Fla. Admin. Code Ann. R. 69O-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.
Notes
Rulemaking Authority 624.308, 627.410(9) FS. Law Implemented 624.424(1)(c), 627.410, 636.216, 627.410(9) FS.
New 10-29-91, Amended 5-15-96, 4-4-02, 5-2-02, 6-19-03, Formerly 4-149.022, Amended 4-7-05, 1-12-06, 1-28-13, 12-10-13.
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