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Florida Administrative Code (Last Updated: April 18, 2024) |
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59. Agency for Health Care Administration |
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59B. Cost Management and Control |
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59B-14. Health Plan Consumer Report |
1(1) Health insurers shall report health plan data to the Agency for Health Care Administration (agency) on July 1 of each year for each of the insureds included in the satisfaction survey results to be reported on July 1 of the same year as specified in Rule 4859B-14.004, 49F.A.C. The reported health plan data must be current as of the date the sampling frame is prepared.
67(2) Health plan data shall be reported for each insured sampled as described in paragraphs (a) through (f) below. All data elements (a) through (f) are required except that data elements (e) and (f) may be reported as UNKNOWN if the information is missing or unavailable. The percentage of unknown responses for any data element must not exceed 2 percent of total records, except that for measurement year 2005, the percentage of unknown responses for any data element must not exceed 5 percent of total records.
153(a) Report the Florida company code assigned by the Florida Office of Insurance Regulation.
167(b) Report the NAIC company code as assigned by the National Association of Insurance Commissioners.
182(c) Report the measurement year in four digits.
190(d) Designate the plan type as:
1961. Health plan of health maintenance organization as defined under Chapter 641, F.S.; or
2102. Health plan of health insurer defined under Chapter 627, F.S.
221(e) Report the county of record for the insured in text, capitalizing the first letter, without using abbreviations or the word “County.” Report the insured’s county of residence except for employer groups, report the county where the employer is located. Report Dade County as Miami-Dade.
266(f) Designate covered benefits as:
2711. Network; or
2742. No network.
277If the health plan conditions payment of covered benefits on the use of providers with whom the health insurer has entered into written agreements to provide such benefits by altering cost sharing or in any manner altering covered benefits, report subparagraph 1. network. If the health plan does not condition payment of covered benefits on the use of providers who have entered into written agreements with the health insurer to provide such benefits by altering cost sharing or in any manner altering covered benefits, report subparagraph 2. no network. Report responses as a single digit, 1 or 2.
375(3) The health plan data shall be reported in a text file in the order described in subsection (2) using a tab between each data element. Report each plan type in a separate file, appending data (a) through (f) for each insured to the corresponding survey data for the insured required in Rule 42859B-14.004, 429F.A.C., starting a new line for each respondent as described in subsection 44159B-14.004(7), 442F.A.C.
443Rulemaking Authority 445408.15(8) FS. 447Law Implemented 449408.05(3)(l), 450408.061(1)(c), 451(e) FS. History–New 12-25-05.
