Fla. Admin. Code Ann. R. 69O-156.012 - Filing and Approval of Policies and Certificates and Premium Rates

(1) An issuer shall not deliver or issue for delivery a policy or certificate to a resident of this State unless the policy form or certificate form has been filed with and approved by the Office including any riders or amendments to policy or certificate forms to delete outpatient prescription drug benefits as required by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, in accordance with Sections 627.410, 627.411, 627.674, F.S.

(2) An issuer shall not use or change premium rates for a Medicare supplement policy or certificate unless the rates, rating schedule and supporting documentation have been filed with and approved by the Office in accordance with Sections 627.410, 627.411, 627.674, F.S.

(3)

(a) Except as provided in paragraph 69O-156.012(3)(b), F.A.C., an issuer shall not file for approval more than one form of a policy or certificate of each type for each standard Medicare supplement benefit plan.

(b) An issuer may offer, with the approval of the Office, up to four (4) additional policy forms or certificate forms of the same type for the same standard Medicare supplement benefit plan, one for each of the following cases:

1. The inclusion of new or innovative benefits;

2. The addition of either direct response or agent marketing methods;

3. The addition of either guaranteed issue or underwritten coverage;

4. The offering of coverage to individuals eligible for Medicare by reason of disability.

(c) For the purposes of this rule, a "type" means an individual policy, a group policy, an individual Medicare Select policy, or a group Medicare Select policy.

(d) Acceptable rate classification criteria within a form include only age, gender, area and smoker status or tobacco usage.

(4)

(a) Except as provided in subparagraph 69O-156.012(4)(a) 1., F.A.C., an issuer shall continue to make available for purchase any policy form or certificate form issued after the effective date of this rule chapter that has been approved by the Office. A policy form or certificate form shall not be considered to be available for purchase unless the issuer has actively offered it for sale in the previous twelve (12) months.

1. An issuer may discontinue the availability of a policy form or certificate form if the issuer provides to the Office in writing its decision at least thirty (30) days prior to discontinuing the availability of the form of the policy or certificate. After receipt of the notice by the Office, the issuer shall no longer offer for sale the policy form or certificate form in this State.

2. An issuer that discontinues the availability of a policy form or certificate form pursuant to subparagraph 69O-156.012(4)(a) 1., F.A.C., or Section 627.410, F.S., shall not file for approval a new policy form or certificate form of the same type for the same standard Medicare supplement benefit plan as the discontinued form for a period of five (5) years after the issuer provides notice to the Office of the discontinuance.

(b) The sale or other transfer of Medicare supplement business to another issuer shall be considered a discontinuance for the purposes of this rule.

(c) A change in the rating structure or methodology shall be considered a discontinuance under paragraph 69O-156.012(4)(a), F.A.C., unless the issuer complies with the following requirements:

1. The issuer provides an actuarial memorandum describing the manner in which the revised rating methodology and resultant rates differ from the existing rating methodology and existing rates.

2. The issuer does not subsequently put into effect a change of rates or rating factors that would cause the percentage differential between the discontinued and subsequent rates as described in the actuarial memorandum to change. The Office may approve a change to the differential which is in the public interest.

(5)

(a) Except as provided in paragraph 69O-156.012(5)(b), F.A.C., the experience of all policy forms or certificate forms of the same type in a standard Medicare supplement benefit plan shall be combined for purposes of the refund or credit calculation prescribed in Rule 69O-156.011, F.A.C., and for all other rating purposes. The issue date of a standard Medicare supplement benefit plan is not a basis to separate experience of two or more plans of the same plan letter.

(b) Forms assumed under an assumption reinsurance agreement shall not be combined with the experience of other forms for purposes of the refund or credit calculation.

Notes

Fla. Admin. Code Ann. R. 69O-156.012

Rulemaking Authority 624.308 FS. Law Implemented 624.307(1), 627.410, 627.411, 627.674 FS.

New 1-1-92, Amended 7-14-96, 3-4-01, Formerly 4-156.012, Amended 9-15-05, 1-4-10.

New 1-1-92, Amended 7-14-96, 3-4-01, Formerly 4-156.012, Amended 9-15-05, 1-4-10.