reglab/statecodes huggingface dataset:
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-191 - HEALTH MAINTENANCE ORGANIZATIONS › Section 69O-191.090 - Cash Management Systems

Current through Reg. 50, No. 138; July 16, 2024
An HMO may participate in a cash management program with
				  affiliated companies as long as the HMO maintains title to and control over all
				  funds. The trustee or custodian which is to invest these funds, as allowed
				  under Sections 641.35(9) through
				  (17), F.S., shall maintain a separate
				  custodial account for the HMO and the HMO's officers must have direct access to
				  the funds at all times in the normal course of business.
Rulemaking Authority 641.36 FS. Law Implemented
					 641.35(1)(a), 641.35(9)-(17) FS.
New 5-28-92, Formerly
					 4-191.090.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-191 - HEALTH MAINTENANCE ORGANIZATIONS › Section 69O-191.091 - Guaranteeing Organizations

Current through Reg. 50, No. 138; July 16, 2024
In order to meet the qualifications for a guaranteeing
				  organization, an entity shall comply with the following:
(1) The guarantor shall comply with Section
				641.19(10),
				F.S., by appointing the Chief Financial Officer as its agent for service of
				process in Florida. The entity must complete a consent form and board
				resolution approved by the Office and submit originals to the Office of
				Insurance Regulation, Life and Health Financial Oversight, 200 East Gaines
				Street, Tallahassee, Florida 32399-0300.
(2) The guarantor shall comply with Section
				641.225(4),
				F.S., by submitting audited financial statements certified by an independent
				CPA, prepared in accordance with generally accepted accounting principles,
				covering the guarantor's two most current annual accounting periods.
(3) The guarantor shall comply with the
				financial requirements of Section
				641.225, F.S., as they relate to
				surplus requirements.
(4) The
				guarantor shall execute an appropriate guarantee agreement as required by
				Section 641.225(4),
				F.S. The guarantee agreement shall be signed by an officer of the guarantor who
				has the authority to bind the organization and shall be notarized. The
				guarantor shall submit the original of the guarantee agreement to the Office.
				Evidence must be submitted that substantiates the fact that the officer that
				signs the guarantee agreement has the authority to bind the organization for
				purposes of executing the guarantee agreement (certified original copy of Board
				Resolution accompanied by certified original copy of the current Articles of
				Incorporation and By-Laws of the guarantor).
(5) The guarantor shall maintain continued
				compliance with Section
				641.225, F.S., relating to
				requirements for guaranteeing organizations, which includes annual financial
				reporting requirements.
Rulemaking Authority 641.36 FS. Law Implemented 624.424,
					 641.19(5), 641.225, 641.285 FS.
New 2-22-88, Amended 10-25-89, Formerly 4-31.091, Amended
					 5-28-92, Formerly 4-191.091.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-191 - HEALTH MAINTENANCE ORGANIZATIONS › Section 69O-191.094 - Change of Name

Current through Reg. 50, No. 138; July 16, 2024
(1) No name other
				than that certified by the Office shall be used by the HMO. The name of the HMO
				shall not be changed without prior approval of the Office. The approval process
				is as follows:
(a) The HMO shall file a
				request with the Office to change the HMO's name. The request shall include a
				plan by which current subscribers and providers will be notified of the name
				change. This plan shall include a copy of any proposed notice to be sent to
				subscribers and providers.
(b) Once
				the Office approves the name change, the HMO shall submit:
1. A Board Resolution from the HMO affirming
				the decision to change the HMO's name;
2. Amendments to the Articles of
				Incorporation and By-Laws of the HMO affirming the name change;
3. Certification from the Secretary of State
				Office that the name has been changed, and that the change has been filed with
				the Secretary of State's Office;
4.
				Documentation showing that the name change has been made on all insurance
				policies covering the HMO; and,
5.
				Documentation showing that all new subscriber contracts will include the new
				name of the HMO.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-191 - HEALTH MAINTENANCE ORGANIZATIONS › Section 69O-191.095 - Change of Address

Current through Reg. 50, No. 138; July 16, 2024
Every licensed HMO shall notify the Office of Insurance
				  Regulation, Life and Health Financial Oversight, in writing, 60 days prior to
				  such change, of any change in its Florida principal or corporate business
				  address. Any health service clinics or centers owned or controlled by the HMO
				  shall maintain current addresses with the corporate office and shall be made
				  available upon request by the Office.
Rulemaking Authority 641.36 FS. Law Implemented 624.424,
					 641.21, 641.221, 641.27 FS.
New 5-28-92, Formerly
					 4-191.095.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-191 - HEALTH MAINTENANCE ORGANIZATIONS › Section 69O-191.097 - Change of Ownership (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 641.36 FS. Law Implemented 628.4615
					 FS.
New 2-22-88, Amended 10-25-89, Formerly 4-31.097, Amended
					 5-28-92, Formerly 4-191.097, Repealed
					 9-28-22.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-191 - HEALTH MAINTENANCE ORGANIZATIONS › Section 69O-191.100 - Operational HMOs; Issuance of Certificate

