Fla. Admin. Code Ann. R. 69O-191.051 - Filing, Approval of Subscriber Contract and Related Forms

(1) Every subscriber group, individual, or conversion contract and every rider, endorsement, certificate, application or other forms (including the initial subscriber communication outlining their rights and responsibilities under the grievance process) to be used or issued in connection with any subscriber contract shall be filed by the HMO for approval by the Office. The form may be used immediately upon filing, but is subject to disapproval by the Office. If disapproved, use of the form shall be discontinued immediately. Documentation evidencing any proposed rates or rate changes as required in Rule 69O-191.054, F.A.C., shall accompany the form filing for approval by the Office.

(2) Every form required to be filed by the HMO shall be identified by a unique form number, placed in the lower left hand corner of each form.

(3) One copy of each form filing shall be submitted at the time of filing. HMOs in possession of a Certificate of Authority shall submit all contract filings to the Office electronically through http://www.floir.com/iportal.

(4)

(a) Each HMO shall provide one copy of a written informed consent notice used to disclose the intent of testing a person for HIV infection or other specific sickness as required in Section 641.3007(4)(b), F.S. The form shall include the following:

1. Explanation of the testing;

2. Purpose of the test;

3. Potential uses of the form information and limitations;

4. The meaning of the test results; and,

5. Person's rights to confidential treatment of the information obtained.

(b) The HMO is required to establish a procedure for notifying the applicant's designated physician of a positive test result and in the absence of such designation, by the Florida Office of Health and Rehabilitative Services (DHRS). Positive HIV test results should be transmitted to DHRS in the following manner, when necessary:

(5) Each HMO shall include a copy of the following forms:

(a) Form OIR-B2-1507, "Office of Insurance Regulation, Life and Health Forms and Rates Universal Standardized Data Letter" as adopted in Rule 69O-149.022, F.A.C., completely filled out in accordance with Form OIR-B2-1507A, "Office of Insurance Regulation, Life and Health Forms and Rates Universal Standardized Data Letter Instruction Sheet," as adopted in Rule 69O-149.022, F.A.C.

(b) Form DI4-1356, The Office of Insurance Regulation, Florida HMO Contract Checklist (Includes Individual, Large and Small Group), as adopted in Rule 69O-149.022, F.A.C.

Notes

Fla. Admin. Code Ann. R. 69O-191.051

Rulemaking Authority 641.36 FS. Law Implemented 624.424, 641.21(1)(f), 641.3007(4)(b), (c), 641.31(2), (3) FS.

New 2-22-88, Amended 10-25-89, Formerly 4-31.051, Amended 5-28-92, 8-15-02, 6-19-03, Formerly 4-191.051, Amended by Florida Register Volume 43, Number 138, July 18, 2017 effective 7/30/2017.

New 2-22-88, Amended 10-25-89, Formerly 4-31.051, Amended 5-28-92, 8-15-02, 6-19-03, Formerly 4-191.051, Amended 7-30-17.