Fla. Stat. 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:Must be nonprofit.Must be established by a trade association, industry association, professional association of employers or professionals, or a bona fide group that has a constitution or bylaws specifically stating its purpose and that has been organized for purposes in addition to obtaining or providing insurance.
A trade association consists of employer members who are in the same trade as recognized by the appropriate licensing agency.
An industry association consists of employer members 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 subparagraph 1. or subparagraph 3.
A professional association consists of employer members who are of the same profession as recognized by the appropriate licensing agency.
A bona fide group is a group or association of employers which meets the following requirements:
The primary purpose of the group or association may be to offer and provide health coverage to its employer members and their employees. However, the group or association must also have at least one substantial business purpose unrelated to such primary purpose. For purposes of this sub-subparagraph, a substantial business purpose is deemed to exist if the group or association would be a viable entity in the absence of sponsoring an employee benefit plan. A substantial business purpose includes promoting common business interests in a given trade or employer community and is not required to be a for-profit activity.
Each employer member of the group or association which participates in the group health plan is a person acting directly as an employer of at least one employee who is a participant covered under the plan.
The group or association has a formal organizational structure with a governing body and has bylaws or other similar indications of formality.
The functions and activities of the group or association are controlled by its employer members, and the group’s or association’s employer members that participate in the group health plan control the plan. Control must be present both in form and in substance.
The employer members have a principal place of business in the same region that does not exceed the boundaries of a single state or metropolitan area, even if the metropolitan area includes more than one state.
The group or association does not make health coverage through the group’s or association’s group health plan available to any person other than:
An employee of a current employer member of the group or association;
A former employee of a current employer member of the group or association who became eligible for coverage under the group health plan when the former employee was an employee of the employer; or
A beneficiary, such as a spouse or dependent child, of an individual described in sub-sub-subparagraph (I) or sub-sub-subparagraph (II).
The group or association and the health coverage offered by the group or association comply with the nondiscrimination provisions of s. 627.6699.
The group or association is not a health insurance issuer as defined in s. 733(b)(2) of the Employee Retirement Income Security Act of 1974, 29 U.S.C. s. 1191b(b)(2), or owned or controlled by such a health insurance issuer or by a subsidiary or affiliate of such a health insurance issuer, other than to the extent such entities participate in the group or association in their capacity as employer members of the group or association.

The requirements of this paragraph do not apply to an arrangement licensed before April 1, 1995, regardless of the nature of its business. However, an arrangement exempt from the requirements of this paragraph 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 paragraph.

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.Must be neither offered nor advertised to the public generally.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.Must be operated in accordance with sound actuarial principles.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:
The physician has more than one employee.
The physician employer enters into a contract to render medical services to the arrangement’s plan participants.
The physician employer agrees to waive any fee due from the arrangement in the event that the arrangement becomes insolvent.
The physician employer agrees to be subject to the same assessments and surcharges as apply to arrangement members.

(a)

Must be nonprofit.

(b)

Must be established by a trade association, industry association, professional association of employers or professionals, or a bona fide group that has a constitution or bylaws specifically stating its purpose and that has been organized for purposes in addition to obtaining or providing insurance.A trade association consists of employer members who are in the same trade as recognized by the appropriate licensing agency.An industry association consists of employer members 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 subparagraph 1. or subparagraph 3.A professional association consists of employer members who are of the same profession as recognized by the appropriate licensing agency.A bona fide group is a group or association of employers which meets the following requirements:
The primary purpose of the group or association may be to offer and provide health coverage to its employer members and their employees. However, the group or association must also have at least one substantial business purpose unrelated to such primary purpose. For purposes of this sub-subparagraph, a substantial business purpose is deemed to exist if the group or association would be a viable entity in the absence of sponsoring an employee benefit plan. A substantial business purpose includes promoting common business interests in a given trade or employer community and is not required to be a for-profit activity.
Each employer member of the group or association which participates in the group health plan is a person acting directly as an employer of at least one employee who is a participant covered under the plan.
The group or association has a formal organizational structure with a governing body and has bylaws or other similar indications of formality.
The functions and activities of the group or association are controlled by its employer members, and the group’s or association’s employer members that participate in the group health plan control the plan. Control must be present both in form and in substance.
The employer members have a principal place of business in the same region that does not exceed the boundaries of a single state or metropolitan area, even if the metropolitan area includes more than one state.
The group or association does not make health coverage through the group’s or association’s group health plan available to any person other than:
An employee of a current employer member of the group or association;
A former employee of a current employer member of the group or association who became eligible for coverage under the group health plan when the former employee was an employee of the employer; or
A beneficiary, such as a spouse or dependent child, of an individual described in sub-sub-subparagraph (I) or sub-sub-subparagraph (II).
The group or association and the health coverage offered by the group or association comply with the nondiscrimination provisions of s. 627.6699.
The group or association is not a health insurance issuer as defined in s. 733(b)(2) of the Employee Retirement Income Security Act of 1974, 29 U.S.C. s. 1191b(b)(2), or owned or controlled by such a health insurance issuer or by a subsidiary or affiliate of such a health insurance issuer, other than to the extent such entities participate in the group or association in their capacity as employer members of the group or association.

