The Office of Insurance Regulation is updating Chapter 69O-203.

 

DEPARTMENT OF FINANCIAL SERVICES

OIR – Insurance Regulation

RULE NOS.:RULE TITLES:

69O-203.010Scope

69O-203.013Definitions for the Purpose of These Rules

69O-203.020Application for Certificate of Authority

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

69O-203.065Reinsurance (Excess Loss Insurance)

69O-203.070Annual and Quarterly Reports

69O-203.078Fees

69O-203.093Change of Ownership

69O-203.100Prescribed Forms

69O-203.210Forms Incorporated by Reference

69O-203.215Annual Reports

PURPOSE AND EFFECT: The Office of Insurance Regulation is updating Chapter 69O-203.

SUMMARY: Rules 69O-203.010, 69O-021, 69O-203.093, and 69O-203.100 are repealed. Rule 69O-203.013 is amended to remove the definition for “complete application.” Rule 69O-203.020 is amended to contain all application materials for Prepaid Limited Health Service Organizations. Rule 69O-203.065 is amended to update the submission process for filing excess loss or reinsurance contracts with the Office. Rule 69O-203.070 is amended to incorporate the two annual reports and include the Office’s website for how the reports must be filed with the Office. Rule 69O-203.078 is amended to remove references to application filings. Rule 69O-203.210 is amended to make the Discount Plan Organization application rule consistent with other application rules. Rule 69O-203.215 is created to comprise all annual report requirements for Discount Plan Organizations. Forms incorporated by reference are amended to comply with notary requirement changes due to Chapter 2019-71, Laws of Florida.

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), 636.067, 636.232 FS.

LAW IMPLEMENTED: 624.321(1)(a), 624.424, 628.4615, 636.003, 636.005, 363.007, 636.008, 636.009, 636.012, 636.015, 636.016, 636.043, 636.057, 636.058, 635.065, 636.204, 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., Chief Legal Counsel, Office of Insurance Regulation, [e-mail], [phone].

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

69O-203.010 Scope.

Rulemaking Authority 636.067 FS. Law Implemented Chapter 636 FS. History–New 11-15-94, Formerly 4-203.010. Repealed, _________.

 

69O-203.013 Definitions for the Purpose of These Rules.

(1) All terms defined in the Prepaid Limited Health Service Organization Act, chapter 636, F.S., which are used in these rules shall have the same meaning as in the Act.

(2) Advertising. This includes, but is not limited to, printed and published material, descriptive literature and sales aids, sales talks and sales materials, booklets, forms and pamphlets, illustrations, depictions and form letters, newspaper, radio, television, or direct mail advertising. This includes any material or information intended to solicit or induce membership or the purchase of a limited health service plan.

(3) Co-payment. A specific dollar amount or percentage discount as specified in a subscriber contract, except as otherwise provided for by statute, that the subscriber must pay upon receipt of covered health care services.

(4) Emergency Services. Services which are needed immediately because of an injury or unforeseen medical condition as provided for in the Subscriber Contract.

(5) PLHSO. Prepaid Limited Health Service Organization shall be abbreviated as PLHSO in these rules.

(6) Premium. The contracted sum paid by or on behalf of a subscriber or group of subscribers on a prepaid per capita or a prepaid aggregate basis for limited health services rendered by or through the PLHSO.

(7) Complete Application. An application for a certificate of authority that contains all of the items specified in rule 69O-203.020, F.A.C., and Form OIR-1119 (rev. 8/94) “Application for Certificate of Authority,” incorporated by reference in rule 69O-203.100, F.A.C. The application must be completed in accordance with Chapter 636, F.S., and these rules in the manner specified within the application in order for each individual item to be considered complete for the purpose of determining that a properly completed application has been filed.

(7)(8) Waiting Period. Waiting period shall relate to that period of time which may be specified in the contract and which must follow the date a person is initially covered under the contract before coverage shall become effective as to such person.

(8)(9) Pre-Existing Condition or Illness. A condition, or symptoms thereof, which was diagnosed and for which the individual received medical advice or treatment from a physician within a 3 month period preceding the effective date of coverage.

