To provide more pooling of cancer forms and to make a few clarifications to existing provisions.

DEPARTMENT OF FINANCIAL SERVICES
OIR – Insurance Regulation

RULE NO: RULE TITLE
69O-149.003: Rate Filing Procedures
69O-149.005: Reasonableness of Benefits in Relation to Premiums
69O-149.007: Annual Rate Certification (ARC) Filing Procedures
PURPOSE AND EFFECT: To provide more pooling of cancer forms and to make a few clarifications to existing provisions.
SUBJECT AREA TO BE ADDRESSED: Florida law requires rates for health insurance to be reasonable in relation to the benefits. Section 627.410(6)(b), F.S., provides that the Commission may establish by rule procedures to the used in ascertaining the reasonableness of filed rates. These rules provide guidelines for insurers so they can be assured the rates they charge comply with this mandate. There are three amendments to the rules. The first, in Rule 69O-149.003, F.A.C., establishes rules for pooling of cancer claims. The second, in Rule 69O-149.005, F.A.C., prohibits an insurer knowingly pricing an individual rate to be charged to an insured to be excessive. The third tightens up the requirements for rate certifications, to make sure that when an insurer annually states its rates meet Florida law, that statement is true. The rule does this by setting forth the steps an insurer must take to rectify the problem if the Office determines a rate certification was inaccurate. Pursuant to the rule, knowingly filing a false rate certification constitutes an unfair and deceptive trade practice in violation of Section 626.9541(1)(e), F.S.
SPECIFIC AUTHORITY: 624.424, 627.410 FS.
LAW IMPLEMENTED: 627.9175 FS.
IF REQUESTED IN WRITING AND NOT DEEMED UNNECESSARY BY THE AGENCY HEAD, A RULE DEVELOPMENT WORKSHOP WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:
TIME AND DATE: May 27, 2009, 9:30 a.m.
PLACE: 142 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: Gerry Smith, 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 DEVELOPMENT AND A COPY OF THE PRELIMINARY DRAFT, IF AVAILABLE, IS: Gerry Smith, Office of Insurance Regulation; e-mail [e-mail]

THE PRELIMINARY TEXT OF THE PROPOSED RULE DEVELOPMENT IS AVAILABLE AT NO CHARGE FROM THE CONTACT PERSON LISTED ABOVE.