Florida Administrative Code

(1)(a) An insurer may offer policyholders or certificateholders the option to exchange an existing Long-Term Care contract for a new Long-Term Care contract. (b) An exchange occurs when an insurer offers an existing long-term care policyholder or certificateholder the option to r…

(1) Every insurer shall maintain records for each agent of that agent's amount of replacement sales as a percentage of the agent's total annual sales in this state and the amount of lapses of long-term care insurance policies sold by the agent as a percentage of the agent's total…

(1)(a) When long-term care benefits are provided through the acceleration of benefits under group or individual life policies or riders to such policies which meet the conditions of subsection 69O-157.113(9), F.A.C., policy reserves for the benefits shall be determined in accorda…

(1) An insurer shall file with the Office for approval any premium rate schedule increase, including an exceptional increase, pursuant to Section 627.410, F.S. The filing shall include: (a) A filing made pursuant to rule Chapter 69O-149, F.A.C., with the actuarial information ide…

(1) No group long-term care insurance coverage may be offered to a resident of this state under a group policy issued in another state to a group described in Section 627.9405(1)(c) or (d), F.S., unless this state or such other state having statutory and regulatory long-term care…

Every insurer, health care service plan or other entity providing long-term care insurance or benefits in this state shall provide a copy of any long-term care insurance advertisement and marketing material intended for use in this state whether through written, radio, television…

Insurers providing Long-Term Care insurance shall maintain records, subject to Office review upon request, that before any producer sells, solicits or negotiates a long-term care insurance policy, that they receive necessary and sufficient training to understand partnership polic…

(1) This rule shall not apply to life insurance policies that accelerate benefits for long-term care. (2) Every insurer, health care service plan, or other entity marketing long-term care insurance (the "insurer") shall: (a) Develop and use suitability standards to determine whet…

If a long-term care insurance policy or certificate replaces another long-term care policy or certificate, the replacing insurer shall waive any time periods applicable to time limit on certain defenses, preexisting conditions and probationary periods in the new long-term care po…

(1) This rule does not apply to life insurance policies or riders meeting the conditions of subsection 69O-157.113(9), F.A.C., containing accelerated long-term care benefits. (2)(a) All insurers offering long term care insurance in this state shall offer a nonforfeiture protectio…

(1) A qualified long term care insurance contract shall pay only for qualified long term care services received by a chronically ill individual provided pursuant to a plan of care prescribed by a licensed health care practitioner. (2)(a)1. A qualified long-term care insurance con…

This rule implements, interprets, and makes specific, the provisions of Section 627.9407(10), F.S., in prescribing a standard format and the content of an outline of coverage. (1) The outline of coverage shall be a freestanding document, using no smaller than 10-point type. (2) T…

(1) A long-term care insurance shopper's guide in the format developed by the National Association of Insurance Commissioners (2001), which is incorporated herein by reference, or a guide developed by the Office, shall be provided to all prospective applicants of a long-term care…

In addition to any other penalties provided by the laws of this state, any insurer and any agent found to have violated any requirement of this state relating to the regulation of long-term care insurance or the marketing of such insurance shall be subject to a fine of up to 3 ti…

(1)(a) A policy or certificate, herein referred to as policy, marketed or represented to qualify as an approved long-term care partnership program policy as provided by Section 409.9102, F.S., hereinafter referred to as a 'partnership', shall be a policy where: 1. Such form and r…

(1) Rate increase filings for long term care insurance shall be filed in accordance with filing requirements and standards of Rule Chapters 69O-149 and 69O-157, F.A.C. (2) The term "policies with similar coverage" has the same meaning as "similar policy forms" as defined in subse…

Rulemaking Authority 627.9408(1) FS. Law Implemented 627.9407(7) FS. History-New 11-1-07, Amended 5-31-09, 7-19-10, Repealed 11-3-15.

