Current through Reg. 50, No. 187; September 24, 2024
(1)
(a)
This rule chapter applies to all individual and group health insurance
policies, including single premium credit disability insurance. All other
credit insurance is not subject to this rule chapter. Credit disability is
defined under Section
627.677(2),
F.S.
(b) This rule chapter is
effective December 31, 1998, for policies and contracts in force and issued
thereafter.
(2) When an
insurer determines that adequacy of its health insurance reserves requires
reserves in excess of the minimum standards specified herein, the increased
reserves shall be held and shall be considered the minimum reserves for that
insurer.
(3)
(a) With respect to any block of contracts,
or with respect to an insurer's health business as a whole, a prospective gross
premium valuation is the ultimate test of reserve adequacy as of a given
valuation date.
(b) Gross premium
valuations shall take into account, for contracts in force, in a claims status,
or in a continuation of benefits status on the valuation date, the present
value as of the valuation date of:
1. All
expected benefits unpaid;
2. All
expected expenses unpaid; and,
3.
All unearned or expected premiums, adjusted for future premium increases
reasonably expected to be put into effect.
(4)
(a) A
gross premium valuation shall be performed whenever a significant doubt exists
as to reserve adequacy with respect to any major block of contracts, or with
respect to the insurer's health business as a whole.
(b) If inadequacy is found to exist,
immediate loss recognition shall be made and the reserves restored to
adequacy.
(c) Adequate reserves
(inclusive of claim, premium, and contract reserves, if any) shall be held with
respect to all contracts, regardless of whether contract reserves are required
for the contracts under these standards.
(5) Whenever minimum reserves, as defined in
these standards, exceed reserve requirements as determined by a prospective
gross premium valuation, the minimum reserves remain the minimum requirement
under these standards.
Rulemaking Authority 624.308(1), 625.121(14), 625.081 FS.
Law Implemented 624.307(1), 625.081, 625.121
FS.
New 4-14-99, Formerly 4-154.201, Amended
3-1-04.