Current through Reg. 50, No. 138; July 16, 2024
In order to establish that the exemption from the requirement
				  for a Certificate of Authority applies, an entity shall notify the Office that
				  it is operating as an HMO in compliance with Section
				  641.38, F.S. The notification
				  shall include conclusive proof that there has been no change in the controlling
				  ownership of the entity since January 1, 1947.
Rulemaking Authority 641.36 FS. Law Implemented 641.38
					 FS.
New 2-22-88, Formerly 4-31.100,
					 4-191.100.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-191 - HEALTH MAINTENANCE ORGANIZATIONS › Section 69O-191.105 - Individual Subscriber Enrollment Procedures

Current through Reg. 50, No. 138; July 16, 2024
(1) After a subscriber signs an HMO
				enrollment application and before the HMO can process the application changing
				or initiating the subscriber coverage, each HMO must verify the intent and
				desire of the individual subscriber to join the HMO. The verification must be
				in writing and conducted by someone outside the HMO's marketing Office. Each
				verification shall include the following:
(a)
				Confirmation that the subscriber intends and desires to join the HMO;
(b) If the subscriber is a Medicare
				recipient, confirmation must be provided that the subscriber understands by
				joining the HMO they will be limited to the benefits provided by the HMO, and
				Medicare will pay the HMO for the subscriber coverage;
(c) Confirmation that the subscriber
				understands the applicable restrictions of HMOs, especially that they must use
				the HMO providers and secure approval from the HMO to use health care providers
				outside the plan; and,
(d) If the
				subscriber is a member of an HMO, confirmation must be provided that the
				subscriber understands they are transferring to another
				HMO.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-191 - HEALTH MAINTENANCE ORGANIZATIONS › Section 69O-191.107 - Prescribed Forms (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 624.308(1), 641.36 FS. Law Implemented
					 624.424, 627.410(6), (7), 627.413(4), 627.4145, 627.6699(12), 627.6735,
					 627.682, 627.9407(2), 628.4615, 641.19(13)(d), 641.21(1), 641.26(1), (2),
					 641.29 FS.
New 2-22-88, Amended 10-25-89, Formerly 4-31.107, Amended
					 5-28-92, 8-15-94, 8-15-02,Formerly 4-191.107, Amended 7-30-17, Repealed
					 9-28-22.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-191 - HEALTH MAINTENANCE ORGANIZATIONS › Section 69O-191.300 - Health Maintenance Organization (HMO) Penalty Categories

Current through Reg. 50, No. 138; July 16, 2024
(1) Purpose. The purpose of this rule is to
				establish penalty categories that specify varying ranges of monetary fines for
				willful and nonwillful violations of applicable provisions of the Florida
				Insurance Code, or rules promulgated thereunder, that are committed by
				HMOs.
(2) Scope. This rule applies
				to all HMOs licensed under Chapter 641, F.S. It applies to all violations of
				the provisions of the Florida Insurance Code, or rules promulgated thereunder,
				applicable to HMOs pursuant to Section
				641.25, F.S.
(3) Definitions. The following terms have the
				following meanings for purposes of this rule:
(a) "Action" means an event or events leading
				to the commission of a violation.
(b) "Office" shall have the same meaning as
				Section 624.05, F.S.
(c) "Office Rules" means rules adopted by the
				Office which apply to HMOs.
(d)
				"Examination" means an inspection of an HMO as authorized by Section
				641.27, F.S.
(e) "Florida Insurance Code" shall have the
				same meaning as Section
				624.01, F.S.
(f) "HMO" means a health maintenance
				organization as defined in Section
				641.19(13),
				F.S., and licensed pursuant to the provisions of Chapter 641, F.S.
(g) "Investigation" means any official
				departmental review, analysis, inquiry, or research into referrals, complaints,
				or inquiries to determine the existence of a violation.
(h) "Knowing and willful" means any act or
				omission, which is committed intentionally as opposed to accidentally and which
				is committed with knowledge of the act's unlawfulness or with reckless
				disregard as to the unlawfulness of the act.
(i) "Repeat Violations" means a second or
				subsequent offense of any given violation under this rule within the preceding
				four years.
(j) "Violation" means
				any instance of noncompliance by an HMO with any applicable provisions of the
				Florida Insurance Code, rules or orders of the Office governing
				HMOs.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-192 - MULTIPLE EMPLOYER WELFARE ARRANGEMENTS › Section 69O-192.001 - Purpose and Scope (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 624.4431 FS. Law Implemented 624.436
					 FS.
New 7-15-90, Formerly 4-116.001, Amended 11-16-92, Formerly
					 4-192.001, Repealed 9-28-22.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-192 - MULTIPLE EMPLOYER WELFARE ARRANGEMENTS › Section 69O-192.004 - Definitions

Current through Reg. 50, No. 138; July 16, 2024
(1) All terms defined in the Florida
				Nonprofit Multiple Employer Welfare Arrangement Act, chapter 624, F.S., which
				are used in these rules shall have the same meaning as in the Act.
(2) "Accounting Period" as used in section
				624.4415, F.S., means the time
				period for which financial statements, unaudited or audited, are required to be
				filed with the Office.
(3) "Fees"
				means any compensation, including, but not limited to cash, or other assets of
				the arrangement, transferred for either contracted or noncontracted services,
				rendered to the sponsoring association or the arrangement.
Rulemaking Authority 624.4431 FS. Law Implemented 624.4411,
					 624.4415 FS.
New 11-16-92, Formerly
					 4-192.004.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-192 - MULTIPLE EMPLOYER WELFARE ARRANGEMENTS › Section 69O-192.008 - Multiple-Employer Welfare Arrangement Application

