Florida Administrative Code (Last Updated: October 8, 2024) |
69. Department of Financial Services |
69O. OIR – Insurance Regulation |
69O-154. Health Insurance Policies |
1Specific minimum standards for morbidity, mortality and interest which apply to claim reserves according to year of incurral and to contract reserves according to year of issue:
28(1) Morbidity.
30(a) Minimum morbidity standards for valuation of specified individual contract health insurance benefits are as follows:
461. Disability Income Benefits Due to Accident or Sickness.
55a. Contract Reserves:
58(I) Contracts issued on or after January 1, 1965, and prior to January 1, 1998: The 1964 Commissioners Disability Table (64 CDT), incorporated by reference in Rule 8569O-154.210, 86F.A.C., or a table acceptable to the Department as specified in paragraph 9869O-154.204(1)(c), 99F.A.C.
100(II) Contracts issued on or after January 1, 1999:
109(A) The 1985 Commissioners Individual Disability Tables A (85CIDA), incorporated by reference in Rule 12369O-154.210, 124F.A.C; or
126(B) The 1985 Commissioners Individual Disability Tables B (85CIDB), incorporated by reference in Rule 14069O-154.210, 141F.A.C.
142(III) Contracts issued on or after January 1, 1998 and prior to January 1, 1999 inclusive: Optional use of either the 1964 Table or the 1985 Tables, or a table acceptable to the Department as specified in paragraph 18069O-154.204(1)(c), 181F.A.C.
182(IV) Each insurer may elect, with respect to all individual contracts issued in any one statement year, whether it will use Tables A or Tables B as the minimum standard. The insurer shall, however, elect to use the other tables with respect to any subsequent statement year.
229b. Claim Reserves:
232(I) For claims incurred on or before December 31, 2002, the minimum morbidity standard in effect for contract reserves on currently issued contracts as of the date the claim is incurred.
263(II)(A) For claims incurred on or after January 1, 2003, the 1985 Commissioners Individual Disability Table A (85CIDA) with claim termination rates multiplied by the following adjustment factors:
291Duration
292Adjustment Factor
294Adjusted Termination Rates*
297Week
2981
2990.366
3000.04831
3012
3020.366
3030.04172
3043
3050.366
3060.04063
3074
3080.366
3090.04355
3105
3110.365
3120.04088
3136
3140.365
3150.04271
3167
3170.365
3180.04380
3198
3200.365
3210.04344
3229
3230.370
3240.04292
32510
3260.370
3270.04107
32811
3290.370
3300.03848
33112
3320.370
3330.03478
33413
3350.370
3360.03034
337Month
3384
3390.391
3400.08758
3415
3420.371
3430.07346
3446
3450.435
3460.07531
3477
3480.500
3490.07245
3508
3510.564
3520.06655
3539
3540.613
3550.05520
35610
3570.663
3580.04705
35911
3600.712
3610.04486
36212
3630.756
3640.04309
36513
3660.800
3670.04080
36814
3690.844
3700.03882
37115
3720.888
3730.03730
37416
3750.932
3760.03448
37717
3780.976
3790.03026
38018
3811.020
3820.02856
38319
3841.049
3850.02518
38620
3871.078
3880.02264
38921
3901.107
3910.02104
39222
3931.136
3940.01932
39523
3961.165
3970.01865
39824
3991.195
4000.01792
401Year
4023
4031.369
4040.16839
4054
4061.204
4070.10114
4085
4091.199
4100.07434
4116 and later
4141.000
415**
416*The adjusted termination rates derived from the application of the adjustment factors to the DTS Valuation Table termination rates shown in exhibits 3a, 3b, 3c, 4, and 5 (Transactions of the Society of Actuaries (TSA) XXXVII, pp. 457-463) is displayed. The adjustment factors for age, elimination period, class, sex, and cause displayed in exhibits 3a, 3b, 3c, and 4 should be applied to the adjusted termination rates shown in this table.
487**Applicable DTS Valuation Table duration rate from exhibits 3c and 4 (TSA XXXVII, pp. 462-463).
502(B) The 85CIDA table so adjusted for the computation of claim reserves shall be known as 85CIDC (The 1985 Commissioners Individual Disability Table C).
5262. Hospital Benefits, Surgical Benefits and Maternity Benefits (Scheduled benefits or fixed time period benefits only).
542a. Contract Reserves:
545(I) Contracts issued on or after January 1, 1955, and before January 1, 1982: The 1956 Intercompany Hospital-Surgical Tables, incorporated by reference in Rule 56969O-154.210, 570F.A.C., or a table acceptable to the Department as specified in paragraph 58269O-154.204(1)(c), 583F.A.C.
