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Florida Administrative Code (Last Updated: October 28, 2024) |
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69. Department of Financial Services |
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69O. OIR – Insurance Regulation |
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69O-191. Health Maintenance Organizations |
1(1) Group Coverage is as provided by subsection 969O-149.0055(1), 10F.A.C.
11(2) Individual Coverage.
14(a)1. All HMOs that provide for a healthy lifestyle rebate shall file for approval the standards it will use for determining the level of rebate, i.e., between 0% and 10%, for different health status indicators, which shall include reduction in weight, body mass index, and smoking cessation.
612. The filed standards shall provide that the rebate is available and attainable by all subscribers on a nondiscriminatory basis and be without regard to the health or claim status of the subscriber.
943. The filing of the standards shall address the method and timing of the determination and application of the rebate.
114(b)1. For purposes of rate filings, the rebate made shall be accounted as a reduction to the earned premium and clearly identified in the filing.
1392. Rate filings shall include the number of contracts participating in the rebate program and the distribution of the contracts by size of rebate earned.
164(c) The HMO shall provide an appropriate rebate for maintenance or improvement of health status for any program approved by the HMO as determined by agreed upon health status indicators.
194(d) This rule shall be effective for all contracts issued or renewed on or after July 1, 2005 with the first rebate available in 2006.
219Specific Authority 221641.36, 222641.31(2) FS. 224Law Implemented 226641.31(40) FS. 228[HB 1629] History–New 3-24-05, Amended 1-12-06.
