state; or that the business operations of the arrangement are or have
been marked, to the detriment of the employers participating in the
arrangement, of persons receiving benefits from the arrangement, or of
creditors or the public, by the improper manipulation of assets, accounts, or
specific excess insurance or by bad faith.
(6) To qualify for and retain approval to transact business, an
arrangement shall make all contracts with administrators or service companies
available for inspection by the department initially, and annually thereafter
upon reasonable notice.
(7) Failure to maintain compliance with the eligibility
requirements established by this section and the filing requirements of ss.
624.33(1) and 624.439 shall be grounds for suspension or revocation of the
certificate of authority of an arrangement.
History: s. 3, ch. 83-203; s. 3, ch. 84-94; s. 3, ch. 85-212; ss. 25, 187, 188,
ch. 91-108; s. 4, ch. 91-429; s. 1, ch. 94-133; s. 2, ch.
95-340.