Calculation of Premium Rates, Employee Health Care Access Act Statement Reporting Requirement

DEPARTMENT OF FINANCIAL SERVICES
OIR Insurance Regulation

RULE NO: RULE TITLE
69O-149.037: Calculation of Premium Rates
69O-149.038: Employee Health Care Access Act Statement Reporting Requirement

NOTICE OF CHANGE

Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol.32,No.03, January 20, 2006 issue of the Florida Administrative Weekly.

These changes are being made to address concerns expressed at the public hearing held on February 13, 2006.

Proposed Rule 69O-149.037(8)(a)1., F.A.C., is changed to read:

1. For employee + dependent coverage when the dependent is electing continuation of coverage, the difference between the employee + dependent rate and the employee only rate shall be determined. This difference shall then be divided by the average number of dependents used by the carrier in developing the rate schedule. This value shall reflect the implied single dependent rate. To determine the COBRA rate, the implied dependent rate shall be multiplied by a factor that does not exceed one plus the applicable load. The employee shall be charged the group employee only rate.

Proposed Rule 69O-149.037(8)(a)2., FA.C., is changed to read:

2. For family coverage where the dependent is electing continuation of coverage, the difference between the family rate and the employee + spouse only rate shall be determined. This difference shall then be divided by the average number of dependents used by the carrier in developing the rate schedule. This value shall reflect the implied single dependent rate. To determine the COBRA rate, the implied single dependent rate shall be multiplied by a factor that does not exceed one plus the applicable load. The employee shall be charged the group rate applicable to the remaining covered lives in the group, e.g., if the remaining covered lives are the employee, spouse and another dependent, then the family rate would be charged. If the remaining covered lives are only the employee and spouse, then the employee + spouse rate would be charged.

Proposed Rule 69O-149.038(3)(a)2., F.A.C., is changed to read:

2. The experience of any group category that is not subject to underwriting, pursuant to subsection 69O-149.037(6), F.A.C., such as 1-life groups, shall not be included in the report.

The remainder of the rule reads as previously published.