These rule revisions update the rules to reflect electronic filing process.

 

DEPARTMENT OF FINANCIAL SERVICES

OIR – Insurance Regulation

RULE NOS.:RULE TITLES:

69O-191.051Filing, Approval of Subscriber Contract and Related Forms

69O-191.054Rates

69O-191.075Annual and Quarterly Reports

69O-191.107Prescribed Forms

PURPOSE AND EFFECT: These rule revisions update the rules to reflect electronic filing process.

SUMMARY: The various rules indicate how forms and filings are to be made to the Office. These rule revisions update the rules to reflect the electronic fling process and in some cases the forms have been updated to reflect current practice.

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: 624.308(1), 641.31, 641.36, FS

LAW IMPLEMENTED: 624.424, 628.4615, 627.410(6), (7), 627.413(4), 627.4145, 627.6699(12)(d)4., 627.6735, 627.682, 627.9407(2), 628.4615, 641.19(5),(13)(d), 641.21(1), 641.219(1)(e), 641.22(2),(9), (4), (6), 641.221, 641.225, 641.285, 641.26(1),(2), 641.27, 641.29, 641.3007(4)(b),(c), 641.31(2),(3),(5), 641.31074, 641.3922(3), FS.

IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE HELD AT THE DATE,TIME AND PLACE SHOWN BELOW(IF NOT REQUESTED, THIS HEARING WILL NOT BE HELD):

DATE AND TIME: April 13, 2017, 9:30 a.m.

PLACE: 116 Larson Building, 200 East Gaines Street, Tallahassee, Florida.

Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 5 days before the workshop/meeting by contacting: Chris Struk, Office of Insurance Regulation, E-mail [e-mail].. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Chris Struk, Office of Insurance Regulation, E-mail [e-mail].

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

69O-191.051 Filing, Approval of Subscriber Contract and Related Forms.

(1) thru (2) No change..

(3)(a) One copy of each form filing shall be submitted at the time of filing. HMOs in possession of a Certificate of Authority shall submit all contract filings to the Office electronically through http://www.floir.com/iportal. Bureau of Life and Health Forms and Rates, Office of Insurance Regulation, Post Office Box 8040, Tallahassee, Florida 32301-8040, or submitted electronically to https://iportal.fldfs.com. All filings sent by Federal Express or any other form of special delivery shall be delivered to: Bureau of Life and Health Forms and Rates, Office of Insurance Regulation, 1st Floor, Larson Building, 200 East Gaines Street, Tallahassee, FL 32399-0328.

(b) Subsequent to July 1, 2003, all filings shall be submitted electronically to https://iportal.fldfs.com, or by computer diskette meeting the compatibility requirements mandated by Section 624.424(1)(c), F.S. Deadlines for filing will not be extended due to shipping delays, format incompatibility, data corruption, or any other impediment which results from an election to file by diskette.

(4) through (5) No change..

Rulemaking Specific Authority 641.36 FS. Law Implemented 624.424,  641.21(1)(e), 641.3007(4)(b), (c), 641.31(2), (3) FS. History–New 2-22-88, Amended 10-25-89, Formerly 4-31.051, Amended 5-28-92, 8-15-02, 6-19-03, Formerly 4-191.051,  Amended______________.

 

69O-191.054 Rates.

(1) No change.

(2) Filings of rating methodologies shall provide adequate information, so that the Office, in accordance with generally accepted actuarial principles as applied to Health Maintenance Organizations, may verify that the rating methodology does not produce inadequate, excessive, or unfairly discriminatory premiums. All rate classifications should be clearly identified, and the formulas and/or methods of calculating premiums adequately described, as defined in Rule 69O-191.055, F.A.C.

(a) No change.

(b) Filings, as that term is defined in paragraph (a), shall be submitted to the Office electronically through http://www.floir.com/iportal. mailed to: Office of Insurance Regulation, Division of Insurer Services, Bureau of Life and Health Forms and Rates, Post Office Box 8040, Tallahassee, Florida 32301-8040 or submitted electronically to https://iportal.fldfs.com. All filings sent to the Office by Federal Express or any other form of special delivery shall be delivered to: Office of Insurance Regulation, Division of Insurer Services, Bureau of Life and Health Forms and Rates, 1st Floor, Larson Building, 200 East Gaines Street, Tallahassee, FL 32399-0328.

(c) No change.

(3) through (11) No change. 

Rulemaking Specific Authority 641.31, 641.36 FS. Law Implemented 624.424,  641.21(1)(e), 641.22(2), (4), (6), 641.31(2), (3), 641.31074, 641.3922(3) FS. History– New 2-22-88, Amended 10-25-89, Formerly 4-31.054, Amended 10-8-96, 8-15-02, 1-19-03, Formerly 4-191.054, Amended 6-18-07, ________________.

 

69O-191.075 Annual and Quarterly Reports.