Current through Reg. 50, No. 138; July 16, 2024
(1) An application for a person applying for
				a certificate of authority as a multiple-employer welfare arrangement consists
				of the following:
(a) Form OIR-C1-983,
				"Application for Certificate of Authority Multiple Employer Welfare
				Arrangement," effective 07/23, hereby incorporated by reference and available
				at
http://www.flrules.org/Gateway/reference.asp?No=Ref-16190
;
(b) Form OIR-C1-905, incorporated by
				reference in Rule 69O-136.100, F.A.C.;
(c) Form OIR-C1-938, incorporated by
				reference in Rule 69O-136.100, F.A.C.;
(d) Form OIR-C1-1423, incorporated by
				reference in Rule 69O-136.100, F.A.C.;
(e) Form OIR-C1-0500, incorporated by
				reference in Rule 69O-136.100, F.A.C.;
(f) Form OIR-C1-0501, incorporated by
				reference in Rule 69O-136.100, F.A.C.;
(g) Form OIR-C1-0502, incorporated by
				reference in Rule 69O-136.100, F.A.C.;
(h) Form OIR-C1-0503, incorporated by
				reference in Rule 69O-136.100, F.A.C.;
(i) Form OIR-C1-0504, incorporated by
				reference in Rule 69O-136.100, F.A.C.;
(j) Form OIR-C1-0505, incorporated by
				reference in Rule 69O-136.100, F.A.C.;
(k) Form OIR-C1-0506, incorporated by
				reference in Rule 69O-136.100, F.A.C.;
(l) Form OIR-C1-0507, incorporated by
				reference in Rule 69O-136.100, F.A.C.;
(m) Form OIR-C1-0509, incorporated by
				reference in Rule 69O-136.100, F.A.C.;
				and
(n) Form OIR-C1-2221,
				incorporated by reference in Rule
				69O-136.100,
				F.A.C.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-192 - MULTIPLE EMPLOYER WELFARE ARRANGEMENTS › Section 69O-192.018 - Financial

Current through Reg. 50, No. 138; July 16, 2024
(1) Cash management systems. The arrangement
				may participate in a cash management program as long as the arrangement has
				direct access to its funds at all times and the depository or custodian
				maintains a separate accounting for each account. The depository must also be
				one which is consistent with section
				625.012(1),
				F.S.
(2) Surplus Notes. No surplus
				note(s) or the interest thereon shall be paid or repaid without the specific
				written approval of the Office. Each note, should there be more than one, shall
				have its own unique identification number in the upper left hand corner of each
				page of the document.
(3) All
				ratios specified in section
				624.439, F.S., shall be
				calculated on a statutory accounting basis.
Rulemaking Authority 624.4431 FS. Law Implemented
					 624.4361(5), (6)(c), (d), 625.012(1), 624.439(6)(b)2.c.,
					 624.4432
					 FS.
New 11-16-92, Formerly
					 4-192.018.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-192 - MULTIPLE EMPLOYER WELFARE ARRANGEMENTS › Section 69O-192.028 - Policy or Contract

Current through Reg. 50, No. 138; July 16, 2024
Each covered employee shall receive a policy, contract,
				  certificate, summary arrangement description, or evidence of the benefits and
				  coverages provided. Each document shall have on the first page inside the cover
				  of the document, or if the document does not have a cover, on the first page
				  the statement required by section
				  624.438(2),
				  F.S.
Rulemaking Authority 624.4431 FS. Law Implemented
					 624.438(2) FS.
New 11-16-92, Formerly
					 4-192.028.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-192 - MULTIPLE EMPLOYER WELFARE ARRANGEMENTS › Section 69O-192.035 - Agreements and Management Contracts

Current through Reg. 50, No. 138; July 16, 2024
Any agreement between the arrangement and any administrator
				  or service company which is to be made available for review rather than filed
				  with the Office shall be subject to the following:
(1) The document shall be made available to
				the Office at a location in Tallahassee or at such other location as is
				agreeable to the Office at no travel expense to the Office.
(2) If the Office determines that the
				document is the basis for denial of the arrangement's application for a
				Certificate of Authority, the arrangement shall provide the document at any
				hearing that is conducted pursuant to such denial.
Rulemaking Authority 624.4431 FS. Law Implemented
					 624.439(10), 624.4411 FS.
New 11-16-92, Formerly
					 4-192.035.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-192 - MULTIPLE EMPLOYER WELFARE ARRANGEMENTS › Section 69O-192.038 - Administrative, Provider, and Management Contracts

Current through Reg. 50, No. 138; July 16, 2024
(1) Arrangements are prohibited from paying
				any fees, other than for reimbursement of specific expenses, to its sponsoring
				association unless the services rendered to the arrangement are available to
				the arrangement from persons, or companies other than the sponsoring
				association.
(2) The fees for such
				services shall not be in excess of what would be charged in an arms length
				transaction. Reasonable fees may also be determined by comparing those charged
				to other arrangements in Florida.
Rulemaking Authority 624.4431 FS. Law Implemented
					 624.4411(1), (2) FS.
New 7-28-94, Formerly
					 4-192.038.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-192 - MULTIPLE EMPLOYER WELFARE ARRANGEMENTS › Section 69O-192.043 - Assessments

