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Florida Administrative Codes
that are Pertinent to Insurance
(all-in-one)

28 Part 101
Organization

28 FAC 101.001 | Statement of Agency Organization and Operation

(1) The agency head shall maintain a current Statement of Agency Organization and Operation. The statement shall describe the organization of the agency and outline the general course of the agency's operations. The purpose of the statement is:
(a) To inform the public, in a complete and concise manner, of the nature of the agency's business, operations, delegation of authority, internal organization and other related matters;

(b) To provide assistance to the public when dealing with the agency; and

(c) To expedite the processing of agency matters on behalf of the public.
(2) The Statement of Agency Organization and Operation shall:
(a) Describe the agency head and his or her duties, as well as state the method of selection or appointment of the agency head, and the length of his or her term.

(b) Describe the organizational units and sub-units within the agency, including their assigned functions, duties, responsibilities, statutory authority, and statutes and rules they are charged with implementing. The designation of units and sub-units shall be consistent with Section 20.04, F.S., or as otherwise provided by law.

(c) Describe the manner by which publications, documents, forms, applications for licenses, permits and other similar certifications or rights granted by the agency, or other information, may be obtained.

(d) Identify the agency clerk by name, position, address, e-mail address, and telephone number; and set out his or her duties and responsibilities.

(e) State whether documents can be filed by electronic mail or facsimile transmission, including applicable telephone numbers and electronic mail addresses where filings may be submitted, and set forth the acceptable nature and scope of such filings, including the following:
That the filing date for a document transmitted by electronic mail or by facsimile shall be the date the agency receives the complete document. Any document received by the office of the agency clerk after 5:00 p.m. shall be filed as of 8:00 a.m. on the next regular business day.
(f) Identify the name, address, and e-mail address of the appropriate contact person for obtaining information about variances from or waivers of agency rules, and indicate how to file a petition for variance or waiver.

(g) Set forth the agency's hours of operation during which filings will be accepted.

(h) Set forth where and how agency index of final orders can be accessed.
(3) The agency clerk shall provide a copy of its Statement of Agency Organization and Operation to any person upon request.

(4) An agency shall publish a statement of organization and operation on the agency's website.

28 Part 102
Agenda and Scheduling of Meetings, Hearings, and Workshops

28 FAC 102.001 | Notice of Public Meeting, Hearing, or Workshop

(1) Except where otherwise provided, the agency shall give at least seven days notice of any public meeting, hearing, or workshop by publication in the Florida Administrative Register and on agency's website. Provisions regarding notices of hearings in proceedings for determining substantial interests are found in Rules 28-106.208 and 28-106.302, F.A.C.

(2) An agency shall utilize the following form, or a substantially similar form, in providing notice of any public meeting, hearing, or workshop.

NOTICE OF PUBLIC MEETING, HEARING, OR WORKSHOP

The (name of the agency) announces a public meeting, hearing, or workshop to which all persons are invited.
DATE AND TIME:__________________________________________________________________________________
PLACE:__________________________________________________________________________________
PURPOSE:__________________________________________________________________________________
A copy of the agenda may be obtained by writing to (name of the agency) at (address) or by calling (name) at (telephone number).

Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/hearing/meeting is asked to advise the agency at least 5 days before the workshop/hearing/meeting by contacting (name) at (telephone number). If you are hearing or speech impaired, please contact the agency by calling (telephone number of TDD).

28 FAC 102.002 | Agenda of Meetings, Hearings, and Workshops

(1)
(a) The agenda shall state with specificity the items that will be considered at a meeting, hearing, or workshop. All matters involving the exercise of agency discretion and policy-making shall be listed and summarized on the agenda. Matters which are solely ministerial, or internal administrative matters that do not affect the interests of the public generally, may be included on the agenda.

(b) An agency shall utilize the following form, or substantially similar form in preparing its agenda:

NAME OF AGENCY TIME, DATE & PLACE OF MEETING THIS MEETING IS OPEN TO THE PUBLIC

1. Call to Order.

2. Review of Minutes.

3. Old Business: Specific listing of all matters involving agency discretion or policy-making with brief summary of each.

4. New Business: Specific listing of all matters involving agency discretion or policy-making with brief summary of each.

5. Other Business: Specific listing of all matters involving agency discretion or policy-making with brief summary of each.
(2) The person designated to preside may make specific changes in the agenda after it has been made available for distribution, only for "good cause" shown.

(3) The agenda and any meeting materials available in electronic form shall be published on the agency's website. Confidential and exempt information need not be published.

28 FAC 102.003 | Emergency Meetings

(1) An agency may hold an emergency meeting notwithstanding the provisions of Rules 28-102.001 and 28-102.002, F.A.C., for the purpose of acting upon emergency matters posing an immediate danger to the public health, safety or welfare.

(2) Whenever an emergency meeting must be held, the agency shall give notice of the meeting on its website, if it has one, and by any procedure that is fair under the circumstances, such as notifying at least one major newspaper of general circulation in the area where the meeting will take place, and the agency may also notify all major wire services of the time, date, place, and purpose of the meeting.

(3) Following an emergency meeting, the agency shall publish in the appropriate publication prescribed by Section 120.54(3), F.S., and on its website, if it has one, notice of the time, date and place of the meeting, a statement setting forth the reasons why an emergency meeting was necessary and a statement setting forth the action taken at the meeting. This notice is in addition to the notice requirements of Section 120.525(3)(c), F.S.

28 Part 103
Rulemaking

28 FAC 103.001 | Advance Notice of Agency Rulemaking Proceedings (Repealed)

28 FAC 103.002 | Rule Development Workshops (Repealed)

28 FAC 103.003 | Negotiated Rulemaking (Repealed)

28 FAC 103.004 | Public Hearing (Repealed)

28 FAC 103.005 | Evidentiary Proceeding During Rulemaking (Repealed)

28 FAC 103.006 | Petitions to Initiate Rulemaking (Repealed)


28 Part 104
Variance or Waiver

28 FAC 104.001 | Purpose; Construction

28 FAC 104.002 | Petition for Variance or Waiver

(1) A petition for a variance from or waiver of an agency rule shall be filed with the clerk of the agency that adopted the rule, with a copy to the Joint Administrative Procedures Committee, Room 680, Pepper Building, 111 W. Madison Street, Tallahassee, Florida 32399-1400.

(2) The petition must include the following information:
(a) The caption shall read:
Petition for (Variance from) or (Waiver of) Rule (Citation)
(b) The name, address, any e-mail address, telephone number, and any facsimile number of the petitioner, if the party is not represented by an attorney or a qualified representative;

(c) The name, address, e-mail address, telephone number, and any facsimile number of the attorney or qualified representative of the petitioner, if any;

(d) The applicable rule or portion of the rule;

(e) The citation to the statute the rule is implementing;

(f) The type of action requested;

(g) The specific facts that demonstrate a substantial hardship or a violation of principles of fairness that would justify a waiver or variance for the petitioner;

(h) The reason why the variance or the waiver requested would serve the purposes of the underlying statute; and

(i) A statement whether the variance or waiver is permanent or temporary. If the variance or waiver is temporary, the petition shall include the dates indicating the duration of the requested variance or waiver.
(3) The petition for a variance or waiver may be withdrawn by the applicant at any time before final agency action.

(4) Upon receipt of a petition for variance or waiver, the agency shall furnish a copy of the petition to any other agency responsible for implementing the rule.

28 FAC 104.003 | Comments on Petition

(1) Any interested person or other agency may submit written comments on the petition for a variance or waiver within 14 days after the notice required by Section 120.542(6), F.S. The agency shall state in any order disposing of the petition whether comments were received by the agency.

(2) The agency shall maintain the comments as part of the record.

(3) The right to comment pursuant to this section does not alone confer party status in any proceeding arising from a petition for variance or waiver.

28 FAC 104.004 | Petition for Emergency Variance or Waiver

(1) A person requesting an emergency variance from or waiver of an agency rule shall so state in the caption to the petition.

(2) In addition to the other requirements of Section 120.542(5), F.S., and this chapter, the petition shall specify:
(a) The specific facts that make the situation an emergency; and

(b) The specific facts to show that the petitioner will suffer an immediate adverse effect unless the variance or waiver is issued more expeditiously than the time frames provided in Section 120.542, F.S.

28 FAC 104.005 | Time for Consideration of Emergency Petition

(1) Within 5 days after filing a petition for emergency variance or waiver with the agency clerk, the agency shall give notice of receipt of the petition on its website, if it has one. The agency shall also give notice by any procedure that is fair under the circumstances or provide notice of the petition to the Department of State for publication in the first available issue of the Florida Administrative Register. Any notice under this subsection shall inform interested persons of the right to submit comments. Interested persons or other agencies may submit written comments on the petition for emergency variance or waiver within 5 days after publication of the notice required herein. The notice and comment requirements in this subsection shall not apply if the agency head finds that an immediate danger to the public health, safety, or welfare requires an immediate final order, which final order shall recite with particularity the facts underlying such finding.

(2) The agency shall grant or deny a petition for emergency variance or waiver or determine that the request is not an emergency within 30 days of its receipt by the agency. If such petition is not granted or denied within this time limit, the petition shall be deemed approved unless the time limit is waived by the petitioner.

(3) If the agency decides that the situation is not an emergency, the agency shall so notify the petitioner in writing, and the petition shall then be reviewed by the agency on a non-emergency basis as set forth in Section 120.542(7), F.S.

(4) The duration of an emergency variance or waiver shall be determined by the agency.

(5) The agency shall issue a written order granting or denying the petition. The order shall state the facts and reasons supporting the agency's action.

28 FAC 104.0051 | Revocation of Emergency or Temporary Variance or Waiver

(1) Upon receipt of evidence sufficient to show that the recipient of an order granting an emergency or temporary variance or waiver is not in compliance with the requirements of that order, the agency shall issue an order to show cause why the emergency variance or waiver should not be revoked.

(2) The recipient of an emergency or temporary variance or waiver shall respond to the order to show cause why the emergency variance or waiver should not be revoked within 15 days of the mailing date of the order to show cause. Failure to timely respond shall result in a final order revoking the emergency or temporary variance or waiver.

28 FAC 104.006 | Request for Information

(1) When a person inquires of the agency about the possibility of relief from any rule requirements or the remedies available pursuant to Section 120.542, F.S., the agency shall provide the information required by Section 120.542(4), F.S., within 15 days of the inquiry.

(2) In its response to a request for information, the agency shall indicate the name, address and e-mail address of the appropriate contact person for additional information and shall indicate how a petition for variance or waiver is filed with the agency.

28 Part 105
Declaratory Statements

28 FAC 105.001 | Purpose and Use of Declaratory Statement

A declaratory statement is a means for resolving a controversy or answering questions or doubts concerning the applicability of statutory provisions, rules, or orders over which the agency has authority. A petition for declaratory statement may be used to resolve questions or doubts as to how the statutes, rules, or orders may apply to the petitioner's particular circumstances. A declaratory statement is not the appropriate means for determining the conduct of another person.

28 FAC 105.002 | The Petition

A petition seeking a declaratory statement shall be filed with the clerk of the agency that has the authority to interpret the statute, rule, or order at issue and shall provide the following information:
(1) The caption shall read:
Petition for Declaratory Statement Before (Name of Agency).
(2) The name, address, any e-mail address, telephone number, and any facsimile number of the petitioner.

(3) The name, address, any e-mail address, telephone number, and any facsimile number of the petitioner's attorney or qualified representative if any.

(4) The statutory provision(s), agency rule(s), or agency order(s) on which the declaratory statement is sought.

(5) A description of how the statutes, rules, or orders may substantially affect the petitioner in the petitioner's particular set of circumstances.

(6) The signature of the petitioner or of the petitioner's attorney or qualified representive.

(7) The date.

28 FAC 105.0024 | Notice of Filing

The agency shall file a notice of the Petition for Declaratory Statement in the next available Florida Administrative Register including the following information:
(1) The name of the agency with which the Petition for Declaratory Statement is filed.

(2) The name of the Petitioner.

(3) The date the Petition for Declaratory Statement was received.

(4) The statutory provision(s), rule(s) or order(s) on which the declaratory statement is sought.

(5) The contact name, address, e-mail address, and phone number where a copy of the petition may be obtained.

(6) The applicable time limit for filing motions to intervene or petitions for administrative hearing by persons whose substantial interests may be affected.

28 FAC 105.0027 | Intervention

(1) Persons other than the original parties to a pending proceeding whose substantial interests will be affected by the disposition of the declaratory statement and who desire to become parties may move the presiding officer for leave to intervene. The presiding officer shall allow for intervention of persons meeting the requirements for intervention of this rule. Except for good cause shown, motions for leave to intervene must be filed within 21 days after publication of (or such later time as is specified in) the notice in the Florida Administrative Register. The presiding officer may impose terms and conditions on the intervener to limit prejudice to other parties.

(2) The motion to intervene shall contain the following information:
(a) The name, address, the e-mail address, and facsimile number, if any, of the intervener; if the intervener is not represented by an attorney or qualified representative; and

(b) The name, address, e-mail address, telephone number, and any facsimile number of the intervener's attorney or qualified representative, if any; and

(c) Allegations sufficient to demonstrate that the intervener is entitled to participate in the proceeding as a matter of constitutional or statutory right or pursuant to agency rule, or that the substantial interests of the intervener are subject to determination or will be affected by the declaratory statement; and

(d) The signature of the intervener or intervener's attorney or qualified representative; and

(e) The date.
(3) Any party may, within seven days of service of the motion, file a response in opposition.

28 FAC 105.003 | Agency Disposition

The agency may hold a hearing to consider a petition for declaratory statement. If the agency is headed by a collegial body, it shall take action on a petition for declaratory statement only at a duly noticed public meeting. The agency may rely on the statements of fact set out in the petition without taking any position with regard to the validity of the facts. Within 90 days of the filing of the petition, the agency shall render a final order denying the petition or issuing a declaratory statement.

28 FAC 105.004 | Notice of Disposition

The agency shall file a Notice of Disposition for the Declaratory Statement or denial of the petition in the next available issue of the Florida Administrative Register including the following information:
(1) The name of the agency.

(2) A summary statement of the agency's decision.

(3) The agency, contact person, address, and e-mail address where a copy of the petition and final order may be obtained.

(4) The date the final order is filed.

28 Part 106
Decisions Determining Substantial Interests

28 FAC 106.101 | Scope of this Chapter

This chapter shall apply in all proceedings in which the substantial interests of a party are determined by the agency and shall be construed to secure the just, speedy, and inexpensive determination of every proceeding. This chapter applies to all proceedings under Chapter 120 except as follows:
(1) Where the agency has adopted rules covering the subject matter pursuant to Section 120.54(5)(a)2., F.S.;

(2) Agency investigations or determinations of probable cause preliminary to agency action; and

(3) Mediation conducted pursuant to Section 120.573, F.S. The notice provisions in Rule 28-106.111 and Part IV, F.A.C., of this subchapter apply to such mediation.

28 FAC 106.102 | Presiding Officer

"Presiding officer" means an agency head, or member thereof, who conducts a hearing or proceeding on behalf of the agency, an administrative law judge assigned by the Division of Administrative Hearings, or any other person authorized by law to conduct administrative hearings or proceedings who is qualified to resolve the legal issues and procedural questions which may arise.

28 FAC 106.103 | Computation of Time

In computing any period of time allowed by this chapter, by order of a presiding officer, or by any applicable statute, the day of the act from which the period of time begins to run shall not be included. The last day of the period shall be included unless it is a Saturday, Sunday, or legal holiday, in which event the period shall run until the end of the next day which is not a Saturday, Sunday, or legal holiday. When the period of time allowed is less than 7 days, intermediate Saturdays, Sundays, and legal holidays shall be excluded in the computation. As used in these rules, legal holiday means those days designated in Section 110.117, F.S. Except as provided in Rule 28-106.217, F.A.C., five days shall be added to the time limits when service has been made by regular U.S. mail. One business day shall be added when service is made by overnight courier. No additional time shall be added if service is made by hand, facsimile transmission, or electronic mail or when the period of time begins pursuant to a type of notice described in Rule 28-106.111, F.A.C.

28 FAC 106.104 | Filing

(1) In construing these rules or any order of a presiding officer, filing shall mean received by the office of the agency clerk during normal business hours or by the presiding officer during the course of a hearing.

(2) All pleadings filed with the agency shall contain the following:
(a) The style of the proceeding involved;

(b) The docket, case or file number, if any;

(c) The name of the party on whose behalf the pleading is filed;

(d) The name, address, any e-mail address, and telephone number of the person filing the pleading;

(e) The signature of the person filing the pleading; and

(f) A certificate of service that copies have been furnished to all other parties as required by subsection (4) of this rule.
(3) Any document received by the office of the agency clerk before 5:00 p.m. shall be filed as of that day but any document received after 5:00 p.m. shall be filed as of 8:00 a.m. on the next regular business day.

(4) Whenever a party files a pleading or other document with the agency, that party shall serve copies of the pleading or other document upon all other parties to the proceeding. A certificate of service shall accompany each pleading or other document filed with the agency.

(5) All parties, if they are not represented, or their attorneys or qualified representatives shall promptly notify all other parties and the presiding officer of any changes to their contact information by filing a notice of the change.

(6) All papers filed shall be titled to indicate clearly the subject matter of the paper and the party requesting relief.

(7) All original pleadings shall be on white paper measuring 8 1/2 by 11 inches, with margins of no less than one inch. Originals shall be printed or typewritten.

(8) A document shall be filed by only one method (e-filing, facsimile, courier, hand-delivery, or U.S. mail) and shall not be filed multiple times. A duplicate filing will not be docketed and will be destroyed.

28 FAC 106.105 | Appearances

(1) Counsel or qualified representatives who file a request for a hearing involving disputed issues of material fact with the agency have entered an appearance in the proceeding and shall be deemed counsel or qualified representative of record. All others who seek to appear shall file a notice of appearance as soon as possible.

(2) Service on counsel of record or on a qualified representative shall be the equivalent of service on the party represented.

(3) On written motion served on the party represented and all other parties of record, the presiding officer shall grant counsel of record and qualified representatives leave to withdraw for good cause shown. The motion shall contain the address, any e-mail address, and telephone number of the party represented.

(4) A qualified representative who has filed an initial pleading or notice of appearance for a party shall be deemed the qualified representative of record until the presiding officer makes the determination required by Rule 28-106.106, F.A.C.

28 FAC 106.106 | Who May Appear; Criteria for Qualified Representatives

(1) Any party who appears in any agency proceeding has the right, at his or her own expense, to be represented by counsel or by a qualified representative. Counsel means a member of The Florida Bar or a law student certified pursuant to Chapter 11 of the Rules Regulating The Florida Bar. An attorney disbarred in any state shall not be authorized to serve as a qualified representative.

(2)
(a) A party seeking representation by a qualified representative shall file a written request with the presiding officer as soon as practicable, but no later than any pleading filed by the person seeking to appear on behalf of the party. The request shall identify the name, address, e-mail adress, and telephone number of the representative and shall state that the party is aware of the services which the representative can provide, and is aware that the party can be represented by counsel at the party's own expense and has chosen otherwise.

(b) The presiding officer shall consider whether the representative is qualified to appear in the administrative proceeding and capable of representing the rights and interests of the party. The presiding officer may consider a representative's sworn affidavit setting forth the representative's qualifications.

(c) The presiding officer shall determine the qualifications of the representative within a reasonable time after the request required by paragraph (a) is filed.
(3) The presiding officer shall authorize the representative to appear if the presiding officer is satisfied that the representative has the necessary qualifications to responsibly represent the party's interests in a manner which will not impair the fairness of the proceeding or the correctness of the action to be taken.

(4) The presiding officer shall make a determination of the qualifications of the representative in light of the nature of the proceedings and the applicable law. The presiding officer shall consider:
(a) The representative's knowledge of jurisdiction;

(b) The representative's knowledge of the Florida Rules of Civil Procedure relating to discovery in an administrative proceeding;

(c) The representative's knowledge regarding the rules of evidence, including the concept of hearsay in an administrative proceeding;

(d) The representative's knowledge regarding the factual and legal issues involved in the proceedings; and

(e) The representative's knowledge of and compliance with the Standards of Conduct for Qualified Representatives, Rule 28-106.107, F.A.C.
(5) If the presiding officer determines a representative is not qualified, the reasons for the decision shall be in writing and included in the record.

28 FAC 106.107 | Standards of Conduct for Qualified Representatives

The following standards of conduct are mandatory for all qualified representatives.
(1) A representative shall exercise due diligence to insure that any motion or pleading is filed and argued in good faith.

(2) A representative shall advise the client to obey the law.

(3) A representative shall not:
(a) Engage in conduct involving dishonesty, fraud, deceit, or misrepresentation;

(b) Engage in conduct that is prejudicial to the administration of justice;

(c) Handle a matter which the representative knows or should know that he or she is not competent to handle;

(d) Handle a legal or factual matter without adequate preparation;

(e) Communicate, or cause another to communicate, as to the merits of the proceeding with the presiding officer except on the record or in writing with a copy promptly delivered to the opposing party; or

(f) Communicate with an adverse party regarding matters at issue in the administrative proceeding where the representative knows that the adverse party is represented by an attorney or other qualified representative.
(4) Failure to comply with these provisions shall authorize the presiding officer to disqualify the representative appearing in the administrative proceeding.

28 FAC 106.108 | Consolidation

28 FAC 106.109 | Notice to Interested Parties

28 FAC 106.110 | Service of Papers

28 FAC 106.111 | Point of Entry into Proceedings and Mediation

(1) The notice of agency decision shall contain the information required by Section 120.569(1), F.S. The notice shall also advise whether mediation under Section 120.573, F.S., is available, and if available, that pursuit of mediation will not adversely affect the right to administrative proceedings in the event mediation does not result in a settlement.

(2) Unless otherwise provided by law, persons seeking a hearing on an agency decision which does or may determine their substantial interests shall file a petition for hearing with the agency within 21 days of receipt of written notice of the decision.

(3) An agency may, for good cause shown, grant a request for an extension of time for filing an initial pleading. Requests for extension of time must be filed with the agency prior to the applicable deadline. Such requests for extensions of time shall contain a certificate that the moving party has consulted with all other parties, if any, concerning the extension and that the agency and any other parties agree to or oppose the extension. A timely request for extension of time shall toll the running of the time period for filing a petition until the request is acted upon.

(4) Any person who receives written notice of an agency decision and who fails to file a written request for a hearing within 21 days waives the right to request a hearing on such matters. This provision does not eliminate the availability of equitable tolling as a defense.

(5) The agency may publish, and any person who has timely requested mediation may, at the person's own expense, cause the agency to publish, a notice of the existence of the mediation proceeding in the Florida Administrative Register or in a newspaper of general circulation in the affected area. The mediation notice can be included in the notice of intended agency action.
(a) The notice of the mediation proceeding shall include:
1. A statement that the mediation could result in a settlement adopted by final agency action;

2. A statement that the final action arising from mediation may be different from the intended action set forth in the notice which resulted in a timely request for mediation;

3. A statement that any person whose substantial interests may be affected by the outcome of the mediation shall within 21 days of the notice of mediation proceeding file a request with the agency to participate in the mediation; and

4. An explanation of the procedures for filing such a request.
(b) The notice shall also advise that in the absence of a timely request to participate in the mediation, any person whose substantial interests are or may be affected by the result of the mediation waives any right to participate in the mediation.

28 FAC 106.201 | Initiation of Proceedings

(1) Unless otherwise provided by statute, and except for agency enforcement and disciplinary actions that shall be initiated under Rule 28-106.2015, F.A.C., initiation of proceedings shall be made by written petition to the agency responsible for rendering final agency action. The term "petition" includes any document that requests an evidentiary proceeding and asserts the existence of a disputed issue of material fact. Each petition shall be legible and on 8 1/2 by 11 inch white paper. Unless printed, the impression shall be on one side of the paper only and lines shall be double-spaced.

(2) All petitions filed under these rules shall contain:
(a) The name and address of each agency affected and each agency's file or identification number, if known;

(b) The name, address, any e-mail address, any facsimile number, and telephone number of the petitioner, if the petitioner is not represented by an attorney or a qualified representative; the name, address, and telephone number of the petitioner's representative, if any, which shall be the address for service purposes during the course of the proceeding; and an explanation of how the petitioner's substantial interests will be affected by the agency determination;

(c) A statement of when and how the petitioner received notice of the agency decision;

(d) A statement of all disputed issues of material fact. If there are none, the petition must so indicate;

(e) A concise statement of the ultimate facts alleged, including the specific facts the petitioner contends warrant reversal or modification of the agency's proposed action;

(f) A statement of the specific rules or statutes the petitioner contends require reversal or modification of the agency's proposed action, including an explanation of how the alleged facts relate to the specific rules or statutes; and

(g) A statement of the relief sought by the petitioner, stating precisely the action petitioner wishes the agency to take with respect to the agency's proposed action.
(3) Upon receipt of a petition involving disputed issues of material fact, the agency shall grant or deny the petition, and if granted shall, unless otherwise provided by law, refer the matter to the Division of Administrative Hearings with a request that an administrative law judge be assigned to conduct the hearing. The request shall be accompanied by a copy of the petition and a copy of the notice of agency action.

28 FAC 106.2015 | Agency Enforcement and Disciplinary Actions

(1) Prior to entry of a final order to suspend, revoke, or withdraw a license, to impose administrative fines, or to take other enforcement or disciplinary action against a licensee or person or entity subject to the agency's jurisdiction, the agency shall serve upon the licensee an administrative complaint. For purposes of this rule, an agency pleading or communication that seeks to exercise an agency's enforcement authority and to take any kind of disciplinary action against a licensee or other person shall be deemed an administrative complaint.

(2) An agency issuing an administrative complaint shall be the petitioner, and the licensee against whom the agency seeks to take disciplinary action shall be the respondent.

(3) The agency's administrative complaint shall be considered the petition, and service of the administrative complaint on the respondent shall be deemed the initiation of proceedings.

(4) The agency's administrative complaint shall contain:
(a) The name of the agency, the respondent or respondents against whom disciplinary action is sought and a file number.

(b) The statutory section(s), rule(s) of the Florida Administrative Code, or the agency order alleged to have been violated.

(c) The facts or conduct relied on to establish the violation.

(d) A statement that the respondent has the right to request a hearing to be conducted in accordance with Sections 120.569 and 120.57, F.S., and to be represented by counsel or other qualified representative.
(5) Requests for hearing filed by the respondent in accordance with this rule shall include:
(a) The name, address, any e-mail address, telephone number, and facsimile number, if any, of the respondent, if the respondent is not represented by an attorney or qualified representative.

(b) The name, address, e-mail address, telephone number, and facsimile number of the attorney or qualified representative of the respondent, if any, upon whom service of pleadings and other papers shall be made.

(c) A statement requesting an administrative hearing identifying those material facts that are in dispute. If there are none, the petition must so indicate.

(d) A statement of when the respondent received notice of the administrative complaint.

(e) A statement including the file number to the administrative complaint.

28 FAC 106.202 | Amendment of Petitions or Requests for Hearing

A petition or request for hearing may be amended prior to the designation of the presiding officer by filing and serving an amended petition or amended request for hearing in the manner prescribed for filing and serving an original petition or request for hearing. Thereafter the petitioner may amend the petition or request for hearing only upon order of the presiding officer.

28 FAC 106.203 | Answer

28 FAC 106.204 | Motions

(1) All requests for relief shall be by motion. All motions shall be in writing unless made on the record during a hearing, and shall fully state the action requested and the grounds relied upon. The original written motion shall be filed with the presiding officer. When time allows, the other parties may, within 7 days of service of a written motion, file a response in opposition. No reply to the response shall be permitted unless leave is sought from and given by the presiding officer. Written motions will normally be disposed of after the response period has expired, based on the motion, together with any supporting or opposing memoranda. The presiding officer shall conduct such proceedings and enter such orders as are deemed necessary to dispose of issues raised by the motion.

(2) Unless otherwise provided by law, motions to dismiss the petition or request for hearing shall be filed no later than 20 days after assignment of the presiding officer, unless the motion is based upon a lack of jurisdiction or incurable errors in the petition.

(3) All motions, other than a motion to dismiss, shall include a statement that the movant has conferred with all other parties of record and shall state as to each party whether the party has any objection to the motion. Any statement that the movant was unable to contact the other party or parties before filing the motion must provide information regarding the date(s) and method(s) by which contact was attempted.

(4) Motions for extension of time shall be filed prior to the expiration of the deadline sought to be extended and shall state good cause for the request.

28 FAC 106.205 | Intervention

(1) Persons other than the original parties to a pending proceeding whose substantial interest will be affected by the proceeding and who desire to become parties may move the presiding officer for leave to intervene. Except for good cause shown, motions for leave to intervene must be filed at least 20 days before the final hearing unless otherwise provided by law. The parties may, within 7 days of service of the motion, file a response in opposition. The presiding officer may impose terms and conditions on the intervenor to limit prejudice to other parties.

(2) The motion to intervene shall contain the following information:
(a) The name, address, e-mail address, telephone number, and any facsimile number of the intervener, if the intervener is not represented by an attorney or qualified representative; and

(b) The name, address, e-mail address, telephone number, and any facsimile number of the intervenor's attorney or qualified representative; and

(c) Allegations sufficient to demonstrate that the intervenor is entitled to participate in the proceeding as a matter of constitutional or statutory right or pursuant to agency rule, or that the substantial interests of the intervenor are subject to determination or will be affected by the proceeding; and

(d) A statement as to whether the intervenor supports or opposes the preliminary agency action; and

(e) The statement required by subsection 28-106.204(3); and

(f) The signature of the intervenor or intervenor's attorney or qualified representative; and

(g) The date.
(3) Specifically-named persons, whose substantial interests are being determined in the proceeding, may become a party by entering an appearance and need not request leave to intervene.

28 FAC 106.206 | Discovery

After commencement of a proceeding, parties may obtain discovery through the means and in the manner provided in Rules 1.280 through 1.400, Florida Rules of Civil Procedure. The presiding officer may issue appropriate orders to effectuate the purposes of discovery and to prevent delay, including the imposition of sanctions in accordance with the Florida Rules of Civil Procedure, except contempt.

28 FAC 106.207 | Venue

(1) Whenever practicable and permitted by statute or rule, hearings shall be held in the area of residence of the non-governmental parties affected by agency action, or at the place most convenient to all parties as determined by the presiding officer.

(2) Failure to respond timely to any order requiring or allowing the parties to suggest an appropriate locality for final hearing may constitute a waiver of venue.

28 FAC 106.208 | Notice of Hearing

28 FAC 106.209 | Prehearing Conferences

At any time after a matter has been filed with the agency, the presiding officer may direct the parties to confer for the purpose of clarifying and simplifying issues, discussing the possibilities of settlement, examining documents and other exhibits, exchanging names and addresses of witnesses, resolving other procedural matters, and entering into a pre-hearing stipulation.

28 FAC 106.210 | Continuances

28 FAC 106.211 | Conduct of Proceedings

28 FAC 106.212 | Subpoenas

(1) Upon the request of any party, a presiding officer shall issue subpoenas for the attendance of witnesses for deposition or at the hearing. The requesting party shall specify whether the witness is also requested to bring documents.

(2) A subpoena may be served by any person specified by law to serve process or by any person who is not a party and who is 18 years of age or older. Service shall be made by delivering a copy to the person named in the subpoena. Proof of service shall be made by affidavit of the person making service if not served by a person specified by law to serve process.

(3) Any motion to quash or limit the subpoena shall be filed with the presiding officer and shall state the grounds relied upon.

28 FAC 106.213 | Evidence

(1) Oral evidence shall be taken only on oath or affirmation.

(2) Each party shall have the right to impeach any witness regardless of which party called the witness to testify.

(3) Hearsay evidence, whether received in evidence over objection or not, may be used to supplement or explain other evidence, but shall not be sufficient in itself to support a finding unless the evidence falls within an exception to the hearsay rule as found in Sections 90.801-.805, F.S.

(4) The rules of privilege apply to the same extent as in civil actions under Florida law.

(5) If requested and if the necessary equipment is reasonably available, testimony may be taken by means of video teleconference or by telephone.
(a) If a party cross-examining the witness desires to have the witness review documents or other items not reasonably available for the witness to review at that time, then the party shall be given a reasonable opportunity to complete the cross-examination at a later time or date for the purpose of making those documents or other items available to the witness.

(b) For any testimony taken by telephone, a notary public must be physically present with the witness to administer the oath. The notary public shall provide a written certification to be filed with the presiding officer confirming the identity of the witness, and confirming the affirmation or oath by the witness. It shall be the responsibility of the party calling the witness to secure the services of a notary public.
(6) When official recognition is requested, the parties shall be notified and given an opportunity to examine and contest the material. Requests for official recognition shall be by motion and shall be considered in accordance with the provisions governing judicial notice in Sections 90.201-.203, F.S.

28 FAC 106.214 | Recordation

(1) Responsibility for preserving the testimony at final hearings shall be that of the agency transmitting the petition to the Division of Administrative Hearings pursuant to Sections 120.569 and 120.57, F.S., the agency whose rule is being challenged, or the agency whose action initiated the proceeding. Proceedings shall be recorded by a certified court reporter or by recording instruments.

(2) No later than 10 days prior to the final hearing, the agency shall notify the parties of the method by which the agency will record the testimony at the final hearing. Any party to a hearing may, at its own expense, provide a certified court reporter if the agency does not. The presiding officer may provide a certified court reporter. At hearings reported by a court reporter, any party who wishes a transcript of the testimony shall order the same at its own expense. If a court reporter records the proceedings, the recordation shall become the official transcript.

28 FAC 106.215 | Post-Hearing Submittals

28 FAC 106.216 | Entry of Recommended Order

(1) If a hearing is conducted by other than the agency head, or member thereof, the presiding officer shall, within 30 days after the hearing or receipt of the hearing transcript, whichever is later, file a recommended order which shall include a caption, time and place of hearing, appearances entered at the hearing, statement of the issues, findings of fact and conclusions of law, separately stated, and recommendation for final agency action.

(2) By agreeing to a deadline for filing post-hearing submissions that is more than 10 days after the conclusion of the hearing or the filing of the hearing transcript, whichever is later, a party waives the provisions of subsection (1) above.

28 FAC 106.217 | Exceptions and Responses

(1) Parties may file exceptions to findings of fact and conclusions of law contained in recommended orders with the agency responsible for rendering final agency action within 15 days of entry of the recommended order except in proceedings conducted pursuant to Section 120.57(3), F.S. Exceptions shall identify the disputed portion of the recommended order by page number or paragraph, shall identify the legal basis for the exception, and shall include any appropriate and specific citations to the record.

(2) Exceptions shall be provided to all parties by facsimile or electronic mail, if a facsimile number or e-mail address has been provided number or address provided, the day they are filed with the agency.

(3) Any party may file responses to another party's exceptions within 10 days from the date the exceptions were filed with the agency.

(4) No additional time shall be added to the time limits for filing exceptions or responses to exceptions when service has been made by mail.

28 FAC 106.301 | Initiation of Proceedings

(1) Unless otherwise provided by statute and except for agency enforcement and disciplinary actions initiated under subsection 28-106.2015(1), F.A.C., initiation of a proceeding shall be made by written petition to the agency responsible for rendering final agency action. The term "petition" includes any document which requests a proceeding. Each petition shall be legible and on 8 1/2 by 11 inch white paper or on a form provided by the agency. Unless printed, the impression shall be on one side of the paper only and lines shall be doubled-spaced.

(2) All petitions filed under these rules shall contain:
(a) The name and address of each agency affected and each agency's file or identification number, if known;

(b) The name, address, any email address, and telephone number of the petitioner, if the petitioner is not represented by an attorney or qualified representative; the name, address, email address, facsimile number, and telephone number of the petitioner's representative; if any, which shall be the address for service purposes during the course of the proceeding;

(c) An explanation of how the petitioner's substantial interests will be affected by the agency determination;

(d) A statement of when and how the petitioner received notice of the agency decision;

(e) A concise statement of the ultimate facts alleged, including the specific facts the petitioner contends warrant reversal or modification of the agency's proposed action;

(f) A statement of the specific rules or statutes that the petitioner contends require reversal or modification of the agency's proposed action;

(g) A statement of the relief sought by the petitioner, stating precisely the action petitioner wishes the agency to take with respect to the agency's proposed action; and

(h) A statement that no material facts are in dispute.

28 FAC 106.302 | Notice of Proceeding

(1) The agency shall serve written notice on all parties at their address of record, allowing at least 14 days from the date of the notice for the parties to provide any documents, memorandum of law, or other written material in support of or opposition to the agency action or refusal to act or in aggravation or mitigation of any penalty which may be imposed. If only written evidence is submitted, the notice shall provide that all other parties shall have 14 days to respond in writing to that written evidence.

(2) The agency may schedule a hearing on the matter for the purpose of taking oral evidence or argument. If it does so, the agency shall serve written notice at least 14 days prior to the hearing, setting forth the place, date, time of the hearing, and legal authority and jurisdiction under which the hearing is to be held.

28 FAC 106.303 | Motions

(1) All requests for relief shall be by motion. All motions shall be in writing unless made on the record during a hearing and shall fully state the action requested and the grounds relied upon. The original motion shall be filed with the presiding officer. When time allows, the other parties may, within seven days of service of a written motion, file a response in opposition. No reply to the response shall be permitted unless leave is sought from and given by the presiding officer. Written motions will normally be disposed of after the response period has expired, based on the motion, together with any supporting or opposing memoranda. The presiding officer shall conduct proceedings and enter such orders as are deemed necessary to dispose of issues raised by the motion.

(2) All motions, other than a motion to dismiss, shall include a statement that the movant has conferred with all other parties of record and shall state whether any party has an objection to the motion.

(3) Motions for extension of time shall be filed prior to the expiration of the deadline sought to be extended and shall state good cause for the request.

28 FAC 106.304 | Continuances

28 FAC 106.305 | Conduct of Proceedings

28 FAC 106.306 | Recordation

(1) Responsibility for preserving the testimony at final hearings shall be that of the agency responsible for taking final agency action. Proceedings shall be recorded by a certified court reporter or by recording instruments.

(2) Any party to a hearing may, at its own expense, provide a certified court reporter if the agency does not. The presiding officer may provide a certified court reporter. At hearings reported by a court reporter, any party who wishes a transcript of the testimony shall order the same at its own expense. If a court reporter records the proceedings, the recordation shall become the official transcript.

28 FAC 106.307 | Post-Hearing Submittals

28 FAC 106.401 | Purpose

This rule applies to all mediation proceedings conducted pursuant to Section 120.573, F.S.
(1) Mediation is a process whereby a third person acts to encourage and facilitate a resolution of an administrative dispute, without prescribing what the resolution should be. Mediation is an informal and nonadversarial process with the objective of helping the parties reach a mutually acceptable agreement.

(2) Mediation proceedings are available to settle administrative disputes if provided for in the announcement of agency actions. If an agreement to mediation by the agency and all parties is filed within 10 days of the announcement for election of an administrative remedy under Sections 120.569 and 120.57, F.S., the time limitations shall be tolled until the completion of the mediation with settlement or impasse.

28 FAC 106.402 | Contents of Request for Mediation

28 FAC 106.403 | Allocation of Costs and Fees

28 FAC 106.404 | Contents of Agreement to Mediate

The agreement to mediate shall set forth:
(1) The names, addresses, any e-mail address, and telephone numbers of any persons who may attend the mediation;

(2) The name, address, e-mail address, and telephone number of the mediator agreed to by the parties;

(3) How the costs and fees associated with mediation will be allocated;

(4) The agreement of the parties regarding the confidentiality of discussions and documents introduced during mediation to the extent authorized by law;

(5) The date, time, and place of the first mediation session;

(6) The name of the party's representative who shall have authority to settle or recommend settlement; and

(7) The signatures of the parties.

28 FAC 106.405 | Standards of Conduct for Mediators

(1) Mediators shall adhere to the highest standards of integrity, impartiality, and professional competence.

(2) On commencement of the mediation session, a mediator shall inform all parties that the process is consensual in nature, that the mediator is an impartial facilitator, and that the mediator may not impose or force any settlement on the parties.

(3) A mediator shall:
(a) Perform the mediation services in a timely and expeditious fashion, avoiding delays wherever possible;

(b) Be impartial and advise all parties of any circumstances bearing on possible bias, prejudice, or impartiality; and

(c) Withdraw from mediation if the mediator believes the mediator can no longer be impartial.
(4) A mediator shall not:
(a) Coerce or unfairly influence a party into a settlement agreement and shall not make substantive decisions for any party to a mediation process;

(b) Intentionally or knowingly misrepresent material facts or circumstances in the course of conducting a mediation; or

(c) Give or accept a gift, request, favor, loan, or any other item of value to or from a party, attorney, or any other person involved in, or associated with any person involved in, the mediation process.

28 FAC 106.501 | Emergency Action

(1) If the agency finds that immediate serious danger to the public health, safety, or welfare requires emergency action, the agency shall enter an emergency order summarily suspending, limiting, or restricting a license, or taking such other emergency action as is authorized by law.

(2) The agency's emergency order shall include a notice of the licensee's (or person or entity subject to the agency's jurisdiction) right to an immediate appeal of the emergency final order pursuant to Section 120.569(2)(n) or 120.60(6), F.S.

(3) In the case of the emergency suspension, limitation, or restriction of a license, unless otherwise provided by law, within 20 days after emergency action taken pursuant to subsection (1) of this rule, the agency shall initiate administrative proceedings in compliance with Sections 120.569, 120.57 and 120.60, F.S. and Rule 28-106.2015, F.A.C.

28 FAC 106.601 | Conflict


28 Part 107
Licensing

28 FAC 107.001 | General (Repealed)

28 FAC 107.002 | Application for License (Repealed)

28 FAC 107.003 | Denial of License (Repealed)

28 FAC 107.004 | Suspension, Revocation, Annulment, or Withdrawal (Repealed)

28 FAC 107.005 | Emergency Action (Repealed)


28 Part 108
Exception to Uniform Rules of Procedure

28 FAC 108.001 | Petition for Exception to Uniform Rules of Procedure

(1) The agency head shall file a petition with the Administration Commission for an exception to the Uniform Rules of Procedure as provided in Section 120.54(5)(a)2., F.S., for procedural rules within the scope of any Uniform Rule of Procedure that includes the following:
(a) Grounds for the request for the exception.

(b) Citation to the particular Uniform Rule of Procedure for which each exception is sought.

(c) Specific citation to the provisions of existing agency rule for which an exception is sought, if any.

(d) Attachment of the proposed rule language as an exhibit to the petition.
(2) The agency shall publish notice of the petition in the next available edition of the Florida Administrative Register, after consultation with the agency clerk of the Administration Commission. The notice shall include:
(a) The name of the agency seeking an exception;

(b) The uniform rule of procedure from which the exception is sought;

(c) The date the matter is expected to be heard by the Administration Commission;

(d) The contact name, address, e-mail address, and phone number where a copy of the petition may be obtained.
(3) The Administration Commission shall provide interested persons with the opportunity to file written statements or make oral presentations in support of or in opposition to the exception.

28 FAC 108.002 | Final Disposition on Petition for Exception


28 Part 109
Conducting Proceedings by Communications Media Technology

28 FAC 109.001 | Purpose

28 FAC 109.002 | Definitions as Used in this Rule Chapter

(1) "Access point" means a designated place where a person interested in attending a communications media technology proceeding may go for the purpose of attending the proceeding.

(2) "Attend" means having access to the communications media technology network being used to conduct a proceeding, or being used to take evidence, testimony, or argument relative to issues being considered at a proceeding.

(3) "Communications media technology" (CMT) means the electronic transmission of printed matter, audio, full-motion video, freeze frame video, compressed video, and digital video by any method available.

28 FAC 109.003 | Application and Construction

28 FAC 109.004 | Government in the Sunshine

(1) Nothing in this chapter shall be construed to permit the agency to conduct any proceeding otherwise subject to the provisions of Section 286.011, F.S., exclusively by means of CMT without making provision for the attendance of any member of the public who desires to attend.

(2) No proceeding otherwise subject to Section 286.011, F.S., shall be conducted exclusively by means of CMT if the available technology is insufficient to permit all interested persons to attend. If during the course of a CMT proceeding technical problems develop with the communications network that prevent interested persons from attending, the agency shall terminate the proceeding until the problems have been corrected.

28 FAC 109.005 | Notice

When the agency chooses to conduct a CMT proceeding, it shall provide notice in the same manner as required for a non-CMT proceeding, and shall plainly state that such proceeding is to be conducted utilizing CMT and identify the specific type of CMT to be used. The notice shall describe how interested persons may attend and shall include:
(1) The address or addresses of all access points, specifically designating those which are in locations normally open to the public.

(2) The address of each access point where an interested person may go for the purpose of attending the proceeding.

(3) An address, e-mail address, and telephone number where an interested person may write or call for additional information.

(4) An address, e-mail address, and designated person to whom a person may submit written or other physical evidence which he or she intends to offer into evidence during the CMT proceedings.

28 FAC 109.006 | Evidence, Testimony, and Argument

(1) Any evidence, testimony, and argument which is offered utilizing CMT shall be afforded equal consideration as if it were offered in person, and shall be subject to the same objections.

(2) In situations where sworn testimony is required by the agency, persons offering such testimony shall be responsible for making appropriate arrangements for offering sworn testimony.

28 Part 110
Bid Protests

28 FAC 110.001 | Purpose and Scope

(1) This chapter supplements the statutes on protests that arise from the contract procurement process under Chapters 24, 255, 287, 334 through 349 and Sections 282.303 through 282.313, F.S., and other statutes applicable to agencies as defined in Section 120.52(1), F.S.

(2) Policies and procedures are established primarily by Section 120.57(3), F.S. Interested persons must follow the requirements of those statutes as well as these rules. Other statutes may apply to specific circumstances.

28 FAC 110.002 | Definitions

For purposes of this subchapter, the following terms mean:
(1) "Contract procurement process" has the same meaning as "contract solicitation or award process" as used in Section 120.57(3), F.S. This includes procurements by invitation to bid (ITB), request for proposal (RFP), or invitation to negotiate (ITN), as each is defined in Section 287.012, F.S., approval of a single source procurement, as defined in Section 287.057(5)(c), F.S., or other solicitation documents as permitted by law.

(2) "Decision or intended decision" means:
(a) The contents of a solicitation, including addenda;

(b) A determination that a specified procurement can be made only from a single source;

(c) Rejection of a response or all responses to a solicitation; or

(d) Intention to award a contract as indicated by a posted solicitation tabulation or other written notice.
(3) "Competitive solicitation" or "solicitation" shall have the meaning ascribed in Section 287.012(97), F.S.

(4) "Electronic posting" shall have the meaning ascribed in Section 287.012(11), F.S.

28 FAC 110.003 | Notice of Protest

(1) A notice of protest shall be addressed to the office that issued the solicitation or made any other decision that is intended to be protested; shall identify the solicitation by number and title or any other language that will enable the agency to identify it; and shall state that the person intends to protest the decision. If a bond is required, it shall not be filed with the notice unless otherwise required by law.

(2) A notice of protest shall not be filed before the 72-hour period begins. The 72-hour period begins upon electronic posting of a decision or intended decision. The notice of protest must be received by the agency before the 72-hour period expires. The notice of protest must be filed with the agency clerk unless otherwise designated by the solicitation.

(3) The 72-hour period is not extended by service of the notice of protest by mail.

28 FAC 110.004 | Formal Written Protest

(1) The "formal written protest" required by Section 120.57(3)(b), F.S., is a petition that states with particularity the facts and law upon which the protest is based. The formal written protest shall contain the information specified in Section 120.54(5)(b)4., F.S., and in subsection 28-106.201(2), F.A.C. If the formal written protest is filed in proper form within the 72-hour period for filing a notice of protest, the formal written protest will also constitute the notice of protest. Thereafter, all time limits relative to formal written protests apply.

(2) Form of Petition.
STATE OF FLORIDA
DEPARTMENT OF ______
XYZ CORPORATION, a corporation organized under the laws of Florida,
Petitioner,
vs. Case No.:_____
STATE OF FLORIDA DEPARTMENT OF _____
Respondent.
_____/

PETITION

XYZ Corporation, a corporation organized under the laws of Florida, brings this petition against State of Florida Department of __________ and alleges:
1. This is a bid protest under Section 120.57(3), F.S.

2. Respondent issued an invitation to bid (ITB) entitled Bid No. _________.

3. Petitioner submitted the low bid but Respondent rejected its bid for the stated reason that _________.

4. The stated reason for rejection is erroneous because _________.

5. (Additional relevant facts, if any)

6. The facts that are in dispute between Petitioner and Respondent are: _________

7. A copy of the bid tabulation is attached.

8. (Applicable points of law.)
Petitioner requests a hearing involving disputed issues of material fact and an order awarding the contract to Petitioner (or other relief).

(Note: If the relevant facts are not in dispute the petition should so allege and request a hearing not involving disputed issues of material fact. The above allegations are illustrative. They should be altered to suit varying circumstances).
(3) The time allowed for filing a petition or a bond is not extended by mailing either document.

28 FAC 110.005 | Bond

(1) Bid protest bonds are required by Section 287.042(2)(c), F.S., for procurements under Chapter 287, F.S. (commodities, contractual services, professional services and insurance) and by Section 255.25(3)(c), F.S., for procurements of leases of space in privately owned buildings. Bonds are not required for protests involving building construction projects undertaken pursuant to Chapter 255, F.S., except that Section 255.0516, F.S., authorizes school boards, community college boards of trustees and a state university board of trustees to require bonds under some circumstances. Bonds are also required by Section 337.11(5)(a), F.S., for certain procurements by the Department of Transportation.

(2) Bonds required by Section 337.11(5)(a), F.S., must be filed with the notice of protest. Other bonds are not to be filed with the notice of protest, but must be filed with the formal written protest or within the 10-day period allowed for filing the formal written protest. The bond must accompany a protest filed pursuant to Section 24.109(2)(a), F.S. A bond can be in substantially the following form:

STATE OF FLORIDA ADMINISTRATION COMMISSION PROCUREMENT PROTEST BOND

Bond Number:_________
Contract Number: _________
KNOW ALL PERSONS BY THESE PRESENTS:
That we, _________ a (mark one) [ ] corporation, [ ] partnership, [ ] proprietorship, organized and existing under the laws of the State of _________, and having its principal place of business at _________, as PRINCIPAL; and _________, a surety company, organized under the laws of the State of _________, and duly authorized to do business in the State of Florida, whose principal place of business is _________, as SURETY, are held and firmly bound unto the STATE OF FLORIDA, (Agency), as OBLIGEE, in the amount of $_________ for the payment of which sum we, as Principal and Surety, bind ourselves, our heirs, personal representatives, successors and assigns, jointly and severally.

THIS BOND is issued under the provisions of _________ Florida Statutes. The above-named Principal has initiated an administrative protest regarding the Obligee's decision or intended decision pertaining to (mark one) [ ] Bid Number _________ [ ] an agency's request for approval of an exceptional purchase of _________ submitted by _________. Said protest is conditioned upon the posting of a bond at the time of filing the formal written protest.

NOW, THEREFORE, the condition of this Bond is that if the Principal, after the administrative hearing process and/or any appellate court proceedings regarding the protest, shall satisfy all costs and charges allowed by final order and/or judgment, and interest thereon, in the event the Obligee prevails, then the obligation shall be null and void; otherwise it shall remain in full force and effect.

The Obligee may bring an action in a court of competent jurisdiction on this bond for the amount of such liability, including all costs and attorneys' fees.
PRINCIPAL:____________________________
BY:____________________________
Title:____________________________ (CORPORATE SEAL)
ATTEST:____________________________
____________________________
SURETY:____________________________
BY:____________________________
Title:____________________________ (CORPORATE SEAL)
Florida Resident Agent:____________________________
(Note: Power of Attorney showing authority of Surety's agent or Attorney in Fact must be attached).
Bonds must be countersigned by an agent licensed in Florida. Section 287.042(2)(c), F.S., authorizes a cashier's check or money order in lieu of a bond, for procurements governed by Chapter 287, F.S.
(3) When a bond is required, a notice of decision or intended decision shall contain this statement:
"Failure to file a protest within the time prescribed in Section 120.57(3), F.S., or failure to post the bond or other security required by law within the time allowed for filing a bond shall constitute a waiver of proceedings under Chapter 120, F.S."
If the notice advises of the bond requirement but a bond or statutorily authorized alternate is not posted when required, the agency shall summarily dismiss the petition.

(4) If, at the conclusion of the proceeding and any appellate proceedings, the petitioner prevails, the agency shall return the bond, cashier's check or money order to the petitioner. If the agency prevails but the petitioner is not ordered to pay costs, the agency shall return the bond or alternate security to the petitioner. If the petitioner is ordered to pay costs, the agency shall return the bond or alternate security as provided by Section 255.25(3)(c), 287.042(2)(c) or 337.11(5)(b), F.S. The entire bond may be forfeited if circumstances warrant under Section 337.11(5)(a), F.S.

28 Part 111
Court Cost for Court Facilities

28 FAC 111.001 | Receipt and Investment of Funds (Repealed)

28 FAC 111.002 | Expenditure of Funds (Repealed)

28 FAC 111.003 | Accounting and Reporting (Repealed)


28 Part 112
Exception to Uniform Rules Relating to State Employment

28 FAC 112.001 | Petition for Exception to Uniform Rules Relating to State Employment

(1) The agency head shall file a petition with the Administration Commission for an exception to uniform rules as provided in Sections 110.201(1)(b) and 110.217, F.S., that includes the following:
(a) Grounds for the request for the exception.

(b) Citation to the particular uniform rule for which each exception is sought.

(c) Specific citation to the provisions of existing agency rule for which an exception is sought, if any.

(d) Attachment of the proposed rule language as an exhibit to the petition.
(2) The agency shall publish notice of the petition in the next available edition of the Florida Administrative Register, after consultation with the agency clerk of the Administration Commission. The notice shall include:
(a) The name of the agency seeking an exception;

(b) The uniform rule from which the exception is sought;

(c) The date the matter is expected to be heard by the Administration Commission; and

(d) The contact name, address, e-mail address, and phone number where a copy of the petition may be obtained.
(3) The Administration Commission shall provide interested persons with the opportunity to file written statements or make oral presentations in support of or in opposition to the exception.

28 FAC 112.002 | Final Disposition on Petition for Exception


69H Part 1
State Risk Management Trust Fund

69H FAC 1.001 | Purpose (Repealed)

69H FAC 1.002 | Premium Assessments

(1) Premium assessments shall be paid within thirty days from date of invoice/billing, or coverage may be suspended by reasonable notice.

(2) In the event budgeted funds are not adequate to pay all claims for the current budget year, the Division of Risk Management may submit an interim premium assessment to the agency during the fiscal year in which the deficit occurs and the additional charge will be payable on receipt of invoice.

(3) Within 30 days of notification by the Division of Risk Management, agencies and universities shall make annual property value updates through the Division of Risk Management Insurance Management System at https://live.origamirisk.com/.

69H FAC 1.003 | Certificate and Other Forms Adopted (Repealed)

Rulemaking AuthorityLaw ImplementedHistory
284.17 FS.255.03(1), 284.01 FS.New , Formerly 4-29.04, 4-29.004, Amended , , , , Formerly 4H-1.003, Amended , , Repealed .

69H FAC 1.004 | Renewals

69H FAC 1.005 | Automatic Coverage and Certificate of Coverage

(1) Automatic coverage will be provided on any acquired risk for a period of thirty days during which time formal application must be made on Form DFS-D0-850, Coverge Request Form, (Effective 09/2022), which is hereby incorporated by reference and available through the Division of Risk Management Insurance Management System at https://live.origamirisk.com/ or at http://www.flrules.org/Gateway/reference.asp?No=Ref-15370, for buildings and contents.

(2) A Certificate of Coverage, Form DFS-D0-852, Certificate of Property Coverage, (Effective 09/2022), which is hereby incorporated by reference and available at https://myfloridacfo.com/Division/Risk/ or http://www.flrules.org/Gateway/reference.asp?No=Ref-15371, will be issued initially upon acceptance and then annually thereafter.

(3) When required by the specific circumstances of the risk involved, Form DFS-D0-853, Certificate of Rental Value Coverage, (Effective 09/2022), which is hereby incorporated by reference and available at https://myfloridacfo.com/Division/Risk/ or http://www.flrules.org/Gateway/reference.asp?No=Ref-15372, will be attached and made a part of the Certificate of Coverage.

69H FAC 1.006 | Losses

The insured must notify the Fund of all losses electronically through the Division of Risk Management Insurance Management System on Form DFS-D0-854, Notice of Property Loss, (Effective 09/2022), which is hereby incorporated by reference and available at https://live.origamirisk.com/ or http://www.flrules.org/Gateway/reference.asp?No=Ref-15373.

69H FAC 1.007 | Settlement of Losses

(1) Losses are to be settled on an actual cash value (ACV) basis of the damaged property that has been replaced with property of like kind and quality; or pay the cost of repairing; whichever is less. Actual cash value for the building and contents is defined as replacement cost less depreciation.

(2) Lightning losses will require submission of Form DFS-D0-855, Statement – Lightning Losses, (Effective 09/2022), which is hereby incorporated by reference in addition to the standard documentation for a claim. A copy of the form is available at https://myfloridacfo.com/Division/Risk/ or http://www.flrules.org/Gateway/reference.asp?No=Ref-15374.

(3) When final settlement of a claim is agreed to, the claims coordinator will sign and return Form DFS-D0-856, Certificate of Proof of Loss, (Effective 09/2022), which is hereby incorporated by reference, to the Division of Risk Management. A copy of the form is available at https://myfloridacfo.com/Division/Risk or http://www.flrules.org/Gateway/reference.asp?No=Ref-15375.

69H FAC 1.008 | Building Replacement Value (Repealed)

69H Part 2
State Risk Management Trust Fund, State Casualty Claims

69H FAC 2.001 | Purpose

69H FAC 2.002 | Coverage Exclusion

69H FAC 2.003 | Premium Assessments

(1) Premiums will be charged to insured agencies based on exposure to loss and loss experience. Premium invoices will be mailed to the agency on or about July 1 of each year and the invoice shall be paid within 30 days from the date of budget release of funds or coverage may be suspended after reasonable notice.

(2) In the event budgeted funds are not adequate to pay all claims for the current budget year, the Division of Risk Management (Division) may submit an interim premium assessment to the agency during the fiscal year in which the deficit occurs and the additional charge will be payable on receipt of invoice.

(3) Prior to July 1 of each budget year the Division will send to each insured agency a request to complete the Exposure Base Inquiry Survey to determine risk exposure. Insured agencies shall complete the Exposure Base Inquiry Survey, DFS-D0-861 (Effective 07/23), in the Division’s Insurance Management System at https://live.origamirisk.com/ within 30 days of notification. The Exposure Base Inquiry Survey, DFS-D0-861, is incorporated by reference herein, and a copy of the form is available at https://myfloridacfo.com/Division/Risk/ or http://www.flrules.org/Gateway/reference.asp?No=Ref-15493.

(4) Prior to July 1 of each budget year the Division will send Form DFS-D0-1401, Account Design (Effective 07/23), to each insured agency to determine the cost center structure for recording claims. Form DFS-D0-1401 is incorporated by reference herein, and a copy of the form is available at https://myfloridacfo.com/Division/Risk/ or http://www.flrules.org/Gateway/reference.asp?No=Ref-15486. Each agency shall complete the form and return it to the Division within thirty (30) days.

69H FAC 2.004 | Certificate of Coverage

(1) The Department shall adopt and use a Certificate of Coverage form indicating the insured agency and the coverage provided by the Fund.

(2) Form DFS-D0-867, “State Employee Workers’ Compensation and Employer’s Liability Certificate of Coverage,” (Effective 07/23), incorporated herein by reference, will be used to provide employee workers’ compensation and employer’s liability coverage to the agency named on the certificate. A copy of the form is available at http://www.flrules.org/Gateway/reference.asp?No=Ref-15485.

(3) Form DFS-D0-863, “General Liability Certificate of Coverage,” (Effective 07/23), incorporated herein by reference, will be used to provide general liability insurance coverage to the agency named on the certificate. A copy of the form is available at http://www.flrules.org/Gateway/reference.asp?No=Ref-15482.

(4) Form DFS-D0-864, “Automobile Liability Certificate of Coverage,” (Effective 07/23), incorporated herein by reference, will be used to provide fleet automobile liability coverage to the agency named on the certificate. A copy of the form is available at http://www.flrules.org/Gateway/reference.asp?No=Ref-15483.

(5) Form DFS-D0-864A, “State Risk Management Trust Fund Addendum to Automobile Liability Certificate of Coverage for Off-Duty Law Enforcement Vehicle Property Damage,” (Rev. 11/05), incorporated herein by reference, will be used to provide an addendum to automobile liability coverage to the agency named on the certificate.

(6) Form DFS-D0-865, “Federal Civil Rights Liability and Employment Discrimination Certificate of Coverage,” (Effective 07/23), incorporated herein by reference, will be used to provide coverage for federal civil rights actions under 42 U.S.C. 1983 or similar federal statutes to the agency named on the certificate. A copy of the form is available at http://www.flrules.org/Gateway/reference.asp?No=Ref-15494.

(7) Form DFS-D0-862, “Court Awarded Attorney Fees Certificate of Coverage,” (Rev. 11/05), incorporated herein by reference, will be used to provide coverage for court awarded attorney’s fees in other proceedings against the agency named on the certificate.

(8) Form DFS-D0-1994, Firefighter Cancer Benefits Certificate of Coverage, (Effective 07/23), incorporated herein by reference, will be used to provide coverage for firefighter cancer benefits payable under Section 112.1816(2), F.S. A copy of the form is available at http://www.flrules.org/Gateway/reference.asp?No=Ref-15492.

(9) Copies of these forms are available from the Division of Risk Management, Department of Financial Services, 200 East Gaines Street, Tallahassee, FL 32399-0337, or at https://myfloridacfo.com/Division/Risk/.

69H FAC 2.006 | Notice of Settlement

(1) Any notice of tort claim settlement which may be required to be given to the public as provided under Section 69.081(9), F.S., shall be provided in substantially the following format:
(STYLE OF CASE)
Plaintiff(s)

vs.

Defendant(s)
Name of agency and/or Officials
)
)
)
)
)
)
)
)
Name of Court & Location

Case Number

NOTICE OF SETTLEMENT

Notice is hereby given that the above referenced parties have entered into a settlement of the plaintiff’s tort claims(s) against the defendant(s), for the total amount of $________.
Representative or Attorney for
Defendant(s)
Address
(2) For those claims in which the state agency is being represented by defense counsel, such counsel shall sign and submit the notice to the appropriate newspaper for publication. When no defense counsel is involved, a representative of the Division of Risk Management shall sign the notice. The notice required by Section 69.081(9), F.S., shall be provided within sixty (60) days of the completion of any transactions necessary to finalize the settlement, such as exchange and receipt of documents and payments between the parties involved in the claim.

69H FAC 2.007 | Loss Prevention Programs

(1) The head of each insured agency shall appoint a Safety Coordinator who shall, at the direction of the agency head, develop and implement a comprehensive departmental safety program. The appointment shall be on Form DFS-D0-858, “Safety Coordinators Appointment Form,” (Effective 07/23) incorporated herein by reference. In the event of a change in either the Safety Coordinator or the Alternate Safety Coordinator, the agency head shall submit an updated Form DFS-D0-858, Safety Coordinator Appointment Form, (Effective 07/23), with the name of both the new Safety Coordinator and Alternate Safety Coordinator within thirty (30) days of the change. A copy of the form is available at https://myfloridacfo.com/Division/Risk/ or http://www.flrules.org/gateway/reference.asp?no=ref-15480.

(2) Pursuant to section 284.50(3), F.S., if an agency is required to maintain a return-to-work program, the agency shall review and complete the return-to-work dashboard report provided by the Division on a monthly basis to identify information on employees being accommodated with modified or alternate duty. The Division will provide the report to the agency no later than the 5th business day of each month. The completed dashboard shall be returned to the Division no later than the last Friday of each month.

(3) The appointed Safety Coordinator of each insured agency shall review and respond within 10 business days of receipt to each DFS-D0-1993, Claim Investigation Report, (Effective 07/23), incorporated herein by reference, provided by the Division identifying unsafe or inappropriate conditions, policies, procedures, trends, equipment, or actions or inactions that have led or may lead to accidents or claims involving the state of Florida. A copy of the form is available at https://myfloridacfo.com/Division/Risk/ or http://www.flrules.org/gateway/reference.asp?no=ref-15495.

69H FAC 2.008 | Other Forms Adopted

(1) The following forms are incorporated herein by reference. These forms shall be used to aid the Division in the performance of its administrative duties by securing pertinent facts and information on claims filed against the Fund, as the circumstances of particular cases may require.
(a) DFS-D0-280, Release of All Claims, (Effective 07/23), http://www.flrules.org/Gateway/reference.asp?No=Ref-15477;

(b) DFS-D0-866, “Mileage Reimbursement,” (Effective 07/23), http://www.flrules.org/Gateway/reference.asp?No=Ref-15484;

(c) DFS-D0-1403, “General Liability Loss Report,” (Effective 07/23), http://www.flrules.org/Gateway/reference.asp?No=Ref-15487;

(d) DFS-D0-1404, “Lien Disclosure Statement,” (Rev. 11/05);

(e) DFS-D0-1406, “Insurer’s Disclosure Statement Pursuant to Section 627.4137, F.S.,” (Rev. 11/05);

(f) DFS-D0-1407, “Medical Authorization,” (Rev. 2/10);

(g) DFS-D0-1408, Release for Property Damage Only (Effective 07/23) http://www.flrules.org/Gateway/reference.asp?No=Ref-15488.

(h) DFS-D0-1990, “Medicare Secondary Payer Reporting Questionnaire,” (Effective 07/23) http://www.flrules.org/Gateway/reference.asp?No=Ref-15489;

(i) DFS-D0-1991, “Medicare Beneficiary/Eligibility Information,” (Effective 07/23) http://www.flrules.org/Gateway/reference.asp?No=Ref-15490; and,

(j) DFS-D0-1992, Firefighter Cancer Benefit Information Form (Effective 07/23), http://www.flrules.org/Gateway/reference.asp?No=Ref-15491.
(2) Copies of each form adopted and incorporated by reference in this rule chapter are available from the Division of Risk Management, Department of Financial Services, 200 East Gaines Street, Tallahassee, Florida 32399-0336, or at https://myfloridacfo.com/Division/Risk/.

69H FAC 2.009 | Florida Motor Vehicle No-Fault Forms

(1) The following forms are incorporated herein by reference. These forms shall be used to aid the Division in the performance of its administrative duties by securing pertinent facts and information on Florida Motor Vehicle No-Fault claims filed against the Fund, as the circumstances may require:
(a) DFS-D0-281, “Claim for ‘No-Fault’ Benefits,” (Effective 07/23), http://www.flrules.org/Gateway/reference.asp?No=Ref-15478.

(b) DFS-D0-283, “Wage and Salary Verification,” (Effective 07/23), http://www.flrules.org/Gateway/reference.asp?No=Ref-15479.
(2) Copies of these forms are available from the Division of Risk Management, Department of Financial Services, 200 East Gaines Street, Tallahassee, Florida 32399-0300, or at https://myfloridacfo.com/Division/Risk/.

69H FAC 2.010 | Property Damage Coverage for State-Owned Vehicles

(1) The following definitions shall apply to the property damage coverage established in this rule:
(a) “Accidental loss” – A loss that is unintended by a law enforcement officer covered by this rule.

(b) “Actual cash value” – Replacement cost minus depreciation.

(c) “At fault” – A law enforcement officer shall be deemed “at fault” if the “contributing cause” code on a Florida Traffic Crash Report, Long Form, is anything other than code “01,” no improper driving action.

(d) “Motor vehicle” – Any self-propelled vehicle with two or more wheels, which is of a type both designed and required to be licensed for use on the highways of this state and any trailer or semi trailer designed for use with such vehicle. The term includes a “private passenger motor vehicle,” which is any motor vehicle which is a sedan, station wagon, or jeep-type vehicle and, if not used primarily for occupational, professional or business purposes, a motor vehicle of the pickup, panel, van, camper, or motor home type. The term also includes a “commercial motor vehicle,” which is any motor vehicle that is not a private passenger motor vehicle. The term does not include a mobile home or any motor vehicle which is used in mass transit, other than public school transportation, and designed to transport more than five passengers exclusive of the operator of the motor vehicle and which is owned by a municipality, a transit authority, or a political subdivision of the State.

(e) “Property damage” – Physical damage to the covered motor vehicle due to collision or impact with another vehicle or object or due to other accidental loss.
(2) Coverage Provided.
(a) The State Risk Management Trust Fund will pay for property damage to a motor vehicle owned by a state agency when this property damage occurs while the motor vehicle is being used by a law enforcement officer, as defined in Section 943.10, F.S., for off-duty work for which the officer must reimburse the state, subject to the exclusions and deductible amounts, as defined in paragraphs (2)(d) and (2)(e) of this rule. The Fund will pay reasonable repair costs or the actual cash value of the vehicle whichever is less.

(b) If an independent appraisal of the property damage is required, the Fund will pay for this expense. If the accidental loss results in the motor vehicle being declared a total loss, the Fund will pay the state agency the actual cash value of the motor vehicle, minus any applicable deductible amounts, and the Fund shall retain the salvage value of the motor vehicle.

(c) The Fund will reduce the payments for property damage to the state agency by any applicable deductible amount when the law enforcement officer is determined to be at fault in causing property damage to the motor vehicle.

(d) Any proceedings to appeal the determination of fault will be pursued with the employing agency.

(e) Exclusions: The Fund will not pay for property damage if:
1. The law enforcement officer was not in the course and scope of approved off-duty activities when the property damage occurred;

2. The law enforcement officer is found to have acted in bad faith, with malicious purpose, or in a manner exhibiting wanton and willful disregard of human rights, safety or property;

3. The law enforcement officer does not have to reimburse the State for use of the motor vehicle;

4. The property damage is due to wear and tear or mechanical breakdown;

5. The property damaged is equipment owned by the State and unattached to the motor vehicle; or

6. The property damaged is the personal property of the law enforcement officer.
(f) Limit of Liability: The Fund’s limit of liability will be the lesser of the actual cash value of the damaged property or an amount necessary to repair or replace the property with other property of like kind and quality. An adjustment for depreciation and physical condition will be made in determining actual cash value in the event of a total loss. If a repair or replacement results in better than like kind and quality, the Fund will not pay for the betterment.

(g) Secondary coverage: The coverage set forth in this rule is secondary to any primary coverage available from any other source. A claim must first be presented under all existing primary coverages available to the claimant, after which a claim under this rule may be made.
(3) Premium Assessments and Reimbursement.
(a) The Division will determine the exposure base for the calculation of costs of providing physical damage coverage according to the number of law enforcement officers using state motor vehicles while performing off-duty employment.

(b) The Division will determine the experience base by the dollar amount paid on claims.

(c) Each state agency shall, no later than July 1 each fiscal year, report to the Division the estimated number of law enforcement officers using state motor vehicles while performing their off-duty employment for the upcoming fiscal year. A state agency shall use Form DFS-D0-861, “Exposure Base Inquiry Survey,” (Effective 07/23), incorporated by reference in Rule 69H-2.003, F.A.C., in the Division’s Insurance Management System at https://live.origamirisk.com/.

(d) Premium calculation.
1. The Division will calculate the total premium based on agencies’ experience and exposure, except for the first year. Assessment amounts will fluctuate each year depending on exposure and experience criteria.

2. The assessment amount will be the total anticipated cash payments to be made for property damage payments during the fiscal year, plus an additional charge to offset the Division’s operating costs. The Division will calculate this additional charge by multiplying the total anticipated annual property damage payments by an industry average operating cost percentage.

3. The Division will apply any surplus or deficit amounts assessed in the fiscal year, less the administrative portion of the assessment, against the following fiscal year assessment.

4. The Division will assess each state agency according to its proportionate amount of the entire statewide assessment.
(e) Invoices.
1. Each fiscal year, the Division will invoice each state agency for the total amount of its assessment.

2. Each state agency shall pay the assessed amount to the Division within thirty days following the state agency’s receipt of the assessment invoice. Payments will be provided from one of the agencies’ standard operating categories.

3. Each state agency will administer and collect the law enforcement officers’ portion of the agency assessment. The Division shall have no role in this administration and collection. Reimbursements will not be given to officers who leave state employment during the covered fiscal year. The premium is annualized, and will not be prorated for those officers who leave state employment or who request coverage during the covered fiscal year.
(4) Deductible Assessment.
(a) The Division will apply a deductible amount toward the costs of repairs and/or total loss payments, for accidents in which the off-duty officer is determined to be at fault.

(b) The Division will adjust the deductible amount at the beginning of each fiscal year. The amount of the deductible shall not exceed $500 per incident. The Division will notify state agencies of the deductible amount no later than July 1 of each fiscal year.
(5) Claims Processing.
(a) Accidents shall be reported to the Division, using Form DFS-D0-261, “Automobile Accident Report,” (Effective 07/23), incorporated herein by reference. Copies of the form are available from the Division of Risk Management, Department of Financial Services, 200 East Gaines Street, Tallahassee, Florida 32399-0338, or online at https://myfloridacfo.com/Division/Risk/, or http://www.flrules.org/Gateway/reference.asp?No=Ref-15476.

(b) The state agency will submit all supporting documentation for the accident to the Division, including at a minimum the following:
1. The name of the state agency employing the law enforcement officer;

2. A statement certifying that:
a. The employee is a law enforcement officer as defined in Section 943.10, F.S.;

b. The state agency approved the off-duty employment;

c. The law enforcement officer was required to reimburse the agency for use of the motor vehicle; and,

d. The law enforcement officer purchased coverage by payment of a premium for the fiscal year in which the accident occurred, verified by a receipt from the agency showing such payment or a copy of the law enforcement officer’s pay stub showing such payment.
3. If the form described in paragraph (5)(a) of this rule is unavailable, then an opinion as to whether the state agency believes the law enforcement officer was at fault in causing the property damage;

4. Photographs of the vehicle damage if feasible;

5. If other than a total loss of the motor vehicle occurs, then two estimates for vehicle repairs, and invoices for the repairs; and,

6. All available accident reports.
(c) The Division will adjust the claim and issue payment for the repairs to the state agency, according to its Policies and Procedures.

(d) In the event of a total loss claim the Division will dispose of the salvage and retain any salvage value.

(e) The Division will pursue subrogation on claims caused by the negligence of another party, and will retain any funds recouped by it.
69H Part 3
Florida Art and Artifacts Indemnity Program

69H FAC 3.001 | Purpose and Scope

Disclaimer© State of Florida
Rulemaking AuthorityLaw ImplementedHistory
265.53(2), 265.55(1) FS.265.53(2), 265.55(1) FS.New 8-11-83, Formerly 4-55.01, 4-55.001, 4H-3.001, Repealed .

69H FAC 3.002 | Qualification Procedures

Disclaimer© State of Florida
Rulemaking AuthorityLaw ImplementedHistory
265.53(2) FS.265.53(2) FS.New 8-11-83, Formerly 4-55.02, 4-55.002, Formerly 4H-3.002, Repealed .

69H FAC 3.003 | Physical Security of Exhibition Facilities

Disclaimer© State of Florida
Rulemaking AuthorityLaw ImplementedHistory
265.53(2) FS.265.53(2)(a) FS.New 8-11-83, Formerly 4-55.03, 4-55.003, 4H-3.003, Repealed .

69H FAC 3.004 | Transportation of Eligible Items

Disclaimer© State of Florida
Rulemaking AuthorityLaw ImplementedHistory
265.53(2) FS.265.53(2)(a) FS.New 8-11-83, Formerly 4-55.04, 4-55.004, 4H-3.004, Repealed .

69H FAC 3.005 | Qualification of Applicant's Staff

Disclaimer© State of Florida
Rulemaking AuthorityLaw ImplementedHistory
265.53(2) FS.265.53(2)(b) FS.New 8-11-83, Formerly 4-55.05, 4-55.005, Formerly 4H-3.005, Repealed .

69H FAC 3.006 | Eligibility for Commercial Insurance

Disclaimer© State of Florida
Rulemaking AuthorityLaw ImplementedHistory
265.53(2) FS.265.53(2)(c) FS.New 8-11-83, Formerly 4-55.06, 4-55.006, 4H-3.006, Repealed .

69H FAC 3.007 | Environmental Control

Disclaimer© State of Florida
Rulemaking AuthorityLaw ImplementedHistory
265.53(2) FS.265.53(2)(d) FS.New 8-11-83, Formerly 4-55.07, 4-55.007, 4H-3.007, Repealed .

69H FAC 3.008 | Loss Adjustment

Disclaimer© State of Florida
Rulemaking AuthorityLaw ImplementedHistory
265.55(1) FS.265.54(3), 265.55(1) FS.New 8-11-83, Formerly 4-55.08, 4-55.008, 4H-3.008, Repealed .

69H FAC 3.009 | Arbitration and Appraisal

Disclaimer© State of Florida
Rulemaking AuthorityLaw ImplementedHistory
265.55(1) FS.265.55(1) FS.New 8-11-83, Formerly 4-55.09, 4-55.009, 4H-3.009, Repealed .

69N-3 | Smoking Policy

69N FAC 3.001 | Purpose and Scope (Repealed)

69N FAC 3.002 | Definitions (Repealed)

69N FAC 3.003 | Prohibition (Repealed)

69N FAC 3.004 | No-Smoking Areas (Repealed)

69N FAC 3.005 | Action by Office Officials and Employees (Repealed)

69N FAC 3.006 | Posting of Signs (Repealed)

69N FAC 3.007 | Enforcement, Penalties (Repealed)

69N-121 | Departmental Organization and Operations; Rules of Practice and Procedure

69N FAC 121.003 | Organizational Structure of the Office

(1) Under the Commissioner of the Office are hereby established a chief of staff, a general counsel, and deputy commissioners as follows:
(a) Deputy commissioner for property and casualty; and,

(b) Deputy commissioner for life and health.

(c) Deputy commissioner for market regulation.
(2) The general counsel shall also serve as the agency clerk for the Office.

(3) The following organizational units are established within the Office of Insurance Regulation:
(a) Office of Inspector General, which shall be headed by the inspector general.

(b) Office of General Counsel, which shall be headed by the general counsel.

(c) Division of Property and Casualty, which shall include the following business units:
1. Property and Casualty Financial Oversight Bureau.

2. Property and Casualty Product Review Bureau.
(d) Division of Life and Health, which shall include the following business units:
1. Life and Health Financial Oversight Bureau.

2. Life and Health Product Review Bureau.
(e) Division of Market Regulation, which shall include the following business units:
1. Property and Casualty Market Regulation Bureau.

2. Life and Health Market Regulation Bureau.
(4) Each Division shall be headed by a Deputy Commissioner.

(5) Each Bureau shall be headed by a Director.
Disclaimer© State of Florida
Rulemaking AuthorityLaw ImplementedHistory
20.121(3)(b) FS.20.121(3)(b) FS.New , Amended , .

69N FAC 121.007 | Public Records and Availability of Forms: Procedures for Inspecting and Copying Public Records and for Obtaining Office Forms (Repealed)

69N FAC 121.010 | Indexing, Management, and Availability of Final Orders (Repealed)

69N FAC 121.066 | Informal Conferences

(1) Informal Conferences Authorized. The Office head or a hearing officer designated by the Office may order an informal conference prior to a formal or informal proceeding.

(2) Procedures for Conferences Held Pursuant to Section 624.319(1), F.S.
(a) Every insurer will receive a draft of a report of examination (draft report) resulting from an examination under Section 624.316, F.S. The insurer may review the draft report for a period of up to 30 days as determined from the date of the report's receipt by the insurer. If the insurer desires modifications to the draft report, the insurer shall request an informal conference, as permitted by Section 624.319(1), F.S., by writing to the Office no later than 30 days from the date of the report's receipt by the insurer as shown on the return receipt requested card returned to the Office by the U.S. Postal Service. Requests for an informal conference must be directed to: Bureau Chief, (Name of appropriate solvency bureau), Office of Insurance Regulation, Larson Building, 200 East Gaines Street, Tallahassee, Florida. The zip code for the Life and Health bureau is 32399-0327; the zip code for the Property and Casualty bureau is 32399-0329. Requests may be made by facsimile transmission.

(b) Although Section 624.319, F.S., uses the word "hearing" to refer to this meeting, the "hearing" is conducted pursuant to Section 624.324, F.S., and is not within the scope of Chapter 120, F.S. Instead it is an informal conference at which the insurer has an opportunity to resolve disputed provisions of the draft examination report prior to the Office filing the report as a public document. The Office has found that the following procedures are helpful in reaching an informed resolution in a fair and efficient manner. Therefore, an insurer requesting the informal conference shall comply with the requirements of this subsection.
1. The request for an informal conference must contain a specific listing for each point in the draft report for which the insurer requests a modification. The listing for each point must state all of the facts and provide documentation which support the position of the insurer relative to a modification of the report.

2. Due to the varied nature of requests for modifications to a draft report, the informal conference does not have any specific agenda. During the informal conference the insurer may present any information or evidence relative to the facts which it believes will support its position that modification should be made to the draft report.
(c) After reviewing the information and documentation presented at the informal conference, the Office will either: provide a new draft report to the company in accordance with the conditions of Section 624.319(2), F.S.; perform additional field examination work; or notify the company that it intends to file the report as presented in the draft form.

(d) In the absence of a timely request, the Office shall file the draft report as a finalized report and make it a public document.

(e) If disputed points are not settled in the conference, and the Office notifies the company that it intends to file the report and make it a public document as presented in the draft form, the insurer may request a formal hearing to resolve the disputed issues, as provided for under Chapter 120, F.S., and in accordance with the Notice of Rights which are a part of the Office's notification.

69N FAC 121.087 | Fingerprint Fee

Each set of fingerprints filed with the Office of Insurance Regulation shall be accompanied by a processing fee. The processing fee shall be the total of the following amounts:
$25.00 for processing by the Office; and

the fee charged to the Office by the Florida Department of Law Enforcement for its processing of the fingerprint card; and

the fee charged to the Office by the Federal Bureau of Investigation for its processing of the fingerprint card.
69N-127 | Fees and Procedures Regarding Department Information and Services

69N FAC 127.001 | Database Information

69N FAC 127.002 | Cost of Publications

69O-123 | Civil Remedy

69O FAC 123.001 | Purpose (Repealed)

69O FAC 123.002 | Procedure (Repealed)

69O-124 | Anti-Coercion

69O FAC 124.001 | Definitions (Repealed)

69O FAC 124.002 | Rights of Borrower (Repealed)

69O FAC 124.010 | Substitution of Policies (Repealed)

69O FAC 124.011 | Renewals; Selection and Approval (Repealed)

69O FAC 124.013 | Statement of Anti-coercion; Form (Repealed)

69O FAC 124.014 | Continuous or Prepaid Policies (Repealed)

69O FAC 124.015 | Lender, Insurance Information (Repealed)

69O FAC 124.016 | Title Insurance (Repealed)

69O FAC 124.021 | Purpose (Repealed)

69O FAC 124.022 | Scope (Repealed)

69O FAC 124.023 | Qualification for Student Loan Not Contingent on Purchase of Insurance from Insurance Company

Concurrent with the solicitation of an application for an insurance product that is marketed in conjunction with obtaining a student loan from the same insurance company, the insurance company shall provide the applicant with a written disclosure form as provided in Rule 69O-124.024, F.A.C., herein. In the event an applicant refuses to sign the form, the insurance company shall be precluded from selling an insurance policy to the loan applicant unless the company's representative indicates at the bottom of the form that the applicant refuses to sign the form, lists the names of the applicant and the company representative who discussed the form with the applicant, indicates the date the form was discussed with the applicant, and the reason, if any, given by the applicant as to why he or she refuses to sign the form. Each participating insurance company shall maintain said form on file for the life of any and all policies that are written on behalf of the applicant.

69O FAC 124.024 | Disclosure Form

The following disclosure form shall be utilized:

IMPORTANT NOTICE TO APPLICANTS REGARDING STUDENT LOANS OBTAINED THROUGH:
___________ Name of Insurance Company

PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY:
1. IF YOU APPLY FOR A STUDENT LOAN FROM AN INSURANCE COMPANY, THE INSURANCE LAWS OF THIS STATE PROVIDE THAT YOU CANNOT BE REQUIRED TO PURCHASE INSURANCE FROM THE INSURANCE COMPANY IN ORDER TO QUALIFY FOR THE LOAN.

2. THE STANDARDS FOR QUALIFYING FOR A FEDERAL OR STATE GUARANTEED STUDENT LOAN AS WELL AS THE REQUIREMENTS FOR REPAYING EACH LOAN ARE ESTABLISHED BY FEDERAL AND STATE LAW AND YOU MUST MEET THESE STANDARDS REGARDLESS OF WHETHER YOU ALSO DECIDE TO PURCHASE INSURANCE.
I certify that I have read the above statements and that I understand my rights and privileges relative to the purchase of any insurance in connection with my student loan application.

____________________________
Signature of Insurance Applicant

____________________________
Date

69O FAC 124.025 | Readability of Statement

Type sizes for the disclosure statement required in Rule 69O-124.024, F.A.C., herein shall not be less than fourteen (14) point for the heading, twelve (12) point for each of the statements enumerated in the body and eight (8) point for the acknowledgement and signature block. Type style shall be selected with legibility as the primary consideration. The disclosure statement shall appear on a separate sheet of paper with no other text included on the sheet.
69O-125 | Unfair Discrimination

69O FAC 125.001 | Unfair Discrimination Because of Sex or Marital Status

(1) No insurer nor person authorized to engage in the business of insurance in the State of Florida shall refuse to issue any policy, contract or certificate of insurance of annuity contract or shall cancel or decline to renew any policy, contract or certificate of insurance or annuity contract solely because of the sex or marital status of the applicant, insured, policyholder, certificate holder or annuitant; nor shall said insurer or person engaged in the business of insurance in this state provide in such policy, contract or certificate of insurance or annuity contract for the payment of dividends or other benefits of whatever nature or kind, nor provide therein contractual terms or conditions, which based solely upon the sex or marital status of the applicant, insured, policyholder, certificate holder or annuitant, except to the extent the amount of benefits, term, conditions, or type of coverage vary as a result of the application of rate differentials permitted under the Florida Insurance Code. However, nothing in this rule shall prohibit an insurer from taking marital status into account for the purpose of defining persons eligible for dependents' benefits.

(2) This rule does not apply to or affect the right of fraternal benefit societies to determine eligibility requirements for membership. If a fraternal benefit society does, however, admit members of both sexes, this rule is applicable to the insurance benefits available to members thereof.

(3) Specific examples of practices prohibited by this rule include but are not limited to the following:
(a) Denying coverage to females gainfully employed at home, employed part-time or employed by relatives when coverage is offered to males similarly employed.

(b) Denying policy riders to females when the riders are available to males.

(c) Denying maternity benefits to insureds or prospective insureds purchasing an individual contract when comparable family coverage contracts offer maternity benefits.

(d) Denying under group contracts, dependent coverage to husbands of female employees, when dependent coverage is available to wives of male employees.

(e) Denying disability income contracts to employed women when coverage is offered to men similarly employed.

(f) Treating complications of pregnancy differently from any other illness or sickness under the contract.

(g) Restricting, reducing, modifying, or excluding benefits relating to coverage involving the genital organs of only one sex.

(h) Offering lower maximum monthly benefits to women than to men who are in the same classification under a disability income contract.

(i) Offering more restrictive benefit periods and more restrictive definitions of disability to women than to men in the same classifications under a disability income contract.

(j) Establishing different conditions by sex under which the policyholder may exercise benefit options contained in the contract.

(k) Limiting the amount of coverage an insured or prospective insured may purchase based upon the marital status unless such limitation is for the purpose of defining persons eligible for dependents' benefits.
(4) This rule shall be adopted on being filed with the Department of State and shall become effective on January 1, 1978.

69O FAC 125.002 | Unfair Discrimination in Insurance Rates ‒ Multi-policy Discounts (Repealed)

69O FAC 125.003 | Unfair Discrimination Because of Travel Plans

(1) No insurer nor person authorized to engage in the business of insurance in the State of Florida shall refuse to issue or refuse to continue any policy, contract or certificate of insurance of any individual, or limit the amount, extent or kind of insurance coverage offered to an individual, an accident, disability or health insurance policy or certificate, because of the intent of the applicant to engage in future lawful foreign travel or based upon past lawful foreign travel, unless the insurer can demonstrate that insureds who have traveled or intend to travel are a separate actuarially supportable class whose risk of loss is different from those insureds who have not traveled and do not intend to travel.

(2) No insurer nor person authorized to engage in the business of insurance in the State of Florida, shall, in determining the rates charged an applicant for coverage under any policy, contract or certificate of life insurance, annuity contract, accident, disability or health insurance, issued or to be issued to be delivered to any resident of this state, consider the intent of the applicant to engage in future lawful foreign travel or past lawful travel of the applicant, unless the insurer can demonstrate that insureds who have traveled or intend to travel are a separate actuarially supportable class whose risk of loss is different from those insureds who have not traveled and do not intend to travel.

(3) No insurer nor person authorized to engage in the business of insurance in the State of Florida shall refuse to issue any policy, contract or certificate of life insurance to or refuse to continue any policy, contract or certificate of life insurance of any individual or limit the amount, extent or kind of life insurance coverage offered to an individual based solely on the individual's past lawful foreign travel.

(4) No insurer nor person authorized to engage in the business of insurance in the State of Florida shall refuse to issue any policy, contract or certificate of life insurance to or refuse to continue any policy, contract or certificate of life insurance of an individual, or limit the amount, extent or kind of life insurance coverage offered an individual based solely on the individual's future lawful foreign travel plans unless the insurer can demonstrate that individuals who travel are a separate actuarially supportable class whose mortality risk is different from that of individuals who do not travel, and that such risk classification is based on sound actuarial principles and actual or reasonably anticipated experience that correlates to the risk of travel to a specific destination.

(5) An insurer shall file for approval information demonstrating that individuals who travel to a specific destination constitute a separate actuarially supportable class. The insurer shall not utilize such information within any underwriting decision resulting in a refusal to issue, refusal to continue, limitation on amount, extent or kind of life insurance coverage available to an individual until the Office has first approved the filing and determined that the insurer has demonstrated that the underwriting proposed meets compliance with the standards of section 626.9541(1)(dd), F.S. Nothing in this rule prevents an insurer from asking questions about foreign travel on an application in order to compile information provided such information is not used in any underwriting decision unless the insurer has received prior approval from the Office.

(6) In determining individuals who travel are a separate actuarially supportable class whose risk of loss is different from those individuals who do not travel based on sound actuarial principles and actual or reasonably anticipated experience that correlates to the risk of travel to a specific destination, insurers shall:
(a) Have performed a detailed actuarial analysis detailing the specific impact of the proposed risk;

(b) Demonstrate that all similar risks with similar risk exposure are similarly treated and that the risk is outside of the underwriting parameters that the insurer is accepting for its maximum rated risks;

(c) Use statistically credible data that is specific and relevant to the analysis and risk being evaluated, that is, using a country population death rate is not relevant to the analysis of the risk of short-term travel. In the absence of actual experience, an actuary may submit for the Office's consideration clear actuarial evidence, including clinical experience or expert opinion relied upon by the actuary that demonstrates to the Office that differences in risk are related to the travel;

(d) Disclose the range of underwriting and rating options and how each is supported by the analysis;

(e) Maintain a report prepared by the actuary providing the information used and relied upon by the actuary in preparing his conclusions, including but not limited to: summarizing the source, basis and relevancy of data used, the impact of the risk on expected loss, the range of expected loss within the underwriting class and how the proposed travel risk falls inside or outside of such underwriting range, the analysis performed and the basis of any conclusions reached. Such report shall disclose how compliance with all appropriate actuarial standards of practice is met and specifically detail any standards that are not.
(7) In accordance with section 626.9541(1)(dd)3., F.S., an insurer may file a petition for a variance or waiver with the Office for a limited exception from the statute and this rule. The petition shall contain supporting information demonstrating that the requested limited exception(s) are based upon national or international emergency conditions that affect the public health, safety, and welfare and are consistent with public policy.

(8)
(a) Insurers are required to maintain the following data. The data for each calendar year shall be submitted to the Office annually by January 31 of the following year:
1. The number of applications under which a policy or certificate of life insurance was denied,

2. The number of applications under which a policy or certificate of life insurance's continuation was refused; and,

3. The number of applications under which a policy or certificate of life insurance coverage was limited.
(b) For each specific case, the insurer shall provide the reason for taking such action.

(c) For each case the insurer shall provide a brief summary, prepared by an actuary, of the supporting data and analysis used in taking such action for such specific destination. Such underlying data and analysis shall be available upon request of the Office.
(9)
(a) Violation of this rule constitutes unfair discrimination prohibited by sections 626.9541(1)(g) and (dd), F.S.

(b) An insurer that uses past travel or future lawful travel in underwriting decisions without having first filed and received approval of the Office shall, among other administrative penalties:
1. Provide restitution to all applicants or insureds that were negatively acted upon by the insurer,

2. Issue the coverage applied for which was rejected, subject to the applicants option of the effective date being the date of application or the current date; and,

3. Pay any valid claim of an applicant incurred subsequent to the initial application date.
(10) "Travel" shall not include "residency" or relocation for employment. An individual who is absent from the United States for more than one hundred eighty (180) consecutive days and has established a residence in a foreign country during that period is considered to be residing in that country. Residency in a foreign country is not considered "foreign travel" for purposes of this rule.

69O FAC 125.004 | Credit Report Use and Disclosure in Consideration of Insurance Applications

(1) The purposes and scope of this rule are:
(a) To assure that insurance applicants are given notice when credit reports will be requested and reviewed in underwriting an insurance application; and,

(b) To prevent the unfairly discriminatory use of credit reports in underwriting insurance applications.

(c) This rule applies to the underwriting of applications for personal lines automobile and homeowners insurance only.
(2) For purposes of this rule:
(a) The term "credit report" means any written, oral, or other communication of any information by a consumer reporting agency (as defined in the Federal Fair Credit Reporting Act) bearing on a consumer's credit worthiness, credit standing, or credit capacity, which is used or expected to be used or collected in whole or in part for the purpose of serving as a factor in establishing the consumer's eligibility for personal lines automobile or homeowner insurance to be used primarily for person, family, or household purposes.

(b) The term "adverse underwriting decision" means a decision to reject an insurance application or to issue the policy with restrictions that would not apply but for the consideration of the credit report.
(3) Any insurer that requests or utilizes credit reports in the review of personal lines automobile or homeowner insurance applications shall maintain and adhere to written procedures established by the insurer which shall specify:
(a) The circumstances under which credit reports will or may be requested and the reports will or may be used in underwriting decisions;

(b) That the insurer shall notify the applicant prior to such request that a credit report will or may be requested in connection with an insurance application.

(c) That this notification shall be written, or in the same medium as the application. If the insurer is using the application to provide notice, then it shall provide a space for the initials of the person completing the application, denoting that the notice was provided. Once notice is given to an applicant, it need not be provided again as to subsequent applications by the same applicant.

(d) That the decision to request a credit report will not be made based upon race, color, creed, marital status, sex, or national origin of the applicant; and,

(e) That any applicant that is affected by an adverse underwriting decision as defined in this rule shall be advised of the means by which the applicant can obtain a copy of the credit report.
(4)
(a) Any insurer that requests or utilizes credit reports in consideration of an application for personal lines automobile or homeowners insurance shall maintain evidence of its compliance with the written procedures prescribed in subsection (3).

(b) The evidence need not be in any particular form, so long as it is sufficient to reasonably demonstrate compliance.

(c) The evidence shall be made available for review by the Office at the offices of the insurer for examination by the Office.

(d) When an insurer within the scope of this rule denies an application based on information in a credit report, the reasons accompanying the notice of denial as specified by section 627.4091, F.S., must indicate the means by which the applicant may obtain a copy of the credit report, and by which the applicant may identify the specific items in the credit report which resulted in the denial. Evidence of the notice of denial shall be retained by the insurer, and a record of the contents of the credit report shall be maintained by the insurer or pursuant to the insurer's agreement with the consumer reporting agency for a sufficient time to be available during the next market conduct examination conducted pursuant to section 624.3161, F.S.
69O-127 | Fees and Procedures Regarding Department Information and Services

69O FAC 127.001 | Database Information

69O FAC 127.002 | Cost of Publications

69O-128 | Privacy of Consumer Financial and Health Information

69O FAC 128.001 | Purpose and Scope

(1) Purpose. This rule governs the treatment of nonpublic personal health information and nonpublic personal financial information about individuals by all licensees regulated pursuant to the Florida Insurance Code. In addition, the provisions of this rule chapter are applicable to a licensee domiciled in this state that engages in activities with respect to persons residing or domiciled in another state that has not enacted laws or regulations necessary to comply with the requirements of the Gramm-Leach-Bliley Act (PL 102-106). These rules:
(a) Require a licensee to provide notice to individuals about its privacy policies and practices;

(b) Describe the conditions under which a licensee may disclose nonpublic personal health information and nonpublic personal financial information about individuals to affiliates and nonaffiliated third parties; and,

(c) Provide methods for individuals to prevent a licensee from disclosing that information.
(2) Scope. These rules apply to:
(a) Nonpublic personal financial information about individuals who obtain or are claimants or beneficiaries of products or services primarily for personal, family or household purposes from licensees. These rules do not apply to information about companies or about individuals who obtain products or services for business, commercial or agricultural purposes; and,

(b) All nonpublic personal health information.
(3) Rule of Construction. The examples in these rules and the sample clauses in Appendix A, incorporated by reference in Rule 69O-128.007, F.A.C., are not exclusive. Compliance with an example or use of a sample clause, to the extent applicable, constitutes compliance with this rule.

69O FAC 128.002 | Definitions

As used in these rules, unless the context requires otherwise:
(1) "Affiliate" means a company that controls, is controlled by or is under common control with another company.

(2)
(a) "Clear and conspicuous" means that a notice is reasonably understandable and designed to call attention to the nature and significance of the information in the notice.

(b) Examples.
1. Reasonably understandable. A licensee makes its notice reasonably understandable if it:
a. Presents the information in the notice in clear, concise sentences, paragraphs and sections;

b. Uses short explanatory sentences or bullet lists whenever possible;

c. Uses definite, concrete, everyday words and active voice whenever possible;

d. Avoids multiple negatives;

e. Avoids legal and highly technical business terminology whenever possible; and,

f. Avoids explanations that are imprecise and readily subject to different interpretations.
2. Designed to call attention. A licensee designs its notice to call attention to the nature and significance of the information in it if the licensee:
a. Uses a plain-language heading to call attention to the notice;

b. Uses a typeface and type size that are easy to read;

c. Provides wide margins and ample line spacing;

d. Uses boldface or italics for key words; and,

e. In a form that combines the licensee's notice with other information, uses distinctive type size, style, and graphic devices, such as shading or sidebars.
3. Notices on web sites. If a licensee provides a notice on a web page, the licensee designs its notice to call attention to the nature and significance of the information in it if the licensee uses text or visual cues to encourage scrolling down the page if necessary to view the entire notice and ensure that other elements on the web site, such as text, graphics, hyperlinks or sound, do not distract attention from the notice, and the licensee either:
a. Places the notice on a screen that consumers frequently access, such as a page on which transactions are conducted; or

b. Places a link on a screen that consumers frequently access, such as a page on which transactions are conducted, that connects directly to the notice and is labeled appropriately to convey the importance, nature and relevance of the notice.
(3) "Collect" means to obtain information that the licensee organizes or can retrieve by the name of an individual or by identifying number, symbol or other identifying particular assigned to the individual, irrespective of the source of the underlying information.

(4) "Company" means a corporation, limited liability company, business trust, general or limited partnership, association, sole proprietorship or similar organization.

(5)
(a) "Consumer" means an individual who seeks to obtain, obtains, or has obtained an insurance product or service from a licensee that is to be used primarily for personal, family or household purposes, and about whom the licensee has nonpublic personal information, or that individual's legal representative.

(b) Examples.
1. An individual who provides nonpublic personal information to a licensee in connection with obtaining or seeking to obtain financial, investment or economic advisory services relating to an insurance product or service is a consumer regardless of whether the licensee establishes an ongoing advisory relationship.

2. An applicant for insurance prior to the inception of insurance coverage is a licensee's consumer.

3. An individual who is a consumer of another financial institution is not a licensee's consumer solely because the licensee is acting as agent for, or provides processing or other services to, that financial institution.

4. An individual is a licensee's consumer if the individual is:
a.
(I) A beneficiary of a life insurance policy underwritten by the licensee;

(II) A claimant under an insurance policy issued by the licensee;

(III) An insured or an annuitant under an insurance policy or an annuity, respectively, issued by the licensee; or

(IV) A mortgagor of a mortgage covered under a mortgage insurance policy; and,
b. The licensee discloses nonpublic personal financial information about the individual to a nonaffiliated third party other than as permitted under Rules 69O-128.014, 69O-128.015 and 69O-128.016, F.A.C.
5. Provided that the licensee provides the initial, annual and revised notices under Rules 69O-128.005, 69O-128.006 and 69O-128.009, F.A.C., to the plan sponsor, group or blanket insurance policyholder or group annuity contract holder or workers' compensation plan participant, and further provided that the licensee does not disclose to a nonaffiliated third party nonpublic personal financial information about such an individual other than as permitted under Rules 69O-128.014, 69O-128.015 and 69O-128.016, F.A.C., an individual is not the consumer of the licensee solely because he or she is:
a. A participant or a beneficiary of an employee benefit plan that the licensee administers or sponsors or for which the licensee acts as a trustee, insurer or fiduciary;

b. Covered under a group or blanket insurance policy or group annuity contract issued by the licensee; or

c. A beneficiary in a workers' compensation plan.
6.
a. The individuals described in sub-subparagraphs (5)(b)5.a. through c. of this paragraph, are consumers of a licensee if the licensee does not meet all the conditions of subparagraph (5)(b)5.

b. In no event shall the individuals, solely by virtue of the status described in sub-subparagraphs (5)(b)5.a. through c., above, be deemed to be customers for purposes of this rule.
7. An individual is not a licensee's consumer solely because he or she is a beneficiary of a trust for which the licensee is a trustee.

8. An individual is not a licensee's consumer solely because he or she has designated the licensee as trustee for a trust.
(6) "Consumer reporting agency" has the same meaning as in Section 603(f) of the federal Fair Credit Reporting Act (15 U.S.C. 1681a(f)).

(7) "Control" means:
(a) Ownership, control or power to vote 25 percent or more of the outstanding shares of any class of voting security of the company, directly or indirectly, or acting through one or more other persons;

(b) Control in any manner over the election of a majority of the directors, trustees or general partners (or individuals exercising similar functions) of the company; or

(c) The power to exercise, directly or indirectly, a controlling influence over the management or policies of the company, as the Office determines.
(8) "Customer" means a consumer who has a customer relationship with a licensee.

(9)
(a) "Customer relationship" means a continuing relationship between a consumer and a licensee under which the licensee provides one or more insurance products or services to the consumer that are to be used primarily for personal, family or household purposes.

(b) Examples.
1. A consumer has a continuing relationship with a licensee if:
a. The consumer is a current policyholder of an insurance product issued by or through the licensee; or

b. The consumer obtains financial, investment or economic advisory services relating to an insurance product or service from the licensee for a fee.
2. A consumer does not have a continuing relationship with a licensee if:
a. The consumer applies for insurance but does not purchase the insurance;

b. The licensee sells the consumer airline travel insurance or similar limited duration types of travel related insurance in an isolated transaction not involving a continuing policyholder relationship;

c. The individual is no longer a current policyholder of an insurance product or no longer obtains insurance services with or through the licensee;

d. The consumer is a beneficiary or claimant under a policy and has submitted a claim under a policy choosing a settlement option involving an ongoing relationship with the licensee;

e. The consumer is a beneficiary or a claimant under a policy and has submitted a claim under that policy choosing a lump sum settlement option;

f. The customer's policy is lapsed, expired, or otherwise inactive or dormant under the licensee's business practices, and the licensee has not communicated with the customer about the relationship for a period of 12 consecutive months, other than annual privacy notices, material required by law or rule, communication at the direction of a state or federal authority, or promotional materials;

g. The individual is an insured or an annuitant under an insurance policy or annuity, respectively, but is not the policyholder or owner of the insurance policy or annuity; or

h. For the purposes of this rule, the individual's last known address according to the licensee's records is deemed invalid. An address of record is deemed invalid if mail sent to that address by the licensee has been returned by the postal authorities as undeliverable and if subsequent attempts by the licensee to obtain a current valid address for the individual have been unsuccessful.
(10)
(a) "Financial institution" means any institution the business of which is engaging in activities that are financial in nature or incidental to such financial activities as described in Section 4(k) of the Bank Holding Company Act of 1956 (12 U.S.C. 1843(k)).

(b) Financial institution does not include:
1. Any person or entity with respect to any financial activity that is subject to the jurisdiction of the Commodity Futures Trading Commission under the Commodity Exchange Act (7 U.S.C. 1 et seq.),

2. The Federal Agricultural Mortgage Corporation or any entity charged and operating under the Farm Credit Act of 1971 (12 U.S.C. 2001 et seq.); or

3. Institutions chartered by Congress specifically to engage in securitizations, secondary market sales (including sales of servicing rights) or similar transactions related to a transaction of a consumer, as long as the institutions do not sell or transfer nonpublic personal information to a nonaffiliated third party.
(11)
(a) "Financial product or service" means a product or service that a financial holding company could offer by engaging in an activity that is financial in nature or incidental to such a financial activity under Section 4(k) of the Bank Holding Company Act of 1956 (12 U.S.C. 1843(k)).

(b) Financial service includes a financial institution's evaluation or brokerage of information that the financial institution collects in connection with a request or an application from a consumer for a financial product or service.
(12) "Health care" means:
(a) Preventive, diagnostic, therapeutic, rehabilitative, maintenance or palliative care, services, procedures, tests or counseling that:
1. Relates to the physical, mental or behavioral condition of an individual; or

2. Affects the structure or function of the human body or any part of the human body, including the banking of blood, sperm, organs or any other tissue; or
(b) Prescribing, dispensing or furnishing to an individual drugs or biologicals, or medical devices or health care equipment and supplies.
(13) "Health care provider" means a physician or other health care practitioner licensed, accredited or certified to perform specified health services consistent with state law, or a health care facility.

(14) "Health information" means any information or data except age or gender, whether oral or recorded in any form or medium, created by or derived from a health care provider or the consumer that relates to:
(a) The past, present or future physical, mental or behavioral health or condition of an individual;

(b) The provision of health care to an individual; or

(c) Payment for the provision of health care to an individual.
(15)
(a) "Insurance product or service" means any product or service that is offered by a licensee pursuant to the insurance laws of this state.

(b) Insurance service includes a licensee's evaluation, brokerage or distribution of information that the licensee collects in connection with a request or an application from a consumer for a insurance product or service.
(16)
(a)
1. "Licensee" means all licensed insurers, producers and other persons licensed or required to be licensed, or authorized or required to be authorized, or registered or required to be registered pursuant to the Florida Insurance Code.

2. "Licensee" does not include persons or entities regulated pursuant to Chapter 634, F.S.
(b) A licensee is not subject to the notice and opt out requirements for nonpublic personal financial information set forth in these rules if the licensee is an employee, agent or other representative of another licensee ("the principal"), and:
1. The principal otherwise complies with, and provides the notices required by, the provisions of these rules; and,

2. The licensee does not disclose any nonpublic personal information to any person, including the principal or its affiliates, unless in a manner permitted by this rule.
(c)
1. Subject to subparagraph (b)2., above, "licensee" shall also include an unauthorized insurer that accepts business placed through a licensed surplus lines agent in this state, but only in regard to the surplus lines placements placed pursuant to Section 626.916, F.S.

2. A surplus lines agent, producing agent, or surplus lines insurer shall be deemed to be in compliance with the notice and opt out requirements for nonpublic personal financial information set forth in these rules provided:
a. The surplus lines agent, producing agent, or insurer does not disclose nonpublic personal information of a consumer or a customer to nonaffiliated third parties for any purpose, including joint servicing or marketing under Rule 69O-128.014, F.A.C., except as permitted by Rule 69O-128.015 or 69O-128.016, F.A.C.; and,

b. The surplus lines agent, producing agent or insurer delivers a notice to the consumer at the time a customer relationship is established on which the following is printed in 16-point type:

PRIVACY NOTICE

"Neither the U.S. brokers that handled this insurance nor the insurers that have underwritten this insurance will disclose nonpublic personal information concerning the buyer to nonaffiliates of the brokers or insurers except as permitted by law."
(17)
(a) "Nonaffiliated third party" means any person except:
1. A licensee's affiliate; or

2. A person employed jointly by a licensee and any company that is not the licensee's affiliate (but nonaffiliated third party includes the other company that jointly employs the person).
(b) Nonaffiliated third party includes any company that is an affiliate solely by virtue of the direct or indirect ownership or control of the company by the licensee or its affiliate in conducting merchant banking or investment banking activities of the type described in Section 4(k)(4)(H) or insurance company investment activities of the type described in Section 4(k)(4)(I) of the federal Bank Holding Company Act (12 U.S.C. 1843(k)(4)(H) and (I)).
(18) "Nonpublic personal information" means nonpublic personal financial information and nonpublic personal health information.

(19)
(a) "Nonpublic personal financial information" means:
1. Personally identifiable financial information; and,

2. Any list, description or other grouping of consumers (and publicly available information pertaining to them) that is derived using any personally identifiable financial information that is not publicly available.
(b) Nonpublic personal financial information does not include:
1. Health information,

2. Publicly available information, except as included on a list described in subparagraph (19)(a)2. of this rule; or

3. Any list, description or other grouping of consumers (and publicly available information pertaining to them) that is derived without using any personally identifiable financial information that is not publicly available.
(c) Examples of lists.
1. Nonpublic personal financial information includes any list of individuals' names and street addresses that is derived in whole or in part using personally identifiable financial information that is not publicly available, such as account numbers.

2. Nonpublic personal financial information does not include any list of individuals' names and addresses that contains only publicly available information, is not derived in whole or in part using personally identifiable financial information that is not publicly available, and is not disclosed in a manner that indicates that any of the individuals on the list is a consumer of a financial institution.
(20) "Nonpublic personal health information" means health information:
(a) That identifies an individual who is the subject of the information; or

(b) With respect to which there is a reasonable basis to believe that the information could be used to identify an individual.
(21)
(a) "Personally identifiable financial information" means any information:
1. A consumer provides to a licensee to obtain an insurance product or service from the licensee;

2. About a consumer resulting from a transaction involving an insurance product or service between a licensee and a consumer; or

3. The licensee otherwise obtains about a consumer in connection with providing an insurance product or service to a consumer.
(b) The following are examples of personally identifiable financial information:
1. Information a consumer provides to a licensee on an application to obtain an insurance product or service;

2. Account balance information and payment history;

3. The fact that an individual is or has been one of the licensee's customers or has obtained an insurance product or service from the licensee;

4. Any information about the licensee's consumer if it is disclosed in a manner that indicates that the individual is or has been the licensee's consumer;

5. Any information that a consumer provides to a licensee or that the licensee or its agent otherwise obtains in connection with collecting on a loan or servicing a loan;

6. Any information the licensee collects through an Internet cookie (an information-collecting device from a web server); and,

7. Information from a consumer report.
(c) Personally identifiable financial information does not include:
1. Health information;

2. A list of names and addresses of customers of an entity that is not a financial institution; and,

3. Information that does not identify a consumer, such as aggregate information or blind data that does not contain personal identifiers such as account numbers, names or addresses.
(22)
(a) "Publicly available information" means any information that a licensee has a reasonable basis to believe is lawfully made available to the general public from:
1. Federal, state or local government records;

2. Widely distributed media; or

3. Disclosures to the general public that are required to be made by federal, state or local law.
(b) Reasonable basis. A licensee has a reasonable basis to believe that information is lawfully made available to the general public if the licensee has taken steps to determine:
1. That the information is of the type that is available to the general public; and,

2. Whether an individual can direct that the information not be made available to the general public and, if so, that the licensee's consumer has not done so.
(c) Examples.
1. Government records. Publicly available information in government records includes information in government real estate records and security interest filings.

2. Widely distributed media. Publicly available information from widely distributed media includes information from a telephone book, a television or radio program, a newspaper or a website that is available to the general public on an unrestricted basis. A web site is not restricted merely because an Internet service provider or a site operator requires a fee or a password, so long as access is available to the general public.

3. Reasonable basis.
a. A licensee has a reasonable basis to believe that mortgage information is lawfully made available to the general public if the licensee has determined that the information is of the type included on the public record in the jurisdiction where the mortgage would be recorded.

b. A licensee has a reasonable basis to believe that an individual's telephone number is lawfully made available to the general public if the licensee has located the telephone number in the telephone book or the consumer has informed you that the telephone number is not unlisted.

69O FAC 128.005 | Initial Privacy Notice to Consumers Required

(1) Initial notice requirement. A licensee shall provide a clear and conspicuous notice that accurately reflects its privacy policies and practices to:
(a) Customer. An individual who becomes the licensee's customer, not later than when the licensee establishes a customer relationship, except as provided in subsection (5) of this rule; and,

(b) Consumer. A consumer, before the licensee discloses any nonpublic personal financial information about the consumer to any nonaffiliated third party, if the licensee makes a disclosure other than as authorized by Rules 69O-128.015 and 69O-128.016, F.A.C.
(2) When initial notice to a consumer is not required. A licensee is not required to provide an initial notice to a consumer under paragraph (1)(b), of this rule if:
(a) The licensee does not disclose any nonpublic personal financial information about the consumer to any nonaffiliated third party, other than as authorized by Rules 69O-128.015 and 69O-128.016, F.A.C., and the licensee does not have a customer relationship with the consumer; or

(b) A notice has been provided by an affiliated licensee, as long as the notice clearly identifies all licensees to whom the notice applies and is accurate with respect to the licensee and the other institutions.
(3) When the licensee establishes a customer relationship.
(a) General rule. A licensee establishes a customer relationship at the time the licensee and the consumer enter into a continuing relationship.

(b) Examples of establishing customer relationship. A licensee establishes a customer relationship when the consumer:
1. Becomes a policyholder of a licensee that is an insurer when the insurer delivers an insurance policy or contract to the consumer, or in the case of a licensee that is an insurance producer or insurance broker, obtains insurance through that licensee; or

2. Agrees to obtain financial, economic or investment advisory services relating to insurance products or services for a fee from the licensee.
(4) Existing customers. When an existing customer obtains a new insurance product or service from a licensee that is to be used primarily for personal, family or household purposes, the licensee satisfies the initial notice requirements of subsection (1) of this rule as follows:
(a) The licensee may provide a revised policy notice, under Rule 69O-128.009, F.A.C., that covers the customer's new insurance product or service; or

(b) If the initial, revised or annual notice that the licensee most recently provided to that customer was accurate with respect to the new insurance product or service, the licensee does not need to provide a new privacy notice under subsection (1) of this rule.
(5) Exceptions to allow subsequent delivery of notice.
(a) A licensee may provide the initial notice required by paragraph (1)(a) of this rule, within a reasonable time after the licensee establishes a customer relationship if:
1. Establishing the customer relationship is not at the customer's election; or

2. Providing notice not later than when the licensee establishes a customer relationship would substantially delay the customer's transaction and the customer agrees to receive the notice at a later time.
(b) Examples of exceptions.
1. Not at customer's election. Establishing a customer relationship is not at the customer's election if a licensee acquires or is assigned a customer's policy from another financial institution or residual market mechanism and the customer does not have a choice about the licensee's acquisition or assignment.

2. Substantial delay of customer's transaction. Providing notice not later than when a licensee establishes a customer relationship would substantially delay the customer's transaction when the licensee and the individual agree over the telephone to enter into a customer relationship involving prompt delivery of the insurance product or service.

3. No substantial delay of customer's transaction. Providing notice not later than when a licensee establishes a customer relationship would not substantially delay the customer's transaction when the relationship is initiated in person at the licensee's office or through other means by which the customer may view the notice, such as on a website.
(6) Delivery. When a licensee is required to deliver an initial privacy notice by this rule, the licensee shall deliver it according to Rule 69O-128.010, F.A.C. If the licensee uses a short-form initial notice for non-customers according to subsection 69O-128.007(4), F.A.C., the licensee may deliver its privacy notice according to paragraph 69O-128.007(4)(c), F.A.C.

69O FAC 128.006 | Annual Privacy Notice to Customers Required

(1)
(a) General rule. A licensee shall provide a clear and conspicuous notice to customers that accurately reflects its privacy policies and practices not less than annually during the continuation of the customer relationship. Annually means at least once in any period of 12 consecutive months during which that relationship exists. A licensee may define the twelve consecutive month period, but the licensee shall apply it to the customer on a consistent basis.

(b) Example. A licensee provides a notice annually if it defines the twelve-consecutive-month period as a calendar year and provides the annual notice to the customer once in each calendar year following the calendar year in which the licensee provided the initial notice. For example, if a customer opens an account on any day of year 1, the licensee shall provide an annual notice to that customer by December 31 of year 2.
(2)
(a) Termination of customer relationship. A licensee is not required to provide an annual notice to a former customer. A former customer is an individual with whom a licensee no longer has a continuing relationship.

(b) Examples.
1. A licensee no longer has a continuing relationship with an individual if the individual no longer is a current policyholder of an insurance product or no longer obtains insurance services with or through the licensee.

2. A licensee no longer has a continuing relationship with an individual if the individual's policy is lapsed, expired or otherwise inactive or dormant under the licensee's business practices, and the licensee has not communicated with the customer about the relationship for a period of 12 consecutive months, other than to provide annual privacy notices, material required by law or rule, or promotional materials.

3. For the purposes of this rule, a licensee no longer has a continuing relationship with an individual if the individual's last known address according to the licensee's records is deemed invalid. An address of record is deemed invalid if mail sent to that address by the licensee has been returned by the postal authorities as undeliverable and if subsequent attempts by the licensee to obtain a current valid address for the individual have been unsuccessful.

4. A licensee no longer has a continuing relationship with a customer in the case of providing real estate settlement services, at the time the customer completes execution of all documents related to the real estate closing, payment for those services has been received, or the licensee has completed all of its responsibilities with respect to the settlement, including filing documents on the public record, whichever is later.
(3) Delivery. When a licensee is required by this rule to deliver an annual privacy notice, the licensee shall deliver it according to Rule 69O-128.010, F.A.C.

69O FAC 128.007 | Information to be Included in Privacy Notices

(1) General rule. The initial, annual and revised privacy notices that a licensee provides under Rules 69O-128.005, 69O-128.006 and 69O-128.009, F.A.C., shall include each of the following items of information, in addition to any other information the licensee wishes to provide, that applies to the licensee and to the consumers to whom the licensee sends its privacy notice:
(a) The categories of nonpublic personal financial information that the licensee collects;

(b) The categories of nonpublic personal financial information that the licensee discloses;

(c) The categories of affiliates and nonaffiliated third parties to whom the licensee discloses nonpublic personal financial information, other than those parties to whom the licensee discloses information under Rules 69O-128.015 and 69O-128.016, F.A.C.;

(d) The categories of nonpublic personal financial information about the licensee's former customers that the licensee discloses and the categories of affiliates and nonaffiliated third parties to whom the licensee discloses nonpublic personal financial information about the licensee's former customers, other than those parties to whom the licensee discloses information under Rules 69O-128.015 and 69O-128.016, F.A.C.;

(e) If a licensee discloses nonpublic personal financial information to a nonaffiliated third party under Rule 69O-128.014, F.A.C. (and no other exception in Rules 69O-128.015 and 69O-128.016, F.A.C., applies to that disclosure), a separate description of the categories of information the licensee discloses and the categories of third parties with whom the licensee has contracted;

(f) An explanation of the consumer's right under subsection 69O-128.011(1), F.A.C., to opt out of the disclosure of nonpublic personal financial information to nonaffiliated third parties, including the methods by which the consumer may exercise that right at that time;

(g) Any disclosures that the licensee makes under Section 603(d)(2)(A)(iii) of the federal Fair Credit Reporting Act (15 U.S.C. 1681a(d)(2)(A)(iii))(that is, notices regarding the ability to opt out of disclosures of information among affiliates);

(h) The licensee's policies and practices with respect to protecting the confidentiality and security of nonpublic personal information; and,

(i) Any disclosure that the licensee makes under subsection (2) of this rule.
(2) Description of parties subject to exceptions. If a licensee discloses nonpublic personal financial information as authorized under Rules 69O-128.015 and 69O-128.016, F.A.C., the licensee is not required to list those exceptions in the initial or annual privacy notices required by Rules 69O-128.005 and 69O-128.006, F.A.C. When describing the categories of parties to whom disclosure is made, the licensee is required to state only that it makes disclosures to other affiliated or nonaffiliated third parties, as applicable, as permitted by law.

(3) Examples.
(a) Categories of nonpublic personal financial information that the licensee collects. A licensee satisfies the requirement to categorize the nonpublic personal financial information it collects if the licensee categorizes it according to the source of the information, as applicable:
1. Information from the consumer;

2. Information about the consumer's transactions with the licensee or its affiliates;

3. Information about the consumer's transactions with nonaffiliated third parties; and,

4. Information from a consumer reporting agency.
(b) Categories of nonpublic personal financial information a licensee discloses.
1. A licensee satisfies the requirement to categorize nonpublic personal financial information it discloses if the licensee categorizes the information according to source, as described in paragraph (a), above, as applicable, and provides a few examples to illustrate the types of information in each category. These might include:
a. Information from the consumer, including application information, such as assets and income and identifying information, such as name, address and social security number,

b. Transaction information, such as information about balances, payment history and parties to the transaction; and,

c. Information from consumer reports, such as a consumer's creditworthiness and credit history.
2. A licensee does not adequately categorize the information that it discloses if the licensee uses only general terms, such as transaction information about the consumer.

3. If a licensee reserves the right to disclose all of the nonpublic personal financial information about consumers that it collects, the licensee may simply state that fact without describing the categories or examples of nonpublic personal information that the licensee discloses.
(c) Categories of affiliates and nonaffiliated third parties to whom the licensee discloses.
1. A licensee satisfies the requirement to categorize the affiliates and nonaffiliated third parties to which the licensee discloses nonpublic personal financial information about consumers if the licensee identifies the types of businesses in which they engage.

2. Types of businesses may be described by general terms only if the licensee uses a few illustrative examples of significant lines of business. For example, a licensee may use the term financial products or services if it includes appropriate examples of significant lines of businesses, such as life insurer, automobile insurer, consumer banking or securities brokerage.

3. A licensee also may categorize the affiliates and nonaffiliated third parties to which it discloses nonpublic personal financial information about consumers using more detailed categories.
(d) Disclosures under exception for service providers and joint marketers. If a licensee discloses nonpublic personal financial information under the exception in Rule 69O-128.014, F.A.C., to a nonaffiliated third party to market products or services that it offers alone or jointly with another financial institution, the licensee satisfies the disclosure requirement of paragraph (1)(e) of this rule, if it:
1. Lists the categories of nonpublic personal financial information it discloses, using the same categories and examples the licensee used to meet the requirements of paragraph (1)(b) of this rule, as applicable; and,

2. States whether the third party is:
a. A service provider that performs marketing services on the licensee's behalf or on behalf of the licensee and another financial institution; or

b. A financial institution with whom the licensee has a joint marketing agreement.
(e) Simplified notices. If a licensee does not disclose, and does not wish to reserve the right to disclose, nonpublic personal financial information about customers or former customers to affiliates or nonaffiliated third parties except as authorized under Rules 69O-128.015 and 69O-128.016, F.A.C., the licensee may simply state that fact, in addition to the information it shall provide under paragraphs (1)(a), (h) and (i), and subsection (2) of this rule.

(f) Confidentiality and security. A licensee describes its policies and practices with respect to protecting the confidentiality and security of nonpublic personal financial information if it does both of the following:
1. Describes in general terms who is authorized to have access to the information; and,

2. States whether the licensee has security practices and procedures in place to ensure the confidentiality of the information in accordance with the licensee's policy. The licensee is not required to describe technical information about the safeguards it uses.
(4) Short-form initial notice with opt out notice for non-customers.
(a) A licensee may satisfy the initial notice requirements in paragraph 69O-128.005(1)(b), and subsection 69O-128.008(3), F.A.C., for a consumer who is not a customer by providing a short-form initial notice at the same time as the licensee delivers an opt out notice as required in Rule 69O-128.008, F.A.C.

(b) A short-form initial notice shall:
1. Be clear and conspicuous;

2. State that the licensee's privacy notice is available upon request; and,

3. Explain a reasonable means by which the consumer may obtain that notice.
(c) The licensee shall deliver its short-form initial notice according to Rule 69O-128.010, F.A.C. The licensee is not required to deliver its privacy notice with its short-form initial notice. The licensee instead may simply provide the consumer a reasonable means to obtain its privacy notice. If a consumer who receives the licensee's short-form notice requests the licensee's privacy notice, the licensee shall deliver its privacy notice according to Rule 69O-128.010, F.A.C.

(d) Examples of obtaining privacy notice. The licensee provides a reasonable means by which a consumer may obtain a copy of its privacy notice if the licensee:
1. Provides a toll-free telephone number that the consumer may call to request the notice; or

2. For a consumer who conducts business in person at the licensee's office, maintains copies of the notice on hand that the licensee provides to the consumer immediately upon request.
(5) Future disclosures. The licensee's notice may include:
(a) Categories of nonpublic personal financial information that the licensee reserves the right to disclose in the future, but does not currently disclose; and,

(b) Categories of affiliates or nonaffiliated third parties to whom the licensee reserves the right in the future to disclose, but to whom the licensee does not currently disclose, nonpublic personal financial information.
(6) Sample clauses. Sample clauses illustrating some of the notice content required by this rule are included in Appendix A of this rule, which is incorporated herein by reference.

69O FAC 128.008 | Form of Opt Out Notice to Consumers and Opt Out Methods

(1)
(a) Form of opt out notice. If a licensee is required to provide an opt out notice under subsection 69O-128.011(1), F.A.C., it shall provide a clear and conspicuous notice to each of its consumers that accurately explains the right to opt out under that rule. The notice shall state:
1. That the licensee discloses or reserves the right to disclose nonpublic personal financial information about its consumer to a nonaffiliated third party;

2. That the consumer has the right to opt out of that disclosure; and,

3. A reasonable means by which the consumer may exercise the opt out right.
(b) Examples.
1. Adequate opt out notice. A licensee provides adequate notice that the consumer can opt out of the disclosure of nonpublic personal financial information to a nonaffiliated third party if the licensee:
a. Identifies all of the categories of nonpublic personal financial information that it discloses or reserves the right to disclose, and all of the categories of nonaffiliated third parties to which the licensee discloses the information, as described in paragraphs 69O-128.007(1)(a) and (b), F.A.C., and states that the consumer can opt out of the disclosure of that information; and,

b. Identifies the insurance products or services that the consumer obtains from the licensee, either singly or jointly, to which the opt out direction would apply.
2. Reasonable opt out means. A licensee provides a reasonable means to exercise an opt out right if it:
a. Designates check-off boxes in a prominent position on the relevant forms with the opt out notice;

b. Includes a reply form together with the opt out notice;

c. Provides an electronic means to opt out, such as a form that can be sent via electronic mail or a process at the licensee's web site, if the consumer agrees to the electronic delivery of information; or

d. Provides a toll-free telephone number that consumers may call to opt out.
3. Unreasonable opt out means. A licensee does not provide a reasonable means of opting out if:
a. The only means of opting out is for the consumer to write his or her own letter to exercise that opt out right; or

b. The only means of opting out as described in any notice subsequent to the initial notice is to use a check-off box that the licensee provided with the initial notice but did not include with the subsequent notice.
4. Specific opt out means. A licensee may require each consumer to opt out through a specific means, as long as that means is reasonable for that consumer.
(2) Same form as initial notice permitted. A licensee may provide the opt out notice together with or on the same written or electronic form as the initial notice the licensee provides in accordance with Rule 69O-128.005, F.A.C.

(3) Initial notice required when opt out notice delivered subsequent to initial notice. If a licensee provides the opt out notice later than required for the initial notice in accordance with Rule 69O-128.005, F.A.C., the licensee shall also include a copy of the initial notice with the opt out notice in writing or, if the consumer agrees, electronically.

(4) Joint relationships.
(a) If 2 or more consumers jointly obtain an insurance product or service from a licensee, the licensee may provide a single opt out notice. The licensee's opt out notice shall explain how the licensee will treat an opt out direction by a joint consumer as explained in paragraph (4)(e) of this subsection.

(b) Any of the joint consumers may exercise the right to opt out. The licensee may either:
1. Treat an opt out direction by a joint consumer as applying to all of the associated joint consumers; or

2. Permit each joint consumer to opt out separately.
(c) If a licensee permits each joint consumer to opt out separately, the licensee shall permit one of the joint consumers to opt out on behalf of all of the joint consumers.

(d) A licensee may not require all joint consumers to opt out before it implements any opt out direction.

(e) Example. If John and Mary are both named policyholders on a homeowner's insurance policy issued by a licensee and the licensee sends policy statements to John's address, the licensee may do any of the following, but it shall explain in its opt out notice which opt out policy the licensee will follow:
1. Send a single opt out notice to John's address, but the licensee shall accept an opt out direction from either John or Mary.

2. Treat an opt out direction by either John or Mary as applying to the entire policy. If the licensee does so and John opts out, the licensee may not require Mary to opt out as well before implementing John's opt out direction.

3. Permit John and Mary to make different opt out directions. If the licensee does so:
a. It shall permit John and Mary to opt out for each other;

b. If both opt out, the licensee shall permit both of them to notify it in a single response (such as on a form or through a telephone call); and,

c. If John opts out and Mary does not, the licensee may only disclose nonpublic personal financial information about Mary, but not about John and not about John and Mary jointly.
(5) Time to comply with opt out. As to opt outs received from consumer later than 30 days after the opt out notification is delivered by the licensee, a licensee shall comply with a consumer's opt out direction as soon as reasonably practicable after the licensee receives it.

(6) Continuing right to opt out. A consumer may exercise the right to opt out at any time.

(7) Duration of consumer's opt out direction.
(a) A consumer's direction to opt out under this rule is effective until the consumer revokes it in writing or, if the consumer agrees, electronically.

(b) When a customer relationship terminates, the customer's opt out direction continues to apply to the nonpublic personal financial information that the licensee collected during or related to that relationship. If the individual subsequently establishes a new customer relationship with the licensee, the opt out direction that applied to the former relationship does not apply to the new relationship.
(8) Delivery. When a licensee is required to deliver an opt out notice by this rule, the licensee shall deliver it according to Rule 69O-128.010, F.A.C.

69O FAC 128.009 | Revised Privacy Notices

(1) General rule. Except as otherwise authorized in these rules, a licensee shall not, directly or through an affiliate, disclose any nonpublic personal financial information about a consumer to a nonaffiliated third party other than as described in the initial notice that the licensee provided to that consumer under Rule 69O-128.005, F.A.C., unless:
(a) The licensee has provided to the consumer a clear and conspicuous revised notice that accurately describes its policies and practices;

(b) The licensee has provided to the consumer a new opt out notice;

(c) The licensee has given the consumer a reasonable opportunity, before the licensee discloses the information to the nonaffiliated third party, to opt out of the disclosure; and,

(d) The consumer does not opt out.
(2) Examples.
(a) Except as otherwise permitted by Rules 69O-128.014, 69O-128.015, and 69O-128.016, F.A.C., a licensee shall provide a revised notice before it:
1. Discloses a new category of nonpublic personal financial information to any nonaffiliated third party;

2. Discloses nonpublic personal financial information to a new category of nonaffiliated third party; or

3. Discloses nonpublic personal financial information about a former customer to a nonaffiliated third party, if that former customer has not had the opportunity to exercise an opt out right regarding that disclosure.
(b) A revised notice is not required if the licensee discloses nonpublic personal financial information to a new nonaffiliated third party that the licensee adequately described in its prior notice.
(3) Delivery. When a licensee is required to deliver a revised privacy notice by this rule, the licensee shall deliver it according to Rule 69O-128.010, F.A.C.

69O FAC 128.010 | Delivery

(1) How to provide notices. A licensee shall provide any notices that this rule requires so that each consumer can reasonably be expected to receive actual notice in writing or, if the consumer agrees, electronically.

(2)
(a) Examples of reasonable expectation of actual notice. A licensee may reasonably expect that a consumer will receive actual notice if the licensee:
1. Hand-delivers a printed copy of the notice to the consumer;

2. Mails a printed copy of the notice to the last known address of the consumer separately, or in a policy, billing or other written communication;

3. For a consumer who conducts transactions electronically, posts the notice on the electronic site and requires the consumer to acknowledge receipt of the notice as a necessary step to obtaining a particular insurance product or service; or

4. For an isolated transaction with a consumer, such as the licensee providing an insurance quote or selling the consumer travel insurance, posts the notice and requires the consumer to acknowledge receipt of the notice as a necessary step to obtaining the particular insurance product or service.
(b) Examples of unreasonable expectation of actual notice. A licensee may not, however, reasonably expect that a consumer will receive actual notice of its privacy policies and practices if it:
1. Only posts a sign in its office or generally publishes advertisements of its privacy policies and practices; or

2. Sends the notice via electronic mail to a consumer who does not obtain an insurance product or service from the licensee electronically.
(3) Annual notices only. A licensee may reasonably expect that a customer will receive actual notice of the licensee's annual privacy notice if:
(a) The customer uses the licensee's website to access insurance products and services electronically and agrees to receive notices at the website and the licensee posts its current privacy notice continuously in a clear and conspicuous manner on the website; or

(b) The customer has requested that the licensee refrain from sending any information regarding the customer relationship, and the licensee's current privacy notice remains available to the customer upon request.
(4) Oral description of notice insufficient. A licensee may not provide any notice required by this rule solely by orally explaining the notice, either in person or over the telephone.

(5) Retention or accessibility of notices for customers.
(a) For customers only, a licensee shall provide the initial notice required by paragraph 69O-128.005(1)(a), F.A.C., the annual notice required by subsection 69O-128.006(1), F.A.C., and the revised notice required by Rule 69O-128.009, F.A.C., so that the customer can retain them or obtain them later in writing or, if the customer agrees, electronically.

(b) Examples of retention or accessibility. A licensee provides a privacy notice to the customer so that the customer can retain it or obtain it later if the licensee:
1. Hand-delivers a printed copy of the notice to the customer;

2. Mails a printed copy of the notice to the last known address of the customer; or

3. Makes its current privacy notice available on a web site, or a link to another website, for the customer who obtains an insurance product or service electronically and agrees to receive the notice at the website.
(6) Joint notice with other financial institutions. A licensee may provide a joint notice from the licensee and one or more of its affiliates or other financial institutions, as identified in the notice, as long as the notice is accurate with respect to the licensee and the other institutions. A licensee also may provide a notice on behalf of another financial institution.

(7) Joint relationships. If 2 or more consumers jointly obtain an insurance product or service from a licensee, the licensee may satisfy the initial, annual and revised notice requirements of subsections 69O-128.005(1), 69O-128.006(1), and 69O-128.009(1), F.A.C., respectively, by providing one notice to those consumers jointly.

69O FAC 128.011 | Limits on Disclosure of Nonpublic Personal Financial Information to Nonaffiliated Third Parties

(1)
(a) Conditions for disclosure. Except as otherwise authorized in these rules, a licensee may not, directly or through any affiliate, disclose any nonpublic personal financial information about a consumer to a nonaffiliated third party unless:
1. The licensee has provided to the consumer an initial notice as required under Rule 69O-128.005, F.A.C.,

2. The licensee has provided to the consumer an opt out notice as required in Rule 69O-128.008, F.A.C.,

3. The licensee has given the consumer a reasonable opportunity, before it discloses the information to the nonaffiliated third party, to opt out of the disclosure; and,

4. The consumer does not opt out.
An agent may not disclose a consumer's nonpublic personal financial information to appointing insurers to shop for insurance products or services other than those initially requested by the consumer unless such disclosure meets the requirements of this subparagraphs 69O-128.011(1)(a)1.-4., F.A.C., or the conditions set forth in subsection 69O-128.015(1), F.A.C.

(b) Opt out definition. Opt out means a direction by the consumer that the licensee not disclose nonpublic personal financial information about that consumer to a nonaffiliated third party, other than as permitted by Rules 69O-128.014, 69O-128.015, and 69O-128.016, F.A.C.

(c) Examples of reasonable opportunity to opt out. A licensee provides a consumer with a reasonable opportunity to opt out if:
1. By mail. The licensee mails the notices required in paragraph (1)(a) of this subsection, to the consumer at the consumer's last known address and allows the consumer a time period of at least 30 days from the date the licensee mailed the notices to opt out by mailing a form, calling a toll-free telephone number, or any other reasonable means.

2. By electronic means. A customer opens an on-line account with a licensee and agrees to receive the notices required in paragraph (a) of this subsection electronically, and the licensee allows the customer to opt out by any reasonable means within 30 days after the date that the customer acknowledges receipt of the notices in conjunction with opening the account.

3. Isolated transaction with consumer. For an isolated transaction such as providing the consumer with an insurance quote, a licensee provides the consumer with a reasonable opportunity to opt out if the licensee provides the notices required in paragraph (1)(a) of this subsection, at the time of the transaction and requests that the consumer decide, as a necessary part of the transaction, whether to opt out before completing the transaction.
(2) Application of opt out to all consumers and all nonpublic personal financial information.
(a) A licensee shall comply with this rule, regardless of whether the licensee and the consumer have established a customer relationship.

(b) Unless a licensee complies with this rule, the licensee may not, directly or through any affiliate, disclose any nonpublic personal financial information about a consumer that the licensee has collected, regardless of whether the licensee collected it before or after receiving the direction to opt out from the consumer.
(3) Partial opt out. A licensee may allow a consumer to select certain nonpublic personal financial information or certain nonaffiliated third parties with respect to which the consumer wishes to opt out.

69O FAC 128.012 | Limits on Redisclosure and Reuse of Nonpublic Personal Financial Information

(1)
(a) Information the licensee receives under an exception. If a licensee receives nonpublic personal financial information from a nonaffiliated financial institution under an exception in Rule 69O-128.015 or 69O-128.016, F.A.C., the licensee's disclosure and use of that information is limited as follows:
1. The licensee may disclose the information to the affiliates of the financial institution from which the licensee received the information,

2. The licensee may disclose the information to its affiliates, but the licensee's affiliates may, in turn, disclose and use the information only to the extent that the licensee may disclose and use the information; and,

3. The licensee may disclose and use the information pursuant to an exception in Rule 69O-128.015 or 69O-128.016, F.A.C., in the ordinary course of business to carry out the activity covered by the exception under which the licensee received the information.
(b) Example. If a licensee receives information from a nonaffiliated financial institution for claims settlement purposes, the licensee may disclose the information for fraud prevention, or in response to a properly authorized subpoena. The licensee may not disclose that information to a third party for marketing purposes or use that information for its own marketing purposes.
(2)
(a) Information a licensee receives outside of an exception. If a licensee receives nonpublic personal financial information from a nonaffiliated financial institution other than under an exception in Rule 69O-128.015 or 69O-128.016, F.A.C., the licensee may disclose the information only:
1. To the affiliates of the financial institution from which the licensee received the information,

2. To its affiliates, but its affiliates may, in turn, disclose the information only to the extent that the licensee may disclose the information; and,

3. To any other person, if the disclosure would be lawful if made directly to that person by the financial institution from which the licensee received the information.
(b) Example. If a licensee obtains a customer list from a nonaffiliated financial institution outside of the exceptions in Rule 69O-128.015 or 69O-128.016, F.A.C.:
1. The licensee may use that list for its own purposes; and,

2. The licensee may disclose that list to another nonaffiliated third party only if the financial institution from which the licensee purchased the list could have lawfully disclosed the list to that third party. That is, the licensee may disclose the list in accordance with the privacy policy of the financial institution from which the licensee received the list, as limited by the opt out direction of each consumer whose nonpublic personal financial information the licensee intends to disclose, and the licensee may disclose the list in accordance with an exception in Rule 69O-128.015 or 69O-128.016, F.A.C., such as to the licensee's attorneys or accountants.
(3) Information a licensee discloses under an exception. If a licensee discloses nonpublic personal financial information to a nonaffiliated third party under an exception in Rule 69O-128.015 or 69O-128.016, F.A.C., the third party may disclose and use that information only as follows:
(a) The third party may disclose the information to the licensee's affiliates;

(b) The third party may disclose the information to its affiliates, but its affiliates may, in turn, disclose and use the information only to the extent that the third party may disclose and use the information; and,

(c) The third party may disclose and use the information pursuant to an exception in Rule 69O-128.015 or 69O-128.016, F.A.C., in the ordinary course of business to carry out the activity covered by the exception under which it received the information.
(4) Information a licensee discloses outside of an exception. If a licensee discloses nonpublic personal financial information to a nonaffiliated third party other than under an exception in Rule 69O-128.015 or 69O-128.016, F.A.C., the third party may disclose the information only:
(a) To the licensee's affiliates;

(b) To the third party's affiliates, but the third party's affiliates, in turn, may disclose the information only to the extent the third party can disclose the information; and,

(c) To any other person, if the disclosure would be lawful if the licensee made it directly to that person.

69O FAC 128.013 | Limits on Sharing Account Number Information for Marketing Purposes

(1) General prohibition on disclosure of account numbers. A licensee shall not, directly or through an affiliate, disclose, other than to a consumer reporting agency, a policy number or similar form of access number or access code for a consumer's policy or transaction account to any nonaffiliated third party for use in telemarketing, direct mail marketing or other marketing through electronic mail to the consumer.

(2) Exceptions. Subsection (1) of this rule does not apply if a licensee discloses a policy number or similar form of access number or access code:
(a) To the licensee's service provider solely in order to perform marketing for the licensee's own products or services, as long as the service provider is not authorized to directly initiate charges to the account;

(b) To a licensee who is a producer solely in order to perform marketing for the licensee's own products or services; or

(c) To a participant in an affinity or similar program where the participants in the program are identified to the customer when the customer enters into the program.
(3) Examples.
(a) Policy number. A policy number, or similar form of access number or access code, does not include a number or code in an encrypted form, as long as the licensee does not provide the recipient with a means to decode the number or code.

(b) Policy or transaction account. For the purposes of this rule, a policy or transaction account is an account other than a deposit account or a credit card account. A policy or transaction account does not include an account to which third parties cannot initiate charges.

69O FAC 128.014 | Exception to Opt Out Requirements for Disclosure of Nonpublic Personal Financial Information for Service Providers and Joint Marketing

(1) General rule.
(a) The opt out requirements in Rules 69O-128.008 and 69O-128.011, F.A.C., do not apply when a licensee provides nonpublic personal financial information to a nonaffiliated third party to perform services for the licensee or functions on the licensee's behalf, if the licensee:
1. Provides the initial notice in accordance with Rule 69O-128.005, F.A.C.; and,

2. Enters into a contractual agreement with the third party that prohibits the third party from disclosing or using the information other than to carry out the purposes for which the licensee disclosed the information, including use under an exception in Rule 69O-128.015 or 69O-128.016, F.A.C., in the ordinary course of business to carry out those purposes.
(b) Example. If a licensee discloses nonpublic personal financial information under this rule to a financial institution with which the licensee performs joint marketing, the licensee's contractual agreement with that institution meets the requirements of subparagraph (1)(a)2. of this subsection, if it prohibits the institution from disclosing or using the nonpublic personal financial information except as necessary to carry out the joint marketing or under an exception in Rule 69O-128.015 or 69O-128.016, F.A.C., in the ordinary course of business to carry out that joint marketing.
(2) Service may include joint marketing. The services a nonaffiliated third party performs for a licensee under subsection (1) of this rule, may include marketing of the licensee's own products or services or marketing of financial products or services offered pursuant to joint agreements between the licensee and one or more financial institutions.

(3) Definition of "joint agreement." For purposes of this rule, "joint agreement" means a written contract pursuant to which a licensee and one or more financial institutions jointly offer, endorse or sponsor a financial product or service.

69O FAC 128.015 | Exceptions to Notice and Opt Out Requirements for Disclosure of Nonpublic Personal Financial Information for Processing and Servicing Transactions

(1) Exceptions for processing transactions at consumer's request. The requirements for initial notice in paragraph 69O-128.005(1)(b), F.A.C., the opt out in Rules 69O-128.008 and 69O-128.011, F.A.C., and service providers and joint marketing in Rule 69O-128.014, F.A.C., do not apply if the licensee discloses nonpublic personal financial information as necessary to effect, administer or enforce a transaction that a consumer requests or authorizes, or in connection with:
(a) Servicing or processing an insurance product or service that a consumer requests or authorizes;

(b) Maintaining or servicing the consumer's account with a licensee, or with another entity as part of a private label credit card program or other extension of credit on behalf of such entity;

(c) A proposed or actual securitization, secondary market sale (including sales of servicing rights) or similar transaction related to a transaction of the consumer; or

(d) Reinsurance or stop loss or excess loss insurance.
(2) "Necessary to effect, administer or enforce a transaction" means that the disclosure is:
(a) Required, or is one of the lawful or appropriate methods, to enforce the licensee's rights or the rights of other persons engaged in carrying out the financial transaction or providing the product or service; or

(b) Required, or is a usual, appropriate or acceptable method:
1. To carry out the transaction or the product or service business of which the transaction is a part, and record, service or maintain the consumer's account in the ordinary course of providing the insurance product or service;

2. To administer or service benefits or claims relating to the transaction or the product or service business of which it is a part;

3. To provide a confirmation, statement or other record of the transaction, or information on the status or value of the insurance product or service to the consumer or the consumer's agent or broker;

4. To accrue or recognize incentives or bonuses associated with the transaction that are provided by a licensee or any other party;

5. To underwrite insurance at the consumer's request or for any of the following purposes as they relate to a consumer's insurance: account administration, reporting, investigating or preventing fraud or material misrepresentation, processing premium payments, processing insurance claims, administering insurance benefits (including utilization review activities), participating in research projects or as otherwise required or specifically permitted by federal or state law; or

6. In connection with:
a. The authorization, settlement, billing, processing, clearing, transferring, reconciling or collection of amounts charged, debited or otherwise paid using a debit, credit or other payment card, check or account number, or by other payment means;

b. The transfer of receivables, accounts or interests therein; or

c. The audit of debit, credit or other payment information.

69O FAC 128.016 | Other Exceptions to Notice and Opt Out Requirements for Disclosure of Nonpublic Personal Financial Information

(1) Exceptions to opt out requirements. The requirements for initial notice to consumers in paragraph 69O-128.005(1)(b), F.A.C., the opt out in Rules 69O-128.008 and 69O-128.011, F.A.C., and service providers and joint marketing in Rule 69O-128.014, F.A.C., do not apply when a licensee discloses nonpublic personal financial information:
(a) With the consent or at the direction of the consumer, provided that the consumer has not revoked the consent or direction;

(b)
1. To protect the confidentiality or security of a licensee's records pertaining to the consumer, service, product or transaction;

2. To protect against or prevent actual or potential fraud or unauthorized transactions;

3. For required institutional risk control or for resolving consumer disputes or inquiries;

4. To persons holding a legal or beneficial interest relating to the consumer; or

5. To persons acting in a fiduciary or representative capacity on behalf of the consumer;
(c) To provide information to insurance rate advisory organizations, guaranty funds or agencies, agencies that are rating a licensee, persons that are assessing the licensee's compliance with industry standards, and the licensee's attorneys, accountants and auditors;

(d) To the extent specifically permitted or required under other provisions of law and in accordance with the federal Right to Financial Privacy Act of 1978 (12 U.S.C. 3401 et seq.), to law enforcement agencies (including the Federal Reserve Board, Office of the Comptroller of the Currency, Federal Deposit Insurance Corporation, Office of Thrift Supervision, National Credit Union Administration, the Securities and Exchange Commission, the Secretary of the Treasury, with respect to 31 U.S.C. Chapter 53, Subchapter II (Records and Reports on Monetary Instruments and Transactions) and 12 U.S.C. Chapter 21 (Financial Record keeping), a state insurance authority, and the Federal Trade Commission), self-regulatory organizations or for an investigation on a matter related to public safety;

(e)
1. To a consumer reporting agency in accordance with the federal Fair Credit Reporting Act (15 U.S.C. 1681 et seq.); or

2. From a consumer report reported by a consumer reporting agency;
(f) In connection with a proposed or actual sale, merger, transfer or exchange of all or a portion of a business or operating unit if the disclosure of nonpublic personal financial information concerns solely consumers of the business or unit;

(g)
1. To comply with federal, state or local laws, rules and other applicable legal requirements;

2. To comply with a properly authorized civil, criminal or regulatory investigation, or subpoena or summons by federal, state or local authorities; or

3. To respond to judicial process or government regulatory authorities having jurisdiction over a licensee for examination, compliance, or other purposes as authorized by law;
(h) For purposes related to the replacement of a group benefit plan, a group health plan, a group welfare plan or a workers' compensation plan; or

(i) Pursuant to the provisions of Chapter 631, F.S., the Office is required to collect on reinsurance policies, pay claims, transfer policies to other insurers, and engage in similar activities with respect to insurers which are in receivership. In connection with the performance of its statutory obligations, the Office often must disclose insureds' non-public personal information to third parties. The disclosure of such information by the Office is considered to be required by law, and Office is therefore not subject to the requirements of this rule in connection with the disclosure of personal financial information incident to the performance of activities under Chapter 631, F.S.
(2) Example of revocation of consent. A consumer may revoke consent by subsequently exercising the right to opt out of future disclosures of nonpublic personal information as permitted under subsection 69O-128.008(6), F.A.C.

69O FAC 128.017 | When Authorization Required for Disclosure of Nonpublic Personal Health Information

(1) Except as provided in subsections (2) and (3) of this rule, a licensee shall not disclose nonpublic personal health information about a consumer or customer unless an authorization is obtained from the consumer or customer whose nonpublic personal health information is sought to be disclosed.

(2) Nothing in this rule shall prohibit, restrict, or require an authorization for the disclosure of nonpublic personal health information by a licensee for the performance of the following insurance functions by or on behalf of the licensee:
(a) Claims administration;

(b) Claims adjustment and management;

(c) Detection, investigation or reporting of actual or potential fraud, misrepresentation or criminal activity;

(d) Underwriting;

(e) Policy placement or issuance;

(f) Loss control;

(g) Ratemaking and guaranty fund functions;

(h) Reinsurance and excess loss insurance;

(i) Risk management;

(j) Case management;

(k) Disease management;

(l) Quality assurance;

(m) Quality improvement;

(n) Performance evaluation;

(o) Provider credentialing verification;

(p) Utilization review;

(q) Peer review activities;

(r) Actuarial, scientific, medical or public policy research;

(s) Grievance procedures;

(t) Internal administration of compliance, managerial, and information systems;

(u) Policyholder service functions;

(v) Auditing;

(w) Reporting;

(x) Database security;

(y) Administration of consumer disputes and inquiries;

(z) External accreditation standards;

(aa) The replacement of a group benefit plan or workers' compensation policy or program;

(bb) Activities in connection with a sale, merger, transfer or exchange of all or part of a business or operating unit;

(cc) Any activity that permits disclosure without authorization pursuant to the Federal Health Insurance Portability And Accountability Act privacy rules promulgated by the U.S. Department Of Health And Human Services;

(dd) Disclosure that is required, or is one of the lawful or appropriate methods, to enforce the licensee's rights or the rights of other persons engaged in carrying out a transaction or providing a product or service that a consumer requests or authorizes; and,

(ee) Any activity otherwise permitted by law, required pursuant to governmental reporting authority, or to comply with legal process.

(ff) Disclosure of information obtained by a licensee to a hospital, physician, or other medical care provider in connection with the provision of health care services to a customer of the licensee.

(gg) Additional insurance functions that the Office determines to be necessary for appropriate performance of insurance functions and that are fair and reasonable to the interest of consumers.
(3) Non-public health information may be disclosed for scientific, medical, or public policy research in accordance with federal law regardless of whether the research is conducted by or on behalf of the licensee.

69O FAC 128.018 | Authorizations

(1) A valid authorization to disclose nonpublic personal health information pursuant to this Part shall be in written or electronic form and shall contain all of the following:
(a) The identity of the consumer or customer who is the subject of the nonpublic personal health information;

(b) A general description of the types of nonpublic personal health information to be disclosed;

(c) General descriptions of the parties to whom the licensee discloses nonpublic personal health information, the purpose of the disclosure and how the information will be used;

(d) The signature of the consumer or customer who is the subject of the nonpublic personal health information or the individual who is legally empowered to grant authority and the date signed; and,

(e) Notice of the length of time for which the authorization is valid and that the consumer or customer may revoke the authorization at any time and the procedure for making a revocation.
(2) An authorization for the purposes of this Part shall specify a length of time for which the authorization shall remain valid, which in no event shall be for more than 24 months.

(3) A consumer or customer who is the subject of nonpublic personal health information may revoke an authorization provided pursuant to this Part at any time, subject to the rights of an individual who acted in reliance on the authorization prior to notice of the revocation.

(4) A licensee shall retain the authorization or a copy thereof in the record of the individual who is the subject of nonpublic personal health information.

69O FAC 128.019 | Authorization Request Delivery

A request for authorization and an authorization form may be delivered to a consumer or a customer as part of an opt-out notice pursuant to Rule 69O-128.010, F.A.C., provided that the request and the authorization form are clear and conspicuous. An authorization form is not required to be delivered to the consumer or customer or included in any other notices unless the licensee intends to disclose protected health information pursuant to subsection 69O-128.017(1), F.A.C.

69O FAC 128.020 | Relationship to Federal Rules

(1) If the Office determines that a health insurer or health maintenance organization licensed by the Office is in compliance with, or is actively undertaking compliance with, the consumer privacy protection rules adopted by the United States Department of Health and Human Services in conformance with the Health Insurance Portability and Affordability Act, (except for its effective date provision) the licensee shall be considered to be in compliance with this part.

(2) Effective April 14, 2003, with respect to health insurance coverage issued by a health insurer or contracts issued by a health maintenance organization, such licensees must be in actual compliance with the Health and Human Services rules in order to be considered in compliance with this Part. As of such date, any other licensee that would satisfy the requirements of the HHS rules if it were subject to such rules will be considered to be in compliance with this part.

69O FAC 128.021 | Relationship to State Laws

69O FAC 128.022 | Protection of Fair Credit Reporting Act

Nothing in these rules shall be construed to modify, limit or supersede the operation of the federal Fair Credit Reporting Act (15 U.S.C. 1681 et seq.), and no inference shall be drawn on the basis of the provisions of these rules regarding whether information is transaction or experience information under Section 603 of that Act.

69O FAC 128.023 | Nondiscrimination

(1) A licensee shall not unfairly discriminate against any consumer or customer because that consumer or customer has opted out from the disclosure of his or her nonpublic personal financial information pursuant to the provisions of these rules.

(2) A licensee shall not unfairly discriminate against a consumer or customer because that consumer or customer has not granted authorization for the disclosure of his or her nonpublic personal health information pursuant to the provisions of these rules.

69O FAC 128.024 | Effective Date

(1)
(a) Not later than 30 days following the effective date of Emergency Rules 4ER01-1 through 22, F.A.C., each licensee shall provide an initial notice, as required by Rule 69O-128.005, F.A.C., to consumers who are the licensee's customers on July 1, 2001.

(b) Example. A licensee provides an initial notice to consumers who are its customers on July 1, 2001, if, by July 31, 2001, the licensee has established a system for providing an initial notice to all new customers and has mailed the initial notice to all the licensee's existing customers.
(2) Until July 1, 2002, a contract that a licensee has entered into with a nonaffiliated third party to perform services for the licensee or functions on the licensee's behalf satisfies the provisions of subparagraph 69O-128.014(1)(a)2., F.A.C., of this rule, even if the contract does not include a requirement that the third party maintain the confidentiality of nonpublic personal information, as long as the licensee entered into the agreement on or before July 1, 2000.

69O FAC 128.025 | Confidentiality of Personal Financial and Health Information Pursuant to Section 627.3111, F.S. (Repealed)

69O FAC 128.030 | Preamble

(1) These rules establish standards for developing and implementing administrative, technical and physical safeguards to protect the security, confidentiality, and integrity of customer information, pursuant to Sections 501, 505(b), and 507 of the Gramm-Leach-Bliley Act, codified at 15 U.S.C. 6801, 6805(b) and 6807.

(2)
(a) Section 501(a) provides that it is the policy of the Congress that each financial institution has an affirmative and continuing obligation to respect the privacy of its customers and to protect the security and confidentiality of those customers' nonpublic personal information.

(b) Section 501(b) requires the state insurance regulatory authorities to establish appropriate standards for the financial institutions under their jurisdiction relating to administrative, technical, and physical safeguards:
1. To ensure the security and confidentiality of customer records and information;

2. To protect against any anticipated threats or hazards to the security or integrity of such records; and,

3. To protect against unauthorized access to or use of records or information that could result in substantial harm or inconvenience to a customer.
(c) Section 505(b)(2) requires state insurance regulatory authorities to implement the standards prescribed under Section 501(b) by rule with respect to persons engaged in providing insurance.

(d) Section 507 provides, among other things, that a state regulation may afford persons greater privacy protections than those provided by subtitle A of Title V of the Gramm-Leach-Bliley Act.
(3) This Part requires that the safeguards established pursuant to this Part shall apply to nonpublic personal information, including nonpublic personal financial information and nonpublic personal health information.

69O FAC 128.031 | Definitions

For purposes of this part, the following definitions apply:
(1) "Customer" means a customer of the licensee as the term customer is defined in subsection 69O-128.002(8), F.A.C.

(2) "Customer information" means nonpublic personal information as defined in subsection 69O-128.002(18), F.A.C., about a customer, whether in paper, electronic, or other form, that is maintained by or on behalf of the licensee.

(3) "Customer information systems" means the electronic or physical methods used to access, collect, store, use, transmit, protect, or dispose of customer information.

(4) "Licensee" means a licensee as that term is defined in subsection 69O-128.002(16), F.A.C., except that "licensee" shall not include: a purchasing group, or an unauthorized insurer in regard to the surplus line business conducted pursuant to Section 626.938, F.S.

(5) "Service provider" means a person that maintains, processes, or otherwise is permitted access to customer information through its provision of services directly to the licensee.

69O FAC 128.032 | Information Security Program

(1) Each licensee shall implement a comprehensive written information security program that includes administrative, technical, and physical safeguards for the protection of customer information.

(2) The administrative, technical, and physical safeguards included in the information security program shall be appropriate to the size and complexity of the licensee and the nature and scope of its activities.

69O FAC 128.033 | Objectives of Information Security Program

A licensee's information security program shall be designed to:
(1) Ensure the security and confidentiality of customer information;

(2) Protect against any anticipated threats or hazards to the security or integrity of the information; and,

(3) Protect against unauthorized access to or use of the information that could result in substantial harm or inconvenience to any customer.

69O FAC 128.034 | Examples of Methods of Development and Implementation

The following actions and procedures are examples of methods of implementation of the requirements of Rules 69O-128.032 and 69O-128.033, F.A.C. These examples are non-exclusive illustrations of actions and procedures that licensees may follow to implement Rules 69O-128.032 and 69O-128.033, F.A.C.
(1) Assess Risk. The licensee:
(a) Identifies reasonably foreseeable internal or external threats that could result in unauthorized disclosure, misuse, alteration, transmission, or destruction of customer information or customer information systems;

(b) Assesses the likelihood and potential damage of these threats, taking into consideration the sensitivity of customer information; and,

(c) Assesses the sufficiency of policies, procedures, customer information systems, and other safeguards in place to control risks.
(2) Manage and Control Risk. The licensee:
(a) Designs its information security program to control the identified risks, commensurate with the sensitivity of the information as well as the complexity and scope of the licensee's activities;

(b) Trains staff as appropriate to implement the licensee's information security program; and,

(c) Regularly tests or otherwise regularly monitors the key controls, systems, and procedures of the information security program. The frequency and nature of these tests or other monitoring practices are determined by the licensee's risk assessment.
(3) Oversee Service Provider Arrangements. The licensee:
(a) Exercises appropriate due diligence in selecting its service providers; and,

(b) Requires its service providers to implement appropriate measures designed to meet the objectives of this rule; and, where indicated by the licensee's risk assessment, takes appropriate steps to confirm that its service providers have satisfied these obligations.
(4) Adjust the Program. The licensee monitors, evaluates, and adjusts as appropriate the information security program in light of any relevant changes in:
(a) Technology;

(b) The sensitivity of its customer information;

(c) The volume of its customer information;

(d) Internal or external threats to information; and,

(e) The licensee's own changing business arrangements, such as:
1. Mergers and acquisitions;

2. Alliances and joint ventures;

3. Outsourcing arrangements; and,

4. Changes to customer information systems.

69O FAC 128.035 | Effective Date

69O-136 | Application Procedures for Companies Seeking to Do Business in Florida

69O FAC 136.002 | Foreign and Alien Insurers Filing for a Certificate of Authority

All foreign or alien entities seeking a certificate of authority shall comply with the requirements of sections 624.404, 624.413, and related Florida Statutes. Each applicant shall comply with the instructions contained in the Uniform Certificate of Authority Expansion Application and any other requirements listed or referenced in the Uniform Certificate of Authority Expansion Application package, Form OIR-C1-1413. Such filings shall not exempt a foreign or alien insurer from any requirements under Florida law.
(1) Applicants shall comply with the directions on, or otherwise submit, the following applicable forms:
(a) The biographical information package as defined in subsection 69O-136.100(3), F.A.C.;

(b) Form OIR-C1-1413, "Uniform Certificate of Authority Application (UCAA) Expansion Application," incorporated by reference in Rule 69O-136.100, F.A.C.;

(c) Form OIR-C1-1414, "Uniform Certificate of Authority Application (UCAA) Expansion Application Checklist For Expansion Application Only," incorporated by reference in Rule 69O-136.100, F.A.C.;

(d) Form OIR-C1-1416, "Uniform Certificate of Authority Application (UCAA) Lines of Insurance," incorporated by reference in Rule 69O-136.100, F.A.C.;

(e) Form OIR-C1-1422, "Uniform Certificate of Authority Application Questionnaire," incorporated by reference in Rule 69O-136.100, F.A.C.;

(f) Form OIR-C1-1424, "Uniform Certificate of Authority Application," incorporated by reference in Rule 69O-136.100, F.A.C.;

(g) Form OIR-C1-1524, "Uniform Certificate of Authority Application (UCAA) Uniform Consent to Service of Process," incorporated by reference in Rule 69O-136.100, F.A.C.;

(h) Form OIR-C1-2221, "Management Information Form," incorporated by reference in Rule 69O-136.100, F.A.C.;

(i) Form OIR-D0-896, "UCAA Proforma Financial Statements, Property and Casualty Insurance Company," incorporated by reference in Rule 69O-136.100, F.A.C.;

(j) Form OIR-D0-904, "UCAA Proforma Financial Statements, Life & Health Insurer," incorporated by reference in Rule 69O-136.100, F.A.C.;

(k) Form OIR-D0-2119, "UCAA Proforma Financial Statements, Title Insurance Company," incorporated by reference in Rule 69O-136.100, F.A.C.; and

(l) Form OIR-D0-2165, "UCAA Proforma Financial Statements, Health," incorporated by reference in Rule 69O-136.100, F.A.C.
(2) Applicants must also submit:
(a) A certificate of compliance certified by the domiciliary regulator.

(b) A certificate of deposit certified by the domiciliary regulator.
(3) All the forms listed in subsection (1) may be obtained from the Office's website at http://www.FLOir.com and shall be submitted electronically via the Office's iApply system at https://www.FLOir.com/iPortal. Forms relating to specific kinds of insurance in subsection (1) are to be submitted only by companies issuing policies relating to the kind of insurance specified on the form.

69O FAC 136.004 | Surplus Lines

Applications submitted as an insurer under Florida's Surplus Lines Law, pursuant to section 626.913, Florida Statutes, shall contain all of the following forms.
(1) Applicants shall comply with the directions on, or otherwise submit, the following applicable forms:
(a) Form OIR-C1-916, "Application for Eligibility as a Surplus Lines Insurer," incorporated by reference in Rule 69O-136.100, F.A.C.;

(b) Form OIR-C1-144, "Service of Process Consent & Agreement," incorporated by reference in Rule 69O-136.100, F.A.C.;

(c) Form OIR-C1-1416, "Uniform Certificate of Authority Application (UCAA) Lines of Insurance," incorporated by reference in Rule 69O-136.100, F.A.C.;

(d) The biographical information package as defined in subsection 69O-136.100(3), F.A.C.; and

(e) Form OIR-C1-2221, "Management Information Form," incorporated by reference in Rule 69O-136.100, F.A.C.
(2) All the forms listed in subsection (1) may be obtained from the Office's website at http://www.FLOir.com and shall be submitted electronically via the Office's iApply system at https://www.FLOir.com/iPortal.

69O FAC 136.006 | Domestic Insurers Filing for an Application for Permit and Subsequent Certificate of Authority

(1) All domestic insurers filing an Application for Permit, pursuant to Chapter 628, F.S., for the following: domestic property and casualty insurers, title insurers, life and health insurers, and domestic assessable mutual insurers, pursuant to section 628.051, F.S. except for domestic reciprocal insurers which are addressed in (2); domestic assessable mutual insurers, pursuant to section 628.051, F.S, and Domestic Captive Insurers, pursuant to Chapter 628, Part III, F.S.:
(a) Shall comply with the directions on, or otherwise submit, the following applicable forms:
1. Form OIR-C1-100, "Application For Permit Domestic Stock or Mutual Insurer", incorporated by reference in Rule 69O-136.100, F.A.C.

2. The biographical information package as defined in subsection 69O-136.100(3), F.A.C.;

3. Form OIR-C1-2221, "Management Information Form," incorporated by reference in Rule 69O-136.100, F.A.C.;

4. Form OIR-D0-896, "UCAA Proforma Financial Statements, Property and Casualty Insurance Company," incorporated by reference in Rule 69O-136.100, F.A.C.;

5. Form OIR-D0-904, "UCAA Proforma Financial Statements, Life & Health Insurer," incorporated by reference in Rule 69O-136.100, F.A.C.;

6. Form OIR-D0-2119, "UCAA Proforma Financial Statements, Title Insurance Company," incorporated by reference in Rule 69O-136.100, F.A.C.; and

7. Form OIR-D0-2165, "UCAA Proforma Financial Statements, Health," incorporated by reference in Rule 69O-136.100, F.A.C.
(b) Once applicant has received a permit from the Office pursuant to paragraph (1)(a) above, it shall submit Form OIR-C1-1524, "Uniform Certificate of Authority Application (UCAA) Uniform Consent to Service of Process," incorporated by reference in Rule 69O-136.100, F.A.C., as well as any other documents required in the permit. Once it has submitted all documents, satisfied the permit conditions, and is otherwise in compliance with Florida law, applicant will be granted a certificate of authority.
(2) All domestic reciprocal insurers filing an Application for Permit, pursuant to sections 628.051, F.S, and Chapters 624 and 629, F.S.,
(a) Shall follow the directions on, or otherwise submit, the following forms:
1. Form OIR-C1-908, "Application for Permit Domestic Reciprocal Insurer," incorporated by reference in Rule 69O-136.100, F.A.C.;

2. The biographical information package as defined in subsection 69O-136.100(3), F.A.C.;

3. Form OIR-C1-2221, "Management Information Form," incorporated by reference in Rule 69O-136.100, F.A.C.;

4. Form OIR-D0-896, "UCAA Proforma Financial Statements, Property and Casualty Insurance Company," incorporated by reference in Rule 69O-136.100, F.A.C.;

5. Form OIR-D0-2119, "UCAA Proforma Financial Statements, Title Insurance Company," incorporated by reference in Rule 69O-136.100, F.A.C.; and

6. Form OIR-D0-2165, "UCAA Proforma Financial Statements, Health," incorporated by reference in Rule 69O-136.100, F.A.C.
(b) Once applicant has received a permit from the Office pursuant to paragraph (2)(a) above, it shall follow the directions on, or otherwise submit, the following forms:
1. Form OIR-C1-151, "Application for Certificate of Authority Domestic Reciprocal Insurer," incorporated by reference in Rule 69O-136.100, F.A.C., and

2. Form OIR-C1-1524, "Uniform Certificate of Authority Application (UCAA) Uniform Consent to Service of Process," incorporated by reference in Rule 69O-136.100, F.A.C.
(c) Once applicant has submitted all documents, satisfied the permit and application requirements, and is otherwise in compliance with Florida law, applicant will be granted a certificate of authority.
(3) All the forms listed in subsection (1) and (2) above may be obtained from the Office's website at http://www.FLOir.com and shall be submitted electronically via the Office's iApply system at https://www.FLOir.com/iPortal. Forms relating to specific kinds of insurance in subsection (1) and (2) are to be submitted only by companies issuing policies relating to the kind of insurance specified on the form.

69O FAC 136.007 | Redomestication Procedure

(1) Any insurer which is organized under the laws of any other state for the purpose of writing insurance may apply for a certificate of authority as a domestic insurer in this state and shall comply with all of the requirements relative to the organization and licensing of a domestic insurer of the same type and by designating its principal place of business at a place in this state upon approval by the Office.

(2) A retaliatory application fee shall be submitted pursuant to section 624.5091, F.S. The retaliatory fee is the greater of:
(a) The amount that the applicant's domiciliary state or country would charge a Florida domestic insurer making application in the applicant's state or country of domicile; or

(b) The Florida application fee pursuant to section 624.501(1)(a), F.S.
(3) Any insurer seeking a certificate of authority as a domestic insurer in this state shall comply with the directions on, or otherwise submit, the following applicable forms:
(a) Form OIR-C1-101, "Application to Redomesticate a Stock or Mutual Insurer", incorporated by reference in Rule 69O-136.100, F.A.C.;

(b) The biographical information package as defined in subsection 69O-136.100(3), F.A.C.;

(c) Form OIR-C1-1416, "Uniform Certificate of Authority Application (UCAA) Lines of Insurance," incorporated by reference in Rule 69O-136.100, F.A.C.;

(d) Form OIR-C1-1422, "Uniform Certificate of Authority Application Questionnaire," incorporated by reference in Rule 69O-136.100, F.A.C.;

(e) Form OIR-C1-1522, "Primary Application Florida Specific Information," incorporated by reference in Rule 69O-136.100, F.A.C.;

(f) Form OIR-C1-1524, "Uniform Certificate of Authority Application (UCAA) Uniform Consent to Service of Process," incorporated by reference in Rule 69O-136.100, F.A.C.;

(g) Form OIR-C1-2221, "Management Information Form," incorporated by reference in Rule 69O-136.100, F.A.C.;

(h) Form OIR-D0-896, "UCAA Proforma Financial Statements, Property and Casualty Insurance Company," incorporated by reference in Rule 69O-136.100, F.A.C.;

(i) Form OIR-D0-904, "UCAA Proforma Financial Statements, Life & Health Insurer," incorporated by reference in Rule 69O-136.100, F.A.C.;

(j) Form OIR-D0-2119, "UCAA Proforma Financial Statements, Title Insurance Company," incorporated by reference in Rule 69O-136.100, F.A.C.; and

(k) Form OIR-D0-2165, "UCAA Proforma Financial Statements, Health," incorporated by reference in Rule 69O-136.100, F.A.C.
(4) All the forms listed in subsection (3) above may be obtained from the Office's website at http://www.FLOir.com and shall be submitted electronically via the Office's iApply system at https://www.FLOir.com/iPortal. Forms relating to specific kinds of insurance are to be submitted only by companies issuing policies relating to the kind of insurance specified.

69O FAC 136.011 | Commercial Self-Insurance Funds Filing for a Certificate of Authority

(1) Applicants for a certificate of authority as a commercial self-insurance fund pursuant to section 624.462, F.S., shall comply with the directions on, or otherwise submit, the following applicable forms:
(a) Form OIR-C1-845, "Application for Certificate of Authority Commercial Self-Insurance Fund," incorporated by reference in Rule 69O-136.100, F.A.C.;

(b) Form OIR-C1-144, "Service of Process Consent & Agreement," incorporated by reference in Rule 69O-136.100, F.A.C.;

(c) Form OIR-C1-1416, "Uniform Certificate of Authority Application (UCAA) Lines of Insurance," incorporated by reference in Rule 69O-136.100, F.A.C.;

(d) The biographical information package as defined in subsection 69O-136.100(3), F.A.C.; and

(e) Form OIR-C1-2221, "Management Information Form," incorporated by reference in Rule 69O-136.100, F.A.C.
(2) All the forms listed in subsection (1) above may be obtained from the Office's website at http://www.FLOir.com and shall be submitted electronically via the Office's iApply system at https://www.FLOir.com/iPortal. Forms relating to specific kinds of insurance are to be submitted only by companies issuing policies relating to the kind of insurance specified.

69O FAC 136.012 | Forms Adopted (Repealed)

69O FAC 136.013 | Advisory Organizations

(1) Any advisory organization seeking to conduct operations in this state shall submit Form OIR-B1-PCR3, "Filing requirements Advisory Organization," effective 7/23, hereby incorporated by reference in Rule 69O-136.100, F.A.C.

(2) After receipt by the Office of Form OIR-B1-PCR3 and any accompanying documents, the Office shall review the material for compliance with the requirements of Section 627.301, F.S. On meeting the requirements, the Office shall notify the advisory organization by letter that it is in compliance with Section 627.301, F.S., and therefore may operate in this state.

(3) Any advisory organization seeking to notify the Office of any change in information as required by s. 627.301(2), F.S., shall submit Form OIR-B1-PCR3 electronically at https://www.FLOir.com/iPortal.

69O FAC 136.014 | Rating Organizations

(1) An application for a person applying for a license as a rating organization consists of the following:
(a) Form OIR-C1-PCR1, "Application for License Rating Organization," incorporated by reference in Rule 69O-136.100, F.A.C.;

(b) Form OIR-C1-1416, "Uniform Certificate of Authority Application (UCAA) Lines of Insurance," incorporated by reference in Rule 69O-136.100, F.A.C.;

(c) The biographical information package as defined in subsection 69O-136.100(3), F.A.C.;

(d) Form OIR-C1-2221, "Management Information Form," incorporated by reference in Rule 69O-136.100, F.A.C.
(2) A person applying for a license as a rating organization shall submit forms in subsection (1) as directed by the Office electronically at https://www.FLOir.com/iPortal.

(3) Annual License Renewal
(a)
1. All rating organization licenses shall expire on September 30.

2. Failure to submit the application for continuance by September 30 shall result in expiration of the license and will require the filing of a new application for licensure.
(b) A licensee seeking to continue operating as a rating organization shall submit the following:
1. Form OIR-C1-PCR2, "License Renewal Rating Organization," incorporated by reference in Rule 69O-136.100, F.A.C.;

2. Form OIR-C1-1416, "Uniform Certificate of Authority Application (UCAA) Lines of Insurance," incorporated by reference in Rule 69O-136.100, F.A.C.; and

3. A fee of $25.00 filed annually in conjunction with the license renewal.
(c) Any licensee who fails to renew a rating organization license shall immediately cease and desist from engaging in the rating organization business in the state of Florida.

69O FAC 136.015 | Corporate Amendment Procedure to Amend an Existing Certificate of Authority

(1) This rule applies to all authorized insurers, as defined in section 624.09, F.S.

(2) Any insurer seeking to add or delete a line of insurance on an existing certificate of authority, file a name change, redomesticate (between foreign jurisdictions only), change its statutory home office address, merge two or more foreign insurers, file a change of control of a foreign insurer, amend its articles of incorporation, amend its bylaws, change its address or contact notification, or amend its Service of Process shall comply with the directions on, or otherwise submit, the following applicable forms:
(a) Form OIR-C1-0508, "Uniform Certificate of Authority Application (UCAA) Affidavit of Lost Certificate of Authority," incorporated by reference in Rule 69O-136.100, F.A.C.;

(b) Form OIR-C1-0510, "Uniform Certificate of Authority Application (UCAA) Corporate Amendments Application Application to Amend Certificate of Authority," incorporated by reference in Rule 69O-136.100, F.A.C.;

(c) Form OIR-C1-0511, "Uniform Certificate of Authority Application (UCAA) Corporate Amendments Application Checklist for Corporate Amendments Application Only," incorporated by reference in Rule 69O-136.100, F.A.C.;

(d) Form OIR-C1-0512, "Uniform Certificate of Authority Application Questionnaire for Adding or Deleting Lines of Business to an Existing Certificate of Authority," incorporated by reference in Rule 69O-136.100, F.A.C.;

(e) Form OIR-C1-0522, "Uniform Certificate of Application (UCAA) Change of Mailing Address/Contact Notification Form," incorporated by reference in Rule 69O-136.100, F.A.C.;

(f) 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," incorporated by reference in Rule 69O-136.100, F.A.C.;

(g) Form OIR-C1-1416, "Uniform Certificate of Authority Application (UCAA) Lines of Insurance," incorporated by reference in Rule 69O-136.100, F.A.C.; and

(h) Form OIR-C1-1524, "Uniform Certificate of Authority Application (UCAA) Uniform Consent to Service of Process," incorporated by reference in Rule 69O-136.100, F.A.C.
(3) Since the addition of any new line of business to a company's certificate of authority may impact the company's surplus and/or writing ratios, any such request to amend an existing certificate will be carefully evaluated by applying current standards required of an insurer seeking a certificate of authority from this state. The Office shall not authorize the addition of any lines of insurance to an insurer's existing certificate of authority unless evidence is presented satisfactory to the Office that authorization of the additional lines of insurance would be in the best interests of the financial solvency of the insurer and in the best interests of the policyholders.

(4) All the forms listed in subsection (2) may be obtained from the Office's website at http://www.FLOir.com and shall be submitted electronically via the Office's iApply system at https://www.FLOir.com/iPortal.

69O FAC 136.017 | Authorization to Transact Insurance; When Required

(1) No insurer shall issue insurance policies or otherwise transact insurance, as that term is defined in Section 624.10, F.S., involving risks resident or located in this state unless the insurer has a current certificate of authority issued by the Office.

(2) No insurer shall from offices or by personnel or facilities located in this state solicit insurance applications or otherwise transact insurance in another state or country unless it holds a current certificate of authority issued by the Office authorizing it to transact the same kind or kinds of insurance in this state.

(3) A current certificate of authority issued by the Office is not required under certain specific circumstances. These circumstances are as follows:
(a) A current Florida certificate of authority is not required if the activities of the unauthorized insurer involve only the investigation, settlement, or litigation of claims under policies previously lawfully written in this state, or only the liquidation of the assets and liabilities of the insurer which are the result of previously authorized operations in this state. This exception to the requirement shall not be construed to include the collection of premiums or the renewal of policies.

(b) A current Florida certificate of authority is not required to service a policy within the state, subsequent to the lawful issuance of the policy, so long as the subject of the policy of insurance was not resident, located, or expressly to be performed in this state at the time of issuance, and so long as the policy of insurance was lawfully solicited, written, or delivered outside of this state. The Office interprets Section 624.402(2), F.S., to mean that an unauthorized insurer may utilize personnel or facilities located in this state to transact insurance in other states or in foreign countries, provided that all such activities occur subsequent to and do not pertain to the issuance or effectuation of the insurance coverage.

(c) A current Florida certificate of authority is not required to engage in transactions pursuant to surplus lines coverage lawfully written under Part VIII of Chapter 626, F.S., so long as the insurer is an eligible surplus lines insurer under Sections 626.917 or 626.918, F.S. The Office interprets Section 626.918(2)(b), F.S., to mean that an unauthorized insurer cannot meet the requirements to be an eligible surplus lines insurer unless the unauthorized insurer has offices in and transacts insurance in its state or country of domicile. A surplus lines insurer eligible pursuant to Section 626.918, F.S., is not prohibited by this rule from utilizing offices or personnel in this state to transact insurance in another jurisdiction, provided it is licensed as a surplus lines or authorized insurer in that jurisdiction.

(d) A current Florida certificate of authority is not required to transact the business of reinsurance, so long as such reinsurance is transacted as authorized under Section 624.610, F.S.

(e) A current Florida certificate of authority is not required when an insurer has withdrawn from and is not transacting any new insurance in this state, but is solely continuing in force and continuing to service life insurance or health insurance policies or annuity contracts which remain in force and which insure residents of this state.

(f) A current Florida certificate of authority is not required when an unauthorized foreign insurer invests its funds in real estate in this state or in securities secured thereby, if the foreign insurer complies with the laws of this state relating generally to foreign business corporations.
(4) For purposes of this rule and Section 624.402(2), F.S., the issuance of an insurance policy includes any of the following acts:
(a) Solicitation of prospective insureds. For purposes of this rule, solicitation means face-to-face communications, or intra- or inter-state transmission of written, electronic, or telephonic communications from an unauthorized insurer or its agent to a prospective insured, for the purpose of generating a response or inquiry or which incidentally includes mention of matters of insurance.

(b) Transmitting applications to prospective insureds. For purposes of this rule, transmitting applications means face-to-face communications, or intra- or inter-state transmission of written, electronic, or telephonic communications from an unauthorized insurer or its agent to prospective insureds, for the purpose of consummating a contract of insurance or a relationship which may lead to a contract of insurance.

(c) Receiving applications from or on behalf of prospective insureds. For purposes of this rule, receiving applications means face-to-face communications, or intra- or inter-state transmission of written, electronic, or telephonic communications to an unauthorized insurer or its agent for use by the unauthorized insurer as a basis to determine the eligibility or insurability of prospective insureds or risks.

(d) Underwriting to determine insurability of a risk. For purposes of this rule, underwriting means face-to-face communications, or intra- or inter-state transmission of written, electronic, or telephonic communications from prospective insureds or risks for use by the unauthorized insurer as a basis to determine the eligibility or insurability of prospective insureds or risks.

(e) Analysis of insurance applications, questionnaires, or materials prepared by or concerning prospective insureds or risks to determine the eligibility, insurability, or underwriting in any fashion of prospective insureds or risks.

(f) Receiving initial premium payments from or on behalf of insureds.

(g) Mailing or otherwise transmitting a policy or any other evidence of coverage, as described in subsection (5), below, to an insured, to a policyholder, or to any other person.
(5) For purposes of this rule and Section 624.402(2), F.S., the effectuation of an insurance policy means the issuance of an oral or written agreement called an insurance contract, an insurance policy, a certificate of insurance, an insurance binder or cover note, a summary plan description or trust document; or any letter or other communication confirming insurance coverage; or an insurance identification card or other proof of insurance intended to demonstrate insurance coverage to a third party; or any similar document, by whatever name called, which evidences or is intended to evidence insurance coverage. For purposes of this rule, the issuance of any of the documents described in the preceding sentence constitutes the effectuation of insurance when such issuance occurs after face-to-face communications, or intra- or inter-state transmission of written, oral, electronic or telephonic communications from an unauthorized insurer or its agent consummating an insurance contract. Effectuation of an insurance contract is also evidenced by the receipt by an unauthorized insurer or its agent of any monies intended by the prospective insured or third party to serve as premium payment or consideration for an insurance contract.

(6) Any person conducting insurance-related activities in this state, whether or not required to be licensed under the provisions of this rule chapter, shall be subject to the provisions of the Unfair Insurance Trade Practices Act (Part IX of Chapter 626, F.S.), regardless of the situs or residence of the risk insured.

69O FAC 136.018 | Determination of Eligibility to Operate as an Alien Insurer in Florida Pursuant to Sections 624.402(8) or 624.402(9), F.S.

(1) The below are to be used in determination of eligibility to operate as an Alien Insurer pursuant to section 624.402(8) F.S. Applicants shall comply with the directions on, or otherwise submit, the following applicable forms:
(a) Form OIR-C1-2176, incorporated by reference in Rule 69O-136.100, F.A.C.;

(b) Form OIR-C1-1416, incorporated by reference in Rule 69O-136.100, F.A.C.; and

(c) Form OIR-C1-2221, incorporated by reference in Rule 69O-136.100, F.A.C.
(2) The below are to be used in determination of eligibility to operate as an Alien Insurer pursuant to section 624.402(9), F.S. Applicants shall comply with the directions on, or otherwise submit, Form OIR-C1-1654, incorporated by reference in Rule 69O-136.100, F.A.C.

(3) The forms listed in subsections (1) and (2) may be obtained from the Office's website at http://www.FLOir.com and shall be submitted electronically via the Office's iApply system at https://www.FLOir.com/iPortal.

69O FAC 136.031 | Registration as a Purchasing Group

(1) All entities seeking registration as a purchasing group shall comply with the requirements of section 627.948, F.S., and shall (1) All entities seeking registration as a purchasing group shall comply with the requirements of section 627.948, F.S., and shall comply with the directions on, or otherwise submit, the following applicable forms:
(a) Form OIR-C1-515, "Application for Registration as a Risk Purchasing Group," incorporated by reference in Rule 69O-136.100, F.A.C.; and

(b) Form OIR-C1-144, "Service of Process Consent & Agreement," incorporated by reference in Rule 69O-136.100, F.A.C.
(2) All domestic entities, as well as any foreign entities whose officers or directors collect premiums, shall comply with the directions on, or otherwise submit, the following applicable forms:
(a) The biographical information package as defined in subsection 69O-136.100(3), F.A.C.; and

(b) Form OIR-C1-2221, "Management Information Form," incorporated by reference in Rule 69O-136.100, F.A.C.
(3) In addition to the information required on the forms in subsection (1) & (2) above, the entity shall:
(a) Identify all other states in which the group is currently registered;

(b) Specify the method by which, and the person or persons, if any, through whom insurance will be offered to its members whose risks are resident or located in this state; and,

(c) Provide such other information as is necessary for the Office to determine whether the persons through whom insurance will be offered meet the standard set forth in section 626.611(14), F.S.
(4) During the pendency of the application, if any of the information submitted in response to the requirements of this rule changes, the entity shall notify the Office of the change within ten days of the change.

(5) All the forms listed in subsection (1) & (2) may be obtained from the Office's website at http://www.FLOir.com and shall be submitted electronically via the Office's iApply system at https://www.FLOir.com/iPortal.

69O FAC 136.032 | Registration as a Risk Retention Group

(1) All foreign entities seeking licensure as a risk retention group shall comply with the requirements of section 627.944, F.S., as applicable, and shall comply with the directions on, or otherwise submit, Form OIR-C1-513, incorporated by reference in Rule 69O-136.100, F.A.C.

(2) The form listed in subsection (1) may be obtained from the Office's website at http://www.FLOir.com and shall be submitted electronically via the Office's iApply system at https://www.FLOir.com/iPortal.

(3) Applicants shall also submit:
(a) A copy of each examination of the risk retention group as certified by the innsurance commissioner or public official conducting the exam;

(b) A copy of any audit performed with respect to the risk retention group; and

(c) A certificate of compliance or licensing letter from the state of domicile dated within the last year.
(4) Applicants should not conduct business in this state until notified by the Office that the registation is complete.

(5) All domestic applicants applying pursuant to section 627.943, F.S, shall comply with the directions in Rule 69O-136.006(1) & (3) for domestic insurers.

69O FAC 136.033 | Restrictions on Insurance Purchased by Purchasing Groups

(1) A purchasing group which obtains liability insurance from an insurer not admitted in this state or a risk retention group shall inform each of the members of such group which have a risk resident or located in this state that such risk is not protected by an insurance insolvency guaranty fund in this state, and that such risk retention group or such insurer may not be subject to all insurance laws and rules of this state.

(2) Purchases of insurance by purchasing groups are subject to the same standards regarding aggregate limits which are applicable to all purchases of group insurance.

69O FAC 136.034 | Uniform Certificate of Authority Expansion Application (Repealed)

69O FAC 136.040 | Health Maintenance Organizations

(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," incorporated by reference in Rule 69O-136.100, F.A.C;

(b) 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," incorporated by reference in Rule 69O-136.100, F.A.C.;

(c) The biographical information package as defined in subsection 69O-136.100(3), F.A.C.; and,

(d) Form OIR-C1-2221, "Management Information Form," incorporated by reference in Rule 69O-136.100, F.A.C.
(2) All the forms listed in subsection (1) may be obtained from the Office's website at http://www.FLOir.com and shall be submitted electronically via the Office's iApply system at https://www.FLOir.com/iPortal.

69O FAC 136.041 | Multiple-Employer Welfare Arrangements

(1) An application for a person applying for a certificate of authority as a multiple-employer welfare arrangement consists of the following:
(a) Form OIR-C1-983, incorporated by reference in Rule 69O-136.100, F.A.C.;

(b) The biographical information package as defined in subsection 69O-136.100(3), F.A.C.; and,

(c) Form OIR-C1-2221, "Management Information Form," incorporated by reference in Rule 69O-136.100, F.A.C.
(2) A person applying for a certificate of authority as a multiple-employer welfare arrangement shall submit forms in subsection (1) as directed by the Office electronically at https://www.FLOir.com/iPortal. The forms may be obtained from https://www.FLOir.com/iPortal.

69O FAC 136.042 | Continuing Care Contracts

(1) Application for Certificate of Authority.
(a) An application for a person applying for a certificate of authority for a continuing care provider consists of the following:
1. Form OIR-C1-473, incorporated by reference in Rule 69O-136.100, F.A.C.

2. Form OIR-C1-144, "Service of Process Consent & Agreement," incorporated by reference in Rule 69O-136.100, F.A.C.;

3. The biographical information package as defined in subsection 69O-136.100(3), F.A.C.; and,

4. Form OIR-C1-2221, "Management Information Form," incorporated by reference in Rule 69O-136.100, F.A.C.
(b) A person applying for a certificate of authority as a continuing care provider shall submit forms in paragraph (1)(a) as directed by the Office electronically at https://www.FLOir.com/iPortal. The forms may be obtained from https://www.FLOir.com/iPortal.
(2) Application for Provisional Certificate of Authority.
(a) An application for a person applying for a provisional certificate of authority for a continuing care provider consists of the following if applicable:
1. Form OIR-C1-471, ncorporated by reference in Rule 69O-136.100, F.A.C.;

2. Form OIR-C1-144, "Service of Process Consent & Agreement," incorporated by reference in Rule 69O-136.100;

3. The biographical information package as defined in subsection 69O-136.100(3), F.A.C.; and,

4. Form OIR-C1-2221, "Management Information Form," incorporated by reference in Rule 69O-136.100.
(b) A person applying for a provisional certificate of authority as a continuing care provider shall submit forms in paragraph (2)(a) as directed by the Office electronically at https://www.FLOir.com/iPortal. The forms may be obtained from https://www.FLOir.com/iPortal.
(3) Consolidated Application for Provisional Certificate of Authority and Certificate of Authority.
(a) A consolidated application for a provisional certificate of authority and certificate of authority for a continuing care provider consists of the following if applicable:
1. Form OIR-C1-2220, "Consolidated Application for Provisional Certificate of Authority and Certificate of Authority for a Continuing Care Provider," incorporated by reference in Rule 69O-136.100, F.A.C.;

2. Form OIR-C1-144, "Service of Process Consent & Agreement," incorporated by reference in Rule 69O-136.100;

3. The biographical information package as defined in subsection 69O-136.100(3), F.A.C.; and,

4. Form OIR-C1-2221, "Management Information Form," incorporated by reference in Rule 69O-136.100.
(b) A person filing a consolidated application for provisional certificate of authority and certificate of authority for a continuing care provider shall submit forms in paragraph (3)(a) as directed by the Office electronically at https://www.FLOir.com/iPortal. The forms may be obtained from https://www.FLOir.com/iPortal.
(4) Application for the Simultaneous Acquisition of a Continuing Care Facility and Issuance of a Certificate of Authority to a Provider.
(a) An application for the simultaneous acquisition of a continuing care facility and issuance of a certificate of authority consists of the following if applicable:
1. Form OIR-C1-2219, "Application for the Simultaneous Acquisition of a Continuing Care Facility and Issuance of a Certificate of Authority to a Provider," incorporated by reference in Rule 69O-136.100, F.A.C.;

2. Form OIR-C1-144, "Service of Process Consent & Agreement," incorporated by reference in Rule 69O-136.100, F.A.C.;

3. The biographical information package as defined in subsection 69O-136.100(3), F.A.C.; and,

4. Form OIR-C1-2221, "Management Information Form," incorporated by reference in Rule 69O-136.100, F.A.C.; and
(b) A person applying for simultaneous acquisition of a continuing care facility and issuance of a certificate of authority shall submit forms in paragraph (4)(a) as directed by the Office electronically at https://www.FLOir.com/iPortal.

(c) Disclaimer of Control
1. A person may attempt to rebut a presumption of control pursuant to Section 651.0245, F.S., by electronically filing at https://www.FLOir.com/iPortal one of the following forms, which may be obtained from https://www.FLOir.com/iPortal, with the Office:
a. Form OIR-C1-1467, "Disclaimer of Control - Individual," incorporated by reference in Rule 69O-136.100, F.A.C.;

b. Form OIR-C1-1468, "Disclaimer of Control - Entity," incorporated by reference in Rule 69O-136.100, F.A.C.;

c. Form OIR-C1-2211, "Disclaimer of Control - Investment Companies," incorporated by reference in Rule 69O-136.100, F.A.C.
2. A person may attempt to rebut a presumption of control pursuant to section 651.0245, F.S., by filing a copy of a Schedule 13G filed with the Securities and Exchange Commission pursuant to Rule 13d-1(b) or (c), 17 C.F.R. s. 240.13d-1, under the Securities Exchange Act of 1934, as amended, to the Office electronically at https://www.FLOir.com/iPortal.

3. Pursuant to Section 651.0245(6), F.S., the Office is authorized to disallow a disclaimer of control filed pursuant to subparagraphs (4)(c)1. and (4)(c)2.
(5) Application for Expansion.
(a) An application for a person applying for expansion of a certificated continuing care facility consists of the following:
1. Form OIR-C1-2218, "Application for Expansion of a Certificated Continuing Care Facility," incorporated by reference in Rule 69O-136.100, F.A.C.;

2. The biographical information package defined in subsection 69O-136.100(3), F.A.C.; and,

3. Form OIR-C1-2221, "Management Information Form," incorporated by reference in Rule 69O-136.100, F.A.C.
(b) A person applying for expansion of a certificated continuing care facility shall submit forms in paragraph (5)(a) as directed by the Office electronically at https://www.FLOir.com/iPortal. The forms may be obtained from https://www.FLOir.com/iPortal.
(6) Manager or Management Company.
(a) To comply with the filing requirements of Section 651.043(2), F.S., for each new management company or manager not employed by a management company within 10 business days of a change in management, the provider shall submit the following:
1. The biographical information package as defined in subsection 69O-136.100(3), F.A.C.; and,

2. A copy of the written management contract, if applicable.
(b) The documents in paragraph (6)(a) shall be submitted to the Office electronically at https://www.FLOir.com/iPortal. The forms may be obtained from https://FLOir.com/iPortal.

69O FAC 136.043 | Prepaid Health Clinic

(1) An application for a person applying for a certificate of authority as a prepaid health clinic consists of the following:
(a) Form OIR-C1-483, "Application for Certificate of Authority Prepaid Health Clinic," incorporated by reference in Rule 69O-136.100, F.A.C.;

(b) The biographical information package as defined in subsection 69O-136.100(3), F.A.C.; and,

(c) Form OIR-C1-2221, "Management Information Form," incorporated by reference in Rule 69O-136.100, F.A.C.
(2) A person applying for a certificate of authority as a prepaid health clinic shall submit forms in subsection (1) as directed by the Office electronically at https://www.FLOir.com/iPortal. The forms may be obtained from https://www.FLOir.com/iPortal.

69O FAC 136.044 | Insurance Administrators

(1) A person applying for a Certificate of Authority to operate as an insurance administrator, including an applicant seeking to register as a pharmacy benefit manager, shall submit the following:
(a) Form OIR-C1-1075, "Application for Certificate of Authority of an Insurance Administrator," incorporated by reference in Rule 69O-136.100, F.A.C.;

(b) The biographical information package as defined in subsection 69O-136.100(3), F.A.C.; and,

(c) Form OIR-C1-2221, "Management Information Form," incorporated by reference in Rule 69O-136.100, F.A.C.
(2) A person applying for a certificate of authority as an insurance administrator, including an applicant seeking to register as a pharmacy benefit manager, shall submit forms listed in subsection (1) as directed by the Office electronically at https://www.FLOir.com/iPortal.

69O FAC 136.045 | Donor Annuity Organizations

(1) Any person engaging in the business of issuing donor annuity agreements must submit Form OIR-C1-1208, "Notification to the Office of Insurance Regulation as a Qualifying Issuer of Donor Annuity Agreements Pursuant to section 627.481, F.S.," incorporated by reference in Rule 69O-136.100, F.A.C., to the Office electronically at https://www.FLOir.com/iPortal on the date on which the person enters into the first of these annuity agreements. The form may be obtained from https://www.FLOir.com/iPortal.

(2) Any person subject to section 627.481, F.S., that fails to submit the required notification form is subject to penalty as provided in section 626.9521, F.S.

69O FAC 136.046 | Prepaid Limited Health Service Organizations

(1) A person applying for a certificate of authority as a prepaid limited service organization shall submit the following if applicable:
(a) Form OIR-C1-1119, "Application for Certificate of Authority Prepaid Limited Health Service Organization," incorporated by reference in Rule 69O-136.100, F.A.C.; and

(b) The biographical information package defined in subsection 69O-136.100(3), F.A.C.
(2) A person shall submit the forms listed in subsection (1) electronically via the Office's iApply system at https://www.FLOir.com/iPortal. The forms may be obtained from https://www.FLOir.com/iPortal.

69O FAC 136.047 | Discount Plan Organizations

(1) A person applying for a certificate of authority as a discount plan organization shall submit the following if applicable:
(a) Form OIR-C1-1606, "Application for License Discount Plan Organization (DPO)," incorporated by reference in Rule 69O-136.100, F.A.C.;

(b) Form OIR-C1-144, "Service of Process Consent & Agreement," incorporated by reference in Rule 69O-136.100, F.A.C.;

(c) The biographical information package as defined in subsection 69O-136.100(3), F.A.C.; and,

(d) Form OIR-C1-2221, "Management Information Form," incorporated by reference in Rule 69O-136.100, F.A.C.
(2) A person shall submit the forms listed in subsection (1) electronically via the Office's iApply system at https://www.FLOir.com/iPortal. The forms may be obtained from https://www.FLOir.com/iPortal.

69O FAC 136.050 | Premium Finance Companies

(1) Application for License as a Premium Finance Company.
(a) A person applying for a license as a premium finance company shall submit the following if applicable:
1. Form OIR-C1-958, "Application for License Premium Finance Company," incorporated by reference in Rule 69O-136.100, F.A.C.;

2. Form OIR-A3-453, "Premium Finance Company Surety Bond," incorporated by reference in Rule 69O-136.100, F.A.C.;

3. Form OIR-C1-454, "Personal Financial Statement," incorporated by reference in Rule 69O-136.100, F.A.C.;

4. Form OIR-C1-957, "Instructions for Statutory Compliance of Forms: Premium Finance Companies," incorporated by reference in Rule 69O-136.100, F.A.C.;

5. The biographical information package as defined in subsection 69O-136.100(3), F.A.C.; and,

6. Form OIR-C1-2221, "Management Information Form," incorporated by reference in Rule 69O-136.100, F.A.C.; and
(b) The applicant shall submit the forms listed in paragraph (1)(a) electronically at https://www.FLOir.com/iPortal.
(2) Annual License Renewal
(a)
1. All premium finance company licenses shall expire on October 1.

2. Failure to submit the application for renewal before October 1 shall result in expiration of the license and will require the filing of a new application for licensure.
(b) A licensee seeking to continue operating as a premium finance company shall submit Form OIR-A3-1563, "Application for Renewal of License Premium Finance Company," incorporated by reference in Rule 69O-136.100, F.A.C filed electronically at https://www.FLOir.com/iPortal.

69O FAC 136.051 | Service Warranty Associations

(1) Application for License as a Service Warranty Association
(a) An application for a person applying for a license as a service warranty association consists of the following if applicable:
1. Form OIR-C1-997, "Application for License Service Warranty Association," incorporated by reference in Rule 69O-136.100, F.A.C.;

2. Form OIR-A3-455, "Home or Service Warranty Association Surety Bond," incorporated by reference in Rule 69O-136.100, F.A.C.;

3. Form OIR-C1-144, "Service of Process Consent & Agreement," incorporated by reference in Rule 69O-136.100, F.A.C.;

4. The biographical information package as defined in subsection 69O-136.100(3), F.A.C.; and,

5. Form OIR-C1-2221, "Management Information Form," incorporated by reference in Rule 69O-136.100, F.A.C.
(b) A person applying for a license as a service warranty association shall submit forms listed in paragraph (1)(a) as directed by the Office electronically at https://www.FLOir.com/iPortal.
(2) License Continuance for Service Warranty Association
(a)
1. A service warranty association's license shall continue in force as long as the licensee is in compliance with the provisions of Chapter 634, Part III, F.S.

2. Failure to submit the application for continuance by March 1 shall result in expiration of the license and will require the filing of a new application for licensure.
(b) A licensee seeking to continue operating as a service warranty association shall submit the following:
1. Form OIR-A3-110, "License Continuance Form Service Warranty Association," incorporated by reference in Rule 69O-136.100, F.A.C., filed electronically at https://www.FLOir.com/iPortal; and

2. A fee of $200.00 filed annually in conjunction with the March 1 filing of the annual statement.
(c) Any licensee who fails to renew a service warranty association license shall immediately cease and desist from engaging in the service warranty business in the state of Florida. The service warranty association shall honor those service warranty contracts in force until the date of expiration or the date of cancellation and a refund is made to the consumer.
(3) Application for License as a Service Warranty Association Manufacturer or Affiliate.
(a) An application for a person applying for a license as a service warranty association manufacturer or affiliate consists of the following:
1. Form OIR-C1-989, "Application for License Service Warranty Association Manufacturer or Affiliate," incorporated by reference in Rule 69O-136.100, F.A.C.;

2. Form OIR-C1-144, "Service of Process Consent & Agreement," incorporated by reference in Rule 69O-136.100, F.A.C.; and

3. Form OIR-C1-2221, "Management Information Form," incorporated by reference in Rule 69O-136.100, F.A.C.
(b) A person applying for a license as a service warranty association shall submit forms listed in paragraph (3)(a) as directed by the Office electronically at https://www.FLOir.com/iPortal.
(4) License Continuance for Service Warranty Association Manufacturer or Affiliate
(a)
1. A service warranty association manufacturer or affiliate's license shall continue in force as long as licensee is in compliance with the provisions of Chapter 634, part III, F.S.

2. Failure to submit the application for continuance by March 1 shall result in expiration of the license and will require the filing of a new application for licensure.
(b) A licensee seeking to continue operating as a service warranty association manufacturer or affiliate shall submit the following:
1. Form OIR-A3-955, "License Continuance Form Service Warranty Association Manufacturer or Affiliate," incorporated by reference in Rule 69O-136.100, F.A.C., filed electronically at https://www.FLOir.com/iPortal; and

2. A fee of $500.00 filed annually in conjunction with the March 1 filing of the annual statement.
(c) Any licensee who fails to renew a service warranty association license shall immediately cease and desist from engaging in the service warranty business in the state of Florida. The service warranty association shall honor those service warranty contracts in force until the date of expiration or the date of cancellation and a refund is made to the consumer.

69O FAC 136.052 | Home Warranty Associations

(1) Application for License as a Home Warranty Association.
(a) An application for a person applying for a license as a home warranty association consists of the following if applicable:
1. Form OIR-C1-490, "Application for License Home Warranty Association," incorporated by reference in Rule 69O-136.100, F.A.C.;

2. Form OIR-A3-455, "Home or Service Warranty Association Surety Bond," incorporated by reference in Rule 69O-136.100, F.A.C.;

3. Form OIR-C1-144, "Service of Process Consent & Agreement," incorporated by reference in Rule 69O-136.100, F.A.C.;

4. The biographical information package as defined in subsection 69O-136.100(3), F.A.C.; and,

5. Form OIR-C1-2221, "Management Information Form," incorporated by reference in Rule 69O-136.100, F.A.C.
(b) A person applying for a license as a home warranty association shall submit the forms listed in paragraph (1)(a) as directed by the Office electronically at https://www.FLOir.com/iPortal.
(2) Annual License Renewal.
(a)
1. All home warranty association licenses shall expire on June 1.

2. Failure to submit the application for continuance by June 1 shall result in expiration of the license and will require the filing of a new application for licensure.
(b) A licensee seeking to continue operating as a home warranty association shall submit the following:
1. Form OIR-A3-1073, "Application for Renewal of License Home Warranty Association," incorporated by reference in Rule 69O-136.100, F.A.C., filed electronically at https://www.FLOir.com/iPortal, and

2. A fee of $200.00 filed annually in conjunction with the June 1 filing of the Annual Statement.
(c) Any licensee who fails to renew a home warranty association license shall immediately cease and desist from engaging in the home warranty business in the state of Florida. The home warranty association shall honor those home warranty contracts in force until the date of expiration or the date of cancellation and a refund is made to the consumer.

69O FAC 136.053 | Motor Vehicle Service Agreement Companies

(1) Application for License as a Motor Vehicle Service Agreement Company.
(a) An application for a license as a motor vehicle service agreement company consists of the following if applicable:
1. Form OIR-C1-994, "Application for License Motor Vehicle Service Agreement Company," incorporated by reference in Rule 69O-136.100, F.A.C.;

2. Form OIR-C1-144, "Service of Process Consent & Agreement," incorporated by reference in Rule 69O-136.100, F.A.C.;

3. The biographical information package as defined in subsection 69O-136.100(3), F.A.C.; and,

4. Form OIR-C1-2221, "Management Information Form," incorporated by reference in Rule 69O-136.100, F.A.C.;
(b) A person applying for a license as a motor vehicle service agreement company shall submit the forms listed in paragraph (1)(a) as directed by the Office electronically at https://www.FLOir.com/iPortal. The forms may be obtained from https://www.FLOir.com/iPortal.
(2) License Continuance for Motor Vehicle Service Agreement Company.
(a)
1. All motor vehicle service agreement company licenses shall continue in force as long as licensee is entitled thereto under Chapter 634, part I, F.S.

2. Failure to submit the application for continuance by March 1 shall result in expiration of the license and will require the filing of a new application for licensure.
(b) A licensee seeking to continue operating as a motor vehicle service agreement company shall submit Form OIR-A3-467 LR, "Application for License Continuance Motor Vehicle Service Agreement Company," incorporated by reference in Rule 69O-136.100, F.A.C., filed electronically at https://www.FLOir.com/iPortal. The form may be obtained from https://www.FLOir.com/iPortal.
Rulemaking AuthorityLaw ImplementedHistory
634.021, 634.061(1), (2)(c) FS.634.041 FS.New , Formerly 4-200.004, Amended , , , Formerly 69O-200.004, Amended .

69O FAC 136.054 | Legal Expense Insurance Corporations

(1) Application for Certificate of Authority as a Legal Expense Insurance Corporation.
(a) An application for a person applying for a certificate of authority as a legal expense insurance corporation consists of the following if applicable:
1. Form OIR-C1-480, "Application for Certificate of Authority Legal Expense Insurance," incorporated by reference in Rule 69O-136.100, F.A.C.;

2. Form OIR-A3-478, "Legal Expense Insurance Corporation Surety Bond," incorporated by reference in Rule 69O-136.100, F.A.C.;

3. 3. Form OIR-C1-144, "Service of Process Consent & Agreement," incorporated by reference in Rule 69O-136.100, F.A.C.;

4. The biographical information package as defined in subsection 69O-136.100(3), F.A.C.; and,

5. Form OIR-C1-2221, "Management Information Form," incorporated by reference in Rule 69O-136.100, F.A.C.;
(b) A person applying for a certificate of authority as a legal expense insurance corporation shall submit forms listed in paragraph (1)(a) as directed by the Office electronically at https://www.FLOir.com/iPortal.
(2) Annual Renewal
(a)
1. A legal expense insurance corporation's certificate of authority shall continue in force as long as the legal expense insurance corporation is in compliance with the provisions of Chapter 642, F.S.

2. Failure to submit the application for continuance by June 1 shall result in expiration of the certificate of authority and will require the filing of a new application for licensure.
(b) The qualified certificate of authority holder seeking to continue operating as a legal expense insurance corporation shall submit Form OIR-A3-1077, "Application for License Continuance Legal Expense Insurance," incorporated by reference in Rule 69O-136.100, F.A.C., at https://www.FLOir.com/iPortal; and

(c) The legal expense insurance corporation shall honor those contracts in force until the date of expiration or the date of cancellation and a refund is made to the consumer.

69O FAC 136.070 | Merger or Acquisition of the Attorney-in-Fact of a Domestic Reciprocal Insure

(1) Any person acquiring the attorney-in-fact of a domestic reciprocal insurer pursuant to section 629.225, F.S., shall comply with the instructions contained on Form OIR-C1-150, "Application for the Acquisition of the Attorney-in-Fact of a Domestic Reciprocal Insurer," incorporated by reference in Rule 69O-136.100, F.A.C., and shall also comply with directions on, or otherwise submit, the following applicable forms:
(a) Form OIR-C1-144, "Service of Process Consent & Agreement," incorporated by reference in Rule 69O-136.100, F.A.C.;

(b) Form OIR-C1-152, "Letter of Notification Acquisition of the Attorney-in-Fact of a Domestic Reciprocal Insurer," incorporated by reference in Rule 69O-136.100, F.A.C.;

(c) The biographical information package as defined in subsection 69O-136.100(3), F.A.C.; and,

(d) Form OIR-C1-2221, "Management Information Form," incorporated by reference in Rule 69O-136.100, F.A.C.

(e) In addition, prior to a final decision on whether to approve the proposed acquisition, the Office shall request such other information as is necessary, depending on the facts and circumstances of the specific persons and entities involved, pursuant to section 629.225(3), F.S., to determine the character, experience, ability, and other qualifications required by statute, of the person or affiliated person of such person for the protection of the policyholders and shareholders of the insurer and the public. The Office shall make no final decision on any proposed acquisition without complete information, as required by section 629.225, F.S.
(2) All the forms listed in subsection (1) may be obtained from the Office's website at http://www.FLOir.com and shall be submitted electronically via the Office's iApply system at https://www.FLOir.com/iPortal.

(3) A retaliatory application fee shall be submitted pursuant to section 624.5091, F.S. The retaliatory fee is the greater of:
(a) The amount that the applicant's domiciliary state or country would charge a Florida domestic insurer making application in the applicant's state or country of domicile; or

(b) The Florida application fee pursuant to section 624.501(1)(a), F.S.
(4) Disclaimer of Control
(a) A person may attempt to rebut a presumption of control pursuant to section 629.225(11), F.S., by electronically filing via the Office's iApply system at https://www.FLOir.com/iPortal one of the following forms with the Office:
1. Form OIR-C1-1467, "Disclaimer of Control - Individual," incorporated by reference in Rule 69O-136.100, F.A.C.;

2. Form OIR-C1-1468, "Disclaimer of Control - Entity," incorporated by reference in Rule 69O-136.100, F.A.C.;

3. Form OIR-C1-2211, "Disclaimer of Control - Investment Companies," incorporated by reference in Rule 69O-136.100, F.A.C.
(b) A person may attempt to rebut a presumption of control pursuant to section 629.225(11), F.S., by filing a copy of a Schedule 13G filed with the Securities and Exchange Commission pursuant to Rule 13d-1(b) or (c), 17 C.F.R. s. 240.13d-1, under the Securities Exchange Act of 1934, as amended, to the Office electronically via the Office's iApply system at https://www.FLOir.com/iPortal.

(c) Pursuant to section 629.225(11), F.S., the Office is authorized to disallow a disclaimer of control filed pursuant to paragraphs (a) and (b).

69O FAC 136.075 | Merger or Conversion of a Reciprocal Insurer

(1) A reciprocal insurer may merge with another reciprocal insurer or be converted to a stock or mutual insurer, by filing Form OIR-C1-153, "Application for Merger or Conversion Reciprocal Insurer," incorporated by reference in Rule 69O-136.100, F.A.C.

(2) A retaliatory application fee shall be submitted pursuant to section 624.5091, F.S. The retaliatory fee is the greater of:
(a) The amount that the applicant's domiciliary state or country would charge a Florida domestic insurer making application in the applicant's state or country of domicile; or

(b) The Florida application fee pursuant to section 624.501(1)(a), F.S.