Rulemaking Authority 627.9408(1) FS. Law Implemented 627.9407(7) FS. History-New 11-1-07, Amended 5-31-09, 7-19-10, Repealed 11-3-15.

Rulemaking Authority 627.9408(1) FS. Law Implemented 627.9407(7) FS. History-New 11-1-07, Amended 5-31-09, 7-19-10, Repealed 11-3-15.

Rulemaking Authority 409.910, 624.308 FS. Law Implemented 409.910, 624.424(9), 641.261, 641.411 FS. History-New 11-14-89, Formerly 4-80.001, 4-158.001, Repealed 4-27-26.

Rulemaking Authority 409.910, 624.308 FS. Law Implemented 409.910, 624.424(9), 641.261, 641.411 FS. History-New 11-14-89, Formerly 4-80.002, 4-158.002, Repealed 4-27-26.

The following definitions shall apply to this rule chapter: (1) "Office" shall mean the Office of Regulation. (2) "AHCA" shall mean the Agency for Health Care Administration. (3) "Insurer" shall mean an entity authorized by the Office to transact health insurance, multiple employ…

(1) Every health insurer shall, upon request of AHCA for any records or any information contained in such records, pertaining to the coverage of any individual under a health insurance policy or to the medical benefits paid by or claims made to any insurer pursuant to such policy…

The purpose of this chapter is to establish uniform claim forms for claims relating to health insurance and industrial life insurance policies, to establish guidelines for all prior authorization forms which ensure the general uniformity of such forms, and to adopt a prior author…

This chapter applies to all insurance companies authorized to write health insurance or industrial life insurance in Florida. Rulemaking Authority 624.308(1), 627.647 FS. Law Implemented 624.307(1), 627.510(2), 627.647 FS. History-New 4-25-88, Formerly 4-74.002, Amended 6-8-94, F…

All companies writing industrial life insurance shall use the Uniform Life Insurance Claim Form (OIR Form 4-371) (2/94) which is hereby incorporated and made part of this rule chapter by reference. Rulemaking Authority 624.308(1) FS. Law Implemented 624.307(1), 627.510(2) FS. His…

All companies writing health insurance shall accept the Uniform Health Insurance Claim Form (Form HCFA-1500) (12/90), which is hereby incorporated and made part of this rule chapter by reference. Rulemaking Authority 624.308(1), 627.647 FS. Law Implemented 624.307(1), 627.647 FS.…

All companies writing dental insurance shall accept Form HCFA 1500 (12/90) and the American Dental Association Dental Claim Form (Form J510, J511, or J512) (1/94). For informational purposes only, the Florida Medicaid dental program shall accept the Non-Institutional Dentist Clai…

All companies writing health insurance shall accept the Universal Pharmacy Claim Form (Form DAH) (2/89) and Form HCFA 1500, which are hereby incorporated and made part of this rule chapter by reference. Rulemaking Authority 624.308(1), 627.647 FS. Law Implemented 624.307(1), 627.…

All companies writing health insurance shall accept the Uniform Hospital Claim Form (Form UB-92, HCFA 1450) (2/94), which is hereby incorporated and made part of this rule chapter by reference. Rulemaking Authority 624.308(1), 627.647 FS. Law Implemented 627.647 FS. History-New 6…

Nothing in this rule chapter shall prevent an insurance company from requesting additional information which is not contained on the forms specified by this rule chapter in order to determine the eligibility of the patient or the medical necessity of the service rendered. Rulemak…

All forms referenced in this rule chapter may be obtained at www.floir.com/iportal. Rulemaking Authority 624.308(1), 627.647 FS. Law Implemented 624.307(1), 627.510(2), 627.647 FS. History-New 6-8-94, Formerly 4-161.009, Amended 1-11-17.