(1) Each HMO shall furnish to the Office an annual report at the time specified in Section 641.26, F.S., on a form furnished by the Office of Insurance Regulation, Life and Health Financial Oversight Bureau of Specialty Insurers, Tallahassee, Florida 32399-0300, incorporated in Rule 69O-191.107, F.A.C. The financial statement shall also be filed on a diskette; the Office must approve the electronic format for reporting the financial information. The annual report shall be submitted to the Office electronically through http://www.floir.com/iportal. The completed annual statement form shall be accompanied by the items required in Section 641.26, F.S., as well as a supplemental actuarial certification and an organization chart of the HMO identifying ownership and affiliated companies, and shall be submitted by April 1 or within three months after the end of its reporting period. The audit report required by Section 641.26, F.S., that is found to have assets which are not allowed pursuant to Section 641.35, F.S., shall be granted a fifteen (15) day extension from the date of notification of disallowed assets to resubmit a corrected audit report. The extension will be granted only for submission of a corrected audit report. If the Office determines that the HMO has been notified previously that the asset has been disallowed, the audit report will be deemed not filed. No extension shall be granted for correction of the audit report.

(2) through (5) No change. 

(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 on a form, provided by the Office of Insurance Regulation,Life and Health Financial Oversight Bureau of Specialty Insurers, Tallahassee, Florida 32399-0300, incorporated herein by reference and also be filed electronically on a diskette in accordance with subsection (1) of this section, and shall contain the following supplemental schedules:

(a) through (i) No change.

(7) No change.

Rulemaking Specific Authority 641.36 FS. Law Implemented  624.424, 641.26(1) FS. History–New 2-22-88, Amended 10-25-89, Formerly 4-31.075, Amended 5-28-92, Formerly 4-191.075, Amended_________________.

 

69O-191.107 Prescribed Forms.

(1) The forms listed below are incorporated into, and made a part of, these rules by reference.

		DATE OF
		LATEST
FORM	DESCRIPTION	REVISION
NUMBER
(a) OIR-C1-942	HMO COA Application Form	12/05 2/92
(b) OIR-943	Quarterly Report of Subscriber Grievances (Summary)	11/91
(c) OIR-944	Individual Quarterly Grievance Report	11/91
(d) OIR-945	Request for Review by the Statewide Subscriber Assistance Panel	11/91
(e) OIR-946	HMO Response Form for Statewide Subscriber Assistance Panel	11/91
(f) OIR-947	Annual HMO Report Form	11/91
(g) OIR-948	Annual Report Supplement – Audited Financial Statement	11/91
(b)(h) OIR-A2-949	Annual Report Supplement – Contracts Issued & Outstanding	07/04 11/91
(c)(i) OIR-A2-950	Annual Report Supplement – Damage Claims & Medical Injury	07/04 11/91
(j) OIR-951	Annual Report Supplement – Actuarial Certification	11/91
(k) OIR-952	Annual Report Supplement – Actuarial Report	11/91
(l) OIR-953	Quarterly HMO Report Form	11/91
(d)(m) OIR-C1-448	Acquisition Application	12/05 5/89
(e)(n)OIR-C1-938954	Fingerprint Card Instructions	5/13 4/91
(f)(o) OIR-C1-903	Fingerprint Invoice	12/05 9/91
(g )(p) OIR-C1-144	Consent and Agreement in Re: Service of Process	06/04 11/90
(q) OIR-414	Registration of Non-Office Representative	6/89
(h)(r)OIR-C1-1423 422	BiographicalAffidavit Statement	8/14 11/90
(s) OIR-449	Abbreviated Biographical	1/91
(i)(t) OIR-C1-450	Authority for Release of Information	5/00 8/91
(j) OIR-D0-516	Insurance Holding Company System Annual Registration Statement	5/16
(k) OIR-A2-1083	Annual Report Filing Fees	01/03

 

(2) Form OIR-B2-1507, Form OIR-B2-1507A, and Form OIR-B2-1356 as incorporated in Rule 69O-149.022, F.A.C., are also used for purposed of this rule chapter.

(3) Copies of all forms listed in subsection (1) above may be obtained from through the Office of Insurance Regulation’s web site: http://www.floir.com/iportal. Bureau of Specialty Insurers, Tallahassee, Florida 32399-0300.

Rulemaking Specific Authority 624.308(1), 641.36 FS. Law Implemented 624.424,  627.410(6), (7), 627.413(4), 627.4145, 627.6699(12)(d)4., 627.6735, 627.682, 627.9407(2), 628.4615, 641.19(13)(d), 641.21(1), 641.26(1), (2), 641.29 FS. History–New 2-22-88, Amended 10-25-89, Formerly 4-31.107, Amended 5-28-92, 8-15-94, 8-15-02, Formerly 4-191.107, Amended__________________.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Chris Struk, Office of Insurance Regulation, E-mail [e-mail].

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: THE FINANCIAL SERVICES COMMISSION

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: March 14, 2017

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: February 22, 2017