584(II) Contracts issued on or after January 1, 1982: The 1974 Medical Expense Tables, Table A, Transactions of the Society of Actuaries, Volume XXX, pg. 63, incorporated by reference in Rule 61569O-154.210, 616F.A.C., or a table acceptable to the Department as specified in paragraph 62869O-154.204(1)(c), 629F.A.C. Refer to the paper (in the same volume, pg. 9) to which this table is appended, including its discussions, for methods of adjustment for benefits not directly valued in Table A: “Development of the 1974 Medical Expense Benefits,” Houghton and Wolf, incorporated by reference in Rule 67769O-154.210, 678F.A.C.
679b. Claim Reserves: No specific standard. See sub-subparagraph 5., below entitled “Other Individual Contract Benefits”.
6943. Cancer Expense Benefits (Scheduled benefits or fixed time period benefits only).
706a. Contract Reserves:
709(i) Contracts issued on or after January 1, 1986, and prior to January 1, 1999: The 1985 NAIC Cancer Claim Cost Tables, incorporated by reference in Rule 73669O-154.210, 737F.A.C., or a table acceptable to the Department as specified in paragraph 74969O-154.204(1)(c), 750F.A.C.
751(i) Contracts issued on or after January 1, 1999: The 1985 NAIC Cancer Claim Cost Tables, incorporated by reference in Rule 77269O-154.210, 773F.A.C.
774b. Claim Reserves: No specific standard. See subparagraph 5., below entitled “Other Individual Contract Benefits”.
7894. Accidental Death Benefits.
793a. Contract Reserves: Contracts issued on or after January 1, 1965: The 1959 Accidental Death Benefits Table, incorporated by reference in Rule 81569O-154.210, 816F.A.C.
817b. Claim Reserves: Actual amount incurred.
8235. Single Premium Credit Disability.
828a. Contract Reserves:
831(I) For contracts issued on or after January 1, 2003:
841(A) For plans having less than a 30 day elimination period, the 1985 Commissioners Individual Disability Table A (85CIDA) with claim incidence rates increased by 12 percent.
868(B) For plans having a 30 day and greater elimination period, the 85CIDA for a 14 day elimination period with the adjustment in sub-sub-subparagraph (A).
893(II) For contracts issued prior to January 1, 2003, each insurer may elect either sub-sub-subparagraphs (A) or (B) to use as the minimum standard. Once an insurer elects to calculate reserves for all contracts on the standard defined in sub-subparagraph (I), all future valuations must be on that basis.
942(A) The minimum morbidity standard in effect for contract reserves on currently issued contracts, as of the date the contract was issued; or
965(B) The standard as defined in sub-subparagraph (I), applied to all contracts.
977b. Claim Reserves: Claim reserves are to be determined as provided in paragraph 99069O-154.203(1)(c), 991F.A.C.
9926. Other Individual Contract Benefits.
997a. Contract Reserves: For all other individual contract benefits, morbidity assumptions shall be determined as provided in the reserve standards.
1017b. Claim Reserves: For all benefits other than disability, claim reserves shall be determined as provided in the standards.
1036(b) Minimum morbidity standards for valuation of specified group contract health insurance benefits shall be as follows:
10531. Disability Income Benefits Due to Accident or Sickness 1062where Rules 106469O-154.201 1065‒ 106669O-154.210 1067reference 106869O-154.204, 1069F.A.C.; otherwise Actuarial Guideline XLVII, as included in the most current version of the NAIC 1084Accounting Practices and Procedures Manual 1089adopted by subsection 109269O-137.001(4), 1093F.A.C1094.
1095a. Contract Reserves:
1098(I) Contract1100s issued prior to January 1, 1999: The same basis, if any, as that employed by the insurer as of January 1, 1999 or a table acceptable to the Department as specified in paragraph 113469O-154.204(1)(c), 1135F.A.C.
1136(II) Contracts issued on or after January 1, 1999: The 1987 Commissioners Group Disability Income Table (87CGDT).
1153b. Claim Reserves:
1156(I) For claims incurred on or after January 1, 1999: The 87CGDT.
1168(II) For claims incurred prior to January 1, 1999: Use of the 87CGDT is optional.
11832. Single Premium Credit Disability.
1188a. Contract Reserves:
1191(I) For contracts issued on or after January 1, 2003:
1201(A) For plans having less than a 30 day elimination period, the 1985 Commissioners Individual Disability Table A (85CIDA) with claim incidence rates increased by 12 percent.