69O FAC 136.080 | Mergers and Acquisition of Controlling Stock of a Florida Domestic Insurer

(1) Any person acquiring a Florida domestic insurer pursuant to Section 628.461, F.S., shall comply with the instructions contained on Form OIR-C1-918, incorporated by reference in Rule 69O-136.100, F.A.C., and shall also comply with directions, or otherwise submit, the following applicable forms:
(a) Form OIR-C1-918, incorporated by reference in Rule 69O-136.100, F.A.C.;

(b) Form OIR-C1-1416, "Uniform Certificate of Authority Application (UCAA) Lines of Insurance," incorporated by reference in Rule 69O-136.100, F.A.C.;

(c) The biographical information package as defined in subsection 69O-136.100(3), F.A.C.;

(d) Form OIR-C1-1524, "Uniform Certificate of Authority Application (UCAA) Uniform Consent to Service of Process," incorporated by reference in Rule 69O-136.100, F.A.C., if required as per the instructions in Form OIR-C1-918;

(e) Form OIR-C1-2069, "Letter of Notification," incorporated by reference in Rule 69O-136.100, F.A.C.;

(f) Form OIR-C1-2221, "Management Information Form," incorporated by reference in Rule 69O-136.100, F.A.C.;

(g) Form OIR-D0-896, "UCAA Proforma Financial Statements, Property and Casualty Insurance Company," incorporated by reference in Rule 69O-136.100, F.A.C.;

(h) Form OIR-D0-904, "UCAA Proforma Financial Statements, Life & Health Insurer," incorporated by reference in Rule 69O-136.100, F.A.C.;

(i) Form OIR-D0-2119, "UCAA Proforma Financial Statements, Title Insurance Company," incorporated by reference in Rule 69O-136.100, F.A.C.;

(j) Form OIR-D0-2165, "UCAA Proforma Financial Statements, Health," incorporated by reference in Rule 69O-136.100, F.A.C.; and

(k) Prior to a final decision on whether to approve the proposed acquisition, the Office shall request such other information as is necessary, depending on the facts and circumstances of the specific persons and entities involved, pursuant to section 628.461(3), F.S., to determine the character, experience, ability, and other qualifications required by statute, of the person or affiliated person of such person for the protection of the policyholders and shareholders of the insurer and the public. The Office shall make no final decision on any proposed acquisition without complete information, as required by section 628.461, F.S.
(2) All the forms listed in subsection (1) may be obtained from the Office's website at http://www.FLOir.com and shall be submitted electronically via the Office's iApply system at https://www.FLOir.com/iPortal. Forms relating to specific kinds of insurance in subsection (1) are to be submitted only by companies issuing policies relating to the kind of insurance specified on the form.

(3) Any merger effected between or among one or more domestic or foreign stock insurers authorized to transact insurance in this state and one or more other entities authorized to transact insurance and self-insurance in this state, including a self-insurance trust fund existing pursuant to section 627.357, F.S., shall comply with the provisions of sections 628.461 and 628.451, F.S., and this rule.

(4) Any merger effected involving a not-for-profit health maintenance organization that is in a holding company system shall comply with the provisions of sections 628.461, 628.471, 641.255 F.S., and this rule.

(5) Any merger effected involving a for-profit health maintenance organization that is in a holding company system shall comply with sections 628.461, 628.451, 641.255 F.S., and this rule.

(6) A retaliatory application fee shall be submitted pursuant to section 624.5091, F.S. The retaliatory fee is the greater of:
(a) The amount that the applicant's domiciliary state or country would charge a Florida domestic insurer making application in the applicant's state or country of domicile; or

(b) The Florida application fee pursuant to section 624.501(1)(a), F.S.
(7) Disclaimer of Control
(a) A person may attempt to rebut a presumption of control pursuant to section 628.461, F.S., by electronically filing via the Office's iApply system at https://www.FLOir.com/iPortal one of the following forms with the Office:
1. Form OIR-C1-1467, incorporated by reference in Rule 69O-136.100, F.A.C.;

2. Form OIR-C1-1468, incorporated by reference in Rule 69O-136.100, F.A.C.;

3. Form OIR-C1-2211, incorporated by reference in Rule 69O-136.100, F.A.C.
(b) A person may attempt to rebut a presumption of control pursuant to section 628.461, F.S., by filing a copy of a Schedule 13G filed with the Securities and Exchange Commission pursuant to Rule 13d-1(b) or (c), 17 C.F.R. s. 240.13d-1, under the Securities Exchange Act of 1934, as amended, to the Office electronically via the Office's iApply system at https://www.FLOir.com/iPortal.

(c) Pursuant to section 628.461(12)(a), F.S., the Office is authorized to disallow a disclaimer of control filed pursuant to paragraphs (a) and (b).

69O FAC 136.090 | Merger, Consolidation, or Acquisition of Controlling Stock, Ownership Interests, Assets, or Control of a Specialty Insurer

(1) Any person acquiring a specialty insurer pursuant to section 628.4615, F.S., shall comply with the instructions contained on Form OIR-C1-448, incorporated by reference in Rule 69O-136.100, F.A.C., and shall also comply with directions, or otherwise submit, the following applicable forms:
(a) Form OIR-C1-144, "Service of Process Consent & Agreement," incorporated by reference in Rule 69O-136.100, F.A.C.;

(b) Form OIR-C1-448, incorporated by reference in Rule 69O-136.100, F.A.C.;

(c) The biographical information package as defined in subsection 69O-136.100(3), F.A.C.;

(d) Form OIR-C1-2069, "Letter of Notification," incorporated by reference in Rule 69O-136.100, F.A.C.;

(e) Form OIR-C1-2221, "Management Information Form," incorporated by reference in Rule 69O-136.100, F.A.C.; and,

(f) In addition, prior to a final decision on whether to approve the proposed acquisition, the Office shall request such other information as is necessary, depending on the facts and circumstances of the specific persons and entities involved, pursuant to Section 628.4615(4), F.S., to determine the character, experience, ability, and other qualifications required by statute, of the person or affiliated person of such person for the protection of the policyholders and shareholders of the insurer and the public. The Office shall make no final decision on any proposed acquisition without complete information, as required by Section 628.4615, F.S.
(2) All the forms listed in subsection (1) may be obtained from the Office's website at http://www.FLOir.com and shall be submitted electronically via the Office's iApply system at https://www.FLOir.com/iPortal.

(3) Any merger effected involving a not-for-profit health maintenance organization that is not in a holding company system shall comply with Sections 628.4615, 628.471, and 641.255 F.S., and this rule.

(4) Any merger effected involving a for-profit health maintenance organization that is not in a holding company system shall comply with Sections 628.4615, 628.451, and 641.255 F.S., and this rule.

(5) A retaliatory application fee shall be submitted pursuant to Section 624.5091, F.S. The retaliatory fee is the greater of:
(a) The amount that the applicant's domiciliary state or country would charge a Florida domestic insurer making application in the applicant's state or country of domicile; or

(b) The Florida application fee pursuant to Section 624.501(1)(a), F.S.
(6) Disclaimer of Control
(a) A person may attempt to rebut a presumption of control pursuant to section 628.4615(11), F.S., by electronically filing via the Office's iApply system at https://www.FLOir.com/iPortal one of the following forms with the Office:
1. Form OIR-C1-1467, "Disclaimer of Control - Individual," incorporated by reference in Rule 69O-136.100, F.A.C.;

2. Form OIR-C1-1468, "Disclaimer of Control - Entity," incorporated by reference in Rule 69O-136.100, F.A.C.;

3. Form OIR-C1-2211, "Disclaimer of Control - Investment Companies," incorporated by reference in Rule 69O-136.100, F.A.C.
(b) A person may attempt to rebut a presumption of control pursuant to section 628.4615(11), F.S., by filing a copy of a Schedule 13G filed with the Securities and Exchange Commission pursuant to Rule 13d-1(b) or (c), 17 C.F.R. s. 240.13d-1, under the Securities Exchange Act of 1934, as amended, to the Office electronically via the Office's iApply system at https://www.FLOir.com/iPortal.

(c) Pursuant to section 628.4615(11), F.S., the Office is authorized to disallow a disclaimer of control filed pursuant to paragraphs (a) and (b).

69O FAC 136.100 | Forms Incorporated by Reference

(1) The forms incorporated in this rule are available and may be printed from the Office of Insurance Regulation's website: https://www.FLOir.com/iPortal, and are hereby incorporated by reference.

(2)
(a) Forms OIR-A3
1. Form OIR-A3-110, "License Continuance Form Service Warranty Association," effective 01/25, hereby incorporated by reference and available at https://www.FLRules.org/Gateway/Reference.asp?No=Ref-17411;

2. Form OIR-A3-453, "Premium Finance Company Surety Bond," effective 01/25, hereby incorporated by reference and available at https://www.FLRules.org/Gateway/Reference.asp?No=Ref-17413;

3. Form OIR-A3-455, "Home or Service Warranty Association Surety Bond," effective 01/25, hereby incorporated by reference and available at https://www.FLRules.org/Gateway/Reference.asp?No=Ref-17414;

4. Form OIR-A3-467 LR, "Application for License Continuance Motor Vehicle Service Agreement Company," effective 01/25, hereby incorporated by reference and available at https://www.FLRules.org/Gateway/Reference.asp?No=Ref-17415;

5. Form OIR-A3-478, "Legal Expense Insurance Corporation Surety Bond," effective 01/25, available at https://www.FLRules.org/Gateway/Reference.asp?No=Ref-17416;

6. Form OIR-A3-955, "License Continuance Form Service Warranty Association Manufacturer or Affiliate," effective 01/25, hereby incorporated by reference and available at https://www.FLRules.org/Gateway/Reference.asp?No=Ref-17417;

7. Form OIR-A3-1073, "Application for Renewal of License Home Warranty Association," effective 01/25, hereby incorporated by reference and available at https://www.FLRules.org/Gateway/Reference.asp?No=Ref-17418;

8. Form OIR-A3-1077, "Application for License Continuance Legal Expense Insurance," effective 01/25, hereby incorporated by reference and available at https://www.FLRules.org/Gateway/Reference.asp?No=Ref-17419; and

9. Form OIR-A3-1563, "Application for Renewal of License Premium Finance Company," effective 01/25, hereby incorporated by reference and available at https://www.FLRules.org/Gateway/Reference.asp?No=Ref-17420.
(b) Form OIR-B1-PCR3, "Filing requirements Advisory Organization," effective 7/23, hereby incorporated by reference and available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-16192, electronically at https://www.FLOir.com/iPortal.

(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 7/23, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-16193.

(d) Forms OIR-C1
1. Form OIR-C1-0508, "Uniform Certificate of Authority Application (UCAA) Affidavit of Lost Certificate of Authority," effective 7/23, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-16202;

2. Form OIR-C1-0510, "Uniform Certificate of Authority Application (UCAA) Corporate Amendments Application Application to Amend Certificate of Authority," effective 7/23, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-16206;

3. Form OIR-C1-0511, "Uniform Certificate of Authority Application (UCAA) Corporate Amendments Application Checklist for Corporate Amendments Application Only," effective 7/23, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-16208;

4. Form OIR-C1-0512, "Uniform Certificate of Authority Application Questionnaire for Adding or Deleting Lines of Business to an Existing Certificate of Authority," effective 7/23, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-16210;

5. Form OIR-C1-0522, "Uniform Certificate of Application (UCAA) Change of Mailing Address/Contact Notification Form," effective 7/23, http://www.FLRules.org/Gateway/Reference.asp?No=Ref-16214;

6. Form OIR-C1-100, "Application for Permit Domestic Stock or Mutual Insurer", effective 1/25, available at https://FLRules.org/Gateway/Reference.asp?No=Ref-17909.

7. Form OIR-C1-101, "Application to Redomesticate a Stock or Mutual Insurer", effective 1/25, available at https://FLRules.org/Gateway/Reference.asp?No=Ref-17910.

8. Form OIR-C1-144, "Service of Process Consent & Agreement," effective 01/25, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-17423;

9. Form OIR-C1-150, "Application for Acquisition of the Attorney-in-Fact of a Domestic Reciprocal Insurer," effective 01/25, https://www.FLRules.org/Gateway/Reference.asp?No=Ref-17424;

10. Form OIR-C1-151, "Application for Certificate of Authority Domestic Reciprocal Insurer," effective 01/25, available at https://www.FLRules.org/Gateway/Reference.asp?No=Ref-17425;

11. Form OIR-C1-152, "Letter of Notification Acquisition of the Attorney-in-Fact of a Domestic Reciprocal Insurer," effective 01/25, available at https://www.FLRules.org/Gateway/Reference.asp?No=Ref-17426;

12. Form OIR-C1-153, "Application for Merger or Conversion Reciprocal Insurer," effective 01/25, hereby incorporated by reference and available at https://www.FLRules.org/Gateway/Reference.asp?No=Ref-17427;

13. Form OIR-C1-448, "Application for Acquisition of Controlling Stock, Ownership Interest, Assets, or Control of a Florida Specialty Insurer; Merger or Consolidation," effective 01/25, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-17428;

14. Form OIR-C1-454, "Personal Financial Statement," effective 01/25, hereby incorporated by reference and available at https://www.FLRules.org/Gateway/Reference.asp?No=Ref-17430;

15. Form OIR-C1-471, "Application for Provisional Certificate of Authority for a Continuing Care Provider," effective 01/25, hereby incorporated by reference and available at https://www.FLRules.org/Gateway/Reference.asp?No=Ref-17431;

16. Form OIR-C1-473, "Application for Certificate of Authority for a Continuing Care Provider," effective 01/25, hereby incorporated by reference and available at https://www.FLRules.org/Gateway/Reference.asp?No=Ref-17432;

17. Form OIR-C1-480, "Application for Certificate of Authority Legal Expense Insurance," effective 01/25, available at https://www.FLRules.org/Gateway/Reference.asp?No=Ref-17433;

18. Form OIR-C1-483, "Application for Certificate of Authority Prepaid Health Clinic," effective 01/25, hereby incorporated by reference and available at https://www.FLRules.org/Gateway/Reference.asp?No=Ref-17434;

19. Form OIR-C1-490, "Application for License Home Warranty Association," effective 01/25, hereby incorporated by reference and available at https://FLRules.org/Gateway/Reference.asp?No=Ref-17911;

20. Form OIR-C1-513, "Application for Registration as a Risk Retention Group," effective 01/25, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-17437;

21. Form OIR-C1-515, "Application for Registration as a Risk Purchasing Group," effective 01/25, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-17912;

22. Form OIR-C1-845, "Application for Certificate of Authority Commercial Self-Insurance Fund," effective 01/25, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-17913;

23. Form OIR-C1-908, "Application for Permit Domestic Reciprocal Insurer," effective 01/25, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-17914;

24. Form OIR-C1-916, "Application for Eligibility as a Surplus Lines Insurer," effective 7/23, available at www. http://www.FLRules.org/Gateway/Reference.asp?No=Ref-16229;

25. Form OIR-C1-918, "Application for Acquisition of Controlling Stock of a Florida Domestic Insurer," effective 01/25, available at https://www.FLRules.org/Gateway/Reference.asp?No=Ref-17442;

26. Form OIR-C1-942, "Application for Certificate of Authority Health Maintenance Organization," effective 01/25, hereby incorporated by reference and available at https://www.FLRules.org/Gateway/Reference.asp?No=Ref-17443;

27. Form OIR-C1-957, "Instructions for Statutory Compliance of Forms: Premium Finance Companies," effective 01/25, hereby incorporated by reference and available at https://www.FLRules.org/Gateway/Reference.asp?No=Ref-17915;

28. Form OIR-C1-958, "Application for License Premium Finance Company," effective 01/25, hereby incorporated by reference and available at https://www.FLRules.org/Gateway/Reference.asp?No=Ref-17445;

29. Form OIR-C1-983, "Application for Certificate of Authority Multiple Employer Welfare Arrangement," effective 01/25, hereby incorporated by reference and available at https://www.FLRules.org/Gateway/Reference.asp?No=Ref-17446;

30. Form OIR-C1-989, "Application for License Service Warranty Association Manufacturer or Affiliate," effective 01/25, hereby incorporated by reference and available at https://www.FLRules.org/Gateway/Reference.asp?No=Ref-17447;

31. Form OIR-C1-994, "Application for License Motor Vehicle Service Agreement Company," effective 01/25, hereby incorporated by reference and available at https://www.FLRules.org/Gateway/Reference.asp?No=Ref-17448;

32. Form OIR-C1-997, "Application for License Service Warranty Association," effective 01/25, hereby incorporated by reference and available at https://www.FLRules.org/Gateway/Reference.asp?No=Ref-17449;

33. Form OIR-C1-1075, "Application for Certificate of Authority of an Insurance Administrator," effective 01/25, hereby incorporated by reference and available at https://www.FLRules.org/Gateway/Reference.asp?No=Ref-17450;

34. Form OIR-C1-1119, "Application for Certificate of Authority Prepaid Limited Health Service Organization," effective 01/25, hereby incorporated by reference and available at https://www.FLRules.org/Gateway/Reference.asp?No=Ref-17451;

35. Form OIR-C1-1208, "Notification to the Office of Insurance Regulation as a Qualifying Issuer of Donor Annuity Agreements Pursuant to section 627.481, F.S.," effective 01/25, is hereby incorporated by reference and available at https://www.FLRules.org/Gateway/Reference.asp?No=Ref-17452.

36. Form OIR-C1-1413, "Uniform Certificate of Authority Application (UCAA) Expansion Application," effective 7/23, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-16230;

37. Form OIR-C1-1414, "Uniform Certificate of Authority Application (UCAA) Expansion Application Checklist For Expansion Application Only," effective 7/23, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-16231;

38. Form OIR-C1-1416, "Uniform Certificate of Authority Application (UCAA) Lines of Insurance," effective 07/23, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-16232;

39. Form OIR-C1-1422, "Uniform Certificate of Authority Application Questionnaire," effective 7/23, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-16233;

40. Form OIR-C1-1424, "Uniform Certificate of Authority Application," effective 7/23, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-16234;

41. Form OIR-C1-1467, "Disclaimer of Control - Individual," effective 7/21, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-14442

42. Form OIR-C1-1468, "Disclaimer of Control - Entity," effective 7/21, available at https://www.FLRules.org/Gateway/Reference.asp?No=Ref-14443;

43. Form OIR-C1-1522, "Primary Application Florida Specific Information," effective 7/23, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-16235;

44. Form OIR-C1-1524, "Uniform Certificate of Authority Application (UCAA) Uniform Consent to Service of Process," effective 12/19, available at https://www.FLRules.org/Gateway/Reference.asp?No=Ref-14444;

45. Form OIR-C1-1606, "Application for License Discount Plan Organization (DPO)," effective 01/25, hereby incorporated by reference and available at https://www.FLRules.org/Gateway/Reference.asp?No=Ref-17453;

46. Form OIR-C1-1654, "Determination of Eligibility to Operate as an Alien Insurer in Florida Pursuant to Section 624.402(9), Florida Statutes," effective 7/23, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-16236;

47. Form OIR-C1-2069, "Letter of Notification," effective 01/25, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-17454;

48. Form OIR-C1-2176, "Letter of Notification/Registration to Operate as a Non-US Based (Alien) Insurer (also referred to as "Offshore Insurer") in Florida Pursuant to Section 624.402(8), Florida Statutes," effective 7/23, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-16238;

49. Form OIR-C1-2211, "Disclaimer of Control - Investment Companies," effective 7/21, available at https://www.FLRules.org/Gateway/Reference.asp?No=Ref-14445;

50. Form OIR-C1-2218, "Application for Expansion of a Certificated Continuing Care Facility," effective 01/25, hereby incorporated by reference and available at https://www.FLRules.org/Gateway/Reference.asp?No=Ref-17455;

51. Form OIR-C1-2219, "Application for the Simultaneous Acquisition of a Continuing Care Facility and Issuance of a Certificate of Authority to a Provider," effective 01/25, hereby incorporated by reference and available at https://www.FLRules.org/Gateway/Reference.asp?No=Ref-17916;

52. Form OIR-C1-2220, "Consolidated Application for Provisional Certificate of Authority and Certificate of Authority for a Continuing Care Provider," effective 01/25, hereby incorporated by reference and available at https://www.FLRules.org/Gateway/Reference.asp?No=Ref-17457;

53. Form OIR-C1-2221, "Management Information Form," effective 01/25, available at https://www.FLRules.org/Gateway/Reference.asp?No=Ref-17917;

54. Form OIR-C1-PCR1, "Application for License Rating Organization," effective 7/23, hereby incorporated by reference and available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-16239; and

55. Form OIR-C1-PCR2, "License Renewal Rating Organization," effective 01/25, hereby incorporated by reference and available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-17459, filed electronically at https://www.FLOir.com/iPortal.
(e) Forms OIR-D0
1. Form OIR-D0-896, "UCAA Proforma Financial Statements, Property and Casualty Insurance Company," effective 1/19, available at https://www.FLRules.org/Gateway/Reference.asp?No=Ref-14448;

2. Form OIR-D0-904, "UCAA Proforma Financial Statements, Life & Health Insurer," effective 1/19, available at https://www.FLRules.org/Gateway/Reference.asp?No=Ref-16761;

3. Form OIR-D0-2119, "UCAA Proforma Financial Statements, Title Insurance Company," effective 1/19, available at https://www.FLRules.org/Gateway/Reference.asp?No=Ref-14593; and

4. Form OIR-D0-2165, "UCAA Proforma Financial Statements, Health," effective 1/19, available at https://www.FLRules.org/Gateway/Reference.asp?No=Ref-14450.
(3) The "biographical information package" is defined as all of the forms listed in this subsection.
(a) All individuals submitting a biographical information package shall complete and submit forms:
1. Form OIR-C1-938, "Fingerprints and Social Security Number," effective 01/25, hereby incorporated by reference and available at https://www.FLRules.org/Gateway/Reference.asp?No=Ref-17461; and

2. Form OIR-C1-1423, "Uniform Certificate of Authority Application (UCAA) Biographical Affidavit," effective 12/20, hereby incorporated by reference and available at https://www.FLRules.org/Gateway/Reference.asp?No=Ref-14441;
(b) In addition, the individual shall submit all of the following forms that are applicable to their circumstances:
1. Form OIR-C1-0500, "UCAA Biographical Affidavit Addendum Blank," effective 7/23, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-16194;

2. Form OIR-C1-0501, "UCAA Biographical Affidavit Addendum Education," effective 7/23, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-16195;

3. Form OIR-C1-0502, "UCAA Biographical Affidavit Addendum Employment," effective 7/23, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-16196;

4. Form OIR-C1-0503, "UCAA Biographical Affidavit Addendum General," effective 7/23, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-16197;

5. Form OIR-C1-0504, "UCAA Biographical Affidavit Addendum Licenses," effective 7/23, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-16198;

6. Form OIR-C1-0505, "UCAA Biographical Affidavit Addendum Professional," effective 7/23, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-16199;

7. Form OIR-C1-0506, "UCAA Biographical Affidavit Addendum Residence," effective 7/23, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-16200;

8. Form OIR-C1-0507, "UCAA Biographical Affidavit Addendum Societies," effective 7/23, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-16201; and,

9. Form OIR-C1-0509, "Uniform Certificate of Authority Application (UCAA) Biographical Affidavit Cover Letter Holding Company Structure," effective 7/23, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-16203.
69O-137 | Insurer Reporting Requirements

69O FAC 137.001 | Annual and Quarterly Reporting Requirements

(1) The purpose of this rule is to establish uniform requirements reporting of annual and quarterly statement information for all authorized insurers as defined in Section 624.09, F.S.

(2) Each authorized insurer shall file with the Office a full and true statement of its financial condition, transactions, and affairs.
(a) An annual statement covering the preceding calendar year shall be filed on or before March 1, and quarterly statements covering the periods ending on March 31, June 30, and September 30 shall be filed within 45 calendar days after each such date.

(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 insurer, such as rehabilitation pursuant to Chapter 631, F.S., or the laws of the state of domicile; severe damage to the insurer'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.
(3) Annual and Quarterly Statement Reporting.
(a) Each insurer shall submit its annual and quarterly statement information electronically to the National Association of Insurance Commissioners in accordance with the electronic filing instructions specified in paragraph (3)(b), below.

(b)
1. The National Association of Insurance Commissioners electronic transmission filing instructions (Financial Internet Filing Online User's Guide 2023) are hereby adopted and incorporated by reference, http://www.FLRules.org/Gateway/Reference.asp?No=Ref-16337.

2. A copy of these specifications may be obtained from the National Association of Insurance Commissioners at http://www.NAIC.org/industry_financial_filing.htm.
(4) Manuals Adopted.
(a) Annual statements shall be prepared in accordance with the following manuals, which are hereby adopted and incorporated by reference:
1. The NAIC's Annual Statement Instructions, Property and Casualty, 2022;

2. The NAIC's Annual Statement Instructions, Life, Accident and Health\Fraternal, 2022;

3. The NAIC's Annual Statement Instructions, Health, 2022;

4. The NAIC's Annual Statement Instructions, Title, 2022; and,

5. The NAIC's Accounting Practices and Procedures Manual, as of March 2022.
(b) Quarterly statements shall be prepared in accordance with the following manuals, which are hereby adopted and incorporated by reference:
1. The NAIC's Quarterly Statement Instructions, Property and Casualty, 2023;

2. The NAIC's Quarterly Statement Instructions, Life, Accident and Health\Fraternal, 2023;

3. The NAIC's Quarterly Statement Instructions, Health, 2023;

4. The NAIC's Quarterly Statement Instructions, Title, 2023; and,

5. The NAIC's Accounting Practices and Procedures Manual, as of March 2023.
(c) The agency has determined that posting these incorporated materials would be a violation of federal copyright law. The materials are available for public inspection at the Office of Insurance Regulation, Larson Building, 200 East Gaines Street, Tallahassee, Florida 32399-0300, or at the Department of State, R.A. Gray Building, 500 South Bronough Street, Tallahassee, Florida 32399-0250. A copy of the manuals may also be obtained from the National Association of Insurance Commissioners 1100 Walnut Street, Suite 1500, Kansas City, MO 64106-2197, Telephone (816)783-8500, website: http://www.NAIC.org.
Disclaimer© State of Florida
Rulemaking AuthorityLaw ImplementedHistory
624.308(1), 624.424(1) FS.624.424(1) FS.New , Amended , , , , , , , , , , , Formerly 4-137.001, Amended , , , , , , , , , , , , , , .

69O FAC 137.002 | Annual Audited Financial Reports

(1) The purpose of this rule is to improve the Office's surveillance of the financial condition of insurers by requiring an annual audit of financial statements reporting the financial position and the results of operations of insurers by:
(a) Independent certified public accountants;

(b) Communication of Internal Control Related Matters Noted in an audit; and,

(c) Management's Report of Internal Control over Financial Reporting.
(2)
(a) Every authorized insurer, as defined in subsection (3), below, shall be subject to this rule. Insurers having direct premiums written in this state of less than $1,000,000 in any calendar year and fewer than 1,000 policyholders or certificateholders of direct written policies nationwide at the end of the calendar year shall be exempt from this rule for the year (unless the Office makes a specific finding that compliance is necessary for the Office to carry out statutory responsibilities), except that insurers having assumed premiums pursuant to contracts and/or treaties of reinsurance of $1,000,000 or more will not be so exempt. Any insurer subject to an exemption must submit by March 1 following the year to which the exemption applies an affidavit sworn to by a responsible officer of the insurer specifying the amount of direct premiums written in this state and number of policyholders or certificateholders. Form OIR-DO-1431, (Rev. 7/01), "Audited Financial Statements Exemption Affidavit," is hereby incorporated by reference to be the form specified in Section 624.424(8)(b), F.S., for exemptions from compliance with the filing of an annual audited financial statement. Forms are available at http://www.FLOir.com/iPortal.

(b) Foreign or alien insurers filing Audited Financial Reports in another state, pursuant to that state's requirement for filing of Audited Financial Reports which has been found by the Office to be substantially similar to the requirements herein, may, in lieu of the other requirements herein, be exempt from subsections (4) through (13) of this rule if:
1. A copy of the Audited Financial Report, Communications of Internal Control Related Matters Noted in an Audit, and the Accountant's Letter of Qualifications which are filed with the other state are made available to the Office upon request in accordance with the filing dates specified in subsections (4), (11) and (12), respectively (Canadian insurers may submit accountants' reports as filed with the Office of the Superintendent of Financial Institutions, Canada); and,

2. A copy of any Notification of Adverse Financial Condition Report filed with the other state are made available to the Office upon request within the time specified in subsection (10).
(c) This rule shall not prohibit, preclude, or in any way limit the Office from ordering and/or conducting and/or performing examinations of insurers under its rules.

(3) Definitions.

(a) "Accountant" and "Independent Certified Public Accountant" means an independent Certified Public Accountant or accounting firm in good standing with the American Institute of Certified Public Accountants (AICPA) and in all states in which he or she is licensed to practice. For Canadian and British companies, it means a Canadian-chartered or British-chartered accountant.

(b) "Affiliate" of, or person "affiliated" with, a specific person, is a person that directly or indirectly through one or more intermediaries, controls, or is controlled by, or is under common control with, the person specified.

(c) "Audit committee" means a committee (or equivalent body) established by the board of directors of an entity for the purpose of overseeing the accounting and financial reporting processes of an insurer or Group of insurers, the Internal audit function of an insurer or Group of insurers (if applicable), and external audits of financial statements of the insurer or Group of insurers. The Audit committee of any entity that controls a Group of insurers may be deemed to be the Audit committee for one or more of these controlled insurers solely for the purposes of this regulation at the election of the controlling person. Refer to paragraph (14)(e), for exercising this election. If an Audit committee is not designated by the insurer, the insurer's entire board of directors shall constitute the Audit committee.

(d) "Audited Financial Report" means and includes those items specified in subsection (5), below.

(e) "Indemnification" means an agreement of indemnity or a release from liability where the intent or effect is to shift or limit in any manner the potential liability of the person or firm for failure to adhere to applicable auditing or professional standards, whether or not resulting in part from knowing of other misrepresentations made by the insurer or its representatives.

(f) "Independent board member" has the same meaning as described in paragraph (14)(c).

(g) "Insurer" means an authorized insurer as defined in Section 624.09, F.S.

(h) "Group of insurers" means those licensed insurers included in the reporting requirements of Chapter 628, Part IV, F.S. or a set of insurers as identified by management, for the purpose of assessing the effectiveness of internal control over financial reporting.

(i) "Internal audit function" means a person or persons that provide independent, objective, and reasonable assurance designed to add value and improve an organization's operations and accomplish its objectives by bringing a systematic, disciplined approach to evaluate and improve the effectiveness of risk management, control, and governance processes.

(j) "Internal control over financial reporting" means a process effected by an entity's board of directors, management and other personnel designed to provide reasonable assurance regarding the reliability of the financial statements, i.e., those items specified in subparagraphs (5)(b)2. through 7. of this regulation, and includes those policies and procedures that:
1. Pertain to the maintenance of records that, in reasonable detail, accurately and fairly reflects the transactions and dispositions of assets,

2. Provide reasonable assurance that transactions are recorded as necessary to permit preparation of the financial statements, i.e., those items specified in subparagraphs (5)(b)2. through 7. of this regulation, and that receipts and expenditures are being made only in accordance with authorizations of management and directors; and,

3. Provide reasonable assurance regarding prevention or timely detection of unauthorized acquisition, use or disposition of assets that could have a material effect on the financial statements, i.e., those items specified in subparagraphs (5)(b)2. through 7. of this regulation.
(k) "Office" means the Office of Insurance Regulation.

(l) "SEC" means the United States Securities and Exchange Commission.

(m) "Section 404" means Section 404 of the Sarbanes-Oxley Act of 2002 and the SEC's rules and regulations promulgated thereunder.

(n) "Section 404 Report" means management's report on "internal control over financial reporting" as defined by the SEC and the related attestation report of the independent certified public accountant as described in paragraph (3)(a).

(o) "SOX Compliant Entity" means an entity that either is required to be compliant with, or voluntarily is compliant with, all of the following provisions of the Sarbanes-Oxley Act of 2002: (i) the preapproval requirements of Section 201 (Section 10A(i) of the Securities Exchange Act of 1934); (ii) the Audit committee independence requirements of Section 301 (Section 10A(m)(3) of the Securities Exchange Act of 1934); and (iii) the Internal control over financial reporting requirements of Section 404 (Item 308 of SEC Regulation S-K).

(p) "Section 16 Report" means a Management's Report of Internal Control over Financial Reporting provided in subsection (17) of this rule.

(4) General Requirements Related to Filing and Extensions for Filing of Annual Audited Financial Report and Audit Committee Appointment.

(a) All insurers shall have an annual audit by an independent Certified Public Accountant and shall file an Audited Financial Report with the Office on or before June 1 for the year ended December 31 immediately preceding. The Office may require an insurer to file an Audited Financial Report earlier than June 1 with ninety (90) days advance notice to the insurer.

(b) Every insurer required to file an annual Audited Financial Report pursuant to this regulation shall designate a group of individuals as constituting its Audit committee, as defined in subsection (3). The Audit committee of an entity that controls an insurer may be deemed to be the insurer's Audit committee for purposes of this regulation at the election of the controlling person.

(5) Contents of Annual Audited Financial Report.

(a) The Annual Audited Financial Report shall report the financial position of the insurer as of the end of the most recent calendar year and the results of its operations, cash flows, and changes in capital and surplus for the year then ended in conformity with statutory accounting practices prescribed, or otherwise permitted, by the state of domicile.

(b) The Annual Audited Financial Report shall include the following:
1. Report of independent Certified Public Accountant.

2. Balance sheet reporting admitted assets, liabilities, capital and surplus.

3. Statement of operations.

4. Statement of cash flows.

5. Statement of changes in capital and surplus.

6. Notes to financial statements. These notes shall be those required by the appropriate NAIC Annual Statement Instructions (incorporated by reference in subsection 69O-137.001(4), F.A.C.) and the NAIC Accounting Practices and Procedures Manual (incorporated by reference in subsection 69O-137.001(4), F.A.C.) and any other notes required by generally accepted accounting principles and shall also include reconciliation of differences, if any, between the audited statutory financial statements and the Annual Statement filed pursuant to Section 624.424(1), F.S., with a written description of the nature of these differences.

7. The financial statements included in the Audited Financial Report shall be prepared in a form and using language and groupings substantially the same as the relevant sections of the Annual Statement of the insurer filed with the Office, and the financial statement shall be comparative, presenting the amounts as of December 31 of the current year and the amounts as of the immediately preceding December 31. However, in the first year in which an insurer is required to file an Audited Financial Report, the comparative data may be omitted.

(6) Designation of Independent Certified Public Accountant.

(a) Each insurer required by this rule to file an annual Audited Financial Report must, by December 31 of the year subject to audit, register with the Office in writing the name and address of the independent Certified Public Accountant or accounting firm retained to conduct the annual audit set forth in this rule.

(b) The insurer shall obtain a letter from the accountant, and file a copy with the Office, stating that the accountant is aware of the provisions of the Insurance Code and the Rules and Regulations of the state of domicile that relate to accounting and financial matters, and affirming that the accountant will express his or her opinion on the financial statements in terms of their conformity to the statutory accounting practices prescribed or otherwise permitted by that Insurance Department, specifying the exceptions as he or she may believe appropriate.

(c) If an accountant who was the accountant for the immediately preceding filed Audited Financial Report is dismissed or resigns, the insurer shall within five (5) business days notify the Office of this event. The insurer shall also furnish the Office with a separate letter within ten (10) business days of the above notification stating whether in the twenty-four (24) months preceding that event there were any disagreements with the former accountant on any matter of accounting principles or practices, financial statement disclosure, or auditing scope or procedure; which disagreements, if not resolved to the satisfaction of the former accountant, would have caused him or her to make reference to the subject matter of the disagreement in connection with his or her opinion. The disagreements required to be reported in response to this paragraph include both those resolved to the former accountant's satisfaction and those not resolved to the former accountant's satisfaction. Disagreements contemplated by this subsection are those that occur at the decision-making level, i.e., between personnel of the insurer responsible for presentation of its financial statements and personnel of the accounting firm responsible for rendering its report. The insurer shall also in writing request the former accountant to furnish a letter addressed to the insurer stating whether the accountant agrees with the statements contained in the insurer's letter, and if not, stating the reasons for which he or she does not agree; and the insurer shall furnish the responsive letter from the former accountant to the Office together with its own.

(7) Qualifications of Independent Certified Public Accountant.

(a) The Office shall not recognize any person or firm as a qualified independent Certified Public Accountant if the person or firm:
1. Is not in good standing with the American Institute of Certified Public Accountants (AICPA) and in all states in which the accountant is licensed to practice, or for a Canadian or British company, that is not a chartered accountant;

2. Has not completed 4 hours of insurance related continuing education as required by Section 624.424(8)(d), F.S.; or

3. Has either directly or indirectly entered into an agreement of indemnity or release from liability (collectively referred to as indemnification) with respect to the audit of the insurer.
(b) Except as otherwise provided in this rule, the Office shall recognize an independent Certified Public Accountant as qualified as long as he or she prepares reports, filings, and statements as required by the Florida Insurance Code, and conforms to the standards of his or her profession as contained in the Rules and Regulations and Code of Ethics and Rules of Professional Conduct of the Florida Board of Public Accountancy, or similar code.

(c)
1. The lead (or coordinating) audit partner (having primary responsibility for the audit) may not act in that capacity for more than five (5) consecutive years. The person shall be disqualified from acting in that or a similar capacity for the same company or its insurance subsidiaries or affiliates for a period of five (5) consecutive years. An insurer may make application to the Office for relief from the above rotation requirement based on an unusual hardship to the insurer and a determination by the Office that the accountant is exercising independent judgement that is not unduly influenced by the insurer. This application should be made at least thirty (30) days before the end of the calendar year. The Office shall consider the following factors in determining if the relief should be granted:
a. Number of partners, expertise of the partners, or the number of insurance clients in the currently registered firm;

b. Premium volume of the insurer; and,

c. Number of jurisdictions in which the insurer transacts business.
2. The insurer shall file, with its annual statement filing, the approval for relief from paragraph (7)(c), with the states that it is licensed in or doing business in and with the NAIC. If the nondomestic state accepts electronic filing with the NAIC, the insurer shall file the approval in an electronic form acceptable to the NAIC.
(d) The Office shall neither recognize as a qualified independent Certified Public Accountant, nor accept an annual Audited Financial Report prepared in whole or in part by any natural person who:
1. Has been found guilty of, or has pleaded guilty or nolo contendere to, any felony or crime punishable by imprisonment of one year or more under the law of the United States or any state thereof or under the law of any other country, which involves moral turpitude, without regard to whether a judgement of conviction has been entered by the court having jurisdiction in such case;

2. Has been found to have violated the insurance laws of this state with respect to any previous reports submitted under this rule; or

3. Has failed to detect or disclose material information in previous reports filed under the provisions of this rule.
(e) In accordance with the provisions of Sections 624.307 and 624.324, F.S., and in its own rules of departmental practice, the Office shall conduct a hearing to determine whether an independent Certified Public Accountant is qualified if Office records do not contain sufficient information to demonstrate that the Certified Public Accountant is qualified. Considering the evidence presented, the Office shall conclude that the accountant is not qualified for purposes of expressing his or her opinion on the financial statements in the annual Audited Financial Report made pursuant to this rule, if the accountant fails to meet the qualifications and other requirements of this rule. If the accountant is found to be not qualified, the Office shall require the insurer to replace the accountant with another whose relationship with the insurer is qualified within the meaning of this rule. Upon determination by the Office that the accountant is not qualified to express an opinion on the financial statements in the annual Audited Financial Report made pursuant to this rule the insurer may request a hearing pursuant to Section 120.57, F.S.

(f) A qualified independent certified accountant may enter into an agreement with an insurer to have disputes relating to an audit resolved by mediation or arbitration. However, in the event of a delinquency proceeding commenced against the insurer under Chapter 631, F.S., the mediation or arbitration provisions shall operate at the option of the statutory successor.

(g)
1. The Office shall not recognize as a qualified independent certified public accountant, nor accept an annual Audited Financial Report, prepared in whole or in part by an accountant who provides to an insurer, contemporaneously with the audit, the following non-audit services:
a. Bookkeeping or other services related to the accounting records or financial statements of the insurer;

b. Financial information systems design and implementation;

c. Appraisal or valuation services, fairness opinions, or contribution in-kind reports;

d. Actuarially-oriented advisory services involving the determination of amounts recorded in the financial statements. The accountant may assist an insurer in understanding the methods, assumptions and inputs used in the determination of amounts recorded in the financial statement only if it is reasonable to conclude that the services provided will not be subject to audit procedures during an audit of the insurer's financial statements. An accountant's actuary may also issue an actuarial opinion or certification ("opinion") on an insurer's reserves if the following conditions have been met:
(I) Neither the accountant nor the accountant's actuary has performed any management functions or made any management decisions;

(II) The insurer has competent personnel (or engages a third party actuary) to estimate the reserves for which management takes responsibility; and,

(III) The accountant's actuary tests the reasonableness of the reserves after the insurer's management has determined the amount of the reserves;
e. Internal audit outsourcing services;

f. Management functions or human resources;

g. Broker or dealer, investment adviser, or investment banking services; or

h. Legal services or expert services unrelated to the audit.
2. In general, the principles of independence with respect to services provided by the qualified independent certified public accountant are largely predicated on three basic principles, violations of which would impair the accountant's independence. The principles are that the accountant cannot function in the role of management, cannot audit his own work, and cannot serve in an advocacy role for the insurer.
(h) Insurers having direct written and assumed premiums of less than $100,000,000 in any calendar year may request an exemption from subparagraph (g)1. The insurer shall file with the Office a written statement discussing the reasons why the insurer should be exempt from these provisions. If the Office finds, upon review of this statement, that compliance with this regulation would constitute an undue financial or organizational hardship upon the insurer, an exemption shall be granted.

(i) A qualified independent certified public accountant who performs the audit may engage in other non-audit services, including tax services that are not described in subparagraph (g)1., or that do not conflict with subparagraph (g)2., only if the activity is approved in advance by the Audit committee, in accordance with paragraph (j).

(j) All auditing services and non-audit services provided to an insurer by the qualified independent certified public accountant of the insurer shall be preapproved by the Audit committee. The preapproval requirement is waived with respect to non-audit services if the insurer is a SOX Compliant Entity or a direct or indirect wholly-owned subsidiary of a SOX Compliant Entity or:
1. The aggregate amount of all such non-audit services provided to the insurer constitutes not more than five percent (5%) of the total amount of fees paid by the insurer to its qualified independent certified public accountant during the fiscal year in which the non-audit services are provided;

2. The services were not recognized by the insurer at the time of the engagement to be non-audit services; and,

3. The services are promptly brought to the attention of the Audit committee of the insurer and approved prior to the completion of the audit by the Audit committee or by one or more members of the Audit committee who are the members of the board of directors to whom authority to grant such approvals has been delegated by the Audit committee.
(k) The Audit committee may delegate to one or more designated members of the Audit committee the authority to grant the preapprovals required by paragraph (l). The decisions of any member to whom this authority is delegated shall be presented to the full Audit committee at each of its scheduled meetings.

(l)
1. The Office shall not recognize an independent certified public accountant as qualified for a particular insurer if a member of the board, president, chief executive officer, controller, chief financial officer, chief accounting officer, or any person serving in an equivalent position for that insurer, was employed by the independent certified public accountant and participated in the audit of that insurer during the one-year period preceding the date that the most current statutory opinion is due. This subsection shall only apply to partners and senior managers involved in the audit.

2. The insurer shall file, with its annual statement filing, the approval for relief from subparagraph (l)1., with the states that it is licensed in or doing business in and the NAIC. If the nondomestic state accepts electronic filing with the NAIC, the insurer shall file the approval in an electronic format acceptable to the NAIC.

(8) Consolidated or Combined Audits.

(a) An insurer may make written application to the Office for approval to file audited consolidated or combined financial statements in lieu of separate annual audited financial statements if the insurer is part of a group of insurance companies which utilizes a pooling or one hundred percent reinsurance agreement that affects the solvency and integrity of the insurer's reserves, and the insurer cedes all of its direct and assumed business to the pool. In these cases, a columnar consolidating or combining worksheet shall be filed with the report, as follows:
1. Amounts shown on the consolidated or combined Audited Financial Report shall be shown on the worksheet.

2. Amounts for each insurer subject to this section shall be stated separately.

3. Noninsurance operations may be shown on the worksheet on a combined or individual basis.

4. Explanations of consolidating and eliminating entries shall be included; and,

5. A reconciliation shall be included of any differences between the amounts shown in the individual insurer columns of the worksheet and comparable amounts shown on the Annual Statements of the insurers.
(b)
1. The application for approval to consolidate is required each year, and must be filed with the Office prior to the end of the calendar year for which the approval is being granted, except that applications for approval will be accepted after the end of such calendar year subject to the imposition of an administrative fine on each insurer involved in such application as provided for in Section 624.4211(2), F.S.

2. The amount of the fine shall be $50 per day for each day beyond the end of the calendar year, not to exceed an aggregate amount of $10,000 for the group of insurers requesting permission to file on a consolidated basis.
(c) Approval to consolidate or combine statements shall be granted unless the Office makes a specific finding that approval would prevent the Office from carrying out its statutory responsibilities.

(9) Scope of Audit and Report of Independent Certified Public Accountant.

Financial statements furnished pursuant to subsection (5) above, shall be examined by the independent certified public accountant. The audit of the insurer's financial statements shall be conducted in accordance with generally accepted auditing standards. In accordance with AU-C 610 of the Professional Standards of the AICPA, Using the Work of Internal Auditors, effective 12/15/14, and AU-C Section 940 of the Professional Standards of the AICPA, An Audit of Internal Control Over Financial Reporting That is Integrated With an Audit of Financial Statements, effective 12/15/16, the independent certified public accountant should obtain an understanding of internal control sufficient to plan the audit. To the extent required by AU-C 610 and AU-C Section 940, for those insurers required to file a Management's Report of Internal Control over Financial Reporting pursuant to subsection (17), the independent certified public accountant should consider (as that term is defined in of the Professional Standards of the AICPA, AU-C 200 Overall Objectives of the Independent Auditor and the Conduct of an Audit in Accordance With Generally Accepted Auditing Standards, effective 12/15/12) the most recently available report in planning and performing the audit of the statutory financial statements. Consideration should also be given to the other procedures illustrated in the Financial Condition Examiner's Handbook promulgated by the National Association of Insurance Commissioners (incorporated by reference in Rule 69O-138.001, F.A.C.) as the independent Certified Public Accountant deems necessary.

(10) Notification of Adverse Financial Condition.

(a) The insurer required to furnish the annual Audited Financial Report shall require the independent Certified Public Accountant to report, in writing, within five (5) business days to the board of directors or its Audit committee any determination by the independent Certified Public Accountant that the insurer has materially misstated its financial condition as reported to the Office as of the balance sheet date currently under audit, or that the insurer does not meet the minimum capital and surplus requirement of the Florida Insurance Code as of that date. An insurer who has received a report pursuant to this paragraph shall forward a copy of the report to the Office within five (5) business days of receipt of said report and shall provide the independent Certified Public Accountant making the report with evidence of the report being furnished to the Office. If the independent Certified Public Accountant fails to receive the evidence within the required five (5) business day period, the independent Certified Public Accountant shall furnish to the Office a copy of its report within the next five (5) business days.

(b) An independent certified public accountant shall not be liable in any manner to any person for any statement made in connection with the above paragraph if the statement is made in good faith in compliance with the above paragraph.

(c) If the accountant, subsequent to the date of the Audited Financial Report filed pursuant to this rule, becomes aware of facts which might have affected his report, the Office notes the obligation of the accountant to take such action as prescribed in AU-C 560 of the Professional Standards of the AICPA, Subsequent Events and Subsequently Discovered Facts, effective 12/15/12.

(11) Communication of Internal Control Related Matters Noted in an Audit.

(a) In addition to the annual Audited Financial Report, each insurer shall furnish the Office with a written communication as to any unremediated material weaknesses in its Internal control over financial reporting noted during the audit. Such communication shall be prepared by the accountant within sixty (60) days after the filing of the annual Audited Financial Report, and shall contain a description of any unremediated material weakness (as the term material weakness is defined by AU-C 265 of the Professional Standards of the AICPA, Communicating Internal Control Related Matters Identified in an Audit), effective 12/15/12, as of December 31 immediately preceding (so as to coincide with the Audited Financial Report discussed in subsection (4)) in the insurer's Internal control over financial reporting noted by the accountant during the course of their audit of the financial statements. If no unremediated material weaknesses were noted, the communication should so state.

(b) The insurer is required to provide a description of remedial actions taken or proposed to correct unremediated material weaknesses if the actions are not described in the accountant's communication.

(12) Accountant's Letter of Qualifications.

(a) The accountant shall furnish a letter to the insurer in connection with, and for inclusion in, the filing of the annual Audited Financial Report.

(b) The letter shall state:
1. That the accountant is independent with respect to the insurer and conforms to the standards of his or her profession as contained in the Code of Professional Ethics and pronouncements of the AICPA and the Rules of Professional Conduct of the Florida Board of Public Accountancy, or similar code,

2. The background and experience in general, and the experience in audits of insurers of the staff assigned to the engagement and whether each is an independent Certified Public Accountant. Nothing within this rule shall be construed as prohibiting the accountant from utilizing his or her staff as he or she deems appropriate where use is consistent with the standards prescribed by generally accepted auditing standards,

3. That the accountant understands the annual Audited Financial Report, and his or her opinion thereon will be filed in compliance with this rule, and that the Office will be relying on this information in the monitoring and regulation of the financial position of insurers,

4. That the accountant consents to the requirements of subsection (13), below, and that the accountant consents and agrees to make the workpapers as defined in subsection (13), below, available for review by the Office,

5. A representation that the accountant is properly licensed by an appropriate state licensing authority and is a member in good standing in the AICPA; and,

6. A representation that the accountant is in compliance with the requirements of subsection (7) of this rule.

(13) Definition, Availability, and Maintenance of Independent Certified Public Accountants Workpapers.

(a) Workpapers are the records kept by the independent Certified Public Accountant of the procedures followed, the tests performed, the information obtained, and the conclusions reached pertinent to the accountant's audit of the financial statements of an insurer. Workpapers, accordingly, may include audit planning documentation, work programs, analyses, memoranda, letters of confirmation and representation, abstracts of company documents and schedules, or commentaries prepared or obtained by the independent Certified Public Accountant in the course of his or her audit of the financial statements of an insurer, and which support the accountant's opinion.

(b) Every insurer required to file an Audited Financial Report pursuant to this rule shall require the accountant to make available for review by Office examiners all workpapers prepared in the conduct of the accountant's audit, and any communications related to the audit between the accountant and the insurer, at the offices of the insurer, at the Office or at any other reasonable place designated by the Office. The insurer shall require that the accountant retain the audit workpapers and communications until the Office has filed a Report on Examination covering the period of the audit, but no less than seven (7) years from the date of the audit report.

(c) In the conduct of the aforementioned periodic review by the Office examiners, it shall be agreed that photocopies of pertinent audit workpapers may be made and retained by the Office. The reviews by the Office examiners shall be considered investigations, and all working papers and communications obtained during the course of the investigations shall be afforded the same confidentiality as other examination workpapers generated by the Office until the Report of Examination is filed by the Office.

(14) Requirements for Audit Committee.

This section shall not apply to foreign or alien insurers licensed in this state or an insurer that is a SOX Compliant Entity or a direct or indirect wholly-owned subsidiary of a SOX Compliant Entity.
(a) The Audit committee shall be directly responsible for the appointment, compensation and oversight of the work of any accountant (including resolution of disagreements between management and the accountant regarding financial reporting) for the purpose of preparing or issuing the Audited Financial Report or related work pursuant to this rule. Each accountant shall report directly to the Audit committee.

(b) The Audit committee of an insurer or Group of insurers shall be responsible for overseeing the insurer's Internal audit function and granting the person or persons performing the function suitable authority and resources to fulfill their responsibilities if required by subsection 15 of this Regulation.

(c) Each member of the Audit committee shall be a member of the board of directors of the insurer or a member of the board of directors of an entity elected pursuant to paragraphs (f) and (3)(c).

(d) In order to be considered independent for purposes of this section, a member of the Audit committee may not, other than in his or her capacity as a member of the Audit committee, the board of directors, or any other board committee, accept any consulting, advisory or other compensatory fee from the entity or be an affiliated person of the entity or any subsidiary thereof.

(e) If a member of the Audit committee ceases to be independent for reasons outside the member's reasonable control, that person, with notice by the responsible entity to the state, may remain an Audit committee member of the responsible entity until the earlier of the next annual meeting of the responsible entity or one year from the occurrence of the event that caused the member to be no longer independent.

(f) To exercise the election of the controlling person to designate the Audit committee for purposes of this regulation, the ultimate controlling person shall provide written notice to the Office of the affected insurers. Notification shall be made timely prior to the issuance of the statutory audit report and include a description of the basis for the election. The election can be changed through notice to the Office by the insurer, which shall include a description of the basis for the change. The election shall remain in effect for perpetuity, until rescinded.

(g)
1. The Audit committee shall require the accountant that performs for an insurer any audit required by this regulation to timely report to the Audit committee in accordance with the requirements of AU-C 260 of the Professional Standards of the AICPA, The Auditor's Communication With Those Charged with Governance, effective 12/15/12, including:
a. All significant accounting policies and material permitted practices,

b All material alternative treatments of financial information within statutory accounting principles that have been discussed with management officials of the insurer, ramifications of the use of the alternative disclosures and treatments, and the treatment preferred by the accountant; and,

c. Other material written communications between the accountant and the management of the insurer, such as any management letter or schedule of unadjusted differences.
2. If an insurer is a member of an insurance holding company system, the reports required by subparagraph (g)1., may be provided to the Audit committee on an aggregate basis for insurers in the holding company system, provided that any substantial differences among insurers in the system are identified to the Audit committee.
(h) The proportion of independent Audit committee members shall meet or exceed the following criteria:
Prior Calendar Year Direct Written and Assumed Premiums
$0 – 300,000,000Over $300,000,000 – 500,000,000Over 500,000,000
No minimum requirements.

See also Notes A and B.
Majority (50% or more) of members shall be independent.

See also Notes A and B.
Supermajority of members (75% or more) shall be independent.

See also Note A.
Note A: The Office has authority afforded by Section 624.4085, F.S., to require the entity's board to enact improvements to the independence of the Audit committee membership if the insurer is in a Risk Based Capital action level event, meets one or more of the standards of an insurer deemed to be in hazardous financial condition, or otherwise exhibits qualities of a troubled insurer.

Note B: All insurers with less than $500,000,000 in prior year direct written and assumed premiums are encouraged to structure their Audit committees with at least a supermajority of independent Audit committee members.

Note C: Prior calendar year direct written and assumed premiums shall be the combined total of direct premiums and assumed premiums from non-affiliates for the reporting entities.
(i) An insurer with direct written and assumed premium, excluding premiums reinsured with the Federal Crop Insurance Corporation and Federal Flood Program, less than $500,000,000 may make application to the Office for a waiver from the subsection (14), requirements based upon hardship. The insurer shall file, with its annual statement filing, the approval for relief from subsection (14), with the states that it is licensed in or doing business in and the NAIC. If the non-domestic state accepts electronic filing with the NAIC, the insurer shall file the approval in an electronic format acceptable to the NAIC.

(15) Internal Audit Function Requirements.

(a) Exemption - An insurer is exempt from the requirements of this section if:
1. The insurer has annual direct written and unaffiliated assumed premium, including international direct and assumed premium but excluding premiums reinsured with the Federal Crop Insurance Corporation and Federal Flood Program, less than $500,000,000; and,

2. If the insurer is a member of a Group of insurers, the group has annual direct written and unaffiliated assumed premium, including international direct and assumed premium but excluding premiums reinsured with the Federal Crop Insurance Corporation and Federal Flood Program, less than $1,000,000,000.
(b) Note: An insurer or Group of insurers exempt from the requirements of subsection (15) is encouraged, but not required, to conduct a review of the insurer business type, sources of capital, and other risk factors to determine whether an Internal audit function is warranted. The potential benefits of an Internal audit function should be assessed and compared against the estimated costs.

(c) Function - The insurer or Group of insurers shall establish an Internal audit function providing independent, objective, and reasonable assurance to the Audit committee and insurer management regarding the insurer's governance, risk management, and internal controls. This assurance shall be provided by performing general and specific audits, reviews, and tests and by employing other techniques deemed necessary to protect assets, evaluate control effectiveness and efficiency, and evaluate compliance with policies and regulations.

(d) Independence - In order to ensure that internal auditors remain objective, the Internal audit function must be organizationally independent. Specifically, the Internal audit function will not defer ultimate judgment on audit matters to others, and shall appoint an individual to head the Internal audit function who will have direct and unrestricted access to the board of directors. Organizational independence does not preclude dual-reporting relationships.

(e) Reporting - The head of the Internal audit function shall report to the Audit committee regularly, but no less than annually, on the periodic audit plan, factors that may adversely impact the Internal audit function's independence or effectiveness, material findings from completed audits, and the appropriateness of corrective actions implemented by management as a result of audit findings.

(f) Additional Requirements - If an insurer is a member of an insurance holding company system or included in a Group of insurers, the insurer may satisfy the Internal audit function requirements set forth in this section at the ultimate controlling parent level, an intermediate holding company level, or the individual legal entity level.

(16) Conduct of Insurer in Connection with the Preparation of Required Reports and Documents.

(a) No director or officer of an insurer shall, directly or indirectly:
1. Make or cause to be made a materially false or misleading statement to an accountant in connection with any audit, review or communication required under this regulation; or

2. Omit to state, or cause another person to omit to state, any material fact necessary in order to make statements made, in light of the circumstances under which the statements were made, not misleading to an accountant in connection with any audit, review or communication required under this regulation.
(b) No officer or director of an insurer, or any other person acting under the direction thereof, shall directly or indirectly take any action to coerce, manipulate, mislead or fraudulently influence any accountant engaged in the performance of an audit pursuant to this regulation if that person knew or should have known that the action, if successful, could result in rendering the insurer's financial statements materially misleading.

(c) For purposes of paragraph (b) of this section, actions that, "if successful, could result in rendering the insurer's financial statements materially misleading" include, but are not limited to, actions taken at any time with respect to the professional engagement period to coerce, manipulate, mislead or fraudulently influence an accountant:
1. To issue or reissue a report on an insurer's financial statements that is not warranted in the circumstances (due to material violations of statutory accounting principles prescribed by the Office or generally accepted auditing standards);

2. Not to perform audit, review or other procedures required by generally accepted auditing standards;

3. Not to withdraw an issued report; or

4. Not to communicate matters to an insurer's Audit committee.

(17) Management's Report of Internal Control over Financial Reporting.

(a) Every insurer required to file an Audited Financial Report pursuant to this regulation that has annual direct written and assumed premiums, excluding premiums reinsured with the Federal Crop Insurance Corporation and Federal Flood Program, of $500,000,000 or more shall prepare a report of the insurer's or Group of insurers' Internal control over financial reporting, as these terms are defined in subsection (3). The report shall be filed with the Office along with the Communication of Internal Control Related Matters Noted in an Audit described under subsection (11). Management's Report of Internal Control over Financial Reporting shall be as of December 31 immediately preceding.

(b) Notwithstanding the premium threshold in paragraph (16)(a), the Office shall require an insurer to file Management's Report of Internal Control over Financial Reporting if the insurer is in any Risk Based Capital level event, or meets any one or more of the standards of an insurer deemed to be in hazardous financial condition. "Hazardous financial condition" shall mean any of the conditions that subject an insurer to suspension or revocation of its certificate of authority as provided in Section 624.418, F.S.

(c) An insurer or a Group of insurers that is:
1. Directly subject to Section 404;

2. Part of a holding company system whose parent is directly subject to Section 404;

3. Not directly subject to Section 404 but is a SOX Compliant Entity; or

4. A member of a holding company system whose parent is not directly subject to Section 404 but is a SOX Compliant Entity; may file its or its parent's Section 404 Report and an addendum in satisfaction of this Section's requirement provided that those internal controls of the insurer or Group of insurers having a material impact on the preparation of the insurer's or Group of insurers' audited statutory financial statements (those items included in subparagraphs (5)(b)2. through (5)(b)7. of this regulation) were included in the scope of the Section 404 Report. The addendum shall be a positive statement by management that there are no material processes with respect to the preparation of the insurer's or Group of insurers' audited statutory financial statements (those items included in subparagraphs (5)(b)2. through (5)(b)7. of this rule) excluded from the Section 404 Report. If there are internal controls of the insurer or Group of insurers that have a material impact on the preparation of the insurer's or Group of insurers' audited statutory financial statements and those internal controls were not included in the scope of the Section 404 Report, the insurer or Group of insurers may either file (i) a subsection (16) report, or (ii) the Section 404 Report and a subsection (16) report for those internal controls that have a material impact on the preparation of the insurer's or Group of insurers' audited statutory financial statements not covered by the Section 404 Report.
(d) Management's Report of Internal Control over Financial Reporting shall include:
1. A statement that management is responsible for establishing and maintaining adequate internal control over financial reporting,

2. A statement that management has established internal control over financial reporting and an assertion, to the best of management's knowledge and belief, after diligent inquiry, as to whether its internal control over financial reporting is effective to provide reasonable assurance regarding the reliability of financial statements in accordance with statutory accounting principles,

3. A statement that briefly describes the approach or processes by which management evaluated the effectiveness of its internal control over financial reporting,

4. A statement that briefly describes the scope of work that is included and whether any internal controls were excluded,

5. Disclosure of any unremediated material weaknesses in the internal control over financial reporting identified by management as of December 31 immediately preceding, after the effective date of this rule. Management is not permitted to conclude that the internal control over financial reporting is effective to provide reasonable assurance regarding the reliability of financial statements in accordance with statutory accounting principles if there is one or more unremediated material weaknesses in its internal controls over financial reporting,

6. A statement regarding the inherent limitations of internal control systems; and,

7 Signatures of the chief executive officer and the chief financial officer (or equivalent position/title).
(e) Management shall document and make available upon financial condition examination the basis upon which its assertions, required in paragraph (d), above, are made. Management may base its assertions, in part, upon its review, monitoring and testing of internal controls undertaken in the normal course of its activities.
1. Management shall have discretion as to the nature of the internal control framework used, and the nature and extent of documentation, in order to make its assertion in a cost effective manner and, as such, may include assembly of or reference to existing documentation.

2. Management's Report on Internal Control over Financial Reporting, required by paragraph (a), above, and any documentation provided in support thereof during the course of a financial condition examination, shall be kept confidential by the Office.

(18) Exemptions and Effective Dates.

(a) Upon written application of any insurer, the Office shall grant an exemption from compliance with any and all provisions of this rule if the Office finds, upon review of the application, that compliance with this regulation would constitute an undue financial or organizational hardship upon the insurer.

(b) Domestic insurers shall comply with this rule for the year ending December 31, 2010, and each year thereafter.

(c) Foreign insurers shall comply with this rule for the year ending December 31, 2010, and each year thereafter.

(d) The requirements of paragraph (7)(c), shall be in effect for audits of the year ending December 31, 2010, and thereafter.

(e) The requirements of subsection (14), are to be in effect for audits of the year ending December 31, 2010. An insurer or Group of insurers that is not required to have independent Audit committee members or only a majority of independent Audit committee members (as opposed to a supermajority) because the total written and assumed premium is below the threshold and subsequently becomes subject to one of the independence requirements discussed in this paragraph due to changes in premium shall have one (1) year following the year the threshold is exceeded (but not earlier than January 1, 2010) to comply with the independence requirements discussed in this paragraph. Likewise, an insurer that becomes subject to one of the independence requirements discussed in this paragraph as a result of a business combination shall have one (1) calendar year following the date of acquisition or combination to comply with the independence requirements.

(f) The requirements of subsection (17), and other modified sections, except for subsection (14), covered above, are effective beginning with the reporting period ending December 31, 2010, and each year thereafter. An insurer or Group of insurers that is not required to file a report because the total written premium is below the threshold and subsequently becomes subject to the reporting requirements shall have two (2) years following the year the threshold is exceeded (but not earlier than December 31, 2010) to file a report. Likewise, an insurer acquired in a business combination shall have two (2) calendar years following the date of acquisition or combination to comply with the reporting requirements.

(g) If an insurer or Group of insurers that has been exempt from the subsection 15 requirements no longer qualifies for that exemption, it shall have one year after the year the threshold is exceeded to comply with the requirements of this rule.

(19) Canadian and British Companies.

(a) In the case of Canadian and British insurers, the annual Audited Financial Report shall be defined as the annual statement of total business on the form filed by the companies with their supervision authority duly audited by an independent chartered accountant.

(b) For these insurers, the letter required in paragraph (6)(b), above, shall state that the accountant is aware of the requirements relating to the annual Audited Financial Report filed with the Office pursuant to subsection (4), above, and shall affirm that the opinion expressed is in conformity with these requirements.

(20) Severability Provision.

If any section or portion of this rule or its applicability to any person or circumstance is held invalid by a court, the remainder of the rule or the applicability of the provision to other persons or circumstances shall not be affected.

(21) Standards Incorporated by Reference.

(a) The following standards are hereby incorporated by reference:
1. AU-C 610 of the Professional Standards of the AICPA, Using the Work of Internal Auditors, effective 12/15/14;

2. AU-C 200 of the Professional Standards of the AICPA, Overall Objectives of the Independent Auditor and the Conduct of an Audit in Accordance With Generally Accepted Auditing Standards, effective 12/15/12;

3. AU-C 560 of the Professional Standards of the AICPA, Subsequent Events and Subsequently Discovered Facts, effective 12/15/12;

4. AU-C 265 of the Professional Standards of the AICPA, Communicating Internal Control Related Matters Identified in an Audit, effective 12/15/12;

5. AU-C 260 of the Professional Standards of the AICPA, The Auditor's Communication With Those Charged With Governance, effective 12/15/12; and

6. AU-C Section 940 of the Professional Standards of the AICPA, An Audit of Internal Control Over Financial Reporting That is Integrated With an Audit of Financial Statements, effective 12/15/16.
(b) The standards incorporated in this section are available:
1. From the American Institute of Certified Public Aaccountants' (AICPA) website at: http://www.AICPA.org/Publications; and,

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

69O FAC 137.003 | Premium Growth Reporting

Section 624.4243(3), F.S., requires that a form for reporting premium growth be adopted by rule for each insurer that has been authorized to transact property and casualty insurance in Florida for less than three years. Form OIR-A1-1229, http://www.FLRules.org/Gateway/Reference.asp?No=Ref-08298 (rev. 9/06), entitled "Office of Insurance Regulation Premium Growth Reporting Form," is hereby incorporated by reference to be the form specified in Section 624.4243(3), F.S., for reporting premium growth. Forms are available at http://www.FLOir.com/iPortal. All forms may be reproduced at will.

69O FAC 137.004 | Reports of Information by Health Insurers Required

(1) Any insurer authorized to write a policy or certificate of health insurance in the state shall, on or before April 1 for the preceding year ending December 31, report the information required by;
(a) Form OIR-B2-1094, "Report of Gross Annual Premiums and Enrollment Data for Health Benefit Plans Issued to Florida Residents", providing information on health benefit plans written in this state and

(b) Form OIR-B2-575, "Implemented Health Insurance Measures", providing information on measures implemented or proposed to contain health insurance costs or cost increases.
(2) The following forms are hereby adopted and incorporated by reference:
(a) OIR-B2-1094, (rev. 01/23), "Report of Gross Annual Premiums and Enrollment Data for Health Benefit Plans Issued to Florida Residents" available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-16178.

(b) OIR-B2-575, (new 07/23), "Implemented Health Insurance Measures" available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-16177.

(c) Copies of forms are available and may be printed from the Office's website: http://www.FLOir.com/iPortal.

(d) All filings shall be submitted electronically through http://www.FLOir.com/iPortal.

69O FAC 137.008 | Filing of Statistical and Quarterly Reports for Individually Rated Risks and Excess Rates

(1) Purpose and Scope.

The purpose of this rule is to provide procedures for filing statistical reports for individually rated risks pursuant to Section 627.062(3)(a), F.S., and for excess rates pursuant to Section 627.171, F.S., since they are not rated in accordance with the insurer's rates, rating schedules, rating manuals, and underwriting rules which have been filed with the Office. Every insurer in this state which is authorized to transact any of the lines of insurance subject to Part II of Chapter 627, F.S., and which rates risks on an individual or excess basis shall be subject to this rule. Reports for individually rated risks and excess rates shall be received by the Office on a quarterly basis for each company. The information shall be reported within 45 days of the close of each quarter on Form OIR-B1-588, http://www.FLRules.org/Gateway/Reference.asp?No=Ref-08272, "Office of Insurance Regulation/Property & Casualty - Quarterly Report/Individually Rated Risks and Excess Rates," rev. 7/03, which is hereby adopted and incorporated by reference. A quarterly report need not be filed if no individually rated risks or risks subject to excess rates have been written during the quarter for which the report would otherwise be due. However, if an insurer does not file Form OIR-B1-588 because of not having written such business for four consecutive quarters, then for the quarter after the fourth consecutive quarter for which no business was written, the insurer shall file Form OIR-B1-588 and check the box thereon indicating that the insurer has not been subject to filing for the past four consecutive quarters. The form may be obtained from http://www.FLOir.com/iPortal. A separate report must be completed for each quarter. The reports are due 45 days after the close of each quarter.

(2) Submitting the Report.

Forms shall be filed electronically at https://www.FLOir.com/iPortal.

69O FAC 137.009 | Filing Procedures for Commercial and Personal Residential Property Supplemental Report

(1) The procedures in this rule apply to all commercial and residential property policies as defined below. Each insurer or insurer group doing business in Florida shall file with the office a supplemental report with information, listed by company, on personal lines and commercial lines residential property insurance policies written in this state. The data submitted shall be calculated from the end of the last business day of each month. Non-renewal information shall be determined by the policy expiration dates.

(2) For purpose of this rule the following definitions are provided:
(a) "Homeowners" excludes condominium unit owners, tenants, and farm owners.

(b) "Mobile Homeowners" include coverage on mobile homes regardless of the type of policy used to cover the mobile homes.

(c) "Other Personal" includes all other personal residential policies not included under other coverage.

(d) "Other Commercial' includes all other commercial residential property policies not insured under any other coverage.
(3) The supplemental report shall include information, listed by company, as described on the supplemental report for each type of personal lines and commercial lines residential property policies written for each line by month and total premiums written for the quarter. The data shall be compiled as of the end of the last business day of each month. A separate report shall be prepared for each zip code in which business was written.

(4) The supplemental report for each shall be filed on or before the last day of the following month on Form OIR-D0-1185 (05/24) "Market Intelligence Report," which is hereby adopted and incorporated by reference and available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-16773. The information shall be submitted or be obtained from the Office's website at http://www.FLOir.com/iPortal.

69O FAC 137.010 | Holocaust Victims Insurance Report and Standards of Proof (Transferred)

69O FAC 137.011 | Reinsurance Summary Statement

Section 624.610(12), F.S., requires each domestic or commercially domiciled insurer ceding directly written risks of loss to file with the office one copy of a summary statement containing information about each treaty. The required information shall be filed on Form OIR-D0-1433 (rev. 10/23), entitled "Reinsurance Summary Statement," which is hereby incorporated by reference and available at https://www.FLRules.org/Gateway/Reference.asp?No=Ref-16774. The form may also be obtained from https://FLOir.com/property-casualty/property-casualty-financial-oversight. Form OIR-D0-1433 shall be filed within 30 days after receipt of a cover note or similar confirmation of coverage, or, without exception, no later than 6 months after the effective date of the reinsurance treaty. Forms are available and shall be filed electronically at http://www.FLOir.com/iPortal. All forms may be reproduced at will.

69O FAC 137.014 | Notice of Temporary Discontinuance of Writing New Residential Property Insurance Policies

(1) In addition to meeting all other requirements of law, each authorized insurer intending to temporarily suspend writing new residential property insurance policies must submit the required notification to the Office the earlier of:
(a) 20 business days before the effective date of the temporary suspension of writing, or

(b) 5 business days before notifying its agents of the temporary suspension of writing.
(2) An authorized insurer is not required to provide notice of under paragraph (1) if the conditions of Section 624.4301(1)(a), F.S., are met and the temporary suspension is in response to:
(a) a hurricane that may make landfall in this state, or

(b) a declared state of emergency due to natural emergency as defined in 252.34(8), F.S.
(3) The required notification shall be submitted on Form OIR-A1-1500 (effective 7/23), entitled "Notice of Temporary Discontinuance of Writing New Residential Property Insurance Policies," which is hereby incorporated by reference and available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-16186. The form may be obtained from https://www.FLOir.com.

(4) The notification shall be submitted via the Insurance Regulation Filing System (IRFS) application at https://irfs.fldfs.com.

69O FAC 137.015 | Notice of Nonrenewal of Residential Property Insurance Policies

(1) In addition to meeting all other requirements of law, each authorized insurer intending to nonrenew more than 10,000 residential property insurance policies within a 12-month period must submit the required notification to the Office at least 90 days before the issuance of any notices of nonrenewal.

(2) The required notification shall be submitted on Form OIR-A1-1680 (effective 05/24), entitled "Notice of Nonrenewal of Residential Property Insurance Policies," which is hereby incorporated by reference and available at https://www.FLRules.org/Gateway/Reference.asp?No=Ref-16775. The form may be obtained from https://www.FLOir.com.

(3) The notification shall be submitted via the Insurance Regulation Filing System (IRFS) application at https://irfs.fldfs.com.
69O-138 | Financial Examinations and Requirements

69O FAC 138.001 | NAIC Financial Condition Examiners Handbook Adopted

(1)
(a) The National Association of Insurance Commissioners Financial Condition Examiners Handbook 2023, is hereby adopted and incorporated by reference.

(b) The National Association of Insurance Commissioners Financial Condition Examiners Handbook 2022, is hereby adopted and incorporated by reference.

(c) The agency has determined that posting these incorporated materials would be a violation of federal copyright law. The materials are available for public inspection at the Office of Insurance Regulation, Larson Building, 200 East Gaines Street, Tallahassee, Florida 32399-0300, or at the Department of State, R.A. Gray Building, 500 South Bronough Street, Tallahassee, Florida 32399-0250. A copy of the handbooks may also be obtained from the National Association of Insurance Commissioners 1100 Walnut Street, Suite 1500, Kansas City, MO 64106-2197, Telephone (816) 783-8500, website: http://www.NAIC.org.
(2) Financial examinations by the Office shall be performed in substantial conformity with the methodology outlined in the Handbook, so long as that methodology is consistent with statutory accounting principles and the Florida Insurance Code.
Disclaimer© State of Florida
Rulemaking AuthorityLaw ImplementedHistory
624.308(1), 624.316(1)(c) FS.624.316(1)(c) FS.New , Amended , , , , , , , Formerly 4-138.001, Amended , , , , , , , , , , , , , , .

69O FAC 138.002 | Financial, Rate, and Market Conduct Examination Reimbursement Expenses

(1) This rule establishes rates and procedures for reimbursement to the Office for examination and per diem expenses for examinations conducted by Office employees pursuant to the provisions of Sections 624.316 and 624.3161, F.S.

(2) Examination and per diem charges will be computed beginning at the start of the examination of the insurer to be examined and the examiner's active participation in the examination planning, and ending at the completion of the examination and the end of the examiner's active participation in the examination. Where the examiner does not spend a full eight hour day in conducting the examination or planning, the insurer will only be charged for the time actually spent on planning or examination on a pro rata basis. If the examiner begins planning the examination more than a week prior to the actual on-site work, the Office will give written notice to the company being examined. No charges will be made for clerical or research work done by support staff to facilitate the examination or examiner's report. Charges will also be assessed for actual travel days as certified by the Office.

(3) The daily examination fee for each financial examination employee or dual financial and market conduct examination employee shall be at the rates as published in the National Association of Insurance Commissioners Financial Condition Examiners Handbook Attachment B which is adopted in Rule 69O-138.001, F.A.C. The rates as published are applied as follows:
(a) The Insurance Company Examiner rate is applied to our Financial Examiner/Analyst I positions and any other positions not specifically identified.

(b) The Senior Insurance Examiner rate is applied to our Financial Examiner/Analyst II and Financial Specialist positions when such examiners are not in an examiner-in-charge role.

(c) The Insurance Examiner-In-Charge rate is applied to any of our positions when such examiner is in the examiner-in-charge.

(d) The Administrative Examiner rate is applied to our Financial Examiner/Analyst Supervisor and any other positions that are in a supervisory capacity. In addition, the daily examination fee shall be $232 for each market conduct examination employee and $461 for each actuarial employee. The daily rates are applicable to each day the employees are participating in the examination.
(4) The per diem and other travel charges shall be the charges contained in the most current version of the Office's Administrative Policy and Procedure 7-4, (2-27-05) which is incorporated by reference and is available for inspection at the Tallahassee office of the Office, and shown on the examiner's expense voucher. Other travel expenses will also be charged based on actual travel expenses incurred by the examiners.

69O FAC 138.003 | Market Conduct Exam Methodology

The Office will prioritize scheduling and conducting market conduct examinations of insurers and other entities regulated by the Office based on the following selection methodology.

(1) Priority 1 - Statutorily Required Examinations:

(a) Pharmacy Benefit Managers, pursuant to s. 626.8828, F.S.,

(b) Citizens Property Insurance Corporation, pursuant to s. 627.351(6)(l), F.S., and

(c) Premium Finance Companies, pursuant to s. 627.834, F.S.

(2) Priority 2 - Post-hurricane Required Examinations.

(3) Priority 3 - Identified Market Concerns:

(a) Potentially hazardous business practice identified to be negatively affecting consumers,

(b) Companies for re-examinations, and

(c) Multi-state examinations.

(4) Priority 4 - Non-statutory Examinations:

(a) Complaint data analysis,

(b) Other state actions,

(c) Market Conduct Annual Statement (MCAS) data, and

(d) Any other conditions for examination as deemed warranted by the Office.

69O FAC 138.004 | Risk-Based Selection Methodology for Scheduling Financial Examinations

(1) This rule established a risk-based selection methodology for scheduling examinations of insurers subject to the provisions of Section 624.316, F.S.

(2) Section 624.316, F.S. permits the Office to examine each insurer holding a certificate of authority for three years or longer as often as may be warranted for the protection of the policyholders and in the public interest, but must, at a minimum, examine:
(a) High-risk insurers at least once every 3 years.

(b) Average- and low-risk insurers at least once every 5 years.
(3) The assessment of whether an insurer is deemed a High-risk insurer will include:
(a) A risk-focused analysis that indicates a decline in the insurer's financial condition;

(b) Prioritization of property insurers for which the office identifies significant concerns about an insurer's solvency pursuant to Section 627.7154, F.S.; and

(c) Consideration of the following:
1.The level of capitalization.

2. Unfavorable trends related to profitability or cashflow from operations.

3. National Association of Insurance Commissioners Insurance Regulatory Information System ratio results.

4. Risk-based capital and risk-based capital trend test results.

5. The structure and complexity of the insurer.

6. Changes in the insurer's officers or board of directors.

7. Changes in the insurer's business strategy or operations.

8. Findings and recommendations from an examination made pursuant to this section or Section 624.3161, F.S.

9. Current or pending regulatory actions by the office or the department.

10. Other regulatory agency or rating agency information or reports.

11. The impact of an insurer's insolvency on policyholders of the insurer and the public generally.

12. Any other matters the Office deems necessary for the protection of policyholders.
(4) The National Association of Insurance Commissioners Financial Analysis Handbook, 2023 is hereby adopted and incorporated by reference. The agency has determined that posting these incorporated materials would be a violation of federal copyright law. The materials are available for public inspection at the Office of Insurance Regulation, Larson Building, 200 East Gaines Street, Tallahassee, Florida 32399-0300, or at the Department of State, R.A. Gray Building, 500 South Bronough Street, Tallahassee, Florida 32399-0250. A copy of the handbooks may also be obtained from the National Association of Insurance Commissioners 1100 Walnut Street, Suite 1500, Kansas City, MO 64106-2197, Telephone (816) 783-8500, website: http://www.NAIC.org.

(5) Risk-focused analysis by the Office shall be performed in substantial conformity with the methodology outlined in the Handbook, so long as that methodology is consistent with statutory accounting principles and the Florida Insurance Code.

(6) Scheduling of insurers deemed High-risk will begin with the year-end 2023 financial exam schedule.

69O FAC 138.005 | Exams By Non Employees

(1) The Office is required by Section 624.316(1)(a), F.S., to examine the affairs, transactions, accounts, records and assets of each authorized insurer and of the attorney in fact of a reciprocal insurer. The examination standards with which the Office must comply are established by statute and adopted by rule. The statutes and rules meet the requirements of the National Association of Insurance Commissioners for accreditation in the area of financial regulation. Any report received from another jurisdiction pursuant to this rule is received for purposes of assessing the financial condition of the insurer and not any other purpose. Any information contained in such a report which would be the subject of a market conduct report prepared by this Office is not relevant to this rule. The Office will be bound only by the information relevant to the financial condition of the insurer.

(2) Section 624.316(2)(b), F.S., requires the Office to examine each insurer applying for an initial Certificate of Authority to transact business in this state before granting the initial certificate. For purposes of this provision, the Office will, in the absence of a reasonable belief that the examination report is not accurate, accept the examination report of a foreign insurer as prepared by the insurance office of the insurer's domiciliary state if the domiciliary insurance office is accredited by the National Association of Insurance Commissioners in the area of financial regulation or if the examination is performed under the supervision of or with the participation of an examiner from a state which is so accredited and who, after a review of the examination work papers and report, state under oath that the examination was performed in a manner consistent with the standards and procedures required by their Insurance Office.

(3) Section 624.316(2)(c), F.S., permits the Office, in lieu of making its own examination of a foreign insurer, to accept a full report of the most recent examination of a foreign insurer, as certified to by the insurance supervisory official of another state. For purposes of this provision, the Office will, in the absence of a reasonable belief that the examination report is not accurate, accept the examination report of a foreign insurer as prepared by the insurance office of the insurer's domiciliary state if the domiciliary insurance office is accredited by the National Association of Insurance Commissioners in the area of financial regulation or if the examination is performed under the supervision of or with the participation of an examiner from a state which is so accredited and who, after a review of the examination work papers and report, states under oath that the examination was performed in a manner consistent with the standards and procedures required by that Insurance Office. Such reports of examination must be certified to by the insurance supervisory official of the state of domicile and mailed to the Office within 10 calendar days of receipt by the insurer, except that, if the report shows that the insurer has materially misstated its financial condition or that the insurer does not meet the minimum capital and surplus requirements of the Florida Insurance Code, the report must be sent to the Office within 5 business days of receipt using a facility that offers next day delivery service. A material misstatement is defined as a collective amount of 10% or more of total assets, total liabilities, or total capital and surplus.

(4) Section 624.316(2)(e), F.S., allows the Office to conduct examinations of an insurer by contracting for the services of an independent Certified Public Accountant, an actuary, a reinsurance specialist, an investment specialist, information technology specialist, or any combination of these individuals, as the particular circumstances of the examination require. An examination performed pursuant to this subsection must meet the requirements of subsection (1).
(a) An actuary meeting the criteria established in Rule 69O-138.043 or 69O-170.031, F.A.C., will qualify to conduct an examination under this subsection.

(b)
1. A reinsurance specialist shall be qualified to conduct an examination under this subsection if that contractor can demonstrate competency by education and experience to perform such an examination. Competency by education and experience shall be demonstrated if any one of the following is true:
a. An individual qualifies as an actuary pursuant to either Rule 69O-138.043 or 69O-170.031, F.A.C., and has at least one years' experience with the kind of reinsurance which will be the subject of the examination.

b. An individual has a bachelor's degree from an accredited college or university and four years of professional experience in insurance/reinsurance accounting or in reinsurance transactions. A master's degree from an accredited college or university in accounting, insurance, or risk management can substitute for one year of the required experience. Professional experience as described above can substitute on a year-for-year basis for the required education.

c. An individual is in good standing with the Society of Financial Examiners and is certified by that organization to be eligible to hold the title of Certified Financial Examiner.
2. In selecting a person as a reinsurance specialist the Office shall consider the individual's experience, knowledge, skill, and abilities as they relate to the needs of the examination to be performed. This consideration shall include the individual's experience with the kind of insurance which is the subject of the examination; knowledge of accounting principles, practices and procedures; ability to prepare financial statements to reflect the reinsurance transactions; ability to provide professional and technical assistance; understanding of risk transfer as defined in the NAIC Examiners Handbook and the NAIC Accounting Practices and Procedures and Annual Statement Instruction Manuals, as adopted in Rule 69O-137.001, F.A.C.; and the ability to evaluate claims experience, both reported and incurred but not reported, relevant to the type of insurance which is the subject of the examination.
(c)
1. An investment specialist shall be qualified to conduct an examination under this subsection if that contractor can demonstrate competency by education and experience to perform such an examination in that capacity. Competency by education and experience shall be demonstrated if any one of the following is true:
a. An individual has a bachelor's degree from an accredited college or university and four years of professional experience in the capacity for which the contractor is to perform. A master's degree from an accredited college or university in accounting, or finance can substitute for one year of the required experience. Professional experience as described above can substitute on a year-for-year basis for the required education.

b. An individual is in good standing with the Society of Financial Examiners and is certified by that organization to be eligible to hold the title of Certified Financial Examiner.
2. In selecting a person as an investment specialist the Office shall consider the individual's experience, knowledge, skill, and abilities as they relate to the needs of the examination to be performed.
(d)
1. An information technology specialist shall be qualified to conduct an examination under this subsection if that contractor can demonstrate competency by education and experience to perform such an examination in that capacity. Competency by education and experience shall be demonstrated if the individual has a bachelor's degree from an accredited college or university and four years of professional experience in the capacity for which the contractor is to perform. A master's degree from an accredited college or university in information technology or a similar field can substitute for one year of the required experience. Professional experience as described above can substitute on a year-for-year basis for the required education.

2. In selecting a person as an information technology specialist the Office shall consider the individual's experience, knowledge, skill, and abilities as they relate to the needs of the examination to be performed.
(e) The firm selected by the office to perform the examination shall have no conflicts of interest that might affect its ability to independently perform its responsibilities on the examination.

(f) The rates charged to the insurer being examined under the contract shall be consistent with rates charged by other firms in a similar profession and shall be comparable with the rates charged for comparable examinations. The rates and terms shall be set forth in the contract.

(g) Contractors may submit a curriculum vitae detailing their experience and qualifying credentials to the Office, as well as a proposed hourly rate for services to be performed. The acceptability of a contractor to the Office shall be determined based on consideration of the firm's professional competence, objectivity, and that the rates charged are consistent with rates charged by other firms in a similar profession, as referenced in subsection (4), above, providing comparable services, so as to protect the examined insurer from being overcharged for the examination. Once a contractor has been accepted by the Office, they will be placed on a list of eligible examination contractors.

(h) In selecting contractors to conduct a specific examination, the Office shall consider the contractor's experience, knowledge, skill, and abilities as they relate to the needs of the examination to be performed. This consideration shall include the contractor's experience with the kind of insurance which is the subject of the examination.

(i) After a contractor has been selected for a specific examination the Office shall enter into a contract with the contractor, detailing the scope of work for the engagement. The contract shall include a provision that the contractor has no conflict of interest that might affect its ability to independently perform its responsibilities. The contractor shall submit all requests for payment to the Office in the manner prescribed by the contract.

(j) All requests for reimbursement of travel expenses are to be made on Form DFS-C1-500, http://www.FLRules.org/Gateway/Reference.asp?No=Ref-08299, State of Florida Voucher For Reimbursement of Travel Expenses, (Rev. 12/13). This form is incorporated by reference and adopted by this rule for this purpose. It is available at http://www.FLOir.com/sitedocuments/DFS-C1-500.xls.

(k) Upon receipt and review of the contractor's request for payment, the Office will invoice the insurer being examined and the insurer shall make payment to the Office pursuant to Sections 624.316(2)(e)3. and 624.320(1), F.S.

(l) Upon receipt of the payment from the insurer being examined, the Office will make payment to the contractor in accordance with the rates and terms set out in the contract.
(5) Section 624.316(2)(f), F.S., requires the examination of a domestic insurer once each year for any domestic insurer that has continuously held a Certificate of Authority for less than 3 years. For purposes of an examination under this subsection, the 3 years shall constitute the time period from the date the Certificate of Authority is granted through the following 3 full calendar years in which the insurer has been licensed. The examination must cover the preceding fiscal year or the time period since the last examination.

69O FAC 138.020 | Requirements for Maintaining Cash and Certificates of Deposit Outside the State of Florida

(1) This rule applies to all domestic insurers subject to Part I of Chapter 628, F.S.

(2) Definitions.
(a) "Coin and currency of the United States," as used in Section 625.306, F.S., shall include demand certificates of deposit as long as the certificates are non-negotiable, can be redeemed prior to maturity, and are issued by a solvent national bank, savings and loan association, or trust company which is a member of the Federal Reserve System.

(b) "National bank, savings and loan association, or trust company" is defined as a banking institution which is a member of the Federal Reserve System.
(3) An insurer which has deposits in banking institutions outside the State of Florida shall be deemed to be in compliance with Section 628.271(2), F.S., if the insurer maintains the original physical evidence of ownership and the original bank records within Florida.

69O FAC 138.021 | Special Consent Investments

(1) This rule implements the provisions of Section 625.331, F.S., and applies to all authorized insurers as defined in Section 624.09, F.S.

(2) Automatic Revocation and Renewal Procedure.
(a) Each special consent investment currently on an insurer's statutory balance sheet, which has been approved or granted by the Office, either expressly or by implication, prior to December 31, 1991, is revoked 90 days after the effective date of this rule. Each insurer that currently has a special consent investment on its statutory balance sheet approved or granted by the Office, either expressly or by implication, on or before December 31, 1991, shall resubmit the investment to the Office for renewal pursuant to provisions of paragraph (2)(c) of this subsection.

(b) On or after January 1, 1992, all special consent investments approved or granted by the Office shall have an effective duration of one year or less, but may be for a period in excess of 1 year if the approval contains a specific expiration date for that special consent. Unless otherwise specified, all special consents shall expire at midnight on March 15, of the year following the date the special consent was granted.
(c) All requests for special consent investments shall be clearly labeled as such and shall contain the following information: name and NAIC code number of the insurer requesting the special consent; nature and amount of the proposed investment; requested dates of approval and expiration; reason for the special consent request; date of submission for approval; and information regarding any previous special consents granted to the insurer for the same or nearly the same investments. All filings shall be submitted electronically to http://www.FLOir.com/iPortal.

69O FAC 138.024 | Agents' Balances in the Course of Collection; Calculation of 90 Days Past Due

(1) This rule implements the provisions of Section 625.012(5), F.S., and applies to all authorized insurers as defined in section 624.09, F.S.

(2) All agents' balances shall be aged on a separate policy by policy basis.

(3) For purposes of determining the admissibility as an asset of agents' balances, the policy inception date, defined as the time when the insurance thereunder takes effect, is the first day of the 90 days in which the agents' balances must be collected or be considered past due.

(4) Any agents' balance in excess of 90 days shall not be reflected as an admitted asset on the company's financial statement.

69O FAC 138.031 | Financial Requirements for Assessable Mutual Insurers

(1) Purpose and Scope.

This rule sets forth office policy and legal interpretation concerning applicants for licensure as an assessable mutual insurer and licensed assessable mutual insurers operating under Part II of Chapter 628, F.S.

(2) Definitions.

(a) "Office" means the Office of Insurance Regulation.

(b) "Applicant" and "application" refer to the application of an entity applying for a certificate of authority as an assessable mutual insurer.

(3) Specification of Maximum Contingent Liability in Articles of Incorporation; Procedures.

(a) As required by the reference in Section 628.6011(1), F.S., to "part I" of chapter 628, F.S., the articles of incorporation of an entity applying for a certificate of authority as an assessable mutual shall specify the maximum contingent assessment liability of its members, in accordance with Section 628.081(3)(e), F.S.

(b) The office will review the maximum contingent liability specified in the articles of incorporation. The office shall reject an application for a certificate of authority if the office finds that the maximum contingent liability so specified is inadequate, pursuant to the procedures established in this rule.

(c) It is office policy that the maximum contingent liability of members shall generally be set at a factor of ten times annual premium, pursuant to Section 628.081(3)(e), F.S., unless the applicant or mutual insurer demonstrates that special conditions or provisions exist or have been made which justify a lower maximum contingent liability. Any such conditions or provisions which an insurer contends justifies a lower maximum contingent liability shall relate to the financial strength of the assessable mutual insurer. The office will consider any factors presented as justification which relate to the entity's financial strength. The office will consider the factors in subparagraphs (3)(c)1. and 2., below, if included by the applicant as part of its demonstration and will base its determination on whether those factors, together with any other special conditions or provisions presented by the entity which relate to its financial strength provide the same degree of financial strength as setting the maximum contingent liability at ten times annual premium.
1. Extra contributed capital above the minimum required capital; or

2. A reinsurance program with admitted or approved reinsurers, of unusual strength and scope. For purposes of this subparagraph, "unusual strength and scope" means a reinsurance program consisting of aggregate excess of loss reinsurance, equivalent to that required under Section 624.469, F.S., and is the minimum program which the office will consider to merit any decrease in the maximum contingent liability.
(d) In particular cases there may exist other factors, which factors may offset the positive effect of the conditions or provisions specified in this subsection, so that no decrease in maximum contingent liability is merited notwithstanding the existence of the special conditions or provisions. These other factors are necessarily so fact-specific to particular situations that they cannot be enumerated here.

(4) Modification of Reinsurance Program After Issuance of a Certificate of Authority.

Once a certificate of authority has been issued to an assessable mutual insurer, wherein the assessable mutual insurer was authorized by the office to use a maximum contingent liability less than ten times annual premium in reliance in whole or in part on its description to the office of its proposed reinsurance program, as provided for in paragraph (3)(c), above, that assessable mutual insurer shall not modify its reinsurance program in such a way as to decrease or lessen the reinsurance levels or protection as same was described to the office in the application for certificate of authority, without the written approval of the office. Insurers who are in doubt as to whether a proposed change to their reinsurance program would be viewed by the office as decreasing or lessening the reinsurance levels or protection, shall seek written guidance from the office.

(5) Subsequent Increase to Maximum Contingent Liability.

(a) Subsequent to receiving a certificate of authority, the office shall require the maximum contingent liability of a assessable mutual insurer to be changed, on a prospective basis, if the office determines that the financial condition of the assessable mutual insurer has changed to such an extent that such an increase is required for the protection of claimants and insureds.

(b) In determining whether such an increase is required, the office shall consider:
1. Any change in the assessable mutual insurer's reinsurance program.

2. Adverse operating results.

3. Any similar deterioration of financial position which endangers the insurer's policyholders, its overall financial condition, or its solvency.
(c) The increased maximum contingent liability shall apply only to policies entered into or renewed, and deficits arising, after the higher liability takes effect.

(6) Meaning of Maximum Contingent Liability.

(a) The specification of a maximum contingent liability does not mean that the amount so specified is the maximum amount a member may be assessed and required to pay in any one year, if the assessment is due to deficits arising in multiple years. An assessable mutual insurer may in the same assessment levy assessment for deficits arising in multiple years, and the maximum contingent liability limit is applied separately to each year in which a deficit occurred.

Example. An assessable mutual insurer incurs operating deficits in 1993, 1994, and 1995. Assume that at all times relevant the maximum contingent liability was three times annual premium paid. Also assume for the sake of the example that the deficit in each year was equal to three times premium paid that year. The assessable mutual insurer may levy, and a member may be liable to pay, an assessment in 1995, which assessment may be three times premiums paid in 1993 plus three times premium paid in 1994 plus three times annual premiums paid in 1995.

(b) A member may be assessed for a deficit arising in a particular year only to the extent of premiums paid by that member in that year.

Example. An assessable mutual insurer incurs operating deficits in 1994 and 1995. Assume that at all times relevant the maximum contingent liability was three times annual premium paid. Also assume for the sake of the example that the deficit arising in 1994 would take an assessment of 1.5 times annual premiums paid in that year; and that the deficit arising in 1995 would take an assessment of five times annual premium paid in 1995. The assessable mutual insurer may levy an assessment in 1995 of 1.5 times premiums paid in 1994 plus three times premium paid in 1995.

(7) Liability of Members After Terminating Membership.

A member remains liable for assessment for deficits arising while that member was a member even after that member terminates membership.

69O FAC 138.040 | Purpose

The purpose of this part is to prescribe:
(1) Requirements for statements of actuarial opinion that are to be submitted in accordance with subsection (3) of the Standard Valuation Law, and for supporting memoranda;

(2) Rules applicable to the appointment of an appointed actuary; and,

(3) Guidance as to the meaning of "adequacy of reserves."

69O FAC 138.041 | Scope

(1) This part shall apply to all life and health insurance companies and fraternal benefit societies doing business in this state, and to all life insurance companies and fraternal benefit societies that are authorized to reinsure life insurance, annuities, or accident and health insurance business in this state. This part shall be applied in a manner that allows the appointed actuary to utilize his or her professional judgment in performing the asset analysis and developing the actuarial opinion and supporting memoranda, consistent with relevant actuarial standards of practice. However, the Office shall have the authority to specify specific methods of actuarial analysis and actuarial assumptions when these specifications are necessary for an acceptable opinion to be rendered relative to the adequacy of reserves and related items.

(2) This rule shall be applicable to all annual statements filed with the Office. A statement of opinion on the adequacy of the reserves and related actuarial items based on an asset adequacy analysis in accordance with Rule 69O-138.046, F.A.C., of this part, and a memorandum in support thereof in accordance with Rule 69O-138.047, F.A.C., of this part, shall be required each year. All filings shall be submitted electronically to http://www.FLOir.com/iPortal.

69O FAC 138.042 | Definitions

(1) "Actuarial Opinion" means the opinion of an appointed actuary regarding the adequacy of the reserves and related actuarial items based on an asset adequacy analysis in accordance with Rule 69O-138.046, F.A.C., and with applicable actuarial standards of practice.

(2) "Actuarial Standards Board" means the board established by the American Academy of Actuaries to develop and promulgate standards of actuarial practice.

(3) "Annual Statement" means that statement required by Section 624.424, F.S., to be filed by the company with the Office annually.

(4) An "Appointed Actuary" is a qualified actuary who is appointed or retained, either directly by or by the authority of the board of directors through an executive officer of the company other than an officer who is the qualified actuary, to prepare the statement of actuarial opinion as required by subsection (3), of the Standard Valuation Law.

(5) "Asset Adequacy Analysis" means an analysis that meets the standards and other requirements referred to in subsection 69O-138.043(3), F.A.C., of this part.

(6) "Company" means a life insurance company, fraternal benefit society or reinsurer subject to the provisions of this part.

(7) "Office" means the Office of Insurance Regulation.

(8) "NAIC" means the National Association of Insurance Commissioners.

(9) "NAIC Actuarial Opinion and Memorandum Regulation" means this part.

(10) "Qualified Actuary" means any individual who meets the criteria specified in paragraph 69O-138.043(2)(b), F.A.C.

(11) "Standard Valuation Law" means that defined in Section 625.121, F.S.

69O FAC 138.043 | General Requirements

(1) Submission of Statement of Actuarial Opinion.

(a) Included on or attached to Page 1 of the annual statement for each year, shall be the statement of an appointed actuary, entitled "Statement of Actuarial Opinion," setting forth an opinion relating to reserves and related actuarial items held in support of policies and contracts, in accordance with Rule 69O-138.046, F.A.C.

(b) Upon written request by the company, the Office will, for good cause, grant an extension of the date for submission of the statement of actuarial opinion. Good cause includes the occurrence of an event or circumstance beyond the control of the company, which prevents compliance and could not be reasonably remedied or foreseen by the company.

(2) Qualified Actuary.

(a) The company shall give the Office, prior to or concurrent with the filing of the first annual statement to which this rule applies, written notice of the name, title (and, in the case of a consulting actuary, the name of the firm) and manner of appointment or retention of each person appointed or retained by the company as an appointed actuary and shall state in such notice that the person meets the requirements set forth in this paragraph (2)(b), below.

(b) Any appointed actuary will be considered to be a "Qualified Actuary" if he or she:
1. Is a member in good standing of the American Academy of Actuaries;

2. Is qualified to sign statements of actuarial opinion for life and health insurance company annual statements in accordance with the American Academy of Actuaries qualification standards for actuaries signing such statements;

3. Is familiar with the valuation requirements applicable to life and health insurance companies;

4. Has not been found by the Office (or if so found has subsequently been reinstated as a qualified actuary), following appropriate notice and hearing to have:
a. Violated any provision of, or any obligation imposed by, the Insurance Code or other state or federal law relating to insurance in the course of his or her dealings as a qualified actuary;

b. Been found guilty of or pleaded guilty or nolo contendere to fraudulent or dishonest practices without regard to whether a judgment of conviction has been entered by the court having jurisdiction in such case;

c. Demonstrated his or her incompetency, lack of cooperation, or untrustworthiness to act as a qualified actuary;

d. Submitted to the Office during the past 5 years, pursuant to this part, an actuarial opinion or memorandum that the Office rejected because it did not meet the provisions of this part including standards set by the Actuarial Standards Board; or

e. Resigned or been removed as an appointed actuary within the past 5 years as a result of acts or omissions indicated in any adverse report on examination or as a result of failure to adhere to generally acceptable actuarial standards; and,
5. Has not failed to notify the Office of any action taken by any insurance supervisory official of any other state similar to that under subparagraph (2)(b)4., above.
(c) Once notice is furnished, no further notice is required with respect to this person provided the company shall give the Office written notice in the event the actuary ceases to be appointed or retained as an appointed actuary or to meet the requirements set forth in paragraph 69O-138.043(2)(b), F.A.C. Notice must be prior to or concurrent with the termination of the actuary's appointment or retention, or upon discovery that the actuary no longer meets the requirements set forth in paragraph 69O-138.043(2)(b), F.A.C. All filings shall be submitted electronically to http://www.FLOir.com/iPortal.

(d) If any person appointed or retained as an appointed actuary replaces a previously appointed actuary, the notice shall so state and give the reasons for replacement.

(3) Standards for Asset Adequacy Analysis.

The asset adequacy analysis required by this part shall:
(a) Conform to the Standards of Practice as promulgated from time to time by the Actuarial Standards Board and on any additional standards under this part, which standards are to form the basis of the statement of actuarial opinion in accordance with Rule 69O-138.046, F.A.C., of this part; and,

(b) Be based on methods of analysis deemed appropriate for such purposes by the Actuarial Standards Board.

(4) Liabilities to be Covered.

(a) Under authority of subsection (3), of the Standard Valuation Law, section 625.121, F.S., the statement of actuarial opinion shall apply to all in-force business on the statement date regardless of when or where issued, e.g., reserves of Exhibits 5, 6 and 7, and claim liabilities in Exhibit 8, Part I of the Annual Statement, and equivalent items in the separate account statement or statements.

(b) If the appointed actuary, as the result of asset adequacy analysis, determines that a reserve shall be held in addition to the aggregate reserve held by the company and calculated in accordance with methods set forth in subsections 7, 11, 12, and 14 of the Standard Valuation Law, the company shall establish the additional reserve.

(c) Additional reserves established under paragraph (4)(b), above, and deemed not necessary in subsequent years may be released. Any amounts released shall be disclosed in the actuarial opinion for the applicable year. The release of such reserves will not be deemed an adoption of a lower standard of valuation.

69O FAC 138.046 | Statement of Actuarial Opinion Based on an Asset Adequacy Analysis

(1) General Description.

The statement of actuarial opinion submitted in accordance with this section shall consist of:
(a) A paragraph identifying the appointed actuary and his or her qualifications (see paragraph (2)(a), below);

(b) A scope paragraph identifying the subjects on which an opinion is to be expressed and describing the scope of the appointed actuary's work, including a tabulation delineating the reserves and related actuarial items which have been analyzed for asset adequacy and the method of analysis (see paragraph (2)(b), below), and identifying the reserves and related actuarial items covered by the opinion which have not been so analyzed;

(c) A reliance paragraph describing those areas, if any, where the appointed actuary has deferred to other experts in developing data, procedures or assumptions, (e.g., anticipated cash flows from currently owned assets, including variation in cash flows according to economic scenarios (see paragraph (2)(c), below), supported by a statement of each such expert in the form prescribed by subsection 69O-138.046(5), F.A.C.; and,

(d) An opinion paragraph expressing the appointed actuary's opinion with respect to the adequacy of the supporting assets to mature the liabilities (see paragraph (2)(d), below).

(e) One or more additional paragraphs will be needed in individual company cases as follows:
1. If the appointed actuary considers it necessary to state a qualification of his or her opinion;

2. If the appointed actuary must disclose an inconsistency in the method of analysis or basis of asset allocation used at the prior opinion date with that used for this opinion;

3. If the appointed actuary must disclose whether additional reserves of the prior opinion date are released as of this opinion date, and the extent of the release;

4. If the appointed actuary chooses to add a paragraph briefly describing the assumptions which form the basis for the actuarial opinion.

(2) Recommended Language.

The following paragraphs are to be included in the statement of actuarial opinion. Language is that which in typical circumstances shall be included in a statement of actuarial opinion. The language may be modified as needed to meet the circumstances of a particular case, but the appointed actuary shall use language that clearly expresses his or her professional judgment, and retains all pertinent aspects of the language provided in this section.
(a) The opening paragraph shall indicate the appointed actuary's relationship to the company and his or her qualifications to sign the opinion.
1. For a company actuary, the opening paragraph of the actuarial opinion shall include a statement such as follows:
"I, (name), am (title) of (insurance company name) and a member of the American Academy of Actuaries. I was appointed by, or by the authority of, the Board of Directors of said insurer to render this opinion as stated in the letter to the Office of Insurance Regulation dated (insert date). I meet the Academy qualification standards for rendering the opinion, and am familiar with the valuation requirements applicable to life and health insurance companies."
2. For a consulting actuary, the opening paragraph shall contain a sentence such as:
"I, (name), a member of the American Academy of Actuaries, am associated with the firm of (name of consulting firm). I have been appointed by, or by the authority of, the Board of Directors of (name of company) to render this opinion as stated in the letter to the Office of Insurance Regulation dated (insert date). I meet the Academy qualification standards for rendering the opinion, and am familiar with the valuation requirements applicable to life and health insurance companies."
(b) The scope paragraph shall include a statement such as:
"I have examined the actuarial assumptions and actuarial methods used in determining reserves and related actuarial items listed below, as shown in the annual statement of the company, as prepared for filing with state regulatory officials, as of December 31, 20__. Tabulated below are those reserves and related actuarial items which have been subjected to asset adequacy analysis.
Asset Adequacy Tested Amounts Reserves and Liabilities
Statement ItemFormula Reserves (1)Additional Actuarial Reserves (2)
Note (i)
below
Analysis Method
Note (ii)
below
Other Amount (3)Total Amount (4) (1)+(2)+(3)
Exhibit 5
A Life Insurance
B Annuities
C Supplementary Contracts Involving Life Contingencies
D Accidental Death Benefit
E Disability – Active
F Disability – Disabled
G Miscellaneous
Total (Exhibit 5 Item 1, Page 3)
Exhibit 6
A Active Life Reserve
B Claim Reserve
Total (Exhibit 6 Item 2, Page 3)
Exhibit 7
Premium and Other Deposit Funds (Column 5, Line 14)
Guaranteed Interest Contracts (Column 2, Line 14)
Other (Column 6, Line 14)
Supplemental Contracts and Annuities Certain (Column 3, Line 14)
Dividend Accumulations or Refunds (Column 4, Line 14)
Total Exhibit 7 (Column 1, Line 14)
Exhibit 8 Part 1
1 Life (Page 3, Line 4.1)
2 Health (Page 3, Line 4.2)
Total Exhibit 8, Part 1
Separate Accounts (Page 3 of the Annual Statement of the Separate Accounts, Lines 1, 2, 3.1, 3.2, 3.3)
TOTAL RESERVES
IMR (General Account, Page __ Line __) (Separate Accounts, Page __ Line __)
AVR (Page __ Line __)Note (iii)
below
Net Deferred and Uncollected Premium
Note (i): The additional actuarial reserves are the reserves established under paragraph (b), of subsection 69O-138.043(4), F.A.C.

Note (ii): The appointed actuary shall indicate the method of analysis, determined in accordance with the standards for asset adequacy analysis referred to in subsection 69O-138.043(3), F.A.C., by means of symbols which shall be defined in footnotes to the table.

Note (iii): Allocated amount of Asset Valuation Reserve (AVR).
(c)
1.
a. If the appointed actuary has relied on other experts to develop certain portions of the analysis, the reliance paragraph shall include a statement such as:
"I have relied on [name], [(title] for [e.g., "anticipated cash flows from currently owned assets, including variations in cash flows according to economic scenarios" or "certain critical aspects of the analysis performed in conjunction with forming my opinion"], as certified in the attached statement. I have reviewed the information relied upon for reasonableness."
b. Such a statement of reliance on other experts shall be accompanied by a statement by each of such experts of the form prescribed by subsection 69O-138.046(5), F.A.C.
2. If the appointed actuary has examined the underlying asset and liability records, the reliance paragraph shall include a statement such as:
"My examination included such review of the actuarial assumptions and actuarial methods and of the underlying basic asset and liability records and such tests of the actuarial calculations as I considered necessary."
3.
a. If the appointed actuary has not examined the underlying records, but has relied upon data; (e.g., listings and summaries of policies in force or asset records) prepared by the company, the reliance paragraph shall include a statement such as:
"In forming my opinion on [specify types of reserves] I relied upon data prepared by [name and title of company officer certifying in force records or other data] as certified in the attached statements. I evaluated that data for reasonableness and consistency. I also reconciled that data to [exhibits and schedules to be listed as applicable] of the company's current annual statement. In other respects, my examination included review of the actuarial assumptions and actuarial methods used and tests of the calculations I considered necessary."
b. Such a section shall be accompanied by a statement by each person relied upon of the form prescribed by subsection 69O-138.046(5), F.A.C.
(d) The opinion paragraph shall include a statement such as:
"In my opinion the reserves and related actuarial values concerning the statement items identified above:"
1. Are computed in accordance with presently accepted actuarial standards consistently applied and are fairly stated, in accordance with sound actuarial principles;

2. Are based on actuarial assumptions that produce reserves at least as great as those called for in any contract provision as to reserve basis and method, and are in accordance with all other contract provisions;

3. Meet the requirements of the Insurance Law and regulation of the state of (state of domicile) and are at least as great as the minimum aggregate amounts required by the state in which this statement is filed;

4. Are computed on the basis of assumptions consistent with those used in computing the corresponding items in the annual statement of the preceding year-end (with any exceptions noted below); and,

5. Include provision for all actuarial reserves and related statement items which ought to be established.
"The reserves and related items, when considered in light of the assets held by the company with respect to such reserves and related actuarial items including, but not limited to, the investment earnings on the assets, and the considerations anticipated to be received and retained under the policies and contracts, make adequate provision, according to presently accepted actuarial standards of practice, for the anticipated cash flows required by the contractual obligations and related expenses of the company.

"The actuarial methods, considerations and analyses used in forming my opinion conform to the appropriate Standards of Practice as promulgated by the Actuarial Standards Board which form the basis of this statement of opinion.

"To the best of my knowledge, there have been no material changes from the applicable date of the annual statement to the date of the rendering of this opinion which shall be considered in reviewing this opinion."

or

"The following material change(s) which occurred between the date of the statement for which this opinion is applicable and the date of this opinion shall be considered in reviewing this opinion: (describe the change or changes.)

Note: Choose one of the above two paragraphs, whichever is applicable.

The impact of unanticipated events subsequent to the date of this opinion is beyond the scope of this opinion. The analysis of asset adequacy portion of this opinion shall be viewed recognizing that the company's future experience may not follow all the assumptions used in the analysis.

___________________________________
Signature of Appointed Actuary

___________________________________
Address of Appointed Actuary

___________________________________
Telephone Number of Appointed Actuary"

_____________________
Date

(3) Assumptions for New Issues.

The adoption for new issues or new claims or other new liabilities of an actuarial assumption that differs from a corresponding assumption used for prior new issues or new claims or other new liabilities is not a change in actuarial assumptions within the meaning of this Rule 69O-138.046, F.A.C.

(4) Adverse Opinions.

If the appointed actuary is unable to form an opinion, he or she shall refuse to issue a statement of actuarial opinion. If the appointed actuary's opinion is adverse or qualified, he or she shall issue an adverse or qualified actuarial opinion explicitly stating the reason(s) for such opinion. This statement shall follow the scope paragraph and precede the opinion paragraph.

(5) Reliance on Information Furnished by Other Persons.

(a) If the appointed actuary relies on the certification of others on matters concerning the accuracy or completeness of any data underlying the actuarial opinion, or the appropriateness of any other information used by the appointed actuary in forming the actuarial opinion, the actuarial opinion should indicate the persons the actuary is relying upon and a precise identification of the items subject to reliance.

(b) The persons on whom the appointed actuary relies shall provide a certification that precisely identifies the items on which the person is providing information and a statement as to the accuracy, completeness, or reasonableness, as applicable, of the items. The certification shall include the signature, title, company, address, and telephone number of the person rendering the certification, as well as the date on which it is signed.

69O FAC 138.047 | Description of Actuarial Memorandum Including an Asset Adequacy Analysis and Regulatory Asset Adequacy Issues Summary

(1) General.

(a)
1. In accordance with subsection (3), of the Standard Valuation Law, the appointed actuary shall prepare a memorandum to the company describing the analysis done in support of his or her opinion regarding the reserves.

2. The memorandum shall be made available for examination by the Office upon its request. Any memorandum in support of the opinion, and any other material provided by the company to the Office in connection therewith, is confidential and exempt from the provisions of Section 119.07(1), F.S., as provided in Section 625.121(3)(a)10., F.S.
(b) In preparing the memorandum, the appointed actuary may include as a part of his or her own memorandum, memoranda prepared and signed by other actuaries who are qualified within the meaning of subsection 69O-138.043(2), F.A.C., with respect to the areas covered in the memoranda, and shall so state in their memoranda.

(c) If the Office requests a memorandum and no such memorandum exists, or if the Office finds that the analysis described in the memorandum fails to meet the standards of the Actuarial Standards Board or the standards and requirements of this part, the Office may designate a qualified actuary to review the opinion and prepare for review the required supporting memorandum. The reasonable and necessary expense of the independent review shall be paid by the company but shall be directed and controlled by the Office.

(d)
1. The reviewing actuary shall have the same status as an examiner for purposes of obtaining data from the company.

2. The work papers and documentation of the reviewing actuary shall be retained by the Office.

3. Any information provided by the company to the reviewing actuary and included in the work papers shall be considered as material provided by the company to the Office and kept confidential to the same extent prescribed by law with respect to other material provided by the company to the Office pursuant to the statute governing this part.

4. The reviewing actuary shall not be an employee of a consulting firm involved with the preparation of any prior memorandum or opinion for the insurer pursuant to this part for the current year or any one of the preceding 3 years.
(e) In accordance with Section 625.121(3), F.S., the appointed actuary shall prepare a regulatory asset adequacy issues summary, the contents of which are specified in subsection 69O-138.047(3), F.A.C.
1. The regulatory asset adequacy issues summary shall be submitted no later than March 15 of the year following the year for which a statement of actuarial opinion based on asset adequacy is required.

2. The regulatory asset adequacy issues summary shall be kept confidential to the same extent and under the same conditions as the actuarial memorandum.

(2) Details of the Memorandum Section Documenting Asset Adequacy Analysis.

When an actuarial opinion is provided, the memorandum shall demonstrate that the analysis has been done in accordance with the standards for asset adequacy referred to in subsection 69O-138.043(3), F.A.C., and any additional standards under this part. It shall specify:
(a) For reserves:
1. Product descriptions, including market description, underwriting, and other aspects of a risk profile, and the specific risks the appointed actuary deems significant;

2. Source of liability in force;

3. Reserve method and basis;

4. Investment reserves;

5. Reinsurance arrangements;

6. Identification of any explicit or implied guarantees made by the general account in support of benefits provided through a separate account or under a separate account policy or contract and the methods used by the appointed actuary to provide for the guarantees in the asset adequacy analysis.

7.
a. Documentation of assumptions to test reserves for the following:
(I) Lapse rates (both base and excess);

(II) Interest crediting rate strategy;

(III) Mortality;

(IV) Policyholder dividend strategy;

(V) Competitor or market interest rate;

(VI) Annuitization rates;

(VII) Commissions and expenses; and,

(VIII) Morbidity.
b. The documentation of the assumptions shall be such that an actuary reviewing the actuarial memorandum can form a conclusion as to the reasonableness of the assumptions.
(b) For assets:
1. Portfolio descriptions, including a risk profile disclosing the quality, distribution, and types of assets;

2. Investment and disinvestment assumptions;

3. Source of asset data;

4. Asset valuation bases; and,

5.
a. Documentation of assumptions made for:
(I) Default costs;

(II) Bond call function;

(III) Mortgage prepayment function;

(IV) Determining market value for assets sold due to disinvestment strategy; and,

(V) Determining yield on assets acquired through the investment strategy.
b. The documentation of the assumptions shall be such that an actuary reviewing the actuarial memorandum can form a conclusion as to the reasonableness of the assumptions.
(c) For the analysis basis:
1. Methodology;

2. Rationale for inclusion/exclusion of different blocks of business, and how pertinent risks were analyzed;

3. Rationale for degree of rigor in analyzing different blocks of business (include in the rationale the level of "materiality" that was used in determining how rigorously to analyze different blocks of business);

4. Criteria for determining asset adequacy (include in the criteria the precise basis for determining if assets are adequate to cover reserves under "moderately adverse conditions" or other conditions as specified in relevant actuarial standards of practice); and,

5. Whether the impact of federal income taxes was considered and the method of treating reinsurance in the asset adequacy analysis.
(d) Summary of material changes in methods, procedures, or assumptions from prior year's asset adequacy analysis;

(e) Summary of Results; and,

(f) Conclusion(s).

(3) Details of the Regulatory Asset Adequacy Issues Summary.

(a) The regulatory asset adequacy issues summary shall include:
1. Descriptions of the scenarios tested (including whether those scenarios are stochastic or deterministic) and the sensitivity testing done relative to those scenarios,
a. If negative ending surplus results under certain tests in the aggregate, the actuary should describe those tests and the amount of additional reserve as of the valuation date which, if held, would eliminate the negative aggregate surplus values.

b. Ending surplus values shall be determined by either extending the projection period until the in force and associated assets and liabilities at the end of the projection period are immaterial or by adjusting the surplus amount at the end of the projection period by an amount that appropriately estimates the value that can reasonably be expected to arise from the assets and liabilities remaining in force.
2. The extent to which the appointed actuary uses assumptions in the asset adequacy analysis that are materially different than the assumptions used in the previous asset adequacy analysis;

3. The amount of reserves and the identity of the product lines that had been subjected to asset adequacy analysis in the prior opinion but were not subject to analysis for the current opinion;

4. Comments on any interim results that may be of significant concern to the appointed actuary. For Example, the impact of the insufficiency of assets to support the payment of benefits and expenses and the establishment of statutory reserves during one or more interim periods;

5. The methods used by the actuary to recognize the impact of reinsurance on the company's cash flows, including both assets and liabilities, under each of the scenarios tested; and,

6. Whether the actuary has been satisfied that all options whether explicit or embedded, in any asset or liability (including but not limited to those affecting cash flows embedded in fixed income securities) and equity-like features in any investments have been appropriately considered in the asset adequacy analysis.
(b) The regulatory asset adequacy issues summary shall contain the name of the company for which the regulatory asset adequacy issues summary is being supplied and shall be signed and dated by the appointed actuary rendering the actuarial opinion.

(4) Conformity to Standards of Practice.

The memorandum shall include a statement:
"Actuarial methods, considerations, and analyses used in the preparation of this memorandum conform to the appropriate Standards of Practice as promulgated by the Actuarial Standards Board which form the basis for this memorandum."

(5) Use of Assets Supporting the Interest Maintenance Reserve and the Asset Valuation Reserve.

(a) An appropriate allocation of assets in the amount of the Interest Maintenance Reserve (IMR), whether positive or negative, shall be used in any asset adequacy analysis.
1. Analysis of risks regarding asset default may include an appropriate allocation of assets supporting the Asset Valuation Reserve (AVR); these AVR assets may not be applied for any other risks with respect to reserve adequacy.

2, Analysis of these and other risks may include assets supporting other mandatory or voluntary reserves available to the extent not used for risk analysis and reserve support.
(b)
1. The amount of the assets used for the AVR shall be disclosed in the Table of Reserves and Liabilities of the opinion and in the memorandum.

2. The method used for selecting particular assets or allocated portions of assets shall be disclosed in the memorandum.

(6) Documentation.

The appointed actuary shall retain on file for at least seven (7) years sufficient documentation so that it will be possible to determine the procedures followed, the analyses performed, the bases for assumptions and the results obtained.
69O-141 | Administrative Supervision and Withdrawal from the State

69O FAC 141.001 | Purpose

69O FAC 141.002 | Standards Regarding Administrative Supervision

(1) The Office's determination as to whether the provisions of part VI, chapter 624, F.S., regarding administrative supervision are appropriate for an insurer shall be based on the standards set out in sections 624.80 and 624.81, F.S.

(2) Criteria which shall be considered in determining whether an insurer is in unsound condition as provided in section 624.80(2), F.S., or is engaging in methods or practices which render the continuance of business hazardous to the public or insureds include the following:
(a) Adverse findings reported in financial condition and market conduct examination reports;

(b) The National Association of Insurance Commissioners Insurance Regulatory Information System and its related reports;

(c) The ratios of commission expense, general insurance expense, policy benefits and reserve increases as to annual written premium and net investment income which could lead to an impairment of capital and surplus;

(d) That the insurer's asset portfolio when viewed in light of current economic conditions is not of sufficient value, liquidity, or diversity to assure the company's ability to meet its outstanding obligations as they mature;

(e) The ability of an assuming reinsurer to perform and whether the insurer's reinsurance program provides sufficient protection for the company's remaining surplus after taking into account the insurer's cash flow and the classes of business written as well as the financial condition of the assuming reinsurer;

(f) That the insurer's operating loss in the last twelve month period or any shorter period of time, including but not limited to net capital gain or loss, change in non-admitted assets, and cash dividends paid to shareholders, is greater than 50% of such insurer's remaining surplus as regards policyholders in excess of the minimum required;

(g) Whether any parent, holding company, affiliate, subsidiary, or reinsurer is insolvent, threatened with insolvency, or delinquent in payment of its monetary or other obligations;

(h) Contingent liabilities, pledges or guaranties which either individually or collectively involve a total amount which in the Office's opinion may affect the solvency of the insurer;

(i) Whether any "controlling person" of an insurer is delinquent in the transmitting to, or payment of, net premiums to such insurer;

(j) The age and collectibility of receivables;

(k) Whether the management of an insurer, including officers, directors, or any other person who directly or indirectly controls the operation of such insurer, fails to possess and demonstrate the competence, fitness and reputation deemed necessary to serve the insurer in such position;

(l) Whether management of an insurer has failed to respond to inquiries relative to the condition of the insurer or has furnished false or misleading information concerning an inquiry;

(m) Whether management of an insurer either has filed any false or misleading sworn financial statement, or has released any false or misleading financial statement to lending institutions or to the general public, or has made a false or misleading entry, or has omitted an entry of material amount in the books of the insurer;

(n) Whether an insurer has grown so rapidly and to such an extent that it lacks adequate financial and administrative capacity to meet its obligations in a timely manner;

(o) Whether an insurer has experienced or will experience in the foreseeable future cash flow and/or liquidity problems;

(p) Whether an insurer has violated any applicable statutes or rules, or has been subjected to any final agency action relating to violation of such statutes or rules;

(q) Whether an insurer has incurred substantial new debt, has had to rely on frequent or substantial capital infusions, has a highly leveraged balance sheet, or relies increasingly on outside consulting sources (e.g. TPA's, MGA's, or management companies);

(r) Whether the Office has received a noticeable increase of consumer complaints for non-payment of claims or unusual delays in claim payments;

(s) Whether the Office believes future problems with insurer solvency will occur because of known or developing current events or situations (e.g. declining occupancy rates, inadequate reserves or change in reserve practices, or increase in debt service, or adverse changes in financial markets);

(t) Whether an insurer has voluntarily allowed the suspension or revocation of its certificate of authority in any state;

(u) Whether transactions with an insurer's affiliates, parent company, holding company, subsidiaries, officers, directors, shareholders, owners, management company, employees, agents, creditors, or any other person or entity have affected the insurer's solvency or liquidity in a manner which places the insurer's insureds at risk of loss of contracted benefits or security; or

(v) Whether a deadlock or dispute that threatens the solvency or viability of an insurer exists between the officers, directors, managing owners, managers, or other persons who control the operations of an insurer.
(3) Administrative supervision shall include affiliates, subsidiaries, parent companies, or holding companies of an insurer if:
(a) There have been any transactions resulting in the transfer of funds from the insurer to any of those entities; or

(b) The insurer has the authority to transfer funds to any of those entities without prior approval from the Office; and,

(c) The transfers are found to affect the solvency or viability of the insurer.
(4) Actions under administrative supervision shall include the use of all powers of enforcement as provided by section 624.310, F.S., including actions against any affiliated party. These enforcement powers shall apply but not be limited in application to all entities which are subject to administrative supervision based on the criteria set forth in subsection (3) of this rule, whether or not the entity has consented to administrative supervision and whether or not a plan of correction has been approved.

69O FAC 141.003 | Plan of Correction

(1) The plan referred to in section 624.81(4), F.S., shall where applicable include the actions specified in subsection (2), below.

(2) The Office shall if applicable, and upon consent of the supervised insurer:
(a) Disregard any credit or amount receivable resulting from transactions with a reinsurer which is insolvent, impaired or otherwise subject to a delinquency proceeding;

(b) Make appropriate adjustments to asset values attributable to investments in or transactions with parents, subsidiaries, or affiliates;

(c) Refuse to recognize the stated value of accounts receivable if the ability to collect receivables is highly speculative in view of the age of the account or the financial condition of the debtor;

(d) Increase the insurer's liability in an amount equal to any contingent liability, pledge, or guarantee not otherwise included if there is a substantial risk that the insurer will be called upon to meet the obligation undertaken within the next twelve-month period;

(e) Reduce the total amount of an insurer's present and potential liability for policy benefits by reinsurance;

(f) Reduce, suspend or limit an insurer's volume of business being accepted or renewed;

(g) Reduce an insurer's general insurance and commission expenses by specified methods;

(h) Increase an insurer's capital and surplus;

(i) Suspend or limit the declaration and payment of dividends by an insurer to its stockholders or to its policyholders;

(j) Require an insurer to file reports clearly and accurately reflecting the market value of the insurer's assets;

(k) Require an insurer to limit or withdraw from certain investments or to discontinue certain investment practices;

(l) Require an insurer to document the adequacy of premium rates in relation to the risks insured;

(m) Require an insurer to file, in addition to regular annual statements, interim financial reports;

(n) Impose restricted activities pursuant to section 624.83, F.S.; or

(o) Appoint a deputy supervisor to oversee and monitor the operations of the insurer.
(3) The requirements of a corrective plan will vary depending upon the specific circumstances surrounding the troubled situation. Some of the elements necessary for a corrective plan include but are not limited to the following:
(a) An executive summary identifying the objectives to be attained in the plan, with key implementation dates and a projected date for full statutory compliance;

(b) Background and description of the company, describing the insurer's history, ownership structure, relationships with affiliates, management structure, key employees, and overall operating structure of the organization;

(c) The financial condition of the insurer, summarizing major categories of revenues and expenses, assets and liabilities, and debt and capital structure for the past two years based on actual results, and for the next three years based on forecasted results;

(d) The causes of the unsound or hazardous conditions giving rise to supervision proceedings;

(e) Corrective action required, identifying operational changes, contractual changes, management changes, and changes in internal control systems;

(f) Specific business plans by function, including current marketing plans, company operations such as claims processing, projected monthly financial forecasts for at least a two-year period and quarterly financial forecasts thereafter; and,

(g) Monitoring and reporting systems providing a periodic review of progress and comparisons of actual results with the corrective plan objectives.
(4) Any reports submitted to the Office pursuant to any approved corrective plan shall be electronically filed at http://www.FLOir.com/iPortal unless otherwise indicated through a consent order. All other reports required by statute or rule shall be submitted in the manner required by such statute or rule, regardless of whether the insurer is in administrative supervision.

(5) Any notice, request, or other communication received by an insurer while in administrative supervision from any person acting for the Office, but not responsible for the administrative supervision, shall be reported to the person in the office responsible for the administrative supervision by the insurer within five (5) days of receipt.

69O FAC 141.004 | Period of Supervision

69O FAC 141.005 | Appointment of Deputy Supervisors

(1) A contract for services of a deputy supervisor pursuant to section 624.87, F.S., may be executed by the deputy supervisor directly with the insurer at rates of compensation negotiated by the Office. In such situations, the deputy supervisor will be compensated directly by the insurer.

(2) All deputy supervisors will be under the direction and control of the Office regardless of compensation method, and will be operating as agents of state.

(3) Industry working groups formed by the Office and outside consultants may be appointed as deputy supervisors to assist with identifying alternative solutions to the troubled situations.

69O FAC 141.006 | Costs of Administrative Supervision

In addition to the cost of travel and related expenses which is to be paid to the Office by the insurer subject to administrative supervision, such insurer shall pay to the Office an amount equal to the fee for examination of insurers as specified in subsection 69O-138.002(3), F.A.C., plus fifty percent (50%) for attendant administrative expenses.

69O FAC 141.020 | Procedures for Withdrawal, Surrender of Certificate of Authority, or Discontinuance of Writing Insurance in this State Pursuant to Section 624.430, Florida Statutes

(1) Scope and Purpose.

This rule provides implementation procedures and Office policy regarding section 624.430, F.S.

(2) Definitions.

(a) "Office" refers to the Office of Insurance Regulation.

(b) "Reduce presence in Florida," "Reduce," and "Reduction," as used in this rule, are inclusive terms meant to collectively refer to any and all of the following actions as may be desired or taken by an insurer: to surrender its Florida certificate of authority; to withdraw from Florida; or to discontinue the writing of any one or multiple lines or kinds of insurance in Florida.

(c) "Kinds" of insurance, as used in section 624.430, F.S., and this rule, includes the kinds set out in section 624.6011, F.S., which kinds of insurance are as follows: Life; Health; Property; Casualty; Surety; Marine; and Title.

(d) "Lines of insurance," as used in section 624.430, F.S., and this rule, is as defined in section 624.6012, F.S. Pursuant to the express rulemaking authority given the Office in section 624.6012, F.S., for the purpose of implementation of section 624.430, F.S., the Office determines each of the following to be a line of insurance (in addition to lines of insurance as may be elsewhere established by rule of the Office): Homeowners property insurance; mobile homeowners property insurance; condo unit owners contents insurance; renter's/dwellers contents insurance; and residential condominium association property coverages.

(3) Actions Having the Substantial Effect of a Withdrawal or Discontinuance of Writing Insurance in this State.

Reductions subject to section 624.430, F.S., include any action or actions the reasonably foreseeable substantial effect of which is, or will be when the action is completed, to have discontinued the writing of a kind or line of insurance or to have withdrawn from Florida. "Substantial effect" means that, for example, the continuance of a token amount of writing in Florida will not prevent a conclusion that a reduction subject to section 624.430, F.S., has or will occur. Furthermore, it is not determinative of the existence of a reduction requiring notice under section 624.430, F.S., that the action is taken in a single step, or by a series of steps over time, if the reasonably foreseeable effect of the action or actions is or will to be to have substantially effected a reduction. The application of section 624.430, F.S., does not depend upon the insurer's subjective statement of desire or intent as to the effect of its actions.

(4) The Office interprets the requirement of notice as authorizing the Office to prohibit the withdrawal, surrender, or discontinuance of writing, when such withdrawal, surrender, or discontinuance of writing is done in violation of any law or rule.

(5) Notice to Precede Action to Reduce Presence in Florida.

An insurer shall take no action in furtherance of a reduction, prior to the expiration of 90 days after the receipt by the Office of the notice required by section 624.430, F.S. Prohibited actions include sending any notice of cancellation of termination, or notice of intent to cancel or terminate, to any policyholder, agent, managing general agent, reinsurer, or other person or entity.

(6) Procedure for Providing Notice of Reduction.

(a) Format of Notice.

The notice required under section 624.430(1), F.S., shall be in the form of a letter, on the letterhead of the insurer, dated and signed by an officer of the insurer. The letter shall begin with the following language after the salutation: "This constitutes the notice required by section 624.430, F.S., of this insurer's desire to _____," where the blank space is filled in as applicable with "surrender its certificate of authority," or "withdraw from the state," or "discontinue writing one or more lines of insurance."

(b) Copies.

The notice shall consist of an original and two complete copies of the notice and all attachments.

(c) Designated Filing Office.

The letter of notice with the two copies shall be addressed to and delivered by certified or registered mail to the following address: Insurance Commissioner, Office of Insurance Regulation, 200 East Gaines Street, Tallahassee, FL 32399-0326. There shall be no constructive receipt of the notice by the above-designated filing office, other than upon receipt by the Office's mail room in the usual course of business, of a properly addressed notice by U.S. mail. The 90 days shall not begin to run until a properly addressed notice, in a form substantially complying with this rule, is received by the Office, by U.S. mail.

(d) Incomplete Notices; Notices Not in Proper Format.

Notices that are incomplete or not in proper format shall be summarily returned and are not effective as notice under section 624.430, F.S.

(e) Contents of Notice.

1. If the notice is of discontinuance of writing one or more lines in this state, it shall specify the lines to be discontinued.

2. The notice shall specify the desired timetable of events related to the desired reduction.

3. The notice shall specify in detail the reason for the proposed action.

4. Insurers shall also provide the Office with the following information in the notice:
a. A listing of all lines of insurance the insurer then has in force in Florida which will be affected by the reduction, and for each line, a statement of the approximate number of policies and dollars of premium then in force in Florida and which will be affected by the desired reduction.

b. A description of what notice and treatment will be given by the insurer to its affected Florida policyholders concerning the reduction; and what steps will be taken by the insurer regarding processing of any outstanding covered claims of such policyholders while and after the insurer accomplishes its reduction.

c. A description of projected impact of the reduction upon the insurer's Florida agent and agency force, if any. In addition to any other information related to the impact on agents, the insurer shall state the number of affected agents and give a brief description of what they are being told.

d. A description of any reduction or discontinuation of writings in any other state or states.

(7) Office Action Upon Receipt of Notice.

(a) Subsequent to receiving the initial filing, the Office will request the insurer to provide further information, or will conduct such other investigation as is necessary to determine whether the initial information provided is accurate and whether the proposed action will have the effects projected by the insurer.

(b) The Office shall inform the insurer if the proposed reduction would be in violation of, or cause a violation of, any provision of the Insurance Code or rule of the Office. Within 5 calendar days of the date of such notice, the insurer shall file with the Office a response indicating whether it will proceed to implement the reduction.
(8) Notwithstanding rule 69O-167.001, F.A.C., when an insurer withdraws from a line of business resulting in the cancellation of residential property insurance policies, the insurer must return to the insured, within fifteen (15) working days of the postmark date of the cancellation notice, the gross unearned premium corresponding to coverage beyond the effective date of the cancellation.

69O FAC 141.021 | Procedures Implementing the Moratorium Phaseout in Section 627.7013, Florida Statutes (Repealed)

69O-142 | Insurer Conduct

69O FAC 142.002 | Insurer Complaint Ratios

(1) This rule implements the publication requirements of Section 624.313, F.S., which requires the Office to publish complaint ratios for the 10 largest insurers or insurer groups by line of insurance and each insurer or insurer group that has 1 percent or more of a line of insurance in this state. This rule does not apply to private passenger automobile insurance coverages. This rule also identifies the procedures by which insurer complaint ratios, herein referred to as complaint indexes, are calculated. Insurer Complaint indexes can be used by the Office to identify insurers with questionable claims handling practices and allow the Office to take appropriate regulatory action to avoid an interruption in services to the insurance consumer. The insurance consumer will be able to compare insurers by line of insurance to assist in the purchase of insurance.

(2) Definitions.

The following words and phrases, when used in this rule shall have the following meanings, except where the context clearly indicates a different meaning:
(a) "Bureau" means the Bureau of Consumer Assistance, a bureau within the Division of Insurance Consumer Services.

(b) "Complaint" for purposes of the complaint index, means any written communication, by an insured or named beneficiary, primarily expressing a grievance or dissatisfaction over which the Office has regulatory authority. Complaints which will not be used to calculate the complaint index include complaints against an incorrect entity; complaints against companies providing administrative services for self-funded benefit plans; complaints regarding properly filed or approved rates; suspected fraudulent claim complaints; and complaints which are duplicative, harassing or frivolous.

(c) "Complaint Index" means an index derived by dividing the complaint share by the market share for a specific insurer by line of insurance.

(d) "Complaint Share" means the percentage of complaints received by the Office relevant to an insurer for any given line of insurance when compared to the total complaints received by the Office for that line of insurance.

(e) "Office" means the Office of Insurance Regulation.

(f) "Direct Written Premium" means a consideration paid, or to be paid, to the insurer for the issuance and delivery of any binder or policy of insurance or annuity written directly to the consumer.

(g) "Division" means the Division of Insurance Consumer Services, a division within the Department of Financial Services.

(h) "Insurer" includes every individual, company, association, organization, partnership, syndicate, business trust, corporation or legal entity engaged as indemnitor, surety or contractor, holding a certificate of authority issued by the Office, which is authorized to enter into contracts of insurance or annuity.

(i) "Line of Insurance" means the subclassifications of kinds of insurance which are required to be annually reported on the standardized Annual Statement adopted by the Office.

(j) "Market Share" means the percentage of the direct written premiums when compared to the total direct written premiums in the State of Florida for a given line of insurance.

(3) Computing the Complaint Index.

(a) All direct written premiums for the reporting period will be compared to determine the market share of insurance business for each insurer by line of insurance.

(b) Insurer complaint information for the reporting period will be obtained from the Division for all insurers.
1. Complaint information will be subdivided by line of insurance for each insurer.

2. The complaint share will be determined for each insurer by line of insurance based on complaints received by the Office.
(c) An insurer complaint index, for each insurer, will be calculated by dividing the complaint share by line of insurance by the market share of direct written premium for that line of insurance.
1. A complaint index of 1.00 will indicate that the insurer has received a proportionate number of complaints as compared to the market share of direct written premium for a particular line of insurance.

2. A complaint index of less than 1.00 will indicate that the insurer has a complaint share that is less than their market share of direct written premium for that particular line of insurance.

3. A complaint index of more than 1.00 will indicate that the insurer has a complaint share that is more than their market share of direct written premium for that line of insurance.

(4) Complaint Indexes.

Complaint indexes by line of insurance will be published by the Office annually as required by Section 624.313, F.S., and may be published at such other times as the Office deems appropriate. The Office shall make available to insurers, upon written request, a copy of the index prior to publication. If the insurer disagrees with the index, the insurer shall provide the Office with written supporting documentation within 15 days of receipt of the index.

69O FAC 142.011 | Insurer Conduct Penalty Guidelines

(1) Purpose.

The purpose of this rule is to establish uniform guidelines for the assessment of administrative fines imposed upon entities, concerning certain violations of the Florida Insurance Code and applicable Office Rules.

(2) Scope.

(a) This rule applies to all entities issuing life, health, property, casualty, liability, surety, marine, mortgage guaranty, or title insurance. This rule shall apply to all such entities regardless of whether they are organized as a stock company, mutual, assessable mutual, reciprocal, fraternal benefit society, risk retention group, self-insurance fund, or other legal form. This rule applies to all violations discovered or investigated through financial examinations, market conduct examinations, or office investigations. This rule shall not be construed as creating any substantive violations not otherwise proscribed by statute or rule.

(b) Specialty Insurers Excluded. This rule does not apply to entities issuing only one or several of the following products:
1. Warranties under Chapter 634, F.S.

2. Professional service plans under Chapter 637, F.S.

3. Ambulance service contracts under Chapter 638, F.S.

4. Legal expense insurance under Chapter 642, F.S.

5. Continuing care contracts under Chapter 651, F.S.

6. Bail bonds under Chapter 648, F.S.

7. Health care service programs under Chapter 641, F.S., (including HMOs and Prepaid Health Clinics).
(c) Certain Chapter 626, F.S., Licensees Excluded. This rule does not apply to any licensees under Chapter 626, F.S., other than general agents, third party administrators, and service companies.

(d) Late filing penalties. Penalties for late filing of routine financial reports is dealt with by separate rule.

(3) Definitions.

The following terms have the following meanings for purposes of this rule.
(a) "Action" means an event or events leading to the commission of a violation.

(b) "Office" means the Florida Office of Insurance Regulation.

(c) "Office Rules" means any and all valid rules adopted by the Financial Services Commission which apply to insurers or other entities within the jurisdiction of the Office.

(d) "Florida Insurance Code" means Chapters 440, 624 through 632, 634, 635, 637, 638, 641, 642, 648, 651, 817, F.S.

(e) "Repeat Violations" means a second or subsequent offense of any given violation subject to a fine under this rule for which an insurer has been assessed an administrative fine or has received written notification of the violation from the Office in either of the two immediately preceding financial or market conduct examinations or as a result of a Office investigation conducted within the immediately preceding six years.

(f) "Violation" means any non-compliance with the Florida Insurance Code or any applicable Office Rules or Orders.

(g) "Knowing and willful:"
1. With respect to any act or omission which constitutes a violation of Part I of Chapter 627, F.S., the insurer must violate the standard established in the definition of "willful" set forth in Section 627.041(7), F.S., in order for a penalty to be assessed as "willful" under this rule.

2. With respect to all other violations of the Florida Insurance Code, as used in Section 624.4211, F.S., and for purposes of the assessment of administrative fines under this rule, and taking into account the requirements of Section 624.11, F.S., the term "knowing and willful" means any act of commission or omission which is committed intentionally as opposed to accidentally and which is committed with knowledge of the act's unlawfulness or with reckless disregard as to the unlawfulness of the act.
(h) "Investigation" means any official Office review, analysis, inquiry, and/or research into referrals, complaints, or inquiries to determine the existence of violations.

(i) "Numerator" means the number of violations of a specific statute for a particular line of business.

(j) "Denominator" means the number of occurrences examined to determine compliance with a specific statute.

(k) "Error ratio" means the percentage computed when the numerator is divided by the denominator, rounded up to the nearest hundredth.

(l) "Permissible error ratio" means the permissible percentage of violations to occurrences examined to determine compliance as established in paragraph (4)(g), below.

(4) General Provisions.

(a) Rule Not All-Inclusive. This rule contains illustrative violations. This rule does not, and is not intended to, encompass all possible violations of statute or Office rule that might be committed by insurers. The absence of any violation from this rule shall in no way be construed to indicate that same is not subject to penalty. In any instance wherein the violation is not listed in this rule, then the penalty shall be determined by consideration of:
1. The penalty factors specified in this rule; and,

2. Any closely analogous violation that is listed in this rule.
(b) Rule and Statutory Violations Included. This rule applies whether the violation is of a statutory provision, of a Office rule, or of an order implementing a statutory provision.

(c) Rule Establishes Norms. The penalty guidelines specified in this rule are the appropriate final penalty only in those cases which are resolved through the execution of a settlement stipulation and the incorporation of that settlement stipulation in a final order. This rule and any precedents developed under it do not apply to any case in which an entity disputes the existence of a violation by using a proceeding under Section 120.57, F.S. The penalty guidelines assume the typical mix of aggravating and mitigating factors found in actual practice in typical cases, in the Office experience. However, these guidelines shall not supersede the Office authority to suspend or revoke an entity's certificate of authority or to require specific corrective action in cases in which the imposition of administrative penalties is not appropriate. For example, notwithstanding the specification of relatively smaller fines for particular violations, the Office will not impose such fines but will instead initiate action to suspend or revoke a certificate of authority as a result of such violations where significant aggravating factors are present, as enumerated in subsection (5), below. Any action taken by the Office which results in the imposition of fines under this rule or which may result in the suspension or revocation of a certificate of authority shall be conducted pursuant to the provisions of Chapter 120, F.S. The Office shall reduce the amount of a penalty which would otherwise be imposed pursuant to this rule if the payment of such a penalty would reduce surplus to an extent which the Office determines, based on the particular circumstances of the entity involved, would jeopardize the financial condition of the insurer to such an extent that the provisions of Part VI of Chapter 624, F.S., relating to administrative supervision or of Chapter 631, F.S., relating to rehabilitation and liquidation, would have to be invoked. This determination is not subject to the hearing rights provided for in Chapter 120, F.S.

(d) Description of Violations. Although the violations in subsections (8) through (11), below, include specific references to statutes and/or rules, the violations are described in general language because in many cases several statutes or rules are involved. The use of general language shall not be construed to expand or modify the statute. Violations are not necessarily described herein using the language that would be used to formally allege the violation in a specific case. In some instances a basic generic violation is described herein (e.g., misleading advertising), but there also appear one or more specific variations of that same general violation, with different penalties specified, where the Office has determined that different treatment is needed or merited (e.g., misleading advertising in medicare supplement insurance). If any statutory or rule citations in subsections (8) through (11), are changed but the violation remains the same and the tracking tables in the Florida Statutes or the history notes in the Florida Administrative Code indicate the new statutory or rule citation, then the use of the previous statutory or rule citation will not invalidate this rule.

(e) Relationship to Other Rules. The provisions of this rule shall be subordinated in the event that any other rule more specifically addresses a particular violation or violations in particular lines of insurance.

(f) Other Licensees. The imposition of a penalty upon any insurer in accordance with this rule shall in no way be interpreted as barring the imposition of a penalty upon any agent, adjuster, or other licensee in connection with the same conduct.

(g) Permissible Error Ratios.
1. Claims Violations. Subject to subparagraphs 3. and 4. of this paragraph, a permissible error ratio of seven percent (7%) is established for claims violations. This permissible error ratio is applicable to all nonwillful claims violations as set forth in the individual penalty categories in this rule. For those claims violations subject to the permissible error ratio, if the error ratio for a nonwillful violation of a specific statute or rule for a particular line of business does not exceed the permissible error ratio of 7%, no penalty shall be assessed for the noted claims violations of such statute or rule for that line of business. If the error ratio for a specific statute or rule for a particular line of business exceeds the permissible error ratio of 7%, a penalty shall be assessed for those violations which exceed the error ratio.

2. Other Violations. Subject to subparagraphs (4)(g)3. and 4. of this paragraph, a permissible error ratio of ten percent (10%) is established for all nonwillful violations other than claims violations. This permissible error ratio is applicable to all nonwillful violations other than claims violations as set forth in the individual penalty categories in this rule. For those other violations subject to the permissible error ratio, if the error ratio for a nonwillful violation of a specific statute or rule for a particular line of business does not exceed the permissible error ratio of 10%, no penalty shall be assessed for the noted other violations of such statute for that line of business. If the error ratio for a specific statute or rule for a particular line of business does exceed the permissible error ratio of 10%, a penalty shall be assessed for those violations which exceed the error ratio.

3. Whether the error ratio for any violation(s) is less than, equal to, or exceeds the permissible error ratio does not preclude the Office from requiring corrective action(s).

4. For those violations subject to an error ratio, the Office will increase the sample size used to determine the error ratio if it receives a written request from the insurer or other entity to do so. The sample size will be increased by up to, but no more than, 200 files.
(h) Investigations. Any violation(s) found as a result of a Office investigation shall not be subject to the permissible error ratio provisions of this rule. The Office experience over the years has been that error ratios are not appropriately applied to the majority of investigations conducted by the Office because of the nature and scope of investigations and because of the type of business being investigated. However, if the allegations being investigated are ones which lend themselves to the application of error ratios, the Office shall, if the particular circumstances relating to the alleged violations reasonably require further investigation in the context of an examination, convert the investigation into a target examination, at which point error ratios will be applied to the results of the examination.

(5) Penalty Factors.

The following factors are considered in determining penalties for violations not listed in this rule, and, as to listed violations, the placement of the penalty within the range specified. The factors are not necessarily listed in order of importance.
(a) Willfulness and knowledge of the violation.

(b) Actual harm or damage to any insured, claimant, applicant, or other person or entity caused directly or indirectly by the violation, as determined by the Office financial examination, market conduct examination, or Office investigation.

(c) Degree of potential harm to which any insured or claimant was exposed by the violation, as determined by the Office financial examination, market conduct examination, or Office investigation.

(d) Degree to which the violation, if not detected, tends to undermine the regulatory process or regulatory system or the integrity of regulatory reports.

(e) Whether the entity reasonably should have known of the act's unlawfulness.

(f) Corrective activities which are substantially initiated only after the violation or possibility of violation is formally or informally noted or brought to the attention of the entity by the Office. The Office will not assess a penalty for violations for which successful corrective activities were actually and substantially initiated (not just planned) and implemented by the insurer before the violation was noted by or brought to the attention of the Office, and before the insurer was made aware that the Office was investigating the alleged violation. Insurers shall take note of the requirements of Section 624.4211(2), F.S., regarding restitution. It has been the Office experience that corrective activities have included remedial procedures put in place to assure that the violation does not recur; adverse personnel activities taken when appropriate; and making any injured party whole as to harm suffered in relation to the violation. The entity's corrective activities may include other measures as the entity deems appropriate.

(g) Financial gain or loss to the insurer from the violation.

(h) Degree of cooperation of the insurer with the Office in remedying the violation including any restitution provided to affected consumers.

(i) Previous fines or suspensions imposed by the Office against the insurer.

(j) Whether the violation is a repeat violation.

(k) The extent to which any applicable permissible error ratio is exceeded.

(6) Multiple Violations.

(a) For those violations not subject to the permissible error ratio provisions of this rule, each factually separate occurrence is a separate violation for purposes of this rule and application of the penalties, and penalties for such separate violations are cumulative, to the extent provided in Section 624.4211, F.S., notwithstanding that the violations are of the same statutory or rule provision.

(b) For those violations subject to the permissible error ratio provisions of this rule that comprise the numerator when divided by the denominator exceed the permissible error ratio established by this rule, each such violation is a separate violation for purposes of this rule and for the application of the penalties set forth in this rule to the extent provided in Section 624.4211, F.S., notwithstanding that the violations are of the same statutory or rule provision.

(7) Penalty Categories and Fines Assessed.

Violations are divided into four categories. Category I violations are the most serious and category IV violations are the least serious. The Office will use the factors in subsection (5), above, to determine, within the penalty ranges specified below, the fine for each violation within a category. The penalty amount does not include any investigative or legal costs that are assessed in addition to the fine.

(8) Category I.

If the violation is knowing and willful, the fine assessed per violation will range from $12,000 to $20,000. If the violation is nonwillful, the fine assessed per violation will range from $1,000 to $2,500 per violation. Violations listed in this category are exempt from the permissible error ratio provisions of this rule.
(a) Violation of any lawful order of the Office, pursuant to Section 624.418(2)(a), F.S.

(b) Failure to take corrective activities or other measures as agreed to by the insurer in writing to the Office, pursuant to Section 624.418(2)(a), F.S.

(c) Failure to take effective corrective activities or other measures on a formal written criticism made by the Office in a previous exam report, after that report becomes final, pursuant to Sections 624.316 and 624.3161, F.S.

(d) Failure of insurer or any of its officers to properly respond to or cooperate with the Office in reporting, or providing information to the Office, or producing or making reasonably available, any of its accounts, records, or files, as requested by the Office, pursuant to Sections 624.318 and 624.418(2)(b), F.S.

(e) Use of an unlicensed managing general agent or third party administrator, pursuant to Sections 626.091(3), 626.112, and 626.901, F.S.

(f) Assisting in or facilitating insurance agency activities in prohibited association with a financial institution, pursuant to Section 626.988, F.S., and rule Chapter 69O-223, F.A.C.

(g) Filing or causing to be filed any materially incorrect financial report with the Office, pursuant to Section 624.424(1), F.S.

(h) Writing any line of insurance other than those authorized by the certificate of authority, pursuant to Section 624.401(2), F.S.

(i) Violation of an emergency rule, pursuant to Section 624.418(2), F.S.

(j) Improperly assisting an unlicensed insurer, pursuant to Section 626.901, F.S.

(k) Violation of Medicare Supplement and Long-Term Care standards for marketing and provisions relating to excessive duplicative insurance, pursuant to Sections 627.6741, 627.6743, 627.6744 and 627.9407, F.S., and Chapters 69O-156 and 69O-157, F.A.C.

(l) Violation of the Unfair Trade Practices Act, pursuant to Part IX, Section 626.9541, F.S.

(m) Violation of long-term care disclosure advertising, and/or performance standards, pursuant to Section 627.9407, F.S., and rule Chapter 69O-157, F.A.C.

(n) Failure to maintain records, pursuant to Sections 624.318, 626.561, and 626.875, F.S.

(o) Failure to file advertising as required, pursuant to Chapters 69O-150, 69O-156 and 69O-157, F.A.C.

(p) Failure to timely refund unearned premium, pursuant to sections 627.4133, 627.6043, 627.6741, 627.728, 627.7282, and 627.7283, F.S., and Rules 69O-167.001 and 69O-167.002, F.A.C.

(q) Use of unfiled rates or forms, pursuant to Sections 627.062, 627.0645, 627.0651, 627.091, 627.191, and 627.410, F.S., and Chapter 69O-149, F.A.C.

(r) Use of unfiled rate manuals, underwriting guidelines, or other required filings, pursuant to Sections 627.062, 627.0651, 627.091, 627.410(6), 627.640, 627.6745, and 627.6785, F.S., and Parts I and III of Chapter 69O-149; part I of Chapter 69O-156; Rule 69O-157.022; Chapter 69O-170; and Rule 69O-175.004, F.A.C.

(s) Failure to provide 15-day advance notice of premium increase when automatic bank withdrawal arrangement is in force, pursuant to Section 627.0665, F.S.

(t) Failure to allow Free-Look period, pursuant to Sections 626.99(4)(a) and 627.674(3)(d), F.S. and Rules 69O-154.003 and 69O-157.018, F.A.C.

(u) Failure to comply with replacement requirements, pursuant to Chapters 69O-151, 69O-156 and 69O-157, F.A.C.

(v) Failure to notify Office of withdrawal from line of business, pursuant to Section 624.430, F.S.

(w) Failure to maintain company records and assets in the State of Florida, pursuant to Sections 628.271 and 624.443, F.S.

(x) Failure to establish or comply with reserve requirements, pursuant to Sections 625.041, 625.051, 625.061, 625.071, 625.081, 625.091, 625.111, 625.121 and 625.131, F.S.

(y) Investments in ineligible investments, pursuant to Section 625.302, F.S.

(z) Failure to comply with limits on investments without a special consent from the Office pursuant to Sections 625.305, 625.306, 625.307, 625.308, 625.309, 625.310, 625.311, 625.312, 625.313, 625.314, 625.315, 625.316, 625.317, 625.318, 625.319, 625.320, 625.321, 625.322, 625.323, 625.324, 625.325, 625.3255, 625.326, 625.3262, 625.327, and 625.329, F.S.

(aa) Making prohibited investments as defined in Section 625.332, F.S.

(bb) Violation of the restrictions on maximum annual premiums writing, pursuant to Section 624.4095, F.S.

(cc) Improper allocation of any item on the balance sheet having a material effect on the balance sheet, pursuant to Rule 69O-137.001, F.A.C.

(dd) Failure to obtain approval for converting company from a stock company to a mutual company, merging or selling, or acquiring a controlling interest, pursuant to Sections 628.441, 628.451, 628.461, 628.471, 628.481 and 624.491, F.S.

(ee) Failure to file and acquire approval to pay commissions to persons with effective control, pursuant to Section 628.255, F.S.

(ff) Violation of the Small Employer Health Care Access Act, pursuant to Section 627.6699, F.S., and Part III of Chapter 69O-149, F.A.C.

(gg) Violation of requirements regarding excluded assets in determination of the financial condition of an insurer, pursuant to Section 625.031, F.S.

(hh) Failure to document subjective modifications, pursuant to Section 627.062, F.S., and Rules 69O-170.004 and 69O-170.013, F.A.C.

(9) Category II.

If the violation is knowing and willful, the fine assessed per violation will range from $2,500 to $10,000. If the violation is nonwillful, the fine assessed per violation will range from $750 to $2,000 per violation.
(a) Those nonwillful violations subject to the permissible error ratio provisions of this rule include:
1. Failure to properly supervise company adjuster, pursuant to Section 626.878, F.S., and paragraph 69O-220.201(4)(g), F.A.C.

2. Advertisement of the existence of the Guaranty Fund(s) as an inducement to sell, pursuant to Sections 631.65 and 631.735, F.S.

3. Cancellation or nonrenewal of policy for unapproved reasons, pursuant to Sections 627.4133, 627.728, 627.7282, F.S.

4. Failure to make payment of loss within 20 days of settlement, pursuant to Section 627.4265, F.S.

5. Failure to pay a claim and any interest when due, pursuant to Sections 627.4265 and 627.613, F.S.

6. Failure to provide outline of coverage, pursuant to Sections 627.4143, 627.642 and 627.9407(10), F.S.

7. Failure to include the fraud statement, pursuant to Section 817.234(1)(b), F.S.

8. Failure to pay interest on cash surrender of life or annuity policy after 30 days, pursuant to Section 627.482, F.S.

9. Failure to provide required minimum cancellation, nonrenewal or change in rates notice, pursuant to Sections 627.4133, 627.6043, 627.6645 and 627.7281, F.S.
(b) Those violations, willful or nonwillful, not subject to the permissible error ratio provisions of this rule include:
1. Furnishing supplies to unlicensed agents, pursuant to Section 626.342, F.S.

2. Failure to show insurer's name on application, pursuant to Section 627.4085, F.S.

3. Use of unlicensed adjuster, agent, or representative, pursuant to Section 626.112, F.S.

4. Failure to make delivery of policy, pursuant to Section 627.421(1), F.S.

5. Failure to provide extension of benefits, pursuant to Section 627.667, F.S.

6. Failure to provide conversion policy, pursuant to Sections 627.646 and 627.6675, F.S.

7. Failure to file Certificate of Compliance for Advertising, pursuant to subsections 69O-150.018(2), 69O-150.119(2) and 69O-156.120(2), F.A.C.

8. Failure to maintain claims office in the state for school accident insurance, pursuant to Section 627.661, F.S.

9. Failure to affix out of state group stamp, pursuant to Sections 627.5515 and 627.6515, F.S.

10. Filing financial statements with the Office prepared in a manner inconsistent with NAIC Accounting Practices and Procedures, as required by Rule 69O-137.001, F.A.C.

11. Violation of admitted asset requirements, pursuant to Section 625.012, F.S.

12. Failure to correctly value bonds or other evidences of debt having a fixed term and rate of interest, pursuant to section 625.141, F.S.

13. Failure to correctly value securities (other than bonds), pursuant to Section 625.151, F.S.

14. Failure to correctly value real and personal property, pursuant to Section 625.161, F.S.

15. Failure to correctly value purchase money mortgages on real property, pursuant to Section 625.171, F.S.

16. Failure to comply with the retention of risk on any one subject of risk, pursuant to Section 624.609, F.S.

(10) Category III.

If the violation is knowing and willful, the fine assessed per violation will range form $1,500 to $2,500. If the violation is nonwillful, the fine assessed per violation will range from $500 to $1,000 per violation.
(a) Those nonwillful violations subject to the permissible error ratio provisions of this rule include:
1. Use of an agent who is licensed but not properly licensed for the product sold, pursuant to Section 626.112, F.S.

2. Failure to meet continuing education requirements for agents appointed by the company, pursuant to Section 626.2815, F.S.

3. Acceptance of business by an insurer from an agent not properly appointed pursuant to Section 624.425, F.S.

4. Failure to adjust a claim in accordance with the terms and conditions of the contract, pursuant to Section 626.877, F.S.

5. Failure to adjust claims including partial losses in accordance with the valued policy law and to provide a statement by the insurer limiting the amount of the recovery, pursuant to Section 627.702, F.S.

6. Failure to properly handle claims per certification from the Department of Labor and Employment Security, pursuant to Section 440.20(16)(a), F.S.

7. Failure to respond to claimant's attorney within 30 days, pursuant to Section 627.7264, F.S.
(b) Those violations, willful and nonwillful, not subject to the permissible error ratio provisions of this rule include:
1. Failure to register or appoint agent, pursuant to Section 626.112, F.S.

2. Failure to request additional appointments for life and health agents when placing business with another insurer and receipt of commissions prior to receipt of appointment by the Office, pursuant to Section 626.341, F.S.

3. Refusal to write worker's compensation based on premium volume, pursuant to Section 627.1615, F.S.

4. Failure to file experience reports for health insurance, pursuant to Section 627.9175(2)(a), F.S.

5. Failure to state the source of statistics used in an advertisement, pursuant to Chapter 69O-150, F.A.C.

6. Failure of a solicitation of coverage to be from and contain the name of a Florida licensed agent, pursuant to Chapter 69O-150, F.A.C.

7. Use of a commercial rating system in an advertisement without the required disclosure as to the extent of such rating, and the scope and limitation of such rating, pursuant to Chapters 69O-150 and 69O-156, F.A.C.

8. Failure to notify the Office of terminating the appointment of an agent, pursuant to Section 626.511, F.S.

9. Failure to dispose of ineligible property and securities not in compliance within the time frame provided by Section 625.338, F.S.

10. Non-compliance with Section 624.45, F.S., concerning financial institutions' participation in reinsurance or insurance exchanges.

11. Failure to comply with Section 624.610, F.S., concerning reinsurance.

12. Making investments other than a policy loan or annuity contract loan of a life insurer without being authorized or approved by the insurer's board of directors or by a committee authorized by such boards or in any other manner not in compliance with Section 625.304, F.S.

13. Failure to notify the Office of any change in directors or principal officers, pursuant to Section 628.261, F.S.

14. Failure to provide personal injury coverage, or to pay personal injury protection claims, pursuant to Section 627.736, F.S.

15. Failure to honor personal injury protection requirements of claims mediation, pursuant to Section 627.745, F.S., and Rule 69O-176.022, F.A.C.

16. Failure to comply with provisions of Chapter 440, F.S., pursuant to Section 440.52(3), F.S.

(11) Category IV.

If the violation is knowing and willful, the fine assessed per violation will range from $1,000 to $1,500. If the violation is nonwillful, the fine assessed per violation will range from $100 to $500 per violation.
(a) Those nonwillful violations subject to the permissible error ratio provisions of this rule include:
1. Failure to notify applicant of Florida Joint Underwriting Association availability for private passenger auto coverages, pursuant to Section 627.728(6), F.S.

2. Failure to provide $10,000 property damage liability or $30,000 combined bodily injury liability and property damage liability with each personal injury protection policy, pursuant to Section 627.7275, F.S., and Rule 69O-175.004, F.A.C. (Note that the property damage liability requirement is effective for policies issued on and after 10/1/89.)

3. Insufficient timing of binder cancellation, pursuant to Section 627.420, F.S.

4. Failure to provide specific reasons including underwriting reasons either on denial of an application, or to accompany each notice of nonrenewal and cancellation, pursuant to Sections 627.4091 and 627.4133, F.S.

5. Failure to attach mandatory forms to policy, pursuant to Section 627.412, F.S.

6. Failure to provide premium installment plans for workers' compensation policies with over $1,000 in annual premium, pursuant to Section 627.162, F.S.

7. Failure to adhere to filed underwriting rules for private passenger auto and homeowners' coverages, pursuant to Sections 627.062 and 627.0651, F.S., and Rules 69O-170.013, 69O-170.014 and 69O-175.003, F.A.C.

8. Error in workers' compensation statistical data reported by insurer, pursuant to Section 627.331, F.S.

9. Failure to use acceptable workers' compensation application form, as required by Section 440.381, F.S., and Rule 69O-189.003, F.A.C.

10. Failure to properly forward auto titles to Department of Highway Safety and Motor Vehicles, pursuant to section 319.30, F.S.

11. Violations of countersignature provisions, pursuant to Section 624.425, F.S.

12. Improper application of safe driver points to comprehensive coverage, pursuant to Section 627.0652, F.S.

13. Failure to make available risk management guidelines, pursuant to Section 627.0625, F.S.

14. Failure to provide rules for and apply credit for completion of the Department of Highway Safety and Motor Vehicles approved accident prevention course by persons 55 or older, pursuant to Section 627.0652, F.S.

15. Failure of insurer to provide premium credits; on Liability, PIP and Collision for Anti-lock brakes; on PIP and Med Pay for Air Bags; on Comprehensive Coverage for Anti-Theft Devices for private passenger autos as approved by the Office, pursuant to Section 627.0653, F.S.

16. Failure to list forms and edition dates on declaration, pursuant to Section 627.413(1)(g), F.S.

17. Failure to display rates for auditable exposures, pursuant to Section 627.413(2), F.S.

18. Failure to show coinsurance statement on property insurance policy subject to coinsurance provisions, pursuant to Section 627.701, F.S.

19. Regarding uninsured motorist coverages, providing uninsured motorist at lesser limit than bodily injury without signed election form; or failure to annually notify insureds of uninsured motorist option and to document offers; or failure to make election part of application; or providing uninsured motorists coverage that differs from that selected by insured; or failure to document uninsured motorist's elections; or failure to offer uninsured motorists coverage, pursuant to Section 627.727, F.S.

20. Issuing a personal injury protection and property damage liability auto policy for less than 6 months except as permitted by Section 627.7295, F.S., or violation of 2-month cancellation restriction and policy free provision or charging an unfiled policy fee, pursuant to Section 627.7295, F.S.

21. Failure to notify insured that cancellation or non-renewal will be reported to Department of Highway Safety and Motor Vehicles, pursuant to Section 627.736(9)(b), F.S. Note that the policing of the various required notices is the responsibility of the Department of Highway Safety and Motor Vehicles.

22. Failure to notify insureds of annual personal injury protection options including deductibles, pursuant to Section 627.739(2), F.S.

23. Failure to comply with preinspection of privately purchased private passenger automobiles for physical damage coverage for new business policies issued in counties with populations of 500,000 or more, pursuant to Section 627.744, F.S., and Rule 69O-167.004, F.A.C.

24. Failure to show on an auto policy not providing bodily injury liability and property damage liability that the policy does not comply with the wording required by Florida law, pursuant to Rules 69O-184.011 and 69O-184.012, F.A.C.

25. Failure to use imprint information on non-pay cancellation notice by premium finance company, pursuant to Section 627.848, F.S., and Rule 69O-196.001, F.A.C.

26. Failure to comply with rules for completion of underwriting for private passenger auto coverages, pursuant to Section 627.7282, F.S., and Rule 69O-167.002, F.A.C.

27. Failure to reduce collision rates 3.5% on policies effective 1/1/90 to reflect mandatory $10,000 property damage liability coverage or $30,000 when property damage liability and bodily injury liability are combined, pursuant to Rule 69O-175.005, F.A.C.

28. Misapplication: failure to follow filed rating plans, underwriting guidelines, or other required filings, pursuant to Sections 627.062, 627.0645, 627.0651, 627.091, 627.191, 627.640, 627.6745, and 627.6785, F.S.
(b) Those violations, willful and nonwillful, not subject to the permissible error ratio provisions of this rule include:
1. Violations of licensed agent law, life and health insurance, pursuant to Section 624.428, F.S.

2. Failure to show subjects of insurance in the policy declaration and including in part, claims conditions and limitations and failure to include prescribed policy contents, pursuant to Section 627.413, F.S.

3. Failure to provide required policy information to any other person with an insurable interest in the policy, pursuant to Section 627.421(2), F.S.

4. Failure to follow the equity dating statute and follow rule for processing additional premium due company, pursuant to Section 627.7282, F.S., and Rule 69O-167.001, F.A.C.

5. Applying deductible to a windshield loss, pursuant to Section 627.7288, F.S.

6. Failure to cancel policy on an insured's request basis, when financed by a premium finance company, pursuant to Section 627.848(4), F.S.

7. Use of unfiled premium finance forms and charges and interest plans under in-house control, pursuant to Section 627.904, F.S.

8. Use of short rate rules that develop premium greater than 90% of pro rata unless filed and approved by the Office, pursuant to Section 627.062, F.S., and Rule 69O-170.010, F.A.C.

9. Failure of advertising material produced in quantity to bear an identifying form number or other identifying means, pursuant to Chapter 69O-150, F.A.C.

10. Failure to comply with the requirements for the placement of excess or rejected business, pursuant to Sections 626.793 and 626.837, F.S.

11. Deposits not in compliance with Sections 624.411, 624.412, 626.5091, 625.50, 625.51, 625.52, 625.53, 625.55, 625.56, 625.57, 625.58, F.S.

12. Exceeding limits on dividends to stockholders and policyholders, pursuant to Sections 628.371 and 628.381, F.S.

13. Failure to file with the Office any amendments to articles of incorporation or by-laws, pursuant to Sections 628.101, 628.111 and 628.221, F.S.

14. Deficient, inadequate or improper internal controls as established by NAIC guidelines in manuals adopted in Rule 69O-137.001, F.A.C.

15. Failure of the company to assure that the company is managed by not less than five (5) directors, pursuant to Section 628.231, F.S.

16. Failure to secure a fidelity bond in the recommended amount as established by NAIC guidelines in manuals adopted in Rule 69O-137.001, F.A.C.

69O FAC 142.012 | NAIC Market Regulation Handbook Adopted

The National Association of Insurance Commissioners Market Regulation Handbook 2023 is hereby adopted and incorporated by reference. The agency has determined that posting the incorporated material would be a violation of federal copyright law. The Market Regulation Handbook is available for public inspection during regular business hours at the Office of Insurance Regulation, Larson Building, 200 East Gaines Street, Tallahassee, Florida 32399-0300, or at the Department of State, R.A. Gray Building, 500 South Bronough Street, Tallahassee, Florida 32399-0250. A copy of the Market Regulation Handbook may also be obtained from the National Association of Insurance Commissioners 1100 Walnut Street, Suite 1500, Kansas City, MO 64106-2197, Telephone (816)783-8500, website: http://www.NAIC.org.

69O FAC 142.015 | Standardized Requirements Applicable to Insurers After Hurricanes or Natural Disasters

This rule adopts standardized requirements that may be applied to insurers as a consequence of a hurricane or other natural disaster. The Office is authorized to issue an Order or Orders deemed necessary to protect the health, safety and welfare, activating the requirements herein, in whole or in part. An Order may be amended as deemed necessary to accommodate the particular circumstances of the specified hurricane or natural disaster. The following standardized provisions may be activated as provided herein:

(1) Claims Reporting Requirements.

(a) This subsection applies to all property and casualty contracts of insurance subject to regulation under the Florida Insurance Code including:
1. All policies referenced in Chapters 440, 624, 626, and 627, F.S.; and

2. Premium finance company contracts associated with property and casualty contracts.
References in this subsection herein to "policy" or "contract of insurance" includes all property and casualty contracts regulated under the Florida Insurance Code. References to "insurer" include all regulated entities issuing these contracts.

(b) All insurers having direct premiums written in Florida and authorized, approved or otherwise eligible to provide the coverages indicated below in subparagraphs (1)(b)1. and 2., shall report the requested information to the Office. The reporting shall be submitted with such frequency and for such areas as set forth in the Order. The applicable coverages are:
1. Those coverages as defined in Sections 627.4025(1) and 215.555(2)(c), F.S.

2. Other property coverages where loss is not specifically excluded in the policy's outline of coverage such as:
a. Private Passenger Auto Physical Damage;

b. Commercial Auto Physical Damage;

c. Commercial Property, including Fire and Allied Lines;

d. Commercial Multiple Peril;

e. Farmowners Multiple Peril;

f. Ocean Marine;

g. Inland Marine;

h. Aircraft; and,

i. Boiler and Machinery.
(c)
1. Insurers shall electronically submit the data required for each reporting event. Required data may include:
a. Policies in force;

b. Claims reported;

c. Open claims with payment;

d. Open claims without payment;

e. Claims closed with payment;

f. Claims closed without payment;

g. Number of open claims;

h. Percent of claims closed;

i. Paid loss excluding loss adjustment expense;

j. Paid allocated loss adjustment expense;

k. Case incurred loss excluding loss adjustment expense; and,

l. Case allocated loss adjustment expense.
2. All information shall be submitted electronically through http://www.FLOir.com/iPortal.

(2) Grace Periods and Temporary Postponement of Cancellations or Non-renewals.

(a) This subsection applies to all property and casualty contracts of insurance subject to regulation under the Florida Insurance Code including:
1. All policies referenced in Chapters 440, 624, 626 and 627, F.S.; and

2. Premium finance company contracts.
References in this subsection herein to "policy" or "contract of insurance" includes all property and casualty contracts regulated under the Florida Insurance Code. References to "insurer" include all regulated entities issuing these contracts.

(b) Reinsurance contracts are not subject to this rule, however, ceding insurers shall, within ten (10) days, notify the Office, of the cancellation or nonrenewal of any reinsurance contract reinsuring property risks located in the state. All filings shall be submitted electronically to http://www.FLOir.com/iPortal.

(c) As to any policy provision, notice, correspondence, or law that imposes a time limit upon an insured to perform any act, including transmitting information or funds with respect to a contract of insurance, which act was to have been performed on or after the date specified in the Order of the Office, the time limit shall be extended to a date specified in the Order.
1. This extension of time shall not relieve a policyholder who has a claim resulting from the designated hurricane or natural disaster from compliance with their obligations to provide information and cooperate in the claim adjustment process relative to their property damage claim.

2. This extension of time shall also not apply to new policies effective on or after the date specified in the Order.
No interest, penalties, or other charges, shall accrue or be assessed, as the result of the extensions required herein. Interest that is owed pursuant to premium financing plans with premium finance companies or insurers or their affiliates may be assessed.

(d) During the dates specified in the Order, no insurer or other entity regulated under the Florida Insurance Code shall cancel or non-renew, or issue a notice of cancellation or nonrenewal of a policy or contract of insurance covering a property or risk in the referenced areas as specified in the Order, except at the written request or written concurrence of the policyholder.

(e) All notices of cancellation issued or mailed within ten (10) calendar days preceding the date specified in the Order and, affecting the referenced areas, shall be withdrawn and reissued to insureds on or after the date specified in the Order.

(f) A cancellation or nonrenewal may occur prior to the expiration date specified in the Order, at the written request or written concurrence of the policyholder.

(g) Except as provided in paragraphs (2)(d) and (e), with respect to a notice of cancellation or nonrenewal that, but for this rule, would have taken effect during the dates specified in the Order, such notice is not made invalid by this rule; however;
1. The insurer shall extend the coverage to and including the date specified in the Order, or a later date specified by the insurer; and

2. The premium for the extended term of coverage shall be the appropriate pro rata portion of the premium for the entire term of the policy.
(h) An insurer or other regulated entity that was unable to cancel or non-renew a policy due to the operation of this rule, may upon proper notice, cancel or non-renew such policy, effective on the date the policy would have otherwise been cancelled or non-renewed, in the event the insured has not filed a claim under the policy and not paid outstanding premium due.

(i) No policy shall be cancelled or non-renewed solely because of a claim resulting from a hurricane or natural disaster.

(j) An insurer's offer of replacement coverage, that is voluntarily accepted by an insured or applicant in an affiliated company, or made pursuant to a depopulation program, assumption or other arrangement approved by the Office does not constitute a nonrenewal or cancellation for purposes of this rule.

(k) Any insurer who receives a claim from an insured owing premium may offset the premium due to the insurer or a premium finance company from any claim payment made under the policy.

(l) Nothing in this rule shall be construed to exempt or excuse an insured from liability for premiums otherwise due for actual coverage provided.

(m) This rule shall not apply to new policies effective on or after the initial activation date specified in the Order.

(n) If the contract of insurance was financed by a premium finance company for risks located in the referenced areas, the following provisions apply:
1. Premium finance companies may issue advisory 10-day notices of intent to cancel and cancellation notices in accordance with the terms of the premium finance agreement signed by the insured. In addition, each such advisory notice shall prominently contain the following statement:
"If you have been displaced through the loss of your home or damage to your home which has caused you to reside elsewhere on a temporary basis, or if you have temporarily become unemployed due to the destruction caused by Hurricane [name of hurricane or natural disaster], please contact this office at once.

Victims of Hurricane [name of hurricane or natural disaster] will receive an automatic extension of time to and including [date specified in the Order], to bring their accounts up to date and no late charges will be applied to any late payments received which were due on their accounts during the period of the dates specified in the Order.

Therefore, if you are a victim of Hurricane [name of hurricane or natural disaster], please contact us at once at the number provided at the bottom of this notice so that we may advise you of the status of your account.

If you decide that you no longer need or desire to keep the coverage provided by the insurance policy financed by your contract with us, please contact us at once so that we may instruct you on how to effect cancellation with your insurer."
2. If a premium finance loan is in default at the end of the grace period, a premium finance company shall give proper notice by:
a. Issuing a 10 day notice of intent to cancel to the insured by the means provided under Section 627.848(1)(a)1., F.S., and applicable regulations; and,

b. If the insured does not bring their loan current within the time provided in the notice of intent, a premium finance company may mail the insurer a request for cancellation as provided in Section 627.848(1)(a)2., F.S.
3. Upon receipt of a request for cancellation from a premium finance company after the grace period specified in an Emergency Order expires, the insurer will process the cancellation in accordance with paragraph (2)(h).

4. Any insurer who is unable to cancel because it has received a claim under a policy for which it receives a notice of cancellation from a premium finance company will offset the balance owed the premium finance company, as disclosed in the notice of cancellation, from the first claim payments made under the policy.

5. No late charges shall be assessed for any insured who qualifies for protection under this rule.
(o) Subsection (2) of this rule, shall not apply to policies for the following kinds of insurance issued by authorized insurers that cover a business that is domiciled or maintains its primary place of business outside of Florida:
Surety insurance as defined in Section 624.606, F.S.;

Fidelity insurance as defined in Section 624.6065, F.S.;

Marine insurance, wet marine and transportation insurance and inland marine insurance as defined in Section 624.607, F.S.;

Title insurance as defined in Section 624.607, F.S.;

Collateral Protection insurance as defined in Section 624.6085, F.S.;

Workers' Compensation insurance as defined in Section 624.605, F.S.;

Casualty insurance as defined in Section 624.605, F.S., but limited to coverage of commercial risks other than residential or personal property; and

property insurance as defined in Section 624.604, F.S., but limited to coverage of commercial risks other than residential or personal property.
Additionally, this rule shall not apply to life insurance policies or annuity contracts that are owned by a person other than the insured or the annuitant or where the premium payer under such policy is a person other than the insured or annuitant and such owner or premium payer does not reside in the referenced areas.

(p) Any insurer that becomes impaired or insolvent due to a hurricane or natural disaster or the operation of subsequent rules and orders has a duty to report the resulting financial condition to the Office as soon as possible. Notwithstanding any other provisions contained herein, an insurer may file a petition pursuant to Section 120.542, F.S. if compliance with this rule may be reasonably expected to result in such insurer being subject to financial regulatory action levels by the Office.

(q) The provisions of this rule shall be liberally construed to effectuate the intent and purposes expressed therein and to afford maximum consumer protection.

(3) Grace Periods and Temporary Postponement of Cancellations or Non-renewals.

(a) This subsection applies to all life and health contracts of insurance subject to regulation under the Florida Insurance Code including:
1. All policies referenced in Chapters 624, 626, 627, 636, 641, and 651, F.S.;

2. Contracts issued by Multiple Employer Welfare Arrangements and Commercial Self-Insurance Trusts; and

3. Premium finance company contracts associated with life and health contracts.
References in this subsection to "policy" or "contract of insurance" includes all life or health agreements regulated under the Florida Insurance Code. References to "insurer" include all regulated entities issuing these agreements.

(b) Any free look period in a variable life policy or variable annuity contract is not extended by this rule.

(c) As to any policy provision, notice, correspondence, or law which imposes a time limit upon an insured to perform any act or transmit information or funds with respect to a contract of insurance, which act was to have been performed on or after the date specified in the Order of the Office, the time limit shall be extended to the date specified in the Order, except that:
1. This extension of time shall not relieve an insured who has a claim during this period from compliance with any obligation to provide information and cooperate in the claim adjustment process relative to their claim.

2. This extension of time shall not apply to new policies effective on or after the date specified in the Order.
No interest, penalties, or other charges shall accrue or be assessed as the result of the extensions required herein. However, interest that is owed pursuant to premium financing plans with premium finance companies or insurers or their affiliates may be assessed.

(d) During the dates specified in the Order, no insurer or other entity regulated under the Florida Insurance Code shall cancel or non-renew a policy or contract of insurance or issue a notice of cancellation or nonrenewal on a contract of insurance covering a person in the referenced areas as specified in the Order, except at the written request or written concurrence of the policyholder.

(e) All notices of cancellation issued or mailed within ten (10) calendar days preceding the date specified in the Order, affecting a person in the specified areas, shall be withdrawn and reissued to insureds on or after the date specified in the Order.

(f) A cancellation or nonrenewal may occur prior to the expiration date specified in the Order, at the written request or written concurrence of the policyholder. The application for and issuance of a replacement major medical health insurance policy which is subject to regulation by the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, as amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, may be regarded by the insurer as a written request for cancellation of the current major medical insurance policy by the applicant/policyholder, provided the date of cancellation is not effectuated prior to the date of the effectuation of the replacement policy's coverage.

(g) Except as provided in paragraphs (3)(e) and (f), with respect to a notice of cancellation or nonrenewal which, but for this rule, would have taken effect during the dates specified in the Order, such notice is not made invalid by this rule; however;
1. The insurer shall extend the coverage to and including the date specified in the Order, or a later date specified by the insurer; and

2. The premium for the extended term of coverage shall be the appropriate pro rata portion of the premium for the entire term of the policy.
(h) Retroactive cancellation due to non-payment of premium:
1. For health policies or contracts, an insurer or other regulated entity that was unable to cancel or non-renew a policy due to the operation of this rule, may upon proper notice, cancel or non-renew such policy, effective on the date the policy would have otherwise been cancelled or non-renewed, in the event the insured has not paid outstanding premium due. For all other policies under this subsection, an insurer or other regulated entity that was unable to cancel or non-renew a policy due to the operation of this rule, may upon proper notice, cancel or non-renew such policy, effective on the date the policy would have otherwise been cancelled or non-renewed, in the event the insured has not paid the outstanding premium due.

2. Insurers or Health Maintenance Organizations subject to the notice provisions of Sections 627.6645(5) and 641.3108(2), F.S., respectively, may issue notices of cancellation that comport with those sections that specify no cancellation shall take place prior to the date specified in the Order.
(i) No policy shall be cancelled or non-renewed solely because of a claim resulting from a hurricane or natural disaster.

(j) An insurer's offer of replacement coverage, which is voluntarily accepted by an insured or made pursuant to other arrangement approved by the Office does not constitute a nonrenewal or cancellation for purposes of this rule.

(k) Any insurer who receives a claim from an insured owing premium may offset the premium due to the insurer or a premium finance company from any claim payment made under the policy.

(l) Nothing in this rule shall be construed to exempt or excuse an insured from liability for premiums otherwise due for actual coverage provided.

(m) This rule shall not apply to new policies effective on or after the initial activation date specified in the Order.

(n) If the contract of insurance was financed by a premium finance company for persons located in the specified areas, the following provisions apply:
1. Premium finance companies may issue advisory 10-day notices of intent to cancel and cancellation notices in accordance with the terms of the premium finance agreement signed by the insured. In addition, each such advisory notice shall prominently contain the following statement:
"If you have been displaced through the loss of your home or damage to your home which has caused you to reside elsewhere on a temporary basis, or if you have temporarily become unemployed due to the destruction caused by Hurricane [name of hurricane or natural disaster], please contact this office at once.

Victims of Hurricane [name of hurricane or natural disaster] will receive an automatic extension of time to and including [date specified in the Order], to bring their accounts up to date and no late charges will be applied to any late payments received which were due on their accounts during the period of the dates specified in the Order.

Therefore, if you are a victim of Hurricane [name of hurricane or natural disaster], please contact us at once at the number provided at the bottom of this notice so that we may advise you of the status of your account.

If you decide that you no longer need or desire to keep the coverage provided by the insurance policy financed by your contract with us, please contact us at once so that we may instruct you on how to effect cancellation with your insurer."
2. If a premium finance loan is in default at the end of the grace period, a premium finance company shall give proper notice by:
a. Issuing a 10 day notice of intent to cancel to the insured by the means provided under Section 627.848(1)(a)1., F.S., and applicable regulations; and,

b. If the insured does not bring their loan current within the time provided in the notice of intent, a premium finance company may mail the insurer a request for cancellation as provided in Section 627.848(1)(a)2., F.S.
3. Upon receipt of a request for cancellation from a premium finance company after the grace period specified in an Emergency Order expires, the insurer will process the cancellation in accordance with paragraph (3)(h).

4. Any insurer who is unable to cancel because it has received a claim under a policy for which it receives a notice of cancellation from a premium finance company will offset the balance owed the premium finance company, as disclosed in the notice of cancellation, from the first claim payments made under the policy.

5. No late charges shall be assessed for any insured who qualifies for protection under this rule.
(o) This rule shall not apply to life insurance policies or annuity contracts that are owned by a person other than the insured or the annuitant or where the premium payer under such policy is a person other than the insured or annuitant and such owner or premium payer does not reside in the referenced areas.

(p) Any insurer that becomes impaired or insolvent due to a hurricane or natural disaster or the operation of subsequent rules and orders has a duty to report the resulting financial condition to the Office as soon as possible. Notwithstanding any other provisions contained herein, an insurer may file a petition pursuant to Section 120.542, F.S. if compliance with this rule may be reasonably expected to result in such insurer being subject to financial regulatory action levels by the Office.

(q) The provisions of this rule shall be liberally construed to effectuate the intent and purposes expressed therein and to afford maximum consumer protection.
This subsection does not apply to major medical health insurance policies subject to regulation by the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, as amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, and regulations adopted pursuant to those acts, to the extent this requirement would result in a violation of federal law.

69O FAC 142.200 | Military Sales Practices

(1) The purpose of this regulation is to set forth standards to protect active duty service members of the United States Armed Forces from dishonest and predatory insurance sales practices by declaring certain identified practices to be false, misleading, deceptive or unfair.

(2) Scope - This regulation shall apply only to the solicitation or sale of any life insurance or annuity product by an insurer to an active duty service member of the United States Armed Forces.

(3) Exemptions - This regulation shall not apply to solicitations or sales involving:
(a) Credit insurance;

(b) Group life insurance or group annuities where there is no in-person, face-to-face solicitation of individuals by an insurance producer or where the contract or certificate does not include a side fund;

(c) An application to the existing insurer that issued the existing policy or contract when a contractual change or a conversion privilege is being exercised; or, when the existing policy or contract is being replaced by the same insurer pursuant to a program filed with and approved by the commissioner; or, when a term conversion privilege is exercised among corporate affiliates;

(d) Individual stand-alone health policies, including disability income policies;

(e) Contracts offered by Servicemembers' Group Life Insurance (henceforth "SGLI") or Veterans' Group Life Insurance (henceforth "VGLI"), as authorized by 38 U.S.C. Section 1965 et seq.;

(f) Life insurance contracts offered through or by a non-profit military association, qualifying under Section 501(c)(23) of the Internal Revenue Code (IRC), and which are not underwritten by an insurer; or

(g) Contracts used to fund:
1. An employee pension or welfare benefit plan that is covered by the Employee Retirement and Income Security Act (ERISA),

2. A plan described by Sections 401(a), 401(k), 403(b), 408(k) or 408(p) of the IRC, as amended, if established or maintained by an employer;

3. A government or church plan defined in Section 414 of the IRC, a government or church welfare benefit plan, or a deferred compensation plan of a state or local government or tax exempt organization under Section 457 of the IRC;

4. A nonqualified deferred compensation arrangement established or maintained by an employer or plan sponsor;

5. Settlements of or assumptions of liabilities associated with personal injury litigation or any dispute or claim resolution process; or

6. Prearranged funeral contracts.
(h) Nothing herein shall be construed to abrogate the ability of nonprofit organizations (and/or other organizations) to educate members of the United States Armed Forces in accordance with Department of Defense DoD Instruction 1344.07 - PERSONAL COMMERCIAL SOLICITATION ON DoD INSTALLATIONS or successor directive.

(i) For purposes of this regulation, general advertisements, direct mail and internet marketing shall not constitute "solicitation." Telephone marketing shall not constitute "solicitation" provided the caller explicitly and conspicuously discloses that the product concerned is life insurance and makes no statements that avoid a clear and unequivocal statement that life insurance is the subject matter of the solicitation. Provided however, nothing in this subsection shall be construed to exempt an insurer from this regulation in any in-person, face-to-face meeting established as a result of the "solicitation" exemptions identified in this subsection.
(4) Definitions:
(a) "Active Duty" means full-time duty in the active military service of the United States and includes members of the reserve component (National Guard and Reserve) while serving under published orders for active duty or full-time training or in a drill status in the National Guard or United States Armed Forces Reserve.

(b) "Department of Defense (DoD) Personnel" means all active duty service members and all civilian employees, including nonappropriated fund employees and special government employees, of the Department of Defense.

(c) "Door to Door" means a solicitation or sales method whereby an insurance producer proceeds randomly or selectively from household to household without prior specific appointment.

(d) "General Advertisement" means an advertisement having as its sole purpose the promotion of the reader's or viewer's interest in the concept of insurance, or the promotion of the insurer or the insurance producer.

(e) "Insurer" means an insurance company required to be licensed under the laws of this state to provide life insurance products, including annuities.

(f) "Insurance producer" means a person required to be licensed under the laws of this state to sell, solicit or negotiate life insurance, including annuities.

(g) "Known" or "Knowingly" means, depending on its use herein, the insurance producer or insurer had actual awareness, or in the exercise of ordinary care should have known, at the time of the act or practice complained of, that the person solicited is a service member.

(h) "Life Insurance" means insurance coverage on human lives including benefits of endowment and annuities, and may include benefits in the event of death or dismemberment by accident and benefits for disability income and unless otherwise specifically excluded, includes individually issued annuities.

(i) "Military Installation" means any federally owned, leased, or operated base, reservation, post, camp, building, or other facility to which service members are assigned for duty, including barracks, transient housing, and family quarters.

(j) "MyPay" is a Defense Finance and Accounting Service (DFAS) web-based system that enables service members to process certain discretionary pay transactions or provide updates to personal information data elements without using paper forms.

(k) "Service Member" means any active duty officer (commissioned and warrant) or enlisted member of the United States Armed Forces.

(l) "Side Fund" means a fund or reserve that is part of or otherwise attached to a life insurance policy (excluding individually issued annuities) by rider, endorsement or other mechanism which accumulates premium or deposits with interest or by other means. The term does not include:
1. Accumulated value or cash value or secondary guarantees provided by a universal life policy;

2. Cash values provided by a whole life policy which are subject to standard nonforfeiture law for life insurance; or

3. A premium deposit fund which:
a. Contains only premiums paid in advance which accumulate at interest;

b. Imposes no penalty for withdrawal;

c. Does not permit funding beyond future required premiums;

d. Is not marketed or intended as an investment; and,

e. Does not carry a commission, either paid or calculated.
(m) "Specific Appointment" means a prearranged appointment agreed upon by both parties and definite as to place and time.

(n) "United States Armed Forces" means all components of the Army, Navy, Air Force, Marine Corps, and Coast Guard.
(5) The following acts or practices when committed on a military installation by an insurer with respect to the in-person, face-to-face solicitation of life insurance are declared to be unfair or deceptive acts or practices prohibited by Sections 626.9541(1)(a), (b), (d), (e), (g), (k), (l), F.S.:
(a) Knowingly soliciting the purchase of any life insurance product "door to door" or without first establishing a specific appointment for each meeting with the prospective purchaser.

(b) Soliciting service members in a group or "mass" audience or in a "captive" audience where attendance is not voluntary.

(c) Knowingly making appointments with or soliciting service members during their normally scheduled duty hours.

(d) Making appointments with or soliciting service members in barracks, day rooms, unit areas, or transient personnel housing or other areas where the installation commander has prohibited solicitation.

(e) Soliciting the sale of life insurance without first obtaining permission from the installation commander or the commander's designee.

(f) Posting unauthorized bulletins, notices or advertisements.

(g) Failing to present DD Form 2885, Personal Commercial Solicitation Evaluation, to service members solicited or encouraging service members solicited not to complete or submit a DD Form 2885.

(h) Knowingly accepting an application for life insurance or issuing a policy of life insurance on the life of an enlisted member of the United States Armed Forces without first obtaining for the insurer's files a completed copy of any required form which confirms that the applicant has received counseling or fulfilled any other similar requirement for the sale of life insurance established by regulations, directives or rules of the DoD or any branch of the Armed Forces.

(i) Using DoD personnel, directly or indirectly, as a representative or agent in any official or business capacity with or without compensation with respect to the solicitation or sale of life insurance to service members.

(j) Using an insurance producer to participate in any United States Armed Forces sponsored education or orientation program.

(6) The following acts or practices by an insurer constitute corrupt practices, improper influences or inducements and are declared to be unfair or deceptive acts or practices prohibited by Sections 626.9541(1)(a), (b), (d), (e), (g), (k), (l), F.S., regardless of location:
(a) Submitting, processing or assisting in the submission or processing of any allotment form or similar device used by the United States Armed Forces to direct a service member's pay to a third party for the purchase of life insurance. The foregoing includes, but is not limited to, using or assisting in using a service member's "MyPay" account or other similar internet or electronic medium for such purposes. This subsection does not prohibit assisting a service member by providing insurer or premium information necessary to complete any allotment form.

(b) Knowingly receiving funds from a service member for the payment of premium from a depository institution with which the service member has no formal banking relationship. For purposes of this section, a formal banking relationship is established when the depository institution:
1. Provides the service member a deposit agreement and periodic statements and makes the disclosures required by the Truth in Savings Act, 12 U.S.C. 4301 et seq. and the regulations promulgated thereunder; and,

2. Permits the service member to make deposits and withdrawals unrelated to the payment or processing of insurance premiums.
(c) Employing any device or method or entering into any agreement whereby funds received from a service member by allotment for the payment of insurance premiums are identified on the service member's Leave and Earnings Statement or equivalent or successor form as "Savings" or "Checking" and where the service member has no formal banking relationship as defined in paragraph (6)(b).

(d) Entering into any agreement with a depository institution for the purpose of receiving funds from a service member whereby the depository institution, with or without compensation, agrees to accept direct deposits from a service member with whom it has no formal banking relationship.

(e) Using DoD personnel, directly or indirectly, as a representative or agent in any official or unofficial capacity with or without compensation with respect to the solicitation or sale of life insurance to service members, or to the family members of such personnel.

(f) Offering or giving anything of value, directly or indirectly, to DoD personnel to procure their assistance in encouraging, assisting or facilitating the solicitation or sale of life insurance to another service member.

(g) Knowingly offering or giving anything of value to a service member for his or her attendance to any event where an application for life insurance is solicited.

(h) Advising a service member to change his or her income tax withholding or State of legal residence for the sole purpose of increasing disposable income to purchase life insurance.

(i)
1. Making any representation, or using any device, title, descriptive name or identifier that has the tendency or capacity to confuse or mislead a service member into believing that the insurer, insurance producer or product offered is affiliated, connected or associated with, endorsed, sponsored, sanctioned or recommended by the U.S. Government, the United States Armed Forces, or any state or federal agency or government entity. Examples of prohibited insurance producer titles include, but are not limited to, "Battalion Insurance Counselor," "Unit Insurance Advisor," "Servicemen's Group Life Insurance Conversion Consultant," or "Veteran's Benefits Counselor."

2. Nothing herein shall be construed to prohibit a person from using a professional designation awarded after the successful completion of a course of instruction in the business of insurance by an accredited institution of higher learning. Such designations include, but are not limited to, Chartered Life Underwriter (CLU), Chartered Financial Consultant (ChFC), Certified Financial Planner (CFP), Master of Science In Financial Services (MSFS), or Masters of Science Financial Planning (MS).
(j) Soliciting the purchase of any life insurance product through the use of or in conjunction with any third party organization that promotes the welfare of or assists members of the United States Armed Forces in a manner that has the tendency or capacity to confuse or mislead a service member into believing that either the insurer, insurance producer or insurance product is affiliated, connected or associated with, endorsed, sponsored, sanctioned or recommended by the U.S. Government, or the United States Armed Forces.

(k) Using or describing the credited interest rate on a life insurance policy in a manner that implies that the credited interest rate is a net return on premium paid.

(l) Excluding individually issued annuities, misrepresenting the mortality costs of a life insurance product, including stating or implying that the product "costs nothing" or is "free."

(m) Making any representation regarding the availability, suitability, amount, cost, exclusions or limitations to coverage provided to a service member or dependents by SGLI or VGLI, which is false, misleading or deceptive.

(n) Making any representation regarding conversion requirements, including the costs of coverage, or exclusions or limitations to coverage of SGLI or VGLI to private insurers which is false, misleading or deceptive.

(o) Suggesting, recommending or encouraging a service member to cancel or terminate his or her SGLI policy or issuing a life insurance policy which replaces an existing SGLI policy unless the replacement shall take effect upon or after the service member's separation from the United States Armed Forces.

(p) Deploying, using or contracting for any lead generating materials designed exclusively for use with service members that do not clearly and conspicuously disclose that the recipient will be contacted by an insurance producer, if that is the case, for the purpose of soliciting the purchase of life insurance.

(q) Failing to disclose that a solicitation for the sale of life insurance will be made when establishing a specific appointment for an in-person, face-to-face meeting with a prospective purchaser.

(r) Excluding individually issued annuities, failing to clearly and conspicuously disclose the fact that the product being sold is life insurance.

(s) Failing to make, at the time of sale or offer to an individual known to be a service member, the written disclosures required by Section 10 of the "Military Personnel Financial Services Protection Act," Pub. L. No. 109-290, p.16.

(t) Excluding individually issued annuities, when the sale is conducted in-person face-to-face with an individual known to be a service member, failing to provide the applicant at the time the application is taken:
1. An explanation of any free look period with instructions on how to cancel if a policy is issued; and,

2. Either a copy of the application or a written disclosure. The copy of the application or the written disclosure shall clearly and concisely set out the type of life insurance, the death benefit applied for and its expected first year cost. A basic illustration that meets the requirements of Section 626.99, F.S., shall be deemed sufficient to meet this requirement for a written disclosure.
(u) Excluding individually issued annuities, recommending the purchase of any life insurance product which includes a side fund to a service member unless the insurer has reasonable grounds for believing that the life insurance death benefit, standing alone, is suitable.

(v) Offering for sale or selling a life insurance product which includes a side fund to a service member who is currently enrolled in SGLI, is presumed unsuitable unless, after the completion of a needs assessment, the insurer demonstrates that the applicant's SGLI death benefit, together with any other military survivor benefits, savings and investments, survivor income, and other life insurance are insufficient to meet the applicant's insurable needs for life insurance.
1. "Insurable needs" are the risks associated with premature death taking into consideration the financial obligations and immediate and future cash needs of the applicant's estate and/or survivors or dependents.

2. "Other military survivor benefits" include, but are not limited to: the Death Gratuity, Funeral Reimbursement, Transition Assistance, Survivor and Dependents' Educational Assistance, Dependency and Indemnity Compensation, TRICARE Healthcare benefits, Survivor Housing Benefits and Allowances, Federal Income Tax Forgiveness, and Social Security Survivor Benefits.
(w) Excluding individually issued annuities, offering for sale or selling any life insurance contract which includes a side fund:
1. Unless interest credited accrues from the date of deposit to the date of withdrawal and permits withdrawals without limit or penalty,

2. Unless the applicant has been provided with a schedule of effective rates of return based upon cash flows of the combined product. For this disclosure, the effective rate of return will consider all premiums and cash contributions made by the policyholder and all cash accumulations and cash surrender values available to the policyholder in addition to life insurance coverage. This schedule will be provided for at least each policy year from one (1) to ten (10) and for every fifth policy year thereafter ending at age 100, policy maturity or final expiration; and,

3. Which by default diverts or transfers funds accumulated in the side fund to pay, reduce or offset any premiums due.
(x) Excluding individually issued annuities, offering for sale or selling any life insurance contract which after considering all policy benefits, including but not limited to endowment, return of premium or persistency, does not comply with standard nonforfeiture law for life insurance.

(y) Selling any life insurance product to an individual known to be a service member that excludes coverage if the insured's death is related to war, declared or undeclared, or any act related to military service except for an accidental death coverage, e.g., double indemnity, which may be excluded.
69O-143 | Domestic Insurers

69O FAC 143.001 | Application and Scope of Chapter

The following rules and regulations shall be applicable to and govern equity securities of all domestic stock insurers, unless:
(1) Such securities shall be registered, or shall be required to be registered, pursuant to section 12 of the Securities Exchange Act of 1934, as amended, or unless

(2) Such domestic stock insurer shall not have any class of its equity securities held of record by 100 or more persons on the last business day of the year next preceding the year in which such securities would be subject to the provisions of Sections 625.75, 625.76 and 625.77, F.S., in which event such securities shall be exempt from the provisions of said Sections 625.75, 625.76 and 625.77, F.S.

69O FAC 143.002 | Definitions

(1) "Insurer" means any domestic stock insurance company, with an equity security subject to the provisions of Part IV of Chapter 625, F.S., and not exempt thereunder.

(2) "Act" means Part IV of Chapter 625, F.S.

(3) "Director" means Director of the Office of Insurance Regulation.

(4) "Officer" means a president, vice president, treasurer, actuary, secretary, controller and any other person who performs for the insurer functions corresponding to those performed by the foregoing officers.

(5) "Equity Security" means any stock or similar security; or any voting trust certificate or certificate of deposit for such a security; or any security convertible, with or without consideration into such a security, or carrying any warrant or right to subscribe to or purchase such a security; or any such warrant or right; or any other security which the Director shall deem to be of a similar nature and consider necessary or appropriate in the public interest or for the protection of investors, to treat as an equity security.

(6) Securities "held of record."
(a) For the purpose of determining whether the equity securities of an insurer are held of record by one hundred or more persons, securities shall be deemed to be "held of record" by each person who is identified as the owner of such securities on records of security holders maintained by or on behalf of the insurer, subject to the following:
1. In any case where the records of security holders have not been maintained in accordance with accepted practice, any additional person who would be identified as such an owner on such records if they had been maintained in accordance with accepted practice shall be included as a holder of record.

2. Securities identified as held of record by a corporation, a partnership, a trust whether or not the trustees are named, or other organization shall be included as so held by one person.

3. Securities identified as held of record by one or more persons as trustees, executors, guardians, custodians or in other fiduciary capacities with respect to a single trust, estate or account shall be included as held of record by one person.

4. Securities held by two or more persons as co-owners shall be included as held by one person.

5. Each outstanding unregistered or bearer certificate shall be included as held of record by a separate person, except to the extent that the insurer can establish that, if such securities were registered, they would be held of record, under the provisions of this rule, by a lesser number of persons.

6. Securities registered in substantially similar names where the insurer has reason to believe because of the address or other indications that such names represent the same person, may be included as held of record by one person.
(b) Notwithstanding paragraph (6)(a) of this subsection:
1. Securities held, to the knowledge of the insurer, subject to a voting trust, deposit agreement or similar arrangement shall be included as held of record by the record holders of the voting trust certificates, certificates of deposit, receipts or similar evidences of interest in such securities; provided however, that the insurer may rely on good faith on such information as is received in response to its request from a non-affiliated insurer of the certificates or evidences of interest.

2. If the insurer knows or has reason to know that the form of holding securities of record is used primarily to circumvent the provisions of the Act, the beneficial owners of such securities shall be deemed to be the record owners thereof.
(7) "Class" means all securities of an insurer which are of substantially similar character and the holders of which enjoy substantially similar rights and privileges.

69O FAC 143.003 | Filing of Statements

Initial statements of beneficial ownership of equity securities required by Section 625.75, F.S., of the Act shall be filed on Form A [eff. 4/66, available from Office of the Director]. Statements of changes in such beneficial ownership required by said section shall be filed on Form B, [eff. 4/66, available from Office of the Director]. All such statements shall be prepared and filed in accordance with the requirements of the applicable form.

69O FAC 143.004 | Ownership of More Than 10 Percent of an Equity Security

In determining, for the purpose of Section 625.75, F.S., of the Act, whether a person is the beneficial owner, directly or indirectly, of more than 10 percent of any class of any equity security, such class shall be deemed to consist of the total amount of such class outstanding, exclusive of any securities of such class held by or for the account of the insurer or a subsidiary of the insurer; except that for the purpose of determining percentage ownership of voting trust certificates or certificates of deposit for equity securities, the class of voting trust certificates or certificates of deposit shall be deemed to consist of the amount of voting trust certificates or certificates of deposit issuable with respect to the total amount of outstanding equity securities of the class which may be deposited under the voting trust agreement or deposit agreement in question, whether or not all of such outstanding securities have been so deposited. For the purpose of this section a person acting in good faith may rely on the information contained in the latest Convention Form Statement filed with the Director with respect to the amount of securities of a class outstanding or in the case of voting trust certificates or certificates of deposit the amount thereof issuable.

69O FAC 143.005 | Disclaimer of Beneficial Ownership

69O FAC 143.006 | Exemptions from Section 625.75 and 625.76 of the Act

(1) During the period of 12 months following their appointment and qualification, securities held by the following persons shall be exempt from Sections 625.75 and 625.76, F.S., of the Act:
(a) Executors or administrators of the estate of a decedent;

(b) Guardians or committees for an incompetent; and,

(c) Receivers, trustees in bankruptcy, assignees for the benefit of creditors, conservators, liquidating agents, and other similar persons duly authorized by law to administer the estate or assets of other persons.
(2) After the 12-month period following their appointment or qualification the foregoing persons shall be required to file reports with respect to the securities held by the estates which they administer under Section 625.75, F.S., of the Act, and shall be liable for profits realized from trading in such securities pursuant to Section 625.76, F.S., of the Act, only when the estate being administered is a beneficial owner of more than 10 percent of any class of equity security of an insurer subject to the Act.

(3) Securities reacquired by or for the account of an insurer and held by it for its account shall be exempt from Sections 625.75 and 625.76, F.S., of the Act, during the time they are held by the insurer.

69O FAC 143.007 | Exemption from the Act of Securities Purchased or Sold by Odd-lot Dealers

69O FAC 143.008 | Certain Transactions Subject to Section 625.75 of the Act

69O FAC 143.009 | Ownership of Securities Held in Trust

(1) Beneficial ownership of a security for the purpose of Section 625.75, F.S., of the Act shall include:
(a) The ownership of securities as a trustee where either the trustee or members of his immediate family have a vested interest in the income or corpus of the trust;

(b) The ownership of a vested beneficial interest in a trust; and,

(c) The ownership of securities as a settlor of a trust in which the settlor has the power to revoke the trust without obtaining the consent of all the beneficiaries.
(2) Except as provided in subsection (3) hereof, beneficial ownership of securities solely as a settlor or beneficiary of a trust shall be exempt from the provisions of Section 625.75, F.S., of the Act, where less than twenty percent in market value of the securities having a readily ascertainable market value held by such trust, determined as of the end of the preceding fiscal year of the trust, consists of equity securities with respect to which reports would otherwise be required. Exemption is likewise accorded from said Section 625.75, F.S., with respect to any obligation which would otherwise be imposed solely by reason of ownership as settlor or beneficiary of securities held in trust, where the ownership, acquisition, or disposition of such securities by the trust is made without prior approval by the settlor or beneficiary. No exemption pursuant to this subsection shall, however, be acquired or lost solely as a result of changes in the value of the trust assets during any fiscal year of during any time when there is no transaction by the trust in the securities otherwise subject to the reporting requirements of section 1.

(3) In the event that 10 percent of any class of any equity security of an insurer is held in a trust, that trust and the trustees thereof as such shall be deemed a person required to file the reports specified in Section 625.75, F.S., of the Act.

(4) Not more than one report need be filed to report any holdings or with respect to any transaction in securities held by a trust, regardless of the number of officers, directors or ten percent stockholders who are either trustees, settlors, or beneficiaries of a trust, provided that the report filed shall disclose the names of all trustees, settlors and beneficiaries who are officers, directors, or ten percent stockholders. A person having an interest only as a beneficiary of a trust shall not be required to file any such report so long as he relies in good faith upon an understanding that the trustee of such trust will file whatever reports might otherwise be required of such beneficiary.

(5) As used in this section the "immediate family" of a trustee means:
(a) A son or daughter of the trustee, or a descendant of either;

(b) A stepson or stepdaughter of the trustee;

(c) The father or mother of the trustee, or an ancestor of either;

(d) A stepfather or stepmother of the trustee;

(e) A spouse of the trustee. For the purpose of determining whether any of the foregoing relations exists, a legally adopted child of a person shall be considered a child of such person by blood.
(6) In determining, for the purposes of Section 625.75, F.S., of the Act, whether a person is the beneficial owner, directly or indirectly, of more than 10 percent of any class of any equity security, the interest of such person in the remainder of a trust shall be excluded from the computation.

(7) No report shall be required by any person, whether or not otherwise subject to the requirement of filing reports under Section 625.75, F.S., of the Act, with respect to his indirect interest in portfolio securities held by:
(a) A pension or retirement plan holding securities of an insurer whose employees generally are the beneficiaries of the plan;

(b) A business trust with over 25 beneficiaries.
(8) Nothing in this section shall be deemed to impose any duties or liabilities with respect to reporting any transaction or holding prior to its effective date.

69O FAC 143.010 | Exemption for Small Transactions

(1) Any acquisition of securities shall be exempt from Section 625.75, F.S., of the Act where:
(a) The person effecting the acquisition does not within six months thereafter effect any disposition, otherwise than by way of gift, of securities of the same class; and,

(b) The person effecting such acquisition does not participate in acquisitions or in dispositions of securities of the same class having a total market value in excess of $3,000 for any six months' period during which the acquisition occurs.
(2) Any acquisition or disposition of securities by way of gift, where the total amount of such gifts does not exceed $3,000 in market value for any six months' period, shall be exempt from Section 625.75, F.S., of the Act, and may be excluded from the computations prescribed in paragraph (1)(b).

(3) Any person exempted by subsection (1) or (2) of this section, shall include in the first report filed by him after a transaction within the exemption a statement showing his acquisitions and dispositions for each six months' period or portion thereof which has elapsed since his last filing.

69O FAC 143.011 | Exemption from Section 625.76 of the Act of Transactions Which Need Not Be Reported under Section 625.75

Any transaction which has been or shall be exempted from the requirements of Section 625.75, F.S., of the Act shall, insofar as it is otherwise subject to the provisions of Section 625.76, F.S., be likewise exempted from Section 625.76, F.S.

69O FAC 143.012 | Exemption from Section 625.76 of Certain Transactions Effected in Connection with a Distribution

(1) Any transaction of purchase and sale, or sale and purchase, of a security which is effected in connection with the distribution of a substantial block of securities shall be exempt from the provisions of Section 625.76, F.S., of the Act, to the extent specified in this section as not comprehended within the purpose of said section of the Act, upon the following conditions:
(a) The person effecting the transaction is engaged in the business of distributing securities and is participating in good faith, in the ordinary course of such business, in the distribution of such block of securities;

(b) The security involved in the transaction is:
1. A part of such block of securities and is acquired by the person effecting the transaction, with a view to the distribution thereof, from the insurer or other person on whose behalf such securities are being distributed or from a person who is participating in good faith in the distribution of such block of securities; or

2. A security purchased in good faith by or for the account of the person effecting the transaction for the purpose of stabilizing the market price of securities of the class being distributed or to cover an over-allotment or other short position created in connection with such distribution; and,
(c) Other persons not within the purview of Section 625.76, F.S., of the Act, are participating in the distribution of such block of securities on terms at least as favorable as those on which such person is participating and to an extent at least equal to the aggregate participation of all persons exempted from the provisions of Section 625.76, F.S., of the Act, by this section. However, the performance of the functions of manager of a distributing group and the receipt of a bona fide payment for performing such functions shall not preclude an exemption which would otherwise be available under this section.
(2) The exemption of a transaction pursuant to this section with respect to the participation therein of one party thereto shall not render such transaction exempt with respect to participation of any other party therein unless such other party also meets the conditions of this section.

