Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-149 - FILING OF FORMS AND RATES FOR LIFE/HEALTH INSURANCE › Section 69O-149.022 - Forms Adopted

Current through Reg. 50, No. 138; July 16, 2024
(1) The forms
				adopted in subsection (2), below, shall be used, as applicable, by insurers
				making form filings for life and accident insurance, annuities, and health
				insurance. All the forms in subsections (2) and (3), below, are hereby adopted
				and incorporated by reference. All forms are available and may be printed from
				the Office's website:
www.floir.com
.
(2)
(a)
				Form OIR-B2-1507, "Office of Insurance Regulation, Life and Health Forms and
				Rates Universal Standardized Data Letter", Rev. 06/12.
http://www.flrules.org/Gateway/reference.asp?No=Ref-01706
.
(b) Form OIR-B2-1507 A, "Office of Insurance
				Regulation, Life and Health Forms and Rates Universal Standardized Data Letter
				Instruction Sheet", Rev. 06/12.
http://www.flrules.org/Gateway/reference.asp?No=Ref-01707
.
(c) Health Checklists.
1. OIR-B2-1616, "Blanket Application
				Checklist," Rev. 1/05.
2.
				OIR-B2-535, "Blanket Health Contract Checklist," Rev. 1/04.
3. OIR-B2-527, "Debtor Group Application
				Checklist," Rev. 1/04.
4.
				OIR-B2-529, "Debtor Group Contract Checklist," Rev. 1/04.
5. OIR-B2-528, "Florida Additional
				Information Checklist for Debtor Group," Rev. 8/03.
6. OIR-B2-1607, "Discount Medical Plan
				Organization (DMPO) Contract and Application Checklist," 9/04.
7. OIR-B2-539, "Excess-Specific and Aggregate
				Checklist," Rev. 1/04.
8.
				OIR-B2-540, "Informational Memorandum Checklist - Florida Excess Specific and
				Aggregate - Section 624.406, F.S.," Rev.
				1/04.
9. OIR-B2-1356, "Florida HMO
				Contract Checklist," Rev. 1/04.
10.
				OIR-B2-1617, "Florida HMO Individual Application Checklist," 1/05.
11. OIR-B2-1618, "Florida HMO Master Group
				Application Checklist," 1/05.
12.
				OIR-B2-536, "Franchise Health Application Checklist," Rev. 1/04.
13. OIR-B2-538, "Franchise Health Contract
				Checklist," Rev. 1/04.
14.
				OIR-B2-537, "Franchise Health Outline of Coverage Checklist," Rev.
				1/04.
15. OIR-B2-525, "Group Health
				Application Checklist - Employers, Labor Unions, Association Groups and
				Additional Groups," Rev. 1/04.
16.
				OIR-B2-526, "Group Health Contract Checklist - Employers, Labor Unions,
				Association Groups and Additional Groups," Rev. 1/04.
17. OIR-B2-520, "Individual Health
				Application Checklist," Rev. 1/04.
18. OIR-B2-523, "Individual Health Contract
				Checklist," Rev. 1/04.
19.
				OIR-B2-521, "Individual Health Outline of Coverage Checklist," Rev.
				1/04.
20. OIR-B2-1619, "Long Term
				Care Advertisement Checklist," 1/05.
21. OIR-B2-541, "Long Term Care Application
				Checklist," Rev. 1/04.
22.
				OIR-B2-543, "Long Term Care Contract Checklist," Rev. 1/04.
23. OIR-B2-542, "Long Term Care Outline of
				Coverage Checklist," Rev. 1/04.
24.
				OIR-B2-1620, "Medicare Supplement Advertisement Checklist," 1/05.
25. OIR-B2-1354, "Medicare Supplement
				Application Checklist," Rev. 1/04.
26. OIR-B2-1355, "Medicare Supplement
				Contract Checklist," Rev. 1/04.
27.
				OIR-B2-1621, "Medicare Supplement Outline of Coverage," 1/05.
28. OIR-B2-524, "Out-of-State Group Health
				Checklist," Rev. 1/04.
29.
				OIR-B2-1353, "Pre-Paid Limited Benefit Contract Checklist," Rev.
				1/04.
30. OIR-B2-1359, "Pre-Paid
				Limited Benefit Conversion Application Checklist," Rev. 1/04.
31. OIR-B2-1358, "Pre-Paid Limited Benefit
				Group Application Checklist," Rev. 1/04.
32. OIR-B2-1360, "Pre-Paid Limited Benefit
				Individual Application Checklist," Rev. 1/04.
33. OIR-B2-1622, "Small Group Advertisement
				Checklist," 1/05.
34. OIR-B2-1357,
				"Florida Small Group Health Checklist for Indemnity Plans Other Than Standard
				and Basic," Rev. 1/04.
(d) Life Checklists.
1. OIR-B2-1624, "Credit Disability Policy
				Checklist," 1/05.
2. OIR-B2-1625,
				"Credit Life or Disability Application Checklist," 1/05.
3. OIR-B2-1626, "Credit Life Policy
				Checklist," 1/05.
