Florida Administrative Code

(1) Pursuant to Section 624.610(4), F.S., the Office shall allow credit for reinsurance ceded by a domestic insurer to an assuming insurer that is licensed to write reinsurance by, and has its head office or is domiciled in, a reciprocal jurisdiction, and which meets the other re…

(1) The purpose and intent of this rule is to implement the national standards governing reserve financing arrangements pertaining to life insurance policies containing guaranteed nonlevel gross premiums, guaranteed nonlevel benefits and universal life insurance policies with sec…

(1) Background and Purpose. The provisions of section 626.785, F.S., provide for insurance agents to sell life insurance and annuities on a limited basis to fund preneed services and merchandise. The statute provides that if a funeral establishment contracts with a life insurance…

(1)(a)1. Every policy, rider or endorsement form affecting benefits which is submitted for approval shall be submitted in accordance with the provisions of Part II of this rule chapter and shall be accompanied by a rate filing or an actuarial certification that such policy, rider…

(1)(a) Actual-to-Expected (A/E) ratio: The ratio of actual incurred claims under the policy form divided by expected claims. This is equivalent to the actual annual loss ratio divided by the applicable durational loss ratios of the approved durational loss ratio table. (b) For pr…

(1)(a) Pooling. For purposes of submitting a rate filing under this part for individual policy forms and for group Medicare supplement and long-term care group policy forms, in order to encourage adequate risk sharing for all generations of policyholders, the experience of all po…

(1) The level of detail and the degree of integrity incorporated in the experience records of the insurer are vital factors in the presentation and review of rate filings. Benefits to policyholders and insurer viability and profitability are significantly impaired with less than …

(1) Benefits will be determined to be reasonable in relation to the premium rates charged if the premium schedule is not excessive, not inadequate and not unfairly discriminatory. In determining whether a premium schedule satisfies these requirements, the Office will consider all…

(1) Group Coverage. (a) All insurers and HMOs subject to the provisions of Section 627.65626 or 641.31(40), F.S., shall provide for a healthy lifestyle rebate. (b)1. All insurers and HMOs providing a healthy lifestyle rebate shall file for approval the standards it will use for d…

(1) In order for a rate filing to be reviewed properly by the Office, the actuarial memorandum required by subparagraph 69O-149.003(2)(b)4., F.A.C., shall contain the items listed in subsection (2), below, for a new product filing, a rate revision or justification of existing rat…

(1) This rule applies to filings made pursuant to Section 627.410(7)(a)2., F.S., in which no rate change is proposed. (2) The filings required by this rule shall be on an individual company basis. (3) This rule is not applicable for Medicare supplement coverage. Medicare suppleme…

(1) Applicability. This rule is applicable to individual accident and health insurance policy forms whose original new product filing is submitted for approval on or after October 1, 1991 and to rate revisions for policy forms submitted for approval before October 1, 1991. Insure…

No insurer authorized to engage in the business of insurance in the State of Florida shall refuse to insure, or continue to insure, an individual risk or a group for accident and health insurance coverage because of the residence of the individual or location of the group within …

Rules 69O-149.020 to 69O-149.024, F.A.C., shall apply to all form filings of policies and applications for accident and health insurance, including outlines of coverage, and to all form filings for life and annuity insurance submitted to the Office for review. Except for subparag…

(1)(a)1. All filings shall be made in accordance with paragraph (1)(b), below. 2.a. For purposes of the rules in this part and the time periods in Section 627.410, F.S., a filing is considered "filed" with the Office upon the receipt of the material required by paragraph (1)(b), …

(1) The forms adopted in subsection (2), below, shall be used, as applicable, by insurers making form filings for life and accident insurance, annuities, and health insurance. All the forms in subsections (2) and (3), below, are hereby adopted and incorporated by reference. All f…

(1) Filings will be reviewed for compliance with applicable statutes and rules as stated on the forms adopted in Rule 69O-149.022, F.A.C., and will be disapproved for failure to comply. Filings will be disapproved for inconsistencies or ambiguities which are misleading. (2) The p…

(1) Purpose. The purpose of this rule is to implement Section 627.479, F.S., which prohibits the issuance of certain policies in the State of Florida. (2) Scope. This rule applies to all insurers and to any prohibited policy defined in this rule. (3) Definitions. For purposes of …

The purpose of these rules is to implement Section 627.6699, F.S., pertaining to requirements of small employer group insurance, to promote the public interest, to promote the availability of small employer group insurance policies, to protect applicants for small employer group …

(1) Except as otherwise provided, the provisions of the rules in this part shall apply, to the extent provided in Section 627.6699, F.S., and this rule, to small employer health benefit plans delivered or issued for delivery in this state by an authorized insurer, a health mainte…

(1) A small employer carrier which offers coverage to a small employer shall offer coverage to each eligible employee and to each of the dependents of the employees who elect coverage. The small employer carrier shall offer the same health benefit plans to each employee and depen…

A small employer carrier shall not consider the occupation of the employees of a small employer or the industry or type of business in which the small employer is engaged in determining whether to issue or continue to provide coverage to the small employer. Rulemaking Authority 6…

(1) This rule is applicable for all health benefit plans subject to Section 627.6699, F.S., and is in addition to Parts I and II. (2)(a) A group's rate shall not be changed due to employee age changes which occur during the period when a premium schedule is guaranteed. (b) The ra…

(1) Pursuant to Section 627.6699, F.S., each carrier that provides health benefit plans in this state shall file an actuarial certification, pursuant to paragraph 69O-149.044(2)(b), F.A.C., on or before March 15 of each year that the carrier is in compliance with the provisions o…

