These rules are being amended to conform to the changes made to Chapter 636, Part II, Discount Plan Organizations, Sections 636.202 – 636.244, Florida Statutes, by Chapter 2017-112, Laws of Florida, and to update forms.

 

DEPARTMENT OF FINANCIAL SERVICES

OIR – Insurance Regulation

RULE NO.:RULE TITLE:

69O-203.201Definitions

69O-203.202Standards for Discount Medical Plans

69O-203.203Standards for the Form and Content of Advertisements or Marketing Materials

69O-203.210Forms Incorporated by Reference

PURPOSE AND EFFECT: These rules are being amended to conform to the changes made to Chapter 636, Part II, Discount Plan Organizations, Sections 636.202 – 636.244, Florida Statutes, by Chapter 2017-112, Laws of Florida, and to update forms.

SUMMARY: These rules will be updated to conform to the statutory changes, implemented by Chapter 2017-112, Laws of Florida, renaming “discount medical plan organizations” to “discount plan organizations” and revising conditions for reimbursement, disclosure requirements, reporting requirements, fee requirements, marketing requirements, and the authority for the Financial Services Commission to adopt rules.

SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS AND LEGISLATIVE RATIFICATION:

The Agency has determined that this will not have an adverse impact on small business or likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule. A SERC has not been prepared by the Agency.

The Agency has determined that the proposed rule is not expected to require legislative ratification based on the statement of estimated regulatory costs or if no SERC is required, the information expressly relied upon and described herein: Agency personnel familiar with the subject matter of the rule amendment have performed an economic analysis of the rule amendment that shows that the rule amendment is unlikely to have an adverse impact on the State economy in excess of the criteria established in Section 120.541(2)(a), Florida Statutes.

Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.

RULEMAKING AUTHORITY: 624.424(1)(c), 636.232, FS.

LAW IMPLEMENTED: 624.424, 636.202, 636.204, 636.216, 636.218, 636.220, 636.226, 636.228, 636.234, 636.236, FS.

IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE SCHEDULED AND ANNOUNCED IN THE FAR.

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Michael Lawrence, Jr., Assistant General Counsel, [e-mail], [phone].

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

69O-203.201 Definitions.

(1) No change.

(2) Contract or Form means the document, by whatever name called; such as agreement, certificate or handbook which describes the benefits under the discount medical Plan.

(3) Discount Medical Plan (Plan) means a business arrangement or contract in which a person, in exchange for fees, dues, charges, or other consideration, provides access for Pplan members to providers of medical services and the right to receive one or more medical services from those providers at a discount.

(4) DPO DMPO is the Discount Medical Plan Organization defined in subsection 636.202(2), F.S., that contracts with providers, provider networks, or other DMPOs, to provide discounted medical services to Plan members and determines the charges to the members.

(5) No change.

Rulemaking Specific Authority 636.232 FS. Law Implemented 636.202 FS. History–New 4-7-05, Amended________________.

 

69O-203.202 Standards for Discount Medical Plans.

(1) No change.

(a) Name and address of the DPO DMPO;

(b) through (l) No change.

(j) Provisions for adding new family members; and

(k) All plan contracts and application forms shall have a unique form number in the lower left hand corner; and

(k)(l) Member complaint procedure.

(2) No change.

(3)(a) All charges to members must be filed with the Office, and the Office must approve any periodic charge exceeding $30.00 per month, or $50.00 per month as provided by paragraph 69O-203.204(1)(b), F.A.C., for the contract issued and not per member covered on the contract, before the periodic charges can be used. Periodic charges approved pursuant to this paragraph must remain in compliance with this paragraph. Consequently, subsequent to the initial approval, the periodic charges remain subject to review by the Office to ensure continued compliance.

(b) In a filing made pursuant to paragraph (a) above, the discount medical plan organization has the burden of proof that the periodic charges bear a reasonable relationship to the benefits received by the member. If the discount medical plan organization uses member savings as the basis of demonstrating the benefits received by the member, the benefits shall be benefits and savings that can be reasonably anticipated by an average Floridian who may purchase such contract. 

(c) A discount medical plan organization may, at its option, make a filing that meets one of the following standards that have been determined to meet the requirement of paragraph (b) above:

1. The discount medical plan organization provides financial information to demonstrate that at least sixty percent (60%) of the periodic charge is used to pay the costs associated with providing access to discount medical services, excluding any administrative costs, commissions and profits; or

2. The discount medical plan organization provides financial information to demonstrate that the plan’s periodic charge does not exceed sixty percent (60%) of the actual benefit of the discounted services to members, measured as the actual savings realized by members, i.e., provider billed charges without the discount less the discounted provider charges paid by the member. These values shall be measured in the aggregate for all members and all actual services utilized over a period of twelve months with experience from at least 2,000 members; or

3. The discount medical plan organization provides specific financial information to demonstrate that at least seventy-five percent (75%) of the periodic charge is used to pay the costs associated with providing access to discount medical services, member support services and administrative costs excluding commissions and profits.

Rulemaking Specific Authority 636.232 FS. Law Implemented 636.216 FS. History–New 4-7-05, Amended 11-1-07, ____________.

 

69O-203.203 Standards for the Form and Content of Advertisements or Marketing Materials.

(1) No change.

(2) (a) through (c) No change.

(d) The term “insurance” may not be used as a descriptive term for DPO DMPO benefits. However, the term “insurance” may be used in a disclaimer of any relationship between DPO DMPO benefits and insurance including the disclosures required in Section 636.212, F.S.

Rulemaking Specific Authority 636.232 FS. Law Implemented 636.228 FS. History–New 4-7-05, Amended______________.

 

Substantial rewording of Rule 69O-203.210, F.A.C. follows.  See Florida Administrative Code for present text.

 

69O-203.210 Forms Incorporated by Reference.

(1) The following forms are hereby incorporated by reference:

(a) Form OIR-C1-1606, Application for License Discount Plan Organization (DPO), effective 01/18, available at www.flrules.org/XXXXX;

(b) Form OIR-C1-1423, Biographical Affidavit, effective 03/18, available at www.flrules.org/XXXXX;

(c) Form OIR-C1-938, Fingerprint Payment and Submission Procedure, effective 10/18, available at www.flrules.org/XXXXX;

(d) Form OIR-C1-144, Service of Process Consent & Agreement, effective 06/04, available at www.flrules.org/XXXXX;

(e) Form OIR-C1-1298, Management Information Form Complete List of Officers, Directors, and Shareholders (10% or more), effective 03/18, available at www.flrules.org/XXXXX; and

(f) OIR-A1-1671, Annual Report – Discount Plan Organizations (05/18), available at www.flrules.org/XXXXX;

(g) Form OIR-C1-905, Instructions for Funishing Background Investigative Reports, effective 02/15, available at www.flrules.org/XXXXX.

(2) All of the above referenced forms are available and may be printed from the Office of Insurance Regulation’s website: http://www.floir.com/iportal.

Rulemaking Authority 624.424(1)(c), 636.232 FS. Law Implemented 624.424, 636.204, 636.218, 636.220, 636.226, 636.228, 636.234, 636.236 FS. History–New 5-22-05, Amended 10-29-08, 7-30-17, _____.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Michael Lawrence, Jr., Assistant General Counsel

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Financial Services Commission

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: December 4, 2018

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: August 16, 2018