To establish the requirements for annual and quarterly reports submitted by prepaid limited health service organizations.

 

DEPARTMENT OF FINANCIAL SERVICES
OIR – Insurance Regulation

RULE NO: RULE TITLE
69O-203.070: Annual and Quarterly Reports
PURPOSE AND EFFECT: To establish the requirements for annual and quarterly reports submitted by prepaid limited health service organizations.
SUMMARY: This rule is being amended to reflect the correct forms to be used by the prepaid limited health service organizations in filing their quarterly and annual financial statements. The rule is being updated to require the filings to be submitted on the National Association of Insurance Commissioners (NAIC) Health blanks.
SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS: No Statement of Estimated Regulatory Cost was prepared.
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.
SPECIFIC AUTHORITY: 636.067 FS.
LAW IMPLEMENTED: 636.009(1)(f), 636.043, 626.058 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: May 13, 2008, 9:30 a.m.
PLACE: 143 Larson Building, 200 East Gaines Street, Tallahassee, Florida
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: Marie Bachman [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: Marie Bachman [e-mail]

THE FULL TEXT OF THE PROPOSED RULE IS:

69O-203.070 Annual and Quarterly Reports.

(1)(a) Pursuant to Section 636.043, F.S., eEach PLHSO shall furnish to the Office an annual report by April 1, or within 3 months after the end of the reporting period at the time specified in Section 636.043, F.S., on  NAIC Annual Statement Health Blanks as adopted, forms OIR-1131 and OIR-1132 which are incorporated by reference in Rule 69O-137.001 69O-203.100, F.A.C.

(b) The completed annual statement form shall be accompanied by the items required in Section 636.043, F.S., and as well as an organization chart of the PLHSO identifying ownership and affiliated parent and subsidiary companies, and shall be submitted by April 1, or within three months after the end of its reporting period.

(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 based upon its total operations. In addition, the PLHSO shall file a separate schedule of all financial statements specified in the 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 based upon its total operations. In addition, the entity shall file a separate schedule of all financial statements specified in the annual report form, including the audited financial statement, which covers the PLHSO operation only.

(5) The 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 cCertificate of aAuthority. 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 form OIR-1136, incorporated by reference in Rule 69O-203.100, 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;

(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.

Specific Authority 636.067 FS. Law Implemented 636.009(1)(f), 636.043, 626.058 FS. History–New 11-15-94, Formerly 4-203.070, Amended_________.

NAME OF PERSON ORIGINATING PROPOSED RULE: Marie Bachman [e-mail]
NAME OF SUPERVISOR OR PERSON WHO APPROVED THE PROPOSED RULE: Marie Bachman [e-mail]
DATE PROPOSED RULE APPROVED BY AGENCY HEAD: November 9, 2007
DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAW: December 21, 2007