69O-149.038. Employee Health Care Access Act Statement Reporting Requirement

(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 of Section 627.6699(6), F.S., as required by Section 627.6699(8)(b), F.S., for the prior calendar year and that the current rating methods of the carrier are actuarially sound. The actuary shall provide a detailed explanation if this certification cannot be made.

(2) Quarterly Reports: Within 45 days following each calendar quarter each small employer carrier shall file, pursuant to paragraph 69O-149.044(2)(b), F.A.C., a report on Form OIR-B2-1117, Florida Employee Health Care Access Act Enrollment Report, adopted in Rule 69O-149.044, F.A.C.

(3)(a)1. All small employer carriers utilizing rating adjustments pursuant to subsection 69O-149.037(6), F.A.C., shall make semiannual reports that reflect their experience from January 1 through June 30 and from July 1 through December 31 of each year. The reports shall be filed with the Office, pursuant to paragraph 69O-149.044(2)(b), F.A.C., within 45 days following the last day of the reporting period using Form OIR-B2-1575, “Small Employer Group Underwriting Experience Report Form” adopted in Rule 69O-149.044, F.A.C.

2. The experience of any group category that is not subject to underwriting, pursuant to subsection 69O-149.037(6), F.A.C., such as 1-life groups, shall not be included in the report.

(b)1. If the percentage deviation from the modified community rate due to adjustments in the rate actually charged policyholders for claim experience, health status, or duration adjustments is 4 percent or more, the carrier shall limit the application of claim experience, health status, or duration adjustments to credits only effective no more than 60 days following the report date.

2. This shall apply to all groups with original issue dates or anniversary dates for renewals on or after this 60 days.

3. If a group was in process of application review and issuance, and would have received a surcharge, but the policy was not issued or renewed until after the 60 day period, the surcharge may not be applied.

(c) If the above report is not submitted by the date required, the carrier shall limit the application of claim experience, health status, or duration adjustments to credits only effective no more than 60 days following the due date. This shall apply to all groups with original issue dates or anniversary dates for renewals on or after this 60 days. If a group was in process of application review and issuance, and would have received a surcharge, but the policy was not issued or renewed until after the 60 day period, the surcharge may not be applied.

(d) A carrier that is limited to credits only, pursuant to paragraph (b) or (c) above, shall be limited to credits only until a subsequent reporting period demonstrating that the percentage deviation from the modified community rate due to adjustments in the rate actually charged policyholders for claim experience, health status, or duration adjustments is less than 4 percent.

Specific Authority 627.6699(5)(i)4., (6), (17), 627.9175 FS. Law Implemented 624.424(6), 627.6699, 627.6699(5)(i), (6)(b)5., (8)(b), 627.9175 FS. History–New 3-1-93, Amended 11-7-93, 8-4-02, 6-19-03, Formerly 4-149.038, Amended 5-18-04, 3-24-05, 9-15-05, 7-6-06.