Chapter 197 is amended to incorporate changes to implement Chapter 2023-29, Laws of Florida.

 

DEPARTMENT OF FINANCIAL SERVICES

OIR – Insurance Regulation

RULE NOS.:RULE TITLES:

69O-197.001Application for Certificate of Authority as an Insurance Administrator

69O-197.004Remittance Requirements

69O-197.005Independent Professional Examiners

69O-197.006Insurance Administrator Annual Report

PURPOSE AND EFFECT: Chapter 197 is amended to incorporate changes to implement Chapter 2023-29, Laws of Florida.

SUMMARY: Rule 69O-197.001 is created to incorporate the application for a certificate authority as an insurance administrator. Rules 69O-197.004 and 69O-197.005 are created to implement Chapter 2023-29, Laws of Florida. Rule 69O-197.006, F.A.C., is amended to update parts of the annual statement filed an insurance administrator.

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), 624.490, 626.8805(2), 626.8825(3), 626.8828(2), (7), 626.89(1), 626.8991 FS.

LAW IMPLEMENTED: 624.490, 626.8805, 626.8809, 626.8825, 626.8828, 626.89, 626.891 F.S.

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, [e-mail], [phone].

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

69O-197.001 Application for Certificate of Authority as an Insurance Administrator.

(1) A person applying for a Certificate of Authority to operate as an insurance administrator, including an applicant seeking to register as a pharmacy benefit manager, shall submit the following:

(a) Form OIR-C1-1075, “Application for Certificate of Authority of an Insurance Administrator,” effective 7/23, available at www.flrules.org/XXXXX;

(b) Form OIR-C1-905, incorporated by reference in Rule 69O-136.100, F.A.C.;

(c) Form OIR-C1-938, incorporated by reference in Rule 69O-136.100, F.A.C.;

(d) Form OIR-C1-1423, incorporated by reference in Rule 69O-136.100, F.A.C.;

(e) Form OIR-C1-0500, incorporated by reference in Rule 69O-136.100, F.A.C.;

(f) Form OIR-C1-0501, incorporated by reference in Rule 69O-136.100, F.A.C.;

(g) Form OIR-C1-0502, incorporated by reference in Rule 69O-136.100, F.A.C.;

(h) Form OIR-C1-0503, incorporated by reference in Rule 69O-136.100, F.A.C.;

(i) Form OIR-C1-0504, incorporated by reference in Rule 69O-136.100, F.A.C.;

(j) Form OIR-C1-0505, incorporated by reference in Rule 69O-136.100, F.A.C.;

(k) Form OIR-C1-0506, incorporated by reference in Rule 69O-136.100, F.A.C.;

(l) Form OIR-C1-0507, incorporated by reference in Rule 69O-136.100, F.A.C.;

(m) Form OIR-C1-0509, incorporated by reference in Rule 69O-136.100, F.A.C.; and

(n) Form OIR-C1-2221, incorporated by reference in Rule 69O-136.100, F.A.C.

(2) A person applying for a certificate of authority as an insurance administrator, including an applicant seeking to register as a pharmacy benefit manager, shall submit forms listed in subsection (1) as directed by the Office electronically at https://www.floir.com/iportal.

Rulemaking Authority 624.308(1), 624.490, 626.8805(2), 626.8991 FS. Law Implemented 624.490, 626.8805 FS. History–New ____________.

 

69O-197.004 Remittance Requirements.

The following must be included in the remittance provided by the pharmacy benefit manager to the pharmacy:

(1) The applicable network reimbursement ID or plan ID as defined in the most current version of the National Council for Prescription Drug Programs (NCPDP) Telecommunication Standard Implementation Guide, or its nationally recognized successor industry guide;

(2) Payor information; and

(3) Contact information.

Rulemaking Authority 624.308(1), 626.8825(3), 626.8991 FS. Law Implemented 626.8825 FS. History–New ______.

 

69O-197.005 Independent Professional Examiners.

The following are independent professional examiners who may conduct examinations under section 626.8828, F.S.:

(1) Independent certified accountants;

(2) Actuaries;

(3) Investment specialists;

(4) Information technology specialists;

(5) Pharmacists and/or people with pharmacy experience;

(6) Persons with insurance and/or pharmacy benefit manager experience;

(7) Persons with experience conducting market conduct examinations; and

(8) Other persons with specializations and expertise that lend themselves to particular examination.

Rulemaking Authority 624.308(1), 626.8828(2), (7), 626.8991 FS. Law Implemented 626.8828 FS. History–New ______.

 

69O-197.006 Insurance Administrator Annual Statement Report

(1) An annual statement and a $250 filing fee shall be filed with the Office within 3 months after the end of the insurance administrator’s fiscal year on Form OIR-A3-975, “Annual Statement,” effective 7/23, hereby incorporated by reference and available at www.flrules.org/XXXXX.  The form adopted in subsection (2) below, is a form that Insurance Administrators must submit to the Office of Insurance Regulation to report financial information. This form may be viewed at the Office’s website: http://www.floir.com/iportal.

(2) Form OIR-A3-975, “Insurance Administrator Annual Report” (REV 12/08), is hereby incorporated by reference and is to be submitted to the Office of Insurance Regulation to report financial information.

(2)(3) All forms submitted for review or approval shall be submitted electronically to http://www.floir.com/iportal.

Rulemaking Authority 624.308(1), 626.89(1), 626.8991 FS. Law Implemented 626.8805, 626.8809, 626.89, 626.891 FS. History–New 3-4-09. Amended _________.

 

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: September 18, 2023

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: July 20, 2023