Current through Reg. 50, No. 138; July 16, 2024
(1) Each employer application to participate
				in the arrangement shall disclose in the same manner as described in rule
				69O-192.028, F.A.C., the
				following disclaimer: "The benefits and coverages described herein are provided
				through a self insured trust fund established and funded in full or in part by
				a group of employers. It is not an insurance company and it is not protected by
				a guaranty fund in the event of insolvency. Participating employers are
				assessable for any losses incurred or as determined by the trust or as directed
				by the Office," or other language previously approved by the Office.
(2) If at the end of any accounting period
				the fund balance of the trust is below that which is required by law, the fund
				shall file with the Office a plan to assess all employers, within 15 days of
				such determination, to bring the arrangement into compliance with section
				624.4392, F.S. The assessment
				shall take place no longer than 45 days after the filing of the plan.
(3) In the event that any member(s) fail to
				pay their assessment, the other members shall be assessed within 60 days of the
				original assessment to bring the arrangement into compliance with section
				624.4392, F.S.
(4) The arrangement shall at the same time
				referenced in subsection (3), above, institute legal action against those
				members who failed to pay the assessment in subsection (2), above. Any
				recoveries made, shall at the discretion of the Board of Trustees, be refunded
				to those employers who were assessed under subsection (3), above, and who paid
				the additional assessment.
Rulemaking Authority 624.4431 FS. Law Implemented
					 624.4415(1), (3), (4)(b), (c) FS.
New 11-16-92, Formerly
					 4-192.043.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-192 - MULTIPLE EMPLOYER WELFARE ARRANGEMENTS › Section 69O-192.048 - Annual and Quarterly Reporting Requirements

Current through Reg. 50, No. 138; July 16, 2024
(1) Each Multiple Employer Welfare
				Arrangement ("MEWA") shall file with the Office a full and true report of its
				financial condition, transactions, and affairs.
(a) An annual report covering the preceding
				fiscal year shall be filed within 3 months after the end of the fiscal year,
				and quarterly reports within 45 days after the end of each of its four
				quarterly reporting periods.
(b)
				The Office shall grant an extension of time for filing an annual or quarterly
				report if there exist conditions beyond the control of the authorized MEWA,
				such as rehabilitation pursuant to Chapter 631, F.S., or the laws of the state
				of domicile; severe damage to the MEWA's physical premises by a natural or
				man-made disaster; or some other reason of similar gravity and severity. The
				request for an extension of time for filing an annual or quarterly report shall
				be submitted to the Office at least 7 days before the filing is due. The
				extension shall be for the amount of time reasonable to file under the
				conditions which justified the extension.
(c) For purposes of this rule, the
				requirement that reports be filed with the Office means that the report has
				been transmitted electronically to the National Association of Insurance
				Commissioners and that the executed Jurat page of said report has been
				transmitted electronically to the Office via the Regulatory Electronic Filing
				System, "REFS." The date affixed by the Office's electronic data processing
				system shall serve as evidence of the timeliness of the report. Annual and
				quarterly reports in any other format shall not be submitted to the
				Office.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-192 - MULTIPLE EMPLOYER WELFARE ARRANGEMENTS › Section 69O-192.053 - Examination by the Office

Current through Reg. 50, No. 138; July 16, 2024
If the Office makes a determination that the records of the
				  arrangement are not adequate to make a determination of solvency or insolvency
				  the Office may take any action (administrative or otherwise) available to the
				  Office as if the arrangement were insolvent.
Rulemaking Authority 624.4431 FS. Law Implemented
					 624.44(1)(a), (2), 624.444, 624.445, 624.446
					 FS.
New 7-28-94, Formerly
					 4-192.053.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-192 - MULTIPLE EMPLOYER WELFARE ARRANGEMENTS › Section 69O-192.058 - Forms Incorporated by Reference (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 624.4431 FS. Law Implemented 624.424,
					 624.439, 624.442, 628.4615 FS.
New 7-15-90, Formerly 4-116.015, Amended 7-28-94, Formerly
					 4-192.058, Amended 7-30-17, Repealed
					 9-28-22.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-193 - CONTINUING CARE CONTRACTS › Section 69O-193.001 - Purpose and Scope (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 651.015 FS. Law Implemented 651
					 FS.
New 6-25-90, Formerly 4-45.010, 4-193.001, Repealed
					 3-12-20.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-193 - CONTINUING CARE CONTRACTS › Section 69O-193.002 - Definitions

Current through Reg. 50, No. 138; July 16, 2024
(1) All terms defined in Chapter 651, F.S.,
				which are used in these rules shall have the same meaning as in Chapter 651,
				F.S.
(2) "Administrator or
				executive director" means a natural person who has the general day-to-day
				administrative charge of a facility.
(3) "Affiliate" means any person that
				exercises control over or is directly or indirectly controlled by the provider
				through:
(a) Equity ownership of voting
				interests or securities;
(b) Common
				managerial control; or
(c)
				Collusive participation by the management of the provider and affiliate in the
				management of the provider or the affiliate.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-193 - CONTINUING CARE CONTRACTS › Section 69O-193.003 - Applications and Management Change