(1) Scope: This rule applies to all insurance companies, health maintenance organizations, and managed care entities authorized to write health insurance in Florida. (2) Definitions: As used in this rule: (a) "Health Insurer" means an authorized insurer offering health insurance …

All authorized insurers offering health insurance as defined in Section 624.603, F.S., managed care plans as defined in Section 409.962(9), F.S., and health maintenance organizations as defined in Section 641.19(12), F.S., which do not provide an electronic prior authorization pr…

The following Rules and Regulations shall govern the issuance and delivery of Variable Annuity Contracts pursuant to the authority set forth in Chapter 627, Part XIV, F.S. Rulemaking Authority 627.805 FS. Law Implemented 627.801 FS. History-New 12-24-74, Formerly 4-10.01, 4-10.00…

No variable annuity contract shall be delivered or issued for delivery in this state by any insurance company until a copy of the form thereof (and, in the case of a contract on a group basis, the form of any certificates evidencing variable benefits issued pursuant thereto) and …

Illustrations of benefits payable under any variable contract shall not involve projections of past investment experience into the future. Rulemaking Authority 626.9611, 627.805 FS. Law Implemented 627.803, 626.9541(1) FS. History-New 12-24-74, Formerly 4-10.03, 4-10.003, 4-162.0…

No individual variable annuity contract shall be delivered or issued for delivery in this state unless it contains in substance the following provisions: (1) That, in the event of default in the payment of any consideration beyond the period of grace allowed by the contract for t…

Any variable annuity contract delivered or issued for delivery in this state, and any application for such contract, and any group annuity certificate, shall contain on its first page, in a prominent position in ten (10) point type or larger, a clear statement that the annuity be…

Any individual or group variable annuity contract delivered or issued for delivery in this state shall stipulate the expense, mortality, and investment increment factors to be used in computing the dollar amount of variable benefits or other contractual payments or values thereun…

Sales of variable annuity contracts shall be made or solicited only by persons authorized under licenses from the Department of Financial Services to sell life insurance only after certification by the Department as having satisfactorily completed an examination given or authoriz…

(1) All companies authorized to issue and deliver contracts on a variable basis, all contracts, certificates and other forms in connection therewith, and all agents and other representatives are subject to the provisions of Chapter 626, Part VII, F.S. (2) Illustration of benefits…

Every domestic life insurance company which issues variable annuity contracts shall be permitted to invest and reinvest amounts received in connection with such variable contracts in common stocks, subject to the following limitations: (1) All such common stock investments shall …

(1) The valuation of variable annuity contract account assets for all purposes, including annual reports of the company to the Office of Insurance Regulation, shall be determined in accordance with the market value of such assets, notwithstanding the application of other valuatio…

(1) Every company authorized to issue and deliver in this state annuity contracts on a variable basis shall, on or before the first of March in each and every year, file with the Director the statement required by Section 624.424(1), F.S. Such statement shall contain, in addition…

No domestic or foreign life insurance company shall undertake the issuance of any variable annuity contract in this state until said domestic company has shown to the satisfaction of the Director that it has successfully engaged in the business of transacting life insurance for a…

Assets and liabilities of the separate account established in connection with variable annuity contracts shall be distinguishable from other accounts of the same domestic insurance company. There shall be no sales or transfers between accounts of the same domestic insurance compa…

(1) No person while serving as an elected or appointed officer, director or trustee of any domestic life insurance company shall receive directly or indirectly any commission on the variable annuity business transactions of the company. (2) The deductions that may be made from th…

The following rules shall govern annuity mortality tables for use in reserves as set forth in Section 625.121, F.S. Rulemaking Authority 624.308, 625.121(5)(i) FS. Law Implemented 624.307(1), 625.121 FS. History-New 12-23-98, Formerly 4-162.101.

The purpose of this rule is to recognize the following mortality tables for use in determining the minimum standard of valuation for annuity and pure endowment contracts: the Annuity 2000 Mortality Table, the 1994 Group Annuity Reserving (1994 GAR) Table, and the 2012 IAR Mortali…