(9)(10) Prepayment. Any premium paid by or on behalf of a subscriber which entitles the subscriber to access to limited health services.

Rulemaking Authority 636.067 FS. Law Implemented 636.003, 636.008, 636.009, 636.015, 636.016 FS. History–New 11-15-94, Formerly 4-203.013. Amended _______.

 

69O-203.020 Prepaid Limited Health Service Organization Application for Certificate of Authority.

Substantial rewording of Rule 69O-203.020, F.A.C. follows.  See Florida Administrative Code for present text.

 

(1) A person applying for a certificate of authority as a prepaid limited service organization shall submit the following:

(a) Form OIR-C1-1119, “Application for Certificate of Authority Prepaid Limited Health Service Organization,” effective 6/20, hereby incorporated by reference and available at www.flrules.org/XXXXX;

(b) Form OIR-C1-905, “Instructions for Furnishing Background Investigative Reports,” effective 6/20, hereby incorporated by reference and available at www.flrules.org/XXXXX;

(c) Form OIR-C1-938, “Fingerprint Payment and Submission Procedures,” effective 6/20, hereby incorporated by reference and available at www.flrules.org/XXXXX;

(d) Form OIR-1423, “Biographical Affidavit,” effective 6/20, hereby incorporated by reference and available at www.flrules.org/XXXXX.

(2) A person shall submit the forms listed in subsection (1) electronically via the Office’s iApply system at https://www.floir.com/iportal.

An application, Form number OIR-C1-1119, incorporated by reference, in rule 69O-203.100, F.A.C., accompanied by the appropriate filing fee, shall be completed by each entity desiring to obtain a certificate of authority as a PLHSO. The applicant shall specify in the application the contact person or persons for the PLHSO for purposes of corresponding between the Office and the PLHSO concerning the application. During the investigation of the application, only contact persons specified by the PLHSO shall be permitted access to the application materials submitted. The applicant shall address correspondence to the Application Coordination Section, Insurer Services Support, Office of Insurance Regulation, Tallahassee, Florida 32399-0332. The Office shall accept and begin its investigation of an application promptly after receiving it. All application reviews will be conducted pursuant to chapter 120, F.S.

Rulemaking Authority 636.067 FS. Law Implemented 636.005. 636.007, 636.008, 636.009 FS. History–New 11-15-94, Formerly 4-203.020. Amended _______.

 

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

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

 

69O-203.065 Reinsurance (Excess Loss Insurance).

PLHSOs may obtain reinsurance (excess loss insurance) in order to limit the PLHSO’s financial risk. All excess loss or reinsurance contracts shall be filed with and approved by the Office. In addition to the regular insurance filing of any reinsurance (excess loss insurance) contract, if the reinsurance (excess loss insurance) contract contains insolvency protection for the PLHSO, the contract shall be submitted for prior approval to the Office of Insurance Regulation, Life and Health Financial Oversight, electronically through http://www.floir.com/iportal. Bureau of Life and Health Insurer Solvency Office of Insurance Regulation, Tallahassee, Florida 32399-0327.

Rulemaking Authority 636.067 FS. Law Implemented 636.009 FS. History–New 11-15-94, Formerly 4-203.065. Amended _______.

 

69O-203.070 Annual and Quarterly Reports.

(1) Each PLHSO shall file with the Office a full and true report of its financial condition, transactions, and affairs.

(a) An Annual Report covering the preceding fiscal year shall be filed on or before April 1 or within 3 months of the end of the reporting period of the clinic. Pursuant to Section 636.043, F.S., each PLHSO shall furnish to the Office an annual report by April 1, or within 3 months after the end of the reporting period on NAIC Annual Statement Health Blanks as adopted in Rule 69O-137.001, F.A.C.

1. The Annual Report shall be transmitted electronically to the National Association of Insurance Commissioners and that the executed Jurat page of said report has been transmitted electronically to the Office via the Regulatory Electronic Filing System, “REFS.” The date affixed by the Office’s electronic data processing system shall serve as evidence of the timeliness of the Annual Report. An Annual Report in any other format shall not be submitted to the Office.