69O FAC 143.013 | Exemption from Section 625.76 of the Act of Acquisitions of Shares of Stock and Stock Options under Certain Stock Bonus, Stock Option or Similar Plans

Any acquisition of shares of stock (other than stock acquired upon the exercise of an option, warrant or right) pursuant to a stock bonus, profit sharing, retirement, incentive, thrift, savings or similar plan, or any acquisition of a qualified or a restricted stock option pursuant to a qualified or a restricted stock option plan, or a stock option pursuant to an employee stock purchase plan, by a director or officer of an insurer issuing such stock or stock option shall be exempt from the operation of Section 625.76, F.S., of the Act, if the plan meets the following conditions:
(1) The plan has been approved directly or indirectly;
(a) By the affirmative votes of the holders of a majority of the securities of such insured present, or represented, and entitled to vote at a meeting duly held in accordance with the applicable laws of the State of Florida; or

(b) By the written consent of the holders of a majority of the securities of such insurer entitled to vote: provided, however, that if such vote or written consent was not solicited substantially in accordance with the proxy rules and regulations prescribed by the Office in effect at the time of such vote or written consent, the insurer shall furnish in writing to the holders of record of the securities entitled to vote for the plan substantially the same information concerning the plan which would be required by any such rules and regulations so prescribed and in effect at the time such information is furnished, if proxies to be voted with respect to the approval or disapproval of the plan were then being solicited, on or prior to the date of the first annual meeting of security holders held subsequent to the later of;
1. The date the Act first applies to such insurer; or

2. The acquisition of an equity security for which exemption is claimed.
Such written information may be furnished by mail to the last known address of the security holders of record within 30 days prior to the date of mailing. Four copies of such written information shall be filed with, the Office electronically at http://www.FLOir.com/iPortal not later than the date on which it is first sent or given to security holders of the insurer. For the purposes of this paragraph, the term "insurer" includes a predecessor corporation if the plan or obligations to participate thereunder were assumed by the insurer in connection with the succession.
(2) If the selection of any director or officer of the insurer to whom stock may be allocated or to whom qualified, restricted or employee stock purchase plan stock options may be granted pursuant to the plan, or the determination of the number or maximum number of shares of stock which may be allocated to any such director or officer or which may be covered by qualified, restricted or employee stock purchase plan stock options granted to any such director or officer, is subject to the discretion of any person, then such discretion shall be exercised only as follows:
(a) With respect to the participation of directors.
1. By the board of directors of the insurer, a majority of which board and a majority of the directors acting in the matter are disinterested persons;

2. By, or only in accordance with the recommendations of, a committee of three or more persons having full authority to act in the matter, all of the members of which committee are disinterested persons; or

3. Otherwise in accordance with the plan, if the plan (i) specifies the number or maximum number of shares of stock which directors may acquire or which may be subject to qualified, restricted or employee stock purchase plan stock options granted to directors and the terms upon which, and the times at which, or the periods within which, such stock may be acquired or such options may be acquired and exercised; or (ii) sets forth, by formula or otherwise, effective and determinable limitations with respect to the foregoing based upon earnings of the insurer, dividends paid, compensation received by participants, option prices, market value of shares, outstanding shares or percentages thereof outstanding from time to time, or similar factors.
(b) With respect to the participation of officers who are not directors.
1. By the board of directors of the insurer or a committee of three or more directors; or

2. By, or only in accordance with the recommendations of, a committee of three or more persons having full authority to act in the matter, all of the members of which committee are disinterested persons.
For the purpose of this paragraph, a director or committee member shall be deemed to be a disinterested person only if such person is not at the time such discretion is exercised eligible and has not at any time within one year prior thereto been eligible for selection as a person to whom stock may be allocated or to whom qualified, restricted or employee stock purchase plan stock options may be granted pursuant to the plan or any other plan of the insurer or any of its affiliates entitling the participants therein to acquire stock or qualified, restricted or employee stock purchase plan stock options of the insurer or any of its affiliates.

(c) The provisions of this paragraph shall not apply with respect to any option granted, or other equity security acquired, prior to the effective date of the Act.
(3) As to each participant or as to all participants the plan effectively limits the aggregate dollar amount or the aggregate number of shares of stock which may be allocated, or which may be subject to qualified, restricted, or employee stock purchase plan stock options granted, pursuant to the plan. The limitations may be established on an annual basis, or for the duration of the plan, whether or not the plan has a fixed termination date; and may be determined either by fixed or maximum dollar amounts or fixed or maximum numbers of shares or by formulas based upon earnings of the insurer, dividends paid, compensation received by participants, option prices, market value of shares, outstanding shares or percentages thereof outstanding from time to time, or similar factors which will result in an effective and determinable limitation. Such limitations may be subject to any provisions for adjustment of the plan or of stock allocable or options outstanding thereunder to prevent dilution or enlargements of rights.

(4) Unless the context otherwise requires, all terms used in this section shall have the same meaning as in the Act or elsewhere in these rules or regulations. In addition, the following definitions apply:
(a) The term "plan" includes any plan, whether or not set forth in any formal written document or documents and whether or not approved in its entirety at one time.

(b) The definition of the terms "qualified stock option" and "employee stock purchase plan" that are set forth in sections 422 and 423 of the Internal Revenue Code of 1954, as amended, are to be applied to those terms where used in this section. The term "restricted stock option" as defined in section 424(b) of the Internal Revenue Code of 1954, as amended, shall be applied to that term as used herein, provided however, that for the purposes hereof an option which meets all of the conditions of said section, of the Internal Revenue Code, other than the date of issuance, shall be deemed to be a "restricted stock option."

(c) The term "exercise of an option, warrant or right" contained in the parenthetical clause of the first paragraph of this rule shall not include:
1. The making of any election to receive under any plan an award of compensation in the form of stock or credits therefor, provided that such election is made prior to the making of the award, and provided further that such election is irrevocable until at least six months after termination of employment;

2. The subsequent crediting of such stock;

3. The making of any election as to a time for delivery of such stock after termination of employment, provided that such election is made at least six months prior to any such delivery;

4. The fulfillment of any condition to the absolute right to receive such stock; or

5. The acceptance of certificates for shares of such stock.

69O FAC 143.014 | Exemption from Section 625.76 of the Act of Certain Transactions in Which Securities Are Received by Redeeming Other Securities

Any acquisition of an equity security (other than a convertible security or right to purchase a security) by a director or officer of the insurer issuing such security shall be exempt from the operation of Section 625.76, F.S., of the Act, upon condition that:
(1) The equity security is acquired by way of redemption of another security of an insurer substantially all of whose assets other than cash (or Government bonds) consist of securities of the insurer issuing the equity security so acquired, and which:
(a) Represented substantially and in practical effect a stated or readily ascertainable amount of such equity security;

(b) Had a value which was substantially determined by the value of such equity security; and,

(c) Conferred upon the holder the right to receive such equity security without the payment of any consideration other than the security redeemed;
(2) No security of the same class as the security redeemed was acquired by the director or officer within six months prior to such redemption or is acquired within six months after such redemption;

(3) The insurer issuing the equity security acquired has recognized the applicability of subsection (1) of this section, by appropriate corporate action.

69O FAC 143.015 | Exemption of Long Term Profits Incident to Sales Within 6 Months of the Exercise of an Option

Transactions that are not subject to Section 628.461, F.S., and that are the result of the following are exempt from Sections 625.75 and 625.76, F.S.:
(1) Acquisitions of shares of stock and stock options under a stock bonus plan, stock option plan, or similar plan securities acquired by redeeming other securities by an insurer;

(2) Consolidations or mergers of insurers that hold over 85 percent of the companies being merged or consolidated;

(3) Acquisitions or dispositions of an equity security involved in the deposit of the security under, or the withdrawal of the security from, a voting trust or deposit agreement; or

(4) Conversions of an insurer's equity securities into another equity security of the same insurer.

69O FAC 143.016 | Exemption from Section 625.76 of the Act of Certain Acquisitions and Dispositions of Securities Pursuant to Merger or Consolidations

(1) The following transactions shall be exempt from the provisions of Section 625.76, F.S., of the Act, as not comprehended within the purpose of said section:
(a) The acquisition of a security of an insurer, pursuant to a merger or consolidation, in exchange for a security of a company which, prior to said merger or consolidation, owned 85 percent or more of the equity securities of all other companies involved in the merger or consolidation except, in the case of consolidation, the resulting company;

(b) The disposition of a security, pursuant to a merger or consolidation of an insurer which, prior to said merger or consolidation, owned 85 percent or more of the equity securities of all other companies involved in the merger or consolidation except, in the case of consolidation, the resulting company;

(c) The acquisition of a security of an insurer, pursuant to a merger or consolidation, in exchange for a security of a company which, prior to said merger or consolidation, held over 85 percent of the combined assets of all the companies undergoing merger or consolidation, computed according to their book values prior to the merger or consolidation as determined by reference to their most recent available financial statements for a 12-month period prior to the merger or consolidation;

(d) The disposition of a security, pursuant to a merger or consolidation, of an insurer which, prior to said merger or consolidation, held over 85 percent of the combined assets of all the companies undergoing merger or consolidation, computed according to their book values prior to merger or consolidation, as determined by reference to their most recent available financial statements for a 12-month period prior to the merger or consolidation.
(2) A merger within the meaning of this section shall include the sale or purchase of substantially all the assets of one insurer by another in exchange for stock which is then distributed to the security holders of the insurer which sold its assets.

(3) Notwithstanding the foregoing, if an officer, director or stockholder shall make any purchase (other than a purchase exempted by this section) of a security in any company involved in the merger or consolidation and any sale (other than a sale exempted by this section) of a security in any other company involved in the merger or consolidation within any period of less than six months during which the merger or consolidation took place, the exemption provided by this section shall be unavailable to such officer, director, or stockholder.

69O FAC 143.017 | Exemption from Section 625.76 of Certain Securities Received upon Surrender of Similar Equity Securities

Any acquisition or disposition of an equity security involved in the deposit of such security under, or the withdrawal of such security from, a voting trust or deposit agreement, and the acquisition or disposition in connection therewith of the certificate representing such security, shall be exempt from the operation of Section 625.76, F.S., of the Act, if substantially all of the assets held under the voting trust or deposit agreement immediately after the deposit or immediately prior to the withdrawal, as the case may be, consisted of equity securities of the same class as the security deposited or withdrawn provided, however, that this rule shall not apply to the extent that there shall have been either:
(1) A purchase of an equity security of the class deposited and a sale of any certificate representing an equity security of such class; or

(2) A sale of an equity security of the class deposited and a purchase of any certificate representing an equity security of such class (otherwise than in a transaction involved in such deposit or withdrawal or in a transaction exempted by any other provisions of Section 625.76, F.S., of the Act) within a period of less than six months which includes the date of the deposit or withdrawal.

(3) The surrender and issuance are made pursuant to provisions of a certificate of incorporation which require that the shares issued upon such surrender shall be registered upon issuance in the name of a person or persons other than the holder of the shares surrendered and may be required to be issued as of right only in connection with the public offering, sale and distribution of such shares and the immediate sale by such holder of such shares for that purpose, or in connection with a gift of such shares.

(4) Neither the shares so surrendered nor any shares of the same class, nor other shares of the same class as those issued upon such surrender, have been or are purchased (otherwise than in a transaction exempted by this section), by the person surrendering such shares, within six months before or after such surrender or issuance.

69O FAC 143.018 | Exemption from Section 625.76 of the Act of Certain Transactions Involving an Exchange of Similar Securities

(1) Any acquisition or disposition of an equity security involved in the conversion of an equity security which, by its terms or pursuant to the terms of the insurer's charger or other governing instruments, is convertible immediately or after a stated period of time into another equity security of the same insurer, shall be exempt from the operation of Section 625.76, F.S., of the Act; provided, however, that this rule shall not apply to the extent that there shall have been either:
(a) A purchase of any equity security of the class convertible (including any acquisition of or change in a conversion privilege) and a sale of any equity security of the class issuable upon conversion; or

(b) A sale of any equity security of the class convertible and any purchase of any equity security issuable upon conversion (otherwise than in a transaction involved in such conversion or in a transaction exempted by any other provisions of Section 625.76, F.S., of the Act) within a period of less than six months which includes the date of conversion.
(2) For the purpose of this rule, an equity security shall not be deemed to be acquired or disposed of upon conversion of an equity security if the terms of the equity security converted require the payment or entail the receipt, in connection with such conversion, of cash or other property (other than equity securities involved in the conversion) equal in value at the time of conversion to more than 15 percent of the value of the equity security issued upon conversion.

(3) For the purpose of this rule, an equity security shall be deemed convertible if it is convertible at the option of the holder or of some other person or by operation of the terms of the security or the governing instruments.

69O FAC 143.019 | Exemption of Certain Securities from Section 625.78 of the Act

69O FAC 143.020 | Exemption from Section 625.78 of the Act of Certain Transactions Effected in Connection with a Distribution

Any security shall be exempt from the operation of Section 625.78, F.S., of the Act, to the extent necessary to render lawful under such section any sale made by or on behalf of a dealer in connection with a distribution of a substantial block of securities, upon the following conditions:
(1) The sale is represented by an over-allotment in which the dealer is participating as a member of an underwriting group, or the dealer or a person acting on his behalf intends in good faith to offset such sale with a security to be acquired by or on behalf of the dealer as a participant in an underwriting, selling or soliciting-dealer group of which the dealer is a member at the time of the sale, whether or not the security to be so acquired is subject to a prior offering to existing security holders or some other class of persons; and,

(2) Other persons not within the purview of Section 625.78, F.S., of the Act, are participating in the distribution of such block of securities on terms at least as favorable as those on which such dealer is participating and to an extent at least equal to the aggregate participation of all persons exempted from the provisions of Section 625.78, F.S., of the Act, by this section. However, the performance of the functions of manager of a distributing group and the receipt of a bona fide payment for performing such functions shall not preclude an exemption which would otherwise be available under this section.

69O FAC 143.021 | Exemption from Section 625.78 of the Act of Sales of Securities to Be Acquired

(1) Whenever any person is entitled, as an incident to his ownership of an issued security and without the payment of consideration, to receive another security "when issued" or "when distributed," the security to be acquired shall be exempt from the operation of Section 625.78, F.S., provided that:
(a) The sale is made subject to the same conditions as those attaching to the right of acquisition; and,

(b) Such person exercises reasonable diligence to deliver such security to the purchaser promptly after his right of acquisition matures; and,

(c) Such person reports the sale on the appropriate form for reporting transactions by persons subject to Section 625.75, F.S., of the Act.
(2) This section shall not be construed as exempting transactions involving both a sale of a security "when issued" or "when distributed" and a sale of the security by virtue of which the seller expects to receive the "when-issued" or "when-distributed" security, if the two transactions combined result in a sale of more units than the aggregate of those owned by the seller plus those to be received by him pursuant to his right of acquisition.

69O FAC 143.022 | Arbitrage Transactions under Section 625.79 of the Act

It shall be unlawful for any director or officer of an insurer to effect any foreign or domestic arbitrage transaction in any equity security of such insurer, unless he shall include such transaction in the statements required by Section 625.75, F.S., of the Act, and shall account to such insurer for the profits arising from such transaction, as provided in Section 625.76, F.S., thereof. The provisions of Section 625.78, F.S., shall not apply to such arbitrage transactions. The provisions of the Act shall not apply to any bona fide foreign or domestic arbitrage transaction insofar as it is effected by any person other than such director or officer of the insurer.

69O FAC 143.026 | Application and Scope of Chapter

The following rules and regulations shall be applicable to and govern all domestic stock insurers having one hundred or more stockholders; provided, however, that said rules shall not apply to any insurer if ninety-five percent or more of its stock is owned or controlled by a parent or an affiliated insurer and the remaining shares are held by less than five hundred stockholders. A domestic stock insurer which files with the Securities and Exchange Commission forms of proxies, consents and authorizations complying with the requirements of the Securities and Exchange Act of 1934, the Securities and Exchange Acts Amendments of 1964, and Regulation X-14 of the Securities and Exchange Commission promulgated thereunder, shall be exempt from the provisions of said rules.

69O FAC 143.027 | Proxies, Consents and Authorizations

No domestic stock insurer, or any director, officer or employee of such insurer subject to Rule 69O-143.026, F.A.C., hereof, or any other person, shall solicit, or permit the use of his name to solicit, by mail or otherwise, any proxy, consent or authorization in respect of any stock of such insurer in contravention of this chapter, and without first having filed with the Director, in writing, the information requested in Rules 69O-143.036 and 69O-143.037, F.A.C., hereof.

69O FAC 143.028 | Disclosure of Equivalent Information

Unless proxies, consents or authorizations in respect of any class of stock of a domestic insurer subject to Rule 69O-143.026, F.A.C., are solicited by or on behalf of the management of such insurer from the holders of record of stock of such insurer in accordance with this chapter prior to any annual or other meeting, such insurer shall, in accordance with this chapter and such further rules and regulations as the Director may adopt, file with the Director and transmit to all stockholders of record information substantially equivalent to the information which would be required to be transmitted if a solicitation were made. Such insurer shall transmit a written information statement containing the information specified in subsection 69O-143.030(4), F.A.C., to every stockholder who is entitled to vote in regard to any matter to be acted upon at the meeting and from whom a proxy is not solicited on behalf of the management of the insurer; provided, that in the case of a class of stock in unregistered or bearer form such statement need be transmitted only to those stockholders whose names and addresses are known to the insurer.

69O FAC 143.029 | Definitions

(1) The definitions and instructions set out in Schedule SIS, as promulgated by the National Association of Insurance Commissioners, shall be applicable for the purposes of this chapter.

(2) The terms "solicit" and "solicitation" for purposes of this chapter shall include:
(a) Any request for a proxy, whether or not accompanied by or included in a form of proxy; or

(b) Any request to execute or not to execute, or to revoke, a proxy; or

(c) The furnishing of a proxy or other communication to stockholders under circumstances reasonably calculated to result in the procurement, withholding or revocation of a proxy.
(3) The terms "solicit" and "solicitation" shall not include:
(a) Any solicitation by a person in respect of stock of which he is the beneficial owner;

(b) Action by a broker or other person in respect to stock carried in his name or in the name of his nominee in forwarding to the beneficial owner of such stock soliciting material received from the company, or impartially instructing such beneficial owner to forward a proxy to the person, if any, to whom the beneficial owner desires to give a proxy, or impartially requesting instructions from the beneficial owner with respect to the authority to be conferred by the proxy and stating that a proxy will be given if the instructions are received by a certain date;

(c) The furnishing of a form of proxy to a stockholder upon the unsolicited request of such stockholder, or the performance by any person of ministerial acts on behalf of a person soliciting a proxy.
(4) The term "stock" for the purposes of this chapter shall be intended to mean "equity security."

(5) The term "stockholder" for the purposes of this chapter shall be intended to mean "security holder."

69O FAC 143.030 | Information to Be Furnished to Stockholders

(1) No solicitation subject to this chapter shall be made unless each person solicited is concurrently furnished or has previously been furnished with a written proxy statement containing the information specified in Rule 69O-143.036, F.A.C.

(2) If the solicitation is made on behalf of the management of the insurer and relates to an annual meeting of stockholders at which directors are to be elected, each proxy statement furnished pursuant to subsection (3), hereof, shall be accompanied or preceded by an annual report (in preliminary or final form) to such stockholders containing such financial statements for the last fiscal year as are referred to in Schedule SIS under the heading "Financial Reporting to Stockholders." Subject to the foregoing requirements with respect to financial statements, the annual report to stockholders may be in any form deemed suitable by the management.

(3) Two copies of each report sent to the stockholders pursuant to this section shall be filed electronically with the Office at http://www.FLOir.com/iPortal not later than the date on which such report is first sent or given to stockholders or the date on which preliminary copies of solicitation material are filed with the Office, pursuant to subsection (1), of Rule 69O-143.032, F.A.C., of this rule, whichever date is later.

(4) If no solicitation is being made by management of the insurer with respect to any annual or other meeting, such insurer shall mail to every stockholder of record at least twenty days prior to the meeting date, an information statement as required in Rule 69O-143.028, F.A.C., containing the information called for by subsections (2) and (5) through (15), of Rule 69O-143.036, F.A.C., which would be applicable to any matter to be acted upon at the meeting if proxies were to be solicited in connection with the meeting. If such information statement relates to an annual meeting at which directors are to be elected, it shall be accompanied by an annual report to such stockholders in the form provided in subsection (2) of this rule.

69O FAC 143.031 | Requirements as to Proxy and Information Statement

(1) The form of proxy shall:
(a) Indicate in boldface type whether or not the proxy is solicited on behalf of the management;

(b) Provide a specifically designated blank space for dating the proxy; and,

(c) Identify clearly and impartially each matter or group of related matters intended to be acted upon, whether proposed by the management, or stockholders. No reference need be made to proposals as to which discretionary authority is conferred pursuant to subsection (3) hereof.
(2) Means shall be provided in the proxy for the person solicited to specify by ballot a choice between approval or disapproval of each matter or group of related matters referred to therein. A proxy may confer discretionary authority with respect to matters as to which a choice is not so specified if the form of proxy states in bold-face type how it is intended to vote the shares or authorization represented by the proxy in each such case.

(3) A proxy may confer discretionary authority with respect to other matters which may come before the meeting, provided the persons on whose behalf the solicitation is made are not aware a reasonable time prior to the time the solicitation is made that any other matters are to be presented for action at the meeting and provided further that a specific statement to that effect is made in the proxy statement or in the form of proxy.

(4) No proxy shall confer authority to:
(a) Vote for the election of any person to any office for which a bona fide nominee is not named in the proxy statement; or

(b) Vote at any annual meeting other than the next annual meeting (or any adjournment thereof) to be held after the date on which the proxy statement and form of proxy are first sent or given to stockholders.
(5) The proxy statement or form of proxy shall provide, subject to reasonable specified conditions, that the proxy will be voted and that where the person solicited specifies by means of ballot provided pursuant to subsection (2), hereof, a choice with respect to any matter to be acted upon, the vote will be in accordance with the specifications so made.

(6) The information included in the proxy statement or information statement shall be clearly presented and the statements made shall be divided into groups according to subject matter, with appropriate headings. All printed proxy statements or information statements shall be clearly and legibly presented.

(7) The filing with the Director of any proxy statement, form of proxy, information statement or other soliciting material shall not be deemed a finding by the Director that such material is accurate or complete or not false or misleading, or that the Director has passed upon the merits of or approved any statement contained therein, or any matter to be acted upon by security holders.

(8) No representation contrary to subsection (7) shall be made, provided that after approval by the Director of any matter required by law to be approved, the insurer may include as an exhibit to the proxy statement, form of proxy or information statement reproduction of such written approval.

69O FAC 143.032 | Material Required to Be Filed

(1) Two preliminary copies of the information statement or the proxy statement and form of proxy and any other soliciting material to be furnished to stockholders concurrently therewith shall be filed with the Office at least fifteen days prior to the date definitive copies of such material are first sent or given to stockholders, or such shorter period prior to that date as the Office may authorize upon a showing of good cause therefor.

(2) Two preliminary copies of any additional soliciting material relating to the same meeting or subject matter to be furnished to stockholders subsequent to the proxy statements shall be filed with the Office at least two days (exclusive of Saturdays, Sundays or holidays) prior to the date copies of this material are first sent or given to stockholders or a shorter period prior to such date as the Office may authorize upon a showing of good cause therefor.

(3) Two definitive copies of the information statement or the proxy statement, form of proxy and all other soliciting material, in the form in which this material is furnished to stockholders, shall be filed with the Office not later than the date such material is first sent or given to the stockholders.

(4) Where any information statement or proxy statement, form of proxy or other material filed pursuant to this chapter is amended or revised, two of the copies shall be marked to clearly show such changes.

(5) Copies of replies to inquiries from stockholders requesting further information and copies of communications which do no more than request that forms of proxy theretofore solicited be signed and returned need not be filed pursuant to this section.

(6) Notwithstanding the provisions of subsections (1) and (2), hereof and of subsection (5), of Rule 69O-143.035, F.A.C., copies of soliciting material in the form of speeches, press releases and radio or television scripts may, but need not, be filed with the Office prior to use or publication. Definitive copies, however, shall be filed with the Office as requested by subsection (3), hereof, not later than the date such material is used or published. The provisions of subsections (1) and (2), hereof, and subsection (5) of Rule 69O-143.035, F.A.C., shall apply, however, to any reprints or reproductions of all or any part of such material. All filings made pursuant to this rule shall be submitted electronically at http://www.FLOir.com/iPortal.

69O FAC 143.033 | False or Misleading Statements

No proxy statement, form of proxy, notice of meeting, information statement, or other communication, written or oral, subject to this chapter, shall contain any statement which at the time and in the light of the circumstances under which it is made, is false or misleading with respect to any material fact, or which omits to state any material fact necessary in order to make the statements therein not false or misleading or necessary to correct any statement in any earlier communication with respect to the same meeting or subject matter which has become false or misleading.

69O FAC 143.034 | Prohibition of Certain Solicitations

No person making a solicitation which is subject to this chapter shall solicit any undated or postdated proxy or any proxy which provides that it shall be deemed to be dated as of any date subsequent to the date on which it is signed by the stockholder.

69O FAC 143.035 | Special Provisions Applicable to Election Contests

(1) Applicability.

This section shall apply to any solicitation subject to this chapter by any person or group for the purpose of opposing a solicitation subject to this chapter by any other person or group with respect to the election or removal of directors at any annual or special meeting of stockholders.

(2) Participant or Participant in a Solicitation.

(a) For purposes of this section the terms "participant" and "participant in a solicitation" include:
1. The insurer;

2. Any director of the insurer, and any nominee for whose election as a director proxies are solicited;

3. Any other person, acting alone or with one or more other persons, committees or groups, in organizing, directing or financing the solicitation.
(b) For the purposes of this section the term "participant" and "participant in a solicitation" do not include:
1. A bank, broker or dealer who, in the ordinary course of business, lends money or executes orders for the purchase of sale of stock and who is not otherwise a participant;

2. Any person or organization retained or employed by a participant to solicit stockholders or any person who merely transmits proxy soliciting material or performs ministerial or clerical duties;

3. Any person employed in the capacity of attorney, accountant, or advertising, public relations or financial adviser, and whose activities are limited to the performance of his duties in the course of such employment;

4. Any person regularly employed as an officer or employee of the insurer or any of its subsidiaries or affiliates who is not otherwise a participant; or

5. Any officer or director of, or any person regularly employed by any other participant, if such officer, director, or employee is not otherwise a participant.

(3) Filing of Information Required by Rule 69O-143.037, F.A.C.

(a) No solicitation subject to this section shall be made by any person other than the management of an insurer unless at least five business days prior thereto, or such shorter period as the Office may authorize upon a showing of good cause therefor, there has been filed with the Office by or on behalf of each participant in such solicitation, a statement in duplicate containing the information specified by Rule 69O-143.037, F.A.C., and a copy of any material proposed to be distributed to stockholders in furtherance of such solicitation. Where preliminary copies of any materials are filed, distribution to stockholders should be deferred until the Office's comments have been received and complied with.

(b) Within five business days after a solicitation subject to this section is made by the management of an insurer, or such longer periods as the Office may authorize upon a showing of good cause therefor, there shall be filed with the Office by or on behalf of each participant in such solicitation, other than the insurer, and by or on behalf of each management nominee for director, a statement in duplicate containing the information specified by Rule 69O-143.037, F.A.C.

(c) If any solicitation on behalf of management or any other person has been made, or if proxy material is ready for distribution, prior to a solicitation subject to this section in opposition thereto, a statement in duplicate containing the information specified in Rule 69O-143.037, F.A.C., shall be filed with the Office, by or on behalf of each participant in such prior solicitation, other than the insurer, as soon as reasonably practicable after the commencement of the solicitation in opposition thereto.

(d) If, subsequent to the filing of the statements required by paragraphs (a), (b), and (c) of this subsection, additional persons become participants in a solicitation subject to this rule, there shall be filed with the Office, by or on behalf of each such person, a statement in duplicate containing the information specified by Rule 69O-143.037, F.A.C., within three business days after such person becomes a participant, or such longer period as the Office may authorize upon a showing of good cause therefor.

(e) If any material change occurs in the facts reported in any statement filed by or on behalf of any participant, an appropriate amendment to such statement shall be filed promptly with the Office.

(f) Each statement and amendment thereto filed, pursuant to this subsection shall be part of the public files of the Office.

(4) Solicitations Prior to Furnishing Required Proxy Statement.

Notwithstanding the provisions of subsection (1) of Rule 69O-143.030, F.A.C., a solicitation subject to this section may be made prior to furnishing stockholders a written proxy statement containing the information specified in Rule 69O-143.036, F.A.C., with respect to such solicitation, provided that:
(a) The statements required by subsection (3), hereof, are filed by or on behalf of each participant in such solicitation.

(b) No form of proxy is furnished to stockholders prior to the time the written proxy statement required by subsection (1) of Rule 69O-143.030, F.A.C., is furnished to such persons; provided, however, that this paragraph (4)(b), shall not apply where a proxy statement then meeting the requirements of Rule 69O-143.036, F.A.C., has been furnished to stockholders.

(c) At least the information specified in paragraphs (3)(b) and (c), of the statements required by subsection (3), hereof, to be filed by each participant, or an appropriate summary thereof, are included in each communication sent or given to stockholders in connection with the solicitation.

(d) A written proxy statement containing the information specified in Rule 69O-143.036, F.A.C., with respect to a solicitation is sent or given to stockholders at the earliest practicable date.

(5) Solicitations Prior to Furnishing Required Written Proxy Statements - Filing Requirements.

Two copies of any soliciting material proposed to be sent or given to stockholders prior to the furnishing of the written proxy statement required by subsection (1) of Rule 69O-143.030, F.A.C., shall be filed with the Office in preliminary form at least five business days prior to the date definitive copies of such material are first sent or given to such persons, or such shorter period as the Office may authorize upon a showing of good cause therefor.

(6) Application of this section to Report.

Notwithstanding the provisions of subsections (1) and (2) of Rule 69O-143.030, F.A.C., two copies of any portion of the report referred to in subsection (1) of Rule 69O-143.030, F.A.C., which comments upon or refers to any solicitation subject to this section, or to any participant in any such solicitation, other than the solicitation by the management, shall be filed with the Office as proxy material subject to this rule. Such portion of the report shall be filed with the Office, in preliminary form, at least five business days prior to the date copies of the report are first sent or given to the stockholders. All filings required by this rule shall be filed electronically at http://www.FLOir.com/iPortal.

69O FAC 143.036 | Information to Be Filed in Proxy Statements

(1) Revocability of Proxy.

State whether or not the person giving the proxy has the power to revoke it. If the right of revocation before the proxy is exercised, is limited or is subject to compliance with any formal procedure, briefly describe such limitation or procedure.

(2) Dissenters' Rights of Appraisal.

Outline briefly the rights of appraisal or similar rights of dissenting stockholders with respect to any matter to be acted upon and indicate any statutory procedure required to be followed by such stockholders in order to protect their rights. Where such rights may be exercised only within a limited time after the date of the adoption of a proposal, the filing of a charter amendment, or other similar act, state whether the person solicited will be notified of such date.

(3) Persons Making Solicitations not Subject to Rule 69O-143.035, F.A.C.

(a) If the solicitation is made by the management of the insurer, so state. Give the name of any director of the insurer who has informed the management in writing that he intends to oppose any action intended to be taken by the management and indicate the action which he intends to oppose.

(b) If the solicitation is made otherwise than by the management of the insurer, state the names and addresses of the persons by whom and on whose behalf it is made and the names and addresses of the persons by whom the cost of solicitation has been or will be borne, directly or indirectly.

(c) If the solicitation is to be made by specially engaged employees or paid solicitors, state:
1. The material features of any contract or arrangement for such solicitation and identify the parties; and,

2. The cost or anticipated cost thereof.

(4) Interest of Certain Persons in Matters to be Acted Upon.

Describe briefly any substantial interest, direct or indirect, by stockholding or otherwise, of any director, nominee for election for director, officer and, if the solicitation is made otherwise than on behalf of management, each person on whose behalf the solicitation is made, in any matter to be acted upon other than elections to office.

(5) Stocks and Principal Stockholders.

(a) State, as to each class of voting stock of the insurer entitled to be voted at the meeting, the number of shares outstanding and the number of votes to which each class is entitled.

(b) Give the dates as of which the record list of stockholders entitled to vote at the meeting will be determined. If the right to vote is not limited to stockholders of record on that date, indicate the conditions under which other stockholders may be entitled to vote.

(c) If action is to be taken with respect to the election of directors and if the persons solicited have cumulative voting rights, make a statement that they have such rights and state briefly the conditions precedent to the exercise thereof.

(6) Nominees and Directors.

If action is to be taken with respect to the election of directors furnish the following information, in tabular form to the extent practicable, with respect to each person nominated for election as a director and each other person whose term of office as a director will continue after the meeting:
(a) Name each such person, state when his term of office or the term of office for which he is a nominee will expire, and all other positions and offices with the insurer presently held by him, and indicate which persons are nominees for election as directors at the meeting.

(b) State his present principal occupation or employment and give the name and principal business of any corporation or other organization in which such employment is carried on. Furnish similar information as to all his principal occupations or employments during the last five years, unless he is now a director and was elected to his present term of office by a vote of stockholders at a meeting for which proxies were solicited under this chapter.

(c) If he is or has previously been a director of the insurer, state the period or periods during which he has served as such.

(d) State, as of the most recent practicable date, the approximate amount of each class of stock of the insurer or any of its parents, subsidiaries or affiliates other than directors' qualifying shares, beneficially owned directly or indirectly by him. If he is not the beneficial owner of any such stocks make a statement to that effect.

(7) Remuneration and Other Transactions with Management and Others.

Furnish the information reported or required in Item One of Schedule SIS under the heading "Information Regarding Management and Directors" if action is to be taken with respect to:
(a) The election of directors;

(b) Any remuneration plan, contract or arrangement in which any director, nominee for election as a director, or officer of the insurer, will participate;

(c) Any pension or retirement plan in which any such person will participate; or

(d) The granting or extension to any such person of any options, warrants or rights to purchase any stocks, other than warrants or rights issued to stockholders, as such, on a pro rata basis. If the solicitation is made on behalf of persons other than the management, information shall be furnished only as to Item One-A of the aforesaid heading of Schedule SIS.

(8) Bonus, Profit-Sharing and Other Remuneration Plans.

If action is to be taken with respect to any bonus, profit-sharing, or other remuneration plan of the insurer, furnish the following information:
(a) A brief description of the material features of the plan, each class of persons who will participate therein, the approximate number of persons in each such class, and the basis of such participation.

(b) The amounts which would have been distributable under the plan during the last calendar year to:
1. Each person named in subsection (7) of this section;

2. Directors and officers as a group; and,

3. To all other employees as a group, if the plan had been in effect.
(c) If the plan to be acted upon may be amended (other than by a vote of stockholders) in a manner which would materially increase the cost thereof to the insurer or to materially alter the allocation of the benefits as between the groups specified in paragraph (8)(b) of this subsection, the nature of such amendments should be specified.

(9) Pension and Retirement Plans.

If action is to be taken with respect to any pension or retirement plan of the insurer, furnish the following information:
(a) A brief description of the material features of the plan, each class of persons who will participate therein, the approximate number of persons in each such class, and the basis of such participation.

(b) State:
1. The approximate total amount necessary to fund the plan with respect to past services, the period over which such amount is to be paid, and the estimated annual payments necessary to pay the total amount over such period;

2. The estimated annual payment to be made with respect to current services; and,

3. The amount of such annual payments to be made for the benefit of:

a. Each person named in subsection (7) of this section;

b. Directors and officers as a group; and,

c. Employees as a group.
(c) If the plan to be acted upon may be amended (other than by a vote of stockholders) in a manner which would materially increase the cost thereof of the insurer or to materially alter the allocation of the benefits as between the groups specified in subparagraph (9)(b)3. of this subsection, the nature of such amendments should be specified.

(10) Options, Warrants or Rights.

If action is to be taken with respect to the granting or extension of any options, warrants or rights (all referred to herein as "warrants") to purchase stock of the insurer or any subsidiary or affiliate, other than warrants issued to all stockholders on a pro rata basis, furnish the following information:
(a) The title and amount of stock called for or to be called for, the prices, expiration dates and other material conditions upon which the warrants may be exercised, the consideration received or to be received by the insurer, subsidiary or affiliate for the granting or extension of the warrants and the market value of the stock called for or to be called for by the warrants, as of the latest practicable date.

(b) If known, state separately the amount of stock called for or to be called for by warrants received or to be received by the following persons, naming each such person:
1. Each person named in subsection (7) of this section; and,

2. Each other person who will be entitled to acquire five percent or more of the stock called for or to be called for by such warrants.
(c) If known, state also the total amount of stock called for or to be called for by such warrants, received or to be received by all directors and officers of the company as a group and all employees, without naming them.

(11) Authorization or Issuance of Stock.

(a) If action is to be taken with respect to the authorization or issuance of any stock of the insurer furnish the title, amount and description of the stock to be authorized or issued.

(b) If the shares of stock are other than additional shares of common stock of a class outstanding, furnish a brief summary of the following, if applicable: dividend, voting, liquidation, preemptive, and conversion rights, redemption and sinking fund provisions, interest rate and date of maturity.

(c) If the shares of stock to be authorized or issued are other than additional shares of common stock of a class outstanding, the Director may require financial statements comparable to those contained in the annual report.

(12) Mergers, Consolidations, Acquisitions and Similar Matters:

(a) If action is to be taken with respect to a merger, consolidation, acquisition, or similar matter, furnish in brief outline the following information.
1. The rights of appraisal or similar rights of dissenters with respect to any matters to be acted upon. Indicate any procedure required to be followed by dissenting stockholders in order to perfect such rights.

2. The material features of the plan or agreement.

3. The business done by the company to be acquired or whose assets are being acquired.

4. If available, the high and low sales prices for each quarterly period within two years.

5. The percentage of outstanding shares which must approve the transaction before it is consummated.
(b) For each company involved in a merger, consolidation or acquisition, the following financial statements should be furnished:
1. A comparative balance sheet as of the close of the last two fiscal years.

2. A comparative statement of operating income and expenses for each of the last two fiscal years and, as a continuation of each statement, a statement of earnings per share after related taxes and cash dividends paid per share.

3. A pro forma combined balance sheet and income and expenses statement for the last fiscal year giving effect to the necessary adjustments with respect to the resulting company.

(13) Restatement of Accounts.

If action is to be taken with respect to the restatement of any asset, capital, or surplus of the insurer, furnish the following information:
(a) State the nature of the restatement and the date as of which it is to be effective.

(b) Outline briefly the reasons for the restatement and for the selection of the particular effective date.

(c) State the name and amount of each account affected by the restatement and the effect of the restatement thereon.

(14) Matters Not Required to Be Submitted.

If action is to be taken with respect to any matter which is not required to be submitted to a vote of stockholders, state the nature of such matter, the reason for submitting it to a vote of stockholders and what action is intended to be taken by the management in the event of a negative vote on the matter by the stockholders.

(15) Amendment of Charter, By-Laws, or Other Documents.

If action is to be taken with respect to any amendment of the insurer's charter, by-laws, or other documents as to which information is not required above, state briefly the reasons for the general effect of such amendment and the vote needed for its approval.

69O FAC 143.037 | Information to Be Filed by or on Behalf of a Participant (Other Than the Insurer) in a Proxy Solicitation in an Election Contest

(1) Insurer.

State the name and address of the insurer.

(2) Identity and Background.

(a) State the following:
1. Your name and business address.

2. Your present principal occupation or employment and the name, principal business and address of any corporation or other organization in which such employment is carried on.
(b) State the following:
1. Your residence address.

2. Information as to all material occupations, positions, offices or employments during the last ten years, giving starting and ending dates of each and the name, principal business and address of any business corporation or other business organization in which each such occupation, position, office or employment was carried on.
(c) State whether or not you are or have been a participant in any other proxy contest involving this company or other companies within the past ten years. If so, identify the principals, the subject matter and your relationship to the parties and the outcome.

(d) State whether or not, during the past ten years, you have been convicted in a criminal proceeding (excluding traffic violations or similar misdemeanors) and, if so, give dates, nature of conviction, name and location of court, and penalty imposed or other disposition of the case. A negative answer to this subparagraph need not be included in the proxy statement or other proxy soliciting material.

(3) Interest in Stock of the Insurer.

(a) State the amount of each class of stock of the insurer which you own beneficially, directly or indirectly.

(b) State the amount of each class of stock of the insurer which you own of record but not beneficially.

(c) State with respect to the stock specified in paragraphs (3)(a) and (b), the amounts acquired within the past two years, the dates of acquisition and the amounts acquired on each date.

(d) If any part of the purchase price or market value of any of the stock specified in paragraph (3)(c), is represented by funds borrowed or otherwise obtained for the purpose of acquiring or holding such stock, so state and indicate the amount of the indebtedness as of the latest practicable date. If such funds were borrowed or obtained otherwise than pursuant to a margin account or bank loan in the regular course of business of a bank, broker or dealer, briefly describe the transaction, and state the names of the parties.

(e) State whether or not you are a party to any contracts, arrangements or understandings with any person with respect to any stock of the insurer, including but not limited to joint ventures, loan or option arrangements, puts or calls, guarantees against loss or guarantees of profits, division of losses or profits, or the giving or withholding of proxies. If so, name the persons with whom such contracts, arrangements, or understandings exist and give the details thereof.

(f) State the amount of stock of the insurer owned beneficially, directly or indirectly, by each of your associates and the name and address of each such associate.

(g) State the amount of each class of stock of any parent, subsidiary or affiliate of the insurer which you own beneficially, directly or indirectly.

(4) Further Matters to Be Furnished.

(a) Describe the time and circumstances under which you became a participant in the solicitation and state the nature and extent of your activities or proposed activities as a participant.

(b) Describe briefly, and where practicable state the approximate amount of any material interest, direct or indirect, of yourself and of each of your associates in any material transactions since the beginning of the company's last fiscal year, or in any material proposed transactions, to which the company or any of its subsidiaries or affiliates was or is to be a party.

(c) State whether or not you or any of your associates have any arrangement or understanding with any person:
1. With respect to any future employment by the insurer or its subsidiaries or affiliates; or

2. With respect to any future transactions to which the insurer or any of its subsidiaries or affiliates will or may be a party. If so, describe such arrangement or understanding and state the names of the parties thereto.

(5) Signature.

The statement required in this section shall be dated and signed in the following manner:
I certify that the statements made in this statement are true, complete, and correct, to the best of my knowledge and belief.

_________________________________________

(Date)

_________________________________________

(Signature)

69O FAC 143.041 | Definitions

For the purpose of this chapter, the following definitions shall apply (for any terms defined in Section 628.511(2), F.S., these definitions are supplementary):
(1) "Agent" shall mean a national bank, state bank, trust company or broker/dealer which maintains an account in its name in a clearing corporation or which is a member of the Federal Reserve System and through which a custodian participates in a clearing corporation, including the Treasury/Reserve Automated Debt Entry Securities System (TRADES) or Treasury Direct System, except that with respect to securities issued by institutions organized or existing under the laws of any foreign country or securities used to meet the deposit requirements pursuant to the laws of a foreign country as a condition of doing business therein, "agent" may include a corporation which is organized or existing under the laws of any foreign country and which is legally qualified under such laws to accept custody of securities.

(2) "Custodian" shall mean:
(a) A national bank, state bank, or trust company which shall at all times during which it acts as a custodian pursuant to this chapter be no less than adequately capitalized as determined by the standards adopted by United States banking regulators and that is regulated by either state banking laws or is a member of the Federal Reserve System and which is legally qualified to accept custody of securities in accordance with the standards set forth below;

(b) With respect to securities issued by institutions organized or existing under the laws of any foreign country, or securities used to meet the deposit requirements pursuant to the laws of a foreign country as a condition of doing business therein, "custodian" may include a bank or trust company incorporated or organized under the laws of a country other than the United States that is regulated as such by that country's government or an agency thereof that at all times during which it acts as a custodian pursuant to this chapter be no less than adequately capitalized as determined by the standards adopted by international banking authorities and that is legally qualified to accept custody of securities; or

(c) A broker/dealer that is registered with and subject to jurisdiction of the Securities and Exchange Commission, maintains membership in the Securities Investor Protection Corporation, and has a tangible net worth equal to or greater than two hundred fifty million dollars ($250,000,000).
(3) "Custodied securities" means securities held by the custodian or its agent or in a clearing corporation, including the Treasury/Reserve Automated Debt Entry Securities System (TRADES) or Treasury Direct systems.

(4) "Tangible net worth" means shareholders equity, less intangible assets, as reported in the broker/dealer's most recent Annual or Transition Report (S.E.C. Form 10-K) filed with the Securities and Exchange Commission.

(5) "Treasury/Reserve Automated Debt Entry Securities Systems (TRADES)" and "Treasury Direct" mean the book entry securities systems established pursuant to 31 U.S.C. chapter 31, 12 U.S.C. s. 391 and 5 U.S.C. s. 301.

69O FAC 143.042 | Custody Agreement; Requirements

(1) A domestic insurance company may, by written agreement with a custodian, provide for the custody of its securities with that custodian. The securities that are the subject of the agreement may be held by the custodian or its agent or in a clearing corporation.

(2) Any such agreement shall be in writing and shall be authorized by a resolution of the Board of Directors of the insurance company or of an authorized committee thereof. The terms of the agreement shall comply with the following:
(a) Securities' certificates held by the custodian shall be held separate from the securities certificates of the custodian and of all of its other customers.

(b) Securities held indirectly by the custodian and securities in a clearing corporation shall be separately identified on the custodian's official records as being owned by the insurance company. Said records shall identify which securities are held by the custodian or by its agent and which securities are in a clearing corporation. If the securities are in a clearing corporation, said records shall also identify where the securities are and if in a clearing corporation, the name of the clearing corporation and if through an agent, the name of the agent.

(c) All custodied securities that are registered shall be registered in the name of the company or in the name of a nominee of the company or in the name of the custodian or its nominee or, if in a clearing corporation, in the name of the clearing corporation or its nominee.

(d) Custodied securities shall be held subject to the instructions of the insurance company and shall be withdrawable upon the demand of the insurance company, except that custodied securities used to meet the deposit requirements set forth in Section 624.411, F.S., shall, to the extent required by that section, be under the control of the Office and shall not be withdrawn by the insurance company without the approval of the Office.

(e) The custodian shall be required to send or cause to be sent to the insurance company a confirmation of all transfers of custodied securities to or from the account of the insurance company. In addition, the custodian shall be required to furnish no less than monthly the insurance company with reports of holdings of custodied securities at such times and containing such information as may be reasonably requested by the insurance company. The custodian's trust committee's annual report of its review of the insurer's trust accounts shall also be provided to the insurance company. Reports and verifications may be transmitted in electronic or paper form.

(f) During the course of the custodian's regular business hours, any officer or employee of the insurance company, any independent accountant selected by the insurance company and any representative of an appropriate regulatory body shall be entitled to examine, on the premises of the custodian, the custodian's records relating to custodied securities, but only upon furnishing the custodian with written instructions to that effect from an appropriate officer of the insurance company.

(g) The custodian and its agents shall be required to send to the insurance company all reports which they receive from a clearing corporation their respective systems of internal accounting control and reports prepared by outside auditors on the custodians or its agent's internal accounting control of custodied securities that the insurance company may reasonably request.

(h) The custodian shall maintain records sufficient to determine and verify information relating to custodied securities that may be reported in the insurance company's Annual Statement and supporting Schedules and information required in any audit of the financial statements of the insurance company.

(i) The custodian shall provide, upon written request from the Office or from an appropriate officer of the insurance company, the appropriate affidavits, on Forms OIR-A1-341 (A), (B), or (C) (rev. 12-07), or substantially similar forms with respect to custodied securities. Forms OIR-A1-341 (A), (B) and (C) (rev. 12-07), entitled "Custodian Affidavit," are hereby incorporated by reference. Forms are available at http://www.FLOir.com/iPortal.

(j) A national bank, state bank or trust company shall secure and maintain insurance protection in an adequate amount covering the bank's or trust company's duties and activities as custodian for the insurer's assets, and shall state in the custody agreement that protection is in compliance with the requirements of the custodian's banking regulator. A broker/dealer shall secure and maintain insurance protection for each insurance company's custodied securities in excess of that provided by the Securities Investor Protection Corporation in an amount equal to or greater than the market value of each respective insurance company's custodied securities.

(k) The custodian shall be obligated to indemnify the insurance company for any loss of custodied securities occasioned by the negligence or dishonesty of the custodian's officers or employees, or burglary, robbery, holdup, theft or mysterious disappearance, including loss by damage or destruction.

(l) In the event that there is a loss of custodied securities for which the custodian shall be obligated to indemnify the insurance company as provided in paragraph (2)(k), above, the custodian shall promptly replace the securities or the value thereof and the value of any loss of rights or privileges resulting from said loss of securities.

(m) The agreement may provide that the custodian will not be liable for any failure to take any action required to be taken under the agreement in the event and to the extent that the taking of such action is prevented or delayed by war (whether declared or not and including existing wars), revolution, insurrection, riot, civil commotion, act of God, accident, fire, explosion, stoppage of labor, strikes or other differences with employees, laws, regulations, orders or other acts of any governmental authority, or any other cause whatever beyond its reasonable control.

(n) In the event that the custodian gains entry in a clearing corporation through an agent, there shall be an agreement between the custodian and the agent under which the agent shall be subject to the same liability for loss of custodied securities as the custodian, provided, however, that, if the agent shall be subject to regulation under the laws of a jurisdiction which is different from the jurisdiction the laws of which regulate the custodian, the Director may accept a standard of liability applicable to the agent which is different from the standard of liability applicable to the custodian.

(o) The custodian shall provide written notification to the Office if the custodial agreement with the insurer has been terminated or if 100% of the account assets in any one custody account have been withdrawn. This notification shall be remitted to the Office within three (3) business days of the receipt by the custodian of the insurer's written notice of termination or within three (3) business days of the withdrawal of 100% of the account assets. All filings shall be submitted electronically to http://www.FLOir.com/iPortal.
(3)
(a) Nothing in this rule shall prevent an insurance company from depositing securities with another insurance company with which the depositing insurance company is affiliated, provided that the securities are deposited pursuant to a written agreement authorized by the board of directors of the depositing insurance company or an authorized committee thereof and that the receiving insurance company is organized under the laws of one of the states of the United States of America or of the District of Columbia. If the respective states of domicile of the depositing and receiving insurance companies are not the same, the depositing insurance company shall have given notice of the deposit to the insurance commissioner in the state of its domicile and the insurance commissioner shall not have objected to it within thirty (30) days of the receipt of the notice. All filings shall be submitted electronically to http://www.FLOir.com/iPortal.

(b) The terms of any such agreement shall comply with the following:
1. The insurance company receiving the deposit shall maintain records adequate to identify and verify the securities belonging to the depositing insurance company.

2. The receiving insurance company shall allow representatives of an appropriate regulatory body to examine records relating to securities held subject to the agreement.

3. The depositing insurance company may authorize the receiving insurance company:
a. To hold the securities of the depositing insurance company in bulk, in certificates issued in the name of the receiving insurance company or its nominee, and to commingle them with securities owned by other affiliates of the receiving insurance company; and,

b. To provide for the securities to be held by a custodian, including the custodian of securities of the receiving insurance company or in a clearing corporation.

69O FAC 143.045 | Definitions (Repealed)

69O FAC 143.046 | Registration of Insurers

(1) Every insurer which is authorized to do business in this state and which is a member of an insurance holding company system shall register with the Office by April 1, except a foreign insurer subject to disclosure requirements and standards adopted by statute or regulation in the jurisdiction of its domicile which are substantially similar to those contained in this rule and Rule 69O-143.047, F.A.C. Any insurer which becomes subject to registration under this rule after April 1 shall register within fifteen days after it becomes subject to registration. The Office may require any authorized insurer which is a member of a holding company system which is not subject to registration under this rule to furnish a copy of the registration statement or other information filed by such insurance company with the insurance regulatory authority of domiciliary jurisdiction.

(2) All filings required by this rule shall be submitted electronically to the Office via the Regulatory Electronic Filing System, "REFS" at http://www/FLOir.com/iPortal.

(3) Every insurer subject to registration shall file a registration statement on a Form OIR-D0-516, incorporated by reference in paragraph 69O-143.046(15)(a), F.A.C. The form shall provide current information about:
(a) The capital structure, general financial condition, ownership and management of the insurer and any person controlling the insurer;

(b) The identity and relationship of every member of the insurance holding company system;

(c) The following agreements in force and transactions currently outstanding or which have occurred during the last calendar year between the insurer and its affiliates:
1. Loans, other investments, or purchases, sales or exchanges of securities of the affiliates by the insurer or of the insurer by its affiliates;

2. Purchases, sales, or exchanges of assets;

3. Transactions not in the ordinary course of business;

4. Guarantees or undertakings for the benefit of an affiliate which result in an actual contingent exposure of the insurer's assets to liability, other than insurance contracts entered into in the ordinary course of the insurer's business;

5. All management and service contracts and all cost-sharing arrangements;

6. Reinsurance agreements;

7. Dividends and other distributions to shareholders; and,

8. Consolidated tax allocation agreements.
(d) Any pledge of the insurer's stock, including stock of any subsidiary or controlling affiliate, for a loan made to any member of the insurance holding company system;

(e) If requested by the Office, the insurer shall include financial statements of or within an insurance holding company system, including all affiliates. Financial statements may include but are not limited to annual audited financial statements filed with the U.S. Securities and Exchange Commission (SEC) pursuant to the Securities Act of 1933, as amended or the Securities Exchange Act of 1934, as amended. An insurer required to file financial statements pursuant to this paragraph may satisfy the request by providing the Office with the most recently filed parent corporation financial statements that have been filed with the SEC;

(f) Other matters concerning transactions between registered insurers and any affiliates as may be included from time to time in any registration forms adopted or approved by the Office; and,

(g) Statements that the insurer's board of directors oversees corporate governance and internal controls and that the insurer's officers or senior management have approved, implemented, and continue to maintain and monitor corporate governance and internal control procedures.
(4) All registration statements shall contain a summary outlining all items in the current registration statement representing changes from the prior registration statement filed on a Form OIR-A1-2116, incorporated by reference in paragraph 69O-143.046(15)(b), F.A.C.

(5) No information need be disclosed on the registration statement filed pursuant to subsection (3) of this rule, if such information is not material for the purposes of this rule and Rule 69O-143.047, F.A.C. Unless the Office by rule, regulation or order provides otherwise, sales, purchases, exchanges, loans, or extensions of credit, or investments, involving one-half of 1% or less of an insurer's admitted assets as of the prior year end shall not be deemed material for purposes of this section.

(6) Each registered insurer shall keep current the information required to be disclosed in its registration statement by reporting all material changes or additions on an amended Form OIR-D0-516 incorporated by reference in paragraph 69O-143.046(15)(a), F.A.C., within fifteen calendar days after the end of the month in which it learns of each such change or addition. The amended Form OIR-D0-516 should only address those items which are being amended, and should include at the top of the cover page "Amendment No. [insert number] to Form B for [insert year]." Notwithstanding the provisions of this paragraph, dividends and other distributions to shareholders are to be reported to the Office pursuant to Section 628.371, F.S.

(7) In addition to the registration statement required in subsection (3), each registered insurer, except foreign insurers subject to disclosure requirements and standards adopted by statute or regulation in the jurisdiction of its domicile which are substantially similar to those contained in this rule and Rule 69O-143.047, F.A.C., shall also provide on Form OIR-A1-2118, incorporated by reference in paragraph 69O-143.046(15)(c), F.A.C., the information required under Section 628.801(2), F.S.

(8) The Office shall terminate the registration of any insurer which demonstrates that it no longer is a member of an insurance holding company system.

(9) The Office may require or allow two or more affiliated insurers subject to registration hereunder to file a consolidated registration statement or consolidated reports amending their consolidated registration statement or their individual registration statement.

(10) The Office may allow an insurer which is authorized to do business in this state and which is part of an insurance holding company system to register on behalf of any affiliated insurer which is required to register under subsection (1) of this rule, and to file all information and material required to be filed under this rule.

(11) The provisions of this rule shall not apply to any insurer, information or transaction if and to the extent that the Office by rule, regulation, or order shall exempt the same from the provisions of this rule.

(12) Any person may file with the Office a disclaimer of affiliation with any authorized insurer or such a disclaimer may be filed by such insurer or any member of an insurance holding company system. The disclaimer shall fully disclose all material relationships and bases for affiliation between such person and such insurer as well as the basis for disclaiming such affiliation. After a disclaimer has been filed, the insurer shall be relieved of any duty to register or report under this rule which may arise out of the insurer's relationship with such person unless and until the Office disallows such a disclaimer. A disclaimer of affiliation shall be deemed to have been granted unless the Office, within thirty (30) calendar days following the receipt of a complete disclaimer, notifies the filing party that it is disallowed.

(13) Any person within an insurance holding company system subject to registration shall be required to provide complete and accurate information to an insurer, where such information is reasonably necessary to enable the insurer to comply with the provisions of this rule chapter.

(14) The failure to file a registration statement or any amendment thereto required by this rule within the time specified for such filing shall be a violation of this rule.

(15) The following forms are hereby incorporated by reference:
(a) Form OIR-D0-516, "Form B ? Insurance Holding Company System Annual Registration Statement," effective 09/18, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-11238;

(b) Form OIR-A1-2116, "Form C ? Summary of Changes to Registration Statement," effective 09/18, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-11239; and,

(c) Form OIR-A1-2118, "Form F ? Enterprise Risk Report," effective 09/18, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-11240.

69O FAC 143.0465 | Groupwide Supervision of Internationally Active Insurance Groups

(1) For the purposes of this rule, "internationally active insurance group" means an insurance holding company system that:
(a) Includes an insurer registered under Rule 69O-143.046, F.A.C.; and

(b) Meets the following criteria:
1. Premiums written in at least three countries;

2. The percentage of gross premiums written outside the United States is at least ten percent (10%) of the insurance holding company system's total gross written premiums; and

3. Based on a three-year rolling average, the total assets of the insurance holding company system are at least fifty billion dollars ($50,000,000,000) or the total gross written premiums of the insurance holding company system are at least ten billion dollars ($10,000,000,000).
(2) "Insurance Holding Company System" consists of two or more affiliated persons, one or more of which is an insurer.

(3)
(a) The Office is authorized to act as the groupwide supervisor for any internationally active insurance group in accordance with Rule 69O-143.046, F.A.C., and Section 628.804, F.S. However, the Office may otherwise acknowledge another regulatory official as the groupwide supervisor where the internationally active insurance group:
1. Does not have substantial insurance operations in the United States;

2. Has substantial insurance operations in the United States, but not in this state; or

3. Has substantial insurance operations in the United States and this state, but the Office has determined pursuant to the factors set forth in subsections (4) and (8) that the other regulatory official is the appropriate groupwide supervisor.
(b) An insurance holding company system that does not otherwise qualify as an internationally active insurance group may request that the Office make a determination or acknowledgment as to a groupwide supervisor pursuant to this subsection.
(4)
(a) In cooperation with other state, federal and international regulatory agencies, the Office will identify a single groupwide supervisor for an internationally active insurance group. The Office may determine that the Office is the appropriate groupwide supervisor for an internationally active insurance group that conducts substantial insurance operations concentrated in this state. However, the Office may acknowledge that a regulatory official from another jurisdiction is the appropriate groupwide supervisor for the internationally active insurance group. The Office shall consider the following factors when making a determination or acknowledgment under this subsection:
1. The place of domicile of the insurers within the internationally active insurance group that hold the largest share of the group's written premiums, assets or liabilities;

2. The place of domicile of the top-tiered insurer(s) in the insurance holding company system of the internationally active insurance group;

3. The location of the executive offices or largest operational offices of the internationally active insurance group;

4. Whether another regulatory official is acting or is seeking to act as the groupwide supervisor under a regulatory system that the Office determines to be:
a. Substantially similar to the system of regulation provided under the laws of this state, or b. Otherwise sufficient in terms of providing for groupwide supervision, enterprise risk analysis, and cooperation with other regulatory officials; and

5. Whether another regulatory official acting or seeking to act as the groupwide supervisor provides the Office with reasonably reciprocal recognition and cooperation.
(b) However, a regulatory official identified under this rule as the groupwide supervisor may determine that it is appropriate to acknowledge another supervisor to serve as the groupwide supervisor. The acknowledgment of the groupwide supervisor shall be made after consideration of the factors listed in subparagraphs (a)1. through (a)5. above, and shall be made in cooperation with and subject to the acknowledgment of other regulatory officials involved with supervision of members of the internationally active insurance group, and in consultation with the internationally active insurance group.
(5) Notwithstanding any other provision of law, when another regulatory official is acting as the groupwide supervisor of an internationally active insurance group, the Office shall acknowledge that regulatory official as the groupwide supervisor. However, in the event of a material change in the internationally active insurance group that results in:
(a) The internationally active insurance group's insurers domiciled in this state holding the largest share of the group's premiums, assets or liabilities; or

(b) This state being the place of domicile of the top-tiered insurer(s) in the insurance holding company system of the internationally active insurance group, the Office shall make a determination or acknowledgment as to the appropriate groupwide supervisor for such an internationally active insurance group pursuant to subsection (4).
(6) Pursuant to Section 628.801(3), F.S., the Office is authorized to collect from any insurer registered pursuant to Rule 69O-143.046, F.A.C., all information necessary to determine whether the Office may act as the groupwide supervisor of an internationally active insurance group or if the Office may acknowledge another regulatory official to act as the groupwide supervisor. Prior to issuing a determination that an internationally active insurance group is subject to groupwide supervision by the Office, the Office shall notify the insurer registered pursuant to Rule 69O-143.046, F.A.C., and the ultimate controlling person within the internationally active insurance group. The internationally active insurance group shall have not less than thirty (30) days to provide the Office with additional information pertinent to the pending determination. The Office shall publish the identity of internationally active insurance groups that the Office has determined are subject to groupwide supervision by the Office.

(7) If the Office is the groupwide supervisor for an internationally active insurance group, the Office is authorized to engage in any of the following groupwide supervision activities.
(a) Assess the enterprise risks within the internationally active insurance group to ensure that:
1. The material financial condition and liquidity risks to the members of the internationally active insurance group that are engaged in the business of insurance are identified by management; and

2. Reasonable and effective mitigation measures are in place.
(b) Request, from any member of an internationally active insurance group subject to the Office's supervision, information necessary and appropriate to assess enterprise risk, including, but not limited to, information about the members of the internationally active insurance group regarding:
1. Governance, risk assessment and management;

2. Capital adequacy; and

3. Material intercompany transactions.
(c) Coordinate and, through the authority of the regulatory officials of the jurisdictions where members of the internationally active insurance group are domiciled, compel development and implementation of reasonable measures designed to ensure that the internationally active insurance group is able to timely recognize and mitigate enterprise risks to members of such internationally active insurance group that are engaged in the business of insurance.

(d) Communicate with other state, federal and international regulatory agencies for members within the internationally active insurance group and share relevant information subject to the confidentiality provisions of Section 628.801(4), F.S., through supervisory colleges as set forth in Section 628.805, F.S., or otherwise.

(e) Enter into agreements with or obtain documentation from any insurer registered under Rule 69O-143.046, F.A.C., any member of the internationally active insurance group, and any other state, federal and international regulatory agencies for members of the internationally active insurance group, providing the basis for or otherwise clarifying the Office's role as groupwide supervisor, including provisions for resolving disputes with other regulatory officials. Such agreements or documentation shall not serve as evidence in any proceeding that any insurer or person within an insurance holding company system not domiciled or incorporated in this state is doing business in this state or is otherwise subject to jurisdiction in this state.

(f) Other groupwide supervision activities, consistent with the authorities and purposes enumerated above, as considered necessary by the Office.
(8) If the Office acknowledges that another regulatory official from a jurisdiction that is not accredited by the NAIC is the groupwide supervisor, the Office is authorized to reasonably cooperate, through supervisory colleges or otherwise, with groupwide supervision undertaken by the groupwide supervisor, provided that:
(a) The Office's cooperation is in compliance with the laws of this state; and

(b) The regulatory official acknowledged as the groupwide supervisor also recognizes and cooperates with the Office's activities as a groupwide supervisor for other internationally active insurance groups where applicable. Where such recognition and cooperation is not reasonably reciprocal, the Office is authorized to refuse recognition and cooperation.
(9) The Office is authorized to enter into agreements with or obtain documentation from any insurer registered under Rule 69O-143.046, F.A.C., any affiliate of the insurer, and other state, federal and international regulatory agencies for members of the internationally active insurance group, that provide the basis for or otherwise clarify a regulatory official's role as groupwide supervisor.

69O FAC 143.0466 | Contents of Corporate Governance Annual Disclosure

The corporate governance annual disclosure filed in accordance with Section 628.8015, F.S., must describe:
(1) The insurer's or insurance group's corporate governance framework and structure including consideration of the following:
(a) The Board of Directors ("Board") and various committees thereof ultimately responsible for overseeing the insurer or insurance group and the level(s) at which that oversight occurs, including ultimate control level, intermediate holding company, and legal entity. The insurer or insurance group shall describe and discuss the rationale for the current Board size and structure; and

(b) The duties of the Board and each of its significant committees and how they are governed, including the bylaws, charters, and informal mandates, as well as how the Board's leadership is structured, including a discussion of the roles of Chief Executive Officer and Chairman of the Board within the organization.
(2) The policies and practices of the most senior governing entity and significant committees thereof, including a discussion of the following factors:
(a) How the qualifications, expertise and experience of each Board member meet the needs of the insurer or insurance group;

(b) How an appropriate amount of independence is maintained on the Board and its significant committees.;

(c) The number of meetings held by the Board and its significant committees over the past year as well as information on director attendance.; and

(d) How the insurer or insurance group identifies, nominates, and elects members to the Board and its committees. The discussion should include:
1. Whether a nomination committee is in place to identify and select individuals for consideration,

2. Whether term limits are placed on directors,

3. How the election and re-election processes function,

4. Whether a Board diversity policy is in place and if so, how it functions, and

5. The processes in place for the Board to evaluate its performance and the performance of its committees, as well as any recent measures taken to improve performance and any Board or committee training programs that have been put in place).
(3) The policies and practices for directing senior management, including a description of the following factors:
(a) Any processes or practices, including suitability standards, to determine whether officers and key persons in control functions have the appropriate background, experience and integrity to fulfill their prospective roles, including:
1. Identification of the specific positions for which suitability standards have been developed and a description of the standards employed, and

2. Any changes in an officer's or key person's suitability as outlined by the insurer's or insurance group's standards and procedures to monitor and evaluate such changes;
(b) The insurer's or insurance group's code of business conduct and ethics, the discussion of which considers:
1. Compliance with laws, rules, and regulations, and

2. Proactive reporting of any illegal or unethical behavior;
(c) The insurer's or insurance group's processes for performance evaluation, compensation and corrective action to ensure effective senior management throughout the organization, including a description of the general objectives of significant compensation programs and what the programs are designed to reward. The description shall include sufficient detail to allow the Office to understand how the organization ensures that compensation programs do not encourage and/or reward excessive risk taking. Elements to be discussed may include:
1. The Board's role in overseeing management compensation programs and practices,

2. The various elements of compensation awarded in the insurer's or insurance group's compensation programs and how the insurer or insurance group determines and calculates the amount of each element of compensation paid,

3. How compensation programs are related to both company and individual performance over time,

4. Whether compensation programs include risk adjustments and how those adjustments are incorporated into the programs for employees at different levels,

5. Any clawback provisions built into the programs to recover awards or payments if the performance measures upon which they are based are restated or otherwise adjusted, and

6. Any other factors relevant in understanding how the insurer or insurance group monitors its compensation policies to determine whether its risk management objectives are met by incentivizing its employees; and
(d) The insurer's or insurance group's plans for the Chief Executive Officer and senior management succession.
(4) The insurer or insurance group shall describe the processes by which the Board, its committees, and senior management ensure an appropriate amount of oversight to the critical risk areas impacting the insurer's business activities, including a discussion of:
(a) How oversight and management responsibilities are delegated between the Board, its committees and senior management;

(b) How the Board is kept informed of the insurer's strategic plans, the associated risks, and steps that senior management is taking to monitor and manage those risks;

(c) How reporting responsibilities are organized for each critical risk area. The description should allow the Office to understand the frequency at which information on each critical risk area is reported to and reviewed by senior management and the Board. This description may include the following critical risk areas of the insurer:
1. Risk management processes. An ORSA summary report filer may refer to its ORSA summary report,

2. Actuarial function,

3. Investment decision-making processes,

4. Reinsurance decision-making processes,

5. Business strategy/finance decision-making processes,

6. Compliance function,

7. Financial reporting/internal auditing, and

8. Market conduct decision-making processes.

69O FAC 143.047 | Standards

(1) Material transactions by registered insurers with their affiliates shall be subject to the following standards:
(a) The terms shall be fair and reasonable;

(b) Charges or fees for services performed shall be reasonable;

(c) Expenses incurred and payment received shall be allocated to the insurer in conformity with customary insurance accounting practices consistently applied;

(d) The books, accounts and records of each party to all such transactions shall be so maintained as to clearly and accurately disclose the precise nature and details of the transactions including such accounting information as is necessary to support the reasonableness of the charges or fees to the respective parties;

(e) The insurer's surplus as regards policyholders following any dividends or distributions to shareholder affiliates shall be reasonable in relation to the insurer's outstanding liabilities and adequate to its financial needs; and,

(f) For cost sharing services and management services, such agreements shall, as applicable:
1. Identify the person providing services and the nature of such services;

2. Set forth the methods to allocate costs;

3. Require timely settlement, not less frequently than on a quarterly basis, and compliance with the requirements in the National Association of Insurance Commissioner's Accounting Practices and Procedures Manual as adopted in subsection 69O-137.001(4), F.A.C.;

4. Prohibit advancement of funds by the insurer to the affiliate except to pay for services defined in the agreement;

5. State that the insurer will maintain oversight for functions provided to the insurer by the affiliate and that the insurer will monitor services annually for quality assurance;

6. Define books and records of the insurer to include all books and records developed or maintained under or related to the agreement;

7. Specify that all books and records of the insurer are and remain the property of the insurer and are subject to control of the insurer;

8. State that all funds and invested assets of the insurer are the exclusive property of the insurer, held for the benefit of the insurer and are subject to the control of the insurer;

9. Include standards for termination of the agreement with and without cause;

10. Include provisions for indemnification of the insurer in the event of gross negligence or willful misconduct on the part of the affiliate providing services;

11. Specify that, if the insurer is placed in receivership or seized by the commissioner:
a. All of the rights of the insurer under the agreement extend to the receiver or commissioner; and,

b. All books and records will immediately be made available to the receiver or the commissioner, and shall be turned over to the receiver or commissioner immediately upon the receiver or the commissioner's request;
12. Specify that the affiliate has no automatic right to terminate the agreement if the insurer is placed in receivership; and,

13. Specify that the affiliate will continue to maintain any systems, programs, or other infrastructure notwithstanding the initiation of receivership proceedings pursuant to Chapter 631, F.S., and will make them available to the receiver, for so long as the affiliate continues to be contractually and legally obligated to receive timely payment for the cost of services rendered.
(2) For the purposes of this rule in determining whether an insurer's surplus as regards policyholders is reasonable in relation to the insurer's outstanding liabilities and adequate to its financial needs, the following factors, among others, shall be considered:
(a) The size of the insurer as measured by its assets, capital and surplus, reserves, premium writings, insurance in force and other appropriate criteria;

(b) The extent to which the insurer's business is diversified among the several lines of insurance;

(c) The number and size of risks insured in each line of business;

(d) The extent of the geographical dispersion of the insurer's insured risks;

(e) The nature and extent of the insurer's reinsurance program;

(f) The quality, diversification, and liquidity of the insurer's investment portfolio;

(g) The recent past and projected future trend in the size of the insurer's surplus as regards policyholders;

(h) The surplus as regards policyholders maintained by other comparable insurers;

(i) The adequacy of the insurer's reserves; and,

(j) The quality and liquidity of investments in subsidiaries made pursuant to Section 625.325, F.S.
The Office may treat any such investment as a disallowed asset for purposes of determining the adequacy of surplus as regards policyholders whenever in its judgment such investment so warrants.

(3) No domestic stock insurer shall pay any extraordinary dividend or make any other extraordinary distribution to its shareholders until:
(a) 30 calendar days after the Office has received notice of the declaration thereof and has not within such period disapproved such payment; or

(b) The Office shall have approved such payment within such 30 calendar day period.
A notice to the Office shall commence to run from the date of receipt as may be evidence by transmitting electronically to the Office via, Regulatory Electronic Filing System, "REFS," return receipt if sent certified or registered mail, return receipt requested or signed receipt by Office if otherwise delivered.

For purposes of this rule, an extraordinary dividend or distribution includes any dividend or distribution that is in excess of that permitted without the approval of the Office pursuant to Section 628.371, F.S., but shall not include pro rata distributions of any class of the insurer's own securities.

Notwithstanding any other provision of law, an insurer may declare an extraordinary dividend or distribution which is conditional upon the Office's approval thereof, and such a declaration shall confer no rights upon shareholders until the Office has approved the payment of such dividend or distribution.

(4) The following transactions involving a domestic insurer and any person in its holding company system may not be entered into unless the insurer has notified the Office, via Form OIR-A1-2117, "Form D - Prior Notice of a Transaction," new 5/16, http://www.FLRules.org/Gateway/Reference.asp?No=Ref-06551, which is hereby adopted and incorporated by reference, and is available at www.FLOir.com/iPortal, of its intention to enter into such a transaction at least thirty (30) calendar days prior thereto, or such shorter period as the Office in its discretion may permit, and the Office has not disapproved it within such period. The notice for amendments or modifications shall include the reasons for the change and the financial impact on the insurer.
(a) Sales, purchases, exchanges, loans or extensions of credit, guarantees, or investments provided such transactions are equal to or exceed:
1. With respect to nonlife insurers, the lesser of three percent of the insurer's admitted assets or 25 percent of surplus as regards policyholders; and,

2. With respect to life insurers, three percent of the insurer's admitted assets; each as of the prior year end.
(b) Loans or extensions of credit to any person who is not an affiliate, where the insurer makes such loans or extensions of credit with the agreement or understanding that the proceeds of such transactions, in whole or in substantial part, are to be used to make loans or extensions of credit to, to purchase assets of, or to make investments in, any affiliate of the insurer making such loans or extensions of credit provided such transactions are equal to or exceed:
1. With respect to nonlife insurers, the lesser of three percent of the insurer's admitted assets or 25 percent of surplus as regards policyholders; and,

2. With respect to life insurers, three percent of the insurer's admitted assets; each as of the prior year end.
(c) Reinsurance agreements or modifications thereto, including:
1. All reinsurance pooling agreementss

2. Agreements in which the reinsurance premium or a change in the insurer's liabilities equals or exceeds five percent of the insurer's surplus as regards policyholders, as of the prior year end, including those agreements which may require as consideration the transfer of assets from an insurer to a non-affiliate, if an agreement or understanding exists between the insurer and non-affiliate that any portion of such assets will be transferred to one or more affiliates of the insurers
(d) All management agreements, service contracts, tax allocation agreements and all cost-sharing arrangements; and,

(e) Any material transactions which the Office determines may adversely affect the interests of the insurer's policyholders.
(5) The filing required in subsection (4), above, shall be filed with the Office electronically via the Regulatory Electronic Filing System ("REFS").

(6) Nothing in subsection (4), above, shall be deemed to authorize or permit any transactions which, in the case of an insurer not a member of the same holding company system, would be otherwise contrary to Florida statute or rule.

(7) A domestic insurer shall not enter into transactions which are part of a plan or series of like transactions with persons within the holding company system if the purpose of those separate transactions is to avoid the statutory threshold amount and thus avoid the review which would otherwise occur. If the Office determines that such separate transactions were entered into over any twelve month period for such purpose, the insurer may be subject to the provisions of Section 628.803, F.S.

(8) The Office, in reviewing transactions pursuant to subsection (4), above, shall consider whether the transactions comply with the standards set forth in subsection (1), above, and whether they may adversely affect the interests of policyholders.

(9) The Office shall be notified within thirty (30) calendar days of any investment of the domestic insurer in any one corporation if the total investment in such corporation by the insurance holding company system exceeds ten percent of such corporation's voting securities.

(10) All filings shall be submitted electronically to http://www.FLOir.com/iPortal.

69O FAC 143.048 | Incorporation by Reference

Except as otherwise provided in these rules, a person making a report, request, or filing required by this rule chapter may incorporate therein by reference any required then current information already on file with the Director, or any diagram or chart previously filed. In such event the person filing shall cause the paper filed to identify the report, statement, document, instrument, diagram, chart or other paper to which reference is made, the approximate date it was filed with the Director, and the page or pages thereof wherein is shown the information incorporated by reference.

69O FAC 143.049 | Investments

Whether any investment pursuant to Section 625.325(2), F.S., meets the applicable requirements thereof is to be determined before such investment is made, by calculating the applicable investment limitations as though the investment had already been made, taking into account the then outstanding principal balance on all previous investments in debt obligations, and the value of all previous investments in equity securities as of the day they were made, net of any return of capital invested, not including dividends.

69O FAC 143.050 | Voting of Securities

No security which is the subject of any agreement or arrangement regarding acquisition, or which is acquired or to be acquired, in contravention of any statute or rule adopted thereunder, may be voted at any shareholder's meeting, or may be counted for quorum purposes, and any action of shareholders requiring the affirmative vote of a percentage of shares may be taken as though such securities were not issued and outstanding; but no action taken at any such meeting shall be invalidated by the voting of such securities, unless the action would materially affect the control of the insurer or unless a court of competent jurisdiction has so ordered. If the Office has reason to believe that any security of the insurer has been or is about to be acquired in contravention of the provisions of Part II of Chapter 628, F.S., or this rule chapter, the Office may pursue its remedies pursuant to Sections 628.802 and 628.803, F.S.

69O FAC 143.055 | Purpose

69O FAC 143.056 | Acquisition of Controlling Stock (Transferred)

69O FAC 143.060 | Purpose

69O FAC 143.061 | Redomestication Procedure (Transferred)

69O-144 | Reinsurance

69O FAC 144.001 | Purpose (Repealed)

69O FAC 144.002 | Reinsurance Application Procedures

(1) Filing requirements and costs.
(a) Insurers making the required filings under the provisions of Section 624.610, F.S., and the rules of this chapter shall submit such filings electronically to the Office at www.FLOir.com/iPortal.
1. Application filings shall be submitted to the Office's Company Admissions System, "iApply."

2. Other annual, quarterly, or requested filings shall be submitted to the Office's Regulatory Electronic Filing System, "REFS."
(b) The costs and expenses incurred by the Office to review an application for, and subsequent reviews of accredited reinsurer status under Section 624.610, F.S., and the rules of this chapter shall be charged to and collected from the applicant assuming insurer. Costs are defined as the sum of the time spent by Office personnel calculated at payroll rates inclusive of personnel benefit expenses and overhead expenses for each Office employee, and other Office expenses related to processing the application; or, the actual charges incurred by a third party retained to assist in the Office's review of the application.
1. Should it become necessary to hire an outside consultant in the process of the review, the insurer shall be contacted in advance to consent to this and agree to the cost. In the event that the Office and the insurer agree to utilize the services of an outside consultant to conduct the review, the following applies:
a. The acceptability of a person or firm to the Office shall be determined based on consideration of the person or firm's professional competence, objectivity, and cost.

b. Consent of the insurer shall be demonstrated by written confirmation from an officer of the insurer agreeing to an examination or the specific services to be performed by the person or firm, and acknowledgment that the person or firm is acceptable to the insurer and that the cost will be paid by the applicant.

c. All payments for services under this provision shall be made directly to the person or firm in accordance with the rates and terms agreed to by the Office, the insurer, and the person or firm performing the examination.
(c) Failure to pay the assessed costs under paragraph (1)(b) may be grounds for revocation of the insurer's application or accreditation, pursuant to Section 624.610, F.S.
(2)
(a) An assuming insurer seeking accredited reinsurer status in this state, pursuant to Section 624.610(3), F.S. and Rule 69O-144.005, F.A.C., shall file an application in compliance with the directions in Form OIR-C1-923, "Application for Accredited Reinsurer Status," effective 07/23, which is hereby incorporated by reference and available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-16187. The forms incorporated by reference in this paragraph may be obtained from https://www.FLOir.com/iPortal. The insurer shall further submit, or otherwise comply with, the following:
1. Form OIR-A1-2116, "Form C Summary of Changes to Registration Statement," effective 9/21, is hereby incorporated by reference and available at https://www.FLRules.org/Gateway/Reference.asp?No=Ref-14666;

2. Form OIR-C1-905, incorporated by reference in Rule 69O-136.100, F.A.C.;

3. Form OIR-C1-938, incorporated by reference in Rule 69O-136.100, F.A.C.;

4. Form OIR-C1-1423, incorporated by reference in Rule 69O-136.100, F.A.C.;

5. Form OIR-C1-0500, incorporated by reference in Rule 69O-136.100, F.A.C.;

6. Form OIR-C1-0501, incorporated by reference in Rule 69O-136.100, F.A.C.;

7. Form OIR-C1-0502, incorporated by reference in Rule 69O-136.100, F.A.C.;

8. Form OIR-C1-0503, incorporated by reference in Rule 69O-136.100, F.A.C.;

9. Form OIR-C1-0504, incorporated by reference in Rule 69O-136.100, F.A.C.;

10. Form OIR-C1-0505, incorporated by reference in Rule 69O-136.100, F.A.C.;

11. Form OIR-C1-0506, incorporated by reference in Rule 69O-136.100, F.A.C.;

12. Form OIR-C1-0507, incorporated by reference in Rule 69O-136.100, F.A.C.;

13. Form OIR-C1-0509, incorporated by reference in Rule 69O-136.100, F.A.C.;

14. Form OIR-C1-1464, "Florida Certificate of Assuming Insurer," effective 9/21, which is hereby incorporated by reference and available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-14675, as required by paragraph 69O-144.005(2)(a), F.A.C.;

15. Form OIR-C1-1524, incorporated by reference in Rule 69O-136.100, F.A.C.; and,

16. Form OIR-C1-2221, incorporated by reference in Rule 69O-136.100, F.A.C.
(b) An assuming insurer seeking to maintain its accredited reinsurer status in this state, pursuant to Rule 69O-144.005, F.A.C., shall submit the following:
1. Annually, a copy of its annual statements prepared in accordance with the National Association of Insurance Commissioners (NAIC) manuals adopted in Rule 69O-137.001, F.A.C., as filed with the insurance regulator of the assuming insurer's state of domicile or, in the case of a U.S. branch of an alien assuming insurer, as filed with the state through which it is entered and in which it is licensed to transact insurance or reinsurance;

2. If quarterly statements are required by the assuming insurer's state of domicile, or if quarterly statements are not required by the state of domicile but the Office makes a written request of them from the assuming insurer: then quarterly, a copy of the assuming insurer's quarterly statements prepared in accordance with the NAIC manuals adopted in Rule 69O-137.001, F.A.C., with the insurance regulator of the assuming insurer's state of domicile or, in the case of a U.S. branch of an alien assuming insurer, with the state through which it is entered and in which it is licensed to transact insurance or reinsurance; and,

3. Annually, a copy of the assuming insurer's most recent audited financial statement.
(3)
(a) An assuming insurer seeking trusteed reinsurer status in this state, pursuant to Section 624.610(3)(c), F.S. and subparagraph 69O-144.006(1)(a)1., F.A.C., shall file an application in compliance with the directions in Form OIR-C1-1466, "Application for Trusteed Reinsurer Status," effective 5/22, which is hereby incorporated by reference and available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-14682. The insurer shall further submit, or otherwise comply with, the following:
1. A copy of its annual statement with information substantially the same as that required to be reported in the NAIC Annual Statement form by authorized insurers, as incorporated by reference in Rule 69O-137.001, F.A.C., in the same format required by such form and including all supporting documents;

2. A certified copy of the trust agreement and any trust amendments, including an approval from the insurance regulator of the state in which the trust is domiciled or of the insurance regulator of another state who, pursuant to the terms of the trust instrument, has accepted principal regulatory oversight of the trust;

3. A statement from the trustee of the trust to the insurance regulator having regulatory oversight of the trust certifying the balance of the trust and the trust's investments at the preceding year end with certification that the trust will not expire prior to the following December 31;

4. Form OIR-C1-1423, incorporated by reference in Rule 69O-136.100, F.A.C.;

5. Form OIR-C1-1469, "Certificate of Assuming Insurer to Submit to Examination and Bear the Cost of Examination," effective 9/21, is hereby incorporated by reference and available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-14683;

6. Form OIR-C1-1524, incorporated by reference in Rule 69O-136.100, F.A.C.; and

7. Form OIR-C1-2221, incorporated by reference in Rule 69O-136.100, F.A.C.
(b) An assuming insurer seeking to maintain its trusteed reinsurer status in this state, pursuant to Section 624.610(3)(c), F.S., and subparagraph 69O-144.006(1)(a)2., F.A.C., shall:
1. File annually with the Office substantially the same information as that required to be reported on the NAIC Annual Statement form by authorized insurers, which is incorporated in Rule 69O-137.001, F.A.C., to enable the Office to determine the sufficiency of the trust fund; and,

2. Comply with the ongoing requirements in subsection 69O-144.006(1), F.A.C.
(4)
(a) An assuming insurer seeking certified reinsurer status in this state, pursuant to Section 624.610(3), F.S. and paragraph 69O-144.007(8)(a), F.A.C., shall file an application in compliance with the directions in Form OIR-C1-996, "Application for Certified Reinsurer Status," effective 5/22, which is hereby incorporated by reference and available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-14672. The insurer shall further submit, or otherwise comply with, the following:
1. Audited annual financial statements for the last two (2) years, as filed with the assuming insurer's domiciliary jurisdiction;

2. The report(s) of the independent auditor for the financial statements of the assuming insurer's insurance enterprise from the last two (2) years, as filed with the assuming insurer's domiciliary jurisdiction;

3. The most recent actuarial opinion as filed with the assuming insurer's domiciliary jurisdiction;

4. Form OIR-C1-2116, "Certificate of Certified Reinsurer," effective 9/21, which is hereby incorporated by reference and available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-14677, as required by paragraph 69O-144.007(8)(a), F.A.C.;

5. Form OIR-C1-2117, "NAIC Form CR-F" (for property/casualty), effective 9/21, which is hereby incorporated by reference and available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-14678, or Form OIR-C1-2118, "NAIC Form CR-S" (for life and health), effective 9/21, which is hereby incorporated by reference and available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-14679;

6. A list of all disputed or overdue recoverables due to or claimed by ceding insurers, whether or not the claims are in litigation or arbitration;

7. A certification from the domiciliary jurisdiction of the assuming insurer that the insurer is in good standing with that jurisdiction and that the insurer maintains capital in excess of the jurisdiction's highest regulatory action level;

8. Form OIR-C1-1416, incorporated by reference in Rule 69O-136.100, F.A.C.;

9. Form OIR-C1-1524, incorporated by reference in Rule 69O-136.100, F.A.C.; and

10. Form OIR-C1-2221, incorporated by reference in Rule 69O-136.100, F.A.C.
(b) An assuming insurer seeking to maintain its certified reinsurer status in this state, pursuant to Section 624.610(3), F.S., and paragraph 69O-144.007(8)(h), F.A.C., shall annually submit the following, no later than July 1:
1. Form OIR-C1-2117, "NAIC Form CR-F" (for property/casualty), or Form OIR-C1-2118, "NAIC Form CR-S" (for life and health), both of which are incorporated in paragraph (4)(a) of this rule;

2. The assuming insurer's most recent audited financial statements, as filed with its domiciliary jurisdiction;

3. The report(s) of the independent auditor for the most recent financial statements of the assuming insurer's insurance enterprise, as filed with the assuming insurer's domiciliary jurisdiction;

4. The most recent actuarial opinion as filed with the assuming insurer's domiciliary jurisdiction;

5. A statement from the assuming insurer's domiciliary jurisdiction that the assuming insurer is in good standing and maintains capital in excess of the jurisdiction's highest regulatory action level;

6. A statement certifying that there has been no change in the provisions of the assuming insurer's domiciliary license or any of its financial strength ratings, or a statement describing such changes and the reasons therefore;

7. Any change in the assuming insurer's directors and officers;

8. An updated list of all disputed and overdue reinsurance claims regarding reinsurance assumed from ceding insurers; and,

9. Any other information that the Office reasonably requires to evaluate the assuming insurer's status, including any information required by paragraph 69O-144.007(8)(h), F.A.C.
(c) If an NAIC accredited jurisdiction has determined that a certified reinsurer has met the conditions in that jurisdiction to become a certified reinsurer, the Office may accept documentation filed with that NAIC accredited jurisdiction or with the NAIC to satisfy the certified reinsurer's status in this state.
(5)
(a) An assuming insurer seeking reciprocal jurisdiction reinsurer status in this state, pursuant to Section 624.610(4), F.S., and paragraph 69O-144.011(3)(e), F.A.C., shall, on behalf of itself and any legal predecessors, file an application in compliance with the directions in Form OIR-C1-518, "Application for Reciprocal Jurisdiction Reinsurer Status," effective 5/22, which is hereby incorporated by reference and available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-14668. The insurer shall further submit, or otherwise comply with, the following:
1. Form OIR-C1-517, "Certificate of Reinsurer Domiciled in Reciprocal Jurisdiction," effective 9/21, which is hereby incorporated by reference and available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-14667, as required by paragraph 69O-144.011(3)(d), F.A.C.;

2. Written confirmation from the assuming insurer's reciprocal jurisdiction that as of the preceding December 31 or as of the most recent date otherwise statutorily reported to the jurisdiction, the assuming insurer has complied with the requirements set forth in paragraphs 69O-144.011(3)(b) and (3)(c), F.A.C.;

3. For the two (2) years preceding entry into the reinsurance agreement, the assuming insurer's annual audited financial statements, in accordance with the applicable law of the assuming insurer's reciprocal jurisdiction, including the external audit report;

4. For the two (2) years preceding entry into the reinsurance agreement, the solvency and financial condition report or actuarial opinion, if filed with the assuming insurer's supervisor;

5. Prior to entry into the reinsurance agreement, a current list of all disputed and overdue reinsurance claims outstanding for 90 days or more, regarding reinsurance assumed from ceding insurers domiciled in the United States;

6. Prior to entry into the reinsurance agreement, information regarding the assuming insurer's assumed reinsurance by ceding insurer, ceded reinsurance by the assuming insurer, and reinsurance recoverable on paid and unpaid losses by the assuming insurer to allow for the evaluation of the criteria set forth in paragraph 69O-144.011(3)(f), F.A.C.;

7. Form OIR-C1-1524, incorporated by reference in Rule 69O-136.100, F.A.C.;

8. Form OIR-C1-2221, incorporated by reference in Rule 69O-136.100, F.A.C.; and,

9. Any other information required or requested by the Office, pursuant to Section 624.610(4), F.S., or subsection 69O-144.011(3), F.A.C., provided that such requirements are not in conflict with an applicable covered agreement.
(b) An assuming insurer seeking to maintain its reciprocal jurisdiction reinsurer status in this state, pursuant to Section 624.610(4), F.S., and paragraph 69O-144.011(3)(g), F.A.C., shall annually submit the following, no later than each July 1:
1. Written confirmation from the assuming insurer's reciprocal jurisdiction that as of the preceding December 31 or as of the annual date otherwise statutorily reported to the jurisdiction, the assuming insurer complies with the requirements set forth in paragraphs 69O-144.011(3)(b) and (3)(c), F.A.C.;

2. The assuming insurer's most recent audited financial statements, in accordance with the applicable law of the assuming insurer's reciprocal jurisdiction, including the external audit report;

3. The assuming insurer's most recent solvency and financial condition report or actuarial opinion, if filed with its supervisor;

4. An updated list of all disputed and overdue reinsurance claims outstanding for 90 days or more, regarding reinsurance assumed from ceding insurers domiciled in the United States;

5. Information regarding the assuming insurer's assumed reinsurance by ceding insurer, ceded reinsurance by the assuming insurer, and reinsurance recoverable on paid and unpaid losses by the assuming insurer, to allow for the evaluation of the criteria set forth in paragraph 69O-144.011(3)(f), F.A.C.; and,

6. Any other information required or requested by the Office, pursuant to Section 624.610(4), F.S., or paragraph 69O-144.011(3)(g), F.A.C., provided that such requirements are not in conflict with an applicable covered agreement.
(c) If an NAIC accredited jurisdiction has determined that a reciprocal jurisdiction reinsurer has met the conditions in that jurisdiction to become a reciprocal jurisdiction reinsurer, the Office may accept documentation filed with that NAIC accredited jurisdiction or with the NAIC to satisfy the reciprocal jurisdiction reinsurer's status in this state.

(d) This subsection does not limit the authority of the Office to request additional information pertaining to the reinsurance agreement, or any subsequent reinsurance agreement entered into by the assuming insurer and Florida ceding insurers, under Section 624.610(4)(e), F.S., provided that such requirements are not in conflict with an applicable covered agreement.
(6) An assuming insurer meeting any other eligibility criteria under the rules of this chapter or under Section 624.610, F.S., shall make the necessary and applicable filings with the Office.

69O FAC 144.005 | Credit for Reinsurance; Accredited Reinsurers

(1) Credit for reinsurance by a domestic insurer shall be allowed when the reinsurance is ceded to an assuming insurer that is accredited as a reinsurer in this state pursuant to Section 624.610(3)(b), F.S., and the rules of this chapter, as of any date on which statutory financial statement credit for reinsurance is claimed.

(2) Application and documentation requirements. An assuming insurer seeking accredited reinsurer status in this state pursuant to Section 624.610(3)(b), F.S., must file an application with the Office in accordance with paragraph 69O-144.002(2)(a), F.A.C. The application must include documentation that the assuming insurer:
(a) Submits to this state's jurisdiction and to this state's authority to examine its books and records, via a properly executed Form OIR-C1-1464, "Florida Certificate of Assuming Insurer," which is incorporated by reference in subparagraph 144.002(2)(a)5., F.A.C.;

(b) Is licensed or authorized to transact insurance or reinsurance in at least one state; or in the case of a U.S. branch of an alien assuming insurer, is entered through at least one state, or is licensed or authorized to transact insurance or reinsurance in at least one state; and,

(c) Maintains a surplus as regards policyholders in an amount not less than $20 million.
(3) Pursuant to Section 624.610(3)(b), F.S., an assuming reinsurer that meets the requirements of subsection (2) of this rule shall be considered accredited if either:
(a) The Office approves the assuming insurer's accreditation application; or

(b) The Office does not deny the assuming insurer's accreditation application within ninety (90) days of the application date.
(4) Accreditation renewal requirements. An assuming insurer seeking to maintain its accreditation in this state must file the appropriate documentation with the Office, in accordance with paragraph 69O-144.002(2)(b), F.A.C.

(5) The Office shall follow the procedures and standards in Section 624.610(3)(b)2., F.S., when determining whether to approve or deny the assuming insurer's application for accreditation, and when determining whether to maintain or revoke an accredited reinsurer's accreditation.

69O FAC 144.006 | Credit for Reinsurance: Reinsurers Maintaining Trust Funds

(1) Trusteed Reinsurers. Pursuant to Section 624.610(3)(c)1., F.S., the Office shall allow credit for reinsurance ceded by a domestic insurer to an assuming insurer which, as of any date on which statutory financial statement credit for reinsurance is claimed, and thereafter for so long as credit for reinsurance is claimed, maintains a trust fund in an amount prescribed below in a qualified financial institution as defined in Section 624.610(6)(b), F.S., for the payment of the valid claims of its U.S. domiciled ceding insurers, their assigns and successors in interest. Such reinsurers shall be referred to as "trusteed reinsurers" if approved by the Office.
(a)
1. An assuming insurer seeking trusteed reinsurer status in this state, pursuant to Section 624.610(3)(c), F.S., and this rule, shall file an application under the standards provided in paragraph 69O-144.002(3)(a), F.A.C., and in this rule.

2. An assuming insurer seeking to maintain its trusteed reinsurer status in this state shall make the additional filings required by paragraph 69O-144.002(3)(b), F.A.C., and shall continue to meet the applicable requirements of this rule.
(b) The following requirements apply to the following categories of assuming insurer:
1.
a. The trust fund for a single assuming insurer shall consist of funds in trust in an amount not less than the assuming insurer's liabilities attributable to reinsurance ceded by U.S. domiciled insurers; and,

b. The assuming insurer shall maintain a trusteed surplus of not less than $20 million, except as provided in sub-subparagraph (1)(b)1.c. of this subsection.

c. At any time after the assuming insurer has permanently discontinued underwriting new business secured by the trust for at least three full years, the insurance regulator with principal regulatory oversight of the trust may authorize a reduction in the required trusteed surplus, but only after a finding, based on an assessment of the risk, that the new required surplus level is adequate for the protection of U.S. ceding insurers, policyholders and claimants in light of reasonably foreseeable adverse loss development. The risk assessment may involve an actuarial review, including an independent analysis of reserves and cash flows, and shall consider all material risk factors, including when applicable the lines of business involved, the stability of the incurred loss estimates and the effect of the surplus requirements on the assuming insurer's liquidity or solvency. The minimum required trusteed surplus may not be reduced to an amount less than thirty percent (30%) of the assuming insurer's liabilities attributable to reinsurance ceded by U.S. ceding insurers covered by the trust.
2.
a. In the case of a group including incorporated and individual unincorporated underwriters, the trust fund shall consist of:
(I) For reinsurance ceded under reinsurance agreements with an inception, amendment, or renewal date on or after August 1, 1995, a trusteed account in an amount not less than the group's several liabilities attributable to business ceded by United States domiciled ceding insurers to any member of the group;

(II) For reinsurance ceded under reinsurance agreements with an inception date on or before July 31, 1995, and not amended or renewed after that date, notwithstanding the other provisions of this rule, funds in trust in an amount not less than the group's several insurance and reinsurance liabilities attributable to business written in the United States; and,

(III) In addition to these trusts, the group shall maintain a trusteed surplus of which $100 million shall be held jointly for the benefit of the U.S. domiciled ceding insurers of any member of the group for all the years of account.
b.
(I) The incorporated members of the group shall not be engaged in any business other than underwriting as a member of the group and shall be subject to the same level of regulation and solvency control by the group's domiciliary regulator as are the unincorporated members.

(II) The group shall, within ninety (90) days after its financial statements are due to be filed with the group's domiciliary regulator, provide to the Office:
(A) An annual certification by the group's domiciliary regulator of the solvency of each underwriter member of the group; or

(B) If a certification is unavailable, a financial statement, prepared by independent public accountants, of each underwriter member of the group.
(c)
1.
a. Credit for reinsurance shall not be granted unless the form of the trust and any amendments to the trust have been approved by either the insurance regulator of the state where the trust is domiciled or the insurance regulator of another state who, pursuant to the terms of the trust instrument, has accepted responsibility for regulatory oversight of the trust.

b. The form of the trust and any trust amendments also shall be filed with the insurance regulator of every state in which the ceding insurer beneficiaries of the trust are domiciled.

c. The trust instrument shall provide that:
(I) Contested claims shall be valid and enforceable out of funds in trust to the extent remaining unsatisfied thirty (30) days after entry of the final order of any court of competent jurisdiction in the United States;

(II) Legal title to the assets of the trust shall be vested in the trustee for the benefit of the grantor's U.S. ceding insurers, their assigns and successors in interest;

(III) The trust shall be subject to examination as determined by the Office;

(IV) The trust shall remain in effect for as long as the assuming insurer, or any member or former member of a group of insurers, shall have outstanding obligations under reinsurance agreements subject to the trust; and,

(V) No later than February 28 of each year, the trustee of the trust shall report to the Office in writing setting forth the balance in the trust and listing the trust's investments at the preceding year-end, and shall certify the date of termination of the trust, if so planned, or certify that the trust shall not expire prior to the following December 31.

(VI) Any amendment to the trust shall be filed with the Office no later than thirty (30) days after approval of the amendment by the insurance regulator with principal regulatory oversight of the trust.
2.
a. Notwithstanding any other provisions in the trust instrument, if the trust fund is inadequate because it contains an amount less than the amount required by this subsection, or if the grantor of the trust has been declared insolvent or placed into receivership, rehabilitation, liquidation, or similar proceedings under the laws of its state or country of domicile, the trustee shall comply with an order of the insurance regulator with regulatory oversight over the trust or with an order of a court of competent jurisdiction directing the trustee to transfer to the insurance regulator with regulatory oversight over the trust or other designated receiver all of the assets of the trust fund.

b. The assets shall be distributed by and claims shall be filed with and valued by the insurance regulator with regulatory oversight over the trust in accordance with the laws of the state in which the trust is domiciled applicable to the liquidation of domestic insurance companies.

c. If the insurance regulator with regulatory oversight over the trust determines that the assets of the trust fund or any part thereof are not necessary to satisfy the claims of the U.S. beneficiaries of the trust, the insurance regulator with regulatory oversight over the trust shall return the assets, or any part thereof, to the trustee for distribution in accordance with the trust agreement.

d. The grantor shall waive any right otherwise available to it under U.S. law that is inconsistent with this provision.
(d) For purposes of this rule, the term "liabilities" shall mean the assuming insurer's gross liabilities attributable to reinsurance ceded by U.S. domiciled insurers that are not otherwise secured by acceptable means, and, shall include:
1. For business ceded by domestic insurers authorized to write accident and health, and property and casualty insurance:
a. Losses and allocated loss expenses paid by the ceding insurer, recoverable from the assuming insurer;

b. Reserves for losses reported and outstanding;

c. Reserves for losses incurred but not reported;

d. Reserves for allocated loss expenses; and,

e. Unearned premiums.
2. For business ceded by domestic insurers authorized to write life, health and annuity insurance:
a. Aggregate reserves for life policies and contracts net of policy loans and net due and deferred premiums;

b. Aggregate reserves for accident and health policies;

c. Deposit funds and other liabilities without life or disability contingencies; and,

d. Liabilities for policy and contract claims.
(e) Assets deposited in the trust and the trusteed surplus of a single assuming insurer shall consist of assets of a quality and limitation substantially similar to that required in Part II of Chapter 625, F.S., and shall be valued according to their fair market value.

(f) Assets deposited in the trust and the trusteed surplus of a group including incorporated and individual unincorporated underwriters established to meet the requirements of Section 624.610(3)(c)3.b., F.S., shall be of the type and subject to limitations of the following:
1. Assets deposited in the trusts established pursuant to Section 624.610(3)(c)3.b., F.S., and this rule shall be valued according to their fair market value and shall consist only of cash in U.S. dollars, certificates of deposit issued by a U.S. financial institution as defined in Section 624.610(6)(a), F.S., clean irrevocable, unconditional and "evergreen" letters of credit issued or confirmed by a qualified U.S. financial institution, as defined in Section 624.610(6)(a), F.S., and investments of the type specified in this subsection.

2. Investments in or issued by an entity controlling, controlled by or under common control with either the grantor or beneficiary of the trust shall not exceed five percent (5%) of total investments.

3. No more than ten percent (10%) of the total of the investments in the trust may be securities denominated in foreign currencies. For purposes of applying the preceding sentence, a depository receipt denominated in U.S. dollars and representing rights conferred by a foreign security shall be classified as a foreign investment denominated in a foreign currency.

4. No more than twenty percent (20%) of the total of the investments in the trust may be foreign investments authorized under sub-sub-subparagraph (1)(f)5.a.(V), sub-subparagraph (1)(f)5.c., sub-sub-subparagraph (1)(f)5.f.(II) or sub-subparagraph (1)(f)5.g. of this subsection.

5. The assets of a trust established to satisfy the requirements of subsection (1) shall be invested only as follows:
a. Government obligations that are not in default as to principal or interest, that are valid and legally authorized and that are issued, assumed or guaranteed by:
(I) The United States or by any agency or instrumentality of the United States;

(II) A state of the United States;

(III) A territory, possession or other governmental unit of the United States;

(IV) An agency or instrumentality of a governmental unit referred to in sub-subparagraphs (1)(f)5.(I) and (II) of this paragraph, if the obligations shall be by law (statutory or otherwise) payable, as to both principal and interest, from taxes levied or by law required to be levied or from adequate special revenues pledged or otherwise appropriated or by law required to be provided for making these payments, but shall not be obligations eligible for investment under this paragraph if payable solely out of special assessments on properties benefited by local improvements; or

(V) The government of any other country that is a member of the Organization for Economic Cooperation and Development and whose government obligations are rated A or higher, or the equivalent, by a rating agency recognized by the Securities Valuation Office of the NAIC;
b. Obligations that are issued in the United States, or that are dollar denominated and issued in a non-U.S. market, by a solvent U.S. institution (other than an insurance company) or that are assumed or guaranteed by a solvent U.S. institution (other than an insurance company) and that are not in default as to principal or interest if the obligations:
(I) Are rated A or higher (or the equivalent) by a securities rating agency recognized by the Securities Valuation Office of the NAIC, or if not so rated, are similar in structure and other material respects to other obligations of the same institution that are so rated;

(II) Are insured by at least one authorized insurer (other than the investing insurer or a parent, subsidiary or affiliate of the investing insurer) licensed to insure obligations in this state and, after considering the insurance, are rated AAA (or the equivalent) by a securities rating agency recognized by the Securities Valuation Office of the NAIC; or

(III) Have been designated as Class One or Class Two by the Securities Valuation Office of the NAIC;
c. Obligations issued, assumed or guaranteed by a solvent non-U.S. institution chartered in a country that is a member of the Organization for Economic Cooperation and Development or obligations of U.S. corporations issued in a non-U.S. currency, provided that in either case the obligations are rated A or higher, or the equivalent, by a rating agency recognized by the Securities Valuation Office of the NAIC;

d. An investment made pursuant to the provisions of sub-subparagraph (1)(f)5.a., b. or c. of this subsection, shall be subject to the following additional limitations:
(I) An investment in or loan upon the obligations of an institution other than an institution that issues mortgage-related securities shall not exceed five percent (5%) of the assets of the trust;

(II) An investment in any one mortgage-related security shall not exceed five percent (5%) of the assets of the trust;

(III) The aggregate total investment in mortgage-related securities shall not exceed twenty-five percent (25%) of the assets of the trust; and,

(IV) Preferred or guaranteed shares issued or guaranteed by a solvent U.S. institution are permissible investments if all of the institution's obligations are eligible as investments under sub-subparagraphs b.(I) and b.(II) of this subsection, but shall not exceed two percent (2%) of the assets of the trust.
e. As used in this chapter:
(I) "Mortgage-related security" means an obligation that is rated AA or higher (or the equivalent) by a securities rating agency recognized by the Securities Valuation Office of the NAIC and that either:
(A) Represents ownership of one or more promissory notes or certificates of interest or participation in the notes (including any rights designed to assure servicing of, or the receipt or timeliness of receipt by the holders of the notes, certificates, or participation of amounts payable under, the notes, certificates or participation), that:
(i) Are directly secured by a first lien on a single parcel of real estate, including stock allocated to a dwelling unit in a residential cooperative housing corporation, upon which is located a dwelling or mixed residential and commercial structure, or on a residential manufactured home as defined in 42 U.S.C. section 5402(6), whether the manufactured home is considered real or personal property under the laws of the state in which it is located; and,

(ii) Were originated by a savings and loan association, savings bank, commercial bank, credit union, insurance company, or similar institution that is supervised and examined by a federal or state housing authority, or by a mortgagee approved by the Secretary of Housing and Urban Development pursuant to 12 U.S.C. sections 1709 and 1715b, or, where the notes involve a lien on the manufactured home, by an institution or by a financial institution approved for insurance by the Secretary of Housing and Urban Development pursuant to 12 U.S.C. section 1703; or
(B) Is secured by one or more promissory notes or certificates of deposit or participations in the notes (with or without recourse to the insurer of the notes) and, by its terms, provides for payments of principal in relation to payments, or reasonable projections of payments, or notes meeting the requirements of sub-sub-sub-subparagraphs (1)(f)5.e.(A)(i) and (A)(ii) of this subsection;
(II) "Promissory note," when used in connection with a manufactured home, shall also include a loan, advance or credit sale as evidenced by a retail installment sales contract or other instrument.
f. Equity interests:
(I) Investments in common shares or partnership interests of a solvent U.S. institution are permissible if:
(A) Its obligations and preferred shares, if any, are eligible as investments under this subsection; and,

(B) The equity interests of the institution (except an insurance company) are registered on a national securities exchange as provided in the Securities Exchange Act of 1934, 15 U.S.C. sections 78a to 78kk or otherwise registered pursuant to that Act, and if otherwise registered, price quotations for them are furnished through a nationwide automated quotations system approved by the National Association of Securities Dealers, Inc. A trust shall not invest in equity interests under this paragraph an amount exceeding one percent (1%) of the assets of the trust even though the equity interests are not so registered and are not issued by an insurance company;
(II) Investments in common shares of a solvent institution organized under the laws of a country that is a member of the Organization for Economic Cooperation and Development, if:
(A) All its obligations are rated A or higher, or the equivalent, by a rating agency recognized by the Securities Valuation Office of the NAIC; and,

(B) The equity interests of the institution are registered on a securities exchange regulated by the government of a country that is a member of the Organization for Economic Cooperation and Development;
(III) An investment in or loan upon any one institution's outstanding equity interests shall not exceed one percent (1%) of the assets of the trust. The cost of an investment in equity interests made pursuant to this paragraph, when added to the aggregate cost of other investments in equity interests then held pursuant to this paragraph, shall not exceed ten percent (10%) of the assets in the trust;
g. Obligations issued, assumed or guaranteed by a multinational development bank, provided the obligations are rated A or higher, or the equivalent, by a rating agency recognized by the Securities Valuation Office of the NAIC.

h. Letters of Credit.
(I) In order for a letter of credit to qualify in funding the trust, the trustee shall have the right and the obligation pursuant to the deed of trust or some other binding agreement (as duly approved by the Office) to immediately draw down the full amount of the letter of credit and hold the proceeds in trust for the beneficiaries of the trust if the letter of credit will otherwise expire without being renewed or replaced.

(II) The trust agreement shall provide that the trustee shall be liable for its negligence, willful misconduct or lack of good faith. The failure of the trustee to draw against the letter of credit in circumstances where such draw would be required shall be deemed to be negligence and willful misconduct.
(2) Certified reinsurers involved with trust funds should refer to subsection 69O-144.007(10), F.A.C. Insurers dealing with trust funds that do not meet the requirements of this rule should refer to Rule 69O-144.009, F.A.C.

69O FAC 144.007 | Credit for Reinsurance from Certified Reinsurers

(1) Purpose. Section 624.610(3)(e), F.S., gives the Office the option to allow credit for reinsurance without full collateral for transactions involving assuming insurers not meeting the requirements of Section 624.610(3)(a), (b), (c), or (d), F.S. This rule does not apply to assuming insurers that meet the requirements of Section 624.610(3)(a), (b), (c), or (d), F.S. This rule is not an attempt to assert extra-territorial jurisdiction. Insurers that write in states other than Florida will need to comply with the laws of those states.

(2) Definitions. As used in this rule the following terms have the following meanings:
(a) "Certified reinsurer" means an assuming insurer that may not meet the requirements of Section 624.610(3)(a), (b), (c), or (d), F.S., and that has been determined by the Office to have met the requirements set forth in subsections (7) and (8) of this rule.

(b) "Qualified jurisdiction" means a jurisdiction which has met the requirements set forth in subsection (9) of this rule.
(3) Credit for reinsurance under this rule shall apply only to reinsurance contracts entered into renewed or amended on or after the effective date of the certification of the assuming insurer, provided that the certified reinsurer holds surplus in excess of $250 million and maintains a secure financial strength rating from at least two of the rating agencies indicated in this subsection. Due consideration shall be given to the group rating where appropriate. The credit is subject to the limitations set forth in this rule. As provided in Section 624.610(3)(e), F.S., acceptable rating agencies are:
(a) Standard and Poor's;

(b) Moody's Investors Service;

(c) Fitch Ratings;

(d) A.M. Best Company;

(e) Demotech; and,

(f) Any other rating agency deemed acceptable by order of the Office. Copies of the orders issued by the Office deeming rating agencies as having experience and expertise in rating insurers doing business in Florida pursuant to Section 624.610(3)(e), F.S., are located at https://www.FLOir.com/resources-and-reports/certified-reinsurers.
(4) The collateral required to allow one hundred percent (100%) credit shall be no less than the percentage specified for the lowest rating as indicated below:
RatingCollateral RequiredBestS&PMoody'sFitchDemotech
Secure - 10A++AAAAaaAAAA"
Secure - 20.1A+AA+, AA, AA-Aa1, Aa2, Aa3AA+, AA, AA-A'
Secure - 30.2AA+, AA1, A2A+, AA
Secure - 40.5A-A-A3A-n/a
Secure - 50.75B++, B+BBB+, BBB, BBB-Baa1, Baa2, Baa3BBB+, BBB, BBB-n/a
Vulnerable - 61B, B-, C++, C+, C, C-, D, E, FBB+, BB, BB-, B+, B, B-, CCC, CC, C, D, RBa1, Ba2, Ba3, B1, B2, B3, Caa, Ca, CBB+, BB, BB-, B+, B, B-, CCC+, CC, CCC-, DDn/a
For reinsurance ceded by Florida domestic property insurers for short-tailed lines as defined below, any collateral required to be posted may be subject to a one-year deferral from the date of the first instance of a liability reserve entry as a result of a catastrophic loss from a named Hurricane. For these purposes, a short-tailed line of business is defined as any one of the following lines of business as reported on the NAIC annual financial statement:
Line 1 Fire

Line 2 Allied Lines

Line 3 Farmowners multiple peril

Line 4 Homeowners multiple peril

Line 5 Commercial multiple peril

Line 9 Inland marine

Line 12 Earthquake

Line 21 Auto physical damage
(5) Nothing in this rule shall be construed to deny the ceding insurer the ability to take credit for reinsurance for the remainder of its liabilities with a certified reinsurer so long as those amounts are secured with acceptable collateral pursuant to Section 624.610(5), F.S., and subsection 69O-144.005(5), F.A.C.

(6) In addition to the trust fund required under Section 624.610(3)(c), F.S., the Office shall permit an assuming insurer that maintains a trust fund in a qualified U.S. financial institution, as that term is defined in Section 624.610(6)(b), F.S., for the payment of the valid claims of its U.S. ceding insurers and their assigns and successors in interest to also maintain in a qualified U.S. financial institution a trust fund constituting a trusteed amount at least equal to the collateral required in accordance with subsection (4) of this rule, to secure the liabilities attributable to U.S. ceding insurers under reinsurance policies (contracts) entered into or renewed by such assuming insurer on or after the effective date of this rule or such other date as may be established in other states for ceding insurers domiciled in such states, but only when maintenance of such a trust fund serves to protect the interests of the public and the interests of insurer solvency.

(7) A ceding insurer may not take credit pursuant to this rule unless:
(a) The assuming insurer has been determined, by order of the Office, to be a certified reinsurer, pursuant to subsection (8) of this rule;

(b) The ceding insurer maintains satisfactory evidence that the certified reinsurer meets the standards of solvency, including standards for capital adequacy, established by its domestic regulator; and,

(c) All reinsurance contracts between the ceding insurer and the certified reinsurer provide for:
1. An insolvency clause in conformance with Section 624.610(9), F.S.;

2. A submission to jurisdiction clause in conformance with Sections 624.610(3)(f)1.a. and 2., F.S.; and,

3. A service of process clause in conformance with Sections 624.610(3)(f)1.b. and 2., F.S.
(8) Status as certified reinsurer:
(a) An assuming insurer seeking certified reinsurer status in this state pursuant to this rule, shall file an application in accordance with paragraph 69O-144.002(4)(a), F.A.C., and the requirements of this rule. The application shall include written confirmation, in the form of a properly executed Form OIR-C1-2116, "Certificate of Certified Reinsurer," which is incorporated by reference in paragraph 69O-144.002(4)(a), F.A.C., that the assuming insurer submits to the jurisdiction of the U.S. courts, appoints the Chief Financial Officer, pursuant to Section 48.151, F.S., as its agent for service of process in this state, and agrees to post one hundred percent (100%) collateral for its Florida liabilities if it resists enforcement of a valid and final judgment from a court in the United States, or if otherwise required by the Office pursuant to this rule. If an NAIC accredited jurisdiction has determined that a certified reinsurer has met the conditions in that jurisdiction to become a certified reinsurer, the Office may accept documentation filed with that NAIC accredited jurisdiction or with the NAIC to satisfy the certified reinsurer's status in this state.

(b) Upon receipt of an application for a determination as a certified reinsurer, the Office shall post notice on the Office's website. Such notice shall include instructions on how members of the public may respond to the application. The Office shall not take final action on the application until at least thirty (30) days after posting the notice required by this paragraph.

(c) The determination of certified reinsurer status will be made by order issued by the Office.

(d) To become a certified reinsurer, the assuming insurer, at a minimum:
1. Shall hold surplus in excess of $250 million. This requirement may also be satisfied by an association including incorporated and individual unincorporated underwriters having minimum capital and surplus equivalents (net of liabilities) of at least $250 million and a central fund containing a balance of at least $250 million,

2. Shall be authorized in its domiciliary jurisdiction to assume the kind or kinds of reinsurance ceded by the ceding insurer; and,

3. Shall be domiciled in a qualified jurisdiction, as defined in subsection (9) of this rule.
(e) Each certified reinsurer shall be rated on a legal entity basis, with due consideration being given to the group rating where appropriate, except that an association including incorporated and individual unincorporated underwriters that has been approved to do business as a single certified reinsurer may be evaluated on the basis of its group rating. Factors that may be considered as part of the evaluation process include, but are not limited to, the following:
1. The certified reinsurer's financial strength rating from an acceptable rating agency. The maximum rating that a certified reinsurer may be assigned will correspond to its financial strength rating as outlined in subsection (4) of this rule. The Office shall use the lowest financial strength rating received from a rating agency indicated in subsection (3) of this rule, in establishing the maximum rating of a certified reinsurer. A failure to obtain or maintain at least two financial strength ratings from acceptable rating agencies pursuant to subsection (3), will result in loss of eligibility for certification;

2. The business practices of the certified reinsurer in dealing with its ceding insurers, including its record of compliance with reinsurance contractual terms and obligations;

3. For certified reinsurers domiciled in the U.S., a review of the most recent applicable NAIC Annual Statement Blank, either Schedule F (for property/casualty reinsurers) or Schedule S (for life and health reinsurers);

4. The reputation of the certified reinsurer for prompt payment of claims under reinsurance agreements, based on an analysis of ceding insurers' Schedule F reporting of overdue reinsurance recoverables, including the proportion of obligations that are more than ninety (90) days past due or are in dispute, with specific attention given to obligations payable to companies that are in administrative supervision or receivership;

5. Regulatory actions against the certified reinsurer;

6. The liquidation priority of obligations to a ceding insurer in the certified reinsurer's domiciliary jurisdiction in the context of an insolvency proceeding; and,

7. The certified reinsurer's participation in any solvent schemes of arrangement, or similar procedure, that involves U.S. ceding insurers. The certified reinsurer shall notify the Office prior to participation in any solvent scheme of arrangement.
(f) If the Office determines, based upon the material submitted, and any other relevant information, that it is in the best interests of market stability and the solvency of ceding insurers, the Office will find, by order, that the insurer is a certified reinsurer and will set an amount of credit allowed for the reinsurer if lower than the amount set forth in subsection (4).

(g) The Office shall publish and maintain a list of certified reinsurers on the Office's website. Such list shall disclose the rating assigned to the certified reinsurer pursuant to subsection (4) of this rule.

(h) An assuming insurer seeking to maintain its certified reinsurer status in this state shall annually file the information required by paragraph 69O-144.002(4)(b), F.A.C. If an NAIC accredited jurisdiction has determined that a certified reinsurer has met the conditions in that jurisdiction to become a certified reinsurer, the Office may accept documentation filed with that NAIC accredited jurisdiction or with the NAIC to satisfy the certified reinsurer's status in this state.

(i) A certified reinsurer must advise the Office within ten (10) days of any changes in its ratings assigned by rating agencies, domiciliary license status, or of any regulatory actions taken against the certified reinsurer. Such notice shall include a statement describing such actions and the reasons therefore.

(j) At any time, if the Office determines that it is in the best interests of market stability and the solvency of ceding insurers, the Office will withdraw, by order, any determination of an insurer as a certified reinsurer or require the certified reinsurer to post additional collateral.

(k) If the rating of a certified reinsurer rises above that used by the Office in its determination of the credit allowed for the reinsurer, an affected party may petition the Office for a redetermination of the credit allowed. If it is in the best interests of market stability and the solvency of ceding insurers, the Office will raise the credit allowed for the certified reinsurer.
(9) Qualified Jurisdictions.
(a) The determination of a jurisdiction as a qualified jurisdiction is to be made by the Office. No jurisdiction shall be determined to be a qualified jurisdiction unless:
1. The insurance regulatory body of the jurisdiction agrees that it will provide information requested by the Office regarding its certified domestic reinsurers;

2. The Office has determined that the jurisdiction has a satisfactory structure and authority with regard to solvency regulation, acceptable financial and operating standards for reinsurers in the domiciliary jurisdiction, acceptable transparent financial reports filed in accordance with generally accepted accounting principles, and verifiable evidence of adequate and prompt enforcement of valid U.S. judgments or arbitration awards;

3. The Office has determined that the history of performance by reinsurers in the jurisdiction is such that the insuring public will be served by a finding of qualification;

4. For non-U.S. jurisdictions, the jurisdiction allows U.S. reinsurers access to the market of the domiciliary jurisdiction on terms and conditions that are at least as favorable as those provided in Florida law and regulations for unaccredited non-U.S. assuming insurers; and,

5. There is no other documented information that it would not serve the best interests of the insuring public and the solvency of ceding insurers to make a finding of qualification.
(b) If the NAIC issues findings that certain jurisdictions should be considered qualified jurisdictions, the Office shall, if it would serve the best interests of the insuring public and the solvency of ceding insurers, make a determination that jurisdictions on the NAIC list are qualified jurisdictions.

(c) A U.S. jurisdiction that meets the requirements for accreditation under the NAIC financial standards and accreditation program shall be recognized as a qualified jurisdiction.

(d) The Office shall publish a list of jurisdictions that have been determined to be qualified on its website.

(e) If the Office determines that it is in the best interests of market stability and the solvency of ceding insurers, the Office shall withdraw, by order, the determination of a jurisdiction as a qualified jurisdiction.
(10) A certified reinsurer shall secure obligations assumed from U.S. ceding insurers under this rule and Section 624.610(3)(e), F.S., at a level consistent with its rating pursuant to subsections (3) and (4) of this rule, or by order of the Office pursuant to Section 624.610(5), F.S.
(a) In order for a domestic ceding insurer to qualify for full financial statement credit for reinsurance ceded to a certified reinsurer, the certified reinsurer shall maintain security as allowed by Section 624.610(5), F.S., and consistent with Section 624.610(3)(e), F.S., or in a multibeneficiary trust in accordance with Section 624.610(3)(c), F.S., and Rule 69O-144.006, F.A.C., except as otherwise provided in this subsection.

(b) If a certified reinsurer maintains a trust to fully secure its obligations subject to Section 624.610(3)(c), F.S., and Rule 69O-144.006, F.A.C., and chooses to secure its obligations incurred as a certified reinsurer in the form of a multibeneficiary trust, the certified reinsurer shall maintain separate trust accounts for its obligations incurred under reinsurance agreements issued or renewed as a certified reinsurer with reduced security as permitted by this subsection or comparable laws of other U.S. jurisdictions and for its obligations subject to Section 624.610(3)(c), F.S., and Rule 69O-144.006, F.A.C. It shall be a condition to the grant of certification under Section 624.610(3)(e), F.S., and this rule, that the certified reinsurer shall have bound itself, by the language of the trust and agreement with the insurance regulator with principal regulatory oversight of each such trust account, to fund, upon termination of any such trust account, out of the remaining surplus of such trust any deficiency of any other such trust account.

(c) The minimum trusteed surplus requirements provided in Section 624.610(3)(c), F.S., and Rule 69O-144.006, F.A.C., are not applicable with respect to a multibeneficiary trust maintained by a certified reinsurer for the purpose of securing obligations incurred under this subsection, except that such trust shall maintain a minimum trusteed surplus of $10 million.

(d) With respect to obligations incurred by a certified reinsurer under this subsection, if the security is insufficient, the Office shall reduce the allowable credit by an amount proportionate to the deficiency, and has the discretion to impose further reductions in allowable credit upon finding that there is a material risk that the certified reinsurer's obligations will not be paid in full when due.

(e) For purposes of this subsection, a certified reinsurer whose certification has been terminated for any reason shall be treated as a certified reinsurer required to secure one hundred percent (100%) of its obligations.
1. As used in this subsection, the term "terminated" refers to revocation, suspension, voluntary surrender and inactive status.

2. If the Office continues to assign a higher rating as permitted by other provisions of this rule, this requirement does not apply to a certified reinsurer in inactive status or to a reinsurer whose certification has been suspended.
(11)
(a) If the rating of a certified reinsurer is below or falls below that required in subsection (4) of this rule, for the respective amount of credit, the Office shall upon written notice assign a new rating to the certified reinsurer in accordance with subsection (4). Notwithstanding the change or withdrawal of a certified reinsurer's rating, the Office, upon a determination that the interest of ensuring market stability and the solvency of the ceding insurer requires it, shall, upon request by the ceding insurer, authorize the ceding insurer to continue to take credit for the reinsurance recoverable, or part thereof, relating to the rating change or withdrawal for some specified period of time following such change or withdrawal, unless the reinsurance recoverable is deemed uncollectible.

(b) If the ceding insurer's experience in collecting recoverables from any certified reinsurer indicates that the credit to the ceding insurer should be lower, the ceding insurer shall notify the Office of this.

(c) The Office shall have the authority to suspend, revoke, or otherwise modify a certified reinsurer's certification at any time if the certified reinsurer fails to meet its obligations or security requirements under this rule, or if other financial or operating results of the certified reinsurer, or documented significant delays in payment by the certified reinsurer, would cause the Office to determine that the certified reinsurer is unwilling or unable to meet its contractual obligations.

(d) If the rating of a certified reinsurer is upgraded by the Office, the certified reinsurer may meet the security requirements applicable to its new rating on a prospective basis, but the Office shall require the certified reinsurer to post security under the previously applicable security requirements as to all contracts in force on or before the effective date of the upgraded rating. If the rating of a certified reinsurer is downgraded by the Office, the Office shall require the certified reinsurer to meet the security requirements applicable to its new rating for all business it has assumed as a certified reinsurer.

(e) Upon revocation of the certification of a certified reinsurer by the Office, the assuming insurer shall be required to post security in accordance with Section 624.610, F.S., in order for the ceding insurer to continue to take credit for reinsurance ceded to the assuming insurer.
(12) The ceding insurer shall give immediate notice to the Office and provide for the necessary increased reserves with respect to any reinsurance recoverables applicable, in the event:
(a) That obligations of a certified reinsurer for which credit for reinsurance was taken under this rule are more than ninety (90) days past due and not in dispute, or

(b) That there is any indication or evidence that any certified reinsurer, with whom the ceding insurer has a contract, fails to substantially comply with the solvency requirements under the laws of its domiciliary jurisdiction.
(13) The Office shall disallow all or a portion of the credit based on a review of the ceding insurer's reinsurance program, the financial condition of the certified reinsurer, the certified reinsurer's claim payment history, or any other relevant information when such action is in the best interests of market stability and the solvency of the ceding insurer. At any time, the Office may request additional information from the certified reinsurer. The failure of a certified reinsurer to cooperate with the Office is grounds for the Office to withdraw the status of the insurer as a certified reinsurer or for the disallowance or reduction of the credit granted under this rule.

(14)
(a) Upon the entry of an order of rehabilitation, liquidation, or conservation against the ceding insurer, pursuant to Chapter 631, Part I, F.S., or the equivalent law of another jurisdiction, a certified reinsurer, within thirty (30) days of the order, shall fund the entire amount that the ceding insurer has taken, as an asset or deduction from reserves, for reinsurance recoverable from the certified reinsurer. The insurer may request a variance and waiver from this provision as provided by Section 120.542, F.S.

(b) If a certified reinsurer fails to comply on a timely basis with paragraph (a) of this subsection, the Office shall withdraw the reinsurer's certification under this rule.
(15) The Office may, by order, determine that credit shall not be allowed to any ceding insurer for reinsured risk pursuant to this rule if it appears to the Office that granting of the credit to the ceding insurer would not be in the public interest or serve the best interests of the ceding insurer's solvency.

(16) Nothing in this rule prohibits a ceding insurer and a reinsurer from entering into agreements establishing collateral requirements in excess of those set forth in this rule.

69O FAC 144.009 | Credit for Reinsurance: Other Requirements and Provisions

(1) Credit shall be allowed for foreign and alien insurers when the reinsurance is ceded to an assuming insurer which is domiciled or licensed in, or, in the case of a U.S. branch of an alien assuming insurer, which is entered through, a state which employs standards regarding credit for reinsurance substantially similar to those applicable under this chapter, provided the Office verifies that the assuming insurer and reinsurance agreement meet the requirements established by this chapter and Section 624.610, F.S. Verification by the Office under this subsection may be made via direct review of the information that the assuming insurer has filed with the state in which it is domiciled, licensed, or entered through.

(2) Concentration risk requirements for domestic ceding insurers. The following requirements apply to all domestic ceding insurers in this state that seek to claim credit for reinsurance from assuming insurers under Sections 624.610(2) through (4), F.S., or the respective rules of this chapter.
(a) A ceding insurer shall notify the Office within thirty (30) days after reinsurance recoverables from any single assuming insurer, or group of assuming insurers, exceeds fifty percent (50%) of the ceding insurer's last reported surplus to policyholders, or after it is determined that reinsurance recoverables from any single assuming insurer, or group of assuming insurers, is likely to exceed this limit. The notification shall demonstrate that the exposure is safely managed by the domestic ceding insurer.

(b) A ceding insurer shall notify the Office within thirty (30) days after ceding to any single assuming insurer, or group of assuming insurers, more than twenty percent (20%) of the ceding insurer's gross written premium in the prior calendar year, or after it is determined that the reinsurance ceded to any single assuming insurer, or group of assuming insurers, is likely to exceed this limit. The notification shall demonstrate that the exposure is safely managed by the ceding insurer.
(3) Trust agreements qualified under Section 624.610(5), F.S. The provisions of this subsection and subsection (4) concern assuming insurers that do not meet the requirements of Sections 624.610(2) through (4), F.S., or the respective rules of this chapter, including Rule 69O-144.007, F.A.C.
(a) As used in this subsection:
1. "Beneficiary" means the entity for whose sole benefit the trust has been established and any successor of the beneficiary by operation of law. If a court of law appoints a successor in interest to the named beneficiary, then the named beneficiary includes and is limited to the court appointed domiciliary receiver (including conservator, rehabilitator or liquidator).

2. "Grantor" means the entity that has established a trust for the sole benefit of the beneficiary. When established in conjunction with a reinsurance agreement, the grantor is the unlicensed, unaccredited assuming insurer.

3. "Obligations," as used in sub-subparagraphs (3)(b)11.b. and c. of this subsection, means:
a. Reinsured losses and allocated loss expenses paid by the ceding company, but not recovered from the assuming insurer;

b. Reserves for reinsured losses reported and outstanding;

c. Reserves for reinsured losses incurred but not reported; and,

d. Reserves for allocated reinsured loss expenses and unearned premiums.
(b) Required conditions:
1. The trust agreement shall be entered into between the beneficiary, the grantor and a trustee, which shall be a qualified U.S. financial institution as defined in Section 624.610(6)(b), F.S.

2. The trust agreement shall create a trust account into which assets shall be deposited.

3. All assets in the trust account shall be held by the trustee at the trustee's office in the United States.

4. The trust agreement shall provide that:
a. The beneficiary shall have the right to withdraw assets from the trust account at any time, without notice to the grantor, subject only to written notice from the beneficiary to the trustee;

b. No other statement or document is required to be presented to withdraw assets, except that the beneficiary may be required to acknowledge receipt of withdrawn assets;

c. It is not subject to any conditions or qualifications outside of the trust agreement; and,

d. It shall not contain references to any other agreements or documents except as provided for in subparagraph (3)(b)11. below.
5. The trust agreement shall be established for the sole benefit of the beneficiary.

6. The trust agreement shall require the trustee to:
a. Receive assets and hold all assets in a safe place;

b. Determine that all assets are in such form that the beneficiary, or the trustee upon direction by the beneficiary, may whenever necessary negotiate any such assets, without consent or signature from the grantor or any other person or entity;

c. Furnish to the grantor and the beneficiary a statement of all assets in the trust account upon its inception and at intervals no less frequent than the end of each calendar quarter;

d. Notify the grantor and the beneficiary within ten (10) days of any deposits to or withdrawals from the trust account;

e. Upon written demand of the beneficiary, immediately take any and all steps necessary to transfer absolutely and unequivocally all right, title and interest in the assets held in the trust account to the beneficiary and deliver physical custody of the assets to the beneficiary; and,

f. Allow no substitutions or withdrawals of assets from the trust account, except on written instructions from the beneficiary, except that the trustee may, without the consent of but with notice to the beneficiary, upon call or maturity of any trust asset, withdraw the asset upon condition that the proceeds are paid into the trust account.
7. The trust agreement shall provide that at least thirty (30) days prior to termination of the trust account written notification of termination shall be delivered by the trustee to the beneficiary and to the Office.

8. The trust agreement shall be made subject to and be governed by the laws of the state in which the trust is domiciled.

9. The trust agreement shall prohibit invasion of the trust corpus for the purpose of paying compensation to, or reimbursing the expenses of, the trustee.

10. The trust agreement shall provide that the trustee shall be liable for its negligence, willful misconduct, or lack of good faith. The failure of the trustee to draw against the letter of credit in circumstances where such draw would be required shall be deemed to be negligence and willful misconduct.

11. Notwithstanding any other provisions of this rule, when a trust agreement is established to meet the requirements of Section 624.610(5), F.S., in conjunction with a reinsurance agreement covering risks other than life, annuities, and accident and health, where it is customary practice to provide a trust agreement for a specific purpose, the trust agreement may provide that the ceding insurer shall undertake to use and apply amounts drawn upon the trust account, without diminution because of the insolvency of the ceding insurer or the assuming insurer, only for the following purposes:
a. To pay or reimburse the ceding insurer for the assuming insurer's share under the specific reinsurance agreement regarding any losses and allocated loss expenses paid by the ceding insurer, but not recovered from the assuming insurer, or for unearned premiums due to the ceding insurer if not otherwise paid by the assuming insurer;

b. To make payment to the assuming insurer of any amounts held in the trust account that exceed 102 percent of the actual amount required to fund the assuming insurer's obligations under the specific reinsurance agreement; or

c. Where the ceding insurer has received notification of termination of the trust account and where the assuming insurer's entire obligations under the specific reinsurance agreement remain unliquidated and undischarged ten (10) days prior to the termination date, to withdraw amounts equal to the obligations and deposit those amounts in a separate account, in the name of the ceding insurer in any qualified U.S. financial institution apart from its general assets, in trust for such uses and purposes specified in sub-subparagraphs a. and b., above, as may remain executory after the withdrawal and for any period after the termination date.
12. Notwithstanding other provisions of this rule, when a trust agreement is established to meet the requirements of Section 624.610(5), F.S., in conjunction with a reinsurance agreement covering life, annuities, or accident and health risks, where it is customary to provide a trust agreement for a specific purpose, the trust agreement may provide that the ceding insurer shall undertake to use and apply amounts drawn upon the trust account, without diminution because of the insolvency of the ceding insurer or the assuming insurer, only for the following purposes:
a. To pay or reimburse the ceding insurer for:
(I) The assuming insurer's share under the specific reinsurance agreement of premiums returned, but not yet recovered from the assuming insurer, to the owners of policies reinsured under the reinsurance agreement on account of cancellations of the policies; and,

(II) The assuming insurer's share under the specific reinsurance agreement of surrenders and benefits or losses paid by the ceding insurer, but not yet recovered from the assuming insurer, under the terms and provisions of the policies reinsured under the reinsurance agreement;
b. To pay to the assuming insurer amounts held in the trust account in excess of the amount necessary to secure the credit or reduction from liability for reinsurance taken by the ceding insurer; or

c. Where the ceding insurer has received notification of termination of the trust and where the assuming insurer's entire obligations under the specific reinsurance agreement remain unliquidated and undischarged ten (10) days prior to the termination date, to withdraw amounts equal to the assuming insurer's share of liabilities, to the extent that the liabilities have not yet been funded by the assuming insurer, and deposit those amounts in a separate account, in the name of the ceding insurer in any qualified U.S. financial institution apart from its general assets, in trust for the uses and purposes specified in a. and b. above as may remain executory after withdrawal and for any period after the termination date.
13. The reinsurance agreement may, but need not, contain the provisions required in paragraph (5)(d) of this subsection, so long as these required conditions are included in the trust agreement.

14.
a. Notwithstanding any other provisions in the trust instrument, if the grantor of the trust has been declared insolvent or placed into receivership, rehabilitation, liquidation, or similar proceedings under the laws of its state or country of domicile, the trustee shall comply with an order of the insurance regulator with regulatory oversight over the trust or court of competent jurisdiction directing the trustee to transfer to the insurance regulator with regulatory oversight or other designated receiver all of the assets of the trust fund.

b. The assets shall be applied in accordance with the priority statutes and laws of the state in which the trust is domiciled applicable to the assets of insurance companies in liquidation.

c. If the insurance regulator with regulatory oversight determines that the assets of the trust fund or any part thereof are not necessary to satisfy claims of the U.S. beneficiaries of the trust, the assets or any part of them shall be returned to the trustee for distribution in accordance with the trust agreement.
(c) Permitted conditions:
1.
a. The trust agreement may provide that the trustee may resign upon delivery of a written notice of resignation, effective not less than ninety (90) days after the beneficiary and grantor receive the notice and that the trustee may be removed by the grantor by delivery to the trustee and the beneficiary of a written notice of removal, effective not less than ninety (90) days after the trustee and the beneficiary receive the notice.

b. The resignation or removal shall not be effective until a successor trustee has been duly appointed and approved by the beneficiary, and the grantor and all assets in the trust have been duly transferred to the new trustee.
2.
a. The grantor may have the full and unqualified right to vote any shares of stock in the trust account and to receive from time to time payments of any dividends or interest upon any shares of stock or obligations included in the trust account.

b. Any interest or dividends shall be either forwarded promptly upon receipt to the grantor or deposited in a separate account established in the grantor's name.
3. The trustee may be given authority to invest, and accept substitutions of, any funds in the account, provided that no investment or substitution shall be made without prior approval of the beneficiary, unless the trust agreement specifies categories of investments acceptable to the beneficiary and authorizes the trustee to invest funds and to accept substitutions that the trustee determines are at least equal in market value to the assets withdrawn and that are consistent with the restrictions in paragraph (3)(d) of this subsection.

4.
a. The trust agreement may provide that the beneficiary may at any time designate a party to which all or part of the trust assets are to be transferred.

b. Transfer may be conditioned upon the trustee receiving, prior to or simultaneously, other specified assets.
5. The trust agreement may provide that, upon termination of the trust account, all assets not previously withdrawn by the beneficiary shall, with written approval by the beneficiary, be delivered over to the grantor.
(d) A reinsurance agreement may contain provisions that stipulate that assets deposited in the trust account shall be valued according to their current fair market value and shall consist only of cash in U.S. dollars, certificates of deposit issued by a U.S. bank and payable in U.S. dollars, and investments permitted by Part II of Chapter 625, F.S., or any combination of the above, provided investments in or issued by an entity controlling, controlled by or under common control with either the grantor or the beneficiary of the trust shall not exceed five percent (5%) of total investments. The reinsurance agreement may further specify the types of investments to be deposited. Where a trust agreement is entered into in conjunction with a reinsurance agreement covering risks other than life, annuities and accident and health, then the trust agreement may contain the provisions required by this paragraph in lieu of including such provisions in the reinsurance agreement.

(e) A trust agreement may be used to reduce any liability for reinsurance ceded to an unauthorized assuming insurer in financial statements required to be filed with the Office in compliance with this chapter when established on or before the date of filing of the financial statement of the ceding insurer. Further, the reduction for the existence of an acceptable trust account may be up to the current fair market value of acceptable assets available to be withdrawn from the trust account at that time, but such reduction shall be no greater than the specific obligations under the reinsurance agreement that the trust account was established to secure.
(4) Letters of credit qualified under Section 624.610(5), F.S.
(a)
1. The letter of credit shall be clean, irrevocable, unconditional, and issued or confirmed by a qualified U.S. financial institution.

2. As used in this subsection, a qualified U.S. financial institution is one which meets the definition set forth in Section 624.610(6)(a), F.S.

3. The letter of credit shall contain an issue date and expiration date and shall stipulate that the beneficiary need only draw a sight draft under the letter of credit and present it to obtain funds and that no other document need be presented.

4. The letter of credit also shall indicate that it is not subject to any condition or qualifications outside of the letter of credit.

5. The letter of credit shall not contain reference to any other agreements, documents, or entities, except as provided in subparagraph (4)(f)1. of this subsection.

6.
a. As used in this subsection, "beneficiary" means the domestic insurer for whose benefit the letter of credit has been established and any successor by operation of law of the named beneficiary, including without limitation any liquidator, rehabilitator, receiver or conservator.

b. If a court of law appoints a successor in interest to the named beneficiary, then the named beneficiary includes and is limited to the court appointed domiciliary receiver, including conservator, rehabilitator, or liquidator.
(b)
1. The heading of the letter of credit may include a boxed section containing the name of the applicant and other appropriate notations to provide a reference for the letter of credit.

2. The boxed section shall be clearly marked to indicate that such information is for internal identification purposes only.
(c) The letter of credit shall contain a statement to the effect that the obligation of the qualified U.S. financial institution under the letter of credit is in no way contingent upon reimbursement with respect thereto.

(d)
1. The term of the letter of credit shall be for at least one year and shall contain an "evergreen clause" that prevents the expiration of the letter of credit without due notice from the issuer.

2. The "evergreen clause" shall provide for a period of no less than sixty (60) days' notice prior to expiration date or nonrenewal.
(e)
1. The letter of credit shall be subject to and governed by the laws of the state of Florida;

2. All drafts drawn on the letter of credit shall be presentable at an office in the United States of a qualified U.S. financial institution.
(f) Reinsurance agreement provisions.
1. The reinsurance agreement in conjunction with which the letter of credit is obtained may contain provisions that:
a. Require the assuming insurer to provide letters of credit to the ceding insurer and specify what they are to cover.

b. Stipulate that the assuming insurer and ceding insurer agree that the letter of credit provided by the assuming insurer pursuant to the provisions of the reinsurance agreement may be drawn upon at any time, notwithstanding any other provisions in the agreement, and shall be utilized by the ceding insurer or its successors in interest only for one or more of the following reasons:
(I) To pay or reimburse the ceding insurer for:
(A) The assuming insurer's share under the specific reinsurance agreement of premiums returned, but not yet recovered from the assuming insurers, to the owners of policies reinsured under the reinsurance agreement on account of cancellations of such policies; and,

(B) The assuming insurer's share, under the specific reinsurance agreement, of surrenders and benefits or losses paid by the ceding insurer, but not yet recovered from the assuming insurers, under the terms and provisions of the policies reinsured under the reinsurance agreement; and,

(C) Any other amounts necessary to secure the credit or reduction from liability for reinsurance taken by the ceding insurer.
(II) Where the letter of credit will expire without renewal or be reduced or replaced by a letter of credit for a reduced amount and where the assuming insurer's entire obligations under the specific reinsurance remain unliquidated and undischarged ten (10) days prior to the termination date, to withdraw amounts equal to the assuming insurer's share of the liabilities, to the extent that the liabilities have not yet been funded by the assuming insurer and exceed the amount of any reduced or replacement letter of credit, and deposit those amounts in a separate account in the name of the ceding insurer in a qualified U.S. financial institution apart from its general assets, in trust for such uses and purposes specified in sub-sub-subparagraph (4)(f)1.b.(I) of this subsection, as may remain after withdrawal and for any period after the termination date.
c. All of the provisions of this subparagraph (4)(f)1., shall be applied without diminution because of insolvency on the part of the ceding insurer or assuming insurer.
2. Nothing in this paragraph (4)(f), shall preclude the ceding insurer and assuming insurer from providing for:
a. An interest payment, at a rate not in excess of the prime rate of interest, on the amounts held pursuant to sub-subparagraph (4)(f)1.b., above; or

b. The return of any amounts drawn down on the letters of credit in excess of the actual amounts required for the above or any amounts that are subsequently determined not to be due.

69O FAC 144.010 | Accounting Requirements: Life and Health Reinsurance Agreements

(1) Scope.

This rule applies to all domestic life and accident and health insurers and to all other authorized life and accident and health insurers which are not subject to a substantially similar regulation in their domiciliary state. This rule also applies to authorized property and casualty insurers with respect to their accident and health business. This rule does not apply to assumption reinsurance, yearly renewable term reinsurance, or certain nonproportional reinsurance, such as stop loss or catastrophe reinsurance.

(2) Accounting Requirements.

(a) An insurer subject to this rule shall not, for reinsurance ceded, reduce any liability or establish any asset in any financial statement filed with the Office if, by the terms of the reinsurance agreement, in substance or effect, any of the following conditions exist:
1. Renewal expense allowances provided or to be provided to the ceding insurer by the reinsurer in any accounting period are not sufficient to cover anticipated allocable renewal expenses of the ceding insurer on the portion of the business reinsured, unless a liability is established for the present value of the shortfall using assumptions equal to the applicable statutory reserve basis on the business reinsured. Those expenses include commissions, premium taxes, and all direct expenses, such as billing, valuation, claims and maintenance, expected by the company at the time the business is reinsured;

2. The ceding insurer can be deprived of surplus or assets at the reinsurer's option or automatically upon the occurrence of some event, such as the insolvency of the ceding insurer, except that termination of the reinsurance agreement by the reinsurer for nonpayment of reinsurance premiums or other amounts due, such as modified coinsurance reserve adjustments, interest and adjustments on funds withheld, and tax reimbursements, shall not be considered to be such a deprivation of surplus or assets;

3. The ceding insurer is required to reimburse the reinsurer for negative experience under the reinsurance agreement, except that neither offsetting experience refunds against current and prior years' losses under the agreement nor payment by the ceding insurer of an amount equal to the current and prior years' losses under the agreement upon voluntary termination of in force reinsurance by the ceding insurer shall be considered such a reimbursement to the reinsurer for negative experience. Voluntary termination does not include situations where termination occurs because of unreasonable provisions which allow the reinsurer to reduce its risk under the agreement. An example of such a provision is the right of the reinsurer to increase reinsurance premiums or risk and expense charges to excessive levels forcing the ceding company to prematurely terminate the reinsurance treaty;

4. The ceding insurer must, at specific points in time scheduled in the agreement, terminate or automatically recapture all or part of the reinsurance ceded;

5. The reinsurance agreement involves the possible payment by the ceding insurer to the reinsurer of amounts other than from income realized from the reinsured policies. A ceding company may not pay reinsurance premiums or other fees or charges to a reinsurer which are greater than the direct premiums collected by the ceding company;

6.
a. The reinsurance agreement does not transfer all of the significant risk inherent in the business being reinsured. The table entitled "Risk Category" in this subparagraph identifies, for a representative sampling of products or types of business, the risks which are considered to be significant. For products not specifically included, the risks determined to be significant shall be consistent with this table.

b. The risk categories are designated by the letters "a" through "f" in the table below. The references are as follows:
(I) The letter "a" refers to morbidity.

(II) The letter "b" refers to mortality.

(III) The letter "c" refers to lapse. For purposes of this rule, the term "lapse" is the risk that a policy will voluntarily terminate prior to the recoupment of a statutory surplus strain experienced at issue of the policy.

(IV) The letter "d" refers to credit quality. For purposes of this rule, the term "credit quality" is the risk that invested assets supporting the reinsured business will decrease in value. The main hazards are that assets will default or that there will be a decrease in earning power. This term excludes market value declines due to changes in interest rates.

(V) The letter "e" refers to reinvestment. For purposes of this rule, the term "reinvestment" is the risk that interest rates will fall and funds reinvested (coupon payments or monies received upon asset maturity or call) will therefore earn less than expected. If asset durations are less than liability durations, the mismatch will increase.

(VI) The letter "f" refers to disintermediation. For purposes of this rule, the term "disintermediation" is the risk that interest rates rise and policy loans and surrenders increase or maturing contracts do not renew at anticipated rates of renewal. If asset durations are greater than the liability durations, the mismatch will increase. As a result, policyholders will move their funds into new products offering higher rates. The company may have to sell assets at a loss to provide for these withdrawals.
c. For purposes of the table below, the plus sign (+) means that the risk is significant and the zero (0) means that the risk is insignificant.

d. For purposes of the table below, the term "LTC" refers to Long Term Care Insurance and the term "LTD" refers to Long Term Disability Insurance.
RISK CATEGORYabcdef
Health Insurance - other than LTC/LTD+0+000
Health Insurance - LTC/LTD+0+++0
Immediate Annuities0+0++0
Single Premium Deferred Annuities00++++
Flexible Premium Deferred Annuities00++++
Guaranteed Interest Contracts000+++
Other Annuity Deposit Business00++++
Single Premium Whole Life0+++++
Traditional Non-Par Permanent0+++++
Traditional Non-Par Term0++000
Traditional Par Permanent0+++++
Traditional Par Term0++000
Adjustable Premium Permanent0+++++
Indeterminate Premium Permanent0+++++
Universal Life Flexible Premium0+++++
Universal Life Fixed Premium0+++++
Universal Life Fixed Premium0+++++
(dump-in premiums allowed)
7.
a. The credit quality, reinvestment, or disintermediation risk is significant for the business reinsured and the ceding company does not (other than for the classes of business excepted in subparagraph b., below), either transfer the underlying assets to the reinsurer or legally segregate such assets in a trust or escrow account or otherwise establish a mechanism accomplishing the same end which legally segregates, by contract or contract provision, the underlying assets.

b. Notwithstanding the requirements of sub-subparagraph a., above, the assets supporting the reserves for the following classes of business and any classes of business which do not have a significant credit quality, reinvestment, or disintermediation risk may be held by the ceding company without segregation of such assets: health insurance (including long term care insurance and long term disability insurance); traditional non-par permanent; traditional par permanent; adjustable premium permanent; indeterminate premium permanent; and universal life fixed premium (no dump-in premiums allowed).

c. In determining the reserve interest rate adjustment, the formula must reflect the ceding company's investment earnings and incorporate all realized and unrealized gains and losses reflected in the statutory statement. The following is an acceptable formula.

Note that the line references are for the 2001 National Association of Insurance Commissioners (NAIC) Annual Statement and are supplied as a convenient reference. Line references may be different in subsequent annual statements.
Rate = 2 * (I + CG) | (X + Y - I - CG)

Where:
I
Is the net investment income (Exhibit 2, Line 16, Column 7)
CG
Is capital gains less capital losses (Exhibit 3, Line 9, Column 4 plus Exhibit 4, Line 9, Column 4)
X
Is the current year cash and invested assets (Page 2, Line 11, Column 1)

Plus investment income due and accrued (Page 2, Line 18, Column 1) less

Borrowed money (Page 3, Line 22, Column 1)
Y
Is the same as X but for the prior year
8. Settlements are made less frequently than quarterly or payments due from the reinsurer are not made in cash within ninety (90) days of the settlement date.

9. The ceding insurer is required to make representations or warranties not reasonably related to the business being reinsured.

10. The ceding insurer is required to make representations or warranties about future performance of the business being reinsured.

11. The reinsurance agreement is entered into for the principal purpose of producing significant surplus relief for the ceding insurer, typically on a temporary basis, while not transferring all of the significant risks inherent in the business reinsured and, in substance or effect, the expected potential liability to the ceding insurer remains basically unchanged.
(b) Notwithstanding paragraph (2)(a), an insurer subject to this rule may, with the prior approval of the Office, take such reserve credit or establish such asset if the Office finds that the insurer would otherwise not meet the minimum surplus requirements of section 624.408, F.S., and if the insurer has submitted and the Office has approved a plan for eliminating such reserve credit or asset.

(c)
1. Any agreement which is subject to this rule and which is entered into after the effective date of this rule which involve the reinsurance of business issued prior to the effective date of the agreements, along with any subsequent amendments thereto, shall be filed by the ceding company with the Office within thirty (30) days from its date of execution. Each filing shall include data detailing the financial impact of the transaction.

2. Any increase in surplus net of federal income tax resulting from arrangements described in subparagraph (2)(a)1., above, shall be identified separately in the insurer's statutory financial statement as a surplus item (aggregate write-ins for gains and losses in surplus in the Capital and Surplus Account, page 4 of the NAIC Annual Statement) and recognition of the surplus increase as income shall be reflected on a net of tax basis in the "Reinsurance ceded" line, page 4 of the NAIC Annual Statement, as earnings emerge from the business reinsured.

3. The following is an example of the accounting treatment prescribed in subparagraph (2)(a)2., above:
On the last day of calendar year N, company XYZ pays a $20.0 million initial commission and expense allowance to company ABC for reinsuring an existing block of business. Assuming a 34% tax rate, the net increase in surplus at inception is $13.2 million ($20.0 million - $6.8 million) which is reported on the "Aggregate write-ins for gains and losses in surplus" line in the Capital and Surplus account. $6.8 million (34% of $20.0 million) is reported as income on the "Commissions and expense allowances on reinsurance ceded" line of the Summary of Operations.

At the end of year N+1 the business has earned $4 million. ABC has paid $.5 million in profit and risk charges in arrears for the year and has received a $1 million experience refund. Company ABC's annual statement would report $1.65 million (66% of $4 million - $1 million - $.5 million) up to a maximum of $13.2 million) on the "Commissions and expense allowance on reinsurance ceded" line of the Summary of Operations, and -$1.65 million on the "Aggregate write-ins for gains and losses in surplus" line of the Capital and Surplus account. The experience refund would be reported separately as a miscellaneous income item in the Summary of Operations.

(3) Written Agreements.

(a) No reinsurance agreement or amendment to any agreement shall be used to reduce any liability or to establish any asset in any financial statement filed with the Office, unless the agreement, amendment, or a binding letter of intent has been duly executed by both parties no later than the "as of date" of the financial statement.

(b) In the case of a letter of intent, a reinsurance agreement or an amendment to a reinsurance agreement must be executed within a reasonable period of time, not exceeding ninety (90) days from the execution date of the letter of intent, in order for credit to be granted for the reinsurance ceded.

(c) The reinsurance agreement shall contain provisions which provide:
1. That the agreement shall constitute the entire agreement between the parties with respect to the business being reinsured thereunder and that there are no understandings between the parties other than as expressed in the agreement; and,

2. That any change or modification to the agreement shall be null and void unless made by amendment to the agreement and signed by both parties.

3. That the reinsurance is payable by the reinsurer on the basis of the liability of the ceding insurer under the contract or contracts reinsured without diminution because of insolvency of the ceding insurer, and that payments by the reinsurer will be made directly to the ceding insurer or its receiver. However, the reinsurance agreement need not contain this provision if either of the following applies:
a. The reinsurance agreement specifically provides payment by the reinsurer to the named insured, assignee, or named beneficiary of the policy issued by the ceding insurer in the event of the insolvency of the ceding insurer; or

b. The reinsurer, with the consent of the named insured, has assumed the policy obligations of the ceding insurer as direct obligations of the reinsurer in substitution for the obligations of the ceding insurer to the named insured.

(4) Existing Agreements.

Insurers subject to this rule shall reduce to zero by December 31, 1997, any reserve credits or assets established with respect to reinsurance agreements entered into prior to the effective date of this rule which, under the provisions of this rule, would not be entitled to recognition of the reserve credits or assets; provided, however, that the reinsurance agreements shall have been in compliance with the statutory provisions and rules which were effective immediately preceding the effective date of this rule.

(5) Actuarial Opinion.

The ceding insurer's actuary who signs the financial statement actuarial opinion with respect to valuation of reserves shall consider this rule and any applicable actuarial standards of practice when determining the proper credit in financial statements filed with this Office. The actuary shall maintain adequate documentation and be prepared upon request to describe the actuarial work performed for inclusion in the financial statements and to demonstrate that such work conforms to this rule.

69O FAC 144.011 | Credit for Reinsurance from Reinsurers Domiciled in Reciprocal Jurisdictions

(1) Pursuant to Section 624.610(4), F.S., the Office shall allow credit for reinsurance ceded by a domestic insurer to an assuming insurer that is licensed to write reinsurance by, and has its head office or is domiciled in, a reciprocal jurisdiction, and which meets the other requirements of the statute and this rule.

(2) As used in this chapter, a "reciprocal jurisdiction" is a jurisdiction, as designated by the Office pursuant to subsection (4) of this rule, that is one of the following:
(a) A non-United States jurisdiction that is subject to an in-force covered agreement with the United States, each within its legal authority; or, in the case of a covered agreement between the United States and the European Union, a jurisdiction that is a member state of the European Union. As used in this rule, the term "covered agreement" has the same definition as that within Section 624.610(4)(a)1., F.S.

(b) A United States jurisdiction that meets the requirements for accreditation under the Financial Regulation Standards and Accreditation Program of the National Association of Insurance Commissioners.

(c) A qualified jurisdiction, as defined in subsection 69O-144.007(9), F.A.C., which meets the additional requirements present in Section 624.610(4)(a)3., F.S.
(3) Credit shall be allowed when the reinsurance is ceded from an insurer domiciled in this state to an assuming insurer meeting each of the conditions set forth below.
(a) The assuming insurer must be licensed to transact reinsurance by, and have its head office or be domiciled in, a reciprocal jurisdiction.

(b) The assuming insurer must have and maintain on an ongoing basis minimum capital and surplus, or its equivalent, calculated on at least an annual basis as of the preceding December 31 or at the annual date otherwise statutorily reported to the reciprocal jurisdiction, and confirmed as set forth in paragraph (3)(g) according to the methodology of its domiciliary jurisdiction, in the following amounts:
1. No less than $250 million; or

2. If the assuming insurer is an association, including incorporated and individual unincorporated underwriters:
a. Minimum capital and surplus equivalents (net of liabilities) or own funds of the equivalent of at least $250 million; and

b. A central fund containing a balance of the equivalent of at least $250 million.
(c) The assuming insurer must have and maintain on an ongoing basis a minimum solvency or capital ratio, as applicable, as follows:
1. If the assuming insurer has its head office or is domiciled in a reciprocal jurisdiction as defined in Section 624.610(4)(a)1., F.S., the ratio specified in the applicable covered agreement;

2. If the assuming insurer is domiciled in a reciprocal jurisdiction as defined in Section 624.610(4)(a)2., F.S., a risk-based capital (RBC) ratio of three hundred percent (300%) of the authorized control level, calculated in accordance with the formula developed by the NAIC; or

3. If the assuming insurer is domiciled in a reciprocal jurisdiction as defined in Section 624.610(4)(a)3., F.S., after consultation with the reciprocal jurisdiction and considering any recommendations published through the NAIC Committee Process, such solvency or capital ratio as the Office determines to be an effective measure of solvency.
(d) The assuming insurer must agree to and provide adequate assurance, in the form of a properly executed Form OIR-C1-517, "Certificate of Reinsurer Domiciled in Reciprocal Jurisdiction," which may be obtained from https://www.FLOir.com/iPortal, of its agreement to the following:
1. The assuming insurer must agree to provide prompt written notice and explanation to the Office if it falls below the minimum requirements set forth in paragraph (3)(b) or (3)(c) of this subsection, or if any regulatory action is taken against it for serious noncompliance with applicable law.

2. The assuming insurer must consent in writing to the jurisdiction of the courts of this state and to the appointment of the Chief Financial Officer, pursuant to Section 48.151, F.S., as its agent for service of process in this state.
a. The Office may also require that such consent be provided and included in each reinsurance agreement under the Office's jurisdiction.

b. Nothing in this provision shall limit or in any way alter the capacity of parties to a reinsurance agreement to agree to alternative dispute resolution mechanisms, except to the extent such agreements are unenforceable under applicable insolvency or delinquency laws.
3. The assuming insurer must consent in writing to pay all final judgments, wherever enforcement is sought, obtained by a ceding insurer, that have been declared enforceable in the territory where the judgment was obtained.

4. The assuming insurer must agree to include a provision in each reinsurance agreement requiring the assuming insurer to provide security in an amount equal to one hundred percent (100%) of the assuming insurer's liabilities attributable to reinsurance ceded pursuant to that agreement if the assuming insurer resists enforcement of a final judgment that is enforceable under the law of the jurisdiction in which it was obtained or a properly enforceable arbitration award, whether obtained by the ceding insurer or by its legal successor on behalf of its estate, if applicable.

5. The assuming insurer must confirm that it is not presently participating in any solvent scheme of arrangement, which involves this state's ceding insurers, and agrees to notify the ceding insurer and the Office and to provide one hundred percent (100%) security to the ceding insurer consistent with the terms of the scheme, should the assuming insurer enter into such a solvent scheme of arrangement. Such security shall be in a form consistent with the provisions of Sections 624.610(3) and (5), F.S., and Rule 69O-144.009, F.A.C. For purposes of this rule, the term "solvent scheme of arrangement" means a foreign or alien statutory or regulatory compromise procedure subject to requisite majority creditor approval and judicial sanction in the assuming insurer's domiciliary jurisdiction either to finally commute liabilities of duly noticed classed members or creditors of a solvent debtor, or to reorganize or restructure the debts and obligations of a solvent debtor on a final basis, and which may be subject to judicial recognition and enforcement of the arrangement by a governing authority outside the ceding insurer's domiciliary jurisdiction.

6. The assuming insurer must agree in writing to meet the applicable information filing requirements as set forth in paragraphs (3)(e) and (3)(g) of this subsection.
(e) The assuming insurer must file an application for reciprocal jurisdiction reinsurer status, in accordance with paragraph 69O-144.002(5)(a), F.A.C., and the requirements of this rule. If an NAIC accredited jurisdiction has determined that a reciprocal jurisdiction reinsurer has met the conditions in that jurisdiction to become a reciprocal jurisdiction reinsurer, the Office may accept documentation filed with that NAIC accredited jurisdiction or with the NAIC to satisfy the reciprocal jurisdiction reinsurer's status in this state.

(f) The assuming insurer must maintain a practice of prompt payment of claims under reinsurance agreements. The lack of prompt payment will be evidenced if any of the following criteria is met:
1. More than fifteen percent (15%) of the reinsurance recoverables from the assuming insurer are overdue and in dispute as reported to the Office;

2. More than fifteen percent (15%) of the assuming insurer's ceding insurers or reinsurers have overdue reinsurance recoverable on paid losses of 90 days or more which are not in dispute and which exceed for each ceding insurer $100,000, or as otherwise specified in a covered agreement; or

3. The aggregate amount of reinsurance recoverable on paid losses which are not in dispute, but are overdue by 90 days or more, exceeds $50 million, or as otherwise specified in a covered agreement.
(g) To maintain its reciprocal jurisdiction reinsurer status in this state, the assuming insurer or its legal successor must annually provide the information required by paragraph 69O-144.002(5)(b), F.A.C. If an NAIC accredited jurisdiction has determined that a reciprocal jurisdiction reinsurer has met the conditions in that jurisdiction to become a reciprocal jurisdiction reinsurer, the Office may accept documentation filed with that NAIC accredited jurisdiction or with the NAIC to satisfy the reinsurer's status in this state.

(h) Nothing in this chapter precludes an assuming insurer from providing the Office with information on a voluntary basis.

(i) The provisions of this chapter do not limit the authority of the Office to request additional information pertaining to the reinsurance agreement, or any subsequent reinsurance agreement entered into by the assuming insurer and Florida ceding insurers, under Section 624.610(4)(e), F.S.
(4) The Office shall publish and maintain a list of approved reciprocal jurisdictions on its website. The Office shall timely create and publish a list of Reciprocal Jurisdictions.
(a) A list of Reciprocal Jurisdictions is published through the NAIC Committee Process. The Office's list shall include any Reciprocal Jurisdiction as defined under paragraphs (2)(a) and (2)(b) and shall consider any other Reciprocal Jurisdiction included on the NAIC list. The Office may approve a jurisdiction that does not appear on the NAIC list of Reciprocal Jurisdictions as provided by applicable law, regulation, or in accordance with criteria published through the NAIC Committee Process.

(b) The Office may remove a jurisdiction from the list of Reciprocal Jurisdictions upon a determination that the jurisdiction no longer meets one or more of the requirements of a Reciprocal Jurisdiction, as provided by applicable law, regulation, or in accordance with a process published through the NAIC Committee Process, except that the Office shall not remove from the list a Reciprocal Jurisdiction as defined under paragraphs (2)(a) and (2)(b). Upon removal of a Reciprocal Jurisdiction from this list credit for reinsurance ceded to an assuming insurer domiciled in that jurisdiction shall be allowed, if otherwise allowed pursuant to this rule and Section 624.610(4), F.S.
(5) The Office shall publish and maintain a list of reciprocal jurisdiction reinsurers on its website. The Office shall timely create and publish a list of assuming insurers that have satisfied the conditions set forth in this section and to which cessions shall be granted credit in accordance with this section.
(a) If an NAIC accredited jurisdiction has determined that the conditions set forth in subsection (3) have been met, the Office has the discretion to defer to that jurisdiction's determination, and add such assuming insurer to the list of assuming insurers to which cessions shall be granted credit in accordance with this subsection. The Office may accept financial documentation filed with another NAIC accredited jurisdiction or with the NAIC in satisfaction of the requirements of subsection (3).

(b) When requesting that the Office defer to another NAIC accredited jurisdiction's determination, an assuming insurer must submit a properly executed Form OIR-C1-517, "Certificate of Reinsurer Domiciled in Reciprocal Jurisdiction," incorporated by reference in paragraph (3)(d),and additional information as the Office may require. A state that has received such a request will notify other states through the NAIC Committee Process and provide relevant information with respect to the determination of eligibility.
(6) The determination of reciprocal jurisdiction reinsurer status shall be made by order issued by the Office.

(7) If the Office determines that an assuming insurer no longer meets one or more of the requirements under Section 624.610, F.S., or this chapter, the Office may revoke or suspend the status of the assuming insurer.
(a) While an assuming insurer's status is suspended, no reinsurance agreement issued, amended or renewed after the effective date of the suspension qualifies for credit except to the extent that the assuming insurer's obligations under the contract are secured in accordance with Section 624.610(5), F.S.

(b) If an assuming insurer's status is revoked, no credit for reinsurance may be granted after the effective date of the revocation with respect to any reinsurance agreements entered into by the assuming insurer, including reinsurance agreements entered into prior to the date of revocation, except to the extent that the assuming insurer's obligations under the contract are secured in a form acceptable to the Office and consistent with the provisions of Section 624.610(4), F.S.
(8) Before denying statement credit or imposing a requirement to post security with respect to subsection (7) of this rule or adopting any similar requirement that will have substantially the same regulatory impact as security, the Office shall:
(a) Communicate with the ceding insurer, the assuming insurer, and the assuming insurer's supervisory authority that the assuming insurer no longer satisfies one of the conditions listed in subsection (3) of this rule;

(b) Provide the assuming insurer with 30 days from the initial communication to submit a plan to remedy the defect, and 90 days from the initial communication to remedy the defect, except in exceptional circumstances in which a shorter period is necessary for policyholder and other consumer protection;

(c) After the expiration of 90 days or less, as set out in paragraph (8)(b), if the Office determines that no or insufficient action was taken by the assuming insurer, the Office may impose any of the requirements as set out in this subsection; and

(d) Provide a written explanation to the assuming insurer of any of the requirements set out in this subsection.
(9) If subject to a legal process of rehabilitation, liquidation or conservation, as applicable, the ceding insurer, or its representative, may seek and, if determined appropriate by the court in which the proceedings are pending, may obtain an order requiring that the assuming insurer post security for all outstanding liabilities.

69O FAC 144.012 | Term and Universal Life Insurance Reserve Financing

(1) The purpose and intent of this rule is to implement the national standards governing reserve financing arrangements pertaining to life insurance policies containing guaranteed nonlevel gross premiums, guaranteed nonlevel benefits and universal life insurance policies with secondary guarantees; and to ensure that, with respect to each such financing arrangement, funds consisting of primary security and other security, as defined in subsection (3) of this rule, are held by or on behalf of ceding insurers in the forms and amounts required herein. In general, reinsurance ceded for reserve financing purposes has one or more of the following characteristics: some or all of the assets used to secure the reinsurance treaty or to capitalize the reinsurer:
(a) Are issued by the ceding insurer or its affiliates; or

(b) Are not unconditionally available to satisfy the general account obligations of the ceding insurer; or

(c) Create a reimbursement, indemnification or other similar obligation on the part of the ceding insurer or any if its affiliates (other than a payment obligation under a derivative contract acquired in the normal course and used to support and hedge liabilities pertaining to the actual risks in the policies ceded pursuant to the reinsurance treaty).
(2) This rule shall apply to reinsurance treaties that cede liabilities pertaining to covered policies, as that term is defined in paragraph (3)(b) of this rule, issued by any life insurance company domiciled in this state.

(3) Definitions.
(a) "Actuarial method" means the methodology used to determine the required level of primary security, as described in subsection (5) of this rule.

(b) "Covered policies" means policies, other than grandfathered policies and the exemptions described in subsection (4) of this rule, of the following policy types:
1. Life insurance policies with guaranteed nonlevel gross premiums and/or guaranteed nonlevel benefits, except for flexible premium universal life insurance policies; or

2. Flexible premium universal life insurance policies with provisions resulting in the ability of a policyholder to keep a policy in force over a secondary guarantee period.
(c) "Grandfathered policies" means policies of the types described in subparagraphs (b)1. and (b)2. of this rule that were:
1. Issued prior to January 1, 2015; and

2. Ceded, as of December 31, 2014, as part of a reinsurance treaty that would not have met one of the exemptions set forth in subsection (4) of this rule, had the rule then been in effect.
(d) "NAIC" means the National Association of Insurance Commissioners.

(e) "Non-covered policies" means any policy that does not meet the definition of covered policies, including grandfathered policies.

(f) "Required level of primary security" means the dollar amount determined by applying the actuarial method to the risks ceded with respect to covered policies, but not more than the total reserve ceded.

(g) "Primary security" means the following forms of security:
1. Cash meeting the requirements of Section 624.610(5)(a), F.S.;

2. Securities listed by the NAIC Securities Valuation Office meeting the requirements of Section 624.610(5)(b), F.S., but excluding any synthetic letter of credit, contingent note, credit-linked note or other similar security that operates in a manner similar to a letter of credit, and excluding any securities issued by the ceding insurer or any of its affiliates; and

3. For security held in connection with funds-withheld and modified coinsurance reinsurance treaties:
a. Commercial loans in good standing of CM3 quality and higher as defined and calculated pursuant to Section 624.4085(1)(m), F.S.;

b. Policy loans; and

c. Derivatives acquired in the normal course and used to support and hedge liabilities pertaining to the actual risks in the policies ceded pursuant to the reinsurance treaty.
(h) "Other security" means any security acceptable to the office pursuant to Section 625.151, F.S., other than security meeting the definition of primary security.

(i) "Valuation Manual" means the valuation manual adopted by the NAIC as defined in Section 625.1212(2)(k), F.S., with all amendments adopted by the NAIC that are effective for the financial statement date on which credit for reinsurance is claimed.

(j) "VM-20" means "Requirements for Principle-Based Reserves for Life Products," including all relevant definitions, from the Valuation Manual defined in Section 625.1212(2)(k), F.S.
(4) This rule does not apply to the following situations:
(a) Reinsurance of:
1. Policies that satisfy the criteria for exemption set forth in paragraph 69O-164.020(6)(f) or (g), F.A.C.; and which are issued before the later of:
a. The effective date of this rule, and

b. The date on which the ceding insurer begins to apply the provisions of VM-20 (as defined in subsection (3) of this rule) to establish the ceded policies' statutory reserves, but in no event later than January 1, 2020;
2. Portions of policies that satisfy the criteria for exemption set forth in paragraph 69O-164.020(6)(e), F.A.C., and which are issued before the later of:
a. The effective date of this rule, and

b. The date on which the ceding insurer begins to apply the provisions of VM-20 to establish the ceded policies' statutory reserves, but in no event later than January 1, 2020;
3. Any universal life policy that meets all of the following requirements:
a. Secondary guarantee period, if any, is five (5) years or less;

b. Specified premium for the secondary guarantee period is not less than the net level reserve premium for the secondary guarantee period based on the Commissioners Standard Ordinary (CSO) valuation tables and valuation interest rate applicable to the issue year of the policy as provided in Section 625.121(5), F.S.; and

c. The initial surrender charge is not less than 100 percent of the first year annualized specified premium for the secondary guarantee period;
4. Credit life insurance;

5. Any variable life insurance policy that provides for life insurance, the amount or duration of which varies according to the investment experience of any separate account or accounts; nor

6. Any group life insurance certificate unless the certificate provides for a stated or implied schedule of maximum gross premiums required in order to continue coverage in force for a period in excess of one year.
(b) Reinsurance ceded to an assuming insurer that meets the applicable requirements of Section 624.610(3)(c), F.S.;

(c) Reinsurance ceded to an assuming insurer that meets the applicable requirements of Section 624.610(3)(a) or (3)(b), F.S., and that, in addition:
1. Prepares statutory financial statements in compliance with the NAIC Accounting Practices and Procedures Manual, which are incorporated by reference in Rule 69O-137.001, F.A.C., without any departures from NAIC statutory accounting practices and procedures pertaining to the admissibility or valuation of assets or liabilities that increase the assuming insurer's reported surplus and are material enough that they need to be disclosed in the financial statement of the assuming insurer pursuant to Statement of Statutory Accounting Principles No. 1 ("SSAP 1"); and

2. Is not in a company action level event, regulatory action level event, authorized control level event, or mandatory control level event (as those terms are defined in Section 624.4085, F.S.), when its risk-based capital ("RBC") is calculated in accordance with the life RBC report including overview and instructions for companies, as the same may be amended by the NAIC from time to time, without deviation;
(d) Reinsurance ceded to an assuming insurer that meets the applicable requirements of Section 624.610(3)(a) or (3)(b), F.S., and that, in addition:
1. Is not an affiliate, as that term is defined in Section 624.10(1), F.S., of:
a. The insurer ceding the business to the assuming insurer; or

b. Any insurer that directly or indirectly ceded the business to that ceding insurer;
2. Prepares statutory financial statements in compliance with the NAIC Accounting Practices and Procedures Manual;

3. Is both:
a. Licensed or accredited in at least 10 states (including its state of domicile), and

b. Not licensed in any state as a captive, special purpose vehicle, special purpose financial captive, special purpose life reinsurance company, limited purpose subsidiary, or any other similar licensing regime; and
4. Is not, or would not be, below 500 percent of the authorized control level RBC (as that term is defined in Section 624.4085, F.S.) when its RBC is calculated in accordance with the life RBC report including overview and instructions for companies, as the same may be amended by the NAIC from time to time, without deviation, and without recognition of any departures from NAIC statutory accounting practices and procedures pertaining to the admission or valuation of assets or liabilities that increase the assuming insurer's reported surplus;
(e) Reinsurance ceded to an assuming insurer that:
1. Meets this state's conditions for reciprocal jurisdiction reinsurers, as set forth in Section 624.610(4), F.S., and Rule 69O-144.011, F.A.C.; or

2. Is certified as a reinsurer in this state, in accordance with Rule 69O-144.007, F.A.C.; or

3. Maintains at least $250 million in capital and surplus when determined in accordance with the NAIC Accounting Practices and Procedures Manual, including all amendments thereto adopted by the NAIC, excluding the impact of any permitted or prescribed practices; and is:
a. Licensed in at least 26 states; or

b. Licensed in at least 10 states, and licensed or accredited in a total of at least 35 states;
(f) If a person submits a petition under Section 120.542, F.S., to the office, reinsurance not otherwise exempt under paragraphs (a) through (e) if the office, after consulting with the NAIC Financial Analysis Working Group (FAWG) or other group of regulators designated by the NAIC, as applicable, determines under all the facts and circumstances that all of the following apply:
1. The risks are clearly outside of the intent and purpose of this rule (as described in subsection (1) of this rule);

2. The risks are included within the scope of this rule only as a technicality; and

3. The application of this rule to those risks is not necessary to provide appropriate protection to policyholders. The office shall publicly disclose any decision made pursuant to this paragraph to exempt a reinsurance treaty from this rule, as well as the general basis therefor (including a summary description of the treaty).
(5) The actuarial method.

(a) Actuarial Method.

The actuarial method to establish the required level of primary security for each reinsurance treaty subject to this rule shall be VM-20, applied on a treaty-by-treaty basis, including all relevant definitions, from the Valuation Manual as then in effect, applied as follows:
1. For covered policies described in subparagraph (3)(b)1. of this rule, the actuarial method is the greater of the deterministic reserve or the net premium reserve (NPR) regardless of whether the criteria for exemption testing can be met. However, if the covered policies do not meet the requirements of the stochastic reserve exclusion test in the Valuation Manual, then the actuarial method is the greatest of the deterministic reserve, the stochastic reserve, or the NPR. In addition, if such covered policies are reinsured in a reinsurance treaty that also contains covered policies described in subparagraph (3)(b)2. of this rule, the ceding insurer may elect to instead use subparagraph 2. of this paragraph as the actuarial method for the entire reinsurance agreement. Whether subparagraph 1. or 2. is used, the actuarial method must comply with any requirements or restrictions that the Valuation Manual imposes when aggregating these policy types for purposes of principle-based reserve calculations.

2. For covered policies described in subparagraph (3)(b)2. of this rule, the actuarial method is the greatest of the deterministic reserve, the stochastic reserve, or the NPR regardless of whether the criteria for exemption testing can be met.

3. Except as provided in subparagraph 4., the actuarial method is to be applied on a gross basis to all risks with respect to the covered policies as originally issued or assumed by the ceding insurer.

4. If the reinsurance treaty cedes less than 100 percent of the risk with respect to the covered policies then the required level of primary security may be reduced as follows:
a. If a reinsurance treaty cedes only a quota share of some or all of the risks pertaining to the covered policies, the required level of primary security, as well as any adjustment under sub-subparagraph c. below, may be reduced to a pro rata portion in accordance with the percentage of the risk ceded;

b. If the reinsurance treaty in a non-exempt arrangement cedes only the risks pertaining to a secondary guarantee, the required level of primary security may be reduced by an amount determined by applying the actuarial method on a gross basis to all risks, other than risks related to the secondary guarantee, pertaining to the covered policies, except that for covered policies for which the ceding insurer did not elect to apply the provisions of VM-20 to establish statutory reserves, the required level of primary security may be reduced by the statutory reserve retained by the ceding insurer on those covered policies, where the retained reserve of those covered policies should be reflective of any reduction pursuant to the cession of mortality risk on a yearly renewable term basis in an exempt arrangement;

c. If a portion of the covered policy risk is ceded to another reinsurer on a yearly renewable term basis in an exempt arrangement, the required level of primary security may be reduced by the amount resulting by applying the actuarial method including the reinsurance section of VM-20 to the portion of the covered policy risks ceded in the exempt arrangement, except that for covered policies issued prior to January 1, 2017, this adjustment is not to exceed [cx/ (2 * number of reinsurance premiums per year)] where cx is calculated using the same mortality table used in calculating the NPR; and

d. For any other treaty ceding a portion of risk to a different reinsurer, including but not limited to stop loss, excess of loss and other non-proportional reinsurance treaties, there will be no reduction in the required level of primary security.
It is possible for any combination of sub-subparagraphs a., b., c., and/or d. to apply. Such adjustments to the required level of primary security will be done in the sequence that accurately reflects the portion of the risk ceded via the treaty. The ceding insurer should document the rationale and steps taken to accomplish the adjustments to the required level of primary security due to the cession of less than 100 percent of the risk.

The adjustments for other reinsurance will be made only with respect to reinsurance treaties entered into directly by the ceding insurer. The ceding insurer will make no adjustment as a result of a retrocession treaty entered into by the assuming insurers.

5. In no event will the required level of primary security resulting from application of the actuarial method exceed the amount of statutory reserves ceded.

6. If the ceding insurer cedes risks with respect to covered policies, including any riders, in more than one reinsurance treaty subject to this rule, in no event will the aggregate required level of primary security for those reinsurance treaties be less than the required level of primary security calculated using the actuarial method as if all risks ceded in those treaties were ceded in a single treaty subject to this rule;

7. If a reinsurance treaty subject to this rule cedes risk on both covered and non-covered policies, credit for the ceded reserves shall be determined as follows:
a. The actuarial method shall be used to determine the required level of primary security for the covered policies, and subsection (6) of this rule shall be used to determine the reinsurance credit for the covered policy reserves; and

b. Credit for the non-covered policy reserves shall be granted only to the extent that security, in addition to the security held to satisfy the requirements of sub-subparagraph a., is held by or on behalf of the ceding insurer in accordance with Sections 624.610(3) through (5), F.S. Any primary security used to meet the requirements of this sub-subparagraph may not be used to satisfy the required level of primary security for the covered policies.

(b) Valuation used for Purposes of Calculations

For the purposes of both calculating the required level of primary security pursuant to the actuarial method and determining the amount of primary security and other security, as applicable, held by or on behalf of the ceding insurer, the following shall apply:
1. For assets, including any such assets held in trust, that would be admitted under the NAIC Accounting Practices and Procedures Manual if they were held by the ceding insurer, the valuations are to be determined according to statutory accounting procedures as if such assets were held in the ceding insurer's general account and without taking into consideration the effect of any prescribed or permitted practices; and

2. For all other assets, the valuations are to be those that were assigned to the assets for the purpose of determining the amount of reserve credit taken in compliance with the valuation manual defined in Section 625.1212(2)(k), F.S.
(6) Requirements Applicable to covered policies to Obtain Credit for Reinsurance; Opportunity for Remediation
(a) Requirements. Subject to the exemptions described in subsection (4) of this rule and the provisions of paragraph (6)(b) of this rule, credit for reinsurance shall be allowed with respect to ceded liabilities pertaining to covered policies pursuant to Sections 624.610(2) through (5), F.S., if, and only if, in addition to all other requirements imposed by law or regulation, the following requirements are met on a treaty-by-treaty basis:
1. The ceding insurer's statutory policy reserves with respect to the covered policies are established in full and in accordance with the applicable requirements of Section 625.121, F.S., and related regulations and actuarial guidelines, and credit claimed for any reinsurance treaty subject to this rule does not exceed the proportionate share of those reserves ceded under the contract; and

2. The ceding insurer determines the required level of primary security with respect to each reinsurance treaty subject to this rule and provides support for its calculation as determined to be acceptable to the office; and

3. Funds consisting of primary security, in an amount at least equal to the required level of primary security, are held by or on behalf of the ceding insurer, as security under the reinsurance treaty within the meaning of Section 624.610(5), F.S., on a funds withheld, trust, or modified coinsurance basis; and

4. Funds consisting of other security, in an amount at least equal to any portion of the statutory reserves as to which primary security is not held pursuant to subparagraph 3. above, are held by or on behalf of the ceding insurer as security under the reinsurance treaty within the meaning of Section 624.610(5), F.S.; and

5. Any trust used to satisfy the requirements of this subsection shall comply with all of the conditions and qualifications of Section 624.610(5), F.S., except that:
a. Funds consisting of primary security or other security held in trust, shall for the purposes identified in paragraph (5)(b) of this rule, be valued according to the valuation rules set forth in that paragraph, as applicable; and

b. There are no affiliate investment limitations with respect to any security held in such trust if such security is not needed to satisfy the requirements of subparagraph (a)3.; and

c. The reinsurance treaty must prohibit withdrawals or substitutions of trust assets that would leave the fair market value of the primary security within the trust (when aggregated with primary security outside the trust that is held by or on behalf of the ceding insurer in the manner required by subparagraph (a)3.) below 102 percent of the level required by subparagraph (a)3. at the time of the withdrawal or substitution; and

d. The determination of reserve credit under paragraph 69O-144.009(3)(e), F.A.C, shall be determined according to the valuation rules set forth in paragraph (5)(b) of this rule, as applicable; and
6. The reinsurance treaty has been approved by the office.
(b) Requirements at Inception Date and on an Ongoing Basis; Remediation
1. The requirements of paragraph (6)(a) must be satisfied as of the date that risks under covered policies are ceded (if such date is on or after the effective date of this rule) and on an ongoing basis thereafter. Under no circumstances shall a ceding insurer take or consent to any action or series of actions that would result in a deficiency under subparagraph (6)(a)3. or 4. with respect to any reinsurance treaty under which covered policies have been ceded, and in the event that a ceding insurer becomes aware at any time that such a deficiency exists, it shall use its best efforts to arrange for the deficiency to be eliminated as expeditiously as possible.

2. Prior to the due date of each Quarterly or Annual Statement required by Rule 69O-137.001, F.A.C., each life insurance company that has ceded reinsurance within the scope of subsection (2) shall perform an analysis, on a treaty-by-treaty basis, to determine, as to each reinsurance treaty under which covered policies have been ceded, whether as of the end of the immediately preceding calendar quarter (the valuation date) the requirements of subparagraph (6)(a)3. or 4. were satisfied. The ceding insurer shall establish a liability equal to the excess of the credit for reinsurance taken over the amount of primary security actually held pursuant to subparagraph (6)(a)3., unless either:
a. The requirements of subparagraph (6)(a)3. or 4. were fully satisfied as of the valuation date as to such reinsurance treaty; or

b. Any deficiency has been eliminated before the due date of the Quarterly or Annual Statement to which the valuation date relates through the addition of primary security and/or other security, as the case may be, in such amount and in such form as would have caused the requirements of subparagraph (6)(a)3. or 4. to be fully satisfied as of the valuation date.
3. Nothing in subparagraph (6)(b)2. shall be construed to allow a ceding company to maintain any deficiency under subparagraphs (6)(a)3. or 4. for any period of time longer than is reasonably necessary to eliminate it.
(7) No insurer that has covered policies as to which this rule applies (as set forth in subsection (3) of this rule) shall take any action or series of actions, or enter into any transaction or arrangement or series of transactions or arrangements if the purpose of such action, transaction or arrangement or series thereof is to avoid the requirements of this rule, or to circumvent its purpose and intent, as set forth in subsection (1) of this rule.
69O-148 | Funding of Preneed Contracts with Life Insurance or Annuities

69O FAC 148.001 | Funding of Preneed Contracts With Life Insurance or Annuities

(1) Background and Purpose.

The provisions of section 626.785, F.S., provide for insurance agents to sell life insurance and annuities on a limited basis to fund preneed services and merchandise. The statute provides that if a funeral establishment contracts with a life insurance agent to sell a preneed contract pursuant to chapter 497, F.S., the benefits payable under the insurance contract are limited to the approximate retail price of the funeral service and merchandise. The purpose of this rule is to clarify the statutory limitations to ensure that consumers are protected.

(2) General Limitation.

For purposes of section 626.785, F.S., and this rule only, and pursuant to section 624.602, F.S., the transaction of life insurance shall include the sale of nonvariable type annuities.

(3) Limitation of License.

An agent licensed pursuant to section 626.785(3), F.S., is limited to selling life insurance and nonvariable type annuity contracts for the purpose of providing funds to pay for funeral services and merchandise selected under the terms of a preneed funeral contract.

(4) "Face Amount" Defined.

For purposes of section 626.785, F.S., and this rule, the term face amount shall, provided that any subsequent increase in the benefit payable under the life insurance policy or annuity does not exceed the reasonably expected increase in the retail price of the services and merchandise specified in the preneed funeral contract, mean:
(a) The total consideration for an annuity contract; or

(b) As to a life insurance policy with full first day coverage, the death benefit payable at the time the policy is issued; or

(c) As to a life insurance policy which has a limited death benefit in the early years, the death benefit designated at the time the policy is issued which is payable when the limited benefits are inapplicable.

(5) Limitation of Coverage.

(a) Life insurance or nonvariable type annuity contracts may be sold to cover the cost of services and merchandise specified in a preneed funeral contract of an insured or annuitant, provided the face amount of the life insurance policy, or the total consideration paid for such annuity, does not exceed the amount set forth in section 626.785, F.S. Any increase in the death benefit of such life insurance or annuity shall be limited to the reasonably anticipated increase in the retail price of the services and merchandise specified in the preneed funeral contract.

(b) The aggregate amount of insurance proceeds payable under such life insurance or annuity contracts, for the benefit of any one life which may be paid to a preneed certificate holder licensed pursuant to chapter 497, F.S., shall not exceed the retail price of the services and merchandise which are provided at time of need. All other proceeds shall be paid to the beneficiary named in such contracts, or, if no beneficiary has been designated, to the estate of the insured or annuitant.

(c) All annuity contracts shall contain an age or event whereby the annuitant shall start receiving annuity benefits. If the maturity date of the annuity contract is age 70 or greater, or upon the death of the annuitant, the annuity contract must permit the contract owner the option to change the maturity date at the owner's option.

(6) Form Filing Notification.

Any form filed with the Office pursuant to section 627.410, F.S., for use in funding a preneed funeral contract in this State, shall include a notification of the form's intended use for this purpose.
69O-149 | Filing of Forms and Rates for Life/Health Insurance

69O FAC 149.002 | Scope and Applicability

(1)
(a)
1. Every policy, rider or endorsement form affecting benefits which is submitted for approval shall be submitted in accordance with the provisions of Part II of this rule chapter and shall be accompanied by a rate filing or an actuarial certification that such policy, rider, or endorsement form does not require a change in rates.

2. Any subsequent addition to or change in rates applicable to such policy, rider, or endorsement form shall also be filed.
(b) Unless the context specifically states otherwise, this Part I of this rule chapter applies to:
1. All individual health insurance issued to Florida residents;

2. All group health insurance insuring the residents of Florida where the master contract is issued in the state of Florida;

3. All franchise health insurance issued to Florida residents; and,

4. All Group Health Insurance and Health Maintenance Organization contracts insuring the residents of Florida where the master contract is issued to an association group or a group trust, in or outside the State of Florida, and the insurance is provided to the employees of a small employer as defined in Section 627.6699, F.S.
(c)
1. Insurers may make filings that incorporate prospective premium schedule rate changes in which the future change period is up to one year. Examples include increasing the new issue premium by a predetermined amount each month or each quarter, or implementing a rate increase in segments over a one-year period.

2. The renewal premium schedule shall be consistent with any adjustments in the new premium schedule in a predefined and approved fashion.

3. All prospective rate changes or methodologies for rate changes must be approved before implementation in accordance with this part.
(2) As required by Section 627.410(7), F.S., all health insurers shall comply with the annual rate filing requirements in Rule 69O-149.007, F.A.C., including for forms subject to subsection (5), below.

(3) Part I of rule Chapter 69O-149, F.A.C., does not apply to:
(a) Credit disability insurance as defined in Section 627.677, F.S.;

(b) Contract forms as defined in Section 627.601(3), F.S.
(4) The rates for every individual accident and health policy form filed pursuant to a loss ratio guarantee permitted by Section 627.410(8), F.S., shall comply with the provisions of Rules 69O-149.002 through 69O-149.006 and 69O-149.008, F.A.C. The provisions of Section 627.410(8), F.S., are optional.

(5) The rules of this part I are applicable to all policies and certificates in force or issued on or after February 1, 1994, except that:
(a) As to forms approved prior to February 1, 1994, and as to which the insurer does not continue to issue new policies after June 1, 1994, only those rules in effect on October 1, 1993 shall apply; and,

(b) As to forms approved prior to February 1, 1994, and as to which the insurer continues to issue new policies after June 1, 1994, policies in force on May 31, 1994, shall be subject only to rules in effect on October 1, 1993, and policies issued on or after June 1, 1994, shall be subject to these rules. The rating prohibitions described in paragraphs 69O-149.005(10)(a) and (b), F.A.C., are applicable to all policies and certificates issued on or after October 1, 1993.
(6) Pursuant to the provisions of Section 627.410(6)(b), F.S., rate filings required by Rule 69O-149.003, F.A.C., and Annual Rate Certification (ARC) filings required by Rule 69O-149.007, F.A.C., are not required to be made for the following; however, the rating standards contained in this Part I and applicable statutes shall continue to apply as if the rate schedules were required to be filed for approval:
(a) Annually rated group health insurance policies as defined by Section 627.652(1), F.S., including blanket insurance as defined by Section 627.659, F.S., issued in this state that provide availability of coverage only to groups with 51 or more employees/members.

(b) This filing exemption does not apply to franchise policies issued pursuant to Section 627.663, F.S.

(c) This filing exemption does not apply to stop-loss policy forms, unless the policy is issued only to employers with 51 or more employees.
(7)
(a) Forms that provide for the acceleration of the benefits of a life insurance policy that are incidental to the total life insurance coverage are not subject to the annual rate or ARC filing requirements of Section 627.410, F.S., or these rules. The insurer is required to submit an actuarial demonstration with the initial filing for approval demonstrating such incidental compliance.

(b) The acceleration is considered incidental if the value of the accelerated benefit is less than 10 percent of the total value of the benefits provided by the life insurance coverage. These values shall be measured as the present values of the benefits determined as of the date of issue, determined according to the formula (NSP2-NSP1)/NSP1, applied over a range of underwriting classes and plans at which the benefit is being made available, is not in any case greater than 10%, where:
1. NSP1 and NSP2 are determined using an effective annual interest rate of 6%.

2. NSP1 is the net single premium for the base policy benefits assuming there is no accelerated death benefit.

3. NSP2 is the net single premium for the base policy benefits assuming that the full death benefit is paid at time of death or the occurrence of the non-death accelerated death benefit trigger.
(c) If a separate premium or cost of insurance (COI) charge is the only charge being charged for the accelerated benefit provided, the ratio of the present value of the accelerated benefit premiums or COI charges over the life of the policy to the present value of the policy premiums or COI charges exclusive of any riders, does not exceed 10%, the present values shall be determined using an effective annual interest rate of 6%.

(d) Upon request of the Office, the insurer shall provide an actuarial demonstration that the accelerated death benefit continues to meet these standards. If it is determined that the accelerated death benefit fails to comply with these standards, the provisions of these rules shall apply.

69O FAC 149.0025 | Definitions

(1)
(a) Actual-to-Expected (A/E) ratio: The ratio of actual incurred claims under the policy form divided by expected claims. This is equivalent to the actual annual loss ratio divided by the applicable durational loss ratios of the approved durational loss ratio table.

(b) For projected periods, the A/E ratio is the ratio of the projected claims divided by the expected claims.

(c) Both the year-by-year pattern of the A/E ratios and the aggregate past, future, and lifetime ratios shall be presented.
(2) Annually Rated Group Policies: Group policies, including major medical coverage, which meet all of the following criteria:
(a) The policies are funded on a 1-year basis to satisfy loss ratio requirements.

(b) The policies are expected to be repriced annually based on trend and demographic changes.

(c) Effects of underwriting, if any, are part of the composite assumptions so that durational claims experience is incorporated into the composite rate.

(d) Aging is not pre-funded, as in a Medicare supplement or long term care policy.
(3) Anticipated Loss Ratio: The present value of future benefits divided by the present value of future premiums computed over the entire future lifetime of the policy form. For annually rated groups, the anticipated loss ratio expected over the rating period is also referred to as the target loss ratio.

(4) Attained Age Premium Schedule: An attained age premium schedule is one in which the policyholder's premium is dependent upon his or her age at policy renewal.
(a) The aging component of the claim cost is not pre-funded.

(b) These schedules shall be constructed so that the slope by age is substantially similar to the slope of the ultimate claim cost curve. The premiums shall form a smooth progression and, to eliminate jumps in premium caused by bracketed age groups, insurers shall use each available renewable age.

(c) These requirements do not apply to any group policy where the final premium charged is an average of the individual members.
(5) Closed Policy Form: A policy form is closed for rating purposes if the insurer has not actively offered it for sale in the previous 12 months.

(6) Credible Data:
(a) Except as provided in paragraph (b), if a policy form has 2,000 or more policies in force, then full (100 percent) credibility is given to the experience; if fewer than 500 policies are inforce, then zero (0 percent) credibility is given.

(b)
1. For policy forms with low expected claims frequency, the data from the fewest number of entire calendar years, starting with the most recent experience year and looking back year by year as necessary, to the calendar year in which the accumulated claims first equal or exceed a total of 1,000 claims, shall be assigned 100 percent credibility; 200 claims shall be assigned 0 percent credibility. If 100 percent credibility is not achieved by using the most recent five year period, the data from the most recent five year period only shall be used. The determination of low expected claims frequency is determined at issue and not at different durations of the coverage.
(I) Policy forms that are determined not to be low expected claims frequency forms include, but are not limited to: Medicare Supplement, vision, dental, hospital indemnity, medical expense and other coverage described in Section 627.6562(3), F.S., as creditable coverage.

(II) Policy forms that are determined to be low expected claims frequency forms include, but are not limited to: accident, disability with benefit periods of 24 months or longer, coverage subject to the Long-Term Care Insurance Act, Sections 627.9401 - 627.9408, F.S., cancer, specified disease, and critical illness.
2. For purposes of this section, a claim is counted as the first incidence or diagnosis of an event resulting in a covered benefit or series of covered benefits. It is not each provider encounter or service that may provide care or benefits due to such event.

3. A distinct incident resulting from a recurring chronic condition may be considered as a new claim if the incident triggering the claim is distinct from the incident triggering the prior claim, and the insured had recovered from the prior claim.
(c) Linear interpolation is used for inforce amounts between the low and high values in paragraph (a) or (b).

(d) For group policy forms, the numbers in this definition refer to individual group certificates or subscribers, not policies.

(e) For coverage that is not subject to paragraph (f), below,:
1. Florida only experience shall be used if it is 100 percent credible.

2.
a. If Florida experience is not 100 percent credible, a combination of Florida and nationwide experience shall be used.

b. The Florida data shall be given the weight of the ratio of the Florida credibility to the nationwide credibility. For example, if Florida data is 10 percent credible and nationwide is 40 percent credible, the Florida data will be given the weight of [10%/40%] 25 percent.

c. The nationwide data shall be given the weight of the ratio of the nationwide credibility less the Florida credibility to the nationwide credibility. In the above example, the nationwide data will be given the weight of [(40%-10%)/40%] 75 percent.

d. The data is combined using the indicated weights (in the example above, the experience data would be weighted 25%/75%). The combination of the two weights will always equal 100 percent. A rate change is determined from the blended data. If the nationwide credibility is less than 100 percent, the indicated rate change is weighted by the nationwide credibility (40 percent in the above example) and medical trend, if applicable, by the compliment of the nationwide credibility (60 percent in the above example). If nationwide credibility is 100 percent, there would be no trend component.
3. The analysis in subparagraph (6)(e)2., above, is equivalent to determining the indicated rate increase from the Florida only data and the total nationwide data separately, and then weighting the resulting rate changes from each distinct analysis by the credibility of each distinct component. In the example above, the Florida rate increase would be weighted by 10 percent, the nationwide rate increase would be weighted by 30 percent (40%-10% = the non-Florida credibility component) and trend would be weighted by the complement of the nationwide credibility (1-40%) 60 percent.
(f) Due to the geographic pricing of medical expense coverage, Florida-only data shall be used. When Florida data is not fully credible, the complement of the experience credibility factor shall be weighted with medical trend.
(7) Durational Loss Ratio Table: The table of annual loss ratios where a loss ratio is the ratio of incurred claims divided by earned premium for each policy duration, by policy duration determined from the original actuarial memorandum when the form was first approved.
(a)
1.
a. The company shall adjust the durational loss ratio table when the average annual premium at the time of filing results in a loss ratio standard pursuant to the provisions of subsection 69O-149.005(4), F.A.C., that is changed by at least .5 percent from the current lifetime loss ratio standard for the form.

b. Each loss ratio in the durational loss ratio table shall be increased by the ratio of the loss ratio standard determined from the current average annual premium divided by the prior lifetime loss ratio standard;
2.
a. When the loss ratio is adjusted pursuant to sub-subparagraph (7)(a)1.a., above, the lifetime loss ratio standard for the form shall be the prior lifetime standards weighted by the accumulated earned premiums applicable to each standard with the weight for the new lifetime loss ratio standard being the present value of projected premiums.

b. If the company is unable to provide the historical information necessary to calculate the appropriate weighting, the new standard will be the lifetime loss ratio as determined by sub-subparagraph (7)(a)1.a., above.
(b) The approved durational loss ratio table is the durational loss ratio table contained in the filing when the form was originally approved, or any subsequent durational loss ratio table filed where the Office explicitly approved the table. The present value of these durational loss ratios is designated as the lifetime target loss ratio.
(8) Earned Premium:
(a) The portion of the total premium paid by the insured attributable to the period of coverage elapsed. This includes all modal loadings, fees, or charges that are required to be paid by the insured.

(b) Premium shall be earned uniformly over the period for which coverage is provided.

(c) Sections 627.6043(2) and 627.6645(4), F.S., provide that the company may have a short rate table approved. If approved, the short rate table is used in lieu of uniform earning (pro-rata) for determining refunds upon cancellation, and shall not be incorporated for rate filing purposes.
(9) Entire Future Lifetime: The maximum period over which the policy would be in effect if not terminated by action of the insurer or the insured.
(a) For individual and group policies other than annually rated group policies, the minimum acceptable period for calculation purposes is the number of years before fewer than 5 percent of the original policyholders or certificateholders remain inforce. This period is determined using the anticipated termination rates for the form.

(b) For annually rated group policies, the entire future lifetime is the rating period.
(10) Expected Claims:
(a) The actual earned premium or, for projected periods the projected premium, times the applicable policy durational loss ratio from the approved durational loss ratio table which was in effect for the time period covered by the premiums.

(b) For annually rated group policies, this reflects the actual target loss ratio for the group; i.e., reflecting different retention loads based on group differences.
(11) Franchise Policies: These are considered to be individual policies under these rules unless the franchise policies are health benefit plans under Section 627.6699, F.S. In this event, the franchise policies will be considered to be group policy forms.

(12) Group Insurance Policy Form: Any insurance provided by a group master contract issued to any entity representing a group specified in Chapter 627, Part VII, F.S., such as a trust, an association, a union, an employer, or a group established primarily for the purpose of providing insurance coverage.

(13) Group Size:
(a) For Group Insurance Policy Forms insuring employer/employee relationships, the group size is the average number of certificates per employer.

(b) For other types of groups, the group size is the number of certificates issued in the state of Florida for out-of-state group master contracts or the average number of certificates per master contract issued in the state of Florida for in-state groups, up to a maximum of 50 certificates.
(14) Incurred Claims: Claims occurring within a fixed period, whether or not paid during the same period, under the terms of the policy form.

(15) Line of Business: For rating purposes, the Office recognizes the following types of policy forms:
(a) Medical Expense: Policy forms that pay benefits based on the actual costs charged for hospital care (in or out patient), health care provider services, durable medical equipment, drugs, blood, medical supplies, x-ray and radiology services, lab work or like services which are reasonable and medically necessary and are not otherwise excluded under the policy.
1. The Policy Form will be considered a "medical expense" policy if at least 50 percent of total benefits of the policy based upon expected claim costs are subject to medical trend.

2. The following coverages will not be considered medical expense insurance:
a. Medicare Supplement insurance.

b. Long Term Care insurance.

c. Coverage supplemental to liability insurance.

d. Workers' compensation or similar insurance.

e. Automobile medical payment insurance.
(b) Medical Indemnity: Policy forms that pay a predetermined, specified, fixed benefit for services provided.
1. Claim costs under these forms are generally not subject to medical trend, although they may be subject to utilization changes.

2. Policy forms that can use this structure include hospital indemnity, dread disease, and accident policy forms.
(c) Medicare Supplement: Policy forms as defined in Part VIII of Chapter 627, F.S.;

(d) Long Term Care: Policy forms as defined in Part XVIII of Chapter 627, F.S.

(e) Loss of Income: Policy forms which pay a regular income as long as the insured is disabled but not beyond the benefit period.
(16) New Policy Form: A policy form that is proposed for approval to the Office and has no policies issued or inforce.

(17) Policy Form or Form: A single policy form or any collection of policy forms that have been combined for rating purposes. A collection once combined continues to be combined.

(18) Premium Schedule: The collection of rates to be charged encompassing base rates and any modifying factors.

(19) Rate Change: Any change to the premium schedule being charged.

(20) Renewal Clauses:
(a) Optionally Renewable: Renewal can be declined on any individual or group contract at the option of the insurer.

(b) Conditionally Renewable: Renewal can be declined by class, by geographic area or for stated reasons other than deterioration of health. The insurer may revise rates on a class basis.

(c) Guaranteed Renewable includes:
1. Policy forms where the renewal cannot be declined by the insurer for any reason other than fraud, misrepresentation, failure to pay the premium when due, or expiration of the contract, but the insurer can revise rates on a class basis.

2.
a. Policy forms subject to Sections 627.6425 or 627.6571, F.S.

b. When an insurer discontinues offering a particular policy form for health insurance coverage pursuant to Section 627.6425(3)(a), F.S.:
(I) The nonrenewal of coverage shall occur on the policy anniversary;

(II) The offer of new coverage pursuant to Section 627.6425(3)(a)2., F.S., shall be considered a renewal of coverage and shall be renewed on the policy anniversary at the same class basis as the coverage being discontinued.

(III) If the forms do not have consistent class definitions, the class shall be determined based on the original application and underwriting status of the individual when the discontinued coverage was first issued.

(IV) For policy forms subject to Section 627.6571, F.S., the renewal or nonrenewal of coverage shall be coincident with the effective date of coverage when the group is rerated, which is generally the annual anniversary of the group.
(d) Non-Cancelable: Renewal cannot be declined for any reason other than fraud, misrepresentation, or failure to pay the premium when due, and that rates cannot be revised by the insurer.

(e) Non-Renewable: A contractual provision exists which prevents a policy duration of more than a specific period, which shall be no more than 1 year.
(21) Select and Ultimate Premium Schedule: Any premium schedule which has premiums that vary based on the time elapsed since issuance of the policy. These do not include rate schedules that reduce due to temporary risk charges, a one-time policy fee, or policyholder action to reduce benefits.

(22) Similar Benefits:
(a) Policy forms shall be considered to have similar benefits if the benefit configuration under the forms is of the same type. Dental, hospital and accidental death are examples of different benefit configurations. Policy forms providing expense coverage are not considered similar to policy forms providing indemnity coverage.

(b) Covered services, benefit triggers, copay amounts, copay options, deductible sizes, daily limits, inside and outside limits may vary and shall be considered as having similar benefits.
(23) Stop-Loss Insurance: Coverage purchased by an entity, generally an employer, for the purpose of covering the entity's obligation for the excess cost of medical care provided under a self-insured health benefit plan. Stop-loss coverage issued to a small employer shall not be subject to the requirements of Section 627.6699, F.S. The coverage shall be considered as a health insurance policy, rather than as a stop-loss insurance policy if the policy:
(a) Has an attachment point for claims incurred per individual which is lower than $20,000; or

(b)
1. For insured employer groups with fifty (50) or fewer covered employees, has an aggregate attachment point which is lower than the greater of:
a. $4,000 times the number of employees;

b. 120 percent of expected claims; or

c. $20,000; or
2. For insured employer groups with fifty-one (51) or more covered employees, has an aggregate attachment point which is lower than 110 percent of expected claims.

3. Insurers shall determine the number of covered employees of an employer on a consistent basis (such as annually and at a uniform time).
(24) Target Loss Ratio: The lifetime loss ratio and the present value of the durational loss ratios developed in initial pricing projections as may be subsequently amended and approved pursuant to this rule chapter. For annually rated groups, the anticipated loss ratio over the rating period.

69O FAC 149.003 | Rate Filing Procedures

(1)
(a) Pooling. For purposes of submitting a rate filing under this part for individual policy forms and for group Medicare supplement and long-term care group policy forms, in order to encourage adequate risk sharing for all generations of policyholders, the experience of all policy forms providing similar benefits, whether open or closed, shall be combined.
1. Separate rating pools may be used for policy forms defined in subsections 69O-149.005(5) and (6), F.A.C., and for stop-loss insurance policy forms.

2. Once policy forms have been combined, they remain so for all rating purposes, unless otherwise approved by the Office. This combining of the experience of policy forms is referred to as pooling. All policy forms within a pool are reviewed based on the analysis of the aggregate experience.

3. The same percentage rate adjustment shall be applicable to all policy forms within the pool.

4. In lieu of subparagraph (1)(a)3., above, percentage rate adjustments that are not the same for all policy forms within the pool shall be permitted subject to the following:
a. Resulting premium rate schedules are actuarially equivalent based on benefit differences or different regulatory standards, such as margins or retentions, between the policy forms within the pool;

b. Assumptions used to determine future experience and actuarial equivalence shall be based on the same set of common morbidity assumptions for all policy forms within the pool;

c. Policy forms with existing premium rate schedules not meeting the standards of sub-subparagraphs a. and b. above shall not be required to reduce rates to bring the policy forms into compliance, but any proposed rate adjustment shall be required to improve the relationship of the policy forms' premium rate schedules to bring them closer to compliance with sub-subparagraphs a. and b., above; and

d. Non-uniform rate increases shall be subject to the implementation provisions of sub-sub-subparagraph 69O-149.006(3)(b)20.b.(V), F.A.C., on a revenue neutral basis as though a level percentage adjustment had been applied.
5. The experience of policies and policy forms where the rate schedule is not subject to change, such as non-cancellable policy forms and paid up policies, shall not be pooled with policy forms where the rates are subject to change.

6. The rate increase for a Medicare supplement form may be adjusted, on a revenue neutral basis, to mitigate the impact on the refund credit calculation required for the form pursuant to Rule 69O-156.011, F.A.C., where the company can demonstrate that without such adjustment, the rate increase will result in refunds being required.
(b) Credibility. In analyzing the experience of policy forms, and to improve the statistical credibility and predictability of anticipated experience, credible data shall be used.
(2) Filing Format for Individual Policies and Group Policies and Certificates.
(a)
1. All filings shall be made in accordance with paragraph (2)(b), below.

2
a. For purposes of the rules in this part and the time periods in Section 627.410, F.S., a filing is considered "filed" with the Office upon the receipt of the material required by paragraph (2)(b), on business days between the hours of 8:00 a.m. and 5:00 p.m. eastern time. Filings received after 5:00 p.m. shall be considered to be received the following business day.

b. For purposes of the rules in this part, the term "filed" does not mean "approved." The term "filed" refers to the date on which the filing is filed with the Office and is the date on which the approval process of Section 627.410, F.S., commences.

c. Filings shall be made on a company distinct basis.
(b) A health insurance rate filing shall consist of the following items:
1. A brief letter explaining the type and nature of the filing. The letter shall indicate if the filing is for a new policy form, a benefit revision, a rate revision, justification of existing rates, or a resubmission. If the filing is a resubmission, the letter shall indicate the Florida filing number of the prior filing.

2. Form OIR-B2-1507, "Office of Insurance Regulation Life and Health Forms and Rates Universal Standardized Data Letter" as adopted in Rule 69O-149.022, F.A.C., completely filled out in accordance with Form OIR-B2-1507A, "Office of Insurance Regulation Life and Health Forms and Rates Universal Standardized Data Letter Instruction Sheet" as adopted in Rule 69O-149.022, F.A.C.

3. The actuarial memorandum, completed as required by Rule 69O-149.006, F.A.C.

4. Rate pages that define all proposed rates, rating factors and methodologies for determining rates applicable in the state.
a. For companies that have a complete rate manual on file with the Office, only the pages that are being changed need to be filed, unless requested by the Office.

b. For Medicare Supplement filings, rates must be submitted through the on-line Medicare Supplement Rate Collection System which is part of the i-file system.
(3) Filings shall be submitted electronically to http://www.FLOir.com/iPortal.

(4)
(a) Every insurer submitting a rate filing shall be notified as to whether the filing has been affirmatively approved by the Office or has been disapproved by the Office within any statutory review period of the date of receipt of the filing.

(b) Submissions that do not include the required material to meet the definition of a filing, or that include material that is illegible, shall not be accepted and shall be returned as incomplete without processing.

(c) Every insurer submitting a rate filing which does not comply with the requirements of Rules 69O-149.002-.006, F.A.C., or for which the Office determines that additional information is necessary for a proper review, will be notified of the additional information necessary within the statutory limit. Every insurer shall submit the required data by a date certain stated in the clarification letter, to allow the Office sufficient time to perform a proper review. Failure to correct the filing by the date certain in the clarification letter will result in an affirmative disapproval of the filing by the Office.
(5)
(a) Insurers with fewer than 1,000 Florida policyholders, under any form or pooled group of Medicare supplement, or medical expense forms with coverage meeting the definition of Section 627.6562(3)(a)2., F.S., may, at their option, file a streamlined rate increase filing not exceeding medical trend as provided in subsection (6), below.

(b) The number indicated in paragraph (5)(a), above, represents the individual primary insureds and does not include spouses or dependants.

(c) For group coverage, the number indicated in paragraph (5)(a), above, represents the individual certificateholders or subscribers.

(d) For Medicare supplement business, this provision applies for each type considered separately: Standard, Pre-standard and Select Medicare supplement coverage.

(e) The filing:
1. Shall be made in accordance with paragraph 69O-149.003(2)(b), F.A.C.; and,

2. Shall provide a certification that the filing includes all forms with similar benefits in lieu of the actuarial memorandum referenced in subparagraph 69O-149.003(2)(b)3., F.A.C.
(f) This provision is an option available to the company. The company may choose, at its option, to make a complete filing in accordance with paragraph 69O-149.003(2)(b), F.A.C., including a complete actuarial memorandum in accordance with Rule 69O-149.006, F.A.C.
(6)
(a) The tables found at www.FLOir.com shall apply to filings made pursuant to subsection (5), above. They contain the maximum medical trend for medical expense coverage described in Section 627.6562(3)(a)2., F.S., and the maximum medical trend for Medicare Supplement coverage.

(b) A company without fully credible data may, at its option, use an annual medical trend assumption not to exceed the values in the tables referenced in paragraph (6)(a), for the medical trend assumption used in a complete filing made pursuant to paragraph 69O-149.003(2)(b), F.A.C., including the actuarial memorandum required by Rule 69O-149.006, F.A.C., without providing explicit trend justification.

(c) Use of an annual medical trend assumption exceeding the maximum medical trend in the tables referenced in paragraph (6)(a), shall be filed pursuant to subparagraph 69O-149.006(3)(b)18., F.A.C.

