OIR Rule Development Workshop Report: Reasonableness of Health Insurance Rates; Pooling of Cancer Forms
May 27, 2009
On May 27, 2009, the Florida Office of Insurance Regulation (“OIR”) held a Rule Development Workshop on the following proposed Rules:
- 69O-149.003: Rate Filing Procedures
- 69O-149.005: Reasonableness of Benefits in Relation to Premiums
- 69O-149.007: Annual Rate Certification (ARC) Filing Procedures
The proposed Rules are being promulgated to provide more pooling of cancer forms and to make clarifications to existing provisions. Florida law requires health insurance rates to be reasonable in relation to the provided benefits. These Rules provide guidelines for insurers to help ensure rate compliance.
Three amendments to these Rules were considered over the course of a two-hour discussion: The first establishes rules for pooling of cancer claims in Rule 69O-149.003, F.A.C. The second, in Rule 69O-149.005, F.A.C., prohibits an insurer from knowingly pricing an excessive individual rate to be charged to an insured. The third further restricts the requirements for rate certifications to ensure the veracity and legal compliance of insurers’ rate statements by establishing procedures to be taken by an insurer if the OIR determines a rate certification was inaccurate. (Pursuant to the Rule, knowingly filing a false rate certification constitutes an unfair and deceptive trade practice in violation of Florida law.)
Following the extensive discussion, the presiding OIR officials agreed to continue the Workshop to a later date, which will be determined.
Any written comments on these proposed Rules should be submitted to the OIR before the close of business on June 21, 2009. A copy of the proposed Rules is attached for your review.
Should you have any questions or comments, please contact Colodny Fass.
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