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

Notes

Fla. Admin. Code Ann. R. 69O-149.203

Rulemaking Authority 624.308, 627.410(6)(b), 627.6675(3)(c) FS. Law Implemented 624.307(1), 627.410(6)(a), 627.6498(4), 627.6675(3), 641.3922(3) FS.

New 3-2-00, Amended 4-2-01, Formerly 4-149.203, Amended 5-18-04.

New 3-2-00, Amended 4-2-01, Formerly 4-149.203, Amended 5-18-04.