Current through Reg. 50, No. 138; July 16, 2024
(1)
				Application for Certificate of Authority.
(a)
				An application for a person applying for a certificate of authority for a
				continuing care provider consists of the following:
1. Form OIR-C1-473, "Application for
				Certificate of Authority for a Continuing Care Provider," effective 07/23,
				hereby incorporated by reference and available at
http://www.flrules.org/Gateway/reference.asp?No=Ref-16309
;
2. Form OIR-C1-144, incorporated by reference
				in Rule 69O-136.100, F.A.C.;
3. Form OIR-C1-905, "Instructions for
				Furnishing Background Investigative Reports," effective 6/20, hereby
				incorporated by reference and available at
https://www.flrules.org/Gateway/reference.asp?No=Ref-14451
;
4. Form OIR-C1-938, incorporated by reference
				in Rule 69O-136.100, F.A.C.;
5.
				Form OIR-C1-1423, incorporated by reference in Rule 69O-136.100,
				F.A.C.;
6. Form OIR-C1-0500,
				incorporated by reference in Rule 69O-136.100, F.A.C.;
7. Form OIR-C1-0501, incorporated by
				reference in Rule 69O-136.100, F.A.C.;
8. Form OIR-C1-0502, incorporated by
				reference in Rule 69O-136.100, F.A.C.;
9. Form OIR-C1-0503, incorporated by
				reference in Rule 69O-136.100, F.A.C.;
10. Form OIR-C1-0504, incorporated by
				reference in Rule 69O-136.100, F.A.C.;
11. Form OIR-C1-0505, incorporated by
				reference in Rule 69O-136.100, F.A.C.;
12. Form OIR-C1-0506, incorporated by
				reference in Rule 69O-136.100, F.A.C.;
13. Form OIR-C1-0507, incorporated by
				reference in Rule 69O-136.100, F.A.C.;
14. Form OIR-C1-0509, incorporated by
				reference in Rule 69O-136.100, F.A.C.; and
15. Form OIR-C1-2221, incorporated by
				reference in Rule 69O-136.100, F.A.C.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-193 - CONTINUING CARE CONTRACTS › Section 69O-193.005 - Monthly, Quarterly, and Annual Reports

Current through Reg. 50, No. 138; July 16, 2024
(1) Monthly Statements.
If required by the Office pursuant to Section
				  651.0261(3),
				  F.S., a provider shall file Form OIR-A3-973 within 25 days after the end of
				  each month. Form OIR-A3-973, "Monthly Financial Report," effective 7/20, is
				  hereby incorporated by reference and available at
https://www.flrules.org/Gateway/reference.asp?No=Ref-14458
.
				  The filing shall be submitted electronically via the Office's system at
https://www.floir.com/iportal
.
(2) Quarterly Statements.
(a) As required by Section
				651.0261(2),
				F.S., a provider shall file Form OIR-A3-974 within 45 days after the end of the
				fiscal quarter. Form OIR-A3-974, "Quarterly Financial Report," effective7/20,
				is hereby incorporated by reference and available at
https://www.flrules.org/Gateway/reference.asp?No=Ref-14459
.
				The filing shall be submitted electronically via the Office's system at
https://www.floir.com/iportal
.
(b) In addition to Form OIR-A3-974, a
				provider shall submit Form OIR-A3-1245 for any facility for which a certificate
				of occupancy has not yet been issued. Form OIR-A3-1245, "Sales and Financial
				Report for a Non-Operational Facility," effective 7/20, is hereby incorporated
				by reference and available at
https://www.flrules.org/Gateway/reference.asp?No=Ref-14460
.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-193 - CONTINUING CARE CONTRACTS › Section 69O-193.006 - Financial Viability

Current through Reg. 50, No. 138; July 16, 2024
(1) In addition to
				days cash on hand, debt service coverage ratio, and occupancy as defined in
				Section 651.011, F.S., the Office may
				utilize measures set forth in this rule to assess the financial viability of a
				provider.
(2) The Office may
				analyze trends in performance of a provider or facility using the information
				filed pursuant to Rule
				69O-193.005, F.A.C., and any
				other relevant information available to the Office pursuant to Chapter 651,
				F.S., Chapter 69O-193, F.A.C., or an order of the Office.
(3) Prior to making a determination regarding
				the financial viability of a facility or provider, the Office shall consider
				the impact of any extraordinary or unusual occurrences affecting the facility
				or provider.
(4) The Office may
				seek the assistance of members of the Continuing Care Advisory Council or other
				experts in reviewing and evaluating information regarding a facility or
				provider.
(5) In the event that
				additional information is necessary to assess the financial viability of a
				provider, the Office may request and consider such additional information.
				Additional information includes information, reports, data, and documentation
				related to the following:
(a) The governing
				body of the provider, its financial statements, and its financial
				policies;
(b) The management or
				management company;
(c) The
				organization's financial plans;
(d)
				Financial feasibility studies, projections, examinations, professional studies,
				opinions, reports, or other similar documents prepared by or on behalf of a
				provider;
(e) Compliance with
				local, state and federal laws, rules, or ordinances;
(f) Marketing plans;
(g) Continuing care contract benefits and
				services;
(h) Pricing;
(i) Commitment of financial support from
				other organizations; and,
(j) Other
				information;
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-193 - CONTINUING CARE CONTRACTS › Section 69O-193.007 - Manager or Management Company (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 651.015(3) FS. Law Implemented
					 651.022, 651.023, 651.026, 651.1151
					 FS.
New 7-16-92, Formerly 4-193.007, Repealed
					 3-12-20.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-193 - CONTINUING CARE CONTRACTS › Section 69O-193.010 - Place (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 651.015(3) FS. Law Implemented
					 651.011(5) FS.
New 7-16-92, Formerly 4-193.010, Repealed
					 3-12-20.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-193 - CONTINUING CARE CONTRACTS › Section 69O-193.012 - Phases

