(1)
Health insurers shall report health plan data to the Agency for Health Care
Administration (agency) on July 1 of each year for each of the insureds
included in the satisfaction survey results to be reported on July 1 of the
same year as specified in Rule
59B-14.004, F.A.C. The reported
health plan data must be current as of the date the sampling frame is
prepared.
(2) Health plan data shall
be reported for each insured sampled as described in paragraphs (a) through (f)
below. All data elements (a) through (f) are required except that data elements
(e) and (f) may be reported as UNKNOWN if the information is missing or
unavailable. The percentage of unknown responses for any data element must not
exceed 2 percent of total records, except that for measurement year 2005, the
percentage of unknown responses for any data element must not exceed 5 percent
of total records.
(a) Report the Florida
company code assigned by the Florida Office of Insurance Regulation.
(b) Report the NAIC company code as assigned
by the National Association of Insurance Commissioners.
(c) Report the measurement year in four
digits.
(d) Designate the plan type
as:
1. Health plan of health maintenance
organization as defined under Chapter 641, F.S.; or
2. Health plan of health insurer defined
under Chapter 627, F.S.
(e) Report the county of record for the
insured in text, capitalizing the first letter, without using abbreviations or
the word "County." Report the insured's county of residence except for employer
groups, report the county where the employer is located. Report Dade County as
Miami-Dade.
(f) Designate covered
benefits as:
1. Network; or
2. No network.
If the health plan conditions payment of covered benefits on
the use of providers with whom the health insurer has entered into written
agreements to provide such benefits by altering cost sharing or in any manner
altering covered benefits, report subparagraph 1. network. If the health plan
does not condition payment of covered benefits on the use of providers who have
entered into written agreements with the health insurer to provide such
benefits by altering cost sharing or in any manner altering covered benefits,
report subparagraph 2. no network. Report responses as a single digit, 1 or
2.
(3)
The health plan data shall be reported in a text file in the order described in
subsection (2) using a tab between each data element. Report each plan type in
a separate file, appending data (a) through (f) for each insured to the
corresponding survey data for the insured required in Rule
59B-14.004, F.A.C., starting a
new line for each respondent as described in subsection
59B-14.004(7),
F.A.C.
