Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-203 - PREPAID LIMITED HEALTH SERVICE ORGANIZATIONS AND DISCOUNT MEDICAL PLAN ORGANIZATIONS › Section 69O-203.060 - Insurance - General Liability and Medical Malpractice

Current through Reg. 50, No. 138; July 16, 2024
(1) Each PLHSO, in order to obtain its
				Certificate of Authority, shall furnish evidence of adequate insurance coverage
				or an adequate plan of self-insurance to respond to claims for injuries arising
				out of the furnishing of limited health services. Once the PLHSO obtains its
				Certificate of Authority, it shall maintain on file with the Office continued
				evidence of adequate insurance coverage or evidence of the continuation of the
				self-insurance plan. Any reduction in the insurance coverage for the PLHSO
				shall be submitted to and approved by the Office prior to the time at which the
				reduction takes place. Evidence of the existence of the approved insurance plan
				shall also be submitted with each annual report. The medical malpractice or
				professional liability insurance shall insure coverage for the PLHSO, and also
				the professional personnel, if applicable.
(2) The Office of Insurance Regulation shall
				be listed on General Liability and Medical Malpractice or Professional
				Liability insurance policies such that the Office shall receive written
				notification of any reduction of coverage, cancellation, non-renewal, or
				termination of any insurance policy required by Florida Statutes or these
				rules. Except for non-payment of premium, each agreement shall remain in full
				force and effect until replaced or for at least 30 days following written
				notification to the Office by registered mail of cancellation, termination, or
				any substantial change in the policy by either party. If coverage is cancelled
				or terminated due to non-payment of premium, coverage shall remain in full
				force and effect for at least ten days following written notification to the
				Office by registered mail.
(3)
				Medical Malpractice or Professional Liability. Adequate insurance coverage is
				defined as follows:
Entity
Minimum Limits
Occurrence/Aggregate
Dental Care Service
$500,000/$500,000
Vision Care Service
$500,000/$500,000
Pharmaceutical Service
$500,000/$500,000
All Other Services
$1,000,000/$1,000,000
If the level of insurance required above exceeds what is
				  available in the insurance market, the required level of coverage will be the
				  maximum available under market conditions. Maximum coverage available under
				  market conditions is subject to Office verification and
				  approval.
(4) General
				Liability. Adequate insurance coverage is defined as follows:
Entity
Minimum Limits
Occurrence/Aggregate
All Services
$500,000/$1,000,000
If the level of insurance required above exceeds what is
				  available in the insurance market, the required level of coverage will be the
				  maximum available under market conditions. Maximum coverage available under
				  market conditions is subject to Office verification and
				  approval.
(5)
				Self-Insurance.
(a) Any PLHSO choosing to
				implement a self-insurance plan shall support its proposed plan for
				self-insurance by filing with the Office an actuarial study prepared by a
				qualified actuary as defined in section
				636.003(11),
				F.S., or supervised by an actuary who is a member of the Casualty Actuarial
				Society.
1. The actuarial study shall
				establish a funding level based on the following factors:
a. Past and prospective loss and expense
				experience of other PLHSOs and other health care providers with similar
				exposure;
b. The prior claims
				experience of the PLHSO;
c. A risk
				loading sufficient to reduce the probability of the need for additional funding
				of the self-insurance plan for any policy year to 10% or less;
d. Administrative expenses necessary to
				administer the self-insured plan.