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Florida Administrative Code (Last Updated: November 11, 2024) |
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69. Department of Financial Services |
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69O. OIR – Insurance Regulation |
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69O-154. Health Insurance Policies |
1(1)(a) This rule chapter applies to all individual and group health insurance policies, including single premium credit disability insurance. All other credit insurance is not subject to this rule chapter. Credit disability is defined under Section 37627.677(2), F.S.
39(b) This rule chapter is effective December 31, 1998, for policies and contracts in force and issued thereafter.
57(2) When an insurer determines that adequacy of its health insurance reserves requires reserves in excess of the minimum standards specified herein, the increased reserves shall be held and shall be considered the minimum reserves for that insurer.
95(3)(a) With respect to any block of contracts, or with respect to an insurer’s health business as a whole, a prospective gross premium valuation is the ultimate test of reserve adequacy as of a given valuation date.
132(b) Gross premium valuations shall take into account, for contracts in force, in a claims status, or in a continuation of benefits status on the valuation date, the present value as of the valuation date of:
1681. All expected benefits unpaid;
1732. All expected expenses unpaid; and,
1793. All unearned or expected premiums, adjusted for future premium increases reasonably expected to be put into effect.
197(4)(a) A gross premium valuation shall be performed whenever a significant doubt exists as to reserve adequacy with respect to any major block of contracts, or with respect to the insurer’s health business as a whole.
233(b) If inadequacy is found to exist, immediate loss recognition shall be made and the reserves restored to adequacy.
252(c) Adequate reserves (inclusive of claim, premium, and contract reserves, if any) shall be held with respect to all contracts, regardless of whether contract reserves are required for the contracts under these standards.
285(5) Whenever minimum reserves, as defined in these standards, exceed reserve requirements as determined by a prospective gross premium valuation, the minimum reserves remain the minimum requirement under these standards.
315Rulemaking Authority 317624.308(1), 318625.121(14), 319625.081 FS. 321Law Implemented 323624.307(1), 324625.081, 325625.121 FS. 327History–New 4-14-99, Formerly 4-154.201, Amended 3-1-04.
