The Office of Insurance Regulation is updating Chapter 69O-191.

 

DEPARTMENT OF FINANCIAL SERVICES

OIR – Insurance Regulation

RULE NOS.:RULE TITLES:

69O-191.021Scope

69O-191.027Application for Certificate of Authority

69O-191.028Standards for Fingerprint Cards for New Applicants and Acquisition Applications

69O-191.075Annual and Quarterly Reports

69O-191.085Fees

69O-191.097Change of Ownership

69O-191.107Prescribed Forms

PURPOSE AND EFFECT: The Office of Insurance Regulation is updating Chapter 69O-191.

SUMMARY: 69O-191.021, .028, .097, and .107 are repealed. 69O-191.027 is amended to transfer all aspects of the applications process from other rules in the chapter to one single rule. 69O-191.075 is amended to incorporate the annual reports that must be filed with the Office. 69O-191.085 is amended to delete reference to fees for filing an application.

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: 641.26, 641.36 FS.

LAW IMPLEMENTED: 624.424, 641.21, 641.22, 641.26, 641.29, 641.36 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-191.021 Scope.

 

Rulemaking Authority 641.36 FS. Law Implemented 641.36 FS. History–New 2-22-88, Formerly 4-31.021, 4-191.021, Repealed ______________.

 

69O-191.027 Application for Certificate of Authority.

 

Substantial rewording of Rule 69O-191.027, F.A.C. follows.  See Florida Administrative Code for present text.

 

(1) An application for a person applying for a certificate of authority as a health maintenance organization consists of the following:

(a) Form OIR-C1-942, “Application for Certificate of Authority Health Maintenance Organization,” effective 6/20, hereby incorporated by reference and available at www.flrules.org/XXXXX;

(b) Form OIR-C1-1263, “Application for Certificate of Authority Health Maintenance Organization Rehabilitation Administrative Expense Fund (Pursuant to Section 641.227, F.S.,” effective 6/96, hereby incorporated by reference and available at www.flrules.org/XXXXX;

(c) Form OIR-B2-1093, “Small Employer Carrier’s Application to Become a Risk Assuming Carrier or a Reinsuring Carrier, as Required by Section 627.6699(9), Florida Statutes,” effective 8/03, hereby incorporated by reference and available at www.flrules.org/XXXXX;

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

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

(f) Form OIR-C1-1423, “Biographical Affidavit,” 6/20, hereby incorporated by reference and available at www.flrules.org/XXXXX; and

(g) Form OIR-C1-2221, “Management Information Form,” effective 6/20, hereby incorporated by reference and available at www.flrules.org/XXXXX.

(2) A person applying for a certificate of authority as a health maintenance organization shall submit forms in subsection (1) as directed by the Office electronically at https://www.floir.com/iportal.

 

Rulemaking Authority 641.36 FS. Law Implemented 120.60(2), 641.21, 641.22, 641.29(1) FS. History–New 2-22-88, Amended 10-25-89, Formerly 4-31.027, Amended 5-28-92, Formerly 4-191.027, Amended ________________.

 

69O-191.028 Standards for Fingerprint Cards for New Applicants and Acquisition Applications.

 

Rulemaking Authority 641.36 FS. Law Implemented 641.21(1)(d) FS. History–New 5-28-92, Formerly 4-191.028, Repealed ______________.

 

 

69O-191.075 Annual and Quarterly Reports.

 

Substantial rewording of Rule 69O-191.075, F.A.C. follows.  See Florida Administrative Code for present text.

 

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

(a) An annual statement covering the preceding fiscal year shall be filed within 3 months after the end of the fiscal year, and quarterly statements within 45 days after the end of each of its quarterly reporting periods for the first three quarters of the fiscal year.

(b) The Office shall grant an extension of time for filing an annual or quarterly statement if there exist conditions beyond the control of the authorized HMO, such as rehabilitation pursuant to chapter 631, F.S., or the laws of the state of domicile; severe damage to the HMO’s physical premises by a natural or man-made disaster; or some other reason of similar gravity and severity. The extension shall be for the amount of time reasonable to file under the conditions which justified the extension.

(c) For purposes of this rule, the requirement that statements be filed with the Office means that the statement has been transmitted electronically to the National Association of Insurance Commissioners and that the executed Jurat page of said statement 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 statement. Annual and quarterly statements in any other format shall not be submitted to the Office.

(2) Annual and Quarterly Statement Reporting.

Each HMO shall submit its annual and quarterly statement information 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) Manuals Adopted.

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

(b) Quarterly statements shall be prepared in accordance with the manuals incorporated by reference in paragraph 69O-137.001(4)(b), F.A.C.

(c) Copies of the manuals are available:

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

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

 

Rulemaking Authority 641.26, 641.36 FS. Law Implemented 624.424, 641.26(1) FS. History–New 2-22-88, Amended 10-25-89, Formerly 4-31.075, Amended 5-28-92, Formerly 4-191.075, Amended 7-30-17, Amended ________________.

 

69O-191.085 Fees.

Checks for the original application filing or amendments thereto, for filing of each annual report, and for any other fees collected under this law, shall be made payable to the “Florida Department of Financial Services.” “State Treasurer, State of Florida.”

 

Rulemaking Authority 641.36 FS. Law Implemented 641.29 FS. History–New 2-22-88, Formerly 4-31.085, 4-191.085, Amended ________________.

 

69O-191.097 Change of Ownership.

 

Rulemaking Authority 641.36 FS. Law Implemented 628.4615 FS. History–New 2-22-88, Amended 10-25-89, Formerly 4-31.097, Amended 5-28-92, Formerly 4-191.097, Repealed ______________.

 

 

69O-191.107 Prescribed Forms.

 

Rulemaking Authority 624.308(1), 641.36 FS. Law Implemented 624.424, 627.410(6), (7), 627.413(4), 627.4145, 627.6699(12), 627.6735, 627.682, 627.9407(2), 628.4615, 641.19(13)(d), 641.21(1), 641.26(1), (2), 641.29 FS. History–New 2-22-88, Amended 10-25-89, Formerly 4-31.107, Amended 5-28-92, 8-15-94, 8-15-02, Formerly 4-191.107, Amended 7-30-17, Repealed ______________.

 

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: June 15, 2021