69O FAC 149.004 | Experience Records

(1) The level of detail and the degree of integrity incorporated in the experience records of the insurer are vital factors in the presentation and review of rate filings. Benefits to policyholders and insurer viability and profitability are significantly impaired with less than excellent record-keeping. The detail necessary to complete the experience on the form, as defined in subparagraph 69O-149.006(3)(b)23., F.A.C., is sufficient for rate filing and review purposes. Any requests for additional information shall be only for such information as is required by sound actuarial principles.

(2) The data required shall be available on a nationwide and on a Florida-only basis.

(3)
(a) If an insurer does not have all necessary data, and is unable to reconstruct the data at a reasonable expense, the insurer shall consult with the Office to address the issue of determining compliance with the required loss ratio standards.

(b) If the insurer is able to demonstrate that the missing data will not materially affect the analysis, the missing data shall not be required.

(c) If the missing data would affect the analysis, the missing data shall either be reconstructed, or a conservative estimate that minimizes the current rate increase request shall be used.

69O FAC 149.005 | Reasonableness of Benefits in Relation to Premiums

(1) Benefits will be determined to be reasonable in relation to the premium rates charged if the premium schedule is not excessive, not inadequate and not unfairly discriminatory. In determining whether a premium schedule satisfies these requirements, the Office will consider all items presented in the filing with special emphasis placed on the information included in the actuarial memorandum.

(2) A premium schedule is not excessive if the following are true:
(a) For a new policy form, group or individual, the anticipated loss ratio is not less than the indicated adjusted entry in the loss ratio tables, in subsection (4), below.

(b)
1. For individual forms, and group policy forms other than annually rated group policy forms, approved on or after 2/1/94 or issued on or after 6/1/94, the Premium Schedule satisfies the following:
a. An Anticipated Loss Ratio test such that the present value of projected claims is not less than the present value of expected claims over the entire future lifetime of the form. This is equivalent to the present value of the future A/E ratio not being less than 1.0; and,

b. The current lifetime loss ratio, as defined in subparagraph 69O-149.006(3)(b)24., F.A.C., is not less than the initial filed target loss ratio for the form as may be subsequently amended and approved pursuant to this rule chapter.
2. For annually rated group policy forms, the target loss ratio is not less than the loss ratio anticipated in the current premium schedule, as may be subsequently amended and approved pursuant to this rule chapter.
(c) For an existing Individual Policy Form issued up to 6/1/94 for forms approved prior to 2/1/94, the Premium Schedule satisfies subparagraphs 1. and 2., below:
1. The anticipated Loss Ratio is not less than the initial filed loss ratio; and,

2. The current lifetime Loss Ratio is not less than the initial filed loss ratio.
(d) For an existing group policy form issued up to 6/1/94 for forms approved prior to 2/1/94, the anticipated loss ratio is not less than the appropriate adjusted entry in the loss ratio tables in subsection (3), below.
(3) Loss Ratios for Individual Policies and Group Certificates issued up to 6/1/94 for forms approved prior to 2/1/94. The loss ratios in the table in paragraph (d), below, are adjusted pursuant to paragraph (a), (b), or (c), below, where:
I = (CPI-U, year N-1)/103.9 N-1 is the calendar year immediately preceding the calendar year (N) in which the rate filing is submitted in Florida, and CPI-U is the consumer price index for all urban consumers, for all items and for all regions of the U.S. combined, as determined by the U.S. Department of Labor, Bureau of Labor Statistics; and the CPI-U for any year is the value as of September. (a) If the average annual premium per individual policy or group certificate, (X), is less than $ 300xI, then the minimum loss ratio is adjusted to R' by the following formula: R' = R x ((800xI + X)/(1100xI)), where the reduction cannot exceed 10 percentage points.

(b) If the average annual premium per individual policy or group certificate, (X) exceeds $ (I*2000), then the minimum loss ratio is adjusted to R' by the following formula: R' = R*((I*9000)+X)/(I*11000)). R' cannot exceed R by more than 10 percentage points.

(c) For group insurance certificates, there is an additional adjustment R''.
1. For E greater than 0 and less than or equal to 100
R'' = R' x ((550 + E) / 550)
2. For E greater than 100
R'' = R' x ((6400 + E) / 5500)
3. E is normally the average number of certificateholders in a group rating class.

4. However, where a group is composed of subgroups, e.g., multiple employer trusts, E is the average number of certificateholders per subgroup. Where a group is composed of certificateholders issued as a result of solicitations of individuals through the mail or by mass media advertising, including both print and broadcast advertising, E shall be 50. In no event will R'' be greater than 80%. The average annual premium (X) shall be per certificate under a group policy and shall be estimated by the insurer based on an anticipated distribution of business considering all significant criteria having a rate difference. Such estimate shall assume an annual mode for all certificates, i.e., the fractional premium loading shall not affect the average annual premium or anticipated loss ratio calculation. The value of X shall be determined on the basis of the rates being filed.
(d) Loss Ratio Table:
Renewal ClausesLoss Ratio in %
Optionally Renewable60
Conditionally Renewable55
Guaranteed Renewable55
Non-cancellable50
Non-renewable50
(4) Loss Ratios for Individual Policies and Group Certificates approved on or after 2/1/94 or issued on or after 6/1/94. These tables are also applicable to paid family leave policies. These tables are not applicable to Medicare Supplement or Long-Term Care Policy Forms. The minimum loss ratios for those policy forms are found in rule Chapters 69O-156 and 69O-157, F.A.C., respectively.
(a) The loss ratios in the tables below are adjusted in accordance with the following formula, where:
R
the loss ratio from the table,
A
the average annual premium per individual policy or per group certificate,
R'
the adjusted loss ratio, and
I is as defined in subsection 69O-149.005(3), F.A.C.

Then R' = (A-25I)R/A and R' cannot be more than 10 percentage points less than R, for coverage with at least 12 months and pro rata for coverage with less than 12 months, nor less than 50 percent; except R' cannot be less than 45 percent as to accident only non-cancellable policies.

(b) Loss Ratio Table - Group Policy Forms
Group SizeMedical Expense
Loss Ratio
Medical Indemnity or any policy with an
average annual premium per certificate less than $1,000
Loss Ratio
Fewer than 51 certificates65%57.5%
51 through 500 certificates70%62.5%
All others75%67.5%
(c) 1. Loss Ratio Table - Individual and Stop-loss Policy Forms.
Renewal ClauseMedical Expense
Loss Ratio %
Medical Indemnity, Loss of Income
Loss Ratio
Non-Cancellable55%50%
Non-Renewable60%55%
Guaranteed Renewable65%60%
All Other70%65
Minimum Acceptable55%50%
2. For purposes of determining the minimum required loss ratio for stop-loss policies, the average annual premium for purposes of determining the R' above, shall be the average premium per employee covered by the employer's stop-loss policy.
(5)
(a) Group conversion insurance, other than long-term care and medicare supplement insurance, issued on either a group or an individual basis, is exempt from the loss ratios required above.

(b) The loss ratio for group conversion insurance shall not be less than 120 percent.

(c) The insurer may charge the excess of the group conversion loss ratio over that required for group insurance on active lives to the experience for insurance on active lives.

(d) The premium to be charged for group conversion insurance subject to Section 627.6675, F.S., shall not exceed the limits of Section 627.6675(3), F.S., based on the standard risk rates as established in part X of this rule chapter.
(6) Blanket Insurance is exempt from the loss ratios required above. The minimum loss ratio for blanket insurance is 65%.

(7) As provided by Section 627.411(3)(a), F.S., the minimum loss ratio in the above tables for health insurance coverage as described in Section 627.6562(3)(a)2., F.S., shall be at least 65 percent.

(8) Anticipated loss ratios lower than those otherwise required by this part shall not be permitted unless the insurer demonstrates that the proposed loss ratios are in accordance with sound actuarial principles; do not result in unfair discrimination in sales practices; and are otherwise in substantial compliance with the requirements of this part.

(9) A premium schedule shall not be disapproved on the grounds of inadequacy if:
(a) The expected profit margin on the policy form is non-negative. This margin equals the sum of premium income and investment income, minus the sum of benefit payments, expenses, taxes and contingency margins;

(b) The premium schedule incorporates for the entire future lifetime of the policy, the projected entire effects of insurance trend; and,

(c) The premium schedule is determined such that if all assumptions are satisfied, the annual rate increases needed will not be greater than medical trend, as defined in subparagraph 69O-149.006(3)(b)18., F.A.C.
(10) A premium schedule is unfairly discriminatory if it incorporates any of the following:
(a) For all long term care policy forms and other policy forms under which more than 50 percent of the policies/certificates are issued to persons age 65 or older, attained age premium structures, are prohibited. Only premium structures which prefund the aging component of future claim costs are allowed.

(b) Select and Ultimate Premium Schedules are prohibited.

(c) Attained age premium schedules where the slope by age is substantially different from the slope of the ultimate claim cost curve are prohibited.
(11) Attained age rated individual medical expense health insurance coverage may incorporate into the rate schedule a rating factor that provides for a reapplication of the factor subsequent to the original issuance of the coverage, subject to the following:
(a) The factor shall be limited to those categories where an insured is able to qualify for the factor based solely on the insured's right to apply for the option at the time, such as continued discount for non-tobacco use;

(b) The determination for qualification of the factor shall be based on well-defined objective criteria;

(c) Health or claim status of the insured does not limit the ability of an individual to qualify for the factor;

(d) The factor shall be applied uniformly to all insureds;

(e) The timing of the redetermination of the factor shall be predetermined and disclosed in the policy. The application of the factor shall be in a nondiscriminatory manner; i.e., at every anniversary, at each third year anniversary, etc.;

(f) The availability, initial determination, redetermination, or value of the factor is not based on any health-status-related factors, as described in Section 627.65625(1), F.S., in relation to the individual or a covered dependant of the individual.
(12) Upon request of the Office, the company shall provide an actuarial demonstration that benefit and premium relativities provided on a form currently available for sale are reasonable in relation to benefit and premium relativities provided in other forms currently available for sale in the same rating pool, given actuarial considerations generally used in pricing a product.

(13)
(a) Whenever a company makes a non-contractual offering to existing insureds, without underwriting, to replace or exchange their policy with alternate coverage where the original policy is priced on an issue age rate schedule, the rate charged to the insured for the new policy shall recognize the policy reserve buildup, due to the prefunding inherent in the use of an issue at rate basis, to the benefit of the insured. The method proposed by the company must be filed for approval. The rate for the conversion shall be at the most similar rating class as was the original coverage. A statutorily required conversion provision would be considered contractual.

(b) Not withstanding the above, a company may always convert at the original issue age and duration of the insured without providing justification to the Office.
(14) An insurer may issue multiple year rate guarantee or rating cap provisions subject to the following:
(a) The coverage is for annually rated group health insurance policies for which filing of rates is exempted by Section 627.410(6), F.S.

(b) The provision may not apply for greater than 24 months unless otherwise exempted by the Office;

(c) The rate for the entire rating period reflects the increased risk of a rate guarantee with an increased premium or other consideration is actuarially sound, includes claim costs projected at trend levels at least as high as those applicable to other groups with similar benefit structures in the rating area covered under the form(s) and is reasonably anticipated to meet the target loss ratio for the group;

(d) The provision is available to groups on a nondiscriminatory basis as determined by the insurer's underwriting standards; and,

(e) The insurer uses experience rating in determining the group's rate consistently based on its rating and underwriting practices without regard to whether the rate is issued with or without a rate guarantee.
(15) Accident only, accidental death and dismemberment, dental, disability income, hearing, hospital indemnity, hospital/surgical medical expense, intensive care, and vision policies issued by an insurer are exempt from the requirement of paragraph (14)(b). This provision may not apply for greater than 60 months for accident only, accidental death and dismemberment, dental, disability income, hearing, hospital indemnity, hospital/surgical medical expense, intensive care, and vision policies issued by an insurer.

69O FAC 149.0055 | Healthy Lifestyle Rebate

(1) Group Coverage.

(a) All insurers and HMOs subject to the provisions of Section 627.65626 or 641.31(40), F.S., shall provide for a healthy lifestyle rebate.

(b)
1. All insurers and HMOs providing a healthy lifestyle rebate shall file for approval the standards it will use for determining the level of rebate, i.e., between 0% and 10%, for different health status indicators, which shall include reduction in weight, body mass index, and smoking cessation.

2. The filed standards shall provide that the rebate is available and attainable by all policy or contract holders on a nondiscriminatory basis and be without regard to the health or claim status of the member or subscriber.

3. The filing of the standards shall address the method and timing of the determination and application of the rebate.
(c)
1. For purposes of rate filings, the rebate made shall be accounted as a reduction to the earned premium and clearly identified in the filing.

2. Rate filings shall include the number of members or subscribers participating in the rebate program and the distribution of the policies or contracts by size of rebate earned.
(d) The insurer or HMO shall provide an appropriate rebate for maintenance or improvement of health status for any program offered by a policy or contract holder as determined by agreed upon health status indicators.

(e) This rule shall be effective for all policies issued or renewed on or after July 1, 2005 with the first rebate available in 2006.

(2) Individual Coverage.

(a) Any individual health insurance coverage subject to the provisions of Section 627.6402, F.S., and where such coverage meets the standards of creditable coverage as defined in Section 627.6562(3), F.S., may provide for a healthy lifestyle rebate.

(b)
1. All insurers that provide for a healthy lifestyle rebate shall file for approval the standards it will use for determining the level of rebate, i.e., between 0% and 10%, for different health status indicators, which shall include reduction in weight, body mass index, and smoking cessation.

2. The filed standards shall provide that the rebate is available and attainable by all insureds on a nondiscriminatory basis and be without regard to the health or claim status of the insured.

3. The filing of the standards shall address the method and timing of the determination and application of the rebate.
(c)
1. For purposes of rate filings, the rebate made shall be accounted as a reduction to the earned premium and clearly identified in the filing.

2. Rate filings shall include the number of policies participating in the rebate program and the distribution of the policies by size of rebate earned.
(d) The insurer shall provide an appropriate rebate for maintenance or improvement of health status for any program approved by the insurer as determined by agreed upon health status indicators.

(e) This rule shall be effective for all policies issued or renewed on or after July 1, 2005 with the first rebate available in 2006.

69O FAC 149.006 | Actuarial Memorandum

(1) In order for a rate filing to be reviewed properly by the Office, the actuarial memorandum required by subparagraph 69O-149.003(2)(b)4., F.A.C., shall contain the items listed in subsection (2), below, for a new product filing, a rate revision or justification of existing rates. Pricing assumptions shall reflect insurer experience to the degree credible, and industry experience where insurer experience is not credible, available or appropriate. Assumptions shall reflect what the insurer fully expects to occur, rather than assumptions developed primarily for rate filing purposes based on sound actuarial principles. All such items shall be adequately justified by supporting data. In reviewing these assumptions, the Office will use, as an initial point of reference, comparisons of the assumptions with those from similar products of the same insurer, similar products of other insurers and independent studies. If an insurer provides projections that differ from those historically experienced for similar coverage, it shall provide supporting data to justify how and why the projections will differ from the actual historical experience. Additional information will be required, if, given the particular facts and circumstances of the filing, the Office determines that the additional information is necessary to properly complete its review of the filing to determine if the benefits are reasonable in relation to the premiums charged. All filings reviewed under Rules 69O-149.002 through 69O-149.006, F.A.C., shall be reviewed in accordance with sound actuarial principles and, except where the context plainly does not involve an actuarial determination, all adverbs in these rules such as "properly" and "appropriately" shall be construed in light of those principles.

(2) Note that the numbers preceding the item names refer to the descriptions in subsection (3), below.
(a) Item 1. Scope & Purpose.

(b) Item 2. Benefit Description.

(c) Item 3. Renewability Clause.

(d) Item 4. Applicability.

(e) Item 5. Morbidity.

(f) Item 6. Mortality.

(g) Item 7. Persistency.

(h) Item 8. Expenses.

(i) Item 9. Marketing Method.

(j) Item 10. Underwriting.

(k) Item 11. Premium Classes.

(l) Item 12. Issue Age Range.

(m) Item 13. Area Factors.

(n) Item 14. Average Annual Premium.

(o) Item 15. Premium Modalization Rules.

(p) Item 16. Claim Liability and Reserves.

(q) Item 17. Active Life Reserves.

(r) Item 18. Trend Assumption - Medical and Insurance.

(s) Item 19. Minimum Loss Ratio.

(t) Item 20. Anticipated Loss Ratio.

(u) Item 21. Distribution of Business.

(v) Item 22. Contingency & Risk Margins.

(w) Item 23. Experience - Past & Future.

(x) Item 24. Lifetime Loss Ratio.

(y) Item 25. History of Rate Adjustments.

(z) Item 26. Number of Policyholders.

(aa) Item 27. Proposed Effective Date.

(bb) Item 28. Actuarial Certification.
(3) Descriptions.
(a)
1. For new filings, rate revisions, and justification of existing rates, the assumptions presented shall be appropriate at the time of the filing.

2. Rate revision filings shall clearly identify all rating factors or methods proposed to be changed.

3. New policy forms shall include a rate and benefit comparison to at least the two largest volume policy forms of the insurer that provide similar benefits, including all forms currently available for sale. The insurer shall demonstrate that the proposed premium rate schedule represents an actuarially sound relationship between the policy forms and between benefit options within policy forms, giving appropriate consideration to experience emerging under existing forms.
(b) The descriptions, by item number, of the terms listed above in subsection (2), follow:
1. Scope and Purpose of Filing: This section shall specify whether this is a new filing, a rate revision, or a justification of an existing rate. If the filing is a rate revision, the reason for the revision shall be stated.

2. Description of Benefits: This section shall include a brief description of the benefits provided by the policy, the benefit amounts per unit of coverage, and the available number of units.

3. Renewability Clause: This section shall identify the renewability classification of the form.

4. Applicability: This section shall specify whether the insurer anticipates new issues under the form or renewals only.

5. Morbidity: This section shall describe the morbidity basis for the form, including the source or sources used. Any substantive adjustments from either the source or earlier assumptions shall be explained. The morbidity assumed shall be adequately justified by supporting data.

6. Mortality: This section shall state the mortality basis. Any substantive adjustments from earlier assumptions shall be explained and adequately justified by supporting data.

7. Persistency: This section shall state and describe the lapse rates used. Any substantive adjustments from earlier assumptions shall be explained. The Office shall request historical lapse rates on an inforce policy block or on a similar policy form if needed to judge the actuarial reasonableness of the filed lapse rates.

8. Expenses: This section shall include a brief description of any expense assumptions used, including, for example, per policy and percentage of premium expense for acquisition, maintenance, and commissions. These must be provided separately for each policy year.

9. Marketing Method: This section shall provide a brief description of the market and the marketing method. An example of an acceptable brief description is: "This product is sold in a home service debit market by a captive agency force." The information requested is not intended to compromise the insurer's proprietary interests but rather to inform the Office's consideration of allocation of expenses and acquisition costs, as required by Section 627.411(2), F.S.

10. Underwriting: This section shall provide a brief description of the extent to which this product will be underwritten, if any, and the expected impact by duration and in total, on the claim costs. The insurer shall state separately the effects of different types of underwriting: medical, financial and plan appropriateness. An example of an acceptable brief description is:
"This Policy Form is subject to limited underwriting with yes/no questions. The expected impact is:
Duration 1=.15;

duration 2=.05;

overall=.03 decrease in claim costs."
The information requested is not intended to compromise the insurer's proprietary interests but rather to inform the Office's consideration of past and prospective loss experience, as required by Section 627.411(2), F.S.

11. Premium Classes: This section shall state all the attributes upon which the premium rates vary.

12. Issue Age Range: This section shall specify the issue age range of the form. A statement shall be made as to whether the premiums are on an issue age, attained age or other basis.

13. Area Factors: This section shall include a brief description for any area factors used, and an explanation of any changes since the last filing. The area factors and definitions must also be displayed.

14. Average Annual Premium: This section shall display the average annual premium for both Florida and the nation. If a rate adjustment is proposed, average annual premiums reflecting the Premium Schedule both before and after the proposed adjustment shall be provided. The average annual premium per policy for individual insurance or per certificate for group insurance shall be calculated based on the distribution of Florida business considering any factors which actuarially justify a rate difference. This distribution is the anticipated issue distribution if the filing is a new policy form, and the actual inforce distribution if the filing is for a rate revision or rate justification. Premiums for riders, endorsements and amendments must be added to the base plan premiums to yield this average. For the purpose of calculating the average annual premium and loss ratios, any fractional premium loading shall not be incorporated in this average.

15. Premium Modalization Rules: This section shall display the modalization factors and fees as applicable. For premium modes other than annual, the level of the fees and factors shall be adequately justified by supporting data.

16. Claim Liability and Reserves: This section represents the present value of future claim payments on claims incurred prior to the valuation date. This includes both the accrued and unaccrued portions of the liability and reserve as of the valuation date. A complete description of the development of these reserves shall be presented. A display which compares the reserve held to the actual claim runoff shall be included. For loss ratio purposes, the interest rates used to determine these reserves and liabilities shall be consistent with the insurer's premium determination interest rates, which may be different from rates used for valuation purposes. Claim runoff is a common insurance industry term which means the pattern of claims payout after the establishment of reserves.

17. Active Life Reserves: Because these reserves do not represent claim payments, but provide for timing differences, they shall not be included in any benefit and loss ratio calculations. The active life reserve as of the evaluation date for rate revision filings shall be provided.

18. Trend Assumptions - Medical and Insurance:
a. This section must describe the trend assumptions used in pricing, which assumptions must be appropriate for the specific line of business, product design, benefit configuration, and time period.

b. All factors affecting the projection of future claims must be presented.

c. The trend assumptions shall be presented under two categories:
(I) Medical Trend: the combined effect of medical provider price increases, utilization changes, medical cost shifting, and new medical procedures and technology. In determining medical trend from underlying data, the analysis:
(A) Shall use credible data and make appropriate adjustments to claims data to isolate the effects of medical trend only; and,

(B) Shall not include the effects of underwriting wearoff, aging, or changes to claim costs due to changes in demographics, policy coverages, geographic distribution, or reinsurance.
(II) Insurance Trend: the combined effect of underwriting wearoff, deductible leveraging, antiselection resulting from rate increases, and discontinuance of new sales.
(A) Medical trend must be determined or assumed before insurance trend can be determined.

(B) Underwriting wearoff means the gradual increase from initial low expected claims which result from underwriting selection to higher expected claims for later (ultimate) durations.
19. Minimum Required Loss Ratio for the Form: This section shall state the minimum required loss ratio for the form.

20. Anticipated Loss Ratio: This section shall provide the anticipated loss ratio and the interest rate(s) used in the determination of the value. The target loss ratio for an individual or group policy form may be increased through a justification of the proposed change. The target loss ratio for an individual or group policy form may be reduced upon demonstration and justification of an increase in administrative costs, but may not be reduced to less than the minimum required standard for the policy form in Rule 69O-149.005, F.A.C. The proposed decrease due to administrative costs cannot be more than 0.5% per year.
a. When claim cost projections include the effect of medical trend, such as for Medicare supplement and medical expense coverage, premium projections shall also include the effects of such trend.

b. This section shall also include the current approved durational loss ratio table for the form.
(I) If a revised durational loss ratio table is being proposed, the proposed table, together with a justification for the new table, shall be provided.

(II) The proposed new table shall be consistent with the claim projections contained in the filing.

(III) If approved, the new table will be used in filings made subsequent to the one in which it is being proposed.

(IV) A new table shall produce a lifetime loss ratio at least as great as the lifetime loss ratio developed from the current approved loss ratio table and shall become the lifetime standard or target loss ratio for the form.

(V)
(A) When the slope or shape of the durational loss ratio table is changed, or the persistency or interest assumptions are changed, from those used in the last approved rate filing, any rate increase due to the change shall be uniformly implemented over a 3 year period.

(B) The insurer may request a shorter phase-in period if it can be demonstrated that the shorter period is not expected to result in the greater of a 5 percent reduction in persistency and a 25 percent increase in lapse rate from what had been assumed in the last approved rate filing.

(C) At its option, a company may request a new business rate schedule based on the full effect of the new assumptions with the phase-in period only applicable to inforce insureds.

(D) When a new business rate is elected, the rate analysis for the form shall be based on the new business rate schedule level.
21. Distribution of Business: This section shall provide the anticipated issue distribution for new policy forms and the actual inforce distribution for rate revisions. All criteria having a rating difference shall be included.

22. Contingency and Risk Margins: This section shall describe the contingency and risk margins anticipated for the Policy Form at the time of the filing. The information requested is not intended to compromise the insurer's proprietary interests, but rather to inform the Office's consideration of risk and contingency margins, as required by Section 627.411(2), F.S.

23. Experience on the Form (Past and Future Anticipated): This section shall display the actual experience on the form and that expected for the future.
a. Past Experience: Experience from inception (or the last 3 years for annually rated group coverages) shall be displayed, although, with proper interest adjustment, the experience for calendar years more than 10 years in the past may be combined. Excluding annually rated group policy forms, earned premiums, actual incurred and expected claims experience shall also be displayed, for each policy year or issue year, within the calendar year. The following information shall be displayed (A sample experience exhibit is illustrated in Appendix A, Illustrative Experience Exhibit (2/04), which is hereby incorporated by reference):
(I) Year;

(II) Earned premium;

(III) Claims incurred and paid, for past periods only;

(IV) Remaining claim liability and reserve, for past periods only. These reserves shall be updated to reflect actual claim runoff as it develops;

(V) Incurred claims (=(III)+(IV));

(VI) Incurred loss ratio (=(V)/(II));

(VII) Expected loss ratio;

(VIII) Expected incurred claims;

(IX) Actual-to-expected claims (=(V)/(VIII) or equivalently (=(VI)/(VII));

(X) Earned premium on a manual rate basis for at least the past 5 calendar years or the experience period used for projection purposes for annually rated group products; i.e., removing the impact of adjustments to the approved rate manual due to underwriter adjustments, the impact of any rate limits, and experience rating. This restatement to a manual basis does not apply to annually rated group products exempt from the filing and prior approval of rate schedules as provided by subsection 69O-149.002(6), F. A.C.

(XI) Earned premium on a current rate basis for at least the past 5 calendar years or the experience period used for projection purposes for annually rated group products. This is not required for annually rated group products exempt from the filing and prior approval of rate schedules as provided by subsection 69O-149.002(6), F.A.C.
b. Future periods where the projected values are based on inforce experience:
(I) The experience period used as the basis for determining projected values shall be clearly indicated.

(II) The experience period shall reflect the most current data available. For forms subject to the credibility standards of paragraph 69O-149.0025(6)(b), F.A.C., the experience period shall be the period of time used to determine credible data pursuant to paragraph 69O-149.0025(6)(b), F.A.C. For other forms, the experience period shall be the period consisting of the most recently completed four (4) calendar quarters, where such period must end at least 45 days before the date of the filing. (For example, the experience period for a filing submitted on August 1 would be April 1 of the prior year through March 31 of the current year. The experience period for a filing submitted on September 1 would be July 1 of the prior year through June 30 of the current calendar year). Use of other data shall be justified to the office as to why the requisite data is not available or appropriate to use.

(III) An exhibit showing the development of the expected claims and A/E ratio for the experience period shall be provided. (A sample exhibit demonstrating an expected development is illustrated in Appendix A)

(IV) The projected values shall represent the experience that the actuary fully expects to occur. In order for the proposed premium schedule or rate change to be reasonable, the underlying experience used as the basis of a projection must be reflective of the experience anticipated over the rating period. The Office will consider how the following items are considered in evaluating the reasonableness of the projections and ultimate rates. In order to expedite the review process, the actuary is encouraged to provide information on how each of the following have or have not been addressed in the experience period data used as the basis for determining projected values, or otherwise addressed in the ratemaking process.
(A) Large nonrecurring claims;

(B) Seasonality of claims;

(C) Prior rate changes not fully realized;

(D) Rate limits, rate guarantees, and other rates not charged at the full manual rate level;

(E) Experience rating, if any;

(F) Reinsurance costs and recoveries for excess claims subject to non-proportional reinsurance;

(G) Coordination of benefits and subrogation;

(H) Benefit changes during the experience period or anticipated for the rating period;

(I) Operational changes during the experience period or anticipated for the rating period that will affect claim costs;

(J) Punitive damages, lobbying, or other costs that are not policy benefits;

(K) Claim costs paid which exceed contract terms or provisions;

(L) Benefit payments triggered by the death of an insured, such as waiver of premium or spousal benefits;

(M) Risk charges for excess group conversion costs or other similar costs for transferring risk;

(N) The extent and justification of any claim administration expenses included in claim costs; and,

(O) Other actuarial considerations that affect the determination of projected values.

(V) The method or formulas, including necessary assumptions and sample calculations, used in determining the projected values from the experience period used shall be provided.
(VI) Projection years shall include columns I, II, V, VI, VII, VIII and IX as indicated in sub-subparagraph 23.a., above.

(VII) Two projections will be required to be submitted to the Office. Projections shall be based on existing inforce business with and without new sales assumed during the projection period.

(VIII) A summary of the historical and projected data shall be provided for all experience columns providing the accumulated past values, future values, and lifetime values both with and without interest and with and without the proposed rate change.
c. Projections for new forms or otherwise not based on experience shall:
(I) Two projections will be required to be submitted to the Office. Project an initial assumed cohort of new business with and without new sales assumed during the projection period; and,

(II) Shall display columns for each policy year, anticipated premiums, claims and loss ratios and include the lifetime values both with and without interest.
d. The experience exhibit shall be submitted electronically in an active Excel worksheet or workbook, i.e., not converted to a PDF or other image format. Formulas used to develop other values in the worksheet or workbook shall be included. It is noted that the I-file system does provide for the submission of information on a trade secret basis. If this is used, the company shall additionally file a workbook without the trade secret information for the public domain.
24. Lifetime Loss Ratio: This is the loss ratio determined over the rating period for annually rated groups. For other forms, the loss ratio is derived by dividing A by B where:
a. A is the accumulation with interest of incurred claims from the original effective date of the policy form to the evaluation date, and the present value of future incurred claims over the entire future lifetime of the policy form; and,

b. B is the accumulation with interest of earned premiums from the original effective date of the policy form to the evaluation date, and the present value of future earned premiums over the entire future lifetime of the policy form.

c. The evaluation date is the endpoint of the actual experience review period.
25. History of Rate Adjustments: This section shall list the approval dates and average percentage rate adjustments both nationwide and in Florida for the last 5 years. Nationwide information is not required when Florida data is 100 percent credible.

26. Number of Policyholders: This section shall report the number of Florida policyholders/certificateholders who will be affected by the proposed rate revision, and the number of policyholders/certificateholders inforce nationwide.

27. Proposed Effective Date: This section shall state the proposed effective date and method of the proposed rate revision implementation.

28. Actuarial Certification:
a. Certification by a qualified actuary that to the best of the actuary's knowledge and judgment:
(I) The entire rate filing is in compliance with the applicable laws of the State of Florida and with the rules of the Office;

(II) Complies with the Commonly Accepted Actuarial Practice as defined in subsection 69O-154.202(28), F.A.C.; and,

(III) The benefits provided are reasonable in relation to the proposed premiums. The premium schedule is not excessive, inadequate, nor unfairly discriminatory.
b. In making the certification:
(I) The actuary shall recognize that the certification is a prescribed statement of actuarial opinion.

(II) The actuary's opinion shall comply with the Commonly Accepted Actuarial Practice as defined in subsection 69O-154.202(28), F.A.C.
c. A qualified actuary is one who is a member of the Society of Actuaries or the American Academy of Actuaries, and who is qualified in the area of health insurance.

d. If the actuary is unable to provide the certification without qualification, a detailed explanation and reason for the qualification shall be provided as part of the certification.

69O FAC 149.007 | Annual Rate Certification (ARC) Filing Procedures

(1) This rule applies to filings made pursuant to Section 627.410(7)(b)2., F.S., in which no rate change is proposed.

(2) The filings required by this rule shall be on an individual company basis.

(3) This rule is not applicable for Medicare supplement coverage. Medicare supplement forms are subject to Rule 69O-149.003, F.A.C.

(4) Non-cancellable coverages which are no longer available for sale and which have not been sold or marketed for at least 5 years and are in compliance with the reasonableness standards of Rule 69O-149.005, F.A.C., shall be exempt from the filing requirements of this rule. If a company is subsequently discovered not to have met the standards, they shall, in addition to other administrative remedies, be required to enhance benefits and make premium refunds to bring the form into full compliance with the loss ratio standards of Rule 69O-149.005, F.A.C.

(5) An ARC filing shall consist of:
(a) A cover letter indicating the nature of the filing;

(b) Form OIR-B2-1507, as adopted in Rule 69O-149.022, F.A.C.; and,

(c) A certification by an actuary, in accordance with subparagraph 69O-149.006(3)(b)28., F.A.C. For policies subject to the provisions of Part II of Chapter 69O-157, F.A.C., the certification in accordance with paragraph 69O-157.108(1)(c), F.A.C., is required.
(6) A filing shall include only forms that are pooled together for rating purposes as provided by subsection 69O-149.003(1), F.A.C. Separate filings shall be made for separate rating pools.

(7) For noncredible blocks of business on a nationwide basis, the company may request a waiver of the requirement. The request shall be made annually and be accompanied by a letter indicating the nature of the filing, the type of product, and the reason for the request.

(8) When a company using a current rate schedule is unable to demonstrate that the minimum loss ratio standards in Rule 69O-149.005, F.A.C., are met, it shall make a rate filing with the Office pursuant to Rule 69O-149.003, F.A.C., to reduce rates, enhance benefits, make refunds, or a combination of these to satisfy the standards.
(a) A company may make a certification in compliance with this rule without such change to benefits, refunds, or premiums if the A/E ratio for the past experience periods are, both in pattern and aggregate value, consistently at or in excess of .85; or

(b) For rating pools that are not fully credible, the company may make a certification in compliance with this rule if both the lifetime A/E ratio and the future A/E ratio are at or in excess of .85 when assuming best estimate assumptions in determining projected values.

(c) If the certification in paragraph (a) or (b), is unable to be made, and the company has been in compliance with these rules, the company shall make a rate filing pursuant to Rule 69O-149.003, F.A.C., to reduce rates, enhance benefits, make refunds, or a combination of these which shall target a future A/E ratio of at least 1.0.
(9) A company may request exemption from all future ARC filings upon demonstration that the form or rating pool consists only of policy forms which are no longer available for sale; and,
(a) The company has no other form with similar benefits that is currently available for sale;

(b) The accumulated experience from inception to date exceeds the required lifetime loss ratio standard for the form;

(c) The present value of future premiums is less than 10 percent of the accumulated value of past earned premiums or the data is 0 percent credible; and,

(d) The company certifies that it will not increase premiums in the future.
(10) All filings made pursuant to this rule shall be on a company distinct basis and submitted electronically to http://www.FLOir.com/iPortal.

69O FAC 149.008 | Loss Ratio Guarantee Filings

(1) Applicability. This rule is applicable to individual accident and health insurance policy forms whose original new product filing is submitted for approval on or after October 1, 1991 and to rate revisions for policy forms submitted for approval before October 1, 1991. Insurers are not required to make filings pursuant to the provisions of Section 627.410(8), F.S. However, insurers may elect to exercise the loss ratio guarantee option in Section 627.410(8), F.S., in lieu of making filings pursuant to Sections 627.410(6) and (7), F.S. If an insurer elects the loss ratio guarantee option, then the provisions of Section 627.410(8), F.S., and this rule are mandatory. Medicare Supplement policies, as defined by Section 627.672, F.S.; long-term care policies, as defined by section 627.9404, F.S.; and other policy forms under which more than 50% of the policies are issued to individuals age 65 or over, are not eligible to be filed pursuant to the loss ratio guarantee provisions of Section 627.410(8), F.S.

(2) Initial Filing Exercising the Loss Ratio Guarantee Option. In order for an insurer to exercise the rate filing option in Section 627.410(8), F.S., the initial loss ratio guarantee filing for new products and for rate revisions to already-approved forms shall be made in compliance with Rules 69O-149.001 through 69O-149.006, F.A.C., and shall be accompanied by a specific written statement regarding the details of the loss ratio guarantee, documenting the durational and lifetime loss ratios. The terms of the guarantee, and the durational and lifetime loss ratios, are subject to Office approval. The guarantee shall be signed by an officer of the insurer.

(3) Rate Renewals Pursuant to a Currently Approved Loss Ratio Guarantee. The rates shall be considered approved upon receipt by the Office of a filing which contains the rates and any modification factors, if applicable, and is accompanied by the most current approved loss ratio guarantee. This guarantee shall:
(a) Be in writing;

(b) Be signed by an officer of the insurer;

(c) Contain a presentation of the anticipated lifetime and durational target loss ratios contained in the actuarial memorandum in the filing when it was originally approved. If statutory changes render any portion of the original actuarial memorandum obsolete, an amended memorandum shall be filed to reflect those changes and shall contain revised durational and lifetime target loss ratios, which are subject to approval by the Office;

(d) Contain a guarantee that the applicable loss ratios for the experience period in which the revised rates will take effect, and for each one year experience period thereafter until further revised rates are filed, will meet the applicable durational and lifetime target loss ratios;

(e) Contain a certification, signed by an actuary, that the currently expected lifetime loss ratio is not more than 5% less than the filed lifetime loss ratio. The certification shall contain the currently expected lifetime loss ratio and its justification;

(f) Contain a guarantee that the applicable loss ratio results for the experience period shall be audited at the insurer's expense by an independent auditor. An independent auditor shall be an actuary or an accountant who is without bias with respect to the insurer and who is free from any obligation to or interest in the insurer, its management, or its owners. The independent auditor shall not have any relationships with the insurer or any conflict of interest which would impair integrity or objectivity or give the impression of impairing integrity or objectivity. The audit shall be performed in the second calendar quarter of the year following the end of the experience period and the results of the audit shall be reported to the Office no later than the end of that quarter. The audit shall be performed in accordance with generally accepted actuarial and accounting principles and shall conform to the actuarial demonstration requirements set forth in Rule 69O-149.006, F.A.C.;

(g) Contain a guarantee that a refund will be made to policyholders, of the amount necessary to bring the applicable experience period loss ratio up to the durational target loss ratios referred to in paragraph (3)(c), above. Any such refund shall:
1. Be proportional, based on earned premium during the experience period;

2. Be made to all policyholders in this state who are insured under the applicable policy form as of the last day of the experience period;

3. Not be required for an individual if that refund would be less than $10. Refunds of less than $10 shall be aggregated and paid proportionally to the policyholders receiving refunds;

4. Include interest compounded monthly at the then current variable loan interest rate for life insurance policies established by the National Association of Insurance Commissioners, from the end of the experience period until the date of payment;

5. Be paid during the third calendar quarter of the year following the experience period. However, no refund shall be made until 60 days after the filing of the audit report required by paragraph (3)(f), above; and,

6. Be calculated so that the refund is subtracted from earned premiums in the loss ratio calculation. The premium refund shall not be considered a benefit payment; and,
(h) Contain a guarantee that if the applicable loss ratio exceeds the durational target loss ratio for that experience period by more than 20% of the durational target loss ratio, the insurer shall withdraw the policy form for purposes of issuing new policies, if so directed by the Office. This guarantee will apply only when there are at least 2,000 policyholders nationwide or 2,000 accumulated policyholder years.
(4) "Applicable loss ratio" shall be defined as the loss ratio attributable solely to this state if there are 2,000 or more policyholders in the state. If there are at least 500 policyholders in the state, but fewer than 2,000, the applicable loss ratio shall be the linear interpolation between the nationwide and state-only loss ratios. For example, if there are 1,200 policyholders in the state, the applicable loss ratio is:
(1,200 – 500)state
loss ratio
+(2,000 – 1,200)U.S.
loss ratio
(2,000 – 500)(2,000 – 500)
If there are fewer than 500 policyholders in the state, the applicable loss ratio shall be the nationwide loss ratio.

69O FAC 149.010 | Refusal to Insure Based on Geographical Location

No insurer authorized to engage in the business of insurance in the State of Florida shall refuse to insure, or continue to insure, an individual risk or a group for accident and health insurance coverage because of the residence of the individual or location of the group within the State unless the insurer performs a written analysis which establishes that there is a reasonable relationship between the residence of the individual or location of the group and the coverage refused. Every analysis shall be retained in the records of the insurer for a period of three years.

69O FAC 149.020 | Purpose and Scope

The purpose of this part is to establish filing procedures to assist insurers and the Office in preparing and processing life, annuity, accident, and health insurance form filings. This part shall apply to all form filings of policies and applications for accident and health insurance, including outlines of coverage, and of all form filings for life insurance and annuities submitted to the Office for review. Except for subparagraphs 69O-149.021(1)(b)1., 2., and 6.-8., F.A.C., this part shall not apply to any filings of amendments, endorsements, or riders, or to any medicare supplement filings.

69O FAC 149.021 | Form Filing Procedures

(1)
(a)
1. All filings shall be made in accordance with paragraph (1)(b), below.

2.
a. For purposes of the rules in this part and the time periods in Section 627.410, F.S., a filing is considered "filed" with the Office upon the receipt of the material required by paragraph (1)(b), on business days between the hours of 8:00 a.m. and 5:00 p.m. eastern time. Filings received after 5:00 p.m. shall be considered to be received the following business day.

b. For purposes of the rules in this part, the term "filed" does not mean "approved." The term "filed" refers to the date on which the filing is filed with the Office and is the date on which the approval process of Section 627.410, F.S., commences.
(b) A form filing shall consist of the following items:
1.
a. A brief transmittal letter explaining the type and nature of the filing, including the subject, the purpose, and any unusual features relative to products being sold by other companies. The letter shall also indicate if the filing is new or is a resubmission.

b. If the filing is a resubmission, the letter shall indicate the Florida filing number of the prior filing.

c. If the filing is either a group life or a group annuity form, the letter shall indicate the Florida Statute number under which the form is to be issued.
2. Form OIR-B2-1507, "Office of Insurance Regulation Life and Health Forms and Rates Universal Standardized Data Letter" as adopted in Rule 69O-149.022, F.A.C., completely filled out in accordance with Form OIR-B2-1507A, "Office of Insurance Regulation Life and Health Forms and Rates Universal Standardized Data Letter Instruction Sheet" as adopted in Rule 69O-149.022, F.A.C.

3. The checklist appropriate for the type of form being filed and any information required by that checklist. All forms and checklists are listed and adopted in Rule 69O-149.022, F.A.C.

4. Any certifications of rates, cost indices, or other items, if required by the appropriate checklist or by rule.

5. The form(s) being filed. Each form shall include the name of the company, and have an identifying form number in the lower left hand corner of the first page of the form.

6. Each filing shall contain an actuarial memorandum, certified and signed by a qualified actuary. The actuarial memorandum for life and annuity product filings shall demonstrate compliance with the Standard Valuation Law (Section 625.121, F.S.). In addition, filings for life insurance products other than annuities shall demonstrate compliance with the Standard Nonforfeiture Law (Section 627.476, F.S.).
(2) Each filing shall contain forms for only one type of coverage, i.e., ordinary life, variable life, major medical, etc. However, a filing may contain more than one form if the forms are for the same type of coverage.

(3) Each filing shall contain forms for only one company.

(4) Combination forms, products that contain both life and health coverages, shall be submitted separately but simultaneously and shall be clearly marked to indicate that they are combination filings, one as life and one as health.

(5) Complete filings shall be submitted electronically to http://www.FLOir.com/iPortal.

(6)
(a) Every insurer submitting a form filing shall be notified as to whether the filing has been affirmatively approved by the Office, or has been disapproved by the Office within any statutory review period of the date of receipt of the filing.

(b) Submissions that do not include the required material to meet the definition of a filing, or that include material that is illegible, shall not be accepted and shall be returned as incomplete without processing.

(c) Every insurer submitting a form filing for which the Office determines that additional information is necessary for a proper review will be notified of the additional information within the statutory limit. Every insurer shall submit the required data by a date certain stated in the clarification letter to allow the Office sufficient time to perform a proper review. Failure to correct the filing by the date certain in the clarification letter will result in an affirmative disapproval of the filing by the Office.
(7) Definitions. As used in this rule:
(a) New Filing - A new filing is one that is being submitted for the first time. This includes submission of revisions to a previously approved form.

(b) Resubmission - A filing submission in response to a final disapproval from the Office is a resubmission. It is given a new filing number by the Office. This term does not apply to ongoing correspondence under the same filing number before an affirmative approval or disapproval by the Office.

69O FAC 149.022 | Forms Adopted

(1) The forms adopted in subsection (2), below, shall be used, as applicable, by insurers making form filings for life and accident insurance, annuities, and health insurance. All the forms in subsections (2) and (3), below, are hereby adopted and incorporated by reference. All forms are available and may be printed from the Office's website: www.FLOir.com.

(2)
(a) Form OIR-B2-1507, "Office of Insurance Regulation, Life and Health Forms and Rates Universal Standardized Data Letter", Rev. 06/12. http://www.FLRules.org/Gateway/Reference.asp?No=Ref-01706.

(b) Form OIR-B2-1507 A, "Office of Insurance Regulation, Life and Health Forms and Rates Universal Standardized Data Letter Instruction Sheet", Rev. 06/12. http://www.FLRules.org/Gateway/Reference.asp?No=Ref-01707.

(c) Health Checklists.
1. OIR-B2-1616, "Blanket Application Checklist," Rev. 1/05.

2. OIR-B2-535, "Blanket Health Contract Checklist," Rev. 1/04.

3. OIR-B2-527, "Debtor Group Application Checklist," Rev. 1/04.

4. OIR-B2-529, "Debtor Group Contract Checklist," Rev. 1/04.

5. OIR-B2-528, "Florida Additional Information Checklist for Debtor Group," Rev. 8/03.

6. OIR-B2-1607, "Discount Medical Plan Organization (DMPO) Contract and Application Checklist," 9/04.

7. OIR-B2-539, "Excess-Specific and Aggregate Checklist," Rev. 1/04.

8. OIR-B2-540, "Informational Memorandum Checklist - Florida Excess Specific and Aggregate - Section 624.406, F.S.," Rev. 1/04.

9. OIR-B2-1356, "Florida HMO Contract Checklist," Rev. 1/04.

10. OIR-B2-1617, "Florida HMO Individual Application Checklist," 1/05.

11. OIR-B2-1618, "Florida HMO Master Group Application Checklist," 1/05.

12. OIR-B2-536, "Franchise Health Application Checklist," Rev. 1/04.

13. OIR-B2-538, "Franchise Health Contract Checklist," Rev. 1/04.

14. OIR-B2-537, "Franchise Health Outline of Coverage Checklist," Rev. 1/04.

15. OIR-B2-525, "Group Health Application Checklist - Employers, Labor Unions, Association Groups and Additional Groups," Rev. 1/04.

16. OIR-B2-526, "Group Health Contract Checklist - Employers, Labor Unions, Association Groups and Additional Groups," Rev. 1/04.

17. OIR-B2-520, "Individual Health Application Checklist," Rev. 1/04.

18. OIR-B2-523, "Individual Health Contract Checklist," Rev. 1/04.

19. OIR-B2-521, "Individual Health Outline of Coverage Checklist," Rev. 1/04.

20. OIR-B2-1619, "Long Term Care Advertisement Checklist," 1/05.

21. OIR-B2-541, "Long Term Care Application Checklist," Rev. 1/04.

22. OIR-B2-543, "Long Term Care Contract Checklist," Rev. 1/04.

23. OIR-B2-542, "Long Term Care Outline of Coverage Checklist," Rev. 1/04.

24. OIR-B2-1620, "Medicare Supplement Advertisement Checklist," 1/05.

25. OIR-B2-1354, "Medicare Supplement Application Checklist," Rev. 1/04.

26. OIR-B2-1355, "Medicare Supplement Contract Checklist," Rev. 1/04.

27. OIR-B2-1621, "Medicare Supplement Outline of Coverage," 1/05.

28. OIR-B2-524, "Out-of-State Group Health Checklist," Rev. 1/04.

29. OIR-B2-1353, "Pre-Paid Limited Benefit Contract Checklist," Rev. 1/04.

30. OIR-B2-1359, "Pre-Paid Limited Benefit Conversion Application Checklist," Rev. 1/04.

31. OIR-B2-1358, "Pre-Paid Limited Benefit Group Application Checklist," Rev. 1/04.

32. OIR-B2-1360, "Pre-Paid Limited Benefit Individual Application Checklist," Rev. 1/04.

33. OIR-B2-1622, "Small Group Advertisement Checklist," 1/05.

34. OIR-B2-1357, "Florida Small Group Health Checklist for Indemnity Plans Other Than Standard and Basic," Rev. 1/04.
(d) Life Checklists.
1. OIR-B2-1624, "Credit Disability Policy Checklist," 1/05.

2. OIR-B2-1625, "Credit Life or Disability Application Checklist," 1/05.

3. OIR-B2-1626, "Credit Life Policy Checklist," 1/05.

4. OIR-B2-1367, "Endorsements, Amendments & Riders Checklist," Rev. 1/04.

5. OIR-B2-1627, "Group Annuity Enrollment Application Checklist," 1/05.

6. OIR-B2-1628, "Group Life Enrollment Application Checklist," 1/05.

7. OIR-B2-1363, "Group Non-Variable Annuity Contract Checklist," Rev. 1/04.

8. OIR-B2-1349, "Group Non-Variable Annuity Enrollment Application Checklist," Rev. 1/04.

9. OIR-B2-1488, "Group Term Life Policy Checklist," Rev. 1/04.

10. OIR-B2-1345, "Group Universal Life Policy Checklist," Rev. 1/04.

11. OIR-B2-1365, "Group Variable Annuity Contract Checklist," Rev. 1/04.

12. OIR-B2-1342, "Group Variable Annuity Enrollment Application Checklist," Rev. 1/04.

13. OIR-B2-1629, "Group Variable Life Enrollment Application Checklist," 1/05.

14. OIR-B2-1489, "Group Variable Life Policy Checklist," Rev. 1/04.

15. OIR-B2-1490, "Group Whole Life Policy Checklist," Rev. 1/04.

16. OIR-B2-1630, "Individual Fraternal Life Application Checklist," 1/05.

17. OIR-B2-1631, "Individual Fraternal Non-Variable Annuity Application Checklist," 1/05.

18. OIR-B2-1632, "Individual Fraternal Non-Variable Annuity Contract Checklist," 1/05.

19. OIR-B2-1382, "Individual Fraternal Term Life Policy Checklist," Rev. 1/04.

20. OIR-B2-1491, "Individual Fraternal Universal Life Policy Checklist," Rev. 1/05.

21. OIR-B2-1633, "Individual Fraternal Variable Annuity Application Checklist," 1/05.

22. OIR-B2-1634, "Individual Fraternal Variable Annuity Contract Checklist," 1/05.

23. OIR-B2-1635, "Individual Fraternal Variable Life Application Checklist," 1/05.

24. OIR-B2-1636, "Individual Fraternal Variable Life Policy Checklist," 1/05.

25. OIR-B2-1314, "Individual Fraternal Whole Life Policy Checklist," Rev. 1/04.

26. OIR-B2-1346, "Individual Life Application Checklist," Rev. 1/04.

27. OIR-B2-1637, "Individual Non-Variable Annuity Application Checklist," 1/05.

28. OIR-B2-1352, "Individual Non-Variable Annuity Contract Checklist," Rev. 1/04.

29. OIR-B2-1493, "Individual Term Life Policy Checklist," Rev. 1/04.

30. OIR-B2-1494, "Individual Universal Life Policy Checklist," Rev. 1/04.

31. OIR-B2-1348, "Individual Variable Annuity Application Checklist," Rev. 1/04.

32. OIR-B2-1364, "Individual Variable Annuity Contract Checklist," Rev. 1/04.

33. OIR-B2-1638, "Individual Variable Life Application Checklist," 1/05.

34. OIR-B2-1384, "Individual Variable Life Policy Checklist," Rev. 1/04.

35. OIR-B2-1496, "Individual Whole Life Policy Checklist," Rev. 1/04.

36. OIR-B2-1350, "Master Group Application Checklist," Rev. 1/04.

37. OIR-B2-1639, "Out-of-State Group Life Enrollment Application Checklist," 1/05.

38. OIR-B2-1640, "Out-of-State Group Non-Variable Annuity Contract Checklist," 1/05.

39. OIR-B2-1641, "Out-of-State Group Non-Variable Annuity Enrollment Application Checklist," 1/05.

40. OIR-B2-1328, "Out-of-State Group Term Life Policy Checklist," Rev. 1/05.

41. OIR-B2-1330, "Out-of-State Group Universal Life Policy Checklist," Rev. 1/05.

42. OIR-B2-1642, "Out-of-State Group Variable Annuity Contract Checklist," 1/05.

43. OIR-B2-1644, "Out-of-State Group Variable Annuity Enrollment Application Checklist," 1/05.

44. OIR-B2-1643, "Out-of-State Group Variable Life Enrollment Application Checklist," 1/05.

45. OIR-B2-1343, "Out-of-State Group Variable Life Policy Checklist," Rev. 1/05.

46. OIR-B2-1329, "Out-of-State Group Whole Life Policy Checklist," Rev. 1/05.

47. OIR-B2-1646, "Viatical Contract Checklist," 3/05.

48. OIR-B2-1647, "Viatical Settlement Escrow Form Checklist," 3/05.

49. OIR-B2-1648, "Viatical Settlement Purchase Agreement Checklist," 3/05.

50. OIR-B2-1649, "Viatical Settlement Related Form Checklist," 3/05.
(3) Form OIR-B2-2112 "Consumer Notice The Impact of Federal Health Care Reform on Your Health Plan Costs" (New 9/13) http://www.FLRules.org/Gateway/Reference.asp?No=Ref-02990.

69O FAC 149.023 | Review

(1) Filings will be reviewed for compliance with applicable statutes and rules as stated on the forms adopted in Rule 69O-149.022, F.A.C., and will be disapproved for failure to comply. Filings will be disapproved for inconsistencies or ambiguities which are misleading.

(2) The policy may not reserve the right to change contractual provisions without the written consent of the policyholder unless the nature and parameters of such changes are clearly expressed in the contract.

(3) A group life or annuity policy may not reserve the right to change contractual provisions which will adversely affect the annuitization benefit for a certificateholder which is attributable to premiums or contributions already made to the contract.

(4) The insurer shall submit a description of distribution systems (e.g. direct marketing, marketing through agents, marketing through financial or other institutions, etc.), and the intended target population for all product filings.

69O FAC 149.024 | Prohibited Policies

(1) Purpose.

The purpose of this rule is to implement Section 627.479, F.S., which prohibits the issuance of certain policies in the State of Florida.

(2) Scope.

This rule applies to all insurers and to any prohibited policy defined in this rule.

(3) Definitions.

For purposes of this rule and Section 627.479, F.S., the following terms are defined:
(a) "Tontine policy or contract" refers to a financial arrangement in which a group of participants share advantages on such terms that upon the default or death of any participant, his advantages are distributed among the remaining participants until only one remains, whereupon the whole goes to him; or on the expiration of an agreed period, the whole goes to those participants remaining at that time. Under the "tontine" plan of insurance, no accumulation or earnings are credited to the policy unless it remains in force for the tontine period of a specified number of years. Thus those who survive the period and keep their policies in force share in the accumulated funds and those who die or permit their policies to lapse during period do not; neither do their beneficiaries participate in such accumulation.

(b) "Contingent endowment policy or contract" means a tontine type policy which provides a cash payment or other benefit convertible to cash, payable to the last surviving insured contingent upon the prior death of all other insureds who have been grouped together.

(c) "Coupon policy or contract" or "annual endowment policy or contract" refers to a specialty-type of life insurance with coupons or annual endowments attached to the policy. Each coupon or endowment is redeemable in cash at the end of the policy year. Generally premiums on these types of policies are higher than on standard life insurance policies in order to pay for the coupons. This definition does not include traditional annuity or life insurance contracts which pay benefits annually.

(d) "Pure endowment policy or contract" refers to an specialty-type policy which only pays a benefit if the designated person is living at the end of the specified period.

(e) "Joint and last survivorship option" is a policy option which provides for payment of the policy proceeds to two people. If either person dies, the same income payments continue to the survivor for life. When that survivor dies no further payments are made to anyone.

(4) Prohibition.

Any person issuing a policy or contract described in this rule is acting as an insurer. Any licensed insurer issuing any policy defined or described in paragraphs (3)(a)-(d) of this rule, or any policy which meets the definitions of any of the above described policies by whatever name called shall have its certificate of authority revoked.

(5) Limitation.

(a) This rule shall not be construed to prohibit joint and last survivorship options or policies.

(b) This rule shall not be construed to limit the prohibitions specified in Section 627.479(1), F.S.

69O FAC 149.030 | Purpose

The purpose of these rules is to implement Section 627.6699, F.S., pertaining to requirements of small employer group insurance, to promote the public interest, to promote the availability of small employer group insurance policies, to protect applicants for small employer group insurance from unfair or deceptive sales or enrollment practices, to establish standards for small employer group insurance, to facilitate public understanding and comparison of small employer group insurance policies.

69O FAC 149.031 | Applicability and Scope; Penalties

(1) Except as otherwise provided, the provisions of the rules in this part shall apply, to the extent provided in Section 627.6699, F.S., and this rule, to small employer health benefit plans delivered or issued for delivery in this state by an authorized insurer, a health maintenance organization, or any other person providing a health benefit plan subject to insurance regulation in this state to a small employer group.

(2) The rules in this part shall apply to any health benefit plan, whether provided on a group or individual basis, which:
(a) Satisfies Section 627.6699(4), F.S.; and,

(b) Provides coverage to one or more employees of a small employer located in this state, without regard to whether the policy or certificate was issued in this state.
(3) The Office shall impose penalties for non-compliance with the act or for abusive market conduct practices in accordance with Rule 69O-142.011, F.A.C. Such non-compliance or abusive market conduct practices are divided into three levels based on severity and intent.
(a) Level 1. This level will be treated as a violation under Category IV in Rule 69O-142.011, F.A.C., upon its becoming effective. Inadvertent miscommunications on the part of an agent or carrier. These are practices which evidence no bad faith on the carrier's or agent's part. Such practices include omissions, and "one time" actions without any consequences. All parties involved shall take necessary steps to clear up the miscommunication once the situation is brought to their attention.

(b) Level 2. This level will be treated as a violation under Category II in Rule 69O-142.011, F.A.C., upon its becoming effective. Deliberate action on the part of a carrier or agent that is in violation of the Act. These include repetitive acts and omissions. The violation must be corrected within 30 days, once it is brought to the carrier's or agent's attention in order to avoid being considered a Level 3 violation.

(c) Level 3. This level will be treated as a violation under Category I in Rule 69O-142.011, F.A.C., upon its becoming effective. Deliberate practice which has a severe economic impact on the insured or the policyholder and is clearly in violation of the Act.

69O FAC 149.032 | Requirement to Insure Entire Groups

(1) A small employer carrier which offers coverage to a small employer shall offer coverage to each eligible employee and to each of the dependents of the employees who elect coverage. The small employer carrier shall offer the same health benefit plans to each employee and dependent.

(2) A small employer carrier is permitted to offer the small employer the option of choosing among one or more health benefit plans, provided that each employee is permitted to choose any of the offered plans.

(3) New entrants to a small employer group shall be offered coverage under the health benefit plan provided to the group. If a small employer carrier has offered more than one health benefit plan to a small employer group, new entrants shall be offered the same choice of health benefit plans.

69O FAC 149.033 | Consideration of Industry

69O FAC 149.037 | Calculation of Premium Rates

(1) This rule is applicable for all health benefit plans subject to Section 627.6699, F.S., and is in addition to Parts I and II.

(2)
(a) A group's rate shall not be changed due to employee age changes which occur during the period when a premium schedule is guaranteed.

(b) The rate applicable to new or terminating enrollees or any change in dependent status shall be made at the premium schedule in effect at the employer's policy/certificate anniversary.
(3)
(a) All contract forms issued pursuant to Section 627.6699, F.S., are subject to modified community rating and must be pooled together for all rating purposes, except that health maintenance organization plans need not be pooled with indemnity plans.

(b) Premiums for health benefit plans shall recognize benefit, deductible, and copay differentials as well as other plan structures that can be demonstrated to have a direct impact on costs. As an example, if the Standard Plan is enriched by the addition of riders for a particular employer by 20 percent, then the premium shall be 20 percent higher than a Standard Plan issued to the same employer. This does not prohibit reflecting appropriate premium differences due to cost differences of provider networks between plans.

(c)
1. To avoid over insurance and to provide for coordination of benefits pursuant to Section 627.4235, F.S., a plan may include a provision to exclude claims for health benefits covered under the plan and paid by workers' compensation insurance coverage of the employer.

2. To reflect the benefit differences provided by the plan, a carrier may file for approval a rating factor reflecting the additional benefits being provided by the health plan if the small employer does not have workers' compensation insurance.
(4) Rate filing requirements:
(a) Modified Community Rating. Premium schedules for benefit plans offered to small employer groups shall be based solely on the following categories and factors applicable to eligible employees, without regard to the nature of the employer group.
1. Age Factors. Employee age shall be determined as of the date of issue and each subsequent renewal date thereafter as defined in the policy and certificate. If not explicitly defined in the contract, age shall be the attained age as of the date of issue or renewal of the certificate.
a. Age Categories Effective Prior to October 1, 2006.
(I) < 30 years of age

(II) 30-39 years of age

(III) 40-49 years of age

(IV) 50-54 years of age

(V) 55-59 years of age

(VI) 60-64 years of age

(VII) 65 & above years of age - Medicare is Primary

(VIII) 65 & above years of age - Health Plan is Primary
b. Age Categories Effective On or After October 1, 2006.
(I) < 24 years of age

(II) 25-29 years of age

(III) 30-34 years of age

(IV) 35-39 years of age

(V) 40-44 years of age

(VI) 45-49 years of age

(VII) 50-54 years of age

(VIII) 55-59 years of age

(IX) 60-64 years of age

(X) 65 & above years of age - Medicare is Primary

(XI) 65 & above years of age - Health Plan is Primary
c. The rate for the age 65 & above - Medicare is Primary category shall be applicable when both employee and spouse are enrolled in Medicare. If one is enrolled and one is not, regardless of which spouse is the employee, the rate charged shall be adjusted to reflect the reduction of exposure due to the fact that one spouse is enrolled in Medicare. The rate shall be determined assuming that one individual is enrolled in Medicare. The rate for the individual enrolled in Medicare will be isolated, multiplied by the Medicare is Primary to the Health Plan is Primary ratio, and then added back to the portion of the rate that is not Medicare primary. Samples of illustrative calculations are as follows and other combinations should be calculated in a similar manner:
(I) For employee + spouse coverage where Medicare is the primary coverage for the spouse - The difference between the employee + spouse rate where the Health plan is primary and the employee only rate where the Health Plan is Primary shall be determined. This value shall reflect the implied spouse rate. This implied spouse rate shall be multiplied by the ratio of the Medicare is Primary rate divided by the Health Plan is Primary rate. This resulting rate shall be added to the employee only rate.

(II) For family coverage - The difference between the family rate and the employee + dependent rate shall be determined. This difference shall reflect the implied spouse rate. This implied spouse rate shall be multiplied by the ratio of the Medicare is Primary rate divided by the Health Plan is Primary rate. This resulting rate shall be added to the employee + dependent only rate.
2. Gender/Family Composition Factors.
a. Gender/Family Composition Categories.
(I) Employee - Male

(II) Employee - Female

(III) Employee - Male - Dependent Children

(IV) Employee - Female - Dependent Children

(V) Employee - Spouse

(VI) Employee - Spouse - Dependent Children
b. For both the employee with spouse plus dependent children category and the employee with dependent children category, companies may include up to three optional dependent children categories.

c. At the option of the company, dependent only categories.
3. Area Factors by County.

4. Tobacco Usage Factor (>1, base rates are for non-tobacco user).

5. Effective Date and Trend Adjustment Factor. The premium schedule may be adjusted based on a medical trend table, approved pursuant to Part I of this rule chapter, reflecting the period of time from the date the rate schedule is effective to the anniversary date of the new or renewing group for medical trend adjustment.
(b) SERCS. Small group rates must be filed on a 2-50 life basis using the Small Employer Rate Collection System (SERCS), Form OIR-B2-SERCS (Rev. 6/19/06), which is hereby adopted and incorporated by reference. These forms are available at: http://www.FLOir.com/iPortal.
(5) The minimum loss ratio is 65 percent.

(6)
(a)
1.
a. A small employer carrier may make up to a 15 percent adjustment in rates from the modified community rate schedule for claims experience, health status, or duration of coverage for a particular employer group from that otherwise determined from the tabular rate schedule determined above pursuant to Section 627.6699(6)(b)5., F.S.

b. A small employer carrier may make an adjustment to a small employer's renewal premium, not to exceed 10 percent annually due to claims experience, health status, or duration of coverage subject to a maximum 15 percent differential from the modified community rate pursuant to Section 627.6699(6)(b)5., F.S.
2. The objective criteria and standards for application of this rate adjustment shall be applicable to and used for all small employer groups on a non-discriminatory basis.

3. Such criteria and standards shall be filed for approval pursuant to part I of this rule chapter.

4. A small employer carrier may require completion of an application including health questions, but shall not decline to offer coverage if the employer is unwilling or unable to provide prior claims experience.

5. Such adjustment shall be uniformly applied to the entire premium schedule.
(b) A small employer carrier may file rating factors to provide a credit to the approved tabular community rate schedule to reflect efficiencies in administrative and acquisition expenses based on the size of the small employer. Such factors shall be filed for approval pursuant to Part I of this rule chapter, and shall be used for all small employer groups on a non-discriminatory basis.

(c) If a small employer carrier makes adjustments to individual employer group rates based on the provisions of paragraph (6)(a) or (b), above, the carrier shall provide experience in all rate filings including both the actual premiums charged and the premium which would have resulted had no adjustments been made and the tabular community rate schedule was used. Rate analysis and rate adjustments shall be based on the restated premium as though the tabular community rate schedule were used without adjustment.

(d) Coverage available to an Alliance or other group association pursuant to Section 627.6699(6)(b), F.S., is subject to the provisions of Section 627.6699, F.S., and shall be available to the Alliance or other group association on a guaranteed issue basis. Any rate adjustments made pursuant to paragraph (6)(b), above, shall be applied uniformly to all members of the Alliance or other group association and not on an individual employer basis. Rate adjustments pursuant to paragraph (6)(a), above, shall be determined and applied on an individual employer group basis.
(7)
(a) A small employer carrier may file for approval subject to part I of this rule chapter a rate factor to be applied to one-life groups.

(b) If elected, the carrier shall file the rate schedule applicable to the 2-50 eligible employee groups and include the rate factor to be applied to such rate schedule resulting in the rate schedule to be applied to one-life groups.

(c) The one-life factor shall not exceed 1.50.

(d) The one-life factor shall be applied to all one-life groups.

(e) If the small employer carrier elects the option permitted by subsection 69O-149.037(6), F.A.C., in addition to this option, the one-life factor shall be determined such that the one-life factor times the maximum increase permitted under subsection 69O-149.037(6), F.A.C., does not exceed 1.50.

(f) If the small employer carrier elects the options permitted by subsection 69O-149.037(6), F.A.C., and this option, the rate quoted to the one-life group shall first apply the one-life factor under this subsection (7) and then apply the provisions of subsection (6), with the total adjustment limited to 1.50.

(g) Future filings shall include aggregate small group experience, actual one-life group experience, one-life group experience with the earned premium restated to remove the one-life factor; i.e., restate earned premium as though the 2-50 eligible employee rate schedule without the one-life factor rate had been charged, and the 2-50 group experience with the earned premium restated to the current manual rate basis.

(h) The aggregate experience, as well as the separate one-life experience, shall meet the target loss ratio standards for the form.
(8) Calculation of COBRA Rates. The premium paid for continuation of coverage may not exceed 115 percent of the group rate for groups that consist of fewer than 20 employees as permitted by Section 627.6692(5)(f), F.S., and 102 percent for groups with 20 or more employees as provided by Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C.A. 1162 (2005). The additional rate indicated above, i.e., 15 percent and 2 percent shall be hereinafter referred to as the applicable load.
(a) Qualified beneficiaries, as defined in Section 627.6692(4)(f), F.S., electing continuation of coverage shall be charged the group rate applicable to the qualified beneficiary on the day before the qualifying event, as increased by the applicable load. Whenever the small employer group's rates change, generally on the group's anniversary, the rate subsequently charged to the qualified beneficiary for the continuation of coverage will be based on the small employer group's rate which the qualified beneficiary would have been charged if the qualified beneficiary had remained within the group. If the qualified beneficiary electing continuation of coverage is a spouse or dependent of the covered employee, and the covered employee remains in the group, the rate charged to the covered employee shall be adjusted to reflect the reduction of risk exposure to the company, e.g., the group's rate applicable after the demographic change. The rate charged for the spouse or dependent shall be isolated from the group's rate and multiplied by a factor, not to exceed one plus the applicable load, to determine the COBRA rate. Samples of illustrative calculations are as follows and other combinations should be calculated in a similar manner:
1. For employee + dependent coverage when the dependent is electing continuation of coverage, the difference between the employee + dependent rate and the employee only rate shall be determined. This difference shall then be divided by the average number of dependents used by the carrier in developing the rate schedule. This value shall reflect the implied single dependent rate. To determine the COBRA rate, the implied dependent rate shall be multiplied by a factor that does not exceed one plus the applicable load. The employee shall be charged the group employee only rate.

2. For family coverage where the dependent is electing continuation of coverage, the difference between the family rate and the employee + spouse only rate shall be determined. This difference shall then be divided by the average number of dependents used by the carrier in developing the rate schedule. This value shall reflect the implied single dependent rate. To determine the COBRA rate, the implied single dependent rate shall be multiplied by a factor that does not exceed one plus the applicable load. The employee shall be charged the group rate applicable to the remaining covered lives in the group, e.g., if the remaining covered lives are the employee, spouse and another dependent, then the family rate would be charged. If the remaining covered lives are only the employee and spouse, then the employee + spouse rate would be charged.

3. If a small employer carrier uses optional dependent children categories as provided by sub-subparagraph (4)(a)2.b., above, the dependent rate shall be directly determined by calculating the difference between the two family tier rates, e.g., a rate with two dependents minus the rate with one dependent shall determine the single dependent rate.
(b) COBRA rates do not need to be filed unless the small employer carrier seeks to utilize a different rating methodology other than the one described above.

69O FAC 149.038 | Employee Health Care Access Act Statement Reporting Requirement

(1) Pursuant to Section 627.6699, F.S., each carrier that provides health benefit plans in this state shall file an actuarial certification, pursuant to paragraph 69O-149.044(2)(b), F.A.C., on or before March 15 of each year that the carrier is in compliance with the provisions of section 627.6699(6), F.S., as required by Section 627.6699(8)(b), F.S., for the prior calendar year and that the current rating methods of the carrier are actuarially sound. The actuary shall provide a detailed explanation if this certification cannot be made.

(2) Quarterly Reports: Within 45 days following each calendar quarter each small employer carrier shall file, pursuant to paragraph 69O-149.044(2)(b), F.A.C., a report on Form OIR-B2-1117, Florida Employee Health Care Access Act Enrollment Report, adopted in Rule 69O-149.044, F.A.C.

(3)
(a)
1. All small employer carriers utilizing rating adjustments pursuant to subsection 69O-149.037(6), F.A.C., shall make semiannual reports that reflect their experience from January 1 through June 30 and from July 1 through December 31 of each year. The reports shall be filed with the Office, pursuant to paragraph 69O-149.044(2)(b), F.A.C., within 45 days following the last day of the reporting period using Form OIR-B2-1575, "Small Employer Group Underwriting Experience Report Form" adopted in Rule 69O-149.044, F.A.C.

2. The experience of any group category that is not subject to underwriting, pursuant to subsection 69O-149.037(6), F.A.C., such as 1-life groups, shall not be included in the report.
(b)
1. If the percentage deviation from the modified community rate due to adjustments in the rate actually charged policyholders for claim experience, health status, or duration adjustments is 4 percent or more, the carrier shall limit the application of claim experience, health status, or duration adjustments to credits only effective no more than 60 days following the report date.

2. This shall apply to all groups with original issue dates or anniversary dates for renewals on or after this 60 days.

3. If a group was in process of application review and issuance, and would have received a surcharge, but the policy was not issued or renewed until after the 60 day period, the surcharge may not be applied.
(c) If the above report is not submitted by the date required, the carrier shall limit the application of claim experience, health status, or duration adjustments to credits only effective no more than 60 days following the due date. This shall apply to all groups with original issue dates or anniversary dates for renewals on or after this 60 days. If a group was in process of application review and issuance, and would have received a surcharge, but the policy was not issued or renewed until after the 60 day period, the surcharge may not be applied.

(d) A carrier that is limited to credits only, pursuant to paragraph (3)(b) or (c), above, shall be limited to credits only until a subsequent reporting period demonstrating that the percentage deviation from the modified community rate due to adjustments in the rate actually charged policyholders for claim experience, health status, or duration adjustments is less than 4 percent.

69O FAC 149.039 | Designation of Election to Become a Risk-Assuming or Reinsuring Carrier Under Section 627.6699, Florida Statutes, the Employee Health Care Access Act

(1) A small employer carrier shall file, pursuant to paragraph 69O-149.044(1)(b), F.A.C., a final designation of election to become either a risk-assuming carrier or a reinsuring carrier using Form OIR-B2-1093, "State of Florida/Small Employer Carrier's Application to Become a Risk Assuming Carrier or a Reinsuring Carrier, as Required by Section 627.6699(9), F.S.," adopted in Rule 69O-149.044, F.A.C.

(2) The Office shall provide notice by publication of a small employer carrier's designation of election to become a risk assuming carrier and shall provide 21 days from publication for comment prior to making a decision on the election. The Office shall hold a hearing on the election if requested by the carrier.

(3) The Office shall approve or disapprove any application within 60 days after filing, based on the criteria in Section 627.6699(10), F.S.

(4) The filing shall be submitted to the Office electronically through http://www.FLOir.com/iPortal.

69O FAC 149.040 | Change of Status of Small Employer Carrier's Election to Become Risk-Assuming Carrier or Reinsuring Carrier

(1) Any small employer carrier seeking to change the election made by the carrier under Section 627.6699(9)(a), F.S., to become either a risk-assuming carrier or a reinsuring carrier shall request a change of status, pursuant to paragraph 69O-149.044(2)(b), F.A.C., on Form OIR-B2-1095, State of Florida/Small Employer Carrier's Application to Modify Previous Election to Become a Risk Assuming or a Reinsuring Carrier, As Required by Section 627.6699(9), F.S., adopted in Rule 69O-149.044, F.A.C.

(2) Within 60 days after the form and its attached information is filed with the Office, the Office will hold a hearing on the request. Within 30 days after the conclusion of the hearing and the submission of any post-hearing documentation or argument, the Office will approve or disapprove the request, based on the criteria in Section 627.6699(10)(b), F.S.

(3) The filing shall be submitted to the Office electronically through http://www.FLOir.com/iPortal.

69O FAC 149.041 | Marketing Communication Material and Marketing Guidelines

(1) Any marketing communication shall comply with the requirements of rule Chapter 69O-150, Part III, F.A.C.

(2) Any insurer marketing small group health plans shall comply with the following guidelines:
(a) The small group health history or size shall not be used to direct the small group to a particular small group plan except as permitted by the provisions of Section 627.6699, F.S.

(b)
1. In determining eligibility for small group coverage an employer/employee income may not be used.

2. A carrier may request information and documentation to determine whether an individual qualifies as an active business that is eligible for coverage.

3. The following information, records, or documents may be requested or considered in determining whether an employer meets the definition of small employer pursuant to Section 627.6699(3)(v), F.S. If the employer was required by applicable law to maintain the information, record or documents or to file the document with a local, state or federal governmental agency or authority; maintains the information in the normal course of business; or was issued the information, records, or documents by a local, state, or deferral agency or authority:
a. IRS form 1040, Schedule C or F.

b. IRS 941 (quarterly wage and tax form).

c. IRS 1065 (for partnership income).

d. IRS 1120 (corporate income).

e. IRS 1099 (which may include payments to independent contractors).

f. IRS 2106 (employee business expenses).

g. IRS 990 (for non-profits with annual receipts over $25,000).

h. Occupational Licenses.

i. State Licenses.

j. Florida UT 6 (unemployment compensation tax form).

k. Articles of incorporation.

l. Partnership agreements.

m. Affidavits from the customers or suppliers of the small employer.

n. Auditable personal records of receipts, expenditures, invoices.

o. Leases and other contracts.
4.
a. Refusal to insure an eligible small employer because of the employer's refusal or unwillingness to provide information, records or documents which are not necessary to reasonably establish that the employer meets the definition of Section 627.6699(3)(v), F.S., violates Section 627.6699(5)(a), F.S.

b. Any statement that requires information not necessary for determining eligibility be provided for coverage to be issued shall constitute an unfair method of competition in violation of Section 626.9541(1)(b), F.S.
(c) In the instance where a company splits to become two or more corporations, with each corporation employing less than 50 employees, they are considered an eligible small employer if:
1. The group is not splitting solely with the intent of providing health insurance coverage to a separate class of employees;

2. The new company can produce signed documentation (i.e., articles of incorporation) that substantiates that there is a legitimate business with business activity;

3. All eligible employees are working 25 hours or more per week.
(d) New and renewal policies for the Basic and Standard policies issued on or after May 1, 1995, must include the 1995 Basic and Standard Health Benefit Plans (OIR-B2-95) pursuant to Section 627.6699(12), F.S., which is incorporated herein by reference and can be obtained from the Bureau of Life and Health Forms and Rates.

(e)
1. Pursuant to Section 626.9611, F.S., the Office identifies the following as being prohibited by Section 626.9541(1)(b), F.S., for a small employer carrier in reflecting any of the permitted rate adjustments in subsection 69O-149.037(6), F.A.C.:
a. To quote a rate which does not reflect the actual characteristics of the individual group; or

b. Where necessary underwriting information has not been analyzed, to quote a rate other than the approved community rate. Any such quote of the community rate shall include a disclosure that the rate will be affected by the results of underwriting by up to 15 percent up or down for new groups, or up to a 10 percent increase for renewal groups.
2. This does not restrict carriers from quoting rates to groups based on estimated enrollment or demographics provided by the employer.
(f) Any practice that results in the declination of an application from an eligible small employer, other than for statutorily permitted reasons, constitutes a failure to comply with the guaranteed-issue requirements of Section 627.6699(5), F.S.; for example, imposing standards for eligibility that are not required by law, such as:
1. Requiring the small employer to be a domestic entity; or

2. Requiring the group to have prior group coverage; or

3. Requiring payment of premiums with business checks instead of personal checks.

69O FAC 149.043 | Small Employer Health Reinsurance Program

(1) Beginning January 1, 1994, the board of the "Florida Small Employer Health Reinsurance Program," as established in Section 627.6699(11), F.S., shall consist of the Director or his designee, who shall serve as chairman, and eight (8) additional members who are representatives of carriers and who are appointed by the commissioner in accordance with the requirements of Sections 627.6699(11)(b)3. and 6., F.S., with the restrictions in Section 627.6699(11)(b)3.a., F.S., and with this rule.

(2) Of the 8 additional members of the board, subsequently amended to 13 in the 2000 legislative session, 5 shall be selected from individuals recommended by small employer carriers. Any small employer carrier wishing to do so may submit a list of recommended appointees to the commissioner either on its own behalf or through its trade organization. The list shall be submitted to: Insurance Commissioner, Office of Insurance Regulation, Larson Building, Tallahassee, FL 32399-0328, or submitted electronically to InsuranceCommissioner@FLOir.com. The carrier or trade organization submitting the list shall include the following information about the persons it is recommending:
(a) Name, present affiliation, business address and business phone number.

(b) Educational background to the extent the small employer carrier deems it relevant to the selection process.

(c) Work experience to the extent the small employer carrier deems it relevant to the selection process.

(d) Professional qualifications not addressed in paragraphs (b) and (c), above, such as membership in professional societies and publications, to the extent the small employer carrier deems it relevant to the selection process.

69O FAC 149.044 | Forms

(1) The following forms are hereby adopted and incorporated by reference:
(a) OIR-B2-1117, Rev. 1/05, Florida Employee Health Care Access Act Enrollment Report.

(b) OIR-B2-1093, Rev. 5/02, State of Florida/Small Employer Carrier's Application to Become a Risk Assuming Carrier or a Reinsuring Carrier, as Required by Section 627.6475(5), F.S.

(c) OIR-B2-1095, Rev. 5/02, State of Florida/Small Employer Carrier's Application to Modify Previous Election to Become a Risk Assuming or a Reinsuring Carrier, as Required by Section 627.6699(9), F.S.

(d) OIR-B2-1575, Rev. 10/03, Small Employer Group Underwriting Experience Report Form.
(2)
(a) Copies of forms are available and may be printed from the Office's website: http://www.FLOir.com/iPortal.

(b) Filings shall be submitted electronically through http://www.FLOir.com/iPortal.

69O FAC 149.052 | Establishing a Self-Funded Health Benefit Plan

(1) Prior to establishing a Self-Funded Health Benefit Plan, the local governmental unit shall submit the following:
(a) A copy of its Plan, including a list of its offered benefits;

(b) Form OIR-B2-570, "General Information on Self-Funded Health Benefit Plans"; as adopted in Rule 69O-149.054, F.A.C.;

(c) Form OIR-B2-571 "New Plan Operating Projections for Self-Funded Health Benefit Plans"; as adopted in Rule 69O-149.054, F.A.C.;

(d) Form OIR-B2-573, "Operating Projections for Self-Funded Health Benefit Plans"; as adopted in Rule 69O-149.054, F.A.C.; and,

(e) A certification as to the actuarial soundness of the Plan prepared by an actuary who is a member of the Society of Actuaries or the American Academy of Actuaries accompanied by an explanation or basis of how the certification was made.
(2) The filing shall be submitted to the Office electronically through http://www.FLOir.com/iPortal.
Rulemaking AuthorityLaw ImplementedHistory
112.08(6) FS.112.08(2) FS.New 7-9-91, Formerly 4-111.002, 4-149.052, Amended .

69O FAC 149.053 | On-Going Review of the Self-Funded Health Benefit Plan

(1) Once the Plan has been approved by the Office and has commenced operations, the local governmental unit shall submit the following, no later than 90 days after the close of the Plan's fiscal year:
(a) Form OIR-B2-570, "General Information on Self-Funded Health Benefit Plans," as adopted in Rule 69O-149.054, F.A.C.;

(b) Form OIR-B2-572, "Annual Report of Self-Funded Health Benefit Plans," as adopted in Rule 69O-149.054, F.A.C.;

(c) Form OIR-B2-573, "Operating Projections for Self-Funded Health Benefit Plans," as adopted in Rule 69O-149.054, F.A.C.;

(d) Form OIR-B2-574, "General Information and Surplus Statement for Self-Funded Health Benefit Plans," as adopted in Rule 69O-149.054, F.A.C.; and,

(e) A certification as to the actuarial soundness of the Plan prepared by an actuary who is a member of the Society of Actuaries or the American Academy of Actuaries accompanied by an explanation or basis of how the certification was made.
(2) The filing shall be submitted to the Office electronically through http://www.FLOir.com/iPortal.
Rulemaking AuthorityLaw ImplementedHistory
112.08(6) FS.112.08(2) FS.New 7-9-91, Formerly 4-111.003, 4-149.053, Amended .

69O FAC 149.054 | Forms Incorporated by Reference

(1) The following forms are hereby adopted and incorporated by reference:
(a) Form OIR-B2-570 (12/03) "General Information on Self-Funded Health Benefit Plans";

(b) Form OIR-B2-571 (12/03) "New Plan Operating Projections for Self-Funded Health Benefit Plans";

(c) Form OIR-B2-572 (12/03) "Annual Report of Self-Funded Health Benefit Plans";

(d) Form OIR-B2-573 (12/03) "Operating Projections for Self-Funded Health Benefit Plans";

(e) Form OIR-B2-574 (12/03) "General Information and Surplus Statement for Self-Funded Health Benefit Plans";
(2) The above forms are hereby adopted and incorporated by reference.

(3) All forms are available and may be printed from the Office website: "http://www.FLOir.com/iPortal."

69O FAC 149.200 | Purpose

The purpose of this part is to establish the standard annual risk rates pursuant to Section 627.6675(3), F.S., to be used as the maximum rate for group conversion insurance forms and by the Florida Comprehensive Health Association ("FCHA") in establishing rates for coverages issued by the association.

69O FAC 149.201 | Scope

The provisions of this part shall apply to all group conversion coverage issued or renewed in Florida on or after the effective date of this rule for coverage issued:
(1) As an individual policy; or

(2) As a certificate under a group policy; including group policies issued or delivered outside of this state.

69O FAC 149.202 | Standard Risk Rate

(1) Standard risk rates, pursuant to the provisions of Section 627.6675(3), F.S., are provided for the following "categories of coverages":
(a) Indemnity policies;

(b) Preferred provider organization ("PPO")/exclusive provider organization ("EPO") policies; and,

(c) Health maintenance organization ("HMO") contracts.
(2) The standard risk rates for a particular county are determined by multiplying the standard risk rate schedule times the appropriate county factor.

(3) Standard risk rates are provided for the Standard Health Benefit Plan pursuant to Section 627.6699(12), F.S., outlined in Rule 69O-149.204, F.A.C.

(4) Standard risk rates reflect the predominant rates charged in the market for newly issued coverage.

69O FAC 149.203 | Group Conversion Premium

(1) The maximum group conversion rates to be charged an insured shall not exceed the standard risk rate times 2.0.

(2) All rate filings shall provide a comparison table clearly identifying benefit differences from those benefits listed in rule 69O-149.204, F.A.C., from which the standard risk rates contained in this part were derived.

(3) The maximum group conversion rate determined in subsection (1), above, shall be adjusted for benefit differences from those benefits used for the standard risk rates based on a common morbidity basis of all other individual major medical forms of the company, or if none, other major medical group forms for the same category of coverage. Such adjustment factor shall be included in the comparison table of subsection (2), above, for each benefit difference identified. For purposes of this subsection, "common morbidity" means a set of values for the frequency and intensity of claims from which claim costs for a set of benefits may be calculated.

(4) A company providing coverage issued on a family basis may file a family factor for approval. Any such factor proposed for approval may be no greater than that used by the company for other individual major medical products, or if none, other similar products.

(5) Terminating employees or members shall be offered the same "category of coverage" (see subsection 69O-149.202(1), F.A.C.) as the underlying group policy form from which they are being offered conversion coverage.

(6) The following benefit adjustment factors to reflect the benefit difference from the $1,000 deductible plan provided in this part will be accepted without further justification required by subsection (8):
(a) 1.171, for $250 deductible;

(b) 1.107, for $500 deductible;

(c) 1.050, for $750 deductible;

(d) 0.914, for $1,500 deductible;

(e) 0.847, for $2,000 deductible;

(f) 0.797, for $2,500 deductible;

(g) 0.632, for $5,000 deductible.
(7) For any coverage that provides for a lifetime maximum, the premium charged to one individual shall not exceed the remaining lifetime maximum at any point in time.

(8) Group conversion rate schedules are subject to all applicable filing and approval requirements of Section 627.410(6) or 641.31(3), F.S., and Chapter 69O-149 or Rule 69O-191.054, F.A.C.

(9) If the company has more than one coverage of the 2003 Standard Health Benefit Plan approved, the coverage offered to an individual shall be the benefit design nearest to the insured's current group coverage.

(10) The following benefit adjustment factors shall be used to reflect the benefit differences from Plan A, which is the published rate for each category, to Plan options B through E:
(a) 0.871 for PPO/EPO Plan B;

(b) 0.917 for Indemnity Plan B;

(c) 0.846 for PPO/EPO Plan C;

(d) 0.891 for Indemnity Plan C;

(e) 0.834 for HMO Plan B;

(f) 0.828 for HMO Plan C;

(g) 0.762 for HMO Plan D;

(h) 0.752 for HMO Plan E.

69O FAC 149.204 | Outline of Coverage (Repealed)

69O FAC 149.205 | Indemnity Standard Risk Rate

(1) The table below provides the standard annual risk rates for indemnity plans for the Standard Health Benefit Plan. The 200% standard risk rate referenced in Section 627.6675(3)(a), F.S., is determined by multiplying each value in the table by the factor 2.0.

(2) To determine the rate for a particular county, multiply the rate schedule below by the appropriate area factor.

(3) Standard risk rates for coverage providing benefits coordinating with or otherwise considering coverage under Medicare, parts A and B, shall be determined by multiplying the standard risk rates identified herein by.278.
STANDARD HEALTH BENEFIT PLAN
AgeMaleFemaleCountyArea Factor
0-17$1,407.85$1,407.85Alachua0.70
18$1,796.44$2,599.81Baker0.78
19$1,796.44$2,599.81Bay0.80
20$1,796.44$2,599.81Bradford0.82
21$1,796.44$2,599.81Brevard0.93
22$1,796.44$2,599.81Broward1.41
23$1,796.44$2,599.81Calhoun0.75
24$1,796.44$2,599.81Charlotte0.95
25$1,796.44$2,599.81Citrus0.72
26$1,965.21$2,760.44Clay0.80
27$2,105.71$2,915.99Collier0.93
28$2,219.57$3,067.27Columbia0.80
29$2,311.89$3,214.48Dade1.30
30$2,385.29$3,358.84De Soto0.74
31$2,443.44$3,499.75Dixie0.69
32$2,490.21$3,639.65Duval0.94
33$2,528.84$3,777.51Escambia0.77
34$2,562.39$3,914.75Flagler0.86
35$2,581.30$4,072.95Franklin0.75
36$2,600.42$4,173.39Gadsden0.75
37$2,619.33$4,291.12Gilchrist0.75
38$2,637.02$4,423.90Glades0.98
39$2,707.98$4,571.31Gulf0.76
40$2,809.03$4,759.80Hamilton0.77
41$2,940.59$4,927.55Hardee0.80
42$3,101.43$5,100.79Hendry0.97
43$3,297.44$5,260.81Hernando0.85
44$3,516.83$5,434.66Highlands0.71
45$3,749.65$5,605.46Hillsborough0.82
46$3,985.51$5,774.43Holmes0.75
47$4,217.72$5,925.51Indian River0.92
48$4,327.72$5,976.75Jackson0.77
49$4,484.69$6,040.80Jefferson0.75
50$4,687.01$6,149.58Lafayette0.78
51$4,933.86$6,225.42Lake0.90
52$5,219.74$6,299.43Lee0.97
53$5,426.53$6,311.43Leon0.79
54$5,720.55$6,336.64Levy0.80
55$6,090.61$6,370.19Liberty0.75
56$6,517.61$6,440.55Madison0.79
57$6,973.07$6,541.60Manatee0.91
58$7,420.81$6,678.85Marion0.77
59$7,820.77$6,853.51Martin0.94
60$8,133.69$7,038.14Monroe1.30
61$8,327.27$7,276.65Nassau0.85
62$8,372.81$7,528.98Okaloosa0.76
63$8,372.81$7,769.53Okeechobee0.97
64$8,372.81$7,960.46Orange0.90
65$8,372.81$7,960.46Osceola0.91
66$8,372.81$7,960.46Palm Beach1.00
67$8,372.81$7,960.46Pasco0.90
68$8,372.81$7,960.46Pinellas0.87
69$8,372.81$7,960.46Polk0.84
70$8,372.81$7,960.46Putnam0.81
71$8,372.81$7,960.46St. Johns0.77
72$8,372.81$7,960.46St. Lucie0.99
73$8,372.81$7,960.46Santa Rosa0.77
74$8,372.81$7,960.46Sarasota0.76
75$8,372.81$7,960.46Seminole0.92
76$8,372.81$7,960.46Sumter0.81
77$8,372.81$7,960.46Suwannee0.82
78$8,372.81$7,960.46Taylor0.79
79$8,372.81$7,960.46Union0.79
0.92
Wakulla0.75
Walton0.76
Washington0.76

69O FAC 149.206 | Preferred Provider/Exclusive Provider Standard Risk Rates

(1) The table below provides the standard annual risk rates for PPO/EPO plans for the FCHA and Standard Health Benefit Plan. The 200% standard risk rate referenced in section 627.6675(3)(a), F.S., is determined by multiplying each value in the table by the factor 2.0.

(2) To determine the rate for a particular county, multiply the rate schedule below by the appropriate area factor.

(3) Standard risk rates for coverage providing benefits coordinating with or otherwise considering coverage under Medicare, parts A and B, shall be determined by multiplying the standard risk rates identified herein by .278.

(4) Standard risk rates for coverage providing benefits as defined in section 627.6498, F.S. (FCHA plan), shall multiply the standard risk rates identified herein by .96.
STANDARD HEALTH BENEFIT PLAN
AgeMaleFemaleCountyArea Factor
0$2,269.71$2,205.88Alachua0.70
1$2,269.71$2,205.88Baker0.78
2$1,862.25$1,831.86Bay0.80
3$1,646.48$1,616.10Bradford0.82
4$1,524.94$1,464.16Brevard0.93
5$1,464.16$1,339.66Broward1.41
6$1,400.43$1,218.11Calhoun0.75
7$1,339.66$1,126.95Charlotte0.95
8$1,278.88$1,032.73Citrus0.72
9$1,248.50$1,032.73Clay0.80
10$1,278.88$1,063.12Collier0.93
11$1,309.27$1,126.95Columbia0.80
12$1,339.66$1,218.11Dade1.30
13$1,445.38$1,401.89De Soto0.74
14$1,569.89$1,526.40Dixie0.69
15$1,661.05$1,647.95Duval0.94
16$1,782.60$1,769.49Escambia0.77
17$1,846.43$1,868.63Flagler0.86
18$1,677.62$1,731.60Franklin0.75
19$1,729.06$1,833.53Gadsden0.75
20$1,779.55$1,938.77Gilchrist0.75
21$1,856.45$2,067.93Glades0.98
22$1,911.43$2,205.39Gulf0.76
23$1,963.55$2,315.98Hamilton0.77
24$2,015.45$2,431.51Hardee0.80
25$2,067.34$2,528.50Hendry0.97
26$2,119.01$2,592.34Hernando0.85
27$2,176.62$2,653.36Highlands0.71
28$2,257.50$2,718.82Hillsborough0.82
29$2,316.80$2,786.17Holmes0.75
30$2,372.69$2,833.44Indian River0.92
31$2,436.98$2,879.75Jackson0.77
32$2,506.76$2,954.83Jefferson0.75
33$2,578.54$3,031.05Lafayette0.78
34$2,649.40$3,082.98Lake0.90
35$2,741.76$3,134.92Lee0.97
36$2,816.34$3,188.48Leon0.79
37$2,898.23$3,246.48Levy0.80
38$2,974.23$3,279.60Liberty0.75
39$3,052.57$3,329.10Madison0.79
40$3,129.28$3,390.47Manatee0.91
41$3,201.52$3,480.97Marion0.77
42$3,307.34$3,602.71Martin0.94
43$3,405.57$3,738.45Monroe1.30
44$3,504.04$3,875.01Nassau0.85
45$3,620.45$4,027.23Okaloosa0.76
46$3,743.36$4,186.98Okeechobee0.97
47$3,867.57$4,332.64Orange0.90
48$4,044.14$4,487.03Osceola0.91
49$4,254.26$4,647.82Palm Beach1.00
50$4,484.29$4,817.80Pasco0.90
51$4,712.62$4,964.22Pinellas0.87
52$4,992.07$5,108.97Polk0.84
53$5,243.22$5,219.95Putnam0.81
54$5,532.82$5,375.90St. Johns0.77
55$5,798.51$5,533.46St. Lucie0.99
56$6,114.18$5,718.08Santa Rosa0.77
57$6,471.97$5,933.22Sarasota0.76
58$6,819.70$6,156.54Seminole0.92
59$7,192.79$6,400.67Sumter0.81
60$7,454.79$6,678.58Suwannee0.82
61$7,701.77$6,911.27Taylor0.79
62$7,900.57$7,143.56Union0.79
63$8,070.52$7,316.73Volusia0.92
64$8,206.71$7,426.21Wakulla0.75
65$8,758.12$7,836.62Walton0.76
66$8,793.24$7,867.77Washington0.76
67$8,851.33$7,900.07
68$8,929.30$7,940.58
69$9,007.04$7,983.68
70$9,085.01$8,023.71
71$9,162.51$8,064.69
72$9,244.24$8,109.88
73$9,318.22$8,145.70
74$9,388.96$8,183.89
75$9,463.41$8,224.62
76$9,537.41$8,257.64
77$9,611.39$8,296.75
78$9,648.63$8,348.73
79$9,685.87$8,400.24

69O FAC 149.207 | Health Maintenance Organization Standard Risk Rates

(1) The table below provides the standard annual risk rates for HMO plans for the Standard Benefit Plan. The 200% standard risk rate referenced in section 627.6675(3)(a), F.S., is determined by multiplying each value in the table by the factor 2.0.

(2) To determine the rate for a particular county, multiply the rate schedule below by the appropriate area factor.

(3) Standard risk rates for coverage providing benefits coordinating with or otherwise considering coverage under Medicare, parts A and B, shall be determined by multiplying the standard risk rates identified herein by .278.
AgeMaleFemaleCountyArea Factor
0$5,258.45$5,250.04Alachua1.04
1$2,968.48$2,960.07Baker1.06
2-6$2,909.90$2,901.49Bay0.90
7-12$2,822.45$2,814.04Bradford1.04
13-17$2,972.73$2,964.33Brevard0.94
18$2,549.95$4,120.85Broward1.00
19$2,570.16$4,301.90Calhoun0.90
20$2,610.13$4,382.36Charlotte0.99
21$2,630.36$4,472.30Citrus0.92
22$2,670.38$4,539.11Clay1.06
23$2,729.45$4,663.20Collier0.90
24$2,776.56$4,759.79Columbia1.04
25$2,819.35$4,883.42Dade1.00
26$2,899.75$5,051.05De Soto0.90
27$2,983.75$5,227.91Dixie1.04
28$3,047.19$5,290.86Duval1.06
29$3,150.59$5,242.98Escambia1.08
30$3,236.87$5,247.52Flagler0.90
31$3,279.13$5,177.31Franklin0.90
32$3,340.11$5,172.07Gadsden0.90
33$3,402.20$5,136.91Gilchrist1.05
34$3,444.91$5,106.34Glades0.90
35$3,532.78$5,128.20Gulf0.90
36$3,580.77$5,108.61Hamilton0.90
37$3,649.52$5,085.24Hardee0.84
38$3,748.38$5,099.53Hendry0.96
39$3,815.47$5,111.88Hernando1.03
40$3,923.62$5,139.24Highlands0.84
41$4,003.19$5,186.08Hillsborough1.01
42$4,102.20$5,276.71Holmes0.90
43$4,235.88$5,400.47Indian River0.90
44$4,359.59$5,523.74Jackson0.90
45$4,486.17$5,621.99Jefferson0.90
46$4,682.63$5,747.05Lafayette0.90
47$4,872.08$5,874.81Lake0.94
48$5,109.97$5,986.94Lee1.01
49$5,341.56$6,117.55Leon0.90
50$5,598.42$6,278.89Levy1.04
51$5,909.83$6,447.58Liberty0.90
52$6,253.14$6,612.37Madison0.90
53$6,590.04$6,778.15Manatee1.06
54$6,966.54$6,965.19Marion0.97
55$7,360.26$7,102.09Martin1.02
56$7,730.02$7,258.77Monroe0.90
57$8,099.29$7,390.68Nassau1.06
58$8,615.15$7,721.59Okaloosa1.05
59$9,149.91$8,070.04Okeechobee0.94
60$9,714.17$8,467.78Orange0.94
61$10,192.09$8,914.29Osceola0.96
62$10,667.92$9,373.20Palm Beach1.06
63$11,239.30$9,927.57Pasco1.01
64$11,819.57$10,475.54Pinellas1.01
65$14,318.73$12,839.86Polk1.15
66$14,377.66$12,885.56Putnam1.01
67$14,436.21$12,930.98St. Johns1.06
68$14,494.23$12,975.97St. Lucie1.01
69$14,551.64$13,020.50Santa Rosa1.08
70$14,608.25$13,064.41Sarasota1.07
71$14,663.96$13,107.62Seminole0.97
72$14,718.64$13,150.03Sumter0.97
73$14,772.15$13,191.51Suwannee0.94
74$14,824.35$13,232.00Taylor0.90
75$14,875.09$13,271.34Union0.90
76$14,924.27$13,309.50Volusia1.00
77$14,971.75$13,346.31Wakulla0.90
78$15,017.41$13,381.72Walton1.07
79$15,061.10$13,415.60Washington0.90
69O-150 | Life and Health Advertising Requirements

69O FAC 150.001 | Purpose

The purpose of these rules is to provide prospective purchasers with clear and unambiguous statements in the advertisement of health insurance, and to assure the clear, truthful and adequate disclosure of the benefits, limitations and exclusions of policies sold as health insurance. This purpose is intended to be accomplished by the establishment of guidelines and standards of permissible and impermissible conduct in the advertising of health insurance to assure that product descriptions are presented in a manner which prevents unfair, deceptive and misleading advertising and is conducive to the accurate presentation and description of health insurance to the insurance buying public through the advertising media and material used by insurance agents and companies.

69O FAC 150.002 | Applicability

(1) These rules shall apply to any Health Insurance "advertisement," disseminated in this State which the insurer knows or reasonably should know is intended for presentation, distribution or dissemination in this State when such presentation, distribution or dissemination is made either directly by an insurer or indirectly on behalf of an insurer, by an agent, broker, producer or solicitor or any other person who has either actual or apparent authority to act on behalf of the insurer; provided the insurer shall not be responsible for advertisements that are published in violation of written procedures or guidelines of the insurer.

(2) Advertising materials which are reproduced in quantity shall be identified by form numbers or other identifying means. Such identification shall be sufficient to distinguish an advertisement from any other advertising materials, policies, applications or other materials used by the insurer.

(3) Except where specifically provided otherwise, these rules shall apply to advertisements for long-term care policies issued pursuant to Sections 627.9401-.9408, F.S.

69O FAC 150.003 | Definitions

For the purpose of these rules, the terms below are defined as follows:
(1) An "Advertisement" includes any method of communicaton listed in Sections 626.9541(1)(b)1. through 4., F.S.

(2) The definition of "Advertisement" does not include:
(a) Material to be used solely for the training and education of an insurer's employees, agents, or brokers;

(b) Material used exclusively in-house by insurers;

(c) Communications within an insurer's own organization not intended for dissemination to the public;

(d) Individual communications of a personal nature with current policyholders regarding existing coverage other than material urging such policyholders to renew, increase or expand coverages;

(e) Correspondence between a prospective group or blanket policyholder and an insurer in the course of negotiating a group or blanket contract;

(f) Court approved material ordered by a court to be disseminated to policyholders; or

(g) A general announcement from a group or blanket policyholder to eligible individuals on an employment or membership list which may include a brief description of coverage and is primarily a notification that a contract or program has been written or arranged; provided, the announcement must clearly indicate that it is preliminary to the issuance of a booklet, pamphlet, brochure or other similar paper preliminary to coverage by the insurer.
(3) "Application" means the form which must be filled in by the person seeking to effectuate an insurance policy.

(4) "Application Period" also includes any enrollment period.

(5) "Certificate" means any certificate issued under a group health policy which certificate has been delivered or issued for delivery in this state.

(6) "Exception" means any provision in a policy whereby coverage for a specified hazard is entirely eliminated; it is a statement of a risk not assumed under the policy.

(7) "Health Insurance Policy" includes any policy, plan, certificate, contract, agreement, statement of coverage, rider or endorsement which provides accident or sickness benefits, or medical, surgical or hospital expense benefits, whether on an indemnity, reimbursement, service or prepaid basis, except when issued in connection with another kind of insurance other than life, and except disability, waiver of premium and double indemnity benefits included in life insurance annuity contracts, and, except medicare supplement policies.

(8) "Institutional Advertisement" means an advertisement having as its sole purpose the promotion of the readers', viewers' or listeners' interest in the concept of Health Insurance or the promotion of the insurer as a seller of Health Insurance.

(9) "Insurer" includes any individual, corporation, association, partnership, reciprocal exchange, inter-insurer, Lloyds, fraternal benefit society, hospital service corporation, medical service corporation, and any other legal entity which is defined as an "insurer" in the Insurance Code of this state.

(10) "Invitation to Contract" means an advertisement which is neither an institutional advertisement nor an invitation to inquire.

(11)
(a) "Invitation to Inquire" means an advertisement that:
1. Has as its objective the creation of a desire to inquire further about a health insurance policy;

2. Is limited to a brief description of coverage that shall include only:
a. A brief description of the loss for which benefits are payable;

b. The dollar amount of benefits payable; and,

c. The period of time during which benefits are payable; and,
3. Contains a provision in the following or substantially similar form: "This policy has (exclusions) (limitations) (reductions of benefits) (terms under which the policy may be continued in force or discontinued). For costs and complete details of the coverage call (or write) your insurance agent or company." (whichever is applicable)
(b) An invitation to inquire shall not:
1. Employ devices that are designed to create undue anxiety;

2. Exaggerate the value of the benefits available under the marketed health benefit plan;

3. State premium cost. If an advertisement which would otherwise be considered an invitation to inquire does state a cost, it shall be considered an invitation to contract pursuant to this rule chapter; or

4. Otherwise violate these rules or the Insurance Code.
(12) "Limitation" means any provision which restricts coverage under the policy other than an exception or a reduction.

(13) "Person" means any natural person, association, organization, partnership, trust, group, discretionary group, corporation or any other entity.

(14) "Reduction" means any provision which reduces the amount of the benefit; this term includes a situation where a risk of loss is assumed, but payment upon the occurrence of such loss is limited to some amount or period less than would be otherwise payable had such reduction not been used.

69O FAC 150.004 | Method of Disclosure of Required Information

All information required to be disclosed by these rules shall be set out conspicuously and in close conjunction with the statements to which such information relates or under appropriate captions of such prominence that it shall not be minimized, rendered obscure or presented in an ambiguous fashion or intermingled with the context of the advertisement so as to be confusing or misleading.

69O FAC 150.005 | Form and Content of Advertisements

(1) The form and content of a Health Insurance advertisement shall be sufficiently complete and clear to avoid deception or the capacity or tendency to mislead or deceive. Whether an advertisement has a capacity or tendency to mislead or deceive shall be determined by the Director from the overall impression that the advertisement may be reasonably expected to create upon a person of average education or intelligence, within the segment of the public to which it is directed.

(2) Advertisements shall be truthful and not misleading in fact or in implication. Words or phrases, whose meanings are clear only by implication or by the consumer's familiarity with insurance terminology shall not be used.

(3)
(a) An insurer must clearly identify its health insurance policy as an insurance policy in its advertisements.

(b) The name of any policy shall be followed by or include the words "Insurance Policy" or similar words clearly identifying, the fact that an insurance policy is being offered, through the use of the full generic name of the product; e.g., long term care insurance policy, major medical insurance policy, limited benefit health insurance policy, or disability insurance policy.
(4) No insurer, agent, broker, producer, solicitor or other person shall solicit a resident of this State for the purchase of Health Insurance in connection with or as the result of the use of any advertisement which:
(a) Contains any misleading representations, misrepresentations, or is otherwise untrue, deceptive or misleading with regard to the information imparted, the status, character or representative capacity of such person or the true purpose of the advertisement; or

(b) Otherwise violates the provisions of these rules; or

(c) Otherwise violates the provisions of the Florida Insurance Code.
(5) No insurer, agent, broker, producer, solicitor or other person shall solicit residents of this State for the purchase of Health Insurance through the use of a true or fictitious name which is deceptive or misleading with regard to the status, character, or proprietary or representative capacity of such person or the true purpose of the advertisement.

(6) No insurer, agent, broker, producer, solicitor, or other person shall effectuate insurance coverage prior to a full explanation of the coverage offered and completion of an application form.

69O FAC 150.006 | Advertisements of Benefits Payable, Losses Covered or Premiums Payable

(1) Deceptive Words, Phrases, or Illustrations Prohibited.
(a) No advertisement shall omit information or use words, phrases, statements, references or illustrations if the omission of such information or use of such words, phrases, statements, references, or illustrations has the capacity, tendency, or effect of misleading or deceiving purchasers or prospective purchasers as to the nature or extent of any policy benefit payable, loss covered or premium payable. The fact that the policy offered is made available to a prospective insured for inspection prior to consummation of the sale or an offer is made to refund the premium if the purchaser is not satisfied, does not remedy misleading statements.

(b) No advertisement shall contain or use words or phrases such as "all," "full," "complete," "comprehensive," "unlimited," "up to," "as high as," "this policy will help pay your hospital and surgical bills," "this policy will help fill some of the gaps that your present insurance leaves out," "this policy will help to replace your income" (when used to express loss of time benefits), or similar words and phrases, in a manner which exaggerates any benefits beyond the terms of the policy.

(c)
1. An advertisement that is also an invitation to join an association, trust, or discretionary group shall solicit insurance coverage on a separate and distinct application that requires separate signatures for each application.

2. The insurance program must be presented so as not to mislead or deceive the prospective members regarding the fact that they are purchasing insurance as well as applying for membership, if that is the case.

3. Any applicable membership fees or dues shall be disclosed on each application and must appear separately so as not to be construed as part of the premium for insurance coverage.
(d) An advertisement shall not contain descriptions of a policy limitation, exception, or reduction, worded in a positive manner to imply that it is a benefit, such as describing a waiting period as a "benefit builder," or stating "even pre-existing conditions are covered after a limited period of time." Words and phrases used in an advertisement to describe such policy limitations, exceptions and reductions shall fairly and accurately describe the negative features of such limitations, exceptions, and reductions of the policy offered.

(e) No advertisement of a benefit for which payment is conditional upon confinement in a hospital or similar facility shall use words or phrases such as "tax free," "extra cash," "extra income," "extra pay," or substantially similar words or phrases in a manner which would have the capacity, tendency or effect of misleading the public into believing that the policy advertised will, in some way, enable them to make a profit from being hospitalized or disabled.

(f) No advertisement of a hospital or other similar facility confinement benefit shall advertise that the amount of the benefit is payable on a monthly or weekly basis when, in fact, the amount of the benefit payable is based upon a daily pro rata basis relating to the number of days of confinement. When the policy contains a limit on the number of days of coverage provided, such limit must appear in the advertisement.

(g) No advertisement of a policy covering only one disease or a list of specified diseases shall imply coverage beyond the terms of the policy. Synonymous terms shall not be used to refer to any disease so as to imply broader coverage than is the fact.

(h) An advertisement for a policy providing benefits for specified illnesses only, such as cancer, or for specified accidents, such as automobile accidents, or for a limited benefit, such as nursing home coverage only, shall clearly and conspicuously in prominent type state the limited nature of the policy. The statement shall be worded in language identical to, or substantially similar to the following:
"THIS IS A LIMITED POLICY,"

"THIS IS A CANCER ONLY POLICY,"

"THIS IS AN AUTOMOBILE ACCIDENT ONLY POLICY,"

"THIS IS A NURSING HOME COVERAGE ONLY POLICY."
(i) An advertisement of health insurance sold by direct response shall not use the phrases, "no salesman will call," or "no agent will call," or "by eliminating the agent and/or commission, we can offer this low cost plan" or similar wording in a misleading manner.
(2) Exceptions, Reductions, and Limitations.
(a) An advertisement which is an invitation to contract shall disclose those exceptions, reductions, and limitations affecting the basic provisions of the policy.

(b) An advertisement which is subject to the requirements of the preceding paragraph shall disclose the existence of a waiting, elimination, probationary, or similar time period between the effective date of the policy and the effective date of coverage under the policy, or the existence of a time period between the date a loss occurs and the date benefits begin to accrue for such loss in a manner as prominent as the benefit amount or benefit time period advertised.

(c) An advertisement shall not use the words "only," "just," "merely," "minimum," or similar words or phrases to describe the applicability of any exceptions, reductions, or limitations, such as: "This policy is subject to the following minimum exceptions and reductions."
(3) Pre-Existing Conditions.
(a) An advertisement which is an invitation to contract for Health benefits shall, in negative terms, disclose the extent to which any loss is not covered if the cause of such loss is traceable to a condition existing prior to the effective date of the policy. The term "pre-existing condition" without an appropriate definition or description shall not be used.

(b) When a policy does not cover losses resulting from pre-existing conditions, no advertisement of the policy shall state or imply that the applicant's physical condition or medical history will not affect the issuance of the policy or payment of a claim thereunder. This rule prohibits the use of the phrase "no medical examination required" and phrases of similar import in a misleading manner. If an insurer requires a medical examination for a specified policy, the advertisement shall disclose that a medical examination is required.

(c) When coverage is in any way limited for pre-existing conditions, the application shall contain a statement which reflects the pre-existing condition provisions of the policy immediately preceding the blank space for the applicant's signature. For example, such an application form shall contain a statement substantially as follows:
This policy has a pre-existing condition limitation and if a physician has provided treatment or recommended treatment for any injury or illness or other condition within the month period prior to issuance of the (policy/certificate) for which I am applying, no coverage will be provided for that illness or injury or other condition until __ months after the (policy/certificate) has been issued.

69O FAC 150.007 | Necessity for Disclosing Policy Provisions Relating to Renewability, Cancellability, and Termination

An advertisement which is an invitation to contract shall disclose the provisions relating to renewability, cancellability and termination and any modification of benefits, losses covered or premiums because of age or for other reasons, in a manner which shall not minimize or render obscure the qualifying conditions.

69O FAC 150.008 | Testimonials or Endorsements by Third Parties

(1) Testimonials and endorsements used in advertisements must be genuine, represent the current opinion of the author, be applicable to the policy advertised and be accurately reproduced. The insurer, in using a testimonial or endorsement, makes as its own all of the statements contained therein, and the advertisement, including such statement is subject to all the provisions of these rules. When a testimonial or endorsement is used more than one year after it was originally given, a confirmation must be obtained.

(2) A person shall be deemed a "spokesperson" if the person making the testimonial or endorsement:
(a) Has a financial interest in the insurer or a related entity as a stockholder, director, officer, employee or otherwise; or

(b) Is an entity formed by the insurer, is owned or controlled by the insurer, its employees, or the person or persons who own or control the insurer; or

(c) Is in a policy-making position who is affiliated with the insurer in any of the above described capacities; or

(d) Is in any way directly or indirectly compensated for making a testimonial or endorsement.
(3) Any person acting as a spokesperson, as defined in the preceding paragraph, who performs any of the following acts in an advertisement shall be considered soliciting an insurance product, and such person shall be a licensed insurance agent pursuant to the Florida Insurance Code:
(a) Solicits insurance or procures applications; or

(b) Engages or holds himself out as engaging in the business of analyzing or abstracting insurance policies; or

(c) Engages in counseling, advising, or giving opinions to persons relative to insurance contracts; or

(d) Performs an invitation to contract, except where performed by a company officer in a manner which does not violate Section 626.112(4), F.S.
(4) The fact of a financial interest or the proprietary or representative capacity of a spokesperson shall be disclosed in an advertisement and shall be accomplished in the introductory portion of the testimonial or endorsement in the same form and with equal prominence thereto. If a spokesperson is directly or indirectly compensated for making a testimonial, endorsement or appraisal, such fact shall be disclosed by use of the phrase "Paid Endorsement" or words of similar import in a type style and size that is at least equal to that used for the spokesperson's name or the body of the testimonial or endorsement, whichever is larger. In the case of television or radio advertising, the required disclosure must be accomplished in the introductory portion of the advertisement and must be given prominence, and if printed must be presented in a type style and size that is at least equal to the largest type otherwise used in the advertisement. The use of the phrase "Paid Endorsement" is not required where the spokesperson is a company officer who is paid generally but not specifically for making the advertisement.

(5) The disclosure requirements of this rule shall not apply where the sole financial interest or compensation of a spokesperson, for all testimonials or endorsements made on behalf of the insurer, consists of the payment of union "scale" wages required by union rules, and if the payment is actually for such "scale" for TV or radio performances.

(6) An advertisement shall not state or imply that an insurer or a policy has been approved or endorsed by any individual, group of individuals, society, association, or other organization, governmental agency or other entity, unless such is the fact, and unless any proprietary relationship between an organization and the insurer is disclosed. If the entity making the endorsement or testimonial has been formed by the insurer or is owned or controlled by the insurer or the person or persons who own or control the insurer, such fact shall be disclosed in the advertisement. If the insurer or an officer of the insurer formed or controls the association, or holds any policy-making position in the association, that fact must be disclosed.

(7) When a testimonial refers to benefits received under a policy for a specific claim, the specific claim data, including claim number, date of loss, and other pertinent information shall be retained by the insurer for inspection for a period of four years or until the filing of the next regular report on examination of the insurer, whichever is the longer period of time. The use of testimonials which do not correctly reflect the present practices of the insurer or which are not applicable to the policy or benefits being advertised is not permissible.

(8) The provisions of subsections (2), (3) and (4) of this section, shall not apply to a written endorsement which does not describe specific benefits, coverages or premiums and which is made by an association of individuals which:
(a) Has been in existence for more than one year prior to making the written endorsement; and,

(b) Is formed for purposes other than soliciting insurance; and,

(c) Has a valid and bona fide governing constitution and by-laws; and,

(d) Has as its principal purpose some goal or objective other than providing or soliciting insurance, as determined by the Director in accordance with the procedures and requirements of Chapter 120, F.S., the Administrative Procedure Act.

69O FAC 150.009 | Use of Statistics

(1) An advertisement relating to the dollar amount of claims paid, the number of persons insured, or similar statistical information relating to any insurer or policy or contract shall not use irrelevant facts, and shall not be used unless it accurately reflects all of the relevant facts. Such an advertisement shall not imply that such statistics are derived from the policy or contract advertised unless such is the fact, and when applicable to other policies or contracts or plans shall specifically so state.
(a) An advertisement shall specifically identify the policy to which statistics relate and, where statistics are given which are applicable to a different policy, it must be stated clearly that the data do not relate to the policy being advertised.

(b) An advertisement shall not contain statements which are untrue in fact, or by implication misleading, with respect to the assets, corporate structure, financial standing, age or relative position of the insurer in the insurance business.
(2) An advertisement shall not represent or imply that claim settlements by the insurer are liberal or generous, or use words of similar import, or state or imply that claim settlements are or will be beyond the actual terms of the contract. An unusual amount paid for a unique claim for the policy advertised is misleading and shall not be used.

(3) The source of any statistics used in an advertisement shall be identified in such advertisement.

69O FAC 150.010 | Identification of Plan or Number of Policies

(1) When a choice of the amount of benefits is referred to, an advertisement shall disclose that the amount of benefits provided depends upon the plan selected and that the premium will vary with the amount of the benefits selected.

(2) When an advertisement refers to various benefits which may be contained in two or more policies, other than group master policies, the advertisement shall disclose that such benefits are provided only through a combination of such policies.

69O FAC 150.011 | Disparaging Comparisons and Statements

(1) An advertisement shall not directly or indirectly make unfair or incomplete comparisons of policies or contracts or benefits or comparisons of non-comparable policies or contracts of other insurers, and shall not disparage competitors, their policies, or contracts, services or business methods, and shall not disparage or unfairly minimize competing methods of marketing insurance.

(2) An advertisement should not contain statements such as "no red tape" or "here is all you do to receive benefits."

(3) Advertisements which state or imply that competing insurance coverage customarily contain certain exceptions, reductions or limitations not contained in the advertised policies are unacceptable unless such exceptions, reductions or limitations are contained in a substantial majority of such competing coverages.

(4) Advertisements which state or imply in a misleading or incomplete manner that an insurer's premiums are lower or that its loss ratios are higher because its organizational structure differs from that of competing insurers shall not be used.

69O FAC 150.012 | Jurisdictional Licensing and Status of Insurer

(1) An advertisement which is intended to be seen or heard beyond the limits of the jurisdiction in which the insurer is licensed shall not imply licensing beyond those limits.

(2) An advertisement shall not create the impression directly or indirectly that the insurer, its financial condition or status, or the payment of its claims, or the merits, desirability, or advisability of its policy forms or kinds of plans of insurance are approved, endorsed, or accredited by any division or agency of this State or the United States Government or if such relationship exists, such advertisement shall not exaggerate or otherwise be misleading with respect to the nature or extent of such relationship.

(3) An advertisement shall not imply in a misleading manner that approval, endorsement, or accreditation of policy forms or advertising has been granted by any division or agency of the state or federal government. "Approval" of either policy forms or advertising shall not be used by an insurer to imply or state that a governmental agency has endorsed or recommended the insurer, its policies, advertising or its financial conditions.

69O FAC 150.013 | Identity of Insurer

(1)
(a) The name of the actual insurer shall be stated in all of the insurer's advertisements.

(b) The form number or numbers of the policy advertised shall be stated in any invitation to contract.

(c) An advertisement shall not use a trade name, any insurance group designation, name of the parent company of the insurer, name of a particular division of the insurer, name of any reinsurere or any other party, service mark, slogan, symbol or other device which would be misleading as to the true identity of the insurer or create the false impression that the parent company or reinsurer or any other party would have any responsibility fo rthe finacial obligation of the insurer.
(2) No advertisement shall use any combination of words, symbols, or physical materials which by their content, phraseology, shape, color or other characteristics are so similar to combination of words, symbols, or physical materials used by agencies of the federal government or of this State, or otherwise appear to be of such a nature that it tends to confuse or mislead prospective insureds into believing that the solicitation is in some manner connected with an agency of the municipal, county, state, or federal government or if such relationship exists, such advertisement shall not exaggerate or otherwise be misleading with respect to the nature or extent of such relationship.

(3) Advertisements, envelopes, or stationery which utilize words, letters, initials, symbols, or other devices which are so similar to those used by governmental agencies or other insurers are not permitted if they may tend to mislead or confuse the public into believing:
(a) That the advertised coverages are somehow provided by or are endorsed by such governmental agencies or such other insurers; or

(b) That the advertiser is the same as, is connected with, or is endorsed by such governmental agencies or such other insurers.
(4) No advertisement shall use the name of a state or a political subdivision thereof in a policy name or description.

(5) No advertisement in the form of envelopes or stationery of any kind may use any name, service mark, slogan, symbol, or any device in such a manner that implies that the insurer or the policy advertised, or that any agent who may call upon the consumer as a result of the advertisement is connected with a governmental agency, such as the Social Security Administration.

(6) The use of letters, initials, or symbols of the corporate name or a trademark that would have the tendency or capacity to mislead or deceive the public as to the true identity of the insurer is prohibited unless the true, correct and complete name of the insurer is in close conjunction and in the same size type as the letters, initials, or symbols of the corporate name or trademark.

(7) The use of the name of an agency or other nomenclature in type, size and location so as to have the capacity and tendency to mislead or deceive as to the true identity of the insurer is prohibited.

(8) The use of an address so as to mislead or deceive as to the true identity of the insurer or any other entity or its location or licensing status is prohibited.

(9) No insurer may use, in the trade name of its insurance policy, any terminology or words so similar to the name of a governmental agency or governmental program as to have the tendency to confuse, deceive or mislead the prospective purchaser.

(10) All advertisements used by agents, producers, brokers or solicitors of an insurer must have prior written approval or prior oral approval with subsequent written confirmation of approval by the insurer.

(11) An agent who makes contact with a consumer, as a result of acquiring that consumer's name from a lead generating device or from a list of prospective consumers compiled therefrom, or from an entity or individual providing such services, must disclose such fact in the initial contact with the consumer.

69O FAC 150.014 | Group or Quasi-Group Implications

(1) An advertisement of a particular policy shall not state or imply that prospective insureds become group or quasi-group members covered under a group policy and as such enjoy special rates or underwriting privileges, unless such is the fact.

(2) No solicitation of a particular class, such as governmental employees, shall state or imply that the occupational status of group members entitles them to reduced rates on a group or other basis when, in fact, the policy being advertised is sold only on an individual basis at regular rates.

69O FAC 150.015 | Introductory, Initial, or Special Offers

(1) An advertisement of an individual policy shall not directly or by implication represent that a contract or combination of contracts is an introductory, initial, or special offer, or that applicants will receive substantial advantages not available at a later date, or that the offer is available only to a specified group of individuals, unless such is the fact. An advertisement shall not contain phrases describing an application period as "special," "limited," or similar words or phrases when the insurer uses such application periods as the usual method of advertising Health Insurance.

(2) An application period during which a particular insurance product may be purchased on an individual basis shall not be offered within this State unless there has been a lapse of not less than six months between the close of the immediately preceding application period for effectively the same product and the opening of the new application period. The advertisement shall indicate the date by which the applicant must mail the application which shall be not less than ten days and not more than forty days from the date that such application period is advertised for the first time. This rule applies to all advertising media, i.e., mail, newspapers, radio, television, magazines, and periodicals, by any one insurer. This prohibition shall not be applicable to solicitations of employees or members of a particular group or association which otherwise would be eligible under specific provisions of the Insurance Code for group, blanket, or franchise insurance. The phrase "any one insurer" includes all the affiliated companies of a group of insurance companies under common management or control.

(3) This rule does not require separation by six months of application periods for the same insurance product in this state if the advertising material is directed by an admitted insurer to persons by direct mail on the basis that a common relationship exists with more than one entity. Examples of such would be a bank and its depositors, a department store to its charge account customers, or an oil company to its credit card holders, and more than one of such organizations is sponsoring such insurance product at different times if providing such insurance under such a method is not otherwise prohibited by law. However, the 6-month rule does apply to one specific sponsor to the same persons in this State on the basis of their status as customers of that one specific entity only.

(4) This rule prohibits any statement or implication to the effect that only a specific number of policies will be sold, or that a time is fixed for the discontinuance of the sale of the particular policy advertised because of special advantages available in the policy, unless such is the fact.

(5) The phrase "a particular insurance product" in subsection (2) of this section, means an insurance policy which provides substantially different benefits than those contained in any other policy. Different terms of renewability, an increase or decrease in the dollar amounts of benefits, or an increase or decrease in any elimination period or waiting period from those available during an application period for another policy shall not be sufficient to constitute the product being offered as a different product eligible for concurrent or overlapping application periods.

(6) An advertisement shall not offer a policy which utilizes a reduced initial premium rate, nor shall an advertisement offer a policy waiving the initial premium.

(7) Meaningless awards, such as a "safe drivers' award" shall not be used in connection with advertisements of Health Insurance.

69O FAC 150.016 | Statements About an Insurer

(1) An advertisement shall not contain statements which are untrue in fact, or by implication misleading, with respect to the assets, corporate structure, financial standing, age or relative position of the insurer in the insurance business.

(2) An advertisement shall not contain a recommendation by any commercial rating system unless the advertisement clearly indicates the purpose of the recommendation and the limitations of the scope and extent of the recommendation.

(3) An advertisement shall not refer to a holding company or subsidiary of an insurer unless the advertisement fully discloses that the holding company or subsidary is a separate entity and not responsible for the insurer's financial condition or contractual obligations.

69O FAC 150.018 | Enforcement Procedures

(1) Each insurer shall maintain at its home or principal office a complete file containing:
(a) Every printed, published or prepared advertisement of its individual policies;

(b) Typical printed, published or prepared advertisements of its blanket, franchise and group policies hereafter disseminated in this; and,

(c) A notation attached to each advertisement indicating the manner and extent of distribution and the form number of any policy advertised.
(2) The file shall specifically include those advertisements submitted to the insurer by agents, broker, or others and approved by the insurer for use.

(3) The file shall be available for inspection by the Office.

(4) All advertisements shall be maintained in the file for a period of four years or until the filing of the next regular report or examination of the insurer, whichever is the longer period of time.

69O FAC 150.019 | Filing for Review

(1) An insurer shall file with the Office all long-term care insurance advertising material intended for use in this state at least thirty (30) days prior to use of the advertisement in this state as required by Section 627.9407(2), F.S.

(2) Only advertisements that are required by law to be filed will be routinely received and reviewed by the Office.

69O FAC 150.020 | Severability Provision

If any section or portion of a section of these rules, or any amendment thereto, or the applicability thereof to any person or circumstance is held invalid by a court, the remainder of the rules, or the applicability of such provision to other persons or circumstances shall not be affected thereby.

69O FAC 150.021 | Prior Rules

69O FAC 150.101 | Purpose

The purpose of these rules is to provide prospective purchasers with clear and unambiguous statements in the advertisement of Life Insurance and Annuity Contracts, and to assure the clear, truthful and adequate disclosure of the benefits, limitations and exclusions of policies sold as Life Insurance and Annuity Contracts. This purpose is intended to be accomplished by the establishment of guidelines and standards of permissible and impermissible conduct in the advertising of Life Insurance and Annuity Contracts to assure that product descriptions are presented in a manner which prevents unfair, deceptive and misleading advertising and is conducive to accurate presentation and description of Life Insurance and Annuity Contracts to the segment of the insurance buying public through the advertising media and material used by insurance agents and companies.

69O FAC 150.102 | Applicability

(1) These rules shall apply to any Life Insurance Policy and Annuity Contract "advertisement," disseminated in this State which the insurer knows or reasonably should know is intended for presentation, distribution or dissemination in this State, when such presentation, distribution or dissemination is made either directly by an insurer or indirectly on behalf of an insurer, by an agent, broker, producer or solicitor or any other person who has either actual or apparent authority to act on behalf of the insurer; provided the insurer shall not be responsible for advertisements that are published in violation of written procedures or guidelines of the insurer. Further, provided, that in variable contracts where disclosure requirements are established pursuant to Federal regulation, these rules shall be interpreted so as to minimize or eliminate conflict with such Federal Regulation wherever possible.

(2) Advertising materials which are reproduced in quantity shall be identified by form numbers or other identifying means. Such identification shall be sufficient to distinguish an advertisement from any other advertising materials, policies, applications or other materials used by the insurer.

69O FAC 150.103 | Definitions

For the purpose of these rules, the terms below are defined as follows:
(1) An "Advertisement" includes any method of communication listed in Sections 626.9541(1)(b)1. through 4., F.S.

(2) The definition of "Advertisement" does not include:
(a) Material to be used solely for the training and education of an insurer's employees, agents, or brokers;

(b) Material used exclusively in-house by insurers;

(c) Communications within an insurer's own organization not intended for dissemination to the public;

(d) Individual communications of a personal nature with current policyholders regarding existing coverage other than material urging such policyholders to renew, increase or expand coverages;

(e) Correspondence between a prospective group policyholder and an insurer in the course of negotiating a group contract;

(f) Court approved material ordered by a court to be disseminated to policyholders; or

(g) A general announcement from a group policyholder to eligible individuals on an employment or membership list which may include a brief description of coverage and is primarily a notification that a contract or program has been written or arranged; provided, the announcement must clearly indicate that it is preliminary to the issuance of a booklet, pamphlet, brochure or other similar paper preliminary to coverage by the insurer.
(3) "Application" means the form which must be filled in by the person seeking to effectuate an insurance policy.

(4) "Application Period" also includes any enrollment period.

(5) "Certificate" means any certificate issued under a group Life Insurance and Annuity Contract which certificate has been delivered or issued for delivery in this State.

(6) "Exception" means any provision in a policy whereby coverage for a specified hazard is entirely eliminated; it is a statement of a risk not assumed under the policy.

(7) "Institutional Advertisement" means an advertisement having as its sole purpose the promotion of the readers', viewers' or listeners' interest in the concept of Life Insurance and Annuity Contracts or the promotion of the insurer as a seller of Life Insurance and Annuity Contracts.

(8) "Insurer" includes any individual, corporation, association, partnership, reciprocal exchange, inter-insurer, Lloyds, fraternal benefit society, and any other legal entity which is defined as an "insurer" in the Insurance Code of this state.

(9) "Invitation to Contract" means an advertisement which is neither an institutional advertisement nor an invitation to inquire, and shall include any training or agent education materials when received by a prospective policyholder when such distribution was intended by the insurer for consumer use or distribution to the public regardless of any "agent use only" disclaimer language appearing on such materials.

(10)
(a) "Invitation to Inquire" means an advertisement that:
1. Has as its objective the creation of a desire to inquire further about life insurance and annuity contracts;

2. Is limited to a brief description of coverage that shall include only:
a. A brief description of the loss for which benefits are payable;

b. The dollar amount of benefits payable; and,

c. The period of time during which benefits are payable; and,
3. Contains a provision in the following or substantially similar form:
"This policy has (exclusions) (limitations) (reductions of benefits) (terms under which the policy may be continued in force or discontinued). For costs and complete details of the coverage call (or write) your insurance agent or the company."
(whichever is applicable)
(b) An invitation to inquire shall not:
1. Employ devices that are designed to create undue anxiety;

2. Exaggerate the value of the benefits available under the advertised policy;

3. State premium cost. If an advertisement which would otherwise be considered an invitation to inquire does state a cost, it shall be considered an invitation to contract pursuant to this rule chapter; or

4. Otherwise violate these rules or the Insurance Code.
(11) "Life insurance policy and annuity contract" includes any policy, plan, certificate, contract, agreement, statement of coverage, rider or endorsement which provides for life insurance or annuity contract benefits, or a combination thereof.

(12) "Limitation" means any provision which restricts coverage under the policy other than an exception or a reduction.

(13) "Person" means any natural person, association, organization, partnership, trust, group, discretionary group, corporation or any other entity.

(14) "Reduction" means any provision which reduces the amount of the benefit; this term includes a situation where a risk of loss is assumed, but payment upon the occurrence of such loss is limited to some amount or period less than would be otherwise payable had such reduction not been used.

69O FAC 150.104 | Method of Disclosure of Required Information

All information required to be disclosed by these rules shall be set out conspicuously, in the same size type as that used in the body of the advertisement, and in close conjunction with the statements to which such information relates, or under appropriate captions of such prominence that it shall not be minimized, rendered obscure or presented in an ambiguous fashion, or intermingled with the context of the advertisement so as to be confusing or misleading.

69O FAC 150.105 | Form and Content of Advertisements

(1) The form and content of a Life Insurance and Annuity Contracts advertisement shall be sufficiently complete and clear to avoid deception or the capacity or tendency to mislead or deceive. Whether an advertisement has a capacity or tendency to mislead or deceive shall be determined by the Director from the overall impression that the advertisement may be reasonably expected to create upon a person of average education or intelligence, within the segment of the public to which it is directed.

(2) Advertisements shall be truthful and not misleading in fact or in implication. Words or phrases, whose meanings are clear only by implication or by the consumer's familiarity with insurance terminology, shall not be used.

(3)
(a) An insurer shall clearly identify its life insurance and annuity contract as an insurance policy or annuity contract in its advertisements.

(b) The trade name of any policy shall be followed by or include the words "Insurance Policy" or "Annuity" or similar words clearly identifying the fact that an insurance policy or annuity is being offered through the use of the full generic name of the product, such as but not limited to whole life insurance policy, variable life insurance policy, flexible premium life insurance policy, level term life insurance, reducing term life insurance, single premium deferred annuity, immediate annuity.
(4) No insurer, agent, broker, producer, solicitor or other person shall solicit a resident of this state for the purchase of Life Insurance and Annuity Contracts in connection with or as the result of the use of any advertisement which:
(a) Contains any misleading representations, misrepresentations, or is otherwise untrue, deceptive or misleading with regard to the information imparted, the status, character or representative capacity of such person or the true purpose of the advertisement; or

(b) Otherwise violates the provisions of these rules; or

(c) Otherwise violates the provisions of the Florida Insurance Code.
(5) No insurer, agent, broker, producer, solicitor or other person shall solicit residents of this State for the purchase of Life Insurance and Annuity Contracts through the use of a true or fictitious name which is deceptive or misleading with regard to the status, character, or proprietary or representative capacity of such person or the true purpose of the advertisement.

(6) No insurer, agent, broker, producer, solicitor or other person shall effectuate insurance coverage prior to a full explanation of the coverage offered and completion of an application form.

69O FAC 150.106 | Disclosure Requirements for Indeterminated Value Life and Annuity Contract Advertisements

In addition to the requirements of Rules 69O-150.104 and 69O-150.105, F.A.C., advertisements of indeterminate value life and annuity contracts as defined in Section 627.8015(1), F.S., shall be subject to the following requirements:
(1) Advertisements containing a rate to be earned, including interest rates, rates of return, or any other designation of earnings performance, are prohibited unless all limitations and conditions which affect the rate of return ultimately realized by the policyholder/certificateholder or annuitant are disclosed prominently with equal emphasis to describe the interest rate or rate of return. The disclosure shall include:
(a) Premium expense charges, if any;

(b) Administrative charges, if any;

(c) The full surrender charge, year by year; and,

(d) Any policy fees;

(e) Free withdrawal provisions or bail-outs, if any;

(f) Market value adjustment, if any;

(g) Participation rates, if any;

(h) Any other provisions which affect the rate of return ultimately realized by the policyholder/certificateholder or annuitant, and how the return is affected;

(i) Guaranteed minimum interest rate during the accumulation period, if any;

(j) Guaranteed minimum interest rate during the annuitization period, if any.
(2) Advertisements of indeterminate life policies and annuities which have multiple fund crediting rates established by the insurer shall also disclose that if an interest rate is disclosed fo rany fund in the contract, the interest rate for any other funds shall be disclosued with equal emphasis.

(3) An advertisement shall not refer to an annuity as a CD annuity.

(4) All variable life and annuity advertisements shall clearly disclose whether the insured may realize positive or negative returns on the principal, including a potential loss of the original principal contribution.

(5) Any depiction comparing the returns possible under a specific contract to alternative financial vehicles, whether charts, graphs, or other methods, must compare the information in a comparable fashion. As an example, if comparing to an annually taxable investment, the indeterminate value life and annuity comparison shall also reflect the impact of all contract charges and illustrate the after-tax surrender value for all time points illustrated for the annually taxable investment. This does not prohibit the use of generic comparisons of a tax deferred return to a non-tax deferred account if used in an institutional advertisement.

(6) For annuities with a rate declared by the insurer to be applied to any or all of an account value held within the contract, the term "yield" shall only be used to reflect the net ultimate return to the policyholder/certificateholder or annuitant after all contract charges and deductions have been made. The term shall not be used to reflect the gross credited rate of interest to a fund.

(7)
(a) Illustrations of policy or contract values shall clearly indicate whether the values are at the end of the year or the beginning of the year shown.

(b) All ages shown shall be for the same time point as the associated values.

(c) Policy or contract values may be indicated only if guaranteed values are also shown.

(d) The guaranteed values illustrated may only be those values explicitly guaranteed in the contract.

69O FAC 150.107 | Advertisements of Proceeds Payable, Premiums Payable, or Limited, Graded, or Modified Features

(1) Deceptive Words, Phrases, or Illustrations Prohibited.
(a) No advertisement shall omit information or use words, phrases, statements, references or illustrations if such omission or such use has the capacity, tendency or effect of misleading or deceiving purchasers or prospective purchasers as to the nature or extent of any policy or contract benefit payable, loss covered or premium payable. The fact that the policy or contract offered is made available to a prospective insured for inspection prior to consummation of the sale or an offer is made to refund the premium if the purchaser is not satisfied, does not remedy misleading statements.

(b) Invitations to contract must clearly reflect the insurer, the agent, the policy form number(s), the type plan, premium payable, payment period, and if applicable, changes in face amounts and premiums.

(c) A simultaneous disclosure of the plan of insurance being offered shall be made in close proximity to the advertised face and premium amounts.

(d) An advertisement of life insurance sold by direct response shall not contain the phrase "no salesman will call," or "no agent will call," or "by eliminating the agent and/or commission we can offer this low cost plan," or similar wording in a misleading manner.

(e) Full benefit policies or contracts may use the term "non-medical" or "no medical examination required" or similar terms where issue is not guaranteed, but this statement shall be accompanied by a further disclosure that health questions are required and that issuance of the policy or contract may depend upon evidence of insurability.

(f) A full explanation must be made of the use of units in which a common premium is specified and varying face amounts according to age are described.

(g) An advertisement which is an invitation to contract shall disclose those limitations affecting the basic provisions of the policy.

(h) An advertisement which also is an invitation to join an association, trust, or discretionary group must solicit insurance coverage on a separate and distinct application which requires separate signatures for each application. The insurance program must be presented so as not to mislead or deceive the prospective members regarding the fact that they are purchasing insurance as well as applying for membership, if that is the case. Any applicable membership fees or dues shall be disclosed on each such application and shall appear separately so as not to be construed as part of the premium for insurance coverage.

(i) An advertisement shall not refer to premium solely as a "deposit."

(j) An advertisement containing an interest rate to be earned, rate of return to be earned, or yield to be earned, is prohibited unless all limitations and conditions which affect the ultimate rate of return earned by the policyholder/insured/beneficiary are disclosed prominently and conspicuously with equal emphasis to describe the interest rate, rate of return or yield.
(2) Limited, Graded or Modified Features.
(a) An advertisement for a policy or contract containing graded, modified or other limiting benefits shall fairly and accurately describe such negative features.

(b) If an insurer fails to require evidence of insurability as a condition for issuance of a policy or contract with graded, modified, or other limiting benefits an advertisement of such policy or contract shall not state or imply that the applicant's physical condition or medical history will not affect the issuance of the policy or contract or payment of a claim thereunder. This rule prohibits the use of the phrases, "no medical examination required," "no health questions asked," and phrases of a similar import in a misleading manner, but does not prohibit explaining "guarantee issue" as long as it is done contiguous to and in a manner as prominent as the term being defined.

69O FAC 150.108 | Necessity for Disclosing Policy Provisions Relating to Renewability, Cancellability, and Termination

An advertisement which is an invitation to contract shall disclose the provisions relating to renewability, cancellability, and termination and any modification of benefits, losses covered or premiums because of age or for other reasons, in a manner which shall not minimize or render obscure the qualifying conditions.

69O FAC 150.109 | Use of Dividends

(1) An advertisement shall not be used that utilizes or describes dividends in a manner which is misleading or has a tendency to mislead.

(2) An advertisement shall not directly or indirectly state or imply that the amount of dividends or divisible surplus is guaranteed; nor shall such advertisement state or imply that a policyholder will profit by the growth of the company.

(3) Any comparison between participating and non-participating policies or contracts must be true and accurate.

69O FAC 150.110 | Testimonials or Endorsements by Third Parties

(1) Testimonials and endorsements used in advertisements must be genuine, represent the current opinion of the author, be applicable to the policy advertised and be accurately reproduced. The insurer, in using a testimonial or endorsement, makes as its own all of the statements contained therein, and the advertisement, including such statements, is subject to all the provisions of these rules. When a testimonial or endorsement is used more than one year after it was originally given, a confirmation must be obtained.

(2) A person shall be deemed a "spokesperson" if the person making a testimonial, or endorsement:
(a) Has a financial interest in the insurer or a related entity as a stockholder, director, officer, employee, or otherwise; or

(b) Is an entity formed by the insurer, is owned or controlled by the insurer, its employees, or the person or persons who own or control the insurer; or

(c) Is in a policy-making position who is affiliated with the insurer in any of the above described capacities; or

(d) Is in any way directly or indirectly compensated for making a testimonial or endorsement.
(3) Any person acting as a spokesperson, as defined in the preceding paragraph, who performs any of the following acts in an advertisement shall be considered soliciting an insurance product, and such person shall be a licensed insurance agent pursuant to the Florida Insurance Code:
(a) Solicits insurance or procures applications; or

(b) Engages or holds himself out as engaging in the business of analyzing or abstracting insurance policies; or

(c) Engages in counseling, advising, or giving opinions to persons relative to insurance contracts; or

(d) Performs an invitation to contract, except where performed by a company officer in a manner which does not violate Section 626.112(4), F.S.
(4) The fact of a financial interest or the proprietary or representative capacity of a spokesperson shall be disclosed in an advertisement and shall be accomplished in the introductory portion of the testimonial or endorsement in the same form and with equal prominence thereto. If a spokesperson is directly or indirectly compensated for making a testimonial, endorsement or appraisal, such fact shall be disclosed by use of the phrase "Paid Endorsement" or words of similar import in a type style and size that is at least equal to that used for the spokesperson's name or the body of the testimonial or endorsement, whichever is larger. In the case of television or radio advertising, the required disclosure must be accomplished in the introductory portion of the advertisement and must be given prominence, and if printed must be presented in a type style and size that is at least equal to the largest type otherwise used in the advertisement. The use of the phrase "Paid Endorsement" is not required where the spokesperson is a company officer who is paid generally but not specifically for making the advertisement.

(5) The disclosure requirements of this rule shall not apply where the sole financial interest or compensation of a spokesperson, for all testimonials or endorsements made on behalf of the insurer, consists of the payment of union "scale" wages required by union rules, and if the payment is actually for such "scale" for TV or radio performances.

(6) An advertisement shall not state or imply that an insurer or a policy or contract has been approved or endorsed by any individual, group of individuals, society, association, organization, governmental agency or other entity, unless such is the fact, and unless any proprietary relationship between an organization and the insurer is disclosed. If the entity making the endorsement or testimonial has been formed by the insurer or is owned or controlled by the insurer, or the person or persons who own or control the insurer, such fact shall be disclosed in the advertisement. If the insurer or an officer of the insurer formed or controls the association, or holds any policy-making position in the association, that fact must be disclosed.

(7) When a testimonial refers to benefits received under a policy for a specific claim, the claim data, including claim number, date of loss, and other pertinent information shall be retained by the insurer for inspection for a period of four years or until the filing of the next regular report of examination of the insurer, whichever is the longer period of time. The use of testimonials which do not correctly reflect the present practices of the insurer or which are not applicable to the policy or benefits being advertised is not permissible.

(8) The provisions of subsections (2), (3) and (4) of this section, shall not apply to a written endorsement which does not describe specific benefits, coverages or premiums and which is made by an association of individuals which:
(a) Has been in existence for more than one year prior to making the written endorsement; and,

(b) Is formed for purposes other than soliciting insurance; and,

(c) Has a valid and bona fide governing constitution and by-laws; and,

(d) Has as its principal purpose some goal or objective other than providing or soliciting insurance, as determined by the Insurance Commissioner in accordance with the procedures and requirements of Chapter 120, F.S., the Administrative Procedure Act.

69O FAC 150.111 | Use of Statistics

(1) An advertisement relating to the dollar amounts of claims paid, the number of persons insured, total amount of insurance in force, relative standing, or similar statistical information relating to any insurer or policy or contract shall not use irrelevant facts, and shall not be used unless it accurately reflects all of the relevant facts. Such an advertisement shall not imply that such statistics are derived from the policy or contract advertised unless such is the fact, and when applicable to other policies or contracts or plans shall specifically so state.
(a) An advertisement shall specifically identify the policy to which statistics relate and, where statistics are given which are applicable to a different policy, it must be stated clearly that the data do not relate to the policy being advertised.

(b) An advertisement shall not contain statements which are untrue in fact, or by implication misleading with respect to the assets, corporate structure, financial standing, age or relative position of the insurer in the insurance business.
(2) An advertisement shall not represent or imply that claim settlements by the insurer are "liberal" or "generous", or use words of similar import, or state or imply that claim settlements are or will be beyond the actual terms of the contract. An unusual amount paid for a unique claim for the policy advertised is misleading and shall not be used.

(3) The source of any statistics used in an advertisement shall be identified in such advertisement.

69O FAC 150.112 | Disparaging Comparisons and Statements

(1) An advertisement shall not directly or indirectly make unfair or incomplete comparisons of policies or contracts or benefits or comparisons of non-comparable policies or contracts of other insurers, and shall not disparage competitors, their policies or contracts, services or business methods, and shall not disparage or unfairly minimize competing methods of marketing insurance.

(2) An advertisement should not contain statements such as "no red tape" or "here is all you do to receive benefits."

(3) Advertisements which state or imply that competing insurance coverages customarily contain certain exceptions, reductions or limitations not contained in the advertised policies are unacceptable unless such exceptions, reductions or limitations are contained in a substantial majority of such competing coverage.

(4) Advertisements which state or imply in a misleading or incomplete manner that an insurer's premiums are lower or that its loss ratios are higher because its organizational structure differs from that of competing insurers shall not be used.

69O FAC 150.113 | Jurisdictional Licensing and Status of Insurer

(1) An advertisement which is intended to be seen or heard beyond the limits of the jurisdiction in which the insurer is licensed shall not imply licensing beyond those limits.

(2) An advertisement shall not create the impression directly or indirectly that the insurer, its financial condition or status, or the payment of its claims, or the merits, desirability, or advisability of its policy or contract forms or kinds of plans of insurance are approved, endorsed, or accredited by any division or agency of this State or the United States Government or if such relationship exists, such advertisement shall not exaggerate or otherwise be misleading with respect to the nature or extent of such relationship. This shall not include those cases where permission is necessary to transact insurance within military installations.

(3) An advertisement shall not imply in a misleading manner that approval, endorsement, or accreditation of policy forms or advertising has been granted by any division or agency of the state or federal government. "Approval" of either policy forms or advertising shall not be used by an insurer to imply or state that a governmental agency has endorsed or recommended the insurer, its policies, advertising or its financial conditions.

69O FAC 150.114 | Identity of Insurer

(1)
(a) The name of the actual insurer shall be stated in all of the insurer's advertisements.

(b) The form number or numbers of the policy advertised shall be stated in any invitation to contract.

(c) An advertisement shall not use a trade name, any insurance group designation, name of the parent company of the insurer, name of a particular division of the insurer, name of any reinsurer or any other party, service mark, slogan, symbol or other device which would be misleading as to the true identity of the actual insurer or create the false impression that the parent company or reinsurer or any other party would have any responsibility for the financial obligation of the insurer.
(2) No advertisement shall use any combination of words, symbols, or physical materials which by their content, phraseology, shape, color or other characteristics, are so similar to combination of words, symbols, or physical materials used by agencies of the federal government or of this State, or otherwise appear to be of such a nature that it tends to confuse or mislead prospective insureds into believing that the solicitation is in some manner connected with an agency of the municipal, county, state, or federal government, or if such relationship exists, such advertisement shall not exaggerate or otherwise mislead with respect to the nature or extent of such relationship.

(3) Advertisements, envelopes, or stationery which utilize words, letters, initials, symbols, or other devices which are so similar to those used by governmental agencies or other insurers are not permitted if they may tend to mislead or confuse the public into believing:
(a) That the advertised coverages are somehow provided by or are endorsed by such governmental agencies or such other insurers; or

(b) That the advertiser is the same as, is connected with, or is endorsed by such governmental agencies or such other insurers.
(4) No advertisement shall use the name of a state or a political subdivision thereof in a policy name or description.

(5) No advertisement in the form of envelopes or stationery of any kind may use any name, service mark, slogan, symbol, or any device in such a manner that implies that the insurer or the policy advertised, or that any agent who may call upon the consumer as a result of the advertisement is connected with a governmental agency.

(6) The use of letters, initials, or symbols of the corporate name or a trademark that would have the tendency or capacity to mislead or deceive the public as to the true identity of the insurer is prohibited unless the true, correct and complete name of the insurer is in close conjunction and in the same size type as the letters, initials, or symbols of the corporate name or trademark.

(7) The use of the name of an agency or other nomenclature in type, size and location so as to have the capacity and tendency to mislead or deceive as to the true identity of the insurer is prohibited.

(8) The use of an address so as to mislead or deceive as to the true identity of the insurer or any other entity or its location or licensing status is prohibited.

(9) No insurer may use, in the trade name of its insurance policy, any terminology or words so similar to the name of a governmental agency or governmental program as to have the tendency to confuse, deceive or mislead the prospective purchaser.

(10) All advertisements used by agents, producers, brokers or solicitors of an insurer must have prior written approval or prior oral approval with subsequent written confirmation of approval by the insurer.

69O FAC 150.115 | Group or Quasi-Group Implications

(1) An advertisement of a particular policy or contract shall not state or imply that prospective insureds become group or quasi-group members covered under a group policy or contract and as such enjoy special rates or underwriting privileges, unless such is the fact. The term "enrollment" shall not be used except in connection with the offer of group insurance.

(2) No solicitation of a particular class, such as governmental employees, which state or imply that their occupational status of group members entitles them to reduced rates on a group or other basis when, in fact, the policy being advertised is sold only on an individual basis at regular rates.

69O FAC 150.116 | Introductory, Initial, or Special Offers

(1) An advertisement of an individual policy shall not directly or by implication represent that a contract or combination of contracts is an introductory, initial, or special offer, or that applicants will receive substantial advantages not available at a later date, or that the offer is available only to a specified group or individuals, unless such is the fact. An advertisement shall not contain phrases describing an application period as "special," "limited," or similar words or phrases when the insurer uses such application or periods as the usual method of advertising Life Insurance and Annuity Contracts.

(2) An application period during which a particular insurance product may be purchased on an individual basis shall not be offered within this State unless there has been a lapse of not less than six months between the close of the immediately preceding application period for the same product and the opening of the new application period. The advertisement shall indicate the date by which the applicant must mail the application, which shall be not less than ten days and not more than forty days from the date that such application period is advertised for the first time. This rule applies to all advertising media, i.e., mail, newspapers, radio, television, magazines, and periodicals, by any one insurer. This prohibition shall not be applicable to solicitations of employees or members of a particular group or association which otherwise would be eligible under specific provisions of the insurance code for group insurance. The phrase "any one insurer" includes all the affiliated companies of a group of insurance companies under common management or control.

(3) This rule does not require separation by 6 months of application periods for the same insurance product in this State if the advertising material is directed by an admitted insurer to persons by direct mail on the basis that a common relationship exists with more than one entity. Examples of such would be a bank and its depositors, a department store to its charge account customers, or an oil company to its credit card holders, and more than one of such organizations is sponsoring such insurance product at different times if providing such insurance under such a method is not otherwise prohibited by law. However, the 6-month rule does apply to one specific sponsor to the same persons in this State on the basis of their status as customers of that one specific entity only.

(4) This rule prohibits any statement or implication to the effect that only a specific number of policies will be sold, or that a time is fixed for the discontinuance of the sale of the particular policy advertised because of special advantages available in the policy, unless such is the fact.

(5) The phrase "a particular insurance product" in subsection (2) of this section, means an insurance policy which provides substantially different benefits than those contained in any other policy. Different terms of renewability, an increase or decrease in the dollar amounts of benefits, or an increase or decrease in any elimination period or waiting period from those available during an application period for another policy shall not be sufficient to constitute the product being offered as a different product eligible for concurrent or overlapping application periods.

(6) Except for modified and step rated policies or contracts, an advertisement shall not offer a policy or contract which utilizes a reduced initial premium rate.

(7) Meaningless awards, such as a "safe drivers award" shall not be used in connection with advertisements of Life Insurance and Annuity Contracts.

69O FAC 150.117 | Statements about an Insurer

(1) An advertisement shall not contain statements which are untrue in fact, or by implication misleading, with respect to the assets, corporate structure, financial standing, age or relative position of the insurer in the insurance business.

(2) An advertisement shall not contain a recommendation by any commercial rating system unless the advertisement clearly indicates the purpose of the recommendation and the limitations of the scope and extent of the recommendation.

(3) An advertisement shall not refer to a holding company or subsidiary of an insurer unless the advertisement fully discloses that the holding company or subsidiary is a separate entity and not responsible for the insurer's financial condition or contractual obligations.

69O FAC 150.119 | Enforcement Procedures

(1) Each insurer shall maintain at its home or principal office a complete file containing:
(a) Every printed, published or prepared advertisement of its individual policies;

(b) Typical printed, published or prepared advertisement of its blanket, franchise, and group policies hereafter disseminated in this state; and,

(c) A notation attached to such advertisement indicatng the manner and extent of distribution and the form number of any policy advertised.
(2) The file shall specifically include those advertisements submitted by and approved for use by agents, brokers or others.

(3) The file shall be available for inspection by the Office.

(4) All advertisements shall be maintained in the file for a period of four years or until the filing of the next regular report or examination of the insurer, whichever is the longer period of time.

69O FAC 150.120 | Filing for Review

69O FAC 150.121 | Severability Provision

If any section or portion of a section of these rules, or any amendment thereto, or the applicability thereof to any person or circumstance is held invalid by a court, the remainder of the rules, or the applicability of such provision to other persons or circumstances, shall not be affected thereby.

69O FAC 150.122 | Prior Rules

69O FAC 150.201 | Purpose

(1) The purpose of these rules is to provide small employers with clear and unambiguous statements in the marketing of health benefit plans issued pursuant to the Employee Health Care Access Act, as set forth in Section 627.6699, F.S., and to assure the clear, truthful, and adequate disclosure of the benefits, limitations, and exclusions of policies or contracts sold as health benefit plans.

(2) This purpose is intended to be accomplished by the establishment of guidelines and standards of conduct in the marketing of health benefit plans to ensure that product descriptions are presented in a manner that prevents unfair, deceptive, and misleading marketing and is conducive to the accurate presentation and description of health benefit plans to small employers.

69O FAC 150.202 | Applicability

(1) These rules shall apply to any health benefit plan marketing communication in this state that a small employer carrier knows or reasonably should know is intended for presentation, distribution, or dissemination in this state either directly by a small employer carrier or indirectly on behalf of a small employer carrier by an agent, broker, producer, solicitor, or any other person who has either actual or apparent authority to act on behalf of the small employer carrier. The small employer carrier shall be responsible for marketing communications that are published in violation of written procedures or guidelines of the small employer carrier.

(2) Marketing materials that are reproduced in quantity shall be identified by form numbers or other identifying means that shall be sufficient to distinguish a marketing communication from any other marketing material, policy, application, or other material used by the small employer carrier.

69O FAC 150.203 | Definitions

For purposes of these rules, the terms below are defined as follows:
(1) "Application" means the form that must be filled in by the person seeking to effectuate a health benefit plan.

(2) "Application Period" includes any enrollment period.

(3)
(a) "Carrier" means a person that provides a health benefit plan in this state, including any authorized carrier, health maintenance organization, multiple-employer welfare arrangement, or any other person providing a health benefit plan that is subject to insurance regulation in this state and as set forth in Section 627.6699, F.S.

(b) "Carrier" does not include a multiple-employer welfare arrangement established by an association of members of the same profession that:
1. Operates solely for the benefit of the members or the members and employees of the members;

2. Was in existence on January 1, 1992; and,

3. Provides coverage upon the member's request for any member of the association with eleven (11) or more employees, or any eleven (11) members and dependents of members.
(4) "Certificate" means any certificate that has been delivered or issued for delivery in this state and issued under a health benefit plan.

(5) "Exclusion" means any provision in a plan or policy that entirely eliminates coverage for a specified hazard; it is a statement of a risk not assumed under the plan or policy.

(6) "Health Benefit Plan" or "Plan" includes any policy, plan, certificate, contract, agreement, statement of coverage, rider, or endorsement that provides basic, standard, or limited benefit coverage to a small employer as described in Section 627.6699(3)(r), F.S.

(7) "Institutional Marketing Communication" means a marketing communication having as its sole purpose the promotion of the readers', viewers', or listeners' interest in the concept of health benefit plans or the promotion of the small employer carrier as a seller of health benefit plans.

(8) "Invitation to Contract" means a marketing communication that is neither an institutional marketing communication, a lead generating device nor an invitation to inquire.

(9)
(a) "Invitation to Inquire" means a marketing communication that:
1. Has as its objective the creation of a desire to inquire further about a health benefit plan;

2. Is limited to a brief description of coverage that shall include only:
a. A brief description of the loss for which benefits are payable;

b. The dollar amount of benefits payable; and,

c. The period of time during which benefits are payable.
3. Contains a provision in the following or substantially similar form: "This plan has (exclusions) (limitations) (terms under which the plan may be continued in force or discontinued). For costs and complete details of the coverage call (or write) your insurance agent or company (carrier)." (whichever is applicable)
(b) An invitation to inquire shall not:
1. Employ devices that are designed to create undue anxiety;

2. Exaggerate the value of the benefits available under the marketed health benefit plan;

3. State premium cost. If an advertisement which would otherwise be considered an invitation to inquire does state a cost, it shall be considered and invitation to contact pursuant to this rule chapter; or

4. Otherwise violate these rules or the Insurance Code.
(10) "Limitation" means any provision, other than an exclusion, that restricts coverage under a health benefit plan.

(11) "Marketing Communication" includes any method of communication listed in Sections 626.9541(1)(b)1. through 4., F.S.

(12) "Small Employer Carrier" means a carrier that offers health benefit plans covering eligible employees of one or more small employers.

69O FAC 150.204 | Method of Disclosure of Required Information

All information required to be disclosed by these rules shall be set out conspicuously and in close conjunction with the statements to which the information relates or under appropriate captions of such prominence that the information shall not be minimized, rendered obscure, or presented in an ambiguous fashion or intermingled with the context of the marketing communication so as to be confusing or misleading.

69O FAC 150.205 | Form and Content of Marketing Communications

(1) The form and content of a health benefit plan marketing communication shall be sufficiently complete and clear to avoid deception or the capacity or tendency to mislead or deceive, as determined by the Office from the overall impression that the marketing communication may be reasonably expected to create upon a person of average education or intelligence within the segment of the public to which it is directed.

(2) Marketing communications shall be truthful and not misleading in fact or in implication. Words and phrases with meanings that are clear only by implication or by the small employer, employee, or other consumer's familiarity with insurance terminology shall not be used.

(3)
(a) A small employer carrier shall clearly identify the small employer carrier's health benefit plan as a health benefit plan in its plan marketing communications.

(b) The trade name on any health benefit plan shall be followed by the words "Health Benefit Plan" or similar words clearly identifying the fact that a health benefit plan is being offered.
(4) A small employer carrier, agent, broker, producer, solicitor, or other person shall not solicit a resident of this state for the purchase of a health benefit plan in connection with or as the result of the use of any marketing communication that contains any misleading representation or misrepresentation or is otherwise untrue, deceptive, or misleading with regard to the information imparted, the status, character, or representative capacity of the person, or the true purpose of the marketing communication, or otherwise violates the provisions of these rules or of the Florida Insurance Code.

(5) A small employer carrier, agent, broker, producer, solicitor, or other person shall not solicit residents of this state for the purchase of a health benefit plan through the use of a true or fictitious name that is deceptive or misleading with regard to the status, character, or proprietary or representative capacity of the person, or the true purpose of the marketing communication.

(6) A small employer carrier, agent, broker, producer, solicitor, or other person shall not effectuate plan coverage prior to a full explanation of the coverage offered and completion of an application form.

69O FAC 150.206 | Marketing Communications of Benefits Payable, Losses Covered, and Premiums Payable

(1) Deceptive Words, Phrases, or Illustrations Prohibited.
(a) A marketing communication shall not omit information or use words, phrases, statements, references, or illustrations that have the capacity, tendency, or effect of misleading or deceiving purchasers or prospective purchasers as to the nature or extent of any health benefit payable, loss covered, or premium payable. The fact that the plan offered is made available to the prospective plan purchaser for inspection prior to consummation of the sale, or that an offer is made to refund the premium if the purchaser is not satisfied, does not remedy misleading statements.

(b) A marketing communication shall not contain or use words or phrases such as "all," "full," "complete," "comprehensive," "unlimited," "up to," "high as," "this plan will help pay your hospital and surgical bills," "this plan will help fill some of the gaps that your present insurance leaves out," or similar words and phrases, in a manner that exaggerates any benefits beyond the terms of the plan.

(c) A marketing communication shall not contain descriptions of a plan limitation or exclusion worded in a positive manner to imply that it is a benefit, such as, "even pre-existing conditions are covered after a limited period of time." Words and phrases used in a marketing communication to describe plan limitations and exclusions shall fairly and accurately describe the negative features of the limitations and exclusions of the plan offered.

(d) A marketing communication of a benefit for which payment is conditional upon confinement in a hospital or similar facility shall not use words or phrases such as "tax free," "extra cash," "extra income," "extra pay," or substantially similar words or phrases in a manner that would have the capacity, tendency, or effect of misleading the public into believing that the plan marketed will in some way enable them to make a profit from being hospitalized or disabled.

(e) When the plan marketed contains a limit on the number of days of coverage provided, the limit must appear in the marketing communication.

(f) A marketing communication of a plan covering only one disease or a list of specified diseases shall not imply coverage beyond the terms of the plan. Synonymous terms shall not be used to refer to any disease in order to imply broader coverage than is the fact.

(g) A marketing communication of a health benefit plan sold by direct response shall not use in a misleading manner the phrases, "no salesman will call," "no agent will call," "by eliminating the agent and/or commission, we can offer this low cost plan" or similar wording.
(2) Exclusions and Limitations.
(a) A marketing communication that is an invitation to contract shall disclose those exclusions and limitations that affect the benefit provisions of the plan.

(b) A marketing communication shall not use the words "only," "just," "merely," "minimum," or similar words or phrases to describe the applicability of any exclusions, reductions, or limitations, such as, "This plan is subject to the following minimum exclusions and reductions."
(3) Pre-Existing Conditions.
(a) A marketing communication that is an invitation to contract for health benefits shall, in negative terms, disclose the extent to which any loss is not covered if the cause of the loss is traceable to a condition existing prior to the effective date of the plan. The term "pre-existing condition" without an appropriate definition or description shall not be used.

(b) When coverage is in any way limited for pre-existing conditions, any application attached to the marketing communication shall contain immediately preceding the blank space for the applicant's signature a statement of the pre-existing condition provisions of the plan.

69O FAC 150.207 | Disclosure of Plan Provisions Relating to Renewability, Cancellability, and Termination

A marketing communication that is an invitation to contract shall disclose, in a manner that shall not minimize or render obscure the qualifying conditions, the provisions relating to renewability, cancellability, and termination and any modification of benefits, losses covered, or premiums because of age or for other reasons.

69O FAC 150.208 | Testimonials or Endorsements by Third Parties

(1)
(a) Testimonials and endorsements used in marketing communications must:
1. Be genuine;

2. Represent the current opinion of the author;

3. Be applicable to the health benefit plan marketed; and,

4. Be accurately reproduced.
(b) The small employer carrier in using a testimonial or endorsement makes as its own all the statements contained therein, and the marketing communication, including the statement, is subject to these rules.

(c) When a testimonial or endorsement is used more than one year after it was originally given, a confirmation must be obtained.
(2) A person shall be deemed a "spokesperson" if the person making the testimonial or endorsement:
(a) Has a financial interest in the small employer carrier or a related entity as a stockholder, director, officer, employee, or otherwise;

(b) Is an entity formed by the small employer carrier, is owned or controlled by the small employer carrier, its employees, or the person or persons who own or control the small employer carrier;

(c) Is in a policy-making position that is affiliated with the small employer carrier in any of the above described capacities; or

(d) Is in any way directly or indirectly compensated for making a testimonial or endorsement.
(3) Any person acting as a spokesperson as defined in the preceding paragraph who performs any of the following acts in a marketing communication shall be considered to be soliciting a health benefit plan, and shall be a licensed insurance agent pursuant to the Florida Insurance Code:
(a) Solicits insurance or procures applications;

(b) Engages or holds himself out as engaging in the business of analyzing or abstracting insurance policies or plans;

(c) Engages in counseling, advising, or giving opinions to persons relative to insurance contracts or plans; or

(d) Performs an invitation to contract, except where performed by a company officer in a manner that does not violate section 626.112(4), F.S.
(4)
(a) The financial interest or proprietary or representative capacity of a spokesperson shall be disclosed in a marketing communication in the introductory portion of the testimonial or endorsement in the same form and with equal prominence.

(b) If a spokesperson is directly or indirectly compensated for making a testimonial, endorsement or appraisal, that fact shall be disclosed by use of the phrase "paid endorsement" or words of similar import in a type style and size that is at least equal to that used for the spokesperson's name or the body of the testimonial or endorsement, whichever is larger.

(c) In the case of television or radio marketing, the required disclosure shall be in the introductory portion of the marketing communication and must be given prominence. If printed, the disclosure must be presented in a type style and size that is at least equal to the largest type otherwise used in the marketing communication.

(d) The use of the phrase "paid endorsement" is not required where the spokesperson is a company officer who is paid generally, but not specifically for making the marketing communication.
(5) The disclosure requirements of this rule shall not apply where the sole financial interest or compensation of a spokesperson for all testimonials or endorsements made on behalf of the small employer carrier consists of the payment of union scale wages required by union rules, and if the payment is actually for scale for TV or radio performances.

(6) A marketing communication shall not state or imply that a small employer carrier, plan or policy has been approved or endorsed by any individual, group of individuals, society, association, or other organization, governmental agency or other entity, unless that is the fact, and unless any proprietary relationship between an organization and the small employer carrier is disclosed. If the entity making the endorsement or testimonial has been formed by the small employer carrier, or is owned or controlled by the small employer carrier or the person or persons who own or control the small employer carrier, that fact shall be disclosed in the marketing communication.

(7)
(a) When a testimonial refers to benefits received under a health benefit plan for a specific claim, the specific claim data, including claim number, date of loss, and other pertinent information shall be retained by the small employer carrier for inspection for a period of four years or until the filing of the next regular report on examination of the small employer carrier, whichever is the longer period of time.

(b) Testimonials that do not correctly reflect the present practices of the small employer carrier or are not applicable to the health benefit plan or benefits being marketed shall not be used.

69O FAC 150.209 | Use of Statistics

(1) A marketing communication relating to the dollar amount of claims paid, the number of persons insured, or similar statistical information relating to any small employer carrier or plan shall not use irrelevant facts, and shall not be used unless it accurately reflects all of the relevant facts.
(a) The marketing communication shall not imply that the statistics are derived from the plan marketed unless that is the fact, and when applicable to other plans shall specifically so state. A marketing communication shall specifically identify the plan to which statistics relate and, where statistics are given that are applicable to a different plan, it must be stated clearly that the data does not relate to the plan being marketed.

(b) A marketing communication shall not contain statements that are untrue in fact, or misleading by implication, with respect to the assets, corporate structure, financial standing, age, or relative position of a small employer carrier in the insurance or health benefit business.
(2) A marketing communication shall not represent or imply that claim settlements by a small employer carrier are liberal or generous or words of similar import, or state or imply that claim settlements are or will be beyond the actual terms of the plan. An unusual amount paid for a unique claim for the plan marketed is misleading and shall not be used.

(3) The source and date of source of any statistics used in a marketing communication shall be identified in the marketing communication.

69O FAC 150.210 | Disclosure of Choice of Benefits

A marketing communication for a basic, standard, or limited health benefit plan or any combination thereof that refers to a choice of the amount of benefits shall disclose that the amount of benefits provided depends upon the plan selected, and that the premium will vary with the amount of the benefits selected.

69O FAC 150.211 | Disparaging Comparisons and Statements

(1) A marketing communication shall not:
(a) Directly or indirectly make unfair or incomplete comparisons of plans or benefits, or comparisons of non-comparable policies or contracts of other small employer carriers;

(b) Disparage competitors, their plans, policies, contracts, services, or business methods;

(c) Disparage or unfairly minimize competing methods of marketing health benefit plans.
(2) A marketing communication shall not contain statements such as "no red tape" or "here is all you do to receive benefits."

(3) A marketing communication shall not state or imply that competing health benefit plans or insurance coverages customarily contains certain exclusions or limitations not contained in the marketed plans unless the exclusions or limitations are contained in a substantial majority of competing coverages.

(4) A marketing communication shall not state or imply in a misleading or incomplete manner that a small employer carrier's premiums are lower or its loss ratios are higher because its organizational structure differs from that of competing small employer carriers.

69O FAC 150.212 | Jurisdictional Licensing and Status of Small Employer Carrier

(1) A marketing communication shall not create the impression directly or indirectly that the small employer carrier, its financial condition or status, payment of claims, or the merits, desirability, or advisability of its plan or policy forms or kinds of plans of insurance are approved, endorsed, or accredited by any division or agency of this state or of the federal government. If a relationship exists, the marketing communication shall not exaggerate or otherwise mislead with respect to the nature or extent of the relationship.

(2) A marketing communication shall not imply in a misleading manner that approval, endorsement, or accreditation of plan forms or marketing has been granted by any division or agency of the state or of federal government. Approval or non-disapproval of either plan forms or marketing communications shall not be used by a small employer carrier to imply or state that a governmental agency has endorsed or recommended the small employer carrier, its plans, marketing, or financial conditions.

69O FAC 150.213 | Identity of Small Employer Carrier

(1)
(a) The name of the actual small employer carrier shall be stated in all of the small employer carrier's marketing communications.

(b) The form number or numbers of the plan marketed shall be stated in any marketing communication that describes a particular plan's benefits.

(c) A marketing communication shall not use a trade name, any insurance group designation, name of the parent company of the small employer carrier, name of a particular division of the small employer carrier, name of any reinsurer or any other party, service mark, slogan, symbol or other device that would be misleading as to the true identity of the small employer carrier or create the false impression that the parent company or reinsurer or any other party would have any responsibility for the financial obligation of the small employer carrier.
(2) A marketing communication shall not use any combination of words, symbols, or physical materials that by their content, phraseology, shape, color, or other characteristics are so similar to combinations of words, symbols, or physical materials used by agencies of the federal government or of this state, or otherwise appear to be of a nature that tends to confuse or mislead prospective plan purchasers into believing that the solicitation is in some manner connected with an agency of the municipal, county, state, or federal government. If a relationship exists, the marketing communication shall not exaggerate or otherwise be misleading with respect to the nature or extent of the relationship.

(3) Marketing communications, envelopes, or stationery shall not use words, letters, initials, symbols, or other devices that are so similar to those used by governmental agencies or other small employer carriers that they may tend to mislead or confuse the public into believing:
(a) That the marketed coverages are somehow provided or endorsed by governmental agencies or other small employer carriers; or

(b) That the marketer is the same as, connected with, or endorsed by governmental agencies or other small employer carriers.
(4) A marketing communication shall not use the name of a state or a political subdivision in a plan name or description.

(5) A marketing communication in the form of envelopes or stationery of any kind shall not use any name, service mark, slogan, symbol, or any device in a manner that implies that the small employer carrier, the plan marketed, or any agent who may call upon the consumer as a result of the marketing communication is connected with a governmental agency, such as the Social Security Administration.

(6) A marketing communication shall not use letters, initials, or symbols of the corporate name or a trademark that would have the tendency or capacity to mislead or deceive the public as to the true identity of the small employer carrier, unless the true, correct, and complete name of the small employer carrier is in close conjunction and in the same size type as the letters, initials, or symbols of the corporate name or trademark.

(7) A marketing communication shall not use the name of an agency or other nomenclature in a type, size, and location that has the capacity and tendency to mislead or deceive as to the true identity of the small employer carrier.

(8) An address shall not be used to mislead or deceive as to the true identity of the small employer carrier or any other entity, its location, or licensing status.

(9) A small employer carrier shall not use, in the trade name of its health benefit plan, any terminology or words so similar to the name of a governmental agency or governmental program as to have the tendency to confuse, deceive or mislead the prospective purchaser.

(10) All marketing communications created by or used by agents, producers, brokers, or solicitors of a small employer carrier must be submitted to the Office by the small employer carrier.

(11) An agent who contacts a consumer as a result of acquiring that consumer's name from a lead generating device, from a list compiled from a lead generating device, or from a person providing those services, must disclose that fact in the initial contact with the consumer.

69O FAC 150.214 | Introductory, Initial, or Special Offers

(1) A marketing communication of an individual health benefit plan shall not directly or by implication represent that a plan or combination of plans is an introductory, initial, or special offer, or that applicants will receive substantial advantages not available at a later date, or that the offer is available only to a specified group of individuals, unless that is the fact.

(2) A marketing communication shall not contain phrases describing an application period as "special," "limited," or similar words or phrases when the small employer carrier uses the application periods as the usual method of marketing health benefit plans or health insurance.

69O FAC 150.215 | Statements About a Small Employer Carrier

(1) A marketing communication shall not contain statements that are untrue in fact, or misleading by implication, with respect to the assets, corporate structure, financial standing, age, or relative position of the small employer carrier in the insurance business.

(2) A marketing communication that contains a recommendation by any commercial rating system shall clearly indicate the purpose of the recommendation and the limitations of the scope and extent of the recommendation.

(3) A marketing communication that refers to a holding company or subsidiary of a small employer carrier shall fully disclose that the holding company or subsidiary is a separate entity and is not responsible for the small employer carrier's financial condition or contractual obligations.

(4) A marketing communication shall not refer to a reinsurer or the existence of reinsurance.

69O FAC 150.217 | Enforcement Procedures

(1) Marketing File.
(a) Each small employer carrier shall maintain at its home or principal office a complete file, available for inspection by the Office, containing:
1. Every printed, published, or prepared marketing communication;

2. A notation attached to each marketing communication indicating the manner and extent of distribution and the form number of any plan marketed;

3. Those advertisements submitted to the insurer by agents, brokers, or others and approved by the insurer for use.
(2) All marketing communications shall be maintained in the file for a period of 4 years, or until the filing of the next regular report or examination of the small employer carrier, whichever is the longer period of time.

69O FAC 150.218 | Filing for Review

(1) Any marketing of health benefit plans as defined in subsections 69O-150.203(7), (8), (9), and (10), F.A.C., of this rule chapter shall be filed by the small employer carrier with the Office for review not less than 30 days prior to the date the small employer carrier desires to use the marketing communication.

(2)
(a) Marketing communications that will be aired on television or radio shall not be subject to the time period specified in subsection (1) of this rule.

(b) The audio or audio/visual tapes and scripts for use in the marketing communications by television or radio shall be filed by the small employer carrier with the Office for review prior to the date the small employer carrier desires to first air the marketing communication.

(c) The Office shall review the audio or audio/visual tapes and scripts within 30 days of receipt.
(3) Disapproval of Marketing Material.
(a) The Office shall review the marketing material submitted under subsection (1) of this rule, within 30 days after receipt.

(b) A marketing communication submitted under subsection (1) of this rule, will be disapproved if the Office determines that the material violates any of the provisions of Section 627.6699, F.S., Part IX of Chapter 626, F.S., or any applicable rules of the Office.

(c) If the small employer carrier files at least 30 days prior to use and the Office has not issued a preliminary notice of violation within 30 days after filing, and there are no material changes in the marketing communication, the small employer carrier shall not be penalized for any use of the marketing communication that occurs within 30 days after receipt of any subsequent preliminary notice that the marketing communication is in violation of an applicable statute or rule.

(d) The Office shall withdraw any previous approval and disapprove a marketing communication at any time and enter an immediate order requiring that the use of the marketing communication be discontinued if the Office determines that the marketing communication violates any of the provisions of Section 627.6699, F.S., or of Part IX of Chapter 626, F.S., or any applicable rules of the Office.

69O FAC 150.219 | Severability

If any section or portion of a section of these rules, or any amendment, or the applicability to any person or circumstance is held invalid by a court, the remainder of the rules or the applicability of the provision to other persons or circumstances shall not be affected.
69O-151 | Requirements for Replacement of Life and Health Coverage

69O FAC 151.001 | Purpose (Repealed)

69O FAC 151.002 | Definition of Replacement

"Replacement" means any transaction in which new life insurance is to be purchased, and it is known or should be known or to the proposing insurer that by reason of such transaction existing life insurance has been or is to be:
(1) Lapsed, forfeited, surrendered, or otherwise terminated;

(2) Converted to reduced paid-up insurance, continued as extended term insurance, or otherwise reduced in value by the use of nonforfeiture benefits or other policy values;

(3) Amended so as to effect either a reduction in benefits or in the term for which coverage would otherwise remain in force or for which benefits would be paid;

(4) Reissued with any reduction in cash value; or

(5) Pledged as collateral or subjected to borrowing, whether in a single loan or under a schedule of borrowing over a period of time, for amounts in aggregate exceeding twenty-five (25%) of the loan value set forth in the policy.

69O FAC 151.003 | Other Definitions

(1) "Existing Insurer" means the insurance company whose policy is or will be changed or terminated in such a manner as described within the definition of "replacement."

(2) "Existing Life Insurance" means any life insurance in force including life insurance under a binding or conditional receipt or a life insurance policy that is within an unconditional refund period, but excluding life insurance obtained through the exercise of a dividend option.

(3) "Replacing Insurer" means the insurance company that issues a new policy which is a replacement of existing life insurance.

(4) `Sales Proposal" means individualized, written sales aids of all kinds, which are used by an insurer or agent in comparing existing life insurance to proposed life insurance in order to recommend the replacement or conservation of existing life insurance. Sales aids of a generally descriptive nature, which are maintained in the insurer's advertising compliance file, shall not be considered a Sales Proposal within the meaning of this definition.

(5) "Life Insurance" shall include annuities, tax sheltered annuities or life insurance policies which qualify under the definition of tax sheltered annuities.

69O FAC 151.004 | Exemptions

Unless otherwise specifically included, paragraph 69O-151.007(3)(b) and subsection 69O-151.008(1), F.A.C., shall not apply to:
(1) Industrial Insurance;

(2) Group, franchise, and individual credit life insurance;

(3) Group life insurance and life insurance policies issued in connection with a pension, profit sharing or other benefit plan qualifying for tax deductibility of premiums;

(4) An application to the existing insurer that issued the existing life insurance where a contractual change or conversion privilege is being exercised;

(5) Existing life insurance that is a non-convertible term life insurance policy which will expire in five years or less and cannot be renewed, unless such policy has tabular cash values; or

(6) Proposed life insurance that is to replace existing life insurance issued under a binding or conditional receipt delivered by the same company;

(7) Variable life insurance or annuities under which the death benefits and cash values vary in accordance with unit values of investments held in a separate account,

(8) Transactions involving annuity contracts which are governed by Rule 69B-162.011, F.A.C.

69O FAC 151.005 | Duties of Agent (Repealed)

69O FAC 151.006 | Duties of Replacing Agent (Repealed)

69O FAC 151.007 | Duties of Replacing Insurers

Each replacing insurer shall:
(1) Inform its field representatives of the requirements of these rules.

(2) Require with or as part of each completed application for life insurance:
(a) A statement signed by the applicant as to whether or not such insurance will replace existing life insurance; and,

(b) A statement signed by the agent as to whether or not he or she knows replacement is or may be involved in the transaction.
(3) Where a replacement is involved:
(a) Require from the agent with the application for life insurance a completed copy of the Form OIR-B2-312 rev. 07/23, as adopted in Rule 69O-151.010, F.A.C., and a copy of all Sales Proposals used for presentation to the applicant.

(b) Send to the applicant when requested in the, a Form OIR-B2-313, rev. 07/23 as adopted in Rule 69O-151.010, F.A.C., containing complete information required by the Form regarding the proposed insurance. This must be done within five (5) working days of the date the application and the Form OIR-B2-312, rev. 07/23, as adopted in Rule 69O-151.010, F.A.C., are received at its Home or Regional Office, or the date its policy is issued, whichever is sooner. Exemptions from compliance with the provisions of this paragraph are set forth in Rule 69O-151.004, F.A.C.

(c) Send to the existing insurer a copy of the Form OIR-B2-312, rev. 07/23, as adopted in Rule 69O-151.010, F.A.C., immediately upon receipt at its Home or Regional Office. The mailing address to be used for the existing insurer is the address under which that insurer is registered with the Office of Insurance Regulation.

(d) Provide to each prospective purchaser a buyer's guide and a policy summary prior to accepting any applicant's initial premium or premium deposit, unless the policy for which application is made contains a provision for an unconditional refund for a period of at least 10 days, or unless the policy summary contains an offer of such an unconditional refund, in which event the buyer's guide and policy summary must be delivered with the policy or prior to delivery of the policy.

(e) Maintain copies of the Form OIR-B2-312 rev. 07/23, and Form OIR-B2-313 rev. 07/23, as adopted in Rule 69O-151.010, F.A.C., if requested by the applicant, and all Sales Proposals used, and a replacement register, cross indexed, by replacing agent and existing insurer to be replaced, for at least three (3) years or until the conclusion of the next succeeding regular examination by the Insurance Department of its state of domicile, whichever is later.

69O FAC 151.008 | Duties of the Existing Insurer

Each existing insurer shall inform its responsible personnel of the requirements of these rules. Each existing insurer shall:
(1) Within ten (10) days from the date it receives the Form OIR-B2-312, rev. 07/23,as adopted in Rule 69O-151.010, F.A.C., furnish the policyowner, when requested a Form OIR-B2-313, rev. 07/23, as adopted in Rule 69O-151.010, F.A.C., concerning the existing life insurance. The values shown on Form OIR-B2-313 rev. 07/23, as adopted in Rule 69O-151.010, F.A.C.,shall be computed from the current policy year of the existing life insurance. Exemptions from compliance with the provisions of this section are set forth in Rule 69O-151.004, F.A.C.

(2) Maintain a file containing the following:
(a) Copies of the Form OIR-B2-312, rev. 07/23, as adopted in Rule 69O-151.010, F.A.C.,) received from replacing insurers; and,

(b) Copies of the fully completed Form OIR-B2-313, rev. 07/23, as adopted in Rule 69O-151.010, F.A.C., prepared pursuant to subsection 69O-151.008(1), F.A.C.
(3) This material shall be indexed by replacing insurer and held for three (3) years or until the conclusion of the next regular examination conducted by the Insurance Department of its domicile, whichever is later.

69O FAC 151.009 | Penalties (Repealed)

69O FAC 151.010 | Approved Forms

(1) Form OIR-B2-312, "Notice to Applicant Regarding Replacement of Life Insurance," rev. 07/23, hereby incorporated by reference and available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-16290. The form may be obtained from https://www.FLOir.com.

(2) Form OIR-B2-313, "Comparative Information Form for Proposed Insurance," rev. 07/23, hereby incorporated by reference and available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-16291. The form may be obtained from https://www.FLOir.com.

69O FAC 151.012 | Separability (Repealed)

69O FAC 151.101 | Purpose (Repealed)

69O FAC 151.102 | Scope

Rules 69O-151.102 through 69O-151.104, F.A.C., apply to the solicitation of accident and health insurance covering residents of this state. They do not apply to the solicitation of the following accident and health insurance:
(1) Group, blanket or franchise;

(2) Accident only;

(3) Single premium nonrenewable;

(4) Conversion to another individual or family policy issued by the same insurer with continuous coverage;

(5) Conversion to an individual or family policy from a group, blanket or group type policy; and,

(6) Conversion to a Medicare Supplement policy to replace a basic or major-medical accident and health policy.

69O FAC 151.103 | Definitions

As used in these rules:
(1) "Replacement" is any transaction wherein new accident and health insurance is to be purchased and it is known to the agent, broker or insurer at the time of application that, as a part of the transaction, existing accident and health insurance has been or is to be lapsed or the benefits thereof substantially reduced.

(2) "Direct response insurance" is insurance issued to an applicant who has completed the application and forwarded it directly to the insurer's agent in response to a solicitation coming into the applicant's possession by any means of mass communication.

(3) "Continuous coverage" means that the benefits are not less than the benefits under the previous policy, and the policy also covers loss resulting from injury sustained or sickness contracted while coverage was in force under the previous policy to the extent such loss is not covered under any extended benefit or similar provision of the previous policy.

(4) As used in this rule chapter the terms "accident and health insurance," `accident and sickness insurance," and "disability insurance" each shall include the others.

69O FAC 151.104 | Insurance Application

An application form for insurance subject to these rules shall contain a question to elicit information as to whether the insurance to be issued is to replace any insurance presently in force. If replacement of existing coverage is indicated the application shall state the Company name and policy number. A supplementary application or other form to be signed by the applicant and made a part of the company's file containing such a question may be used.

69O FAC 151.105 | Notice Furnished by Forms

(1) Upon determining that a sale will involve replacement, an insurer, other than a direct response insurer, shall furnish the applicant, upon issuance or delivery of the policy, or prior thereto, the notice described below. Once copy of such notice shall be given to the applicant and an additional copy signed by the applicant shall be retained by the insurer in its home office for at least three years or until the conclusion of the next succeeding regular examination by the Insurance Department of its state of domicile, whichever is later. This notice required for an insurer, other than a direct response Insurer, shall be provided in substantially the following form:

NOTICE TO APPLICANT REGARDING REPLACEMENT OF ACCIDENT AND SICKNESS INSURANCE

According to (your application) (information you have furnished), you intend to lapse or otherwise terminate existing accident and sickness insurance (insert policy number) you have with (insert Company name) and replace it with a policy to be issued by (insert Company name). For your information and protection, you should be aware of and seriously consider certain factors which may affect the insurance protection available to you under the new policy.
(1) Health conditions which you may presently have, (pre-existing conditions) may not be immediately or fully covered under the new policy. This could result in denial or delay of a claim for benefits under the new policy, whereas a similar claim might have been payable under your present policy (to be included if pre-existing conditions are not covered under the replacement policy).

(2) You may wish to secure the advice of your present insurer or its agent regarding the proposed replacement of your present policy. This is not only your right, but it is also in your best interests to make sure you understand all the relevant factors involved in replacing your present coverage.

(3) If, after due consideration, you still wish to terminate your present policy and replace it with new coverage, be certain that all questions on the application concerning your medical/health history are truthfully and completely answered. Failure to include all material medical information on an application may provide a basis for the company to deny any future claims and to refund your premium as though your policy had never been in force. After the application has been completed it should be carefully reviewed before being signed to be certain that all information has been properly recorded.

(4) New policies may be issued at an older age than that used for issuance of your present policy; therefore, the cost of the new policy, depending upon the benefits, may be higher than you are paying for your present policy.

(5) The renewal provisions of the new policy should be reviewed so as to make sure of your rights to periodically renew the policy.

The above "Notice to Applicant" was delivered to me on:
______________________________________________
(date)

Witness _______________________________________
(Writing Agent)

______________________________________________
(Applicant's Signature)
(2) A direct response insurer shall deliver to the applicant upon issuance of the policy, or within five working days from receipt of the application, whichever date occurs earlier, the notice described below. This notice required for a direct response insurer shall be in a form substantially as follows:

NOTICE TO APPLICANT REGARDING REPLACEMENT OF ACCIDENT AND SICKNESS INSURANCE

According to (your application) (information you have furnished), you intend to lapse or otherwise terminate existing accident and sickness insurance (insert policy number) you have with (insert Company name) and replace it with the policy delivered herewith issued by (insert Company name). Your new policy provides 10 days within which you may decide without cost whether you desire to keep the policy. For your own information and protection you should be aware of and seriously consider certain factors which may affect the insurance protection available to you under the new policy.
(1) Health conditions which you may presently have, (pre-existing conditions) may not be immediately or fully covered under the new policy. This could result in denial or delay of a claim for benefits under the new policy, whereas a similar claim might have been payable under your present policy.

(2) You may wish to secure the advice of your present insurer or its agent regarding the proposed replacement of your present policy. This is not only your right, but it is also in your best interests to make sure you understand all the relevant factors involved in replacing your present coverage.

(3) (To be included only if the application is attached to the policy.) If, after due consideration, you still wish to terminate your present policy and replace it with new coverage, read the copy of the application attached to your new policy and be sure that all questions are answered fully and correctly. Omissions or misstatements in the application could cause an otherwise valid claim to be denied. Carefully check the application and write to (insert Company Name and Address) within 10 days if any information is not correct and complete, or if any past medical history has been left out of the application.

____________________________
Company Name)
(3) An insurer, within five working days from the receipt of an application at its policy issuance office, shall furnish a copy of such notice to the insurer whose policy is being replaced.

69O FAC 151.106 | Violation (Repealed)

69O FAC 151.107 | Effective Date (Repealed)

69O FAC 151.201 | Purpose and Scope

(1) Rules 69O-151.201, and 69O-151.202, F.A.C., apply to any and all types of policies which include a policy value feature, irrespective of the marketing method by which such policies or contracts are sold.

(2) Rules 69O-151.201, and 69O-151.202, F.A.C., shall not apply to:
(a) Conversions of group or individual term policies; or

(b) Group permanent life, group variable life, group fixed annuities and group variable annuities wherein the group master policyholder retains ownership of the contract.
(3) When exercising the following policy provisions, for a purpose other than as a funding source for the purchase of additional insurance contract(s), paragraph 69O-151.202(2)(a), F.A.C, shall not apply to:
(a) Reduced paid-up or extended term insurance options in group life, group variable life, individual life or variable life policies;

(b) Early annuity options of group fixed, group variable, individual fixed or individual variable annuity products; or

(c) A living benefit settlement option of a group permanent life, group variable life, individual life or individual variable life insurance policy.

69O FAC 151.202 | Requirements

(1) Each insurer shall adopt written procedures to reasonably avoid and discourage the practice of churning, as defined in Section 626.9541(1)(aa), F.S.

(2)
(a) Form OIR-D0-1180, "Policy Disclosure Form and Instructions," rev. 07/23, hereby incorporated by reference and available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-16292, shall be completed by the insurer or its licensed and appointed agent and provided to the applicant prior to or contemporaneous with the time the applicant signs any application for the purchase of an additional life insurance policy or annuity contract to be funded through the use of values accessed in an existing and in-force policy with that same insurer. Form OIR-D0-1180, rev. 07/23 shall be completed for each existing and in-force policy to be utilized as a funding source for the purchase of additional insurance contract(s). Any required replacement and sales forms must also be completed. One copy of Form OIR-D0-1180, rev. 07/23 is to be delivered to the policyowner and one copy must be maintained by the insurer.

(b) If there is a material change in the information originally disclosed to the policyowner on Form OIR-D0-1180 as a result of the underwriting and policy issuance process, an insurer may cause an amended Form OIR-D0-1180, rev. 07/23 to be reissued, delivered and executed by the agent or corporate officer and the policyowner, and such amended Form OIR-D0-1180, rev. 07/23 shall constitute the required disclosure under this rule. An insurer must maintain any and all amended versions of Form OIR-D0-1180, rev. 07/23 in accordance with this rule.
(3) Insurers may reprint Form OIR-D0-1180, rev. 07/23 in its adopted format; however, reprints shall not be in a typesize smaller than the format adopted by the Office.

(4) Insurers may affix their name, address and company logo or insignia on the form in a manner not prohibited by Chapter 69B-150, F.A.C, or other applicable laws and rules.

(5) In accordance with Sections 624.316 and 624.3161, F.S., insurers shall maintain executed forms in active policy files for examination purposes. Accordingly, insurers shall maintain executed forms for at least five (5) years or from examination to examination, whichever is longer. In lieu of retaining original, executed forms, Form OIR-D0-1180, rev. 07/23 may be maintained in a manner retrievable for compliance examination and investigation review purposes.

(6) Policy loan request forms, surrender value request forms, dividend withdrawal request forms or any other applicable service forms that are necessary to access the funds to be used as a funding source for the payment of premiums for the additional insurance policy shall be completed and executed in their entirety at the time of new policy application and after presentation of the completed Form OIR-D0-1180, rev. 07/23.

(7) Form OIR-DO-1180, rev. 07/23 form may be obtained from https://www.FLOir.com.

69O FAC 151.203 | Adoption of Form OIR-D0-1180 (Repealed)

69O-153 | Deceptive Insurance Practices

69O FAC 153.001 | Definitions

For purposes of this chapter:
(1) The term "False Claim" means any written statement which is a part of or supports a claim for payment or other benefit pursuant to an insurance policy or health maintenance organization coverage document for commercial or personal insurance or health maintenance organization coverage and which is knowingly presented or prepared with knowledge or belief that it will be presented to an insurer, health maintenance organization, or third party, and which the preparer or presenter knows to contain materially false information or omissions, as part of or in support of or concerning that claim.

(2) The term "claimant" includes but is not limited to a patient, a health care provider to whom, or a health care facility to which the patient has either assigned his claim for payment or is otherwise entitled to care under a health maintenance organization coverage document.

(3) The term "Health Care Provider" means a physician or any recognized practitioner who provided skilled services pursuant to the prescription of or under the supervision or direction of a physician.

(4) The term "Health Care Facility" means any hospital licensed under Chapter 395, F.S., and any health care institution licensed under Chapter 400, F.S.

(5) The term "Pre-provision of services agreement" means an agreement made or understood to exist in advance of the provision of health care services between the health care provider or health care facility and the patient to waive in whole or in part that patient's payment of the co-payment or deductible amount provided for in the contractual agreement otherwise known as the "policy", or "health maintenance organization coverage document" between the patient and the insurer, health maintenance organization or third party, or an agreement to give the patient a discount for the immediate payment of fees for services rendered.

(6) The term "Third Party" means any individual who, or entity which, collects premiums, assumes financial risks, pays claims, or provides administrative services relative to any insurance policy, insurance contract, health prepayment contract, health car plan, nonprofit health care plan, nonprofit health service plan contract, or employee welfare plan.

(7) The term "insurer, health maintenance organization, or third party" as used in this rule does not include any federally-funded programs, such as Medicare and CHAMPUS or any state-funded programs for the medically indigent or disabled, such as Medicaid, or the agents, contractors, or administrators of these federally-funded or state-funded programs.

69O FAC 153.002 | Deceptive Acts or Practices

The preparation of a false claim for presentation to an insurer, health maintenance organization, or third party and the presentation of a false claim to an insurer, health maintenance organization, or third party by an agent, physician, claimant or other person are deceptive acts or practices involving the business of insurance prohibited by the Insurance Code.

69O FAC 153.003 | Example of a False Claim

The submission or presentation for payment to an insurer, health maintenance organization or third party of a claim form, bill, or other statement for services rendered, prepared or signed by a health care provider or health care facility which does not disclose a pre-provision of services agreement between the health care provider or health care facility and the patient to accept less for the health care services rendered than is reflected on the claim form, bill or statement is an example of a false claim. The submission of a claim form, bill or other statement shall not be considered a false claim merely because the application of a federal or state statutory sliding-scale fee or other federal or state mandated statutory discount for health care services rendered has not been disclosed. The submission of a claim form, bill or other statement shall, also, not be considered a false claim because of failure to disclose the forgiveness or writing-off of all or any portion of the unpaid deductible portion of the patient's bill after reasonable collection efforts have been made. The disclosure of the existence of a pre-provision of services agreement in accordance with Rule 69O-153.004, F.A.C., neither precludes nor requires an insurer, health maintenance organization, or other third party from considering that agreement in determining the actual or usual and customary charge under the terms of the insurance policy, or health maintenance organization coverage document.

69O FAC 153.004 | Disclosure of Agreements

A health care provider shall disclose a pre-provision of services agreement by one of the following methods:
(1) Attaching a copy of the agreement to the claim form;

(2) Attaching a statement that discloses the agreement and the specific terms thereof;

(3) Attaching a copy of the policy which provides for the waiver of all or some portion of a deductible or co-payment for employees of the hospital and others and a representation that the waiver is authorized by the policy as to that provider;

(4) Disclosure on the Office's approved uniform claim form when modified to effectuate such disclosure in a uniform manner as to all claims.
69O-154 | Health Insurance Policies

69O FAC 154.001 | Statement That Application Has Been Read Must Be Attached to Each Policy

(1) It is the opinion of the Insurance Commission that purchasers of disability insurance in this state should realize the importance of the application for insurance, therefore, no policy of disability insurance shall be delivered to any person in this state unless a notice stating as follows is attached to the policy:

IMPORTANT NOTICE

Please read the copy of the application attached to this policy. Carefully check the application and write to the company ___ (address) ___ within 10 days, if any information shown on it is not correct and complete, or if any past medical history has been left out of the application. This application is a part of the policy and the policy was issued on the basis that the answers to all questions and the information shown on the application are correct and complete. This statement, preferably in the form of a sticker to be placed on the policy, shall be printed in a prominent manner on paper or in ink of a contrasting color. Any wording of similar import or any procedure whereby the equal results are obtained may be used upon approval by the Director.
(a) This rule shall not apply where the application for insurance is not attached to and made a part of the contract.

69O FAC 154.002 | Statement of Terms; Acknowledgment by Insured Required

It is the opinion of the Director that the citizens of this state should be aware and should have full knowledge of the meaning of the terms, "This policy is renewable at the option of the company," "This policy is cancellable by the company," or similar captions on renewable term policies issued or issued for delivery in this state. To accomplish this, it shall be the duty of an agent writing such application to obtain from each applicant for such a policy a simple signed statement acknowledging that he knows and understands that upon proper notice the company may terminate the insurance at the end of any period for which the premium has been paid, or may cancel the policy if it contains the cancellation provision. Such statement may be a part of the application itself or may be separate. This statement may be obtained at the time of the application, before the policy is delivered, or when the policy is delivered. The wording of the statement will be as follows: "I am aware that the company may terminate this insurance at the end of any period for which the premium has been paid." Different wording of similar import may be approved so as to accurately describe different renewal conditions or provisions in line with the terms of the contract. If this statement is on the application, it must be isolated or separated, and a separate signature is required at the end of such statement. Such signed statement is to be kept on file by the insurer.

69O FAC 154.003 | Insured's Right to Return Policy; Notice

It is the opinion of the Director that it will be in the public interest and of benefit to all if the person to whom the policy is issued has the opportunity to return the policy if he is not satisfied with it, provided such return is made within a reasonable length of time after receipt of the policy; therefore, each and every company issuing or issuing for delivery a disability policy in this state is requested to have printed or stamped thereon or attached thereto a notice in a prominent place stating in substance that the person to whom the policy or contract is issued shall be permitted to return the policy or contract within ten (10) days of its delivery to said purchaser and to have the premium paid refunded if, after examination of the policy or contract, the purchaser is not satisfied with it for any reason. The notice may provide that if the insured or purchaser pursuant to such notice returns the policy or contract to the insurer at its home office or branch office or to the agent through whom it was purchased, it shall be void from the beginning and the parties shall be in the same position as if no policy or contract had been issued. This rule shall not apply to either single premium non-renewable policies or contracts or travel accident policies or contracts. Notices in this Rule 69O-154.003 and in Rule 69O-154.001, F.A.C., may be combined.

69O FAC 154.004 | Non-cancellable or Non-cancellable and Guaranteed Renewable Policies; Use of Terms

The terms "non-cancellable" or "non-cancellable and guaranteed renewable" may be used only in a policy which the insured has the right to continue in force by the timely payment of premiums set forth in the policy until at least age 50, or in the case of a policy issued after age 44, for at least five years the insurer has no right to make unilaterally any change in any provision of the policy while the policy is in force. Except as provided above, the term "guaranteed renewable" may be used only in a policy in which the insured has the right to continue in force by the timely payment of premiums until at least age 50, or in the case of a policy issued after age 44, for at least five years from its date of issue, during which period the insurer has no right to make unilaterally any change in any provision of the policy while the policy is in force, except that the insurer may make changes in premium rates by classes. The foregoing limitation on use of the term "non-cancellable" shall also apply to any synonymous term such as "not cancellable" and the limitation on use of the term "guaranteed renewable" shall also apply to any synonymous term such as "guaranteed continuable." Nothing herein contained is intended to restrict the development of policies having other guarantees of renewability, or to prevent the accurate description of their terms of renewability or the classification of such policies as guaranteed renewable or non-cancellable for any period during which they may actually be such, provided the terms used to describe them in policy contracts and advertising are not such as may readily be confused with the above terms.

69O FAC 154.005 | Report of Training Instructions Required

69O FAC 154.006 | Exemptions

69O FAC 154.102 | Applicability and Scope

(1) These rules shall apply to all individual and family accident and health insurance policies, subscriber contracts of medical, surgical, or health maintenance organizations and to franchise insurance policies issued or issued for delivery in this state on and after the effective date hereof (except for policies issued to employees or members who are being added to existing franchise plans). The requirements contained in these rules shall be in addition to any other applicable rules previously adopted.

(2) Rules 69O-154.110 through 69O-154.112 and 69O-154.114 through 69O-154.116, F.A.C., shall also apply to insurance coverage subject to the provisions of Section 627.6487, F.S. Notwithstanding the foregoing, nothing in this rule chapter shall be construed to establish that the Office has rate approval authority over any rate applicable to a group policy issued outside this state, where that authority is not separately conferred by statute.

69O FAC 154.104 | Definition of Terms

(1) Accident, accidental injury, accidental means:
(a) The definition shall employ "result" language and shall not include words which establish an "accidental means" test or use words such as "external, violent, visible wounds" or similar words of description or characterization.

(b) The definition shall not be more restrictive than the following: "injury or injuries for which benefits are provided means accidental bodily injuries sustained by the insured person which are the direct cause independently of disease, bodily infirmity or other cause of the loss and occur while the insurance is in force."

(c) Such definitions may provide that injuries shall not include:
1. Injuries for which benefits are provided under:
a. Any workers' compensation, employers' liability or similar law; or

b. Florida Automobile Reparations Reform Act (motor vehicle no-fault plan or similar law); or
2. Injuries occurring while the insured person is engaged for wage or profit in any activity pertaining to any trade, business, employment or occupation.
(2) "Categories of benefits" means the following benefits:
(a) Mental health coverage;

(b) Substance abuse coverage;

(c) Prescription drug coverage;

(d) Dental coverage; and,

(e) Vision coverage.
(3) Convalescent nursing home or extended care facility. The term "convalescent nursing home" or "extended care facility" (skilled nursing facility) may be defined in relation to its status, facilities and available services.
(a) A definition shall not be more restrictive than one requiring that it:
1. Be operated pursuant to law;

2. Be approved for payment of Medicare benefits or be qualified to receive such approval, if so requested;

3. Be primarily engaged in providing, in addition to room and board accommodations, skilled nursing care under the supervision of a duly licensed physician;

4. Provide continuous 24 hour a day nursing service by or under the supervision of a registered graduate professional nurse (R.N.); and,

5. Maintain a daily medical record of each patient.
(b) A the definition may provide that the term shall not include:
1. Any home, facility or part thereof used primarily for rest;

2. Any home or facility for the aged or for the care of drug addicts or alcoholics; or

3. Any home or facility primarily used for the care and treatment of mental diseases or disorders or custodial or educational care.
(4) "Earned first year premium" is the amount of gross premium to be paid by an insured for the twelve months of coverage, measured from the effective date of coverage and which is earned during the period of time being measured.

(5) Hospital. The term "hospital" may be defined in relation to its status, facilities and available services, or to reflect its accreditation by the Joint Commission on Accreditation of Hospitals or the American Osteopathic Hospital Association.
(a) The definition shall not be more restrictive than one requiring that the hospital:
1. Be an institution licensed as a hospital and operated pursuant to law;

2. Be primarily and continuously engaged in providing or operating, either on its premises or in facilities controlled by the hospital, under the supervision of a staff of duly licensed physicians, medical, diagnostic and major surgery facilities for the medical care and treatment of sick or injured persons on an inpatient basis for which a charge is made; and,

3. Provide 24 hour nursing service by or under the supervision of registered graduate professional nurses (R.N.'s).
(b) The definition may state that the term shall not be inclusive of:
1. Any military or veteran's hospital or soldier's home or any hospital contracted for or operated by any national government or agency thereof for the treatment of members or ex-members of the armed forces;

2. Convalescent homes, convalescent, rest, or nursing facilities; or

3.
a. Facilities for the aged, drug addicts, or alcoholics;

b. Facilities primarily affording custodial, educational, or rehabilitory care; or

c. Those primarily affording care for mental and nervous disorders.
(6) "Medical advice, diagnosis, care or treatment" means advice, diagnosis, care or treatment recommended by, or received from an individual licensed or similarly authorized to provide such services under state law and operating within the scope of practice authorized by state law.

(7) "Medical care or condition" means amounts paid for any of the following:
(a) The diagnosis, cure, mitigation or prevention of disease, or amounts paid for the purpose of affecting any structure or function of the body.

(b) Transportation primarily for and essential to medical care referred to in paragraph (7)(a).

(c) Insurance covering medical care referred to in paragraphs (7)(a) and (b).
(8) Mental or Nervous Disorders. A definition of "mental or nervous disorder" as used in a policy shall not be more restrictive than:
(a) Neurosis;

(b) Psychoneurosis;

(c) Psychopathy;

(d) Psychosis; or

(e) Mental or emotional disease or disorder of any kind.
(9) Nurse.
(a) The definition or description of "nurse" may be restricted to a type of nurse, such as:
1. Registered graduate professional nurse (R.N.);

2. Licensed practical nurse (L.P.N.); or

3. Licensed vocational nurse (L.V.N.).
(b) If the words "nurse", "trained nurse" or "registered nurse" are used without specific instruction, then the use of such terms requires the insurer to recognize the services of any individual who qualifies under such terminology in accordance with the applicable statutes or administrative rules of the licensing or registry board of this state.
(10) "Offer" means to actively market.

(11) One Period of Confinement.
(a) "One period of confinement" as used in subsections 69O-154.106(1) and (2), F.A.C., means one or more separate or combined periods of confinement in a hospital, for the same or related causes, unless separated by an interval of not more than six consecutive months between the end of one such period and the beginning of the succeeding period.

(b) When succeeding confinements for the same or related causes are separated by a six-month interval, the following confinement will be considered a new period of confinement, and any applicable benefit provisions will be restored.
(12) Partial Disability. "Partial disability" may be defined in relation to:
(a) One's inability to perform some part or all of the "major," "important," or "essential" duties of his employment or occupation; or

(b) A "percentage" of time worked;

(c) A "specified number of hours";

(d) "Compensation."
(13) Physician.
(a) The definition or description of "physician" may be restricted to a type of physician to the extent allowed by law.

(b)
1. The insurer may also include terms such as "duly qualified physician" or "duly licensed physician."

2. The use of such terms requires an insurer to recognize and to accept, to the extent of its obligation under the contract, all providers of medical care and treatment when they are within the scope of the providers' licensed authority, and are provided pursuant to Section 627.419, F.S.
(14)
(a) "Placement, or being placed, for adoption" means the assumption and retention of a legal obligation for total or partial support of a child by a person with whom the child has been placed in anticipation of the child's adoption.

(b) The child's placement for adoption with the person terminates upon the termination of the legal obligation.
(15) "Service area" means the geographic area approved by the Agency for Health Care Administration within which an insurer is authorized pursuant to Section 627.6472, F.S., to offer a health insurance policy, or within which an HMO is authorized pursuant to Section 641.495, F.S., to provide or arrange for comprehensive health care services.

(16) Sickness.
(a) The definition of "sickness" shall not be more restrictive than the following: Sickness means illness or disease of an insured person which first manifests itself after the effective date of insurance and while the insurance is in force.

(b)
1. A definition of "sickness" which anticipates the exclusion of coverage of preexisting conditions, subject to the limitations in Section 627.607, F.S., shall not use the phrase "the cause of which originates" or any similar phrase.

2. Such definitions may provide for a probationary period which will not exceed 30 days except as stated in paragraph 69O-154.105(6)(a), F.A.C.
(c) The definition may be further modified to exclude sickness or disease for which benefits are provided under any workers' compensation, occupational disease, employers' liability or similar law.
(17) Total Disability.
(a) A general definition of "total disability" must not be more restrictive than one requiring the individual to be totally disabled from engaging in any employment or occupation for which the individual is or may become qualified by reason of education, training, or experience, and not in fact engaged in any employment or occupation for wage or profit.

(b) "Total disability" may be defined in relation to the inability of the person to perform duties, but the inability may not be based solely upon an individual's ability to:
1. Perform "any occupation whatsoever" or "any occupational duty"; or

2. Engage in any training or rehabilitation program;

3. An insurer may specify the requirement of the complete inability of the person to perform substantially all of the material duties pertaining to his regular occupation, or words of similar import.
(c)
1. The definition may reasonably require regular care and attendance by a physician, other than the insured or a member of insured's immediate family.

2. The definition may require that the total disability be "continuous" or "uninterrupted" for a specified period of time or to a specified age which shall be consistent with the type of coverage afforded.
(d) If the insured's total disability shall continue to the specified age or for the specified period and shall then and thereafter continue, the definition of "total disability" may predicate continuance of benefits on the insured's inability to perform any work or occupation for which he is reasonably trained or qualified by education or experience.

69O FAC 154.105 | Standards for Policy Provisions

(1) Terms of renewability - Each individual or family policy of accident and health insurance shall include a renewal, continuation or nonrenewal provision. The language or specifications of such provision must be consistent with the type of contract to be issued (e.g., noncancellable and guaranteed renewable, guaranteed renewable, renewable at the option of the insurer, single term nonrenewable, etc.). Such provision must be appropriately captioned and commence or be referenced on the first page of the policy and must clearly state the duration, where limited, of renewability and the duration of the term of coverage for which the policy is issued and for which it may be renewed.
(a) Noncancellable and Guaranteed Renewable Policy - A renewal provision of a policy characterized as "noncancellable and guaranteed renewable" must be consistent with the minimum requirements as adopted and set forth in Rule 69O-154.004, F.A.C. In a family policy covering both husband and wife the age of the younger spouse must be used as the basis for fulfilling the age (at least to age 50) or durational (for at least 5 years if issued after age 44) requirements of the definitions of "noncancellable" and "guaranteed renewable" policies for the purpose of defining the period of guaranteed renewability of the policy. This requirement shall not prevent termination of coverage of the older spouse upon attainment of the state age limit (e.g., age 65) so long as the policy may be continued in force as to the younger spouse to the age or for the durational period as specified in said definition.

(b) Guaranteed Renewable Policy - The renewal provision used in a policy which is characterized as a "guaranteed renewable policy" must be consistent with the minimum requirements of Rule 69O-154.004, F.A.C. The renewal provision of a "guaranteed renewable policy" will be the same as that contained in a "noncancellable and guaranteed renewable policy" except for the reservation of the right to the insurer to change premium on a class basis. Such right shall be clearly expressed within the renewal provision and referenced in the caption of such provision.

