The rules are being amended to conform rules and forms governing discount plan organizations to recent statutory changes and to remove regulations no longer supported by statutory authority.

 

DEPARTMENT OF FINANCIAL SERVICES

OIR – Insurance Regulation

RULE NOS.:RULE TITLES:

69O-203.021Standards for Fingerprint Cards for New Applicants and Acquisition Applications

69O-203.202Standards for Discount Medical Plans

PURPOSE AND EFFECT: The rules are being amended to conform rules and forms governing discount plan organizations to recent statutory changes and to remove regulations no longer supported by statutory authority.

SUMMARY: The 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: 636.067; 636.232, FS.

LAW IMPLEMENTED: 636.007; 636.008; 636.216, 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: Wednesday, May 9, 2018, 9:30 a.m.

PLACE: 116 Larson Building, 200 East Gaines Street, Tallahassee, Florida. To join by telephone, call [phone] and enter conference ID# 7023472.

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: Christopher 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: Christopher Struk, Office of Insurance Regulation, E-mail: [e-mail].

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

69O-203.021 Standards for Fingerprint Cards for New Applicants and Acquisition Applications.

(1) No change.

(2) The Office has adopted Form OIR-C1-938 (rev. 5/13 4/91), incorporated by reference in Rule 69O-203.100, F.A.C., which provides instructions on how fingerprint cards are to be completed.

Rulemaking Specific Authority 636.067 FS. Law Implemented 636.007, 636.008 FS. History–New 11-15-94, Formerly 4-203.021, 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.

(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, Amended______________.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Christopher 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 7, 2018

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: July 12, 2017