2. Each PLHSO shall submit its Annual Report electronically to the National Association of Insurance Commissioners in accordance with the electronic filing instructions incorporated by reference in paragraph 69O-137.001(3)(b), F.A.C.

3. The Annual Report shall be prepared in accordance with the manuals incorporated by reference in paragraph 69O-137.001(4)(a), F.A.C.

4. Copies of the manuals are available:

a. From the National Association of Insurance Commissioners at http://www.naic.org; and,

b. For inspection during regular business hours at the Office of Insurance Regulation, Larson Building, 200 East Gaines Street, Tallahassee, Florida 32399-0300.

(b) Form OIR-A2-949, “Annual Report Contracts Issued & Outstanding,” effective 12/20, hereby incorporated by reference and available www.flrules.org/XXXXX.  Form OIR-A2-949 shall be submitted electronically on or before April 1 or within 3 months of the end of the reporting period of the clinic via the Office’s system at https://www.floir.com/iportal.

(c) Form OIR-A2-950, “Annual Report Damage Claims & Medical Injury,” effective 12/20, hereby incorporated by reference and available at www.flrules.org/XXXXX.  Form OIR-A2-950 shall be submitted electronically on or before April 1 or within 3 months of the end of the reporting period of the clinic via the Office’s system at https://www.floir.com/iportal.

(d)(b) The completed Annual Reports annual statement form shall be accompanied by the items required in section 636.043, F.S., and an organization chart of the PLHSO identifying ownership and affiliated parent and subsidiary companies.

(2) Each PLHSO or applicant shall notify the Office of any legal proceeding, excluding traffic infractions, involving any person subject to providing biographical information. This shall include, but not be limited to, any and all criminal, civil, and administrative actions entered by any state or federal entity and to include pending but yet unresolved actions.

(3) Any PLHSO which has operations in states other than Florida shall file its Annual Report annual report based upon its total operations. In addition, the PLHSO shall file a separate schedule of all financial statements specified in the Annual Report annual report form, including the audited financial statement, which covers the Florida operations only.

(4) If a PLHSO constitutes a portion of or a division of a certificated entity, the entity shall file its Annual Report annual report based upon its total operations. In addition, the entity shall file a separate schedule of all financial statements specified in the Annual Report annual report form, including the audited financial statement, which covers the PLHSO operation only.

(5) The Annual Report annual report shall include disclosure of material transactions between the PLHSO and a related party. The disclosure shall include:

(a) The nature of the relationship(s) involved.

(b) A description of the transaction, including transactions to which no amounts or nominal amounts were ascribed, for each of the periods for which income statements are presented, and such other information deemed necessary to an understanding of the effects of the transaction on the financial statements.

(c) The dollar amounts of transactions for each of the periods for which income statements are presented and the effects of any change in the method of establishing the terms from that used in the preceding period.

(d) Amounts due from or to related parties as of the date of each balance sheet presented and, if not otherwise apparent, the terms and manner of settlement.

(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 in accordance with section 636.043, F.S., on NAIC Quarterly Statement Health Blanks, as adopted in rule 69O-137.001, F.A.C., and shall contain the following supplemental schedules:

(a) A complete identification and dollar value breakdown of all short term investments with individual balances greater than 10% of total short term investments;

(b) A complete list of all debtors with account balances greater than 10% of total prepaid expenses;

(c) An aging analysis on all premium receivables;

(d) A complete aging, identification, and dollar value breakdown of all prepaid expenses with individual balances greater than 10% of total prepaid expenses;

(e) A complete identification and dollar value breakdown of all restricted assets and restricted funds with individual balances greater than 10% of the respective account balance total;

(f) A complete identification and dollar value breakdown of all long term investments with individual balances greater than 10% of total long term investments;

(g) A complete identification and dollar value breakdown of other assets with individual balances greater than 10% of total other assets; and

(h) All surplus notes shall be identified by a complete identification and dollar value breakdown and shall be accompanied by a copy of the surplus note agreement. Each PLHSO is required to submit four (4) quarterly reports in addition to an annual report each fiscal year.