(c) Renewable Subject to Consent of Company and Variants Thereof.
1. The renewal provision of a policy characterized as "renewable subject to the consent of the company" shall be appropriately captioned as:
a. Renewable Subject to Consent of Company; or

b. Renewable Subject to Company Consent; or

c. Renewable at Option of Company.
The designated captions are without prejudice to the right of the insurer to submit another caption, subject to the approval of the Director, which it believes is equally clear or more definitive as to the subject matter of said provision. The provision shall clearly declare that renewal of the policy is subject to the consent of the insurer and that the premium rate applicable to such policy shall be that currently in use on each renewal date of the policy. If the insurer reserves the right of cancellation, notice of the existence of the provision shall be cross-referenced in the renewal provision.

2. Conditional or limited continuance - A policy which provides a qualified right of continuance after expiration of the period during which such policy is "noncancellable and guaranteed renewable" or "guaranteed renewable" must clearly specify the conditions, such as continued gainful employment, which must be fulfilled to permit continuance of the policy. If premiums are to be based on an attained age or on a step-rate basis, such must be declared in the renewal provision. The age limit, if any, to which any policy is renewed shall be declared in the renewal provision.

3. Qualified right of renewal - A renewal provision, other than enumerated above, may grant to the insured the right of renewal by timely payment of premium up to a stated age, if any, subject to the reserved right of the insurer to terminate all such policies on a specified basis upon the giving of a specified period of notice, which shall be set forth in the appropriate provision of the policy. The right of the insured to renew the policy may be conditioned upon the continuation of a specified status (e.g., an employee or a named employer, member of a named organization, while engaged in a specific occupation associated with such employment or such organization, residence in a given state or geographic area, insured under a given form of insurance having like form number identification). The rights of the insured and of the insurer shall be clearly set forth in the renewal provision. Such shall include the specified age limit, if any, requirements as to the professional or occupational status, if any, and requirements as to the continuing relationship, if any, of the employee or member. Continuance of insurance after the insured ceases to be eligible for coverage under the plan may be at the option of the insurer. In the event a different table of premium rates is to be applicable with respect to renewals occurring thereafter, such fact shall be declared in the renewal provision.

4. Single term nonrenewable policy - A policy characterized as a "single term nonrenewable policy" shall include a provision appropriately captioned (e.g., "this policy is not renewable" or words of similar import). Such provision must identify or reference the proper part of the contract within which the term (duration) of the coverage is specified.
(d) Renewable at the option of the insured - A policy which may not be characterized as "noncancellable and guaranteed renewable" or "guaranteed renewable" under existing definitional requirements solely because such policy may not be continuable to age 50 or for a minimum period of five years, may use a renewal provision caption, subject to the approval of the Director, which states that the right of the renewal is vested in the insured (e.g., policies issued to afford coverage for family income protection mortgage payments or temporary debt obligations) for a stated period of years, to a stated age, to the occurrence of a stated event or during the continuance of a given status (e.g., employment, membership).
(2) Initial and Subsequent Conditions of Eligibility - A family policy providing hospital, surgical, medical expense, hospital confinement indemnity, or accident only insurance (which includes accidental death, dismemberment, loss of sight, indemnity for fractures or dislocations, blanket medical expense, etc.) shall include provisions which specify the identity and qualifications applicable to those family members who may become insured under the policy initially or by subsequent addition.
(a) Eligible family members may include:
1. The insured;

2. The insured's spouse;

3. Children of the insured or of the insured's spouse who are over a specified age and under a specified age not to exceed 21, unless a dependency test is specified; and,

4. Any other person dependent upon the insured.
(b) The provisions concerning eligibility shall, for persons who may become insured subsequent to policy issuance, state the conditions under which such coverage may become effective. Such conditions include:
1. Qualifications for automatic coverage and the duration thereof;

2. Required evidence of insurability;

3. The necessity of application or notice from the insured;

4. Any requirements as to the payment of premiums as to such addition; and,

5. The time within which action is to be taken by the insured.
(c) In family policies providing for the addition of newly eligible family members, the Time Limit on Certain Defenses provision may be modified to provide for a new contestable period for each new member so added other than newborn children of the insured, but shall not provide for a new contestable period for the policy.

(d) A family policy providing benefits for accidental injury (e.g., accidental death, dismemberment, loss of sight, indemnity for fractures or dislocations, blanket medical expense, etc.) shall include provisions which specify the identity and qualifications applicable to such family members who may become insured under the policy initially or by subsequent addition. Provisions describing eligibility of family members or the adding of family members will generally follow the pattern specified in subsections 69O-154.105(2) and (3), F.A.C. Generally, causes of termination of coverage of individual family members will be predicated on age, cessation of dependency, legal separation, termination of marriage, and similar causes.
(3) Termination of Insurance - A family policy providing hospital, surgical, medical expense, hospital confinement indemnity or accident only insurance shall include termination provisions which shall specify:
(a) As to the insured: the age or event, if any, upon which coverage under the policy will terminate (e.g., age 65, eligibility for Medicare).

(b) As to the spouse: the age or event, if any, upon which coverage under the policy will terminate (e.g., age 65, eligibility for Medicare, legal separation, termination of marriage by divorce or annulment or similar actions).

(c) As to a child: the age or event upon which coverage under the policy will terminate (e.g., age 21, marriage of the child, cessation of dependency).

(d) Other family members: the age or event, if any, or such other reasons as are appropriate for termination of coverage as to persons not coming within paragraphs (a), (b), or (c) above.

(e) A noncancellable and guaranteed renewable or guaranteed renewable policy may not provide for termination of coverage of the spouse solely because of the occurrence of an event specified for termination of coverage of the insured, other than nonpayment of premium. The provision shall provide that in the event of the insured's death the spouse of the insured, if covered under the policy, shall become the insured.

(f) The provision shall provide that if the insurer accepts premium for coverage extending beyond the date, age or event specified for termination as to an insured family member, then coverage as to such person shall continue during the period for which an identifiable premium was accepted, except where such acceptance was predicated on a misstatement of age as outlined in Sections 627.620 and 627.634, F.S.

(g) The provision shall provide that, in the event of cancellation by the insurer, pursuant to Section 627.626, F.S., or refusal to renew by the insurer of a policy providing pregnancy benefits, such policy shall provide for an extension of benefits as to pregnancy commencing while the policy is in force and for which benefits would have been payable had the policy continued in force.

(h) The provision shall provide that termination of the policy by the insurer shall be without prejudice to any continuous loss which commenced while the policy was in force, but the extension of benefits beyond the period the policy was in force may be predicated upon the continuous total disability of the insured person, limited to the duration of the policy benefit period, payment of the maximum benefits or for a time period of not less than 3 months.

(i) The provision may provide for the termination or suspension of the family members who become eligible for coverage provided by the federal government (CHAMPUS or similar legislation).
(4) Nonduplication of Coverage Provisions:
(a) In addition to any other provisions not prohibited by law or rules, an insurer may avoid duplication of benefits with respect to losses for which benefits are payable under any workers' compensation, occupational disease, employers' liability or similar laws or payable pursuant to the Florida Automobile Reparations Reform Act (motor vehicle no-fault plan or similar law), and any national, state or other governmental plan not limited to civilian governmental employees or their families. An insurer may, alternatively, afford excess insurance to benefits afforded under any workers' compensation, occupational disease, employers' liability or similar laws or any national, state or other governmental plan or Florida Automobile Reparations Reform Act (motor vehicle no-fault plan or similar law), as well as other insurance or employer-employee or union welfare plans.

(b) Nonduplication may involve an interrelation, as related above and as appropriate to the coverage afforded, with other benefit programs including but not limited to individual or family insurance, group insurance, hospital service, medical service, group practice, individual practice and other prepayment plans, employee or employer benefit organizations, union or association welfare plans, Medicare, Florida Automobile Reparations Reform Act (motor vehicle no-fault plan or similar law), and similar benefit programs.
(5) Pre-existing Conditions - The policy must clearly disclose the intent of the insurer as to the applicability or nonapplicability or coverage to pre-existing conditions. If coverage of the policy is not to be applicable to pre-existing conditions, the policy shall specify, in substance, that coverage pertains solely to accidental bodily injuries resulting from accidents occurring after the effective date of coverage and that sicknesses are limited to these which first manifest themselves subsequent to the effective date of coverage or expiration of the probationary period, if any.

(6) Probationary or Waiting Periods - A probationary or waiting period shall relate to that period of time which may be specified in the policy and which must follow the date a person is initially insured under the policy before the coverage or coverages of the policy shall become effective as to such person.
(a) A probationary or waiting period shall not be used with respect to any loss resulting from accidental injuries as defined in the policy; however, as to loss resulting from sickness a policy may specify a probationary or waiting period which shall not exceed 30 days except as follows:
1. For pregnancy, childbirth, complications of pregnancy, 30 days where the probationary or waiting period is expressed in terms of the inception of the pregnancy;

2. Six months for losses resulting from hernia, disorder or reproduction organs, varicose veins, hemorrhoids, appendix, tonsils, adenoids and gall bladder;

3. 120 days for coverages under specified disease insurance.
(b) This subsection does not apply to benefits for dental or vision care.
(7) Limitations - The limitations on the risk undertaken, whether applicable to amounts, duration of benefits, age, or other matters, must be specified with clarity and certainty in the appropriate provision of the contract.

(8) Exceptions, Exclusions and Reductions.
(a) An exception or exclusion is any provision in a policy whereby coverage for a specified hazard is entirely eliminated. It is a statement of a risk not assumed under the terms and provisions of the contract.

(b) A reduction is a provision which takes away some portion, but not all of the coverage of the policy under certain specific conditions. Such relates to a risk assumed by the insurer but benefit upon the occurrence of such loss is limited to some amount or period less than would be otherwise payable had such reduction clause not been used.

(c) Exceptions, exclusions and reductions must be clearly expressed as a part of the benefit provision to which such applies, or if applicable to more than one benefit provision, shall be set forth as a separate provision and appropriately captioned. The use of general policy exclusions and the scope thereof will, of necessity, vary with the type of benefits afforded in a given policy. Such may generally be classified as "result" or "status" types. Policies containing the specified exclusionary subjects appearing in Exhibit A will be acceptable; however, this shall not preclude the consideration or approval of other exceptions or exclusions where such are deemed reasonable and appropriate to the risk undertaken and are approved by the Director.

(d) The listing of specified exclusionary subjects set forth in Exhibit A shall not impair or limit the use of waivers to exclude, limit or reduce coverage or benefits for specifically named or described pre-existing diseases, physical condition or extra hazardous activity. Where waivers are required as a condition of issuance, renewal or reinstatement, signed acceptance by the insured is required unless on initial issuance the full text of the waiver is contained either on the first page or specification page of the policy or unless notice of the waiver appears on the first page or specification page. Any waiver required as a condition precedent of renewal or reinstatement shall include a signed acceptance by the policyholder.
Exceptions or Exclusions Relating to:BASIC HOSPITALBASIC MEDICALBASIC SURGICALHOSPITAL INDEMNITYMAJOR MEDICALDISABILITY INCOMEACCIDENT ONLYSPECIFIED DISEASESPECIFIED ACCIDENT
War, declared or undeclared, or any act thereofXXXXXXXXX
Workmen’s compensation , occupational disease, employers’ liability or similar law, Florida Automobile Reparations Act (motor vehicle no fault), unless prohibited by lawXXXXXXXXX
Suicide, sane or insane or any attempt thereatXXXXXXXXX
Intentionally self-inflicted injuryXXXXXXXXX
Service in armed forces (while on active duty, etc.)XXXXXXXXX
Participation in riot or insurrectionXXXXXXX
Mental or emotional disorders or functional nervous disordersXXXXX
Pregnancy, childbirth, miscarriageXXXXXX
complications thereofXXXXX
Routine physical exams and rest curesXXXXXXX
Dental limitations – except as necessitated by accidental injuryXXXXX
Drugs, narcotics, hallucinogensXXXXXXXX
Transportation limitationsXXXX
Aircraft Travel Limitations; pilot, crew memberXX
Veterans facilities for treatment of veteransXXXXXX
Services covered under government planXXXXXX
Eye refractions, eyeglasses, dentistry, dental X-rays, etc.XXXXXX
Hearing aids, dental prosthetic appliances, cosmetic surgeryXXXXXX
Motorcycle use, racing contests, professional athletics, hazardous occupations or vocationsXXX
HerniaX
Territorial limitationsX
Materials or services not recommended and approved by qualified physiciansXXXXXXXX
Certain specified conditions, tonsils, adenoids, varicose veins, hemorrhoids, etc. for up to 6 monthsXXXX
Services rendered by immediate relatives or members of insured’s familyXXXXXXX
(e) If a policy contains a military service exclusion or a provision suspending coverage during military service, and if the premiums are either reduced or refunded for the period of such military service, the policy shall clearly so state.
1. As to policies other than noncancellable and guaranteed renewable, guaranteed renewable and renewable at option of the insured:
a. If the policy contains a "status" type of exclusion which excludes all coverages applicable to an insured person while in military service on full-time active duty, the policy shall provide, upon receipt of written request, for refund of premiums as applicable to such person on a pro rata basis.

b. If the policy contains a "causation" type exclusion (loss resulting from military service) while an insured person is on full-time active duty, refund of premium is not required since the policy would be operative as to any other loss not resulting from military service causes.

c. A provision for voluntary suspension of coverage as to an insured person during military service may be used, and if an identifiable premium is charged as to such person, then upon written request for suspension, a pro rata premium must be refunded.
2. As to noncancellable and guaranteed renewable, guaranteed renewable and renewable at the option of the insured:
a. The policy may provide for refund of the entire premium for the period of military service or for a partial refund of the premium from the date the insurer receives notice and it may adjust any such refund for any change in reserves during the period of suspension.

b. The policy may contain a military service exclusion or may provide for suspension of coverage upon entry into military service with the right of reinstatement upon termination of such service without evidence of insurability, if applied for within a specified period of not less than 60 days.

c. The insurer may charge a partial premium during the period of suspension which will anticipate accumulation of reserves required by law or regulation and related cost factors.
(9) Elimination Period - Elimination period shall relate to the initial period of time, during the continuance of a condition insured against and specified in respect to a particular benefit, for which such benefit will not be paid. Such periods must be clearly expressed in the policy schedule or benefits page and clearly expressed or referenced in the benefit provision to which such elimination period applies.

(10) Recurrent Conditions - A policy may contain provisions relating to recurrent confinements or recurrent disability; provided, however, a recurrent confinement or recurrent disability provision may not specify that such confinement or such disabilities be separated by a period greater than six months.

(11) Conversion Privileges - If a policy contains a conversion privilege, it shall comply, in substance, with the following:
(a) The caption of the provision shall be "Conversion Privilege", or words of similar import. The provision shall indicate the persons eligible for conversion. The circumstances applicable to the conversion privilege, including any limitations on the conversion, and the person by whom the conversion privilege may be exercised, shall be described in the provision. The provision may indicate that the privilege is subject to the underwriting standards of the insurer relating to overinsurance.

(b) A business overhead expense policy issued on either a guaranteed renewable basis, or on a noncancellable basis, or renewable at the option of the company basis may contain a conversion privilege exercisable upon termination of the business interest, or it may provide for its continuation as a loss of time policy.

(c) A policy issued pursuant to the exercise of a conversion privilege contained in a group, individual family or another individual policy, the converted policy or a rider attached thereto shall reflect the relative rights of each person covered under the converted policy.

69O FAC 154.106 | Minimum Standards for Benefits

An individual policy of accident and health insurance or nonprofit, medical, surgical, or hospital service corporation contract shall not be delivered or issued for delivery in this state unless the outline of coverage required by Section 627.642, F.S., labels and describes the policy or contract in accordance with the specified categories of coverage contained in this rule. Nothing in this rule shall preclude the issuance of any policy or contract combining two or more categories of coverage set forth in Section 627.643(2), F.S. This rule does not apply to policies issued pursuant to a conversion privilege. Types of policies controlled by this rule are as follows:
(1) Basic Hospital Expense Insurance - "Basic Hospital Expense Insurance" is a policy of accident and health insurance which provides coverage for a period of not less than 31 days during any one period of confinement for each person insured under the policy for the expense incurred for necessary treatment and services rendered as a result of an injury or sickness for at least the following:
(a) Daily hospital room and board in an amount not less than the lesser of the average semi-private room rate in the community in which the insured resides or $30.00 per day; and,

(b) Miscellaneous hospital service in an amount not less than ten times the daily hospital room and board benefit for the expense incurred for the charges made by the hospital for services and supplies rendered by the hospital and provided for use only during the period of confinement; and,

(c) Hospital outpatient services up to an amount of $50.00 for hospital-rendered services as an outpatient incurred within 72 hours of any one accident. Benefits provided under paragraphs (a) and (b) above may be provided subject to a combined deductible amount in excess of $100.00. This section does not prohibit a policy or rider especially designed to provide benefits for an insured person to supplement existing in force coverage.
(2) Basic Medical Expense Insurance - "Basic Medical Expense Insurance" is a policy of accident and health insurance which provides coverage for each person insured under the policy for the expense incurred for the necessary services and treatment of an injury or sickness for at least the following: In-hospital medical services, consisting of physician services rendered to a person who is a bed patient in a hospital for treatment of sickness or injury other than that for which surgical care is required, in an amount not less than $5.00 per call, one call per day, for at least 21 such calls during "one period of confinement" or similar benefit acceptable to the Office.

(3) Basic Surgical Expense Insurance - "Basic Surgical Expense Insurance" is a policy of accident and health insurance which provides coverage for each insured under the policy for the expense incurred for the necessary services rendered by a physician for treatment of an injury or sickness for at least the following:
(a) Surgical procedures for the treatment of a sickness, or injury, and endoscopic procedures including any preoperative and postoperative care usually rendered in connection with such operation or procedure, in an amount (a) not less than 75% of the reasonable charges or (b) if specified in dollar amounts, a fee schedule providing amounts for any procedure at least equal to those provided in a fee schedule with a maximum of $400.00 based on a relative value schedule acceptable to the Commissioner of Insurance.

(b) Anesthetic services, consisting of administration of necessary general anesthetics and related procedures in connection with covered surgical service rendered by a physician other than the physician (or his assistant) performing the surgical services, of at least 15 percent of the surgical service benefit provided. Surgical schedules contained in the policy shall include a provision providing coverage for procedures not specifically listed in the schedules and not otherwise excluded by the policy, and benefits therefore shall be consistent with the benefits for comparable procedures. Whenever a policy is written that provides at least the coverages required for both basic hospital expense coverage and basic medical and/or basic surgical expense coverages, the allowable deductible may be applied to the combined coverage.
(4) Hospital Confinement Indemnity Insurance - "Hospital Confinement Indemnity Insurance" is a policy of accident and health insurance which provides daily benefits for hospital confinement on an indemnity basis in an amount not less than $10.00 per day and not less than 31 days during any one period of confinement for each person insured under the policy and with no elimination period unless benefit period is 365 days or more, in which case, a three day elimination period will be acceptable.

(5) Major Medical Expense Insurance:
(a) "Major Medical Expense Insurance" is a policy of accident and health insurance which provides hospital, medical and surgical coverage as follows:
1. The aggregate maximum is not less than $10,000 per covered person.

2. The co-payment by a covered person is not more than 25 percent of covered charges except that the co-payment percentage applicable to subparagraph (5)(b)7. of this section may not be more than 50 percent.

3. The deductible is stated on a per person, per family, per illness, per benefit period or per year basis, or a combination of such basis, and, other than as specified in the next sentence, is not more than 10 percent of the maximum limit under the coverage. In lieu of a fixed dollar amount, the deductible amount may be expressed as (a) the higher of a fixed dollar amount of basic deductible and the policy's covered charges paid by other medical expense coverage; or (b) not more than $500 plus the policy's covered charges paid by other medical expense coverage.

4. The maximum benefit period of an "each cause" type of policy (where a separate deductible is required for different sicknesses and accidents) is not less than 18 months and the maximum benefit period for an "all cause" type of policy (where separate deductibles are not required for different sicknesses or accidents) is not less than the number of days remaining in the calendar or policy year after the deductible has been met.

5. The period allowed to satisfy the deductible is not less than 90 days.
(b) Major Medical Expense Insurance must provide for each covered person coverage of:
1. Hospital room and board expenses, prior to application of the co-payment percentage, for not less than $40.00 daily (or in lieu thereof the average daily cost of semiprivate room rate in the area where the insured resides) for a period of not less than 30 days for any period of continuous hospital confinement;

2. Miscellaneous hospital services, prior to application of the co-payment percentage, for an aggregate maximum of not less than $1,500 or 15 times the daily room and board rate if specified in dollar amounts;

3. Surgical fees, prior to application of the co-payment percentage, to a maximum of not less than $600.00 for the most severe operation with the amounts provided for other operations reasonably related to such maximum amount;

4. Anesthetic services, prior to application of the co-payment percentage of at least 15 percent of the covered surgical fees or, alternatively, if the surgical schedule is based on relative values, not less than the amount provided therein for anesthetic services at the same unit value as used for the surgical schedule;

5. Doctor visits, in or out of the hospital, with minimum dollar amounts per visit, prior to application of the co-payment percentage, equal to not less than $8.00 per visit, covering not less than one visit per day and for an aggregate maximum of such covered charges of not less than $600.00;

6. Out-of-hospital diagnostic x-rays and tests, prior to application of the co-payment percentage, for an aggregate maximum of such covered charges of not less than $600.00;

7. No fewer than three of the following additional benefits, prior to application of the co-payment percentage, for an aggregate maximum of such covered charges of not less than $1,000:
a. Private duty registered or if not available, licensed practical nurse services performed by other than a family member while insured is hospital confined;

b. Convalescent nursing home care;

c. Diagnosis and treatment by a radiologist or physiotherapist;

d. Rental of special medical equipment, as defined by the insurer in the policy;

e. Artificial limbs or eyes, casts, splints, trusses or braces;

f. Treatment for functional nervous disorders, and mental and emotional disorders;

g. Out-of-hospital prescription drugs and medications.
(6) Disability Income Protection Insurance:
(a) "Disability Income Protection Insurance" is a policy of health insurance identified in the outline of coverage, as to scope of coverage, if limited (e.g., accident only or sickness only), which provides for periodic payments, weekly or monthly, for a specified period during the continuance of disability resulting from sickness or injury or a combination thereof.

(b) Such coverage shall not require a loss from accidental injury to commence within less than 30 days after the date of an accident.

(c) No reduction in benefits shall be put into effect because of an increase in Social Security disability benefits during a benefit period.
(7) Accident Only Insurance:
(a) "Accident Only Insurance" is a policy of accident insurance which provides coverage, singly or in combination, for death, dismemberment, disability or hospital and medical care caused by accident.

(b) Accidental death and dismemberment benefits shall be payable if the loss occurs within a period of time of not less than 90 days from the date of the accident, irrespective of total disability. Disability income benefits, if provided, shall not require the loss to commence less than 30 days after the date of the accident.

(c) The amount of the accidental death benefit shall not be less than $1,000.00.

(d) The amount of the dismemberment benefit shall not be less than:
1. $500.00 in the case of a single dismemberment; and,

2. $1,000.00 in the case of a double dismemberment.
(e) Specified dismemberment benefits shall not be in lieu of other benefits unless the specific benefit exceeds the other benefit.
(8) Limited Benefit Insurance - "Limited Benefit Insurance" is that form of policy which provides coverage for each person insured under the policy for a specifically named disease (or diseases), specifically named accident, or specifically named limited market fulfilling an experimental or reasonable need.
(a) "Specified Disease Insurance" is a policy which provides coverage for each person insured under the policy for a specifically named disease (or diseases) with a deductible amount not in excess of $250.00 and an overall aggregate benefit limit of not less than $2,500.00 and a benefit period of not less than 2 years.

(b) "Specified Accident Coverage" is a policy which provides coverage for specifically identified kind of accident (or accidents) for each person insured under the policy for accidental death or accidental death and dismemberment combined, with a benefit amount of not less than $1,000 for accidental death; $1,000 for double dismemberment and $500 for single dismemberment.
(9) Supplemental Insurance - Any policy or contract which provides benefits that are less than the minimum standards for benefits required under subsections (1) through (3) of Rule 69O-154.106, F.A.C., may be delivered or issued for delivery if the outline of coverage describes such policy or contract as "supplemental hospital expense insurance", "supplemental medical expense insurance" or "supplemental surgical expense insurance" and prominently states that it does not meet the requirements of minimum standards for the category involved.

(10) Non-Conventional Coverage - Nothing contained in this section shall prohibit the issuance of a policy or contract that does not fall within subsections (1) through (9) of Rule 69O-154.106, F.A.C., if such policy or contract is either experimental in nature or is demonstrated to be a type coverage that will fulfill a reasonable need of a person or persons to be insured and is appropriately and prominently described in the outline of coverage.

(11) Home Service Health Coverage (Exemption):
(a) "Home Service Health Coverage" is a policy sold by a combination debit company and shall be exempt from the minimum benefit requirements contained in Rule 69O-154.106, F.A.C.

(b) In order for a company to qualify as a combination debit company under this Rule, it must certify that at least 90 percent of its Florida premium income for individual health insurance arises from business produced by home service debit agents. If a combination company does not meet this requirement on an overall basis, but does meet it relative to a combination department, it may qualify under this rule relative only to that combination department; in this case, however, the applicable policy forms may be approved for use only by such combination department.

(c) Such certification as mentioned above must be included in the letter of transmittal of each policy submitted.

69O FAC 154.107 | Outline of Coverage Required

(1) An outline of coverage, as required by Section 627.642, F.S., shall be delivered either at the time the application for the policy is taken or at the time such policy is delivered. Such outline of coverage shall be clearly identified as such and accurately describe the policy or contract and its provisions in a clear and concise manner. If the outline is delivered at the time the application is taken, there must be either a certification of delivery by the agent, or an acknowledgement of receipt by the applicant. Such certification or acknowledgement may be a separate document or by certification in the application.

(2) The requirement of the outline of coverage as set forth in Section 627.642, F.S., shall include the following information:
(a) The name and principal address of the insurer or service association.

(b) A statement of identification of the policy or contract as described in Rule 69O-154.106, F.A.C., of this rule.

(c) A description of each of the principal benefits and coverages, including the benefit amounts, duration or limits, elimination periods, inner limits and any other items appropriate to the coverage provided.

(d) A description of the terms and conditions or renewability of the policy or contract, including any limitations by age, time or event, rights to change premium, status requirements and any other matters appropriate to the terms and conditions of renewability (including any rights of cancellation reserved to the insurer).

(e) A description of the principal exceptions, reductions and limitations contained in the policy or contract, including the pre-existing conditions, if any, and the circumstances under which any reduction provisions become operative.

(f) A statement that the Outline of Coverage is only a brief summary of the policy and is not the contract of insurance. The policy or contract itself sets forth the rights and obligations of the insured and insurer.

69O FAC 154.110 | Certificate of Creditable Coverage (Repealed)

69O FAC 154.111 | Demonstration of Creditable Coverage If Certificate is not Provided (Repealed)

69O FAC 154.112 | Guaranteed Availability of Individual Health Coverage to Eligible Individuals

(1)
(a) Each health insurance issuer that offers individual health insurance coverage shall make available to eligible individuals the two policy forms with the largest and the next to largest premium volume of all such policy forms offered by the issuer in the state or a particular marketing or service area in the individual market.

(b) First year premium volume shall be calculated by using first year premium for the calendar year. In compiling the earned first year premium for the year, the company shall include earned premium for individuals renewing into a replacement form where a previously approved form has been discontinued.

(c) An insurer offering coverage in the individual market is not prohibited from establishing premium discounts.
(2)
(a) Both policy forms shall be designed for, made generally available to, actively marketed to, and enroll both eligible and other individuals.

(b) Issuers are not required to reopen closed blocks to meet this requirement.

(c) Eligible individuals must be offered these policy forms using the rate schedule and rating manual filed with and approved by the Office. If in the application of the company's underwriting standards, the eligible individual is determined to be uninsurable, the highest approved rate class may be used. Rates in each approved rate class must be generally applicable to all individuals and be based on sound actuarial practices without regard to the individual being an eligible individual.
(3) To enable the Office to monitor this coverage, the issuer shall file, no later than April 1 of each year, Form OIR-B2-1386, (Rev. 8/03), Individual Health Coverage Policy Forms Issued/Renewed in Florida, which is hereby adopted and incorporated by reference. All filings shall be submitted electronically to http://www.FLOir.com/iPortal. Copies of the form may be printed from the Office's website: http://www.FLOir.com/iPortal.

(4)
(a) If one or both of the largest first year earned premium volume policy forms are closed blocks of business, the issuer shall so inform the Office.

(b) The issuer shall provide evidence that the Office was notified of the intent to close these policy forms and shall provide the information listed in subparagraph 4. for the replacement forms.
(5)
(a) If the health insurance issuer offers policy forms in the individual market that provide dependent coverage, the issuer may apply a pre-existing condition exclusion to dependents who are not eligible individuals.

(b) The issuer may not apply a preexisting condition exclusion on certain children who have less than 18 months creditable coverage but are dependents who were enrolled as a dependent under a group health plan within 30 days of birth, adoption, or placement for adoption and have not had a significant break in coverage.
(6) Each issuer offering health insurance coverage in the individual market must disclose, in writing, to all applicants at the time of application the availability of quarantee issue coverage for eligible individuals. Each issuer offering health insurance coverage in the individual market is responsible for informing the applicant at the time of application of the information necessary to determine whether an applicant for coverage is an eligible individual as defined in Section 627.6487(3), F.S., as follows:
(a) The issuer shall exercise reasonable diligence in making this determination.

(b) The issuer shall promptly determine whether an applicant is an eligible individual.

(c) If an issuer determines that an individual is an eligible individual, the issuer shall promptly issue a policy to that individual.
(7) If the information presented in or with an application is substantially insufficient for the issuer to make a determination, the issuer may immediately request additional information from the individual. Upon receipt of the requested information, the issuer shall act promptly to make its determination.

(8) If an entity fails to provide the applicant with the certificate required under Section 627.64871, F.S., the issuer is subject to the procedures set forth in Rule 69O-154.111, F.A.C., concerning an individual's right to demonstrate creditable coverage.

69O FAC 154.113 | Discontinuance or Modification of Policy Form

69O FAC 154.114 | Withdrawal From the Individual Market

(1) If a health insurance issuer elects to withdraw from the individual health insurance market, the issuer must provide 180 days' written notice to the Office and to all policyholders, certificateholders and beneficiaries provided coverage by the issuer in that market.

(2) A notice of withdrawal from the individual market means an issuer may then non-renew coverage upon the next renewal date of policies affected by the withdrawal.

(3) A policy may not be terminated except at the next renewal date following the 180 day notice period.

(4) Notice to the Office must include a copy of all forms issued in that market.

(5) With respect to notice to policyholders, certificateholders, beneficiaries, a mailing to one household constitutes a mailing to all covered persons residing in the household.

(6) A separate mailing is required for each separate household.

(7) If the issuer elects to exit or withdraw from the individual market, re-entry into that market is prohibited for five years from the last date of coverage provided in that market.

(8) The filing shall be submitted to the Office electronically through http://www.FLOir.com/iPortal.

69O FAC 154.115 | Designation of Election to Become a Risk-Assuming or Reinsuring Carrier

(1)
(a) All individual health insurance issuers shall file a designation with the Office of their election to become either a risk-assuming or a reinsuring carrier.

(b) The individual issuer desiring to be a risk-assuming or reinsuring carrier shall use Form OIR-B2-1311 (rev. 8/03), http://www.FLRules.org/Gateway/Reference.asp?No=Ref-08294, State of Florida/Individual Carrier's Application to Become a Risk Assuming Carrier or a Reinsuring Carrier, which is hereby adopted and incorporated and may be obtained from the Office's website: http://www.FLOir.com/iPortal, as required by Section 627.6475(5), F.S.
(2)
(a) The Office shall provide notice by publication of the individual issuer's designation of election to become a risk assuming or reinsuring carrier, and shall allow 21 days from the date of publication to receive comment prior to making its decision on the election.

(b) The Office shall hold a hearing on the election if requested by the carrier.
(3) The Office shall approve or disapprove any application within 60 days of receipt of the application, based on the criteria in Section 627.6475(6), F.S., for risk assuming carriers or Section 627.6475(7), F.S., for reinsuring carriers.

69O FAC 154.116 | Change of Status of Individual Issuer’s Election to Become Risk-Assuming Carrier or Reinsuring Carrier

(1) Any individual issuer seeking to change the election made by the carrier under Section 627.6475(5)(a), F.S., to become either a risk-assuming carrier or a reinsuring carrier shall request a change of status on Form OIR-B2-1304 (rev. 10/98), State of Florida/Individual Issuer's Application to Modify Previous Election to Become a Risk Assuming or a Reinsuring Carrier which is hereby adopted and incorporated by reference and may be obtained from http://www.FLOir.com/iPortal, as required by Section 627.6475(5), F.S.

(2)
(a) Within 60 days from the date on which the form and its attached information is filed with the Office, the Office shall hold a hearing on the request.

(b) Within 30 days after the conclusion of the hearing and the submission of any post-hearing documentation or argument, the Office shall approve or disapprove the request, based on the criteria set forth in Section 627.6475(6)(b), F.S.

69O FAC 154.201 | Scope

(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 627.677(2), F.S.

(b) This rule chapter is effective December 31, 1998, for policies and contracts in force and issued thereafter.
(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.

(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.

(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:
1. All expected benefits unpaid;

2. All expected expenses unpaid; and,

3. All unearned or expected premiums, adjusted for future premium increases reasonably expected to be put into effect.
(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.

(b) If inadequacy is found to exist, immediate loss recognition shall be made and the reserves restored to adequacy.

(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.
(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.

69O FAC 154.202 | Definitions

As used in this rule chapter, the following terms have the following meaning:
(1) Annual Claim Cost. The net annual cost per unit of benefit before the addition of expenses, including claim settlement expenses, and a margin for profit or contingencies. For example, the annual claim cost for a $100 monthly disability benefit, for a maximum disability benefit period of one year, with an elimination period of one week, with respect to a male at age 35, in a certain occupation might be $12, while the gross premium for this benefit might be $18. The additional $6 would cover expenses and profit or contingencies.

(2) Claims Accrued. That portion of claims incurred on or prior to the valuation date which result in liability of the insurer for the payment of benefits for medical services which have been rendered on or prior to the valuation date, and for the payment of benefits for days of hospitalization and days of disability which have occurred on or prior to the valuation date, which the insurer has not paid as of the valuation date, but for which it is liable, and will have to pay after the valuation date. This liability is sometimes referred to as a liability for accrued benefits.

(3) Claims Reported. For annual statement purposes, a reported claim is a claim that has been incurred on or before the valuation date and has been reported on or before the valuation date.

(4) Claims Unaccrued. That portion of claims incurred on or prior to the valuation date which result in liability of the insurer for the payment of benefits for medical services expected to be rendered after the valuation date, and for benefits expected to be payable for days of hospitalization and days of disability occurring after the valuation date. This liability is sometimes referred to as a liability for unaccrued benefits.

(5) Claims Unreported. For annual statement purposes, an unreported claim is a claim that has been incurred on or before the valuation date but has not been reported on or before the valuation date.

(6) Date of Disablement. The earliest date the insured is considered disabled under the definition of disability in the contract, based on a doctor's evaluation or other evidence. Normally this date will coincide with the start of any elimination period.

(7) Elimination Period. A specified number of days, weeks, or months starting at the beginning of each period of loss during which no benefits are payable.

(8) Gross Premium. The amount of premium charged by the insurer. It includes the net premium (based on claim-cost) for the risk, together with any loading for expenses, profit, or contingencies.

(9) Group Insurance. The term group insurance includes blanket insurance, franchise insurance, and any other forms of group insurance.

(10) Group Long-Term Disability Income. The term group long-term disability income includes group contracts providing group disability income coverage with a maximum benefit duration longer than two years. Group long-term disability income contracts are based on a group pricing structure. The term "group long-term disability" does not include group short-term disability (coverage with benefit periods of two years or less in maximum duration). It also does not include voluntary group disability income coverage that is priced on an individual risk structure and generally sold in the workplace.

(11) Level Premium. A premium calculated to remain unchanged throughout either the lifetime of the policy or for some shorter projected period of years. The premium need not be guaranteed, in which case, although it is calculated to remain level, it shall be changed if any of the assumptions on which it was based are revised at a later time.

Generally, the annual claim costs are expected to increase each year and the insurer, instead of charging premiums that correspondingly increase each year, charges a premium calculated to remain level for a period of years or for the lifetime of the contract. In this case the benefit portion of the premium is more than needed to provide for the cost of benefits during the earlier years of the policy and less than the actual cost in the later years. The building of a prospective contract reserve is a natural result of level premiums.

(12) Long-Term Care Insurance. Insurance as defined in Section 627.9404, F.S.

(13) Medicare Supplement Insurance. Insurance as defined in Section 627.672, F.S.

(14) Modal Premium. Refers to the premium paid on a contract based on a premium term which could be annual, semi-annual, quarterly, monthly, or weekly. Thus if the annual premium is $100, and instead monthly premiums of $9 are paid, then the modal premium is $9.

(15) Negative Reserve. Normally the terminal reserve is a positive value. However, if the values of the benefits are decreasing with advancing age or duration it could be a negative value, called a negative reserve.

(16) Preliminary Term Reserve Method. Under this method of valuation the valuation net premium for each year falling within the preliminary term period is exactly sufficient to cover the expected incurred claims of that year, so the terminal reserves shall be zero at the end of the year. As of the end of the preliminary term period, a new constant valuation net premium (or stream of changing valuation premiums) becomes applicable so the present value of all such premiums is equal to the present value of all claims expected to be incurred following the end of the preliminary term period.

(17) Present Value of Amounts Not Yet Due on Claims. The reserve for claims unaccrued which may at the option of the insurer be discounted at interest.

(18) Reserve. Includes all items of benefit liability, whether in the nature of incurred claim liability or of contract liability relating to future periods of coverage, and whether the liability is accrued or unaccrued. An insurer under its contracts promises benefits which result in:
(a) Claims which have been incurred; that is, for which the insurer has become obligated to make payment, on or prior to the valuation date. On these claims, payments expected to be made after the valuation date for accrued and unaccrued benefits are liabilities of the insurer which shall be provided for by establishing claim reserves; or

(b) Claims which are expected to be incurred after the valuation date. Any present liability of the insurer for these future claims shall be provided for by the establishment of contract reserves and unearned premium reserves.
(19) Terminal Reserve. The reserve at the end of a contract year, defined as the present value of benefits expected to be incurred after that contract year, minus the present value of future valuation net premiums.

(20) Unearned Premium Reserve.
(a) This reserve values that portion of the premium paid or due to the insurer which is applicable to the period of coverage extending beyond the valuation date. Thus if an annual premium of $120 was paid on November 1, $20 would be earned as of December 31 and the remaining $100 would be unearned. The unearned premium reserve shall be on a gross basis as in this example, or on a valuation net premium basis. The reserve for a policy which provides for the return of unearned premium in the event of termination shall be on a gross basis.

(b) Single premium credit disability insurance, both individual and group, is excluded from this definition of unearned premium reserve.
(21) Valuation Net Modal Premium. The modal fraction of the valuation net annual premium that corresponds to the gross modal premium in effect on any contract to which contract reserves apply. Thus if the mode of payment in effect is quarterly, the valuation net modal premium is the quarterly equivalent of the valuation net annual premium.

(22) Credible Experience. For experience to be considered credible for purposes of sub-sub-subparagraph 69O-154.203(1)(b)1.b.(I), F.A.C., the company shall be able to provide claim termination patterns over no more than six (6) years reflecting at least 5,000 claims terminations during the third through fifth claims durations on reasonably similar applicable policy forms.

(23) Best Estimate Assumptions. Assumptions designed to produce results which on average will prove to have been too high half of the time and too low half of the time. Alternatively, assumptions which have the greatest likelihood of being correct.

(24) Sound Values. To place a sound value on a claim liability means to estimate the amount of future payments in such a way as to reduce the likelihood that the estimate will be less than the amounts ultimately paid. Placing a sound value requires that as uncertainty of the amounts ultimately paid increases, the amount by which the estimated claim liability exceeds the estimated future amount of payments also increases. When past experience exists, it can be used, subject to emerging trends in recovery rates, inflation, and other factors which can be used to make reasonable estimates. In the absence of prior experience, the actuary shall rely on commonly accepted estimations such as fixed number of months of premium or paid claims, or an amount such that the paid claims plus change in the liability equal a percentage of premium. (Unless past experience is not credible the preceding method can be used only in the first two years after a benefit without prior experience has been sold.)

(25) Reasonable Margins. Adjustments (to most likely assumptions) necessary to produce contract or claim reserves which reflect sound values. The use of margins results in reserves which exceed an estimate of most likely future benefit payments. The margin for adverse experience is equal to this excess.

(26) Adequate Reserves. Reserves calculated based on best estimate assumptions adjusted to include reasonable margins. For purposes of this rule, reserves must equal or exceed reserves determined using the minimum standards provided herein.

(27) Adequate Provision for Accrued and Unaccrued Benefits. Amounts deemed necessary to comply with the requirements of Section 625.041, F.S.

(28) Commonly Accepted Actuarial Practice.
(a) Practices consistent with standards of practice established by the Actuarial Standards Board.

(b) The following standards of practice are hereby adopted and incorporated by reference:
1. Actuarial Standard of Practice No. 1 Introductory Actuarial Standard of Practice, effective 03/13, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10519;

2. Actuarial Standard of Practice No. 2 Nonguaranteed Charges or Benefits for Life Insurance Policies and Annuity Contracts, effective 05/11 available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10520;

3. Actuarial Standard of Practice No. 3 Continuing Care Retirement Communities, effective 01/11, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10521;

4. Actuarial Standard of Practice No. 4 Measuring Pension Obligations and Determining Pension Plan Costs or Contributions, effective 12/13, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10522;

5. Actuarial Standard of Practice No. 5 Incurred Health and Disability Claims, effective 03/17, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10523;

6. Actuarial Standard of Practice No. 6 Measuring Retiree Group Benefits Obligations and Determining Retiree Group Benefits Program Periodic Costs or Actuarially Determined Contributions, effective 05/14, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10525;

7. Actuarial Standard of Practice No. 7 Analysis of Life, Health, or Property/Casualty Insurer Cash Flows, effective 05/11, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10526;

8. Actuarial Standard of Practice No. 8 Regulatory Filings for Health Benefits, Accident and Health Insurance, and Entities Providing Health Benefits, effective 03/14, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10547;

9. Actuarial Standard of Practice No. 9 Documentation and Disclosure in Property and Casualty Insurance Ratemaking, Loss Reserving, and Valuations, effective 03/13, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10528;

10. Actuarial Standard of Practice No. 10 Methods and Assumptions for Use in Life Insurance Company Financial Statements Prepared in Accordance with U.S. GAAP, effective 01/11, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10529;

11. Actuarial Standard of Practice No. 11 Financial Statement Treatment of Reinsurance Transactions Involving Life or Health Insurance, effective 01/11, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10530;

12. Actuarial Standard of Practice No. 12 Risk Classification (for All Practice Areas), effective 01/11, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10531;

13. Actuarial Standard of Practice No. 13 Trending Procedures in Property/Casualty Insurance, effective 05/11, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10532;

14. Actuarial Standard of Practice No. 14 When to Do Cash Flow Testing for Life and Health Insurance Companies, effective 03/13, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10533;

15. Actuarial Standard of Practice No. 15 Dividends for Individual Participating Life Insurance, Annuities, and Disability Insurance, effective 05/11, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10534;

16. Actuarial Standard of Practice No. 16 Actuarial Practice Concerning Health Maintenance Organizations and Other Managed-Care Health Plans, effective 04/07, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10535;

17. Actuarial Standard of Practice No. 17 Expert Testimony by Actuaries, effective 06/18, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10538;

18. Actuarial Standard of Practice No. 18 Long-Term Care Insurance, effective 05/11, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10539;

19. Actuarial Standard of Practice No. 19 Appraisals of Casualty, Health, and Life Insurance Businesses, effective 05/11, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10540;

20. Actuarial Standard of Practice No. 20 Discounting of Property/Casualty Unpaid Claim Estimates, effective 09/11, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10541;

21. Actuarial Standard of Practice No. 21 Responding to or Assisting Auditors or Examiners in Connection with Financial Audits, Financial Reviews, and Financial Examination, effective 09/16, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10542;

22. Actuarial Standard of Practice No. 22 Statement of Opinion Based on Asset Adequacy Analysis by Actuaries for Life or Health Insurers, effective 12/12, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10543;

23. Actuarial Standard of Practice No. 23 Data Quality, effective 12/16, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10544;

24. Actuarial Standard of Practice No. 24 Compliance with the NAIC Life Insurance Illustrations Model Regulation, effective 12/16, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10545;

25. Actuarial Standard of Practice No. 25 Credibility Procedures, effective 12/13, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10546;

26. Actuarial Standard of Practice No. 26 Compliance with Statutory and Regulatory Requirements for the Actuarial Certification of Small Employer Health Benefit Plans, effective 05/11, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10548;

27. Actuarial Standard of Practice No. 27 Selection of Economic Assumptions for Measuring Pension Obligations, effective 09/13, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10554;

28. Actuarial Standard of Practice No. 28 Statements of Actuarial Opinion Regarding Health Insurance Liabilities and Assets, effective 12/12, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10550;

29. Actuarial Standard of Practice No. 29 Expense Provisions in Property/Casualty Insurance Ratemaking, effective 05/11, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10551;

30. Actuarial Standard of Practice No. 30 Treatment of Profit and Contingency Provisions and the Cost of Capital in Property/Casualty Insurance Ratemaking, effective 05/11, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10552;

31. Actuarial Standard of Practice No. 31 Documentation in Health Benefit Plan Ratemaking, effective 06/09, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10553;

32. Actuarial Standard of Practice No. 32 Social Insurance, effective 05/11, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10555;

33. Actuarial Standard of Practice No. 33 Actuarial Responsibilities with Respect to Closed Blocks in Mutual Life Insurance Company Conversions, effective 05/11, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10556;

34. Actuarial Standard of Practice No. 34 Actuarial Practice Concerning Retirement Plan Benefits in Domestic Relations Actions, effective 06/15, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10557;

35. Actuarial Standard of Practice No. 35 Selection of Demographic and Other Noneconomic Assumptions for Measuring Pension Obligations, effective 09/14, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10558;

36. Actuarial Standard of Practice No. 36 Statements of Actuarial Opinion Regarding Property/Casualty Loss and Loss Adjustment Expense Reserves, effective 05/11, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10559;

37. Actuarial Standard of Practice No. 37 Allocation of Policyholder Consideration in Mutual Life Insurance Company Demutualizations, effective 05/11, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10560;

38. Actuarial Standard of Practice No. 38 Using Models Outside the Actuary's Area of Expertise (Property and Casualty), effective 05/11, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10561;

39. Actuarial Standard of Practice No. 39 Treatment of Catastrophe Losses in Property/Casualty Insurance Ratemaking, effective 03/13, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10562;

40. Actuarial Standard of Practice No. 40 Compliance with the NAIC Valuation of Life Insurance Policies Model Regulation with Respect to Deficiency Reserve Mortality, effective 05/11, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10563;

41. Actuarial Standard of Practice No. 41 Actuarial Standard of Practice, effective 12/10, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10564;

42. Actuarial Standard of Practice No. 42 Health and Disability Actuarial Assets and Liabilities Other Than Liabilities for Incurred Claims, effective 03/18, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10565;

43. Actuarial Standard of Practice No. 43 Property/Casualty Unpaid Claim Estimates, effective 05/11, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10566;

44. Actuarial Standard of Practice No. 44 Selection of Asset Valuation Methods for Pension Valuations, effective 05/11, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10567;

45. Actuarial Standard of Practice No. 45 The Use of Health Status Based Risk Adjustment Methodologies, effective 01/12, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10568;

46. Actuarial Standard of Practice No. 46 Risk Evaluation in Enterprise Risk Management, effective 09/12, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10569;

47. Actuarial Standard of Practice No. 47 Risk Treatment in Enterprise Risk Management, effective 12/12, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10570;

48. Actuarial Standard of Practice No. 48 Life Settlements Mortality, effective 12/13, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10571;

49. Actuarial Standard of Practice No. 49 Medicaid Managed Care Citation Rate Development and Certification, effective 03/15, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10582;

50. Actuarial Standard of Practice No. 50 Determining Minimum Value and Actuarial Value under the Affordable Care Act, effective 09/15, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10583;

51. Actuarial Standard of Practice No. 51 Assessment and Disclosure of Risk Associated with Measuring Pension Obligations and Determining Pension Plan Contributions, effective 09/17, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10574;

52. Actuarial Standard of Practice No. 52 Principle-Based Reserves for Life Products under the NAIC Valuation Manual, effective 09/17, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10575;

53. Actuarial Standard of Practice No. 53 Estimating Future Costs for Prospective Property/Casualty Risk Transfer and Risk Retention, effective 12/17, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10576; and

54. Actuarial Standard of Practice No. 54 Pricing of Life Insurance and Annuity Products, effective 06/18, available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10577.
(c) A copy of the standards of practice may be obtained from the Actuarial Standards Board at http://www.actuarialstandardsboard.org/standards-of-practice/.
(29) Gross Premium Valuation. A projection of the present values of gross premiums, benefit payments (including dividends or experience refunds), expenses, and taxes, whose uses include testing reserve adequacy. Gross premium valuations use persistency and other assumptions considered most likely to occur. If significant doubt as to reserve adequacy remains after most likely assumptions are used, the gross premium valuation shall include additional sensitivity testing. Sensitivity testing involves adjusting some or all of the assumptions used in the gross premium valuation to measure the effects of adverse experience.

(30) Qualified Actuary. This is defined in Rule 69O-138.043, F.A.C.

(31) Reasonable Method. One which can be shown to produce claim reserves which reflect sound values.

(32) Reasonable Assumptions for Contract Reserves. A reasonable assumption is one which can be shown to produce adequate contract reserve.

(33) Rating Block. A grouping of contracts determined by the valuation actuary based on common characteristics, such as a policy form or forms having similar benefit designs.

69O FAC 154.203 | Categories of Reserves

Adequacy of an insurer's health insurance reserves shall be determined on the basis of all three categories combined. However, these standards emphasize the importance of determining appropriate reserves for each of the three categories separately.
(1) Claim Reserves.
(a) General.
1. Claim reserves are required for all incurred but unpaid claims on all health insurance policies.

2. Appropriate claim expense reserves are required with respect to the estimated expense of settlement of all incurred but unpaid claims.

3. All reserves for prior valuation years shall be tested for adequacy and reasonableness along the lines of claim runoff schedules in accordance with the financial statement pursuant to Section 625.121(14), F.S., including consideration of any residual unpaid liability.
(b) Minimum Standards for Claim Reserves.
1. Disability Income.
a. Interest. The maximum interest rate for claim reserves is specified in subsection 69O-154.204(2), F.A.C.

b. Morbidity. Minimum standards for morbidity are those specified in subsection 69O-154.204(1), F.A.C., except that, at the option of the insurer:
(I) For claims incurred on or before December 31, 2006, with a duration from date of disablement of less than two years, reserves may at the option of the insurer be based on the insurer's experience, if such experience is considered credible, or upon other assumptions designed to place a sound value on the liabilities. Each insurer may elect one of the following to use as the minimum morbidity standard for claim reserves:
(A) The minimum morbidity standard in effect for claim reserves as of the date the claim was incurred, or

(B) The standards as defined in (II) applied to all open claims. Once an insurer elects to calculate reserves for all open claims on the standard defined in (II), all future valuations must be on that basis.
(II) For individual disability income claims incurred on or after January 1, 2007, the minimum standards with respect to morbidity are those specified in Rule 69O-154.204, F.A.C., except that, at the option of the insurer, assumptions regarding claim termination rates for the period less than two years from the date of disablement may, at the option of the insurer, be based on the insurer's experience, if such experience is considered credible, or upon other assumptions designed to place a sound value on the liabilities.

(III) For group disability income claims incurred on or before December 31, 2006, with a duration from date of disablement of more than two (2) years but less than five (5) years, reserves may at the option of the insurer, be based on the insurer's experience for which the insurer maintains underwriting and claim administration control, and in accordance with commonly accepted actuarial practice.

(IV) For group disability income claims incurred on or after January 1, 2007 and on or before September 30, 2014.
(A) Assumptions regarding claim termination rates for the period less than two years from the date of disablement may, at the option of the insurer, be based on the insurer's experience, if such experience is considered credible, or upon other assumptions designed to place a sound value on the liabilities.

(B) Assumptions regarding claim termination rates for the period two or more years but less than five years from the date of disablement may, with the approval of the Office, be based on the insurer's experience, if such experience is considered credible, and for which the insurer maintains underwriting and claim administration control. The request for such approval of a plan of modification to the reserve basis must include:
(i) An analysis of the credibility of the experience;

(ii) A description of how all of the insurer's experience is proposed to be used in setting reserves;

(iii) A description and quantification of the margins to be included;

(iv) A summary of the financial impact that the proposed plan of modification would have had on the insurer's last filed annual statement;

(v) A copy of the approval of the proposed plan of modification by the commissioner of the state of domicile; and,

(vi) Any other information deemed necessary, to provide clarity and completeness, by the office.
(C) Each insurer may elect one of the following to use as the minimum morbidity standard for group long-term disability income claim reserves:
(i) The minimum morbidity standard in effect for claim reserves as of the date the claim was incurred, or

(ii) The standards as defined in sub-sub-sub-sub-subparagraph (1)(b)1.b.(IV)(B)(iii) above, applied to all open claims. Once an insurer elects to calculate reserves for all open claims on a more recent standard then all future valuations must be on that basis.
(V) With respect to sub-sub-subparagraph (1)(a)1.b.(III) and sub-sub-sub-subparagraph (1)(a)1.b.(IV)(B) above, for experience to be considered credible, the company should be able to provide claim termination patterns over no more than six (6) years reflecting at least 5,000 claims terminations during the third through fifth claims durations on reasonably similar applicable policy forms.

(VI) For group long-term disability income claims incurred on or after October 1, 2014, and on or before December 31, 2016, the minimum standards with respect to morbidity may be based on the 2012 GLTD termination table (http://www.NAIC.org/documents/01_naic_2012_group_long-term_disability_valuation_table.xls) http://www.FLRules.org/Gateway/Reference.asp?No=Ref-05857 which is incorporated herein by reference or subsequent table with considerations of:
(A) The insurer's own experience computed in accordance with Actuarial Guideline XLVII as included in the NAIC Accounting Practices and Procedures Manual, adopted by subsection 69O-137.001(4), F.A.C.; and,

(B) An adjustment to include an own experience measurement margin derived in accordance with Actuarial Guideline XLVII, as included in the NAIC Accounting Practices and Procedures Manual; and,

(C) A credibility factor derived in accordance with Actuarial Guideline XLVII.

(D) Subject to the conditions in this paragraph, the 2012 GLTD or subsequent table with considerations outlined in sub-sub-sub-sub-subparagraph (B) shall be used in determining minimum standards with respect to morbidity for group long term disability claims incurred on or after January 1, 2017.
(VII) Subject to the conditions in this Section, the 2012 GLTD or subsequent table with considerations outlined in subparagraph (1)(b)1. shall be used in determining minimum standards with respect to morbidity for group long term disability claims incurred on or after January 1, 2017.
(A) The request for approval of a plan of modification to the reserve basis shall include:
(I) An analysis of the credibility of the experience;

(II) A description of how all of the insurer's experience is proposed to be used in setting reserves;

(III) A description and qualification of the margins to be included;

(IV) A summary of the financial impact that the proposed plan of modification would have had on the insurer's last filed annual statement;

(V) For a company not domiciled in this state, a copy of the approval of the proposed plan of modification by the commissioner of the state of domicile.

(VI) Information necessary for the Office to verify that the claim reserve makes adequate provision for accrued and unaccrued benefits. In determining information, the insurer shall use the NAIC Financial Examiners Handbook as referred to in Rule 69O-138.001, F.A.C.
(B) For claim reserves to reflect "sound values" and/or reasonable margins, reserve tables based on credible experience shall be adjusted regularly to maintain reasonable margins.
c. Duration of Disablement. For contracts with an elimination period, the duration of disablement shall be measured as dating from the time that benefits would have begun to accrue had there been no elimination period.
2. All Other Benefits.
a. Interest. The maximum interest rate for claim reserves is specified in subsection 69O-154.204(2), F.A.C.

b. Morbidity or other Contingency. The reserve shall be based on the insurer's experience, if that experience is considered credible, or upon other assumptions used by the company designed to place a sound value on the liabilities.

c. Claim Reserve Methods Generally.
(I) A reserving method shall be used to estimate claim liabilities if it is:
(A) A generally accepted actuarial reserving method following commonly accepted actuarial practice; or

(B) A reasonable method approved by the Office after a public hearing prior to the statement date. A reasonable method is one where the company is able to demonstrate that the claim reserves calculated using the company's method would not be less than those calculated using a generally accepted actuarial method; or

(C) A combination of these methods.
At its option, an insurer may estimate some of all of its claim liabilities either separately or by using aggregate methods. Approximations based on groupings and averages may also be employed. Adequacy of the claim reserves, however, shall be determined in the aggregate.
(2) Premium Reserves.
(a) General.
1. Except as noted in subparagraph (2)(a)2., unearned premium reserves shall be required for all contracts for the period of coverage for which premiums, other than premiums paid in advance, have been paid beyond the date of valuation.

2. Single premium credit disability insurance individual policies and group certificates, which are subject to the requirements of Section 625.121(13), F.S., are excluded from unearned premium reserve requirements of paragraphs (2)(a), (b), and (c).

3.
a. If premiums due and unpaid are carried as an asset, the premiums shall be treated as premiums in force, subject to unearned premium reserve determination.

b. The value of unpaid commissions, premium taxes, and the cost of collection associated with due and unpaid premiums shall be carried as an offsetting liability.
4. The gross premiums paid in advance for a period of coverage beginning after the next premium due date following the date of valuation may at the option of the insurer be discounted to the valuation date, and shall be held as a separate liability.
(b) Minimum Standards for Unearned Premium Reserves.
1. The minimum unearned premium reserve for any contract is the pro-rata unearned modal premium that applies to the premium period beyond the valuation date, with the premium determined on the basis of:
a. The valuation net modal premium on the contract reserve basis applying to the contract; or

b. The gross modal premium for the contract if no contract reserve applies.
2. In no event shall the sum of the unearned premium and contract reserves for all contracts of the insurer subject to contract reserve requirements be less than the gross modal unearned premium reserve on all these contracts, as of the date of valuation. The reserve shall not be less than the expected claims for the period beyond the valuation date represented by the unearned premium reserve, to the extent not provided for elsewhere.
(c) Premium Reserve Methods Generally. The insurer may at their option employ suitable approximations and estimates, including but not limited to groupings, averages, and aggregate estimation, in computing premium reserves. These approximations or estimates shall be tested periodically to determine their continuing adequacy and reliability.
(3) Contract Reserves.
(a) General.
1. Contract reserves shall be required, unless otherwise specified in sub-sub-sub-sub-subparagraph (3)(a)1.b.(C)(III)2. below, for:
a. All individual and group contracts with which level premiums are used; or

b.
(I) All individual and group contracts for which, due to the gross premium pricing structure at issue, the value of the future benefits at any time exceeds the value of any appropriate future valuation net premiums at that time.

(II)
(A) This evaluation may be applied on a rating block basis if the total premiums for the block were developed to support the total risk assumed and expected expenses for the block each year, and a qualified actuary certifies the premium development.

(B) The actuary shall state in the certification that premiums for the rating block were developed such that each year's premium was intended to cover that year's costs without any prefunding.

(C) For group policies having retrospective pricing agreements, if the premium is also intended to recover costs for any prior years, the actuary shall also disclose the reasons for and magnitude of such recovery.
(III) The values specified in this sub-subparagraph shall be determined on the basis specified in paragraph (3)(b) below entitled "Minimum Standards for Contract Reserves".
2. Contracts not requiring a contract reserve are:
a. Contracts which cannot be continued after one year from issue.

b. For valuation dates on or prior to December 31, 1998, contracts already in force on the effective date of these rules for which no contract reserve was required prior to the effective date of these rules.

c. For valuation dates after December 31, 1998, contracts in force on the effective date of these rules for which no contract reserve is required by the Commissioner of the insurer's State of Domicile.
3. The contract reserve is in addition to claim reserves and premium reserves.

4. The methods and procedures for contract reserves shall be consistent with those for claim reserves for any contract, or else appropriate adjustment shall be made when necessary to assure provision for the aggregate liability. The definition of the date of incurral shall be the same in both determinations.

5. The total contract reserve established shall incorporate provisions for moderately adverse deviations.
(b) Minimum Standards for Contract Reserves.
1. Basis.
a. Morbidity or other Contingency.
(I) Minimum standards for morbidity are specified in rule subsection 69O-154.204(1), F.A.C. Valuation net premiums used under each contract shall have a structure consistent with the gross premium structure at issue of the contract as it relates to advancing age of insured, contract duration, and period for which gross premiums have been calculated.

(II) Except as provided in sub-subparagraph (3)(a)1.b., if for a policy form there is no gross premium variation by age, the valuation net premiums will nonetheless vary based on age at issue for each such contract since at issue the present value of valuation net premiums for a contract must equal the present value of tabular claim costs.

(III) Contracts for which tabular morbidity standards are not specified in subsection 69O-154.204(1), F.A.C., shall be valued using tables established for reserve purposes by a qualified actuary. The morbidity tables shall contain a pattern of incurred claims cost that reflects the underlying morbidity, and shall not be constructed for the primary purpose of minimizing reserves.
(A) In determining the morbidity assumptions, the actuary shall use assumptions that represent the best estimate of anticipated future experience, but shall not incorporate any expectation of future morbidity improvement.

(B) Morbidity improvement is a change, in the combined effect of claim frequency and the present value of future expected claim payments given that a claim has occurred, from the current morbidity tables or experience that will result in a reduction to reserves.

(C) It is not the intent of this provision to restrict the ability of the actuary to reflect the morbidity impact for a specific known event that has occurred and that is able to be evaluated and quantified.
b. Interest. The maximum interest rate is specified in rule subsection 69O-154.204(2), F.A.C.

c. Termination Rates. Termination rates used in the computation of reserves shall be on the basis of a mortality table specified in rule subsection 69O-154.204(3), F.A.C., except as follows:
(I) Under contracts issued on or after January 1, 1999, for which premium rates are not guaranteed, and where the effects of insurer underwriting are specifically used by policy duration in the valuation morbidity standard or for return of premium or other deferred cash benefits, total termination rates may at the option of the insurer be used at ages and durations where these exceed specified mortality table rates, but not in excess of the lesser of:
(A) Eighty percent (80%) of the total termination rate used in the calculation of the gross premiums; or

(B) Eight percent (8%):
(II) For long-term care individual policies or group certificates issued on or after January 1, 1999, the contract reserve shall be established on a basis of:
(A) Separate mortality as specified in rule subsection 69O-154.204(3), F.A.C.; and,

(B) Terminations other than mortality, where such terminations are not to exceed:
(i) For policy years one through four, the lesser of eighty percent (80%) of the voluntary lapse rate used in the calculation of gross premiums and eight percent (8%);

(ii) For policy years five (5) and later, the lesser of one hundred percent (100%) of the voluntary lapse rate used in the calculation of gross premiums and four percent (4%);

(iii) Where a morbidity standard specified in rule subsection 69O-154.204(1), F.A.C., is on an aggregate basis, the morbidity standard shall be adjusted to reflect the effect of insurer underwriting by policy duration. The adjustments shall be appropriate to the underwriting and in accordance with commonly accepted actuarial practice.
(III) Under contracts issued prior to January 1, 1999, voluntary lapse rates accepted for valuation by the Commissioner of the state where the company is domiciled.
(A) In determining the morbidity assumptions, the actuary shall use assumptions that represent the best estimate of anticipated future experience, but shall not incorporate any expectation of future morbidity improvement.

(B) Morbidity improvement is a change, in the combined effect of claim frequency and the present value of future expected claim payments given that a claim has occurred, from the current morbidity tables or experience that will result in a reduction to reserves.

(C) It is not the intent of this provision to restrict the ability of the actuary to reflect the morbidity impact for a specific known event that has occurred and that is able to be evaluated and quantified.
(IV) For long-term care individual policies or group certificates issued on or after January 1, 2005, the contract reserve shall be established on the basis of:
(A) Separate mortality as specified in subsection 69O-154.204(3), F.A.C.; and,

(B) Terminations other than mortality, where the terminations are not to exceed:
(i) For policy year one, the lesser of 80 percent of the voluntary lapse rate used in the calculation of gross premiums and 6 percent;

(ii) For policy years 2 through 4, the lesser of 80 percent of the voluntary lapse rate used in the calculation of gross premiums and 4 percent; and,

(iii) For policy years 5 and later, the lesser of 100 percent of the voluntary lapse rate used in the calculation of gross premiums and 2 percent, except for group long-term care insurance sold to one or more employers, as defined in Section 627.9405(1)(a), F.S., where the 2 percent shall be 3 percent.
d. Reserve Method.
(I) For insurance except long-term care and return of premium or other deferred cash benefits, the minimum reserve is the reserve calculated on the two-year full preliminary term method; that is, under which the terminal reserve is zero at the first and the second contract anniversary.

(II) For long-term care insurance, the minimum reserve is the reserve calculated as follows:
(A) For individual policies and group certificates issued on or before December 31, 1991, reserves calculated on the two-year full preliminary term method, or any other method approved by the Commissioner of the state where the company is domiciled.

(B) For individual policies and group certificates issued on or after January 1, 1992 reserves calculated on the one-year full preliminary term method, except for policies issued prior to January 1, 1999, any method acceptable to the Commissioner of the state where the company is domiciled.
(III) For return of premium or other deferred cash benefits, the minimum reserve is the reserve calculated as follows:
(A) On the one year preliminary term method if the benefits are provided at any time before the twentieth anniversary;

(B) On the two year preliminary term method if the benefits are only provided on or after the twentieth anniversary.

(C) For policies issued prior to January 1, 1999, any method acceptable to the Commissioner of the state where the company is domiciled.
(IV) The preliminary term method shall be applied only in relation to the date of issue of a contract. Reserve adjustments introduced later as a result of rate increases, revisions in assumptions (e.g., projected inflation rates), or for other reasons, shall be applied as of the effective date of adoption of the adjusted basis.
e. Negative Reserves. Negative reserves on any benefit may at the option of the insurer be offset against positive reserves for other benefits in the same contract, but for each contract the total contract reserve for all benefits combined shall not be less than zero.

f. Nonforfeiture benefits. The contract reserve on a policy basis shall not be less than the net single premium for the nonforfeiture benefits at the appropriate policy duration, where the net single premium is computed according to the above specifications.
(c) Alternative Valuation Methods and Assumptions Generally.
1. An insurer may use any reasonable assumptions as to interest rates, termination or mortality rates, and rates of morbidity or other contingency, provided the contract reserve on all contracts to which an alternative method or basis is applied is not less in the aggregate than the amount determined according to the applicable standards specified above.

2. Subject to the condition in subparagraph 1. above, the insurer may employ methods other than the methods stated above in determining a sound value of its liabilities under these contracts, including, but not limited to the following:
a. The net level premium method;

b. The one-year full preliminary term method;

c. Prospective valuation on the basis of actual gross premiums with reasonable allowance for future expenses;

d. The use of approximations such as those involving:
(I) Age groupings;

(II) Groupings of several years of issue;

(III) Average amounts of indemnity;

(IV) Grouping of similar contract forms.
e. The computation of the reserve for one contract benefit as a percentage of, or by other relation to, the aggregate contract reserves exclusive of the benefit or benefits so valued; and,

f. The use of a composite annual claim cost for all or any combination of the benefits included in the contracts valued.
(d) Tests for Adequacy and Reasonableness of Contract Reserves.
1. A review shall be made annually by a qualified actuary of the insurer's prospective contract liabilities on contracts valued by tabular reserves to determine the continuing adequacy and reasonableness of the tabular reserves, giving consideration to future gross premiums. If the review indicates that the prospective reserves are no longer adequate subject to the minimum standards at paragraph (3)(b) above, the insurer shall add increments to the tabular reserves in order to meet or exceed the minimum standard.

2. If a company has a contract, or a group of related similar contracts, for which future gross premiums shall be restricted by contract, administrative rule, or other reasons, such that the future gross premiums reduced by expenses for administration, commissions, and taxes shall be insufficient to cover future claims, the company shall establish contract reserves for the shortfall in the aggregate.

69O FAC 154.204 | Specific Minimum Standards for Morbidity, Mortality and Interest

Specific minimum standards for morbidity, mortality and interest which apply to claim reserves according to year of incurral and to contract reserves according to year of issue:
(1) Morbidity.
(a) Minimum morbidity standards for valuation of specified individual contract health insurance benefits are as follows:
1. Disability Income Benefits Due to Accident or Sickness.
a. Contract Reserves:
(I) Contracts issued on or after January 1, 1965, and prior to January 1, 1998: The 1964 Commissioners Disability Table (64 CDT), incorporated by reference in Rule 69O-154.210, F.A.C., or a table acceptable to the Office as specified in paragraph 69O-154.204(1)(c), F.A.C.

(II) Contracts issued on or after January 1, 1999:
(A) The 1985 Commissioners Individual Disability Tables A (85CIDA), incorporated by reference in Rule 69O-154.210, F.A.C; or

(B) The 1985 Commissioners Individual Disability Tables B (85CIDB), incorporated by reference in Rule 69O-154.210, F.A.C.
(III) Contracts issued on or after January 1, 1998 and prior to January 1, 1999 inclusive: Optional use of either the 1964 Table or the 1985 Tables, or a table acceptable to the Office as specified in paragraph 69O-154.204(1)(c), F.A.C.

(IV) Each insurer may elect, with respect to all individual contracts issued in any one statement year, whether it will use Tables A or Tables B as the minimum standard. The insurer shall, however, elect to use the other tables with respect to any subsequent statement year.
b. Claim Reserves:
(I) For claims incurred on or before December 31, 2002, the minimum morbidity standard in effect for contract reserves on currently issued contracts as of the date the claim is incurred.

(II)
(A) For claims incurred on or after January 1, 2003, the 1985 Commissioners Individual Disability Table A (85CIDA) with claim termination rates multiplied by the following adjustment factors:
DurationAdjustment FactorAdjusted Termination Rates*
Week
10.3660.04831
20.3660.04172
30.3660.04063
40.3660.04355
50.3650.04088
60.3650.04271
70.3650.04380
80.3650.04344
90.3700.04292
100.3700.04107
110.3700.03848
120.3700.03478
130.3700.03034
Month
40.3910.08758
50.3710.07346
60.4350.07531
70.5000.07245
80.5640.06655
90.6130.05520
100.6630.04705
110.7120.04486
120.7560.04309
130.8000.04080
140.8440.03882
150.8880.03730
160.9320.03448
170.9760.03026
181.0200.02856
191.0490.02518
201.0780.02264
211.1070.02104
221.1360.01932
231.1650.01865
241.1950.01792
Year
31.3690.16839
41.2040.10114
51.1990.07434
6 and later1.000**
*The adjusted termination rates derived from the application of the adjustment factors to the DTS Valuation Table termination rates shown in exhibits 3a, 3b, 3c, 4, and 5 (Transactions of the Society of Actuaries (TSA) XXXVII, pp. 457-463) is displayed. The adjustment factors for age, elimination period, class, sex, and cause displayed in exhibits 3a, 3b, 3c, and 4 should be applied to the adjusted termination rates shown in this table.

**Applicable DTS Valuation Table duration rate from exhibits 3c and 4 (TSA XXXVII, pp. 462-463).
(B) The 85CIDA table so adjusted for the computation of claim reserves shall be known as 85CIDC (The 1985 Commissioners Individual Disability Table C).
2. Hospital Benefits, Surgical Benefits and Maternity Benefits (Scheduled benefits or fixed time period benefits only).
a. Contract Reserves:
(I) Contracts issued on or after January 1, 1955, and before January 1, 1982: The 1956 Intercompany Hospital-Surgical Tables, incorporated by reference in Rule 69O-154.210, F.A.C., or a table acceptable to the Office as specified in paragraph 69O-154.204(1)(c), F.A.C.

(II) Contracts issued on or after January 1, 1982: The 1974 Medical Expense Tables, Table A, Transactions of the Society of Actuaries, Volume XXX, pg. 63, incorporated by reference in Rule 69O-154.210, F.A.C., or a table acceptable to the Office as specified in paragraph 69O-154.204(1)(c), F.A.C. Refer to the paper (in the same volume, pg. 9) to which this table is appended, including its discussions, for methods of adjustment for benefits not directly valued in Table A: "Development of the 1974 Medical Expense Benefits," Houghton and Wolf, incorporated by reference in Rule 69O-154.210, F.A.C.
b. Claim Reserves: No specific standard. See sub-subparagraph 5., below entitled "Other Individual Contract Benefits".
3. Cancer Expense Benefits (Scheduled benefits or fixed time period benefits only).
a. Contract Reserves:
(I) Contracts issued on or after January 1, 1986, and prior to January 1, 1999: The 1985 NAIC Cancer Claim Cost Tables, incorporated by reference in Rule 69O-154.210, F.A.C., or a table acceptable to the Office as specified in paragraph 69O-154.204(1)(c), F.A.C.

(II) Contracts issued on or after January 1, 1999: The 1985 NAIC Cancer Claim Cost Tables, incorporated by reference in Rule 69O-154.210, F.A.C.
b. Claim Reserves: No specific standard. See subparagraph 5., below entitled "Other Individual Contract Benefits".
4. Accidental Death Benefits.
a. Contract Reserves: Contracts issued on or after January 1, 1965: The 1959 Accidental Death Benefits Table, incorporated by reference in Rule 69O-154.210, F.A.C.

b. Claim Reserves: Actual amount incurred.
5. Single Premium Credit Disability.
a. Contract Reserves:
(I) For contracts issued on or after January 1, 2003:
(A) For plans having less than a 30 day elimination period, the 1985 Commissioners Individual Disability Table A (85CIDA) with claim incidence rates increased by 12 percent.

(B) For plans having a 30 day and greater elimination period, the 85CIDA for a 14 day elimination period with the adjustment in sub-sub-subparagraph (A).
(II) For contracts issued prior to January 1, 2003, each insurer may elect either sub-sub-subparagraphs (A) or (B) to use as the minimum standard. Once an insurer elects to calculate reserves for all contracts on the standard defined in sub-subparagraph (I), all future valuations must be on that basis.
(A) The minimum morbidity standard in effect for contract reserves on currently issued contracts, as of the date the contract was issued; or

(B) The standard as defined in sub-subparagraph (I), applied to all contracts.
b. Claim Reserves: Claim reserves are to be determined as provided in paragraph 69O-154.203(1)(c), F.A.C.
6. Other Individual Contract Benefits.
a. Contract Reserves: For all other individual contract benefits, morbidity assumptions shall be determined as provided in the reserve standards.

b. Claim Reserves: For all benefits other than disability, claim reserves shall be determined as provided in the standards.
(b) Minimum morbidity standards for valuation of specified group contract health insurance benefits shall be as follows:
1. Disability Income Benefits Due to Accident or Sickness where Rules 69O-154.201 ? 69O-154.210 reference 69O-154.204, F.A.C.; otherwise Actuarial Guideline XLVII, as included in the most current version of the NAIC Accounting Practices and Procedures Manual adopted by subsection 69O-137.001(4), F.A.C.
a. Contract Reserves:
(I) Contracts issued prior to January 1, 1999: The same basis, if any, as that employed by the insurer as of January 1, 1999 or a table acceptable to the Office as specified in paragraph 69O-154.204(1)(c), F.A.C.

(II) Contracts issued on or after January 1, 1999: The 1987 Commissioners Group Disability Income Table (87CGDT).
b. Claim Reserves:
(I) For claims incurred on or after January 1, 1999: The 87CGDT.

(II) For claims incurred prior to January 1, 1999: Use of the 87CGDT is optional.
2. Single Premium Credit Disability.
a. Contract Reserves:
(I) For contracts issued on or after January 1, 2003:
(A) For plans having less than a 30 day elimination period, the 1985 Commissioners Individual Disability Table A (85CIDA) with claim incidence rates increased by 12 percent.

(B) For plans having a 30 day and greater elimination period, the 85CIDA for a 14 day elimination period with the adjustment in (A).
(II) For contracts issued prior to January 1, 2003, each insurer may elect to use either sub-subparagraph (I) or (II) as the minimum standard. Once an insurer elects to calculate reserves for all contracts on the standard defined in sub-subparagraph (I), all future valuations must be on that basis.
(A) The minimum morbidity standard in effect for contract reserves on currently issued contracts, as of the date the contract was issued, or

(B) The standard as defined in sub-subparagraph (I), applied to all contracts.
b. Claim Reserves: Claim reserves are to be determined as provided in paragraph 69O-154.203(1)(c), F.A.C.
3. Other Group Contract Benefits.
a. Contract Reserves: For all other group contract benefits, morbidity assumptions shall be determined as provided in the reserve standards.

b. Claim Reserves: For all benefits other than disability, claim reserves shall be determined as provided in the standards.
(c) A table of factors used to value contract reserves for policies issued on or before December 31, 1998 or used to value claim reserves incurred on or before December 31, 1998, shall be acceptable to the Office if it has been accepted for valuation by the Commissioner of the state where the company is domiciled. If the insurer is a Florida domiciled insurer it will be acceptable if the valuation is done in accordance with commonly accepted actuarial practice.
(2) Interest.
(a) For contract reserves, the maximum interest rate is the maximum rate specified in Section 625.121(6)(a), F.S., in the valuation of whole life insurance with an interest guarantee period greater than twenty years issued on the same date as the health insurance contract. An interest rate used to value contract reserves for policies issued on or before December 31, 1998 or used to value claim reserves incurred on or before December 31, 1998, shall be acceptable to the Office if it has been accepted for valuation by the Commissioner of the state where the company is domiciled.

(b) For claim reserves on policies that require contract reserves, the maximum interest rate is the maximum rate specified in Section 625.121(6)(a), F.S., in the valuation of whole life insurance with an interest guarantee period greater than twenty years issued on the same date as the claim incurral date.

(c) For claim reserves on policies not requiring contract reserves, the maximum interest rate is the maximum rate specified in Section 625.121(5)(a)2., F.A.C., in the valuation of single premium immediate annuities issued on the same date as the claim incurral date, reduced by one hundred basis points.
(3) Mortality.
(a) For all individual policies or group certificates issued before January 1, 1999, the mortality basis used shall be according to a table (but without use of selection factors) permitted by law for the valuation of whole life insurance issued on the same date as the health insurance contract or a table acceptable to the Office as specified in paragraph (3)(d) below.

(b) For all individual policies or group certificates other than long-term care insurance issued on or after January 1, 1999, the mortality basis used shall be according to a table of rates (but without use of selection factors) specified in Section 625.121(5)(a)2., F.S., for the valuation of whole life insurance issued on the same date as the health insurance contract.

(c)
1. For long-term care insurance individual policies or group certificates issued on or after January 1, 1999, the mortality basis used shall be the 1983 Group Annuity Mortality Table, incorporated by reference in Rule 69O-154.210, F.A.C., without projection.

2. For long-term care insurance individual policies or group certificates issued on or after January 1, 2005, the mortality basis used shall be the 1994 Group Annuity Mortality Table, which is the 1994 GAR Table without projection, qx1994, incorporated by reference in Rule 69O-162.108, F.A.C.
(d) A table of mortality factors used for the purpose of valuing contract reserves or claim reserves for policies issued before January 1, 1999, shall be acceptable to the Office if it has been accepted for that purpose by the commissioner of the state where the insurer is domiciled. If the insurer is a Florida domiciled insurer, the mortality factors shall be acceptable if the valuation is done in accordance with commonly accepted actuarial practice.

(e) For single premium credit insurance using the adjusted 85 CIDA table, no separate mortality shall be assumed.

69O FAC 154.205 | Reserves for Waiver of Premium

Waiver of premium reserves involve several special considerations.
(1) The disability valuation tables promulgated by the National Association of Insurance Commissioners are based on exposures that include contracts on premium waiver as in-force contracts. Therefore, contract reserves based on these tables are not reserves on "active lives" but rather reserves on contracts "in force." This is true for the 1964 Commissioner's Disability Table and for both the 1985 CIDA and CIDB tables.

(2) Accordingly, tabular reserves using any of these tables shall value reserves on the following basis:
(a) Claim reserves shall include reserves for premiums expected to be waived, valuing as a minimum the valuation net premium being waived.

(b) Premium reserves shall include contracts on premium waiver as in-force contracts, valuing as a minimum the unearned modal valuation net premium being waived.

(c) Contract reserves shall include recognition of the waiver of premium benefit in addition to other contract benefits provided for, valuing as a minimum the valuation net premium to be waived.
(3)
(a) If an insurer is valuing reserves on what is truly an active life table, or if a specific valuation table is not being used but the insurer's gross premiums are calculated on a basis that includes in the projected exposure only those contracts for which premiums are being paid, then it shall not be necessary to provide specifically for waiver of premium reserves.

(b) Any insurer using a true active life basis shall carefully consider whether additional liability shall be recognized due to premiums waived during periods of disability or during claim continuation.

69O FAC 154.206 | Reinsurance

Increases to or credits against reserves carried arising because of reinsurance assumed or reinsurance ceded, except as noted below, shall be determined in a manner consistent with these minimum reserve standards and with all applicable provisions of the reinsurance contracts which affect the insurer's liabilities. If increases to or credits against reserves are not determined in a manner consistent with these minimum reserve standards, the insurer will be required to demonstrate to the Office that assumed reserves are not less than those required and ceded reserves are not greater than those required by these minimum reserve standards.

69O FAC 154.210 | Tables

(1) The following tables are hereby adopted and incorporated by reference:
(a) 1964 Commissioners Disability Table;

(b) 1985 Commissioners Individual Disability Tables A;

(c) 1985 Commissioners Individual Disability Tables B;

(d) 1956 Intercompany Hospital-Surgical Tables;

(e) 1974 Medical Expense Tables, Table A, Transactions of the Society of Actuaries, Volume XXX, page 63;

(f) "Development of the 1974 Medical Expense Benefits", Houghton and Wolfe, Transactions of the Society of Actuaries, Volume XXX, page 9;

(g) 1985 NAIC Cancer Claim Cost Tables;

(h) 1959 Accidental Death Benefits Table;

(i) 1987 Commissioners Group Disability Income Table;

(j) 1983 Group Annuity Mortality Table.
(2) The tables in subsection (1) above are available from the Bureau of Life & Health Insurer Solvency, 200 East Gaines Street, Tallahassee, Florida 32399-0327.

69O FAC 154.302 | Applicability and Scope

69O FAC 154.303 | Initial Notice (Repealed)

69O FAC 154.304 | Notice of Occurrence of a Qualifying Event

Each contract, policy, certificate and handbook must contain a Notice of Occurrence of a Qualifying Event provision. This provision must include the information required by Section 627.6692(5)(d)1., F.S. The beneficiary shall notify the carrier in writing within sixty-three (63) days, as evidenced by postmark, after the occurrence of the qualifying event or the termination of coverage whichever is later.

69O FAC 154.305 | Election and Premium Notice Form

(1) Within 14 days of the date that the carrier receives the notice of occurrence of a qualifying event from the qualified beneficiary the carrier must send to the employee, covered spouse and covered dependents, by certified mail, the Election and Premium Notice Form OIR-B2-1261 (REV 8/03), which is hereby adopted and incorporated by reference. Copies of the forms are available and may be printed from the Office's website: http://www.FLOir.com/iPortal.

(2) Carriers may develop a similar form which must include the information in Form OIR-B2-1261. Any similar form must be filed and approved before use pursuant to the requirements of Section 627.410, F.S. Any filing shall be submitted to the Office electronically through http://www.FLOir.com/iPortal.

69O FAC 154.306 | Election, Billing and Payment of Premium

(1) The employee, covered spouse and covered dependents have until the 30th day, as evidenced by postmark, after receiving the Election and Premium Notice form described in Rule 69O-154.305, F.A.C., to elect coverage continuation in writing and pay the premium to the carrier.

(2) The carrier or its designee must process all elections, within 30 days and provide coverage retroactively to the day coverage would have otherwise terminated due to the qualifying event. The first premium payment must include the coverage paid to the end of the month in which the first payment of premium is made.

69O FAC 154.410 | Withdrawal From the Group Market

(1) If a health insurance issuer elects to withdraw from the group market, the issuer must provide 180 days' written notice to the Office and to all policyholders, certificateholders and beneficiaries provided coverage by the issuer in that market.

(2) A notice of withdrawal from the group market means an issuer may then non-renew coverage upon the next renewal date of policies affected by the withdrawal.

(3) A policy may not be terminated except at the next renewal date following the 180 day notice period.

(4) Notice to the Office must include a copy of all forms issued in that market.

(5) With respect to notice to policyholders, certificateholders, beneficiaries, a mailing to one household constitutes a mailing to all covered persons residing in the household.

(6) A separate mailing is required for each separate household.

(7) If the issuer elects to exit or withdraw from the group market, re-entry into that market is prohibited for five years from the last date of coverage provided in that market.

(8) The filing shall be submitted to the Office electronically through http://www.FLOir.com/iPortal.

69O FAC 154.512 | Withdrawal From the Small Group Market

(1) If a small employer carrier elects to withdraw from the small group health insurance market, the carrier must provide 180 days' written notice to the Office and to all policyholders, certificateholders and beneficiaries provided coverage by the carrier in that market.

(2) A notice of withdrawal from the small group market means an issuer may then non-renew coverage upon the next renewal date of policies affected by the withdrawal.

(3) A policy may not be terminated except at the next renewal date following the 180 day notice period.

(4) Notice to the Office must include a copy of all forms issued in that market.

(5) With respect to notice to policyholders, certificateholders, beneficiaries, a mailing to one household constitutes a mailing to all covered persons residing in the household.

(6) A separate mailing is required for each separate household.

(7) If the small employer carrier elects to exit or withdraw from the small group market, re-entry into that market is prohibited for five years from the last date of coverage provided in that market.

(8) The filing shall be submitted to the Office electronically through http://www.FLOir.com/iPortal.

69O FAC 154.530 | Renewal of Group Health Insurance

An insurer or health maintenance organization that issues a group health insurance policy must renew or continue in force such coverage at the option of the policyholder. Employers are eligible to renew that exact coverage, subject to the participation requirement provisions of Sections 627.6571(2) and 641.31074(2), F.S.
69O-156 | Medicare Supplement Insurance

69O FAC 156.001 | Purpose

The purpose of this chapter is to provide for the reasonable standardization and simplification of terms and benefits of Medicare supplement policies; to facilitate public understanding and comparison of such policies; to eliminate provisions contained in such policies which may be misleading or confusing in connection with the purchase of such policies or with the settlement of claims; and to provide for full disclosure in the sale of accident and sickness insurance coverage to persons eligible for Medicare.

69O FAC 156.002 | Scope

(1)
(a) These rules shall apply to all Medicare supplement insurance policies, including certificates issued or delivered in this state under a group Medicare supplement policy which has been effectuated within or outside this state, and other Medicare supplement health benefit plans offered by private entities and issued, delivered or issued for delivery in this state on and after January 1, 1992.

(b) For Medicare supplement policies and certificates issued before January 1, 1992, only Rules 69O-156.006, 69O-156.010, 69O-156.011, 69O-156.014 and 69O-156.018, F.A.C., shall apply.
(2) Provisions of these rules that are in conflict with the provisions of any other rule previously promulgated shall, with respect to Medicare supplement insurance, be superior and controlling.

69O FAC 156.003 | Definitions

For purposes of this rule:
(1) "Applicant" means:
(a) In the case of an individual Medicare supplement policy, the person who seeks to contract for insurance benefits, and

(b) In the case of a group Medicare supplement policy, the proposed certificate holder.
(2) "Bankruptcy" means when a Medicare Advantage organization that is not an issuer has filed, or has had filed against it, a petition for declaration of bankruptcy and has ceased doing business in the state.

(3) "Certificate" means any certificate delivered or issued for delivery in this state under a group Medicare supplement policy.

(4) "Certificate Form" means the form on which the certificate is delivered or issued for delivery by the issuer.

(5) "Continuous period of creditable coverage" means the period during which an individual was covered by creditable coverage, if during the period of the coverage the individual had no breaks in coverage greater than sixty-three (63) days.

(6) "Creditable coverage" means, with respect to an individual, coverage of the individual as defined in Section 627.6561(5), F.S.

(7) "Office" means the Office of Insurance Regulation.

(8) "Employee welfare benefit plan" means a plan, fund or program of employee benefits as defined in 29 U.S.C. Section 1002 (1999) (Employee Retirement Income Security Act) which is hereby incorporated by reference.

(9) "Insolvency" means that all the assets of the insurer, if made immediately available, would not be sufficient to discharge all its liabilities or that the insurer is unable to pay its debts as they become due in the usual course of business. When the context of any provision of the insurance code so indicates, insolvency also includes and is defined as impairment of surplus as defined in Section 631.011(10), F.S., and impairment of capital as defined in Section 631.011(9), F.S.

(10) "Issuer" includes insurance companies, fraternal benefit societies, health maintenance organizations, and any other entity delivering or issuing for delivery in this state Medicare supplement policies or certificates.

(11) "Medicare" means the "Health Insurance for the Aged Act," Title XVIII of the Social Security Amendments of 1965, as then constituted or later amended.

(12) "Medicare Advantage plan" means a plan of coverage for health benefits under Medicare Part C as defined in 42 U.S.C. Section 1395w-28(b)(1), which is hereby incorporated by reference, and includes:
(a) Coordinated care plans which provide health care services, including but not limited to health maintenance organization plans (with or without a point-of-service option), plans offered by provide-sponsored organizations, and preferred provider organization plans;

(b) Medical savings account plans coupled with a contribution into a Medicare Advantage medical savings account; and

(c) Medicare Advantage private fee-for-service plans.
(13) "Medicare Supplement Policy" means a group or individual policy of health insurance or a subscriber contract of health maintenance organizations, other than a policy issued pursuant to a contract under Section 1876 of the federal Social Security Act (42 U.S.C. Section 1395 et seq.) or an issued policy under a demonstration project as specified in 42 U.S.C. Section 1395 ss. (g)(1), which is advertised, marketed or designed primarily as a supplement to reimbursements under Medicare for the hospital, medical or surgical expenses of persons eligible for Medicare. "Medicare supplement policy does not include Medicare Advantage plans established under Medicare Part C, Outpatient Prescription Drug plans established under Medicare Part D, or any Health Care Prepayment Plan (HCPP) that provides benefits pursuant to an agreement under 1833(a)(1)(A) of the Social Security Act."

(14) "Newly Eligible Medicare Beneficiary" means anyone who attains age 65 on or after January 1, 2020, or who first becomes eligible for Medicare benefits due to age, disability, or end-stage renal disease on or after January 1, 2020.

(15) "Policy" as used herein is as defined in Section 627.672, F.S.

(16) "Policy Form" means the form on which the policy is delivered or issued for delivery by the issuer.

(17) "Pre-existing condition" shall not be defined to limit or preclude liability under a policy for a period longer than six (6) months because of a condition for which medical advice was given or treatment was recommended by or received from a physician within six months before the effective date of the coverage.

(18) "Pre-Standardized Medicare supplement benefit plan," "Pre-Standardized benefit plan" or "Pre-Standardized plan" means a group or individual policy of Medicare supplement insurance issued prior to January 1, 1992.

(19) "1990 Standardized Medicare supplement benefit plan," "1990 Standardized benefit plan" or "1990 plan" means a group or individual policy of Medicare supplement insurance issued on or after January 1, 1992, and with an effective date for coverage prior to June 1, 2010.

(20) "2010 Standardized Medicare supplement benefit plan," "2010 Standardized benefit plan" or "2010 plan" means a group or individual policy of Medicare supplement insurance with an effective date for coverage on or after June 1, 2010.

(21) "2020 Standardized Medicare supplement benefit plan," "2020 Standardized benefit plan," or "2020 plan" means
(a) For any eligible person, a group or individual policy of Medicare supplement insurance Plan A, B, D, G, High Deductible G, K, L, M, or N with an effective date for coverage on or after January 1, 2020; or

(b) For individuals eligible for Medicare prior to January 1, 2020, a group or individual policy of Medicare supplement insurance Plan A, B, C, D, F, High Deductible F, G, High Deductible G, K, L, M, or N with an effective date for coverage on or after January 1, 2020.
(22) "Replacement" is any transaction wherein new Medicare supplement insurance is to be purchased and it is known to the agent, broker or insurer at the time of application that, as a part of the transaction, existing accident and health insurance has been or is to be lapsed or the benefits thereof substantially reduced.

(23) "Secretary" means the Secretary of the United States Department of Health and Human Services.

69O FAC 156.004 | Policy Definitions and Terms

No policy or certificate may be advertised, solicited or issued for delivery in this state as a Medicare supplement policy or certificate unless such policy or certificate contains definitions or terms which conform to the requirements of this section.

(1) "Accident," "accidental injury" and "accidental means" shall be defined to employ "result" language and shall not include words which establish an accidental means test or use words such as "external, violent, visible wounds" or similar words of description or characterization.
(a) The definition shall not be more restrictive than the following: "Injury or injuries for which benefits are provided means accidental bodily injuries sustained by the insured person which are the direct result of an accident, independent of disease or bodily infirmity or any other cause, and occurs while insurance is in force".

(b) Such definition may provide that injuries shall not include injuries for which benefits are provided or available under any workers' compensation, employers' liability or similar law, or motor vehicle no-fault plan, unless prohibited by law.
(2) "Benefit period" or "Medicare benefit period" shall not be defined more restrictively than as defined in the Medicare program.

(3) "Convalescent nursing home," "extended care facility" or "skilled nursing facility" shall not be defined more restrictively than as defined in the Medicare program.

(4) "Health Care Expenses" means for the purposes of Rule 69O-156.011, F.A.C., expenses of health maintenance organizations associated with the delivery of health care services, which expenses are analogous to incurred losses of insurers.

(5) "Hospital" may be defined in relation to its status, facilities and available services or to reflect its accreditation by the Joint Commission on Accreditation of Hospitals, but not more restrictively than as defined in the Medicare program.

(6) "Medicare" shall be defined in the policy and certificate. Medicare may be substantially defined as "The Health Insurance for the Aged Act, Title XVIII of the Social Security Amendments of 1965 as Then Constituted or Later Amended," or "Title I, Part I of Public Law 89-97, as Enacted by the Eighty-Ninth Congress of the United States of America and popularly known as the Health Insurance for the Aged Act, as then constituted and any later amendments or substitutes thereof," or words of similar import.

(7) "Medicare Eligible Expenses" shall mean expenses of the kinds covered by Medicare Parts A and B, to the extent recognized as reasonable and medically necessary by Medicare.

(8) "Physician" shall not be defined more restrictively than as defined in the Medicare program.

(9) "Sickness" shall not be defined to be more restrictive than the following: "Sickness means illness or disease of an insured person which first manifests itself after the effective date of insurance and while the insurance is in force." The definition may be further modified to exclude sickness or disease to the extent benefits are provided under any workers' compensation, occupational disease, employer's liability or similar law.

69O FAC 156.005 | Policy Provisions

(1) Except for permitted preexisting condition clauses as described in paragraphs 69O-156.006(1)(b), 69O-156.007(1)(a), and 69O-156.0075(1)(a), F.A.C., of this chapter, no policy or certificate may be advertised, solicited or issued for delivery in this State as a Medicare supplement policy if such policy or certificate contains limitations or exclusions on coverage that are more restrictive than those of Medicare.

(2) No Medicare supplement policy or certificate may use waivers to exclude, limit or reduce coverage or benefits for specifically named or described preexisting diseases or physical conditions.

(3) No Medicare supplement policy or certificate in force in the State shall contain benefits which duplicate benefits provided by Medicare.

(4)
(a) Subject to paragraphs 69O-156.006(1)(e), (f), and (h), and paragraphs 69O-156.007(1)(d) and (e), F.A.C., a Medicare supplement policy with benefits for outpatient prescription drugs in existence prior to January 1, 2006, shall be renewed for current policyholders who do not enroll in Part D at the option of the policyholder.

(b) A Medicare supplement policy with benefits for outpatient prescription drugs shall not be issued after December 31, 2005.

(c) After December 31, 2005, a Medicare supplement policy with benefits for outpatient prescription drugs may not be renewed after the policyholder enrolls in Medicare Part D unless:
1. The policy is modified to eliminate outpatient prescription coverage for expenses of outpatient prescription drugs incurred after the effective date of the individual's coverage under a Part D plan; and

2. Premiums are adjusted to reflect the elimination of outpatient prescription drug coverage at the time of Medicare Part D enrollment, accounting for any claims paid, if applicable.

69O FAC 156.006 | Minimum Benefit Standards for Pre-Standardized Medicare Supplement Benefit Plan, Policies or Certificates Issued for Delivery Prior to January 1, 1992

As it relates to Pre-Standarized Medicare Supplement Benefit Plan Policies or certificates issued for delivery prior to January 1, 1992, no policy or certificate may be advertised, solicited, issued, delivered or issued for delivery in this State as a Medicare supplement policy or certificate unless it meets or exceeds the following minimum standards. These are minimum standards and do not preclude the inclusion of other provisions or benefits which are not inconsistent with these standards.

(1) General Standards. The following standards apply to Medicare supplement policies and certificates and are in addition to all other requirements of this regulation.
(a) Medicare supplement coverage shall provide at least, but not be limited to, the benefits provided in Section 627.674, F.S.

(b) A Medicare supplement policy or certificate shall not exclude or limit benefits for losses incurred more than six (6) months from the effective date of coverage because it involved a preexisting condition. The policy or certificate may not define a preexisting condition more restrictively than a condition for which medical advice was given or treatment was recommended by or received from a physician within six (6) months before the effective date of coverage.

(c) A Medicare supplement policy or certificate shall not indemnify against losses resulting from sickness on a different basis than losses resulting from accidents.

(d) A Medicare supplement policy or certificate shall provide that benefits designed to cover cost sharing amounts under Medicare will be changed automatically to coincide with any changes in the applicable Medicare deductible, copayment, or coinsurance amounts. Premiums may be modified to correspond with such changes. The premium changes must be submitted to and approved by the Office pursuant to Sections 627.410, 627.411 and 627.674, F.S.

(e) A "noncancellable," "guaranteed renewable," or "noncancellable and guaranteed renewable" Medicare supplement policy shall not:
1. Provide for termination of coverage of a spouse solely because of the occurrence of an event specified for termination of coverage of the insured, other than the nonpayment of premium; or

2. Be cancelled or nonrenewed by the issuer solely on the grounds of deterioration of health.
(f)
1. An issuer shall neither cancel nor nonrenew a Medicare supplement policy or certificate for any reason other than nonpayment of premium or material misrepresentation.

2.
a. If a group Medicare supplement insurance policy is terminated by the group policyholder and not replaced as provided in subparagraph 69O-156.006(1)(f)4., F.A.C., the issuer shall offer certificateholders an individual Medicare supplement policy. The issuer shall offer the certificateholder at least the following choices:
(I) An individual Medicare supplement policy currently offered by the issuer having comparable benefits to those contained in the terminated group Medicare supplement policy; and

(II) An individual Medicare supplement policy which provides only such benefits as are required to meet the minimum standards as defined in subsection 69O-156.0075(2), F.A.C.
b. In either case, if the group policy was issued on an issue age basis, the individual Medicare supplement policy is issued at the original issue age of the terminated certificateholder, and is at the duration of the terminated certificate at the time of conversion.
3. If membership in a group is terminated, the issuer shall:
a. Offer the certificateholder such conversion opportunities as are described in subparagraph 69O-156.006(1)(f)2., F.A.C.; or

b. At the option of the group policyholder, offer the certificateholder continuation of coverage under the group policy.
4.
a. If a group Medicare supplement policy is replaced by another group Medicare supplement policy purchased by the same policyholder, the succeeding issuer shall offer coverage to all persons covered under the old group policy on its date of termination. Coverage under the new group policy shall not result in any exclusion for preexisting conditions that would have been covered under the group policy being replaced.

b. If the terminated group policy was issued on an issue age basis and the policy reserves are transferred to the new insurer, the new group certificates shall retain the original issue ages of the insureds and shall commence at the same duration as the terminated certificates.
(g) Termination of a Medicare supplement policy or certificate shall be without prejudice to any continuous loss which commenced while the policy was in force, but the extension of benefits beyond the period during which the policy was in force may be predicated upon the continuous total disability of the insured, limited to the duration of the policy benefit period, if any, or payment of the maximum benefits. Receipt of Medicare Part D benefits will not be considered in determining a continuous loss.

(h) If a Medicare supplement policy eliminates an outpatient drug benefit as a result of requirements imposed by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, the modified policy shall be deemed to satisfy the guaranteed renewal requirements of this subsection.
(2) Minimum Benefit Standards.
(a) Coverage of Part A Medicare eligible expenses for hospitalization to the extent not covered by Medicare from the 61st day through the 90th day in any Medicare benefit period.

(b) Coverage for either all or none of the Medicare Part A inpatient hospital deductible amount.

(c) Coverage of Part A Medicare eligible expenses incurred as daily hospital charges during use of Medicare's lifetime hospital inpatient reserve days.

(d) Upon exhaustion of all Medicare hospital inpatient coverage including the lifetime reserve days, coverage of ninety percent (90%) of all Medicare Part A eligible expenses for hospitalization not covered by Medicare subject to a lifetime maximum benefit of an additional 365 days.

(e) Coverage under Medicare Part A for the reasonable cost of the first three (3) pints of blood (or equivalent quantities of packed red blood cells, as defined under Federal regulations) unless replaced in accordance with Federal regulations or already paid for under Part B.

(f) Coverage for the coinsurance amount or in the case of hospital outpatient department services paid under a prospective payment system, the copayment amount, of Medicare eligible expenses under Part B regardless of hospital confinement, subject to a maximum calendar year out-of-pocket amount equal to the Medicare Part B deductible.

(g) Effective January 1, 1990, coverage under Medicare Part B for the reasonable cost of the first three (3) pints of blood (or equivalent quantities of packed red blood cells, as defined under Federal regulations), unless replaced in accordance with Federal regulations or already paid for under Part A, subject to the Medicare deductible amount.

69O FAC 156.007 | Benefit Standards for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued or Delivered on or After January 1, 1992, and with an Effective Date for Coverage Prior to June 1, 2010.

The following standards are applicable to all 1990 standardized Medicare supplement benefit plan policies or certificates delivered or issued for delivery in this state on or after January 1, 1992, and with an effective date for coverage prior to June 1, 2010. No policy or certificate may be advertised, solicited, delivered or issued for delivery in this state as a Medicare supplement policy or certificate unless it complies with these benefit standards.

(1) General Standards. The following standards apply to Medicare supplement policies and certificates and are in addition to all other requirements of this regulation.
(a) A Medicare supplement policy or certificate shall not exclude or limit benefits for losses incurred more than six (6) months from the effective date of coverage because it involved a preexisting condition. The policy or certificate may not define a preexisting condition more restrictively than a condition for which medical advice was given or treatment was recommended by or received from a physician within six (6) months before the effective date of coverage.

(b) A Medicare supplement policy or certificate shall not indemnify against losses resulting from sickness on a different basis than losses resulting from accidents.

(c) A Medicare supplement policy or certificate shall provide that benefits designed to cover cost sharing amounts under Medicare will be changed automatically to coincide with any changes in the applicable Medicare deductible, copayment, or coinsurance amounts. Premiums may be modified to correspond with such changes. The premium changes must be submitted to and approved by the Office pursuant to Sections 627.410, 627.411 and 627.674, F.S.

(d) No Medicare supplement policy or certificate shall provide for termination of coverage of a spouse solely because of the occurrence of an event specified for termination of coverage of the insured, other than the nonpayment of premium.

(e) Each Medicare supplement policy shall be guaranteed renewable and:
1. The issuer shall not cancel or nonrenew the policy solely on the ground of health status of the individual; and

2. The issuer shall not cancel or nonrenew the policy for any reason other than nonpayment of premium or material misrepresentation.

3.
a. If the Medicare supplement policy is terminated by the group policyholder and is not replaced as provided under subparagraph 69O-156.007(1)(e)5., F.A.C., the issuer shall offer certificateholders an individual Medicare supplement policy which, at the option of the certificateholder:
(I) Provides for continuation of the benefits contained in the group policy, or

(II) Provides for such benefits as otherwise meets the requirements of this rule.
b. In either case, if the group policy was issued on an issue age basis, the individual Medicare supplement policy is issued at the original issue age of the terminated certificateholder, and is at the duration of the terminated certificate at the time of conversion.
4. If an individual is a certificateholder in a group Medicare supplement policy and the individual terminates membership in the group, the issuer shall:
a. Offer the certificateholder the conversion opportunity described in subparagraph 69O-156.007(1)(e)3., F.A.C., or

b. At the option of the group policyholder, offer the certificateholder continuation of coverage under the group policy.
5.
a. If a group Medicare supplement policy is replaced by another group Medicare supplement policy purchased by the same policyholder, the succeeding issuer shall offer coverage to all persons covered under the old group policy on its date of termination. Coverage under the new policy shall not result in any exclusion for preexisting conditions that would have been covered under the group policy being replaced.

b. If the terminated group policy was issued on an issue age basis and the policy reserves are transferred to the new insurer, the new group certificates shall retain the original issue ages of the insureds and shall commence at the same duration as the terminated certificates.
6. If a Medicare supplement policy eliminates an outpatient prescription drug benefit as a result of requirements imposed by the Medicare Prescription Drug, Improvement and Modernization Act of 2003, the modified policy shall be deemed to satisfy the guaranteed renewal requirements of this paragraph.

7. If an individual Medicare supplement policy/certificate is issued to replace an existing issue age rated policy/certificate of the same insurer, the replacing policy shall be issued at the original issue age of the policyholder/certificateholder, and is at the duration of the terminated policy/certificate at the time of replacement.
(f) Termination of a Medicare supplement policy or certificate shall be without prejudice to any continuous loss which commenced while the policy was in force, but the extension of benefits beyond the period during which the policy was in force may be conditioned upon the continuous total disability of the insured, limited to the duration of the policy benefit period, if any, or payment of the maximum benefits. Receipt of Medicare Part D benefits will not be considered in determining a continuous loss.

(g)
1. A Medicare supplement policy or certificate shall provide that benefits and premiums under the policy or certificate shall be suspended at the request of the policyholder or certificateholder for the period (not to exceed twenty-four (24) months) in which the policyholder or certificateholder has applied for and is determined to be entitled to medical assistance under Title XIX of the Social Security Act, but only if the policyholder or certificateholder notifies the issuer of such policy or certificate within ninety (90) days after the date the individual becomes entitled to such assistance. Upon receipt of timely notice, the issuer shall return to the policyholder or certificateholder that portion of the premium attributable to the period of Medicaid eligibility, subject to adjustment for paid claims.

2. If such suspension occurs and if the policyholder or certificateholder loses entitlement to such medical assistance, such policy or certificate shall be automatically reinstituted (effective as of the date of termination of such entitlement) as of the termination of such entitlement if the policyholder or certificateholder provides notice of loss of such entitlement within ninety (90) days after the date of such loss and pays the premium attributable to the period, effective as of the date of termination of such entitlement.

3. Each Medicare supplement policy shall provide that benefits and premiums under the policy shall be suspended (for any period that is provided by federal regulation) at the request of the policyholder if the policyholder is entitled to benefits under Section 226(b), of the Social Security Act and is covered under a group health plan (as defined in Section 1862(b)(1)(A)(v), of the Social Security Act). If suspension occurs and if the policyholder or certificate holder loses coverage under the group health plan, the policy shall be automatically reinstituted (effective as of the date of loss of coverage) if the policyholder provides notice of loss of coverage within 90 days after the date of the loss of coverage and pays the premium attributable to the period, effective as of the date of termination of enrollment in the group health plan.

4. Reinstitution of such coverages as described in subparagraphs 2. and 3.:
a. Shall not provide for any waiting period with respect to treatment of preexisting conditions;

b. Shall provide for resumption of coverage that is substantially equivalent to coverage in effect before the date of such suspension. If the suspended Medicare supplement policy provided coverage for outpatient prescription drugs, reinstitution of the policy of Medicare Part D enrollees shall be without coverage for outpatient prescription drugs and shall otherwise provide substantially equivalent coverage to the coverage in effect before the date of suspension; and

c. Shall provide for classification of premiums on terms at least as favorable to the policyholder or certificateholder as the premium classification terms that would have applied to the policyholder or certificateholder had the coverage not been suspended.
(h) If an issuer makes a written offer to the Medicare Supplement policyholders or certificateholders of one or more of its plans, to exchange during a specified period from his or her 1990 Standardized benefit plan, as described in Rule 69O-156.008, F.A.C., to a 2010 Standardized benefit plan, as described in Rule 69O-156.0085, F.A.C., the offer and subsequent exchange shall comply with the following requirements:
1. An issuer need not provide justification to the Office if the insured replaces a 1990 Standardized benefit plan policy or certificate with an issue age rated 2010 Standardized benefit plan policy or certificate at the insured's original issue age and duration. If an insured's policy or certificate to be replaced is priced on an issue age rate schedule at the time of such offer, the rate charged to the insured for the new exchanged policy shall recognize the policy reserve buildup, due to the pre-funding inherent in the use of an issue age rate basis, for the benefit of the insured. The method proposed to be used by an issuer must be submitted to and approved by the Office pursuant to Sections 627.410, 627.411 and 627.674, F.S.

2. The rating class of the new policy or certificate shall be the class closest to the insured's class of the replaced coverage.

3. An issuer may not apply new preexisting condition limitations or a new incontestability period to the new policy for those benefits contained in the exchanged 1990 Standardized benefit plan policy or certificate of the insured, but may apply preexisting condition limitations of no more than six (6) months to any added benefits contained in the new 2010 Standardized benefit plan policy or certificate not contained in the exchanged policy.

4. The new policy or certificate shall be offered to all policyholders or certificateholders within a given plan, except where the offer or issue would be in violation of state or federal law.
(2) Standards for Basic ("Core") Benefits Common to Benefit Plans A-J. Every issuer shall make available a policy or certificate including only the following basic "core" package of benefits to each prospective insured. An issuer may make available to prospective insureds any of the other Medicare Supplement Insurance Benefit Plans in addition to the basic "core" package, but not in lieu thereof.
(a) Coverage of Part A Medicare Eligible Expenses for hospitalization to the extent not covered by Medicare from the 61st day through the 90th day in any Medicare benefit period;

(b) Coverage of Part A Medicare Eligible Expenses incurred for hospitalization to the extent not covered by Medicare for each Medicare lifetime inpatient reserve day used;

(c) Upon exhaustion of the Medicare hospital inpatient coverage including the lifetime reserve days, coverage of 100% of the Medicare Part A eligible expenses for hospitalization paid at the applicable prospective payment system (PPS) rate, or other appropriate Medicare standard of payment, subject to a lifetime maximum benefit of an additional 365 days. The provider shall accept the issuer's payment as payment in full and may not bill the insured for any balance;

(d) Coverage under Medicare Parts A and B for the reasonable cost of the first three (3) pints of blood (or equivalent quantities of packed red blood cells, as defined under federal regulations) unless replaced in accordance with federal regulations;

(e) Coverage for the coinsurance amount, or in the case of hospital outpatient department services paid under a prospective payment system, the copayment amount, of Medicare eligible expenses under Part B regardless of hospital confinement, subject to the Medicare Part B deductible.
(3) Standards for Additional Benefits. The following additional benefits shall be included in Medicare Supplement Benefit Plans "B" through "J" only as provided by Rule 69O-156.008, F.A.C.
(a) Medicare Part A Deductible: Coverage for all of the Medicare Part A inpatient hospital deductible amount per benefit period.

(b) Skilled Nursing Facility Care: Coverage for the actual billed charges up to the coinsurance amount from the 21st day through the 100th day in a Medicare benefit period for post-hospital skilled nursing facility care eligible under Medicare Part A.

(c) Medicare Part B Deductible: Coverage for all of the Medicare Part B deductible amount per calendar year regardless of hospital confinement.

(d) Eighty Percent (80%) of the Medicare Part B Excess Charges: Coverage for eighty percent (80%) of the difference between the actual Medicare Part B charge as billed, not to exceed any charge limitation established by the Medicare program or state law, and the Medicare-approved Part B charge.

(e) One Hundred Percent (100%) of the Medicare Part B Excess Charges: Coverage for all of the difference between the actual Medicare Part B charge as billed, not to exceed any charge limitation established by the Medicare program or state law, and the Medicare-approved Part B charge.

(f) Basic Outpatient Prescription Drug Benefit: Coverage for fifty percent (50%) of outpatient prescription drug charges, after a two hundred fifty dollar ($250) calendar year deductible, to a maximum of one thousand two hundred fifty dollars ($1,250) in benefits received by the insured per calendar year, to the extent not covered by Medicare. The outpatient drug benefit may be included for sale or issuance in a Medicare supplement policy until January 1, 2006.

(g) Extended Outpatient Prescription Drug Benefit: Coverage for fifty percent (50%) of outpatient prescription drug charges, after a two hundred fifty dollar ($250) calendar year deductible to a maximum of three thousand dollars ($3,000) in benefits received by the insured per calendar year, to the extent not covered by Medicare. The outpatient drug benefit may be included for sale or issuance in a Medicare supplement policy until January 1, 2006.

(h) Medically Necessary Emergency Care in a Foreign Country: Coverage to the extent not covered by Medicare for eighty percent (80%) of the billed charges for Medicare-eligible expenses for medically necessary emergency hospital, physician and medical care received in a foreign country, which care would have been covered by Medicare if provided in the United States and which care began during the first sixty (60) consecutive days of each trip outside the United States, subject to a calendar year deductible of two hundred fifty dollars ($250), and a lifetime maximum benefit of fifty thousand dollars ($50,000). For purposes of this benefit, "emergency care" shall mean care needed immediately because of an injury or an illness of sudden and unexpected onset.

(i)
1. Preventive Medical Care Benefit: Coverage for the following preventive health services not covered by Medicare:
i. An annual clinical preventive medical history and physical examination that may include tests and services from sub-subparagraph 69O-156.007(3)(i)1.ii., F.A.C., and patient education to address preventive health care measures.

ii. Preventive screening tests or preventive services, the selection and frequency of which is determined to be medically appropriate by the attending physician.
2. Reimbursement shall be for the actual charges up to one hundred percent (100%) of the Medicare-approved amount for each service, as if Medicare were to cover the service as identified in American Medical Association Current Procedural Terminology (AMA CPT) codes, to a maximum of one hundred twenty dollars ($120) annually under this benefit. This benefit shall not include payment for any procedure covered by Medicare.
(j) At-Home Recovery Benefit: Coverage for services to provide short term, at-home assistance with activities of daily living for those recovering from an illness, injury or surgery.
1. For purposes of this benefit, the following definitions shall apply:
a. "Activities of daily living" include, but are not limited to bathing, dressing, personal hygiene, transferring, eating, ambulating, assistance with drugs that are normally self-administered, and changing bandages or other dressings.

b. "Care provider" means a duly qualified or licensed home health aide/homemaker, personal care aide or nurse provided through a licensed home health care agency or referred by a licensed referral agency or licensed nurses registry.

c. "Home" shall mean any place used by the insured as a place of residence, provided that such place would qualify as a residence for home health care services covered by Medicare. A hospital or skilled nursing facility shall not be considered the insured's place of residence.

d. "At-home recovery visit" means the period of a visit required to provide at-home recovery care, without limit on the duration of the visit, except each consecutive 4 hours in a 24-hour period of services provided by a care provider is one visit.
2. Coverage Requirements and Limitations.
a. At-home recovery services provided must be primarily services which assist in activities of daily living.

b. The insured's attending physician must certify that the specific type and frequency of at-home recovery services are necessary because of a condition for which a home care plan of treatment was approved by Medicare.

c. Coverage is limited to:
i. No more than the number and type of at-home recovery visits certified as necessary by the insured's attending physician. The total number of at-home recovery visits shall not exceed the number of Medicare approved home health care visits under a Medicare approved home care plan of treatment;

ii. The actual charges for each visit up to a maximum reimbursement of forty dollars ($40) per visit;

iii. One thousand six hundred dollars ($1,600) per calendar year;

iv. Seven (7) visits in any one week;

v. Care furnished on a visiting basis in the insured's home;

vi. Services provided by a care provider as defined in this rule;

vii. At-home recovery visits while the insured is covered under the policy or certificate and not otherwise excluded;

viii. At-home recovery visits received during the period the insured is receiving Medicare approved home care services or no more than eight (8) weeks after the service date of the last Medicare approved home health care visit.
3. Coverage is excluded for:
a. Home care visits paid for by Medicare or other government programs; and

b. Care provided by family members, unpaid volunteers or providers who are not care providers.
(4) Standards for Plans K and L.
(a) Standardized Medicare supplement benefit plan "K" shall consist of the following:
1. Coverage of 100% of the Part A hospital coinsurance amount for each day used from the 61st through the 90th day in any Medicare benefit period;

2. Coverage of 100% of the Part A hospital coinsurance amount for each Medicare lifetime inpatient reserve day used from the 91st through the 150th day in any Medicare benefit period;

3. Upon exhaustion of the Medicare hospital inpatient coverage, including the lifetime reserve days, coverage of 100% of the Medicare Part A eligible expenses for hospitalization paid at the applicable prospective payment system (PPS) rate, or other appropriate Medicare standard of payment, subject to a lifetime maximum benefit of an additional 365 days. The provider shall accept the issuer's payment as payment in full and may not bill the insured for any balance;

4. Medicare Part A Deductible: Coverage for 50% of the Medicare Part A inpatient hospital deductible amount per benefit period until the out-of-pocket limitation is met as described in subparagraph 10.;

5. Skilled Nursing Facility Care: Coverage for 50% of the coinsurance amount for each day used from the 21st day through the 100th day in a Medicare benefit period for post-hospital skilled nursing facility care eligible under Medicare Part A until the out-of-pocket limitation is met as described in subparagraph 10.;

6. Hospice Care: Coverage for 50% of cost sharing for all Part A Medicare eligible expenses and respite care until the out-of-pocket limitation is met as described in subparagraph 10.;

7. Coverage for 50%, under Medicare Part A or B, of the reasonable cost of the first three (3) pints of blood (or equivalent quantities of packed red blood cells, as defined under federal regulations) unless replaced in accordance with federal regulations until the out-of-pocket limitation is met as described in subparagraph 10.;

8. Except for coverage provided in subparagraph 9. below, coverage for 50% of the cost sharing otherwise applicable under Medicare Part B after the policyholder pays the Part B deductible until the out-of-pocket limitation is met as described in subparagraph 10.;

9. Coverage of 100% of the cost sharing for Medicare Part B preventive services after the policyholder pays the Part B deductible; and

10. Coverage of 100% of all cost sharing under Medicare Parts A and B for the balance of the calendar year after the individual has reached the out-of-pocket limitation on annual expenditures under Medicare Parts A and B of $4,000 in 2006, indexed each year by the appropriate inflation adjustment specified by the Secretary of the U.S. Department of Health and Human Services.
(b) Standardized Medicare supplement benefit plan "L" shall consist of the following:
1. The benefits described in subparagraphs (4)(a)1., 2., 3. and 9.;

2. The benefit described in subparagraphs (4)(a)4., 5., 6., 7. and 8., but substituting 75% for 50%; and

3. The benefit described in subparagraph (4)(a)10., but substituting $2,000 for $4,000.

69O FAC 156.0075 | Benefit Standards for 2010 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery with an Effective Date for Coverage on or After June 1, 2010.

The following standards are applicable to all 2010 Standardized Medicare supplement policies or certificates delivered or issued for delivery in this state with an effective date for coverage on or after June 1, 2010. No policy or certificate may be advertised, solicited, delivered, or issued for delivery in this state as a Medicare supplement policy or certificate unless it complies with these benefit standards. No issuer may offer any 1990 Standardized Medicare supplement benefit plan for sale on or after June 1, 2010. Benefit standards applicable to Medicare supplement policies and certificates issued with an effective date for coverage prior to June 1, 2010, remain subject to the requirements of Rules 69O-156.006, 69O-156.007, and 69O-156.008, F.A.C.
(1) General Standards. The following standards apply to Medicare supplement policies and certificates and are in addition to all other requirements of this rule.
(a) A Medicare supplement policy or certificate shall not exclude or limit benefits for losses incurred more than six (6) months from the effective date of coverage because it involved a preexisting condition. The policy or certificate may not define a preexisting condition more restrictively than a condition for which medical advice was given or treatment was recommended by or received from a physician within six (6) months before the effective date of coverage.

(b) A Medicare supplement policy or certificate shall not indemnify against losses resulting from sickness on a different basis than losses resulting from accidents.

(c) A Medicare supplement policy or certificate shall provide that benefits designed to cover cost sharing amounts under Medicare will be changed automatically to coincide with any changes in the applicable Medicare deductible, co-payment, or coinsurance amounts. Premiums may be modified to correspond with such changes. The premium changes must be submitted to and approved by the Office pursuant to Sections 627.410, 627.411, and 627.674, F.S.

(d) No Medicare supplement policy or certificate shall provide for termination of coverage of a spouse solely because of the occurrence of an event specified for termination of coverage of the insured, other than the nonpayment of premium.

(e) Each Medicare supplement policy shall be guaranteed renewable.
1. The issuer shall not cancel or nonrenew the policy solely on the ground of health status of the individual.

2. The issuer shall not cancel or nonrenew the policy for any reason other than nonpayment of premium or material misrepresentation.

3.
a. If the Medicare supplement policy is terminated by the group policyholder and is not replaced as provided under subparagraph 69O-156.0075(1)(e)5., F.A.C., the issuer shall offer certificateholders an individual Medicare supplement policy which, at the option of the certificateholder:
(I) Provides for continuation of the benefits contained in the group policy; or

(II) Provides for benefits that otherwise meet the requirements of this rule.
b. In either case, if the group policy was issued on an issue age basis, the individual Medicare supplement policy is issued at the original issue age of the terminated certificateholder, and is at the duration of the terminated certificate at the time of conversion.
4. If an individual is a certificateholder in a group Medicare supplement policy and the individual terminates membership in the group, the issuer shall:
a. Offer the certificateholder the conversion opportunity described in subparagraph 69O-156.0075(1)(e)3., F.A.C.; or

b. At the option of the group policyholder, offer the certificateholder continuation of coverage under the group policy.
5.
a. If a group Medicare supplement policy is replaced by another group Medicare supplement policy purchased by the same policyholder, the issuer of the replacement policy shall offer coverage to all persons covered under the old group policy on its date of termination. Coverage under the new policy shall not result in any exclusion for preexisting conditions that would have been covered under the group policy being replaced.

b. If the terminated group policy was issued on an issue age basis and the policy reserves are transferred to the new insurer, the new group certificates shall retain the original issue ages of the insureds and shall commence at the same duration as the terminated certificates.
6. If an individual Medicare supplement policy/certificate is issued to replace an existing issue age rated policy/certificate of the same insurer, the replacing policy/certificate shall be issued at the original issue age of the policyholder/certificateholder, and is at the duration of the terminated policy/certificate at the time of replacement.
(f) Termination of a Medicare supplement policy or certificate shall be without prejudice to any continuous loss which commenced while the policy was in force, but the extension of benefits beyond the period during which the policy was in force may be conditioned upon the continuous total disability of the insured, limited to the duration of the policy benefit period, if any, or payment of the maximum benefits. Receipt of Medicare Part D benefits will not be considered in determining a continuous loss.

(g)
1. A Medicare supplement policy or certificate shall provide that benefits and premiums under the policy or certificate shall be suspended at the request of the policyholder or certificateholder for the period (not to exceed twenty-four (24) months) in which the policyholder or certificateholder has applied for and is determined to be entitled to medical assistance under Title XIX of the Social Security Act, but only if the policyholder or certificateholder notifies the issuer of the policy or certificate within ninety (90) days after the date the individual becomes entitled to assistance.

2. If suspension occurs and if the policyholder or certificateholder loses entitlement to medical assistance, the policy or certificate shall be automatically reinstituted (effective as of the date of termination of entitlement) as of the termination of entitlement if the policyholder or certificateholder provides notice of loss of entitlement within ninety (90) days after the date of loss and pays the premium attributable to the period, effective as of the date of termination of entitlement.

3. Each Medicare supplement policy shall provide that benefits and premiums under the policy shall be suspended (for any period that may be provided by federal regulation) at the request of the policyholder if the policyholder is entitled to benefits under Section 226 (b) of the Social Security Act and is covered under a group health plan (as defined in Section 1862 (b)(1)(A)(v) of the Social Security Act). If suspension occurs and if the policyholder or certificateholder loses coverage under the group health plan, the policy shall be automatically reinstituted (effective as of the date of loss of coverage) if the policyholder provides notice of loss of coverage within ninety (90) days after the date of the loss and pays the premium attributable to the period, effective as of the date of termination of enrollment in the group health plan.

4. Reinstitution of coverages as described in subparagraphs 2. and 3.:
a. Shall not provide for any waiting period with respect to treatment of preexisting conditions;

b. Shall provide for resumption of coverage that is substantially equivalent to coverage in effect before the date of suspension; and

c. Shall provide for classification of premiums on terms at least as favorable to the policyholder or certificateholder as the premium classification terms that would have applied to the policyholder or certificateholder had the coverage not been suspended.
(2) Standards for Basic (Core) Benefits Common to Medicare Supplement Insurance Benefit Plans A, B, C, D, F, F with High Deductible, G, M, and N. Every issuer of Medicare supplement insurance benefit plans shall make available a policy or certificate including only the following basic "core" package of benefits to each prospective insured. An issuer may make available to prospective insureds any of the other Medicare Supplement Insurance Benefit Plans in addition to the basic core package, but not in lieu of it.
(a) Coverage of Part A Medicare eligible expenses for hospitalization to the extent not covered by Medicare from the 61st day through the 90th day in any Medicare benefit period;

(b) Coverage of Part A Medicare eligible expenses incurred for hospitalization to the extent not covered by Medicare for each Medicare lifetime inpatient reserve day used;

(c) Upon exhaustion of the Medicare hospital inpatient coverage, including the lifetime reserve days, coverage of one hundred percent (100%) of the Medicare Part A eligible expenses for hospitalization paid at the applicable prospective payment system (PPS) rate, or other appropriate Medicare standard of payment, subject to a lifetime maximum benefit of an additional 365 days. The provider shall accept the issuer's payment as payment in full and may not bill the insured for any balance;

(d) Coverage under Medicare Parts A and B for the reasonable cost of the first three (3) pints of blood (or equivalent quantities of packed red blood cells, as defined under federal regulations) unless replaced in accordance with federal regulations;

(e) Coverage for the coinsurance amount, or in the case of hospital outpatient department services paid under a prospective payment system, the co-payment amount, of Medicare eligible expenses under Part B regardless of hospital confinement, subject to the Medicare Part B deductible;

(f) Hospice Care: Coverage of cost sharing for all Part A Medicare eligible hospice care and respite care expenses.

(g) Home Health Care (Parts A & B) Medicare Approved Services: Medically necessary skilled care services and medical supplies.
(3) Standards for Additional Benefits. The following additional benefits shall be included in Medicare supplement benefit Plans B, C, D, F, F with High Deductible, G, M, and N as provided by Section 69O-156.0085, F.A.C.
(a) Medicare Part A Deductible: Coverage for one hundred percent (100%) of the Medicare Part A inpatient hospital deductible amount per benefit period.

(b) Medicare Part A Deductible: Coverage for fifty percent (50%) of the Medicare Part A inpatient hospital deductible amount per benefit period.

(c) Skilled Nursing Facility Care: Coverage for the actual billed charges up to the coinsurance amount from the 21st day through the 100th day in a Medicare benefit period for post-hospital skilled nursing facility care eligible under Medicare Part A.

(d) Medicare Part B Deductible: Coverage for one hundred percent (100%) of the Medicare Part B deductible amount per calendar year regardless of hospital confinement.

(e) One Hundred Percent (100%) of the Medicare Part B Excess Charges: Coverage for all of the difference between the actual Medicare Part B charges as billed, not to exceed any charge limitation established by the Medicare program or state law, and the Medicare-approved Part B charge.

(f) Medically Necessary Emergency Care in a Foreign Country: Coverage to the extent not covered by Medicare for eighty percent (80%) of the billed charges for Medicare-eligible expenses for medically necessary emergency hospital, physician and medical care received in a foreign country, which care would have been covered by Medicare if provided in the United States and which care began during the first sixty (60) consecutive days of each trip outside the United States, subject to a calendar year deductible of $250, and a lifetime maximum benefit of $50,000. For purposes of this benefit, "emergency care" shall mean care needed immediately because of an injury or an illness of sudden and unexpected onset.

69O FAC 156.008 | Standard Medicare Supplement Benefit Plans for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or After January 1, 1992, and with an Effective Date for Coverage Prior to June 1, 2010.

The following applies to all 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates issued for delivery on or after January 1, 1992, and with an effective date for coverage prior to June 1, 2010.
(1) An issuer shall make available to each prospective policyholder and certificateholder a policy form or certificate form containing only the basic "core" benefits, as defined in subsection 69O-156.007(2), F.A.C., of this chapter.

(2) No groups, packages or combinations of Medicare supplement benefits other than those listed in this section shall be offered for sale in this state, except as may be permitted in subsection 69O-156.008(7) and Rule 69O-156.030, F.A.C., of this chapter.

(3)
(a)
1. Benefit plans shall be uniform in structure, language, designation and format to the standard benefit plans "A" through "L" as provided in Form OIR-B2-MSC (Rev. 11/04), "Outline of Medicare Supplement Coverage", and shall conform to the definitions in Rule 69O-156.003, F.A.C.

2. Form OIR-B2-MSC (Rev. 11/04), "Outline of Medicare Supplement Coverage", is hereby adopted and incorporated by reference, is available and may be printed from the Office's website: www.FLOir.com.
(b) Each benefit shall be structured in accordance with the format provided in subsections 69O-156.007(2) and (3), or (4), F.A.C., and shall list the benefits in the order shown in this rule. For purposes of this section, "structure, language, and format" means style, arrangement and overall content of a benefit.
(4) An issuer may use, in addition to the benefit plan designations required in subsection 69O-156.008(3), F.A.C., other designations to the extent permitted by law.

(5) Make-up of benefit plans:
(a) Standardized Medicare supplement benefit plan "A" shall be limited to the Basic ("Core") Benefits Common to All Benefit Plans, as defined in subsection 69O-156.007(2), F.A.C., of this chapter.

(b) Standardized Medicare supplement benefit plan "B" shall include only the following: The Core Benefit as defined in subsection 69O-156.007(2), F.A.C., of this chapter, plus the Medicare Part A Deductible as defined in paragraph 69O-156.007(3)(a), F.A.C.

(c) Standardized Medicare supplement benefit plan "C" shall include only the following: The Core Benefit as defined in subsection 69O-156.007(2), F.A.C., of this chapter, plus the Medicare Part A Deductible, Skilled Nursing Facility Care, Medicare Part B Deductible and Medically Necessary Emergency Care in a Foreign Country as defined in paragraphs 69O-156.007(3)(a), (b), (c) and (h), F.A.C., respectively.

(d) Standardized Medicare supplement benefit plan "D" shall include only the following: The Core Benefit (as defined in subsection 69O-156.007(2), F.A.C., of this rule), plus the Medicare Part A Deductible, Skilled Nursing Facility Care, Medically Necessary Emergency Care in a Foreign Country and the At-Home Recovery Benefit as defined in paragraphs 69O-156.007(2)(a), (b), (h) and (j), F.A.C., respectively.

(e) Standardized Medicare supplement benefit plan "E" shall include only the following: The Core Benefit as defined in subsection 69O-156.007(2), F.A.C., of this chapter, plus the Medicare Part A Deductible, Skilled Nursing Facility Care, Medically Necessary Emergency Care in a Foreign Country and Preventive Medical Care as defined in paragraphs 69O-156.007(3)(a), (b), (h) and (i), F.A.C., respectively.

(f) Standardized Medicare supplement benefit plan "F" shall include only the following: The Core Benefit as defined in subsection 69O-156.007(2), F.A.C., of this chapter, plus the Medicare Part A Deductible, the Skilled Nursing Facility Care, the Part B Deductible, One Hundred Percent (100%) of the Medicare Part B Excess Charges, and Medically Necessary Emergency Care in a Foreign Country as defined in paragraphs 69O-156.007(3)(a), (b), (c), (e) and (h), F.A.C., respectively.

(g) Standardized Medicare supplement benefit high deductible plan "F" shall include only 100% of covered expenses following the payment of the annual high deductible plan "F" deductible.
1. The covered expenses as defined in paragraphs 69O-156.007(3)(a), (b), (e) and (h), F.A.C., respectively include:
a. The core benefit as defined in subsection 69O-156.007(2), F.A.C;

b. The Medicare Part A deductible;

c. Skilled nursing facility care;

d. The Medicare Part B deductible;

e. One hundred percent (100%) of the Medicare Part B excess charges; and

f. Medically necessary emergency care in a foreign country.
2. The annual high deductible plan "F" deductible shall consist of out-of-pocket expenses, other than premiums, for services covered by the Medicare supplement plan "F" policy, and shall be in addition to any other specific benefit deductibles.

3. The annual high deductible plan "F" deductible shall be:
a. $1,500 for 1998 and 1999, and shall be based on the calendar year;

b. Adjusted annually thereafter by the Secretary to reflect the change in the Consumer Price Index for all urban consumers for the twelve-month period ending with August of the preceding year, and rounded to the nearest multiple of $10.
(h) Standardized Medicare supplement benefit plan "G" shall include only the following: The Core Benefit as defined in subsection 69O-156.007(2), F.A.C., of this regulation, plus the Medicare Part A Deductible, Skilled Nursing Facility Care, Eighty Percent (80%) of the Medicare Part B Excess Charges, Medically Necessary Emergency Care in a Foreign Country, and the At-Home Recovery Benefit as defined in paragraphs 69O-156.007(3)(a), (b), (d), (h) and (j), F.A.C., respectively.

(i) Standardized Medicare supplement benefit plan "H" shall consist of only the following: The Core Benefit as defined in subsection 69O-156.007(2), F.A.C., of this chapter, plus the Medicare Part A Deductible, Skilled Nursing Facility Care, Basic Prescription Drug Benefit and Medically Necessary Emergency Care in a Foreign Country as defined in paragraphs 69O-156.007(3)(a), (b), (f) and (h), F.A.C., respectively. The outpatient prescription drug benefit shall not be included in a Medicare supplement policy issued after December 31, 2005.

(j) Standardized Medicare supplement benefit plan "I" shall consist of only the following: The Core Benefit as defined in subsection 69O-156.007(2), F.A.C., of this regulation, plus the Medicare Part A Deductible, Skilled Nursing Facility Care, One Hundred Percent (100%) of the Medicare Part B Excess Charges, Basic Prescription Drug Benefit, Medically Necessary Emergency Care in a Foreign Country and At-Home Recovery Benefit as defined in paragraphs 69O-156.007(3)(a), (b), (e), (f), (h) and (j), F.A.C., respectively. The outpatient prescription drug benefit shall not be included in a Medicare supplement policy issued after December 31, 2005.

(k) Standardized Medicare supplement benefit plan "J" shall consist of only the following: The Core Benefit as defined in subsection 69O-156.007(2), F.A.C., of this chapter, plus the Medicare Part A Deductible, Skilled Nursing Facility Care, Medicare Part B Deductible, One Hundred Percent (100%) of the Medicare Part B Excess Charges, Extended Prescription Drug Benefit, Medically Necessary Emergency Care in a Foreign Country, Preventive Medical Care and At-Home Recovery Benefit as defined in paragraphs 69O-156.007(3)(a), (b), (c), (e), (g), (h), (i) and (j), F.A.C., respectively. The outpatient prescription drug benefit shall not be included in a Medicare supplement policy issued after December 31, 2005.

(l) Standardized Medicare supplement benefit high deductible plan "J" shall include only 100% of covered expenses following the payment of the annual high deductible plan "J" deductible.
1. The covered expenses as defined in paragraphs 69O-156.007(3)(a), (b), (c), (e), (g), (h), (i) and (j), F.A.C., respectively include:
a. The core benefit as defined in subsection 69O-156.007(2), F.A.C;

b. The Medicare Part A deductible;

c. Skilled nursing facility care;

d. Medicare Part B deductible;

e. One hundred percent (100%) of the Medicare Part B Excess charges;

f. Extended Outpatient Prescription Drug Benefit;

g. Medically Necessary Emergency Care in a foreign Country;

h. Preventive Medical Care Benefit; and

i. At-Home Recovery Benefit.
2. The annual high deductible plan "J" deductible shall consist of out-of-pocket expenses, other than premiums, for services covered by the Medicare supplement plan "J" policy, and shall be in addition to any other specific benefit deductibles.

3. The annual deductible shall be:
a. $1,500 for 1998 and 1999 based on a calendar year;

b. Adjusted annually thereafter by the Secretary to reflect the change in the Consumer Price Index for all urban consumers for the twelve-month period ending with August of the preceding year, and rounded to the nearest multiple of $10.

c. The outpatient prescription drug benefit shall not be included in a Medicare supplement policy issued after December 31, 2005.
(6) Make-up of two Medicare supplement plans mandated by The Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA);
(a) Standardized Medicare supplement benefit plan "K" shall consist of only those benefits described in paragraph 69O-156.007(4)(a), F.A.C.

(b) Standardized Medicare supplement benefit plan "L" shall consist of only those benefits described in paragraph 69O-156.007(4)(b), F.A.C.
(7) New or Innovative Benefits: An issuer may, with the prior approval of the commissioner, offer policies or certificates with new or innovative benefits in addition to the benefits provided in a policy or certificate that otherwise complies with the applicable standards. The new or innovative benefits may include benefits that are appropriate to Medicare supplement insurance, new or innovative, not otherwise available, cost-effective, and offered in a manner which is consistent with the goal of simplification of Medicare supplement policies. After December 31, 2005, the innovative benefit shall not include an outpatient prescription drug benefit.

69O FAC 156.0085 | Standard Medicare Supplement Benefit Plans for 2010 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery with an Effective Date for Coverage on or After June 1, 2010

The following standards are applicable to all Medicare supplement policies or certificates delivered or issued for delivery in this state with an effective date for coverage on or after June 1, 2010. No policy or certificate may be advertised, solicited, delivered or issued for delivery in this state as a Medicare supplement policy or certificate unless it complies with these benefit plan standards. Benefit plan standards applicable to Medicare supplement policies and certificates issued with an effective date for coverage before June 1, 2010, remain subject to the requirements of Rules 69O-156.006, 69O-156.007, and 69O-156.008, F.A.C.
(1)
(a) An issuer shall make available to each prospective policyholder and certificateholder a policy form or certificate form containing only the basic (core) benefits, as defined in subsection 69O-156.0075(2), F.A.C.

(b) If an issuer makes available any of the additional benefits described in subsection 69O-156.0075(3), F.A.C., or offers standardized benefit Plans K or L as described in paragraphs 69O-156.0085(5)(h) and (i), F.A.C., then the issuer shall make available to each prospective policyholder and certificateholder, in addition to a policy form or certificate form with only the basic (core) benefits as described in paragraph (1)(a) above, a policy form or certificate form containing either standardized benefit Plan C as described in paragraph 69O-156.0085(5)(c), F.A.C., or standardized benefit Plan F as described in paragraph 69O-156.0085(5)(e), F.A.C.
(2) No groups, packages or combinations of Medicare supplement benefits other than those listed in this rule shall be offered for sale in this state, except as may be permitted in subsection 69O-156.0085(6) and Rule 69O-156.030, F.A.C.

(3)
(a) Benefit plans shall be uniform in structure, language, designation and format to the standard benefit plans listed in this subsection and as provided in Form OIR-B2-MSC2 (05/09), "Outline of Coverage, Benefit Plans, Benefit Chart of Medicare Supplement Plans Sold on or After June 1, 2010", and shall conform to the definitions in Rule 69O-156.003, F.A.C.

(b) Form OIR-B2-MSC2 (05/09), "Outline of Coverage, Benefit Plans, Benefit Chart of Medicare Supplement Plans Sold on or After June 1, 2010", is hereby adopted and incorporated by reference, and is available and may be printed from the Office's website: http://www.FLOir.com/iPortal.

(c) Each benefit shall be structured in accordance with the format provided in subsections 69O-156.0075(2) and 69O-156.0075(3), F.A.C.; or, in the case of plans K or L, in paragraph 69O-156.0085(5)(h) or 69O-156.0085(5)(i), F.A.C. and list the benefits in the order shown. For purposes of this Section, "structure, language, and format" means style, arrangement and overall content of a benefit.
(4) In addition to the benefit plan designations required in subsection 69O-156.0085(3), F.A.C., an issuer may use other designations to the extent permitted by law.

(5) Make-up of 2010 Standardized Benefit Plans:
(a) Standardized Medicare supplement benefit Plan A shall include only the following: The basic (core) benefits as defined in subsection 69O-156.0075(2), F.A.C.

(b) Standardized Medicare supplement benefit Plan B shall include only the following: The basic (core) benefit as defined in subsection 69O-156.0075(2), F.A.C., plus one hundred percent (100%) of the Medicare Part A deductible as defined in paragraph 69O-156.0075(3)(a), F.A.C.

(c) Standardized Medicare supplement benefit Plan C shall include only the following: The basic (core) benefit as defined in subsection 69O-156.0075(2), F.A.C., plus one hundred percent (100%) of the Medicare Part A deductible, skilled nursing facility care, one hundred percent (100%) of the Medicare Part B deductible, and medically necessary emergency care in a foreign country as defined in paragraphs 69O-156.0075(3)(a), (c), (d), and (f), F.A.C., respectively.

(d) Standardized Medicare supplement benefit Plan D shall include only the following: The basic (core) benefit, as defined in subsection 69O-156.0075(2), F.A.C., plus one hundred percent (100%) of the Medicare Part A deductible, skilled nursing facility care, and medically necessary emergency care in a foreign country as defined in paragraphs 69O-156.0075(3)(a), (c), and (f), F.A.C., respectively.

(e) Standardized Medicare supplement [regular] Plan F shall include only the following: The basic (core) benefit as defined in subsection 69O-156.0075(2), F.A.C., plus one hundred percent (100%) of the Medicare Part A deductible, the skilled nursing facility care, one hundred percent (100%) of the Medicare Part B deductible, one hundred percent (100%) of the Medicare Part B excess charges, and medically necessary emergency care in a foreign country as defined in paragraphs 69O-156.0075(3)(a), (c), (d), (e), and (f), F.A.C., respectively.

(f) Standardized Medicare supplement Plan F With High Deductible shall include only the following: one hundred percent (100%) of covered expenses following the payment of the annual deductible set forth in subparagraph 2. below.
1. The basic (core) benefit as defined in subsection 69O-156.0075(2), F.A.C., plus one hundred percent (100%) of the Medicare Part A deductible, skilled nursing facility care, one hundred percent (100%) of the Medicare Part B deductible, one hundred percent (100%) of the Medicare Part B excess charges, and medically necessary emergency care in a foreign country as defined in paragraphs 69O-156.0075(3)(a), (c), (d), (e), and (f), F.A.C., respectively.

2. The annual deductible in Plan F With High Deductible shall consist of out-of-pocket expenses, other than premiums, for services covered by Plan F, and shall be in addition to any other specific benefit deductibles. The basis for the deductible shall be $1,500 and shall be adjusted annually from 1999 by the Secretary of the U.S. Department of Health and Human Services to reflect the change in the Consumer Price Index for all urban consumers for the twelve-month period ending with August of the preceding year, and rounded to the nearest multiple of ten dollars ($10).
(g) Standardized Medicare supplement benefit Plan G shall include only the following: The basic (core) benefit as defined in subsection 69O-156.0075(2), F.A.C., plus one hundred percent (100%) of the Medicare Part A deductible, skilled nursing facility care, one hundred percent (100%) of the Medicare Part B excess charges, and medically necessary emergency care in a foreign country as defined in paragraphs 69O-156.0075(3)(a), (c), (e), and (f), F.A.C., respectively.

(h) Standardized Medicare supplement Plan K is mandated by The Medicare Prescription Drug, Improvement and Modernization Act of 2003, and shall include only the following:
1. Part A Hospital Coinsurance 61st through 90th days: Coverage of one hundred percent (100%) of the Part A hospital coinsurance amount for each day used from the 61st through the 90th day in any Medicare benefit period;

2. Part A Hospital Coinsurance, 91st through 150th days: Coverage of one hundred percent (100%) of the Part A hospital coinsurance amount for each Medicare lifetime inpatient reserve day used from the 91st through the 150th day in any Medicare benefit period;

3. Part A Hospitalization After 150 Days: Upon exhaustion of the Medicare hospital inpatient coverage, including the lifetime reserve days, coverage of one hundred percent (100%) of the Medicare Part A eligible expenses for hospitalization paid at the applicable prospective payment system (PPS) rate, or other appropriate Medicare standard of payment, subject to a lifetime maximum benefit of an additional 365 days. The provider shall accept the issuer's payment as payment in full and may not bill the insured for any balance;

4. Medicare Part A Deductible: Coverage for fifty percent (50%) of the Medicare Part A inpatient hospital deductible amount per benefit period until the out-of-pocket limitation is met as described in subparagraph 10.;

5. Skilled Nursing Facility Care: Coverage for fifty percent (50%) of the coinsurance amount for each day used from the 21st day through the 100th day in a Medicare benefit period for post-hospital skilled nursing facility care eligible under Medicare Part A until the out-of-pocket limitation is met as described in subparagraph 10.;

6. Hospice Care: Coverage for fifty percent (50%) of cost sharing for all Part A Medicare eligible expenses and respite care until the out-of-pocket limitation is met as described in subparagraph 10.;

7. Blood: Coverage for fifty percent (50%), under Medicare Part A or B, of the reasonable cost of the first three (3) pints of blood (or equivalent quantities of packed red blood cells, as defined under federal regulations) unless replaced in accordance with federal regulations until the out-of-pocket limitation is met as described in subparagraph 10.;

8. Part B Cost Sharing: Except for coverage provided in subparagraph (i), coverage for fifty percent (50%) of the cost sharing otherwise applicable under Medicare Part B after the policyholder pays the Part B deductible until the out-of-pocket limitation is met as described in subparagraph 10.;

9. Part B Preventive Services: Coverage of one hundred percent (100%) of the cost sharing for Medicare Part B preventive services after the policyholder pays the Part B deductible; and

10. Cost Sharing After Out-of-Pocket Limits: Coverage of one hundred percent (100%) of all cost sharing under Medicare Parts A and B for the balance of the calendar year after the individual has reached the out-of-pocket limitation on annual expenditures under Medicare Parts A and B of $4000 in 2006, indexed each year by the appropriate inflation adjustment specified by the Secretary of the U.S. Department of Health and Human Services.
(i) Standardized Medicare supplement Plan L is mandated by The Medicare Prescription Drug, Improvement and Modernization Act of 2003, and shall include only the following:
1. The benefits described in subparagraphs 69O-156.0085(5)(h)1., 2., 3., and 9., F.A.C.;

2. The benefit described in subparagraphs 69O-156.0085(5)(h)4., 5., 6., 7., and 8., F.A.C., but substituting seventy-five percent (75%) for fifty percent (50%); and

3. The benefit described in subparagraph 69O-156.0085(5)(h)10., F.A.C., but substituting $2000 for $4000.
(j) Standardized Medicare supplement Plan M shall include only the following: The basic (core) benefit as defined in subsection 69O-156.0075(2), F.A.C., plus fifty percent (50%) of the Medicare Part A deductible, skilled nursing facility care, and medically necessary emergency care in a foreign country as defined in paragraphs 69O-156.0075(3)(b), (c), and (f), F.A.C., respectively.

(k) Standardized Medicare supplement Plan N shall include only the following: The basic (core) benefit as defined in subsection 69O-156.0075(2), F.A.C., plus one hundred percent (100%) of the Medicare Part A deductible, skilled nursing facility care, and medically necessary emergency care in a foreign country as defined in paragraphs 69O-156.0075(3)(a), (c) and (f), F.A.C., respectively, with co-payments in the following amounts:
1. The lesser of twenty dollars ($20) or the Medicare Part B coinsurance or co-payment for each covered health care provider office visit (including visits to medical specialists); and

2. The lesser of fifty dollars ($50) or the Medicare Part B coinsurance or co-payment for each covered emergency room visit, however, this co-payment shall be waived if the insured is admitted to any hospital and the emergency visit is subsequently covered as a Medicare Part A expense.
(6) New or Innovative Benefits: An issuer may, with the prior approval of the Office, offer policies or certificates with new or innovative benefits, in addition to the standardized benefits provided in a policy or certificate that otherwise complies with the applicable standards. The new or innovative benefits shall include only benefits that are appropriate to Medicare supplement insurance, are new or innovative, are not otherwise available, and are cost-effective. Approval of new or innovative benefits must not adversely impact the goal of Medicare supplement simplification. New or innovative benefits shall not include an outpatient prescription drug benefit. New or innovative benefits shall not be used to change or reduce benefits, including a change of any cost-sharing provision, in any standardized plan.

69O FAC 156.0086 | Standard Medicare Supplement Benefit Plans for 2020 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery to Newly Eligible Medicare Beneficiaries with an Effective Date for Coverage on or After January 1, 2020

No policy or certificate that provides coverage of the Medicare Part B deductible may be advertised, solicited, delivered or issued for delivery in this state as a Medicare supplement policy or certificate to Newly Eligible Medicare Beneficiary. In accordance with the Medicare Access and CHIP Reauthorization Act of 2015 (Pub. L. No. 114-10, 129 Stat. 87 (2015)), all policies must comply with the following benefit standards:
(1) Benefit Requirements. The standards and requirements of this rule apply to all Medicare supplement policies or certificates delivered or issued for delivery to Newly Eligible Medicare Beneficiary. Standardized Medicare supplement benefit Plans C, F, and F with High Deductible, as defined in paragraphs 69O-156.0085(5)(c), (e), and (f), F.A.C., may not be offered to Newly Eligible Medicare Beneficiaries.

(2) An issuer shall make available to each prospective policyholder and certificateholder a policy form or certificate form containing the basic (core) benefits, as defined in paragraph (6)(a).

(3) If an issuer makes available any of the additional benefits described in paragraphs (6)(b)-(i), then the issuer shall make available to each prospective policyholder and certificateholder, in addition to a policy form or certificate form with only the basic (core) benefits as described in subsection (2) above, a policy form or certificate form containing either standardized Medicare supplement benefit Plan D as described in paragraph (6)(c) or standardized Medicare supplement benefit Plan G as described in paragraph (6)(d).

(4) Applicability to Certain Individuals. This rule applies only to Newly Eligible Medicare Beneficiaries who are enrolled in Medicare Part B:
(a) By reason of attaining age 65 on or after January 1, 2020; or

(b) By reason of entitlement to benefits under Part A pursuant to sections 226(b) or 226A of the Social Security Act (42 U.S.C. 426(b), 426-1) or who are deemed to be eligible for benefits under section 226(a) of the Social Security Act on or after January 1, 2020.
(5)
(a) Benefit plans shall conform in structure, language, designation, and format to the standard benefit plans listed in this subsection (6) and the definitions in Rule 69O-156.003, F.A.C., and must include a copy of Form OIR-B2-MSC2, Outline of Coverage, Benefit Plans, Benefit Chart of Medicare Supplement Plans Sold on or after January 1, 2020, effective 01/20.

(b) Form OIR-B2-MSC2, Outline of Coverage, Benefit Plans, Benefit Chart of Medicare Supplement Plans Sold on or after January 1, 2020, effective 01/20, is hereby incorporated by reference and available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-11241 and may be printed from the Office's website: http://www.FLOir.com/Sections/LandH/Medicare/MedicareForms.aspx.
(6) Make-up of 2020 Standardized Benefit Plans:
(a) Standardized Medicare supplement benefit Plan A shall include only the following:
1. Coverage of Part A Medicare eligible expenses for hospitalization to the extent not covered by Medicare from the 61st day through the 90th day in any Medicare benefit period.

2. Coverage of Part A Medicare eligible expenses incurred for hospitalization to the extent not covered by Medicare for each Medicare lifetime inpatient reserve day used.

3. Upon exhaustion of the Medicare hospital inpatient coverage, including the lifetime reserve days, coverage of one hundred percent (100%) of the Medicare Part A eligible expenses for hospitalization paid at the applicable prospective payment system (PPS) rate, or other appropriate Medicare standard of payment, subject to a lifetime maximum benefit of an additional 365 days. The provider shall accept the issuer's payment as payment in full and may not bill the insured for any balance.

4. Coverage under Medicare Parts A and B for the reasonable cost of the first 3 pints of blood (or equivalent quantities of packed red blood cells, as defined under federal regulations.

5. Coverage for the coinsurance amount, or in the case of hospital outpatient department services paid under a prospective payment system, the co-payment amount, of Medicare eligible expenses under Part B regardless of hospital confinement, subject to the Medicare Part B deductible.

6. Hospice Care: Coverage of cost sharing for all Part A Medicare eligible hospice care and respite care expenses.

7. Home Health Care (Parts A & B) Medicare Approved Services: Medically necessary skilled care services and medical supplies.
(b) Standardized Medicare supplement benefit Plan B shall include only the following: The basic (core) benefit as defined in paragraph (6)(a), plus one hundred percent (100%) of the Medicare Part A deductible amount per benefit period.

(c) Standardized Medicare supplement benefit Plan D shall include only the following: The basic (core) benefit, as defined in paragraph (6)(a), plus one hundred percent (100%) of the Medicare Part A deductible amount per benefit period; Skilled Nursing Facility Care Coverage for the actual billed charges up to the coinsurance amount from the 21st day through the 100th day in a Medicare benefit period for post-hospital skilled nursing facility care eligible under Medicare Part A; and Medically Necessary Emergency Care in a Foreign Country, which is Coverage to the extent not covered by Medicare for eighty percent (80%) of the billed charges for Medicare-eligible expenses for medically necessary emergency hospital, physician, and medical care received in a foreign country, if such care would have been covered by Medicare if provided in the United States and if such care began during the first sixty (60) consecutive days of each trip outside the United States, subject to a calendar year deductible of $250, and a lifetime maximum benefit of $50,000.

(d) Standardized Medicare supplement [regular] Plan G shall include only the following: The basic (core) benefit as defined in paragraph (6)(a), plus one hundred percent (100%) of the Medicare Part A deductible amount per benefit period; Skilled Nursing Facility Care Coverage for the actual billed charges up to the coinsurance amount from the 21st day through the 100th day in a Medicare benefit period for post-hospital skilled nursing facility care eligible under Medicare Part A; one hundred percent (100%) of the Medicare Part B excess charges and Medically Necessary Emergency Care in a Foreign Country, which is Coverage to the extent not covered by Medicare for eighty percent (80%) of the billed charges for Medicare-eligible expenses for medically necessary emergency hospital, physician and medical care received in a foreign country, if such care would have been covered by Medicare if provided in the United States and if such care began during the first sixty (60) consecutive days of each trip outside the United States, subject to a calendar year deductible of $250, and a lifetime maximum benefit of $50,000.

(e) Standardized Medicare supplement Plan G With High Deductible shall include only the following: one hundred percent (100%) of covered expenses following the payment of the annual deductible set forth in subparagraph 2. below.
1. The basic (core) benefit and additional benefits as defined in paragraph (6)(d).

2. The annual deductible in standardized Medicare supplement Plan G With High Deductible shall consist of out-of-pocket expenses, other than premiums, for services covered by standardized Medicare supplement [regular] Plan G. The basis for the deductible shall be $2,240 and shall be adjusted annually from 2018 by the Secretary of the U.S. Department of Health and Human Services to reflect the change in the Consumer Price Index for all urban consumers for the twelve-month period ending with August of the preceding year, rounded to the nearest multiple of ten dollars ($10).
(f) Standardized Medicare supplement Plan K shall include only the following:
1. Part A Hospital Coinsurance 61st through 90th days: Coverage of one hundred percent (100%) of the Part A hospital coinsurance amount for each day used from the 61st through the 90th day in any Medicare benefit period.

2. Part A Hospital Coinsurance, 91st through 150th days: Coverage of one hundred percent (100%) of the Part A hospital coinsurance amount for each Medicare lifetime inpatient reserve day used from the 91st through the 150th day in any Medicare benefit period.

3. Part A Hospitalization After 150 Days: Upon exhaustion of the Medicare hospital inpatient coverage, including the lifetime reserve days, coverage of one hundred percent (100%) of the Medicare Part A eligible expenses for hospitalization paid at the applicable prospective payment system (PPS) rate, or other appropriate Medicare standard of payment, subject to a lifetime maximum benefit of an additional 365 days. The provider shall accept the issuer's payment as payment in full and may not bill the insured for any balance.

4. Medicare Part A Deductible: Coverage for fifty percent (50%) of the Medicare Part A inpatient hospital deductible amount per benefit period until the out-of-pocket limitation is met as described in subparagraph 11.

5. Skilled Nursing Facility Care: Coverage for fifty percent (50%) of the coinsurance amount for each day used from the 21st day through the 100th day in a Medicare benefit period for post-hospital skilled nursing facility care eligible under Medicare Part A until the out-of-pocket limitation is met as described in subparagraph 11.

6. Hospice Care: Coverage for fifty percent (50%) of cost sharing for all Part A Medicare eligible expenses and respite care until the out-of-pocket limitation is met as described in subparagraph 11.

7. Blood: Coverage for fifty percent (50%), under Medicare Part A or B, of the reasonable cost of the first three (3) pints of blood (or equivalent quantities of packed red blood cells, as defined under federal regulations) until the out-of-pocket limitation is met as described in subparagraph 11.

8. Home Health Care (Parts A & B) Medicare Approved Services: Coverage for fifty percent (50%) of medically necessary skilled care services and medical supplies.

9. Part B Cost Sharing: Coverage for fifty percent (50%) of the cost sharing otherwise applicable under Medicare Part B after the policyholder pays the Part B deductible until the out-of-pocket limitation is met as described in subparagraph 11.

10. Part B Preventive Services: Coverage of one hundred percent (100%) of the cost sharing for Medicare Part B preventive services after the policyholder pays the Part B deductible.

11. Cost Sharing After Out-of-Pocket Limits: Coverage of one hundred percent (100%) of all cost sharing under Medicare Parts A and B for the balance of the calendar year after the individual has reached the out-of-pocket limitation on annual expenditures under Medicare Parts A and B. The basis for the out-of-pocket limitation shall be $5,240 and shall be adjusted annually from 2018 by the Secretary of the U.S. Department of Health and Human Services to reflect the appropriate inflation adjustment.
(g) Standardized Medicare supplement Plan L shall include only the following:
1. Part A Hospital Coinsurance 61st through 90th days: Coverage of one hundred percent (100%) of the Part A hospital coinsurance amount for each day used from the 61st through the 90th day in any Medicare benefit period;

2. Part A Hospital Coinsurance, 91st through 150th days: Coverage of one hundred percent (100%) of the Part A hospital coinsurance amount for each Medicare lifetime inpatient reserve day used from the 91st through the 150th day in any Medicare benefit period.

3. Part A Hospitalization After 150 Days: Upon exhaustion of the Medicare hospital inpatient coverage, including the lifetime reserve days, coverage of one hundred percent (100%) of the Medicare Part A eligible expenses for hospitalization paid at the applicable prospective payment system (PPS) rate, or other appropriate Medicare standard of payment, subject to a lifetime maximum benefit of an additional 365 days. The provider shall accept the issuer's payment as payment in full and may not bill the insured for any balance.

4. Medicare Part A Deductible: Coverage for seventy-five percent (75%) of the Medicare Part A inpatient hospital deductible amount per benefit period until the out-of-pocket limitation is met as described in subparagraph 11.

5. Skilled Nursing Facility Care: Coverage for seventy-five percent (75%) of the coinsurance amount for each day used from the 21st day through the 100th day in a Medicare benefit period for post-hospital skilled nursing facility care eligible under Medicare Part A until the out-of-pocket limitation is met as described in subparagraph 11;

6. Hospice Care: Coverage for seventy-five percent (75%) of cost sharing for all Part A Medicare eligible expenses and respite care until the out-of-pocket limitation is met as described in subparagraph 11.

7. Blood: Coverage for seventy-five percent (75%), under Medicare Part A or B, of the reasonable cost of the first three (3) pints of blood (or equivalent quantities of packed red blood cells, as defined under federal regulations) until the out-of-pocket limitation is met as described in subparagraph 11.

8. Home Health Care (Parts A & B) Medicare Approved Services: Coverage for seventy-five percent (75%) of medically necessary skilled care services and medical supplies.

9. Part B Cost Sharing: Coverage for seventy-five percent (75%) of the cost sharing otherwise applicable under Medicare Part B after the policyholder pays the Part B deductible until the out-of-pocket limitation is met as described in subparagraph 11.

10. Part B Preventive Services: Coverage of one hundred percent (100%) of the cost sharing for Medicare Part B preventive services after the policyholder pays the Part B deductible.

11. Cost Sharing After Out-of-Pocket Limits: Coverage of one hundred percent (100%) of all cost sharing under Medicare Parts A and B for the balance of the calendar year after the individual has reached the out-of-pocket limitation on annual expenditures under Medicare Parts A and B. The basis for the out-of-pocket limitation shall be $5,240 and shall be adjusted annually from 2018 by the Secretary of the U.S. Department of Health and Human Services to reflect the appropriate inflation adjustment.
(h) Standardized Medicare supplement Plan M shall include only the following: The basic (core) benefit as defined in paragraph (6)(a), plus fifty percent (50%) of the Medicare Part A deductible amount per benefit period; Skilled Nursing Facility Care Coverage for the actual billed charges up to the coinsurance amount from the 21st day through the 100th day in a Medicare benefit period for post-hospital skilled nursing facility care eligible under Medicare Part A; and Medically Necessary Emergency Care in a Foreign Country, which is Coverage to the extent not covered by Medicare for eighty percent (80%) of the billed charges for Medicare-eligible expenses for medically necessary emergency hospital, physician and medical care received in a foreign country, if such care would have been covered by Medicare if provided in the United States and if such care began during the first sixty (60) consecutive days of each trip outside the United States, subject to a calendar year deductible of $250, and a lifetime maximum benefit of $50,000.

(i) Standardized Medicare supplement Plan N shall include only the following: The basic (core) benefit as defined in paragraph (6)(a), plus one hundred percent (100%) of the Medicare Part A deductible amount per benefit period; Skilled Nursing Facility Care Coverage for the actual billed charges up to the coinsurance amount from the 21st day through the 100th day in a Medicare benefit period for post-hospital skilled nursing facility care eligible under Medicare Part A; and Medically Necessary Emergency Care in a Foreign Country, which is Coverage to the extent not covered by Medicare for eighty percent (80%) of the billed charges for Medicare-eligible expenses for medically necessary emergency hospital, physician and medical care received in a foreign country, if such care would have been covered by Medicare if provided in the United States and if such care began during the first sixty (60) consecutive days of each trip outside the United States, subject to a calendar year deductible of $250, and a lifetime maximum benefit of $50,000; and Part B coverage with co-payments in the following amounts:
1. The lesser of twenty dollars ($20) or the Medicare Part B coinsurance or co-payment for each covered health care provider office visit (including visits to medical specialists).

2. The lesser of fifty dollars ($50) or the Medicare Part B coinsurance or co-payment for each covered emergency room visit, however, this co-payment shall be waived if the insured is admitted to any hospital and the emergency visit is subsequently covered as a Medicare Part A expense.
For purposes of this subsection, "emergency care" shall mean care needed immediately because of an injury or an illness of sudden and unexpected onset.
(7) New or Innovative Benefits: An issuer may, with the prior written approval of the Office, offer policies or certificates with new or innovative benefits, in addition to the standardized benefits provided in a policy or certificate that otherwise complies with the applicable standards. The new or innovative benefits shall include only benefits that are appropriate to Medicare supplement insurance, are new or innovative, are not otherwise available, and are cost-effective. Approval of new or innovative benefits must not adversely impact the goal of Medicare supplement simplification. New or innovative benefits shall not include an outpatient prescription drug benefit. New or innovative benefits shall not be used to change or reduce benefits, including a change of any cost-sharing provision, in any standardized plan. Benefit plan standards applicable to Medicare supplement policies and certificates issued to individuals who are not a Newly Eligible Medicare Beneficiary remain subject to the requirements of Rules 69O-156.0075 and 69O-156.0085, F.A.C.

69O FAC 156.009 | Open Enrollment

(1) No issuer shall deny or condition the issuance or effectiveness of any Medicare supplement policy or certificate available for sale in this State, nor discriminate in the pricing of such a policy or certificate because of the health status, claims experience, receipt of health care, or medical condition of an applicant in the case of an application for a policy or certificate that is submitted prior to or during the six (6) month period beginning with the first day of the first month in which an individual is both 65 years of age or older and is enrolled for benefits under Medicare Part B. Each Medicare supplement policy and certificate currently available from an insurer shall be made available to all applicants who qualify under this rule without regard to age.

(2)
(a) If an applicant qualifies under subsection (1) and submits an application during the time period referenced in subsection (1) and, as of the date of application, has had a continuous period of creditable coverage of at least six (6) months, the issuer shall not exclude benefits based on a pre-existing condition.

(b) If the applicant qualifies under subsection (1) and submits an application during the time period referenced in subsection (1) and, as of the date of application, has had a continuous period of creditable coverage that is less than six (6) months, the issuer shall reduce the period of any pre-existing condition exclusion by the aggregate of the period of creditable coverage applicable to the applicant as of the enrollment date. The Secretary shall specify the manner of the reduction under this subsection.
(3) Subsections 69O-156.009(1) and 69O-156.019(1), F.A.C., shall not be construed as preventing the exclusion of benefits under a policy, during the first six (6) months, based on a preexisting condition for which the policyholder or certificateholder received treatment or was otherwise diagnosed during the six (6) months before it became effective.

69O FAC 156.0095 | Guaranteed Issue for Eligible Persons

(1) Guaranteed Issue.
(a) Eligible persons are those individuals described in subsection (2) who:
1. Seek to enroll under the policy during the period specified in subsection (3); and

2. Submit evidence of the date of termination, disenrollment, or Medicare Part D enrollment with the application for a Medicare supplement policy.
(b) With respect to eligible persons, an issuer shall not:
1. Deny or condition the issuance or effectiveness of a Medicare supplement policy described in subsection (5) that is offered and is available for issuance to new enrollees by the issuer;

2. Discriminate in the pricing of such a Medicare supplement policy because of;
a. Health status,

b. Claims experience,

c. Receipt of health care, or

d. Medical condition; and
3. Impose an exclusion of benefits based on a preexisting condition under such a Medicare supplement policy.
(2) Eligible Persons. An eligible person is an individual described in any of the following paragraphs:
(a) The individual is enrolled under an employee welfare benefit plan that provides health benefits that supplement the benefits under Medicare, which plan terminates or ceases to provide at least the minimum benefits as provided under a Medicare supplement plan "A" as defined in subsection 69O-156.0085(1), F.A.C., of the supplemental health benefits to the individual;

(b) The individual is enrolled with a Medicare Advantage organization under a Medicare Advantage plan under Part C of Medicare, and any of the following circumstances apply, or the individual is 65 years of age or older and is enrolled with a Program of All-Inclusive Care for the Elderly (PACE) provider under Section 1894 of the Social Security Act, and there are circumstances similar to those described below that would permit discontinuance of the individual's enrollment with such provider if such individual were enrolled in a Medicare Advantage plan:
1. The certification of the organization or plan under this part has been terminated;

2. The organization has terminated or otherwise discontinued providing the plan in the area in which the individual resides;

3. The individual is no longer eligible to elect the plan because of a change in the individual's place of residence or other change in circumstances specified by the Secretary, but not including termination of the individual's enrollment on the basis described in Section 1851(g)(3)(B), of the federal Social Security Act, which is hereby incorporated by reference, (where the individual has not paid premiums on a timely basis or has engaged in disruptive behavior as specified in standards under Section 1856, which is hereby incorporated by reference), or the plan is terminated for all individuals within a residence area;

4. The individual demonstrates, in accordance with guidelines established by the Secretary, that:
a. The organization offering the plan substantially violated a material provision of the organization's contract under this part in relation to the individual, including the failure to provide an enrollee on a timely basis medically necessary care for which benefits are available under the plan or the failure to provide such covered care in accordance with applicable quality standards; or

b. The organization, or agent or other entity acting on the organization's behalf, materially misrepresented the plan's provisions in marketing the plan to the individual, or
5. The individual meets such other exceptional conditions as the Secretary may provide.
(c)
1. The individual is enrolled with:
a. An eligible organization under a contract under Section 1876, 42 U.S.C. Section 1395mm (1999 Supplement) which is hereby incorporated by reference (Medicare cost);

b. A similar organization operating under demonstration project authority, effective for periods before April 1, 1999;

c. An organization under an agreement under Section 1833(a)(1)(A), 42 U.S.C. Section 1395I (1999 Supplement) which is hereby incorporated by reference, (Health care prepayment plan): or

d. An organization under a Medicare Select policy; and
2. The enrollment ceases under the same circumstances that would permit discontinuance of an individual's election of coverage under paragraph 69O-156.0095(2)(b), F.A.C.
(d) The individual is enrolled under a Medicare supplement policy and the enrollment ceases because of:
1.
a. The insolvency of the issuer or bankruptcy of the nonissuer organization; or

b. Other involuntary termination of coverage or enrollment under the policy;
2. The issuer of the policy substantially violated a material provision of the policy; or

3. The issuer, or an agent or other entity acting on the issuer's behalf, materially misrepresented the policy's provisions in marketing the policy to the individual.
(e)
1. The individual was enrolled under a Medicare supplement policy and terminated enrollment and subsequently enrolled, for the first time, with:
a. Any Medicare Advantage organization under Medicare Advantage plan under Part C of Medicare;

b. Any eligible organization under a contract under Section 1876, 42 U.S.C. Section 1395mm (1999 Supplement) which is hereby incorporated by reference (Medicare cost), any similar organization operating under demonstration project authority;

c. Any PACE provider under Section 1894 of the Social Security Act; or

d. A Medicare Select policy; and
2. The subsequent enrollment under subparagraph 1. is terminated by the enrollee during any period within the first twelve (12) months of the subsequent enrollment (during which the enrollee is permitted to terminate the subsequent enrollment under Section 1851(e) of the federal Social Security Act), 42 U.S.C. Section 1395w-21 (1999 Supplement) which is hereby incorporated by reference; or
(f) The individual, upon first becoming eligible for benefits under Part A of Medicare at age 65, enrolls in a Medicare Advantage plan under Part C of Medicare, or with a PACE program provider under Section 1894 of the Social Security Act, and disenrolls from the plan or program by not later than twelve (12) months after the effective date of enrollment;

(g) The individual enrolls in a Medicare Part D plan during the initial enrollment period, and at the time of enrollment in Part D, was enrolled under a Medicare supplement policy that covers outpatient prescription drugs and the individual terminates enrollment in the Medicare supplement policy and submits evidence of enrollment in Medicare Part D along with the application for a policy described in paragraph (5)(d).
(3) Guaranteed Issue Time Periods.
(a) In the case of an individual described in paragraph (2)(a), the guaranteed issue period:
1. Begins on the later of:
a. The date the individual receives a notice of termination or cessation of the supplemental health benefits (or, if a notice is not received, notice that a claim has been denied because of such a termination or cessation); or

b. The date that the applicable coverage terminates or ceases; and
2. Ends sixty-three (63) days thereafter.
(b) In the case of an individual described in paragraph (2)(b), (c), (e) or (f) whose enrollment is terminated involuntarily, the guaranteed issue period begins on the date that the individual receives a notice of termination and ends sixty-three (63) days after the date the applicable coverage is terminated;

(c) In the case of an individual described in subparagraph (2)(d)1., the guaranteed issue period begins on the earlier of:
1. The date that the individual receives a notice of termination, a notice of the issuer's bankruptcy or insolvency, or other similar notice if any; and

2. The date that the applicable coverage is terminated, and ends on the date that is sixty-three (63) days after the date the coverage is terminated.
(d) In the case of an individual described in paragraph (2)(b), subparagraph (d)2. or 3., or paragraph (2)(e) or (f) who disenrolls voluntarily, the guaranteed issue period begins on the date that is sixty (60) days before the effective date of the disenrollment and ends on the date that is sixty-three (63) days after the effective date;

(e) In the case of an individual described in paragraph (2)(g), the guaranteed issue period begins on the date the individual receives notice pursuant to Section 1882(v)(2)(B) of the Social Security Act from the Medicare supplement issuer during the sixty day period immediately preceding the initial Part D enrollment period and ends on the date that is sixty-three (63) days after the effective date of the individual's coverage under Medicare Part D; and

(f) In the case of an individual described in subsection (2) but not described in the preceding provisions of this subsection, the guaranteed issue period begins on the effective date of disenrollment and ends on the date that is sixty-three (63) days after the effective date.
(4) Extended Medicare Supplement access for interrupted trial periods.
(a) In the case of an individual described in paragraph (2)(e) (or deemed to be so described, pursuant to this paragraph) whose enrollment with an organization or provider described in subparagraph (2)(e)1. is involuntarily terminated within the first twelve (12) months of enrollment, and who, without an intervening enrollment, enrolls with another such organization or provider, the subsequent enrollment shall be deemed to be an initial enrollment described in paragraph 69O-156.0095(2)(e), F.A.C.;

(b) In the case of an individual described in paragraph (2)(f) (or deemed to be so described, pursuant to this paragraph) whose enrollment with a plan or in a program described in paragraph (2)(f) is involuntarily terminated within the first twelve (12) months of enrollment, and who, without an intervening enrollment, enrolls in another such plan or program, the subsequent enrollment shall be deemed to be an initial enrollment described in paragraph 69O-156.0095(2)(f), F.A.C.; and

(c) For purposes of paragraphs (2)(e) and (f), no enrollment of an individual with an organization or provider described in subparagraph (2)(e)1., or with a plan or in a program described in paragraph (2)(f), may be deemed to be an initial enrollment under this paragraph after the two year period beginning on the date on which the individual first enrolled with such an organization, provider, plan or program.
(5) Products to Which Eligible Persons Are Entitled. The Medicare supplement policy to which eligible persons are entitled under:
(a) Paragraphs 69O-156.0095(2)(a), (b), (c) and (d), F.A.C., is a Medicare supplement policy which has a benefit package classified as plan A, B, C, F (including F with a high deductible), K, or L offered by any issuer.

(b)
1. Subject to subparagraph 2., paragraph 69O-156.0095(2)(e), F.A.C., is the same Medicare supplement policy in which the individual was most recently previously enrolled, if available from the same issuer, or, if not so available, a policy described in paragraph (5)(a);

2. After December 31, 2005, if the individual was most recently enrolled in a Medicare supplement policy with an outpatient prescription drug benefit, a Medicare supplement policy described in this subparagraph is:
a. The policy available from the same issuer but modified to remove outpatient prescription drug coverage; or

b. At the election of the policyholder, an A, B, C, F (including F with a high deductible), K or L policy that is offered by any issuer;
(c) Paragraph 69O-156.0095(2)(f), F.A.C., shall include any Medicare supplement policy offered by any issuer.

(d) Paragraph 69O-156.0095(2)(g), F.A.C., is a Medicare supplement policy that has a benefit package classified as Plan A, B, C, F (including F with a high deductible), K or L, and that is offered and is available for issuance to new enrollees by the same issuer that issued the individual's Medicare supplement policy with outpatient prescription drug coverage.
(6) Notification provisions.
(a)
1. At the time of an event described in subsection (2) of this rule because of which an individual loses coverage or benefits due to the termination of a contract or agreement, policy, or plan, the organization that terminates the contract or agreement, the issuer terminating the policy, or the administrator of the plan being terminated, respectively, shall notify the individual of his or her rights under this section, and of the obligations of issuers of Medicare supplement policies under subsection (1).

2. The notice shall be communicated contemporaneously with the notification of termination.
(b)
1. At the time of an event described in subsection (2) of this rule because of which an individual ceases enrollment under a contract or agreement, policy or plan, the organization that offers the contract or agreement, regardless of the basis for the cessation of enrollment, the issuer offering the policy, or the administrator of the plan, respectively, shall notify the individual of the individual's rights under this section, and of the obligations of issuers of Medicare supplement policies under subsection (1).

2. The notice shall be communicated within ten working days of the issuer receiving notification of disenrollment.

69O FAC 156.010 | Standards for Claims Payment

(1) An issuer shall comply with Section 1882(c)(3) of the Social Security Act (as enacted by Section 4081(b)(2)(C), of the Omnibus Budget Reconciliation Act of 1987 (OBRA) 1987, Pub. L. No. 100-203) by:
(a) Accepting a notice from a Medicare carrier on dually assigned claims submitted by participating physicians and suppliers as a claim for benefits in place of any other claim form otherwise required and making a payment determination on the basis of the information contained in that notice;

(b) Notifying the participating physician or supplier and the beneficiary of the payment determination;

(c) Paying the participating physician or supplier directly;

(d) Furnishing, at the time of enrollment, each enrollee with a card listing the policy name, number and a central mailing address to which notices from a Medicare carrier may be sent;

(e) Paying user fees for claim notices that are transmitted electronically or otherwise; and

(f) Providing to the Secretary of Health and Human Services, at least annually, a central mailing address to which all claims may be sent by Medicare carriers.
(2) Compliance with the requirements set forth in subsection 69O-156.010(1), F.A.C., shall be certified on the Medicare supplement insurance experience reporting form.

69O FAC 156.011 | Loss Ratio Standards and Refund or Credit of Premium

(1) Loss Ratio Standards.
(a) A Medicare Supplement policy form or certificate form shall not be delivered or issued for delivery unless the policy form, certificate form, or block of pooled forms, can be expected, as estimated for the lifetime of the policy, to return to policyholders and certificateholders in the form of aggregate benefits (not including anticipated refunds or credits) provided under the policy form, certificate form, or block of pooled forms:
1. At least seventy-five percent (75%) of the aggregate amount of premiums earned in the case of group policies, or

2. For individual policies issued or renewed prior to July 1, 1989, at least 60% of the aggregate amount of premiums earned, and for individual policies issued on or after July 1, 1989, at least sixty-five percent (65%) of the aggregate amount of premiums earned, calculated on the basis of incurred claims experience or incurred health care expenses where coverage is provided by a health maintenance organization on a service rather than reimbursement basis and earned premiums for such period and in accordance with accepted actuarial principles and practices. Policies and certificates which were marketed and issued as Medicare Supplement policies and which have been redefined as limited benefit policies shall have the same loss ratio requirements as if they were still defined as Medicare Supplement policies. Incurred health care expenses where coverage is provided by a health maintenance organization shall not include:
a. Home office and overhead costs;

b. Advertising costs;

c. Commissions and other acquisition costs;

d. Taxes;

e. Capital costs;

f. Administrative costs; and

g. Claims processing costs.
(b) All filings of rates and rating schedules shall demonstrate that projected claims in relation to premiums comply with the requirements of this rule when combined with actual experience to date. Filings of rate revisions shall also demonstrate that the anticipated loss ratio over the entire future lifetime can be expected to meet the appropriate loss ratio standards.

(c) For purposes of applying paragraphs 69O-156.011(1)(a) and 69O-156.012(3)(c), F.A.C., only, policies issued as a result of solicitations of individuals through the mails or by mass media advertising (including both print and broadcast advertising) shall be deemed to be individual policies.

(d) For individual policies issued prior to April 25, 1996, all filings of rates, rating schedules or rate revisions shall demonstrate that the future projected claims in relation to premiums shall meet the 65% loss ratio standard:
1. When combined with actual experience beginning with April 25, 1996, and

2. When measured over the entire future lifetime of the policy or block of pooled forms.
(e) For the purposes of this rule, the term "pre-standardized business" shall include:
1. All Medicare Supplement policies and certificates which do not comply with the benefit requirements for standardized policies as defined in Rule 69O-156.008 or 69O-156.0085, F.A.C., and

2. All policies and certificates which were marketed and issued as Medicare Supplement policies, and which have been redefined as limited benefit policies.
(f) Pre-standardized business shall be allocated between the following two types, and combined for all rating purposes within each type: individual business and group business. The minimum lifetime loss ratio for the pooled blocks of business shall be the weighted average of the lifetime minimum loss ratios for each form comprising the block. The weights shall be the amount of earned premium in the last completed calendar year.
(2) Refund or Credit Calculation.
(a)
1. An issuer shall collect the data necessary, and file with the Office each year by May 31, the refund or credit calculation information. This filing shall include:
a. Form OIR-B2-1507, "Office of Insurance Regulation, Life and Health Forms and Rates Universal Standardized Data Letter" as adopted in Rule 69O-149.022, F.A.C., completely filled out in accordance with Form OIR-B2-1507A, "Office of Insurance Regulation, Life and Health Forms and Rates Universal Standardized Data Letter Instruction Sheet," as adopted in Rule 69O-149.022, F.A.C.;

b. The following forms for each type in a standard Medicare supplement benefit plan, and each type of pre-standardized business:
(I)
(A) "Reporting Form for the Calculation of the Benchmark Loss Ratio Since Inception for Individual Policies" Form OIR-B2-MSB-I, for individual business, completed in compliance with the instructions for the form; or

(B) "Reporting Form for the Calculation of the Benchmark Loss Ratio Since Inception for Group Policies" Form OIR-B2-MSB-G, for group business, completed in compliance with the instructions for the form; and
(II) The "Medicare Supplement Refund Calculation Form" Form OIR-B2-MSR, completed in compliance with the instructions for the form.
2. Forms OIR-B2-MSB-I (Rev. 06-09), OIR-B2-MSB-G (Rev. 06-09), and OIR-B2-MSR (Rev. 7/02) are hereby adopted and incorporated by reference. Copies of forms are available and may be printed from the Office's website: http://www.FLOir.com/iPortal.

3. Filings shall be submitted electronically to http://www.FLOir.com/iPortal.
(b)
1. If on the basis of the experience as reported the benchmark ratio since inception (ratio 1) exceeds the adjusted experience ratio since inception (ratio 3), then a refund or credit calculation is required. The refund calculation shall be done on a statewide basis for each type in a standard Medicare supplement benefit plan and each type of pre-standardized business. For purposes of the refund or credit calculation, experience on policies issued within the reporting year shall be excluded.

2. In particular, for policies and certificates issued as pre-standardized business:
a. In the preparation of the "Reporting Form for the Calculation of the Benchmark Loss Ratio Since Inception for Individual Policies" OIR-B2-MSB-I, and "Reporting Form for the Calculation of the Benchmark Loss Ratio Since Inception for Group Policies" Form OIR-B2-MSB-G, the insurer shall consider January 1, 1992, to be the date of inception for all policies and certificates and first year premium shall be the 1992 earned premium.

b. The insurer shall prepare Form OIR-B2-MSR for the two types of pre-standardized business. Since all policies and certificates are considered to have been issued on January 1, 1992, only experience since that date shall be included in this exhibit.

c. All individual businesses, regardless of issue date, shall use the factors on the "Reporting Form for the Calculation of the Benchmark Loss Ratio Since Inception for Individual Policies" Form OIR-B2-MSB-I.
(c) A refund or credit shall be made only when the benchmark loss ratio exceeds the adjusted experience loss ratio and the amount to be refunded or credited exceeds a de minimis level. Such refund shall include interest from the end of the calendar year to the date of the refund or credit at a rate specified by the Secretary of Health and Human Services, but in no event shall it be less than the average rate of interest for 13-week Treasury notes. A refund or credit against premiums due shall be made by September 30 following the experience year upon which the refund or credit is based.
(3) Annual Filing of Premium Rates.
(a)
1. An issuer of Medicare supplement policies and certificates issued before or after January 1, 1992, shall file annually its rates, rating schedule and supporting documentation including ratios of incurred losses to earned premiums by policy duration for approval by the Office in accordance with Sections 627.410, 627.411 and 627.6745, F.S.

2. The supporting documentation shall also demonstrate in accordance with actuarial standards of practice using reasonable assumptions that the appropriate loss ratio standards can be expected to be met over the entire period for which rates are computed. The demonstration shall exclude the change in active life reserves as a component of incurred claims or earned premiums. A projected third-year loss ratio which is greater than or equal to the applicable percentage shall be demonstrated for policies or certificates in force less than three (3) years.
(b) As soon as practicable, but prior to the effective date of enhancements in Medicare benefits, every issuer of Medicare supplement policies or certificates in this State shall file with the Office, in accordance with the applicable filing procedures of this State:
1.
a. Appropriate premium adjustments necessary to produce loss ratios as anticipated for the current premium for the applicable policies or certificates. Such supporting documents as necessary to justify the adjustment shall accompany the filing.

b. An issuer shall make such premium adjustments as are necessary to produce a projected loss ratio under such policy or certificate as will conform with minimum loss ratio standards for Medicare supplement policies and which are projected to result in a loss ratio at least as great as that originally anticipated in the rates used to produce current premiums by the issuer for such Medicare supplement policies or certificates. No premium adjustment which would modify the loss ratio experience under the policy other than the adjustments described herein shall be made with respect to a policy at any time other than upon its renewal date or anniversary date.
2. Any appropriate riders, endorsements or policy forms needed to accomplish the Medicare supplement policy or certificate modifications necessary to eliminate benefit duplications with Medicare. Such riders, endorsements or policy forms shall provide a clear description of the Medicare supplement benefits provided by the policy or certificate.
(c) If an issuer fails to make premium adjustments necessary to meet or exceed the loss ratio required by this rule, the Office shall order premium adjustments, refunds or premium credits required to achieve the loss ratio specified in this rule and maintain compliance with Chapter 69O-149, F.A.C., unless the premium adjustment does not exceed a de minimis level of $10 per policy for the average annual premium.
(4) Public Hearings. The Office may conduct a public hearing to gather information concerning a request by an issuer for an increase in a rate for a policy form or certificate form issued before or after January 1, 1992 if the experience of the form for the previous reporting period is not in compliance with the applicable loss ratio standard. The determination of compliance is made without consideration of any refund or credit for such reporting period. Public notice of such hearing shall be furnished pursuant to the requirements of Chapter 120, F.S.

69O FAC 156.012 | Filing and Approval of Policies and Certificates and Premium Rates

(1) An issuer shall not deliver or issue for delivery a policy or certificate to a resident of this State unless the policy form or certificate form has been filed with and approved by the Office including any riders or amendments to policy or certificate forms to delete outpatient prescription drug benefits as required by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, in accordance with Sections 627.410, 627.411, 627.674, F.S.

(2) An issuer shall not use or change premium rates for a Medicare supplement policy or certificate unless the rates, rating schedule and supporting documentation have been filed with and approved by the Office in accordance with Sections 627.410, 627.411, 627.674, F.S.

(3)
(a) Except as provided in paragraph 69O-156.012(3)(b), F.A.C., an issuer shall not file for approval more than one form of a policy or certificate of each type for each standard Medicare supplement benefit plan.

(b) An issuer may offer, with the approval of the Office, up to four (4) additional policy forms or certificate forms of the same type for the same standard Medicare supplement benefit plan, one for each of the following cases:
1. The inclusion of new or innovative benefits;

2. The addition of either direct response or agent marketing methods;

3. The addition of either guaranteed issue or underwritten coverage;

4. The offering of coverage to individuals eligible for Medicare by reason of disability.
(c) For the purposes of this rule, a "type" means an individual policy, a group policy, an individual Medicare Select policy, or a group Medicare Select policy.

(d) Acceptable rate classification criteria within a form include only age, gender, area and smoker status or tobacco usage.
(4)
(a) Except as provided in subparagraph 69O-156.012(4)(a)1., F.A.C., an issuer shall continue to make available for purchase any policy form or certificate form issued after the effective date of this rule chapter that has been approved by the Office. A policy form or certificate form shall not be considered to be available for purchase unless the issuer has actively offered it for sale in the previous twelve (12) months.
1. An issuer may discontinue the availability of a policy form or certificate form if the issuer provides to the Office in writing its decision at least thirty (30) days prior to discontinuing the availability of the form of the policy or certificate. After receipt of the notice by the Office, the issuer shall no longer offer for sale the policy form or certificate form in this State.

2. An issuer that discontinues the availability of a policy form or certificate form pursuant to subparagraph 69O-156.012(4)(a)1., F.A.C., or Section 627.410, F.S., shall not file for approval a new policy form or certificate form of the same type for the same standard Medicare supplement benefit plan as the discontinued form for a period of five (5) years after the issuer provides notice to the Office of the discontinuance.
(b) The sale or other transfer of Medicare supplement business to another issuer shall be considered a discontinuance for the purposes of this rule.

(c) A change in the rating structure or methodology shall be considered a discontinuance under paragraph 69O-156.012(4)(a), F.A.C., unless the issuer complies with the following requirements:
1. The issuer provides an actuarial memorandum describing the manner in which the revised rating methodology and resultant rates differ from the existing rating methodology and existing rates.

2. The issuer does not subsequently put into effect a change of rates or rating factors that would cause the percentage differential between the discontinued and subsequent rates as described in the actuarial memorandum to change. The Office may approve a change to the differential which is in the public interest.
(5)
(a) Except as provided in paragraph 69O-156.012(5)(b), F.A.C., the experience of all policy forms or certificate forms of the same type in a standard Medicare supplement benefit plan shall be combined for purposes of the refund or credit calculation prescribed in Rule 69O-156.011, F.A.C., and for all other rating purposes. The issue date of a standard Medicare supplement benefit plan is not a basis to separate experience of two or more plans of the same plan letter.

(b) Forms assumed under an assumption reinsurance agreement shall not be combined with the experience of other forms for purposes of the refund or credit calculation.

69O FAC 156.013 | Permitted Compensation Arrangements

(1) An insurer or other entity may provide commission or other compensation to an agent or other representative for the sale of a Medicare supplement policy or certificate only if the first year commission or other first year compensation is no more than 200 percent (200%) of the commission or other compensation paid for selling or servicing the policy or certificate in the second year or period. However, an issuer on entry, who restricts first agent commission or compensation to 15% or less of the policy premium, may elect not to pay any commission or other compensation to an agent or other representative for the renewal or replacement of a Medicare supplement policy or certificate.

(2) The commission or other compensation provided in subsequent (renewal) years must be the same as that provided in the second year or period and must be provided for no fewer than five (5) renewal years.

(3) No issuer or other entity shall provide compensation to its agents or other producers and no agent or producer shall receive compensation greater than the renewal compensation payable by the replacing insurer on renewal policies or certificates if an existing policy or certificate is replaced.

(4) For purposes of this rule, "compensation" includes pecuniary or non-pecuniary remuneration of any kind relating to the sale or renewal of the policy or certificates including but not limited to bonuses, gifts, prizes, awards and finders fees.

69O FAC 156.014 | Required Disclosure Provisions

(1) General Rules.
(a) Medicare supplement policies and certificates shall include a renewal or continuation provision. The language or specifications of such provision shall be consistent with the type of contract issued. Such provision shall be appropriately captioned and shall appear on the first page of the policy, and shall include any reservation by the issuer of the right to change premiums and any automatic renewal premium increases based on the policyholder's age.

(b) Except for riders or endorsements by which the issuer effectuates a request made in writing by the insured, exercises a specifically reserved right under a Medicare supplement policy, or is required to reduce or eliminate benefits to avoid duplication of Medicare benefits, all riders or endorsements added to a Medicare supplement policy after date of issue or at reinstatement or renewal which reduce or eliminate benefits or coverage in the policy shall require a signed acceptance by the insured. After the date of policy or certificate issue, any rider or endorsement which increases benefits or coverage with a concomitant increase in premium during the policy term shall be agreed to in writing signed by the insured, unless the benefits are required by the minimum standards for Medicare supplement policies, or if the increased benefits or coverage is required by law. Where a separate additional premium is charged for benefits provided in connection with riders or endorsements, such premium charge shall be set forth in the policy.

(c) Medicare supplement policies or certificates shall not provide for the payment of benefits based on standards described as "usual and customary," "reasonable and customary," or words of similar import.

(d) If a Medicare supplement policy or certificate contains any limitations with respect to preexisting conditions, such limitations shall appear as a separate paragraph of the policy and be labeled as "Preexisting Condition Limitations."

(e) Medicare supplement policies and certificates shall have a notice prominently printed on the first page of the policy or certificate or attached thereto stating in substance that the policyholder or certificateholder shall have the right to return the policy or certificate within thirty (30) days of its delivery and to have the premium refunded if, after examination of the policy or certificate, the insured person is not satisfied for any reason.

(f) Any issuer delivering or issuing for delivery a Medicare supplement policy, subject to this part, shall give the policyholder or certificateholder at least 45 days advance notice of a change in rates. Such notice shall be mailed to the policyholder's last address as shown by the records of the issuer.

(g) Issuers of accident and sickness policies or certificates which provide hospital or medical expense coverage on an expense incurred or indemnity basis, to a person(s) eligible for Medicare shall provide to those applicants a Guide to Health Insurance for People with Medicare in the form developed jointly by the National Association of Insurance Commissioners and Centers for Medicare and Medicaid Services (CMS) and in a type size no smaller than 12 point type. Delivery of the Guide shall be made whether or not such policies or certificates are advertised, solicited or issued as Medicare supplement policies or certificates as defined in this regulation. Except in the case of direct response issuers, delivery of the Guide shall be made to the applicant at the time of application and acknowledgment of receipt of the Guide shall be obtained by the issuer. Direct response issuers shall deliver the Guide to the applicant upon request but not later than at the time the policy is delivered. For the purposes of this section, "form" means the language, format, type size, type proportional spacing, bold character, and line spacing.
(2) Notice Requirements.
(a) As soon as practicable, but no later than thirty (30) days prior to the annual effective date of any Medicare benefit changes, an issuer shall notify its policyholders and certificateholders of modifications it has made to Medicare supplement insurance policies or certificates in a format acceptable to the Office. Such notice shall:
1. Include a description of revisions to the Medicare program and a description of each modification made to the coverage provided under the Medicare supplement policy or certificate, and

2. Inform each policyholder or certificateholder as to when any premium adjustment is to be made due to changes in Medicare.
(b) The notice of benefit modifications and any premium adjustments shall be in outline form and in clear and simple terms so as to facilitate comprehension.

(c) Such notices shall not contain or be accompanied by any solicitation.
(3) MMA Notice Requirements. Issuers shall comply with any notice requirements of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.

(4) Outline of Coverage Requirements for Medicare Supplement Policies.
(a) Issuers shall provide an outline of coverage to all applicants at the time application is presented to the prospective applicant and, except for direct response policies, shall obtain an acknowledgment of receipt of such outline from the applicant; and

(b) If an outline of coverage is provided at the time of application and the Medicare supplement policy or certificate is issued on a basis which would require revision of the outline, a substitute outline of coverage properly describing the policy or certificate shall accompany such policy or certificate when it is delivered and contain the following statement, in no less than twelve (12) point type, immediately above the company name:
"NOTICE: Read this outline of coverage carefully. It is not identical to the outline of coverage provided upon application and the coverage originally applied for has not been issued."
(c) The outline of coverage shall be in the language prescribed in Form OIR-B2-MSC and formatted in no less than twelve (12) point type. All plans A-L shall be shown on the cover page, and the plan(s) that are offered by the issuer shall be prominently identified. Premium information for plans that are offered shall be shown on the cover page or immediately following the cover page and shall be prominently displayed. The premium and mode shall be stated for all plans that are offered to the prospective applicant. All possible premiums for the prospective applicant shall be illustrated.

(d) Include for each plan prominently identified in the cover page, a chart showing the services, Medicare payments, plan payments and insured payments for each plan, using the same language, in the same order, using uniform layout and format as shown in the charts in Form OIR-B2-MSC. No more than four plans may be shown on one chart. For purposes of illustration, charts for each plan are included in this regulation. An issuer may use additional benefit plan designations on these charts pursuant to subsection 69O-156.008(4), F.A.C., of this chapter.

(e) Include an explanation of any innovative benefits on the cover page and in the chart, in a manner approved by the Office.

(f) Notice Regarding Policies or Certificates Which Are Not Medicare Supplement Policies.
1. Any accident and sickness insurance policy or certificate, other than a Medicare supplement policy; a policy issued pursuant to a contract under Section 1876 of the Federal Social Security Act (42 U.S.C. s. 1395 et seq.), disability income policy; or other policy identified in subsection 69O-156.002(2), F.A.C., of this chapter, issued for delivery in the State to persons eligible for Medicare shall notify insureds under the policy that the policy is not a Medicare supplement policy or certificate. The notice shall either be printed or attached to the first page of the outline of coverage delivered to insureds under the policy, or if no outline of coverage is delivered, to the first page of the policy, or certificate delivered to insureds. The notice shall be in no less than twelve (12) point type and shall contain the following language:

"THIS [POLICY OR CERTIFICATE] IS NOT A MEDICARE SUPPLEMENT [POLICY OR CONTRACT].

If you are eligible for Medicare, review the Guide to Health Insurance for People with Medicare available from the company."
2. Applications provided to persons eligible for Medicare for the health insurance policies or certificates described in subparagraph (f)1. shall disclose, using the applicable statement in Appendix A, "Disclosure Statements" and instructions (11/04), which is hereby adopted and incorporated by reference and is available on the Office's website: http://www.fldfs.com, the extent to which the policy duplicates Medicare. The disclosure statement shall be provided as a part of, or together with, the application for the policy or certificate. Insurers insert the references to outpatient prescription drugs and Serving Health Insurance Needs of Elders (SHINE) included in the Disclosure Statements for use with applications taken after December 31, 2005. The "Disclosure Statement" is hereby adopted and incorporated by reference.

69O FAC 156.015 | Requirements for Application Forms and Replacement Coverage

(1) Application forms shall include the following statements and the following questions designed to elicit information as to whether, as of the date of the application, the applicant currently has Medicare supplement, or Medicare Advantage, Medicaid coverage, or another health insurance policy or certificate in force or whether a Medicare supplement policy or certificate is intended to replace any other accident and sickness policy or certificate presently in force. A supplementary application or other form to be signed by applicant and agent containing such questions and statements may be used.

[Statements]

(a) You do not need more than one Medicare supplement policy.

(b) If you purchase this policy, you may want to evaluate your existing health coverage and decide if you need multiple coverages.

(c) You may be eligible for benefits under Medicaid and may not need a Medicare supplement policy.

(d) If after purchasing this policy, you become eligible for Medicaid, the benefits and premiums under your Medicare supplement policy can be suspended, if requested, during your entitlement to benefits under Medicaid for 24 months. You must request this suspension within 90 days of becoming eligible for Medicaid. If you are no longer entitled to Medicaid, your suspended Medicare supplement policy (or, if that is no longer available, a substantially equivalent policy) will be reinstituted if requested within 90 days of losing Medicaid eligibility. If the Medicare supplement policy provided coverage for outpatient prescription drugs and you enrolled in Medicare Part D while your policy was suspended, the reinstituted policy will not have outpatient prescription drug coverage, but will otherwise be substantially equivalent to your coverage before the date of the suspension.

(e) If you are eligible for, and have enrolled in a Medicare supplement policy by reason of disability and you later become covered by an employer or union-based group health plan, the benefits and premiums under your Medicare supplement policy can be suspended, if requested, while you are covered under the employer or union-based group health plan. If you suspend your Medicare supplement policy under these circumstances, and later lose your employer or union-based group health plan, your suspended Medicare supplement policy (or, if that is no longer available, a substantially equivalent policy) will be reinstituted if requested within 90 days of losing your employer or union-based group health plan. If the Medicare supplement policy provided coverage for outpatient prescription drugs and you enrolled in Medicare Part D while your policy was suspended, the reinstituted policy will not have outpatient prescription drug coverage, but will otherwise be substantially equivalent to your coverage before the date of the suspension.

(f) Counseling services may be available in your state to provide advice concerning your purchase of Medicare supplement insurance and concerning medical assistance through the state Medicaid program, including benefits as a Qualified Medicare Beneficiary (QMB) and a Specified Low-Income Medicare Beneficiary (SLMB).

[Questions]

If you lost or are losing other health insurance coverage and received a notice from your prior insurer saying you were eligible for guaranteed issue of a Medicare supplement insurance policy, or that you had certain rights to buy such a policy you may be guaranteed acceptance in one or more of our Medicare supplement plans. Please include a copy of the notice from your prior insurer with our application. PLEASE ANSWER ALL QUESTIONS.

[Please mark Yes or No below with an "X"] To the best of your knowledge, (1)
(a) Did you turn age 65 in the last 6 months?
Yes__ No__.
(b) Did you enroll in Medicare Part B in the last 6 months?
Yes__ No__.
(c) If yes, what is the effective date? _________________________
(2) Are you covered for medical assistance through the state Medicaid program?
Yes__ No__.
[NOTE TO APPLICANT: If you are participating in a "Spend-Down Program" and have not met your "Share of Cost", please answer NO to this question.]
If yes,
(a) Will Medicaid pay your premiums for this Medicare supplement policy?
Yes__ No__.
(b) Do you receive any benefits from Medicaid OTHER THAN payments toward your Medicare Part B premium?
Yes__ No__.
(3)
(a) If you had coverage from any Medicare plan other than original Medicare within the past 63 days (for example, a Medicare Advantage plan, or a Medicare HMO or PPO) fill in your start and end dates below. If you are still covered under this plan, leave "END" blank.
START __/__/___ END __/__/___
(b) If you are still covered under the Medicare plan, do you intend to replace your current coverage with this new Medicare supplement policy?
Yes__ No__.
(c) Was this your first time in this type of Medicare plan?
Yes__ No__.
(d) Did you drop a Medicare supplement plan to enroll in the Medicare plan?
Yes__ No__.
(4)
(a) Do you have another Medicare supplement policy in force?
Yes__ No__.
(b) If so, with what company, and what plan do you have [optional for Direct Mailers]?______________________________

(c) If so, do you intend to replace your current Medicare supplement policy with this policy?
Yes__ No__.
(5) Have you had coverage under any other health insurance within the past 63 days? (for example, an employer, union, or individual plan)
Yes__ No__.
(a) If so, with what company and what kind of policy? _________________________________________________________

________________________________________________________________________________________________________ ________________________________________________________________________________________________________
(b) What are your dates of coverage under the other policy?
START __/__/___ END __/__/___

(If you are still covered under the other policy, leave "END" blank.)
(2) Agents shall list any other health insurance policies they have issued to the applicant.
(a) List policies issued which are still in force.

(b) List policies issued in the past five (5) years which are no longer in force.
(3) In the case of a direct response issuer, a copy of the application or supplemental form, signed by the applicant, and acknowledged by the issuer, shall be returned to the applicant by the issuer upon delivery of the policy.

(4) Upon determining that a sale will involve replacement of Medicare supplement coverage, any issuer, other than a direct response issuer, or its agent, shall furnish the applicant, prior to issuance or delivery of the Medicare supplement policy or certificate, a notice regarding replacement of Medicare supplement coverage. One copy of the notice signed by the applicant and the agent, except where the coverage is issued without an agent, shall be provided to the applicant and an additional signed copy shall be retained by the issuer. A direct response issuer shall deliver to the applicant at the time of the issuance of the policy the notice regarding replacement of Medicare supplement coverage.

(5) The notice required by subsection 69O-156.015(4), F.A.C., above for an issuer shall be provided in substantially the following form in no less than twelve (12) point type:

NOTICE TO APPLICANT REGARDING

REPLACEMENT OF MEDICARE SUPPLEMENT

INSURANCE OR MEDICARE ADVANTAGE

[Insurance company's name and address]

SAVE THIS NOTICE! IT MAY BE IMPORTANT TO YOU IN THE FUTURE.

According to [your application] [information you have furnished], you intend to terminate existing Medicare supplement or Medicare Advantage insurance and replace it with a policy to be issued by [Company Name] Insurance Company. Your new policy will provide thirty (30) days within which you may decide without cost whether you desire to keep the policy. You should review this new coverage carefully. Compare it with all accident and sickness coverage you now have. If, after due consideration, you find that purchase of this Medicare supplement coverage is a wise decision, you should terminate your present Medicare supplement or Medicare Advantage coverage. You should evaluate the need for other accident and sickness coverage you have that may duplicate this policy.

STATEMENT TO APPLICANT BY ISSUER, AGENT [BROKER OR OTHER REPRESENTATIVE]:

I have reviewed your current medical or health insurance coverage. To the best of my knowledge, this Medicare supplement policy will not duplicate your existing Medicare supplement or, if applicable, Medicare Advantage coverage because you intend to terminate your existing Medicare supplement coverage or leave year Medicare Advantage Plan. The replacement policy is being purchased for the following reason(s) (check one):
____ Additional benefits.

____ No change in benefits, but lower premiums.

____ Fewer benefits and lower premiums.

____ My plan has outpatient prescription drug coverage and I am enrolling in Part D.

____ Disenrollment from a Medicare Advantage plan. Please explain reason for disenrollment. [optional for Direct Mailers].

________________________________________________________________________________________________________
____ Other. (please specify)
________________________________________________________________________________________________________

________________________________________________________________________________________________________

________________________________________________________________________________________________________
1. Note: If the issuer of the Medicare supplement policy being applied for does not impose pre-existing condition limitations, or is prohibited from imposing pre-existing condition limitations, please skip to statement 2 below. Health conditions which you may presently have (pre-existing conditions) may not be immediately or fully covered under the new policy. This could result in denial or delay of a claim for benefits under the new policy, whereas a similar claim might have been payable under your present policy.

2. State law provides that your replacement policy or certificate may not contain new pre-existing conditions, waiting periods, elimination periods or probationary periods. The insurer will waive any time periods applicable to pre-existing conditions, waiting periods, elimination periods, or probationary periods in the new policy (or coverage) for similar benefits to the extent such time was spent (depleted) under the original policy.

3. If you still wish to terminate your present policy and replace it with new coverage, be certain to truthfully and completely answer all questions on the application concerning your medical and health history. Failure to include all material medical information on an application may provide a basis for the company to deny any future claims and to refund your premium as though your policy had never been in force. After the application has been completed and before you sign it, review it carefully to be certain that all information has been properly recorded.

Do not cancel your present policy until you have received your new policy and are sure that you want to keep it.

_______________________________________________________________________
(Signature of Agent, Broker or Other Representative)*

_______________________________________________________________________
[Typed Name and Address of Issuer, Agent or Broker]

_______________________________________________________________________
(Applicant's Signature)

________
(Date)

*Signature not required for direct response sales.
(6) Subparagraphs 1. and 2. of the replacement notice (applicable to pre-existing conditions) may be deleted by an issuer if the replacement does not involve application of a new pre-existing condition limitation.

(7) An insurer, within five (5) working days from the receipt of an application at its policy issuance office, shall furnish a copy of such notice to the insurer whose policy is being replaced.

69O FAC 156.016 | Standards for Marketing

(1) An issuer, directly or through its producers, shall:
(a) Establish marketing procedures to assure that any comparison of policies by its agents or other producers will be fair and accurate.

(b) Establish marketing procedures to assure excessive insurance is not sold or issued.

(c) Display prominently by type, stamp or other appropriate means, on the first page of the policy the following: "Notice to buyer: This policy may not cover all of your medical expenses."

(d) Inquire and otherwise make every reasonable effort to identify whether a prospective applicant or enrollee for Medicare supplement insurance already has accident and sickness insurance and the types and amounts of any such insurance.

(e) Establish auditable procedures for verifying compliance with subsection 69O-156.016(1), F.A.C.
(2) In addition to the practices prohibited in Section 626.9541, F.S., the following acts and practices are prohibited:
(a) Twisting. Knowingly making any misleading representation or incomplete or fraudulent comparison of any insurance policies or insurers for the purpose of inducing, or tending to induce, any person to lapse, forfeit, surrender, terminate, retain, pledge, assign, borrow on, or convert any insurance policy or to take out a policy of insurance with another insurer.

(b) High pressure tactics. Employing any method of marketing having the effect of or tending to induce the purchase of insurance through force, fright, threat, whether explicit or implied, or undue pressure to purchase or recommend the purchase of insurance.

(c) Cold lead advertising. Making use directly or indirectly of any method of marketing which fails to disclose in a conspicuous manner that a purpose of the method of marketing is solicitation of insurance and that contact will be made by an insurance agent or insurance company.
(3) The terms "Medicare Supplement," "Medigap," "Medicare Wrap-Around" and words of similar import shall not be used unless the policy is issued in compliance with this rule chapter.

(4) Health maintenance organizations shall also have their standards of marketing comply with Rule 69O-31.057, F.A.C.

69O FAC 156.017 | Appropriateness of Recommended Purchase and Excessive Insurance

(1) In recommending the purchase or replacement of any Medicare supplement policy or certificate an agent shall make reasonable efforts to determine the appropriateness of a recommended purchase or replacement.

(2) Any sale of Medicare supplement policy or certificate that will provide an individual with more than one Medicare supplement policy or certificate is prohibited.

(3) An issuer shall not issue a Medicare supplement policy or certificate to an individual enrolled in Medicare Part C unless the effective date of the coverage is after the termination date of the individual's Part C coverage.

69O FAC 156.018 | Reporting of Multiple Policies

(1) On or before March 1 of each year, an issuer shall report the following information for every individual resident of this State for which the issuer has in force more than one Medicare supplement policy or certificate:
(a) Policy and certificate number, and

(b) Date of issuance.
(2) The items set forth above must be grouped by individual policyholder.

(3) If applicable to any resident, the information shall be filed with the Office of Insurance Regulation, Attn.: Market Investigations, 200 East Gaines Street, Tallahassee, Florida 32399-4210.

69O FAC 156.019 | Prohibition Against Preexisting Conditions, Waiting Periods, Elimination Periods and Probationary Periods in Replacement Policies or Certificates

(1) If a Medicare supplement policy or certificate replaces another Medicare supplement policy or certificate, the replacing issuer shall waive any time periods applicable to preexisting conditions, waiting periods, elimination periods and probationary periods in the new Medicare supplement policy or certificate to the extent such time was spent under the original policy.

(2) If a Medicare supplement policy or certificate replaces another Medicare supplement policy or certificate which has been in effect for at least six (6) months, the replacing policy shall not provide any time period applicable to preexisting conditions, waiting periods, elimination periods and probationary periods for benefits similar to those contained in the original policy or certificate.

69O FAC 156.020 | Prohibition Against Use of Genetic Information and Requests for Genetic Testing

(1) An issuer of a Medicare supplement policy or certificate;
(a) Shall not deny or condition the issuance or effectiveness of the policy or certificate (including the imposition of any exclusion of benefits under the policy based on a preexisting condition) on the basis of the genetic information with respect to such individual; and

(b) Shall not discriminate in the pricing of the policy or certificate (including the adjustment of premium rates) of an individual on the basis of the genetic information with respect to such individual.
(2) Nothing in subsection 69O-156.020(1), F.A.C., shall be construed to limit the ability of an issuer, to the extent otherwise permitted by law, from:
(a) Denying or conditioning the issuance or effectiveness of the policy or certificate or increasing the premium for a group based on the manifestation of a disease or disorder of an insured or applicant; or

(b) Increasing the premium for any policy issued to an individual based on the manifestation of a disease or disorder of an individual who is covered under the policy (in such case, the manifestation of a disease or disorder in one individual cannot also be used as genetic information about other group members and to further increase the premium for the group).
(3) For the purposes of this Section only "Genetic information" means, with respect to any individual, information about such individual's genetic tests, the genetic tests of family members of such individual, and the manifestation of a disease or disorder in family members of such individual. Such term includes, with respect to any individual, any request for, or receipt of, genetic services, or participation in clinical research which includes genetic services, by such individual or any family member of such individual. Any reference to genetic information concerning an individual or family member of an individual who is a pregnant woman, includes genetic information of any fetus carried by such pregnant woman, or with respect to an individual or family member utilizing reproductive technology, includes genetic information of any embryo legally held by an individual or family member. The term "genetic information" does not include information about the sex or age of any individual.

69O FAC 156.030 | Medicare Select

(1)
(a) This rule applies to Medicare Select policies and certificates, as defined in this rule.

(b) No policy or certificate may be advertised as a Medicare Select policy or certificate unless it meets the requirements of this rule.
(2) For purposes of this rule:
(a) "Complaint" means any dissatisfaction expressed by an individual concerning a Medicare Select issuer or its network providers.

(b) "Grievance" means dissatisfaction expressed in writing by an individual insured under a Medicare Select policy or certificate with the administration, claims practices, or provision of services concerning a Medicare Select issuer or its network providers.

(c) "Medicare Select Issuer" means an issuer offering, or seeking to offer, a Medicare Select policy or certificate.

(d) "Medicare Select Policy" or "Medicare Select Certificate" means, respectively, a Medicare supplement policy or certificate that contains restricted network provisions.

(e) "Network Providers" means a provider of health care, or a group of providers of health care, which has entered into a written agreement with the issuer to provide benefits insured under a Medicare Select policy.

(f) "Restricted Network Provision" means any provision which conditions the payment of benefits, in whole or in part, on the use of network providers.

(g) "Service Area" means the geographic area approved by the Office within which an issuer is authorized to offer a Medicare Select policy.
(3) The Office shall authorize an issuer to offer a Medicare Select policy or certificate, pursuant to Section 627.674, F.S., this rule, and Section 4358 of the Omnibus Budget Reconciliation Act (OBRA) of 1990 if the Office finds that the issuer has satisfied all of the requirements of this rule.

