Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-187 - PROFESSIONAL LIABILITY SELF-INSURANCE TRUST FUNDS › Section 69O-187.004 - Application for the Self-Insurance Trust Fund

Current through Reg. 50, No. 138; July 16, 2024
(1) Application for the purpose of
				establishing a self-insurance trust fund shall be made to the Office at
				Tallahassee. Such application shall contain all information necessary for the
				Office's consideration. At the Office's request, further information or
				verification as may be reasonably required shall be furnished.
(2) The application shall be made on Form
				OIR-370 entitled "Application for Approval as a Medical Malpractice
				Self-Insurance Trust Fund." The application shall be accompanied by:
(a) A copy of the mutual covenants properly
				executed pursuant to Rule 69O-187.0081, F.A.C., which binds each member of the
				Fund to individual, several and proportionate liability as set forth in Section
				627.357(7),
				F.S.
(b) A copy of the application
				form for applying for membership in the Fund. THE FORM SHALL CLEARLY STATE IN
				BOLD PRINT THAT MEMBERS OF THE FUND ARE SUBJECT TO ASSESSMENTS FOR ANY DEFICITS
				WHICH MAY OCCUR IN THE FUND.
(c) A
				copy of the Fund's current financial statement, financial projections, plan of
				operation, commitments for funds or any other data showing evidence of the
				financial ability of the Fund to meet its obligations as a self-insurance trust
				fund. Financial projections of the Fund shall show evidence of the financial
				ability of the Fund to meet its claims and obligations promptly for a three
				year period.
(d) A copy of the
				Service Agent's contract effective upon the inception date of the Fund. The
				contract must clearly show all fees to be paid to the Service Agent. Fees must
				be reasonable in consideration of the duties performed.
(e) A copy of the risk management program
				required pursuant to subsection
				69O-187.005(6),
				F.A.C.
(f) Biographical statements
				completed on the form entitled "Biographical Statement" as contained within the
				Application (Form OIR-370), and fingerprint cards for each individual to be
				participating in the management of the Fund unless submitted pursuant to
				subsection 69O-187.003(6),
				F.A.C.
(g) A copy of all marketing
				material that the Fund intends for general distribution to prospective members.
				All such marketing material shall clearly state in bold print that members of
				the Fund are subject to assessments for any deficits which may occur in any
				Fund year during which the member participated in the Fund. All advertisements
				shall include a statement that "This is an Assessable Self-Insurance Trust."
				The Office shall disapprove any material which contains any inconsistent,
				ambiguous, or misleading clauses.
(h) A copy of the proposed rating plan,
				indicating the expense factors associated with the proposed rates, and
				including any premium discount or surcharge schedule and any experience rating
				plan. The proposed rating plan shall be accompanied by appropriate actuarial
				support and justification.
(i) A
				copy of the proposed underwriting guidelines.
(j) A copy of the fidelity bond required by
				subsection 69O-187.005(5),
				F.A.C.
(k) A copy of any contract,
				policy, or agreement providing specific excess insurance or aggregate excess
				insurance to the Fund as may be required as a condition of approval.
(l) The name of the Fund and the location of
				the Fund's principal office, which shall be maintained within this
				state.
(m) A certified copy of the
				articles of incorporation, and bylaws, if incorporated, certified as true and
				correct by the Secretary of State, and a copy of the policy.
(n) The articles of incorporation, bylaws,
				policy, and mutual covenants shall contain a provision prohibiting any
				distribution of surplus funds except as approved by the Office.
(o) A complete biographical sketch (resume)
				on each Trustee of the Fund.
(p) A
				copy of the Fund's rules and regulations.