The requirements of this paragraph do not apply to an arrangement licensed before April 1, 1995, regardless of the nature of its business. However, an arrangement exempt from the requirements of this paragraph 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 paragraph.

1. A trade association consists of employer members who are in the same trade as recognized by the appropriate licensing agency.
2. An industry association consists of employer members 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 subparagraph 1. or subparagraph 3.
3. A professional association consists of employer members who are of the same profession as recognized by the appropriate licensing agency.
4. A bona fide group is a group or association of employers which meets the following requirements:a. The primary purpose of the group or association may be to offer and provide health coverage to its employer members and their employees. However, the group or association must also have at least one substantial business purpose unrelated to such primary purpose. For purposes of this sub-subparagraph, a substantial business purpose is deemed to exist if the group or association would be a viable entity in the absence of sponsoring an employee benefit plan. A substantial business purpose includes promoting common business interests in a given trade or employer community and is not required to be a for-profit activity.b. Each employer member of the group or association which participates in the group health plan is a person acting directly as an employer of at least one employee who is a participant covered under the plan.c. The group or association has a formal organizational structure with a governing body and has bylaws or other similar indications of formality.d. The functions and activities of the group or association are controlled by its employer members, and the group’s or association’s employer members that participate in the group health plan control the plan. Control must be present both in form and in substance.e. The employer members have a principal place of business in the same region that does not exceed the boundaries of a single state or metropolitan area, even if the metropolitan area includes more than one state.f. The group or association does not make health coverage through the group’s or association’s group health plan available to any person other than:(I) An employee of a current employer member of the group or association;(II) A former employee of a current employer member of the group or association who became eligible for coverage under the group health plan when the former employee was an employee of the employer; or(III) A beneficiary, such as a spouse or dependent child, of an individual described in sub-sub-subparagraph (I) or sub-sub-subparagraph (II).g. The group or association and the health coverage offered by the group or association comply with the nondiscrimination provisions of s. 627.6699.h. The group or association is not a health insurance issuer as defined in s. 733(b)(2) of the Employee Retirement Income Security Act of 1974, 29 U.S.C. s. 1191b(b)(2), or owned or controlled by such a health insurance issuer or by a subsidiary or affiliate of such a health insurance issuer, other than to the extent such entities participate in the group or association in their capacity as employer members of the group or association.
a. The primary purpose of the group or association may be to offer and provide health coverage to its employer members and their employees. However, the group or association must also have at least one substantial business purpose unrelated to such primary purpose. For purposes of this sub-subparagraph, a substantial business purpose is deemed to exist if the group or association would be a viable entity in the absence of sponsoring an employee benefit plan. A substantial business purpose includes promoting common business interests in a given trade or employer community and is not required to be a for-profit activity.
b. Each employer member of the group or association which participates in the group health plan is a person acting directly as an employer of at least one employee who is a participant covered under the plan.
c. The group or association has a formal organizational structure with a governing body and has bylaws or other similar indications of formality.
d. The functions and activities of the group or association are controlled by its employer members, and the group’s or association’s employer members that participate in the group health plan control the plan. Control must be present both in form and in substance.
e. The employer members have a principal place of business in the same region that does not exceed the boundaries of a single state or metropolitan area, even if the metropolitan area includes more than one state.
f. The group or association does not make health coverage through the group’s or association’s group health plan available to any person other than:(I) An employee of a current employer member of the group or association;(II) A former employee of a current employer member of the group or association who became eligible for coverage under the group health plan when the former employee was an employee of the employer; or(III) A beneficiary, such as a spouse or dependent child, of an individual described in sub-sub-subparagraph (I) or sub-sub-subparagraph (II).
(I) An employee of a current employer member of the group or association;
(II) A former employee of a current employer member of the group or association who became eligible for coverage under the group health plan when the former employee was an employee of the employer; or
(III) A beneficiary, such as a spouse or dependent child, of an individual described in sub-sub-subparagraph (I) or sub-sub-subparagraph (II).
g. The group or association and the health coverage offered by the group or association comply with the nondiscrimination provisions of s. 627.6699.
h. The group or association is not a health insurance issuer as defined in s. 733(b)(2) of the Employee Retirement Income Security Act of 1974, 29 U.S.C. s. 1191b(b)(2), or owned or controlled by such a health insurance issuer or by a subsidiary or affiliate of such a health insurance issuer, other than to the extent such entities participate in the group or association in their capacity as employer members of the group or association.