(4) A Medicare Select issuer shall not issue a Medicare Select policy or certificate in this State until its plan of operation has been approved by the Office.

(5) A Medicare Select issuer shall file with the Office of Insurance Regulation, Attn.: Life and Health Product Review, 200 East Gaines Street, Tallahassee, Florida 32399-0328, a proposed plan of operation which shall contain at least the following information:
(a) Evidence that all covered services that are subject to restricted network provisions are available and accessible through network providers, including a demonstration that:
1. Such services can be provided by network providers with reasonable promptness with respect to geographic location, hours of operation and after-hour care. The hours of operation and availability of after-hour care shall reflect usual practice in the local area. Geographic availability shall reflect the usual travel times within the community.

2. The number of network providers in the service area is sufficient, with respect to current and expected policyholders, either:
a. To deliver adequately all services that are subject to a restricted network provision; or

b. To make appropriate referrals.
3. There are written agreements with network providers describing specific responsibilities.

4. Emergency care is available twenty-four (24) hours per day and seven (7) days per week.

5. In the case of covered services that are subject to restricted network provision and are covered by the Medicare Select Policy or Medicare Select Certificate, there are written agreements with network providers prohibiting such providers from billing or otherwise seeking reimbursement from or recourse against any individual insured under a Medicare Select policy or certificate. This paragraph shall not apply to supplemental charges, meaning charges not covered by the Medicare Select Policy or Medicare Select Certificate or coinsurance amounts as stated in the Medicare Select policy or certificate.
(b) A statement or map providing a clear description of the service area.

(c) A description of the grievance procedure to be utilized.

(d) A description of the quality assurance program, including:
1. The formal organizational structure;

2. The written criteria for selection, retention and removal of network providers; and

3. The procedures for evaluating quality of care provided by network providers, and the process to initiate corrective action when warranted.
(e) A list and description, by specialty, of the network providers.

(f) Copies of the written information proposed to be used by the issuer to comply with subsection (9), below.

(g) Any other information requested by the Office.
(6)
(a) A Medicare Select issuer shall file any proposed changes to the plan of operation, except for changes to the list of network providers, with the Office prior to implementing such changes. Such changes shall be considered approved by the Office after thirty (30) days unless specifically disapproved.

(b) An updated list of network providers shall be filed with the Office at least quarterly.
(7) A Medicare Select policy or certificate shall not restrict payment for covered services provided by non-network providers if:
(a) The services are for symptoms requiring emergency care or are immediately required for an unforeseen illness, injury or a condition; and

(b) It is not reasonable to obtain such services through a network provider.
(8) A Medicare Select policy or certificate shall provide payment for full coverage under the policy for covered services that are not available through network providers.

(9) A Medicare Select issuer shall make full and fair disclosure in writing of the provisions, restrictions, and limitations of the Medicare Select policy or certificate to each applicant. This disclosure shall include at least the following:
(a) An outline of coverage sufficient to permit the applicant to compare the coverage and premiums of the Medicare Select policy or certificate with:
1. Other Medicare supplement policies or certificates offered by the issuer; and

2. Other Medicare Select policies or certificates.
(b) A description (including address, phone number and hours of operation) of the network providers, including primary care physicians, specialty physicians, hospitals and other providers.

(c) A description of the restricted network provisions, including payments for coinsurance and deductibles when providers other than network providers are utilized. Except to the extent specified in the policy or certificate, expenses incurred when using out-of-network providers do not count toward the out-of-pocket annual limit contained in plans K and L.

(d) A description of coverage for emergency and urgently needed care and other out-of-service area coverage.

(e) A description of limitations on referrals to restricted network providers and to other providers.

(f) A description of the policyholder's rights to purchase any other Medicare supplement policy or certificate otherwise offered by the issuer.

(g) A description of the Medicare Select issuer's quality assurance program and grievance procedure.
(10) Prior to the sale of a Medicare Select policy or certificate, a Medicare Select issuer shall obtain from the applicant a signed and dated form stating that the applicant has received the information provided pursuant to subsection (9) of this rule and that the applicant understands the restrictions of the Medicare Select policy or certificate.

(11) A Medicare Select issuer shall have and shall use procedures for hearing complaints and resolving written grievances from the subscribers. Such procedures shall be aimed at mutual agreement for settlement and may include arbitration procedures.
(a) The grievance procedure shall be described in the policy and certificates and in the outline of coverage.

(b) At the time the policy or certificate is issued, the issuer shall provide detailed information to the policyholder describing how a grievance may be registered with the issuer.

(c) Grievances shall be considered in a timely manner and shall be transmitted to appropriate decision-makers who have authority to fully investigate the issue and take corrective action.

(d) If a grievance is found to be valid, corrective action shall be taken promptly.

(e) All concerned parties shall be notified about the results of a grievance.

(f) The issuer shall report no later than each March 31 to the Office of Insurance Regulation, Market Investigation, 200 East Gaines Street, Tallahassee, Florida 32399-4210, any grievances that have occurred during the preceding calendar year. The report shall identify each grievance filed and provide a summary of the subject, nature and resolution of the grievance.
(12) At the time of initial purchase, a Medicare Select issuer shall make available to each applicant for a Medicare Select policy or certificate the opportunity to purchase any Medicare supplement policy or certificate otherwise offered by the issuer.

(13)
(a) At the request of an individual insured under a Medicare Select policy or certificate, a Medicare Select issuer shall make available to the individual insured the opportunity to purchase a Medicare supplement policy or certificate offered by the issuer which has comparable or lesser benefits and which does not contain a restricted network provision. The issuer shall make such policies or certificates available without requiring evidence of insurability after the Medicare Select supplement policy or certificate has been in force for six (6) months.

(b) For the purposes of this subsection, a Medicare supplement policy or certificate will be considered to have comparable or lesser benefits unless it contains one or more significant benefits not included in the Medicare Select policy or certificate being replaced. For the purposes of this paragraph, a significant benefit means coverage for the Medicare Part A deductible; coverage for at-home recovery services; or coverage for Part B excess charges.
(14)
(a) Medicare Select policies and certificates shall provide for continuation of coverage in the event the Secretary of Health and Human Services determines the Medicare Select policies and certificates issued pursuant to this section should be discontinued due to either the failure of the Medicare Select Program to be reauthorized under law or its substantial amendment.

(b) Each Medicare Select issuer shall make available to each individual insured under a Medicare Select policy or certificate the opportunity to purchase a Medicare supplement policy or certificate offered by the issuer which has comparable or lesser benefits and which does not contain a restricted network provision. The issuer shall make such policies and certificates available without requiring evidence of insurability.

(c) For the purposes of this subsection, a Medicare supplement policy or certificate will be considered to have comparable or lesser benefits unless it contains one or more significant benefits not included in the Medicare Select policy or certificate being replaced. For the purposes of this paragraph, a significant benefit means coverage for the Medicare Part A deductible, coverage for at-home recovery services or coverage for Part B excess charges.
(15) A Medicare select issuer shall comply with reasonable requests for data made by state or federal agencies, including the United States Department of Health and Human Services, for the purpose of evaluating the Medicare Select Program.

69O FAC 156.050 | Separability

If any provision of this regulation or the application thereof to any person or circumstance is for any reason held to be invalid, the remainder of the regulation and the application of such provision to other persons or circumstances shall not be affected thereby.

69O FAC 156.101 | Purpose

The purpose of these rules is to provide prospective purchasers with clear and unambiguous statements in the advertisement and direct solicitation and sale of Medicare Supplement Insurance, and to assure the clear and truthful disclosure of the benefits, limitations and exclusions of policies sold as Medicare Supplement Insurance. This purpose is intended to be accomplished by the establishment of guidelines and standards of permissible and impermissible conduct in the advertising of Medicare Supplement Insurance to assure that product descriptions are presented in a manner which prevents unfair, deceptive and misleading advertising and is conducive to accurate presentation and description of Medicare Supplement Insurance to the segment of the insurance buying public through the advertising media and material used by insurance agents and companies.

69O FAC 156.102 | Applicability

(1) These rules shall apply to any Medicare Supplement Insurance "advertisement" or direct solicitation and sale made or disseminated in this State which the insurer knows or reasonably should know is intended for presentation, distribution or dissemination in this State when such presentation, distribution or dissemination is made either directly by an insurer or indirectly on behalf of an insurer, by an agent, broker, producer or solicitor or any other person who has either actual or apparent authority to act on behalf of the insurer; provided the insurer shall not be responsible for advertisements that are published in violation of written procedures or guidelines of the insurer.

(2) Every insurer shall establish and at all times maintain a system of control over the content, form, and method of dissemination of all of its Medicare Supplement Insurance advertisements. All such advertisements, regardless of by whom written, created, designed or presented, shall be the responsibility of the insurers benefiting directly or indirectly from their dissemination; provided the insurer shall not be responsible for advertisements that are published in violation of written procedures or guidelines of the insurer.

(3) Advertising materials which are reproduced in quantity shall be identified by form numbers or other identifying means. Such identification shall be sufficient to distinguish an advertisement from any other advertising materials, policies, applications or other materials used by the insurer.

69O FAC 156.103 | Definitions

For the purpose of these rules, the terms below are defined as follows:
(1) An "Advertisement" includes:
(a) Printed and published material, audio visual material and descriptive literature used by or on behalf of an insurer in direct mail, newspapers, magazines, radio scripts, TV scripts, billboards, and similar displays; and

(b) Descriptive literature and sales aids of all kinds issued by an insurer, agent, producer, broker, or solicitor or any other person who has either actual or apparent authority to act on behalf of the insurer for presentation to members of the insurance buying public, including, but not limited to, circulars, leaflets, booklets, depictions, illustrations, form letters, and lead-generating devices as herein defined; and

(c) Prepared sales talks, presentations, and material for use by agents, brokers, producers, solicitors, announcers, celebrities, and other persons, whether prepared by agents, brokers, producers, solicitors, announcers, spokesperson, celebrities, or any other person who has either actual or apparent authority to act on behalf of the insurer; and

(d) Advertising material included with a policy when the policy is delivered and material used in the solicitation of any policy.
(2) The definition of "Advertisement" does not include:
(a) Material to be used solely for the training and education of an insurer's employees, agents, or brokers;

(b) Material used exclusively in-house by insurers;

(c) Communications within an insurer's own organization not intended for dissemination to the public;

(d) Individual communications of a personal nature with current policyholders regarding existing coverage other than material urging such policyholders to renew, increase or expand coverages;

(e) Correspondence between a prospective group or blanket policyholder and an insurer in the course of negotiating a group or blanket contract;

(f) Court approved material ordered by a court to be disseminated to policyholders; or

(g) A general announcement from a group or blanket policyholder to eligible individuals on an employment or membership list which may include a brief description of coverage and is primarily a notification that a contract or program has been written or arranged; provided the announcement clearly indicates that it is preliminary to the issuance of a booklet, pamphlet, brochure or other similar paper preliminary to coverage by the insurer.
(3) "Application" means the form which must be filled in by the person seeking to effectuate an insurance policy.

(4) "Application Period" also includes any enrollment period.

(5) "Certificate" means any certificate issued under a group medicare supplement policy which certificate has been delivered or issued for delivery in this State.

(6) "Exception" means any provision in a policy whereby coverage for a specified hazard is entirely eliminated; it is a statement of a risk not assumed under the policy.

(7) "Institutional Advertisement" means an advertisement having as its sole purpose the promotion of the readers', viewers' or listeners' interest in the concept of Medicare Supplement Insurance or the promotion of the insurer as a seller of Medicare Supplement Insurance.

(8) "Insurer" includes any individual, corporation, association, partnership, reciprocal, exchange, inter-insurer, Lloyds, fraternal benefit society, hospital service corporation, medical service corporation, and any other legal entity which is defined as an "insurer" in the Insurance Code of this State.

(9) "Invitation to Contract" means an advertisement which is neither an institutional advertisement nor an invitation to inquire.

(10) "Invitation to Inquire" means an advertisement having as its objective the creation of a desire to inquire further about a Medicare Supplement Insurance Policy which advertisement is limited to a brief description of coverage and which shall contain a provision in the following or substantially similar form:
"This policy has (exclusions) (limitations) (reductions of benefits) (terms under which the policy may be continued in force or discontinued). For costs and complete details of the coverage call (or write) your insurance agent or the company." [whichever is applicable]

A "brief description of coverage" in an invitation to inquire may consist of an explanation of Medicare benefits, minimum benefits, standards for Medicare supplement policies, the manner in which the advertised Medicare supplement insurance policy supplements the benefits of Medicare and meets or exceeds the minimum benefit requirements. An invitation to inquire shall not refer to cost or the maximum dollar amount of benefits payable.

As with all Medicare supplement insurance advertisements, an invitation to inquire must not:
(a) Employ devices which are designed to create undue anxiety in the minds of the elderly or excite fear of dependence upon relatives or charity;

(b) Exaggerate the gaps in Medicare coverage;

(c) Exaggerate the value of the benefits available under the advertised policy;

(d) Otherwise violate the provisions of these rules.
(11) "Lead Generating Device" means any communication directed to the public which, regardless of form, content, or stated purpose, invites or elicits a response on the subject of insurance and thereby results in the compilation or qualification of a list containing names of, or other personal information regarding persons who have expressed a specific interest in an insurance product or coverage and which is to be used to solicit residents of this State for the purchase of Medicare Supplement Insurance or other insurance.

(12) "Limitation" means any provision which restricts coverage under the policy other than an exception or a reduction.

(13) "Medicare" is defined as "The Health Insurance for the Aged Act, Title XVIII of The Social Security Amendments of 1965 as Then Constituted or Later Amended", or Title I, Part I, of Public Law 89-97, as enacted by the Eighty-Ninth Congress of the United States of America and popularly known as the "Medicare Act", as then constituted and any later amendments or substitutes thereof or words of similar import.

(14) "Medicare Supplement Insurance Policy" means a group or individual policy of accident and sickness insurance or a subscriber contract of hospital and medical service associations which is advertised, marketed or designed primarily as a supplement to reimbursements under the Medicare program for the hospital, medical or surgical expenses of persons eligible for Medicare.

(15) "Person" means any natural person, association, organization, partnership, trust, group, discretionary group, corporation or any other entity.

(16) "Reduction" means any provision which reduces the amount of the benefit; this term includes a situation where a risk of loss is assumed, but payment upon the occurrence of such loss is limited to some amount or period less than would be otherwise payable had such reduction not been used.

69O FAC 156.104 | Method of Disclosure of Required Information

All information required to be disclosed by these rules shall be set out conspicuously and in close conjunction with the statements to which such information relates or under appropriate captions of such prominence that it shall not be minimized, rendered obscure or presented in an ambiguous manner or fashion or intermingled with the context of the advertisement so as to be confusing or misleading.

69O FAC 156.105 | Unfair or Deceptive Acts or Practices Defined

It shall be deemed an unfair or deceptive act or practice in the direct solicitation or sale of Medicare supplement insurance policies, to:
(1) Make any representation by an agent to the effect that such person is a "Counselor," "Advisor" or similar designation, for any association or group of Medicare eligible persons, which fails to reflect the actual role of such agent with respect to the solicitation or sale of such insurance.

(2) Make any misrepresentation or incomplete comparison by the insurance company or agent, by commission or omission, for the purpose of inducing or which would reasonably be expected to induce Medicare eligible persons to purchase, amend, lapse, forfeit, non-renew, change, duplicate coverage already in force, replace a policy that is only technically at variance with the policy or policies being offered, or otherwise surrender existing insurance.

(3) Do any act which causes an applicant to sign any form, application or document in blank.

(4) Use any sales material or presentation which does not disclose that an insurance product is involved.

(5) Effect the sale of Medicare supplemental insurance to any person not eligible for the Medicare Program.

69O FAC 156.106 | Certification Form Required

It shall be the responsibility of each agent directly soliciting a policy of Medicare supplemental insurance to complete a form as indicated by Exhibit "A" herein. Substantially equivalent forms may be adopted with the prior approval of the Director. The original copy of such form shall be furnished to the applicant upon the taking of the application and a copy shall be maintained in the files of the company for a period of three years.

"EXHIBIT A"

CERTIFICATION

I, the undersigned insurance agent certify:
THAT, I have taken an application for Policy Form No. ________ offered by the ________ (Name of Insurance Company) to ________ (Applicant).

THAT, I have explained the provisions of the policy being applied for, including specifically, all the different benefits, exceptions and limitations of the plan.

THAT, I am a licensed agent of this insurance company and have given a company receipt for an initial premium in the amount of $________ (Insert zero if no premium received) which has been paid to me by () Check () Cash () Money Order (Check appropriate method of payment).

THAT, I have clearly explained any benefits of this plan are a supplement to any benefits that the applicant may be entitled to receive from the Medicare Program of the Federal Government.

THAT, I have not made any representation to the applicant that there is any endorsement whatsoever by the Social Security Administration or the Health Care Financing Administration of the Federal Government in connection with this insurance policy being applied for.
________________________________________________________
DateSignature of Agent
____________________________________________________________
I, the undersigned applicant, have received a copy of this formName of Agency
____________________________

____________________________
Address of Agent or Agency
________________________________________________________
Applicant's signaturePhone No.

69O FAC 156.107 | Form and Content of Advertisements

(1) The form and content of a Medicare Supplement Insurance advertisement shall be sufficiently complete and clear to avoid deception or the capacity or tendency to mislead or deceive. Whether an advertisement has a capacity or tendency to mislead or deceive shall be determined by the Commissioner of Insurance from the overall impression that the advertisement may be reasonably expected to create upon a person of average education or intelligence, within the segment of the public to which it is directed.

(2) Advertisements shall be truthful and not misleading in fact or in implication. Words or phrases whose meanings are clear only by implication or by the consumer's familiarity with insurance terminology shall not be used.

(3) An insurer must clearly identify its Medicare Supplement Insurance policy as an insurance policy. With respect to any product first filed to be offered to Florida residents on or after the effective date of these rules, a policy trade name must be followed by the words "Insurance Policy" or similar words clearly identifying the fact that an insurance policy is being offered.

(4) No insurer, agent, broker, producer, solicitor or other person shall solicit a resident of this State for the purchase of Medicare Supplement Insurance in connection with or as the result of the use of any advertisement which:
(a) Contains any misleading representations, misrepresentations, or is otherwise untrue, deceptive or misleading with regard to the information imparted, the status, character or representative capacity of such person or the true purpose of the advertisement; or

(b) Otherwise violates the provisions of these rules; or

(c) Otherwise violates the provisions of the Florida Insurance Code.
(5) No insurer, agent, broker, producer, solicitor or other person shall solicit residents of this State for the purchase of Medicare Supplement Insurance through the use of a true or fictitious name which is deceptive or misleading with regard to the status, character, or proprietary or representative capacity of such person or the true purpose of the advertisement.

(6) No insurer, agent, broker, producer, solicitor, or other person shall use a lead generating device or list of prospective insureds compiled therefrom, if the insurer, agent, broker, producer, solicitor or other person knew or reasonably should have known that the lead generating device or list of prospective members was obtained in a manner which violates any provision of the Florida Insurance Code or otherwise violates the provisions of these rules. No list of prospective insureds may be purchased unless the purchaser requests from the seller any lead-generating devices that were used to compile the list and obtains a specimen copy of any such devices that are disclosed.

(7) The contents of all advertisements, lead generating devices, and lists of prospective insureds, regardless of by whom prepared, created, designed or presented, shall be the responsibility of any insurer benefiting directly or indirectly from its use if the insurer either requested the preparation of, or reasonably should have known of the content of the advertisement, lead generating device or list of prospective insureds.

(8) Each solicitation of coverage which insures Florida resident(s) shall be from and contain the name of a Florida licensed agent.

(9) No insurer, agent, broker, producer, solicitor, or other person shall effectuate insurance coverage prior to a full explanation of the coverage offered and completion of an application form.

69O FAC 156.108 | Advertisements of Benefits Payable, Losses Covered or Premiums Payable

(1) Deceptive Words, Phrases, or Illustrations Prohibited.
(a) No advertisement shall omit information or use words, phrases, statements, references or illustrations if the omission of such information or use of such words, phrases, statements, references, or illustrations has the capacity, tendency, or effect of misleading or deceiving purchasers or prospective purchasers as to the nature or extent of any policy benefit payable, loss covered or premium payable. The fact that the policy offered is made available to a prospective insured for inspection prior to consummation of the sale or an offer is made to refund the premium if the purchaser is not satisfied, does not remedy misleading statements.

(b) No advertisement shall contain or use words or phrases such as "all", "full", "complete", "comprehensive", "unlimited", "up to", "as high as", "this policy will help pay your hospital and surgical bills," "this policy will help fill some of the gaps that Medicare and your present insurance leave out," or similar words and phrases, in a manner which exaggerates any benefits beyond the terms of the policy.

(c) An advertisement which also is an invitation to join an association, trust, or discretionary group must solicit insurance coverage on a separate and distinct application which requires signatures for each application. The insurance program must be presented so as not to mislead or deceive the prospective members regarding the fact that they are purchasing insurance as well as applying for membership, if that is the case.

(d) An advertisement shall not contain descriptions of policy limitations, exceptions, or reductions, worded in a positive manner to imply that it is a benefit, such as describing a waiting period as a "benefit builder" or stating "even pre-existing conditions are covered after a limited period of time." Words and phrases used in an advertisement to describe such policy limitations, exceptions and reductions shall fairly and accurately describe the negative features of such limitations, exceptions, or reductions of the policy offered.

(e) An advertisement of medicare supplement insurance sold by direct response shall not use the phrases, "no salesman will call," or "no agent will call," or "by eliminating the agent and/or commission we can offer this low cost plan" or similar wording in a misleading manner.
(2) Exceptions, Reductions, and Limitations.
(a) An advertisement which is an invitation to contract shall disclose those exceptions, reductions, and limitations affecting the basic provisions of the policy.

(b) An advertisement which is subject to the requirements of the preceding paragraph shall disclose the existence of a waiting, elimination, probationary, or similar time period between the effective date of the policy and the effective date of coverage under the policy, or the existence of a time period between the date a loss occurs and the date benefits begin to accrue for such loss in a manner as prominent as the benefit amount or benefit time period advertised.

(c) An advertisement shall not use the words "only", "just", "merely", "minimum", or similar words or phrases to describe the applicability of any exceptions and reductions or limitations, such as: "This policy is subject to the following minimum exceptions and reductions."
(3) Pre-Existing Conditions.
(a) An advertisement which is an invitation to contract for Medicare Supplement benefits shall, in negative terms, disclose the extent to which any loss is not covered if the cause of such loss is traceable to a condition existing prior to the effective date of the policy. The term "pre-existing condition" shall not be used without an appropriate definition or description.

(b) When a policy does not cover losses resulting from pre-existing conditions, no advertisement of the policy shall state or imply that the applicant's physical condition or medical history will not affect the issuance of the policy or payment of a claim thereunder. This rule prohibits the use of the phrase "no medical examination required" and phrases of similar import, in a misleading manner. If an insurer requires a medical examination for a specified policy, the advertisement shall disclose that a medical examination is required.

(c) When coverage is in any way limited for pre-existing conditions, the application shall contain a statement which reflects the pre-existing condition provisions of the policy immediately preceding the blank space for the applicant's signature. For example, such an application form shall contain a statement substantially as follows:
This policy has a pre-existing condition limitation and if a physician has provided treatment or recommended treatment for any injury or illness or other condition within the 6-month period prior to issuance of the (policy/certificate) for which I am applying, no coverage will be provided for that illness or injury or other condition until 6 months after the (policy/certificate) has been issued.

69O FAC 156.109 | Necessity for Disclosing Policy Provisions Relating to Renewability, Cancellability, and Termination

An advertisement which is an invitation to contract shall disclose the provisions relating to renewability, cancellability, and termination and any modification of benefits, losses covered or premiums because of age or for other reasons, in a manner which shall not minimize or render obscure the qualifying conditions.

69O FAC 156.110 | Testimonials or Endorsements by Third Parties

(1) Testimonials and endorsements used in advertisements must be genuine, represent the current opinion of the author, be applicable to the policy advertised and be accurately reproduced. The insurer, in using a testimonial or endorsement, makes as its own all of the statements contained therein, and the advertisement, including such statement, is subject to all the provisions of these rules. When a testimonial or endorsement is used more than one year after it was originally given, a confirmation must be obtained.

(2) A person shall be deemed a "spokesperson" if the person making the testimonial or endorsement:
(a) Has a financial interest in the insurer or a related entity as a stockholder, director, officer, employee or otherwise; or

(b) Is an entity formed by the insurer, is owned or controlled by the insurer, its employees, or the person or persons who own or control the insurer; or

(c) Is in a policy-making position who is affiliated with the insurer in any of the above described capacities; or

(d) Is in any way directly or indirectly compensated for making a testimonial or endorsement.
(3) Any person acting as a spokesperson, as defined in the preceding paragraph, who performs any of the following acts in any advertisement shall be considered soliciting an insurance product, and such person shall be a licensed insurance agent pursuant to the Florida Insurance Code:
(a) Solicits insurance or procures applications; or

(b) Engages or holds himself out as engaging in the business of analyzing or abstracting insurance policies; or

(c) Engages in counseling, advising, or giving opinions to persons relative to insurance contracts; or

(d) Performs an invitation to contract, except where performed by a company officer in a manner which does not violate Section 626.112(4), F.S.
(4) The fact of a financial interest or the proprietary or representative capacity of a spokesperson shall be disclosed in an advertisement and shall be accomplished in the introductory portion of the testimonial or endorsement in the same form and with equal prominence thereto. If a spokesperson is directly or indirectly compensated for making a testimonial, endorsement or appraisal, such fact shall be disclosed by use of the phrase "Paid Endorsement" or words of similar import in a type style and size that is at least equal to that used for the spokesperson's name or the body of the testimonial or endorsement, whichever is larger. In the case of television or radio advertising, the required disclosure must be accomplished in the introductory portion of the advertisement and must be given prominence, and if printed must be presented in a type style and size that is at least equal to the largest type otherwise used in the advertisement. The use of the phrase "Paid Endorsement" is not required where the spokesperson is a company officer who is paid generally, but not specifically for making the advertisement.

(5) The disclosure requirements of this rule shall not apply where the sole financial interest or compensation of a spokesperson, for all testimonials or endorsements made on behalf of the insurer, consists of the payment of union "scale" wages required by union rules, and if the payment is actually for such "scale" for TV or radio performances.

(6) An advertisement shall not state or imply that an insurer or a policy has been approved or endorsed by any individual, group of individuals, society, association, organization, governmental agency or other entity, unless such is the fact, and unless any proprietary relationship between an organization and the insurer is disclosed. If the entity making the endorsement or testimonial has been formed by the insurer or is owned or controlled by the insurer or the person or persons who own or control the insurer, such fact shall be disclosed in the advertisement. If the insurer or an officer of the insurer formed or controls the association, or holds any policy-making position in the association, that fact must be disclosed.

(7) When a testimonial refers to benefits received under a policy for a specific claim, the claim data, including claim number, date of loss, and other pertinent information shall be retained by the insurer for inspection for a period of four years or until the filing of the next regular report of examination of the insurer, whichever is the longer period of time. The use of testimonials which do not correctly reflect the present practices of the insurer or which are not applicable to the policy or benefits being advertised is not permissible.

(8) The provisions of subsections (2), (3) and (4), of this section shall not apply to a written endorsement which does not describe specific benefits, coverages or premiums and which is made by an association of individuals which:
(a) Has been in existence for more than one year prior to making the written endorsement; and

(b) Is formed for purposes other than soliciting insurance; and

(c) Has a valid and bona fide governing constitution and by-laws; and

(d) Has as its principal purpose some goal or objective other than providing or soliciting insurance, as determined by the Insurance Commissioner in accordance with the procedures and requirements of Chapter 120, F.S., the Administrative Procedure Act.

69O FAC 156.111 | Use of Statistics

(1) An advertisement relating to the dollar amounts of claims paid, the number of persons insured, or similar statistical information relating to any insurer or policy or contract shall not use irrelevant facts, and shall not be used unless it accurately reflects all of the relevant facts. Such an advertisement shall not imply that such statistics are derived from a policy or contract advertised unless such is the fact, and when applicable to other policies or contracts or plans shall specifically so state.
(a) An advertisement shall specifically identify the policy to which statistics relate and, where statistics are given which are applicable to a different policy, it must be stated clearly that the data do not relate to the policy being advertised.

(b) An advertisement shall not contain statements which are untrue in fact, or by implication misleading, with respect to assets, corporate structure, financial standing, age or relative position of the insurer in the insurance business.
(2) An advertisement shall not represent or imply that claim settlements by the insurer are "liberal" or "generous", or use words of similar import, or state or imply that claim settlements are or will be beyond the actual terms of the contract. An unusual amount paid for a unique claim for the policy advertised is misleading and shall not be used.

(3) The source of any statistics used in an advertisement shall be identified in such advertisement.

69O FAC 156.112 | Identification of Plan or Number of Policies

69O FAC 156.113 | Disparaging Comparisons and Statements

(1) An advertisement shall not directly or indirectly make unfair or incomplete comparisons of policies or contracts or benefits or comparisons of non-comparable policies or contracts of other insurers, and shall not disparage competitors, their policies or contracts, services or business methods, and shall not disparage or unfairly minimize competing methods of marketing insurance.

(2) An advertisement should not contain statements such as "no red tape" or "here is all you do to receive benefits."

(3) Advertisements which state or imply that competing insurance coverages customarily contain certain exceptions, reductions or limitations not contained in the advertised policies are unacceptable unless such exceptions, reductions or limitations are contained in a substantial majority of such competing coverages.

(4) Advertisements which state or imply in a misleading or incomplete manner that an insurer's premiums are lower or that its loss ratios are higher because its organizational structure differs from that of competing insurers shall not be used.

69O FAC 156.114 | Jurisdictional Licensing and Status of Insurer

(1) An advertisement which is intended to be seen or heard beyond the limits of the jurisdiction in which the insurer is licensed shall not imply licensing beyond those limits.

(2) An advertisement shall not create the impression directly or indirectly that the insurer, its financial condition or status, or the payment of its claims, or the merits, desirability, or advisability of its policy forms or kinds of plans of insurance are approved, endorsed, or accredited by any division or agency of this State or the United States Government or if such relationship exists, such advertisement shall not exaggerate or otherwise mislead with respect to the nature or extent of such relationship.

(3) An advertisement shall not imply in a misleading manner that approval, endorsement, or accreditation of policy forms or advertising has been granted by any division or agency of the state or federal government. "Approval" of either policy forms or advertising shall not be used by an insurer to imply or state that a governmental agency has endorsed or recommended the insurer, its policies, advertising or its financial conditions.

69O FAC 156.115 | Identity of Insurer

(1) The name of the actual insurer shall be stated in all of its advertisements. The form number or numbers of the policy advertised shall be stated in any invitation to contract. An advertisement shall not use a trade name, any insurance group designation, name of the parent company of the insurer, name of a particular division of the insurer, service mark, slogan, symbol or other device which would have the capacity and tendency to mislead or deceive as to the true identity of the insurer.

(2) No advertisement shall use any combination of words, symbols, or physical materials which by their content, phraseology, shape, color or other characteristics are so similar to combination of words, symbols, or physical materials used by agencies of the federal government or of this State, or otherwise appear to be of such a nature that it tends to confuse or mislead prospective insureds into believing that the solicitation is in some manner connected with an agency of the municipal, county, state, or federal government, or if such relationship exists, such advertisement shall not exaggerate or otherwise be misleading with respect to the nature or extent of such relationship.

(3) Advertisements, envelopes, or stationery which utilize words, letters, initials, symbols, or other devices which are so similar to those used by governmental agencies or other insurers are not permitted if they may tend to mislead or confuse the public into believing:
(a) That the advertised coverages are somehow provided by or are endorsed by such governmental agencies or such other insurers; or

(b) That the advertiser is the same as, is connected with, or is endorsed by such governmental agencies or such other insurers.
(4) No advertisement shall use the name of a state or a political subdivision thereof in a policy name or description.

(5) No advertisement in the form of envelopes or stationery of any kind may use any name, service mark, slogan, symbol, or any device in such a manner that implies that the insurer or the policy advertised, or that any agent who may call upon the consumer as a result of the advertisement is connected with a governmental agency, such as the Social Security Administration.

(6) No advertisement may incorporate the word "Medicare" in the title of the plan or policy being advertised unless, wherever it appears, said word is qualified by language differentiating it from the Medicare program. Such an advertisement, however, shall not use the phrase "________ Medicare Department of the ________ Insurance Company", or similar language of similar import.

(7) No advertisement shall be used that fails to include a disclaimer to the effect of "Not connected with or endorsed by the U.S. Government or the Federal Medicare Program."

(8) No advertisement may imply that the reader may lose a right or privilege or benefit under federal, state, or local law if he fails to respond to the advertisement.

(9) The use of letters, initials, or symbols of the corporate name or a trademark that would have the tendency or capacity to mislead or deceive the public as to the true identity of the insurer is prohibited unless the true, correct and complete name of the insurer is in close conjunction and in the same size type as the letters, initials, or symbols of the corporate name or trademark.

(10) The use of the name of an agency or other nomenclature in type, size and location so as to have the capacity and tendency to mislead or deceive as to the true identity of the insurer is prohibited.

(11) The use of an address so as to mislead or deceive as to the true identity of the insurer or any other entity or its location or licensing status is prohibited.

(12) No insurer may use, in the trade name of its insurance policy, any terminology or words so similar to the name of a governmental agency or governmental program as to have the tendency to confuse, deceive or mislead the prospective purchaser.

(13) All advertisements used by agents, producers, brokers or solicitors of an insurer must have prior written approval or prior oral approval with subsequent written confirmation of approval by the insurer.

(14) An agent who makes contact with a consumer, as a result of acquiring that consumer's name from a lead generating device or from a list of prospective consumers compiled therefrom, or from an entity or individual providing such services, must disclose such fact in the initial contact with the consumer.

69O FAC 156.116 | Group or Quasi-Group Implications

(1) An advertisement of a particular policy shall not state or imply that prospective insureds become group or quasi-group members covered under a group policy and as such enjoy special rates or underwriting privileges, unless such is the fact.

(2) No solicitation of a particular class, such as governmental employees, shall state or imply that the occupational status of group members entitles them to reduced rates on a group or other basis when, in fact, the policy being advertised is sold only on an individual basis at regular rates.

69O FAC 156.117 | Introductory, Initial, or Special Offers

(1) An advertisement of an individual policy shall not directly or by implication represent that a contract or combination of contracts is an introductory, initial, or special offer, or that applicants will receive substantial advantages not available at a later date, or that the offer is available only to a specified group of individuals, unless such is the fact. An advertisement shall not contain phrases describing an application period as "special", "limited", or similar words or phrases when the insurer uses such application periods as the usual method of advertising Medicare Supplement Insurance.

(2) An application period during which a particular insurance product may be purchased on an individual basis shall not be offered within this State unless there has been a lapse of not less than six months between the close of the immediately preceding application period for the same product and the opening of the new application period. The advertisement shall indicate the date by which the applicant must mail the application, which shall be not less than ten days and not more than forty days from the date that such application period is advertised for the first time. This rule applies to all advertising media, i.e., mail, newspapers, radio, television, magazines, and periodicals, by any one insurer. This prohibition shall not be applicable to solicitations of employees or members of a particular group or association which otherwise would be eligible under specific provisions of the Insurance Code for group, blanket, or franchise insurance. The phrase "any one insurer" includes all the affiliated companies of a group of insurance companies under common management or control.

(3) This rule does not require separation by 6 months of application or enrollment periods for the same insurance product in this State if the advertising material is directed by an admitted insurer to persons by direct mail on the basis that a common relationship exists with more than one entity. Examples of such would be a bank and its depositors, a department store to its charge account customers, or an oil company to its credit card holders, and more than one of such organizations is sponsoring such insurance product at different times if providing such insurance under such a method is not otherwise prohibited by law. However, the 6-month rule does apply to one specific sponsor to the same persons in this State on the basis of their status as customers of that one specific entity only.

(4) This rule prohibits any statement or implication to the effect that only a specific number of policies will be sold, or that a time is fixed for the discontinuance of the sale of the particular policy advertised because of special advantages available in the policy, unless such is the fact.

(5) The phrase "a particular insurance product" in subsection (2) of this section means an insurance policy which provides substantially different benefits than those contained in any other policy. Different terms of renewability, an increase or decrease in the dollar amounts of benefits, or an increase or decrease in any elimination period or waiting period from those available during an application period for another policy shall not be sufficient to constitute the product being offered as a different product eligible for concurrent or overlapping application periods.

(6) An advertisement shall not offer a policy which utilizes a reduced initial premium rate, nor shall an advertisement offer a policy waiving the initial premium.

(7) Meaningless awards, such as a "safe drivers award" shall not be used in connection with advertisements of Medicare Supplement Insurance.

69O FAC 156.118 | Statements About an Insurer

An advertisement shall not contain statements which are untrue in fact, or by implication misleading, with respect to the assets, corporate structure, financial standing, age or relative position of the insurer in the insurance business. An advertisement shall not contain a recommendation by any commercial rating system unless it clearly indicates the purpose of the recommendation and the limitations of the scope and extent of the recommendation.

69O FAC 156.119 | Application in Advertisement

Every application for an individual policy, or an in-state group Medicare Supplement policy or contract or enrollment form for an out-of-state group contract which does not comply with Section 627.6515(2), F.S., must be taken by a Florida resident agent. Therefore, to assure compliance with F.S., no advertisement for a Medicare Supplement policy or contract in this State containing an application for a Medicare Supplement either for individual coverage, coverage under an in-state group policy or out-of-state group policy which does not comply with Section 627.6515(2), F.S., shall be used unless such application contains the name of the Florida resident agent or a space for the Florida resident agent's signature, and the completed application shall be returned to the Florida resident agent.

69O FAC 156.120 | Enforcement Procedures

(1) Advertising File.

Each insurer shall maintain at its home or principal office a complete file containing every printed, published, or prepared advertisement of its individual policies and typical printed, published, or prepared advertisements of its blanket, franchise, and group policies hereafter disseminated in this or any other state, whether or not licensed in such other state, with a notation attached to each such advertisement which shall indicate the manner and extent of distribution and the form number of any policy advertised. Such file shall be available for inspection by this Office. All such advertisements shall be maintained in said file for a period of either four years or until the filing of the next regular report of examination of the insurer, whichever is the longer period of time.

(2) Certificate of Compliance.

Each insurer required to file an Annual Statement which is now or which hereafter becomes subject to the provisions of these rules must file with this Office, with its Annual Statement, a Certificate of Compliance executed by an authorized officer of the insurer wherein it is stated that, to the best of his knowledge, information and belief, the advertisements which were disseminated by the insurer during the preceding statement year complied or were made to comply in all respects with the provisions of these rules and the Insurance Laws of this State as implemented and interpreted by these rules.

69O FAC 156.121 | Filing for Review

(1) Every insurer providing Medicare supplement insurance or benefits in this state shall provide a copy of any advertisement no later than 10 calendar days prior to its use in this state to the Office of Insurance Regulation for review by the Commissioner. Such advertisement shall comply with all applicable laws of this state.

(2) All advertising material, whether print, or radio or television, shall be received by the Office no later than 5 p.m. on the day which is the 10th calendar day prior to its intended use. If the insurer files at least 10 calendar days prior to use, and the Office has not issued a preliminary notice of violation within 10 calendar days after such filing, and there are no material changes in the print or production of the advertisement, the insurer shall not be penalized for any use of the advertisement which occurs within 30 calendar days after the insurer's receipt of any subsequent preliminary notice asserting that the advertisement is in violation of any applicable laws of this state.

(3) All television or radio advertisements shall be filed on audio or audio/visual tapes as appropriate using either the actual spokesperson or a "stand-in." An audio/visual tape shall be on VHS format.

69O FAC 156.122 | Severability

If any section or portion of a section of these rules or any amendments thereto, or the applicability thereof to any person or circumstance is held invalid by a court, the remainder of the rules, or the applicability of such provision to other persons or circumstances, shall not be affected thereby.

69O FAC 156.123 | Prior Rules

69O-157 | Long-Term Care Insurance

69O FAC 157.001 | Purpose

The purpose of these rules is:
(1) To implement Part XVIII of Chapter 627, F.S., pertaining to requirements of long-term care insurance policies,

(2) To promote the public interest,

(3) To promote the availability of long-term care insurance policies,

(4) To protect applicants for long-term care insurance from unfair or deceptive sales or enrollment practices,

(5) To establish standards for long-term care insurance,

(6) To facilitate public understanding and comparison of long-term care insurance policies, and

(7) To facilitate flexibility and innovation in the development of long-term care insurance coverage.

69O FAC 157.002 | Applicability and Scope

(1) Except as otherwise specifically provided, the provisions of Chapter 69O-157, F.A.C., shall apply to long-term care insurance policies delivered or issued for delivery in this state, and to policies delivered or issued for delivery outside this state to the extent provided in Section 627.9406, F.S., and Rule 69O-157.004, F.A.C., by an insurer, a fraternal benefit society as defined in Section 632.601, F.S., a health care services plan as defined in Section 641.01, F.S., a prepaid health clinic as defined in Section 641.402, F.S., or a multiple-employer welfare arrangement as defined in Section 624.437, F.S. A policy which is advertised, marketed, or offered as a long-term care policy and as a Medicare supplement policy shall meet the requirements of the rules contained in this chapter and such statutes or rules specifically applicable to Medicare supplement policies and, to the extent of a conflict, be subject to the requirement that is more favorable to the policyholder or certificate holder.

(2) The provisions of Chapter 69O-157, F.A.C., shall apply to such long-term care policies issued or renewed on or after the effective date of Chapter 69O-157, F.A.C.; however, the provisions of Chapter 69O-157, F.A.C., do not apply to any policy that is not subject to the provisions of Sections 627.9401-627.9408, F.S., as presently existing or as hereafter amended.

(3) The provisions of Part I shall apply to all long-term care policies and certificates issued in this state which are not included in the scope of Part II.

(4) All appendices incorporated by reference are available from the Division of Life and Health Product Review, Larson Building, 200 East Gaines Street, Tallahassee, Florida 32399-0328.

69O FAC 157.003 | Definition of Terms

As used in these rules and as used in long-term care policies, the following terms shall have meanings no more restrictive than the following:
(1) "Applicant" means:
(a) In the case of an individual long-term care insurance policy, the person who seeks to contract for benefits.

(b) In the case of a group long-term care insurance policy, the proposed certificate holder.
(2) "Certificate" means any certificate issued under a group long-term care insurance policy, which policy has been delivered or issued for delivery in this State.

(3) "Policy" means any long-term care policy, contract, subscriber agreement, rider, or endorsement delivered or issued for delivery in this state, or delivered or issued for delivery outside this state to the extent these rules are applicable to out-of-state policies by an insurer, a fraternal benefit society, a health care services plan, a health maintenance organization, a prepaid health clinic or a multiple-employer welfare arrangement.

(4) "Nursing home" means a facility or distinctly separate part of a hospital or other institution which is licensed by the appropriate licensing agency to engage primarily in providing nursing care and related services to inpatients and provides 24-hour a day nursing service, and has a nurse on duty or on call at all times and maintains clinical records for all patients.

(5) "Medicare" means "The Health Insurance for Aged Act", Title XVIII of the Social Security Amendments of 1965, as then constituted or later amended, or Title I, Part I of Public Law 89-97, as enacted by the Eighty-Ninth Congress of the United States of America and popularly known as the Health Insurance for the Aged Act, as then constituted and any later amendments or substitutes thereof, or words of similar import.

(6) "Hospital" means a hospital as defined and licensed pursuant to the provisions of Chapter 395, F.S., or pursuant to substantially similar provisions of another state's licensing laws.

(7) "Institutionalization" means that confinement to a hospital, facility, or center licensed pursuant to any Parts of Chapter 400 or Chapter 395, F.S., or pursuant to substantially similar provisions of another state's licensing laws.

69O FAC 157.004 | Out-of-State Group Long-Term Care Insurance

(1) No group long-term care insurance coverage may be offered to a resident of this state under a group policy issued in another state to a group described in Section 627.9405(1)(c) or (d), F.S., unless this state or such other state having statutory and regulatory long-term care insurance requirements substantially similar to those adopted in this state has made a determination that such requirements have been met. Evidence to this effect shall be filed by the insurer with the Office pursuant to the procedures specified in Section 627.410, F.S. Such evidence shall consist of:
(a) Filing of policy and certificate forms, including rates and rate development information, which demonstrate that the requirements of Sections 627.9401-.9408, F.S., and these rules have been met, except Section 627.9405(2) F.S.; or

(b)
1. Filing of a truthful certification by an officer of the insurer that another state having statutory and regulatory long-term care insurance requirements substantially similar to those adopted in Florida has made a determination that such requirements have been met; and

2. Filing of the policy and certificate forms to be issued and delivered, including rates and rate development information, which demonstrate that the requirements of another state having statutory and regulatory long-term care insurance requirements substantially similar to those adopted in Florida have been met.
(2) In order for a state to be deemed to have statutory and regulatory long-term care insurance requirements substantially similar to those adopted in Florida, such state must require that long-term care policies meet at least all of the following requirements:
(a) A minimum period of coverage of at least 24 consecutive months for each covered person. This provision is not applicable to coverage issued or renewed after July 1, 2006.

(b) Minimum loss ratio standards at levels at which benefits are reasonable in relation to premiums and calculated in a manner which provides for adequate reserving of the long-term care insurance risk;

(c) A 30-day "free look" period, or longer, within which individual certificateholders have the right to return the certificate after its delivery and to have the premium refunded for any reason;

(d) A prohibition or limitation on pre-existing condition exclusions at least as favorable to a policyholder as that specified in Section 627.9407(4), F.S.;

(e) A prohibition against a policy or certificate excluding or using waivers or riders of any kind to exclude, limit, or reduce coverage or benefits for specifically named or described pre-existing diseases or physical conditions beyond any pre-existing condition waiting period;

(f) A prohibition or limitation on prior institutionalization provisions at least as favorable to a policyholder as that specified in Section 627.9407(5), F.S., including the mandatory offer provisions of paragraph (5)(c) of such section;

(g) A prohibition or limitation on policy cancellations or nonrenewals at least as favorable to a policyholder as that specified in Section 627.9407(3)(a), F.S.;

(h) A prohibition against a policy restricting its coverage to care only in a nursing home or providing significantly more coverage for such care than coverage for lower levels of care;

(i) A requirement that policies prominently disclose that the policy may not cover all of the costs associated with long-term care which may be incurred by the buyer during the period of coverage and that the buyer is advised to periodically review the policy in relation to the changes in the cost of long-term care; and

(j) Except for nonpayment of premiums and as provided by Section 627.94076, F.S., provide all insureds an endorsement that provides that upon renewal of a policy on or after July 1, 2008, the coverage shall be incontestable after it has been in force during the lifetime of the insured for a period of 2 years after its date of issue.
(3) Unless a group policy issued in another state has been filed for approval in Florida, no such policy or certificate issued thereunder shall contain a statement that the policy has been approved as a long-term care policy meeting the requirements of Florida law or words of similar meaning.

(4)
(a) All changes to rates, together with an actuarial memorandum developing and justifying the rate change, shall be filed with the Office pursuant to the procedures specified in Section 627.410, F.S., and rule Chapter 69O-149, F.A.C., as though the policy had been issued in Florida.

(b) For those policies which have been determined to be regulated by a state with substantially similar long-term care insurance requirements, pursuant to paragraph 69O-157.004(1)(b), F.A.C., form and rate changes shall be filed for informational purposes at least 30 days prior to use.

69O FAC 157.005 | Qualified Right of Renewal

No long-term care policy may contain a renewal provision less favorable to the insured than a right of renewal upon timely payment of premium, except that rates may be revised by the insurer on a class basis. However, the Office may authorize nonrenewal on a statewide basis, on terms and conditions deemed necessary by the Office, to best protect the interests of the insureds, if the insurer demonstrates:
(1) That renewal will jeopardize the insurer's solvency; or

(2) That:
(a) The actual paid claims and expenses have substantially exceeded the premium and investment income associated with the policies; and

(b) The policies will continue to experience substantial and unexpected losses over their lifetime; and

(c) The projected loss experience of the policies cannot be significantly improved or mitigated through reasonable rate adjustments or other reasonable methods; and

(d) The insurer has made repeated and good faith attempts to stabilize loss experience of the policies, including the timely filing for rate adjustments.

69O FAC 157.006 | Pre-existing Conditions

(1) No long-term care insurance policy or certificate other than a policy or certificate thereunder issued to a group as defined in Section 627.9405(1)(a), F.S., shall use a definition of "preexisting condition" which is more restrictive than the following: "Preexisting condition" means the existence of symptoms which would cause an ordinarily prudent person to seek diagnosis, care, or treatment, or a condition for which medical advice or treatment was recommended by or received from a provider of health care services within 6 months preceding the effective date of coverage of an insured person.

(2) No long-term care insurance policy or certificate other than a policy or certificate thereunder issued to a group as defined in Section 627.9405(1)(a), F.S., may exclude coverage for a loss or confinement which is the result of a preexisting condition unless such loss or confinement begins within 6 months following the effective date of coverage of an insured person.

69O FAC 157.007 | Conditions of Eligibility

(1) A policy covering one or more members of the insured's family shall include provisions which specify the identity and qualifications applicable to those family members who may become insured under the policy initially or by subsequent addition.
(a) Eligible family members may include:
1. The insured;

2. The insured's spouse;

3. Children of the insured or of the insured's spouse who are over a specified age not to exceed 21, unless a dependency test is specified;

4. Parents or grandparents of the insured or the insured's spouse; and

5. Any other person dependent upon the insured.
(b) The provisions concerning eligibility shall, for persons who may become insured subsequent to policy issuance, state the conditions under which such coverage may become effective. Such conditions include:
1. Qualifications for automatic coverage and the duration thereof;

2. Required evidence of insurability;

3. The necessity of application or notice from the insured;

4. Any requirements as to the payment of premiums as to such addition; and

5. The time within which action is to be taken by the insured.
(2) No group long-term care policy may be issued or issued for delivery in this state unless all members of the group, or all of any class or classes thereof, are declared eligible and acceptable to the insurer at the time of issuance of the policy, subject to any exception to this requirement expressly authorized by Section 627.9405, F.S., as presently existing or as hereafter amended.

69O FAC 157.008 | Nonduplication of Coverage Provisions

(1) In addition to any other provisions not prohibited by law or rules, an insurer may avoid duplication of benefits in an expense-incurred insurance policy with respect to losses for which benefits are payable under any workers' compensation, occupational disease, employers' liability or similar laws or payable pursuant to the Florida motor vehicle no-fault law, and any national, state or other governmental plan (except Medicaid) not limited to civilian governmental employees or their families. An insurer may, alternatively, afford excess insurance to benefits afforded under any workers' compensation, occupational disease, employers' liability or similar laws or any national, state or other governmental plan or Florida motor vehicle no-fault law, as well as other insurance or employer- employee or union welfare plans.

(2) Nonduplication may involve an interrelation, as related above and as appropriate to the coverage afforded, with other benefit programs including but not limited to individual or family insurance, group insurance, hospital service, medical service, group practice, individual practice and other prepayment plans, employee or employer benefit organizations, union or association welfare plans, Medicare, Florida motor vehicle no-fault law, and similar benefit programs, except Medicaid.

69O FAC 157.009 | Minimum Coverage

(1) All long-term care policies shall provide coverage for at least 24 consecutive months for each covered person for care in a nursing home.

(2) All long-term care policies shall provide coverage for at least one type of lower level of care in addition to coverage for care in a nursing home.

(3) No long-term care policy may provide significantly more coverage for care in a nursing home than coverage for lower levels of care. In furtherance of this requirement, benefits for all lower levels of care, in the aggregate, shall provide a level of benefits equivalent to 50 percent of the benefits provided for nursing home coverage. For the purposes of applying this 50 percent equivalency requirement, if a long-term care policy provides nursing home coverage for an unlimited duration, the nursing home benefit shall be considered to be payable for ten years. A long-term care policy may use an overall lifetime benefit maximum which may be exhausted by any combination of benefits.

(4) For the purposes of this rule, "lower level(s) of care" means the following:
(a) Nursing service;

(b) Adult congregate living facility;

(c) Home health agency;

(d) Adult day care center;

(e) Adult foster home;

(f) Community care for the elderly;

(g) Personal care and social services;

(h) Such other lower levels of care as approved by the Office.

69O FAC 157.010 | Conversion or Continuation Privilege

(1) Group long-term care insurance issued in this state shall provide covered individuals with a basis for continuation or conversion of coverage.

(2) For the purposes of this rule, "a basis for continuation of coverage" means a policy provision which maintains coverage under the existing group policy when such coverage would otherwise terminate and which is subject only to the continued timely payment of premium when due.

(3) For the purposes of this rule, "a basis for conversion of coverage" means a policy provision that an individual whose coverage under the group policy would otherwise terminate or has been terminated for any reason, including discontinuance of the group policy in its entirety or with respect to an insured class, and who has been continuously insured under the group policy (and any group policy which it replaced), for at least six months immediately prior to termination, shall be entitled to the issuance of a converted policy by the insurer under whose group policy he or she is covered, without evidence of insurability.

(4) For the purposes of this rule, "converted policy" means an individual policy of long-term care insurance providing benefits identical to or benefits determined by the Office to be substantially equivalent to or in excess of those provided under the group policy from which conversion is made. If the policy from which conversion is made restricts provision of benefits and services to named providers or facilities, and the circumstances of termination make continued use of these providers or facilities impossible or impractical, the converted policy shall provide coverage on an indemnity or expense incurred basis with benefits equivalent to the reasonable cost of services provided by the named providers or facilities, and shall not restrict provision of benefits and services to any named providers or facilities.

(5) Written application for the converted policy shall be made and the first premium due, if any, shall be paid as directed by the insurer not later than 31 days after termination of coverage under the group policy. The converted policy shall be issued effective on the day following the termination of coverage under the group policy, and shall be renewable annually.

(6)
(a) Unless the group policy from which conversion is made replaced previous group coverage, the premium for the converted policy shall be calculated on the basis of the insured's age and risk class at inception of coverage under the group policy from which conversion is made.

(b) Where the group policy from which conversion is made replaced previous group coverage, the premium for the converted policy shall be calculated on the basis of the insured's age and risk class used in determining the coverage issued at inception of coverage under the group policy replaced.
(7) Continuation of coverage or issuance of a converted policy shall be mandatory, except where:
(a) Termination of group coverage resulted from a certificateholder's failure to make any required payment of premium or contribution when due. This does not include such situations as the individual's authorizing and making payment that is not ultimately paid to the insurer due to bank, employer, or policyholder error, or

(b) The terminating coverage is replaced not later than 31 days after termination, by group coverage effective on the day following the termination of coverage:
1. Providing benefits identical to or benefits determined by the office to be substantially equivalent or in excess of those provided by the terminating coverage; and

2. The premium for which is calculated in a manner consistent with the requirements of subsection (6) of this rule.
(8) Notwithstanding any other provision of this rule, a converted policy issued to an individual who at the time of conversion is covered by another long-term care insurance policy which provides benefits on the basis of incurred expenses, may contain a provision which results in a reduction of benefits payable if the benefits provided under the additional coverage, together with the full benefits provided by the converted policy, would result in payment of more than 100% of incurred expenses. Such provision shall only be included in the converted policy if the converted policy also provides for a premium decrease or refund which reflects the reduction in benefits payable.

(9) The converted policy may provide that the benefits payable under the converted policy, together with the benefits payable under the group policy from which conversion is made, shall not exceed those that would have been payable had the individual's coverage under the group policy remained in force and effect.

(10) Notwithstanding any other provision of this rule, any insured individual whose eligibility for group long-term care coverage is based upon his or her relationship to another person, shall be entitled to continuation of coverage under the group policy upon termination of the qualifying relationship by death or dissolution of marriage.

69O FAC 157.011 | Waiting Period

The term "waiting period" or "probationary period" as used in a long-term care policy shall be that period of time which follows the date a person is initially insured under the policy before the coverage or coverages of the policy shall become effective as to such person. The waiting period shall be specified in the policy and:
(1) A waiting period shall not be used with respect to any loss resulting from accidental injuries as defined in the policy;

(2) A waiting period shall not exceed one year; and

(3) There shall be no policy provision to establish a new waiting period in the event existing coverage is converted to or replaced by new or other forms within the same company, except with respect to an increase in benefits voluntarily selected by the insured individual or group policyholder.

69O FAC 157.012 | Exclusions, Limitations, Reductions

(1) Exclusions, limitations, reductions, generally -
(a) Any exclusions, limitations, or reductions on the risk undertaken whether applicable to amounts, duration of benefits, age, or other matters, must be specified with clarity and certainty in appropriately entitled provision or provisions of the contract;

(b) Such principal exclusions, limitations, or reductions shall be included in the applicable "Outline of Coverage" delivered to an applicant for an individual policy or included in the "Certificate" issued pursuant to a group policy delivered or issued for delivery in this state; and

(c) Any exclusion, limitation, or reduction must be clearly expressed as part of the benefit provision to which it applies or, if applicable, to more than one benefit provision, shall be set forth as a separate provision and appropriately captioned.
(2) Exclusion - An exclusion is any provision in a policy or contract whereby coverage for a specified hazard is entirely eliminated. It is a statement of risk not assumed under the terms and provisions of the contract.

(3) Limitation - A limitation is any provision in a policy or contract whereby coverage amounts or duration of benefits or conditions under which benefits are delivered are specified.

(4) Reduction - A reduction is any provision in a policy or contract which takes away some portion, but not all of the coverage of such policy or contract under certain specific conditions. Such provision may limit the coverage amounts or duration of benefits to some coverage amount or duration of benefit which is less than would be otherwise applicable had such reduction clause not been used.

(5) No long-term care insurance policy or certificate may exclude or use waivers or riders of any kind to exclude, limit, or reduce coverage or benefits for specifically named or described pre-existing diseases or physical conditions beyond any general pre-existing condition waiting period otherwise permitted by statute or rule.

(6) Exclusions and limitations prohibited - No policy or contract may exclude or limit coverage by type of illness, treatment, medical condition or accident, except as follows:
(a) Pre-existing conditions or diseases as further specified in Rule 69O-157.009, F.A.C.;

(b) Mental or nervous disorders which shall not exclude or limit coverage for any condition other than a neurosis, psychoneurosis, psychopathy, psychosis, or mental or emotional disease or disorder of any kind. However, this shall not permit exclusion or limitation of benefits on the basis of Alzheimers Disease or similar organic brain syndrome;

(c) Alcoholism and drug addiction;

(d) Illness, treatment or medical condition arising out of:
1. War or act of war (whether declared or undeclared);

2. Participation in a felony, riot or insurrection; or

3. Service in the armed forces or units auxiliary thereto;

4. Attempted suicide, or intentionally self-inflicted injury.
(7) The exclusions and limitations provisions of this rule are not intended to prohibit those allowable exclusions and limitations by type of provider or territorial limitations, provided that any such territorial limitations may not exclude coverage in any state of the United States.

69O FAC 157.013 | Elimination Period

As used in any long-term care policies, the term "elimination period" means the number of days at the beginning of a period of confinement for which no benefits are payable. No policy shall contain an elimination period in excess of the maximum time period specified in Section 627.9407(3), F.S., as presently existing or as hereafter amended. Such elimination period or periods must be clearly expressed in the policy schedule or benefits page and clearly expressed or referenced in the benefit or benefits provision to which such elimination period or periods apply.

69O FAC 157.014 | Recurrent Utilization

If a policy contains provisions relating to an "elimination period" or a "prior institutionalization" requirement, or a similar provision that establishes a condition that must be met before benefits are payable, such provision may not be applied more than once unless the utilization of covered services is separated by a period greater than 180 days.

69O FAC 157.015 | Extension of Benefits

Termination of a group long-term care policy contract shall be without prejudice to any benefits payable for services which began while the contract was in force and continue without interruption after termination. Such extension of benefits beyond the period the contract was in force may be limited to the duration of benefit period, or the payment of the maximum benefit, whichever is less.

69O FAC 157.016 | Requirements for Replacement

(1) An application form for coverage subject to these rules shall contain a question to elicit information as to whether the insurance to be issued is to replace any insurance presently in force. If replacement of existing coverage is indicated, the application shall state the company name and policy number. A supplementary application or other form to be signed by the applicant and made a part of the company's file containing such questions may be used.

(2) Upon determining that a sale will involve replacement, insurer, other than a direct response insurer, shall furnish the applicant, upon issuance or delivery of the policy, or prior thereto, the notice described below. One copy of such notice shall be given to the applicant, and an additional copy signed by the applicant shall be retained by the insurer in its home office for at least three years or until the conclusion of the next succeeding regular examination by the Insurance Department of its state of domicile, whichever is later. This notice required for an insurer, other than a direct response insurer, shall be provided in substantially the following form:

NOTICE TO APPLICANT REGARDING REPLACEMENT OF LONG-TERM CARE INSURANCE

According to (your application) (information you have furnished), you intend to lapse or otherwise terminate existing long-term care insurance (insert policy number) you have with (insert company name) and replace it with a policy to be issued by (insert company name). For your information and protection, you should be aware of and seriously consider certain factors which may affect the insurance protection available to you under the new policy.
(1) Health conditions which you may presently have (pre-existing conditions) may not be immediately or fully covered under the new policy. This could result in denial or delay of a claim for benefits under the new policy, whereas a similar claim might have been payable under your present policy. (To be included if pre-existing conditions are not covered under the replacement policy.)

(2) You may wish to secure the advice of your present insurer or its agent regarding the proposed replacement of your present policy. This is not only your right, but it is also in your best interest to make sure you understand all the relevant factors involved in replacing your present coverage.

(3) If, after due consideration, you still wish to terminate your present policy and replace it with new coverage, be certain that all questions on the application concerning your medical health history are truthfully and completely answered. Failure to include all material medical information on an application may provide a basis for the company to deny any future claims and to refund your premium as though your policy had never been in force. After the application has been completed, it should be carefully reviewed before being signed to be certain that all information has been properly recorded.

(4) New policies may be issued at an older age than that used for issuance of your present policy; therefore, the cost of the new policy, depending upon the benefits, may be higher than you are paying for your present policy.

(5) The renewal provision of the new policy should be reviewed so as to make sure of your rights to periodically renew the policy.
The above "Notice to Applicant" was delivered to me on:________ (Date)

Witness:
__________________________
(Writing Agent)

__________________________________
(Applicant's Signature)
(3) A direct response insurer shall deliver to the applicant upon issuance of the policy, or within five working days from receipt of the application, whichever date occurs earlier, the notice described below. This notice required for a direct response insurer shall be provided in substantially the following form:

NOTICE TO APPLICANT REGARDING REPLACEMENT OF LONG-TERM CARE INSURANCE

According to (your application) (information you have furnished), you intend to lapse or otherwise terminate existing long-term care insurance (insert policy number) you have with (insert company name) and replace it with the policy delivered herewith issued by (insert company name). Your new policy provides 30 days within which you may decide, without cost, whether you desire to keep the policy. For your own information and protection you should be aware of and seriously consider certain factors which may affect the insurance protection available to you under the new policy.
(1) Health conditions which you may presently have (pre-existing conditions) may not be immediately or fully covered under the new policy. This could result in denial or delay of a claim for benefits under the new policy, whereas a similar claim might have been payable under your present policy.

(2) You may wish to secure the advice of your present insurer or its agent regarding the proposed replacement of your present policy. This is not only your right, but is also in your best interests to make sure you understand all the relevant factors involved in replacing your present coverage.

(3) (To be included only if the application is attached to the policy.) If, after due consideration, you still wish to terminate your present policy and replace it with new coverage, read the copy of the application attached to your new policy and be sure that all questions are answered fully and correctly. Omissions or misstatements in the application could cause an otherwise valid claim to be denied. Carefully check the application and write to (insert company name and address) within 10 days if any information is not correct and complete, or if any past medical history has been left out of the application.
______________
(Company Name)
(4) An insurer, within five working days from the receipt of an application at its policy issuance office, shall furnish a copy of such notice to the insurer whose policy is being replaced.

69O FAC 157.017 | Prior Institutionalization

(1) No contract issued as a long-term care insurance policy shall condition any benefits upon prior institutionalization for a total period of time longer than three days.

(2) If a contract provides benefits only following institutionalization of three days, or less, then benefits may not be conditioned upon admission to a facility for the same or related condition within a period of less than 30 days after discharge from the prior institution.

(3) An entity that advertises, markets, or solicits long-term care coverage in this state which provides benefits only following institutionalization shall also offer to each policyholder, as part of the application, a contract which does not require prior institutionalization as a condition to any benefit.

69O FAC 157.018 | Right to Return Policy – Free Look (Repealed)

69O FAC 157.019 | Long-term Care Policies – Statements Required

All long-term care contracts shall contain the following statements prominently displayed on the face page of the contract:
(1) The policy has been approved as a "Long-Term Care Insurance Policy" meeting the requirements of Florida law.

(2) Notice to Buyer: This policy may not cover all of the costs associated with long-term care which may be incurred by the buyer during the period of coverage. The buyer is advised to periodically review this policy in relation to the changes in the cost of long-term care.

69O FAC 157.020 | Outline of Coverage

An outline of coverage shall be delivered to an applicant for an individual long-term care insurance policy at the time of application for an individual policy. In the case of direct response solicitations, the insurer shall deliver the outline of coverage upon the applicant's request, but regardless of request, shall make such delivery no later than at the time of policy delivery. Such outline of coverage shall include:
(1) The name and principal address of the insurer or service association;

(2) A statement of identification of the policy or contract;

(3) A policy form number;

(4) A description of the principal benefits and coverage provided in the policy;

(5) A statement of the principal exclusions, reductions, and limitations contained in the policy;

(6) If the policy is not expected to cover 100 percent of the cost of services for which coverage is provided, as statement clearly describing any such limitations;

(7) A statement of the renewal provisions, including any reservation in the policy of a right to change premiums;

(8) A statement that the outline of coverage is a summary of the policy issued or applied for and that the policy should be consulted to determine governing contractual provisions; and

(9) A statement that the policy has been approved as a long-term care insurance policy meeting the requirements of Florida Law.

69O FAC 157.021 | Certificate

A certificate issued pursuant to a group long-term care insurance policy, which policy is delivered or issued for delivery in this state, shall include:
(1) A description of the principal benefits and coverage provided in the policy;

(2) A statement of the principal exclusions, reductions, and limitations contained in the policy;

(3) A statement that the description of principal benefits is a summary of the policy and that the group master policy should be consulted to determine governing contractual provisions;

(4) Person insured;

(5) Person to whom benefits are payable;

(6) Group contract number;

(7) Certificate number;

(8) Effective date; and

(9) Time certificate is effective.

69O FAC 157.022 | Loss Ratio Requirements

Benefits under long-term care insurance policies shall be deemed reasonable in relation to premiums charged provided the expected loss ratio is at least sixty percent for individual policies and for group policies, calculated in a manner which provides for adequate reserving of the long-term care insurance risk. In determining whether loss ratio requirements are being met, the Office will exercise its best judgment as to the credibility of the data submitted and what constitutes a reasonable rate structure for the benefits being provided. In evaluating the expected loss ratio, due consideration shall be given to all relevant factors, including:
(1) Statistical credibility of incurred claims experience and earned premiums;

(2) The period for which rates are computed to provide coverage;

(3) Experienced and projected trends;

(4) Concentration of experience within early policy duration;

(5) Expected claim fluctuation;

(6) Experience refunds, adjustment or dividends;

(7) Renewability features;

(8) All appropriate expense factors;

(9) Interest;

(10) Experimental nature of the coverage;

(11) Policy reserves;

(12) Mix of business by risk classification; and

(13) Product features such as long elimination periods, high deductibles and high maximum limits.

69O FAC 157.023 | Reporting

(1) Every insurer shall maintain records for each agent of that agent's amount of replacement sales as a percentage of the agent's total annual sales in this state and the amount of lapses of long-term care insurance policies sold by the agent as a percentage of the agent's total annual sales in this state.

(2) Every insurer shall report annually by June 30 the 10 percent of its agents with the greatest percentages of lapses and replacements as measured by subsection 69O-157.023(1), F.A.C., in the format prescribed by Appendix J, "Long-Term Care Insurance Replacement and Lapse Reporting Form OIR-B2-1555," which is incorporated by reference in Rule 69O-157.111, F.A.C.

(3) Reported replacement and lapse rates do not alone constitute a violation of insurance laws or necessarily imply wrongdoing. The reports are for the purpose of reviewing more closely agent activities regarding the sale of long-term care insurance in this state.

(4) Every insurer shall report annually by June 30 the number of lapsed policies as a percentage of its total annual sales and as a percentage of its total number of policies in force as of the end of the preceding calendar year in this state in the format prescribed in Appendix J.

(5) Every insurer shall report annually by June 30 the number of replacement policies sold as a percentage of its total annual sales and as a percentage of its total number of policies in force as of the preceding calendar year in this state in the format as prescribed in Appendix J.

(6) Every insurer shall report annually by June 30, for qualified long-term care insurance contracts, the number of claims denied for each class of business, expressed as a percentage of claims denied in this state, in the format as prescribed in Appendix E, "Annual Long-Term Care Claims Denial Reporting Form" OIR-B2-1553, which is incorporated by reference in Rule 69O-157.111, F.A.C.

(7) For purposes of this section:
(a) "Policy" means only long-term care insurance;

(b) "Claim" means, subject to paragraph 69O-157.023(8)(c), F.A.C., a request for payment of benefits under an in force policy regardless of whether the benefit claimed is covered under the policy or any terms or conditions of the policy have been met;

(c) "Denied" means the insurer refuses to pay a claim for any reason other than claims not paid for failure to meet the elimination period or because of an applicable preexisting condition; and

(d) "Report" means on a statewide basis.
(8) Every insurer or other entity selling or issuing long-term care insurance benefits shall maintain a record of all policy or certificate rescissions, both state and countrywide, except those that the insured voluntarily effectuated, and shall annually furnish this information to the Office by March 1 of each year in the format prescribed in Appendix A, "Long-Term Care Rescission Report" OIR-B2-1552, which is incorporated by reference in Rule 69O-157.111, F.A.C.

(9) Reports required under this Rule 69O-157.023, F.A.C., are available from and shall be filed with the Division of Market Investigations, Office of Insurance Regulation.

69O FAC 157.101 | Purpose

The purpose of the provisions of this rule chapter is to implement Part XVIII of Chapter 627, F.S., to promote the public interest, to promote the availability of long-term care insurance coverage, to protect applicants for long-term care insurance, as defined, from unfair or deceptive sales or enrollment practices, to facilitate public understanding and comparison of long-term care insurance coverages, and to facilitate flexibility and innovation in the development of long-term care insurance.

69O FAC 157.102 | Applicability and Scope

(1) Except as otherwise specifically provided, the provisions of this rule chapter shall apply to long-term care insurance policies delivered or issued for delivery in this state, and to policies delivered or issued for delivery outside this state to the extent provided in Section 627.9406, F.S., and Rule 69O-157.114, F.A.C., by an insurer, a fraternal benefit society as defined in Section 632.601, F.S., a health care services plan as defined in Section 641.01, F.S., a prepaid health clinic as defined in Section 641.402, F.S., or a multiple-employer welfare arrangement as defined in Section 624.437, F.S.

(2) Pursuant to Section 627.9403, F.S., the provisions of this rule chapter shall also apply to limited benefit policies that limit coverage to care in a nursing home only or to one or more lower levels of care. For limited benefit policies, the term and reference to Long Term Care as used within this rule chapter, shall be considered to be, and replaced by, the term Limited Benefit.

(3) The provisions of this rule chapter apply to policies having indemnity benefits that are triggered by activities of daily living and sold as disability income insurance, if:
(a) The benefits of the disability income policy are dependent upon or vary in amount based on the receipt of long-term care services;

(b) The disability income policy is advertised, marketed or offered as insurance for long-term care services; or

(c) Benefits under the policy may commence after the policyholder has reached Social Security's normal retirement age unless benefits are designed to replace lost income or pay for specific expenses other than long-term care services.
(4) The provisions of this rule chapter shall apply to all long-term care policies or certificates issued on or after March 1, 2003. Notwithstanding the above, for certificates issued under a group long-term care insurance policy as defined in Section 627.9405(1)(a), F.S., which policy was in force at the time this amended rule chapter became effective, the provisions of this rule chapter shall apply to certificates issued on or after the policy anniversary following September 1, 2003.

(5)
(a) The provisions of rule Chapter 69O-149, F.A.C., shall apply to long-term care insurance coverage filings. In the event of conflict between rule Chapter 69O-149, F.A.C., and this Part II, the provisions of this Part II shall prevail.

(b) In filing the required annual rate certification filings pursuant to Section 627.410(7)(b), F.S., and Rule 69O-149.007, F.A.C., the annual rate certification filing shall include the certification required by paragraph 69O-157.108(1)(c), F.A.C.

69O FAC 157.103 | Definitions

As used in these rules and as used in long-term care policies, the following terms shall have meanings no more restrictive than the following:
(1) "Adult day care center" means a program for 6 or more individuals of social and health-related services provided during the day in a community group setting for the purpose of supporting frail, impaired elderly or other disabled adults who can benefit from care in a group setting outside the home.

(2) "Assisted living facility" shall be defined in the policy and shall be defined in relation to the services and facilities required to be available and the licensure or degree status of those providing or supervising the services.

(3)
(a) "Exceptional increase" means only those increases filed by an insurer as exceptional for which the Office determines the need for the premium rate increase is justified:
1. Due to changes in laws or regulations applicable to long-term care coverage in this state; or

2. Due to increased and unexpected utilization that affects the majority of insurers of similar products.
(b) Except as provided in Rule 69O-157.113, F.A.C., exceptional increases are subject to the same requirements as other premium rate schedule increases.

(c) If the insurer is unable to provide justification that the reason for the rate increase meets the definition of "exceptional increase", the Office shall contract a review by an independent actuary or a professional actuarial body, at the expense of the insurer making the filing, of the basis for a request that an increase be considered an exceptional increase. If the review does not determine the basis to be an exceptional increase or if the company does not agree to the contract proposed by the Office, the filing shall be considered as not meeting the definition of exceptional increase.

(d) The Office, in determining that the necessary basis for an exceptional increase exists, shall also determine any potential offsets to higher claims costs.
(4) "Hands-on assistance" or "services" means physical assistance (minimal, moderate or maximal) without which the individual would not be able to perform the activity of daily living.

(5) "Home health services" means medical and non-medical services provided to ill, disabled, or infirm persons in their residences. Such services may include homemaker services, assistance with activities of daily living, and respite care services.

(6) "Hospital" means a hospital as defined and licensed pursuant to the provisions of Chapter 395, F.S., or pursuant to substantially similar provisions of another state's licensing laws.

(7) "Incidental," as used in subsection 69O-157.113(9), F.A.C., means that the value of the long-term care benefits provided is less than 10 percent of the total value of the benefits provided over the life of the policy. These values shall be measured as of the date of issue.

(8) "Institutionalization" means that confinement to a hospital, facility, or center licensed pursuant to any parts of Chapter 400 or 395, F.S., or pursuant to substantially similar provisions of another state's licensing laws.

(9) "Medicare" means "The Health Insurance for the Aged Act, Title XVIII of the Social Security Amendments of 1965 as Then Constituted or Later Amended," or "Title I, Part I of Public Law 89-97, as Enacted by the Eighty-Ninth Congress of the United States of America and popularly known as the Health Insurance for the Aged Act, as then constituted and any later amendments or substitutes thereof," or words of similar import.

(10) "Mental or nervous disorder" shall not be defined to include more than neurosis, psychoneurosis, psychopathy, psychosis, or mental or emotional disease or disorder.

(11) "Nursing home facility" or "nursing home" as defined in Section 400.021(13), F.S.

(12) "Nurse registry" as defined in Section 400.462(15), F.S.

(13) "Personal care" means the provision of hands-on services to assist an individual with activities of daily living.

(14) "Personal information" means any individually identifiable information gathered in connection with an insurance transaction from which judgments can be made about an individual's character, habits, avocations, finances, occupation, general reputation, credit, health or any other personal characteristics. "Personal information" includes an individual's name and address and "medical record information" but does not include "privileged information".

(15) "Privileged information" means any individually identifiable information that:
(a) Relates to a claim for insurance benefits or a civil or criminal proceeding involving an individual; and

(b) Is collected in connection with or in reasonable anticipation of a claim for insurance benefits or civil or criminal proceeding involving an individual.
(16) "Qualified actuary" means a member in good standing of the American Academy of Actuaries.

(17) "Similar policy forms" means all of the long-term care insurance policies and certificates issued by an insurer in the same long-term care benefit classification as the policy form being considered.
(a) Certificates of groups that meet the definition in Section 627.9405(1)(a), F.S., are not considered similar to certificates or policies otherwise issued as long-term care insurance, but are similar to other comparable certificates with the same long-term care benefit classifications.

(b) For purposes of determining similar policy forms, long-term care benefit classifications are defined as follows: institutional long-term care benefits only, non-institutional long-term care benefits only, or comprehensive long-term care benefits.
(18) "Waiting period" or "probationary period" as used in a long-term care policy means that period of time which follows the date a person is initially insured under the policy before the coverage or coverages of the policy shall become effective as to that person.

69O FAC 157.104 | Policy Practices and Provisions

(1) Renewability.

The terms "guaranteed renewable" and "noncancellable" shall not be used in any individual long-term care insurance policy without further explanatory language in accordance with the disclosure requirements of Rule 69O-157.106, F.A.C.
(a) A policy issued to an individual shall not contain renewal provisions other than "guaranteed renewable" or "noncancellable."

(b) The term "guaranteed renewable" shall be used only when the insured has the right to continue the long-term care insurance in force by the timely payment of premiums and when the insurer has no unilateral right to make any change in any provision of the policy or rider while the insurance is in force, and cannot decline to renew, except that rates may be revised by the insurer on a class basis.

(c) The term "noncancellable" shall be used only when the insured has the right to continue the long-term care insurance in force by the timely payment of premiums during which period the insurer has no right to unilaterally make any change in any provision of the insurance or in the premium rate.

(d) The term "level premium" shall only be used when the insurer does not have the right to change the premium.

(e) In addition to the other requirements of this subsection 69O-157.104(1), F.A.C., a qualified long-term care insurance contract shall be guaranteed renewable within the meaning of Section 7702B(b)(1)(C) of the Internal Revenue Code of 1986, as amended.

(2) Limitations and Exclusions.

A policy may not be delivered or issued for delivery in this state as long-term care insurance if the policy limits or excludes coverage by type of illness, treatment, medical condition, or accident, except as follows:
(a) Preexisting conditions or diseases pursuant to Sections 627.9407(4)(a) and (b), F.S.;

(b) Mental or nervous disorders; however, this shall not permit exclusion or limitation of benefits on the basis of Alzheimer's Disease;

(c) Alcoholism and drug addiction;

(d) Illness, treatment, or medical condition arising out of:
1. War or act of war (whether declared or undeclared);

2. Participation in a felony, riot, or insurrection;

3. Service in the armed forces or units auxiliary thereto;

4. Suicide (sane or insane), attempted suicide, or intentionally self-inflicted injury; or

5. Aviation (this exclusion applies only to non-fare-paying passengers).
(e) Treatment provided in a government facility (unless otherwise required by law), services for which benefits are available under Medicare or other governmental program (except Medicaid), any state or federal workers' compensation, employer's liability or occupational disease law, or any motor vehicle no-fault law, services provided by a member of the covered person's immediate family, and services for which no charge is normally made in the absence of insurance;

(f) Expenses for services or items available or paid under another long-term care insurance or health insurance policy;

(g) In the case of a qualified long-term care insurance contract, expenses for services or items to the extent that the expenses are reimbursable under Title XVIII of the Social Security Act or would be so reimbursable but for the application of a deductible or coinsurance amount.

(h) This subsection is not intended to prohibit exclusions and limitations by type of provider or territorial limitations.

(3) Conditions of Eligibility.

The provision of Section 627.9405(2), F.S., does not require the sponsoring policyholder of a group policy to contribute premiums; however, if the sponsoring policyholder does contribute any premium, all members of the group, or all of any class or classes thereof, shall be declared eligible and acceptable to the insurer at the time of issuance of the policy.

(4) Minimum Coverage.

(a) All long-term care policies shall provide coverage for at least 24 consecutive months for each covered person for care in a nursing home. This provision is not applicable to coverage issued or renewed after July 1, 2006.

(b) All long-term care policies shall provide coverage for at least one type of lower level of care, in addition to coverage for care in a nursing home.

(c)
1.
a. No long-term care policy shall provide significantly more coverage for care in a nursing home than coverage for lower levels of care. In furtherance of this requirement, benefits for all lower levels of care in the aggregate, as determined by the insured for each policy, shall provide a level of benefits equivalent to at least 50 percent of the benefits provided for nursing home coverage; i.e., if the nursing home benefit amount is $100 per day then the required lower level of care benefit amount shall be at least $50 per day.

b. For the purposes of applying this 50 percent equivalency requirement to a policy benefit period, the lower level of care shall be, in the aggregate, at least 50 percent of the benefit period provided for nursing home coverage.

c. If a long-term care policy provides nursing home coverage for an unlimited duration, the lower level of care shall be payable for at least 3 years in the aggregate.
2. A long-term care policy may use an overall lifetime benefit maximum, in lieu of the specific coverage identified by paragraph (c), above, which may be exhausted by any combination of benefits provided the overall lifetime benefit maximum is at least 150 percent of the minimum coverage required by paragraph 69O-157.104(4)(a), F.A.C., times the amount of daily nursing home benefit purchased.
(d) For the purposes of this rule, "lower level(s) of care" means the following:
1. Nursing service;

2. Assisted living facility;

3. Home health services;

4. Adult day care center;

5. Adult foster home;

6. Community care for the elderly; and

7. Personal care and social services.

(5) Group Coverage Certificate.

A certificate issued pursuant to a group long-term care insurance policy, which policy is delivered or issued for delivery in this state, shall include:
(a) A description of the principal benefits and coverage provided in the policy;

(b) A statement of the principal exclusions, reductions, and limitations contained in the policy;

(c) A statement that the description of principal benefits is a summary of the policy and that the group master policy should be consulted to determine governing contractual provisions;

(d) Person insured;

(e) Person to whom benefits are payable;

(f) Group contract number;

(g) Certificate number;

(h) Effective date; and

(i) Time certificate is effective.

(6) Death Benefits.

An individual long term care policy shall not include a policy benefit that is incurred upon the death of an insured in excess of $1,000 pursuant to Section 627.603, F.S. Such benefits may be provided as an option that the insured may purchase or not purchase for a separate premium from the base policy coverage.

(7) Extension of Benefits.

(a) Termination of long-term care insurance shall be without prejudice to any benefits payable for institutionalization if the institutionalization began while the long-term care insurance was in force and continues without interruption after termination.

(b) The extension of benefits beyond the period the long-term care insurance was in force may be limited to the duration of the benefit period, if any, or to payment of the maximum benefits, and may be subject to any policy waiting period and all other applicable provisions of the policy.

(8) Continuation or Conversion.

(a) Group long-term care insurance issued in this state shall provide covered individuals with a basis for continuation or conversion of coverage.

(b) For the purposes of this rule, "a basis for continuation of coverage" means a policy provision that maintains coverage under the existing group policy when the coverage would otherwise terminate and which is subject only to the continued timely payment of premium when due.

(c) For the purposes of this rule, "a basis for conversion of coverage" means a policy provision that an individual whose coverage under the group policy would otherwise terminate or has been terminated for any reason, including discontinuance of the group policy in its entirety or with respect to an insured class, and who has been continuously insured under the group policy (and any group policy which it replaced), for at least 6 months immediately prior to termination, shall be entitled to the issuance of a converted policy by the insurer under whose group policy the individual is covered, without evidence of insurability.

(d)
1. For the purposes of this rule, "converted policy" means an individual policy of long-term care insurance providing benefits identical to, or benefits determined by the Office to be substantially equivalent to or in excess of, those provided under the group policy from which conversion is made.

2. The policy and rate schedule for the converted policy shall be a policy that is available, at the time of conversion, for general sales by the insurer.

3. Where the group policy from which conversion is made restricts provision of benefits and services to, or contains incentives to use certain providers or facilities, the Office, in making a determination as to the substantial equivalency of benefits, shall take into consideration the differences between managed care and non-managed care plans, including provider system arrangements, service availability, benefit levels and administrative complexity.
(e) Written application for the converted policy shall be made and the first premium due, if any, shall be paid as directed by the insurer not later than 31 days after termination of coverage under the group policy. The converted policy shall be issued effective on the day following the termination of coverage under the group policy, and shall be renewable annually.

(f)
1. Unless the group policy from which conversion is made replaced previous group coverage, the premium for the converted policy shall be calculated on the basis of the insured's age and risk class at inception of coverage under the group policy from which conversion is made.

2. Where the group policy from which conversion is made replaced previous group coverage, the premium for the converted policy shall be calculated on the basis of the insured's age and risk class used in determining the coverage issued at inception of coverage under the group policy replaced.
(g) Continuation of coverage or issuance of a converted policy shall be mandatory, except where:
1. Termination of group coverage resulted from a certificateholder's failure to make any required payment of premium or contribution when due. This does not include such situations as the individual's authorizing and making payment which is not ultimately paid to the insurer due to bank, employer, or policyholder error; or

2. The terminating coverage is replaced not later than 31 days after termination by group coverage effective on the day following the termination of coverage:
a. Providing benefits identical to or benefits determined by the Office to be substantially equivalent to or in excess of those provided by the terminating coverage; and

b. The premium for which is calculated in a manner consistent with the requirements of paragraph 69O-157.104(8)(f), F.A.C.
(h)
1. Notwithstanding any other provision of this subsection 69O-157.104(8), F.A.C., a converted policy issued to an individual who at the time of conversion is covered by another long-term care insurance policy that provides benefits on the basis of incurred expenses, may contain a provision that results in a reduction of benefits payable if the benefits provided under the additional coverage, together with the full benefits provided by the converted policy, would result in payment of more than 100 percent of incurred expenses.

2. The provision shall only be included in the converted policy if the converted policy also provides for a premium decrease or refund that reflects the reduction in benefits payable.
(i) The converted policy may provide that the benefits payable under the converted policy, together with the benefits payable under the group policy from which conversion is made, shall not exceed those that would have been payable had the individual's coverage under the group policy remained in force and effect.

(j) Notwithstanding any other provision of this subsection 69O-157.104(8), F.A.C., an insured individual whose eligibility for group long-term care coverage is based upon the individual's relationship to another person shall be entitled to continuation of coverage under the group policy upon termination of the qualifying relationship.

(k) For the purposes of this section a "managed-care plan" is a health care or assisted living arrangement designed to coordinate patient care or control costs through utilization review, case management, or use of specific provider networks.

(9) Discontinuance and Replacement.

If a group long-term care policy is replaced by another group long-term care policy issued to the same policyholder, the succeeding insurer shall offer coverage to all persons covered under the previous group policy on its date of termination. Coverage provided or offered to individuals by the insurer and premiums charged to persons under the new group policy:
(a) Shall not result in an exclusion for preexisting conditions that would have been covered under the group policy being replaced; and

(b) Shall not vary or otherwise depend on the individual's health or disability status, claim experience, or use of long-term care services.

(10) Premium Restrictions.

(a) Except for premium rate increases pursuant to Rule 69O-157.113, F.A.C., or due to benefit changes elected by the insured, the premium rate schedule shall be based on the issue age of the insured. Pursuant to Section 627.410(6)(d), F.S., a company is prohibited from using any rate schedule or rating practice which use select and ultimate rating or where the rate varies based on an insured's year of issue or duration that the coverage has been in effect based on the benefits contracted at the issuance of the coverage. Except for differences in rates attributed to differences in modal payment, any discount provided at issue may not be removed once issued.

(b)
1. The purchase of additional coverage shall not be considered a premium rate increase, but for purposes of the calculation required under paragraph 69O-157.118(3)(c), F.A.C., the portion of the premium attributable to the additional coverage shall be added to and considered part of the initial annual premium.

2. A reduction in benefits shall not be considered a premium change, but for purpose of the calculation required under paragraph 69O-157.118(3)(c), F.A.C., the initial annual premium shall be based on the reduced benefits.

(11) Electronic Enrollment for Group Policies.

(a) In the case of a group defined in Section 627.9405(1)(a), F.S., any requirement that a signature of an insured be obtained by an agent or insurer shall be deemed satisfied if:
1. The consent is obtained by telephonic or electronic enrollment by the group policyholder or insurer. A verification of enrollment information shall be provided to the enrollee;

2. The telephonic or electronic enrollment provides necessary and reasonable safeguards to assure the accuracy, retention, and prompt retrieval of records; and

3. The insurer is responsible that the telephonic or electronic enrollment process provides necessary and reasonable safeguards to assure that the confidentiality of personal and privileged information is maintained.
(b) The insurer shall make available, upon request of the Office, records that will demonstrate the insurer's ability to confirm enrollment and coverage amounts.

69O FAC 157.105 | Refund of Premium (Repealed)

69O FAC 157.106 | Required Disclosure Provisions

(1) Renewability.

Individual long-term care insurance policies shall contain a renewability provision.
(a) The provision:
1. Shall be appropriately captioned;

2. Shall appear on the first page of the policy;

3. Shall clearly state that the coverage is guaranteed renewable or noncancellable; and

4. Shall not apply to policies that do not contain a renewability provision, and under which the right to non-renew is reserved solely to the policyholder.
(b) A long-term care insurance policy or certificate, other than one where the insurer does not have the right to change the premium, shall include a statement that premium rates may change, as defined in paragraph 69O-157.104(1)(b), F.A.C.

(2) Riders and Endorsements.

(a) Except for riders or endorsements by which the insurer effectuates a request made in writing by the insured under an individual long-term care insurance policy, all riders or endorsements added to an individual long-term care insurance policy after date of issue or at reinstatement or renewal that reduce or eliminate benefits or coverage in the policy shall require signed acceptance by the individual insured.

(b) After the date of policy issue, any rider or endorsement that increases benefits or coverage with a concomitant increase in premium during the policy term shall be agreed to in writing and signed by the insured, except if increased benefits or coverage are required by law.

(c) Where a separate additional premium is charged for benefits provided in connection with riders or endorsements, the premium charge shall be set forth in the policy, rider, or endorsement.

(3) Payment of Benefits.

A long-term care insurance policy that provides for the payment of benefits based on standards described as "usual and customary," "reasonable and customary" or words of similar import shall include a definition of these terms and an explanation of the terms in the policy and its accompanying outline of coverage in compliance with Section 627.6044, F.S.

(4) Limitations.

If a long-term care insurance policy or certificate contains any limitations with respect to preexisting conditions, the limitations shall appear as a separate paragraph of the policy or certificate and shall be labeled as "Preexisting Condition Limitations."

(5) Other Limitations or Conditions on Eligibility for Benefits.

A long-term care insurance policy or certificate containing any limitations or conditions for eligibility other than those prohibited in Section 627.9407(5), F.S., shall set forth a description of the limitations or conditions, including any required number of days of confinement in a separate paragraph of the policy or certificate and shall label such paragraph "Limitations or Conditions on Eligibility for Benefits."

(6) Disclosure of Tax Consequences.

(a) With regard to life insurance policies that provide an accelerated benefit for long-term care, a disclosure statement is required at the time of application for the policy or rider and at the time the accelerated benefit payment request is submitted that receipt of these accelerated benefits may be taxable, and that assistance should be sought from a personal tax advisor.

(b) The disclosure statement shall be prominently displayed on the first page of the policy or rider and any other related documents.

(c) This disclosure requirement shall not apply to qualified long-term care insurance contracts.

(7) Benefit Triggers.

(a) Activities of daily living and cognitive impairment shall be used to measure an insured's need for long term care, shall be described in the policy or certificate in a separate paragraph, and shall be labeled "Eligibility for the Payment of Benefits."

(b) Any additional benefit triggers shall also be explained in this section.

(c) If these triggers differ for different benefits, explanation of the trigger shall accompany each benefit description.

(d) If an attending physician or other specified person must certify a certain level of functional dependency in order to be eligible for benefits, this too shall be specified.
(8) A qualified long-term care insurance contract shall include a disclosure statement in the policy and in the outline of coverage as required by Section 627.9407(12), F.S., that the policy is intended to be a qualified long-term care insurance contract under Section 7702B(b) of the Internal Revenue Code of 1986, as amended.

(9) A nonqualified long-term care insurance contract shall include a disclosure statement in the policy and in the outline of coverage as required by Section 627.9407(12), F.S., that the policy is not intended to be a qualified long-term care insurance contract.

69O FAC 157.107 | Required Disclosure of Rating Practices to Consumers

(1) Other than policies for which no applicable premium rate or rate schedule increases can be made, insurers shall provide all of the information listed in this rule to the applicant at the time of application or enrollment, unless the method of application does not allow for delivery at that time. In such case, an insurer shall provide all of the information listed in this rule to the applicant no later than at the time of delivery of the policy or certificate.
(a) A statement that the policy may be subject to rate increases in the future;

(b) An explanation of potential future premium rate revisions, and the policyholder's or certificateholder's option in the event of a premium rate revision;

(c) The premium rate or rate schedules applicable to the applicant that will be in effect until a request is made for an increase;

(d) A general explanation for applying premium rate or rate schedule adjustments that shall include:
1. A description of when premium rate or rate schedule adjustments will be effective (e.g., next anniversary date, next billing date, etc.); and

2. The right to a revised premium rate or rate schedule as provided in paragraph 69O-157.107(1)(b), F.A.C., if the premium rate or rate schedule is changed;
(e)
1. Information regarding each premium rate increase on this policy form or similar policy forms over the past 10 years for this state or any other state that, at a minimum, identifies:
a. The policy forms for which premium rates have been increased;

b. The calendar years when the form was available for purchase; and

c. The amount or percentage of each increase. The percentage may be expressed as a percentage of the premium rate prior to the increase, and may also be expressed as minimum and maximum percentages if the rate increase is variable by rating characteristics.
2. The insurer may, in a fair manner, provide additional explanatory information related to the rate increases.

3. An insurer shall have the right to exclude from the disclosure premium rate increases that apply only to blocks of business acquired from other nonaffiliated insurers or the long-term care policies acquired from other nonaffiliated insurers when those increases occurred prior to the acquisition.

4.
a. If an acquiring insurer files for a rate increase on a long-term care policy form acquired from nonaffiliated insurers or a block of policy forms acquired from nonaffiliated insurers on or before the later of the effective date of this Part II or the end of a 24 month period following the acquisition of the block or policies, the acquiring insurer may exclude that rate increase from the disclosure.

b. The nonaffiliated selling insurer shall include the disclosure of that rate increase in accordance with subparagraph 69O-157.107(1)(e)1., F.A.C.
5. If the acquiring insurer in subparagraph 69O-157.107(1)(e)4., F.A.C., files for a subsequent rate increase, even within the 24 month period, on the same policy form acquired from nonaffiliated insurers or block of policy forms acquired from nonaffiliated insurers referenced in subparagraph 69O-157.107(1)(e)4., F.A.C., the acquiring insurer shall make all disclosures required by paragraph 69O-157.107(1)(e), F.A.C., including disclosure of the earlier rate increase referenced in subparagraph 69O-157.107(1)(e)4., F.A.C.
(2) An applicant shall sign an acknowledgement at the time of application, unless the method of application does not allow for signature at that time, that the insurer made the disclosure required under paragraphs 69O-157.107(1)(a) and (e), F.A.C. If due to the method of application the applicant cannot sign an acknowledgement at the time of application, the applicant shall sign no later than at the time of delivery of the policy or certificate.

(3) An insurer shall use the content and format of Appendices B, "Long Term Care Personal Worksheet" (10/02), and F, "Potential Rate Increase Disclosure Form OIR-1554" (10/02), which are incorporated herein by reference, to comply with the requirements of subsection 69O-157.107(1), F.A.C. All Appendices adopted and incorporated by reference in this rule chapter are available from the Division of Life and Health Product Review, 200 East Gaines Street, Tallahassee, Florida 32399-0328.

(4)
(a) An insurer shall provide notice of an upcoming premium rate schedule increase to all policyholders or certificateholders, if applicable, at least 45 days prior to the implementation of the premium rate schedule increase by the insurer.

(b) The notice shall include the information required by subsection 69O-157.107(1), F.A.C., when the rate increase is implemented.

69O FAC 157.108 | Initial Filing Requirements

(1) An insurer shall provide the information listed in this subsection for approval pursuant to Section 627.410, F.S., prior to making a long-term care insurance form available for sale.
(a) A filing made pursuant to rule Chapter 69O-149, F.A.C., with the actuarial material identified below in lieu of the actuarial memorandum required by subparagraph 69O-149.003(2)(b)4., F.A.C.

(b) A copy of the disclosure documents required in Rule 69O-157.107, F.A.C.; and

(c) An actuarial certification consisting of at least the following:
1. A statement that the initial premium rate schedule is sufficient to cover anticipated costs under moderately adverse experience and that the premium rate schedule is reasonably expected to be sustainable over the life of the form with no future premium increases anticipated;

2. A statement that the policy design and coverage provided have been reviewed and taken into consideration;

3. A statement that the underwriting and claims adjudication processes have been reviewed and taken into consideration;

4. A complete description of the basis for contract reserves that are anticipated to be held under the form, to include:
a. Sufficient detail or sample calculations provided so as to have a complete depiction of the reserve amounts to be held;

b. A statement that the assumptions used for reserves contains reasonable margins for adverse experience;

c. A statement that the net valuation premium for renewal years does not increase; and

d. A statement that the difference between the gross premium and the net valuation premium for renewal years is sufficient to cover expected renewal expenses; or if such a statement cannot be made, a complete description of the situations where this does not occur;
(I) An aggregate distribution of anticipated issues may be used as long as the underlying gross premiums maintain a reasonably consistent relationship;

(II) If the gross premiums for certain age groups appear to be inconsistent with this requirement, upon request of the Office, a demonstration under subsection 69O-157.108(2), F.A.C., based on a standard age distribution shall be made; and
5.
a. A statement that the premium rate schedule is not less than the premium rate schedule for existing similar policy forms also available from the insurer except for reasonable differences attributable to benefits; or

b. A comparison of the premium schedules and benefits for similar policy forms that are currently available from the insurer with an explanation of the relative value of the benefit differences; and
6.
a. The date and explanation of the reason for the discontinuance of all forms discontinued within the past 5 years;

b. Whether any currently available form will be discontinued upon approval of the proposed form; and

c. A summary of the significant differences between the forms.
(2) If the filed material is inadequate to substantiate the reasonableness of the premiums, the Office shall request an actuarial demonstration that benefits are reasonable in relation to premiums. The actuarial demonstration shall include either premium and claim experience on similar policy forms, adjusted for any premium or benefit differences, relevant and credible data from other studies, or both.

69O FAC 157.109 | Prohibition Against Post-Claims Underwriting

(1) All applications for long-term care insurance policies or certificates except those that are guaranteed issue shall contain clear and unambiguous questions designed to ascertain the health condition of the applicant.

(2)
(a) If an application for long-term care insurance contains a question that asks whether the applicant has had medication prescribed by a physician, it must also ask the applicant to list the medication that has been prescribed.

(b) If the medications listed in the application were known by the insurer, or should have been known at the time of application, to be directly related to a medical condition for which coverage would otherwise be denied, then the policy or certificate shall not be rescinded for that condition.
(3) Except for policies or certificates that are guaranteed issue:
(a) The following language shall be set out conspicuously and in close conjunction with the applicant's signature block on an application for a long-term care insurance policy or certificate:
"Caution: If your answers on this application are incorrect or untrue, [company] may have the right to deny benefits or rescind your policy."
(b) The following language, or language substantially similar to the following, shall be set out conspicuously on the long-term care insurance policy or certificate at the time of delivery:
Caution: The issuance of this long-term care insurance [policy] [certificate] is based upon your responses to the questions on your application. A copy of your [application] [enrollment form] [is enclosed] [was retained by you when you applied]. If your answers are incorrect or untrue, the company may have the right to deny benefits or rescind your policy. The best time to clear up any questions is now, before a claim arises! If, for any reason, any of your answers are incorrect, contact the company at this address: [insert address]
(c) Prior to issuance of a long-term care policy or certificate to an applicant age 80 or older, the insurer shall obtain one of the following:
1. A report of a physical examination;

2. An assessment of functional capacity;

3. An attending physician's statement; or

4. Copies of medical records.
(4) A copy of the completed application or enrollment form (whichever is applicable) shall be delivered to the insured no later than at the time of delivery of the policy or certificate unless it was retained by the applicant at the time of application.

69O FAC 157.110 | Requirements for Application Forms and Replacement Coverage

(1) Application forms shall include the following questions designed to elicit information as to whether, as of the date of the application, the applicant has another long-term care insurance policy or certificate in force or whether a long-term care policy or certificate is intended to replace any other accident and sickness or long-term care policy or certificate presently in force. A supplementary application or other form to be signed by the applicant and agent containing the questions may be used. With regard to a replacement policy issued to a group defined by Section 627.9405(1)(a), F.S., the following questions may be modified only to the extent necessary to elicit information about health or long-term care insurance policies other than the group policy being replaced, provided that the certificateholder has been notified of the replacement.
(a) Do you have another long-term care insurance policy or certificate in force (including health care service contract, health maintenance organization contract)?

(b) Did you have another long-term care insurance policy or certificate in force during the last 12 months?
1. If so, with which company?

2. If that policy lapsed, when did it lapse?
(c) Are you covered by Medicaid?

(d) Do you intend to replace any of your medical or health insurance coverage with this policy [certificate]?
(2) Agents shall list any other health insurance policies they have sold to the applicant.
(a) List policies sold that are still in force.

(b) List policies sold in the past 5 years that are no longer in force.
(3) Solicitations Other than Direct Response.
(a) Upon determining that a sale will involve replacement, an insurer, other than an insurer using direct response solicitation methods or its agent; shall furnish the applicant prior to issuance or delivery of the individual long-term care insurance policy a notice regarding replacement of accident and sickness or long-term care coverage.

(b) One copy of the notice shall be retained by the applicant and an additional copy signed by the applicant shall be retained by the insurer.

(c) The notice shall be provided in the format prescribed in Appendix G, "Notice to Applicant Regarding Replacement" (10/02), which is incorporated herein by reference.
(4) Direct Response Solicitations.
(a) Whenever a sale will involve replacement, an insurer using direct response solicitation methods shall deliver a notice regarding replacement of accident and sickness or long-term care coverage to the applicant upon issuance of the policy.

(b) The notice shall be provided in the format prescribed in Appendix H, "Notice of Applicant Regarding Replacement", (10/02), which is incorporated herein by reference.
(5) Where replacement is intended, the replacing insurer shall notify in writing the existing insurer of the proposed replacement.
(a) The existing policy shall be identified by the insurer, name of the insured, and policy number or address including zip code.

(b) Notice shall be made within 5 working days from the date the application is received by the insurer or the date the policy is issued, whichever is sooner.

69O FAC 157.110 | Requirements for Application Forms and Replacement Coverage

(1)
(a) An insurer may offer policyholders or certificateholders the option to exchange an existing Long-Term Care contract for a new Long-Term Care contract.

(b) An exchange occurs when an insurer offers an existing long-term care policyholder or certificateholder the option to replace an existing policy with a different long-term care policy or certificate, and the policyholder or certificateholder accepts the offer to terminate the existing contract and accepts the new contract.
(2)
(a) Any offer shall be made to all policyholders or certificateholders on a nondiscriminatory basis.

(b) An exchange offer shall be deferred to all policyholders or certificateholders that are currently eligible for benefits, within an elimination period on a claim, or who would not be eligible to apply for coverage due to issue age limitations under the new contract, until such time when such condition expires.
(3)
(a) If the new coverage has the actuarial value of benefits equal or lesser than the actuarial value of benefits of the existing coverage, based on constant morbidity and uniform pricing assumptions as determined on the date of issue of a new insured determined using the same underwriting class and issue age, such new coverage shall be offered on a nonunderwritten basis.

(b) If the new coverage has the actuarial value of benefits exceeding the actuarial value of benefits of the existing coverage, the insurer shall apply consistent new business underwriting for the increased benefits only.
(4)
(a) If the new coverage has the actuarial value of benefits equal or lesser than the actuarial value of benefits of the existing coverage, the rate charged for the new coverage shall be determined using the original issue age and risk class of the insured used in determining the rate of the existing coverage.

(b) If the new coverage has the actuarial value of benefits exceeding the actuarial value of benefits of the existing coverage, the rate charged for the new coverage shall be determined using paragraph (4)(a) above for the original level of benefits, increased by the rate for the increased benefits using the then current attained age and underwriting class of the insured for the increased benefits only. All rates charged must be filed and approved with the Office pursuant to Section 627.410(6), F.S., and Rule 69O-149.003, F.A.C.

(c) The new coverage offered shall be on a form that is currently offered for sale in the general market.

(d) In lieu of paragraphs (a) and (b) above, an insurer may make a filing to the Office for approval to utilize a different issue age for the new contract, or in some other way recognize the policy reserve build-up. Such filing shall demonstrate why the use of the original issue age is inappropriate and that the policy reserve build-up due to the prefunding inherent in the use of an issue age rate basis is credited to the benefit of the insured.

69O FAC 157.111 | Reporting Requirements

(1) Every insurer shall maintain records for each agent of that agent's amount of replacement sales as a percentage of the agent's total annual sales in this state and the amount of lapses of long-term care insurance policies sold by the agent as a percentage of the agent's total annual sales in this state.

(2) Every insurer shall report annually by June 30 the 10 percent of its agents with the greatest percentages of lapses and replacements as measured by subsection 69O-157.111(1), F.A.C., in the format as prescribed in Appendix J, "Long-Term Care Insurance Replacement and Lapse Reporting Form OIR-B2-1555," effective 07/23 hereby incorporated by reference and available at www.FLRules.org/Gateway/Reference.asp?No=Ref-16244.

(3) Reported replacement and lapse rates do not alone constitute a violation of insurance laws or necessarily imply wrongdoing. The reports are for the purpose of reviewing more closely agent activities regarding the sale of long-term care insurance in this state.

(4) Every insurer shall report annually by June 30 the number of lapsed policies as a percentage of its total annual sales and as a percentage of its total number of policies in force as of the end of the preceding calendar year in this state in the format as prescribed in Appendix J, "Long-Term Care Insurance Replacement and Lapse Reporting Form OIR-B2-1555" (06/2017), which is incorporated herein by reference.

(5) Every insurer shall report annually by June 30 the number of replacement policies sold as a percentage of its total annual sales and as a percentage of its total number of policies in force as of the preceding calendar year in this state in the format as prescribed in Appendix J, "Long-Term Care Insurance Replacement and Lapse Reporting Form OIR-B2-1555" (06/2017), which is incorporated herein by reference.

(6) Every insurer shall report annually by June 30, for qualified long-term care insurance contracts, the number of claims denied for each class of business, expressed as a percentage of claims denied in this state in the format as prescribed in Appendix E, "Annual Long-Term Care Claims Denial Reporting Form" OIR-B2-1553, effective 07/23, hereby incorporated by reference and available at www.FLRules.org/Gateway/Reference.asp?No=Ref-16245.

(7) For purposes of this section:
(a) "Policy" means only long-term care insurance;

(b) "Claim" means, subject to paragraph 69O-157.111(7)(c), F.A.C., a request for payment of benefits under an in force policy regardless of whether the benefit claimed is covered under the policy or any terms or conditions of the policy have been met;

(c) "Denied" means the insurer refuses to pay a claim for any reason other than for claims not paid for failure to meet the waiting period or because of an applicable preexisting condition; and

(d) "Report" means on a statewide basis.
(8) Every insurer shall report annually by June 30 the information required by subsection 69O-157.116(8), F.A.C.

(9) Based on the provisions of Rule 69O-157.109, F.A.C., every insurer or other entity selling or issuing long-term care insurance benefits shall maintain a record of all policy or certificate rescissions, both state and countrywide, except those that the insured voluntarily effectuated and shall annually furnish this information, by March 1 of each year, in the format as prescribed in Appendix A, "Long-Term Care Rescission Reporting Form" OIR-B2-1552," effective 07/23, hereby incorporated by reference and available at www.FLRules.org/Gateway/Reference.asp?No=Ref-16246.

(10) Reports required under this Rule 69O-157.111, F.A.C., shall be filed electronically through the Florida Office of Insurance Regulation, Industry Portal at http://www.FLOir.com/iPortal.

(11) All forms adopted in this rule are available for review on the Office's website at http://www.FLOir.com/iPortal.

69O FAC 157.112 | Reserve Standards

(1)
(a) When long-term care benefits are provided through the acceleration of benefits under group or individual life policies or riders to such policies which meet the conditions of subsection 69O-157.113(9), F.A.C., policy reserves for the benefits shall be determined in accordance with Section 625.121, F.S. Claim reserves shall also be established in the case when the policy or rider is in claim status.

(b)
1. Reserves for policies and riders shall be based on the multiple decrement model utilizing all relevant decrements except for voluntary termination rates.

2. Single decrement approximations are acceptable if the calculation produces essentially similar reserves, if the reserve is clearly more conservative, or if the reserve is immaterial.

3. The calculations may take into account the reduction in life insurance benefits due to the payment of long-term care benefits.

4. In no event shall the reserves for the long-term care benefit and the life insurance benefit be less than the reserves for the life insurance benefit assuming no long-term care benefit.
(c) In the development and calculation of reserves for policies and riders, due regard shall be given to the applicable policy provisions, marketing methods, administrative procedures, and all other considerations which have an impact on projected claim costs, including the following:
1. Definition of insured events;

2. Covered long-term care facilities;

3. Existence of home convalescence care coverage;

4. Definition of facilities;

5. Existence or absence of barriers to eligibility;

6. Premium waiver provision;

7. Renewability;

8. Ability to raise premiums;

9. Marketing method;

10. Underwriting procedures;

11. Claims adjustment procedures;

12. Waiting period;

13. Maximum benefit;

14. Availability of eligible facilities;

15. Margins in claim costs;

16. Optional nature of benefit;

17. Delay in eligibility for benefit;

18. Inflation protection provisions; and

19. Guaranteed insurability option.
(d) Any applicable valuation morbidity table shall be certified by a member of the American Academy of Actuaries as appropriate as a statutory valuation table.
(2) When long-term care benefits are provided other than as in subsection 69O-157.112(1), F.A.C., reserves shall be determined in accordance with Part III of rule Chapter 69O-154, F.A.C.

69O FAC 157.113 | Premium Rate Schedule Increases

(1) An insurer shall file with the Office for approval any premium rate schedule increase, including an exceptional increase, pursuant to Section 627.410, F.S. The filing shall include:
(a) A filing made pursuant to rule Chapter 69O-149, F.A.C., with the actuarial information identified below in lieu of the actuarial memorandum required by subparagraph 69O-149.003(2)(b)4., F.A.C.

(b) Information required by Rule 69O-157.107, F.A.C.;

(c) Certification by a qualified actuary that:
1. No further premium rate schedule increases are anticipated. If the requested premium rate schedule increase is implemented and the underlying assumptions are realized;

2. The premium rate filing is in compliance with the provisions of Rule 69O-157.113, F.A.C.;
(d) An actuarial memorandum justifying the rate schedule change request that includes:
1. Lifetime projections of earned premiums and incurred claims based on both the current rate schedule and the filed premium rate schedule increase; and the method and assumptions used in determining the projected values, including a summary and the reason for any assumptions that deviate from those used for pricing other forms currently available for sale;
a. Pursuant to Section 627.410(6)(e)3., F.S., and as is provided in rule Chapter 69O-149, F.A.C., the experience of all similar policy forms as defined in subsection 69O-157.103(17), F.A.C., shall be combined for all rating purposes. However, forms providing only non-institutional benefits may utilize different experience pools based upon similar benefits consistent with rule Chapter 69O-149, F.A.C.

b. The projections shall include the development of the lifetime loss ratio, including calendar year values for the complete history of the experience of the business and projections of the remaining future lifetime of the business, unless the rate increase is an exceptional increase;

c. The projections shall demonstrate compliance with subsection 69O-157.113(2), F.A.C., if the form is subject to Part II of these rules, or compliance with rule Chapter 69O-149, F.A.C., if the form is subject to Part I of these rules; and

d. For exceptional increases,
(I) The projected experience shall be limited to the increases in claims payments attributable to the approved reasons for the exceptional increase; and

(II) In the event the Office determines as provided in paragraph 69O-157.103(4)(d), F.A.C., that offsets may exist, the insurer shall use appropriate net projected experience;
2. Disclosure of how reserves have been incorporated in this rate increase whenever the rate increase will trigger contingent benefit upon lapse;

3. Disclosure of the analysis performed to determine why a rate adjustment is necessary, which pricing assumptions were not realized and why, and what other actions taken by the insurer have been relied on by the actuary;

4. A statement that policy design, underwriting and claims adjudication practices have been taken into consideration; and

5. In the event that it is necessary to maintain consistent premium rates for new certificates and certificates issued under a group long-term care insurance policy as defined in Section 627.9405(1)(a), F.S., receiving a rate increase, the insurer will need to file composite rates reflecting projections of new certificates;
(e) A statement that renewal premium rate schedules are not greater than new business premium rate schedules except for differences attributable to benefits; and

(f) Sufficient information for review and approval of the premium rate schedule increase by the Office.
(2) All premium rate schedule increases shall be determined in accordance with the following requirements:
(a) Exceptional increases shall provide that 70 percent of the present value of projected additional premiums from the exceptional increase will be returned to policyholders in benefits;

(b) Premium rate schedule increases shall be calculated such that the sum of the accumulated value of incurred claims, without the inclusion of active life reserves, and the present value of future projected incurred claims, without the inclusion of active life reserves, will not be less than the sum of the following:
1. The accumulated value of the initial earned premium times 58 percent;

2. 85 percent of the accumulated value of prior premium rate schedule increases on an earned basis;

3. The present value of future projected initial earned premiums times 58 percent; and

4. 85 percent of the present value of future projected premiums not in subparagraph 69O-157.113(2)(b)3., F.A.C., on an earned basis;
(c) In the event that a policy form has both exceptional and other increases, the values in subparagraphs 69O-157.113(2)(b)2. and 4., F.A.C., will also include 70 percent for exceptional rate increase amounts; and

(d) All present and accumulated values used to determine rate increases shall use a discount rate no less than the maximum valuation interest rate for contract reserves as specified in paragraph 69O-154.204(2)(a), F.A.C. The actuary shall disclose as part of the actuarial memorandum the use of any appropriate averages.
(3)
(a) For each rate increase that is implemented, the insurer shall include within each annual rate certification filing made pursuant to Rule 69O-149.007, F.A.C., updated projections, as defined in paragraph 69O-157.113(1)(d), F.A.C., annually for the next 3 years and include a comparison of actual results to projected values.

(b) The Office shall extend the period to greater than 3 years if actual results are not consistent with projected values from prior projections.

(c) For group insurance policies that meet the conditions in subsection 69O-157.113(10), F.A.C., the projections required by this rule shall be provided to the policyholder in lieu of filing with the Office.
(4)
(a) If any premium rate in the revised premium rate schedule is greater than 200 percent of the comparable rate in the initial premium schedule, lifetime projections, as defined in paragraph 69O-157.113(1)(d), F.A.C., shall be included in each annual rate certification filing made pursuant to Rule 69O-149.007, F.A.C., every 5 years following the end of the required period in subsection 69O-157.113(3), F.A.C.

(b) For group insurance policies that meet the conditions in subsection 69O-157.113(10), F.A.C., the projections required by this subsection shall be provided to the policyholder in lieu of filing with the Office.
(5)
(a) If the Office has determined that the actual experience following a rate increase does not adequately match the projected experience and that the current projections under moderately adverse conditions demonstrate that incurred claims will not exceed proportions of premiums specified in subsection 69O-157.113(2), F.A.C., the Office shall require the insurer to implement any of the following:
1. Premium rate schedule adjustments; or

2. Other measures to reduce the difference between the projected and actual experience.
(b) In determining whether the actual experience adequately matches the projected experience, consideration shall be given to subparagraph 69O-157.113(1)(d)5., F.A.C., if applicable.
(6) If the majority of the policies or certificates to which the increase is applicable are eligible for the contingent benefit upon lapse, the insurer shall file:
(a) A plan for improved administration or claims processing designed to eliminate the potential for further deterioration of the policy form requiring further premium rate schedule increases, or both, or to demonstrate that appropriate administration and claims processing have been implemented or are in effect. Such plan shall be approved by the Office, unless the Office finds that the plan does not meet the above conditions. If the plan is not approved, the Office shall impose the condition in subsection 69O-157.113(7), F.A.C.; and

(b) The original anticipated lifetime loss ratio, and the premium rate schedule increase that would have been calculated according to subsection 69O-157.113(2), F.A.C., had the greater of the original anticipated lifetime loss ratio or 58 percent been used in the calculations described in subparagraphs 69O-157.113(2)(b)1. and 3., F.A.C.
(7)
(a) For a rate increase filing that meets the following criteria, the Office shall review, for all policies included in the filing, the projected lapse rates and past lapse rates during the 12 months following each increase to determine if significant adverse lapsation has occurred or is anticipated:
1. The rate increase is not the first rate increase requested for the specific policy form or forms;

2. The rate increase is not an exceptional increase; and

3. The majority of the policies or certificates to which the increase is applicable are eligible for the contingent benefit upon lapse.
(b)
1. In the event significant adverse lapsation has occurred, is anticipated in the filing, or is evidenced in the actual results as presented in the updated projections provided by the insurer following the requested rate increase, the Office shall determine that a rate spiral exists.

2. Following the determination that a rate spiral exists, the Office shall require the insurer to offer, without underwriting and at the underwriting class that is most comparable to the original underwriting class of each insured, to all in force insureds subject to the rate increase the option to replace existing coverage with one or more reasonably comparable products being offered by the insurer or its affiliates. The offer shall:
a. Be subject to the approval of the Office;

b. Be based on actuarially sound principles, but not be based on attained age; and

c. Provide that maximum benefits under any new policy accepted by an insured shall be reduced by comparable benefits already paid under the existing policy.
3. The insurer shall maintain the experience of all the replacement insureds separate from the experience of insureds originally issued the policy forms. In the event of a request for a rate increase on the policy form, the rate increase shall be limited to the lesser of:
a. The maximum rate increase determined based on the combined experience; and

b. The maximum rate increase determined based only on the experience of the insureds originally issued the form plus 10 percent.
(8) If the Office determines that the insurer has exhibited a persistent practice of filing inadequate initial premium rates for long-term care insurance, the Office shall, in addition to the provisions of subsection 69O-157.113(7), F.A.C., prohibit the insurer from:
(a) Filing and marketing comparable coverage for a period of up to 5 years; and

(b) Offering all other similar coverages and limiting marketing of new applications to the products subject to recent premium rate schedule increases.
(9) Subsections 69O-157.113(1) through (8), F.A.C., shall not apply to policies for which the long-term care benefits provided by the policy are incidental, as defined in subsection 69O-157.103(7), F.A.C., if the policy complies with all of the following provisions:
(a) The interest credited internally to determine cash value accumulations, including long-term care, if any, are guaranteed not to be less than the minimum guaranteed interest rate for cash value accumulations without long-term care set forth in the policy;

(b) The portion of the policy that provides life insurance benefits meets the nonforfeiture requirements of Section 627.476, F.S. or rule Chapter 69O-164, F.A.C., as applicable; and

(c) An actuarial memorandum is filed with the Office that includes:
1. A description of the basis on which the long-term care rates were determined;

2. A description of the basis for the reserves;

3. A summary of the type of policy, benefits, renewability, general marketing method, and limits on ages of issuance;

4. A description and a table of each actuarial assumption used. For expenses, an insurer must include percentage of premium dollars per policy and dollars per unit of benefits, if any;

5. A description and a table of the anticipated policy reserves and additional reserves to be held in each future year for active lives;

6. The estimated average annual premium per policy and the average issue age;

7. A statement as to whether underwriting is performed at the time of application:
a. The statement shall indicate whether underwriting is used and, if used, the statement shall include a description of the type or types of underwriting used, such as medical underwriting or functional assessment underwriting;

b. Concerning a group policy, the statement shall indicate whether the enrollee or any dependent will be underwritten and when underwriting occurs; and
8. A description of the effect of the long-term care policy provision on the required premiums, nonforfeiture values and reserves on the underlying life insurance policy, both for active lives and those in long-term care claim status.
(10) Subsections 69O-157.113(5) and (7), F.A.C., shall not apply to group insurance policies as defined in Section 627.9405(1)(a), F.S., where:
(a) The policies insure 250 or more persons and the policyholder has 5,000 or more eligible employees of a single employer; or

(b) The policyholder, and not the certificateholders, pay a material portion of the premium, which shall not be less than 20 percent of the total premium for the group in the calendar year prior to the year a rate increase is filed.
(11)
(a) An insurer may choose to continue to make a current policy form available for sale after the effective date in subsection 69O-157.102(4), F.A.C.

(b) All policyholders of any form sold after the effective date of subsection 69O-157.102(4), F.A.C., shall be provided equal treatment and protection of the provisions of Rules 69O-157.113 and 69O-157.118, F.A.C.

69O FAC 157.114 | Filing Requirement – Out of State Groups

(1) No group long-term care insurance coverage may be offered to a resident of this state under a group policy issued in another state to a group described in Section 627.9405(1)(c) or (d), F.S., unless this state or such other state having statutory and regulatory long-term care insurance requirements substantially similar to those adopted in this state has made a determination that the requirements have been met. Evidence to this effect shall be filed by the insurer with the Office pursuant to the procedures specified in Section 627.410, F.S. The evidence shall consist of:
(a) Filing of policy and certificate forms, including rates and rate development information, as though the policy/certificate were issued in this state, which demonstrate that the requirements of Sections 627.9401-627.9408, F.S., and these rules have been met; or

(b)
1. Filing of a truthful certification by an officer of the insurer that another state having statutory and regulatory long-term care insurance requirements substantially similar to those adopted in Florida has made a determination that such requirements have been met; and

2. Filing of the policy and certificate forms to be issued and delivered, including rates and rate development information, which demonstrate that the requirements of another state having statutory and regulatory long-term care insurance requirements substantially similar to those adopted in Florida have been met.
(2) In order for a state to be deemed to have statutory and regulatory long-term care insurance requirements substantially similar to those adopted in Florida, that state shall require that long-term care policies meet at least all of the following requirements:
(a) A minimum period of coverage of at least 24 consecutive months for coverage in a nursing home for each covered person and an additional coverage of 50 percent for lower levels of care as provided in subsection 69O-157.104(4), F.A.C. The minimum 24 month nursing home coverage is not applicable to coverage issued or renewed after July 1, 2006.

(b) The standards of Rules 69O-157.108 and 69O-157.113, F.A.C.;

(c) A 30-day "free look" period, or longer, within which individual certificateholders have the right to return the certificate after its delivery and to have the premium refunded for any reason;

(d) A prohibition or limitation on pre-existing condition exclusions at least as favorable to a policyholder as that specified in Section 627.9407(4), F.S.;

(e) A prohibition against a policy or certificate excluding or using waivers or riders of any kind to exclude, limit, or reduce coverage or benefits for specifically named or described pre-existing diseases or physical conditions beyond any pre-existing condition waiting period;

(f) A prohibition or limitation on prior institutionalization provisions at least as favorable to a certificateholder as that specified in Section 627.9407(5), F.S., including the mandatory offer provisions of paragraph (5)(c) of that section;

(g) A prohibition or limitation on certificate cancellations or nonrenewals at least as favorable to a certificateholder as that specified in Section 627.9407(3)(a), F.S.;

(h) A requirement that a policy and certificate prominently disclose that the policy and certificate may not cover all of the costs associated with long-term care which may be incurred by the buyer during the period of coverage and that the buyer is advised to periodically review the certificate in relation to the changes in the cost of long-term care;

(i) A minimum 30 day grace period for nonpayment of premium with notice and protection requirements as provided by Section 627.94073, F.S.;

(j) Pursuant to Section 627.94072, F.S., a mandatory offer to the potential insured policyholder or certificateholder, as applicable, of a nonforfeiture provision meeting the standards of Rule 69O-157.118, F.A.C.;

(k) Pursuant to Section 627.94072, F.S., a mandatory offer to the potential insured policyholder or certificateholder, as applicable, of an inflation protection provision:

(l) Contain a contingent benefit upon lapse provision at least as favorable to the insured as that in Rule 69O-157.118, F.A.C.;

(m) Disclosure of rating practices to consumers as outlined in Rule 69O-157.107, F.A.C.;

(n) A conversion or continuation privilege at least as favorable as subsection 69O-157.104(8), F.A.C.;

(o) A prohibition or limitation on an elimination period in excess of 180 days; and

(p) Pursuant to Section 627.94076, F.S., provide that the policy shall be incontestable after it has been in force during the lifetime of the insured for a period of 2 years after its date of issue except for nonpayment of premiums. For any long-term care insurance policy issued prior to July 1, 2006, the provisions of Section 627.94076, F.S., shall apply to such policy only upon renewal of such policy on or after July 1, 2008, and the policy shall so provide by endorsement to the policy.
(3) Unless a group policy issued in another state has been filed for approval in Florida, no such policy or certificate issued thereunder shall contain a statement that the policy has been approved as a long-term care policy meeting the requirements of Florida law or words of similar meaning.

(4)
(a) All changes to rates, together with an actuarial memorandum developing and justifying the rate change, shall be filed with the Office pursuant to the procedures specified in Section 627.410, F.S., and this rule chapter as though the policy had been issued in Florida.

(b) For those policies which have been determined to be regulated by a state with substantially similar long term care insurance requirements pursuant to paragraph 69O-157.114(1)(b), F.A.C., form and rate changes shall be filed for informational purposes at least 30 days prior to use.

69O FAC 157.115 | Filing Requirements for Advertising

Every insurer, health care service plan or other entity providing long-term care insurance or benefits in this state shall provide a copy of any long-term care insurance advertisement and marketing material intended for use in this state whether through written, radio, television, electronic or other medium for review or approval by the Office as provided by rule Chapter 69O-150, F.A.C.

69O FAC 157.1155 | Producer Training

Insurers providing Long-Term Care insurance shall maintain records, subject to Office review upon request, that before any producer sells, solicits or negotiates a long-term care insurance policy, that they receive necessary and sufficient training to understand partnership policies and their relationship to public and private coverage for long-term care.

69O FAC 157.116 | Suitability

(1) This rule shall not apply to life insurance policies that accelerate benefits for long-term care.

(2) Every insurer, health care service plan, or other entity marketing long-term care insurance (the "insurer") shall:
(a) Develop and use suitability standards to determine whether the purchase or replacement of long-term care insurance is appropriate for the needs of the applicant;

(b) Train its agents in the use of its suitability standards; and

(c) Maintain a copy of its suitability standards and make them available for inspection upon request by the Office.
(3)
(a) To determine whether the applicant meets the standards developed by the insurer, the agent and insurer shall develop procedures that take the following into consideration:
1. The ability to pay for the proposed coverage and other pertinent financial information related to the purchase of the coverage;

2. The applicant's goals or needs with respect to long-term care and the advantages and disadvantages of insurance to meet these goals or needs; and

3. The values, benefits, and costs of the applicant's existing insurance, if any, when compared to the values, benefits, and costs of the recommended purchase or replacement.
(b)
1. The insurer and the agent shall make reasonable efforts to obtain the information set out in paragraph 69O-157.116(3)(a), F.A.C. The efforts shall include presentation to the applicant, at or prior to application, the Long-Term Care Personal Worksheet. The personal worksheet used by the insurer shall contain, at a minimum, the information in the format contained in Appendix B, which is incorporated herein by reference, in not less than 12 point type. The issuer may request the applicant to provide additional information to comply with its suitability standards.

2. A copy of the issuer's personal worksheet shall be filed with the Office.
(c) A completed personal worksheet shall be returned to the insurer prior to the insurer's consideration of the applicant for coverage, except the personal worksheet need not be returned for sales of employer group long-term care insurance to employees and their spouses.

(d) The sale or dissemination outside the insurer or agency by the insurer or agent of information obtained through the personal worksheet is prohibited.
(4) The insurer shall use the suitability standards it has developed pursuant to this section in determining whether issuing long-term care insurance coverage to an applicant is appropriate.

(5) Agents shall use the suitability standards developed by the insurer in marketing long-term care insurance.

(6) At the same time the personal worksheet is provided to the applicant, the disclosure form entitled "Things You Should Know Before You Buy Long-Term Care Insurance" shall be provided. The form shall be in the format as prescribed in Appendix C, which is incorporated herein by reference, in not less than 12 point type.

(7)
(a) If the insurer determines that the applicant does not meet its financial suitability standards, or if the applicant has declined to provide the information, the insurer may reject the application.

(b) In the alternative, the insurer shall send the applicant a letter similar to Appendix D, which is incorporated herein by reference.

(c) If the applicant has declined to provide financial information, the insurer may use some other method to verify the applicant's intent.

(d) Either the applicant's returned letter or a record of the alternative method of verification shall be made a part of the applicant's file.
(8)The insurer shall report annually to the Office:
(a) The total number of applications received from residents of this state;

(b) The number of those who declined to provide information on the personal worksheet;

(c) The number of applicants who did not meet the suitability standards; and

(d) The number of those who chose to confirm after receiving a suitability letter.

69O FAC 157.117 | Prohibition Against Preexisting Conditions and Probationary Periods in Replacement Policies or Certificates

If a long-term care insurance policy or certificate replaces another long-term care policy or certificate, the replacing insurer shall waive any time periods applicable to time limit on certain defenses, preexisting conditions and probationary periods in the new long-term care policy for similar benefits to the extent that similar exclusions have been satisfied under the original policy.

69O FAC 157.118 | Nonforfeiture Benefit Requirement

(1) This rule does not apply to life insurance policies or riders meeting the conditions of subsection 69O-157.113(9), F.A.C., containing accelerated long-term care benefits.

(2)
(a) All insurers offering long term care insurance in this state shall offer a nonforfeiture protection provision at the time of issue as required by Section 627.94072, F.S.

(b) If the insurer offers an option other than the shortened benefit period option, the nonforfeiture protection option offered shall be determined such that the benefits provided are determined at time of issue to be actuarially equivalent to those provided by the shortened benefit period option.
(3)
(a) If the offer for nonforfeiture benefits required to be made under Section 627.94072, F.S., is rejected, for individual and group policies without nonforfeiture benefits the insurer shall include in the policy, or as a rider or endorsement to the policy, the contingent benefit upon lapse described in this rule.

(b) In the event a group policyholder elects to make the nonforfeiture benefit an option to the certificateholder, a certificate shall provide either the nonforfeiture benefit or the contingent benefit upon lapse.

(c) The contingent benefit on lapse shall be triggered every time an insurer increases the premium rates to a level which results in a cumulative increase of the annual premium equal to or exceeding the percentage of the insured's initial annual premium set forth below based on the insured's issue age, and the policy or certificate lapses within 120 days of the due date of the premium so increased. Unless otherwise required, policyholders shall be notified at least 45 days prior to the due date of the premium reflecting the rate increase.
Triggers for a Substantial Premium Increase
Issue AgePercent Increase Over Initial Premium
29 and under200%
30-34190%
35-39170%
40-44150%
45-49130%
50-54110%
55-5990%
6070%
6166%
6262%
6358%
6454%
6550%
6648%
6746%
6844%
6942%
7040%
7138%
7236%
7334%
7432%
7530%
7628%
7726%
7824%
7922%
8020%
8119%
8218%
8317%
8416%
8515%
8614%
8713%
8812%
8911%
90 and over10%
(d) On or before the effective date of a substantial premium increase as defined in paragraph 69O-157.118(3)(c), F.A.C., the insurer shall:
1. Offer to reduce policy benefits provided by the current coverage without the requirement of additional underwriting so that required premium payments are not increased;

2.
a. Offer to convert the coverage to a paid-up status with a shortened benefit period in accordance with the terms of the shortened benefit period nonforfeiture benefit contained in Section 627.94072, F.S.

b. This option may be elected at any time during the 120 day period referenced in paragraph 69O-157.118(3)(c), F.A.C., and shall be available from the end of the grace period and is not restricted to being available only on or after the third policy anniversary; and
3. Notify the policyholder or certificateholder that a default or lapse at any time during the 120 day period referenced in paragraph 69O-157.118(3)(c), F.A.C., shall be deemed to be the election of the offer to convert in subparagraph 69O-157.118(3)(d)2., F.A.C.
(4) To determine whether contingent nonforfeiture upon lapse provisions are triggered under paragraph 69O-157.118(3)(c), F.A.C., a replacing insurer that purchased or otherwise assumed a block or blocks of long-term care insurance policies from another insurer shall calculate the percentage increase based on the initial annual premium paid by the insured when the policy was first purchased from the original insurer.

(5)
(a) When the premium payment period is less than the term of eligibility for benefits under the policy, the insurer shall upon lapse provide a contingent benefit that in the event of any rate increase by the insurer:
1. The insurer shall provide for paid-up policy benefits in the event of policyholder termination within 120 days of the due date of the premium so increased if the ratio in subparagraph 2. below is at least 40 percent.

2. The minimum required paid-up benefits, including the amount paid and the maximum amount of benefits payable, shall be at least equal to the ratio of the number of years (and partial years) paid less one divided by the number of years in the premium paying period less one times the policy benefits at the time of policyholder termination.

3. In addition, the insurer shall provide the contingent benefit upon lapse required by subsection 69O-157.118(3), F.A.C.
(b) Notice shall be provided to insureds at the time of a rate increase notifying them of their benefits under this provision of the contract if they terminate coverage.

69O FAC 157.119 | Additional Standards for Benefit Triggers for Qualified Long-Term Care Insurance Contracts

(1) A qualified long term care insurance contract shall pay only for qualified long term care services received by a chronically ill individual provided pursuant to a plan of care prescribed by a licensed health care practitioner.

(2)
(a)
1. A qualified long-term care insurance contract shall condition the payment of benefits on a determination of the insured's being chronically ill as defined in Section 627.9404(4), F.S.

2. Certifications regarding activities of daily living and cognitive impairment shall be performed by a licensed health care practitioner as defined by Section 627.9404(6), F.S.
(b) When a licensed health care practitioner has certified that an insured is unable to perform activities of daily living for an expected period of at least 90 days due to a loss of functional capacity and the insured is in claim status, the certification shall not be rescinded and additional certifications shall not be performed until after the expiration of the 90 day period.
(3) Qualified long-term care insurance contracts shall include a clear description of the process for appealing and resolving disputes with respect to benefit determinations.

69O FAC 157.120 | Standard Format Outline of Coverage

This rule implements, interprets, and makes specific, the provisions of Section 627.9407(10), F.S., in prescribing a standard format and the content of an outline of coverage.
(1) The outline of coverage shall be a freestanding document, using no smaller than 10-point type.

(2) The outline of coverage shall contain no material of an advertising nature.

(3) Text that is capitalized or underscored in the standard format outline of coverage may be emphasized by other means that provide prominence equivalent to the capitalization or underscoring.

(4) Use of the text and sequence of text of the standard format outline of coverage is mandatory, unless otherwise specifically indicated.

(5) Format for outline of coverage shall be as contained in Appendix I, which is incorporated herein by reference.

69O FAC 157.121 | Requirement to Deliver Shopper's Guide

(1) A long-term care insurance shopper's guide in the format developed by the National Association of Insurance Commissioners (2001), which is incorporated herein by reference, or a guide developed by the Office, shall be provided to all prospective applicants of a long-term care insurance policy or certificate.
(a) An agent shall deliver the shopper's guide prior to the presentation of an application or enrollment form.

(b) In the case of direct response solicitations, the shopper's guide shall be presented in conjunction with any application or enrollment form.
(2) Life insurance policies or riders meeting the conditions of subsection 69O-157.113(9), F.A.C., containing accelerated long-term care benefits are not required to furnish the above referenced guide, but shall furnish the policy summary required under Section 626.99, F.S.

69O FAC 157.122 | Penalties

In addition to any other penalties provided by the laws of this state, any insurer and any agent found to have violated any requirement of this state relating to the regulation of long-term care insurance or the marketing of such insurance shall be subject to a fine of up to 3 times the amount of any commissions paid for each policy involved in the violation or up to $10,000, whichever is greater, however, such penalty shall not exceed the amounts specified in Section 624.4211 or 626.9521(2), F.S.

69O FAC 157.201 | Standards for Approved Long-Term Care Partnership Program Policies

(1)
(a) A policy or certificate, herein referred to as policy, marketed or represented to qualify as an approved long-term care partnership program policy as provided by Section 409.9102, F.S., hereinafter referred to as a `partnership', shall be a policy where:
1. Such form and rates are filed and approved pursuant to the provisions of Part II of this rule chapter and Chapter 69O-149, F.A.C.,

2. The policy is intended to be a qualified long-term care insurance policy under the provisions of Section 627.9404(12), F.S.,

3. The insured individual was a resident of Florida or another state that has entered into a reciprocal agreement with Florida when coverage first became effective under the policy. If the policy is later exchanged for a different long-term care policy, the individual was a resident of Florida or another state that has entered into a reciprocal agreement with Florida when coverage under the earliest policy became effective,

4. The policy is issued with and retains inflation coverage which meets the inflation standards based on the insured's then attained age as defined in subsection (4) below,

5. The effective date of the coverage is on or after January 1, 2007, and

6. Compliance is met with the provisions of these rules.
(b) Insurance benefit payments, for purposes of asset disregard when applying for Medicaid long-term care services, are payments made for long-term care benefits and services and do not include such benefits as cash surrender values, return of premiums, premium waiver, or death benefits.
(2)
(a) An insurer issuing or marketing policies that qualify as partnership policies, shall provide a disclosure notice, on the insurer's letterhead, indicating that at the time of issue of the coverage, the policy is an approved long-term care partnership policy. The disclosure notice shall also explain the benefits associated with a partnership policy, and disclose that the partnership status may be lost if the insured moves to a different state or modifies the coverage after issue, or if changes in federal or state laws occur. The insurer may use Form OIR-B2-1786 (1/2007), Partnership Status Disclosure Notice, which is hereby adopted and incorporated into this rule by reference. This notice shall be provided to the insured no later than the time of policy or certificate delivery. If the insurer uses Form OIR-B2-1786 without modification, no filing is required. If the carrier chooses to modify the language found in this disclosure notice, such notice shall be filed for approval with the Office.

(b)
1. When an insurer is made aware that the policyholders or certificateholders initiate action that will result in the loss of partnership status, the insurer shall provide an explanation of how such action impacts the insured in writing. The policyholders or certificateholders shall also be advised how to retain partnership status if possible.

2. If a partnership plan subsequently loses partnership status, the insurer shall explain to the policyholders or certificateholders in writing the reason for the loss of status.
(3)
(a) An insurer issuing or marketing policies that qualify as partnership policies, shall notify all of its policyholders with existing long-term care coverage issued on or after March 1, 2003, of the benefits associated with a partnership policy. The insurer shall offer all such existing policyholders the option to exchange their policy, as provided by Rule 69O-157.1100, F.A.C., for a partnership policy.

(b) Any policyholder that exchanges their policy shall be provided the required disclosure as provided in subsection (2) above.

(c) The effective date of the partnership policy shall be the date of the exchanged policy.
(4) The issued policy shall meet the following inflation coverage limitations:
(a) Policies or certificates issued to an individual who has not yet attained age 61 shall contain annual compound inflation coverage.

(b) Policies or certificates issued to an individual who has attained age 61 but has not attained age 76 shall contain annual inflation coverage.

(c) For policies or certificates issued with inflation coverage, the policyholders or certificateholders must have the inflation coverage at a level based upon the insured's current age as described in paragraphs (a) and (b) above.
(5) Reporting.
(a) All insurers shall report to the Health and Human Services Secretary such information as required by Centers for Medicare & Medicaid Services (CMS), including but not limited to:
1. Notification regarding when insurance benefits provided under partnership plans have been paid and the amount of such benefits paid, and

2. Notification regarding when such policies otherwise terminate.
(b) All insurers shall provide to any insured requesting such information a copy of the Form OIR-B2-1781 (12/06), Approved Long-Term Care Partnership Program Policy Summary, which is hereby adopted and incorporated into this rule by reference. An insurer may use its own form as long as the information and content is consistent with the information contained in Form OIR-B2-1781 (12/06).

69O FAC 157.301 | Rate Increase Standards

(1) Rate increase filings for long term care insurance shall be filed in accordance with filing requirements and standards of Rule Chapters 69O-149 and 69O-157, F.A.C.

(2) The term "policies with similar coverage" has the same meaning as "similar policy forms" as defined in subsection 69O-157.103(17), F.A.C.

(3) The footnote following Section 627.9407, F.S., states that Section 11, Chapter 2006-254, L.O.F., provides that "[t]his act shall apply to long-term care insurance policies issued or renewed on or after July 1, 2006. For any long-term care insurance policy issued prior to July 1, 2006, the provisions of [Section 627.94076, F.S.] shall apply to such policy only upon renewal of such policy on or after July 1, 2008, and the policy shall so provide by endorsement to the policy."

(4) Pursuant to the provisions of Section 627.9407(7)(c), F.S., for insurers that are currently actively marketing and issuing similar coverage, the rates resulting after a rate increase filing shall not exceed the insurer's new business rate.

(5)
(a) Section 627.9407(7)(c), F.S., requires that the office annually determine and publish the currently available new business rates for similar coverage being sold in Florida. The published new business rates represent the maximum annual rate that may be charged after a rate increase for insurers not currently issuing new coverage.

(b) The published rates shall be determined by first identifying those carriers currently issuing policies with similar coverage. For each of the similar coverage categories, the Florida new business earned premium, defined as first year premium in Florida, is determined for the prior calendar year. Those insurers reporting at least the top 80% of that earned premium, cumulatively, starting with the largest, will be used to tabulate the new business rate. The new business rate shall be the weighted average of the insurers' rates, using the market share, as measured by first year premium in Florida, as the weight.

(c)
1. The new business rates are for the standard underwriting class for the insurer. Standard underwriting class is the underwriting class with the most predominant sales, measured by number of policies, regardless of the name given to it by the insurer.

2. The new business rates for other underwriting classes shall bear the same relationship to the standard rate schedules that the insurer has filed and approved. For example, if an insurer's preferred rate is 85% of its standard rate, the premium limit applicable to the rate increase for business sold as preferred will be 85% of the standard rate schedule.
(d)
1. The published new business rates represent the particular benefit configuration listed. If an insurer has policies in force that have benefits different from the benefit used to determine the published rates, the insurer may contact the office for the new business rate that reflect the different benefits.

2. The office shall determine the new business rates for the requested benefit configuration in the same manner as it used for determining the published rates. The resulting rates shall be consistent with the published new business rates reflecting benefit differences only.

3. Insurers needing a different benefit configuration should make such request of the office in advance of a rate filing so as to give the office time to determine such rates and provide them to the insurer.
4. If the office is unable to determine the rates by a tabulation of the insurers currently selling similar coverage, the office shall use its best actuarial judgment in determining the new business rates using the information available from the insurers in the 80% market share. Alternatively in such cases, at the option of the insurer, the insurer may submit the results of a model used to price new long term care products by an actuarial consulting firm currently pricing long term care for other clients, who is independent of the insurer, acceptable to the office, and contracted by the insurer. The assumptions used shall be available to the office for review and approval. The model will be used to develop the new business pricing for the insurer's policy benefit configuration, the new business pricing for the published benefit configuration, and to develop a factor which is the ratio of the insurer's policy benefits to the published benefits. It is noted that the provisions of Section 627.9407(7)(c), F.S., provide that the differences shall be benefit differences only; all other provisions of the two policies being modeled shall be identical. Such factor, representing benefit differences only, shall be used to adjust the published new business rates. Independent, as used in this section, shall mean that the actuarial consulting firm or the actuary to be involved in the project has no relationship currently or for the last three years with the insurers for pricing, valuation, or other reviews.
(e) If the application of this rule results in different increases being applied to different plans within the filing, the requirements of subparagraph 69O-149.003(1)(a)4., F.A.C. shall apply.

(f) The published rates apply to sales in Hillsborough County. For all other counties, the rate from the published table should be adjusted by the insurer's current area factor applicable in that county relative to the insurer's area factor in Hillsborough County.

(g) The premium for all additional benefits provided in the policy or by rider to the policy shall be the same proportion of the base rates after any rate change as they were before such change.

69O FAC 157.302 | Facility Only Rates (Repealed)

69O FAC 157.303 | Home Health Care Only Rates (Repealed)

69O FAC 157.304 | Comprehensive Only Rates (Repealed)

69O-158 | Exchange of Medicaid Data with Insurers

69O FAC 158.001 | Purpose

The purpose of these rules is to enable the Agency for Health Care Administration, with the assistance of the Office of Insurance Regulation, to obtain information from health insurers and other entities which provide similar coverage so that AHCA may determine whether health insurance or health care services provided pursuant to Chapter 641, F.S., could be, should be, or have been claimed and paid with respect to medical care and services furnished to any person eligible under Section 409.903, F.S.

69O FAC 158.002 | Scope

69O FAC 158.003 | Definitions

The following definitions shall apply to this rule chapter:
(1) "Office" shall mean the Office of Regulation.

(2) "AHCA" shall mean the Agency for Health Care Administration.

(3) "Insurer" shall mean an entity authorized by the Office to transact health insurance, multiple employer welfare arrangement, health maintenance organization, and prepaid health clinic insurance.

(4) "Policy" shall mean health insurance policy, health maintenance contract as defined in Section 641.19(5), F.S., prepaid health clinic contract as defined in Section 641.402(6), F.S., and multiple employer welfare arrangement policy or contract issued pursuant to Sections 624.436-.446, F.S.

(5) "Medical assistance" shall mean payment by AHCA for medical services to any person eligible for Medicaid or for assistance from the Public Medical Assistance Trust Fund pursuant to Section 409.918, F.S.

69O FAC 158.004 | Insurers to Provide AHCA with Certain Information; Reimbursement; Failure to Comply

(1) Every health insurer shall, upon request of AHCA for any records or any information contained in such records, pertaining to the coverage of any individual under a health insurance policy or to the medical benefits paid by or claims made to any insurer pursuant to such policy, make all requested records and information available to AHCA when such individual is a recipient of medical assistance or is a person who is legally responsible for such a recipient.

(2) Information obtained pursuant to this rule and Rule 59G-7.0211, F.A.C., shall be exempt from Chapter 119, F.S. No official, agent, servant, or employee of either the Office or any insurer shall be permitted to make any use of the information furnished pursuant to this rule except for investigations and records made for the purposes of determining whether insurance or other benefits could be, have been or should have been claimed pursuant to an insurance policy or other agreement with respect to items of medical care and services received by a particular individual for which medical assistance has been provided by AHCA or would otherwise be provided by AHCA if not for the liability or an insurer.

(3) Within 30 days from the date of receipt, insurers shall respond to a request by AHCA that the insurer enter into an information reporting agreement or contract with AHCA. Insurers shall enter into information reporting agreements or contracts with AHCA within 90 days from the date of the receipt of the request unless exempted pursuant to paragraph 59G-7.0211(3)(d), F.A.C.

(4) Unless otherwise stipulated in its information reporting contract, an insurer shall furnish to AHCA all requested information within 30 days of the effective date of the contract.

(5) After furnishing the information as agreed, insurers may file with AHCA for reimbursement in the manner set forth in paragraph 59G-7.0211(3)(g), F.A.C.

(6) Failure by any insurer to comply with these rules and related Florida Statutes may subject that insurer to administrative penalties as prescribed in the applicable provision of the Florida Insurance Code. After the Office has been notified, pursuant to paragraph 59G-7.0211(3)(l), F.A.C., that an insurer has not complied with AHCA's request, the Office shall immediately notify the offending insurer by certified mail that if the insurer is not in compliance within 30 days from the date of receipt of the certified letter, the Office may impose an administrative penalty in an amount not to exceed the statutory limit. Upon any subsequent failure of the insurer to timely respond to a request by AHCA, the Office may proceed to suspend or revoke the insurer's certificate of authority. The Office shall keep AHCA informed as to the status of such proceedings and any resulting agreement by the insurer to comply.
69O-161 | Uniform Insurance Claim Forms and Prior Authorization Forms

69O FAC 161.001 | Purpose

The purpose of this chapter is to establish uniform claim forms for claims relating to health insurance and industrial life insurance policies, to establish guidelines for all prior authorization forms which ensure the general uniformity of such forms, and to adopt a prior authorization form for use by health insurance issuers which do not provide an electronic prior authorization process for use by its contracted providers.

69O FAC 161.002 | Scope

69O FAC 161.003 | Use of Industrial Life Insurance Claim Form

69O FAC 161.004 | Use of Health Insurance Claim Form

69O FAC 161.005 | Use of Dental Claim Form

All companies writing dental insurance shall accept Form HCFA 1500 (12/90) and the American Dental Association Dental Claim Form (Form J510, J511, or J512) (1/94). For informational purposes only, the Florida Medicaid dental program shall accept the Non-Institutional Dentist Claim Form (Form 111) (1/89) and Form HCFA 1500. All said forms are hereby incorporated and made part of this rule chapter by reference.

69O FAC 161.006 | Use of Pharmacy Claim Form

69O FAC 161.007 | Use of Hospital Claim Form

69O FAC 161.008 | Additional Information

69O FAC 161.009 | Form Availability

69O FAC 161.010 | Guidelines for Prior Authorization Forms

(1) Scope: This rule applies to all insurance companies, health maintenance organizations, and managed care entities authorized to write health insurance in Florida.

(2) Definitions: As used in this rule:
(a) "Health Insurer" means an authorized insurer offering health insurance as defined in Section 624.603, F.S., a managed care plan as defined in Section 409.962(9), F.S., or a health maintenance organization as defined in Section 641.19(12) F.S.

(b) "Utilization review entity" means any person that performs prior authorization for a health insurer.

(c) "Person" has the same meaning as defined in Section 624.04, F.S.

(d) "Prior authorization" means any practice implemented by a health insurer or a health insurer's utilization review entity in which coverage of a health care service, device, or drug is dependent upon a covered person or health care practitioner obtaining approval from the health insurer or utilization review entity prior to the service, device, or drug being performed, received, or prescribed, as applicable. "Prior authorization" includes prospective or utilization review procedures conducted prior to providing a health care service, device, or drug.
(3) All prior authorization forms must provide for the following information:
(a) Sufficient information to identify the covered person, including the covered person's date of birth, full name, and health plan identification number.

(b) Sufficient information to identify the ordering provider, including the provider's name, National Provider Identification number, and the provider's contact information.

(c) Sufficient information to identify the rendering provider, including the name of the rendering provider, provider group, or facility, corresponding National Provider Identification number, and the rendering provider's contact information.

(d) Sufficient information to identify and contact the rendering facility, if different from subparagraph c.

(e) Where the service or procedure will be performed if different from subparagraph c. or d.

(f) The health care service being requested, including the medical reason therefore.

(g) The unit or volume of the procedure, service, or device being requested when applicable.

(h) All services tried and shown to be ineffective.

(i) A list of any additional documentation required by the health insurer or utilization review entity to complete its review of the prior authorization request, and any other information necessary to facilitate the determination of the medical necessity of the requested procedure, course of treatment or prescription drug benefit.

(j) The priority of the prior authorization request. At a minimum, the prior authorization form shall contain the following designations:
1. Standard.

2. Date of Service, which should include a space for the planned date of a service.

3. Urgent or Emergency, to be used when the provider certifies that applying the standard review time frame may seriously jeopardize the life or health of the patient.
(k) The latest International Classification of Disease primary diagnosis code.

(l) An attestation or certification that all information provided is true and accurate.
(4) All prior authorization forms must contain information where a provider may find a health insurer's list of services subject to prior authorization.

(5) The prior authorization form must contain the direct contact information for the health insurer.

(6) The prior authorization form may not require information that is not needed to make a determination or facilitate a determination of medical necessity of the requested medical procedure, course of treatment, or prescription drug benefit.

(7) Disclosure and review of prior authorization requirements. A health insurer shall make any current prior authorization forms, directions as to when to use such forms, and instructions for filling out such forms, readily accessible on its website and in written form upon request for beneficiaries and health care providers.

69O FAC 161.011 | Use of Prior Authorization Form

All authorized insurers offering health insurance as defined in Section 624.603, F.S., managed care plans as defined in Section 409.962(9), F.S., and health maintenance organizations as defined in Section 641.19(12), F.S., which do not provide an electronic prior authorization process for use by its contracted providers shall use only the Prior Authorization Form (OIR Form OIR-B2-2180) (12/16), Prior Authorization Form for Medical Procedures, Courses of Treatment, or Prescription Drug Benefits, http://www.FLRules.org/Gateway/Reference.asp?No=Ref-07606, which is hereby incorporated and made part of this rule chapter by reference.
69O-162 | Annuity Contracts

69O FAC 162.001 | Scope

69O FAC 162.002 | Policy Form and Application; Prior Approval; Disapproval or Withdrawal of Filing

No variable annuity contract shall be delivered or issued for delivery in this state by any insurance company until a copy of the form thereof (and, in the case of a contract on a group basis, the form of any certificates evidencing variable benefits issued pursuant thereto) and any form of application for such variable annuity contract shall have been filed with the Director. No such form shall be issued or used until the Director shall give his prior written approval of such form. The Director shall disapprove or withdraw approval of any such contract form, application or certificate if:
(1) Such variable annuity contract or application or certificate contains provisions which are ambiguous, misleading or deceptive or likely to mislead or deceive the policyholder, certificate holder, or applicant; or if sales of such contracts are being solicited by any means of advertising, communication or dissemination of information which involves misleading or inadequate description of the provisions of the contract,

(2) The Director, in such event, shall, by written order, promptly notify the company, specifying the particulars of his disapproval. It shall be unlawful for such company thereafter to issue any contract or certificate thereunder or use any application in the form so disapproved.

69O FAC 162.003 | Illustrations of Benefits

69O FAC 162.004 | Grace Period and Nonforfeiture Values

No individual variable annuity contract shall be delivered or issued for delivery in this state unless it contains in substance the following provisions:
(1) That, in the event of default in the payment of any consideration beyond the period of grace allowed by the contract for the payment thereof, the insurance company will make payment of the value of the contract in accordance with a plan provided by the contract commencing not later than the date contractual payments by the company were otherwise to have commenced in accordance with the contract.

(2) That, upon request of the contract holder received by the insurance company at least four months prior to the date contractual payments by the company were otherwise to have commenced, the company will make payment of the value of the contract in accordance with a plan provided by the contract and selected by the contract holder commencing as of the first day of the first month which is at least four months after the date of receipt of such request, unless another date of commencement is requested by the contract holder and agreed to by the company.

(3) That the insurance company will mail to the holder of the contract at least once in each contract year after the first, at his last address known to the company, a report in a form approved by the Director, which shall include a statement of the number of units credited to such contract and the dollar value of a unit as of a date not more than two months previous to the date of mailing and the statement shall be in a form and of a date approved by the Director of the investments held in the appropriate variable contract account.

69O FAC 162.006 | Notice of Variable Values Required

Any variable annuity contract delivered or issued for delivery in this state, and any application for such contract, and any group annuity certificate, shall contain on its first page, in a prominent position in ten (10) point type or larger, a clear statement that the annuity benefits of values thereunder are on a variable basis.

Suggested wording is as follows:
"ANNUITY PAYMENTS AND TERMINATION VALUES PROVIDED BY THIS CONTRACT ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT."

69O FAC 162.008 | Contract Provision; Expense, Mortality and Investment Increment Factor

Any individual or group variable annuity contract delivered or issued for delivery in this state shall stipulate the expense, mortality, and investment increment factors to be used in computing the dollar amount of variable benefits or other contractual payments or values thereunder, and shall guarantee that expense and mortality results shall not adversely affect such dollar amounts. The mortality and investment increment factors used in computing the dollar amount of variable benefits or other contractual payments or values under an individual variable contract shall not produce a larger initial payment than would be produced by the use of annuity mortality tables in Rule 69O-162.108, F.A.C., for policies issued on or before December 31, 2016 and annuity mortality tables for use in determining reserve liabilities in accordance with the NAIC Valuation Manual as adopted by Section 625.1212, F.S., for policies issued on or after January 1, 2017 and an annual investment increment assumption of 3 1/2 %. "Expense" as used in this subsection may exclude some or all taxes as stipulated in the contract.

69O FAC 162.009 | Licensing of Agents

Sales of variable annuity contracts shall be made or solicited only by persons authorized under licenses from the Department of Financial Services to sell life insurance only after certification by the Department as having satisfactorily completed an examination given or authorized by the Department relating to variable annuity contracts.

69O FAC 162.010 | Selling Methods and Advertising

(1) All companies authorized to issue and deliver contracts on a variable basis, all contracts, certificates and other forms in connection therewith, and all agents and other representatives are subject to the provisions of Chapter 626, Part VII, F.S.

(2) Illustration of benefits payable under any variable annuity contract shall not involve projections of past investment experience into the future or attempted predictions of future investment experience.

(3) No advertising, sales literature, or sales presentation for contracts on a variable basis shall be misleading, deceptive or inadequate in any way.

69O FAC 162.011 | Investments

Every domestic life insurance company which issues variable annuity contracts shall be permitted to invest and reinvest amounts received in connection with such variable contracts in common stocks, subject to the following limitations:
(1) All such common stock investments shall be in stock which is listed or admitted to trading on a securities exchange located in the United States of America, or which is publicly held and has been traded in the "over the counter market" for not less than one year preceding the date of purchase of such stock and as to which stock market quotations have been readily available for such one year period.

(2) No domestic life insurance company which issues variable annuity contracts shall invest more than five percent of all of the amounts received in connection with such contracts in the securities of any one corporation or issuer.

(3) No domestic life insurance company which issues variable annuity contracts shall as a result of investing any or all of the amounts received in connection with such contracts, beneficially own or hold, together with the investments permitted under Section 625.305(2)(a), F.S., more than fifteen percent of the outstanding securities of any one corporation or issuer. Any foreign life insurance company which issues variable annuity contracts in this state and which invests the amounts received in connection with such contracts in accordance with the laws of its state of domicile, shall be held to be in compliance with this section.

(4) No domestic life insurance company shall invest in the common stock of any corporation if such investment shall create a conflict of interest between officers and directors of the investing company and those of the corporation whose stock is purchased.

69O FAC 162.012 | Valuation of Account Assets; Reserve Liability

(1) The valuation of variable annuity contract account assets for all purposes, including annual reports of the company to the Office of Insurance Regulation, shall be determined in accordance with the market value of such assets, notwithstanding the application of other valuation methods to assets of the company other than the assets of the variable annuity contract account. Such valuation may be made as of such valuation date as the company shall establish from time to time, except as otherwise required for the annual reports to the Office of Insurance Regulation.

(2) The reserve liability for variable annuity contracts shall be established by the Office pursuant to the requirements of annuity mortality tables for use in determining reserve liabilities listed in Rule 69O-162.108, F.A.C., for policies issued prior to December 31, 2016 and for use in determining reserve liabilities in accordance with the NAIC Valuation Manual as adopted by Section 625.1212, F.S., for policies issued on or after January 1, 2017 and in accordance with actuarial procedures that recognize the variable nature of the benefits provided.

69O FAC 162.013 | Annual Statement; Record of Accumulation Required

(1) Every company authorized to issue and deliver in this state annuity contracts on a variable basis shall, on or before the first of March in each and every year, file with the Director the statement required by Section 624.424(1), F.S. Such statement shall contain, in addition to the information specifically mentioned in said statutory provision, separate information concerning the sale of the variable annuity contracts, amounts of money received and expended, number of contracts in force, and investments. In addition, every such company shall supply, in a form prescribed by the Director, such other information as he may deem necessary to enable him to determine the amount of the reserves, assets, liabilities, expenses and values of the units.

(2) For each variable annuity contract a domestic life insurance company shall maintain a history record card or ledger sheet showing, in addition to the usual premium or contract consideration information, each net annuity consideration applied and accumulated balance on either a unit or a dollar value basis.

69O FAC 162.014 | Company Qualifications

No domestic or foreign life insurance company shall undertake the issuance of any variable annuity contract in this state until said domestic company has shown to the satisfaction of the Director that it has successfully engaged in the business of transacting life insurance for a period of two years (foreign insurers three years), or is the wholly owned subsidiary of such a company and that its condition and methods of operation in connection with the issuance of such variable annuity contracts will not be such as to render its operation hazardous to the public or its policyholders in this state. In determining the qualifications of a company requesting authority to issue or deliver variable annuity contracts within this state, the Director shall consider among other things the history and financial condition of the company; the character, responsibility, and general fitness of the officers and directors of the company; and in the case of a foreign or alien company, whether the regulation provided by the laws of its domicile provides a degree of protection to policyholders and the public substantially equal to that provided by the laws of this state.

69O FAC 162.015 | Separate Accounts Required; Transactions Between Accounts Prohibited

Assets and liabilities of the separate account established in connection with variable annuity contracts shall be distinguishable from other accounts of the same domestic insurance company. There shall be no sales or transfers between accounts of the same domestic insurance company, or between the insurance company and any other company having a common management with the insurance company; provided, however, that the insurance company may buy or sell securities listed on a recognized securities exchange or any recognized "over the counter market" in the United States through an investment dealer or brokerage firm under common management with the insurance company if the investment dealer or brokerage firm receives only such commissions as prescribed by such exchange for the execution of such orders. In the case of "over the counter" transactions, commissions may not exceed those prescribed by the New York Stock Exchange on a similar transaction. The dealer or broker cannot act as principal.

69O FAC 162.016 | Stockholders' Interest; Schedule of Commissions

(1) No person while serving as an elected or appointed officer, director or trustee of any domestic life insurance company shall receive directly or indirectly any commission on the variable annuity business transactions of the company.

(2) The deductions that may be made from the premium to cover expense factors such as administrative costs and premium taxes of the variable annuity business shall be reasonable and shall be filed with the Director for his approval.

(3) Schedules of commissions to agents on variable annuities shall be filed with the Director.

(4) No authority to issue or deliver in this state variable annuity contracts will be granted to any company whose stockholders benefit, to an extent considered unreasonable by the Director, from its variable annuity business.

69O FAC 162.101 | Scope

69O FAC 162.102 | Purpose

69O FAC 162.103 | Definitions

As used in this rule chapter, the following terms have the following meaning:
(1) "1994 GAR Table" - means that mortality table developed by the Society of Actuaries Group Annuity Valuation Table Task Force.

(2) "Annuity 2000 Mortality Table" means that mortality table developed by the Society of Actuaries Committee on Life Insurance Research.

(3) "Period table" means a table of mortality rates applicable to a given calendar year (the Period).

(4 ) "Generational mortality table" means a mortality table containing a set of mortality rates that decrease for a given age from one year to the next based on a combination of a Period table and a projection scale containing rates of mortality improvement.

(5) "2012 IAR Table"or "2012 IAR Mortality Table" means that Generational mortality table developed by the Society of Actuaries Committee on Life Insurance Research and containing rates, qx2012+n, derived from a combination of the 2012 IAM Period Table and Projection Scale G2, using the methodology stated in subsection 69O-162.106(2), F.A.C.

(6) "2012 Individual Annuity Mortality Life (2012 IAM Period) Table" means the Period table containing loaded mortality rates for calendar year 2012. This table contains rates, qx2012, developed by the Society of Actuaries Committee on Life Insurance Research.

(6) "Projection Scale G2 (Scale G2)" is a table of annual rates, G2x, of mortality improvement by age for projecting future mortality rates beyond calendar year 2012. This table was developed by the Society of Actuaries Committee on Life Insurance Research.

69O FAC 162.104 | Individual Annuity or Pure Endowment Contracts

(1) The Annuity 2000 Mortality Table shall be used for determining the minimum standard of valuation for any individual annuity or pure endowment contract issued on or after July 1, 1998 and on or before December 31, 2014.

(2) The 2012 IAR Table shall be used for determining the minimum standard of valuation for any individual annuity or pure endowment contract issued on or after January 1, 2015, for valuation dates on or after September 30, 2015.

(3) The 1983 Table "a" without projection is to be used for determining the minimum standard of valuation for an individual annuity or pure endowment contract issued on or after July 1, 1998, solely when the contract is based on life contingencies and is issued to fund periodic benefits arising from:
(a) Settlements of various forms of claims pertaining to court settlements or out of court settlements for tort actions;

(b) Settlements involving similar actions such as workers compensation claims, or
I Settlements of long term disability claims where a temporary or life annuity has been used in lieu of continuing disability payments.

69O FAC 162.105 | Group Annuity or Pure Endowment Contracts

The 1994 GAR Table shall be used for determining the minimum standard of valuation for any annuity or pure endowment purchased on or after July 1, 1998 under a group annuity or pure endowment contract.
(1) For valuation dates on or after the effective date of this rule and on or before December 31, 1998, a company may, at its option, value its reserves using the mortality table in effect prior to the adoption of this rule if it estimates and holds an additional reserve.

(2) The additional reserve for subsection (1) would be based on ratios of reserve factors using the 1994 GAR table and the table in effect prior to the adoption of this rule, which is the 1983 group annuity mortality table.

(3) The reserve based on the 1983 Group Mortality table will be allocated to segments which correspond to the ratios calculated in subsection (2).

(4) The additional reserve will equal the larger of zero and the sum of the products obtained by multiplying the factors from subsection (2) by the corresponding segment in subsection (3).

69O FAC 162.106 | Application of 1994 GAR Table and the 2012 IAR Mortality Table

(1) In using the 1994 GAR Table, the mortality rate for a person age x in year (1994 + n) is calculated as follows:
qx1994+n = qx1994(1 - AAx)n
where the qx1994s and AAxs are as specified in the 1994 GAR Table.
(2) In using the 2012 IAR Mortality Table, the mortality rate for a person age x in year (2012 + n) is calculated as follows:
qx2012+n = qx2012(1 - G2x)n
(a) The resulting qx2012+n shall be rounded to three decimal places per 1,000, e.g., 0.741 deaths per 1,000. Also, the rounding shall occur according to the formula above, starting at the 2012 period table rate.

(b) For example, for a male age 30, qx2012 = 0.741.
1. qx2013 = 0.741 * (1 - 0.010) ^ 1 = 0.73359, which is rounded to 0.734.

2. qx2014 = 0.741 * (1 - 0.010) ^ 2 = 0.7262541, which is rounded to 0.726.
(c) A method leading to incorrect rounding would be to calculate qx2014 as qx2013 * (1 - 0.010), or 0.734 * 0.99 = 0.727. It is incorrect to use the already rounded qx2013 to calculate qx2014.

69O FAC 162.108 | Tables

(1) The following tables are hereby adopted and incorporated by reference:
(a) The Annuity 2000 Mortality Table;

(b) The 1994 GAR Table;

(c) The 1983 Table "a";

(d) The 2012 IAR Mortality Table which is titled 2012 IAM Period Table in Appendices I and II (01/13) and The Projection Scale G2 (Scale G2) in Appendices III and IV (01/13).
(2) The tables in subsection (1), are available from the Office of Insurance Regulation, Bureau of Life and Health Financial Oversight, 200 East Gaines Street, Tallahassee, Florida 32399-0327, and available at https://www.FLRules.org/Gateway/Reference.asp?No=Ref-05452.

69O FAC 162.201 | Adoption of 2001 Commissioners Standard Ordinary (CSO) Mortality Tables

(1) Scope.

This rule shall govern mortality tables for use in reserves as set forth in Section 625.121, F.S.

(2) Purpose.

The purpose of this rule is to recognize, permit, and prescribe the use of the 2001 Commissioners Standard Ordinary (CSO) Mortality Table in accordance with Sections 625.121(5)(a)3. and 627.476(9)(h)6., F.S., and paragraphs 69O-164.020(5)(a) and (b), F.A.C.

(3) Definitions.

(a) "2001 CSO Mortality Table" means the mortality table, consisting of separate rates of mortality for male and female lives, developed by the American Academy of Actuaries CSO Task Force from the Valuation Basic Mortality Table developed by the Society of Actuaries Individual Life Insurance Valuation Mortality Task Force, and adopted by the NAIC in December 2002. The 2001 CSO Mortality Table is included in the Proceedings of the NAIC (2nd Quarter 2002), which is adopted herein and incorporated by reference. Unless the context indicates otherwise, the "2001 CSO Mortality Table" includes both the ultimate form of that table and the select and ultimate form of that table and includes both the smoker and nonsmoker mortality tables and the composite mortality tables. It also includes both the age-nearest-birthday and age-last-birthday bases of the mortality tables.

(b) "2001 CSO Mortality Table (F)" means the mortality table consisting of the rates of mortality for female lives from the 2001 CSO Mortality Table.

(c) "2001 CSO Mortality Table (M)" means the mortality table consisting of the rates of mortality for male lives from the 2001 CSO Mortality Table.

(d) "Composite mortality tables" means mortality tables with rates of mortality that do not distinguish between smokers and nonsmokers.

(e) "Smoker and nonsmoker mortality tables" means mortality tables with separate rates of mortality for smokers and nonsmokers.

(4) CSO Mortality Table.

(a)
1. For policies not issued in this state, the 2001 CSO Mortality Table may be used as the minimum standard for valuation purposes on valuation dates on or after the date this rule becomes effective for policies issued on or after January 1, 2005, if that is the basis for nonforfeiture purposes and that is the basis permitted or required for the sale of policies in that state.

2. For policies issued in this state, the 2001 CSO Mortality Table may be used as the minimum standard for valuation and nonforfeiture purposes for policies issued on or after the date this rule becomes effective.
(b) Subject to the conditions stated in this rule, the 2001 CSO Mortality Table shall be used in determining minimum standards for policies issued on and after January 1, 2009, to which Sections 625.121(5)(a)3. and 627.476(9)(h)6., F.S., and paragraphs 69O-164.020(5)(a) and (b), F.A.C., are applicable.

(c)
1. For policies not issued in this state, the 2001 CSO Mortality Table may be substituted for the 1980 Commissioners Extended Term (CET) Tables for use as the minimum standard for valuation purposes on valuation dates on or after the date this rule becomes effective for policies issued on or after January 1, 2005 if that is the basis for nonforfeiture purposes and that is the basis permitted or required for the sale of policies in that state.

2. For policies issued in this state, the 2001 CSO Mortality Table may be substituted for the 1980 Commissioners Extended Term (CET) Tables for use as the minimum standard for valuation and nonforfeiture purposes for policies issued on or after the date this rule becomes effective if the same election is made with respect to paragraph (a), above.

(5) Conditions.

(a) For each plan of insurance with separate rates for smokers and nonsmokers an insurer may use:
1. Composite mortality tables to determine minimum reserve liabilities and minimum cash surrender values and amounts of paid-up nonforfeiture benefits;

2. Smoker and nonsmoker mortality tables to determine the valuation net premiums and additional minimum reserves, if any, required by Section 625.121(11), F.S., and use composite mortality tables to determine the basic minimum reserves, minimum cash surrender values and amounts of paid-up nonforfeiture benefits, or

3. Smoker and nonsmoker mortality to determine minimum reserve liabilities and minimum cash surrender values and amounts of paid-up nonforfeiture benefits.
(b) For plans of insurance without separate rates for smokers and nonsmokers the composite mortality tables shall be used.

(c) For the purpose of determining minimum reserve liabilities and minimum cash surrender values and amounts of paid-up nonforfeiture benefits, the 2001 CSO Mortality Table may, at the option of the company for each plan of insurance, be used in its ultimate or select and ultimate form, subject to the restrictions of subsection (6), of this rule, and Rule 69O-164.020, F.A.C., relative to use of the select and ultimate form.

(6) Applicability of the 2001 CSO Mortality Table to Rule 69O-164.020, F.A.C.

(a) The 2001 CSO Mortality Table may be used in applying Rule 69O-164.020, F.A.C., in the following manner, subject to the transition dates for use of the 2001 CSO Mortality Table in subsection (4), of this rule. Unless otherwise noted, the references in this section are to Rule 69O-164.020, F.A.C.:
1. Sub-subparagraph 69O-164.020(3)(a)2.b., F.A.C.: The net level reserve premium is based on the ultimate mortality rates in the 2001 CSO Mortality Table.

2. Paragraph 69O-164.020(4)(b), F.A.C.: All calculations are made using the 2001 CSO Mortality Rate, and, if elected, the optional minimum mortality standard for deficiency reserves stipulated in subparagraph (6)(a)4. The value of "qx+k+t-1" is the valuation mortality rate for deficiency reserves in policy year k+t, but using the unmodified select mortality rates if modified select mortality rates are used in the computation of deficiency reserves.

3. Paragraph 69O-164.020(5)(a), F.A.C.: The 2001 CSO Mortality Table is the minimum standard for basic reserves.

4. Paragraph 69O-164.020(5)(b), F.A.C.: The 2001 CSO Mortality Table is the minimum standard for deficiency reserves. If select mortality rates are used, they may be multiplied by X percent for durations in the first segment, subject to the conditions specified in sub-sub-subparagraphs 69O-164.020(5)(b)2.c.(I)-(IX), F.A.C. In demonstrating compliance with those conditions, the demonstrations may not combine the results of tests that utilize the 1980 CSO Mortality Table with those tests that utilize the 2001 CSO Mortality Table, unless the combination is explicitly required by rule or necessary to be in compliance with relevant Actuarial Standards of Practice.

5. Paragraph 69O-164.020(6)(c), F.A.C.: The valuation mortality table used in determining the tabular cost of insurance shall be the ultimate mortality rates in the 2001 CSO Mortality Table.

6. Subparagraph 69O-164.020(6)(e)4., F.A.C.: The calculations specified in paragraph 69O-164.020(6)(e), F.A.C., shall use the ultimate mortality rates in the 2001 CSO Mortality Table.

7. Subparagraph 69O-164.020(6)(f)4., F.A.C.: The calculations specified in paragraph 69O-164.020(6)(f), F.A.C., shall use the ultimate mortality rates in the 2001 CSO Mortality Table.

8. Subparagraph 69O-164.020(6)(g)2., F.A.C.: The calculations specified in paragraph 69O-164.020(6)(g), F.A.C., shall use the ultimate mortality rates in the 2001 CSO Mortality Table.

9. Sub-subparagraph 69O-164.020(7)(a)1.b., F.A.C.: The one-year valuation premium shall be calculated using the ultimate mortality rates in the 2001 CSO Mortality Table.
(b) Nothing in this subsection shall be construed to expand the applicability of Rule 69O-164.020, F.A.C., to include life insurance policies exempted under paragraph 69O-164.020(3)(a), F.A.C.

(7) Gender-Blended Tables.

(a) For any ordinary life insurance policy delivered or issued for delivery in this state on and after January 1, 2005, subject to the condition stated in Section 627.476(9)(h)5.c., F.S., a mortality table that is a blend of the 2001 CSO Mortality Table (M) and the 2001 CSO Mortality Table (F) may be substituted, at the option of the company for each plan of insurance, for the 2001 CSO Mortality Table for use in determining minimum cash surrender values and amounts of paid-up nonforfeiture benefits. No change in minimum valuation standards is implied by this subsection of the rule.

(b) The company may choose from among the blended tables developed by the American Academy of Actuaries CSO Task Force and adopted by the NAIC in December 2002.

(c) It shall not, in and of itself, be a violation of Section 626.9541, F.S., for an insurer to issue the same kind of policy of life insurance on both a sex-distinct and sex-neutral basis.

69O FAC 162.202 | Adoption of 2001 Commissioners Standard Ordinary (CSO) Ultimate Mortality Tables for Determining Reserve Liabilities for Credit Life Insurance

(1) This rule is adopted to implement Section 625.121(13), F.S.

(2) This rule applies to credit life insurance policies and certificates, and those similar policies and certificates where there is no identifiable charge made to the debtor.

(3) The purpose of this rule is to:
(a) Recognize the 2001 CSO Male Composite Ultimate Mortality Table for use in determining the minimum standard of valuation.

(b) Specify the interest rate and method to be used in determining the minimum standard of valuation.
(4) Definitions.
(a) "2001 CSO Mortality Table" means that mortality table, consisting of separate rates of mortality for male and female lives, developed by the American Academy of Actuaries CSO Task Force from the Valuation Basic Mortality Table developed by the Society of Actuaries Individual Life Insurance Valuation Mortality Task Force, and adopted by the NAIC in December 2002. The 2001 CSO Mortality Table is included in the Proceedings of the NAIC (2nd Quarter 2002), which is adopted and incorporated herein by reference. Unless the context indicates otherwise, the "2001 CSO Mortality Table" includes both the ultimate form of that table and the select and ultimate form of that table and includes both the smoker and nonsmoker mortality tables and the composite mortality tables. It also includes both the age-nearest-birthday and age-last-birthday bases of the mortality tables.

(b) "Composite mortality tables" means mortality tables with rates of mortality that do not distinguish between smokers and nonsmokers.

(c) "Credit Life Insurance" means life insurance as defined in Section 627.677, F.S.
(5) 2001 CSO Male Composite Ultimate Mortality Table.
(a) The minimum standard for both male and female insureds shall be 2001 CSO Male Composite Ultimate Mortality Table.

(b) Where the credit life insurance policy or certificate insures two lives, the minimum standard shall be twice the mortality in the 2001 CSO Male Composite Ultimate Mortality Table based on the age of the older insured.
(6) Minimum Standards.
(a) Rule 69O-164.020, F.A.C., shall not apply to credit life insurance.

(b) The interest rates used in determining the minimum standard for valuation shall be the calendar year statutory valuation interest rates as defined in Section 625.121(6), F.S.

(c) The method used in determining the minimum standard for valuation shall be the commissioners' reserve valuation method as defined in Section 625.121(7), F.S.
(7) Effective Date.
(a) For policies not issued in this state, the 2001 CSO Mortality Table may be used as the minimum standard for valuation purposes on valuation dates on or after the date this rule becomes effective for policies issued on or after January 1, 2005, and prior to the date this rule becomes effective.

(b) Subject to the conditions stated in this rule, the 2001 CSO Mortality Table shall be used in determining minimum standards for policies issued on and after the date this rule becomes effective.

69O FAC 162.203 | Adoption of 2001 Commissioners Standard Ordinary (CSO) Preferred Mortality Tables for Determining Reserve Liabilities for Ordinary Life Insurance

(1) Scope.

This rule shall govern mortality tables for use in reserves as set forth in Section 625.121, F.S.

(2) Purpose.

The purpose of this rule is to recognize, permit and prescribe the use of mortality tables that reflect differences in mortality between Preferred and Standard lives in determining minimum reserve liabilities in accordance with Section 625.121(5)(a)3., F.S., and subsection 69O-164.020(5), F.A.C.

(3) Definitions.

(a) "2001 CSO Mortality Table" means that mortality table, consisting of separate rates of mortality for male and female lives, developed by the American Academy of Actuaries CSO Task Force from the Valuation Basic Mortality Table developed by the Society of Actuaries Individual Life Insurance Valuation Mortality Task Force, and adopted by the NAIC in December 2002. The 2001 CSO Mortality Table is included in the Proceedings of the NAIC (2nd Quarter 2002) and supplemented by the 2001 CSO Preferred Class Structure Mortality Table defined below in paragraph (b). Unless the context indicates otherwise, the "2001 CSO Mortality Table" includes both the ultimate form of that table and the select and ultimate form of that table and includes both the smoker and nonsmoker mortality tables and the composite mortality tables. It also includes both the age-nearest-birthday and age-last-birthday bases of the mortality tables. Mortality tables in the 2001 CSO Mortality Table include the following:
1. "2001 CSO Mortality Table (F)" means that mortality table consisting of the rates of mortality for female lives from the 2001 CSO Mortality Table.

2. "2001 CSO Mortality Table (M)" means that mortality table consisting of the rates of mortality for male lives from the 2001 CSO Mortality Table.

3. "Composite mortality tables" means mortality tables with rates of mortality that do not distinguish between smokers and nonsmokers.

4. "Smoker and nonsmoker mortality tables" means mortality tables with separate rates of mortality for smokers and nonsmokers.
(b) "2001 CSO Preferred Class Structure Mortality Table" means mortality tables with separate rates of mortality for Super Preferred Nonsmokers, Preferred Nonsmokers, Residual Standard Nonsmokers, Preferred Smokers, and Residual Standard Smoker splits of the 2001 CSO Nonsmoker and Smoker tables as adopted by the NAIC September 10, 2006, which is available in the NAIC Proceedings (3rd Quarter 2006) which is adopted herein and incorporated by reference. Unless the context indicates otherwise, the "2001 CSO Preferred Class Structure Mortality Table" includes both the ultimate form of that table and the select and ultimate form of that table. It includes both the smoker and nonsmoker mortality tables. It includes both the male and female mortality tables and the gender composite mortality tables. It also includes both the age-nearest-birthday and age-last-birthday bases of the mortality table.

(c) "Statistical agent" means an entity with proven systems for protecting the confidentiality of individual insured and insurer information; demonstrated resources for and history of ongoing electronic communications and data transfer ensuring data integrity with insurers, which are its members or subscribers; and a history of and means for aggregation of data and accurate promulgation of the experience modifications in a timely manner.

(4) 2001 CSO Preferred Class Structure Table.

(a) At the election of the company, for each calendar year of issue, for any one or more specified plans of insurance and subject to satisfying the conditions stated in this rule, the 2001 CSO Preferred Class Structure Mortality Table may be substituted in place of the 2001 CSO Smoker or Nonsmoker Mortality Table as the minimum valuation standard for policies issued on or after January 1, 2007.
1. On valuation dates beginning with December 31, 2010, for policies issued on or after January 1, 2005 for policies not issued in this state, and on or after June 8, 2005, for policies issued in this state, and prior to January 1, 2007 wherever issued, these tables may be substituted at the option of the insurer and subject to the conditions of subsection (5), if the Regulatory Asset Adequacy Issues Summary required by Rule 69O-138.047, F.A.C., includes, if applicable, the impact of the insufficiency of assets to support the payment of benefits and expenses and the establishment of statutory reserves during one or more interim periods.

2. On valuation dates beginning with December 31, 2010, these tables may be substituted by an insurer not domiciled in this state at its option to value the policies identified in subparagraph (a)1., if the insurer provides the office with a statement from the commissioner of its state of domicile that the conditions for substituting these tables required by that state have been met.
(b) No such election shall be made until the company demonstrates at least 20% of the business to be valued on this table is in one or more of the preferred classes.

(c) A table from the 2001 CSO Preferred Class Structure Mortality Table used in place of a 2001 CSO Mortality Table, pursuant to the requirements of this rule, will be treated as part of the 2001 CSO Mortality Table only for purposes of reserve valuation pursuant to the requirements of Rule 69O-162.201, F.A.C., Adoption of 2001 Commissioners Standard Ordinary (CSO) Mortality Tables.

(5) Conditions.

(a) For each plan of insurance with separate rates for Preferred and Standard Nonsmoker lives, an insurer may use the Super Preferred Nonsmoker, Preferred Nonsmoker, and Residual Standard Nonsmoker tables to substitute for the Nonsmoker mortality table found in the 2001 CSO Mortality Table to determine minimum reserves. At the time of election and annually thereafter, except for business valued under the Residual Standard Nonsmoker Table, the appointed actuary shall certify that:
1. The present value of death benefits over the next ten years after the valuation date, using the anticipated mortality experience without recognition of mortality improvement beyond the valuation date for each class, is less than the present value of death benefits using the valuation basic table corresponding to the valuation table being used for that class.

2. The present value of death benefits over the future life of the contracts, using anticipated mortality experience without recognition of mortality improvement beyond the valuation date for each class, is less than the present value of death benefits using the valuation basic table corresponding to the valuation table being used for that class.
(b) For each plan of insurance with separate rates for Preferred and Standard Smoker lives, an insurer may use the Preferred Smoker and Residual Standard Smoker tables to substitute for the Smoker mortality table found in the 2001 CSO Mortality Table to determine minimum reserves. At the time of election and annually thereafter, for business valued under the Preferred Smoker Table, the appointed actuary shall certify that:
1. The present value of death benefits over the next ten years after the valuation date, using the anticipated mortality experience without recognition of mortality improvement beyond the valuation date for each class, is less than the present value of death benefits using the Preferred Smoker valuation basic table corresponding to the valuation table being used for that class.

2. The present value of death benefits over the future life of the contracts, using anticipated mortality experience without recognition of mortality improvement beyond the valuation date for each class, is less than the present value of death benefits using the Preferred Smoker valuation basic table.
(c) The use of the 2001 CSO Preferred Class Structure Table for the valuation of policies issued prior to January 1, 2007 shall not be permitted in any statutory financial statement in which a company reports, with respect to any policy or portion of a policy coinsured, either of the following:
1. In cases where the mode of payment of the reinsurance premium is less frequent than the mode of payment of the policy premium, a reserve credit that exceeds, by more than the amount specified in this paragraph as Y, the gross reserve calculated before reinsurance. Y is the amount of the gross reinsurance premium that (a) provides coverage for the period from the next policy premium due date to the earlier of the end of the policy year and the next reinsurance premium due date, and (b) would be refunded to the ceding entity upon the termination of the policy.

2.
a. In cases where the mode of payment of the reinsurance premium is more frequent than the mode of payment of the policy premium, a reserve credit that is less than the gross reserve, calculated before reinsurance, by an amount that is less than the amount specified in this paragraph as Z. Z is the amount of the gross reinsurance premium that the ceding entity would need to pay the assuming company to provide reinsurance coverage from the period of the next reinsurance premium due date to the next policy premium due date minus any liability established for the proportionate amount not remitted to the reinsurer.

b. For purposes of this condition, the reserve (i) for the mean reserve method shall be defined as the mean reserve minus the deferred premium asset, and (ii) for the midterminal reserve method shall include the unearned premium reserve. A company may estimate and adjust its accounting on an aggregate basis in order to meet the conditions to use the 2001 CSO Preferred Class Structure Table.

(6) Effective Date.

This rule shall be effective for policies issued on or after January 1, 2007, for valuation dates on or after the date this rule becomes effective.
69O-163 | Credit Life and Credit Disability Insurance

69O FAC 163.0015 | Applicability

(1) Section 627.677, F.S., and this rule chapter apply to credit life insurance and credit disability insurance sold in conjunction with a credit transaction.

(2) A policy or certificate is deemed to be credit life insurance or credit disability insurance if it:
(a) References the creditor or credit transaction within the form;

(b) Conditions the coverage upon the existence, term or coverage of a credit transaction.

69O FAC 163.0017 | Definitions

As used in this rule chapter, the following terms have the following meaning:
(1) Accelerated Death Benefit. Benefit which is paid in advance of the death of the insured. The benefit may be adjusted to consider the time value of money. The requirements shall not be more than a life expectancy of less than 12 months. Definitions that are more or less restrictive shall cause an adjustment of the rate charged based on actuarial justification.

(2) Actual Net Debt. The amount necessary to liquidate the remaining debt in a single lump-sum payment, excluding all unearned interest and other unearned finance charges.

(3) Actuarial Assumptions. The value of a parameter, or other choice, having an impact on an estimate of a future cost or other actuarial item under evaluation.

(4) Actuarial Present Value. The value of an amount or series of amounts payable or receivable at various times, determined as of a given date with each value based on consistent actuarial assumptions.

(5) Actuarially Equivalent. Producing equal actuarial present value, determined as of a given date with each value based on consistent actuarial assumptions.

(6) Credibility. The statistical extent to which the past experience of a case can be expected to recur in the future.

(7) Decreasing Gross Coverages. Coverage where the amount of insurance is decreased by the amount of the payment as the debtor makes each scheduled monthly payment. This results in the amount of insurance being equal to the sum of the remaining payments during the policy term-principal and unearned interest included.

(8) Experience. Earned premium, incurred claims, incurred claims count or number of life years insured, and average amount of insurance during the experience period.

(9) Joint Credit Life or Credit Disability. Insurance on the life of the debtor and the spouse of the debtor, partners, or any other legal cosigner.

(10) Prima Facie Rate. Maximum allowable rate, without experience or justification, pursuant to Section 627.6785(2), F.S.; shall be those contained in Rules 69O-163.010 and 69O-163.011, F.A.C.

69O FAC 163.002 | Premium Rates

69O FAC 163.003 | Cancellation and Refund Requirements

Cancellation and refunds shall be required in accordance with the following provisions applicable to each classification, in order to best protect the borrower from loss of funds by short-rate cancellation or termination of insurance, and to further avoid duplication or overlapping of insurance coverage when the loan is prepaid, refinanced or renewed.
(1) At the time the indebtedness is discharged, any remaining insurance coverage must be promptly terminated unless the insured requests in writing that the coverage be continued, if such continuance is provided for in the policy.

(2) Upon termination of the insurance coverage, the company shall promptly return the unearned premium to the person entitled thereto.

(3) In addition to the above, a refund of 100% of any payment for insurance made in advance of a scheduled payment date subsequent to the date of termination shall be returned to the person entitled thereto.

(4) The formula to be used in computing return premiums (or unearned premiums) shall be filed with and approved by the Director. The minimum basis adopted by any company shall not be less than the Rule of 78 for declining balance only and the actuarial method, which allocates premium in proportion to the remaining insurance risk, for all other types of coverages. If the refund or credit is less than $1.00, no refund or credit is required.

69O FAC 163.0045 | Filing Requirements

(1)
(a) All forms of Credit Life and Credit Disability policies, certificates of insurance, statements of insurance, applications for insurance, enrollment forms, binders, endorsements and riders delivered or issued for delivery in this state and the schedules of premium rates pertaining thereto, shall be filed for approval in accordance with Sections 627.6785 and 627.682, F.S.

(b) Filings shall be submitted electronically to http://www.FLOir.com/iPortal.
(2) A standardized data letter, Form OIR-B2-1507, "Office of Insurance Regulation Life and Health Forms and Rates Universal Standardized Data Letter", completed in accordance with Form OIR-B2-1507A, "Office of Insurance Regulation Life and Health Forms and Rates Universal Standardized Data Letter Instructions", shall accompany each filing and annual rate filing or the filing shall be returned incomplete. Forms OIR-B2-1507 and OIR-B2-1507A are adopted in Rule 69O-149.022, F.A.C.

(3) An actuarial memorandum, signed and dated by an actuary, shall be included in each rate and form filing. The memorandum shall identify the following:
(a) Types of coverage: gross, net, decreasing, level, single life, joint life, full term or truncated;

(b) Types of loans to be insured: open end credit, closed end credit;

(c) Durations of the loans and durations of the coverage. Refer to Rules 69O-163.005, 69O-163.006 and 69O-163.007, F.A.C.;

(d) Methods of premium charge: single premium or monthly premium;

(e) Schedules of premium rates and formulas for each type of coverage and how the rates relate to prima facie rates;

(f) Methods of refund calculation and formulas for each type of coverage; and

(g) Reserve bases.
(4) Each filing, except prima facie rates, shall be accompanied by the development and justification, including experience and credibility, of the proposed rate together with an opinion by an actuary certifying to the reasonableness of the rate, compliance with applicable laws and this rule chapter, and disclosure of the methods and assumptions used to develop compliance with this rule chapter. Credibility shall be determined according to the standard table in Appendix A.

(5) An actuarial memorandum shall not be required of filings:
(a) In which the insurer proposes to use the prima facie rates without any restrictions, exclusions, or exceptions other than those allowed by this rule chapter, except that a reserve statement signed by a qualified actuary (MAAA) shall be included in each filing.

(b) In which have no impact on rates or reserves and are so certified by the company.

69O FAC 163.0055 | Limits of Coverage; Credit Life

(1) The amount of Credit Life insurance for decreasing gross coverage shall be within the limits in Section 627.679, F.S.

(2) If Credit Life Insurance coverage is written on the actual net debt, the amount of credit life insurance shall not exceed the amount of the loan, and the amount payable at the time of loss shall not be less than the actual net debt, less any payments more than 2 months overdue.

(3)
(a) If a premium is assessed to the debtor on a monthly basis and is based on the actual net debt, then the amount of insurance payable at the time of loss shall be the actual net debt.

(b) When the premium for Credit Life insurance is computed on the basis of a balance which does not include accrued past due interest, then the amount payable at the time of loss shall not be less than the actual net debt less any accrued interest more than 2 months past due.
(4) Credit Life Insurance Coverage may, at the option of the insurer, be written for less than the net debt by the following methods:
(a) The amount of insurance may be the lesser of a stated level amount and the amount determined by subsection (2) of this rule; or

(b) The amount of insurance may be a constant percentage of the amount determined by subsection (2) of this rule.

69O FAC 163.0075 | Term and Evidence of Insurance

69O FAC 163.0076 | Provisions Required in Group Contracts

All Group Credit Disability contracts shall conform to Section 627.558, F.S., and shall contain the substance of the following statutory provisions (as appropriate):
(1) 627.559 - Grace period.

(2) 627.560 - Incontestability.

(3) 627.561 - Application: statements deemed representations.

(4) 627.562 - Insurability.

(5) 627.563 - Misstatement of age.

69O FAC 163.008 | Rights and Treatment of Debtors

(1) In the event of termination, an insurer may, at its option:
(a) Refund unearned premium on a daily pro rata basis, or

(b) Make no charge for credit insurance for the first 15 days of a loan month and charge for a full month for 16 days or more of a loan month.
(2) Voluntary prepayment of indebtedness.
(a) If a debtor prepays the indebtedness other than as a result of death or through a lump sum disability payment, and if a disability claim under such coverage is in progress at the time of prepayment, the amount of refund shall be determined as if the prepayment did not occur until the payment of benefits terminates.

(b) No refund shall be paid during any period of disability for which credit disability benefits are payable. A refund shall be computed as if prepayment occurred at the end of the disability period.
(3) Involuntary prepayment of indebtedness. If an indebtedness is prepaid by the proceeds of a credit life insurance policy covering the debtor or by a lump sum payment of a disability claim under a credit insurance policy covering the debtor, then it shall be the responsibility of the insurer to ensure that the following are paid to the insured debtor, if living, or the beneficiary other than the creditor, named by the debtor, or to the debtor's estate:
(a) In the case of prepayment by the proceeds of a credit life insurance policy, or by the proceeds of a lump sum total and permanent disability benefit or accelerated benefit under credit life coverage, an appropriate refund of the credit disability insurance premium in accordance with Rule 69O-163.003, F.A.C.

(b) In the case of prepayment by a lump sum disability claim, an appropriate refund of any credit life insurance premium in accordance with Rule 69O-163.003, F.A.C.

(c) In the case of paragraph (a) or (b), above, the amount of the benefits in excess of the amount required to repay the indebtedness after reducing the indebtedness by any unearned interest or finance charges.

(d)
1. The refund of unearned premium shall be calculated from the date of the event prepaying the indebtedness.

2. An accelerated death prepayment is considered to be a prepayment due to the credit life insurance benefit.

3. Refunds due for the premiums of the life benefit shall include the cost of the accelerated death benefit.
(4) Termination of group or franchise credit insurance policy.
(a) If a debtor is covered by a group or franchise credit insurance policy providing for the payment of single premiums to the insurer, provision shall be made by the insurer that if the policy is terminated for any reason, insurance coverage with respect to any debtor insured under the policy shall be continued for the entire period for which the single premium has been paid.

(b)
1. If a debtor is covered by a group or franchise credit insurance policy providing for the payment of premiums to the insurer on a monthly outstanding balance basis, the policy shall provide that, if the policy is terminated for any reason, termination notice shall be given to the insured debtor at least 30 days prior to the effective date of termination, except where replacement of the coverage by the same or another insurer in the same or greater amount takes place without lapse of coverage.

2. The notice required to be given in this paragraph shall be the responsibility of the insurer, but may at the option of the insurer be provided through the creditor.
(5) Refinancing the Debt.
(a) If the debt is discharged due to refinancing prior to the scheduled maturity date, the insurance in force shall be terminated at the earlier of:
1. The issuance of any new insurance in connection with the refinanced debt; and

2. The date the debt is discharged.
(b)
1. In all cases of termination prior to scheduled maturity, a refund of all unearned premium or unearned insurance charges paid by the debtor shall be paid or credited to the debtor.

2. In any refinancing of the debt, the effective date of the coverage provided by any policy or certificate shall be deemed to be the first date on which the debtor became insured under the policy with respect to the debt which was refinanced, at least to the extent of the amount and term of the debt outstanding at the time of refinancing the debt.
(6) Remittance of premiums. If the creditor adds identifiable insurance charges or premiums for credit insurance to the indebtedness, and any direct or indirect finance, carrying, credit, or service charge is made to the debtor on such insurance charges or premiums, the creditor must remit and the insurer shall collect such premium within sixty (60) days after it is added to the indebtedness.

(7) Maximum Aggregate Provisions. A provision in an individual policy or group certificate that sets a maximum limit on total claim payments shall apply only to that individual policy or group certificate.

69O FAC 163.009 | Determination of Reasonableness of Benefits in Relation to Premium Charge

(1) Section 627.682, F.S., requires that benefits provided by credit insurance policies must be reasonable in relation to the premium charged. This requirement is satisfied if the premium rate charged develops or may be reasonably expected to develop a loss ratio of claims incurred to premiums earned of not less than:
(a) 55% for credit life insurance, and

(b) 50% for credit disability insurance.

(2) Use of rates not greater than those contained in Rules 69O-163.010 and 69O-163.011, F.A.C., ("prima facie rates") shall be deemed premium rates reasonably expected to develop the required loss ratio. An insurer may only file and use rates with such forms which are greater than prima facie rates upon a satisfactory filing with the Office that the use of such rates will not result on a statewide basis for that insurer of a ratio of claims incurred to premiums earned of less than the required loss ratio.
(3) If an actual rate is greater than the prima facie rates, the actual rate may not exceed the prima facie rates plus the difference between:
(a) Claims which may be reasonably expected, and

(b) The product of the required loss ratio and the prima facie rate set forth for the coverage being provided.
(4) When some rates are based on subsection (1) above and others on the prima facie rate, the expected loss ratios of statewide business must meet the minimum loss ratio standard in subsection (1) above.

(5) Nonstandard Coverage. If any insurer files for approval of any form providing coverage more restrictive than that described in Rules 69O-163.010 and 69O-163.011, F.A.C., the insurer shall make a filing to demonstrate to the satisfaction of the Office that the premium rates to be charged for such restricted coverage comply with subsection (1) above or, are less than or equal to rates which are actuarially equivalent to the prima facie rates.

(6) Any deviation from prima facie rates shall require numerical and written justification. The numerical information shall be displayed as illustrated in Form OIR-B1-2213, Appendix A, Illustrative Experience Exhibit, effective 10/18, hereby incorporated by reference and available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-10584, and submitted electronically via the Office's Filing Assembly Submission System (FASS) at https://iPortal.fldfs.com/ifile/fass/default.asp.

69O FAC 163.010 | Credit Life Insurance Rates

(1) Rates for decreasing gross coverage shall not be greater than as set forth in paragraphs (a) and (b) below. Paragraph (c) refers to premium rates for other types of coverage, either alone or in combination with the type of coverages applicable to paragraphs (a) and (b).
(a) If premiums are payable on a monthly outstanding balance basis, $0.69 for single life coverage; $1.21 for joint life coverage per month per $1,000 of outstanding insured indebtedness.

(b) If premiums are payable on a single premium basis:
Single Premium Rate Per $100 Per Year of Initial Insured
Coverage TypeIndebtedness
Single Decreasing Life$0.44
Joint Decreasing Life$0.77
(c) If premiums are payable on a single premium basis when the benefit provided is level term:
Single Premium Rate Per $100 Per Year of Initial Insured
Coverage TypeIndebtedness
Single Level Life$0.82
Joint Level Life$1.43
(d) Premiums charged for dismemberment insurance in the amount of life insurance in force shall not exceed 10% of the amounts specified above.

(e) If the coverages provided are other than those described in subsection (1) above, rates for such coverages shall be actuarially equivalent with the rates provided in subsection (1).

(f) The prima facie rate for accelerated death benefit coverage is:
1. For single premium, decreasing term coverage $.03/$100/year,

2. For single premium, level term coverage $.05/$100/year,

3. For single premium, decreasing term joint life coverage $.06/$100/year,

4. For single premium level term joint life coverage $.08/$100/year.
(2) The premium rates in subsection (1), above, shall apply to policies providing credit life insurance to be issued with or without evidence of insurability, to be offered to all eligible debtors, and containing:
(a) No exclusions other than suicide within 6 months of the incurred indebtedness; and

(b) Either no age restrictions or age restrictions making ineligible for coverage debtors 71 or over at the time the indebtedness is incurred.

(c) However, the coverage shall be provided, at a minimum, until the earlier of the maturity date of the loan or the loan anniversary at age 71. Where loans are in the form of revolving credit arrangements, an insurer may terminate coverage when the debtor attains the age 71.

69O FAC 163.011 | Credit Disability Insurance Rates

(1) Credit disability insurance premium rates for the insured portion of an indebtedness repayable in equal monthly installments, where the insured portion of the indebtedness decreases uniformly by the amount of the monthly installment paid, shall not be greater than in paragraphs (a) and (b). Paragraphs (c), (d) and (e) refer to premium rates for other types of coverages either alone or in combination with the type of coverages applicable to paragraphs (a) and (b).
(a) If premiums are payable on a single-premium basis for the duration of the coverage:
TABLE I
No. of months in which indebtedness is repayable14-Day30-Day7-Day14-Day30-Day
Non-RetroactiveNon-RetroactiveRetroactiveRetroactiveRetroactive
6 or less$0.65$0.29$1.18$1.04$0.84
7-120.90.581.411.261.09
13-181.170.861.641.501.34
19-241.421.151.871.731.58
25-301.691.442.111.961.82
31-361.941.732.342.192.06
37-482.272.162.672.482.38
49-602.532.382.952.702.62
61-72*2.742.623.182.902.82
73-84*2.892.783.343.032.96
85-96*3.012.913.473.143.07
97-108*3.0933.573.213.15
109-120*3.163.083.643.273.22
Per month for terms exceeding 120 months0.02420.02370.0278.0246.0246
(b) If premiums are paid on the basis of a premium rate per month per thousand of outstanding insured indebtedness, these premiums shall be computed according to the formula: OPn=(20XSPn) / (n + 1) using a rate no less than the 24 month rate in Table I above. A company may submit a different formula for approval which produces rates actuarially equivalent to the single premium rates in Table I:
Where
SPn
Single Premium Rate per $100 of initial insured indebtedness repayable in equal monthly installments (Table I).

The Single Premium Rate shall not be less than the 19-24 month rate for the appropriate coverage.

OPn
Monthly Outstanding Balance Premium Rate per $1,000.
n
Original repayment period, in months.
(c) Coverage which provides a constant maximum indemnity for a given period of time shall use rates no greater than those rates which are actuarially equivalent to the rates in paragraph (a) or (b).

(d) If the coverages provided are other than those described in this subsection (1), rates for such coverages shall be actuarially equivalent to the rates provided in paragraph (a), (b) or (c).

(e) Joint coverage rates shall be no greater than 175% of the specific rate for that type of coverage.

(f) The monthly outstanding balance rate for credit disability insurance may be either a term specified rate or may be a single composite term rate applicable to all insured loans.
(2) The premium rates in subsection (1) shall apply to policies providing credit disability insurance to be issued with or without evidence of insurability, to be offered to all eligible debtors, and containing:
(a)
1. No provision excluding or denying a claim for disability resulting from pre-existing conditions, except for those conditions for which the insured debtor received medical advice, diagnosis, or treatment within six months preceding the effective date of the debtor's coverage, and which caused loss within the 6 months following the effective date of coverage;

2. Disability commencing after 6 months following the effective date of coverage resulting from the condition shall be covered.

3. Coverage with no pre-existing provision limitation shall result in an additional premium of 10% of the amounts shown in subsection (1), above.
(b) No other provision which excludes or restricts liability in the event of disability caused in a specific manner, except that it may contain provisions excluding or restricting coverage for intentionally self-inflicted injuries and normal pregnancy.

(c) No provision which requires that the debtor be employed more than thirty (30) hours per week in order to be eligible for insurance coverage.

(d) No age restrictions, or only age restrictions making ineligible for coverage debtors 66 or over at the time the indebtedness is incurred.

(e) However, coverage shall be provided, at a minimum, until the earlier of the maturity date of the loan or the loan anniversary at age 66. Where loans are in the form of revolving credit arrangements, an insurer may terminate coverage when the debtor attains the age 66.

(f) A daily benefit equal in amount to one-thirtieth of the monthly benefit payable under the policy for the indebtedness.

(g)
1. A definition of "disability" which provides that during the first 12 months of disability the insured shall be unable to perform the duties of his occupation at the time the disability occurred, and thereafter the duties of any occupation for which the insured is reasonably fitted by education, training or experience.

2. This paragraph shall not apply to lump sum disability coverage.

69O FAC 163.013 | Effective Date

69O-164 | Valuation and Nonforfeiture

69O FAC 164.010 | Universal Life Valuation and Nonforfeiture

(1) Scope.

This rule encompasses all universal life insurance policies except variable contracts as defined under Section 627.8015(2), F.S. This rule is effective July 1, 1994, for policies issued on and after that date. Except for sub-subparagraph (3)(a)2.b. and subsection (4), this rule will also apply to policies issued prior to July 1, 1994. Any insurer which, as of July 1, 1994, is holding reserves on universal life policies which are less than those produced by the methods defined in subsection (3) shall submit a plan to the Office for its approval no later than September 30, 1994 outlining the procedure which the company will use to bring its universal life reserves into compliance with this rule. The transition from the reserves actually held to the reserves required by this rule shall begin no later than the calendar quarter ending on March 31, 1995 and shall be completed on or before December 31, 1999.

(2) Definitions.

As used in this rule:
(a) "Cash Surrender Value" means the Net Cash Surrender Value plus any amounts outstanding as policy loans.

(b) "Fixed premium universal life insurance policy" means a universal life insurance policy other than a flexible premium universal life insurance policy.

(c) "Flexible premium universal life insurance policy" means a universal life insurance policy which permits the policyowner to vary, independently of each other, the amount or timing of one or more premium payments or the amount of insurance.

(d) "Net Cash Surrender Value" means the maximum amount payable to the policyowner upon surrender.

(e) "Policy Value" means the amount to which separately identified interest credits and mortality, expense, or other charges are made under a universal life insurance policy.

(f) "Universal life insurance policy" means any individual life insurance policy or rider, or any group master policy or individual certificate, under the provisions of which separately identified interest credits (other than in connection with dividend accumulations, premium deposit funds, or other supplementary accounts) and mortality and expense charges are made to the policy. A universal life insurance policy may provide for other credits and charges, such as charges for the cost of benefits provided by rider.

(3) Valuation.

(a) Requirements. The minimum valuation standard for universal life insurance policies shall be the Commissioners' Reserve Valuation Method, as described below, for such policies, and the tables and interest rates specified below.
1. Commissioners' Reserve Valuation Method. The terminal reserve for the basic policy and any benefits and riders for which premiums are not paid separately as of any policy anniversary shall be equal to the net level premium reserves less (C) and less (D), where:
a. Reserves by the net level premium method shall be equal to ((A) - (B))*r where (A), (B) and "r" are as defined below:
i. (A) is the present value of all future guaranteed benefits at the date of valuation. Future guaranteed benefits are determined by projecting the greater of the Guaranteed Maturity Fund, as defined below, and the policy value, taking into account:
A. Future Guaranteed Maturity Premiums, as defined below, if any, and using all guarantees of interest, mortality, expense deductions, etc. contained in the policy or declared by the insurer; and

B. Any benefits guaranteed in the policy or by declaration which do not depend on the policy value.
ii. (B) is the quantity (PVFB/ax)*ax + t, where
A. PVFB is the present value of all benefits guaranteed at issue assuming future Guaranteed Maturity Premiums are paid by the policyowner and taking into account all guarantees contained in the policy or declared by the insurer. The Guaranteed Maturity Premium for flexible premium universal life insurance policies shall be that level gross premium, paid at issue and periodically thereafter over the period during which premiums are allowed to be paid, which will mature the policy on the latest maturity date, if any, permitted under the policy (otherwise at the highest age in the valuation mortality table), for an amount which is in accordance with the policy structure. The Guaranteed Maturity Premium is calculated at issue based on all policy guarantees at issue (excluding guarantees linked to an external referent). The Guaranteed Maturity Premium for fixed premium universal life insurance policies shall be the premium defined in the policy which at issue provides the minimum policy guarantees.

B. ax and ax + t are present values of an annuity of one per year payable on policy anniversaries beginning at ages x and x + t, respectively, and continuing until the highest attained age at which a premium may be paid under the policy. The letter "x" is defined as the issue age and the letter "t" is defined as the duration of the policy.
iii. The letter "r" is equal to one, unless the policy is a flexible premium policy and the policy value is less than the Guaranteed Maturity Fund, in which case "r" is the ratio of the policy value to the Guaranteed Maturity Fund. The Guaranteed Maturity Fund at any duration is that amount which, together with future Guaranteed Maturity Premiums, will mature the policy based on all policy guarantees at issue.
b. (C) is the quantity ((a) - (b))*(ax + t/a * x)*r where (a) - (b) is as described in subsection 625.121(7), F.S., for the plan of insurance defined at issue by the Guaranteed Maturity Premiums and all guarantees contained in the policy or declared by the insurer. ax + t' ax' and r are defined above.

c. (D) is the sum of any additional quantities analogous to (C) which arise because of structural changes in the policy, with each such quantity being determined on a basis consistent with that of (C) using the maturity date in effect at the time of the change.

d. The Guaranteed Maturity Premium, the Guaranteed Maturity Fund and (B) above shall be recalculated to reflect any structural changes in the policy. This recalculation shall be done in a manner consistent with the descriptions above.
2. Interest and mortality rates. All present values shall be determined using:
a. An interest rate (or rates) specified in Sections 625.121(5) and 625.121(6), F.S., for policies issued in the same year;

b. The mortality rates specified in Section 625.121(5), F.S., for policies issued in the same year; and

c. Any other tables needed to value supplementary benefits provided by a rider which is being valued together with the policy.
(b) Alternative Minimum Reserves.
1. If, in any policy year, the Guaranteed Maturity Premium on any universal life insurance policy is less than the valuation net premium for such policy, calculated by the valuation method actually used in calculating the reserve thereon but using the minimum valuation standards of mortality and rate of interest, the minimum reserve required for such contract shall be equal to the greater of a. or b.:
a. The reserve calculated according to the method, the mortality table, and the rate of interest actually used.

b. The reserve calculated according to the method actually used but using the minimum valuation standards of mortality and rate of interest and replacing the valuation net premium by the Guaranteed Maturity Premium in each policy year for which the valuation net premium exceeds the Guaranteed Maturity Premium.
2. For universal life insurance reserves on a net level premium basis, the valuation net premium is PVFB/ax, and for reserves on the Commissioners Reserve Valuation Method, the valuation net premium is (PVFB/ax) + ((a) - (b))/ax, where PVFB, ax, and (a)-(b) are as defined above.

(4) Nonforfeiture.

(a) Minimum Cash Surrender Values for Flexible Premium Universal Life Insurance Policies. Minimum cash surrender values for flexible premium universal life insurance policies shall be determined separately for the basic policy and any benefits and riders for which premiums are paid separately. The requirements of this subsection pertain to a basic policy and any benefits and riders for which premiums are not paid separately.
1.
a. The minimum cash surrender value (before adjustment for indebtedness and dividend credits) available on a date as of which interest is credited to the policy shall be equal to the accumulation to that date of the premiums paid minus the accumulations to that date of:
i. The benefit charges,

ii. The averaged administrative expense charges for the first policy year and any insurance-increase years,

iii. Actual administrative expense charges for other years,

iv. Initial and additional acquisition expense charges not exceeding the initial or additional expense allowances, respectively,

v. Any service charges actually made (excluding charges for cash surrender or election of a paid-up nonforfeiture benefit), and

vi. Any deductions made for partial withdrawals.
b. All accumulations shall be at the actual rate or rates of interest at which interest credits have been made unconditionally to the policy (or have been made conditionally, but for which the conditions have since been met), and minus any unamortized unused initial and additional expense allowances.

c. Interest on the premiums and on all charges referred to in sub-sub-subparagraphs (i)-(vi) above shall be accumulated from and to such dates as are consistent with the manner in which interest is credited in determining the policy value.
2. The benefit charges shall include the charges made for mortality and any charges made for riders or supplementary benefits for which premiums are not paid separately. If benefit charges are substantially level by duration and develop low or no cash values, then the insurer must provide adequate justification that the cash values are appropriate in relation to the policy's other characteristics.

3. The actual administrative expense charges shall include charges per premium payment, charges per dollar of premium paid, periodic charges per thousand dollars of insurance, periodic per policy charges, and any other charges permitted by the policy to be imposed without regard to the policyowner's request for services.

4. The averaged administrative expense charges for any year shall be those which would have been imposed in that year if the charge rate or rates for each transaction or period within the year had been equal to the arithmetic average of the corresponding charge rates which the policy states will be imposed in policy years two through twenty in determining the policy value.

5. The initial acquisition expense charges shall be the excess of the expense charges, other than service charges, actually made in the first policy year over the averaged administrative expense charges for that year. Additional acquisition expense charges shall be the excess of the expense charges, other than service charges, actually made in an insurance-increase year over the averaged administrative expense charges for that year. An insurance-increase year shall be the year beginning on the date of increase in the amount of insurance by policyowner request (or by the terms of the policy).