1228(B) For plans having a 30 day and greater elimination period, the 85CIDA for a 14 day elimination period with the adjustment in (A).
1252(II) For contracts issued prior to January 1, 2003, each insurer may elect to use either sub-subparagraph (I) or (II) as the minimum standard. Once an insurer elects to calculate reserves for all contracts on the standard defined in sub-subparagraph (I), all future valuations must be on that basis.
1301(A) The minimum morbidity standard in effect for contract reserves on currently issued contracts, as of the date the contract was issued, or
1324(B) The standard as defined in sub-subparagraph (I), applied to all contracts.
1336b. Claim Reserves: Claim reserves are to be determined as provided in paragraph 134969O-154.203(1)(c), 1350F.A.C.
13513. Other Group Contract Benefits.
1356a. Contract Reserves: For all other group contract benefits, morbidity assumptions shall be determined as provided in the reserve standards.
1376b. Claim Reserves: For all benefits other than disability, claim reserves shall be determined as provided in the standards.
1395(c) A table of factors used to value contract reserves for policies issued on or before December 31, 1998 or used to value claim reserves incurred on or before December 31, 1998, shall be acceptable to the Office if it has been accepted for valuation by the Commissioner of the state where the company is domiciled. If the insurer is a Florida domiciled insurer it will be acceptable if the valuation is done in accordance with commonly accepted actuarial practice.
1475(2) Interest.
1477(a) For contract reserves, the maximum interest rate is the maximum rate specified in Section 1492625.121(6)(a), F.S., 1494in the valuation of whole life insurance with an interest guarantee period greater than twenty years issued on the same date as the health insurance contract. An interest rate used to value contract reserves for policies issued on or before December 31, 1998 or used to value claim reserves incurred on or before December 31, 1998, shall be acceptable to the Office if it has been accepted for valuation by the Commissioner of the state where the company is domiciled.
1574(b) For claim reserves on policies that require contract reserves, the maximum interest rate is the maximum rate specified in Section 1595625.121(6)(a), F.S., 1597in the valuation of whole life insurance with an interest guarantee period greater than twenty years issued on the same date as the claim incurral date.
1623(c) For claim reserves on policies not requiring contract reserves, the maximum interest rate is the maximum rate specified in Section 1644625.121(5)(a)2., 1645F.A.C., in the valuation of single premium immediate annuities issued on the same date as the claim incurral date, reduced by one hundred basis points.
1670(3) Mortality.
1672(a) For all individual policies or group certificates issued before January 1, 1999, the mortality basis used shall be according to a table (but without use of selection factors) permitted by law for the valuation of whole life insurance issued on the same date as the health insurance contract or a table acceptable to the Office as specified in paragraph (3)(d) below.
1734(b) For all individual policies or group certificates other than long-term care insurance issued on or after January 1, 1999, the mortality basis used shall be according to a table of rates (but without use of selection factors) specified in Section 1775625.121(5)(a)2., F.S., 1777for the valuation of whole life insurance issued on the same date as the health insurance contract.
1794(c)1. For long-term care insurance individual policies or group certificates issued on or after January 1, 1999, the mortality basis used shall be the 1983 Group Annuity Mortality Table, incorporated by reference in Rule 182869O-154.210, 1829F.A.C., without projection.
18322. For long-term care insurance individual policies or group certificates issued on or after January 1, 2005, the mortality basis used shall be the 1994 Group Annuity Mortality Table, which is the 1994 GAR Table without projection, qx1994, incorporated by reference in Rule 187569O-162.108, 1876F.A.C.
1877(d) A table of mortality factors used for the purpose of valuing contract reserves or claim reserves for policies issued before January 1, 1999, shall be acceptable to the Office if it has been accepted for that purpose by the commissioner of the state where the insurer is domiciled. If the insurer is a Florida domiciled insurer, the mortality factors shall be acceptable if the valuation is done in accordance with commonly accepted actuarial practice.
1952(e) For single premium credit insurance using the adjusted 85 CIDA table, no separate mortality shall be assumed.
1970Rulemaking Authority 1972624.308(1), 1973625.121(14), 1974625.081 FS. 1976Law Implemented 1978624.307(1), 1979625.081, 1980625.121 FS. 1982History–New 4-14-99, Formerly 4-154.204, Amended 3-1-04, 4-7-05, 11-2-06, 1-25-16.