Current through Reg. 50, No. 138; July 16, 2024
(1)
(a) A
				provider intending to develop a facility in phases shall submit a feasibility
				study as required by Chapter 651, F.S., which contains all information required
				by law for each phase of the proposed project, as well as the project as it
				will exist upon completion of all construction.
(b) Subsequent to the Office's approval of an
				application containing a feasibility study providing for a facility to be
				developed in phases, a provider must notify the Office in writing within 10
				business days of becoming aware of a material adverse deviation or change.
				Within 60 days of the provider becoming aware of the material adverse deviation
				or change, the provider must also submit any necessary revisions or amendments
				to the feasibility study required to account for the material adverse deviation
				or change.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-193 - CONTINUING CARE CONTRACTS › Section 69O-193.015 - Expansion of a Facility (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 651.015(3) FS. Law Implemented 651.021
					 FS.
New 7-16-92, Formerly 4-193.015, Repealed
					 3-12-20.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-193 - CONTINUING CARE CONTRACTS › Section 69O-193.018 - Waiting List Deposits

Current through Reg. 50, No. 138; July 16, 2024
Any fee in excess of $1,500 paid by a prospective resident to
				  secure a priority right to subscribe to a continuing care agreement shall be
				  escrowed in an escrow account governed by an escrow agreement as prescribed by
				  Section 651.033, F.S., and shall not be
				  released except as provided by Chapter 651, F.S.
Rulemaking Authority 651.015(3) FS. Law Implemented
					 651.033(4) FS.
New 7-16-92, Formerly
					 4-193.018.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-193 - CONTINUING CARE CONTRACTS › Section 69O-193.020 - Continuing Care Contracts

Current through Reg. 50, No. 138; July 16, 2024
All continuing care contracts shall be written in plain
				  language customarily used and understood by people in the conduct of their
				  personal affairs.
Rulemaking Authority 651.015(3) FS. Law Implemented
					 651.011, 651.055 FS.
New 7-16-92, Formerly
					 4-193.020.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-193 - CONTINUING CARE CONTRACTS › Section 69O-193.023 - Escrow Agreements and Amendments

Current through Reg. 50, No. 138; July 16, 2024
(1)
				Each escrow agreement or amendment required by Chapter 651, F.S., shall be
				filed and approved by the Office prior to its use in this state.
(2) Each escrow agreement or amendment must
				be signed by:
(a) The provider;
(b) The escrow agent, which must be a
				financial institution or trust acceptable to the Office.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-193 - CONTINUING CARE CONTRACTS › Section 69O-193.028 - Feasibility Studies (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 651.015(3) FS. Law Implemented
					 651.021, 651.022, 651.023 FS.
New 7-16-92, Formerly 4-193.028, Repealed
					 3-12-20.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-193 - CONTINUING CARE CONTRACTS › Section 69O-193.030 - Updated Feasibility Study

Current through Reg. 50, No. 138; July 16, 2024
(1)
				Definitions of terms as used in this rule.
(a)
				An "extraordinary or unusual change" means a material change to the market
				conditions upon which the feasibility study was based that may cause an adverse
				impact to the facility.
(b) A
				"material deviation" includes, but is not limited to, the following:
1. A change to the type or value of the
				health care benefits provided in the continuing care contracts to be offered by
				the facility;
2. A change regarding
				whether entrance fees will amortize to 0% refundability or if a portion of the
				entrance fee will be refundable regardless of how long the resident resides at
				the unit;
3. A change or deviation
				from the projected financial statements provided in the feasibility study that
				does or will result in a decrease in the days cash on hand or debt service
				coverage ratio projected in the provider's application filing;
4. A change of 15% or more in:
a. The number of units at a particular level
				of care, i.e., independent living units, assisted living units, or skilled
				nursing units; or
b. The total
				number of units at the facility; or
5. A change in the healthcare delivery system
				available at the facility.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-193 - CONTINUING CARE CONTRACTS › Section 69O-193.033 - Hazardous or Injurious Transactions, Methods, or Practices