(1) A small employer carrier shall file, pursuant to paragraph 69O-149.044(1)(b), F.A.C., a final designation of election to become either a risk-assuming carrier or a reinsuring carrier using Form OIR-B2-1093, "State of Florida/Small Employer Carrier's Application to Become a Ri…

(1) Any small employer carrier seeking to change the election made by the carrier under Section 627.6699(9)(a), F.S., to become either a risk-assuming carrier or a reinsuring carrier shall request a change of status, pursuant to paragraph 69O-149.044(2)(b), F.A.C., on Form OIR-B2…

(1) Any marketing communication shall comply with the requirements of rule Chapter 69O-150, Part III, F.A.C. (2) Any insurer marketing small group health plans shall comply with the following guidelines: (a) The small group health history or size shall not be used to direct the s…

(1) Beginning January 1, 1994, the board of the "Florida Small Employer Health Reinsurance Program," as established in Section 627.6699(11), F.S., shall consist of the Director or his designee, who shall serve as chairman, and eight (8) additional members who are representatives …

(1) The following forms are hereby adopted and incorporated by reference: (a) OIR-B2-1117, Rev. 1/05, Florida Employee Health Care Access Act Enrollment Report. (b) OIR-B2-1093, Rev. 5/02, State of Florida/Small Employer Carrier's Application to Become a Risk Assuming Carrier or …

(1) Prior to establishing a Self-Funded Health Benefit Plan, the local governmental unit shall submit the following: (a) A copy of its Plan, including a list of its offered benefits; (b) Form OIR-B2-570, "General Information on Self-Funded Health Benefit Plans"; as adopted in Rul…

(1) Once the Plan has been approved by the Office and has commenced operations, the local governmental unit shall submit the following, no later than 90 days after the close of the Plan's fiscal year: (a) Form OIR-B2-570, "General Information on Self-Funded Health Benefit Plans,"…

(1) The following forms are hereby adopted and incorporated by reference: (a) Form OIR-B2-570 (12/03) "General Information on Self-Funded Health Benefit Plans"; (b) Form OIR-B2-571 (12/03) "New Plan Operating Projections for Self-Funded Health Benefit Plans"; (c) Form OIR-B2-572 …

The purpose of this part is to establish the standard annual risk rates pursuant to Section 627.6675(3), F.S., to be used as the maximum rate for group conversion insurance forms and by the Florida Comprehensive Health Association ("FCHA") in establishing rates for coverages issu…

The provisions of this part shall apply to all group conversion coverage issued or renewed in Florida on or after the effective date of this rule for coverage issued: (1) As an individual policy; or (2) As a certificate under a group policy; including group policies issued or del…

(1) Standard risk rates, pursuant to the provisions of Section 627.6675(3), F.S., are provided for the following "categories of coverages": (a) Indemnity policies; (b) Preferred provider organization ("PPO")/exclusive provider organization ("EPO") policies; and, (c) Health mainte…

(1) The maximum group conversion rates to be charged an insured shall not exceed the standard risk rate times 2.0. (2) All rate filings shall provide a comparison table clearly identifying benefit differences from those benefits listed in rule 69O-149.204, F.A.C., from which the …

Rulemaking Authority 624.308, 627.6675(3)(c) FS. Law Implemented 624.307(1), 627.6498(4), 627.6675(3), 641.3922(3) FS. History-New 3-2-00, Amended 4-2-01, 4-17-02, Formerly 4-149.204, Amended 5-18-04, Repealed 11-21-17.

(1) The table below provides the standard annual risk rates for indemnity plans for the Standard Health Benefit Plan. The 200% standard risk rate referenced in Section 627.6675(3)(a), F.S., is determined by multiplying each value in the table by the factor 2.0. (2) To determine t…

(1) The table below provides the standard annual risk rates for PPO/EPO plans for the FCHA and Standard Health Benefit Plan. The 200% standard risk rate referenced in section 627.6675(3)(a), F.S., is determined by multiplying each value in the table by the factor 2.0. (2) To dete…

(1) The table below provides the standard annual risk rates for HMO plans for the Standard Benefit Plan. The 200% standard risk rate referenced in section 627.6675(3)(a), F.S., is determined by multiplying each value in the table by the factor 2.0. (2) To determine the rate for a…

The purpose of these rules is to provide prospective purchasers with clear and unambiguous statements in the advertisement of health insurance, and to assure the clear, truthful and adequate disclosure of the benefits, limitations and exclusions of policies sold as health insuran…

(1) These rules shall apply to any Health Insurance "advertisement," disseminated in this State which the insurer knows or reasonably should know is intended for presentation, distribution or dissemination in this State when such presentation, distribution or dissemination is mad…

For the purpose of these rules, the terms below are defined as follows: (1) An "Advertisement" includes any method of communicaton listed in Sections 626.9541(1)(b)1. through 4., F.S. (2) The definition of "Advertisement" does not include: (a) Material to be used solely for the t…

All information required to be disclosed by these rules shall be set out conspicuously and in close conjunction with the statements to which such information relates or under appropriate captions of such prominence that it shall not be minimized, rendered obscure or presented in …

(1) The form and content of a Health Insurance advertisement shall be sufficiently complete and clear to avoid deception or the capacity or tendency to mislead or deceive. Whether an advertisement has a capacity or tendency to mislead or deceive shall be determined by the Directo…

(1) Deceptive Words, Phrases, or Illustrations Prohibited. (a) No advertisement shall omit information or use words, phrases, statements, references or illustrations if the omission of such information or use of such words, phrases, statements, references, or illustrations has th…

An advertisement which is an invitation to contract shall disclose the provisions relating to renewability, cancellability and termination and any modification of benefits, losses covered or premiums because of age or for other reasons, in a manner which shall not minimize or ren…