69O-191.054: Rates
    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. 51, December 22, 2006 issue of the Florida Administrative Weekly.

    These changes are being made to address concerns expressed at the public hearing.

    Rule 69O-191.054 is changed to read as follows:

    69O-191.054 Rates.

    (1) through (10) No change.

    (11) An HMO may issue multiple year rate guarantee or rating cap provisions subject to the following:

    (a) The coverage is for annually rated group health insurance contracts for which filing of rates is exempted by Section 641.31(3)(d), F.S.;

    (b) The provision may not apply for greater than 24 months;

    (c) The rate for the entire rating period reflects the increased risk of a rate guarantee with an increased premium or other consideration, is actuarially sound, includes claim costs projected at trend levels at least as high as those applicable to other groups with similar benefit structures in the rating area covered under the form(s) and is reasonably anticipated to meet the target loss ratio for the group;

    (d) The provision is available to groups on a nondiscriminatory basis as determined by the insurer’s underwriting standards; and

    (e) The HMO uses experience rating in determining the group’s rate consistently based on its rating and underwriting practices without regard to whether the rate is issued with or without a rate guarantee.

    Specific Authority 641.31, 641.36 FS. Law Implemented 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_________.

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Related Rules: (1)
69O-191.054. Rates