Current through Reg. 50, No. 138; July 16, 2024
Hazardous or injurious transactions, methods, or practices,
				  may include but are not limited to, the following:
(1) Repeated violations of Part IX of Chapter
				626, F.S., entitled "Unfair Insurance Trade Practices";
(2) Payment or distribution of funds, other
				than salaries and wages earned in the normal course of business, to a provider
				or any affiliate when:
(a) A provider is
				insolvent or no longer financially viable; or
(b) Payment results or could result in a
				facility or provider becoming insolvent or no longer financially
				viable;
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-193 - CONTINUING CARE CONTRACTS › Section 69O-193.035 - Certificate of Occupancy

Current through Reg. 50, No. 138; July 16, 2024
(1) Where a
				certificate of occupancy is required by Chapter 651, F.S., a temporary
				certificate of occupancy may be acceptable if it does not conditionally
				preclude the residents from occupying a structure.
(2) A provider shall not require a resident
				to occupy a unit before the provider obtains a certificate of occupancy as
				required by law.
Rulemaking Authority 651.015(3) FS. Law Implemented 651.023
					 FS.
New 7-16-92, Formerly
					 4-193.035.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-193 - CONTINUING CARE CONTRACTS › Section 69O-193.038 - Form and Content of Advertisements

Current through Reg. 50, No. 138; July 16, 2024
(1)
(a) Advertising must be truthful and not
				misleading in fact or implication.
(b) Words or phrases shall be clear and
				understandable without reliance upon technical terminology.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-193 - CONTINUING CARE CONTRACTS › Section 69O-193.040 - Advertisement Enforcement Procedures

Current through Reg. 50, No. 138; July 16, 2024
(1)
				Each provider shall maintain at its home or principal office in this state a
				complete file containing every printed, published, or prepared advertisement it
				has used in this state, with a notation attached to each indicating the manner
				and extent of distribution and the form number of any contract
				advertised.
(2) This file shall be
				subject to inspection by the Office.
(3) The file shall be maintained for at least
				three (3) years for providers subject to triennial examinations or at least
				five (5) years for accredited providers subject to examination at least once
				every five (5) years, as provided in Section
				651.105(1),
				F.S. Each provider shall retain the advertisements, notations, and form numbers
				until such time that an exam report has been issued for the period of time in
				which the advertisement was used in this state.
Rulemaking Authority 651.015(3) FS. Law Implemented
					 651.095, 651.105 FS.
New 7-16-92, Formerly 4-193.040, Amended
					 3-12-20.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-193 - CONTINUING CARE CONTRACTS › Section 69O-193.043 - Standards for Marketing

Current through Reg. 50, No. 138; July 16, 2024
(1) All sales
				people or representatives of the provider who are engaged in soliciting
				prospective residents are bound by these rules, Section 651.095, and Part IX,
				Chapter 626, F.S.
(2) A provider
				holding a provisional certificate of authority or a certificate of authority is
				responsible for the acts of its representatives in soliciting prospective
				residents.
Rulemaking Authority 651.015(3) FS. Law Implemented
					 651.095, 651.105, 651.106, 651.125 FS.
New 7-16-92, Formerly
					 4-193.043.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-193 - CONTINUING CARE CONTRACTS › Section 69O-193.045 - Administrative Supervision Proceedings (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 651.015(3) FS. Law Implemented 651.018
					 FS.
New 7-16-92, Formerly 4-193.045, Repealed
					 3-12-20.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-193 - CONTINUING CARE CONTRACTS › Section 69O-193.048 - Letters of Credit (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 651.015(3) FS. Law Implemented 651.035
					 FS.
New 7-16-92, Formerly 4-193.048, Repealed
					 3-12-20.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-193 - CONTINUING CARE CONTRACTS › Section 69O-193.053 - Waiver of Minimum Liquid Reserves

Current through Reg. 50, No. 138; July 16, 2024
(1) If
				principal and interest payments are paid to a trust that is beneficially held
				by residents as described in Section
				651.023(7),
				F.S., the Office may waive all or any portion of the escrow requirements for
				mortgage principal and interest if the Office finds that such waiver is not
				inconsistent with the security protections intended by Chapter 651,
				FS.
(2) To obtain a waiver for all
				or any part of the escrow requirement for mortgage principal and interest
				contained in Section 651.035(1),
				F.S., the provider must meet the requirements of Section
				651.023(7),
				F.S., and file Form OIR-A3-1068, "Request for Waiver of Minimum Liquid Reserve
				Requirement," effective 7/20, hereby incorporated by reference and
https://www.flrules.org/Gateway/reference.asp?No=14464
.
				The filings shall be submitted electronically at
https://www.floir.com/iportal
;
(3) For a new facility commencing operations,
				Form OIR-A3-1068 must be submitted no later than 30 days before the provider
				requests the release of moneys held in escrow pursuant to Section
				651.023(6),
				F.S. For a provider whose after escrowed funds have been released, Form
				OIR-A3-1068 shall be filed with the Office, on or before May 1 of each year if
				the provider's fiscal year end is December 31 or within 120 days of the last
				day of the fiscal year of the provider if the provider has declared a fiscal
				year other than the calendar year.
(4) Any previous waiver granted by the Office
				terminates as of the date the provider is required to file its next MLR
				calculation. If the subsequent request for waiver is denied, the provider shall
				have 61 days from the date MLR calculation and Request for Waiver of Minimum
				Liquid Reserve were due to be filed to fully fund the required reserve
				accounts.
Rulemaking Authority 651.015(3) FS. Law Implemented
					 651.023, 651.035 FS.
New 7-16-92, Formerly 4-193.053, Amended 3-12-20,
					 7-21-22.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-193 - CONTINUING CARE CONTRACTS › Section 69O-193.055 - Accreditation

