Florida Regulations 69O-157.007: Conditions of Eligibility
Current as of: 2024 | Check for updates
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(1) A policy covering one or more members of the insured’s family shall include provisions which specify the identity and qualifications applicable to those family members who may become insured under the policy initially or by subsequent addition.
(a) Eligible family members may include:
1. The insured;
2. The insured’s spouse;
3. Children of the insured or of the insured’s spouse who are over a specified age not to exceed 21, unless a dependency test is specified;
4. Parents or grandparents of the insured or the insured’s spouse; and
5. Any other person dependent upon the insured.
(b) The provisions concerning eligibility shall, for persons who may become insured subsequent to policy issuance, state the conditions under which such coverage may become effective. Such conditions include:
1. Qualifications for automatic coverage and the duration thereof;
2. Required evidence of insurability;
3. The necessity of application or notice from the insured;
4. Any requirements as to the payment of premiums as to such addition; and
5. The time within which action is to be taken by the insured.
(2) No group long-term care policy may be issued or issued for delivery in this state unless all members of the group, or all of any class or classes thereof, are declared eligible and acceptable to the insurer at the time of issuance of the policy, subject to any exception to this requirement expressly authorized by Florida Statutes § 627.9405, as presently existing or as hereafter amended.
Rulemaking Authority Florida Statutes § 624.308(1), 627.9407(1) FS. Law Implemented 624.307(1), 627.9407(1), 627.9405(2) FS. History-New 5-17-89, Formerly 4-81.007, 4-157.007.
Terms Used In Florida Regulations 69O-157.007
- Dependent: A person dependent for support upon another.
- Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
1. The insured;
2. The insured’s spouse;
3. Children of the insured or of the insured’s spouse who are over a specified age not to exceed 21, unless a dependency test is specified;
4. Parents or grandparents of the insured or the insured’s spouse; and
5. Any other person dependent upon the insured.
(b) The provisions concerning eligibility shall, for persons who may become insured subsequent to policy issuance, state the conditions under which such coverage may become effective. Such conditions include:
1. Qualifications for automatic coverage and the duration thereof;
2. Required evidence of insurability;
3. The necessity of application or notice from the insured;
4. Any requirements as to the payment of premiums as to such addition; and
5. The time within which action is to be taken by the insured.
(2) No group long-term care policy may be issued or issued for delivery in this state unless all members of the group, or all of any class or classes thereof, are declared eligible and acceptable to the insurer at the time of issuance of the policy, subject to any exception to this requirement expressly authorized by Florida Statutes § 627.9405, as presently existing or as hereafter amended.
Rulemaking Authority Florida Statutes § 624.308(1), 627.9407(1) FS. Law Implemented 624.307(1), 627.9407(1), 627.9405(2) FS. History-New 5-17-89, Formerly 4-81.007, 4-157.007.