(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:The physician has more than one employee.The physician employer enters into a contract to render medical services to the arrangement’s plan participants.The physician employer agrees to waive any fee due from the arrangement in the event that the arrangement becomes insolvent.The physician employer agrees to be subject to the same assessments and surcharges as apply to arrangement members.
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 office shall not grant or continue a certificate of authority for any arrangement if the office 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 office 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.

Source: Section 624.438 — General eligibility, https://www.­flsenate.­gov/Laws/Statutes/2024/0624.­438 (accessed Aug. 7, 2025).

624.44
Examination by the office 624.45
Participation of financial institutions in reinsurance and in insurance exchanges 624.401
Certificate of authority required 624.402
Exceptions, certificate of authority required 624.404
General eligibility of insurers for certificate of authority 624.406
Combinations of insuring powers, one insurer 624.407
Surplus required 624.408
Surplus required 624.410
Permissible insuring combinations without additional capital funds 624.411
Deposit requirement 624.412
Deposit of alien insurers 624.413
Application for certificate of authority 624.414
Issuance or refusal of authority 624.415
Ownership of certificate of authority 624.416
Continuance, expiration, reinstatement, and amendment of certificate of authority 624.418
Suspension, revocation of certificate of authority for violations and special grounds 624.420
Order, notice of suspension or revocation of certificate of authority 624.421
Duration of suspension 624.422
Service of process 624.423
Serving process 624.424
Annual statement and other information 624.425
Agent countersignature required, property, casualty, surety insurance 624.426
Exceptions to countersignature law 624.428
Licensed agent law, life and health insurances 624.430
Withdrawal of insurer or discontinuance of writing certain kinds or lines of insurance 624.436
Florida Nonprofit Multiple-Employer Welfare Arrangement Act 624.437
“Multiple-employer welfare arrangement” defined 624.438
General eligibility 624.439
Filing of application 624.441
Insolvency protection 624.442
Annual reports 624.443
Place of business 624.444
Suspension, revocation of approval 624.445
Order, notice, duration, effect of suspension or revocation 624.446
Rehabilitation, dissolution 624.447
Certificate of insurance for contractors 624.448
Assets of insurers 624.449
Insurer investment in foreign companies 624.460
Short title 624.461
Definition 624.462
Commercial self-insurance funds 624.464
Certificate of authority required 624.466
Application requirements for certificate of authority 624.468
Continuing requirements for certificate of authority 624.470
Annual reports 624.472
Member’s liability 624.473
Dividends 624.474
Assessments 624.475
Tax on premiums, contributions, and assessments 624.476
Impaired self-insurance funds 624.477
Liquidation, rehabilitation, reorganization, and conservation 624.480
Filing, approval, and disapproval of forms 624.482
Making and use of rates 624.483
Self-insurer members 624.484
Registration of agent 624.486
Examination 624.487
Enforcement of specified insurance provisions 624.488
Applicability of related laws 624.489
Liability of trustees of self-insurance trust fund and directors of self-insurance funds operating as corporations 624.490
Registration of pharmacy benefit managers 624.491
Pharmacy audits 624.4031
Church benefit plans and church benefit board 624.4055
Restrictions on existing private passenger automobile insurance 624.4073
Officers and directors of insolvent insurers 624.4085
Risk-based capital requirements for insurers 624.4094
Bail bond premiums 624.4095
Premiums written 624.4135
Redomestication 624.4211
Administrative fine in lieu of suspension or revocation 624.4212
Confidentiality of proprietary business and other information 624.4213
Trade secret documents 624.4241
NAIC filing requirements 624.4243
Reporting of premium growth 624.4245
Change in controlling interest of foreign or alien insurer 624.4301
Notice of temporary discontinuance of writing new residential property insurance policies 624.4305
Nonrenewal of residential property insurance policies 624.4315
Workers’ compensation insurers 624.4361
Definitions 624.4385
Certain words prohibited in name of organization 624.4392
Fund balance 624.4411
Administrative, provider, and management contracts 624.4412
Policy forms 624.4414
Employer participants’ liability 624.4415
Assessments 624.4416
Assessments by receiver 624.4417
Certain sales prohibited 624.4431
Administration 624.4432
Assets, liabilities, and investments 624.4621
Group self-insurance funds 624.4622
Local government self-insurance funds 624.4623
Independent Educational Institution Self-Insurance Funds 624.4625
Corporation not for profit self-insurance funds 624.4626
Electric cooperative self-insurance fund 624.4741
Venue in assessment actions 624.40711
Restrictions on insurers that are wholly owned subsidiaries of insurers to do business in state 624.40851
Confidentiality of risk-based capital information 624.46223
Notice of intent to withdraw 624.46225
Self-insured public utilities 624.46226
Public housing authorities self-insurance funds

Current through Fall 2025

§ 624.438. Gen. eligibility's source at flsenate​.gov