Current through Reg. 50, No. 138; July 16, 2024
(1) A provider or facility is accredited for
				the purposes of Sections 400.235(5)(b)1., and
				651.105(1),
				F.S., if it is accredited without stipulations or conditions by Commission on
				Accreditation of Rehabilitation Facilities International ("CARF
				International").
(2) The provider
				will file evidence that the provider or facility is accredited and in good
				standing each year with its annual report filing.
(3) The provider shall furnish the Office,
				within five business days, a copy of any communication from CARF International
				concerning the loss or potential loss of accreditation of the provider or any
				facility owned or operated by the provider, wherever
				located.
Rulemaking Authority 651.015(3), 651.028 FS. Law
					 Implemented 651.028 FS.
New 7-16-92, Formerly 4-193.055, Amended
					 3-12-20.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-193 - CONTINUING CARE CONTRACTS › Section 69O-193.058 - Continuous Updates

Current through Reg. 50, No. 138; July 16, 2024
Each provider shall immediately notify the Office and file
				  pertinent documents within five business days regarding:
(1) Any litigation alleging a felonious act
				by a provider or any person affiliated with or controlled by a
				provider;
(2) Any proceeding for
				denial, suspension, or revocation of any license or permit needed to operate a
				facility;
(3) Any other information
				that might adversely affect the ability of a provider, facility, or its
				management to operate under the assumptions made in the most recent license
				application; or
(4) Any change in
				the name or fictitious name of a provider or facility.
Rulemaking Authority 651.015(3) FS. Law Implemented
					 651.023, 651.0235, 651.026 FS.
New 7-16-92, Formerly 4-193.058, Amended
					 3-12-20.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-193 - CONTINUING CARE CONTRACTS › Section 69O-193.060 - Background Information (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 651.015(3) FS. Law Implemented
					 651.022(2)(c), 651.023, 651.0235, 651.026
					 FS.
New 7-16-92, Formerly 4-193.060, Repealed
					 3-12-20.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-193 - CONTINUING CARE CONTRACTS › Section 69O-193.062 - Mediation of Resident/Provider Disputes

Current through Reg. 50, No. 138; July 16, 2024
(1) Scope of Rule. This rule implements
				Section 651.123, F.S., and applies to a
				dispute between a resident and a provider except a dispute over increases in
				monthly maintenance fees.
(2)
				Definitions. The following definitions shall apply for purposes of this rule:
(a) "Administrator" means the entity
				designated by contract with the Office to administer mediation conferences
				under this rule. If an entity has not been designated, the Office will be the
				administrator.
(b) "Approved," as
				used in this rule with regard to approval of a mediator, means to designate
				based upon successfully meeting the criteria set forth in Section
				44.106, F.S., and the Florida
				Rules of Certified and Court Appointed Mediators, or Section
				627.745(3)(b),
				F.S. Only approved mediators may mediate disputes under this rule.
(c) "Complainant" refers to the party
				requesting mediation.
(d) "Office"
				means the Office of Insurance Regulation.
(e) "Frivolous" means involving no
				justiciable question and is readily recognizable as devoid of merit.
(f) "Provider" means the owner or operator
				who undertakes to provide continuing care to a resident.
(g) "Resident" means a purchaser of or a
				subscriber to a continuing care agreement or their nominee.
(h) "Respondent" refers to the party not
				first requesting mediation.
(i)
				"Service office" means a designated office of the Bureau of Outreach and
				Education, Division of Insurance Consumer Services, Department of Financial
				Services.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-193 - CONTINUING CARE CONTRACTS › Section 69O-193.063 - Arbitration of Resident/Provider Disputes

Current through Reg. 50, No. 138; July 16, 2024
(1) Scope of Rule. Any portion of a dispute
				which is not resolved in mediation under Rule
				69O-193.062, F.A.C., may be
				submitted by a party to binding arbitration under this rule if all parties
				agree in advance to be bound by the arbitrated result.
(2) Definitions. The following definitions as
				found in this rule and as found in documents incorporated by reference in this
				rule shall apply for purposes of this rule:
(a) "AAA" or "Administrator" refers to the
				entity designated by contract with the Department to administer arbitration
				hearings under this rule. If an entity has not been designated, the Department
				will be the administrator.
(b)
				"Department" means the Department of Financial Services.
Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-193 - CONTINUING CARE CONTRACTS › Section 69O-193.065 - Forms Incorporated by Reference (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 624.308(1), 651.013, 651.015(1), (3)
					 FS. Law Implemented 624.307(1),
					 651.021,
					 651.022,
					 651.023,
					 651.024,
					 651.026,
					 651.033,
					 651.035
					 FS.
New 6-25-90, Formerly 4-45.035, Amended 7-16-92, 11-29-98,
					 12-24-03, Formerly 4-193.065, Repealed
					 3-12-20.