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

Notes

Fla. Admin. Code Ann. R. 69O-149.054

Rulemaking Authority 112.08(6) FS. Law Implemented 112.08 FS.

New 5-18-04.

New 5-18-04.