Rulemaking Authority 636.067 FS. Law Implemented 636.009(1)(f), 636.043, 636.058 626.058 FS. History–New 11-15-94, Formerly 4-203.070, Amended 9-16-08. Amended _______.

 

69O-203.078 Fees.

Checks for the original application filing or amendments thereto, for filing of each annual report, and for any other fees collected pursuant to these rules or chapter 636, F.S., shall be made payable to the Florida Department of Financial Services. “Chief Financial Officer, State of Florida.”

Rulemaking Authority 636.067 FS. Law Implemented 636.057 FS. History–New 11-15-94, Formerly 4-203.078. Amended _______.

 

69O-203.093 Change of Ownership.

Rulemaking Authority 636.067 FS. Law Implemented 636.065, 628.4615 FS. History–New 11-15-94, Formerly 4-203.093. Repealed, _________.

 

69O-203.100 Prescribed Forms.

Rulemaking Authority 636.067 FS. Law Implemented 624.321(1)(a), 624.424, 636.005, 636.008, 636.009, 636.012, 636.043 FS. History–New 11-15-94, Formerly 4-203.100, Amended 7-30-17. Repealed, _________.

 

69O-203.210 Discount Plan Organization Application Forms Incorporated by Reference.

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

 

(1) A person applying for a certificate of authority as a discount plan organization shall submit the following:

(a) Form OIR-C1-1606, “Application for License Discount Plan Organization (DPO),” effective 6/20, hereby incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-10323;

(b) Form OIR-C1-144, “Service of Process Consent & Agreement,” effective 6/04, hereby incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-10326;

(c) Form OIR-C1-905, “Instructions for Furnishing Background Investigative Reports,” effective 6/20, hereby incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-10329;

(d) Form OIR-C1-938, “Fingerprint Payment and Submission Procedures,” effective 6/20, hereby incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-10325;

(e) Form OIR-C1-1423, “Biographical Affidavit,” effective 6/20, hereby incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-10324; and

(f) Form OIR-C1-2221, “Management Information Form,” effective 6/20, hereby incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-10327; and

(2) A person shall submit the forms listed in subsection (1) electronically via the Office’s iApply system at https://www.floir.com/iportal.

(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 http://www.flrules.org/Gateway/reference.asp?No=Ref-10323;

(b) Form OIR-C1-1423, Biographical Affidavit, effective 03/18, available at http://www.flrules.org/Gateway/reference.asp?No=Ref-10324;

(c) Form OIR-C1-938, Fingerprint Payment and Submission Procedure, effective 10/18, available at http://www.flrules.org/Gateway/reference.asp?No=Ref-10325;

(d) Form OIR-C1-144, Service of Process Consent & Agreement, effective 06/04, available at http://www.flrules.org/Gateway/reference.asp?No=Ref-10326;

(e) Form OIR-C1-1298, Management Information Form Complete List of Officers, Directors, and Shareholders (10% or more), effective 03/18, available at http://www.flrules.org/Gateway/reference.asp?No=Ref-10327; and

(f) OIR-A1-1671, Annual Report – Discount Plan Organizations (05/18), available at http://www.flrules.org/Gateway/reference.asp?No=Ref-10328;

(g) Form OIR-C1-905, Instructions for Funishing Background Investigative Reports, effective 02/15, available at http://www.flrules.org/Gateway/reference.asp?No=Ref-10329.

(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, 4-11-19. Amended _______.

 

69O-203.215 Annual Reports.

Annual Reports are to be filed with the Office within three months after the end of each fiscal year on Form OIR-A1-1671, “Annual Report – Discount Plan Organizations,” effective 5/18, hereby incorporated by reference and available at www.flrules.org/XXXXX.  The filings shall be submitted electronically via the Office’s system at https://www.floir.com/iportal.

Rulemaking Authority 638.218(2), 636.232 FS. Law Implemented 636.218 FS. History-New _____.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Michael Lawrence, Jr., Chief Legal Counsel

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

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: March 29, 2022

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: May 18, 2021