Florida Administrative Code (Last Updated: October 28, 2024) |
69. Department of Financial Services |
69O. OIR – Insurance Regulation |
69O-203. Prepaid Limited Health Service Organizations And Discount Medical Plan Organizations |
1(1) Each PLHSO shall file with the Office a full and true report of its financial condition, transactions, and affairs.
21(a) 22An Annual Report covering the preceding fiscal year shall be filed on or before April 1 or within 3 months of the end of the reporting period of the PHLSO.
521. 53For the purpose of this rule, the requirement that the Annual Report be filed with the Office means the Annual Report has been 76transmitted electronically to the National Association of Insurance Commissioners and that the executed Jurat page of said report has been transmitted electronically to the Office via the Regulatory Electronic Filing System, “REFS.” The date affixed by the Office’s electronic data processing system shall serve as evidence of the timeliness of the Annual Report. An Annual Report in any other format shall not be submitted to the Office.
1432. Each PLHSO shall submit its Annual Report electronically to the National Association of Insurance Commissioners in accordance with the electronic filing instructions incorporated by reference in paragraph 17169O-137.001(3)(b), 172F.A.C.
1733. The Annual Report 177shall be prepared in accordance with the manuals incorporated by reference in paragraph 19069O-137.001(4)(a), 191F.A.C.
1924. Copies of the manuals are available:
199a. From the National Association of Insurance Commissioners at http://www.naic.org; and,
210b. For inspection during regular business hours at the Office of Insurance Regulation, Larson Building, 200 East Gaines Street, Tallahassee, Florida 32399-0300.
232(b) Form OIR-A2-949, “Annual Report Contracts Issued & Outstanding,” effective 12/20, hereby incorporated by reference and available 250http://www.flrules.org/Gateway/reference.asp?No=Ref-14740252. 253Form OIR-A2-949 255shall be submitted 258electronically on or before April 1 or within 3 months of the end of the reporting period of the PHLSO via the Office’s system at https://www.floir.com/iportal. 284The form may be obtained from https://www.floir.com/iportal.
291(c) Form OIR-A2-950, “Annual Report Damage Claims & Medical Injury,” effective 12/20, hereby incorporated by reference and available at 311http://www.flrules.org/Gateway/reference.asp?No=Ref-14741313. Form OIR-A2-950 shall be submitted electronically on or before April 1 or within 3 months of the end of the reporting period of the PHLSO via the Office’s system at https://www.floir.com/iportal. The form may be obtained from https://www.floir.com/iportal.
352(d) The completed Annual Reports shall be accompanied by the items required in Section 366636.043, F.S., 368and an organization chart of the PLHSO identifying ownership and affiliated parent and subsidiary companies.
383(2) Each PLHSO shall notify the Office of any legal proceeding, excluding traffic infractions, involving any person subject to providing biographical information. This shall include any and all criminal, civil, and administrative actions entered by any state or federal entity and to include pending but yet unresolved actions.
431(3) Any PLHSO which has operations in states other than Florida shall file its Annual Report based upon its total operations. In addition, the PLHSO shall file a separate schedule of all financial statements specified in the Annual Report, including the audited financial statement, which covers the Florida operations only.
481(4) If a PLHSO constitutes a portion of or a division of a certificated entity, the entity shall file its Annual Report based upon its total operations. In addition, the entity shall file a separate schedule of all financial statements specified in the Annual Report, including the audited financial statement, which covers the PLHSO operation only.
537(5) The Annual Report shall include disclosure of material transactions between the PLHSO and a related party. The disclosure shall include:
558(a) The nature of the relationship(s) involved.
565(b) A description of the transaction, including transactions to which no amounts or nominal amounts were ascribed, for each of the periods for which income statements are presented, and such other information deemed necessary to an understanding of the effects of the transaction on the financial statements.
612(c) The dollar amounts of transactions for each of the periods for which income statements are presented and the effects of any change in the method of establishing the terms from that used in the preceding period.
649(d) Amounts due from or to related parties as of the date of each balance sheet presented and, if not otherwise apparent, the terms and manner of settlement.
677(6) Quarterly reports shall be submitted to the Office within forty-five (45) days following the end of each operating quarter. The initial operating quarter commences after the issuance of a certificate of authority. Quarterly reports shall be submitted in accordance with Section 719636.043, F.S., 721on NAIC Quarterly Statement Health Blanks, as adopted in Rule 73169O-137.001, 732F.A.C., and shall contain the following supplemental schedules:
740(a) A complete identification and dollar value breakdown of all short term investments with individual balances greater than 10% of total short term investments;
764(b) A complete list of all debtors with account balances greater than 10% of total prepaid expenses;
781(c) An aging analysis on all premium receivables;
789(d) A complete aging, identification, and dollar value breakdown of all prepaid expenses with individual balances greater than 10% of total prepaid expenses;
812(e) A complete identification and dollar value breakdown of all restricted assets and restricted funds with individual balances greater than 10% of the respective account balance total;
839(f) A complete identification and dollar value breakdown of all long term investments with individual balances greater than 10% of total long term investments;
863(g) A complete identification and dollar value breakdown of other assets with individual balances greater than 10% of total other assets; and
885(h) All surplus notes shall be identified by a complete identification and dollar value breakdown and shall be accompanied by a copy of the surplus note agreement. Each PLHSO is required to submit four (4) quarterly reports in addition to an annual report each fiscal year.
931Rulemaking Authority 933636.067 FS. 935Law Implemented 937636.009(1)(i), 938636.043, 939636.058 FS. 941History–New 11-15-94, Formerly 4-203.070, Amended 9-16-08, 9-29-22.