Florida Administrative Code
69 - DEPARTMENT OF FINANCIAL SERVICES
69O - OIR - Insurance Regulation
Chapter 69O-191 - HEALTH MAINTENANCE ORGANIZATIONS
Section 69O-191.0545 - Healthy Lifestyle Rebate
Universal Citation: FL Admin Code R 69O-191.0545
Current through Reg. 50, No. 187; September 24, 2024
(1) Group Coverage is as provided by subsection 69O-149.0055(1), F.A.C.
(2) Individual Coverage.
(a)
1. All
HMOs that provide for a healthy lifestyle rebate shall file for approval the
standards it will use for determining the level of rebate, i.e., between 0% and
10%, for different health status indicators, which shall include reduction in
weight, body mass index, and smoking cessation.
2. The filed standards shall provide that the
rebate is available and attainable by all subscribers on a nondiscriminatory
basis and be without regard to the health or claim status of the
subscriber.
3. The filing of the
standards shall address the method and timing of the determination and
application of the rebate.
(b)
1. For
purposes of rate filings, the rebate made shall be accounted as a reduction to
the earned premium and clearly identified in the filing.
2. Rate filings shall include the number of
contracts participating in the rebate program and the distribution of the
contracts by size of rebate earned.
(c) The HMO shall provide an appropriate
rebate for maintenance or improvement of health status for any program approved
by the HMO as determined by agreed upon health status indicators.
(d) This rule shall be effective for all
contracts issued or renewed on or after July 1, 2005 with the first rebate
available in 2006.
Rulemaking Authority 641.36, 641.31(2) FS. Law Implemented 641.31(40) FS. [HB 1629]
New 3-24-05, Amended 1-12-06.
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