4. OIR-B2-1367,
				"Endorsements, Amendments & Riders Checklist," Rev. 1/04.
5. OIR-B2-1627, "Group Annuity Enrollment
				Application Checklist," 1/05.
6.
				OIR-B2-1628, "Group Life Enrollment Application Checklist," 1/05.
7. OIR-B2-1363, "Group Non-Variable Annuity
				Contract Checklist," Rev. 1/04.
8.
				OIR-B2-1349, "Group Non-Variable Annuity Enrollment Application Checklist,"
				Rev. 1/04.
9. OIR-B2-1488, "Group
				Term Life Policy Checklist," Rev. 1/04.
10. OIR-B2-1345, "Group Universal Life Policy
				Checklist," Rev. 1/04.
11.
				OIR-B2-1365, "Group Variable Annuity Contract Checklist," Rev. 1/04.
12. OIR-B2-1342, "Group Variable Annuity
				Enrollment Application Checklist," Rev. 1/04.
13. OIR-B2-1629, "Group Variable Life
				Enrollment Application Checklist," 1/05.
14. OIR-B2-1489, "Group Variable Life Policy
				Checklist," Rev. 1/04.
15.
				OIR-B2-1490, "Group Whole Life Policy Checklist," Rev. 1/04.
16. OIR-B2-1630, "Individual Fraternal Life
				Application Checklist," 1/05.
17.
				OIR-B2-1631, "Individual Fraternal Non-Variable Annuity Application Checklist,"
				1/05.
18. OIR-B2-1632, "Individual
				Fraternal Non-Variable Annuity Contract Checklist," 1/05.
19. OIR-B2-1382, "Individual Fraternal Term
				Life Policy Checklist," Rev. 1/04.
20. OIR-B2-1491, "Individual Fraternal
				Universal Life Policy Checklist," Rev. 1/05.
21. OIR-B2-1633, "Individual Fraternal
				Variable Annuity Application Checklist," 1/05.
22. OIR-B2-1634, "Individual Fraternal
				Variable Annuity Contract Checklist," 1/05.
23. OIR-B2-1635, "Individual Fraternal
				Variable Life Application Checklist," 1/05.
24. OIR-B2-1636, "Individual Fraternal
				Variable Life Policy Checklist," 1/05.
25. OIR-B2-1314, "Individual Fraternal Whole
				Life Policy Checklist," Rev. 1/04.
26. OIR-B2-1346, "Individual Life Application
				Checklist," Rev. 1/04.
27.
				OIR-B2-1637, "Individual Non-Variable Annuity Application Checklist,"
				1/05.
28. OIR-B2-1352, "Individual
				Non-Variable Annuity Contract Checklist," Rev. 1/04.
29. OIR-B2-1493, "Individual Term Life Policy
				Checklist," Rev. 1/04.
30.
				OIR-B2-1494, "Individual Universal Life Policy Checklist," Rev. 1/04.
31. OIR-B2-1348, "Individual Variable Annuity
				Application Checklist," Rev. 1/04.
32. OIR-B2-1364, "Individual Variable Annuity
				Contract Checklist," Rev. 1/04.
33.
				OIR-B2-1638, "Individual Variable Life Application Checklist," 1/05.
34. OIR-B2-1384, "Individual Variable Life
				Policy Checklist," Rev. 1/04.
35.
				OIR-B2-1496, "Individual Whole Life Policy Checklist," Rev. 1/04.
36. OIR-B2-1350, "Master Group Application
				Checklist," Rev. 1/04.
37.
				OIR-B2-1639, "Out-of-State Group Life Enrollment Application Checklist,"
				1/05.
38. OIR-B2-1640,
				"Out-of-State Group Non-Variable Annuity Contract Checklist," 1/05.
39. OIR-B2-1641, "Out-of-State Group
				Non-Variable Annuity Enrollment Application Checklist," 1/05.
40. OIR-B2-1328, "Out-of-State Group Term
				Life Policy Checklist," Rev. 1/05.
41. OIR-B2-1330, "Out-of-State Group
				Universal Life Policy Checklist," Rev. 1/05.
42. OIR-B2-1642, "Out-of-State Group Variable
				Annuity Contract Checklist," 1/05.
43. OIR-B2-1644, "Out-of-State Group Variable
				Annuity Enrollment Application Checklist," 1/05.
44. OIR-B2-1643, "Out-of-State Group Variable
				Life Enrollment Application Checklist," 1/05.
45. OIR-B2-1343, "Out-of-State Group Variable
				Life Policy Checklist," Rev. 1/05.
46. OIR-B2-1329, "Out-of-State Group Whole
				Life Policy Checklist," Rev. 1/05.
47. OIR-B2-1646, "Viatical Contract
				Checklist," 3/05.
48. OIR-B2-1647,
				"Viatical Settlement Escrow Form Checklist," 3/05.
49. OIR-B2-1648, "Viatical Settlement
				Purchase Agreement Checklist," 3/05.
50. OIR-B2-1649, "Viatical Settlement Related
				Form Checklist," 3/05.