6. Service charges shall include charges permitted by the policy to be imposed as the result of a policyowner's request for a service by the insurer (such as the furnishing of future benefit illustrations) or of special transactions.

7. The initial expense allowance shall be the allowance provided by paragraphs (b), (c), and (d) of Section 627.476(6), F.S., or by subparagraphs (a)2. and (a)3. of Section 627.476(9), F.S., as applicable, for a fixed premium, fixed benefit endowment policy with a face amount equal to the initial face amount of the flexible premium universal life insurance policy, with level premiums paid annually until the highest attained age at which a premium may be paid under the flexible premium universal life insurance policy, and maturing on the latest maturity date permitted under the policy, if any, otherwise at the highest age in the valuation mortality table. The unused initial expense allowance shall be the excess, if any, of the initial expense allowance over the initial acquisition expense charges as defined above.

8. If the amount of insurance is subsequently increased upon request of the policyowner (or by the terms of the policy), an additional expense allowance and an unused additional expense allowance shall be determined on a basis consistent with the above and with Section 627.476(9)(e), F.S., using the face amount and the latest maturity date permitted at that time under the policy.

9. The unamortized unused initial expense allowance during the policy year beginning on the policy anniversary at age x + t (where "x" is the same issue age) shall be the unused initial expense allowance multiplied by ax + t/ax where ax + t and ax are present values of an annuity of one per year payable on policy anniversaries beginning at ages x + t and x, respectively, and continuing until the highest attained age at which a premium may be paid under the policy, both on the mortality and interest bases guaranteed in the policy. An unamortized unused additional expense allowance shall be the unused additional expense allowance multiplied by a similar ratio of annuities, with ax replaced by an annuity beginning on the date as of which the additional expense allowance was determined.
(b) Minimum Cash Surrender Values for Fixed Premium Universal Life Insurance Policies. For fixed premium universal life insurance policies, the minimum cash surrender values shall be determined separately for the basic policy and any benefits and riders for which premiums are paid separately. The requirements of this subsection pertain to a basic policy and any benefits and riders for which premiums are not paid separately.
1. The minimum cash surrender value (before adjustment for indebtedness and dividend credits) available on a date as of which interest is credited to the policy shall be equal to ((A) - (B) - (C) - (D)), where:
a. (A) is the present value of all future guaranteed benefits. Future guaranteed benefits are determined by projecting the policy value, taking into account
i. Future premiums, if any, and using all guarantees of interest, mortality, expense deductions, etc., contained in the policy or declared by the insurer; and

ii. Any benefits guaranteed in the policy or by declaration which do not depend on the policy value.
b. (B) is the present value of future adjusted premiums. The adjusted premiums are calculated as described in Section 627.476(6) or in 627.476(9)(a), F.S., as applicable. If Section 627.476(9)(a), F.S., is applicable, the nonforfeiture net level premium is equal to the quantity PVFB/ax, where PVFB is the present value of all benefits guaranteed at issue assuming future premiums are paid by the policyowner and all guarantees contained in the policy or declared by the insurer, and ax is the present value of an annuity of one per year payable on policy anniversaries beginning at age x and continuing until the highest attained age at which a premium may be paid under the policy.

c. (C) is the present value of any quantities analogous to the nonforfeiture net level premium which arise because of guarantees declared by the insurer after the issue date of the policy. ax shall be replaced by an annuity beginning on the date as of which the declaration became effective and payable until the end of the period covered by the declaration.

d. (D) is the sum of any quantities analogous to (B) which arise because of structural changes in the policy.
2. All present values shall be determined using
a. An interest rate (or rates) specified by Sections 627.476(8) and 627.476(9), F.S., for policies issued in the same year, and

b. The mortality rates specified by Sections 627.476(8) and (9), F.S., for policies issued in the same year or contained in such other table as may be approved by the Commissioner for this purpose.
(c) Minimum Paid-Up Nonforfeiture Benefits.
1. If a universal life insurance policy provides for the optional election of a paid-up nonforfeiture benefit, it shall be such that its present value shall be at least equal to the net cash surrender value provided for by the policy on the effective date of the election. The present value shall be based on mortality and interest standards at least as favorable to the policyowner as:
a. In the case of a flexible premium universal life insurance policy, the mortality and interest basis guaranteed in the policy for determining the policy value; or

b. In the case of a fixed premium policy the mortality and interest standards permitted for paid-up nonforfeiture benefits by Sections 627.476(8) and 627.476(9), F.S.
2. In lieu of the paid-up nonforfeiture benefit, the insurer may substitute, upon proper request not later than sixty days after the due date of the premium in default, an actuarially equivalent alternative paid-up nonforfeiture benefit which provides a greater amount or longer period of death benefits, or, if applicable, a greater amount or earlier payment of endowment benefits.

69O FAC 164.020 | Valuation of Life Insurance Policies

(1) Purpose.

(a) The purpose of this rule is to provide:
1. Tables of select mortality factors, identified as Appendix to Rule 69O-164.020, F.A.C., which is hereby adopted and incorporated by reference, and rules for their use;

2. Rules concerning a minimum standard for the valuation of plans with nonlevel premiums or benefits; and

3. Rules concerning a minimum standard for the valuation of plans with secondary guarantees.
(b) The method for calculating basic reserves defined in this rule will constitute the Commissioners' Reserve Valuation Method for policies to which this rule is applicable.

(2)

(a) This rule is consistent with Appendix A-830 of the NAIC Accounting Practices and Procedures Manual as adopted in Rule 69O-137.001, F.A.C.

(b) This rule applies to policies issued during calendar year 2000 in addition to those issued on or after January 1, 2001.

(3) Applicability.

This rule shall apply to all life insurance policies, with or without nonforfeiture values, issued on or after January 1, 2000, subject to the following exceptions and conditions:
(a) Exceptions.
1. This rule shall not apply to any individual life insurance policy issued on or after the effective date of this rule if the policy is issued in accordance with and as a result of the exercise of a reentry provision contained in the original life insurance policy of the same or greater face amount, issued before January 1, 2000, that guarantees the premium rates of the new policy. This rule also shall not apply to subsequent policies issued as a result of the exercise of such a provision, or a derivation of the provision, in the new policy.

2. This rule shall not apply to any universal life policy that meets all the following requirements:
a. Secondary guarantee period, if any, is 5 years or less;

b. Specified premium for the secondary guarantee period is not less than the net level reserve premium for the secondary guarantee period based on the CSO valuation tables as defined in paragraph (4)(f), or the ultimate mortality tables specified in subsection 69O-162.201(6), F.A.C., and the applicable valuation interest rate; and

c. The initial surrender charge is not less than 100 percent of the first year annualized specified premium for the secondary guarantee period.
3. This rule shall not apply to any variable life insurance policy that provides for life insurance the amount or duration of which varies according to the investment experience of any separate account or accounts.

4. This rule shall not apply to any variable universal life insurance policy that provides for life insurance the amount or duration of which varies according to the investment experience of any separate account or accounts.

5. This rule shall not apply to a group life insurance certificate unless the certificate provides for a stated or implied schedule of maximum gross premiums required in order to continue coverage in force for a period in excess of one year.
(b) Conditions.
1. Calculation of the minimum valuation standard for policies with guaranteed nonlevel gross premiums or guaranteed nonlevel benefits (other than universal life policies), or both, shall be in accordance with the provisions of subsection (6).

2. Calculation of the minimum valuation standard for flexible premium and fixed premium universal life insurance policies that contain provisions resulting in the ability of a policyholder to keep a policy in force over a secondary guarantee period shall be in accordance with the provisions of subsection (7).

(4) Definitions.

For purposes of this rule:
(a) "Basic reserves" means reserves calculated in accordance with Section 625.121(7), F.S.

(b)
1. "Contract segmentation method" means the method of dividing the period from issue to mandatory expiration of a policy into successive segments, with the length of each segment being defined as the period from the end of the prior segment (from policy inception for the first segment) to the end of the latest policy year as determined below. All calculations are made using the 1980 CSO valuation tables, as defined in paragraph (f), or the mortality tables specified in subsection 69O-162.201(6), F.A.C., and, if elected, the optional minimum mortality standard for deficiency reserves stipulated in paragraph (5)(b) of this rule.

2. The length of a particular contract segment shall be set equal to the minimum of the value t for which Gt is greater than Rt (if Gt never exceeds Rt the segment length is deemed to be the number of years from the beginning of the segment to the mandatory expiration date of the policy), where Gt and Rt are defined as follows:
Gt=GPx+k+t
GPx+k+t-1
where:
x
original issue age;
k
the number of years from the date of issue to the beginning of the segment;
t
1, 2, ...; t is reset to 1 at the beginning of each segment;
GPx+k+t-1
Guaranteed gross premium per thousand of face amount for year t of the segment, ignoring policy fees only if level for the premium paying period of the policy.
qx+k+t

Rt = __________; however, Rt may be increased or decreased by one

qx+k+t-1 percent in any policy year, at the company's option, but Rt shall not be less than one;

where:
x, k and t are as defined above, and

qx+k+t-1 = valuation mortality rate for deficiency reserves in policy year k+t but using the mortality of Section 5B(2) if Section 5B(3) is elected for deficiency reserves.
However, if GPx+k+t is greater than 0 and GPx+k+t-1 is equal to 0, Gt shall be deemed to be 1000. If GPx+k+t and GPx+k+t-1 are both equal to 0, Gt shall be deemed to be 0.
(c) "Deficiency reserves" means the excess, if greater than zero, of
1. Minimum reserves calculated in accordance with Section 625.121(11), F.S., over

2. Basic reserves.
(d) "Guaranteed gross premiums" means the premiums under a policy of life insurance that are guaranteed and determined at issue.

(e) "Maximum valuation interest rates" means the interest rates defined in Section 625.121(6), F.S., (Computation of Minimum Standard by Calendar Year of Issue) that are to be used in determining the minimum standard for the valuation of life insurance policies.

(f) "1980 CSO valuation tables" means the Commissioners' 1980 Standard Ordinary Mortality Table (1980 CSO Table) without 10-year selection factors, incorporated into the 1980 amendments to the NAIC Standard Valuation Law, and variations of the 1980 CSO Table approved by the NAIC, such as the smoker and nonsmoker versions approved in December 1983.

(g) "Scheduled gross premium" means the smallest illustrated gross premium at issue for other than universal life insurance policies. For universal life insurance policies, scheduled gross premium means the smallest specified premium described in subparagraph (7)(a)3., if any, or else the minimum premium described in subparagraph (7)(a)4.

(h)
1. "Segmented reserves" means reserves, calculated using segments produced by the contract segmentation method, equal to the present value of all future guaranteed benefits less the present value of all future net premiums to the mandatory expiration of a policy, where the net premiums within each segment are a uniform percentage of the respective guaranteed gross premiums within the segment. The uniform percentage for each segment is such that, at the beginning of the segment, the present value of the net premiums within the segment equals:
a. The present value of the death benefits within the segment, plus

b. The present value of any unusual guaranteed cash value (see paragraph (6)(d)) occurring at the end of the segment, less

c. Any unusual guaranteed cash value occurring at the start of the segment, plus

d. For the first segment only, the excess of the Item (I) over Item (II), as follows:
(I) A net level annual premium equal to the present value at the date of issue of the benefits provided for in the first segment after the first policy year; divided by the present value at the date of issue of an annuity of 1 per year payable on the first and each subsequent anniversary within the first segment on which a premium falls due. However, the net level annual premium shall not exceed the net level annual premium on the 19 year premium whole life plan of insurance of the same renewal year equivalent level amount at an age one year higher than the age at issue of the policy.

(II) A net 1 year term premium for the benefits provided for in the first policy year.
2. The length of each segment is determined by the "contract segmentation method," as defined in this rule.

3. The interest rates used in the present value calculations for any policy shall not exceed the maximum valuation interest rate, determined with a guarantee duration equal to the sum of the lengths of all segments of the policy.

4. For both basic reserves and deficiency reserves computed by the segmented method, present values shall include future benefits and net premiums in the current segment and in all subsequent segments.
a. The segmentation requirement shall not be limited to plans with no cash surrender values; otherwise companies could avoid segmentation entirely by designing policies with minimal (positive) cash values.

b. Segmentation for plans with cash surrender values shall be based solely upon gross premium levels.

c. Basing segmentation upon the level of cash surrender values introduces complications because of the inter-relationship between minimum cash surrender values and gross premium patterns.

d. The requirements of this rule relating to reserves for plans with unusual cash values and to reserves if cash values exceed calculated reserves serve to link required reserves and cash surrender values.

e. The calculation of segmented reserves shall not be linked to the occurrence of a positive unitary terminal reserve at the end of a segment.

f. The requirement of this rule to hold the greater of the segmented reserve or the unitary reserve eliminates the need for any linkage.
(i) "Tabular cost of insurance" means the net single premium at the beginning of a policy year for 1 year term insurance in the amount of the guaranteed death benefit in that policy year.

(j) "Ten-year select factors" means the select factors adopted with the 1980 amendments to the NAIC Standard Valuation Law.

(k)
1. "Unitary reserves" means the present value of all future guaranteed benefits less the present value of all future modified net premiums, where:
a. Guaranteed benefits and modified net premiums are considered to the mandatory expiration of the policy; and

b. Modified net premiums are a uniform percentage of the respective guaranteed gross premiums, where the uniform percentage is such that at issue the present value of the net premiums equals the present value of all death benefits and pure endowments, plus the excess of Item (I) over Item (II), as follows:
(I) A net level annual premium equal to the present value at the date of issue of the benefits provided for after the first policy year, divided by the present value, at the date of issue, of an annuity of one per year payable on the first and each subsequent anniversary of the policy on which a premium falls due. However, the net level annual premium shall not exceed the net level annual premium on the 19 year premium whole life plan of insurance of the same renewal year equivalent level amount at an age 1 year higher than the age at issue of the policy.

(II) A net 1 year term premium for the benefits provided for in the first policy year.
2. The interest rates used in the present value calculations for any policy shall not exceed the maximum valuation interest rate, determined with a guarantee duration equal to the length from issue to the mandatory expiration of the policy.
(l) "Universal life insurance policy" means any individual life insurance policy under the provisions of which separately identified interest credits (other than in connection with dividend accumulations, premium deposit funds, or other supplementary accounts) and mortality or expense charges are made to the policy.

(5) General Calculation Requirements for Basic Reserves and Premium Deficiency Reserves.

(a) At the election of the insurer for any one or more specified plans of life insurance, the minimum mortality standard for basic reserves may be calculated using the 1980 CSO valuation tables with select mortality factors or the mortality tables specified in subsection 69O-162.201(6), F.A.C. If select mortality factors are elected for use with the 1980 CSO valuation tables, they may be:
1. The 10 year select mortality factors incorporated into the 1980 amendments to the NAIC Standard Valuation Law; or

2. The select mortality factors in the Appendix.
(b) Deficiency reserves, if any, are calculated for each policy as the excess, if greater than zero, of the quantity A over the basic reserve.
1. The quantity A is obtained by recalculating the basic reserve for the policy using guaranteed gross premiums instead of net premiums when the guaranteed gross premiums are less than the corresponding net premiums.

2. At the election of the insurer for any one or more specified plans of insurance, the quantity A and the corresponding net premiums used in the determination of quantity A may be based upon the 1980 CSO valuation tables with select mortality factors or the mortality tables specified in subsection 69O-162.201(6), F.A.C. If select mortality factors are elected for use with the 1980 CSO valuation tables, they may be:
a. The 10 year select mortality factors incorporated into the 1980 amendments to the NAIC Standard Valuation Law;

b. The select mortality factors in the Appendix of this rule;

c. For durations in the first segment, X percent of the select mortality factors in the Appendix, subject to the following:
(I) X may vary by policy year, policy form, underwriting classification, issue age, or any other policy factor expected to affect mortality experience;

(II) X is such that, when using the valuation interest rate used for basic reserves, item (A) is greater than or equal to Item (B);
(A) The actuarial present value of future death benefits, calculated using the mortality rates resulting from the application of X;

(B) The actuarial present value of future death benefits calculated using anticipated mortality experience without recognition of mortality improvement beyond the valuation date;
(III) X is such that the mortality rates resulting from the application of X are at least as great as the anticipated mortality experience, without recognition of mortality improvement beyond the valuation date, in each of the first 5 years after the valuation date;

(IV) The appointed actuary shall increase X at any valuation date where it is necessary to continue to meet all the requirements of subparagraph (b)3.;

(V) The appointed actuary may decrease X at any valuation date as long as X continues to meet all the requirements of subparagraph (b)3.; and

(VI) The appointed actuary shall specifically take into account the adverse effect on expected mortality and lapsation of any anticipated or actual increase in gross premiums.

(VII) If X is less than 100 percent at any duration for any policy, the following requirements shall be met:
(A) The appointed actuary shall annually prepare an actuarial opinion and memorandum for the company in conformance with the requirements of rule Chapter 69O-138, F.A.C.; and

(B) The appointed actuary shall annually opine for all policies subject to this rule as to whether the mortality rates resulting from the application of X meet the requirements of subparagraph (b)2.c.
I. The opinion shall be supported by an actuarial report, subject to appropriate Actuarial Standards of Practice promulgated by the Actuarial Standards Board of the American Academy of Actuaries.

II. The X factors shall reflect anticipated future mortality without recognition of mortality improvement beyond the valuation date, taking into account relevant emerging experience.
(C) The appointed actuary shall disclose, in the Regulatory Asset Adequacy Issues Summary, the impact of the insufficiency of assets to support the payment of benefits and expenses and the establishment of statutory reserves during one or more interim periods;
(c) This subsection applies to both basic reserves and deficiency reserves. Any set of select mortality factors may be used only for the first segment. However, if the first segment is less than 10 years, the appropriate 10 year select mortality factors incorporated into the 1980 amendments to the NAIC Standard Valuation Law may be used thereafter through the tenth policy year from the date of issue.

(d) In determining basic reserves or deficiency reserves, guaranteed gross premiums without policy fees may be used where the calculation involves the guaranteed gross premium, but only if the policy fee is a level dollar amount after the first policy year. In determining deficiency reserves, policy fees may be included in guaranteed gross premiums even if not included in the actual calculation of basic reserves.

(e) Reserves for policies that have changes to guaranteed gross premiums, guaranteed benefits, guaranteed charges, or guaranteed credits that are unilaterally made by the insurer after issue and that are effective for more than 1 year after the date of the change shall be the greatest of the following:
1. Reserves calculated ignoring the guarantee;

2. Reserves assuming the guarantee was made at issue; and

3. Reserves assuming that the policy was issued on the date of the guarantee.
(f) The company shall document the extent of the adequacy of reserves for material blocks, including policies issued prior to the effective date of this rule. The documentation shall include:
1. A demonstration of the extent to which aggregation with immaterial blocks of business is relied upon in the formation of the appointed actuary opinion pursuant to and consistent with the requirements of Chapter 69O-138, F.A.C.; and

2. A definition of material.

(6) Calculation of Minimum Valuation Standard for Policies with Guaranteed Nonlevel Gross Premiums or Guaranteed Nonlevel Benefits (Other than Universal Life Policies).

(a) Basic Reserves. Basic reserves shall be calculated as the greater of the segmented reserves and the unitary reserves. Both the segmented reserves and the unitary reserves for any policy shall use the same valuation mortality table and selection factors. At the option of the insurer in calculating segmented reserves and net premiums either of the adjustments described in subparagraph 1. or 2. below may be made:
1. Treat the unitary reserve, if greater than zero, applicable at the end of each segment as a pure endowment and subtract the unitary reserve, if greater than zero, applicable at the beginning of each segment from the present value of guaranteed life insurance and endowment benefits for each segment.

2. Treat the guaranteed cash surrender value, if greater than zero, applicable at the end of each segment as a pure endowment; and subtract the guaranteed cash surrender value, if greater than zero, applicable at the beginning of each segment from the present value of guaranteed life insurance and endowment benefits for each segment.
(b) Deficiency Reserves.
1. The deficiency reserve at any duration shall be calculated:
a. On a unitary basis if the corresponding basic reserve determined by paragraph (a) is unitary;

b. On a segmented basis if the corresponding basic reserve determined by paragraph (a) is segmented; or

c. On the segmented basis if the corresponding basic reserve determined by paragraph (a) is equal to both the segmented reserve and the unitary reserve.
2. This subsection shall apply to any policy for which the guaranteed gross premium at any duration is less than the corresponding modified net premium calculated by the method used in determining the basic reserves, but using the minimum valuation standards in paragraph (5)(b) and rate of interest.

3. Deficiency reserves, if any, shall be calculated for each policy as the excess if greater than zero, for the current and all remaning periods, of the quantity A over the basic reserve, where A is obtained as indicated in paragraph (5)(b).

4. For deficiency reserves determined on a segmented basis, the quantity A is determined using segment lengths equal to those determined for segmented basic reserves.
(c) Minimum Value.
1. Basic reserves shall not be less than the tabular cost of insurance for the balance of the policy year if mean reserves are used.

2. Basic reserves shall not be less than the tabular cost of insurance for the balance of the current modal period or to the paid-to-date, if later, but not beyond the next policy anniversary, if mid-terminal reserves are used.

3. The tabular cost of insurance shall use the same valuation mortality table and interest rates as that used for the calculation of the segmented reserves.

4. Mortality tables specified in subsection 69O-162.201(6), F.A.C., may be used.

5. However, if select mortality factors are used with the 1980 CSO valuation tables, they shall be the 10 year select factors incorporated into the 1980 amendments of the NAIC Standard Valuation Law.

6. In no case may total reserves (including basic reserves, deficiency reserves and any reserves held for supplemental benefits that would expire upon contract termination) be less than the amount that the policyowner would receive (including the cash surrender value of the supplemental benefits, if any, referred to above), exclusive of any deduction for policy loans, upon termination of the policy.
(d) Unusual Pattern of Guaranteed Cash Surrender Values.
1. For any policy with an unusual pattern of guaranteed cash surrender values, the reserves actually held prior to the first unusual guaranteed cash surrender value shall not be less than the reserves calculated by treating the first unusual guaranteed cash surrender value as a pure endowment and treating the policy as an n year policy providing term insurance plus a pure endowment equal to the unusual cash surrender value, where n is the number of years from the date of issue to the date the unusual cash surrender value is scheduled.

2. The reserves actually held subsequent to any unusual guaranteed cash surrender value shall not be less than the reserves calculated by treating the policy as an n year policy providing term insurance plus a pure endowment equal to the next unusual guaranteed cash surrender value, and treating any unusual guaranteed cash surrender value at the end of the prior segment as a net single premium, where:
a. n is the number of years from the date of the last unusual guaranteed cash surrender value prior to the valuation date to the earlier of:
(I) The date of the next unusual guaranteed cash surrender value, if any, that is scheduled after the valuation date; or

(II) The mandatory expiration date of the policy; and
b. The net premium for a given year during the n year period is equal to the product of the net to gross ratio and the respective gross premium; and

c. The net to gross ratio is equal to Item I divided by Item II as follows:
(I)
(A) The present value at the beginning of the n year period of death benefits payable during the n year period, plus

(B) The present value at the beginning of the n year period of the next unusual guaranteed cash surrender value, if any, minus

(C) The amount of the last unusual guaranteed cash surrender value, if any, scheduled at the beginning of the n year period.
(II) The present value at the beginning of the n year period of the scheduled gross premiums payable during the n year period.
3. For purposes of this subsection, a policy is considered to have an unusual pattern of guaranteed cash surrender values if any future guaranteed cash surrender value exceeds the prior year's guaranteed cash surrender value by more than the sum of:
a. 110 percent of the scheduled gross premium for that year;

b. 110 percent of one year's accrued interest on the sum of the prior year's guaranteed cash surrender value and the scheduled gross premium using the nonforfeiture interest rate used for calculating policy guaranteed cash surrender values; and

c. 5 percent of the first policy year surrender charge, if any.
(e) Optional Exemption for Yearly Renewable Term Reinsurance. At the option of the company, the following approach for reserves on YRT reinsurance may be used:
1. Calculate the valuation net premium for each future policy year as the tabular cost of insurance for that future year.

2. Basic reserves shall never be less than the tabular cost of insurance for the appropriate period, as defined in paragraph (c).

3. Deficiency reserves.
a. For each policy year, calculate the excess, if greater than zero, of the valuation net premium over the respective maximum guaranteed gross premium.

b. Deficiency reserves shall never be less than the sum of the present values, at the date of valuation, of the excesses determined in accordance with paragraph (a) above.
4. For purposes of this subsection, the calculations use the maximum valuation interest rate and the 1980 CSO mortality tables with or without 10 year select mortality factors or the mortality tables specified in subsection 69O-162.201(6), F.A.C.

5. A reinsurance agreement shall be considered YRT reinsurance for purposes of this subsection if only the mortality risk is reinsured.

6. If the assuming company chooses this optional exemption, the ceding company's reinsurance reserve credit shall be limited to the amount of reserve held by the assuming company for the affected policies.
(f) Optional Exemption for Attained-Age-Based Yearly Renewable Term Life Insurance Policies. At the option of the company, the following approach for reserves for attained-age-based YRT life insurance policies may be used:
1. Calculate the valuation net premium for each future policy year as the tabular cost of insurance for that future year.

2. Basic reserves shall never be less than the tabular cost of insurance for the appropriate period, as defined in paragraph (6)(c).

3. Deficiency reserves.
a. For each policy year, calculate the excess, if greater than zero, of the valuation net premium over the respective maximum guaranteed gross premium.

b. Deficiency reserves shall never be less than the sum of the present values at the date of valuation of the excesses determined in accordance with sub-subparagraph a. above.
4. For purposes of this subsection, the calculations use the maximum valuation interest rate and the 1980 CSO valuation tables with or without 10 year select mortality factors or the mortality tables specified in subsection 69O-162.201(6), F.A.C.

5. A policy shall be considered an attained-age-based YRT life insurance policy for purposes of this subsection if:
a. The premium rates on both the initial current premium scale and the guaranteed maximum premium scale are based upon the attained age of the insured such that the rate for any given policy at a given attained age of the insured is independent of the year the policy was issued; and

b. The premium rates on both the initial current premium scale and the guaranteed maximum premium scale are the same as the premium rates for policies covering all insureds of the same sex, risk class, plan of insurance, and attained age.
6. For policies that become attained-age-based YRT policies after an initial period of coverage, the approach of this subsection may be used after the initial period if:
a. The initial period is constant for all insureds of the same sex, risk class, and plan of insurance; or

b. The initial period runs to a common attained age for all insureds of the same sex, risk class, and plan of insurance; and

c. After the initial period of coverage, the policy meets the conditions of subparagraph 5. above.
7. If this election is made, this approach shall be applied in determining reserves for all attained-age-based YRT life insurance policies issued on or after the effective date of this rule.
(g) Exemption from Unitary Reserves for Certain n-Year Renewable Term Life Insurance Polices. Unitary basic reserves and unitary deficiency reserves need not be calculated for a policy if the following conditions are met:
1. The policy consists of a series of n-year periods including the first period and all renewal periods where n is the same for each period, except that for the final renewal period, n may be truncated or extended to reach the expiry age, provided that:
a. This final renewal period is less than 10 years and less than twice the size of the earlier n-year periods, and

b. For each period, the premium rates on both the initial current premium scale and the guaranteed maximum premium scale are level;
2. The guaranteed gross premiums in all n-year periods are not less than the corresponding net premiums based upon the 1980 CSO Table with or without the 10 year select mortality factors or the mortality tables specified in subsection 69O-162.201(6), F.A.C.; and

3. There are no cash surrender values in any policy year.
(h) Exemption from Unitary Reserves for Certain Juvenile Policies. Unitary basic reserves and unitary deficiency reserves need not be calculated for a policy if the following conditions are met, based upon the initial current premium scale at issue:
1. At issue, the insured is age 24 or younger;

2. Until the insured reaches the end of the juvenile period, which shall occur at or before age 25, the gross premiums and death benefits are level, and there are no cash surrender values; and

3. After the end of the juvenile period, gross premiums are level for the remainder of the premium paying period, and death benefits are level for the remainder of the life of the policy.

(7) Calculation of Minimum Valuation Standard for Flexible Premium and Fixed Premium Universal Life Insurance Policies that Contain Provisions Resulting in the Ability of a Policyowner to Keep a Policy in Force Over a Secondary Guarantee Period.

(a) General.
1. Policies with a secondary guarantee include:
a. A policy with a guarantee that the policy will remain in force at the original schedule of benefits, subject only to the payment of specified premiums;

b. A policy in which the minimum premium at any duration is less than the corresponding 1 year valuation premium, calculated using the maximum valuation interest rate and the 1980 CSO valuation tables with or without 10 year select mortality factors or the mortality tables specified in subsection 69O-162.201(6), F.A.C.; or

c. A policy with any combination of subparagraph a. and b.
2. A secondary guarantee period is the period for which the policy is guaranteed to remain in force subject only to a secondary guarantee.
a. When a policy contains more than one secondary guarantee, the minimum reserve shall be the greatest of the respective minimum reserves at that valuation date of each unexpired secondary guarantee, ignoring all other secondary guarantees.

b. Secondary guarantees that are unilaterally changed by the insurer after issue shall be considered to have been made at issue.

c. Reserves described in paragraphs (b) and (c) below shall be recalculated from issue to reflect these changes.
3. Specified premiums mean the premiums specified in the policy, the payment of which guarantees that the policy will remain in force at the original schedule of benefits but which otherwise would be insufficient to keep the policy in force in the absence of the guarantee if maximum mortality and expense charges and minimum interest credits were made and any applicable surrender charges were assessed.

4.
a. For purposes of this section, the minimum premium for any policy year is the premium that, when paid into a policy with a zero account value at the beginning of the policy year, produces a zero account value at the end of the policy year.

b. The minimum premium calculation shall use the policy cost factors (including mortality charges, loads, and expense charges) and the interest crediting rate which are all guaranteed at issue.
5.
a. The 1 year valuation premium means the net 1 year premium based upon the original schedule of benefits for a given policy year.

b. The 1 year valuation premiums for all policy years are calculated at issue.

c. The select mortality factors defined in subparagraphs (5)(b)2., 3., and 4. shall not be used to calculate the 1 year valuation premiums.
6. The 1 year valuation premium shall reflect the frequency of fund processing, as well as the distribution of deaths assumption employed in the calculation of the monthly mortality charges to the fund.
(b) Basic Reserves for the Secondary Guarantees.
1. Basic reserves for the secondary guarantees shall be the segmented reserves for the secondary guarantee period.

2. In calculating the segments and the segmented reserves, the gross premiums shall be set equal to the specified premiums, if any, or otherwise to the minimum premiums that keep the policy in force.

3. The segments will be determined according to the contract segmentation method as defined in paragraph (4)(b).
(c) Deficiency Reserves for the Secondary Guarantees. Deficiency reserves, if any, for the secondary guarantees shall be calculated for the secondary guarantee period in the same manner as described in paragraph (6)(b) with gross premiums set equal to the specified premiums, if any, or otherwise to the minimum premiums that keep the policy in force.

(d) Minimum Reserves. The minimum reserves during the secondary guarantee period are the greater of:
1. The basic reserves for the secondary guarantee plus the deficiency reserve, if any, for the secondary guarantees; or

2. The minimum reserves required by Rule 69O-164.010, F.A.C., governing universal life plans.

(9) Effective Date.

(a) This rule shall be effective for policies issued on or after January 1, 2000 for valuation dates on or after the date this rule is adopted.

(b) For valuation dates prior to the effective date of this rule, at the option of the company, the company may report reserves for policies issued in calendar year 2000 based upon this rule.

69O FAC 164.030 | Application of Rule 69O-164.020, F.A.C., to Various Product Designs (Repealed)

69O FAC 164.040 | Determining Reserve Liabilities for Preneed Life Insurance

(1) Authority.

This rule is adopted by the commission pursuant to Sections 625.121(5)(a)3. and 627.476(9), F.S.

(2) Scope.

This rule applies to preneed life insurance policies and certificates as defined in Section Four (4) of this rule, and similar policies and certificates.

(3) Purpose.

The purpose of this rule is to recognize the inadequacy of the 2001 Commissioners Standard Ordinary Life Valuation Mortality Table for use in determining the minimum standard of valuation and the minimum standard nonforfeiture value, and to require the continued use of the 1980 Commissioners Standard Ordinary Life Valuation Mortality Table for use in determining the minimum standard of valuation and the minimum standard nonforfeiture value.

(4) Definitions.

(a) The term "2001 CSO Mortality Table" means the 2001 Commissioners Standard Ordinary Life Valuation Mortality Table, consisting of separate rates of mortality for male and female lives, developed by the American Academy of Actuaries CSO Task Force from the Valuation Basic Mortality Table developed by the Society of Actuaries Individual Life Insurance Valuation Mortality Task Force, and adopted by the NAIC in December 2002. The 2001 CSO Mortality Table is included in the Proceedings of the NAIC (2nd Quarter 2002). Unless the context indicates otherwise, the "2001 CSO Mortality Table" includes both the ultimate form of that table and the select and ultimate form of that table and includes both the smoker and nonsmoker mortality tables and the composite mortality tables. It also includes both the age-nearest-birthday and age-last-birthday bases of the mortality tables.

(b) The term "Ultimate 1980 CSO" means the Commissioners' 1980 Standard Ordinary Life Valuation Mortality Tables (1980 CSO) without ten-year (10-year) selection factors, incorporated into the 1980 amendments to the NAIC Standard Valuation Law approved in December 1983.

(c) For the purposes of this rule, preneed insurance is any life insurance policy or certificate that is issued in combination with, in support of, with an assignment to, or as a guarantee for a prearrangement agreement for goods and services to be provided at the time of and immediately following the death of the insured. Goods and services may include, but are not limited to embalming, cremation, body preparation, viewing or visitation, coffin or urn, memorial stone, and transportation of the deceased. The status of the policy or contract as preneed insurance is determined at the time of issue in accordance with the policy form filing.

(5) Minimum Valuation Mortality Standards.

For preneed insurance contracts, as defined in paragraph (4)(c), and similar policies and contracts, the minimum mortality standard for determining reserve liabilities and non-forfeiture values for both male and female insureds shall be the Ultimate 1980 CSO.

(6) Minimum Valuation Interest Rate Standards.

(a) The interest rates used in determining the minimum standard for valuation of preneed life insurance shall be the calendar year statutory valuation interest rates as defined in Section 625.121(6), F.S.

(b) The interest rates used in determining the minimum standard for nonforfeiture values for preneed life insurance shall be the calendar year statutory nonforfeiture interest rates as defined in Section 627.476(9)(i), F.S.

(7) Minimum Valuation Method Standards.

(a) The method used in determining the minimum standard for valuation of preneed life insurance shall be the method as defined in Section 625.121(5), F.S.

(b) The method used in determining the minimum standard for nonforfeiture values for preneed life insurance shall be the method as defined in Section 627.476(9), F.S.

(8) Transition Rules.

(a) For preneed insurance policies issued on or after the effective date of this rule and before January 1, 2012, the 2001 CSO may be used as the minimum standard for reserves and minimum standard for non-forfeiture benefits for both male and female insureds.

(b) If an insurer elects to use the 2001 CSO as a minimum standard for any policy issued on or after the effective date of this rule and before January 1, 2012, the insurer shall provide, as a part of the actuarial opinion memorandum submitted in support of the company's asset adequacy testing, an annual written notification to the domiciliary commissioner. The notification shall include:
1. A complete list of all preneed policy forms that use the 2001 CSO as a minimum standard;

2. A certification signed by the appointed actuary stating that the reserve methodology employed by the company in determining reserves for the preneed policies issued after the effective date and using the 2001 CSO as a minimum standard, develops adequate reserves (For the purposes of this certification, the preneed insurance policies using the 2001 CSO as a minimum standard cannot be aggregated with any other policies.); and

3. Supporting information regarding the adequacy of reserves for preneed insurance policies issued after the effective date of this rule and using the 2001 CSO as a minimum standard for reserves.
(c) Preneed insurance policies issued on or after January 1, 2012, must use the Ultimate 1980 CSO in the calculation of minimum nonforfeiture values and minimum reserves.
(9) This rule is applicable to preneed life policies and certificates as defined in paragraph (4)(c) issued on or after January 1, 2009.
69O-166 | Property and Casualty Insurer Practices

69O FAC 166.021 | Definitions

As used in this part:
(1) "Person" means any individual, association, organization, partnership, business, trust, or corporation.

(2) "Agent" means any person, as defined herein, authorized to represent an insurer with respect to a claim, including adjusters.

(3) "Claimant" means a first-party claimant, a third-party claimant, and, where the claimant is an individual, a member of the claimant's family designated by the claimant.

(4) "First-party claimant" means any person asserting a right to payment as an insured as provided by the insurance policy, arising out of the occurrence of the contingency or loss covered by that policy.

(5) "Insurer" means a person authorized to issue or which issues an insurance policy in this state, or otherwise transacts insurance in this state, including reciprocal and interinsurance exchanges, fraternal benefit societies, stock and mutual insurance companies, mutual fire insurance companies, grants and annuities societies, insurers holding certificates of exemption, motor clubs, medical and health service and related service plans, or the agents of any of the above-designated persons. The term "insurer," for purposes of this part, shall not include surplus lines brokers.

(6) "Insurance policy" and "policy" refer to the written instrument in which any certificate of insurance, contract of insurance, hospital service plan or motor club service is set forth.

(7) "Investigation" means any activities of an insurer or its agent, directly or indirectly related to the determination of liabilities under coverages afforded by an insurance policy, and other obligations or duties arising from an insurance policy.

(8) "Notification of a claim" means any notice to an insurer or its agent by a claimant or an insured that reasonably apprises the insurer that a loss has occurred.

(9) "Notice of loss" means:
(a) Written notice, such as claim forms, medical bills, medical authorizations or other reasonable evidence of the claim that is ordinarily required of a claimant; or

(b) Any notice by or on behalf of a claimant that reasonably apprises the insurer that a loss has occurred and that the claimant wishes to make a claim under an insurance policy or against a person insured under an insurance policy for such loss.
(10) "Tender" shall include mailing to the last known address or designated address of the last known recipient, or otherwise effecting delivery.

(11) "Third-party claimant" means any person asserting a claim against any other person insured under an insurance policy or insurance contract of an insurer.

(12) "Office" means the Office of Insurance Regulation.

69O FAC 166.024 | Failure to Acknowledge Communications and Act Promptly as to Communications with Respect to Claims and to Implement Standards for the Prompt Investigation of Claims

Every insurer shall adopt and implement standards for the acknowledgement of communications and investigation of claims with respect to claims so that:
(1) Upon the insurer's receiving a communication with respect to a claim, it shall, within 14 calendar days, review and acknowledge receipt of such communication unless payment is made within that period of time or unless the failure to acknowledge is caused by factors beyond the control of the insurer which reasonably prevent such acknowledgement. If the acknowledgement is not in writing, a notification indicating acknowledgement shall be made in the insurer's claim file and dated. A communication made to or by an agent of an insurer with respect to a claim shall constitute communication to or by the insurer. As used in this subsection, "agent" means any person to whom an insurer has granted authority or responsibility to receive or make such communications with respect to claims on behalf of the insurer. This subsection shall not apply to claimants represented by counsel beyond those communications necessary to provide forms and instructions.

(2) Such acknowledgement shall be responsive to the communication. If the communication constitutes a notification of a claim, unless the acknowledgement reasonably advises the claimant that the claim appears not to be covered by the insurer, it shall provide necessary claim forms, and instructions, including an appropriate telephone number.

(3) Unless otherwise provided by the policy of insurance or by statutes, such insurer shall within 10 working days of its receipt of proof of loss statements begin such investigation as is reasonably necessary, unless the failure to begin such investigation is caused by factors beyond the control of the insurer which reasonably prevent the commencement of such investigation.

69O FAC 166.025 | Response to Office Inquiries

Every insurer, upon receiving any written or oral inquiry from the Office concerning a claim, shall, within 21 calendar days of receipt of this inquiry, furnish the Office with an appropriate response at the Office's website: http://www.FLOir.com/iPortal. The Office may require a written response as it deems necessary.

69O FAC 166.031 | Mediation of Property Insurance Claims

(1) All insurers subject to Section 627.7015, F.S., shall comply with Rule 69J-166.031, F.A.C., administered by the Department of Financial Services. A violation of Rule 69J-166.031, F.A.C., is a violation of this rule and accordingly a violation of a rule of the Commission.

(2) If an insurer fails to appear at conferences with such frequency as to evidence a general business practice of failure to appear, the insurer shall be subject to penalty, including revocation, suspension, or a fine as specified in Section 624.4211, F.S.

69O FAC 166.040 | Commercial Property and Casualty Risk Management Plans

(1) Each insurer or insurer group offering commercial casualty insurance and/or commercial property insurance covering risks located in this state for which Florida taxable premiums are reported shall develop and make available to its insureds guidelines for risk management plans.
(a) "Commercial property insurance" means insurance as defined in Section 624.604, F.S., but limited to coverage of commercial risks, excluding windstorm coverage, federal crop insurance, crop hail insurance, the Pollution Liability Insurance Association, and other federal governmental pools and associations.

(b) "Commercial casualty insurance" means insurance as defined in Section 624.605, F.S., other than workers' compensation and employer's liability insurance, but limited to coverage of commercial risks.

(c) "Guidelines for risk management plans" are descriptive instructions and criteria for the establishment of risk management plans and deal with one or more specific aspects of risk handling appropriate to one or more insureds.

(d) "Risk management plans" are detailed plans for the management of risk specific to one or more insureds.

(e) "Risk management programs" include all measures, services, guidelines, and plans established by the insurer for the use of its insureds in the handling of the insured's risks.
(2) A description of the risk management program including the guidelines for risk management plans developed by a company or group for its insureds shall be in writing and maintained on file by the insurer and shall be available for inspection by the Office.

(3) The existence and availability of the risk management program shall be communicated in writing to the insured both at the time a new policy is issued and at the time an existing policy is renewed. The insured shall at such time be given information covering the description and scope of the risk management program and the availability of guidelines for risk management plans. If requested in writing by the insured, the insurer or insurer group shall develop and provide the insured with guidelines for a risk management plan within 60 days. The guidelines for the risk management plan shall be evidenced by a written document detailing its specific features.

(4) The risk management program shall include the following:
(a) Safety measures, including, as applicable, the following areas:
1. Pollution and environmental hazards;

2. Disease hazards;

3. Accidental occurrences;

4. Fire hazards and fire prevention and detection;

5. Liability for acts from the course of business;

6. Slip and fall hazards;

7. Product injury; and

8. Hazards unique to a particular class or category of insureds.
(b) Training to insureds in safety management techniques.

(c) Safety management counseling services.
(5) A risk management plan may differ in scope and degree from one insured to the next; however, each plan shall be oriented towards the reduction of losses that are typically associated with the given type of risk.

(6) In developing and making available to insureds guidelines for a particular risk management plan, each insurer or insurer group shall ensure that the guidelines:
(a) Are reasonably related to both the type of risk being insured and the goal of the reduction of losses that are typically associated with that type of risk; and

(b) Are clearly distinguished from the insurer or insurer group's underwriting requirements.
(7) The costs associated with implementation of risk management measures which are required by the insurer as a condition for the acceptance of the risk shall be borne by the insured.

(8) The costs associated with the development of guidelines for risk management plans and the costs of distribution of these guidelines shall be borne by the insurer. Also, the costs of providing any other services available through the insurer's risk management program to an insured which are not voluntarily requested by the insured shall be borne by the insurer.

(9) The costs of developing a risk management plan or of providing any other services available through an insurer's risk management program to an insured when voluntarily requested by the insured may be borne by the insurer or the insured at the option of the insurer.

(10) An insurer can provide training to insureds in safety management techniques and safety management counseling services as part of its own operations or it can supply these services with the use of contractual providers. The insurer or insurer group shall ensure that its insureds have reasonable access to such services.

69O FAC 166.045 | Special Purpose Homeowners Insurance Company (SPHIC); Notice Requirements (Repealed)

69O FAC 166.051 | Examination of Significant Rate Increases

(1) Purpose.

Substantial rate increases by insurers adversely affects the welfare of the insurance consuming public of the State of Florida. The Office is authorized to conduct investigations of insurance matters as it deems proper to determine whether any person has violated any provision of the Florida Insurance Code and to secure information useful in the lawful administration of the Insurance Code. The Office is further authorized to examine each insurer as often as warranted for the protection of the policyholders and the public interest of this State. The Office has determined that the significant increase of rates fundamentally affects the rights of policyholders and the public interest of this State. The Office has determined further that in order to protect the public and to ensure compliance with the Insurance Code, and in the administration of the Code, the public welfare requires an examination of insurers which significantly increase rates in this State. These examinations will be conducted in an open forum, in the form of public hearings.

(2) Scope.

This rule applies to residential and habitational, personal and commercial property insurance in the State of Florida (hereinafter, "residential property insurance"). This rule shall not be construed to limit the Office's authority or ability to conduct any examination authorized by Section 624.316, F.S.

(3) Public Hearings.

(a) Significant Rate Increases. The Office will hold a public hearing on any rate filing where the percentage of rate increase is 25% or more and the aggregate amount of such rate increase is $2,000,000 or more, or a rate increase of 50% or more.

(b) Procedure.
1. The time and place of the public hearing will be noticed by order of the Office.

2. The public hearing shall be for the purpose of gathering information and evidence, and is not subject to the procedures of Chapter 120, F.S. Each insurer shall bear its own costs, including any attorney's fees, which may be associated with this examination and with its attendance at the public hearing. Specifically, the public hearing will provide the Office with, and the insurer shall be prepared to present, information necessary to determine whether the increase renders the rates excessive, inadequate, or unfairly discriminatory.
69O-167 | Property and Casualty Insurance Contracts

69O FAC 167.001 | Return of Unearned Premium

(1) Unless otherwise provided in the contract, upon cancellation of a fire and casualty policy by the company or the insured, the return of gross unearned premium is to be mailed within fifteen (15) working days after the effective date of cancellation, except where the provisions of Sections 627.7283 and 627.848(6), F.S., apply. The date of return made by the company or agent is determined by the post mark.

(2) Unless payment of the amount of the premium to be returned is affirmatively requested by the insured, the insurer need not return any amount of $5.00 or less.

(3) Subsections (1) and (2), above, do not apply to audit policies. Audit policies shall be subject to a time limitation of ninety (90) days from the date of cancellation to make the return of unearned premiums, if any. If such audit is not complete within this time limitation, then the insured's own audit shall be accepted by the insurer. Such unearned premium, if any, shall be mailed within ten (10) working days upon receipt of the insured's audit.

(4) The exception in subsection (3) for audit policies is subject to the full cooperation of the insured with the insurer or agent in securing the necessary data for audit. Proof of non-cooperation of the insured shall be submitted to the Office by the insurer or the agent upon request. In the event that non-cooperation still exists, then the deposit premium shall be considered fully earned, without prejudice as to whether additional premium is due.

69O FAC 167.002 | Private Passenger Motor Vehicle Insurance; Completion of Underwriting Notice of Incorrect Premium, Return of Unearned Premium

(1) Pursuant to the provisions of Section 627.728, F.S., any insurer which issues a policy of private passenger motor vehicle insurance in this state shall be required to complete the underwriting of the policy and make a final determination of the correct premium for the coverage set forth in the insurance application within sixty (60) days after the effectuation of coverage. The requirements of this subsection shall not apply in the event that an incorrect premium was charged due to material misrepresentation or fraud on the part of the insured in the application for insurance. Insurers asserting a common law right of rescission or otherwise asserting rights to void insurance policies ab initio shall, within 90 days of rescinding a policy, report electronically through the Florida Office of Insurance Regulation Industry Portal at http://www.FLOir.com/iPortal. The report shall be on Form OIR-B3-493, http://www.FLRules.org/Gateway/Reference.asp?No=Ref-08271, "Report of Rescinded Policy," rev. 06/2017, which is hereby adopted and incorporated by reference. The report shall be filed electronically through the Florida Office of Insurance Regulation Industry Portal at http://www.FLOir.com/iPortal. The insurer shall retain its files on each rescinded policy for three (3) calendar years from the date of the report to the Office. Each file shall contain a copy of the initial application, a copy of the policy, copies of any claim forms filed, all documentation used by the insurer as a basis for its rescission, including the basis for any denial of coverage; and the name, business address and telephone number of any independent claims adjusting service where files may be located, if no longer in the possession of the insurer.

(2) In the event that an insurer issues a policy of private passenger motor vehicle insurance and timely determines that the policyholder has been charged an incorrect premium, the insurer shall provide notice to the policyholder as provided in Section 627.7282, F.S. Such notice shall include a period of time no less than ten (10) days and no greater than forty-five (45) days within which the policyholder has the option to pay the additional amount of premium due or to cancel the policy and demand a refund of any unearned premiums. The maximum 45-day time period shall not apply in the event the amount of the additional premium due is equal to or less than five percent of the correct premium.

(3) If the policyholder fails to timely respond to the notice referred to in subsection (2), above, the insurer shall cancel the policy as required in Section 627.7282, F.S., on a date no less than fourteen (14) days and no greater than forty-five (45) days after the notice, and return any unearned premium to the insured.

69O FAC 167.004 | Required Preinsurance Inspection of Private Passenger Motor Vehicles

(1) Private passenger motor vehicle insurers providing physical damage coverage, including collision or comprehensive coverage, shall comply with Section 627.744, F.S., regarding preinsurance inspection requirements. Certain preinsurance inspections are excluded as prescribed by Sections 627.744(2)(a)-(l), F.S.
(a) A preinsurance inspection is not required if:
1. The agent/producer or insurer is transferring a book of business from one insurer to another insurer(s);

2. Such transfer was not initiated or within the control of the insured; and

3. The transfer of the block of business is documented in each policyholder's record.
(b)
1. A reinspection is not required when an individual insured's coverage is being transferred by an independent insurance agent to a new insurer and the agent provides the new insurer with a copy of the inspection report completed on behalf of the previous insurer, provided:
a. The independent agent represents both insurers, and

b. The insured vehicle was physically inspected by the previous insurer.
2. If the new insurer does not receive a copy of the inspection report sixty (60) days prior to the first annual renewal date, the insurer shall, upon renewal of the physical damage insurance, require an inspection as set forth in this rule.
(c) If a vehicle which has been previously inspected by an insurer transfers to another insurer under common ownership with the original insurer, a reinspection of the vehicle will not be required. The preinsurance inspection form, or an electronically or photographically reproduced copy, shall be transferred to the new insurer and retained with its policyholder records as provided in subsection (7) below.

(d) Except as to an insurer whose files and established office procedures indicate compliance with Section 627.744, F.S., and the provisions of this rule, an insurer shall indicate in the policyholder's file the reason a vehicle is being exempted from the preinsurance inspection requirements of this rule. This paragraph shall apply only to motor vehicle policies issued on a private passenger motor vehicle garaged in the counties listed in paragraph (1)(e).

(e) The preinsurance inspection requirement applies to a motor vehicle policy issued on a private passenger motor vehicle principally garaged in Duval, Palm Beach, Broward, Dade, Orange, Hillsborough, and Pinellas counties.

(f) A reinspection is not required when a family member transfers title to another family member and the agent or insurer provides the transferee's insurer with a copy of the inspection report completed on behalf of the transferor's insurer. However, if the transferee's insurer does not receive a copy of the inspection report sixty (60) days prior to the first annual renewal date, the insurer shall, upon renewal of the physical damage insurance, require an inspection as set forth in this rule. If an initial inspection was not performed, then such inspection is required if not otherwise exempt.
(2) "Private passenger motor vehicle" shall be defined as one which is:
(a) Owned or registered by a natural person, or one or more related individuals resident of the same household; and

(b) A four-wheel motor vehicle which:
1. Is licensed for use on public roads;

2. Has a load capacity of 1,500 pounds or less;

3. Is not used as a public or livery conveyance for passengers; and

4. Is not rented to others.
(3)
(a) "Private passenger motor vehicle insurance policy" is one that insures private passenger motor vehicles as defined in paragraphs (2)(a) and (b) above.

(b) For the purposes of this rule, a private passenger motor vehicle insurance policy shall not include vendors single interest nor commercial auto fleet policies covering five (5) or more vehicles.
(4) Suspension of insurance coverage applies only to the physical damage coverage and is defined as a discontinuance of physical damage coverage immediately following the thirtieth calendar day if the inspection has not been completed and until the physical damage coverage is reinstated by completion of the inspection. During the period of suspension there is no physical damage coverage.

(5) The inspection shall be recorded on Form OIR-B1-507. An insurer may, however, use its own form(s) and any additional information deemed necessary by the insurer as long as the form(s) used by each insurer has substantially the same information as that contained in Form OIR-B1-507. The insurer may also attach photographs of the inspected vehicle evidencing whether there is pre-existing damage to the vehicle.

(6) The preinsurance inspection form, or an electronically or photographically reproduced copy, shall be retained by the insurer with the insured's policy records at the insurer's home office, regional office, or district office for a period of three (3) years. When the insurer is a surplus lines company, these records shall be kept in the Florida office of the surplus lines agent for that insurer. The original signed preinsurance inspection form shall be maintained by the insurer/surplus lines agent and shall be made available to the Office upon request. A copy of the inspection form, without any optional accompanying photographs, shall be made available to the insured upon request.

(7) The preinsurance inspection form, or an electronically or photographically reproduced copy, shall be completed by a person or organization authorized by the insurer other than the applicant or insured. Such person or organization may be an employee of the insurer, the agent/producer or employee thereof, or an inspection service, including employees thereof. The competency and trustworthiness of the person or organization authorized by the insurer to conduct preinspections shall be the responsibility of the insurer.

(8) In addition to the inspection form, the preinsurance inspection shall include at least paragraph (a), (b), or (c) as follows, which will be for the purpose of positively identifying the vehicle to be insured:
(a) The taking of a physical imprint of the vehicle identification number (VIN) of the motor vehicle by a representative of the insurer other than the applicant or insured. A physical imprint is defined as a tracing or a mold of the actual VIN label (normally located on the dash of the motor vehicle and seen through the windshield from the outside looking into the vehicle).

(b) The taking of a close-up photograph of the VIN label (where the VIN label is usually located on the dash of the vehicle) or the photographing of the Environmental Protection Agency/Federal Certification (EPA) sticker (usually found on the operator's side door jamb). Such close-up photograph shall be taken by a representative of the insurer other than the applicant or insured. The photograph shall be of a sufficient clarity and quality that the information contained on the dash VIN label or the EPA sticker, including the VIN, is legible and easily readable. The VIN recorded on the preinsurance inspection form shall be obtained from a location on the vehicle other than the location being photographed.

(c) The attesting to the authenticity of the VIN by both the insured and the insurer's representative, who shall not be the insured. If this option is selected, each inspector shall individually observe the VIN (usually imprinted on a label on the dash) of the vehicle and record same on Form OIR-B1-507, or a form which contains substantially the information on Form OIR-B1-507. Each inspector shall also individually observe and attest to the VIN as displayed on the EPA sticker (usually affixed to the operator side door jamb), and the VIN as recorded on the vehicle registration form. Such attestation shall be accomplished by signing the statement appearing on the space provided on the vehicle inspection form. If discrepancies are noted, such as a missing VIN, a defaced VIN, or an inconsistency in the VINs, such discrepancies shall be noted on the motor vehicle preinsurance inspection form.
(9) An insurer may defer an inspection for thirty (30) calendar days following the effective date of coverage for a new policy or the actual notice to the insurer or its agent of additional or replacement vehicle(s) to an existing policy, as permitted by Section 627.744(6), F.S. The insurance file shall contain information necessary to identify those circumstances justifying the deferral.
(a) The applicant shall be notified of the requirement for the inspection by Form OIR-B1-505 or Form OIR-B1-508 or a form which contains substantially the information in Form OIR-B1-505 or Form OIR-B1-508. Failure to obtain the inspection within the time period shall result in suspension of physical damage insurance coverage immediately following the time period, which consequences shall be disclosed at the time of application, or by mail posted no later than the next business day in the case of a telephonic binder, to the applicant on Form OIR-B1-506, or a form which contains substantially the information on Form OIR-B1-506. Such suspension shall continue until the inspection is effected.

(b) Suspension of coverage shall apply to all insureds, owners, and lienholders. However, where the lienholder is a federal or state financial institution this rule shall not limit the payment of claims in any manner.

(c)
1. Failure of the insurer or agent to give the insured notice as required in this rule shall not result in a suspension of coverage for the insured. The failure of the insurer to act promptly does not relieve it of its obligation to inspect.

2. After a suspension of coverage, the physical damage coverage is not restored by virtue of an insurer or agent's failure(s) to comply with this rule.
(d) A reinstatement of physical damage coverage shall only be effective upon inspection and if due, payment by the insured to the insurer of the adjusted premium for the physical damage coverage in full or in accordance with the insurer's normal payment plan, at the insurer's option.

(e) Whenever physical damage coverage is suspended for more than fourteen (14) days, the insurer shall make a pro rata premium adjustment (return premium or credit) which shall be mailed to the insured no later than 45 days after the effective date of the suspension. However, when lienholder protection continues, as referenced in paragraph (b) above, no premium adjustment shall be due.

(f) Whenever physical damage coverage is suspended, the insurer shall mail to the insured, the producer of record, and any lienholder other than a state or federal financial institution, a Notice of Suspension of Insurance Coverage, Form OIR-B1-506, or a form which contains substantially the information in Form OIR-B1-506, no later than the 30th calendar day after the effective date of the suspension.

(g) The insurer shall obtain a certificate of mailing or other evidence of mailing the Notice of Suspension to the insured, the producer/agent of record, and any lienholder other than as described in paragraph (b) above, and shall retain the certificate or other evidence of mailing and copy of the Notice for a period of three (3) years.
(10)
(a) In addition to the notice requirements as set forth in subsection (9), the insurer or agent/producer shall furnish the applicant, at the time coverage is effected, with an up-to-date list of inspection sites where the inspection can be conducted, provided that inspection service is not available at the originating agent's place of business.

(b) The list shall include the names, addresses, and business phone numbers of persons or organizations authorized by the insurer that are reasonably convenient to the insurer.

(c) In the case of telephonic binders, the location of reasonably convenient inspection sites may be provided by telephone, provided documentation of verbal notice is contained in the applicant's policy record.

(d) The consequences of the applicant's failure to obtain a timely inspection shall be furnished promptly to the applicant by providing Form OIR-B1-506, or a form which contains substantially the information in Form OIR-B1-506. Documentation of such notice, including the name of the person giving the notice and the identity of the site(s) provided, shall be contained in the applicant's policy record.

(e) The insurer shall make a list of all persons or organizations authorized by the insurer available to the Office upon request.
(11) Inspections required or permitted pursuant to this regulation shall be made by a person or organization authorized by the insurer at a time and place reasonably convenient to the applicant and should not subject the insured/applicant to an unreasonable delay.

(12) Any preinsurance inspection forms issued by the insurer to the applicant for presentation to a person or organization authorized by the insurer shall not contain the Vehicle Identification Number (VIN) of the vehicle to be inspected.

(13) Any decision to defer or not to defer an inspection pursuant to this regulation shall not be based on the age, race, sex, or marital status of the applicant or the customary operators of the vehicle, the principal place of garaging, or the fact that a policy has been placed in the Florida Joint Underwriting Association.

(14) The insurer or the insured's authorized representative who performs the inspection shall maintain a control system or office procedures reasonably designed to prevent the use of forms to fraudulently indicate the performance of inspections which have not in fact occurred, which may include the use of sequentially numbered reports.

(15)
(a) The inspection report, or the relevant data therefrom, shall be reviewed by the insurer to compare previous damage, prior condition, options, and mileage of the motor vehicle on physical damage claims which occur within three (3) years of the issuance of the policy whenever:
1. The appraisal indicates prior damage;

2. The vehicle is a total loss or unrecovered theft; or

3. The damage exceeds $2,000 for all claims.
(b) A copy, which may be an electronically or photographically reproduced copy, of the inspection report, or the relevant data therefrom, shall be utilized in the settlement of all claims referenced in paragraph (15)(a) above.
(16) A person or organization authorized by the insurer shall not be deemed trustworthy if there exists any conflict of interest which may prevent him or her from conducting a thorough and accurate inspection. It shall be a conflict of interest for a person or organization authorized by the insurer to accept, in connection with an inspection, anything of value from any source other than the insurer.

(17) When a private passenger automobile insured for physical damage coverage has been in an accident or otherwise damaged, an insurer may require that the vehicle be made available for inspection prior to continuing physical damage coverage.

(18) Forms OIR-B1-505, "Notice of Mandatory Pre-insurance Inspection Requirement" (7/00), OIR-B1-506, "Notice of Suspended Insurance Coverage" (1/08), OIR-B1-507, "Florida Motor Vehicle Preinsurance Inspection Form" (7/00), and OIR-B1-508, "Acknowledgement of Requirement for Preinsurance Inspection" (5/08), are adopted and incorporated by reference.

(19) Form OIR-B1-505, Form OIR-B1-506, Form OIR-B1-507, and Form OIR-B1-508 may be obtained from:
(a) The Office's website located at http://www.FLOir.com, by clicking on search and entering the form number; or

(b) Property and Casualty Product Review, 200 East Gaines Street, Tallahassee, Florida 32399-0330, (850) 413-3146.

69O FAC 167.005 | Warranties in Policy Forms

69O FAC 167.006 | Property Insurance: Accidental Death and Dismemberment Endorsements

(1) All insurers authorized to write property coverages in this state shall be permitted to attach to or include in the policy, provisions for accidental death and dismemberment coverage and for medical expense coverage.

(2) Such coverage shall become incidental to and a part of the property coverage and shall not be subject to the provisions of the Florida Insurance Code applicable to life or health insurance.

69O FAC 167.007 | Supplementary Payment of Defense Costs (Repealed)

69O FAC 167.009 | Mortgage Property Insurance Requirements Limited

No mortgage lender shall, in connection with any application for a mortgage loan in this state which is secured by a mortgage on residential real estate located in this state, require any prospective mortgagor to obtain by purchase or otherwise a property insurance policy in excess of the replacement value of the covered premises as a condition for granting such a mortgage.

69O FAC 167.010 | Proof of Mailing

When an insurer is required by law to provide notice of cancellation or non-renewal of a property or casualty insurance contract and the insurer provides such notice by mail, proof of mailing may be provided by use of the certified or registered mail services of the United States Postal Service or by a United States Postal Service proof of mailing form. The certification or registration receipts or the proof of mailing form shall state the name of the insured, the policy number, and the date mailed. Alternatively, the insurer may establish any other system to provide proof of notice of cancellation or non-renewal so long as the system clearly indicates the method of notification and the name of the insured, the policy number, and the date mailed.

69O FAC 167.011 | Homeowner's Policies: Offer of Replacement Cost Coverage and Law and Ordinance Coverage

(1) This rule applies to all covered losses arising from claims under homeowners policies as that term is generally used but does not apply to a tenant's form, commonly known as an HO-4 nor to a condominium unit owner's form, commonly known as an HO-6.

(2) Pursuant to Section 627.7011, F.S., insurers are required to obtain a written statement from the holder of a homeowner's policy regarding that policyholder's selection or rejection of replacement cost coverage and law and ordinance coverage, as those coverages are described in Section 627.7011, F.S. Insurers are also required to provide each homeowner's policyholder with notice of the availability of these coverages at least once every three years. However, an insurer is not required to make the offers required by this rule with respect to the issuance or renewal of a homeowners policy which contains the provisions specified in Section 627.7011(1)(b), F.S.

(3) Insurers shall obtain approval to use its own form, and must use an approved form for the required notification every three years. Such form used by the insurer shall be retained by the insurer in the policyholder's file.

(4) If the insurer already includes replacement coverage and law and ordinance coverage as an integral part of its homeowners policy form, it is not necessary to obtain an explicit selection or rejection from the policyholder. However, the insurer shall include an explanation of the coverages in order to fully advise the applicant or policyholder of the nature of the coverages, as required by Section 627.7011(2), F.S.

69O FAC 167.012 | Certificates of Security for Hurricane Deductibles

(1) The purpose of this rule is to specify the form for a Certificate of Security to be used pursuant to Section 627.701(5), F.S.

(2)
(a) An insurer that elects to offer a policy with a secured hurricane deductible on a personal lines property insurance policy shall require the insured to provide a Certificate of Security or a verification that the insured has a 100% equity interest in the property to be insured.

(b) An insurer may not directly or indirectly require a secured hurricane deductible as a condition of issuing or renewing a policy.
(3) An insurer shall accept a Certificate of Security only when it uses form OIR-A1-1203 (8/96), Certificate of Security, which is hereby adopted and incorporated by reference. Form OIR-A1-1203 may be obtained from the Office's website at http://www.FLOir.com/iPortal.

69O FAC 167.013 | Residential Property Insurance Checklists and Disclosures

(1) A basic homeowners', mobile homeowners', dwelling, or condominium unit owners' policy may not be delivered or issued for delivery in this state unless a comprehensive checklist of coverage on a form adopted by the commission and an appropriate outline of coverage have been delivered prior to issuance of the policy or accompany the policy when issued. The commission hereby adopts Form OIR-B1-1670, "Checklist of Coverage" (New 01/01/06), which is incorporated herein by reference. This form is available on the Office's website at http://www.FLOir.com/iPortal.

(2) The term "prominently display" as used in Section 627.701, F.S., means that printed matter is of bold type no less than 12 point type and is of greater size than the surrounding text.

69O FAC 167.014 | Alternative Methods to Handwritten Statements

The handwritten disclosures required by Sections 627.712(2) and 627.701(4)(d)1., F.S., may be obtained by alternative methods from those persons or policyholders who have a disabling condition that prevents them from providing a handwritten statement. Any one or more of the following methods may be used:
(1) Obtaining through an authorized guardian or attorney-in-fact a handwritten statement in conformance with Section 627.712(2) or 627.701(4)(d)1., F.S. The insurer shall maintain on file all documentation necessary to verify that the guardian or attorney is so duly authorized to execute such handwritten statement; or

(2) Videotaping the reading of the disclosure to the policyholder and videotaping the policyholder's verbal acknowledgement that the policyholder understands the disclosure and elects not to purchase the coverage described in the disclosure. The insurer must maintain the videotape with the records of the policyholder.

69O FAC 167.015 | Home Structure Rating System Adopted (Repealed)

Rulemaking AuthorityLaw ImplementedHistory
624.308,(1) FS., Ch. 2007-1, Laws of Florida,  40; Ch. 2006-12, Laws of Florida,  39.624.307(1) FS., Ch. 2007-1, Laws of Florida,  40.New , Repealed .

69O FAC 167.020 | Purpose

The purpose of the rules in this part is to define Inland Marine Insurance by describing the kinds of risks and coverages which may be classified or identified under the insurance laws of the State of Florida as Marine, Inland Marine or Transportation insurance, but does not include all of the kinds of risks and coverages which may be written, classified or identified under Marine, Inland Marine or Transportation insuring powers, nor shall it be construed to mean that the kinds of risks and coverages are solely Marine, Inland Marine or Transportation insurance in all instances.

69O FAC 167.021 | Restrictions or Limitations

69O FAC 167.022 | Conditions under Which Marine and/or Transportation Policies May Cover

Marine and/or transportation policies may cover under the following conditions:
(1) Imports.
(a) Imports may be covered wherever the property may be and without restrictions as to time, provided the coverage of the issuing companies includes hazards of transportation.

(b) An import, as a proper subject, of marine or transportation insurance, shall be deemed to maintain its character as such so long as the property remains segregated in such a way that it can be identified and has not become incorporated and mixed with the general mass of property in the United States, and shall be deemed to have been completed when such property has been:
1. Sold and delivered by the importer, factor or consignee; or

2. Removed from place of storage and placed on sale as part of importer's stock in trade at a point of sale distribution; or

3. Delivered for manufacture, processing or change in form to premises of the importer or of another used for any such purposes.
(2) Exports.
(a) Exports may be covered wherever the property may be without restriction as to time, provided the coverage of the issuing companies includes hazards of transportation.

(b) An export, as a proper subject of marine or transportation insurance, shall be deemed to acquire its character as such when designated or while being prepared for export and retain that character unless diverted for domestic trade, and when so diverted, the provisions of this rule respecting domestic shipments shall apply, provided, however, that this provision shall not apply to long established methods of insuring certain commodities, for example, cotton.
(3) Domestic shipments.
(a) Domestic shipments on consignment, (provided the coverage of the issuing companies includes hazards of transportation) for sale or distribution, exhibit, or trial, or approval or auction, while in transit, while in the custody of others and while being returned, provided that in no event shall the policy cover on premises owned, leased or operated by the consignor.

(b) Domestic shipments not on consignment, provided the coverage of the issuing companies includes hazards of transportation, beginning and ending within the United States, provided that such shipments shall not be covered at manufacturing premises nor after arrival at premises owned, leased or operated by Assured or purchaser.
(4) Bridges, tunnels and other instrumentalities. Bridges, tunnels and other instrumentalities of transportation and communication (excluding buildings, their improvements and betterments, furniture and furnishings, fixed contents and supplies held in storage) includes:
(a) Bridges, tunnels, other similar instrumentalities, including auxiliary facilities and equipment attendant thereto.

(b) Piers, wharves, docks, slips, dry docks and marine railways.

(c) Pipelines, including on-line propulsion, regulating and other equipment appurtenant to such pipelines, but excluding all property at manufacturing, producing, refining, converting, treating or conditioning plants.

(d) Power transmission and Telephone and Telegraph lines, excluding all property at generating, converting or transforming stations, substations and exchanges.

(e) Radio and Television Communication Equipment in use as such including towers and antennae with auxiliary equipment, and appurtenant electrical operating and control apparatus.

(f) Outdoor cranes, loading bridges and similar equipment used to load, unload and transport.
(5) Personal property floater risks. Personal property floater risks covering individuals and/or generally include:
(a) Personal Effects Floater Policies.

(b) The Personal Property Floater.

(c) Government Service Floaters.

(d) Personal Fur Floaters.

(e) Personal Jewelry Floaters.

(f) Wedding Present Floaters for not exceeding ninety (90) days after the day of the wedding.

(g) Silverware Floaters.

(h) Fine Arts Floaters covering paintings, etchings, pictures, tapestries, art glass windows, and other bona fide works of art of rarity, historical value or artistic merit.

(i) Stamp and Coin Floaters.

(j) Musical Instrument Floaters. Radios, televisions, record players and combinations thereof are not deemed musical instruments.

(k) Mobile Articles, Machinery and Equipment Floaters (excluding motor vehicles designed for highway use and auto homes, trailers and semi-trailers except when hauled by tractors not designed for highway use) covering identified property of a mobile or floating nature pertaining to or usual to a household. Such policies shall not cover furniture and fixtures not customarily used away from premises where such property is usually kept.

(l) Installment Sales and Leased Property Policies covering property pertaining to a household and sold under conditional contract of sale, partial payment contract or installment sales contract or leased, but excluding motor vehicles designed for highway use. Such policies must cover in transit but shall not extend beyond the termination of the seller's or lessor's interest.
(6) Commercial Property Floater Risks. Commercial property floater risks covering property pertaining to a business, profession or occupation include:
(a) Radium Floaters.

(b) Physicians' and Surgeons' Instrument Floaters. Such policies may include coverage of such furniture, fixtures and tenant Assured's interest in such improvements and betterments of buildings as are located in that portion of the premises occupied by the Assured in the practice of his profession.

(c) Pattern and Die Floaters.

(d) Theatrical Floaters, excluding buildings and their improvements and betterments, and furniture and fixtures that do not travel about with theatrical troupes.

(e) Film Floaters, including builders' risk during the production and coverage on completed negatives and positives and sound records.

(f) Salesmen's Samples Floaters.

(g) Exhibition Policies on property while on exhibition and in transit to or from such exhibitions.

(h) Builders Risks and/or Installation Risks covering interest of owner, seller or contractor, against loss or damage to machinery, equipment, building materials or supplies, being used with and during the course of installation, testing, building, renovating or repairing. Such policies may cover at points or places where work is being performed, while in transit and during temporary storage or deposit, of property designated for and awaiting specific installation, building, renovating or repairing. Such coverage shall be limited to Builders' Risks or Installation Risks where perils in addition to Fire and Extended Coverage are to be insured. If written for account of owner, the coverage shall cease upon completion and acceptance thereof; or if written for account of a seller or contractor the coverage shall terminate when the interest of the seller or contractor ceases.

(i) Mobile Articles, Machinery and Equipment Floaters (excluding motor vehicles designated for highway use and auto homes, trailers and semi-trailers except when hauled by tractors not designed for highway use and snow plows constructed exclusively for highway use), covering identified property of a mobile or floating nature, not on sale or consignment, or in course of manufacture, which has come into custody or control of parties who intend to use such property for the purpose for which it was manufactured or created. Such policies shall not cover furniture and fixtures not customarily used away from premises where such property is usually kept.

(j) Property in transit to or from and in the custody of bailees (not owned, controlled or operated by the bailor). Such policies shall not cover bailee's property at his premises.

(k) Installment Sales and Leased Property. Policies covering property sold under conditional contract of sale, partial payment contract, installment sales contract, or leased but excluding motor vehicles designed for highway use. Such policies must cover in transit but shall not extend beyond the termination of the seller's or lessor's interest. This section is not intended to include machinery and equipment under certain "lease-back" contracts.

(l) Garment Contractors Floaters.

(m) Furriers or Fur Storer's Customer's Policies (i.e., policies under which certificates or receipts are issued by furriers or fur storers) covering specified articles the property of customers.

(n) Accounts Receivable Policies, Valuable Papers and Records Policies.

(o) Floor Plan Policies, covering property for sale while in possession of dealers under a Floor Plan or any similar plan under which the dealer borrows money from a bank or lending institution with which to pay the manufacturer, provided:
1. Such merchandise is specifically identifiable as encumbered to the bank or lending institution.

2. The dealer's right to sell or otherwise dispose of such merchandise is conditioned upon its being released from encumbrance by the bank or lending institution.

3. That such policies cover in transit and do not extend beyond the termination of the dealer's interest.
Provided, however, that such policies shall not cover automobiles or motor vehicles; merchandise for which the dealer's collateral is the stock or inventory as distinguished from merchandise specifically identifiable as encumbered to the lending institution.

(p) Sign and Street Clock Policies, including neon signs, automatic or mechanical signs, street clocks, which are used for such.

(q) Fine Arts Policies covering paintings, etchings, pictures, tapestries, art glass windows, and other bona fide works of art of rarity, historical value or artistic merit, for account of museums, galleries, universities, businesses, municipalities and other similar interests.

(r) Policies covering personal property which, when sold to the ultimate purchaser, may be covered specifically, by the owner, under Inland Marine Policies including:
1. Musical Instrument Dealers Policies, covering property consisting principally of musical instruments and their accessories. Radios, televisions, record players and combinations thereof are not deemed musical instruments.

2. Camera Dealers Policies, covering property consisting principally of cameras and their accessories.

3. Furrier's Dealers Policies, covering property consisting principally of furs and fur garments.

4. Equipment Dealers Policies, covering mobile equipment consisting of binders, reapers, tractors, harvesters, harrows, tedders, and other similar agricultural equipment and accessories therefor; construction equipment consisting of bulldozers, road scrapers, tractors, compressors, pneumatic tools and similar equipment and accessories therefor, but excluding motor vehicles designed for highway use.

5. Stamp and Coin Dealers covering property of philatelic and numismatic nature.

6. Jewelers' Block Policies.

7. Fine Arts Dealers.
Such policies may include coverage of money in locked safes or vaults on the Assured's premises. Such policies also may include coverage of furniture, fixtures, tools, machinery, patterns, molds, dies and tenant insureds interest in improvements of buildings.

(s) Wool Growers Floaters.

(t) Domestic Bulk Liquids Policies, covering tanks and domestic bulk liquids stored therein.

(u) Difference in Conditions Coverage excluding fire and extended coverage perils.

(v) Electronic Data Processing Policies.

69O FAC 167.023 | Conditions under Which Marine or Transportation Policies Do Not Cover

Unless otherwise permitted, nothing in the foregoing shall be construed to permit marine or transportation policies to cover:
(1) Storage of Assured's merchandise, except as hereinbefore provided.

(2) Merchandise in course of manufacture, the property of and on the premises of the manufacturer.

(3) Built in furniture and fixtures and improvements and betterments to buildings.

(4) Monies and/or securities in safes, vaults, safety deposit vaults, bank or Assured's premises, except while in the course of transportation.

(5) Live animal floaters.

69O FAC 167.024 | Rate Filings for Inland Marine Insurance

(1) This rule applies to marine insurance that is subject to Chapter 627, F.S.

(2) Section 627.021(2)(c), F.S, states that Chapter 627, F.S., does not apply to ocean marine insurance as distinguished from inland marine insurance.
(a) Section 627.021(2)(d), F.S., states that rates and rules are not required to be filed for commercial inland marine risks.

(b) The specific exclusion of commercial inland marine risks indicates that rates and rules for personal inland marine risks must continue to be filed with the Office.

(c) For purposes of this rule, personal inland marine is defined as insurance covering non-business property of a portable or movable nature that would typically be included in or with a homeowner's policy or a separate policy insuring one or more articles of property, including, but not limited to, jewelry, furs, art objects, silverware, glassware, small boats, sports equipment.

(d) For purposes of this rule, commercial inland marine is defined as commercial or industrial property, often but not always of a portable or movable nature or instrumentalities of transportation or communication, that would typically be included in or with a commercial lines policy or written in a separate policy insuring one or more such items of property, including, but not limited to, commercial goods in transit, traffic signals, bridges, tunnels.
69O-170 | Property and Casualty Insurance Rating

69O FAC 170.001 | Purpose

69O FAC 170.002 | Scope

69O FAC 170.003 | Calculation of Investment Income

(1) The purpose of this rule is to specify the manner in which insurers shall calculate investment income attributable to insurance policies written in Florida and the manner in which such investment income is used in the calculation of insurance rates by the development of an underwriting profit and contingency factor compatible with a reasonable rate of return.

(2) As used herein:
(a) "Insurance" means all classes of insurance subject to Section 627.062, F.S.

(b) "Subline" means a type of insurance uniquely identified for purposes of establishing rates under Section 627.062, F.S.

(c) "Property insurance subline" means insurance as defined in Section 624.604, F.S.

(d) Insurer includes rating organizations licensed in Florida.

(e) An underwriting profit and contingency factor can be positive or negative.
(3) Each insurer shall determine separately for each subline of insurance the expected patterns of loss payments over time associated with insurance written in Florida. The determination shall be made using Florida accident year or policy year loss payment patterns, and must fairly represent the insurance loss transaction of the insurer. If Florida data is not credible or is inappropriate, the insurer may exercise reasonable actuarial judgment in utilizing other relevant data or procedures or may use the underwriting profit and contingency factors referred to in subsection (9) of this rule.

(4) Each insurer shall determine YA, the expected investment income yield on invested assets representing unearned premium and loss reserves. The expected investment income yield, YA, shall be calculated using the quantities and formula below:
YA = YN WN + UoWo
Where:
YN
Expected investment income yield on assets newly invested or reinvested during the time the new rates are expected to be in effect.
YO
Expected investment income yield on assets invested prior to the time the new rates are expected to be in effect.
WN
Proportion of assets, held during the time the new rates are expected to be in effect, that is expected to be newly invested or reinvested.
WO
1 - WN
The above expected investment income yield, YA, shall be used for purposes of this rule unless evidence is presented that this quantity is not the investment income yield reasonably expected by the insurer.
(5) Separately for each subline, each insurer shall, using the average date of premium remittance by the insured, determine the discounted value of the expected loss payment pattern determined in subsection (3) using the expected investment income yield, YA, calculated in subsection (4). The undiscounted pattern minus the discounted pattern for each subline is to be expressed as a percent of the expected subline premium that is associated with the series of loss payments over time. This difference is the investment income opportunity associated with the subline.

(6) The investment income opportunities calculated in subsection (5) shall be used as follows to develop the underwriting profit allowance, to be used in rate filings:
(a) Select and specify the underwriting profit and contingency factor to be used in rate filings for the property insurance subline with the smallest investment income opportunity as calculated in subsection (5). If an insurer does not write property insurance in Florida, it shall use relevant data for such property insurance subline from areas other than Florida or shall use industry data, as determined by reasonable actuarial judgment. The selected underwriting profit and contingency factor is presumed to give due recognition to property insurance investment income. An underwriting profit and contingency factor greater than the quantity five percent is prima facie evidence of an excessive expected rate of return and unacceptable, unless supporting evidence is presented demonstrating that an underwriting profit and contingency factor included in the filing that is greater than this quantity is necessary for the insurer to earn a reasonable expected rate of return. In such case, the criteria presented in subsection (7) shall be used by the Office of Insurance Regulation in evaluating this supporting evidence.

(b) Determine the investment income differential between the property insurance subline and any other subline by subtracting the investment income opportunity for the property insurance subline as calculated in subsection (5) from the investment income opportunity for any other subline as calculated in subsection (5).

(c) The underwriting profit and contingency factor for any subline other than that specified in paragraph (6)(a) shall be the underwriting profit and contingency factor for the subline from paragraph (6)(a), minus the investment income differential from paragraph (6)(b). An underwriting profit and contingency factor greater than this quantity is prima facie evidence of an excessive expected rate of return and unacceptable, unless supporting evidence is presented demonstrating that an underwriting profit and contingency factor included in the filings that is greater than this quantity is necessary for the insurer to earn a reasonable rate of return. In such cases, the criteria presented in subsection (7) shall be used by the Office in evaluating this supporting evidence.
(7) An underwriting profit and contingency factor calculated in accordance with this rule is considered to be compatible with a reasonable expected rate of return on net worth. If a determination must be made as to whether an expected rate of return is reasonable, the following criteria shall be used in that determination:
(a) An expected rate of return for Florida business is to be considered reasonable if, when sustained by the insurer for its business during the period for which the rates under scrutiny are in effect, it neither threatens the insurer's solvency nor makes the insurer more attractive to policyholders or investors from a corporate financial perspective than the same insurer would be had this rule not been implemented, all other variables being equal; or

(b) Alternatively, the expected rate of return for Florida business is to be considered reasonable if it is commensurate with the rate of return anticipated for other industries having corresponding risk and it is sufficient to assure confidence in the financial integrity of the insurer so as to maintain its credit and, if a stock insurer, to attract capital, or if a mutual or reciprocal insurer, to accumulate surplus reasonably necessary to support growth in Florida premium volume reasonably expected during the time the rates under scrutiny are in effect.
(8) Each insurer filing insurance rates in Florida shall use an underwriting profit and contingency factor for each subline that is developed in accordance with this rule. The combined profit and contingency factor shall be quantified and stated as a single percentage factor. The entire factor and the component parts of the factors shall be justified by the insurer proposing to use the factor.

(9) For use as permitted in subsection (3) of this rule, the Office shall annually establish appropriate underwriting profit and contingency factors by annual statement lines or classes subject to this rule. Such factors shall be derived by using available and actuarially reasonable industry data. The factors shall be established by order and provided to all affected insurers prior to the date their use is required. Factors distributed for the previous year shall remain in effect until new factors are published.

69O FAC 170.004 | Rating Plans: Discounts, Credits, Surcharges

(1) This rule applies to all commercial property and casualty insurance which is subject to Section 627.062(2), F.S., and which is voluntarily written by an insurer in accordance with a rating plan. It is intended to establish guidelines and procedures for determining whether discounts, credits or surcharges applied under a rating plan are producing rates which are not excessive, inadequate, or unfairly discriminatory. This rule does not apply to workers' compensation and employer's liability insurance, to private passenger motor vehicle insurance, or to risks that are individually rated (pursuant to Subsection 627.062(3), F.S.), or subject to excess rate procedures (pursuant to Section 627.171, F.S.).

(2) As used in this rule:
(a) "Rating plan" means any schedule rating plan, experience rating plan, retrospective rating plan, individual risk premium modification plan, rule, procedure, plan, underwriting rule, schedule, or other such device for modifying filed manual rates and rating rules.

(b) "Subjective discount, credit or surcharge plan" means any rating plan which
(i) applies to a specific policy at the discretion of the insurer, or

(ii) uses subjective, non-quantifiable standards for determining the rate modification, or

(iii) does not specify the exact amount of the modification.
These plans include, but are not limited to, plans commonly called Schedule Rating Plans and Individual Risk Premium Modification Plans. These plans enumerate a number of individual risk characteristics and a range of modifications or modification factors which may be applied to the otherwise applicable manual rate in order to recognize individual risk characteristics. However, individual risk characteristics shall not include the degree of competition for the risk or the rates which may be offered by other insurers. The effect of the modification is to increase (debit) or decrease (credit) the otherwise applicable manual rate.

(c) "Manual rate" means the rate developed using the filed manual rates and premium determination rules prior to the application of any rating plan.

(d) "Experience rating plan" means any rating plan or part of a rating plan used to modify an otherwise applicable manual rate based on the past loss experience of the individual insured.
(3) All rating plans shall clearly define the eligibility standards for the plan as approved by the Office. Experience rating plans shall be mandatory for all eligible insureds. The eligibility for a subjective discount, credit, or surcharge plan shall depend upon manual premium which shall not be less than $1000 in manual premium.

(4) Unless otherwise specified in the premium determination rules, concurrent applications of rating plans shall be multiplicative in determining the final rate. Unless otherwise specified in a subjective discount, credit, or surcharge plan, concurrent application of discounts, credits, and surcharges shall be additive in the determination of the final debit or credit.

(5)
(a) An insurer utilizing a subjective discount, credit, or surcharge plan on a particular policy shall maintain documentation which supports the rate modification. Appropriate documentation includes loss control reports, inspection reports, financial analyses, photographs, and safety plans. Documentation must be maintained for five years. The modification shall remain in effect for all the renewals of that policy or for any replacement policy. If the insurer changes the modification upon renewal or replacement of that policy, the insurer shall maintain appropriate documentation of the revised modification and justify the change in the modification. Documentation for the change must be maintained for five years.

(b) All subjective rating for a particular line of insurance shall be consolidated into a single subjective discount, credit, or surcharge plan. The maximum debit or credit for any individual policy developed by a subjective discount, credit, or surcharge plan shall not exceed 25%.

(c) A credit given under a subjective discount, credit, or surcharge plan may not result in modified premium which is less than the premium that made the risk eligible for the subjective discount, credit, or surcharge plan.
(6) Section 627.062(2)(e)6., F.S., requires premium discounts, credits, or surcharges to bear a reasonable relationship to the expected loss and expense experience among various groups of risks. For policies which have received a premium modification under a subjective discount, credit, or surcharge plan, the insurer shall maintain documentation by line of business showing the policy number, the otherwise applicable manual premium for that policy, the premium debit or credit for that policy, and the incurred loss experience for that policy. For each policy year for each line of business, the insurer shall determine the loss ratio for all policies which have received a premium debit under the subjective discount, credit or surcharge plan, the loss ratio for all policies which have received a premium credit under the subjective discount or surcharge plan, and the loss ratio for all policies which received neither a debit or a credit under the subjective discount, credit, or surcharge plan. The insurer shall maintain such documentation for Office inspection and review. A subjective discount, credit, or surcharge plan which does not bear a reasonable relationship among loss ratios for the debit group, the credit group, and the non-debit/credit group shall be deemed unfairly discriminatory.

69O FAC 170.005 | Use of Filed Rates

(1) This rule applies to all property and casualty insurance to which Section 627.062 or 627.0651, F.S., applies.

(2) Any rate filing made with the Office shall elect whether rates are filed as "file and use" or "use and file" as defined in Section 627.062(2) or 627.0651(1), F.S.

(3) The filing of rates requires that specific rates be filed and precludes the filing of ranges of rates.

(4) All rate filings shall be submitted pursuant to Rule 69O-170.013, F.A.C.

(5) For "use and file" filings, any filing which is not made within the timelines provided by statute, e.g., the filing is received by the Office more than 30 days after the effective date, shall result in the Office's issuance of a Notice of Intent to disapprove.

(6)
(a) Changing the filing designation during the review of the filing from "file and use" to "use and file" or from "use and file" to "file and use", shall constitute a withdrawal of the filing and require a timely resubmission under the revised filing type as a new filing.

(b) Notwithstanding the above and following the approval of the filing by the Office, pursuant to Section 627.062 or 627.0651, F.S., the filer may amend the effective date for a "file and use" filing to be shorter than the 90 or 60 days indicated in Section 627.062 or 627.0651, F.S., as long as the amended effective date is subsequent to the approval of the Office and provides the required statutory policyholder notice.

69O FAC 170.006 | Rate Manual Filings and Revisions

(1) Each insurer shall submit manual pages and a checklist page or manual revision notice specifying the rule of application, effective date and the page number of:
(a) Each new (or revised) manual page included with the filing.

(b) Each existing manual page being replaced by a new (or revised) manual page.

(c) Each existing manual page being deleted and not replaced.

(d) Each unchanged manual page that continues to be applicable if requested by the Office.
(2) The following shall be included on each manual page:
(a) Insurer Name(s);

(b) Line of Business and Program Name (if applicable);

(c) Page Number (each page should have a unique number); and

(d) Revision Date or other Date connected with the filing, e.g., filing date, effective date, editing date, etc. (specify the type of date used).
(3)
(a) Insurers shall include a separate cover letter and manual for each line of business, as designated in paragraph (c) below.

(b) Except for private passenger automobile insurance, homeowners and dwelling fire and liability, insurers authorized by a rating organization to utilize the rating organization's loss costs and rules, after those loss costs and rules have been approved for use by the Office, need only file the loss cost multiplier to be used with those loss costs.

(c) For purposes of identifying filings submitted to the Office, a line of business shall be identified by one of the following. Additional identification may be used as needed. Filings for types of insurance not on this list should contain appropriate identification.
1. Boiler and Machinery.

2. Commercial Automobile.

3. Commercial Fire and Allied Lines (including Glass).

4. Commercial Inland Marine.

5. Commercial Multiple Line.

6. Credit Property and Credit Automobile.

7. Crime.

8. Farm.

9. Fidelity and Surety.

10. Other Liability (including Excess and Umbrella Coverage).

11. Homeowners.

12. Mobile Homeowners.

13. Personal Inland Marine.

14. Personal Liability.

15. Personal Property.

16. Private Passenger Automobile.

17. Professional Liability.

18. Dwelling Fire and Liability.
(d) Insurers that submit filings on a group basis may submit manual pages on a group basis, provided each manual page identifies the insurers to which it is applicable.
(4)
(a) All private passenger automobile and homeowners insurance underwriting guidelines, for both new and renewal business, are subject to filing requirements.

(b) For filings involving base rate adjustments other than private passenger automobile and homeowners, insurers shall describe in sufficient detail all changes to the underwriting guidelines since the inception of the submitted experience period in order that the Office may ascertain the actuarial impact upon proposed rates pursuant to Section 627.062, F.S.

(c) For the purpose of paragraph (4)(b);
1. Underwriting guidelines shall mean qualitative standards affecting the eligibility of risks for insurance, but do not include procedures for determining eligibility (such as delegations of binding authority).

2. Qualitative standards shall mean standards affecting the quality of risk such as loss history, credit scoring, acceptable number of claims or claim frequencies, required loss control, or violation points or prior accidents in the case of motor vehicles; and does not include quantitative standards that relate to the size of risks (such as square footage, number of vehicles, or gross receipts) or standards that relate to the amount of coverage that will be provided.

69O FAC 170.007 | Annual Rate Filings

(1)
(a) This rule applies to each insurer or rating organization subject to Section 627.0645, F.S.

(b)
1. Commercial Multiple Line insurance, for purposes of this rule, is defined as insurance that includes a combination of one or more property lines of insurance, e.g., fire and allied lines, and one or more casualty lines of insurance, e.g., general liability, burglary and theft.

2. Commercial Multiple Line insurance shall be interpreted as being the same as Commercial Multiple Peril insurance.

3. Commercial Multiple Line insurance or Commercial Multiple Peril insurance which is written on an indivisible premium basis is subject to this rule.

4. Divisible premium Commercial Multiple Peril policies shall not be subject to this rule.
(c) A base rate filing considers the overall rate level and individual components of a line or subline being reviewed, although all are not necessarily revised in a base rate filing. A base rate filing may include, for example, a package modification factor.

(d) For purposes of identifying filings submitted to the Office, a line of business shall be identified by one of the following, although additional identification may be used as needed:
1. Commercial Multiple Peril Policy (with indivisible premium),

2. Dwelling Fire and Liability,

3. Homeowners,

4. Mobile Homeowners,

5. Motor Home and Motorcycle,

6. Personal Inland Marine,

7. Personal Liability; and,

8. Private Passenger Automobile.
(2) Each insurer or each rating organization filing rates for one or more insurers shall make annual base rate filings with the Office for each line or subline of insurance no later than 12 months after its previous certification or base rate filing effective date for new business.

(3)
(a) Filings shall be submitted in accordance with the requirements of this rule.
1. Filings submitted in accordance with paragraph (4)(a), below, shall demonstrate that the rates filed are not excessive, inadequate, or unfairly discriminatory, and

2. Filings submitted in accordance with paragraph (4)(b), below, shall demonstrate that the rates are actuarially sound and not inadequate.
(b)
1. The filings required by this rule shall be on an individual insurer basis unless the rates for insurers within a group are derived from the pooled experience of those insurers.

2. If the rates for more than one insurer within a group are derived from pooled experience, then the filing may be made on a multiple insurer basis but the cover letter for the filing shall explicitly state what the rates are and what insurers are included in the group. Insurers may submit a filing on behalf of any combination of insurers within the insurers' group, provided the effective dates are identical for every insurer and program identified in the filing.
(c)
1. The insurer shall submit all filings to the Office at https://iPortal.fldfs.com, the industry portal to the Office's I-File System, as adopted in Rule 69O-170.0155, F.A.C.

2. A filing shall be considered received by the Office on business days between the hours of 8:00 a.m. and 5:00 p.m. eastern time. Filings received after 5:00 p.m. shall be considered to be received the next business day.
(4) The filing required by this rule shall be satisfied by either paragraph (a) or (b), below:
(a) A rate filing prepared by or under the direct supervision of an actuary. The filing shall be signed by the actuary and shall contain documentation demonstrating that the proposed rates are not excessive, inadequate, or unfairly discriminatory, and be submitted pursuant to Rule 69O-170.013, F.A.C.

(b)
1. If no rate change is proposed, a filing which consists of a certification by an actuary that the existing rate level produces rates which are actuarially sound and which are not inadequate.

2. Form OIR-B1-582, "Universal Standardized Data Letter," as adopted in Rule 69O-170.0155, F.A.C.

3. Form OIR-B1-586, "Florida Property and Casualty - Annual Rate Filings Certification," as adopted in Rule 69O-170.0155, F.A.C.

4. The data shall be on a direct basis.
(c) If an insurer does not employ or otherwise retain the services of an actuary, as defined by Section 627.0645(8), F.S., the filing under paragraph (a) or (b), above, shall:
1. Be prepared by a person meeting the requirements of Section 627.0645(5), F.S., herein referred to as a qualified ratemaker.

2. Be reviewed and signed by an employee of the insurer who is authorized to approve rate filings.

3. Include detailed information on the preparer's experience to demonstrate compliance with Section 627.0645(5), F.S.

4. Include a certification of an officer of the insurer that the insurer does not employ or otherwise retain the services of an actuary.

5. If the submission does not contain the material required by this paragraph (c), it will result in the Office's issuance of a Notice of Intent to disapprove.
(d)
1. For purposes of this rule, a prospective loss cost filing, using the most recently approved loss costs, submitted to the Office by a duly authorized rating organization, may be considered as part of a base rate filing.

2. The factors for converting loss costs to rates shall be filed by the submitting insurer and approved by the Office.

3. All deviations from a rating or advisory organization's loss costs are to be certified or adequately supported.

4. An insurer may choose:
a. To file and distribute final rate pages,

b. To file or reference loss cost pages filed and distributed by a rating organization, or

c. To file loss cost pages distributed by an advisory organization plus the insurer's factors used to convert the prospective loss costs to rates.
5. An insurer shall use Form OIR-B1-583, "Florida Expense Supplement Calculation of Insurer Loss Cost Multiplier," as adopted in Rule 69O-170.0155, F.A.C., in filing the factors to convert a rating or advisory organization's prospective loss costs to rates and shall comply with Rule 69O-170.013, F.A.C.
(e)
1. A request for exemption pursuant to Section 627.0645(2)(b), F.S., shall include Form OIR-B1-584, "Florida Property and Casualty - Annual Rate Filing-Exemption," as adopted in Rule 69O-170.0155, F.A.C. and shall be submitted through https://iPortal.fldfs.com.

2. The exemption shall remain in effect for as long as there is not an increase in premium volume.
(5) A request for extension meeting the conditions of Section 627.0645(6), F.S., will be approved automatically upon receipt.

69O FAC 170.010 | Short Rate Cancellations and Fully Earned Premiums Prohibited

(1) This rule applies to all property and casualty insurance to which Section 627.062, F.S., applies. It is intended to clarify the premium amount that an insurer must return to the insured upon cancellation of a policy by the insured. The provisions of this rule do not apply to inspection fees or other fees defined by statute to be fully earned.

(2) Under this rule, the use of short rate cancellation tables or procedures that develop return premiums that are less than 90% of the pro rata unearned premium in a policy being cancelled is prohibited unless actuarial or other justification is provided.
(a) Actuarial justification shall demonstrate that the rates produced by the proposed cancellation procedures are not excessive, inadequate or unfairly discriminatory.

(b) Justification other than actuarial may demonstrate that the insurance cancellation provisions are a minor part of the financial transaction.
(3) The inclusion of fully earned premium provisions in insurance contracts or endorsements is prohibited by this rule unless the insurer requesting the use of these provisions has justified them to the Office prior to their use.
(a) Fully earned premium provisions can only be included in insurance policies or endorsements that provide specialized, relatively short term coverage on specific events or items of property that have a known time period of usefulness or exposure to loss.

(b) Examples of exposures for which fully earned premiums are acceptable include, but are not limited to, crop hail insurance, flood insurance, outdoor concerts, picnics, sporting events, seasonal activities, minimum premium policies, and policies as to which fully-earned premiums are provided by Section 627.7275, F.S.

69O FAC 170.011 | Drafted Water Supplies

(1) In the case of fire insurance rates, consideration shall be given to the public protection grading for the area in which the property is located.

(2) If the property is located within an area that has been graded by a licensed rating organization or insurer, the grading established by that entity shall apply.

(3) If the provisions of subsection (2) do not apply and if the property is located within 5 road miles of a recognized responding fire department but more than 1000 feet from a public fire hydrant connected to an appropriate water supply, then the following alternate, creditable water supply shall be considered:
(a) Lakes, ponds, swimming pools or water reservoirs that are accessible to a responding fire department that is equipped to appropriately use water from these sources.

(b) Tanker trucks capable of carrying sufficient water for fire fighting purposes to any property within the protected area.

69O FAC 170.012 | Sinkhole Insurance (Repealed)

69O FAC 170.013 | Filing Procedures for Property and Casualty Insurance Rates, Rules, Underwriting Guidelines, and Forms

(1)
(a) The procedures in this rule apply to all insurance rate, rule or form filings for property and casualty insurance as defined in Sections 624.604, 624.605, 634.011(8), 634.301(4), 634.401(14), 642.015(3), 648.25(1), 635.011(1) and 627.826(1), F.S.

(b) Underwriting guidelines for private passenger automobile, homeowners' and mobile homeowners' insurance, for both new and renewal business shall be filed pursuant to this rule.
(2) A "rate filing" contains all the information submitted in the filing made by the insurer, plus any supplemental information received during the course of the Office's review, for all purposes of the filing made under Section 627.062(2)(a) or 627.0651, F.S.

(3) Filing Submittal Requirements.
(a) Complete rate, rule, underwriting guidelines for both new and renewal business, and form filings shall be submitted with the following information:
1. Form OIR-B1-582, "Universal Standardized Data Letter," as adopted in Rule 69O-170.015, F.A.C.

2. Cover letter that shall include, at a minimum:
a. The purpose of the filing;

b. For rate and rule filings, an identification as to whether the filing is made under "file and use" or "use and file", including the proposed effective date of the rates or the date the rates were implemented;

c. If this is a resubmission of a previous file, a brief explanation of the prior filing, including reference to the corresponding Florida filing log number shall be provided;

d. For a rate filing for which a form is also being filed, identification of the corresponding filing log number for the form or when the form will be submitted;
3. Explanatory memorandum which shall:
a. Explain the organization of the components of the filing;

b. Identify and highlight the changes from the current situation;

c. Include any explanation required by Rule 69O-170.006, F.A.C.;

d. If there is no rate effect, a detailed explanation of how it was so determined or why it is believed that there is no rate effect.
4. For filings with a rate effect, an actuarial opinion and supporting memorandum prepared pursuant to Rule 69O-170.0135, F.A.C.

5. Filing procedures and content required for specific lines of business as delineated in the following rules:
a. Rule 69O-170.014, F.A.C. (Homeowners and Mobile Homes);

b. Rule 69O-175.003, F.A.C. (Private Passenger Auto);

c. Rule 69O-170.0141, F.A.C. (Dwelling);

d. Rule 69O-170.0142, F.A.C. (Commercial Residential/All Other Property & Casualty);

e. Rule 69O-170.0143, F.A.C. (Professional Liability for Medical Malpractice); and
6. Manual pages formatted in compliance with Rule 69O-170.006(2) F.A.C. Subsequent to the initial filing, the insurer may defer submitting final amended manual pages until the Office concludes its analysis. Final approval will not occur until final manual pages have been submitted.
(b) All filings shall:
1. Be separated into either rate/rule only or form only filings; and

2. Be separated by line of business in accordance with Rule 69O-170.006, F.A.C.
(c) Group Filings. Insurers may submit a filing on behalf of any combination of insurers within the insurers' group, provided the effective dates are identical for every insurer and the program is identified in the filing.
(4)
(a) All filings shall be submitted electronically to http://www.FLOir.com/iPortal, the industry portal to the Office's I-File System, as adopted in Rule 69O-170.0155, F.A.C.

(b) A filing shall be considered received by the Office on business days between the hours of 8:00 a.m. and 5:00 p.m. eastern time. Filings received after 5:00 p.m. shall be considered to be received the next business day.
(5)
(a) A rate filing shall contain documentation demonstrating that the proposed rates meet the standards and conditions of Section 627.062 or 627.0651, F.S., as applicable.

(b) It is the responsibility of the insurer to ensure that the filing contains all the information and documentation the insurer wants considered that supports the rate requested.

(c) A rate filing shall contain information and documentation sufficient for an actuary practicing in the same field to evaluate the work.

(d) Any submission that does not contain the information and documentation required by subsection (3) above, or for which required filing forms have not been completed in their entirety, will result in the Office's issuance of a Notice of Intent to disapprove.
(6)
(a) The Office may request additional information or clarification to evaluate the filing for compliance with applicable statutory provisions.

(b) To allow the Office sufficient time to perform a proper review, the insurer shall submit by a date certain stated in a clarification letter any required additional information, explanation of data, or justification of assumptions.

(c) Unless the date is extended by the Office, failure to adequately address the issues by the date stated in the clarification letter will result in a notice of intent to disapprove the filing by the Office.
(7) This rule applies to that portion of a rate filing relating to terrorism coverage required under the Terrorism Risk Insurance Act of 2002. The Office recognizes the difficulty facing an individual insurer in demonstrating that its rates related to terrorism are not excessive, inadequate, or unfairly discriminatory. An insurer is free to use any methodology the insurer believes demonstrates that the rates requested or implemented are in compliance with Section 627.062, F.S. If an insurer is unable to demonstrate through its own methodology that the rate requested or implemented complies with Section 627.062, F.S., then the insurer may, at its option, adopt the methodology, data, and/or rates or loss costs of another insurer or rating or advisory organization that have been previously approved by the Office for similar risks.

69O FAC 170.0135 | Actual Memorandum

(1)
(a) An actuarial opinion and memorandum supporting the opinion shall state that the rates are not excessive, inadequate, or unfairly discriminatory and comply with the laws of this state.

(b) If the opinion cannot be given, a complete explanation of the reason or qualifications shall be provided.

(c) If the opinion and memorandum are prepared by a different individual from the person who prepared the prior filing, an explanation of the reason for this change shall be provided.
(2)
(a) The memorandum, along with any required online data and rate submission material, shall support and document the basis of the opinion.

(b) It is not necessary to repeat, within the memorandum, any data that has been submitted through the online collection system; however, the memorandum shall so indicate and shall provide any necessary explanation.

(c) If an insurer, in addition to the completion of the required rate indications component of the I-File System, chooses to develop the proposed rates by using data or a method that is different from that which underlies the rate indications component of the I-File System, the memorandum shall contain detailed documentation and development of the method, assumptions and proposed rates, detailed documentation that the method is consistent with generally accepted and reasonable actuarial techniques, and that the resulting rates are not excessive, inadequate or unfairly discriminatory. The insurer may also provide any explanation for the Office to consider in the review of the filing pursuant to Section 627.062 or 627.0651, F.S., as to why it believes that the methodology or technique used in the filing is more appropriate for the filing than the methodology or technique used in the I-File System indications. The use of different data or method does not create a presumption of the appropriateness or inappropriateness of either method.

(d) The memorandum shall be such that an actuary qualified in the same practice area in which the filing is made could evaluate the reasonableness of the work.

(e) Each of the following items that are pertinent to the filing shall be identified and discussed:
1. The source and description of the experience data used, including homogeneity and reasonableness of the data used as a statistical basis to measure the expected claim costs over the rating period;

2. Verification that the data used does not include punitive damage awards;

3. Operational issues, including changes in underwriting guidelines as indicated in paragraph 69O-170.006(4)(b), F.A.C., and other influences on the experience data that will impact the expected experience during the rating period, including large non-recurring claims and loss experience pertaining to actual catastrophic events, how these compare to expected, and how they are incorporated into the rate development;

4. Premium and loss trends;

5. Basis of the credibility standard for complementing the experience data, along with support for the selection of that standard whenever the standard has changed from the previous filing;

6. Average statewide rate change, and an exhibit showing the ranges of impact on policyholders of the changes proposed in the current filing and the factors affecting the range of impact;

7. The effect of reinsurance or any other method of smoothing claim volatility and how it was included in the rate development;

8. Expense experience and anticipated expense needs for the rating period;

9. Analysis of investment income and return on surplus and how it was included in the rate analysis, including demonstration of compliance with the provisions of Rule 69O-170.003 or 69O-175.001, F.A.C.;

10. Disclosure and explanation of the basis of judgment made on assumptions or resulting rates; and

11. The expense factors in each rate filing, which shall be divided into the following categories:
a. Commissions and brokerage;

b. Other acquisition expenses;

c. General expenses;

d. Premium taxes;

e. Miscellaneous licenses and fees;

f. Profit and contingencies;

g. Reinsurance costs; and

h. Other expenses.
(3) Standards.
(a) Premium on-leveling methodology and calculations shall be clearly documented. An overall rate level history for the pertinent past shall be provided. Insurers not using this history in their calculations shall fully describe the method used. The insurer shall provide the policy term distribution, e.g., what percentage of the policies have been annual policies versus six-month policies.

(b) If a model accepted by the Florida Commission on Hurricane Loss Projection Methodology is used, it shall be the current version of the model, however, the immediate prior version of the model accepted by the Commission of the model may be used if the filing is submitted no more than three months after the date the current version is accepted by the Commission. If the insurer is using an averaged model under section 627.062(2)(j)2., F.S., the actuarial memorandum must state that the same averaged model is being used throughout the state and indicate if a weighted average is being used. If a weighted average is used the memorandum must also include an actuarial justification for using that weighted average which shows that it results in a rate that is reasonable, fair, and adequate.

(c) The use of contingent commissions as supporting data for rate changes is prohibited unless:
1. There is a contractual arrangement between the insurer and its agents concerning the payment of contingent commissions; and

2. The insurer demonstrates that it is not paying contingent commissions from profits higher than anticipated in its filings.
(d) The ultimate incurred losses shall be based on best estimate assumptions, i.e., the assumptions the actuary expects to be realized over the period for which the rates are anticipated to be in effect.

69O FAC 170.014 | Homeowners Insurance Ratemaking and Rate Filing Procedures

(1)
(a) This rule shall apply to all homeowners insurance rates filed pursuant to Section 627.062, F.S.

(b) For purposes of this rule, reference to homeowners insurance shall include mobile homeowners insurance written on homeowners type policies and mobile homeowners insurance written on auto physical damage type policies.

(c) The information required by this rule shall be included as a required component of the filing made pursuant to subsection 69O-170.013(3), F.A.C.
(2) Filing Submittal Requirements:
(a) Each insurer shall file electronically the information required by the I-File System and the Homeowners' Rate Collection System (HRCS) as adopted in Rule 69O-170.0155, F.A.C., at http://www.FLOir.com/iPortal.

(b) Required supporting documentation referenced in the I-File System and HRCS shall be provided.

(c) Accurate entry of information into the rate indications workbook component of the I-File System will result in an aggregate average statewide rate indication. The accuracy and integrity of the information provided shall be the responsibility of the insurer.
(3) The information identified in subsections (4) through (9) below is submitted within the I-File System and HRCS collection indicated in subparagraph (2)(a)1. above.

(4)
(a) Each rate filing shall contain either:
1. Separate rate level indications and support for such indications on a statewide basis for each type of homeowners policy which the insurer writes in Florida; or

2. If a series of homeowner types of policies bear a uniform statewide factor relationship to each other, combined rate level indications and support for such indications on a statewide basis for the total program along with supporting data for the proposed factor relationships between each type of policy.
(b)
1. The provisions of this subsection shall apply to all rate filings regardless of whether a filing requests rate changes for one, more than one, or all of the types of policies written.

2. This subsection shall not apply if a rate change is filed in response to law changes which relate to specific types of policies filed.
(5)
(a) Each rate filing which proposes changes to base rates as to any policy for which rates vary by territory shall contain either:
1. Separate support by territory for each type of homeowners policy for which a proposed rate change is filed; or

2. If a series of homeowners types of policies include identical territory relativities, support by territory for all types of policies combined.
(b) The provisions of this subsection shall apply to each territory regardless of whether the rate filing requests rate changes for one, more than one, or all territories.
(6) The earned premiums and incurred losses included in the rate level indications shall be direct calendar/accident year or direct fiscal/accident year, Florida-only data.

(7) The expense factors in each homeowners rate filing shall be divided into the following categories:
(a) Commissions and brokerage;

(b) Other acquisition expenses;

(c) General expenses;

(d) Premium taxes;

(e) Miscellaneous licenses and fees;

(f) Reinsurance costs; and

(g) Other expenses.
(8) The cost of reinsurance shall be included as an expense factor and shall consider:
(a) The amount to be paid to the reinsurer;

(b) Ceding commissions to be paid to the insurer by the reinsurer;

(c) Expected reinsurance recoveries; and

(d) Other relevant information specifically relating to cost such as a retrospective profit sharing agreement between the insurer and the reinsurer.
(9) The use of contingent commissions as supporting data for rate changes is prohibited unless:
(a) There is a contractual arrangement between the insurer and its agents concerning the payment of contingent commissions; and

(b) The insurer demonstrates that it is not paying contingent commissions from profits higher than anticipated in its filings.

69O FAC 170.0141 | Dwelling Insurance Ratemaking and Rate Filing Procedures

(1)
(a) This rule shall apply to all dwelling fire and extended coverage insurance rates filed pursuant to Section 627.062, F.S.

(b) For purposes of this rule, reference to dwelling fire insurance shall include mobile home dwelling insurance written on dwelling fire type policies.

(c) The information required by this rule shall be included as a required component of the filing made pursuant to subsection 69O-170.013(3), F.A.C.
(2) Filing Submittal Requirements:
(a) Each insurer shall file electronically the information as required by the I-File System and the Dwelling Rate Collection System (DRCS), as adopted in Rule 69O-170.0155, F.A.C., at http://www.FLOir.com/iPortal.

(b) Required supporting documentation referenced in the I-File System and DRCS shall be provided.

(c) Accurate entry of information into the rate indications workbook component of the I-File System will result in an aggregate average statewide rate indication. The accuracy and integrity of the information provided shall be the responsibility of the insurer.
(3) The information identified in subsections (4) through (9) below is submitted within the I-File System and DRCS collection indicated in paragraph (2)(a) above.

(4)
(a) Each rate filing shall contain either:
1. Separate rate level indications and support for such indications on a statewide basis for each type of dwelling fire and extended coverage policy which the insurer writes in Florida; or

2. If a series of dwelling fire types of policies bear a uniform statewide factor relationship to each other, combined rate level indications and support for such indications on a statewide basis for the total program along with supporting data for the proposed factor relationships between each type of policy.
(b)
1. The provisions of this subsection shall apply to all rate filings regardless of whether a filing requests rate changes for one, more than one, or all of the types of policies written.

2. This subsection shall not apply if a rate change is filed in response to law changes which relate to specific types of policies filed.
(5)
(a) Each rate filing which changes base rates as to any policy for which rates vary by territory shall contain either:
1. Separate support by territory for each type of dwelling fire policy for which a proposed rate change is filed; or

2. If a series of dwelling fire types of policies include identical territory relativities, support by territory for all types of policies combined.
(b) The provisions of this subsection shall apply to each territory regardless of whether the rate filing requests rate changes for one, more than one, or all territories.
(6) The earned premiums and incurred losses included in the rate level indications shall be direct calendar/accident year or direct fiscal/accident year, Florida-only data.

(7) The expense factors in each dwelling rate filing shall be divided into the following categories:
(a) Commissions and brokerage;

(b) Other acquisition expenses;

(c) General expenses;

(d) Premium taxes;

(e) Miscellaneous licenses and fees;

(f) Reinsurance costs; and

(g) Other expenses.
(8) The cost of reinsurance shall be included as an expense factor and shall consider:
(a) The amount to be paid to the reinsurer;

(b) Ceding commissions to be paid to the insurer by the reinsurer;

(c) Expected reinsurance recoveries; and

(d) Other relevant information specifically relating to cost, such as a retrospective profit sharing agreement between the insurer and the reinsurer.
(9) The use of contingent commissions as supporting data for rate changes is prohibited unless:
(a) There is a contractual arrangement between the insurer and its agents concerning the payment of contingent commissions; and

(b) The insurer demonstrates that it is not paying contingent commissions from profits higher than anticipated in its filings.

69O FAC 170.0142 | Ratemaking and Rate Filing Procedures for Commercial Residential Insurance and All Other Lines

(1)
(a) The procedures in this rule apply to all commercial residential insurance rates filed pursuant to Section 627.062, F.S., and all other lines of property and casualty insurance as defined in Sections 624.604 and 624.605, F.S.

(b) This rule does not apply to medical malpractice coverage which is subject to Rule 69O-170.0143, F.A.C. or workers' compensation insurance as defined in Section 624.605(1)(c), F.S.

(c) For purposes of this rule, reference to commercial residential insurance shall include insurance on the following types of risks:
1. Condominium associations;

2. Homeowners associations;

3. Apartment buildings;

4. Hotels and motels;

5. Dormitories (including sorority and fraternity houses);

6. Boarding houses; and

7. Rooming houses.
(2) The filing submittal requirements in this rule are in addition to the information required by subsection 69O-170.013(3), F.A.C., and shall be included as a required component of the filing made pursuant to subsection 69O-170.013(3), F.A.C.

(3)
(a) Each rate filing shall contain either:
1. Separate rate level indications and support for such indications on a statewide basis for each type of coverage which the insurer writes in Florida; or

2. If a series of policy types bear a uniform statewide factor relationship to each other, combined rate level indications and support for such indications on a statewide basis for the total program, together with the supporting data for the proposed factor relationships between each type of policy.
(b)
1. The provisions of this subsection shall apply to all rate filings regardless of whether a filing requests rate changes for one, more than one, or all of the types of policies written.

2. This subsection shall not apply if a rate change is filed in response to law changes which relate to specific types of policies.
(4)
(a) If the filing adopts a rating organization's prospective loss costs, the filing shall include Form OIR-B1-583 (pages 1 and 2), "Florida Expense Supplement Calculation of Insurer Loss Cost Multiplier" as adopted in Rule 69O-170.0155, F.A.C.

(b) An independent rate filing shall include Form OIR-B1-595, "Florida Expense Supplement for Independent Rate Filings" as adopted in Rule 69O-170.015, F.A.C.

(c) The data shall be on a direct basis.

(d) The data shall identify whether the loss data includes LAE (Loss Adjustment Expense) and/or IBNR (Incurred But Not Reported).
(5)
(a) Each rate filing which changes base rates as to any policy for which rates vary by territory shall contain either:
1. Separate support by territory for each type of policy for which a proposed rate change is filed; or

2. If a series of policy types include identical territory relativities, support by territory for all types of policies combined.
(b) The provisions of this subsection shall apply to each territory regardless of whether the rate filing requests rate changes for one, more than one, or all territories.
(6)
(a) The earned premiums and incurred losses included in the rate level indications shall include Florida-only data.

(b) An insurer shall prepare separate indications for those policies on an occurrence basis and for those policies on a claims-made basis.

(c) The premium and loss data supporting a rate level indication for policies on an occurrence basis shall be stated on an accident year basis.

(d) The premium and loss data supporting a rate level indication for policies on a claims-made basis shall be stated on a report year basis.
(7) Each rate filing shall include a direct rate based on direct expense factors for the following categories:
(a) Commissions and brokerage;

(b) Other acquisitions expenses;

(c) General expenses;

(d) Premium taxes;

(e) Other taxes, miscellaneous licenses, and fees; and

(f) Any other expenses.
(8)
(a) In addition to the direct rate determined in subsection (8), an insurer may elect to include the costs of reinsurance in a rate filing.

(b) Where the insurer elects to do so, the cost of reinsurance shall consider:
1. Reinsurance contracts related to the subject matter of the filing;

2. The amount to be paid to the reinsurer;

3. Ceding commissions to be paid to the insurer by the reinsurer;

4. Expected reinsurance recoveries; and

5. Other relevant information specifically relating to cost such as a retrospective profit sharing agreement between the insurer and the reinsurer.
(9) The use of contingent commissions as supporting data for rate changes is prohibited unless:
(a) There is a contractual arrangement between the insurer and its agents concerning the payment of contingent commissions; and

(b) The insurer demonstrates that it is not paying contingent commissions from profits higher than anticipated in its filings.

69O FAC 170.0143 | Ratemaking and Rate Filing Procedures for Liability Insurance for Medical Malpractice

(1)
(a) This rule shall apply to all medical malpractice insurance rates filed pursuant to Section 627.062, F.S.,

(b) The information required by this rule shall be included as a required component of the filing made pursuant to subsection 69O-170.013(3), F.A.C.

(c) For purposes of this rule, reference to liability insurance for medical malpractice shall include insurance on the following types of risks:
1. Hospitals licensed under Chapter 395, F.S.;

2. Physicians licensed under Chapter 458, F.S.;

3. Osteopathic physicians licensed under Chapter 459, F.S.;

4. Podiatric physicians licensed under Chapter 461, F.S.;

5. Dentists licensed under Chapter 466, F.S.;

6. Chiropractic physicians licensed under Chapter 460, F.S.;

7. Naturopaths licensed under Chapter 462, F.S.;

8. Nurses licensed under Chapter 464, F.S.;

9. Midwives licensed under Chapter 467, F.S.;

10 Clinical laboratories registered under Chapter 483, F.S.;

11. Physician assistants licensed under Chapter 458, F.S., or 459, F.S.;

12. Physical therapists and physical therapist assistants licensed under Chapter 486, F.S.;

13. Health maintenance organizations certificated under Part I of Chapter 641, F.S.;

14. Ambulatory surgical centers licensed under Chapter 395, F.S.;

15 Other medical facilities as defined in Section 627.351(4)(h)2., F.S.;

16. Individuals or facilities licensed under Chapter 400, F.S.;

17.
a. Blood banks,

b. Plasma centers,

c. Industrial clinics, and

d. Renal dialysis facilities;
18.
a. Professional associations,

b. Partnerships,

c. Corporations,

d. Joint ventures, or

e. Other associations for professional activity by health care providers; or
19. Any other liability insurance covering errors or omissions which may result in bodily injury.
(2) All filings shall contain:
(a) Either Form OIR-B1-583 (pages 1 and 2) or Form OIR-B1-595 as adopted in Rule 69O-170.0155, F.A.C., as applicable.

(b)
1. A list of each of the insurer's programs or types of policies within the Medical Malpractice line of business and whether each program or policy type is provided on an occurrence basis, a claim-made basis, or on both bases.

2. A statement by the insurer as to:
a. Whether each program or policy type is subject to the annual rate filing required under Section 627.062(7)(f), F.S.; and

b. Whether that annual rate filing is being made under the current rate filing or has been made under a prior submission.
3. A list of the insurer's programs or types of policies which are rated based on exposure units expressed in Physician Years.
(c) Adoption of Loss Costs Filed by a Rating Organization. A filing which adopts the prospective loss costs promulgated by a rating organization and approved for use by the Office shall include Form OIR-B1-583 (pages 1 and 2), "Florida Expense Supplement Calculation of Insurer Loss Cost Multiplier" as adopted in Rule 69O-170.0155, F.A.C.

(d) Rate Filings not involving the adoption of Loss Costs. Insurers shall provide the following:
1. Ratemaking Methodology:
a. The actuarial memorandum and the supporting exhibits define a standard ratemaking methodology. The proposed rates and/or rate changes should be the result of the ratemaking methodology operating on the insurer's data.

b. An insurer shall establish a standard ratemaking methodology and utilize it consistently over time. However, an insurer may elect to change its standard ratemaking methodology. If an insurer does so, it shall thoroughly document the reasons for the change.
2. Judgment: An insurer may employ its judgment and elect to depart from its ratemaking methodology. If an insurer does so, it shall thoroughly document the reasons for the departure from its standard ratemaking methodology.

3. Loss Data:
a. Programs or policy types written on an occurrence basis shall present the following loss data on an accident year basis:
(I) Direct losses paid to date on reported claims;

(II) Case basis estimates of unpaid direct losses on reported claims;

(III) The total number of reported claims.
b. Programs or policy types written on a claims-made basis shall present the following loss data on a report year basis:
(I) Direct losses paid to date on reported claims.

(II) Case basis estimates of unpaid direct losses on reported claims.

(III) The total number of reported claims.
4. Allocated Loss Adjustment Expense Data: An insurer may, at its option:
a. Include direct paid and unpaid allocated loss adjustment expenses with direct paid and unpaid losses and indicate that the data includes both direct losses and direct allocated loss adjustment expenses; or

b. Present direct paid and unpaid allocated loss adjustment expenses separately from direct paid and unpaid losses.
5. Actuarial Adjustments to Losses and Allocated Loss Adjustment Expenses. Filings shall consider the following adjustments to losses and allocated loss adjustment expenses:
a. Loss Development;

b. Adjustment for known changes in claim costs and claim frequency;

c. Adjustment for anticipated future changes in claim costs and/or claim frequency;

d. Unallocated Loss Adjustment Expenses.
6. Premium and Exposure Data:
a. Filings which utilize a Loss Ratio approach to ratemaking shall provide collected direct written premium and collected direct earned premium;

b. Filings which utilize a Pure Premium approach to ratemaking shall provide direct earned exposure measured in Physician Years;

c. An insurer may also utilize other direct earned exposure units the insurer believes will support its proposed rate change.
7. Actuarial Adjustments to Premium and Exposure Data
a. Filings based on a Loss Ratio approach shall clearly demonstrate:
(I) How collected premium has been adjusted to the current rate level.

(II) That the losses utilized in the filing were generated by the earned premium considered in the filing.
b. Filings based on a Pure Premium approach shall clearly demonstrate:
(I) That base-equivalent exposures, if utilized, have been determined using the current rating plan.

(II) That the losses utilized in the filing were generated by the earned exposure utilized in the filing.
8. Expense (other than loss adjustment expenses) Data:
a. A rate filing, other than the adoption of loss costs, shall include Form OIR-B1-595, "Florida Expense Supplement for Independent Rate Filings" as adopted in Rule 69O-170.0155, F.A.C.

b. All expense data shall be presented on a direct basis:
(I) Commission/Brokerage expense ratios, Premium Tax ratios, and Other Tax ratios shall be determined as ratios to direct written premium.

(II) General Expense ratios and Other Acquisition Expense ratios shall be determined as ratios to direct earned premium.
9. Credibility: The filing shall contain a thorough explanation of how the concept of credibility, including the use of accident-year weights or report-year weights, has been incorporated into the filing.
(e)
1. In addition to the direct ratemaking approach in subsection (5), an insurer may elect to include the costs of reinsurance in a rate filing.

2. Where the insurer elects to do so, the cost of reinsurance shall consider:
a. All reinsurance contracts related to the subject matter of the filing;

b. The amount to be paid to the reinsurer;

c. Ceding commissions to be paid to the insurer by the reinsurer;

d. Expected reinsurance recoveries; and

e. Other relevant information specifically relating to cost such as a retrospective profit sharing agreement between the insurer and the reinsurer.
(f) Actuarial Documentation Required.
1. The actuarial memorandum contained in the filing shall describe in detail how the proposed rates have been derived from the experience presented.

2. The filing shall also contain actuarial exhibits that provide the details of all the calculations involved. The exhibits shall provide adequate documentation and footnotes to facilitate a thorough review of the calculations by the Office.

69O FAC 170.0144 | Public Hurricane Loss Projection Model-Fee Schedule

(1) This rule establishes the procedure and fee schedule, applicable to residential property insurers, for access and use of the Public Hurricane Loss Projection Model, authorized by Section 627.06281, F.S.

(2) A residential property insurer that elects to access and use the Public Hurricane Loss Projection Model shall file a request, and set up an account with, Florida International University at http://hldms.cs.fiu.edu. The fees charged for access and use of the Model, per run, shall be computed as follows: Fee = $2,400 + 0.03 x POL1 + 0.015 x POL2 + .005 x POL3 where POL1, POL2, POL3 are number of policies (records) in the policy file. POL1 is equal to number of policies (records) from 1 to 200,000. POL2 is equal to number of policies (records) in excess of 200,000 with maximum of 400,000. POL3 is equal to number of policies (records) in excess of 400,000.

69O FAC 170.0155 | Forms

The following forms are hereby adopted and incorporated by reference:
(1)
(a) OIR-B1-582, "Universal Standardized Data Letter," (Rev. 10/04).

(b) OIR-B1-583, "Florida Expense Supplement Calculation of Insurer Loss Cost Multiplier," (Rev. 04/04).

(c) OIR-B1-584, "Florida Property and Casualty - Annual Rate Filing-Exemption," (Rev. 07/03).

(d) OIR-B1-586, "Florida Property and Casualty - Annual Rate Filing Certification," (Rev. 07/03).

(e) OIR-B1-595, "Florida Expense Supplement for Independent Rate Filings," (Rev. 07/03).

(f) OIR-B1-HRCS, "Homeowners' Rate Collection System (HRCS)," (07/03).

(g) OIR-B1-DRCS, "Dwelling Rate Collection System (DRCS)," (07/03).

(h) OIR-B1-ARCS, "Automobile Rate Collection System (ARCS)," (07/03).

(i) OIR-B1-RIWBK, "Personal Lines Standardized Rate Indications Workbook," (07/04).

(j) OIR-B1-IFILE, "I-File," (11/04).

(k) OIR-B1-1655, "Notice of Premium Discounts for Hurricane Loss Mitigation," (Rev. 2/10).

(l) OIR-B1-1802, "Uniform Mitigation Verification Inspection Form," (Rev. 01/12) http://www.FLRules.org/Gateway/Reference.asp?No=Ref-00720.

(m) OIR-B1-1790, "Certificate of True and Accurate Rate Filing," (New 03/07).

(n) OIR-B1-1809 "Health Care Provider Certification of Eligibility" http://www.FLRules.org/Gateway/Reference.asp?No=Ref-02229 (Rev. 1/2013).
(2) All Office of Insurance Regulation forms may be obtained from:
(a) The Office's web site located at http://www.FLOir.com/iPortal, or

(b) Property and Casualty Product Review, Office of Insurance Regulation, Larson Building, Tallahassee, FL 32399-0330, (850)413-3146.

69O FAC 170.017 | Windstorm Mitigation Discounts

(1) This rule applies to all residential property insurance rate filings filed on or after January 1, 2007. All residential property insurers must make new filings by March 1, 2007, to reflect the requirements in this rule.

(2) Section 627.0629, F.S., states that discounts on an actuarially reasonable basis or appropriate reductions in deductibles must be provided in the rates for residential property insurance for fixtures or construction techniques, including minimum provisions of the Florida Building Code which have been demonstrated to reduce windstorm loss. The discounts must reflect the discounts as set forth in Form OIR-B1-1700, "Windstorm Mitigation Discounts; Non-Single Family Residences" (10-06) and Form OIR-B1-1699 "Windstorm Mitigation Discounts; Single Family Residences" (10-06), which are incorporated by reference, and which are based upon the studies Development of Loss Relativities for Wind Resistive Features of Residential Structures and Development of Loss Relativities for Wind-Resistive Features of Residential Structures of Five or More Units. These discounts must be used without any modification unless they are supported by detail alternate studies where all assumptions are available to the Office for review. These public domain studies providing data and information on estimated loss reduction for wind resistive building features in residences are incorporated by reference, and are available for downloading at the Office's website at https://www.FLOir.com/sections/pandc/productreview/uniformmitigationform.aspx. The forms are available for downloading at the Office's website www.FLOir.com.

(3) Filings can modify other rating factors to reflect revenue impact on current business only if they have actual information on policies receiving the discounts currently to support the modification.

69O FAC 170.018 | Review of Property and Casualty Rates

(1) The phrase in Sections 627.062(2)(g) and 627.0651(10), F.S., which reads, "for a period of 1 year after the effective date of the filing" relates to rates which have been given final approval by the Office, as well as to rates which have been deemed approved.

(2) Sections 627.062(2)(g) and 627.0651(10), F.S., allow the Office to disapprove a rate as excessive after the passage of one (1) year from the effective date of a filing, without making a finding that a material misrepresentation or material error was made by the insurer or was contained in the filing.

(3) For purposes of this rule, the effective date of a filing is the new business effective date.

69O FAC 170.019 | Individually Rated Risks

(1) The purpose of this rule is to clarify what types of risks may be individually rated under Section 627.062(3), F.S., and the reporting requirements for those individually rated risks.

(2) This rule applies to all lines of property, casualty, and surety insurance except private passenger automobile, homeowners, and workers compensation.

(3) Within the context of this rule:
(a) The term "individual risk" shall mean the insurable interests of a single entity, i.e., a natural person, partnership, corporation, or unincorporated association;

(b) The term "individually rated risk" shall mean an individual risk for which an insurer provides coverage and which has not been rated in accordance with the insurer's rates, rating schedules, rating manuals, underwriting rules, and rating plans filed with the Office;

(c) The terms "refer to company," "(a)-rate," and "a-rate" shall all mean the act of individually rating a risk by an insurer in a manner not in accordance with the insurer's rates, rating schedules, rating manuals, underwriting rules, and rating plans filed with the Office; and

(d) The term "large commercial risk" shall mean a risk which meets any two or more of the following conditions:
1. Employs at least 500 full-time employees or their equivalent.

2. Generates net revenue of at least $100 million in the latest fiscal year as reported in audited financial statements.

3. Has a net worth of at least $50 million in the latest fiscal year as reported in audited financial statements.

4. Pays annual property/casualty insurance premiums of at least $500,000 in total for the following types of insurance:
a. Commercial property including allied lines,

b. Commercial auto,

c. Commercial general liability.
5. Procures insurance through a certified risk manager who shall have at least one of the following credentials: ARM, CPCU, CRM, FRM, BA or higher degree in risk management, or has at least seven years of experience in risk financing, claims administration, loss prevention, or risk and insurance coverage analysis.

6. Is a public entity with a population in excess of 50,000.

7. Is a nonprofit organization or a public entity with minimum annual budget of $45 million.
(4) For individually rated risks, that are not large commercial risks as defined in paragraph (3)(d) of this rule, an insurer shall:
(a) Maintain documentation which identifies the named insured, the policy number, the annual statement line, the classification of the risk, any special characteristics of the risk, the reasons why the risk is being individually rated, and justification for the individual rate, including any modifications to existing approved policy forms used on the risk; the insurer shall maintain these records for a period of at least five years after the effective date of the policy; and

(b) Complete quarterly reports in accordance with Rule 69O-137.008, F.A.C.
(5) The characteristics of a large commercial risk shall be deemed sufficient for it to be eligible for individual risk rating. For large commercial risks which are individually rated, the insurer shall:
(a) Maintain documentation to show that the risk meets the definition of a large commercial risk as defined in paragraph (2)(d) of this rule. This documentation must be maintained for a period of at least five years from the effective date of the policy and is in lieu of the documentation required in paragraph (4)(a) of this rule; and

(b) Complete quarterly reports in accordance with Rule 69O-137.008, F.A.C.
(6) The number of employees, net revenue, net worth, annual property/casualty premiums, population, or budget of a group of individual risks shall not be combined for the purposes of meeting the definition of a large commercial risk.

69O FAC 170.0195 | Reasonable Degree of Competition Criteria – Monroe County

(1) For purposes of determining whether there is a reasonable degree of competition in the personal residential property market in Monroe County, the Office shall:
(a) Review the respective market share of all insurers, including Citizens Property Insurance Corporation using the number of policies issued for each line of personal residential insurance policies as most recently reported pursuant to Section 624.424(1), F.S.;

(b) Calculate a Herfindahl Index for Monroe County.
1. If the Herfindahl Index exceeds 1000, the Office shall consider the Herfindahl Index to be a significant indication of a noncompetitive market in that county. The formula for this index is:
H = (%S1)2 + (%S2)2 + (%S3)2 +.(%Sn)2.

%S stands for the percentages of the market owned by each of the larger companies, so that %S1 is the percentage owned by the largest company, %S2 by the second, and so on. n stands for the total number of companies you are counting.

2. The Herfindahl Index gives added weight to the biggest companies. The higher the index, the more concentration and (within limits) the less open market competition. A monopoly, for example, would have an H index of S12 or 1002, or 10,000. By definition, that's the maximum score. By contrast, an industry with 100 competitors that each has 1% of the market would have a score of 12 + 12 + 12 + ...12 or a total of 100. A 1,000-1,800 value generally indicates moderate concentration. Anything over 1,800 is taken to be token acute concentration; and
(c) Review any other information related to and associated with evaluating market competition for that county, such as entry and exit of insurers into the market, trends in the market share of insurers and the number of new policies being issued.
(2) Upon finding that Monroe County does not have a reasonable degree of competition for any line of personal residential property insurance, the Office shall request Citizens Property Insurance Corporation to make a rate filing that is applicable to that line of business and that is actuarially sound and not excessive, inadequate, or unfairly discriminatory and is in compliance with Section 627.062, F.S., and the applicable provisions of Section 627.351(6), F.S.

69O FAC 170.020 | Purpose

69O FAC 170.021 | Rating Organizations (Transferred)

69O FAC 170.022 | Advisory Organizations (Transferred)

69O FAC 170.030 | Loss Reserve Discounts

(1) No insurer shall apply a discount to its loss reserves other than tabular workers' compensation loss reserves without special permission from the Office. An insurer shall request such special permission in writing, stating the line of insurance to be discounted and the rate of discount to be applied. Any insurer wishing to discount its December 31 reserves shall apply to the Office for special permission no later than December 1.

In evaluating the request to discount loss reserves, at a minimum, the Office shall consider the following:
(a) The risk-based capital;

(b) The ratio of loss and LAE reserves to surplus;

(c) For insurers selling multi-year contracts, the ratio of the unearned premium reserve to surplus;

(d) The ratio of ceded loss and loss adjustment expense reserves to surplus;

(e) The quality of the reinsurance supporting the ceded loss adjustment expense reserves to surplus;

(f) The one-year and two-year reserve development as a precentage of surplus over the last five years;

(g) Gross and Net Writing Ratio to Surplus;

(h) Whether the opining actuary of the insurer has been the opinion actuary of an insurance company that dropped to the company action level, mandatory control level, or receivership within five years of the date of the opinion.
All filings shall be submitted electronically to http://www.FLOir.com/iPortal.

(2) For workers' compensation, an insurer may discount only its tabular loss reserves and the interest rate used to calculate the reserve discount shall be no more than 4%, unless the Office grants special permission for a higher discount rate.

(3) Any reserve discounting shall be shown in Schedule P of the insurer's annual statement. The insurer shall also show both discounted and undiscounted reserves.

(4) If the Office grants special permission to discount reserves, an actuarial report supporting the amount of discount shall be maintained by the insurer and shall be available to the Office on request. The report shall show the calculation of the discount and the payment patterns used to support the discount. The payment patterns supporting the discount shall be derived from appropriate company data, or, if company data is not credible, from appropriate industry data (for example, industry Schedule P data), and the report shall provide appropriate explanations and support with the selected payment patterns.

(5) Allocated and unallocated loss expense reserves are not to be discounted without special permission from the Office.

(6) Upon receipt of permission to discount its reserves, the insurer shall compute the excess of the statutory minimum reserves over statement reserves using the discounted loss and loss expense reserves rather than the undiscounted reserves.

69O FAC 170.031 | Statement of Actuarial Opinion on Loss and Loss Expense Reserves

(1) A Statement of Actuarial Opinion on loss and loss adjustment expense reserves, when it is made, must be made by a qualified actuary. A "qualified actuary" is a person who is either:
(a) A member in good standing of the Casualty Actuarial Society, or

(b) A member in good standing of the American Academy of Actuaries who has been approved as qualified for signing casualty loss reserve opinions by the Casualty Practice Council of the American Academy of Actuaries.
(2) The reserve amounts shall be shown in the Statement of Opinion and shall agree with the corresponding reserves as shown in the annual statement.

(3) The Statement of Opinion must address the adequacy of direct and assumed, ceded, and net loss and loss adjustment expense reserves as contained in Schedule P of the annual statement.

(4) An actuarial report or work papers supporting the loss reserve opinion shall be maintained by the insurer and available to the Office on request for seven years.

69O FAC 170.101 | Title, Scope, Application, and Purpose (Repealed)

69O FAC 170.103 | Demand for Arbitration and Response (Repealed)

69O FAC 170.105 | Costs, Expenses and Fees of the Arbitration (Repealed)

69O FAC 170.107 | Procedure for Arbitration (Repealed)

69O FAC 170.109 | Selection of the Arbitration Panel (Repealed)

69O FAC 170.111 | Scope of the Evidence in a Rate Filing Arbitration (Repealed)

69O FAC 170.113 | Computation of Time; Service by Mail

(1) In computing any period of time prescribed or allowed by these rules, by order of the arbitration panel or by any applicable statute, the day of the act from which the designated period of time begins to run shall not be included. The last day of the period shall be included unless it is a Saturday, Sunday or legal holiday in which event the period shall run until the end of the next day which is neither a Saturday, Sunday or legal holiday. As used in these rules, "legal holiday" means those days designated in Section 110.117, F.S.

(2) Unless otherwise ordered by the arbitration panel, when a party is required or permitted to do an act within a prescribed period after the service of a paper upon that party and the paper is served by mail, five days shall be added to the prescribed period.

69O FAC 170.115 | Filing and Service of Papers; Signing (Repealed)

69O FAC 170.117 | Discovery (Repealed)

69O FAC 170.119 | Subpoenas and Witnesses; Fees (Repealed)

69O FAC 170.121 | Official Recognition of Facts (Repealed)

69O FAC 170.123 | Motion Hearings by Telephone (Repealed)

69O FAC 170.126 | Pre-hearing Conference; Pre-hearing Stipulation (Repealed)

69O FAC 170.127 | Notice of Final Hearing; Scheduling (Repealed)

69O FAC 170.129 | Conduct of Proceedings (Repealed)

69O FAC 170.131 | Conduct of Formal Hearing; Evidence (Repealed)

69O FAC 170.133 | Post-hearing Memorandum (Repealed)

69O FAC 170.135 | Final Decision and Award (Repealed)

69O FAC 170.137 | Related Laws and Rules (Repealed)

69O-171 | Property and Casualty Insurer Reporting Requirements

69O FAC 171.001 | Purpose and Scope

(1) The purpose of these rules is to prescribe certain forms for use by property and casualty insurers in the reporting of particular data which is specified in or required by Parts I and XVII of Chapter 627, F.S.

(2) Every property and casualty insurer in this state authorized to transact insurance in this state shall be subject to the applicable rules in this rule chapter, except that insurers writing workers' compensation coverage are subject to the reporting provisions of rule Chapter 69O-189, F.A.C.

69O FAC 171.002 | General Reporting Requirements

(1) Forms incorporated by reference in Division 69O rules are available on the Office's website: http://www.FLOir.com/iPortal.

(2) All filings shall be submitted electronically to http://www.FLOir.com/iPortal.

(3) All forms shall be filled out completely in accordance with their instructions. If an insurer is without any data required by these rules to be reported, it shall nevertheless complete and file the prescribed form or forms as directed in the instructions associated with each form.

69O FAC 171.003 | Reports by Insurers of Professional Liability Claims and Actions Required

(1) Each self-insurer authorized under Section 627.357, F.S., and each insurer or joint underwriting association providing professional liability insurance to a practitioner of medicine licensed pursuant to the provisions of Chapter 458, F.S., to a practitioner of osteopathic medicine licensed pursuant to the provisions of Chapter 459, F.S., to a podiatric physician licensed pursuant to the provisions of Chapter 461, F.S., to a dentist licensed pursuant to the provisions of Chapter 466, F.S., to a hospital licensed pursuant to the provisions of Chapter 395, F.S., to crisis stabilization units licensed under Part IV of Chapter 394, F.S., to a health maintenance organization certified under Part I of Chapter 641, F.S., to clinics included in Chapter 390, F.S., to an ambulatory surgical center as defined in Section 395.002, F.S., or to a member of the Florida Bar, shall report to the Office of Insurance Regulation any claim or action for damages for personal injuries claimed to have been caused by error, omission, or negligence in the performance of such insured's professional services or based on a claimed performance of professional services without consent. Each insurer or self insurer required to report under this rule shall submit such information electronically by using the Office's website: http://www.FLOir.com/iPortal. A copy of the judgment or settlement must be provided along with any other information required by the Office that is not included in the computer software. The following forms have been converted into the software provided by the Office, are hereby incorporated by reference, and shall take effect on the effective date of this rule amendment: Form OIR-303 (5/99) "Florida Medical Professional Liability Insurance Claims Report" and OIR-304 (5/99) "Lawyers Professional Liability Closed Claim Reporting Form." Professional liability closed claim reports must be filed by the insurer if the claim resulted in:
(a) A final judgment in any amount; or

(b) A settlement in any amount.
(2) Any self-insurance program established under Section 240.213, F.S., shall report electronically to the Office of Insurance Regulation at http://www.FLOir.com/iPortal, any claim or action for damages for personal injuries claimed to have been caused by error, omission, or negligence in the performance of professional services provided by the Board of Regents through an employee or agent of the Board of Regents, including practitioners of medicine licensed under Chapter 458, F.S., practitioners of osteopathic medicine licensed under Chapter 459, F.S., podiatric physicians licensed under Chapter 461, F.S., and dentists licensed under Chapter 466, F.S., or based on a claimed performance of professional services without consent if the claim resulted in a final judgment in any amount, or a settlement in any amount.

(3) Reports are due no later than 30 days following the occurrence of one of the events listed in paragraph (a) or (b), above. A closed claim report which is inaccurate, incomplete, or not properly formatted will be returned unprocessed and will be considered late until an accurate, complete and properly formatted report is received.

(4) The Office shall impose a fine of $250 per day per case, but not to exceed a total of $1,000 per case against an insurer or self-insurer that violates the professional liability closed claim reporting requirements. This applies to claims closed on or after October 1, 1997.

(5) Copies of the Professional Liability Closed Claim Software are available from the Office's website at: http://www.FLOir.com/iPortal.

69O FAC 171.004 | Reports of Information by Products Liability Insurers Required (Repealed)

69O FAC 171.005 | Annual Claims Report by Liability Insurers

(1) If requested by the Office, all authorized liability insurers in Florida shall prepare and submit a report to the Office containing information about personal injury, bodily injury and/or property damage liability claims, as further identified in this rule, which were closed by the insurer, its employees or agents during the preceding calendar year. The Office shall consider the availability of insurance in the market place, any restrictions on availability of coverage, the increased placement of traditional coverages in the surplus lines market, and the affordability of insurance coverages in determining whether to request the reports.

(2) For purposes of this rule, the term "liability insurer" shall mean all insurers authorized to do business in Florida by a subsisting certificate of authority issued by the Office to transact commercial multiperil, products liability, general liability, commercial automobile liability, private passenger automobile liability, or other line of liability insurance.

(3) At such time that the Office requires insurers to report under this rule, the information shall be submitted electronically by using computer software provided by the Office. The following form has been converted into the software provided by the Office, is hereby incorporated by reference, and shall take effect on the effective date of this rule amendment: Form OIR-367 (5/99) "Liability Closed Claim Reporting Form." A closed claim report which is inaccurate, incomplete, or not properly formatted will be returned unprocessed and will be considered late until an accurate, complete and properly formatted report is received.

(4) At such time that a sampling of closed claims is required for a particular year, the Office will provide written instructions to all liability insurers indicating both:

(a) The lines of insurance from which claims closed during the preceding calendar year will be sampled; and,

(b) The size of the sample that is to be taken of claims arising under each specified line of insurance. The size of the sample for each line will be expressed in terms of a percentage of the total claims closed by each insurer during the preceding calendar year.

(5) For each line of insurance specified in the Office's instructions, insurers shall randomly select a sufficient number of claims to satisfy the sample size required by the Office of each line of insurance of which claims are to be sampled.

(6) Reports shall be submitted to: Office of Insurance Regulation, at: http://www.FLOir.com/iPortal.

(7) This report applies to direct Florida business on actions for damages for personal injury, bodily injury and/or property damage liability claimed to have been caused by the error, omission, or negligence of insureds if the claim resulted in:
(a) A final judgment in any amount;

(b) A settlement in any amount; or

(c) A final disposition not resulting in payment on behalf of the insured. The report should not include claims arising under workers' compensation or employer's liability insurance, nor claims arising under coverages for automobile uninsured motorist, medical payments, and personal injury protection benefits.
(8) A copy of the judgment or settlement must be provided along with any other information required by the Office that is not included in the computer software. If, upon its review, the Office determines that the sample reported by an insurer was not selected on a truly random basis, the Office may require the insurer to report additional claims for the line in question.

(9) Copies of the Annual Claims Report Software are available from the Office of Insurance Regulation, at: http://www.FLOir.com/iPortal.

69O FAC 171.006 | Claims Report by Directors and Officers Liability Insurers

(1) Each insurer providing directors and officers liability coverage shall report to the Office of Insurance Regulation any claim or action for damages claimed to have been caused by error, omission, or negligence in the performance of the director's or officer's services, if the claim resulted in:
(a) A final judgment in any amount.

(b) A settlement in any amount.

(c) A final disposition not resulting in payment on behalf of the insured.
(2) Each insurer required to report under this rule shall submit such information electronically by using computer software provided by the Office. A closed claim report which is inaccurate, incomplete, or not properly formatted will be returned unprocessed and will be considered late until an accurate, complete and properly formatted report is received. A copy of the judgment or settlement must be provided along with any other information required by the Office that is not included in the computer software. The following form has been converted into the software provided by the Office and is hereby incorporated by reference, and shall take effect on the effective date of this rule amendment: Form OIR-366 (5/99) "Directors and Officers Liability Reporting Form."

(3) Reports shall be submitted no later than 60 days following the occurrence of one of the events listed in paragraph (a) or (b) or (c), to the address below.

(4) Copies of the Directors and Officers Liability Closed Claim Software are available from the Office of Insurance Regulation, at: http://www.FLOir.com/iPortal.

69O FAC 171.008 | Insurer Experience Reporting – Calendar Year Experience

(1) Any insurer authorized to transact fire, homeowner's, multiple peril, commercial multiple peril, medical malpractice, product liability, workers' compensation, private passenger automobile liability, commercial automobile liability, private passenger automobile physical damage, commercial automobile physical damage, directors' and officers', or other liability insurance shall report, for each such line of insurance, the information required by Sections 627.915(2), (5), F.S., or required by rule, on data reporting form OIR-D0-308 (Revised 02/2007) "Florida Property and Casualty Insurance Calendar Year Experience" which is hereby incorporated by reference and available at: http://www.FLOir.com/iPortal.

(2) Reports for the preceding calendar year are due on or before April 1 of each year.

69O FAC 171.010 | Insurer Assignment Agreement Reporting – Calendar Year Experience

(1) Any insurer authorized to transact residential property or commercial property insurance shall report, for each such line of insurance, the information required by Section 627.7152(12), F.S., or required by rule, on and pursuant to the instructions in Form OIR-B1-2221, "Assignment of Benefits (AOB) Experience Reporting Form," effective 3/20, hereby incorporated by reference and available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-12418.

(2) For purposes of this rule, "residential property and commercial property insurance" includes the following lines of business:
(a) Allied Lines, excluding Time Element;

(b) Commercial Multiple Peril;

(c) Earthquake;

(d) Farmowners Multiple Peril;

(e) Glass;

(f) Homeowners Multiple Peril;

(g) Industrial Extended Coverage;

(h) Industrial Fire;

(i) Mobile Homeowners Multiple Peril;

(j) Mobile Homeowners Physical Damage Only; and

(k) Property (Fire).
(3) The following data elements are to be included in the data reporting form:
(a) NAIC Company Code

(b) Company Name

(c) Unique Claim ID

(d) Type of Policy

(e) County of Loss

(f) Building Replacement Cost

(g) Peril

(h) Date of Loss/Incident

(i) Date Reported to Insurer

(j) Date of First Claim Payment

(k) Date of Most Recent Payment on Claim

(l) Date Closed

(m) Number of AOBs

(n) Date Earliest AOB was Executed

(o) Date Earliest AOB was Reported to Insurer

(p) Assignee's Presuit Settlement Demand

(q) Insurer's Presuit Settlement Offer

(r) Judgment Obtained by Assignee

(s) Litigation on Claim (Y/N)

(t) Reasonable Attorney Fees Awarded Under Section 627.7152(10), F.S. to the Insurer

(u) Reasonable Attorney Fees Awarded Under Section 627.7152(10), F.S. to the Assignee

(v) Total Indemnity Amount Paid by Insurer

(w) Total Allocated Loss Adjustment Expenses (ALAE) Paid by Insurer

(x) Re-opened Claim (Y/N)

(y) If Claim was Previously Reported in a Prior AOB Experience Reporting Form, Most Recent Year Reported

(z) If Claim was Previously Reported in a Prior AOB Experience Reporting Form, Claim ID for that Report
(4) The first report will be due on January 30, 2022, for claims paid in Calendar Year 2021. Reports for the preceding calendar year are due on or before January 30 of each year and shall be filed electronically at https://www.FLOir.com/iPortal.

69O FAC 171.011 | Property Claims Litigation Data Call

(1) Each authorized insurer or insurer group issuing personal lines or commercial lines residential property insurance policies shall report, for each such line of insurance, the information required by Section 624.424(11), F.S., or required by rule, on and pursuant to the instructions in Form OIR-B1-2222, "Florida Property Claims Lifecycle Data Call Reporting Form," effective 08/22, hereby incorporated by reference and available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-14753. The form may be obtained from https://www.FLOir.com/iPortal.

(2) For purposes of this rule, "personal lines or commercial lines residential property insurance" includes the following lines of business:
(a) Allied Lines;

(b) Commercial Multiple Peril;

(c) Farmowners Multiple Peril;

(d) Homeowners Multiple Peril;

(e) Industrial Extended Coverage;

(f) Industrial Fire;

(g) Mobile Homeowners Multiple Peril;

(h) Mobile Homeowners Physical Damage Only; and

(i) Property (Fire).
(3) The first report will be due on March 1, 2023, for claims closed in Calendar Year 2022. Reports for the preceding calendar year are due on or before March 1 of each year and shall be filed electronically at https://www.FLOir.com/iPortal.

69O FAC 171.012 | Claims-Handling Manuals

(1) Each authorized residential property insurer conducting business in this state must certify and attest that the insurer's current claims-handling manuals for residential property insurance comply with the requirements of the Florida Insurance Code, including the provisions of Section 627.4108(1), F.S.

(2) This attestation and certification shall be submitted to the Office no later than May 1 of each year, on Form OIR-B3-495, effective 7/23, "Annual Certification of Claims-Handling Manuals," incorporated herein by reference and available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-16318. The form may be obtained from https://www.FLOir.com.

(3) Upon request by the Office, insurer will provide the Office with a true and correct copy of any claims-handling manual requested within 5 business days as specified on Form OIR-B3-496, 7/23, "Submission of Requested Claims-Handling Manuals," incorporated herein by reference and available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-16319. The form may be obtained from https://www.FLOir.com. Such submission will be accompanied by a completed and signed copy of Form OIR-B3-496.

69O FAC 171.013 | Premium Tax Discounts

(1) Each insurer subject to paying premium tax, pursuant to section 624.509, F.S., and the State Fire Marshal regulatory assessment, pursuant to section 624.515, F.S., must provide discounts for policies that provide coverage for a 12-month period with an effective date between October 1, 2024, and September 30, 2025, consistent with the provisions of section 624.5108, F.S.

(2) The deductions required by section 624.5108(1), F.S., must:
(a) be separately stated on the policy declarations page.

(b) be provided as part of the renewal notice of the policy or the quote provided on new business subject to the time period set forth in paragraph (1).

(c) be applied to the entirety of the premium due at the effectuation of the policy term.
(3) Sections 624.5108(1)(a) and (b), F.S., do not apply to tenant coverage.

(4) Sections 624.5108(1)(a) and (b), F.S., do not apply to condominium unit owner policies that do not contain Coverage A.

(5) Condominium Master policies providing residential coverage on the dwelling of the condominium unit owner are subject to a premium discount, pursuant to sections 624.5108(1)(a) and (b), F.S.

(6) For the purpose of consistency, the discounts provided in section 624.5108(1), F.S., should be titled as follows:
(a) "Legislative Premium Tax Discount" for the discount provided pursuant to section 624.5108(1)(a), F.S.

(b) "Legislative Fire Marshal Discount" for the discount provided pursuant to section 624.5108(1)(b), F.S.

(c) "Legislative Flood Premium Tax Discount" for the discount provided pursuant to section 624.5108(1)(c), F.S.
(7) The discounts provided on a policy subject to both sections 624.5108(1)(a) and (c), F.S., shall not exceed 1.75% of the premium, the amount collectable as premium tax for the policy. Insurers shall report such discounts under the heading "Legislative Premium Tax Discount."

(8) Every authorized insurer required to provide a premium deduction pursuant to section 624.5108(1), F.S., must submit Form OIR-B1-596, as part of its quarterly and annual statements required by section 624.424, F.S., and due on the same day as the quarterly and annual statements, respectively. The form contains the information required by section 624.5108(8), F.S., and must be uploaded separately into the Office's Regulatory Electronic Filing system ("REFS"). Form OIR-B1-596, effective 07/24, "Supplemental Policy Credits to Premium Taxes Reporting Form," is incorporated herein by reference and available at http://FLRules.org/Gateway/Reference.asp?No=Ref-17464. Form can be obtained from https://www.FLOir.com.
69O-175 | Motor Vehicle Insurance

69O FAC 175.001 | Calculation and Use of Investment Income in Motor Vehicle Insurance Rates

(1) This rule shall apply to rates filed or reviewed pursuant to Section 627.0651, F.S.

(2) The purpose of the rule is to specify the manner in which insurers shall calculate investment income attributable to motor vehicle insurance policies written in Florida and the manner in which such investment income is used in the calculation of insurance rates by the development of an underwriting profit allowance compatible with a reasonable rate of return.

(3) As used herein:
(a) Auto insurance means private passenger motor vehicle insurance as defined in Section 627.041(8), F.S.;

(b) Liability subline means the sublines of auto insurance in the aggregate commonly considered to be auto liability insurance;

(c) Physical Damage subline means the sublines of auto insurance in the aggregate commonly considered to be auto physical damage insurance.
(4) Each insurer shall determine the expected patterns of loss payments over time associated with a policy of auto insurance written in Florida. These patterns of loss payments shall be determined separately for the Liability subline of auto insurance and for the Physical Damage subline of auto insurance. The determination shall be made using Florida accident year or policy year loss payment patterns, and must fairly represent the auto insurance loss transactions of the insurer.

(5) Each insurer shall determine YA, the expected investment income yield on invested assets representing unearned premium and loss reserves. The expected investment income yield, YA, shall be calculated using the quantities and formula below:
YA = YnWn + YoWo

Where:
Yn
Expected investment income yield on assets newly invested or reinvested during the time the new rates are expected to be in effect
Yo
Expected investment income yield on assets invested prior to the time the new rates are expected to be in effect
Wn
Proportion of assets, held during the time the new rates are expected to be in effect, that is expected to be newly invested or reinvested
Wo
1 - Wn
The above expected investment income yield, Ya, shall be used for purposes of this rule unless evidence is presented that this quantity is not the investment income yield reasonably expected by the insurer.

(6) Separately for the Liability subline and the Physical Damage subline, each insurer shall determine the discounted value of the expected loss payment pattern determined in subsection (4), using the expected investment income yield, Ya, calculated in subsection (5). The undiscounted pattern minus the discounted pattern for each subline is to be expressed as a percent of the expected subline premium that is associated with the series of loss payments over time. This difference is the investment income opportunity associated with the subline.

(7) The investment income opportunities calculated in subsection (6), shall be used as follows to develop the underwriting profit allowance, as distinguished from the contingency factor, to be used in rate filings:
(a) Select and specify the underwriting profit allowance to be used in rate filings for the Physical Damage subline. The selected underwriting profit allowance is presumed to give due recognition to Physical Damage investment income. An underwriting profit allowance greater than the quantity five percent minus any contingency factor utilized is prima facie evidence of an excessive expected rate of return and unacceptable, unless supporting evidence is presented demonstrating that an underwriting profit allowance included in the filing that is greater than this quantity is necessary for the insurer to earn a reasonable expected rate of return. In such case, the criteria presented in subsection (8), shall be used by the Office in evaluating this supporting evidence.

(b) Determine the investment income differential between the Physical Damage and Liability sublines by subtracting the investment income opportunity for the Physical Damage subline as calculated in subsection (6), from the investment income opportunity for the Liability subline as calculated in subsection (6).

(c) The underwriting profit allowance for the Liability subline shall be the underwriting profit allowance for the Physical Damage subline from paragraph (7)(a), minus the investment income differential from paragraph (7)(b), subject to the provisions of paragraph (7)(d).

(d) If the underwriting profit allowance in paragraph (7)(c) is negative, then the insurer may deviate from the underwriting profit allowance in paragraph (7)(c) only to the extent needed to give a positive underwriting profit allowance.
(8) All provisions for contingencies shall be derived utilizing reasonable actuarial techniques, and appropriate supporting material shall be included in the rate filing. Provisions for contingencies greater than 1.5% of premium are prima facie excessive and unreasonable until actuarially supported by clear and convincing evidence. Provisions for contingencies shall be added to the underwriting profit allowance, as determined under subsection (7) of this rule, in order to produce the percentage factor included in the rate filing for profit and contingencies.

(9) An underwriting profit allowance calculated in accordance with this rule is considered to be compatible with a reasonable expected rate of return on net worth plus provisions for contingencies. If a determination must be made as to whether an expected rate of return is reasonable, the following criteria shall be used in that determination:
(a) An expected rate of return for Florida business is to be considered reasonable if, when sustained by the auto insurer for its business during the period for which the rates under scrutiny are in effect, it neither threatens the insurer's solvency nor makes the insurer more attractive to policyholders or investors from a corporate financial perspective than the same insurer would be had this rule not been implemented, all other variables being equal; or

(b) Alternatively, the expected rate of return for Florida business is to be considered reasonable if commensurate with the rate of return anticipated for other industries having corresponding risk and sufficient to assure confidence in the financial integrity of the company so as to maintain its credit and, if a stock insurer, to attract capital, or if a mutual or a reciprocal insurer, to accumulate surplus reasonably necessary to support growth in Florida premium reasonably expected during the time the rates under scrutiny are in effect.
(10) If an insurer writes less than one half (1/2) of one percent of the Florida market for a subline of insurance, calculated by dividing the current premiums written by the preceding year's total premiums written in the state for that subline, then the insurer shall use industry data for purposes of subsection (4) of this rule, unless evidence is presented that such use of industry data by the insurer does not produce a reasonable expected rate of return for the insurer. The Office of Insurance Regulation shall provide industry data to such an insurer.

(11) Patterns of loss payments for the insurance coverage components of the sublines of auto insurance specified in subsection (4) may be developed if needed to be consistent with an insurer's rating practice. The loss payment patterns shall be used in subsections (6) and (7) to produce an investment income differential and underwriting profit allowance for the components of the sublines of auto insurance similar to the investment income differential and underwriting profit allowance calculated for the Liability and Physical Damage sublines. For purposes of applying this subsection, when it is deemed necessary to do so, the component with the smallest investment income opportunity as calculated by the subsection (6) method shall be substituted for the Physical Damage subline in applying paragraph (7)(a). The remaining components shall individually be substituted for the Liability subline in applying paragraphs (7)(b)-(d) for each such component.

(12) Each insurer filing auto insurance rates in Florida shall use an underwriting profit allowance for each subline that is developed in accordance with this rule.

69O FAC 175.002 | Unlawful Removal of Discounts for Private Passenger Automobile Rates

To the extent that Section 626.9541(1)(o), F.S., prohibits insurers from imposing or requesting additional premiums or surcharges for private passenger automobile insurance because the insured was involved in a motor vehicle accident or was convicted of a moving traffic violation, such prohibition shall apply equally to insurers removing or eliminating a premium discount or credit because the insured was involved in a motor vehicle accident or was convicted of a moving traffic violation.

69O FAC 175.003 | Motor Vehicle Insurance Ratemaking and Rate Filing Procedures

(1)
(a) This rule shall apply to all motor vehicle insurance rates filed pursuant to Sections 627.062 and 627.0651, F.S., except for provisions which are specifically limited to private passenger motor vehicle insurance rates.

(b) The information required by this rule shall be included as a required component of the filing made pursuant to subsection 69O-170.013(3), F.A.C.

(c) Filings shall pertain only to the Private Passenger Automobile Insurance.
(2) Filing Submittal Requirements:
(a)
1. Each insurer shall file electronically the information required by the I-File System (IFS) and the Automobile Rate Collection System (ARCS), as adopted in Rule 69O-170.0155, F.A.C., at http://www.FLOir.com/iPortal.

2. Required supporting documentation referenced in the I-File System or ARCS shall be provided.

3. Accurate entry of information into the rate indications workbook component of the I-File System will result in an aggregate average statewide rate indication developed from such data. The accuracy and integrity of the information provided shall be the responsibility of the insurer.
(b) All filings shall identify by program the percentage of policies written on a 6 month and annual policy term.
(3) The following information shall be submitted within the I-File System and ARCS collection indicated in subparagraph (2)(a)1., above.
(a) Each rate filing which proposes changes to base rates shall contain separate rate level indications and support for such indications on a statewide basis for each type of motor vehicle coverage which the insurer writes in Florida. This provision shall apply to all rate filings regardless of whether a filing requests rate changes for one, more than one, or all coverages written. This subsection shall not apply if a rate change is filed in response to law changes which relate to specific types of coverage.

(b) Each rate filing which proposes changes to base rates as to any coverage for which rates vary by territory shall contain separate support by territory for each type of motor vehicle coverage for which a proposed rate change is filed. This provision shall apply to each territory regardless of whether the rate filing requests rate changes for one, more than one, or all territories.

(c) All rate filings which proposes changes to base rates shall include calendar/accident year, Florida-only data for liability coverages and either calendar year or calendar/accident year, Florida-only data for physical damage coverage.

(d) The expense factors in each private passenger automobile rate filing shall be divided into the following categories:
1. Commissions and brokerages;

2. Other acquisition expenses;

3. General expenses;

4. Premium taxes;

5. Miscellaneous licenses and fees; and,

6. Other special expenses.
(4) Private passenger motor vehicle rates, rating schedules, or rating manuals shall contain provisions for individual risk premium modification for collision, personal injury protection, bodily injury liability, and property damage liability coverage based on, among other factors, at least one aspect of an insured's driving record unless the insurer demonstrates with adequate support that failure to do so is not unfairly discriminatory. For purposes of this subsection, aspects of "driving record" include number or type of accidents, and number or type of violations.

69O FAC 175.006 | Unfair Discrimination in Private Passenger Motor Vehicle Insurance Rates ‒ Allocation of Administrative Expenses

(1) No insurer or person authorized to engage in the business of insurance in the State of Florida shall include in the premium charged for any policy, contract, or certificate of private passenger motor vehicle insurance an amount to cover the insurer's administrative expenses determined by allocating all such expenses as a percentage of premium. Administrative expenses shall be charged to policyholders in a manner which equitably apportions all such expenses. For the purpose of this rule, administrative expenses shall include licenses and fees, general expenses, other special expenses, and acquisition expenses other than commissions and brokerage.

(2) A minimum of 60% of the administrative expenses shall be leveled by coverage in a manner which prevents a disproportionate share of the redistributed charge from being borne by any one coverage.

(3) Administrative expenses shall be leveled for Bodily Injury, Property Damage, Single Limit Liability, Personal Injury Protection, Comprehensive, and Collision.

69O FAC 175.008 | Unfair Discrimination in Private Passenger Motor Vehicle Insurance Rates ‒ Based on History of Accidents

No insurer or person authorized to engage in the business of insurance in the State of Florida shall use any motor vehicle accidents which may have occurred at any time in the past except for the 36 months immediately preceding the effective date of the new or renewal policy as a basis for imposing or requesting an additional premium for or for refusing to renew any policy, contract, or certificate of motor vehicle liability, personal injury protection, medical payment, or collision insurance, or any combination thereof. Notwithstanding the above, the imposition of or the request for an additional premium due to motor vehicle accidents referred to in this rule may be imposed on a policy, contract, or certificate of motor vehicle liability, personal injury protection, medical payment, or collision insurance, or any combination thereof in a manner consistent with the processing procedures of an insurer and may not remain in effect in excess of 36 months.

69O FAC 175.010 | Unfair Discrimination in Private Passenger Motor Vehicle Insurance ‒Based on Age

Pursuant to the provisions of Section 626.9541(1)(x), F.S., the Office has determined that refusal to insure or to continue to insure solely on the basis of years of driving experience is discrimination on the basis of age unless those situations are specifically excluded in which the individual or risk could not legally have acquired the required number of years of driving experience.

69O FAC 175.011 | Deductibles in Mandatory Financial Responsibility Coverages

(1) Purpose and Scope.

(a) This rule applies only to commercial motor vehicle liability coverages used to satisfy mandatory financial responsibility requirements of state or local government.

(b)
1. This rule does not apply to private passenger automobile coverages or to any mandatory liability coverages other than commercial motor vehicles coverages.

2. This rule shall not be interpreted as creating an inference as to allowable terms of coverages and deductibles in coverages other than commercial motor vehicle coverages.
(c) This rule does not apply to policies issued in conjunction with a valid certificate of deposit issued by the Department of Highway Safety and Motor Vehicles pursuant to Section 324.031(3), F.S.

(2) Definitions.

The following definitions apply for purposes of this rule:
(a) "Office" refers to the Florida Office of Insurance Regulation.

(b) "First dollar coverage" means that the insurer's liability commences at the first dollar of the third party claimant's loss, without allowance for any deductible.

(c) "First party claimant" means the insured.

(d) "First party deductible" means a deductible that is applied to reduce the insurer's liability to an insured occurring out of a loss suffered by an insured to the insured's property.

(e) "Third party claim" means a claim by a third party claimant for loss caused by the insured.

(f) "Third party claimant" means any claimant that is not the insured.

(g) "Third party deductible" means any deductible applied to reduce the insurer's liability occurring out of any third party claim.

(3) General Exemptions.

The requirements of this rule shall not apply to the extent that the statute or ordinance requiring the coverage expressly authorizes a coverage or deductible otherwise prohibited by this rule.

(4) Requirements.

(a) Policies subject to this rule must provide first dollar coverage by the insurer to third party claimants for losses for which the insured is liable.

(b) No policy subject to this rule shall contain a third party deductible that is or by its terms may be asserted by or on behalf of or for the benefit of the insurer, against a third party claim or claimant.

(c) A policy form that by its terms allows but does not require the insurer to provide first dollar coverage, or contains a third party deductible which by its terms may be asserted by the insurer at the option of the insurer or insured, does not comply with the requirements of this rule.

(d) Policies subject to this rule shall provide and require:
1. That all third party claims under the policies shall at all stages be processed and adjusted by the insurer, or by other licensed adjusters duly appointed by the insurer as shown in the records of the Office;

2. That at no time shall the insured process, adjust, or otherwise handle such claims except through a licensed adjuster duly appointed by the insurer as shown in the records of the Office; and,

3. That all claims payments, up to policy limits, on third party claims shall be made by or on the draft of the insurer to the third party claimant.

(5) Reimbursement Provisions.

(a) This rule shall not be construed to prohibit the use of policy provisions which require or obligate the insured to reimburse the insurer for a specified amount of each third party claim paid by the insurer, whether or not the obligation is collateralized or pre-funded by the insured.

(b)
1. The following shall not be a defense to the insurer's liability for first-dollar coverage on any third party claims occurring under the insurance;
a. A deficiency, failure, or defect in the fund or collateral;

b. The insurer's inability to collect the reimbursement; or

c. The insured's refusal or inability to pay the reimbursement.
2. Any cancellation of the policy due to deficiency, refusal, or inability to pay shall not be retroactive in effect regarding third party claimants with previously occurring claims.
(c) If the reimbursement provisions are referred to in the policy as deductibles, the policy shall clearly and expressly state that the deductible is a first party deductible and may not be asserted against a third party claimant.

69O FAC 175.021 | Insurer Experience Reporting ‒ Excessive Profits, Automobile Insurance

(1) Any insurer authorized to transact private passenger automobile insurance in the state shall report the information required by Sections 627.931(1) and 627.066, F.S., or required by rule, by completing and submitting to the Office of Insurance Regulation form OIR-B1-307 (07/03) "Private Passenger Automobile Excessive Profits Reporting Form" in accordance with the instructions provided therein which is adopted and incorporated herein by reference.

(2) For purposes of this rule, "insurer group" shall mean one or more insurers operating under common management.

(3) Reports are due on or before July 1st of each year.

(4) Form OIR-B1-307 (07/03), http://www.FLRules.org/Gateway/Reference.asp?No=Ref-08273, is available and shall be submitted electronically through the Data Collection and Analysis Module (DCAM) at http://www.FLOir.com/iPortal.

69O FAC 175.032 | Review Procedures

(1) Any insured wishing to have the cancellation of his auto insurance reviewed by the department shall submit Form STCC-1, "Application to Director for Review of Your Automobile Insurance Policy Cancellation," rev. 1-88, which is hereby adopted and incorporated by reference, accompanied by a fee of $7.50. The fee shall be submitted only by cashier's check, certified check, or money order, and shall be made payable to the Chief Financial Officer. Forms may be obtained from and shall be submitted to the Office of Insurance Regulation, Bureau of Consumer Assistance, 200 East Gaines Street, Tallahassee, Florida 32399-0300.

(2) Upon receipt of a timely filed request for review, the department shall set a hearing on 10 days' notice to the parties. The Office shall issue written findings no later than 2 days after the conclusion of the hearing.
69O-176 | Motor Vehicle Insurance Requirements

69O FAC 176.001 | Definition of Motor Vehicle

"Motor vehicle," as referred to in Section 627.732(1), F.S., means a 4 wheel self-propelled vehicle of a type required to be registered and licensed under Florida law, which is not used as a public or livery conveyance, and which is one of the following types:
(1) A private passenger vehicle, such as a sedan, station wagon or jeep-type vehicle;

(2) A pick-up or panel truck not used primarily in the occupation, business or profession of the owner;

(3) A utility automobile designed for personal use, as a camper, a motor home, a vehicle for family recreational purposes, or a vehicle with chassis and body similar to that of a light panel truck but containing passenger seats rather than open cargo space, but a utility automobile does not include any such automobile used primarily.
(a) In the occupation, profession or business of the owner; or

(b) For the transportation of passengers, other than members of the insured's family and incidental guests.
1. "Motor Vehicle" does not include a vehicle owned by the State of Florida, any political subdivision or municipality thereof, or the Federal Government.

2. "Motor Vehicle" described in subsection (2) or (3) of the above, definition of "Motor Vehicle" which has been specifically insured for Personal Injury Protection benefits on the representation of the named insured that the vehicle will not be driven for more than 50% of its total mileage during the policy period (1) in the occupation, profession or business of the insured or (2) for the transportation of passengers, other than members of the insured's family and incidental guests, shall be deemed to be a motor vehicle to which security has been provided as required by this Act.

69O FAC 176.002 | Definition of Owner

Section 627.732(3), F.S., defining an owner to include one with right to possession of a motor vehicle under a lease with option to purchase, is interpreted to mean that motor vehicle subject to daily, weekly, or other short-term rental, regardless of whether the agreement is called a "lease," and regardless of whether or not the agreement contains an option to purchase, such vehicle shall be construed to be owned by the registered owner. Lessees of motor vehicles subject to long-term lease for a period of six months or more, under an agreement wherein the lessor and lessee mutually agree that insurance will be provided by the lessee, are construed to be "owners," without regard to whether or not the lease agreement contains a purchase option.

69O FAC 176.005 | Personal Injury Protection Benefits; Exclusions; Interpretation

Section 627.736(4)(d), F.S., is interpreted as follows:
(1) As used in this section the phrase "While not an occupant of a motor vehicle or motorcycle" means while a pedestrian or while not an occupant of (a) a motor vehicle or (b) a motorcycle or any other type of self-propelled vehicle for which security under the Act is not required.

(2) In accordance with the intent, the Office interprets Sections 627.736(4)(d)1., as well as 627.736(4)(d)4., F.S., where the identical point is involved, as not requiring personal injury protection benefits to be provided for injuries sustained while a person is actually occupying (that is, not entering into or alighting from) a vehicle which is not a defined motor vehicle.

(3) As used in section 627.736(4)(d)2., F.S., the phrase "while occupying the owner's motor vehicle" includes occupancy of a motor vehicle of which a relative is the owner, provided such relative is in compliance with Section 627.733, F.S.

69O FAC 176.006 | Extent of Insurer's Liability

As to the extent of an insurer's liability as referred to in Sections 627.736(1), 627.737(1) and (2), F.S., an insurer liable to pay Personal Injury Protection Benefits under two or more policies to any one person shall be subject to a maximum as specified in Section 627.736(1), F.S., and tort exemption shall likewise be subject to a maximum as specified in Ssection 627.737, F.S.

69O FAC 176.007 | Reasonable Proof in Conjunction with Driving While under the Influence of Alcohol or Narcotic Drugs

The words "reasonable proof" as used in section 627.736(4)(b), F.S., are interpreted to mean that where there is a pending charge for driving while under the influence of alcohol or narcotic drugs, companies may withhold Personal Injury Protection payments as to such persons, until final disposition of such charge.

69O FAC 176.008 | Requirements and Exemptions Relating to Non-Residents

With reference to Section 627.733(2), F.S., the following regulation relating to non-residents applies:
(1) Non-residents are not required to provide PIP coverage except:
(a) When maintaining a motor vehicle in the state for more than 90 days during the preceding 365 day period.

(b) When required to license a motor vehicle in Florida by Section 320.38, F.S., (employed in the State or children enrolled in public school).
(2) Non-residents do not receive PIP benefits and are not tort exempt except:
(a) When injured in Florida while occupying a motor vehicle the owner of which is required to provide security by the Florida Motor Vehicle No-Fault Law.

(b) When maintaining motor vehicle security as required by the Law.

69O FAC 176.010 | Gross Income and Earning Capacity Defined

As used in Section 627.736(1)(b), F.S.
(1) Determination of "gross income," as to employed persons, shall be established in the same manner as "average weekly wage" under Section 440.14, F.S.

(2) The phrase "loss of earning capacity" is interpreted to mean loss of income which the injured person may reasonably show would have been earned except for the injury.

69O FAC 176.011 | Adherence to Mandated No-Fault Coverage

All motor vehicle insurance policies in effect on or after January 1, 1979, which provide liability insurance on a vehicle which becomes subject to the Florida Automobile Reparations Reform Act on or after such date, shall be endorsed by the insurer to provide the insurance required by Section 627.733, F.S. All such policies in effect on or after January 1, 1979 shall, in any event, be deemed to include such amendment and the vehicle owner shall be considered in compliance with the requirements of Section 627.733, F.S.

69O FAC 176.013 | Notification of Insured's Rights and Standard Disclosure Form; Personal Injury Protection Benefits

(1) Each insurer issuing a policy in this state providing personal injury protection benefits shall mail or deliver Form OIR-B1-1149 http://www.FLRules.org/Gateway/Reference.asp?No=Ref-02232 (Revised 01/2013) "Notification of Personal Injury Protection Benefits" to an insured within 21 days after receiving from the insured notice of an automobile accident or claim involving personal injury to an insured who is covered under the policy.

(2) Form OIR-B1-1571 (1/04) "Standard Disclosure and Acknowledgement Form - Personal Injury Protection - Initial Treatment or Service Provided" shall be utilized by providers as described in Section 627.736(5)(e), F.S.

(3) The forms in subsections (1) and (2) are incorporated herein by reference, and are available from Property and Casualty Product Review, 200 East Gaines St., Tallahassee, FL 32399-0330, or from the Office of Insurance Regulation website at http://www.FLOir.com/iPortal.

69O FAC 176.022 | Mediation of Bodily Injury and Property Damage Claims (Repealed)

69O-184 | Insurance in Connection with Installment Sales

69O FAC 184.001 | Scope

Whereas, the Office has issued rules and regulations covering insurance in connection with real estate mortgages and personal property taken in connection therewith, the rules and regulations herein promulgated shall be applicable to insurance in connection with installment sales of, and loans secured by, personal property, except they shall not apply to credit life and disability insurance.

69O FAC 184.002 | Company and Agent to Be Responsible

69O FAC 184.003 | License Required of All Representatives

Representatives of finance factors (finance companies, banks and other lending institutions), automobile dealers, trailer dealers, motors, boats and marine equipment dealers, or others who, in connection with installment sales or loans, negotiate or effect contracts of insurance covering property in which they have no interest, must hold an agent's license in accordance with the requirements of chapter 626, part II, F.S.; and no insurance company shall enter into any contractual arrangement with such representative where insurance is required as a part of the loan transaction unless such representative is licensed as above set forth.

69O FAC 184.004 | Complete Records Must Be Maintained

The company must at all times maintain complete records of all policies issued, including name and address of all insureds, who are beneficiaries, and the coverage provided; and no plan should be used that fails to require the soliciting agent to report and send to the insurance company and issuing or countersigning agent promptly all applications for insurance, or copy dailies of policies issued. If the policies are written in the home or regional office of the company, then a copy of said policy or daily report must be sent to the countersigning agent for his file.

69O FAC 184.005 | Issuance; Contents of Policies

Except in the case of inland marine installment sales floater policies, (see 2nd paragraph of rule 69O-184.011, F.A.C.) the insurer or agent shall within thirty (30) days after execution of a retail installment contract or the consummation of a loan, send or cause to be sent to the retail buyer, a policy or policies or certificate of insurance issued under a master policy, which insurance policy or certificate shall be written clearly setting forth the name of the insurer, the amount of the premium, the kind or kinds of insurance and the scope of the coverage, the term and effective dates of the policy, the policy number, and shall contain all of the terms, exceptions, restrictions and conditions of the contract or contracts of insurance.

69O FAC 184.006 | Credit Property Insurance

(1) The purpose of this rule is to establish procedures to be used by insurers in the calculation of credit property insurance premiums.

(2) Scope. This rule applies to section 624.605(1)(j), F.S., and to all credit property contracts which provide coverage for property purchased under an installment sales agreement.

(3) Insurers and other persons authorized to engage in the sale of credit property insurance under an installment sales agreement shall charge the credit property insurance premium only on the actual cost of the property and any sales tax thereon. The credit insurance premium shall not be charged on items including, but not limited to, finance or service fees, loan interest, delivery charges and other insurance premiums such as credit life, unemployment, credit disability.

69O FAC 184.007 | Claims; Method of Handling

Adjustment of claims shall be made in accordance with policy terms by qualified representatives of the insurance company. No plan or arrangement should be entered into whereby any person, firm or corporation, other than the company, pays or repays, either directly or indirectly, any losses or claims on policy issued by the company. All claim payments shall be made either by draft drawn upon the insurance company or by check of the insurance company to the order of the claimant to whom payment of claim is due, pursuant to the policy conditions, or upon direction of such claimant to whom payment of claim is due, pursuant to the policy conditions, or upon direction of such claimant to one specified as payee.

69O FAC 184.008 | Retention of Premium by Agent to Pay Losses Prohibited

69O FAC 184.009 | Hold Harmless Agreement in Contract Prohibited

69O FAC 184.010 | Licenses of Finance Factors

69O FAC 184.011 | Binder or Receipt Must Set Forth Coverage and Cost

(1) Any insurance agent, dealer, or finance factor (finance company, bank, and other lending institution) who undertake to arrange for insurance covering a motor vehicle or other personal property shall, at the time of assuming the responsibility of arranging insurance coverage, deliver to the retail buyer (applicant for insurance) a receipt or binder and a clear and concise description of such insurance including the total cost thereof which may be included in the time sales contract, mortgage, or lease or similar instrument.

(2) Appliance and equipment dealers who are insured by an inland marine installment sales floater type of policy, may comply with the above requirements by showing the kind of coverage and amount of premium, on the invoice, time sales contract, lease, mortgage or similar instrument.

(3) When bodily injury and property damage insurance coverage is not provided in the insurance contract, there should be stamped on the receipt or binder, or time sales contract, mortgage or lease, or similar instrument, the following: "BODILY INJURY OR PROPERTY DAMAGE LIABILITY NOT INCLUDED."

69O FAC 184.012 | Physical Damage Policies Must Be Stamped

Automobile policies not containing bodily injury and property damage coverage shall be clearly stamped or printed to the effect that such coverage is not included in the policy in the following manner:
"THIS POLICY DOES NOT PROVIDE BODILY INJURY AND PROPERTY DAMAGE LIABILITY INSURANCE OR ANY OTHER COVERAGE FOR WHICH A SPECIFIC PREMIUM CHARGE IS NOT MADE, AND DOES NOT COMPLY WITH ANY FINANCIAL RESPONSIBILITY LAW."
This legend shall appear on the policy declaration page and on the filing back of the policy and shall be printed in a contrasting color from that used on the policy and in type larger than the largest type used in the text thereof, either as an over-print or by a rubber stamp impression.

69O FAC 184.013 | Contracts Must Comply with Statutes

(1) All contracts of insurance shall be written in accordance with the forms, rates and rules, filed with this Office by the insurer writing said contracts.

(2) No contractual agreement or plan shall be used which permits the collection of any application or policy writing fee, in addition to the premium, unless legally approved.

69O FAC 184.014 | Effective Date and Terms of Policy

All policies of insurance shall be effective the moment a purchaser takes delivery of the property insured, or loan transaction is consummated. Policies or certificates of insurance must be written for the full term for which a premium is charged the purchaser or borrower, in connection with the financing of a purchase, or effecting of a loan.

69O FAC 184.017 | Cancellation and Repossession of Policy

In the event of repossession and cancellation of the policy, the insurance company or agent should protect itself by securing a certificate of repossession on a basis which justifies cancellation, and retention by the finance company, bank and other lending institutions of the return premium as a credit against the unpaid balance of the purchaser or borrower. If crediting the return premium to the account of the purchaser or borrower creates an overage balance, the difference shall be returned to the purchaser or borrower. Where an insured unit has been repossessed, the finance factor (finance company, bank, and other lending institutions) must certify to the insurer, or agent, the facts of such repossession in form satisfactory to the insurer and cancel the policy upon evidence to that effect.

69O FAC 184.018 | Return Premium

69O FAC 184.020 | Anti-coercion

Every purchaser or borrower desiring insurance, to cover either the purchaser's or borrower's interest, or that of the finance factor (finance company, bank, and other lending institutions) or lender, financing a motor vehicle or other personal property, shall be given the option of furnishing to the finance factor (finance company, bank and other lending institutions), or lender, a required policy of insurance, in a company duly licensed in the State, acceptable to the finance factor or lender, which acceptance shall not be arbitrarily withheld providing such a policy contains the coverage that may be required by the finance factor (finance company, bank and other lending institutions) or lender. No coercion in any form or manner shall take place in connection with any insurance transaction.

69O FAC 184.021 | Notice of Cancellation or Change in Policy or Certificate

The insured purchaser or borrower must be promptly notified of any cancellation or change in a policy or certificate, except where cancellation is affected by surrender of the purchaser's copy of the policy contract by the purchaser or borrower, or through a lost policy receipt which shall be accompanied by, or have incorporated therein, a signed request from the named insured for cancellation. All notices of cancellation or change shall be effected as provided for in the policy or contract, with full responsibility on the company or agent to have at all times evidence that notification of a cancellation or change in a policy or certificate has been properly sent to the insured purchaser or borrower. The amount of the return premium due should be shown on all cancellations.
69O-185 | Mortgage Guaranty Insurance

69O FAC 185.001 | Subject of Insurance Defined

69O FAC 185.002 | Subject of Insurance Includes

The "subject of insurance" shall include, but not be limited to, an individual, corporation, partnership, association, or other firm, including developers, contractors or any individual, partnership, corporation or firm engaged in the construction of homes, financing the purchase of real property or lending money upon the security of a mortgage thereon, or engaged in the purchasing or selling of real property for speculation. The 10% limitation in section 635.031(1), F.S., shall apply as to the "subject of insurance" and not to a specific parcel of real property.

69O FAC 185.004 | Reinsurance

69O FAC 185.005 | Advertisement of Mortgage Insurance (Repealed)

69O FAC 185.007 | Insurer to Maintain and File Records (Repealed)

Rulemaking AuthorityLaw ImplementedHistory
635.081 FS..635.071(2) FS.New , Amended , , Formerly 4-2.11, 4-2.011, 4-185.007, Repealed .
69O-186 | Title Insurance Rates

69O FAC 186.002 | Approved Form

Any form of written notice given by the title insurers, agents, members, employees thereof, or by agents, employees, officials of lending or other institutions to the purchaser-mortgagor in substantially the following language shall be deemed in compliance with Section 627.798, F.S.:

NOTICE TO PURCHASER-MORTGAGOR

Pursuant to Section 627.798, F.S., notice is hereby given by ______ (Name of Title Insurer) to the undersigned purchaser-mortgagor that a mortgagee title insurance policy is to be issued to your mortgagee lender, and that such policy does not provide title insurance protection to you as the owner of the real estate you are purchasing.

The undersigned has read the above notice and understands that such mortgage title insurance policy to be issued to the mortgagee lender does not provide title insurance protection to the undersigned as owner.

Dated this ____ day of ____, 20___.

___________________

(Signature of Purchaser)

69O FAC 186.003 | Title Insurance Rates

The following are risk rate premiums to be charged by title insurers in this state for the respective types of title insurance contracts. To compute any insurance premium on a fractional thousand of insurance (except as to minimum premiums), multiply such fractional thousand by the rate per thousand applicable, considering any fraction of $100.00 as a full $100.00.

(1) Original Title Insurance Rates.

(a) For owner and leasehold title insurance:

1.
a. The Premium for the original owner's or for leasehold insurance shall be:
Per ThousandMinimum Insurer Retention
From $0 to $100,000 of liability written$5.7530%
From $100,000 to $1 million, add$5.0030%
Over $1 million to and up to $5 million, add$2.5035%
Over $5 million and up to $10 million, add$2.2540%
Over $10 million, add$2.0040%
b. The minimum premium for all conveyances except multiple conveyances shall be $100.

c. The minimum premium for multiple conveyances on the same property shall be $60.
2. In all cases the owner's policy shall be issued for the full insurable value of the premises.

(b) For mortgage title insurance:

1.
a. The premium for the original mortgage title insurance shall be:
Per ThousandMinimum Insurer Retention
From $0 to $100,000 of liability written$5.7530%
From $100,000 to $1 million, add$5.0030%
Over $1 million and up to $5 million, add$2.5035%
Over $5 million and up to $10 million, add$2.2540%
Over $10 million, add$2.0040%
b. The minimum premium for all conveyances except multiple conveyances shall be $100.

c. The minimum premium for multiple conveyances on the same property shall be $60.
2. A mortgage title insurance policy shall not be issued for an amount less than the full principal debt. A policy may, however, be issued for an amount up to 25 percent in excess of the principal debt to cover interest and foreclosure costs.

(2) Reissue Rates.

(a)
1. The reissue premium charge for owner's, mortgage, and leasehold title insurance policies shall be:
Per Thousand
Up to $100,000 of liability written$3.30
Over $100,000 and up to $1 million, add$3.00
Over $1 million and up to $10 million, add$2.00
Over $10 million, add$1.50
2. The minimum premium shall be $100.00.
(b) Provided a previous owner's policy was issued insuring the seller or the mortgagor in the current transaction and that both the reissuing agent and the reissuing underwriter retain for their respective files copies of the prior owner's policy, the reissue premium rates in paragraph (a) shall apply to:
1. Policies on real property which is unimproved except for roads, bridges, drainage facilities, and utilities if the current owner's title has been insured prior to the application for a new policy;

2. Policies issued with an effective date of less than 3 years after the effective date of the policy insuring the seller or mortgagor in the current transaction; or

3. Mortgage policies issued on refinancing of property insured by an original owner's policy which insured the title of the current mortgagor.
(c) Any amount of new insurance, in the aggregate, in excess of the amount under the previous policy shall be computed at the original owner's or leasehold rates, as provided in subsection (1).

(3) New Home Purchase Discount.

(a) Provided the seller has not leased or occupied the premises, the original premium of a policy on the first sale of residential property with a one to four family improvement that is granted a certificate of occupancy shall be discounted by the amount of premium paid for any prior loan policies insuring the lien of a mortgage executed by the seller on the premises.

(b) In the case of prior loan policies insuring the lien of a mortgage on multiple units or parcels, the discount shall be prorated by dividing the amount of the premium paid for the prior loan policies by the total number of units or parcels without regard to varying unit or parcel value.

(c) The minimum new home purchase premium shall be $200. The new home purchase discount may not be combined with any other reduction from original premium rates provided for in this section.

(d) The insurer shall reserve for unearned premiums only on the excess amount of the policy over the amount of the actual or prorated amount of the prior loan policy.

(4) Substitution Loan Rates.

The following risk premium for substitution loans shall apply:
(a) When the same borrower and the same lender make a substitution loan on the same property, the title to which was insured by an insurer in connection with the original loan.
Age of Original LoanPremium Rates
3 years or under30% of original rates
From 3 to 4 years40% of original rates
From 4 to 5 years50% of original rates
From 5 to 10 years60% of original rates
Over 10 years100% of original rates
Minimum premium$100.00
(b) At the time a substitution loan is made, the unpaid principal balance of the previous loan will be considered the amount of insurance in force on which the foregoing rates shall be calculated. To these rates shall be added the regular rates in the applicable schedules for any new insurance, that is, the difference between the unpaid principal balance of the original loan and the amount of the new loan.

(c) In the case of a substitution loan of $250,000 or more, when the same borrower and any lender make a substitution loan on the same property, the title to which was insured by an insurer in connection with the previous loan, the premium for such substitution loans shall be the rates as set forth in paragraphs (a) and (b).

(5) Simultaneous Issue Rates.

The risk premium for simultaneous issues shall be as follows:
(a) When an owner's and a mortgagee's policy or policies covering identical land are to be issued simultaneously the risk premiums applicable for the owner's policy shall be the regular owner's rate as provided for herein. The rate for the mortgage policy or policies so simultaneously issued will be a minimum $25.00 for an amount of insurance not in excess of the owner's policy. The risk premium on the amount of the mortgage policy or policies in excess of the owner's policy shall be figured at the regular original title insurance rates for mortgage policies.

(b) The title must be examined to a date which includes the filing for record of both the deed to the mortgagor and the mortgage itself. Both policies must bear identical dates and the owner's policy must show the mortgage as an exception under Schedule "B" thereof. It is not essential that the property be acquired simultaneously with the giving of the mortgage, but this rate, where applicable, has reference to the simultaneous issuance of an owner's and mortgagee's policy or policies.

(c) When an owner's and leasehold policy covering identical land are to be issued simultaneously, the risk premium applicable for the owner's policy shall be the regular owner's rate as provided for herein. The rate for the leasehold policy will be 30% of the rate for the owner's policy with which it is being issued simultaneously up to the amount of said owner's policy. The risk premium on the amount of a leasehold policy in excess of the owner's policy will be figured at the regular rate for owner's policies in the applicable schedule.

(6) Contract Purchaser - Lessee Rates.

If a contract purchaser, who has obtained a policy from an insurer insuring his contract and thereafter obtains a deed given in pursuance of the contract makes application for an owner's policy and surrenders the policy, insuring his contract; or a lessee who has obtained a leasehold policy of an insurer, insuring his lease and thereafter purchases the property, makes application for an owner's policy and surrenders such policy, the re-issue risk rate shall be:
Up to $100,000 of liability written25% of the rates set forth in subsection (1)
Over $100,000 add20% of the rates set forth in subsection (1)
Minimum premium shall be$100.00

(7) Binders and Commitments.

A binder of title insurance, or a commitment to insure a title or risk, imposes certain obligations and liabilities upon a title insurer and agents with consequent benefits for an insured. Since such binders and commitments are being increasingly utilized in transactions involving title insurance, it is deemed necessary that in accordance with Section 627.7831, F.S., a portion of the risk premium must be charged for such binder or commitment when it is issued, except for transactions involving residential properties. The risk premium charge for binders and commitments shall be credited to the risk premium due on the policy to be issued.

(8) Construction Loans Secured by Revolving Notes and Mortgages.

When a mortgage policy is issued to insure a mortgage securing periodic advances of the loan proceeds to finance improvements on real property, an additional risk rate premium shall be charged for the value of each new parcel of real property added to the policy's coverage after its original issuance.

(9) Minimum Retention of Premium by Insurer.

(a) A title insurer shall receive and retain at least 30% of the risk premium for policies sold by agents in accordance with Minimum Insurance Retention Schedule, including risk premium for endorsements, and it shall not be decreased, directly or indirectly, by an insurer providing services to any agent for less than actual cost.

(b) Any retention of premium by an insurer in excess of 30% shall not be decreased, directly or indirectly, by providing services to an agent for less than actual cost.

(c) The required retention of funds must be remitted to the insurer by the agent at least monthly, and until remitted these funds are "collected funds" subject to the accountability provisions of Rule 69O-186.009, F.A.C.

(10) Effect of Amendments to Risk Premium.

Any change in the risk premium due to an amendment to this rule shall not affect policies for which a binder or commitment to issue a policy has been issued prior to the effective date of the amendment.

(11) Unlawful Rebates or Abatement of Charges.

(a) No title insurer, title insurance agent or agency, including attorney agent, shall decrease the risk premium by an illegal rebate or abatement of charges for abstracting, examinations, or closing charges. At least actual cost must be charged for related title services in addition to the adopted risk premium.

(b) Charges for related title services (title search, examination, and closing) shall be shown separately on the closing statement, and shall, at a minimum, show title search charges, examination fees, and closing charges. The risk premium as defined by Section 627.7711(2), F.S., and as provided in Section 627.780(1), F.S., shall be shown separately on the closing statement.

(c) Any ongoing or standing offer of gifts, compensation or special services to the same person or customer on a continuing basis as an inducement to referring title insurance transactions is prohibited.
(12) Subsections (1) through (4) of this rule shall become effective July 1, 2002. The remainder of the rule shall become effective 20 days after adoption.

69O FAC 186.004 | Classification of Certificates of Title as a Respective Type of Title Insurance Contract and Promulgation of a Specific Rate Schedule Applicable Thereto

(1) The initial Title Insurance Rate Promulgation Order promulgated on March 7, 1967, pursuant to the provisions of Section 627.0956, F.S. (Rule 69O-186.003, F.A.C.), did not recognize Certificates of Title (commonly identified as Department of the Army Engineers Form 903, dated December 1, 1963, and Department of the Army Engineers Form 1017, dated April 1, 1962) and other substantially similar contracts used by governmental agencies, federal or state, in the acquisition of real property and easements for non-proprietary governmental uses and purposes, as "a respective type of title insurance contract" to which a specific rate schedule would be applicable.

(2) Such Certificates of Title and substantially similar contracts differ from "standard" title insurance contracts contemplated in the initial rate order in that the risk assumed is substantially confined to matters of record only and that in transactions with many such governmental agencies statutes of limitation constitute a bar to action for inverse condemnation.

(3) These distinctions warrant promulgation of a lesser risk premium applicable to such Certificates of Title and substantially similar contracts.

(4) Such a promulgation shall apply only to and be limited to those Certificates of Title and substantially similar contracts used by governmental agencies in the acquisition of real property and easements for a governmental or public purpose for public use as distinguished from such acquisitions by such agencies in the exercise of their proprietary functions.

(5) Transactions involving such Certificates of Title for such purposes usually involved the issuance of several interim title insurance certificates, sometimes referred to as title insurance binders, the cost factor of which should be recognized in the allowance of an interim certificate charge for each certificate issued subsequent to the initial certificate, sometimes referred to as the preliminary certificate, in addition to the risk premium charge.

(6) In recognition of the above factors the following risk premium schedule and interim binder or certificate charges are hereby promulgated as being applicable only to such Certificates of Title and substantially similar contracts when used by governmental agencies, state or federal, for the acquisition of real property and easements for a governmental or public purpose and use as distinguished from a proprietary purpose and use:
Amount of LiabilityPer ThousandFor Each Interim Certificate
Subsequent to Initial Certificate
$0-50,0002.25Plus $5.00
50,000-100,0001.75Plus $5.00
100,000-500,0001.50Plus $5.00
Over 500,0001.25Plus $5.00
Disclaimer© State of Florida
Rulemaking AuthorityLaw ImplementedHistory
624.308,(1) FS.624.307(1), 627.782, FS.New 9-17-71, Amended , Repromulgated , Amended , , Formerly 4-21.04, Amended , , Formerly 4-21.004, 4-186.004.

69O FAC 186.005 | Premium Schedule Applicable to Truth in Lending and Other Endorsements

(1) An additional risk exposure for title insurers has been created by the enactment into law of the Federal "Truth in Lending Act," incorporated in Title 15, United States Code Annotated, Section 1601 et seq., effective May 29, 1968.

(2) Such additional risk exposure is specifically though not exhaustively manifest in the additional risks and expenses incident to the issuance of the "Truth in Lending Endorsement" as reflected in and confined to "Endorsement Number Two of the American Land Title Association" because of the following factors:
(a) The title insurer must determine that a lien is being made for commercial purposes, other than agricultural purposes.

(b) The title insurer must determine that the borrower falls within the category of entities as set forth in Regulation "Z" promulgated by the Federal Reserve.

(c) The title insurer must determine that the home being purchased is or will be the residence of the borrower.

(d) The title insurer must determine that the mortgage being insured by the policy to which the endorsement is being attached is a first lien on the land.

(e) The title insurer must determine that proceeds of the mortgage are disbursed to the seller.

(f) The title insurer may be legally obligated to legally refute the allegations in a foreclosure action against the mortgagor that the matters shown above were not accurately determined.

(g) The penalty for failure to make such correct determination of the above factors may make the title insurer incur liability for the payment or settlement of claims thereon which would not otherwise be incurred in the absence of such Endorsement.
(3) The foregoing factors substantially increase the increment of risk, the expense, and the labor incident to the issuance of title insurance policies brought within the purview of the Truth in Lending Act by utilization of ALTA Endorsement Number Two. Such consequences have a significant potential effect on the fiscal stability of the respective title insurers and the business trust title insurer authorized to transact the business of title insurance in the State of Florida.

(4) Any potential adverse effect of such factors on the fiscal stability of said title insurers with consequent detriment to the title insuring public would be ameliorated or negated by the promulgation of a specific premium rate schedule applicable to such Truth in Lending Endorsement which would reasonably compensate the title insurers for such additional increments of risk.

(5) In recognition of the above findings and factors applicable to Truth in Lending Endorsement Number Two of the ALTA, the following premium schedule is hereby promulgated:
TEN PERCENT (10%) OF MORTGAGEE POLICY PROMULGATED RATE WITH A MINIMUM CHARGE OF TWENTY-FIVE DOLLARS ($25.00) AND A MAXIMUM CHARGE OF ONE HUNDRED DOLLARS ($100.00).
(6)
(a) In recognition of the increased risk in issuing the following endorsements on a mortgage or owner's policy, as such endorsements have been approved by the Office, the minimum premium shall be $25.00 for each endorsement on any mortgage or owner's policy issued. The endorsements shall be itemized on the closing statement furnished to the insured.
1. ALTA 4/4.1 Condominium.

2. ALTA 5/5.1 Planned Unit Development.

3. ALTA 6 Renegotiable Rate.

4. ALTA 6.1 Variable Rate.

5. ALTA 6.2 Negative Amortization.

6. ALTA 7.0 Manufactured Housing.

7. ALTA 8.0/8.1 Environmental Protection Lien.

8. Revolving Credit Endorsement.
(b) The language of the Revolving Credit Endorsement shall conform to the following endorsement language:
1. Notwithstanding any terms or provisions in this policy to the contrary, the company hereby insures the insured that advances made subsequent to the Date of Policy, but within 20 years of the Date of Policy, pursuant to the terms of the mortgage described in Schedule A of this policy, shall be included within the coverage of this policy, even though the principal indebtedness may have been reduced from time to time preceding any such subsequent advances. The Company's liability under this policy shall be reduced hereafter by the filing for record by the mortgagor or his successors in title of a notice pursuant to Section 697.04(1), F.S., limiting the maximum principal amount that may be so secured to an amount not less than the amount actually advanced at the time of such filing.

2. The Company further assures the insured that such subsequent advances shall have the same priority over liens, encumbrances and other matters disclosed by the Public Records, as do advances secured by the insured mortgage as of the Date of Policy, except for the following matters, if any, arising subsequent to the Date of Policy:
a. Federal tax liens which may be recorded against the mortgagor(s) or their successor in title more than forty-five days prior to the making of any such subsequent advances.

b. Federal tax liens which may be recorded against the mortgagor(s) or their successor in title within forty-five days of making any such subsequent advances, the existence of which are actually known to the insured prior to the making of any such subsequent advances.

c. Ad valorem real estate taxes and assessments and other government liens which are on a parity with ad valorem real estate taxes pursuant to F.S.

d. Bankruptcies of the mortgagor(s) or their successors in title prior to the making of any such subsequent advances.

e. Defects, liens, encumbrances or other matters, the existence of which are actually known to the insured prior to the making of any such subsequent advances.
3. The total liability of the company under the policy and any endorsements therein shall not exceed, in the aggregate, the face amount of the policy and sums which the Company is obligated under the conditions and stipulations thereof to pay.

4. This endorsement is made a part of the policy. It is subject to all the terms of the policy and prior endorsements. Except as expressly stated on this endorsement, the terms, dates and amount of the policy and prior endorsements are not changed."
(7)
(a) Both endorsements and affirmative type coverages and their applicable risk rate premium must be approved by the Office prior to their issuance in this state. Accordingly, endorsements and affirmative type coverages are categorized as follows:
1. Permitted endorsements and/or affirmative type coverages,

2. Prohibited endorsements and/or affirmative type coverages,

3. Endorsements and/or affirmative type coverages with no specific Office approval required when there is no increased risk resulting to the insurer.
(b)
1. With the exception of those endorsements listed in subsection (6) of Rule 69O-186.005, F.A.C., above, no endorsement or affirmative type coverage shall be issued except as set forth in this section.

2. If there is a change in a current adopted endorsement and the change results in a further limitation of coverage, the endorsement may be submitted to the Office for approval without an amendment to these rules.
(c) With the exception of policy forms and those endorsements listed in subsection (6) of Rule 69O-186.005, F.A.C., above, all approvals of endorsements given prior to the effective date of this rule are withdrawn. This section shall have no effect on the validity of those endorsements issued prior to the effective date of these rule amendments.

(d) All issued endorsements shall be itemized on the closing statement furnished to the insured with costs for each endorsement shown.

(e) Specific endorsements may be issued by reference to a master list of approved endorsements and have the same validity as if issued individually on each transaction so long as the language in the endorsement specifically conforms without any additions or deletions to the endorsement language as set forth in this section. Any such master list of approved endorsements shall only be issued in conjunction with a mortgage (mortgagee) title insurance policy.
(8) The following permitted endorsements and endorsement language are approved:
(a) Florida Endorsement Form 9; (Restrictions, Easements, Minerals):
1. This endorsement shall not be issued unless there has been a release of the right of entry of the mineral reservation, nor shall it be issued over any adverse matter or defect in title unless such adverse matter or defect has been removed or determined to be legally unenforceable.

2. The language of the Florida Endorsement Form 9 shall conform to the following endorsement language:
"The Company insures the owner of the indebtedness secured by the insured mortgage against loss or damage sustained by reason of:
1. Any incorrectness in the assurance that, at date of policy:
(a) There are no covenants, conditions or restrictions under which the lien of the mortgage referred to in Schedule A can be divested, subordinated or extinguished, or its validity, priority or enforceability impaired.

(b) Unless expressly excepted in Schedule B:
(1) There are no present violations on the land of any enforceable covenants, conditions or restrictions nor do any existing improvements on the land violate building setback lines shown on a plat of subdivision recorded or filed in the public records.

(2) Any instrument referred to in Schedule B as containing covenants, conditions or restrictions on the land does not, in addition, (i) establish an easement on the land; (ii) provide a lien for liquidated damages; (iii) provide for a private charge or assessment; (iv) provide for an option to purchase, a right of first refusal or the prior approval of a future purchaser or occupant.

(3) There is no encroachment of existing improvements located on the land onto adjoining land, nor any encroachment onto the land of existing improvements located on adjoining land.

(4) There is no encroachment of existing improvements located on the land onto that portion of the land subject to any easement excepted in Schedule B.

(5) There are no notices of violation of covenants, conditions, and restrictions relating to environmental protection recorded or filed in the public record.
2. Any future violation on the land of an existing covenant, condition or restriction occurring prior to the acquisition of title to the estate or interest in the land, provided the violation results in:
(a) Impairment or loss of the lien of the insured mortgage; or,

(b) Loss of title to the estate or interest in the land if the insured shall acquire title in satisfaction of the indebtedness secured by the insured mortgage.
3. Damage to existing improvements (excluding lawns, shrubbery or trees).
(a) Which are located on or encroach upon that portion of the land subject to any easement excepted in Schedule B, which damage results from the exercise of the right to maintain the easement for the purpose for which it was granted or reserved.

(b) Which results from the future exercise of any right to use the surface of the land for the extraction or development of minerals excepted from the description of the land or excepted in Schedule B.
4. Any final court order or judgment requiring the removal from any land adjoining the land of any encroachment excepted in Schedule B.

5. Any final court order or judgment denying the right to maintain any existing improvement on the land because of any violation of covenants, conditions or restrictions or building setback lines shown on a plat or subdivision recorded or filed in the public records.
Wherever in this endorsement the words "covenants, conditions or restrictions" appear, they shall not be deemed to refer to or include the terms, covenants, conditions or limitations contained in an instrument creating a lease.

As used in subparagraphs (1)(b)1. and 5., the phrase, "covenants, conditions, or restrictions" shall not be deemed to refer to or include any covenants, conditions or restrictions relating to environmental protection.

This endorsement is made a part of the policy and is subject to all of the terms and provisions thereof and any prior endorsements thereto. Except to the extent expressly stated, it neither modifies any of the terms and provisions of the policy and any prior endorsements, nor does it extend the effective date of the policy and any prior endorsements, nor does it increase the face amount thereof."
(b) Navigational Servitude - The language of the Navigational Servitude Endorsement (Florida) shall conform to the following endorsement language:
1. The Company hereby insures the insured against loss or damage, not exceeding the amount of insurance stated in Schedule A, and costs and attorney's fees and expenses which the Company may become obligated to pay hereunder, sustained or incurred by the insured by reason of forced removal pursuant to a final judgment of a court of competent jurisdiction in favor of the United States Government requiring the removal of any improvements located on the land at date of policy resulting from the exercise of the rights of the United States Government with respect to control over navigable waters, or lands which formerly constituted navigable waters, for purposes of navigation and commerce.

2. This endorsement is made a part of the policy and is subject to all the terms and provisions thereof and of any prior endorsements thereto. Except to the extent expressly stated, it neither modifies any of the terms and provisions of the policy and any prior endorsements, nor does it extend the effective date of the policy and any prior endorsements, nor does it increase the face amount thereof."
(c) Shared Appreciation - The Shared Appreciation Endorsement (Florida) shall conform to the following endorsement language:
1. The Company hereby insures the Insured against loss or damage by reason of:
a. The invalidity or unenforceability of the lien of the insured mortgage resulting from the provisions therein which provide for a shared appreciation interest.

b. Loss of priority of the lien of the insured mortgage as security for (1) the unpaid principal balance of the loan; (2) the stated interest; and (3) the shared appreciation interest, which loss of priority is caused by the provisions in the insured mortgage for payment or allocation to the insured mortgagee of any shared appreciation interest.

c. "Stated Interest" as used in this endorsement shall mean only the per annum interest on the unpaid principal balance of the loan provided in the insured mortgage at date of Policy.

d. "Shared Appreciation Interest" as used in this endorsement shall mean only those amounts (calculated pursuant to the formula provided in the insured mortgage) payable or allocated to the insured mortgagee, out of the amount, if any, by which the land has appreciated in value as established pursuant to the provisions of the insured mortgage at date of Policy.

e. This endorsement does not insure against loss or damage based upon (a) usury, or (b) any consumer credit protection or truth in lending law, or (c) bankruptcy.

f. This endorsement is made a part of the policy and is subject to all of the terms and provisions thereof and of any prior endorsements thereto. Except to the extent expressly stated, it neither modifies any of the terms and provisions of the policy and any prior endorsements, nor does it extend the effective date of the policy and any endorsements, nor does it increase the face amount thereof."
(d) Additional Interest - The language of the Additional Interest Endorsement (Florida) shall conform to the following endorsement language:
1. The Company hereby insures against loss or damage by reason of:
a. The invalidity or unenforceability of the lien of the insured mortgage resulting from the provisions therein which provide for additional interest subsequent to date of Policy.

b. Loss of priority of the lien of the insured mortgage as security for (1) the unpaid principal balance of the loan; (2) the stated interest; (3) the additional interest, which loss of priority is by the provisions in the insured mortgage for payment or allocation to the insured mortgagee of any additional interest.
2. "Stated Interest" as used in this endorsement shall mean only the fixed percent per annum interest on the unpaid principal balance of the loan provided in the insured mortgage at date of Policy.

3. "Additional Interest" as used in this endorsement, shall mean only those amounts calculated pursuant to the formula provided in the insured mortgage payable or allocated to the insured.

4. This endorsement does not insure against loss or damage based upon (a) usury, or (b) any consumer credit protection or truth in lending law, or (c) bankruptcy.

5. This endorsement is made a part of the policy and is subject to all of the terms and provisions thereof and of any prior endorsements thereto. Except to the extent expressly stated, it neither modifies any of the terms and provisions of the policy and any prior endorsements, nor does it extend the effective date of the policy and any prior endorsements, nor does it increase the face amount thereof."
(e) Option Endorsement - The language of the Option Endorsement (Florida) shall conform to the following endorsement language:
1. With respect to the option to purchase described in Schedule B, the option to purchase is hereby incorporated into Schedule A of the policy as an interest insured thereby, vested in the insured, and the Company insures against loss or damage sustained or incurred by the insured by reason of:
a. The unenforceability of the right to exercise the option to purchase except to the extent that such unenforceability or claim thereof is based on the failure of the insured to have fulfilled the terms and conditions of the option.

b. The priority over the option to purchase of any conveyance made of the fee simple estate in the land or of any liens or encumbrances created therein after the date of policy, excepting those liens or encumbrances created or consented to by the insured or created by statute in favor of or for the benefit of governmental bodies or public utilities (including without limitation real estate taxes, special assessments, demolition liens, drainage liens and water liens).
2. Nothing contained in this endorsement shall be construed as insuring the insured against loss or damage sustained or incurred by reason of:
a. Disaffirmance of the option under the provisions of the bankruptcy code or state insolvency law.

b. The effect of any condemnation proceeding including the failure of the optionee to receive all or part of an award entered in a condemnation proceeding unless failure to share in said award stems solely from a court order or judgment which constitutes a final determination and adjudges the option to be invalid.

c. Any lien, or right to a lien, for services, labor or material heretofore or hereafter furnished, imposed by law.
3. Other than expenses necessary for a judicial determination or defense of the validity and priority of the option as described in subsections (1) and (2). above, loss under this endorsement does not include:
a. Expenses required to enforce the option and to obtain a transfer of title from the party or entity in whom title to any interest in the land is vested at the time of exercising the option; or

b. Expenses required to obtain valid conveyances or releases of any rights, interests or liens related to the land which appear of record or are known to the insured at the time of exercising the option.
4. The measure of the loss or damage sustained by the insured under this policy shall be:
a. The excess of the fair market value of the property at the time the insured attempts to exercise the option (or when a law suit contesting the validity of the option is filed, if filed prior to the attempted exercise of the option) above the price at which the insured could acquire the property by exercise of the option; and,

b. The unreimbursed portion of the consideration given by the insured to obtain the option.
5. This endorsement is made a part of the policy and is subject to all of the terms and provisions thereof and of any prior endorsements thereto. Except to the extent expressly stated, it neither modifies any of the terms and provisions of the policy and any prior endorsements, nor does it extend the effective date of the policy and any prior endorsements, nor does it increase the face amount thereof."
(f) Change of Partners - The Change of Partners (Fairways) Endorsement (Florida) shall conform to the following endorsement language:
"1. The Company agrees that in the event of an occurrence of loss insured against by this policy, the Company will not deny liability hereunder on the ground that a dissolution of the partnership has occurred or a new partnership has been formed by reason of one or more of the general partners transferring their interest to another person or entity; by reason of a withdrawal of one or more of the general partners from the partnership; or by reason of the addition of one or more persons or entities as partners.

