Fla. Admin. Code Ann. R. 69O-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.

Notes

Fla. Admin. Code Ann. R. 69O-149.0055

Rulemaking Authority 624.308(1), 627.410(6), 641.31(2), 641.36 FS. Law Implemented 624.307(1), 627.6402, 627.65626, 641.31(40) FS.

New 3-24-05, Amended 1-12-06.

New 3-24-05, Amended 1-12-06.