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Address: 522 S Hunt Club Blvd #335
Apopka, FL 32703
Number: (877) 200-7711
Email: support@floridainsurancelicenseonline.com

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PAUL v. VIRGINIA (1869)

The U.S. Supreme Court decision holding that insurance is not commerce and is therefore not subject to regulation by the federal government.

UNITED STATES v. THE SOUTH-EASTER UNDERWRITER ASSOCIATION (1944)

The Supreme Court ruled that the industry is subject to regulation by the Federal Government in that it IS a business that crosses state lines and is, therefore, subject to FEDERAL antitrust laws. MCCARRAN FERGUSON (1945)

Federal regulation of insurance pushed down to states.

ERISA (1974)

Congress enacted ERISA primarily to establish uniform federal standards to protect private employee pension plans from fraud and mismanagement. ERISA provides detailed standards for vesting, funding, solvency insurance, disclosure and reporting to plan participants, beneficiaries, and the U.S. Department of Labor, nondiscrimination, and administrator fiduciary requirements

ERISA implications for Health Insurance

For health plans, federal law prescribes fewer substantive standards: administrators’ fiduciary standards (to administer the plan in the best interests of beneficiaries) and requirements for plan descriptions to be given to enrollees, reporting to the federal government, and certain minimum standards “continuation” health coverage;

  • group plan guaranteed issue and renewability
  • pre-existing condition exclusion requirements
  • nondiscrimination in premiums and eligibility
  • maternity hospital length-of-stay standards
  • post-mastectomy reconstructive surgery
  • limited mental health “parity”)

PREEMPTION Clause

Several of ERISA’s provisions preempt state law. ERISA’s “preemption clause,” Section 514, makes void all state laws to the extent that they “relate to” employer-sponsored health plans.

SAVINGS Clause

States can regulate the terms and conditions of health insurance, for example, the benefits in an insurance policy or the rules under which the health insurance market must operate.

DEEMER Clause

The “deemer clause,” prohibits states from regulating plans that “self-insure” by bearing the primary insurance risk, even though by bearing risk they appear to be acting like insurance companies. Plans funding coverage through insurance are subject to state insurance regulation, while those that self-insure are completely beyond state jurisdiction.

MULTIPLE-EMPLOYER WELFARE ARRAGEMENTS – MEWAs

  • Two or more employers
  • Requires a Certificate of Authority

Union Plans can be granted exemption from MEWA categorization if created via collective bargaining.
Association Plans are subject to state insurance regulation… (1) they do not represent an employer-employee relationship; and (2) they must be fully insured).

PEO – Professional Employer Organization

PEOs are subject to state regulation: (1) they do not represent an employer-employee relationship; and (2) they must be fully insured).