2. Nothing contained herein shall be construed as extending the insurance hereunder as to matters attaching or created subsequent to the date hereof; or insuring the status of the insured after the transfer of the partnership interest, the withdrawal of partners, or the addition of new partners.

3. This endorsement is made a part of the policy and is subject to all of the terms and provisions thereof and of any prior endorsements thereto. Except to the extent expressly stated, it neither modifies any of the terms and provisions of the policy and any prior endorsements, nor does it extend the effective date of the policy and any prior endorsements, nor does it increase the face amount thereof."
(g) Contiguity Endorsement - The Contiguity Endorsement (Florida) shall conform to the following endorsement language:
"1. The Company insures the Insured herein against loss or damage by virtue of any inaccuracy in the following statement, to wit: Parcel ___ of the legal description and Parcel ___ of the legal description are contiguous to each other along the ___ line of Parcel ___ and ___ line of Parcel ___, and, taken as a tract, constitute one Parcel of land.

2. This endorsement is made a part of the policy and is subject to all of the terms and provisions thereof and of any prior endorsements thereto. Except to the extent expressly stated, it neither modifies any of the terms and provisions of the policy and any prior endorsements, nor does it extend the effective date of the policy and any prior endorsements, nor does it increase the face amount thereof."
(h) Survey Endorsement - The language of the Survey Endorsement (Florida) shall conform to the following endorsement language:
"The Company hereby acknowledges the lands described in Schedule A are the same lands described in the survey prepared by ______ dated _____; however, the Company does not insure the accuracy or completeness of said survey."
(i) Construction Loan Up-date - The language of the Construction Loan Up-date Endorsement shall conform to the following endorsement language:
1. The liability of the Company is increased by $_____ to include disbursements made pursuant to requisition(s) _____ for a cumulative total to date of $______.

2. The Company insures there have been no instruments filed among the Public Records of ___ County, affecting title to the lands described in Schedule A from ______ through ______, other than the following:

3. The Company insures each of the foregoing is subordinate to the lien of the mortgage insured except:

4. This endorsement is made a part of the policy and is subject to all of the terms and provisions thereof and of any prior endorsements thereto. Except to the extent expressly stated, it neither modifies any of the terms and provisions of the policy and any prior endorsements, nor does it extend the effective date of the policy and any prior endorsements, nor does it increase the face amount thereof."
(j) Foreign Currency Endorsement - The language of the Foreign Currency Endorsement shall conform to the following endorsement language:
1. The Company hereby insures against loss or damage by reason of:
a. The invalidity or unenforceability of the lien of the insured mortgage resulting from the provisions therein which provide for revaluation of the indebtedness secured thereby based upon changes in the conversion rate between U.S. dollars and the stated foreign currency.

b. Loss of priority of the lien of the insured mortgage as security for the unpaid principal balance of the loan, which loss of priority is caused by such changes in the conversion rate.
2. The Company acknowledges that changes from time to time in the conversion rate between U.S. dollars and the stated foreign currency may decrease or increase the dollar amount of the indebtedness secured by the insured mortgage. The Company hereby agrees that, so long as any portion of the indebtedness secured by the insured mortgage shall remain outstanding, any such increase in the dollar amount of indebtedness shall not be deemed by the Company to constitute additional principal indebtedness created subsequent to date of policy within the meaning of paragraph 8 of the Conditions and Stipulations of the policy; provided, however, that the total liability of the Company under the policy at any time shall not exceed, in the aggregate, the face amount of the policy and the costs which the Company is obligated to pay under the terms and provisions of the policy.

3. "Changes in the conversion rate" as used in this endorsement, shall mean only those changes in the conversion rate calculated pursuant to the formula provided in the insured mortgage at date of policy.

4. This endorsement does not insure against loss or damage based upon (a) the failure to pay any mortgage recording tax or similar charge applicable to the mortgage described in Schedule A at date of policy or as a result of increases in the amount of indebtedness resulting from changes in the conversion rate of U.S. dollars and the stated foreign currency, (b) usury, (c) any consumer credit protection or truth-in-lending law, (d) bankruptcy, or (e) any invalidity or unenforceability or loss of priority of the mortgage as to any indebtedness in amounts in U.S. dollars in excess of the amount stated in the policy.

5. This endorsement is made a part of the policy and is subject to all of the terms and conditions thereof and of any prior endorsements thereto, except that the insurance afforded by this endorsement is not subject to paragraph (3)(d), of the Exclusions from Coverage. Except to the extent expressly stated, it neither modifies any of the terms and provisions of the policy and any prior endorsements, nor does it increase the face amount thereof."
(k) Assignment of Mortgage - The language of the Assignment of Mortgage Endorsement shall conform to the following endorsement language:
"Endorsement number _________________

Name of original insured:

Original effective date:

Original amount of insurance $________________

Agent's file reference: ______________________

The Company insures that the mortgage described in the above numbered and dated policy has been duly assigned to:

________________________________________________
Assignee

________________________________________________
Address

by an assignment dated the _____ day of _____, 19___, and recorded the _____ day of _____, 19___, in Official Records _____, Page ____, under Clerk's File Number _____, of the Public Records of ___ County, Florida.

This endorsement is to be attached to and form a part of the above numbered and dated policy issued by _____"
(l) Balloon Mortgage Endorsement - The language of the Balloon Mortgage Endorsement shall conform to the following endorsement language:
1. The Company insures the insured mortgagee against loss or damage by reason of:
a. The invalidity or unenforceability of the lien of the insured mortgage resulting from the provisions therein which provide for a conditional right to refinance and a change in the rate of interest as set forth in the Mortgage Rider.

b. Loss of priority of the lien of the insured mortgage as security for the unpaid principal balance of the loan, together with interest thereon, which loss of priority is caused by the exercise of the conditional right to refinance and the extension of the loan term to the new maturity date set forth on the rider and a change in the rate of interest, provided that all the conditions set forth in paragraphs 2 and 5 of the Balloon Mortgage Rider have been met, and there are no other liens, defects, encumbrances, or other adverse matters affecting title recorded subsequent to the date of policy.
2. This endorsement does not insure against loss or damage based upon, (a) Usury or (b) any consumer credit protection or truth-in-lending law or (c) bankruptcy.

3. This endorsement is made a part of the policy and is subject to all of the terms and provisions thereof and of prior endorsements thereto. Except to the extent expressly stated, it neither modifies any of the terms and provisions of the policy and any prior endorsements, nor does it extend the effective date of the policy and any prior endorsements, nor does it increase the face amount thereof."
(9) Recognizing that the endorsements listed in subsection 8 of this section and the affirmative language in a title policy imposes certain obligations and liabilities on a title insurer and agent and the issuance of endorsements and/or affirmative language in a title policy creates an additional risk and a considerable amount of work in addition to the initial search and examination of title required to write a basic policy, a minimum premium shall be charged and collected by an insurer or agent where coverage in the form of affirmative language and/or endorsements to a policy are required. Therefore, the risk rate premium for each of the endorsements listed in paragraph 8 of this section are as follows:
1-4 Family Unit Residential Risks$25 minimum per endorsement
$100 maximum per endorsement
Other Risks (commercial or greater than 1-4 family residential risk.)$100 Minimum per endorsement
except that the risk rate premium for the following approved endorsements shall be at minimum the percentage of the total policy premium as indicated; however, on a simultaneously issued mortgage policy, the endorsement charge shall be based on the underlying owner, and loan policy premium:
(a) Florida Endorsement Form 9-10%. (b) Navigational Servitude - 10%.
(10) Additional risk premium must be charged if additional insurance is purchased.

(11) All loan policies and endorsements are subject to the 125% rule as set forth in paragraph 69O-186.003(4)(b), F.A.C., except that a policy with a Shared Appreciation, or Additional Interest Endorsements may be issued for an amount up to 150% in excess of the principal debt.

(12) The applicable rate to be charged and collected for a loan policy after a mortgage balloons and is subsequently refinanced by the same lender, and borrower on the same land shall be the rates as described in paragraph (5) of Rule 69O-186.003, F.A.C., substitution loan rates.

(13) The Substitution Loan Rate provided in subsection 69O-186.003(5), F.A.C., shall apply to any endorsement which insures a modification of a mortgage which was insured by an outstanding policy where the modification agreement effects any change in the terms, conditions, priority, or security, other than:
(a) An extension of the time for payment of the secured obligation;

(b) Any decrease in the interest rate of the insured mortgage, provided the "cap" on a variable rate mortgage is not greater than the original "cap" and/or the "cap" is not greater than the original fixed rate;

(c) Any increase in the interest rate of the insured mortgage, provided the endorsement contains an exception for the loss of priority occasioned by the increase;

(d) Changes in an amortization schedule to extend the term of the insured mortgage;

(e) A release of a portion of the secured property;

(f) A correction to either perfect the lien of the insured mortgage or comply with the terms of the lender's original commitment;

(g) Future advances made pursuant to Section 697.04, F.S.; or

(h) Encumbrances of additional parcels under a revolving construction loan agreement contained in the original mortgage and contemplated by subsection 69O-186.003(10), F.A.C.
(14) The retention rate for an insurer shall be the same as set forth in subsection 69O-186.003(11), F.A.C.

(15)
(a) The following are prohibited endorsements and affirmative coverages that shall not be issued in this state:
1. Doing Business Endorsement.

2. Non Imputation Endorsement (Imputation of knowledge).

3. Access.

4. Location.

5. Expanded Insured Endorsement.

6. Street Assessment Endorsement.

7. Zoning Endorsement.

8. Usury.
(b) The extension of special affirmative coverage by indirect means is prohibited.
(16) The following endorsements can be issued or affirmative language is permitted with no specific approval required from the Office:
(a) Endorsements correcting mistakes.

(b) Future Insurance (continuing liability under existing policies).

(c) Endorsements deleting exceptions which no longer affect title to the land.

(d) Endorsements insuring future advances.

(e) Changes in effective dates (loan policies only).

(f) Gap coverage endorsement.

(g) Insurance against the attempted enforcement of known claims for ascertainable sums of money in reliance on security commensurate with such risk.

(h) Deletion of General Exceptions.

(i) Endorsements modifying the standard owner's and mortgagee policy to convert to a leasehold policy previously approved by the Office.

(j) Tie-in Spreader (Intra Florida properties only).

69O FAC 186.007 | Title Insurance Limited to Coverage of Real Property

Section 624.608, F.S., which declares that "Title insurance is insurance of owners of real property or others having an interest in real property or contractual interest derived therefrom, or liens or encumbrances on real property, against loss by encumbrance, or defective titles, or invalidity, or adverse claim to title" shall be construed to confine the scope of coverage of title insurance to real property and contractual interests derived therefrom.

69O FAC 186.008 | Escrow Requirements

(1) A title insurance agent or title insurer may not use, endanger, or encumber money held in trust without the permission of the owner of such money, given after full disclosure of the circumstances. Accordingly, except as hereinafter provided, a title insurance agent or title insurer may not disburse funds unless the funds are collected funds. For purposes of this provision, "collected funds" means funds deposited, finally settled and credited to the title insurance agent's or title insurer's trust account. Notwithstanding that a deposit made by a title insurance agent or title insurer to the trust account has not been finally settled and credited to the account, the title insurance agent or title insurer may disburse funds from the trust account in reliance on such deposits under any of the following circumstances:
(a) The deposit is made by a certified check, cashier's check, or money order;

(b) The deposit is made by a check representing loan proceeds issued by a federally- or state-chartered bank, savings bank, savings and loan association, credit union, mortgage broker licensed under Chapter 494, F.S., or other duly licensed or chartered lender;

(c) The deposit is made by a bank check, cashier's check, official check, treasurer's check, or other such official instrument issued by a bank, savings and loan association, or credit union when the instrument is drawn by the bank on itself, or on another bank whether or not the check is "payable through" or "payable at" a bank and the title insurance agent or title insurer has reasonable and prudent grounds to believe the instrument will clear and constitute collected funds in the title insurance agent's or title insurer's trust account within a reasonable period of time. Such instruments are considered by the Federal Reserve Board, under Federal Regulation CC, otherwise cited as 12 C.F.R. 229, to be "next day" payable items. A check drawn by a corporation on a bank or a draft drawn by a corporation on itself whether or not the check or draft is "payable at" or "payable through" a bank and is not a "next day" payable item under Regulation CC unless the depository bank chooses to treat it as such, and may not be disbursed on until collected;

(d) The deposit is made by a check drawn on the trust account of a lawyer licensed to practice in the State of Florida or on the escrow or trust account of a real estate broker licensed under Chapter 475, F.S., or on the account of a mortgage broker licensed under Chapter 494, F.S., or on the escrow trust account of a title insurance agent or title insurer licensed under the Florida Insurance Code, when the title insurance agent or title insurer has a reasonable or prudent belief that the deposit will clear and constitute collected funds in the trust account within a reasonable period of time;

(e) The deposit is made by a check issued by the United States Government, the State of Florida or any agency or political subdivision of the State of Florida;

(f) The deposit is made by a check issued by an insurance company authorized to do business in the State of Florida and the title insurance agent or title insurer has a reasonable and prudent belief that the instrument will clear and constitute collected funds in the trust account within a reasonable period of time;

(g) The deposit is made by a personal check in an amount not to exceed $500 when the title insurance agent or title insurer has a reasonable and prudent belief that the instrument will clear and constitute collected funds in the trust account within a reasonable period of time.
(2) For purposes of this provision, disbursement of funds shall only be made on such negotiable instruments as enumerated above which contain the following elements:
(a) Are signed by the drawer; and,

(b) Contain an unconditional order to pay; and,

(c) Are payable on demand; and,

(d) Are payable to order or to bearer.
(3) Funds received by a licensed title insurance agent or insurer pursuant to a real estate closing transaction involving the issuance of a title insurance binder, commitment, policy of title insurance, or guaranty of title shall not be deposited or transferred to an interest-bearing trust account without the written consent of the buyer and seller.

(4) Funds received from depositors in excess of the insured amount must be deposited in a financial institution that has a rating not less than the minimum standards established by Government National Mortgage Association (GNMA).

69O FAC 186.009 | Reconciliation of Escrow Accounts

(1) Every licensed title insurance agent shall maintain a monthly reconciliation of every escrow account required to be maintained pursuant to Section 626.8473, F.S., and shall, on a monthly basis, report such reconciliation together with appropriate supporting documentation to each title insurer which licensed the agent during the reconciliation period. The reconciliation shall be supported by appropriate documentation, including a monthly bank statement, a list of all outstanding checks as of the date of the reconciliation which are not shown on the monthly bank statement, and a trial balance of the escrow ledger records required to be maintained by subsection (2). Licensed title insurance agents and title insurers shall provide a copy of the monthly escrow account reconciliation to the Office upon its request. Such records shall be maintained by the title insurer for a period of five years.

(2) Every licensed title insurance agent shall maintain a separate ledger card for each real estate closing transaction for which funds are received in escrow. The ledger card shall contain chronological entries of dates and amounts of moneys received and disbursed including the name of the remitter and payee and each check number issued on such escrow account. Such records shall be maintained by the title insurance agent for a period of three years. The ledger card required by this rule may be maintained in computer storage with a print-out available upon request of a title insurer or the Office.

69O FAC 186.010 | Insurer's Assumption of Certain Liabilities

69O FAC 186.013 | Title Insurance Statistical Gathering: Licensed Title Insurance Agencies and Florida Retail Offices of Direct-Writing Title Insurance Underwriters

On or before May 31 of each year, each licensed title insurance agency and Florida retail offices of direct-writing title insurance underwriters shall submit Form OIR-E0-2087, "Title Insurance Experience Reporting - Agents and Retail Offices of Direct-Writing Title Insurance Underwriters," effective 10/19, hereby incorporated by reference and available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-11518. The filing shall be submitted electronically at https://irfs.fldfs.com.

69O FAC 186.014 | Title Insurance Statistical Gathering – Title Insurance Underwriters

(1) The following forms are hereby incorporated by reference and may be obtained from the Office's web site located at http://www.FLOir.com/iPortal:
(a) Form OIR-D0-2115 "Title Insurance Underwriter's Data Call - Part I," effective 7/23, which is available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-16049;

(b) Form OIR-D0-0050 "Title Insurance Underwriter's Data Call - Part II," effective 7/23, which is available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-16050; and

(c) Form OIR-D0-0051 "Title Insurance Underwriter's Data Call - Part III Schedule P - Part 1 Summary," effective 7/23, which is available at http://www.FLRules.org/Gateway/Reference.asp?No=Ref-16051.
(2) By the May 31st of each year, title insurance underwriters must electronically submit statistical data to the Office. The submittal shall be accomplished by electronically completing Forms OIR-D0-2115, OIR-D0-0050, and OIR-D0-0051.

(3) Forms OIR-D0-2115, OIR-D0-0050, and OIR-D0-0051 shall be completed by title insurance underwriters in accordance with the instructions for each submittal year. The submittal shall, in addition to the data for the current year, include an affidavit re-certifying the accuracy and completeness of the prior four years' data. If significant changes have been discovered in the data submitted in any of the four prior years, a corrected submittal shall be made for that year.

Pursuant to Section 627.782, F.S., the statistical data is collected for the purposes of analyzing premium rates, retention rates, and the condition of the title insurance industry.

(4) All submittals shall be submitted to the Office's Insurance Regulatory Filing System (IRFS) at https://irfs.fldfs.com, as a data filing. A filing shall be considered received by the Office when its arrival in the Office is shown electronically to be on business days between the hours of 8:00 a.m. and 5:00 p.m. eastern standard time. Filings received after 5:00 p.m. shall be considered to be received the next business day.

69O FAC 186.015 | Title Insurance Agency Collateral Substitution

When a title insurance agency substitutes a surety bond in place of its deposit of securities pursuant to Section 626.8418(2), F.S., the bond must secure performance by the agency of its responsibilities relating to the title policies issued through the agency, including performance during the time period in which the deposit was in place, prior to the issuance of the bond. All claims made after issuance of the bond based on liability incurred prior to the issuance of the bond, must be covered by the bond.

69O FAC 186.017 | Certificate of Mortgage Release (Repealed)

Rulemaking AuthorityLaw ImplementedHistory
701.041(9) FS.701.041(9) FS.New 3-22-07, Repealed .
69O-187 | Professional Liability Self-Insurance Trust Funds

69O FAC 187.001 | Definitions

When used in the rules in this Part, the following words or terms shall have the meaning as described in this rule.
(1) "Office" means the Office of Insurance Regulation.

(2) "Fund" or "self-insurance trust fund" means a medical malpractice risk management trust fund established in accordance with Section 627.357, F.S., and rule Chapter 69O-187, F.A.C., part I.

(3) "Trustees" means a group of members elected by those members comprising the self-insurance trust fund for stated terms of office to direct the administration of a self-insurance trust fund, and whose duties shall include responsibility for approving applications for new members of such Fund. Such Trustees must be members of the self-insurance trust fund; and a Trustee shall not be an officer or employee of the Service Agent or any other entity retain by the Fund to manage the affairs of all or part of the Fund's operations nor have an ownership interest in any such entity.

(4) "Certified Audit" shall mean an audit upon which the auditor expresses his professional opinion that the accompanying statements present fairly the financial position of the self-insurance trust fund in conformity with generally accepted accounting principles consistently applied, and accordingly including such tests of the accounting records and such other auditing procedures as considered necessary in the circumstances.

(5) "Service Agent" or "Service Agency" means any individual or business entity which has obtained Office approval to contract with self-insurance trust funds for the purpose of providing all or any part of the services necessary to establish and maintain a self-insurance trust fund as defined in Section 627.357(1), F.S. The terms "Service Agent" and "Service Agency" may be used interchangeably in this rule, and when one term is used it shall include the other term.

(6) "Members" means those persons, firms or corporations executing the mutual covenants who have pooled their medical malpractice liabilities pursuant to Section 627.357, F.S.

(7) "Cash Account" shall mean cash in the possession of the Fund or in transit under its control and any funds maintained in a demand account in a bank insured by the FDIC or savings and loan association insured by the FSLIC.

(8) "Termination" means the liquidation of the Fund.

(9) "Voluntary termination" means the termination is initiated by the Fund.

(10) "Merger" means that the liabilities of the Fund are assumed by an insurer authorized to transact insurance in this state resulting in the dissolution of the Fund.

(11) "Voluntary merger" means the merger is initiated by the Fund.
Disclaimer© State of Florida
Rulemaking AuthorityLaw ImplementedHistory
624.308(1), 627.357(6) FS.624.307(1), 627.357 FS.New 10-7-75, Formerly 4-39.01, Amended , Formerly 4-39.001, Amended , Formerly 4-187.001.

69O FAC 187.002 | Responsibilities of the Service Agent

The responsibilities of the Service Agent shall include but not be limited to the following:
(1) The Service Agent shall determine all sums due the Fund from the members, pay all approved items of expense as directed by the Trustees, and give a periodic account of all monies so handled as directed by the Trustees but in no event less frequently than quarterly.

(2) For handling the administrative and servicing functions of the Fund, the Service Agent shall receive a service fee which shall be negotiated from time to time by the Trustees. This service fee shall be in consideration of all services and expenses contracted for with the Fund. The Service Agent's contract shall clearly show all fees to be paid to the Service Agent, and all fees shall be reasonable in consideration of the duties performed.

(3) The Service Agent shall maintain accurate books and records of all transactions concerning the collection and disbursement of funds, purchases of equipment, and all other business-related expenses incurred by the Fund or the Service Agent, and these books and records are to be open to inspection by the Office and by the Trustees or their agents at all reasonable times.

(4) The Service Agent shall deposit at any bank or banks designated by the Trustees, all charges, premiums and assessments as and when collected, and said monies shall be disbursed only as provided by:

(a) The rules and regulations, mutual covenants, and bylaws of the Fund;

(b) The Service Agent's contract; and,

(c) The Rules of the Commission pertaining to medical malpractice self-insurance trust funds.

69O FAC 187.003 | Approval of Service Agent Required

Any Service Agent shall be approved by the Office prior to use by the Fund. The Service Agent shall provide proof that it meets the following conditions before approval may be granted:
(1) The owner(s) of the Service Agent, including members of a copartnership, the officers of a corporation, and any person exercising control or influence over the affairs of the Service Agent, must not have been convicted of a felony or of any crime involving fraud, embezzlement, or theft nor have been an officer, Trustee or Service Agent or Administrator in a self-insurance funded plan that has become insolvent.

(2) The Service Agent shall certify that it either employs or contracts with a sufficient number of experienced and qualified claims personnel to meet the needs of the self-insurance trust fund with which it intends to contract.

(3) The Service Agent shall certify that it employs or contracts with a sufficient number of personnel experienced and qualified in the area of underwriting to meet the needs of the self-insurance trust fund with which it intends to contract or to provide the contractual arrangement made to have such service provided. In this context, the term "underwriting" includes, but is not limited to, the overall planning and coordinating of the self-insurance trust fund, the ability to procure excess insurance, the ability to provide summary data regarding the cost of claims, including the frequency and distribution of claims by type and cause, and the skill to make recommendations to individual members regarding the correction of any deficiencies that arise in the self-insurance trust fund.

(4) The Service Agent shall submit information concerning its organization and staff sufficient to establish fulfillment of the requirements of this section.

(5) The Service Agent shall certify that it has the recordkeeping capabilities specified before any approval may be granted.

(6) The Service Agent shall submit biographical statements on the form entitled "Biographical Statement," which is included in the "Application for Approval as a Medical Malpractice Self-Insurance Trust Fund," Form OIR-370; and fingerprint cards for all persons who have first line responsibility for the operation or management of all or part of the Fund, including but not limited to the principal executive and operating officers of the Service Agent. Form OIR-370 is hereby incorporated by reference and shall become effective on May 10, 1989. Form OIR-370 may be obtained from the Office of Insurance Regulation, Bureau of Property and Casualty Forms and Rates, Larson Building, Tallahassee, Florida 32399-0300.

69O FAC 187.004 | Application for the Self-Insurance Trust Fund

(1) Application for the purpose of establishing a self-insurance trust fund shall be made to the Office at Tallahassee. Such application shall contain all information necessary for the Office's consideration. At the Office's request, further information or verification as may be reasonably required shall be furnished.

(2) The application shall be made on Form OIR-370 entitled "Application for Approval as a Medical Malpractice Self-Insurance Trust Fund." The application shall be accompanied by:
(a) A copy of the mutual covenants properly executed pursuant to Rule 69O-187.0081, F.A.C., which binds each member of the Fund to individual, several and proportionate liability as set forth in Section 627.357(7), F.S.

(b) A copy of the application form for applying for membership in the Fund. THE FORM SHALL CLEARLY STATE IN BOLD PRINT THAT MEMBERS OF THE FUND ARE SUBJECT TO ASSESSMENTS FOR ANY DEFICITS WHICH MAY OCCUR IN THE FUND.

(c) A copy of the Fund's current financial statement, financial projections, plan of operation, commitments for funds or any other data showing evidence of the financial ability of the Fund to meet its obligations as a self-insurance trust fund. Financial projections of the Fund shall show evidence of the financial ability of the Fund to meet its claims and obligations promptly for a three year period.

(d) A copy of the Service Agent's contract effective upon the inception date of the Fund. The contract must clearly show all fees to be paid to the Service Agent. Fees must be reasonable in consideration of the duties performed.

(e) A copy of the risk management program required pursuant to subsection 69O-187.005(6), F.A.C.

(f) Biographical statements completed on the form entitled "Biographical Statement" as contained within the Application (Form OIR-370), and fingerprint cards for each individual to be participating in the management of the Fund unless submitted pursuant to subsection 69O-187.003(6), F.A.C.

(g) A copy of all marketing material that the Fund intends for general distribution to prospective members. All such marketing material shall clearly state in bold print that members of the Fund are subject to assessments for any deficits which may occur in any Fund year during which the member participated in the Fund. All advertisements shall include a statement that "This is an Assessable Self-Insurance Trust." The Office shall disapprove any material which contains any inconsistent, ambiguous, or misleading clauses.

(h) A copy of the proposed rating plan, indicating the expense factors associated with the proposed rates, and including any premium discount or surcharge schedule and any experience rating plan. The proposed rating plan shall be accompanied by appropriate actuarial support and justification.

(i) A copy of the proposed underwriting guidelines.

(j) A copy of the fidelity bond required by subsection 69O-187.005(5), F.A.C.

(k) A copy of any contract, policy, or agreement providing specific excess insurance or aggregate excess insurance to the Fund as may be required as a condition of approval.

(l) The name of the Fund and the location of the Fund's principal office, which shall be maintained within this state.

(m) A certified copy of the articles of incorporation, and bylaws, if incorporated, certified as true and correct by the Secretary of State, and a copy of the policy.

(n) The articles of incorporation, bylaws, policy, and mutual covenants shall contain a provision prohibiting any distribution of surplus funds except as approved by the Office.

(o) A complete biographical sketch (resume) on each Trustee of the Fund.

(p) A copy of the Fund's rules and regulations.
(3) In considering the financial ability of the group to pay its claims and obligations promptly the Office will take into consideration contracts, policies or agreements providing specific excess or aggregate excess coverage of the Fund, the numerical size of the group, the projected gross premiums or charges and the initial financial resources of the group.

(4) The Fund shall not solicit members until such time as the material submitted pursuant to subsection 69O-187.003(2), F.A.C., is preliminarily approved by the Office. Prior to the proposed effective date of the Fund, the Fund shall submit to the Office a copy of each application, proof that each of the prospective members has paid a deposit in an amount of not less than ten (10) percent of the estimated annual premium, and if necessary, proof of alternative financing in an amount sufficient to meet adequate financial ability standards. Nothing herein shall prohibit the organizers of a fund from discussing the formation of the Fund with prospective members.

(5) Prior to final approval, the Office shall be notified of and provided copies of all changes in information or documentation previously submitted. Upon becoming satisfied of the financial ability of the Fund to fulfill all of its obligations that might arise, upon being satisfied that the Fund has the facilities and personnel necessary to service the self-insurance trust fund contemplated and upon being satisfied that the Fund has achieved an adequate level of participation, the Office may grant final approval for the operation of the Fund subject to the conditions herein provided. The Office in determining an adequate level of participation shall take into consideration the retention level of the Fund, any specific excess or aggregate excess coverage, anticipated premium volume and any other pertinent information the Fund may provide. As a guideline only, a 4" to 1" ratio of the initial year retained premium volume to the retention level per claim may be used by the Office in determining a minimum adequate level of participation.

69O FAC 187.005 | Solvency of the Self-Insurance Trust Fund and Trustees' Responsibilities

The Trustees of the Fund shall be responsible for all operations of the Fund and shall assure the financial stability of the operations of the Fund by taking all necessary precautions to safeguard the assets of the Fund, including:
(1) Providing for adequate methods of funding to meet anticipated and incurred losses. The method of funding shall be based upon a pre-determined plan which may include underwriting classifications, geographic territories, and experience modifications.

(2) Exercising active efforts to collect delinquent accounts resulting from any unpaid premiums, charges, and assessments by members. Any member of the Fund who fails to pay the required premiums, charges, and assessments after due notice shall be ineligible for membership until such past due account, including cost of collection, if any, has been paid.

(3) Prohibiting the Trustees or the Service Agent of the Fund from utilizing any of the monies collected for any purpose other than the payment of claims, claims expenses and Fund expenses. Further, the Trustees and the Service Agent of the Fund shall be prohibited from borrowing any monies from the Fund.

(4) Investing any funds not held in cash accounts, but such investments shall be limited to the following:
(a) Securities issued by the U.S. Government or U.S. Government agencies, including bonds, bills, and notes which are guaranteed by the U.S. Government.

(b) Investment share accounts, money market accounts, certificates of deposit, and similar instruments or accounts in or issued by any savings and loan association or duly chartered bank whose deposits are insured by a federal agency. Such investments shall not exceed the federally insured amount.

(c) Securities issued by any state, any county, district, or incorporated district therein, including bonds, notes, and tax exempt securities which are the direct obligations of such state, county, district, or city and for payment of the principal and interest of which the state, county, district, or city has lawful authority to levy taxes or make assessments and revenue securities insured by a recognized insurance association. Such securities with the exception of revenue securities shall be of investment grade meaning of the top three generic letter rating classifications by a securities rating agency. Revenue securities shall be of the top investment grade. "Securities rating agency" means Moody's Investors Service, Standard and Poor's Corporation, Duff and Phelps, Inc., or any successor organization of the aforementioned companies. Further limitations on such securities shall be as follows:
1. At any time a Fund may invest up to one-hundred (100) percent of the Fund's invested assets in the highest rated investment grade.

2. At any time no more than fifty (50) percent of the Fund's invested assets may be invested in the second or third highest investment grade.

3. At any time no more than twenty-five (25) percent of the Fund's invested assets may be invested in the third highest investment grade.

4. No more than five (5) percent of the Fund's assets shall be invested in any one issuer.
(d) Other investment alternatives, subject to Office approval, if such alternative investments provide the same or similar degree of security as the investments permitted under paragraphs (a), (b) and (c), above.

(e) Other investment alternatives may be considered for Funds with assets exceeding on hundred million dollars on a special consent basis and only with Office approval.
(5) Obtaining and maintaining a fidelity bond covering each individual Trustee, employees of the Fund, and any other person who handles funds, naming the Fund as obligee, in an amount sufficient to protect the Fund against the misappropriation or misuse of any monies or securities. Evidence of such bond acceptable to the Office shall be furnished to the Office. The Trustees must require its Service Agent to obtain a bond which provides coverage of its Service Agent.

(6) Obtaining a professional consultant's services for loss prevention and claims coordination under a risk management program or employing a licensed Risk Manager. The risk management program and professional consultant shall be acceptable to the Office prior to the granting of approval for the proposed Fund. These services may be provided by a Service Agent or employee(s) who is not a licensed Risk Manager(s) who demonstrates to the Office adequate experience and expertise in the areas of loss prevention and claims coordination under a medical malpractice risk management program.

(7) Obtaining the services of a Service Agent approved under Rule 69O-187.003, F.A.C., or employing qualified individuals to carry out those management responsibilities and duties of the Fund as defined in this rule.

(8) Annually reviewing the financial needs of the Fund for the coming fund year and revising members premiums to provide adequate funds.

(9) Dispersing to all members of the Fund a copy of pages one (1) through six (6) and Schedule G of Form OIR-342 entitled "Medical Malpractice Self-Insurance Trust Fund Annual Audit" for the latest fund year. As an option, the Fund may upon approval from the Office, provide a summary of this information. Such information shall be mailed to the member within one hundred twenty (120) days of the close of the fund year.

69O FAC 187.006 | Deficit Assessments and Surplus Funds

(1) In the event of a deficit in any fund year, such deficit shall be made up, either from unencumbered surplus from a fund year or years other than the current fund year; or, upon approval by the Office, by assessment of the membership, if necessary and consistent with sound actuarial principles, or by such alternate method as the Office may approve. The Office shall be notified prior to any transfer of unencumbered surplus funds.

(2) If necessary and consistent with sound actuarial principles, the Fund may issue dividends or refunds to its members as approved by the Office.

(3) All filings shall be submitted electronically to http://www.FLOir.com/iPortal.

69O FAC 187.007 | Continuing Requirements Including Filing of Reports and Rates

(1) The Trustees shall have the accounts and records of the Fund audited annually or at any time as may be required by the Office, such audit to be made by Certified Public Accountants or by authorized representatives of the Office, with the Office reserving the right to prescribe a uniform accounting system to be used by the Fund in order that it may determine the solvency of the Fund. An audit prepared by other than Office personnel shall be a certified audit filed with and received by the Office in Tallahassee within ninety (90) days after the close of the fund year. All filings shall be submitted electronically to http://www.FLOir.com/iPortal.

(2) The Trustees shall annually file a report as to financial condition, loss experience, and operational expense of the Fund on Form OIR-342 entitled "Medical Malpractice Self-Insurance Trust Fund Annual Audit." This report shall be due and must be received by the Office within ninety (90) days of the close of the fund year. Form OIR-342, rev. 2/93, is hereby adopted and incorporated by reference. Forms are available at http://www.FLOir.com/iPortal.

(3) The Fund and its Service Agent shall be subject to Office inspection and examination of the affairs, transactions, accounts, books, records, and assets of the self-insurance trust fund or Service Agent as often as the Office deems advisable. The reasonable expense of any such examination including record reconstruction or costs of appraisals shall be borne by the Fund but for no more than one examination per year.

(4) Each Fund shall comply with Section 627.912, F.S., and Rule 69O-171.003, F.A.C., by filing Form OIR-303 entitled "Florida Medical Professional Liability Insurance Claims Report," which is incorporated by reference in Rule 69O-171.003, F.A.C., with the Office. Form OIR-303 may be obtained from the Office of Insurance Regulation, Bureau of Property and Casualty Forms and Rates, Larson Building, Tallahassee, Florida 32399-0300.

(5) The Trustees and the Service Agent shall make available to the Office at their request any or all minutes pertaining to the meetings of the Trustees. Any matter relating to individual members or individual claims may be edited to preserve the confidentiality of the member's name or claim information.

(6) The Fund shall file with the Office all changes or modifications to documents previously filed with the Office at least thirty (30) days prior to the date of implementation and all changes and modifications shall be subject to Office approval. All filings shall be submitted electronically to http://www.FLOir.com/iPortal.

(7) The Fund shall file all rate changes with the Office at least thirty (30) days prior to use and include in such filings the expense factors underlying the proposed rates and such additional information that demonstrates that rates are adequate so as to guarantee the maintenance of sufficient reserves to cover contingent liabilities. The Office's responsibility in the review of such filings shall be as follows:
(a) At such time the Office determines the expense factors are justified, and the associated rates are adequate so as to guarantee the maintenance of sufficient reserves to cover contingent liabilities, the Fund shall be notified in writing that the expense factors are approved and the rates utilizing such expense factors are acceptable for use.

(b) The Office shall disapprove any rate if it is determined that the expense factors are not justified and reasonable or that the rates are inadequate and do not guarantee the maintenance of sufficient reserves to cover contingent liabilities. The Fund shall be notified by certified mail of this fact with an explanation of the underlying factors that led to such conclusion. The Fund shall be entitled to the rights as specified in Chapter 120, F.S. In the event the filing is deficient and the Office cannot make an initial determination, the Office shall within thirty (30) days of the receipt of such filing request in writing additional information. The Fund shall have thirty (30) days from the date of the Office's request to respond, and if such information is not received or is not sufficiently responsive, the rates shall be disapproved. The Fund shall be entitled to the rights as specified in Chapter 120, F.S.
(8) Unless otherwise indicated in these rules, all Funds shall maintain on a continuing basis and file with the Office the requirements pursuant to paragraphs 69O-187.004(2)(a), (d), (e) and (g) through (p), F.A.C. Failure to do so may result in withdrawal of the Fund's self-insurance privilege.

(9) The Trustees shall file quarterly reports as to the financial condition, loss experience and operational expense of the Fund on Form OIR-343, "Medical Malpractice Self-Insurance Trust Fund Quarterly Audit," rev. 2/93, which is hereby adopted and incorporated by reference. This report is due and must be received by the Office within sixty (60) days of the close of the fund quarter. Forms are available at http://www.FLOir.com/iPortal.

(10) Each Fund shall comply with Sections 627.4147 and 627.4148, F.S.

69O FAC 187.008 | Contracts for Excess Insurance

Specific excess and aggregate excess insurance may be required as a condition of approval or continuing operation of the Fund.

The Fund shall not voluntarily reduce its specific excess or aggregate excess insurance without the prior approval of the Office. The Fund shall notify the Office of any involuntary changes in such coverages as soon as the Fund receives notice of any such change in coverage. The Office may approve the continued operations of the Fund with the reduced coverage taking into consideration the availability of such excess insurance, the financial condition of the Fund and the cost of any such excess insurance. All filings shall be submitted electronically to http://www.FLOir.com/iPortal.

69O FAC 187.009 | Termination or Merger of Self-Insurance Trust Fund

(1) The Trustees of the Fund shall oversee and approve the voluntary termination or voluntary merger of the Fund in accordance with Section 627.357(7)(i), F.S. The Service Agent shall cooperate and provide the necessary assistance required to effectuate such termination or merger.

(2) For a voluntary termination or voluntary merger of the Fund, the Trustees shall:
(a) Provide the Office with written notification of the Fund's intent to terminate or merge but only with the consent of a two-thirds vote of the Trustees and of the members.

(b) Provide the Office with minutes of the Trustees' meeting approving the termination or merger.

(c) Submit to the Office a detailed plan to handle the termination or merger. Such plan shall be subject to the approval of the Office and shall include the following:
1. Evidence of adequate disclosure to affected parties including the members and the Trustees of the contemplated termination or merger. Transactions involving affiliates, representatives or interested parties shall be fully disclosed to the members and Trustees, and shall include evidence that said transactions are in the best interest of the Fund. Furthermore, the Office shall require the Trustees to seek independent legal and actuarial counsel regarding the actions taken in contemplation of the termination or merger, to certify the adequacy of all disclosures made and the sufficiency of all due diligence conducted on behalf of the members or the Trustees, in order to assist the Office in determining actuarial soundness. Parties providing such counsel shall not be employed with or in any way affiliated with the assuming insurer.

2. For a termination:
a. The Fund shall continue in a run-off mode, which is a common insurance industry term which means that assets are not released until the last claim has been fully settled. The Fund shall have a reserve analysis completed on its existing liabilities by an actuary who is a member of the Casualty Actuarial Society. The Fund shall maintain compliance with Section 627.357, F.S., and the applicable provisions of this Part, including the continued service of the Trustees and the administration of the Fund by the Service Agent.

b. The Office shall exempt the Fund from the requirements of sub-subparagraph (2)(c)2.a., if the Fund demonstrates that the purchase through competitive bidding of an appropriate insurance product relieving the Fund of any liabilities incurred while operating pursuant to Section 627.357, F.S., is in the best interest of the Fund and that the provider of the product is an insurer authorized to transact insurance in this state.

c. Any monies remaining in the Fund after the satisfaction of all liabilities incurred while operating pursuant to Section 627.357, F.S., shall be declared dividends and returned to the members of the Fund.
3. For a merger:
a. The Fund shall submit a request for a Loss Portfolio Transfer. All filings shall be submitted electronically to http://www.FLOir.com/iPortal.

b. The Fund shall have a reserve analysis completed on its existing liabilities by an independent actuary who is a member of the Casualty Actuarial Society. The liabilities of the Fund as determined in the reserve analysis shall be assumed, as evidenced in the Loss Portfolio Transfer Agreement, by an insurer authorized to transact insurance in this state. The assuming insurer shall provide a three-year pro-forma on both a countrywide and Florida only basis indicating the projected impact of the contemplated assumption of the Fund's liabilities. Furthermore, a three-year business plan shall be provided if the assuming insurer plans to or is currently writing medical malpractice insurance. Rates for any assuming insurer planning to or currently writing medical malpractice insurance shall be actuarially sound and in compliance with Section 627.062(1), F.S. The most recent Annual Statement of the assuming insurer shall contain the appropriate loss reserve certification, as required by Section 624.424, F.S., and Rule 69O-137.001, F.A.C.

c. The Office shall require a portion of the LPT assets deemed to be material in accordance with the application of generally accepted accounting practices and procedures to be placed in an interest bearing trust account designated by the Treasurer of this state and maintained for the purpose of holding such deposits. Such deposit is to be maintained as assurance of the payment of claims arising from policies issued by the Fund; provided, that the interest shall be credited to the assuming insurer and reported to the assuming insurer's taxpayer ID number and that the assuming insurer may take financial statement credit for this deposit. Such deposit shall remain in place for a period of 5 years; provided, that the assuming insurer may apply for release of all or part of the deposit prior to the end of the 5 year period. The Office shall release the deposit if the insurer demonstrates that the interests of the Fund members are otherwise protected. The assuming insurer shall not, without the express consent of the Office, for a period of 5 years, pay any dividend to its shareholders or permit the ratio of its premiums to surplus and capital to exceed 3:1. If the assuming insurer seeks the Office's consent to grant a dividend or increase its writing to surplus ratio, the Office shall grant such a request if the insurer demonstrates that the interests of the Fund members are otherwise protected. In the event the assuming insurer's claims payments for the liabilities of the Fund, including ALAE and ULAE, are less than that projected in the reserve indication set forth in the material presented to the members at the time of the merger, the difference between the projected amount and the amount actually paid shall be refunded back to the Fund members.
(3) A termination or merger of the Fund initiated by the Office shall be in accordance with the provisions of Section 627.357(7)(i), F.S.

69O FAC 187.010 | Bylaws, Mutual Covenants, Rules and Regulations, and Service Agent's Contract

As a condition of the Office's approval of the Fund, the documents filed pursuant to Rule 69O-187.004, F.A.C., shall contain all of the following provisions, but may also contain other provisions not inconsistent with these rules or with the required provisions.
(1) The bylaws of the Fund shall contain the name and location of the fund, its purposes and powers. The meeting of the members shall be specified and meet no less than annually. Members shall be advised of voting rights. Trustee number, qualifications, term of office, election process, and selection of officers shall be addressed. Duties of the Trustees, the times and places of meetings, the removal of a Trustee, the replacement of the Trustee created by the vacancy therein, and any compensation as may be determined shall be a part of this document. Alteration, amendment or repeal of any part of this document shall only be as specified therein.

(2) The mutual covenants, herein after referred to as the Agreement, shall be given to and accepted by each member of the Fund. The Agreement shall be executed by the Chairman of the Trustees, attested by its Secretary, by the Service Agent and by the member. The membership shall be defined, and the statutory authority to pool such liabilities to form the self-insurance trust fund shall be clearly stated. The initial Trustees shall be designated. The parties to this Agreement shall agree as follows:
(a) The Fund and each member will individually, severally and proportionately, but not jointly except as provided in Section 627.357, F.S., covenant and agree to pay premiums, charges and assessments based upon appropriate classifications and rates, and the Fund and its members will individually, severally and proportionately covenant to assume and discharge, by payment, any lawful awards or final judgments entered against any member of the fund, and further, the members will individually, severally and proportionately covenant and agree there will be no disbursements out of the Fund by way of dividends, refunds or distribution of surplus other than upon the Office's approval.

(b) The members shall by executing the Agreement ratify and confirm appointment by the Trustees of the Service Agent, individually and collectively, and further, the members shall be advised of the duties and responsibilities of the Service Agent as provided by Rule 69O-187.002, F.A.C.

(c) The Trustees shall be sole judge of whether an applicant shall be admitted to membership, and whether a member shall be retained by the Fund, and further, shall give proper notice in accordance with Section 627.4147(1)(c), F.S., to any member expelled from the Fund.

(d) The Trustees shall set up, operate and enforce the bylaws and rules and regulations.

(e) There shall be provisions that require each member to abide by the following:
1. Loss prevention and risk management recommendations of the Trustees and Service Agent.

2. In the event of a loss or claim, give immediate notification to the Service Agent on the prescribed forms.

3. Pay all premiums, charges and assessments promptly as required by the Trustees.

4. The member appoints the Service Agent as his agent and attorney-in-fact to act in his behalf and to execute all contracts, reports, waivers, agreements, excess insurance contracts, and service contracts; to make or arrange for payment of claims, and all other things required or necessary insofar as they affect the terms of this Agreement.
(f) Subject to the terms, conditions, limitations and exclusions of the mutual covenants of the Fund or the policy, the Fund shall defend in the name of and on behalf of the member any suits or other proceedings which may at any time be instituted against him on account of injury, death or disablement arising out of medical malpractice including suits or other proceedings alleging such malpractice and demanding damages or compensation therefor, although such suits, other proceedings, allegations or demands are wholly groundless, false or fraudulent, and to pay all judgments, awards or costs taxed against the member in any legal proceeding defended by the Fund, all interest accruing after entry of judgment and all expenses incurred for investigation, negotiation and defense.

(g) The Trustees, the Service Agent and any of their personal representatives shall be permitted to inspect the places where the covered professional services are performed and examine the members' books, documents, and records in order to verify the charges, premiums or assessments payable.

(h) The Trustees shall set aside a reasonable sum for the operating and administrative expenses of the Fund. All other funds shall be used only for payment of claims, including settlements, awards, judgments, legal fees, costs in all contested cases and all expenses of investigation.

(i) The Fund year shall be as stated in the Agreement.

(j) Liability of the Trustees shall be in accordance with Section 624.489, F.S.

(k) The member shall be bound by all terms of the Agreement. Alteration, amendment or repeal of any part of the Agreement shall only be as specified therein.
(3) The rules and regulations shall govern and define the operation of the Fund together with the rules and regulations of the Office governing medical malpractice self-insurance trust funds, the provisions of the mutual covenants, the bylaws of the Fund and the policy issued by the Fund. The Trustees, members and Service Agent shall not borrow any monies or securities from the Fund or in the name of the Fund. The Service Agent is to manage the Fund subject to the overall supervision of the Trustees. Any assessment shall be made in accordance with Section 627.357(7), F.S., and Rule 69O-187.006, F.A.C. The rejection or expulsion of a member is the decision of the Trustees. Notice of any expulsion shall be in accordance with Section 627.4147(1)(c), F.S. The Service Agent shall prepare statistical reports for the Trustees as relates to the overall claims status, trends and loss experience of the Fund. The Trustees shall have the accounts and records of the Fund audited as required by Rule 69O-187.007, F.A.C., and file the appropriate forms as required by the same. The Trustees and Service Agent shall be bonded as required by Rule 69O-187.005, F.A.C. Alteration, amendment or repeal of any part of this document shall only be as specified therein.

(4) The Service Agent's contract shall detail the duties and responsibilities of the Service Agent as required by Rule 69O-187.002, F.A.C. Expenses to be borne by the Service Agent and by the Fund shall be specified. The compensation for the Service Agent and the terms of termination shall be as stated. Alteration, amendment or repeal of any part of this document shall only be as specified therein.

69O FAC 187.011 | Exemptions

Rule 69O-187, F.A.C., as amended on May 10, 1989, shall allow any Fund established prior to this date an exemption from Rules 69O-187.003 and 69O-187.010, F.A.C. At such time as any of the Fund documents filed pursuant to the application process are amended, the amended document(s) shall comply with Rule 69O-187.010, F.A.C. In the event the management of the Fund is changed, the Fund shall adhere to Rule 69O-187.003, F.A.C.

69O FAC 187.012 | Withdrawal of Self-Insurance Privilege

69O-188 | Commercial Self-Insurance Funds

69O FAC 188.001 | Purpose

The purpose of this chapter is to establish a procedure by which notice is acknowledged by applicants for commercial self-insurance funds of the assessability of membership in the self-insurance fund and that it may be necessary to contribute additional monies to meet unfilled obligations of the Fund.

69O FAC 188.002 | Scope

69O FAC 188.010 | Rating Plan: Discounts, Credits, Surcharges

(1) This rule applies to all commercial property and casualty insurance which is written by a commercial self-insurance fund, as defined in Section624.460-.488, F.S., in accordance with a rating plan. It is intended to establish guidelines and procedures for determining whether discounts, credits or surcharges applied under a rating plan are producing rates that are not excessive, inadequate or unfairly discriminatory. This part does not apply to workers' compensation or employer's liability insurance.

(2) As used in this rule:
(a) "Rating plan" means the rate manual and any schedule rating plan, experience rating plan, individual risk premium modification plan, rule, procedure, plan, underwriting rule, schedule or other such device for modifying manual rates.

(b) "Subjective discount, credit or surcharge plan" means any part of the rating plan that
(i) applies to a specific policy at the discretion of the fund or the insured, or

(ii) uses subjective non-quantifiable standards for determining the rate modification, or

(iii) does not specify the exact amount of the modification.
Also called rate modification plans, these plans usually provide various risk characteristics or conditions and a range of modification factors which may be applied to the manual rate of a particular insurance risk in recognition of such characteristics or conditions. The effect of the modification factor is to increase (debit) or decrease (credit) the rate to be charged. These plans include, but are not limited to, plans commonly called Schedule Rating Plans and Individual Risk Premium Modification Plans.

(c) "Manual rate" means the rate developed from the rating plan prior to the application of any subjective discount, credit or surcharge plan. Generally, the manual rate is designed to apply on a generic basis to similar risks and is published in a rate manual by a fund or rating organization. Package rates produced by application of package modification factors to monoline rates are considered to be manual rates.

(d) "Experience rating plan" means any part of a rating plan used to modify an otherwise applicable rate based on the past loss experience of the individual insured.

(e) "Fund" means a commercial self-insurance fund authorized to write one or more property or casualty lines of business in the State of Florida under Sections624.460-.488, F.S.
(3) All experience rating plans shall clearly define the eligibility standards for the plan as approved by the Office. These plans shall be mandatory for all eligible insureds.

(4) Unless otherwise specified in the rating plan, concurrent applications of discounts, credits and surcharges shall be multiplicative in determining the final rate.

(5)
(a) Application of subjective discount, credit or surcharge plans to a specific policy shall be based on "informed" judgment which is supported in the file by appropriate documents, e.g. a loss control report, financial analysis, inspection reports, photographs, and the insured's formal safety plans.

(b) For an individual insured, the total effect of application of subjective discount, credit or surcharge plans may not result in a debit or credit of more than 25% on any policy with an effective date on or after October 1, 1991.
(6)
(a) Each fund shall report information on Form OIR-CSF, "Application of Subjective Discounts, Credits, Surcharges and Experience Rating Reporting Form/Commercial Self-Insurance Fund," rev. 5/91, which, with its Instructions, is hereby adopted and incorporated by reference, to enable the Office to monitor the relationship of aggregate premium actually charged policyholders by each fund to the premium that would have been charged by application of the fund's filed manual rates. The form may be obtained from the Bureau of Property and Casualty Rate and Reserve Analysis, Division of Insurer Services, Office of Insurance Regulation, Larson Building, Tallahassee, FL 32399-0300. The report is due on or before April 1st of each year, beginning with the report which is due April 1, 1992. Failure to file reports on time will result in administrative sanctions pursuant to Section 624.418(2)(a), F.S., which provides that the Office may take action against any fund which violates any rule of the Office. A form which is not complete will be considered a failure to report on time.

(b) The Department may require the information reported on Form OIR-CSF to be submitted in a specified computer-readable form in place of the format provided on the present OIR-CSF reporting form.

(c) Any fund with an insignificant number of policies and/or premium volume written under a rating plan in this state may be exempted from reporting on Form OIR-CSF by completing and submitting Form OIR-CSE, "Florida - Discounts, Credits, Surcharges/Exemption - Rule 69O-188.010, F.A.C.," rev. 5/91, which is hereby adopted and incorporated by reference. The exemption shall be requested annually and shall not be effective until the fund has received approval from the Office. The form may be obtained from and shall be submitted to the Bureau of Property and Casualty Rate and Reserve Analysis, Division of Insurer Services, Office of Insurance Regulation, Larson Building, Tallahassee, Florida 32399-0300. A fund with $250,000.00 or less in annual written premiums for a specific line of business reported under this rule written on Florida risks will be approved without the need for further justification. However, for amounts greater than $250,000.00 or for numbers of policies of 50 or more, the fund shall attach further information to justify a determination of "insignificant."

(d) Any fund with no business written under a rating plan in this state need not submit Form OIR-CSF to the Department for any future reporting period but must advise the Office of this fact in writing.
(7)
(a) If the combined effect of modifications for any line as shown in Column B on Form OIR-CSF shows a departure from the manual rate in excess of plus or minus 5% for the current reporting period, the fund shall limit the application of subjective discounts, credits or surcharges for that line to plus or minus 15% on an individual policy basis beginning not more than 120 days after the notification is sent to the fund by the Office. For the next full reporting period, if the total departure from the manual rates continues to exceed plus or minus 5%, the fund shall limit the application of subjective credits or surcharges for that line to plus or minus 5% on an individual policy basis, beginning not more than 120 days after the notification is sent by the Office, until the departure from manual rates does not exceed plus or minus 5% for one full reporting period.

(b) Use of the full range of subjective discount, credit or surcharge plans for the line may resume as specified in paragraph (5)(b), above, only when the fund has experienced for one full reporting period results which are within the prescribed total limits guidelines, for the line as shown in Column B on Form OIR-CSF, as adopted in this rule.
(8) The effect on manual premiums of experience rating and subjective rating shall be excluded when calculating indicated manual rates and manual rate changes unless it can be shown that their inclusion does not result in excessive, inadequate or unfairly discriminatory rates.

(9)
(a) For filings submitted after January 1, 1994, for any line shown on Form OIR-CSF, adequate supporting information which is acceptable to the Office shall be submitted with every rate filing required under Section 624.482, F.S., and every rate filing subject to subsection (8), above, substantiating that the relationship between subjective discount, credit or surcharge rate modifications and the expected loss and expense experience for the exposures is such that the subjective discount, credit or surcharge plans do not result in excessive, inadequate or unfairly discriminatory rates. The information provided must include an analysis of the experience resulting from the application of the subjective discount, credit or surcharge plan. Each fund must maintain the necessary experience, including the premiums, paid losses, reserved losses and allocated loss adjustment expenses paid or reserved for analysis. Funds which are affiliated with a licensed rating organization for filing purposes and use the rating organization's schedule rating plan may rely upon that organization to file on their behalf the information required under paragraph (9)(a). The experience must be accumulated in at least three categories, including debit rated risks, credit rated risks, and risks rated at the manual level. Generally accepted actuarial procedures shall be used in the analysis of this experience.

(b) If a fund lacks sufficient data for full credibility it may use data from other states or industry data to the extent needed to give credible results when making the analysis in paragraph (a), above.

(c) Failure to prove that a subjective discount, credit or surcharge plan does not result in excessive, inadequate or unfairly discriminatory rates will result in disapproval of such plan.
(10) If a fund fails to comply with the provisions of this rule, the department is authorized by Florida Statutes:
(a) To suspend or revoke the certificate of authority of the fund, under the provisions of Sections 624.418(2)(a), (b), (c), (d), (e), and (g), F.S.; or,

(b) In lieu of such discretionary suspension or revocation, to impose a fine and require restitution, pursuant to the provisions of Section 624.4211, F.S. Fines for willful violations may be as much as $100,000.

69O FAC 188.020 | Purpose

The purpose of the rules in this part is to specify the manner in which each commercial self-insurance fund as defined in Sections624.460-.488, F.S., shall for assessment and financial reporting purposes, report its experience to the Office, and the manner in which the trustees shall levy an assessment upon the members for the amount needed to make up any deficiency.

69O FAC 188.021 | Definitions

As used herein and for purposes of Forms OIR-EX and OIR-IA, the following definitions shall apply. For purposes of reporting on a calendar-accident year basis, references to "policy year" in the rules in this part shall mean "calendar-accident year" as the context may require.
(1) "Office" means the Office of Insurance Regulation.

(2) "Policy Year" means an aggregate record of all transactions for policies becoming effective during a given twelve (12) month period ending on December 31.

(3) "Calendar-Accident Year" means premiums earned during a twelve (12) month period ending December 31 and losses incurred from accidents which occur during the same period.

(4) "Calendar-Year" means the twelve (12) month period ending December 31 for which all policies of a particular policy year were effective. This definition is not applicable to funds reporting on a calendar-accident year basis.

(5) "Earned Premium" means:
(a) For a policy year, all earned premiums collected or due for each policy year including endorsement premiums, post-year audit adjustments, and retro rating plan adjustments less reinsurance expenses associated with such policies and less contributions to aggregate excess funds.

(b) For a calendar-accident year, all earned premiums collected or due for each calendar-accident year less reinsurance expenses associated with such premiums and less contributions to aggregate excess funds. Endorsement premiums, post-year audit adjustments, and retro rating plan adjustments shall be included in the calendar-accident year in which such adjustments are made.
(6) "Collected Premium" means:
(a) For a policy year, all premiums collected for each policy year including endorsement premiums, post-year audit adjustments, and retro rating plan adjustments less reinsurance expenses associated with such policies and less contributions to aggregate excess funds.

(b) For a calendar-accident year, all premiums collected or due for each calendar-accident year less reinsurance expenses associated with such premiums and less contributions to aggregate excess funds. Endorsement premiums, post-year audit adjustments, and retro rating plan adjustments shall be included in the calendar-accident year in which such adjustments are made.
(7) "Investment Income" means net investment gain or loss reported on the fund's most recent annual statement filed with the Office prorated proportionately among all policy years excluding closed policy years as follows:
a x b/c = Investment Income for a specific policy year.
a
Net Investment gain or loss as reported on the fund's most recent annual statement (page 4, column (1), line 9A. of the fund's 1989 annual statement and equivalent item reported on prior and subsequent annual statements if page, column, or line number is different).
b
Current fund balance from line 3., Form OIR-IA, Schedule "A," if positive, of the specific policy year to which investment income is to be allocated. If line 3., Form OIR-IA, Schedule "A," is negative for a specific policy year, b equals zero.
c
Total of current positive fund balances of all policy years from line 3., Form OIR-IA, Schedule "A."
(8) "Allocated Funds" means the annual allocations of positive net fund balances, line 6., Form OIR-EX, among policy years. Funds allocated from a policy year cannot exceed the lesser of 25% of earned premium for that policy year or the net fund balance on Form OIR-EX, line 6., for that policy year. All allocations must be formally approved by the trustees of the fund.

(9) "Other Income and Contributions" means:
(a) Any miscellaneous income resulting from the operations of the fund during each calendar year; and,

(b) Any cash or equivalent voluntary contributions received from trustees, members, or others designated for a specific policy year.
(10) "Losses and Allocated Loss Adjustment Expenses Paid" means amounts paid for losses and allocated expenses necessary for the adjustment of such losses for each policy year less any amounts received or due from reinsurance, salvage, subrogation, and if applicable, from the second injury fund associated with such paid losses and loss adjustment expenses.

(11) "Losses and Allocated Loss Adjustment Expense Reserves" means the value of reserves prior to any discounting, calculated in accordance with sound actuarial principles, for losses and allocated expenses necessary for the adjustment of such losses for reported and unreported occurrences not yet paid for each policy year less any applicable reinsurance, salvage, subrogation, and second injury fund recoverable for such losses and loss adjustment expenses.

(12) "Unallocated Loss Adjustment Expenses Paid" means the amounts paid for such expenses that cannot be allocated to a particular claim and are necessary for the adjustment of losses for each policy year less any amounts received or due from any applicable reinsurance, salvage, subrogation and the second injury fund related to or associated with such paid unallocated loss adjustment expenses.

(13) "Unallocated Loss Adjustment Expense Reserves" means the value of reserves prior to any discounting, calculated in accordance with sound actuarial principles, for expenses that cannot be allocated to a particular claim and are necessary for the adjustment of losses for reported and unreported occurrences not yet paid for each policy year less any applicable reinsurance, salvage, subrogation and second injury fund recoverable for such unallocated adjustment reserves.

(14) "Excess of Statutory Reserves Over Statement Reserves" means the reserves calculated in accordance with the instructions shown on Schedule P of the annual statement. The total of such reserves for all years is shown on the balance sheet on page 3 of the annual statement.

(15) "Present Value of Unallocated Loss Adjustment Expense Reserves," "Present Value of Loss and Allocated Loss Adjustment Expense Reserves," or "Present Value of Excess of Statutory Reserves over Statement Reserves" means reserves discounted to present value using the most recent United States Internal Revenue Service present value factors. All present value calculations shall be done by annual statement line of business.

(16) "Other Underwriting Expenses" means the amount incurred during each calendar year for all expenses not reported elsewhere. Initial organizational costs incurred by the fund may be amortized by the straight line method over sixty (60) months.

(17) "Dividends" means dividends paid for a policy year.

(18) "Trustees" means the Board of Trustees of the fund.

(19) "Aggregate Excess Funds" means the aggregate amounts accumulated by the fund in lieu of or in addition to purchasing aggregate excess insurance coverage, and shall be expended only with Department approval.

(20) "Closed Policy Year" means a policy year in which all expenses for such policy year have been paid, there are no reserves for losses or loss adjustment expenses, there are no open or anticipated claims and there are no unpaid declared dividends.

69O FAC 188.022 | Filing of the Commercial Self-Insurance Fund Experience Reporting Form

(1) On or before March 31 of each year or a later date if approved by the Office Department for good cause, each commercial self insurance fund shall complete for the preceding policy years, excluding closed policy years, evaluated as of the preceding December 31, and submit to the Office Department Form OIR-EX, "Commercial Self-Insurance Fund Experience Reporting Form," rev. 8/90, and Form OIR-IA, "Commercial Self-Insurance Fund Policy Year Investment Income Allocation Schedule (Schedule "A")," rev. 8/90, in accordance with this rule. Forms OIR-EX and OIR-IA, and the accompanying instructions are hereby adopted and incorporated by reference. Forms are available at http://www.FLOir.com/iPortal.

(2) Each fund shall, upon filing its initial Form OIR-EX and Form OIR-IA, elect to report on either a policy year or calendar-accident year basis. Thereafter, the reporting shall be on a consistent basis from year to year. Any changes in accounting or actuarial technique used in developing data shall be approved by the Office. All filings shall be submitted electronically to http://www.FLOir.com/iPortal.

69O FAC 188.023 | Filing of the Annual Statement by Commercial Self-Insurance Funds

(1) Each commercial self-insurance fund shall submit electronically to http://www.FLOir.com/iPortal. For the purpose of complying with rule Chapter 69O-137, F.A.C., a commercial self-insurance fund shall be considered an authorized insurer, except that the fund's annual statement shall be due on or before April 1 of each year.

(2) As an aggregate write-in on the balance sheet of the Annual Statement for assets and policyholders' surplus, an entry for future investment income on losses and allocated loss adjustment expense reserves and unallocated loss adjustment expense reserves shall be reflected. Future investment income shall be calculated as follows:
A + B + C - D
A
Losses and Allocated Loss Adjustment Expense Reserves
B
Unallocated Loss Adjustment Expense Reserves
C
Excess of Statutory Reserves over Statement Reserves
D
Present Value of A + B + C
(3) If a commercial self-insurance fund elects to report on a policy year basis under Rule 69O-188.022, F.A.C., then the commercial self-insurance fund shall file a supplemental schedule on a policy year basis of Schedule P of the NAIC Annual Statement Form for Fire and Casualty Insurers.

69O FAC 188.024 | Deficiency/Assessment Procedure

(1) After four (4) completed policy years, the commercial self-insurance fund trustees shall, within sixty (60) days of filing Forms OIR-EX and OIR-IA with the Office, make up any deficiencies identified in each policy year on Form OIR-EX, line 13., or shall levy an assessment upon the members for the amount needed to make up said deficiencies.

(2) Prior to a fund reporting four (4) complete policy years, the Office shall order the trustees of a fund to make up a deficiency or assess its members who participated in a policy year in which a deficiency is reported unless the fund can present an actuarially sound plan to amortize the deficiency. The Office may require that such plan be certified by an actuary who is a member of the American Academy of Actuaries.

(3) If needed, the trustees shall levy an assessment by sending a notice of assessment by certified mail to the address of record of each member of the fund from whom an assessment is due. The trustees shall take all steps necessary and reasonable to collect the assessment as soon as is reasonably possible. The trustees shall not be required to pursue assessments against a member if to do so would not be cost-effective.

(4) The fund may petition the Office within thirty (30) days of filing Forms OIR-EX and OIR-IA, to delay levying an assessment if it believes to do so is prudent. The Office shall grant the petition if the fund demonstrates to the satisfaction of the Office that the deficiency indicated on Form OIR-EX is likely to be resolved without an assessment. While such petition is under consideration by the Office, the sixty (60) day requirement in subsection 69O-188.024(1), F.A.C., shall not be applicable. However, if such petition is denied by the Office, the fund shall levy the assessment within sixty (60) days of such denial. All forms shall be submitted electronically to http://www.FLOir.com/iPortal.

69O FAC 188.025 | Assessment Calculation

(1) Assessments shall be made only against members having a policy during a policy year reporting a deficiency on Form OIR-EX, line 13. The assessment for each policy year shall be prorated among all policyholders for that policy year as follows:
X/Y x A = B
X
Assessment needed for a specific policy year.
Y
Total earned premium for the policy year being assessed.
A
Each member's earned premium for the policy year being assessed.
B
Assessment due from the member.
(2) For funds reporting on a calendar-accident year basis earned premiums shall include endorsement premiums, post-year audit adjustments and retro rating plan adjustments. For any reassessment necessary, eliminate from the total premiums earned during the policy year (Y) earned premiums of members who fail to pay the assessment. In calculating the amount of assessment necessary, reasonable estimates of the amount of the assessment that will not be collectible may be utilized.

69O FAC 188.026 | Notice Requirement

If after reviewing any form filed pursuant to this part, the Office preliminarily determines that the numbers contained thereon are inaccurate or that justification for the numbers is necessary, it shall issue a notice to the fund requesting that a corrected form be filed or that additional information or justification be submitted to support the form. The notice shall specify those parts of the form which the Office believes to be inaccurate and the nature of the additional information or justification to be filed. The fund shall, within thirty (30) days from the date it receives the notice, file with the Office all information or data which it contends supports or justifies the form. If such information is not so filed, the Office may require the fund to immediately cease accepting any premiums for new (non-renewal) insurance coverage. While the corrected form or additional information or justification is under review by the Office, the sixty (60) day requirement in subsection 69O-188.024(1), F.A.C., shall not be applicable; however, should a determination be made that an assessment is in order, the fund shall levy the assessment within sixty (60) days of such notification by the Office.

69O FAC 188.027 | Excess Funds

(1) Once a policy year is closed, any excess funds must be:
(a) Distributed as dividends to members subject to the approval of the Office; or

(b) Transferred to any open fund year or years. Such transfer must be formally approved by the trustees.
(2) Such action must be effective as of the first December 31 following the closing of a policy year.

69O FAC 188.028 | Additional Provisions

(1) Nothing in this part shall preclude a fund's trustees from levying an assessment to its members under the terms of their policies or shall be used as the basis for a member not to pay such an assessment.

(2) Failure of the trustees to make up deficiencies or assess the members in compliance with Rule 69O-188.024, F.A.C., will result in Office action under Section 624.476, F.S.
69O-189 | Workers' Compensation

69O FAC 189.001 | General Reporting Requirements (Repealed)

69O FAC 189.003 | Workers' Compensation: Application and Audit Procedures

(1)
(a) Each employer applying to a carrier in the voluntary market for workers' compensation coverage required by Section 440.38, F.S., shall use Form ACORD 130 FL (rev. 2019/07), "Florida Workers Compensation Application," which is hereby adopted and incorporated by reference. The form shall be completed and submitted to the carrier with which the employer wishes to contract for coverage.

(b) A carrier wishing to use its own application form shall submit the form electronically to the Florida Office of Insurance Regulation (Office) at http://www.FLOir.com/iPortal, and receive approval prior to its use.
1. At a minimum the form shall require the employer to provide the following information:
a. Name, address, and legal status of the employer;

b. Federal employer identification number;

c. Type of business and contractor licensing number if the employer is a contractor;

d. Rating information including past and prospective payroll;

e. Estimated revenue;

f. Locations;

g. List of officers, sole proprietors and partners including their social security numbers (disclosure of social security number is voluntary; as an alternative, attach a copy of exclusion or inclusion forms filed with the state);

h. List of all employee names, employees' social security numbers and classifications (disclosure of social security numbers is voluntary; as an alternative, the latest RT form with class codes added can be used in lieu of a separate listing of employee names, employees' social security numbers and classifications);

i. Previous workers' compensation experience;

j. Former business names and predecessor companies for the last five years;

k. Former and current owners in the last five years;

l. All names under which the corporation operates; and,

m. Any other information necessary to enable the carrier to accurately underwrite the employer.
2. The application shall contain a statement that the filing of an application containing false, misleading, or incomplete information with the purpose of avoiding or reducing the amount of premiums for workers' compensation coverage is a felony of the third degree.

3. The application shall contain a sworn statement by the employer that complies with Section 92.525, F.S., attesting to the accuracy of the information submitted.

4. The application shall contain a sworn statement by the agent attesting that complies with Section 92.525, F.S., that the agent explained to the employer or officer the classification codes that are used for premium calculations.
(c) Each employer applying for workers' compensation coverage in the Florida Workers' Compensation Joint Underwriting Association (FWCJUA) shall use Form ACORD 130 FL (2019/07) unless the FWCJUA files and receives approval by the Office to use a different application form in accordance with paragraph (1)(b). The FWCJUA shall submit any addendum to the application to the Office and receive approval prior to using. The completed application and all addenda shall be submitted to the FWCJUA at the address on the form.

(d) The Office has determined that posting the incorporated materials would be a violation of federal copyright law. Form ACORD 130 FL (rev. 2019/07) is available from ACORD at https://www.acord.org/home. Form ACORD 130 FL is available for inspection during regular business hours at the Office of Insurance Regulation, Larson Building, 200 East Gaines Street, Tallahassee, Florida 32399-0300.
(2)
(a) An application complying with this rule is required for all policies having covered Florida exposure. For new business effective after the implementation of this rule, a carrier shall use an application that complies with this rule. When this new business policy is renewed, the carrier is not required to obtain another application. These requirements also apply to policies written in other states where there is covered Florida exposure other than incidental Florida exposure.

(b) The employer shall sign the application.

(c) It is permissible for insurers to accept electronic signatures in satisfaction of the application signature requirements to the extent that such acceptance of electronic signatures complies with Parts I and II of Chapter 668, F.S.
(3)
(a) Each employer in the voluntary market or the FWCJUA may be required by their carrier to submit Form ACORD 175-FL (rev. 3/97), "Florida Workers' Compensation Monthly Change Sheet," which is hereby adopted and incorporated by reference. Carriers may use their own monthly change sheet containing the same information shown on the adopted form. This form is used to reflect any change in the required application. The monthly change sheet is applicable to new and renewal policies that have been issued with an application that complies with this rule. It is not necessary for an employer to submit a monthly change sheet if there are no changes to report.

(b) The Office has determined that posting the incorporated materials would be a violation of federal copyright law. Form ACORD 175-FL (rev. 3/97), "Florida Workers' Compensation Monthly Change Sheet," is available: from the Association for Cooperative Operations Research and Development (ACORD), 150 Clove Road, Little Falls, New Jersey 07424, at https://www.acord.org/home. Form ACORD 175-FL and is available for inspection during regular business hours at the Office of Insurance Regulation, Larson Building, 200 East Gaines Street, Tallahassee, Florida 32399-0300 or at the Department of State, The Capitol, 400 S. Monroe Street, Room 701, Tallahassee, FL 32399.
(4)
(a) In order to ensure that the appropriate premium is charged for workers' compensation coverage, each employer and carrier shall comply with:
1. The requirements of Section 440.381, F.S.; and,

2. The current voluntary market audit requirements as set forth in the "NCCI Basic Manual (pages 120-125), Florida State Special Audit Rules", approved for use by the Office effective 1/24, and hereby incorporated by reference. The Office has determined that posting these incorporated materials would be a violation of federal copyright law. The "NCCI Basic Manual (pages 120-125), Florida State Special Audit Rules" is available from the National Council on Compensation Insurance (NCCI) 901 Peninsula Corporate Circle, Boca Raton, Florida 33487-1362 at https://www.ncci.com/pages/default.aspx, and for inspection during regular business hours at the Office of Insurance Regulation, Larson Building, 200 East Gaines Street, Tallahassee, Florida 32399-0300, or at the Department of State, The Capitol, 400 S. Monroe Street, Room 701, Tallahassee, FL 32399.
(b) Each voluntary market carrier and each employer covered by a voluntary market carrier shall comply with the following minimum audit requirements at the expiration of each policy:
1. Final audits shall be conducted for both new and renewal policies as follows:
a. For policies with an estimated annual premium of $10,000 and over, a final physical audit shall be completed annually on all risks regardless of governing classification code;

b. For policies with an estimated annual premium of $1 to $9,999, a final mail or physical audit shall be completed annually on all risks regardless of governing classification;

c. For all new business policies having construction classifications, regardless of premium range a final physical audit shall be completed annually;

d. For all policies having construction classifications, a final physical onsite audit shall be conducted annually if the estimated annual premium is $10,000 and over; and,

e. Per capita policies shall have a final mail or physical audit not less than biennially.
2. Physical audits will be made whenever requested by the employer unless such request is unnecessarily repetitive.

3. Mail audit reports by the employer are permitted only where a physical audit is not required.

4. Records examined during the physical audit shall include the use of the following as applicable:
a. Reemployment Tax (RT) forms;

b. Federal reports of employee income;

c. Payroll records;

d. Cash disbursement journals;

e. Other acceptable accounting records;

f. Certificates of insurance covering subcontractors; and,

g. Independent contractor documents.

h. Any other employer records necessary to establish premium or assign classifications.
5. Each voluntary market carrier or the National Council on Compensation Insurance shall conduct audits to ensure the accurate classification assignments for duties of employees.
(c) The FWCJUA or its service provider and each employer covered by the FWCJUA shall comply with the following minimum audit requirements at the expiration of each policy:
1. Final physical audits shall be conducted as follows:
a. For all policies producing an estimated annual premium of $4,000 and over regardless of governing classification code;

b. For all policies producing an estimated annual premium of $3,999 to $3,000, at least once every three years;

c. For all policies with a governing classification code of 2702, 2710, 5022, 5403, 5437, 5445, 5474, 5551, 5606, 5645, 6217, 7219, 8829, 8835, 8861 and 9110, regardless of premium range;

d. For all policies for employers engaged in leasing employees to others or in providing temporary help to others, regardless of premium range;

e. For all new business policies having construction classification codes, regardless of premium range;

f. For all policies with a loss ratio of 120% or greater the first year the employer qualifies and thereafter, regardless of premium range, subject to the FWCJUA's or its service provider's determination whether such audit is unnecessarily repetitive;

g. Whenever requested by the employer, unless such request is unnecessarily repetitive; and,

h. Whenever otherwise warranted by the FWCJUA's or its service provider's evaluation of the type of business, the amount of exposure, the accuracy of classifications, or the reliability of previous mail or physical audits.
2. Mail audit reports by the employer are permitted only where a physical audit is not required.

3. Records examined during the physical audit shall include the use of the following as applicable:
a. Reemployment Tax (RT) forms;

b. Federal reports of employee income;

c. Payroll records;

d. Cash disbursement journals;

e. Other acceptable accounting records;

f. Certificates of insurance covering subcontractors; and,

g. Independent contractor documents.

h. Any other records necessary to establish premium or assign classifications.
4. The FWCJUA, its service provider or the National Council on Compensation Insurance shall conduct audits to ensure the accurate classification assignment for duties of employees.
(d)
1. In addition, each employer shall submit a copy of the quarterly earning report required by Chapter 443, F.S., to the carrier at the end of each quarter.

2. Each carrier shall develop its own procedures for terminating coverage when the quarterly earning report forms are not received. However, such forms shall be considered timely if received within 45 days of the end of the quarter reported.
(e) The carrier shall retain new or renewal applications, monthly change sheets, and the quarterly earning reports for a minimum of three years from the date the applications, sheets, or reports were received.

(f) Telephone audits are not permitted in lieu of mail or physical audits.

(g) Signatures.
1.
a. A carrier, in order to comply with the signature requirements as provided in Section 440.381(3), F.S., shall use, as applicable:
(I) Form OIR-B1-1562 (rev. 7/03), "Partner's, Sole Proprietor's or Corporate Officer's Statement," hereby incorporated by reference and available at https://www.FLRules.org/Gateway/Reference.asp?No=Ref-16780. The form may be obtained from https://www.FLOir.com/iPortal;

(II) Form OIR-B1-1561 (rev. 7/03), "Statement of Individual Providing Audit Information (other than Partner, Sole Proprietor or Corporate Officer)" hereby incorporated by reference and available at https://www.FLRules.org/Gateway/Reference.asp?No=Ref-16781. The form may be obtained from https://www.FLOir.com/iPortal; and,

(III) Form OIR-B1-1560 (rev. 7/03), "Auditor's Statement," hereby incorporated by reference and available at https://www.FLRules.org/Gateway/Reference.asp?No=Ref-16782. The form may be obtained from https://www.FLOir.com/iPortal.
b. The forms in this subsection (4) are hereby adopted and incorporated by reference and may be obtained from the Office's website at http://www.FLOir.com/iPortal.

c. These forms shall be signed by the appropriate party and submitted to the carrier at the completion of an audit.
2.
a. A carrier wishing to use its own signature forms shall submit the forms electronically to Property and Casualty Product Review at https://iPortal.fldfs.com, and receive approval prior to use.

b. At a minimum the forms shall contain all text as it appears on:
(I) Form OIR-B1-1562 (rev. 7/03);

(II) Form OIR-B1-1561 (rev. 7/03); and,

(III) Form OIR-B1-1560 (rev. 7/03).
3. It is permissible for insurers to accept electronic signatures in satisfaction of the signature requirements of Section 440.381(3), F.S. to the extent that such acceptance of electronic signatures complies with Parts I and II of Chapter 668, F.S.

69O FAC 189.004 | Deviation Filing Information

F.S., authorize the filing of premium deviations which automatically expire after a period of one year unless refiled and reapproved. Any such premium deviation filing shall include the following information:
(1) Proposed effective date of deviation.

(2) Proposed deviation percentage.

(3) The basis for the proposed deviation including all relevant factors to explain the justification for the deviation request.

(4) Calendar year earned premium, accident year incurred losses, accident year loss adjustment expense, and loss ratios of the preceding three years. Show the ratio of accident year loss adjustment expense to accident year incurred losses for each year, including Florida experience for the company filing for the deviation. If no Florida experience is available for part of the experience period requested, so state and show the experience in the group as a whole.

(5) Provide an exhibit showing anticipated expenses for the period of the deviation. This exhibit should show production expenses and general expenses. All companies are generally expected to have the same taxes and profit and contingencies as included in National Council on Compensation Insurance (hereinafter referred to as NCCI) filings. Do not include taxes or profit and contingencies unless justification for such factors is provided.

(6) As support for expense exhibits, show actual expenses for the latest three years for production and general expenses.

(7) Pursuant to Section 627.211(3), F.S., the Office shall consider the following areas when evaluating each company requesting a deviation:
(a) Applicable principles for ratemaking as set forth in Sections 627.062 and 627.072, F.S.;

(b) The financial condition of the insurer.
(8) In order to evaluate the financial condition of the company, the following information shall be provided, accompanied by justification, support and explanations where appropriate:
(a) Indicate whether the company's audited financial statements provide unqualified opinions or contain significant qualifications or "subject to" provisions. Yes responses must be explained;

(b) Indicate whether there has been any independent or other actuarial certification of loss reserves shown on the annual statements;

(c) Indicate whether the company's workers' compensation and employer's liability reserves are above the midpoint or best estimate of the actuary's reserve range estimate;

(d) Indicate whether the proposed deviation will have any detrimental affect on the financial status of the company;

(e) Provide historical experience demonstrating the profitability of the company;

(f) Statements, and documentation if necessary, confirming the existence of excess or other reinsurance that contains a sufficiently low attachment point and maximums that provide adequate protection to the company;

(g) Provide any other factors that are considered relevant to the financial condition of the company.
(9) In order for the Office to complete its review of a request for a deviation, the company shall indicate whether the deviation will constitute predatory pricing, including justification for its response.

(10) Pursuant to Section 627.211(3), F.S., the Office shall disapprove the request for a deviation if it finds that any of the following conditions exist:
(a) The resulting premiums would be excessive, inadequate, or unfairly discriminatory;

(b) The deviation would endanger the financial condition of the company;

(c) The deviation would result in predatory pricing.
(11) Section 627.211, F.S., states that the deviation is to be applied to the premiums produced by the rating system. Since minimum premiums, expense constants, and premium discounts have been filed based on industrywide experience, no deviation will be allowed to these unless specific justification is provided. Indicate in the filing where the uniform premium deviation will be applied and provide a copy of your manual page showing how the deviation will be applied.

(12) A copy of the filing shall be submitted to the NCCI. To assure that premium deviation filings are acted upon on a timely basis, such filings should be submitted electronically to http://www.FLOir.com/iPortal, 90 days in advance of the proposed effective date.

69O FAC 189.0055 | Records and Reports of Information by Workers’ Compensation Insurers Required

(1) The Office shall use one or more designated workers' compensation and employers' liability insurance statistical agents as designated by the Office through the contract solicitation process.

(2) Each insurer and self-insurance fund as defined in Section 624.461, F.S., shall utilize the rules and statistical plans of the Office's designated statistical agents in the recording and reporting of loss, expense, and claims experience for workers' compensation insurance.

(3) Any changes or amendments to the statistical plans and rules of the Office's designated statistical agents are subject to approval by the Office prior to use by insurers and self-insurance funds for Florida experience. Changes or amendments are made when there are economically justifiable reasons made by the industry or the Office.

69O FAC 189.006 | Guidelines for Large Deductible Workers’ Compensation Filings

If a workers' compensation insurer wishes to file for a large deductible, such filing shall be governed by the following guidelines:
(1) Eligibility: Minimum standard premium of $500,000; Minimum deductible of $100,000.

(2) Insurer must be clearly obligated to pay first dollar of loss just like any other workers' compensation policy without a deductible.

(3) Reimbursement of deductible by insured does not affect insurer obligation to pay losses.

(4) Insurer must continue all filing requirements with Department of Financial Services in compliance with Chapter 440, F.S., for all losses including those below the deductible limits.

(5) Insurer must file unit statistical reports with the NCCI which show all losses including those below the deductible limit.

(6) Unit statistical reports are to be completed and filed with the NCCI so that an experience modification factor can be calculated for the insured.

(7) Data must be maintained to allow for reporting on financial calls of Standard Premium at NCCI Level together with all losses including those below the deductible limit.

(8) Insurers must comply with NCCI Aggregate Financial Calls, Detail Claim Information Calls, Unit Statistical Reporting, and other required calls.

(9) Insurer must have an established program to evaluate financial ability of insured to pay losses within the deductible. Insurers are required to use various financial mechanisms to insure that funds are available from the insured to pay deductible portion of losses.

69O FAC 189.007 | Insurer Experience Reporting ‒ Excessive Profits, Workers’ Compensation Insurance (Repealed)

69O FAC 189.010 | Workers’ Compensation Insurance Dividend Plans Defined

(1) An insurer, in order to avoid policy and advertising misrepresentation as set forth in Section 626.9541(1), F.S., shall not include an estimated amount of dividend which may be received, in the calculation of premium on proposals for workers' compensation insurance in the State of Florida.

(2) Insurers may, in connection with such proposals, advise and disclose actual dividends which have been paid by said insurer on policies which expired prior to the date of the proposal, and on which dividends were declared. In all cases, the proposal must include a statement that dividends are declared only at the option of the company's board of directors and cannot be guaranteed.

(3) Any favor or advantage in paying or allowing dividends or other benefits as an inducement to an insurance contract is defined as an unfair method of competition under Section 626.9541(8)(a)2., F.S.

(4) A retention plan may be a rating plan or a dividend plan depending on the method by which the return is made to the policyholder. If any return of premium to the policyholder is subject to the decision of the board of directors of the insurer and is returned in the form of a dividend, then the plan under which the premium is returned is not construed to be a rating plan.

(5) If any return of premium to the insured is not subject to the decision of the board of directors, then the plan under which the premium is returned to the insured is construed to be a rating plan and must be filed by the carrier or a designated rating organization.

69O FAC 189.011 | Cancellation ‒ Workers’ Compensation Insurance

A worker' compensation insurer is required to give thirty days notice of cancellation except when cancellation is for the following reasons:
(1) The policy has been rewritten by the same company, with the same effective date; or

(2) Prior to the effective date of the policy, the employer had sold his business or otherwise was out of business and thereafter had no employees; or

(3) The Division of Worker' Compensation, Department of Financial Services (hereinafter referred to as the "Division") and the employer were given such notice of termination prior to the effective date of the policy.

(4) When the employer sells his business or otherwise goes out of business during the effective period of the policy and thereafter has no person in his employment covered by the provisions of such policy, same may be terminated as of the date the employer ceased having any person in his employment by filing such notice of termination with the "Division" stating therein the reason for termination, and serving a copy thereof upon the employer in person or by mail.

(5) When duplicate or dual coverage exists by reason of two (2) different insurers having issued policies to the same employer, effective the same date, securing the same liability, as evidenced by certificates of insurance on file with the "Division" one (1) of the policies may be cancelled as of the date the notice of termination is filed with the "Division" and a copy thereof served upon the employer; provided that the terminating insurer may effect retroactive cancellation by filing with the "Division" a written statement from the other insurer that it assumes full liability in connection with the insured from the cancellation date of the policy which is to be terminated.

(6) Where duplicate or dual coverage exists by reason of two (2) different insurers having issued policies of insurance with different effective dates to the same employer, covering the same liability, the insurer which was first on the risk may terminate its coverage upon the effective date of the later coverage of the other insurer by giving notice to the "Division" and to the employer. Where the policy with the later effective date has already been terminated by filing official notice of termination, it will be presumed that the employer is without coverage in the absence of a replacement certificate of insurance.

(7) When an employer is not (no longer) required by the Workers' Compensation Law to secure the payment of compensation to his employee(s) and the employer has so advised the insurer in writing that such coverage is not required by the Act, nor desired, during the remainder of the policy period, the insurer may terminate said coverage effective upon filing notice of such termination with the "Division" stating therein the reason for termination and serving a copy thereof upon the employer in person or by mail.

(8) When 45 days notice otherwise is required pursuant to Section 627.4133, F.S., and the policy has been in effect for 90 days, no such policy shall be cancelled by the insurer except when there has been a material misstatement, a nonpayment of premium, a failure to comply with underwriting requirements established by the insurer within 90 days of the date of effectuation of coverage, or a substantial change in the risk covered by the policy or when the cancellation is for all insureds under such policies for a given class of insureds.

69O FAC 189.013 | Workers’ Compensation Excess Insurance Rates

69O FAC 189.014 | Workers’ Compensation Rating Plan for Managed Care Premium Credits (Repealed)

69O FAC 189.015 | Workers’ Compensation Insurer Reporting of Significant Underwriting Change

(1) Purpose: To administer the requirements of Section 624.4315, F.S.

(2) Definitions:
(a) "Insurer Group" means two or more affiliated insurers that are under common ownership and/or management.

(b) "Underwriting" is defined as the insurer selection of policyholders through hazard recognition and evaluation.

(c) "Underwriting Change" is any deliberately planned change in the insurer's administrative policies or procedures that will affect the insurer's acceptance or rejection of applicants for workers' compensation coverage or will affect the insurer's acceptance or rejection of renewal policies or will result in the mid-term cancellation of policies in Florida. An insurer that transfers policyholders to another insurer in the "Insurer Group", with no lapse in coverage occurring for the policyholder, has not made an "Underwriting Change" for purposes of this rule.

(d) "Significant Underwriting Change that materially limits or restricts the number of workers' compensation policies or premiums written in Florida" means an Underwriting Change that is reasonably expected to result in any of the following:
1. For an "Insurer Group" with more than one insurer licensed in Florida for workers' compensation:
a. Will reduce the number of in-force policies in Florida for the "Insurer Group" by at least 750 policies over the 12 months following the change.

b. Will reduce the number of in-force policies in Florida for the "Insurer Group" by at least 250 and will reduce the number of in-force policies in Florida for the "Insurer Group" at the end of the previous calendar year by more than 33% over the 12 months following the change.

c. Will reduce the direct premiums written in Florida by at least $3 million and the direct written premiums for the "Insurer Group" in Florida for the 12 months following the change will be reduced by more than 33% of the prior calendar year, excluding the impact of rate changes and payroll changes.

d. Will result in the complete elimination of all workers' compensation policies in Florida for any insurer in the group.
2. For an individual insurer with no affiliated insurers licensed in Florida for workers' compensation:
a. Will reduce the number of in-force policies in Florida for the insurer by at least 750 policies over the 12 months following the change.

b. Will reduce the number of in-force policies in Florida for the insurer by at least 250 and will reduce the number of in-force policies in Florida for the insurer at the end of the previous calendar year by more than 33% over the 12 months following the change.

c. Will reduce the direct premiums written in Florida by at least $3 million and the direct written premiums for the insurer in Florida for the 12 months following the change will be reduced by more than 33% of the prior calendar year, excluding the impact of rate changes and payroll changes.

d. Will result in the complete elimination of all workers' compensation policies in Florida for the insurer.
(e) Notwithstanding any other provision herein, a Significant Underwriting Change does not occur in the following situations:
1. A reduction in the number of policies or premium results for reasons other than an "Underwriting Change."

2. The reduction in premium results solely from conversion to a large deductible policy unless there has been an "Underwriting Change" such that the policyholder can only purchase a large deductible.

3. The reduction in premium results solely from conversion to a policy written under a retrospective rating plan unless there has been an "Underwriting Change" such that the policyholder can only purchase a retrospectively rated policy.
(3) Any insurer authorized to transact workers' compensation insurance in Florida shall notify the Office within 30 days of implementing any Significant Underwriting Change that will materially limit or restrict the number of workers' compensation policies or premiums written in Florida. The notification shall include the following:
(a) Name of Insurer or Insurers.

(b) A detailed description of the change.

(c) Anticipated number of policies that will be impacted by the change.

(d) Anticipated percentage of policies in force as of December 31 of the prior year that will be impacted by change.

(e) Estimated written premium impacted by change.

(f) Estimated annual written premium impacted by the change as a percent of total annual written premium for the previous calendar year, excluding the impact of rate changes or payroll changes.

(g) Does change affect some classes more than others? Yes, No or Unknown. If the answer is yes, describe the affected classes.

(h) Date that insurer implemented or anticipates implementing the change.

(i) Effective dates of new and renewal policies that will be affected by the change.

(j) If the change will result in the mid-term cancellation of existing policies, how long will it take for the change to be fully implemented?
(4) The information required by this rule shall be reported through the Office's website at http://www.FLOir.com/iPortal.

69O FAC 189.016 | Filing Procedures for Workers’ Compensation Classifications, Rules, Rates, Rating Plans, Deviations and Forms

(1) Purpose: To establish the procedures to be utilized by insurers in the filing of workers' compensation classifications, rules, rates, rating plans, deviations and forms pursuant to Sections 627.091, 627.211 and 627.410, F.S.

(2) Any insurer authorized to transact workers' compensation and employer's liability insurance in Florida shall file with the Office every manual of classifications, rules, rates, rating plans, deviations and every modification of any of the foregoing, which it proposes to use. An insurer may satisfy its obligation to make such filings by becoming a member of, or a subscriber to, a licensed rating organization which makes such filings and by authorizing the Office to accept such filings in its behalf. No insurer shall use any workers' compensation and employer's liability classification, rule, rate or rating plan unless it has been filed with the Office and the filing has been affirmatively approved.

(3) Any insurer authorized to transact workers' compensation and employer's liability insurance in Florida shall file with the Office all policy forms and endorsements as defined in Section 627.402, F.S., which it proposes to use. An insurer may satisfy its obligation to make such filings in part, by becoming a member of, or a subscriber to, a licensed rating organization which makes such filings and by authorizing the Office to accept such filings in its behalf. However, each individual insurer must file with the Office its own unique policy jacket, policy information page, participating language if applicable, and any other insurer specific form or endorsement. No insurer shall use any workers' compensation and employer's liability policy form or endorsement unless the form has been filed with the Office and the filing has been affirmatively approved.

(4) All filings referenced in this rule shall be submitted to the Office in accordance with the requirements outlined in subsections (5) and (6), below. The procedures in this rule supersede any other procedures relating to filing requirements. All material submitted shall be legible.

(5) Filing Submittal Requirements.
(a) Complete classification, rule, rate, rating plan, deviation and form filings shall be submitted with the following information at a minimum:
1. Form OIR-B1-582, which is adopted and incorporated pursuant to Rule 69O-170.0155, F.A.C.;

2. Cover letter; and,

3. Explanatory memorandum.
(b) All filings shall:
1. Be separated into either rate only or form only filings. Classification, rule, deviation and rating plan filings are all considered rate filings for purposes of this rule;

2. Include final printed versions of either the manual pages or forms; and,

3. Include only the workers' compensation line of insurance as defined in Section 624.605(1)(c), F.S. No other line of insurance may be contained within the filing.
(c) Group Filings. Insurers may submit a filing on behalf of any combination of insurers within the insurers' group, provided the information submitted in the filing is identical for every insurer identified in the filing.

(d) Changes to Previously Approved Filings. An insurer that proposes to change a previously approved filing shall provide the following additional information:
1. A detailed explanation of the change(s), including the reason or reasons for the change(s);

2. The estimated impact of the change; and,

3. A strikethrough, underlined version of the proposed change(s).
(6) All filings shall be submitted electronically to the Office through the Filing Assembly and Submission System (OIR-B1-IFile) located at http://www.FLOir.com/iPortal and is adopted and incorporated by reference in Rule 69O-170.0155, F.A.C.

(7) Form OIR-B1-582 is located online with the Filing Assembly and Submission System at http://www.FLOir.com/iPortal.
69O-190 | Rules for Self-Insurers Under the Workers' Compensation Act

69O FAC 190.056 | Application for Self-Insurers Fund

(1) Licensing procedures pursuant to Section 120.60, F.S., and in accordance with the model rules of procedure shall apply to this application.

(2) All applications for a self-insurers fund shall be made in writing on OIR Form BSI-2.

(3) All applications shall be accompanied by:
(a) A properly completed indemnity agreement in accordance with Rule 69O-190.068, F.A.C.

(b) A properly executed Self-Insurer's Surety Bond on OIR Form BSI-4, pursuant to Rule 69O-190.032 and subsection 69O-190.060(4), F.A.C., or proof of cash securities pursuant to Rule 69O-190.033, F.A.C., and in amounts pursuant to Rule 69O-190.060, F.A.C.

(c) Copies of acceptable excess insurance policies pursuant to Rule 69O-190.035, F.A.C., with limits and retentions pursuant to Rule 69O-190.061, F.A.C., and endorsements pursuant to Rule 69O-190.036, F.A.C.

(d) A fidelity bond or insurance policy pursuant to subsection 69O-190.064(5), F.A.C.

(e) A fidelity bond or insurance policy covering the service company pursuant to subsection 69O-190.064(7), F.A.C.

(f) A certification from a designated depository attesting to sufficient monies on hand in order for the fund to meet initial obligations pursuant to paragraph 69O-190.056(5)(c), F.A.C.

(g) Proof of servicing pursuant to Rule 69O-190.031, F.A.C.

(h) Copies of the fund by-laws or trust agreement and written policies pursuant to subsections 69O-190.064(2), (3) and (4), F.A.C.

(i) Membership applications executed on OIR Form BSI-3 or its equivalent complete with declarations and financial statements pursuant to Rule 69O-190.059, F.A.C. Funds must use the BSI-3 unless prior approval of the Office has been granted for use of an alternate form. Such alternate form must contain all information contained on the BSI-3, but may ask for additional information or use a different format. Approval will be granted if the alternate form contains all required information. OIR Form BSI-3, or its equivalent, shall be used for all new business. OIR Form BSI-3, or its equivalent, shall be used for all renewal business for twelve consecutive months. The use of this form for new and renewal business must commence within sixty (60) days of the date of this rule. A copy of this form may be obtained from the Bureau of P & L Insurer Solvency, Tallahassee, Florida.

(j) Proof that the initial membership of the fund have the combined financial conditions and combined premiums as specified in paragraph (m) of this section.

(k) The name of the attorney, certified public accountant, and actuary representing the fund.

(l) A completed Estimated Breakdown of Policy Year Expenses on OIR Form BSI-21.

(m) Each self-insurers fund shall submit a current financial statement on each member at the inception of the self-insurers fund showing the combined net worth of all members applying for coverage to be not less than $1,000,000, each member shall have a current ratio which is the median for the self-insureds standard industry code as published in the 1992 edition of the Robert Morris Associates Annual Statement Studies. An audited financial statement or a financial statement properly certified by an officer, owner or partner for all members joining the self-insurers fund after the inception date shall be submitted to the Office with the application for membership until such time as an audited financial statement is available for the self-insurers fund as a whole. In no event shall the cumulative net worth or current ratio of the combined assets and liabilities of all members be less than the minimum amounts currently required for a fund to qualify.

(n) Each applicant shall submit a feasibility study, prepared by an independent qualified actuary and an independent certified public accountant to satisfactorily address market potential, market penetration, market competition, operating expenses, gross revenues, net income total assets and liabilities, cash flow, and such other items as the division may require. The study shall be for the greater of 3 years or until the arrangement has been projected to be profitable for 12 consecutive months. The feasibility study must reflect and support all premium, reserve, and other financial requirements with which the fund must comply.
(4) Upon receipt of the application and other required materials, the Office will investigate the application and will request any additional information which is required in a letter to the applicant.

(5) The financial condition of the proposed fund shall be determined in light of the following:
(a) In considering the financial strength and liquidity of the group as evidence of ability to pay normal compensation claims promptly, the Office will take into consideration contracts or policies of aggregate excess liability insurance secured in accordance with Rule 69O-190.061, F.A.C.

(b) The trustees shall satisfy the Office that the normal premiums of the self-insurers fund will be at least $500,000 for the first and succeeding years of operation.

(c) The trustees shall submit at least ten (10) days prior to the proposed effective date, positive proof that the members have paid into a common claims fund in a designated depository, cash premiums in an amount of not less than $125,000 or twenty-five percent (25%) of the estimated annual standard premium of the members at inception, whichever amount is greater. The remainder of the deposit premiums shall be collected based on the schedule adopted by the trustees.
(6) If the initial contract for aggregate excess insurance contains a minimum loss fund or retention provision in excess of $70,000 then the trustees must submit with their initial filing, in addition to those of the members at inception, signed member agreements evidencing additional earned normal premium for the first year of operation sufficient to meet the minimum loss fund. These additional agreements may have varying effective dates.

(7) No applicant shall have an aggregate excess contract which provides for a minimum loss fund or retention greater than the product of the aggregate retention percentage and the normal premium of the members submitting signed agreements.

(8) Prior to making a final determination on the approval or denial of the application, the Office may schedule an informal conference in Tallahassee. In the event a meeting is scheduled, the board of trustees of the prospective fund, its administrator, a representative of the service company, its attorney, and its CPA shall meet with the representative of the Office to discuss any matters relevant to the qualification of the fund. A time and date that is mutually agreeable will be selected within the statutory time frame established by Chapter 120, F.S., for the approval and denial of the application.

69O FAC 190.057 | Evaluation of Application for Self-Insurers Fund

(1) The application will be evaluated and a determination will be made of:
(a) Whether the fund application, individual member applications and indemnity agreement are properly completed and that all required information is supplied.

(b) Whether the combined financial condition of the membership meets the criteria established in Rule 69O-190.056, F.A.C.

(c) Whether or not the servicing program satisfied Rule 69O-190.031, F.A.C.

(d) Whether the fidelity bonds or insurance policies for the administrator, service company, fiscal agent, and other individuals pursuant to subsection 69O-190.064(5), F.A.C., are properly executed and in amounts sufficient to protect the fund against loss.

(e) Whether a sufficient amount of premium has been deposited pursuant to subsection 69O-190.056(5), F.A.C.

(f) Whether the by-laws or trust agreement and written policies contain the items specified in subsections 69O-190.064(17), (18), and (19), F.A.C.

(g) Whether the surety bond is properly executed or the cash securities properly assigned and if they are in the proper amounts pursuant to Rules 69O-190.060, 69O-190.032 and 69O-190.033, F.A.C.

(h) Whether the excess contracts have proper endorsements and provide suitable coverage to the fund pursuant to Rules 69O-190.035 and 69O-190.036, F.A.C.

(i) Whether the excess coverages have limits and retentions pursuant to Rule 69O-190.061, F.A.C.

(j) Whether the combined annual normal premiums meet the criteria contained in subsection 69O-190.056(5), F.A.C.

(k) Whether the proforma required in paragraph 69O-190.056(3)(m), F.A.C., provides that the fund complies with all requirement of Chapter 440, F.S., and this rule for the period covered.
(2) Any deficiencies in the original filing will be noted in a letter to the applicant.

(3) The Office in evaluating the application shall review the financial condition of the fund and make the following determinations:
(a) Whether the operating budget of the fund as presented on OIR Form BSI-21 is adequate to meet the fund's needs.

(b) Whether the operating budget as presented on OIR Form BSI-21 contains reasonable estimates of the necessary expenses of the fund.

(c) Whether the fund will have sufficient income to pay for all necessary expenses.

(d) Whether the fund will be able to satisfy its minimum loss fund or retention requirements.

(e) Whether the applicant has demonstrated that it has the necessary financial strength and provides the necessary financial security to guarantee the payment of workers' compensation benefits.
(4) Failure to meet any of the criteria or provide the documentation contained in these rules shall be grounds for denial of the application.

(5) After completing its review of all required documentation contained in these rules, the Office shall issue its decision on the approval or denial of the application in accordance with the model rules of procedure.

69O FAC 190.058 | Conditions for Retaining the Self-Insurance Privilege of Self-Insurers Funds

(1) The self-insurance privilege of a self-insurers fund is granted continuously until revoked.

(2) A review of all self-insurers fund programs will be made annually. As a result of such reviews, changes in the prior requirements to self-insure or the imposition of additional requirements in order to continue to be self-insured may be made pursuant to Rules 69O-190.060 and 69O-190.061, F.A.C.

(3) In addition to complying with the continuing requirements for self-insurance, all self-insurers funds shall be required to submit the following documents and reports on a continuing basis:
(a) Annual financial statements, audited financial statements, and actuarial reports pursuant to Rule 69O-190.059, F.A.C.

(b) Annual Summary Loss Reports on each member pursuant to paragraph 69O-190.062(1)(a), F.A.C.

(c) Annual Payroll Reports on each member pursuant to paragraph 69O-190.062(1)(b), F.A.C.

(d) Quarterly Financial Statements pursuant to Rule 69O-190.059, F.A.C., and Status Reports pursuant to paragraph 69O-190.062(1)(c), F.A.C.

(e) Proof of servicing pursuant to Rule 69O-190.031, F.A.C.

(f) Proof of excess coverage pursuant to Rules 69O-190.061 and 69O-190.035, F.A.C.

(g) Copies of endorsements to excess policies pursuant to Rule 69O-190.036, F.A.C.

(h) Copies of surety bonds or riders pursuant to Rules 69O-190.060 and 69O-190.032, F.A.C.

(i) Proof of cash securities pursuant to Rule 69O-190.032, F.A.C.

(j) Reporting changes in coverage of the membership pursuant to subsection 69O-190.062(3), F.A.C.

(k) Changes in by-laws or trust agreement and written policies pursuant to subsection 69O-190.064(20), F.A.C.

(l) Fidelity bonds, riders, insurance policies or endorsements pursuant to subsection 69O-190.064(5), F.A.C.

(m) Copies of new member applications pursuant to subsection 69O-190.062(2), F.A.C.

(n) Estimated Breakdown of Policy Year Expenses pursuant to subsection 69O-190.059(6), F.A.C.
(4) Whenever the Office determines that the fund has knowingly submitted an application containing false or misleading information, the Office may proceed with revocation of the self-insurer status of the fund.

(5) If any fund intentionally submits any false or misleading document or report required by these rules, the Office may proceed with revocation of the self-insurer status of the fund.
Disclaimer© State of Florida
Rulemaking AuthorityLaw ImplementedHistory
440.39(1)(b), (2)(b), 624.4621 FS.440.39(1)(b), (2)(b), 624.4621 FS.New 10-1-82, Amended , Formerly 38F-5.58, Amended , Formerly 38F-5.058.

69O FAC 190.059 | Financial and Actuarial Reports for Self-Insurers Funds

(1) Each fund shall file with the Office quarterly financial statements on OIR Form BSI-28 or the 1992 National Association of Insurance Commissioners (NAIC) Quarterly Statement, Fire and Casualty Companies Association Edition in its entirety.

(2) Each fund shall file with the Office an annual financial statement on OIR Form BSI-29 or the following portions of the 1992 National Association of Insurance Commissioners Annual Statement, Fire and Casualty Companies Association Edition:
Jurat Page;

Statutory Balance Sheet;

Underwriting and Investment Exhibit - Income Statement;

Cash Flow; Underwriting and Investment Exhibit Part 1, Part 1A, Part 2, Part 2A, Part 3, Part 3A, and Part 4;

Exhibit 1 - Analysis of Assets;

Exhibit 2 - Analysis of Non-Admitted Assets;

Notes to Financial Statements;

Five Year Historical Data (NOTE: funds shall complete this form on a going forward basis);

Schedule of Special Deposits;

Schedule A Part 1;

Schedule B;

Schedule BA;

Schedule C;

Schedule D Part 1, Part 1A, Part 3, Part 4 and Part 5 (NOTE: only 4th quarter transactions need to be reported); Schedule DA Part 1;

Schedule F - Part 1A (NOTE: any amounts in dispute must be disclosed);

Schedule M;

Schedule N;

Schedule P, Part 1 Summary, Part 2 Summary, Part 3 Summary, Part 5 Summary, interrogatories;

Schedule X;

Schedule Y.
(a) As part of its annual financial statement each fund shall file with the Office an Estimated Breakdown of Policy Year Expenses on OIR Form BSI-21 within 60 days after the beginning of each policy year. The projection of its anticipated income and expenses, shall also include the comparable, actual results for the immediate preceding year.
(3) The quarterly and annual financial statements, required by subsections 69O-190.059(1) and 69O-190.059(2), F.A.C., shall be prepared in accordance with the NAIC's Annual Statement Instructions, Property and Casualty, 1993 edition, and the NAIC's Accounting Practices and Procedures Manual for Property and Casualty Insurance Companies, 1993 edition. The NAIC's Accounting Practices and Procedures Manual for Property and Casualty Insurance Companies applies to the preparation of all statements required by this rule, except that the following shall be admitted assets:
(a) Prepaid expenses which have a liquidation value.

(b) Equipment, furniture and fixtures depreciated using a 5-year useful life.

(c) Deferred taxes when the deferred tax asset is created by timing differences in the treatment of bad debt reserves, unearned premiums, and accrued dividends. Such timing differences shall reverse within two years in order to be eligible, and the fund shall provide to the division a statement from the fund's Certified Public Accountant or Tax Attorney that in the event of the insolvency of the fund, these deferred tax assets will generate a refund of prior years' taxes to the estate of the fund. The fund shall also provide upon request from the division a detailed disclosure of the components of the deferred tax asset deemed by the fund to be an admitted asset. This provision shall become inoperative as of December 31, 1995, and deferred taxes shall be deemed nonadmitted assets for all fiscal years beginning after December 31, 1995.

(d) An aggregate write-in on the balance sheet of the annual statement for assets and policy holder's surplus, an entry for future investment income on losses and allocated loss adjustment expense reserves and unallocated loss adjustment expense reserves shall be reflected. Future investment income shall be calculated as follows:
A + B + C - D
A
Losses and Allocated Loss Adjustment Expense Reserves.
B
Unallocated Loss Adjustment Expense Reserves.
C
Excess of Statutory Reserves over Statement Reserves.
D
The present value of A + B + C.
Present value of Unallocated Loss Adjustment Expense Reserves, Present Value of Loss and Allocated Loss Adjustment Expense Reserves, or Present Value of Excess of Statutory Reserves over Statement Reserves means reserves discounted to present value using the most recent United States Internal Revenue Service present value factors.
(4) Each fund shall file with the Office an annual audited financial statement prepared in accordance with the NAIC's Accounting Practices and Procedures Manual for Property and Casualty Insurance Companies, 1993 edition.
(a) Annual audited financial statements shall disclose audited premiums based on the audit of the payrolls of fund members who represent at least 90 percent of the fund's annual normal premium. The type of payroll audit is set forth in Rule 69O-190.073, F.A.C. Nothing in this rule prohibits a fund from doing interim payroll audits, as allowed in Rule 69O-190.073, F.A.C., when the fund determines it must do so to comply with this rule.

(b) The annual audited financial statement shall include the following:
1. Report of an independent certified public accountant. If the report is qualified by the independent certified public accountant the Office shall require the fund to provide a plan to correct the deficiencies noted in the report.

2. Balance sheet reporting admitted assets, liabilities, capital and surplus.

3. Statement of operations.

4. Statement of cash flows.

5. Statement of changes in capital and surplus.

6. The notes to financial statements shall be those required by the NAIC's Annual Statement Instructions, Property and Casualty, 1992 edition, and any other notes required by generally accepted accounting principles. The notes shall also include a reconciliation of differences, if any, between the annual audited financial statement required by subsection 69O-190.059(4), F.A.C., and the annual financial statement required by subsection 69O-190.059(2), F.A.C., with a written description of the nature of these differences.

7. The annual audited financial statement required by subsection 69O-190.059(4), F.A.C., shall be prepared in a form and using substantially the same language and groupings substantially the same as the relevant sections of the annual financial statement of the fund required by subsection 69O-190.059(2), F.A.C. The annual audited financial statement shall be comparative, presenting the amounts as of the end of the current fiscal year and the amounts as of the immediately preceding fiscal year. However, in the first year in which a fund is required to file an annual audited financial statement, the comparative data may be omitted. The fund may submit an audited form BSI-29 if it so chooses, providing the independent certified public accountant report is provided as an addendum to the form.

8. The annual audited financial statement shall reflect, at a minimum, the reserves which have been deemed appropriate by the funds actuaries in the actuarial certification. If the certified public accountant discovers information which may alter the reserves determined by the actuary, they shall notify both the Office and the actuary. If the Office and the actuary concur that this information will materially alter the reserves as determined by the actuary and the report cannot be timely filed, the Office may waive the requirements in subsection 69O-190.038(3), F.A.C., for filing a request for extension. In no event shall the extension be granted for more than 30 days.

9. OIR Form BSI 30, report on Preferred Payment Plans.

10. A copy of the management letter as prepared by the certified public accountant in conjunction with the audit of the fund.

11. A list of the current trustees of the fund along with their business affiliation, the business address, and business phone number.
(5) Each fund shall file with the Division at the same time as the fund's annual audited financial statement an actuarial report prepared by a qualified actuary. The actuarial report shall evaluate the loss development of the fund and estimate the loss reserve including allocated and unallocated loss adjustment expenses and incurred but not reported reserves.
(a) A completed OIR Form BSI-26, Checklist for the Submission of Loss Reserve Reports, shall accompany each actuarial report submitted pursuant to this rule. Actuarial reports shall contain, at a minimum, summaries of the computations and methodologies used to estimate the fund's loss reserves. These reports shall include loss development triangles for all funds with 5 or more years experience. These loss triangles shall include, paid losses, incurred losses, and number of open claims.

(b) Loss reserves in the actuarial report:
1. Shall be calculated in accordance with Sections 625.091, except that 625.091(2)(a), F.S., the discount factor shall be 0%.

2. Shall not contain subrogation awards except for those amounts which have been awarded in a court of law.
(6) Quarterly or annual financial statements or actuarial reports shall contain loss reserves which have not been adjusted to reflect recoveries from the Special Disability Trust Fund (SDTF) except for:
(a) Those recoveries which have been approved by the Special Disability Trust Fund, awarded by a Judge of Compensation Claims, or awarded by a ruling of the First District Court of Appeals.

(b) The prohibition and limitations in this rule against adjustment of loss reserves for anticipated SDTF recoveries does not preclude the use of historical data pertaining to the fund's actual recoveries by actuaries in computations and methodologies implicitly used to develop ultimate reserves.
(7) Any fund whose financial condition is shown to be deficient in the financial statements required by this rule shall be allowed to file a corrective action plan to correct any deficiency. Such corrective action plan shall disclose what specific areas of the fund operations will be addressed, and the time table for taking such actions. If the corrective action plan encompasses more than one reporting (calendar or fiscal) year, the Office shall require that the corrective action plan be revised at the end of each fiscal year if the actual performance of the fund for that reporting year varies more than 10% from the corrective action plan. Such corrective action plan shall be submitted within sixty days of the receipt of notification from the Office. Extensions shall be granted for good cause.

(8) Each fund shall make a copy of its quarterly financial statement, annual financial statement, annual audited financial statement, and actuarial report available to members of the fund upon request. This requirement may be satisfied by making available annually to new and renewal members an extract of the statements or report; the form of such extract shall be approved by the Office in advance of distribution. Such approval shall be given if the Office determines that the extracted information fairly and accurately represents the financial condition of the fund, and discloses any material footnote information disclosed in the filings with the Office. In lieu of Office approval, the fund's certified public accountant and qualified actuary from whose reports the extracts are derived, may file a statement with the Office that they have reviewed the extract and have no objections to it. Such a statement shall contain a copy of the extract for the Office's file.

(9) Due date of quarterly, annual and audited financial statements. Each fund shall submit four (4) quarterly statements which shall be due 45 days after the end of the fund's fiscal quarter. The annual statement and audited annual report shall be due on or before the last day of the sixth month after the end of the fund's fiscal year.

(10) Effective Date. All funds shall comply with this rule for fiscal years beginning after December 31, 1993, and each year thereafter.

(11) Requests for an extension of time to file quarterly, annual, and audited financial statements must be received in writing at least 15 days before the date the report is due. The request must include the reason the extension is requested. Any request received 14 days or less before the date the report is due will be denied except for, but not limited to, death of key management personnel, destruction of records or facilities by fire, flood, hurricane, or some other natural disaster, or act not under control of the management.

69O FAC 190.0591 | Independent Certified Public Accountants

(1) Designation of Independent Certified Public Accountant.
(a) Each fund required by subsection 69O-190.059(4), F.A.C., to file an annual audited financial statement shall, by the end of the fiscal year subject to audit, notify the Office in writing of the name and address of the fund's independent certified public accountant or accounting firm (generally referred to in this rule as the "accountant") retained to conduct the annual audit required by subsection 69O-190.059(4), F.A.C.

(b) The fund shall obtain a letter from the accountant, and file a copy with the Office, stating that the accountant is aware of the provisions of the Florida Statutes which relate to the financial reporting and operation of the fund and the Rules and of the Office, and affirming that he will express his opinion on the financial statements in terms of their conformity to the NAIC's Accounting Practices and Procedures Manual for Property and Casualty Insurance Companies, 1993 edition, specifying the exceptions as he may believe appropriate.

(c) If an accountant who was the accountant for the immediately preceding filed annual audited financial statement is dismissed or resigns, the fund shall within five (5) business days notify the Office of this event. The fund shall also furnish the Office with a separate letter within ten (10) business days of the above notification stating whether in the twenty-four (24) months preceding that event there were any disagreements with the former accountant on any matter of accounting principles or practices, financial statement disclosure, or auditing scope or procedure; which disagreements, if not resolved to the satisfaction of the former accountant, would have caused him to make reference to the subject matter of the disagreement in connection with his opinion. The disagreements required to be reported in response to this section include both those resolved to the former accountant's satisfaction and those not resolved to the former accountant's satisfaction.

(d) Disagreements contemplated by this section are those that occur at the decision-making level, i.e., between personnel of the fund responsible for presentation of its financial statements and personnel of the accounting firm responsible for rendering its report. The fund shall also in writing request the former accountant to furnish a letter addressed to the fund stating whether the accountant agrees with the statements contained in the fund's letter, and if not, stating the reasons for which he does not agree; and the fund shall furnish the responsive letter from the former accountant to the Office together with its own.

(e) The reporting requirements in paragraphs (c) and (d), above, shall also apply to the fund's qualified actuary.
(2) Qualifications of Independent Certified Public Accountant.
(a) The Office shall not recognize any person or firm as a qualified independent certified public accountant that is not in good standing with the licensing authority or accrediting authority for certified public accountants in the State of Florida.

(b) Except as otherwise provided herein, an independent certified public accountant shall be recognized as qualified as long as he or she prepares reports, filings, and statements as required by Florida Statutes, and conforms to the standards of his or her profession as contained in the Rules and Regulations and Code of Ethics and Rules of Professional Conduct of the Florida Board of Public Accountancy, or similar code.
(3) Scope of Examination and Report of Independent Certified Public Accountant. Annual audited financial statements required by subsection 69O-190.059(4), F.A.C., shall be examined by an independent certified public accountant in accordance with generally accepted auditing standards. Consideration should also be given to the procedures set forth in the Financial Condition Examiner's Handbook of the National Association of Insurance Commissioners, 1993 edition.

(4) Notification of Adverse Financial Condition.
(a) Each fund shall require the independent certified public accountant to report, in writing, within five (5) business days to the board of trustees and its audit committee any determination by the independent certified public accountant that the fund has materially misstated its financial condition as reported to the Office as of the balance sheet date currently under examination. A fund which has received a report pursuant to this paragraph shall forward a copy of the report to the Office within five (5) business days of receipt of said report and shall provide the independent certified public accountant making the report with evidence of the report being furnished to the Office. If the independent certified public accountant fails to receive the evidence within the required five (5) business day period, the independent certified public accountant shall furnish to the Office a copy of its report within the next five (5) business days.

(b) An independent certified public accountant shall not be liable in any manner to any person for any statement made in connection with the paragraph 69O-190.0591(4)(a), F.A.C., if the statement is made in good faith in compliance with paragraph 69O-190.0591(4)(a), F.A.C.

(c) If the accountant, subsequent to the date of the annual audited financial statement filed pursuant to subsection 69O-190.059(4), F.A.C., becomes aware of facts which might have affected his report, the accountant shall report those facts to the Office and the fund within seven (7) business days of discovery.
(5) Report on Significant Deficiencies in Internal Controls. In addition to the annual audited financial statement required by subsection 69O-190.059(4), F.A.C., each fund shall file with the Office with a written report prepared by the accountant describing significant deficiencies in the fund's internal control structure noted by the accountant during the audit. The report on significant deficiencies in internal controls of the fund shall be filed with the annual audited financial statement. The report on significant deficiencies in internal controls may be filed as part of the management letter, or may be a separate report. The fund is required to provide a description of remedial actions taken or proposed to correct significant deficiencies, if said actions are not described in the accountant's report.

(6) Definition, Availability, and Maintenance of CPA Workpapers.
(a) Every fund shall require the accountant to make available for review by Office examiners all workpapers prepared in the conduct of his examination, and any communications related to the audit between the accountant and the fund at the offices of the fund, the offices of the certified public accountant, or at any other reasonable place agreed to by the Office. The fund shall require that the accountant retain the audit workpapers and communications until the Office has filed a report on examination covering the period of the audit, but no less than seven (7) years from the date of the audit reports.
(7) Funds shall be subject to examination pursuant to Section 624.316, F.S. Funds shall reimburse the Office for actual expenses incurred for the examination pursuant to Sections 624.316 and 624.320, F.S.

69O FAC 190.060 | Security Deposits or Bonds for Self-Insurers Fund

(1) Pursuant to Section 624.4621, F.S., each self-insurers fund shall deposit with the Office acceptable securities or post a surety bond issued by a corporate surety authorized to do business in the State of Florida or make provisions as otherwise provided in these rules.

(2) The security deposit or bond required of a self-insurers fund providing coverage under Section 624.4621, F.S., shall be equal to the greater of:
(a) $250,000;

(b) 10% of the normal premium; and,

(c) 10% of the total loss reserves.
The amount of the security deposit or bond shall be determined at least annually based on data submitted by the self-insurers fund to the Office for the previous fiscal year end. Documents assigning investment assets to the division shall be filed with the division within 90 days of the effective date of these rules. Extensions may be granted for good cause.

(3) The security deposit requirement shall be satisfied by one of the following means:
(a) Self-insurers funds, upon application and during the first 24 months of operation, may post a surety bond to satisfy the security deposit requirement.

(b) All other funds shall satisfy the security deposit requirement by allocation of general investment assets of the fund to the division. No monies may be allocated from surplus in the loss fund in a given fund year until at least 12 months after the close of the fund year.

(c) If assets are not available, then the fund may post a surety bond in the amount of the difference between the amount of the security deposit requirement and the amount of assets available.

(d) The amount of the surety bond posted shall be considered a contingent liability. The necessity of the surety bond shall be eliminated before any dividends from premiums or investment income will be approved. If the deficiency is not completely eliminated within 12 months after the Office notifies the fund that a deficiency exists, then the failure to eliminate the deficiency shall be evidence of the fund's failure to satisfy the mandatory reserve requirements. Such failure shall be good cause for the revocation of the fund's self-insurance privilege and for the ordering of the assessment of the membership.
(4) Any surety bond posted by a self-insurers fund shall contain the provision that the surety agrees to provide reimbursements under the terms of the bond immediately upon failure or refusal of the self-insurers fund to meet any of its obligations under the Law.
Disclaimer© State of Florida
Rulemaking AuthorityLaw ImplementedHistory
440.38(2)(b), 624.4621 FS.440.38(2)(b), (3), 624.4621 FS.New 10-1-82, Amended , Formerly 38F-5.60, Amended , Formerly 38F-5.060, 4-190.060.

69O FAC 190.061 | Excess Insurance Requirements ‒ Self-Insurers Funds

(1) When used in this rule, the following words or terms shall have the meaning as described herein:
(a) Loss fund - the retention under the terms of an aggregate excess contract, or if no aggregate excess is purchased, the amount remaining from normal premium in each fund year after all necessary expenses are paid. For the purposes of paragraphs 69O-190.061(8)(b) and (c), F.A.C., no loss fund shall be less than 70 percent of earned normal premium without the approval of the Office.

(b) Aggregate loss - the amount of all claims incurred, including reserves for loss development and IBNR, which exceeds the loss fund.
(2) All self-insurers funds shall maintain specific excess insurance with a limit or not less than $1,000,000 or 5 times the policy retention whichever is greater. This amount shall not include the retention amount. Self-insurers funds containing businesses with a high risk of multiple injury from a single accident may be required to maintain higher limits. In determining whether to require such higher limits, the Office shall consider the likelihood of serious multiple injuries occurring in a single accident and the financial condition of the fund.

(3) The maximum retention allowed for a fund's specific excess policy shall be in accordance with the following schedule unless a waiver is granted pursuant to subsections (4), (5), (6) and (7):
(a) For funds with a loss fund of less than $3,000,000 the maximum retention shall be $225,000.

(b) For funds with a loss fund greater than or equal to $3,000,000 and less than $4,000,000, the maximum retention shall be $230,000.

(c) For funds with a loss fund greater than or equal to $4,000,000 and less than $5,000,000, the maximum retention shall be $240,000.

(d) For funds with a loss fund greater than or equal to $5,000,000 and less than $6,000,000, the maximum retention shall be $250,000.

(e) For funds with a loss fund greater than or equal to $6,000,000, and less than $7,000,000, the maximum retention shall be $260,000.

(f) For funds with a loss fund greater than or equal to $7,000,000 and less than $8,000,000, the maximum retention shall be $270,000.

(g) For funds with a loss fund greater than or equal to $8,000,000 and less than $9,000,000, the maximum retention shall be $280,000.

(h) For funds with a loss fund greater than or equal to $9,000,000 and less than $10,000,000, the maximum retention shall be $290,000.

(i) For funds with a loss fund greater than or equal to $10,000,000 and less than $50,000,000, the maximum retention shall be 3 percent of the fund's loss fund.

(j) For funds with a loss fund greater than or equal to $50,000,000 and less than $100,000,000, the maximum retention shall be 3.5 percent of the fund's loss fund.

(k) For funds with a loss fund greater than or equal to $100,000,000 the maximum retention shall be 4 percent of the fund's loss fund.

(l) Regardless of any maximum contained in this paragraph, no fund shall secure a retention which is not actuarially sound. Upon the request of the Office, a fund shall submit evidence of the actuarial soundness of its desired retention in a report prepared by its actuary. In the event that the fund does not have its own actuary, the Office shall prepare its own report on the actuarial soundness of the retention. After evaluating all evidence the Office shall determine if the desired retention is actuarially sound. In the event the desired retention is not actuarially sound, the Office shall not approve the desired retention.
(4) If a fund wishes to secure a specific excess policy with a retention greater than the maximum allowed by subsection (3), then the fund shall comply with the procedure described in subsections (5), (6) and (7).

(5) Funds which have been in operation at least 60 months may request permission to secure a retention higher than that authorized by subsection (3). A fund shall submit a feasibility study prepared by a qualified actuary which analyzes the impact on the fund of the higher retention. The study shall be in writing and shall be submitted to the Office at least 90 days prior to the beginning of the fund year for which the higher retention is requested. The Office shall advise the fund of its decision on allowing the higher retention no later than 45 days prior to the beginning of the fund year in question. If the fund has elected to make application for establishing an aggregate reserve, the specific excess feasibility study may be combined with the aggregate excess feasibility study. If the two studies are combined, the actuary shall specify the intent for the report to satisfy both requirements.

(6) The specific excess study shall analyze the past 5 fund years and illustrate the effect on the fund had the higher retention been in place during the past 5 fund years. The study shall also examine the impact of the higher retention on the fund for the next fund year. The report of the actuary shall also describe the method by which the additional reserves due to the higher retention will be funded. Monies used to fund the higher retentions shall be allocated from premium earned during the year the loss was incurred, from investment earnings from the year in which the loss was incurred or from future investment earnings on the specific loss reserve.

(7) The Office shall deny the use of a higher retention if it finds that the higher retention will adversely affect fund solvency or if the fund is unable to establish reserves using monies authorized by subsection (6).

(8) Each self-insurers fund shall provide security for liabilities in excess of its loss fund in each fund year by selecting one of the following alternatives:
(a) Purchasing an acceptable aggregate excess policy as defined in Rules 69O-190.035, 69O-190.036 and 69O-190.061, F.A.C.,

(b) Upon approval by the Office, pursuant to subsection 69O-190.061(12), F.A.C., post a separate cash security deposit in the amount of $1,000,000 or 20 percent (20%) of annual standard premium, whichever is greater; or

(c) Upon written approval of the Office, pursuant to subsections 69O-190.061(13), (14) and (15), F.A.C., establish a reserve for aggregate excess losses in accordance with this rule. A fund shall have been in operation for at least 60 months before this option may be selected.
(9) The insured aggregate limit for a self-insurers fund shall not be less than $1,000,000. Subject to this minimum, the self-insurers fund shall secure an aggregate limit of at least 20 percent (20%) of the annual standard premium of the fund for the term of the policy. The limit so determined shall be rounded to the nearest $100,000. The retention of an aggregate policy is limited to the highest retention that can be funded from normal premium in the fund year without developing a contingent liability. A higher retention than can be funded from normal premium may be allowed by the Office if the resulting contingent liability can be guaranteed by a cash security deposit.

(10) If the option in paragraph 69O-190.061(8)(a), F.A.C., is selected, the self-insurers fund, upon written approval of the Office, may self-insure part of its aggregate limit by posting as a separate cash security deposit for the amount which is self-insured. The procedures set out in paragraph 69O-190.061(8)(b) and subsection (12), F.A.C., shall be used by the Office to determine whether the aggregate may be partially funded by posting a cash security.

(11) No aggregate excess policy shall be acceptable if it contains a provision for a minimum retention or loss fund which is greater than the product of the aggregate excess retention percentage and the fund's estimated annual normal premium for the term of the policy, unless the fund has sufficient unencumbered surplus to guarantee the resulting contingent liability.

(12) The Office shall grant permission to post the cash security deposit in lieu of the fund purchasing an aggregate excess policy, if the Office determines that based upon a comparison of the assets and liabilities of the fund, the fund has a surplus equal to or greater than the total security deposits required by Rule 69O-190.060, F.A.C., including the cash security to be posted in lieu of purchase of the aggregate excess policy.

(13) If the option in paragraph 69O-190.061(8)(c), F.A.C., is selected, the fund shall make application to the Office, in the manner prescribed herein, at least 90 days prior to the beginning of the first fund year for which permission is requested to establish an aggregate reserve to provide security for aggregate losses. The Office shall render a decision on the application no less than 45 days prior to the beginning of that first fund year. Thereafter, application shall be filed as set out at paragraph 69O-190.061(16)(a), F.A.C., for each year for which permission is sought to establish an aggregate reserve. The time periods set out in this rule shall not apply to applications submitted within the first 90 days after the effective date of this rule.

(14) An application under paragraph 69O-190.061(8)(c), F.A.C., shall be in writing and shall include the following information:
(a) A plan for the first year of operation with a reserve account which establishes the proposed funding of the reserve account. The plan shall set forth the assumptions upon which the funding of the aggregate reserve is based. The plan shall use current rate levels and reasonable estimates of premium income, expenses, and investment rates of return. The plan may also include alternative analyses using anticipated rate level changes, and various assumptions regarding premium income, investment income, and expenses.

(b) A feasibility study by a qualified actuary which evaluates the last 5 fund years. This study must illustrate the effect of using the assumptions contained in the plan applied to the past 5 fund years. In making this study, the rules, as hereinafter provided, governing the funding of the aggregate reserve account shall be used in determining the feasibility of the plan.

(c) A statement by the actuary that, in his opinion, the proposed plan is an actuarially sound method of providing security for aggregate losses on a retrospective and prospective basis. Furthermore, the actuary shall state that the report is complete and accurate and that, in his opinion, the techniques and assumptions used are reasonable and meet the requirements and intent of this rule.
(15) The application shall be rejected if the Office determines that the proposed plan to fund aggregate losses does not comply with this rule.

(16) If a fund receives permission to fund its aggregate losses by establishing an aggregate reserve, the fund shall comply with the following requirements:
(a) At least 60 days prior to the beginning of each policy year for which an aggregate reserve will be established, the fund shall submit a plan for that year as prescribed in paragraphs 69O-190.061(14)(a) and (c), F.A.C. Written approval of the plan by the Office shall be required before an aggregate reserve may be established for the next policy year.

(b) Within 6 months after the end of each fund year, the fund shall submit an actuarial report, by a qualified actuary, of its aggregate reserve for each fund year whose aggregate losses are guaranteed by the reserve. Fund years more than 4 years old may be consolidated for the report. All other years must be evaluated separately.

(c) The actuarial report shall evaluate the losses, estimate loss development and establish a reserve for losses incurred but not reported (IBNR). The report shall provide a single best estimate of ultimate loss for each year evaluated separately and a single best estimate for all years more than 4 years old which are grouped together.

(d) Along with the actuarial report, the fund shall provide financial information which sets forth the financial position of the aggregate reserve. The financial report shall indicate whether the reserve account, including reserves for losses, loss development and IBNR, can be funded from the premium income of the fund. If the monies allocated to the loss fund are insufficient to satisfy the requirements of the aggregate reserve, then the fund shall provide a plan for funding the amounts necessary to make the aggregate reserve actuarially sound.

(e) In developing a plan for funding the aggregate reserve, the actuary shall estimate the amount of time it will take for the fund to pay out the cash currently remaining in its loss fund in each fund year. The plan shall set forth an actuarially sound procedure for allocating money to the aggregate reserve to insure that the fund will have, at any point in the future, sufficient money to meet all its claims payments. At a point in time no later than 4 years from the end of each fund year, the fund shall have fully funded the aggregate reserve for that year, so that taking into account investment earnings, no further contributions will be necessary to fund all future claims liabilities. Failure to meet the requirement for having made all necessary contributions within 4 years shall be good cause for finding that the aggregate reserve is actuarially unsound for purposes of paragraph 69O-190.039(2)(a), F.A.C.

(f) The actuarial report shall also estimate the unfunded liability for each year with an aggregate reserve requirement and determine the ability of the fund to pay its future liabilities under the assumption that no further premium income will be available after the end of the current fund year. The financial report shall review the fund's liquidity and determine if the fund will have sufficient cash available under the assumption that no further premium income will be earned after the end of the current fund year. Failure to demonstrate that the fund will have sufficient cash to meet its claims obligations or eliminate its unfunded liability without the contribution of additional earned premium from subsequent fund years shall be good cause for finding that the aggregate reserve is actuarially unsound for purposes of paragraph 69O-190.039(2)(a), F.A.C.

(g) In actuarially determining the amount of ultimate loss, the fund and its actuary may take into account current or future recoveries from any aggregate or specific excess contract, if such contract complies with these rules.

(h) Any fund with an approved preferred payment plan shall have its actuary determine the necessary amount of additional premium to be paid by the preferred payment plan participants so that all potential funding deficits in the loss fund will be eliminated. Funds which charge this additional premium shall be excused from the requirement to allocate surplus to the loss fund to fund the deficit as required by paragraph 69O-190.066(8)(k), F.A.C.
(17) The Office shall:
(a) Reject an actuarial report or financial report which does not comply with the requirements of subsection 69O-190.061(16), F.A.C. If this occurs, the Office shall conduct its own actuarial or financial review or upon request of the fund allow the fund to submit another actuarial or financial report within sixty (60) days subject to the Office's approval of the party preparing the report.

(b) For good cause, order a fund to cease using an aggregate reserve for securing its aggregate losses. Good cause shall include a finding that the aggregate reserve is actuarially unsound, that the fund is insolvent, that the fund will lack sufficient liquidity to run off its claims without reliance on future premium income, or that the fund has failed to comply with the provisions of this rule.

(c) In the event that the fund's aggregate reserve, or reserves, is actuarially unsound, order the fund to take such corrective action as necessary to make the reserve actuarially sound.
(18) In consideration of approval of its plan to use an aggregate reserve to fund its aggregate losses, the fund agrees to the following:
(a) Payment of dividends from premium in a fund year shall not be requested or approved for that fund year as long as any claims reserves, reserves for loss development or reserves for IBNR are unfunded by actual cash reserves.

(b) No dividends shall be requested or approved from investment earnings unless the aggregate reserves for all years are actuarially sound, taking into account future contributions.

(c) That advance premium discounts and all expenses unnecessary for the fund to meet its obligations under the law will be reduced or eliminated, if necessary, to provide funds to make an aggregate reserve actuarially sound.

(d) That the amounts actuarially determined to be necessary for the reserves for loss development shall be in addition to the fund's security deposit requirement as specified in Rule 69O-190.060, F.A.C.

(e) That no premium from a year prior to the year for which the aggregate reserve is established may be allocated to fund an aggregate reserve until 12 months after the close of the prior year.
Disclaimer© State of Florida
Rulemaking AuthorityLaw ImplementedHistory
440.38(2)(b), 624.4621 FS.440.38(2)(b), (3), 624.4621 FS.New 10-1-82, Amended , , Formerly 38F-5.61, Amended , , , Formerly 38F-5.061, 4-190.061.

69O FAC 190.062 | Filing Reports ‒ Self-Insurers Funds

(1) Reports as to payroll records, coverage, accident experience and compensation payment and such periodic reports as are required to be filed with the Office shall be made as follows:
(a) Summary loss data shall be filed with the Office on each fund member within 60 days after the evaluation date of the losses being reported on OIR Form BSI-17. Procedures for reporting losses as specified in subsection 69O-190.050(3), F.A.C., shall apply.

(b) Properly classified and audited payrolls on each fund member shall be submitted to the Office on OIR Form BSI-5 within 60 days after the evaluation date of the summary loss information required in paragraph (a) above. The classification and audit procedures specified in subsection 69O-190.050(1), F.A.C., shall apply.

(c) Quarterly Status Reports submitted on OIR Form BSI-24 (Revised 3-11-87), which accurately reflect the financial condition of each open fund year shall be filed with the Office within thirty (30) days after the close of each fund year quarter and signed by the chairman of the board of trustees or authorized self-insurers fund administrator. A fund year is considered open as long as one claim from that fund year remains unsettled.
(2) After the inception date of the fund, prospective new members of the self-insurers fund shall submit an application for membership to the board of trustees or its administrator on OIR Form BSI-3 or its equivalent. The trustees or administrator must approve the application for membership in accordance with these rules and the terms of the indemnity agreement for the application to be binding upon the self-insurers fund and the prospective member. A copy of the application for membership shall be filed with the Office along with a properly completed OIR Form BSI-206 within twenty-one (21) days after the effective date of membership.

(3) It shall be the responsibility of each self-insurers fund member to notify the fund to which it belongs or its service company of any changes in the names, addresses, structure and composition of all businesses or subsidiaries which participate in the self-insurers fund. It shall also be the responsibility of the fund member to notify the fund or service company of any additions or deletions in the business or subsidiaries participating in the fund. These changes include changes in majority ownership interest in any business or subsidiary that is covered or that will be covered by the fund. All such changes shall be reported to the fund or its service company within 30 days after the effective date of the change. Each self-insurers fund or service company shall notify the Office, by written endorsement, of any such changes reported to it by its members within 30 days after it has first knowledge of the change. Repeated failure to file the required endorsements within the time prescribed shall result in civil penalties being assessed pursuant to Rule 69O-190.038, F.A.C. If the Office determines the self-insurers fund members made the late reporting, then the penalty shall be assessed against the member; otherwise, the penalty shall be assessed against the self-insurers fund.
Disclaimer© State of Florida
Rulemaking AuthorityLaw ImplementedHistory
440.38(2)(b), (3) FS.440.38(1)(b), (2)(b), 440.51, 624.4621 FS.New 10-1-82, Amended , Formerly 38F-5.62, Amended , , , Formerly 38F-5.062, 4-190.062.

69O FAC 190.063 | Annual Review and Examination ‒ Self-Insurers Funds

(1) All bonds or securities issued by the State of Florida or the United States Government which are posted as security deposits shall be reviewed annually by the Office to determine market value. In the event market value is less than the deposit requirement, the Office may require that additional securities be posted by the self-insurer. In making such a determination, the Office shall consider the self-insurer's financial condition, the amount that market value is less than the deposit requirement and the likelihood that such securities will be needed to provide benefits.

(2) All self-insurers funds shall maintain at a central location within the State of Florida such records as are necessary to verify the accuracy and completeness of all reports submitted to the Office pursuant to these rules as well as all reports necessary to establish the financial solvency of the self-insurers fund. Furthermore, the central location shall be the office of the administrator or fiscal agent of the self-insurers fund. However, the self-insurers fund shall be authorized to transfer its financial records to the offices of the Certified Public Accountant for the self-insurers fund upon the written permission of the Office. In addition, if the self-insurers fund has contracted with a service company for claims handling, then the claims files and related records may be located at the offices of the service company as long as they are within the State of Florida.

(3) All records as herein required shall be open to inspection by authorized representatives of the Office during regular business hours. Records shall be retained for a period of time sufficient to ensure their availability for audit purposes. In the absence of other guidelines, the records shall be retained according to the schedule adopted by the Office for similar records. The location of these records shall be made known to the Office upon the application for self-insurance and at such times thereafter sufficient to keep the Office informed of their location.

(4) The fund, in any agreement or contract with the administrator or fiscal agent, shall require that the records of the administrator or fiscal agent which pertain to fund operations, assets or liabilities under Chapter 440, F.S., shall be open to inspection by authorized representatives of the Office during regular business hours.

(5) Each self-insurers fund's records shall be examined in accordance with Section 624.316, F.S., by representatives of the Office at such time as may be determined by the Office. Prior notice of the audit shall not be required. This audit is in addition to any audit performed in preparation of the financial reports required by these rules.

(6) Each self-insurers fund shall comply with the guidelines regarding questionable claims handling techniques, questionable patterns of claims, repeated unreasonably controverted claims or poor payment practices established pursuant to Section 440.20(16), Florida Statutes.

(7) After each audit, a written report shall be prepared with a copy to the self-insurers fund; such report to be a part of the annual review for compliance with these rules. Any deficiencies cited by this report shall be considered on their merit in determining if there are grounds for revocation of the self-insurance privilege or the imposition of penalties pursuant to subsection (9). Within 45 days after the receipt of an audit report which contains findings that the fund violated a rule contained in rule Chapter 69O-190, F.A.C., the trustees shall convene a meeting to discuss the report. The discussion of the report shall be noted in the minutes of the meeting.

(8) As part of its annual review and audit, the Office shall determine if the self-insurers fund has a contingent liability. In the event the fund is found to have a contingent liability, the Office shall inform the fund and order that this liability be funded in accordance with subsections 69O-190.060(2) and 69O-190.065(5), F.A.C.

(9) In addition to the penalties prescribed in Rule 69O-190.038, F.A.C., the Office may impose civil penalties not to exceed $100 for each violation of the Law or these rules. Penalties shall be imposed pursuant to Section 440.021, F.S.
Disclaimer© State of Florida
Rulemaking AuthorityLaw ImplementedHistory
440.38(2)(b), (3), 624.4621 FS.440.38(2)(b), 624.4621 FS.New 10-1-82, Amended , Formerly 38F-5.63, Amended , , Formerly 38F-5.063, 4-190.063.

69O FAC 190.064 | Trustees’ Responsibilities

(1) The board of trustees shall have complete authority over and shall retain ultimate control of the assets of the fund and shall be responsible for all operations of the fund.

(2) The trustees shall have the authority to approve applications for membership in the fund. The trustees may delegate this authority to the administrator.

(3) The composition of the board of trustees shall be as follows:
(a) A majority of the board shall be owners, officers, directors, partners or employees of one or more members of the fund.

(b) A trustee, or relative of the trustee, shall not be an owner, officer, director, partner or employee of the fund's service company. This does not apply to employment of a relative of the trustee in which the relative's duties are of a clerical, or non-managerial nature. Non-managerial being a position which cannot affect the financial standing of a self-insurer, or the benefits to which an injured employee is entitled under Chapter 440, F.S.
(4) The trustees shall act in a prudent and responsible manner in safeguarding the assests of the fund. The trustees may designate a fiscal agent to oversee, invest and disburse the fund's assets on a day-to-day basis. The trustees may designate an administrator to handle the management of the fund on a day-to-day basis. The administrator may also be delegated the responsibilities of a fiscal agent.

(5) The administrator, fiscal agent or any other individual with authority to disburse funds shall furnish a fidelity bond or insurance policy payable to the trustees in an amount sufficient to protect the fund's assets against misappropriation or misuse. The amount of the bond shall an amount equal to not less than 10 percent of the funds handled annually and issued in the name of the fund covering its trustees, employees, administrator, or other individuals managing or handling the funds or assets of the fund. In no case may such bond be less than $1,000 or more than $500,000, except that the division may for good cause prescribe an amount in excess of $500,000, subject to the 10-percent limitation of the preceding sentence.

(6) The fiscal agent, or administrator, or service company shall be subject to the following conditions:
(a) A fiscal agent or administrator shall be an employee of or under contract to the fund.

(b) The administrator may provide some or all of the services required by the rules.

(c) In delegating authority to the administrator, fiscal agent or service company, the trustees shall insure that no conflict of interest exists between the interests of the fund and that of the administrator, fiscal agent, or service company. In the event that fiscal authority is delegated, the trustees shall insure that adequate division of responsibility exists and that satisfactory internal fiscal controls are established to safeguard the fund's assets.

(d) If the administrator provides claims adjusting services to the fund, the trustees shall not delegate any fiscal authority to the administrator except for control of the claims revolving fund.

(e) If the administrator or its representative, or any officer, director, partner, or management of the service company has a business or financial relationship with a business providing goods or services to the fund, then:
1. Such relationship shall be disclosed by the administrator or service company in writing to the trustees and to the audit committee; and,

2. All business transactions between the fund and the business providing goods or services shall be conducted so that said business or financial relationship will not influence the outcome of the transactions; and,

3. The trustees shall exercise all reasonable precautions so that the business providing goods or services is not unjustly enriched due to the business or financial relationship with the administrator or service company.
(f) Upon receipt of notification as required by subparagraph (e)1., above, the minutes of the next Trustee's meeting shall reflect the discussion of the notification and the action taken by the trustees. The fund shall also maintain a file of the written notices for review by the division.

(g) The trustees shall establish an audit committee subject to the following conditions:
1. The committee shall be independent of the control of the administrator and the service company and shall report directly to the trustees.

2. The committee shall be responsible on a continuing basis for determining that the fund has instituted and is complying with satisfactory internal fiscal controls in order to protect the fund's assets.

3. The committee shall investigate all potential conflicts of interest involving the administrator or service company. It shall report in writing to the trustees all cases of actual conflict of interest.

4. The committee shall work closely with the fund's certified public accountants to verify the accuracy and completeness of the fund's financial records and reports.

5. The management of the fund, the administrator, or officer, stockholder, owner, management of the service company shall not be represented on the committee.

6. The committee shall make at least one written report to the trustees per year detailing its activities and findings.

7. All committee reports shall be reviewed by the trustees and such reviews shall be noted in the minutes of the meeting at which the review was discussed.

8. All written reports by the committee shall be made available for review by authorized representatives of the Office as part of the audit of the fund.
(7) The trustees may establish a revolving fund for the use of the service company for the payment of claims and related expenses, subject to the following:
(a) The service company shall furnish a fidelity bond or insurance policy covering its officers and employees, payable to the trustees of the fund in an amount sufficient to protect all monies placed in the revolving fund. The amount shall be no less than the one months average receipts deposited into the revolving fund. Average receipts shall be the total deposits made during the previous fund year divided by twelve (12).

(b) If the bond or policy required pursuant to subsection 69O-190.064(5), F.A.C., also covers the monies in the revolving fund, a separate bond or policy shall not be required from the service company.
(8) All fidelity bonds or insurance policies required by subsection 69O-190.064(5) and paragraph 69O-190.064(7)(a), F.A.C., may provide for a deductible of not more than $5,000.

(9) The trustees shall maintain up-to-date, accurate, and complete records of the fund's finances. The accounts and records of the fund shall be audited at least annually and at any other time necessary to determine the financial condition of the fund.

(10) The trustees shall obtain audits of the fund and disclose the financial condition of the fund as indicated below.
(a) Audits shall be made by a certified public accountant. Audits may also be made by authorized representatives of the Office.

(b) The Office shall prescribe a standard report of financial condition to be used by all self-insurers funds pursuant to Rule 69O-190.059, F.A.C.

(c) The Office reserves the right to prescribe the types of audits to be performed to determine fund solvency.

(d) The reserves for losses and loss development shall be reviewed annually pursuant to Rule 69O-190.059, F.A.C., to determine the adequacy of these reserves.

(e) Copies of all audits and financial reports required pursuant to Rule 69O-190.059, F.A.C., and prepared by personnel other than Office personnel shall be filed with the Office pursuant to Rule 69O-190.059, F.A.C.
(11) Subject to the terms and conditions indicated below, the trustees may establish a penalty rate to produce premium in excess of standard premium for any class of employers with unfavorable loss experience.
(a) The trustees shall submit to the Office a justification for the application of the penalty rate as well as a description of how it will be applied.

(b) Approval by the Office shall be required prior to implementation of the penalty rate.

(c) Employers subject to a penalty rate shall be notified in writing prior to the effective date of the penalty rate.
(12) The trustees, fiscal agent, or administrator shall not utilize any of the money collected as premium from members for any purpose other than those specifically authorized by these rules or the fund's indemnity agreement.

(13) The trustees shall be prohibited from borrowing money from the fund or in the name of the fund without obtaining prior approval from the Office. Approval shall be granted only if:
(a) The loan is for a productive purpose;

(b) It is consistent with the fund's purpose; and,

(c) It does not impair the financial solvency of the fund.
(14) The trustees shall be authorized to invest the fund's assets only in the manner prescribed by Rule 69O-190.071, F.A.C.

(15) The safety of any investment shall be the responsibility of the trustees.

(16) The trustees shall be prohibited from making any type of investment as authorized by these rules with the intent to trade, dispose or sell the security in any manner other than redeeming it at maturity. Therefore, it shall be the responsibility of the trustees to purchase securities in such denominations and with dates of maturity to ensure that these securities shall be redeemable at the same time and in the same amounts as the self-insurers fund's current and long-term liabilities.

(17) The trustees of each authorized self-insurers fund shall cause to be adopted a set of by-laws or shall enter into a trust agreement which shall govern the operation of the fund. These by-laws or trust agreement shall contain, but not be limited to the following subjects:
(a) Qualifications for self-insurers fund membership including underwriting considerations.

(b) The method for selecting the trustees, including the term of office.

(c) The method of amending the by-laws.

(d) Employer's Liability Limit provided by the self-insurers fund.

(e) The amount of the trustees' remuneration which is in excess of actual expenses incurred.
(18) In addition to the above by-laws, the trustees shall adopt written policies on the following subjects, such policies shall be recorded in the minutes of the meeting at which they were adopted and shall be binding on the administrator and service company:
(a) Investment of surplus monies and claims reserves in accordance with Chapter 440, F.S., and Chapter 69O-190, F.A.C.

(b) Frequency and extent of loss control and safety engineering service to members.

(c) The size of the revolving claims fund.

(d) A schedule for payment and collection of premiums including a definition of delinquent premium.

(e) Cancellation procedures, including cancellation for non-payment of premium and cancellation for excessive losses.

(f) Delineation of authority granted to the administrator or fiscal agent.

(g) Delineation of authority granted to the service company.

(h) A penalty program for surcharging members with excessive losses.

(i) Procedures for handling disputes regarding premium paid by members.

(j) Dividend policies including underwriting criteria.
(19) The trustees shall review at least annually the following items for the purpose of determining whether these areas of concern are being adequately provided for and the findings of such review shall be recorded in the minutes of the meeting at which they were discussed:
(a) Service company performance.

(b) Loss control and safety engineering.

(c) Investment policies.

(d) Collection of bad debt.

(e) Cancellation procedures.

(f) Initial member review.

(g) Administrator performance.

(h) Dividend policies.
(20) All self-insurers shall file copies of the current by-laws or trust agreement and required written policies with the Office. Any changes in the by-laws, trust agreement or written policies shall be filed with the Office no later than ten (10) days after their taking effect. The Office reserves the right to order the self-insurers fund to rescind or revoke any by-law or policy if it is in violation of these rules or the Law.

(21) The board of trustees of a self-insurers fund shall meet from time to time as needed to conduct the business of the fund. However, the trustees shall meet at least four (4) times per fund year and written minutes of each meeting shall be kept. The minutes shall be signed and dated by the chairman or secretary of the board of trustees. Such minutes shall be open to inspection by the Office.

69O FAC 190.065 | Distribution of Surplus Monies by Self-Insurers Funds

(1) Any surplus monies for a fund year in excess of the amount necessary to fulfill all obligations under the Law for that fund year may be declared refundable to members by the trustees at any time. The amount of such declaration shall be a liability of the fund at the time of the declaration. Date of payment shall be as agreed by the trustees and the Division subject to this section.

(2) Distribution of dividends are subject to the following conditions:
(a) Dividends of surplus premium (i.e., underwriting profit) shall be payable only to employers who paid premium to the fund during the year the underwriting profit occurred.

(b) Dividends of surplus investment or miscellaneous income may be paid to any member who meets the criteria established by the fund pursuant to paragraph 69O-190.065(2)(c), F.A.C. Payment of any such dividend shall be subject to a plan filed with and approved in writing by the Division. Any such plan shall comply with Rule 69O-190.072, F.A.C.

(c) Eligibility for dividends pursuant to paragraphs (a) and (b), shall be based on criteria which meet the following conditions:
1. The criteria shall be objective and measurable such as an employer's accident record, the amount of premium paid, or any other criteria which encourages workplace safety or cost containment.

2. The criteria shall only apply to fund membership; and,

3. The amount of dividend otherwise earned shall be prorated based upon the length of membership of the member in the fund.
(d) All dividends from policy years beginning on or after October 1, 1989, whether from premium, investment income or miscellaneous income, shall be payable to employers who were members of the fund at the end of the policy year in question but have since left the fund and are otherwise entitled to receive a dividend according to the criteria established by the trustees.

(e) No fund shall offer to provide a dividend or seek to enlist a new member based upon the promise of payment of a dividend. No fund may promise, or make any representation of, a specific amount of dividend for which a potential member may become eligible. A fund may disclose in its solicitation of new members, the formula which it intends to use to calculate a member's future dividend pursuant to paragraph (2)(c).
(3) A request to the Division for authorization to disburse a declared refund shall be made in writing to the Office by the fund administrator or trustees. A request for permission to pay a dividend shall be in accordance with Section 440.57(5), F.S. Such request shall include a current financial statement and an actuarial report regarding the adequacy of the reserves for all fund years. Such request shall be delivered to the Division in such manner that a signed receipt is provided to the sender.

(4) Before approving any refund distribution request, the Division shall determine that such refund will not impair the financial solvency of the self-insurers fund. In any given fund year, the monies allocated to the loss fund shall not be used for any purpose other than paying claims and authorized expenses until such time as surplus monies are eligible to be refunded. The intent of these rules is to ensure that sufficient monies are retained so that total assets are greater than total liabilities in each fund year.

(5) In the event of a deficit or contingent liability in any fund year, such deficit shall be funded immediately, either from surplus from a fund year other than the current fund year or from trustee' funds or by assessment of the membership, if ordered by the Division, or by such alternate method as the Division may approve. An alternate method shall not increase the liability of the fund. Alternate methods may include, but are not limited to, capital contributions by a sponsoring association, capital contributions from a trustee or member, sale of a fixed asset by the fund, or by disallowing or reducing an advance premium discount to members. The Division shall be notified prior to any transfer of surplus funds.

(6) When a dividend is disbursed, it shall be the responsibility of the fund to ensure that dividends are paid to employers eligible for a dividend including those who are no longer members of the fund. The fund shall give each member, upon joining the fund, written notice that dividends may be payable to a member after leaving the fund. Such notice shall also instruct the member to keep the fund informed of any changes in address after leaving the fund.

(7) When disbursing a dividend, the fund shall make a reasonable effort to locate all former members of the fund who are eligible for a dividend. Reasonable effort shall include:
(a) Mailing the dividend payment to the last known address of the member according to the records of the fund;

(b) For dividends in excess of $500, if the member is not located at the last known address, the fund shall make an attempt to locate the former member through the member's insurance agent, association or through sources of information available to the general public.

69O FAC 190.066 | Premium Billing and Collection

(1) The trustees shall not allow a premium discount to any member for the period beginning on September 1, 1990 and ending on December 31, 1991. Beginning on January 1, 1992, if a self-insurer's fund allows premium discounts to its members, the trustees shall allow a premium discount to each member as follows:
First$5,000 of standard premium0%
Next95,000 of standard premium10.9%
Next400,000 of standard premium12.6%
Over500,000 of standard premium14.4%
It is the intention of the Office that these discounts be identical to the rates approved by the Office of Insurance for voluntary stock premium discounts. The trustees may not authorize a discount in excess of that allowed by the fund's excess insurer in determining the excess policies' premium and retention.

(2) In no event shall a fund using a dividend to offset billed premium make any representation to a member or a potential member that this dividend constitutes an additional advance discount. Premium reported to the Office shall be normal premium.

(3) If in any given fund year, the self-insurers fund will have an unfunded contingent liability, then no advance discount to members shall be allowed that year until the liability is funded.

(4) In determining "net premiums" on which Administrative and Special Disability Assessments are computed pursuant to Sections 440.49(2)(h) and 440.51, F.S., self-insurers funds shall use amounts collected after both advance discounts and refunds. In no event shall the fund be allowed to deduct more than 15 percent from standard premium when calculating net premium.

(5) The trustees shall make all reasonable efforts to collect delinquent premiums. The trustees shall establish premium payment schedules which provide for premium payment dates, corresponding amounts due, and a basis for determining when unpaid premiums are to be considered delinquent. Copies of all payment schedules shall be filed with the Office within 30 days after implementation.

(6) The trustees at their discretion may establish any payment schedule that adequately provides for sufficient cash flow and that gives proper consideration for the potential adverse effects of delinquent premium on fund solvency. Payment schedules, other than preferred payment plans, shall require that a member's annual pro-rata normal premium is payable in full upon presentation of the final annual billing. Such billings shall include credits for amounts already paid and may include credits for any dividend or administrative savings allowed. The Office reserves the right to order modification of any payment schedule contrary to these rules or which it determines will adversely affect the fund's liquidity or solvency.

(7) The trustees may establish preferred payment plans for certain members which allow these members to pay a premium other than normal premium. Each member participating in a preferred payment plan shall enter into a contract or agreement which sets forth the terms and conditions of the plan. Such payment plans shall be subject to the following conditions:
(a) All proposed plans including the proposed contract or agreement shall be submitted to and approved by the Office prior to implementation. In approving or disapproving a plan, the Office shall determine if the plan complies with this rule. Additionally, all revisions to the approved plan, contract, or agreement shall be submitted to the Office and approved prior to implementation.

(b) The plan shall establish a minimum normal premium that a member must pay to qualify for participation in the plan.

(c) The fund shall conduct a reasonable financial review of any employer desiring to participate in the plan for the purpose of determining that the member is financially sound. A description of the financial review shall be part of the plan. Only financially sound employers may participate in these plans.

(d) The plan and contract or agreement shall require that each participant shall pay to the fund a portion of the total fixed expenses for the fund. At the beginning of each policy year in which the plan is offered, the fixed expenses associated with the fund's operation shall be calculated.
1. The minimum fixed expense shall be based upon the portion of the fund's estimated annual normal premium in excess of the aggregate retention or loss fund. The percentage of the estimated annual normal premium determined by the fixed expenses of the fund shall be applied to the estimated annual normal premium of each member in the plan to determine the minimum pro-rata fixed expenses to be paid to the fund by each participant.

2. The fixed expenses owed by each participant may be greater than the minimum but shall be fixed at policy inception and adjusted on final audit only to reflect changes in the member's audited normal premium. Expenses which are allowable charges to the aggregate excess contract loss fund may be deducted from the member's claims deposit.

3. Each fund shall adopt a fixed expense charge which it shall apply to all members of the preferred payment plan during a given fund year. The fund may elect to apply an expense charge which is greater than the actual expense factor of the fund but this charge shall be uniformly applied to all preferred payment plan members in a given year.
(e) If the plan allows the member to pay less than the earned normal premium upon final audit, then the plan shall require, at a minimum, that the member provide security to the fund for the difference between the premium actually paid and the member's annual normal premium. After the end of the policy year, the security may be reduced to the amount of the member's outstanding claims reserves. Such security may be surety bonds, cash security, letters of credit, or other methods approved by the Office. This security shall be adjusted annually to reflect current incurred loss, claims payments, and lump sum settlements. The fund shall establish a reserve for the amount of the outstanding claims reserves.

(f) The plan shall establish a minimum and maximum premium that each member shall be subject to for each policy period in the plan.
1. The minimum premium shall be greater than or equal to the sum of the fixed expenses established pursuant to paragraph 69O-190.066(8)(d), F.A.C., and the cost of all claims incurred net of excess recoveries.

2. The maximum premium shall not be less than 115% of the member's standard premium. The maximum premium established by the fund shall be the most any member shall be required to pay the fund for coverage except for assessments made pursuant to the fund's indemnity agreement.

3. The fund shall collect a deposit premium which shall be at least equal to the amount of the claims deposit plus a pro-rata portion of the expense charge. This deposit premium shall be paid prior to the beginning of the member's participation in the plan in a given year.
(g) The plan shall require that the member forfeit any dividends paid by the fund for the period the member participated in the plan.

(h) The participation in the plan by a member shall be terminated by the fund if the member's financial condition deteriorates to the point where its ability to meet future financial obligations is in doubt. The fund shall maintain a file for each participant, and such file shall be made available to Office personnel upon request. Each file shall contain, but shall not be limited to, financial statements or audited financial statements for each member's three (3) most recent fiscal years.

(i) The plan shall provide that the member provide a cash deposit out of which the fund will pay the member's claims. Such deposit shall be reviewed by the fund at least quarterly and increased or decreased to reflect the actual claims paid by the fund on behalf of the member.
1. Each member shall be billed monthly for any claims paid by the fund during the previous month. It is the intent of this rule that funds should use only the preferred payment plan claims deposits or collateral to pay preferred payment plan claims.

2. Cash claims deposits shall be treated as a liability for accounting purposes and payments made from cash deposits shall be accounted for separately by fund year.

3. A fund may elect to use a loss conversion factor or factors when billing members for reimbursement of the cash claims deposit. These factors will require that the members reimburse the fund for the actual amount of claims paid plus an additional fixed percentage of the amount paid. The loss conversion factors shall be a part of the plan and shall be fixed for any given policy year. If more than one factor is to be used by the fund, the plan shall explicitly state the criteria for applying a specific factor to an individual member.

4. The fund may limit the liability of a member to reimburse the fund for actual claims payments by capping the cost associated with a given claim at the fund's specific excess retention. No other limit shall be used to cap the members' liability to reimburse the fund on individual claims. If the contract period for a member's participation in the preferred payment plan includes two or more specific retentions, then the contract shall be amended to reflect the actual specific retentions in effect during the preferred payment plan contract period. The loss limits specified in this paragraph shall not affect or amend the maximum premium required in paragraph (f).
(j) The plan shall provide that any claims reserves, less specific excess recoveries, outstanding when a member leaves the fund, shall be paid in full by the member or shall be guaranteed by security acceptable to the Office.

(k) The fund's aggregate excess policy shall provide that the retention be determined by using the premium paid or if normal premium is used, then the fund shall establish a reserve funded from surplus in the amount of the difference between normal premium and premium paid.

(l) The fund shall limit the participation in the plan to insure that it has adequate liquidity. In no event shall the fund allow more than 25 percent of its premium in these plans. Such percentage shall be determined by calculating the participating members' normal premium and expressing this amount as a percentage of the fund's total normal premium.

(m) The fund shall report to the Office, as part of its Quarterly Status Reports or annual financial statement, the number of employers participating in the plan, their equivalent normal fund premium, the amount of premium paid in, the amount of claims paid, the amount of reserves outstanding and the amount of any delinquent premium. The Preferred Payment Plan Quarterly Status Reports shall be filed on OIR Form BSI-30.

(n) The fund shall pay its assessments on the basis of normal premium for any employers participating in the plan.

(o) The Office reserves the right to order the preferred payment plans terminated if it determines that the continuation of the plan would adversely affect the solvency of the fund or if the fund fails to comply with the provisions of this rule. All approvals for preferred payment plans shall be for a single fund year only. Plans or any amendments to previously filed plans shall be filed annually and be subject to approval of the Office in the same manner as and according to the same criteria used for approving new plans. If a fund wishes to continue a plan with no changes from the previous year, then the fund may advise the Office in writing and the fund need not make any additional filing for that year.

(p) Any claims remaining open two years after the end of the policy period in which they were incurred may be commuted into a lump sum payment by the employer at the request of the fund or at the request of the employer and with the concurrence of the fund.
(8) Funds may be allowed to offer retrospectively rated plans to their members. Funds may request permission to use plans filed by the National Council on Compensation Insurance (NCCI) with the Office or funds may develop their own plans.
(a) Funds shall obtain the approval of the Office prior to offering any retrospectively rated plans.

(b) Funds shall adopt explicit underwriting criteria which shall be submitted to the Office along with the actual plan. The fund shall also submit with the request an actuarial analysis of the impact of the plan on the solvency and liquidity of the fund.

(c) The Office may approve the use of a plan if the offering of a plan does not adversely affect fund solvency and liquidity. In approving a plan, the Office may limit the participation in the plan to a fixed percentage of fund premium when such limit is necessary to assure fund solvency and liquidity.

(d) Funds may submit their own retrospectively rated plans which have been developed by a qualified actuary. These plans shall address the same issues as are contained in the NCCI plans. Any plan which allows a minimum premium of less than standard premium shall have a maximum premium which is in excess of standard premium. The fund's actuary shall attest that the plan is actuarially sound.

(e) All plans shall be reviewed annually by the fund's actuary. The review shall include an analysis of the actuarial soundness of the plan and the effect of the plan on fund solvency and liquidity.

(f) Changes in a plan must be filed with and approved by the Office prior to implementation. All changes must be reviewed by the fund's actuary and included in the actuary's annual analysis of the plan and in its impact on the fund's financial condition.

(g) The Office may withdraw the authorization of a fund to offer a retrospectively rated plan if the office determines that the continuation of the plan would adversely affect fund solvency and liquidity.
Disclaimer© State of Florida
Rulemaking AuthorityLaw ImplementedHistory
440.591,, 440.51(6)(b), 624.4621 FS.440.51(6)(b), 624.4621 FS.New 10-1-82, Amended , Formerly 38F-5.66, Amended , , , , , , Formerly 38F-5.066, 4-190.066.

69O FAC 190.067 | Member’s Qualifications and Responsibilities

(1) All members of a self-insurers fund shall have common interest. Different businesses which are owned or controlled by the same interests shall be eligible for membership in a self-insurers fund provided one of them is eligible.

(2) Unless the context clearly indicates to the contrary, the requirements imposed by these rules shall apply to the self-insurer as defined by Section 440.02(7)(b)3., F.S. The duties, responsibilities and requirements of the members as defined by Section 440.02(7)(b)2., F.S., are as provided by the indemnity agreement as specified in Rule 69O-190.068, F.A.C.

(3) Self-insurers funds are authorized only to accept liability and extend coverage for injuries under Chapter 440, F.S. No fund shall accept as a member any employer who is known to have United States Longshoremen and Harbor Workers Act or Jones Act exposure for which the fund may be liable. Whenever a fund determines that a member has United States Longshoremen and Harbor Workers Act or Jones Act exposure for which the fund was or may be liable, then that member shall be issued a notice of termination by the fund unless such exposure was a one time occurrence and will not be repeated or unless the member secures acceptable insurance coverage for the continuing United States Longshoremen and Harbor Workers Act or Jones Act exposure.

(4) Self-insurers funds shall use form BSI-31 to assure itself that any person claiming exemption from Chapter 440, F.S., pursuant to Section 440.05, F.S., is entitled to such an exemption.

69O FAC 190.068 | Indemnity Agreement

(1) Each self-insurers fund member shall enter into an indemnity agreement jointly and severally binding the self-insurers fund and each member thereof to comply with the provisions of the Florida Workers' Compensation Law and rules of the Office. Employers in the public sector who are legally unable to enter into a joint and several liability indemnity agreement with private employers shall be ineligible to participate in a self-insurers fund with members who are private employers. Self-insurers funds composed entirely of public employers may be authorized and must qualify in the same manner and be subject to the same regulations as all other self-insurers funds.

(2) The indemnity agreement required pursuant to paragraph 69O-190.056(3)(a), F.A.C., shall conform to the form of the indemnity agreement hereinafter set forth and shall contain all its provisions but may also contain other provisions not inconsistent with these rules or with the required provisions. "Administrator" or "Fiscal Agent" may be substituted as may be necessary to reflect the respective authority, responsibility and duties of these agents, consistent with these rules.

INDEMNITY AGREEMENT

THIS INDENTURE, made and entered into this ___ day of ___, A. D., 20___, by and between all the parties who are now or may hereafter become members of the ___ Self-Insurers Fund, acting by and through a Board of Trustees of their own selection.

WITNESSETH

WHEREAS, the undersigned persons, firms and corporations, hereinafter referred to as "Members," have applied to the Office of Insurance Regulation, hereinafter referred to as the "Office," for authority to pool our liabilities pursuant to the terms of the Florida Workers' Compensation Law and specifically as provided by Section 624.4621, F.S., and

WHEREAS, the said members have organized and formed a fund pursuant to said section, which fund shall be known as ___ Self-Insurers Fund, herein referred to as the "Fund," and

WHEREAS, the members of said Fund have designated ___ as its first Board of Trustees to direct the affairs of said Fund and to pass on the admissability of future members of the Fund until the members select succeeding Trustees for said Fund, and

WHEREAS, the said Trustees have designated ___ as Service Agent for said Fund, and

WHEREAS, the Office, upon petition of the group, has made its order approving said application, but upon the following conditions, to-wit:

I

The group shall, before being issued a certificate, post either a corporate surety bond or securities acceptable to the Office in the aggregate sum of ___ dollars ($) to secure performance of any awards which might be made against the Fund or any member thereof, and keep said bond or securities posted as long as may be required by the Office. The Trustees shall from time to time be entitled to receive all interest accruing on any negotiable securities posted, provided that the Fund is not in default in payment of compensation benefits or of any assessment levied by the Office in accordance with Sections 440.20(9), 440.49 and 440.51, F.S.

II

That the members of said Fund execute a covenant or agreement whereby in addition to the collateral just above mentioned, the Fund and its members will jointly and severally covenant to assume and discharge, by payment, any lawful awards entered by the Office against any member of the group, which awards shall have been sustained by the courts where an appeal by either party is taken.

III

That the members of the Fund execute a covenant or agreement whereby the Fund and each member thereof will jointly and severally covenant and agree to pay premiums and assessments, based upon appropriate classifications and rates, into a designated cash reserve fund out of which lawful and proper claims and awards are to be paid, and further, that the group will jointly and severally covenant and agree there will be no disbursements out of this fund by way of dividends or distribution of accumulated reserves to the respective members, except at the direction of the Trustees after application to and approval by the Office.

AND WHEREAS, the members of said fund, through their designated Trustees, have elected to comply with said conditions and become self-insurers, and to execute the other covenants required;

NOW, THEREFORE, for and in consideration of the mutual covenants, promises and obligations herein contained, which are given to and accepted by each member hereof to the other, the parties to this instrument covenant, stipulate and agree as follows:
1. The Fund hereby agrees either to file with the Office a corporate surety bond in the principal sum of ___ dollars ($ ) or to deposit ___ dollars ($ ) in acceptable securities with the Office to secure performance by the Fund of payment of all lawful awards made by the Office against any member or members of the group, predicated on a claim or claims by an employee or employees of any member of the Fund arising out of and in the course of such claimant's employment, and which awards shall have been sustained by the courts where an appeal by either party is taken; and upon condition that said member through which such claim originated shall not have been suspended from, resigned from, or expelled from the Fund after thirty (30) days' notice to the Office of such suspension, resignation, or expulsion, and which notice to the Office shall have been given thirty (30) days prior to the accident complained of.

2. The members of this Fund do jointly and severally covenant and agree that they will pay any such award as would otherwise be a claim against the aforesaid surety bond or securities as soon as the same shall become payable under the laws of the State of Florida; and the group agrees to pay to the Office for the administration of the law such assessments as may be ordered by said Office in accordance with Sections 440.20(9), 440.49 and 440.51, F.S.

3. The members intend this agreement as a mutual covenant of assumption and not as a partnership, but should any court of competent jurisdiction construe same to be a partnership, then it is the intention of the parties that such partnership be limited in scope to the uses for which this contract is executed and no other.

4. That, subject to the approval of the Office, the Trustees of the Fund shall set up, operate, and enforce its own administrative rules, regulations and by-laws as between the individual members of the Fund.

5. The members ratify and confirm appointment by the Trustees of ___ as Service Agent for the Fund and its members, individually and collectively. The Service Agent shall determine all sums due the Fund from the members, pay all approved items of expense as directed by the Trustees, and give a monthly account of all monies so handled. For handling the administrative and servicing functions of the Fund, the Service Agent shall receive a fee which shall be negotiated from time to time by the Trustees. This fee shall be in consideration of all services and expenses contracted for with the Fund, which services or expenses may include the collecting, disbursing, and accounting for monies collected, counseling with members as to safety hazards, claims handling and investigation, and providing for excess insurance coverage. The Service Agent's books and records are to be open to inspection by the Office and by the Trustees or their agents at all reasonable times.

6. The Service Agent shall deposit to the account of the Trustees, at any bank or banks designated by the Trustees, all premiums as and when collected, and said monies shall be disbursed only as provided by (1) the rules, regulations and by-laws of the Trustees, (2) the Agreement between the Trustees and the Service Agent, and (3) the Rules of the Commission pertaining to self-insurers funds.

7. The Trustees are authorized and directed to take all reasonable precaution to protect the members from losses and shall provide for excess insurance coverage designed to protect said members against excess losses. The contracts for coverage shall be governed by the Rules of the Commission pertaining to self-insurers.

8. All members of the Fund hereby agree that the Trustees may admit as members of this Fund only acceptable and financially sound employers in the State of Florida who have common interest as defined in the Rules of the Commission pertaining to self-insurers, and that, subject to the approval of the Office, the Trustees shall be sole judge of whether or not any applying business shall be admitted to membership; and further, that a member may be suspended or expelled from the Fund after thirty (30) days' notice has been given to him and the Office, and that no liability shall accrue to the Fund or its members for any accident to an employee of the suspended or expelled member occurring after thirty (30) days' notice has been given to him and the Office as above provided.

9. The rules and regulations for the administering of the Fund and the admission and expulsion or suspension of members shall be promulgated by the Trustees. However, each member of the Fund agrees to abide by the following rules and regulations:
(a) The member agrees to follow the safety recommendations of the Trustees and the Service Agent in order to give his employees the maximum in safe and sanitary working conditions, and to follow the general recommendations of the Fund in this field to promote the general welfare of his employees.

(b) In the event of an accident or a reported claim, to make immediate provision for remedial care for his employees, and to give immediate notification of said accident to the Service Agent on the prescribed forms.

(c) The members shall make prompt payment of all premiums and assessments as required by the Trustees, said premiums to be determined by applying applicable experience modification to the standard rates for the exposure to risk, said standard rates to be as compiled by the National Council on Compensation Insurance and approved by the Office of Insurance Regulation. Further, said premium shall include loss and expense constants and minimum premiums, where applicable. Finally, said premium may be reduced by any discount allowed by the Trustees as long as such discount does not exceed the amount permitted by the Rules of the Commission pertaining to self-insurers.

(d) The member hereby appoints the Service Agent of this Fund as his agent and attorney-in-fact to act in his behalf and to execute all contracts and reports, waivers, agreements, excess insurance contracts, and service contracts; to make or arrange for payment of claims, medical expenses, and all other things required or necessary insofar as they affect his workers' compensation and/or employer's liability under Florida law and as covered by the terms of this Fund Agreement and the rules and regulations as now provided or as hereafter promulgated by the Trustees and the Office.

(e) The member agrees that in the event of the payment of any loss by the Fund under this contract, the Fund shall be subrogated to the extent of such payment to all the rights of the member against any person or other entity legally responsible for damages for said loss, and in such event the member hereby agrees to render all reasonable assistance, other than pecuniary, to effect recovery.

(f) The Fund is to defend in the name of and on behalf of the member any suits or other proceedings which may at any time be instituted against him on account of injuries or death within the purview of the Florida Workers' Compensation Law or on the basis of employer's liability, including suits or other proceedings alleging such injuries and demanding damages or compensation therefor, although such suits, other proceedings, allegations or demands are wholly groundless, false, or fraudulent, and to pay all costs taxed against this member in any legal proceeding defended by the company, all interest accruing after entry of judgment and all expenses incurred for investigation, negotiation or defense.

(g) Liability of the Fund to the employees of any employer is specifically limited to such obligations as are imposed by Florida law against the employer for workers' compensation and/or employer's liability.

(h) The Trustees of the Fund, the Service Agent, and any of their agents, servants, employees or attorneys shall be permitted at all reasonable times to inspect the work places, plants, works, machinery and appliances covered by this agreement, and shall be permitted at all reasonable times and within two years after the final termination of the membership to examine members' books, vouchers, contracts, documents, and records of any and every kind which show or tend to show or verify the premium which is payable under the terms hereof.

(i) The coverage of the Fund does not apply to punitive or exemplary damages on account of such injuries to any employee or employer in violation of law.

(j) Coverage by the Fund under the terms of this agreement shall expire and be cancelled automatically for nonpayment of premium, and a member may be expelled and dropped from the Fund upon thirty (30) days written notice by the Trustees or the Service Agent of the Fund to the member stating when, no less than thirty (30) days thereafter, cancellation shall be effective.

(k) The Fund shall not be liable for any additional compensation imposed by Section 440.54, F.S.
10. The Trustees are authorized to set aside from the premiums collected a reasonable sum for the operating expenses or administrative expenses of the Fund. All remaining funds coming into their hands during any one fiscal year of the Fund shall be set aside and shall be used only for the following purposes:
(a) Fee for the Service Agent for said Fund as provided in paragraph 5., supra.

(b) Payments for medical, surgical, hospital and nursing expense, and payments of compensation to employees covered by this contract, including settlements, awards, judgments, legal fees, and costs in all contest cases.

(c) Payment of Administrative, Special Disability Fund, and other assessments as required by the Office.

(d) Payment of cost of all bonds and auditing expenses required of the Fund or its agents or employees by the Office.

(e) Distribution to members in such manner as the Trustees shall deem to be equitable of any excess monies remaining after payment of claims and claims expenses and after provision has been made for open claims and outstanding reserves; provided, however, that no such distributions shall be made prior to the approval of the Office, and after complying with the applicable law and rules; provided, further, that undistributed excess funds from previous Fund Years may be distributed at any time if not required for reserves and if approved for distribution by the Office.
11. The Fund shall operate on a fiscal year from 12:01 a.m. ___ first to midnight of the last day in ___ of the succeeding year. Application for continuing membership, when approved in writing by the Trustees or their designee, shall constitute a continuing contract for each succeeding fiscal period unless cancelled by the Office or the fund, or unless the member shall have resigned or withdrawn from said Fund by written notice.

12. The members jointly and severally covenant and agree that there will be no disbursement out of this Fund by way of dividends or distribution of accumulated reserve to members until after provision has been made for all obligations under the Workers' Compensation Law against said Fund and except at the discretion of the Trustees, upon application to and approval by the Division.

13. Any member who formally applies for membership in this Fund and is accepted by the Trustees shall thereupon become a party to this agreement and be bound by all of the terms and conditions hereof, and said approved application shall constitute a counterpart of this agreement.
IN WITNESS WHEREOF, the members of ___ Self-Insurers Fund have caused these presents to be signed by their duly authorized Chairman of the Board of Trustees and have had this agreement attested by its duly authorized secretary.

___ Self-Insurers Fund

By ________________________________
CHAIRMAN

ATTEST:
___________________________________

Secretary of Board of Trustees

Signed, sealed and delivered in the presence of:
____________________________________

____________________________________
We, the undersigned ___ do hereunto set our hands and seals to certify our acceptance of our duties as Service Agent for ___ Self-Insurers Fund this ___ day of ___ A.D., 20___.
By ___________________

Attest _________________
Its Secretary
Signed, sealed and delivered in the presence of:

________________________________________

________________________________________

69O FAC 190.069 | Self-Insurers Fund Member Experience Records

(1) Employers participating in a self-insurers fund under the provisions of Section 624.4621, F.S., shall be subject to the Experience Rating Plan and the payroll classification and premium determination system established by the National Council on Compensation Insurance (NCCI).

(2) The Office shall determine an experience modification for each qualified member of a self-insurers fund annually, or as otherwise provided, on the same basis as if the employer were insured under the provisions of Section 440.38(1)(a), F.S., and such modification is to be used to determine the employer's standard premium as provided by these rules and the indemnity agreement. Funds shall submit only those members who qualify for experience rating in accordance with the NCCI Experience Rating Plan Manual.

(3) For any fund member who's experience must be combined with the experience modification factor of an insured group because of ownership requirements under the NCCI Experience Rating Plan, the fund must provide its experience to NCCI and have a combined experience modification factor calculated by NCCI. Any expenses of this transaction shall be the responsibility of the fund.

(4) Each self-insurers fund administrator and each self-insurers fund service company, if applicable, may be furnished a copy of the experience rating calculations.

(5) Should a member cease to participate in a self-insurers fund and purchase standard insurance coverage, the Experience Rating Plan provides that self-insured experience may be used in the employer's future experience rating calculation.

(6) Loss experience tabulations will be furnished upon request of the employer and a fee for such services may be assessed to defray preparing such tabulations, such cost to be actual reimbursement to the Office.

69O FAC 190.071 | Authorized Investments for Self-Insurers Funds

(1) The trustees of a fund are authorized to invest the assets of the fund only in the manner prescribed by these rules.

(2) Monies allocated to claims reserves net of excess recoveries for all policy years prior to the current year, the current year loss fund, all security deposits, and encumbered miscellaneous income shall be invested only in the following manner:
(a) Bankers acceptances from Prime Money Center Banks located within the United States and purchased through authorized financial institutions as defined in this rule.

(b) Savings accounts, checking accounts, money market accounts, certificates of deposit and fully collateralized repurchase agreements in financial institutions authorized pursuant to this rule.

(c) U.S. Treasury notes, bonds, and bills.

(d) Any security issued by the U.S. government or government agency and backed by the full faith and credit of the U.S. government.

(e) Any security which is a general obligation of the U.S. government or U.S. government agency.

(f) Securities issued by the State of Florida, or any agency or political subdivision which are backed by the full faith and credit of the State of Florida.

(g) Mutual funds which invest 100% in U.S. government or U.S. governments agency securities and whose published management policy limits the risk to principal amount invested. Funds must maintain current prospectuses on all mutual funds in which they invest.

(h) Annuities issued by insurers licensed by the State of Florida and whose policies are subject to the protection of the Florida Life and Health Insurance Guaranty Association. Investments in annuities are subject to the following limitations:
1. At least 30 days prior to the fund purchasing its first annuity, and annually thereafter, a fund shall submit an actuarial review by a qualified actuary examining the impact on the fund's present and future financial condition of purchasing annuities and foregoing the earning of investment income on the amounts invested in the annuities. The actuarial review shall take into account all aggregate reserve requirements and shall estimate the percent of the fund's reserves which may safely be invested in annuities. This percentage shall be the maximum amount allowable for investment in annuities subject to subsequent annual reviews by the fund's actuary. For purposes of this paragraph only, the actuary may be a member of the Society of Actuaries, American Academy of Actuaries or Casualty Actuarial Society.

2. Annuities shall be single premium annuities and shall be purchased only for the purpose of providing a payment stream for a given claim. Claims eligible for annuity funding shall be those claims with specific periodic benefit payments and with payments expected to continue for at least 61 months.

3. All annuities purchased shall have the fund as beneficiary. The fund may instruct the insurer to pay benefits directly to the claimant. The policy shall provide that the sum of the periodic benefit payments paid plus the cash value of the policy shall be greater than or equal to the amount of premium paid.

4. All annuities shall be tied to the claimant's life span.

5. If the cash value of the annuity exceeds $100,000 or the estimated benefits payable under the terms of the annuity, including cash value, exceeds $300,000, then the annuity shall be purchased only from a licensed insurer with a rating from the most recent edition of the A. M. BEST INSURANCE REPORTS, LIFE-HEALTH, of at least "A." The annuity policy shall also be subject to the protection of the Florida Life and Health Insurance Guaranty Association.

6. The rules contained in paragraph (f) relating to the purchase of annuities shall not apply to annuities purchased for a claim settlement pursuant to an order of a Deputy Commissioner.
(i) Land and existing buildings used or acquired for use as its principal home office and for use by its service company, if any, when conducting business involving the fund. Prior to investing in land and buildings, the fund shall submit to the Office the following items:
1. An appraisal of the building and land showing that the market value of the building and land is greater than or equal to the principal amount of the investment. The appraisal shall be prepared in accordance with the Uniform Standards of Professional Appraisal Practice. The Uniform Standards of Professional Appraisal Practice of the Society of Real Estate Appraisers (effective July 1, 1987) are hereby adopted by reference and made a part of this rule by reference.

2. An analysis by the fund's actuary on the impact of the investment on the liquidity of the fund for claims payment purposes.

3. A financial analysis using generally accepted accounting principles showing that the proposed investment will decrease the expense overhead of the fund compared to acquiring office space through renting commercial property.

4. A certified resolution of the board of trustees stating that the investment is intended solely for reducing the overhead expense of the fund and that the investment is not for purposes of speculation or resale.
(j) If the building or land purchased requires modification or renovation in order to make it suitable for the fund's use, then the total cost of purchase of the building and land plus the cost of renovation or modification shall not exceed the 5 percent limit imposed by paragraph (n).

(k) If, instead of buying an existing building, a fund wishes to purchase land and construct a building on the land, then the following conditions shall be met in addition to those imposed by paragraph (i):
1. Land acquired for use in the construction of a building may be held for no longer than 18 months before construction shall begin. If construction is not begun within 18 months, then the fund may request a one time extension period to begin construction. An extension shall be granted upon submission of evidence that the fund has made a reasonable effort to begin construction within the time prescribed and that construction will begin before the end of the extension. If no extension is granted or if construction does not begin by the end of the extension then the land shall be sold.

2. All contracts awarded to the prime contractor shall contain a maximum fixed cost. The fund shall secure a performance bond in the amount of the contract from the prime contractor.

3. The total cost of acquiring the land, improving the land and construction of the building shall not exceed the 5 percent limit imposed by paragraph (n).
(l) The fund shall be the sole owner or mortgagee of the land and building, and no sale of real property for a price less than the original cost of the land and building shall take place without the written consent of the Office. The Office shall approve the sale unless the sale impairs the ability of the fund to meet its financial obligations.

(m) Investment in land or building pursuant to paragraphs (i) and (k), shall be subject to the approval of the Office. In approving this investment, the Office shall consider the impact of the investment on fund liquidity and solvency, the percent of net claims reserves invested and the amount of fund overhead expenses reduced by the investment. All books and records of the fund relating to acquiring land and acquiring or constructing a building shall be open to inspection by the Office.

(n) In no event shall the amount invested in land or building exceed 5 percent of the fund's claims reserves, net of excess recoveries.
1. If the cost of purchasing land, purchasing or constructing a building, renovating a building or improving the land exceeds the 5 percent limit imposed by paragraph (n), then the fund shall allocate all its unencumbered surplus until an amount equal to the portion of the cost in excess of 5 percent is transferred to claims reserves.

2. If the Office subsequently determines that the investment endangers fund solvency or liquidity, or if the original cost of purchasing land, purchasing or constructing a building, renovating a building or improving the land ever exceeds 10 percent of loss reserves as defined by subsection 69O-190.059(3), F.A.C., the fund shall sell the land or building, obtain a mortgage on the property or allocate unappropriated surplus in order to provide sufficient liquidity to meet its obligations.

3. The fund shall allocate an amount each year to claims reserves equal to the amount of depreciation taken on the land and building.
(3) Investments pursuant to subsection (2) paragraphs (a) through (f), shall have maturity dates of not more than 10 years from the date of purchase. Furthermore, all investments shall be made in such a manner that dates of maturity of investments shall coincide with the claim payment needs of the fund. The Commission shall adopt as a rule a schedule which may be amended from time to time and which is based on the analysis of the payment patterns of all active self-insurers funds. Such schedule shall be used by all funds to determine the maturity dates for investments so that the claim payment needs of each fund are satisfied. If a fund submits to the Office an analysis by a qualified actuary which demonstrates the fund's payment pattern is substantially different from the schedule published by the Office, the Office shall authorize the fund to purchase its investments based on the payment pattern of the fund rather than on the published schedule.

(4) No fund shall invest so that more than 10 percent of the fund's assets are invested in a single financial institution unless such investment is fully insured by an agency of the United States government or satisfactorily collateralized pursuant to the conditions contained in subsection (7).

(5) All monies, other than those specified in subsection (2), held by a fund shall be invested in any manner authorized in subsection (2) and for any period of maturity.

(6) Investments pursuant to subsection (4) may be purchased with maturity dates subject to the discretion of the trustees. All such investments shall be purchased through financial institutions within the State of Florida.

(7) The trustees, upon approval by the Office, are authorized to enter into repurchase agreements subject to the following conditions:
(a) The agreement is with a financial institution within the State of Florida.

(b) The fund secures collateral for the agreement in the form of specific securities pledged to the fund whose market value is no less than the amount of the agreement.

(c) All securities pledged as collateral shall be acceptable pursuant to the restrictions imposed by subsections (2), (3) and (4). Upon receipt of proof of compliance with these conditions the Office shall approve the repurchase agreements.
(8) Authorized securities may be purchased through authorized financial institutions. For the purposes of this section, authorized financial institutions shall mean:
(a) Banks, savings and loan associations, and credit unions operating within the State of Florida and licensed by the State of Florida, the U.S. government or authorized under the Reciprocal Regional Banking Act of 1984 and whose accounts are insured by an agency of the U.S. government; and,

(b) Investment brokerage firms licensed by the Securities and Exchange Commission and insured by an agency of the U.S. government and operating within the State of Florida.
(9) The Office shall prohibit a fund from investing in, or order the liquidation of, an otherwise authorized investment upon a finding, based on reasonable cause, that a specific investment has become unsafe or that a specific financial institution is or may become insolvent.

69O FAC 190.072 | Miscellaneous Income of a Self-Insurers Fund

(1) Miscellaneous income is all income received by a fund other than premium paid by members.

(2) If the Office determines that a fund shall allocate miscellaneous income to fund a deficit or contingent liability, then the amount allocated shall be part of the fund's security deposit and shall be encumbered for use only as specified by the Division.

(3) All unencumbered miscellaneous income may be disbursed at the discretion of the trustees in any manner not contrary to the rules or to the purpose for which the fund was established.

(4) Investment income earned after the end of the last policy year shall be disbursed only for essential fund operating expenses and dividends pursuant to subsection 69O-190.065(6), F.A.C. These expenses shall include payment of claims and claims expenses, service fees, administrative overhead, marketing costs, promotional costs, commissions, and other expenses related to the direct operating costs of the fund. Essential fund operating expenses shall not include refunds, dividends, bonuses, or other similar expenses.

69O FAC 190.073 | Premium Audit

(1) All self-insurers funds shall determine the normal premium due from each member in each policy year based on actual audited payroll. Audits shall consist of physical, onsite audits or mail self-audits. The requirements set forth in this rule shall apply to the fund and its present or former members. Funds shall be responsible for the compliance with this rule of contracted audit personnel or firms.

(2) Physical, onsite audits shall be required for all members who meet one of the following conditions:
(a) New members (new businesses or members who had coverage with another fund or carrier when they joined the current fund) who are eligible for experience rating at policy inception.

(b) New members in the construction industry. Any employer with classification codes subject to the Florida Contractors Classification Premium Adjustment program shall be deemed to be in the construction industry.

(c) All renewal members (members who were in the same fund for the new and prior policy period) who are eligible for experience rating at policy renewal.

(d) Any member may be audited at the discretion of the fund.
(3) Mail self-audits will be allowed for all new and renewal accounts not required to have a physical, onsite audit. However, any member shall have the right to request a physical, onsite audit when such a request is made on reasonable grounds.

(4) Each member shall be notified in writing by the fund of the audit requirements and penalties set forth in these rules. Such notice in plain language shall be mailed to the member at least 45 days prior to the end of each policy year.

(5) Each member shall be notified by the fund, either in person, by telephone or in writing prior to date that the physical audit is to be made.

(6) The following procedures shall govern the scheduling of physical, onsite audits:
(a) The fund shall make at least two separate good faith attempts to schedule a physical, onsite audit at a date and time mutually agreeable to the member and the fund.

(b) The fund shall keep a written record of the time and date of each attempt.

(c) After two attempts, if the fund is unable to establish, with the member, a mutually agreeable date for an audit, then the fund shall give the member notice by certified mail of the date of the fund's choice on which an audit is to be performed. The fund may, at this time, issue a notice of termination to the member. This procedure is also applicable if the member cancels, with sufficient notice, two different appointments for a mutually agreed upon audit.

(d) Such notice shall include, in plain language, the statutory penalties for the member's failure to give the fund access to the member's records and for the member's failure to allow the fund to complete its audit.
(7) All funds shall complete audits (both physical or mail) on 90% of its premium within 5 months after the end of the policy year.

(8) If a new member meets one or more of the following criteria then a preliminary, onsite audit should be performed within 6 months of the beginning of the policy year:
(a) Payroll contained on the UCT-6 forms or the monthly application updates is inconsistent with the member's estimated annual premium.

(b) Information contained on the monthly application updates (OIR Form BSI-3A) is inconsistent with the member's estimated annual premium.

(c) Construction risks with estimated annual premium in excess of $10,000.

(d) Any trucking or employee leasing business.

(e) Any business with over $50,000 in estimated annual premium.
(9) A physical onsite audit shall be performed on all members who terminate during their first year of membership. Such audit shall be scheduled within 30 days after the termination date and completed within 60 days after the termination date. Procedures applicable to year ending physical audits shall also apply to audits of terminated members.

(10) The following procedures and standards shall apply to all physical, onsite audits performed by the fund:
(a) The audit shall include a review of the member's records and such review shall be sufficient to determine the actual premium owed to the fund and shall include an inspection of the member's premises sufficient to determine the correctness of classification assignments, if such inspection has not previously been performed.

(b) If all of a member's records are not maintained at one location, then an audit shall be performed at each location containing records.

(c) If a member's estimated annual premium is in excess of $100,000, then an inspection of the member's premises at all locations shall be part of the audit. Locations which were inspected during the expiring policy period by the fund's safety personnel or which were the subject of a classification inspection during the same period need not be visited again during the audit.
(11) The following records are to be audited onsite, as applicable to the individual member:
(a) Payroll records;

(b) Ledgers or journals;

(c) UCT-6 reports;

(d) Checking accounts;

(e) Certificates of insurance for subcontractors;

(f) Form 1099's;

(g) Claims history; and,

(h) Any other pertinent records.
(12) All audit reports, both physical and mail, shall include a summary of the correct audited payroll by classification, payrolls and classifications previously reported by the member, the calculation of the difference in payroll and a determination of the under or over payment of premium. The fund shall retain the audit report for at least 2 years and the audit workpapers for at least one year.

(13) When a fund schedules a mutually agreed upon audit, the member shall provide the name and title of the person who will represent the member at the time of the audit. If the agreed upon audit is more than 7 working days from the date the appointment was made, the fund shall confirm the appointment in writing and include the name of person designated to represent the member at the audit. The confirmation should include a statement that the member is to notify the fund by telephone immediately if the appointment cannot be kept.

(14) The fund shall make at least two good faith attempts to obtain the return of a mail audit before any penalties may be applied.

(15) If the fund attempts to complete a mutually agreed upon audit and cannot complete the audit because the member failed to give the fund access to the necessary records, the fund shall select a new date and time at least 2 weeks in advance. The fund shall send a notice to the member by certified mail advising the member of the audit and of the penalties for failure to allow the fund to complete the scheduled audit. Denial of access of records by the member's agent or representative shall be considered the same as a denial by the member.

(16) If a member disputes the findings of a physical audit or the fund's premium determination based on a mail audit, the following procedures shall apply:
(a) The member shall have 30 days from the date the audit results were mailed to file a written response to the fund. The response shall contain the specific facts in dispute as well as any documents which are pertinent to the dispute.

(b) Upon receipt of a timely notice of the dispute, the fund shall investigate the matter and render a written decision. A written decision shall be rendered on at least 75% of disputed audits within 30 days after the response was mailed by the member.

(c) If the fund does not agree with the member's position, the fund may schedule another audit in the same manner as the original audit.

(d) Any reaudit scheduled shall be used to determine the member's premium and the fund is not obligated to perform any further audit unless there is substantial evidence that both the original audit and the reaudit were incorrectly performed.

(e) The dispute shall be resolved in accordance with the dispute resolution procedure adopted by the fund pursuant to Rule 69O-190.064, F.A.C.

(f) Failure of the member or the fund to comply with the timeframes contained in paragraphs (a) and (b), without reasonable cause shall result in the matter being resolved in favor of the other party.
(17) Any overpayment of premium shall be refunded to the member within 60 days after the completion of any undisputed audit. Refunds of overpayment of premium shall be refunded within 30 days after the resolution of any dispute. The fund shall have the right to apply any overpayment of premium to any unpaid premium.

(18) A member may be fined $500 by a fund for failure to allow access to essential records during the course of a physical audit subject to the following conditions:
(a) The member has failed to allow the completion of a prior physical audit, when such audit was scheduled on a date and time mutually agreeable to the fund and the member; or

(b) The member has canceled two previous appointments for a physical audit; and,

(c) The fund has notified the member by certified mail of the date and time of the next scheduled audit and such notice shall include the penalties for failure to complete the next audit; and,

(d) The fund incurred time and travel expenses in attempting to complete the next audit.
(19) If the fund cannot complete an audit because the employer failed to maintain essential records then the member shall be subject to a $500 fine in the same manner and under the same conditions as if the member denied the fund access to his records.

(20) The $500 fine imposed by the fund shall become a part of the premium owed the fund and shall be collected in the same manner and at the same time as other premium. The $500 fine may be deducted from any premium overpayment owed to the member.

(21) If the failure to complete a physical audit or to return a mail audit results in the fund's inability to determine an accurate final premium, the fund may arbitrarily determine payroll and charge up to a maximum of three times the most recent estimated annual premium in accordance with Section 440.381(8), F.S.

(22) If the member intentionally understates payroll or misrepresents employee duties on the Application for membership or on the monthly updates and this results in an underpayment of premium, the member shall pay 12 percent simple interest to the fund on the amount of underpaid premium. The fund shall not be eligible to collect interest on the underpayment if the understatement of payroll or misrepresentation of employee duties could have been determined from a review of the monthly updates or UCT-6 forms.

(23) If the fund determines that a member has deliberately filed an Application for Membership or monthly updates containing false, misleading or incomplete information for the purpose of avoiding or reducing the amount of premium owed, then the fund shall notify the office and the Bureau of Worker' Compensation Insurance Fraud of the name of the member as well as all supporting documents.

69O FAC 190.074 | Forms, Manuals and Instructions Adopted

(1) OIR forms adopted. The OIR forms set forth in paragraphs (a) through (aa) of this subsection, as well as the accompanying instructions to the forms, are hereby incorporated into rule Chapter 69O-190, F.A.C., by reference. Copies of the forms are available from the Bureau of P & L Insurer Solvency, Office of Insurance Regulation, Tallahassee, Florida 32399-0300.
(a) OIR Form BSI-1, Application for Self-Insurance.

(b) OIR Form BSI-2, Employer Application for Group Coverage.

(c) OIR Form BSI-3, Membership Application.

(d) OIR Form BSI-3A, Self-Insurers Fund Member Application Monthly Change Sheet.

(e) OIR Form BSI-4, Revised Self-Insurers Surety Bond (Guaranty Fund Member).

(f) OIR Form BSI-4A, Self-Insurers Surety Bond (Guaranty Fund Non-Member).

(g) OIR Form BSI-4B, Self-Insurers Surety Bond.

(h) OIR Form BSI-5, Payroll Report, and the accompanying instructions.

(i) OIR Form BSI-6, Self-Insurance Letter of Credit.

(j) OIR Form BSI-11, Indemnity Agreement.

(k) OIR Form BSI-12, Drug-Free Workplace Program.

(l) OIR Form BSI-17, Unit Statistical Report, and the accompanying instructions.

(m) OIR Form BSI-19, Certification of Servicing for Self-Insurance.

(n) OIR Form BSI-20, Report of Workers' Compensation Liabilities.

(o) OIR Form BSI-21, Breakdown of Policy Year Expenses.

(p) OIR Form BSI-22, Service Company Application.

(q) OIR Form BSI-23, Service Company Annual Report Form.

(r) OIR Form BSI-24, Quarterly Status Report.

(s) OIR Form BSI-24A, Preferred Payment Plan Quarterly Report.

(t) OIR Form BSI-26, Checklist for the Submission of Loss Reserve Reports.

(u) OIR Form BSI-27, Biographical Statement.

(v) OIR Form BSI-28, Quarterly Financial Statement.

(w) OIR Form BSI-29, Annual Financial Statement.

(x) OIR Form BSI-30, Report on Preferred Payment Plan.

(y) OIR Form BSI-31, Audit Procedures for Contractor/Independent Contractor Relationship.

(z) OIR Form BCM 201, Notice of Termination.

(aa) OIR Form BSI 206, Certificate of Self-Insurance, and the accompanying instructions.
(2) NAIC forms, instructions and manuals adopted. The NAIC forms, instructions and manual set forth in subparagraphs (a) through (e) of this subsection are hereby incorporated into rule Chapter 69O-190, F.A.C., by reference. Copies of the forms are available from the National Association of Insurance Commissioners, 120 West 12th Street, Suite 1100, Kansas City, Missouri 64105, and are available for inspection during regular business hours at the Office at its headquarters in Tallahassee, Florida.
(a) The 1992 National Association of Insurance Commissioners Quarterly Statement, Fire and Casualty Companies Association Edition.

(b) The Jurat Page; Statutory Balance Sheet; Underwriting and Investment Exhibit - Income Statement; Cash Flow; Underwriting and Investment Exhibit Part 1, Part 1A, Part 2, Part 2A, Part 3, Part 3A and Part 4; Exhibit 1 - Analysis of Assets; Exhibit 2 - Analysis of Non-Admitted Assets; Notes to Financial Statements; Five Year Historical Data (NOTE: funds shall complete this form on a going forward basis); Schedule of Special Deposits; Schedule A Part 1; Schedule B; Schedule BA; Schedule C; Schedule D Part 1, Part 1A, Part 3, Part 4 and Part 5 (NOTE: only 4th quarter transactions need to be reported); Schedule DA Part 1; Schedule F - Part 1A (NOTE: any amounts in dispute must be disclosed), Schedule M; Schedule N; Schedule P, Part 1 Summary, Part 2 Summary, Part 3 Summary, Part 5 Summary, Interrogatories; Schedule X; Schedule Y of the 1992 National Association of Insurance Commissioners Annual Statement, Fire and Casualty Companies Association Edition.

(c) The NAIC's Annual Statement Instructions, Property and Casualty, 1993 edition.

(d) The NAIC's Accounting Practices and Procedures Manual for Property and Casualty Insurance Companies, 1993 edition.

(e) The NAIC's Financial Condition Examiner's Handbook, 1993 edition.
69O-191 | Health Maintenance Organizations

69O FAC 191.021 | Scope (Repealed)

69O FAC 191.024 | Definitions for the Purposes of These Rules

(1) All terms defined in the Health Maintenance Organization Act, Part I, Chapter 641, F.S., which are used in these rules shall have the same meaning as in the Act.

(2) Advertising. Advertising includes but is not limited to printed and published material, descriptive literature and sales aids, sales talks and sales materials, booklets, forms and pamphlets, illustrations, depictions and form letters, newspaper, radio, television or direct mail advertising, and any materials used by agents.

(3) Audited Financial Statements. A statement, prepared by an independent CPA, which shall include an opinion from the CPA concerning the financial statements, a balance sheet, a statement of operations, a statement of cash flow (direct method), and notes to the financial statement, which shall be prepared on the basis of statutory accounting principles (see subsection 69O-191.075(1), F.A.C.), on an accrual basis, covering the HMO's latest annual reporting period.

(4) Combination Model - HMO. A Health Maintenance Organization model that has a combination of the staff and IPA models to provide health care services to its membership.

(5) Community Rate. The per member per month revenue requirement for a set of benefits or services for a specific class of subscribers. Such class may encompass the community as a whole.

(6) Emergency Services. Services which are needed immediately because of an injury or unforeseen medical condition which could reasonably be expected to result in disability or death. These must be provided, or arranged to be provided, on a twenty-four hour basis by the HMO, but also may be covered inpatient services or outpatient services that are furnished by an appropriate source other than the HMO when the time required to reach the HMO providers (or alternatives authorized by the HMO) could mean the risk of permanent damage to the subscriber's health. Notwithstanding the above, these services are considered to be emergency services, in or out of the service area, only as long as transfer of the subscriber to the HMO's source of health care or designated alternative is precluded because of risk to the subscriber's health or because transfer would be unreasonable, given the distance involved in the transfer and nature of the medical condition.

(7) Fraud. A false statement concerning a material fact with knowledge by the person making the false statement and intent that the representation will induce action which results in detrimental reliance.

(8) Health Care Provider Certificate. A certificate issued by the Office of Health and Rehabilitative Services in accordance with Part III, Chapter 641, F.S.

(9) Health Maintenance Organization Type Insurance. The provision of health care services in exchange for a contractually set premium on a prepaid per capita or prepaid aggregate fixed-sum basis. The indemnity insurance type of arrangement which consists of a deductible amount and a percentage of fees due is permitted only where specifically authorized by Florida Statutes.

(10) HMO. Health Maintenance Organization may be abbreviated as HMO in these rules.

(11) Individual Physician. As used in Section 641.2342, F.S., a physician who is a sole practitioner with no other physicians employed by the contracting physician or under contract with the physician to provide primary care services.

(12) Individual Practice Association (IPA) Model - HMO. A Health Maintenance Organization health care delivery model in which the HMO contracts with individual physician(s), a medical group, or physician organization which in turn may contract with other individual physicians or groups. The IPA physicians may practice in their own offices and continue to see their fee-for-service patients.

(13) Medical Emergency. An unexpected and unforeseen disease, illness or injury which will result in disability or death if not treated immediately.

(14) Medical Staff. A formal organization of physicians and other health care practitioners in an HMO with the delegated responsibility to maintain acceptable standards in delivery of health care and to plan for continued betterment of that care.

(15) Minimum Services. Minimum Services include the following services:
(a) Emergency Care. Emergency inpatient, outpatient and physician services shall be available on a twenty-four hour, seven day a week basis, either by the HMO through its own facilities or through arrangements with other providers. Emergency resuscitation supplies shall be available. Physicians and other health care practitioners shall be readily available at all times. In addition, emergency services, as defined in these rules, shall be covered by the HMO.

(b) Inpatient Hospital Services. Inpatient hospital services shall be available on a twenty-four hour, seven day a week basis either through the HMO's own facility or through arrangements with hospitals. Inpatient hospital services shall include, but are not limited to, room and board, general nursing care, meals and special diets when medically necessary, use of operating room and related facilities, use of intensive care unit and services, x-ray services, laboratory and other diagnostic tests, drugs, medications, biologicals, anesthesia and oxygen services, radiation therapy, inhalation therapy, and the providing and administration of whole blood and blood plasma, unless replacement blood is arranged or provided, in accordance with community replacement standards.

(c) Physician Care. Physician care, provided or supervised by physicians licensed under Chapter 458, 459, 460 or 461, F.S., of sufficient type and number to adequately provide for the contracted services. Physician care shall include consultant and referral services by a physician.

(d) Ambulatory Diagnostic Treatment. Outpatient diagnostic treatment service with an emphasis directed toward primary care including but not limited to diagnostic laboratory and diagnostic radiological services.

(e) Preventive Health Care Services. A program of health evaluation, education and immunizations which is designed to prevent illness and disease and to improve the general health of HMO subscribers. This program shall include at least the following:
1. Well-child care from birth;

2. Periodic health evaluations for adults;

3. Eye screenings by a physician or optometrist licensed pursuant to Chapter 463, F.S., and ear screenings by a physician for children through age 17, to determine the need for vision and hearing correction; and,

4. Pediatric and adult immunizations which are medically necessary in accordance with accepted medical practice.
(16) Optionally Renewable Contract. A contract for which renewal can be declined at the option of the HMO.

(17) Pre-Existing Condition or Illness. A condition, or symptoms thereof, which was diagnosed, and for which the individual received medical advice or treatment from a physician within a twenty-four month period preceding the effective date of coverage.

(18) Premium. The contracted sum paid by or on behalf of a subscriber or group of subscribers on a prepaid per capita or a prepaid aggregate basis for the services rendered by the HMO. The HMO may charge co-payments specified in the subscriber contract and in accordance with Rule 69O-191.035, F.A.C.

(19) Properly Completed Application. An application for a Certificate of Authority that contains all of the items specified in the Application for Certificate of Authority, obtained from the Applications Coordination Section, Insurer Services Support, Office of Insurance Regulation, Tallahassee, Florida 32399-0300, which is incorporated herein by reference. The application must be completed in accordance with Part II, Chapter 641, F.S., this rule chapter and in the manner specified within the application in order for each individual item to be considered complete for the purposes of determining that a properly completed application has been filed.

(20) Related Party. A related party means:
(a) Any director, officer, partner, or employee responsible for management of an HMO, or any person who is directly or indirectly beneficial owner of more than 5 percent of the equity of the HMO, any person who is the beneficial owner of a mortgage, deed of trust, note, evidence of indebtedness, or other interest secured by, and having a value of more than 5 percent of the assets of the HMO, and said debt is in default and may be subject to foreclosure and, in the case of an HMO organized as a nonprofit corporation, an incorporator or member of the corporation under applicable State corporation law;

(b) Any entity which has a director, officer, partner, or employee responsible for management or administration of an HMO, any person who is directly or indirectly beneficial owner of more than 5 percent of the equity of the HMO, any person who is the beneficial owner of a mortgage, deed of trust, note, evidence of indebtedness, or other interest, secured by assets of the HMO, and having a value of more than 5 percent of the assets of the HMO, and said debt is in default and may be subject to foreclosure and, in the case of an HMO organized as a nonprofit corporation, an incorporator or member of the corporation under applicable State corporation law or any of the persons identified in paragraph (a), above.
(21) Staff Model - HMO. A Health Maintenance Organization model in which the HMO employs and compensates its physicians. Generally, most ambulatory health services are provided at one or more healthcare delivery locations.

(22) Waiting Period. Waiting period shall relate to that period of time which may be specified in the policy and which must follow the date a person is initially insured under the policy before the coverage or coverages of the policy shall become effective as to such person.

69O FAC 191.027 | Health Maintenance Organizations (Transferred)

69O FAC 191.028 | Standards for Fingerprint Cards for New Applicants and Acquisition Applications (Repealed)

69O FAC 191.029 | Maintaining Eligibility for Certificate of Authority

The HMO place of business shall be located in this state and shall be actively engaged in managed care within six months of licensure, except as provided in Section 641.221(2), F.S. The HMO shall maintain a place of business, the location of which is identifiable by and accessible to the public as determined by the Office. Any HMO holding an existing Certificate of Authority which has not become operational as of the effective date of this rule shall be required to comply within one (1) year of this date.

69O FAC 191.030 | Governing Body

(1) Each HMO shall have a governing body that sets policy and has overall responsibility for the organization, including the following:
(a) Adopting organizational bylaws, rules and regulations, or similar form of document which provides a clear concise statement of the mission, goals, and objectives of the organization.

(b) Adopting a quality assurance program, as required by Chapter 641, Part IV, F.S., that monitors the key areas of the health care delivery system, to identify problems and ensure early recognition of opportunities to improve the delivery of quality health care services.

(c) Maintaining ultimate responsibility for ongoing licensing and credentialing programs.
(2) Nothing in this rule shall prohibit the designation of qualified management personnel to implement the provisions of subsection (1), and to manage the operation of the HMO in the geographic area or areas serviced. The relationship between management personnel and the governing body shall be set forth in writing, including each person's authority, responsibilities and functions.

(3) Biographical statements and character reports are required to be submitted to the Office and shall be included in the application for a Certificate of Authority (COA) on the following persons:
(a) Persons who own or control in excess of five percent of the outstanding stock of the HMO;

(b) Members of the Board of Directors of the HMO;

(c) All officers who are identified by the Office based on a review of the structure of the HMO and the decision making process of the HMO as policy decision making officers and any other individuals who have policy decision making authority;

(d) All officers and directors of any parent corporation or corporations of the HMO, if applicable; and,

(e) All officers and directors of any external management company contracted with the HMO, if applicable, pursuant to paragraph (c), above.

(f) This requirement also applies to individuals who, subsequent to the date of application for a COA, become associated with an HMO and meet any of the qualifications listed in paragraphs (a) through (e), above.
(4) Abbr