1. (1) (a) Pooling. For purposes of submitting a rate filing under this part for individual policy forms and for group Medicare supplement and long-term care group policy forms, in order to encourage adequate risk sharing for all generations of policyholders, the experience of all policy forms providing similar benefits, whether open or closed, shall be combined.

   1. Separate rating pools may be used for policy forms defined in subsections 69O-149.005(5) and (6), F.A.C., and for stop-loss insurance policy forms.

   2. Once policy forms have been combined, they remain so for all rating purposes, unless otherwise approved by the Office. This combining of the experience of policy forms is referred to as pooling. All policy forms within a pool are reviewed based on the analysis of the aggregate experience.

   3. The same percentage rate adjustment shall be applicable to all policy forms within the pool.

   4. In lieu of subparagraph (1)(a)3., above, percentage rate adjustments that are not the same for all policy forms within the pool shall be permitted subject to the following:

   a. Resulting premium rate schedules are actuarially equivalent based on benefit differences or different regulatory standards, such as margins or retentions, between the policy forms within the pool;

   b. Assumptions used to determine future experience and actuarial equivalence shall be based on the same set of common morbidity assumptions for all policy forms within the pool;

   c. Policy forms with existing premium rate schedules not meeting the standards of sub-subparagraphs a. and b. above shall not be required to reduce rates to bring the policy forms into compliance, but any proposed rate adjustment shall be required to improve the relationship of the policy forms’ premium rate schedules to bring them closer to compliance with sub-subparagraphs a. and b., above; and

   d. Non-uniform rate increases shall be subject to the implementation provisions of sub-sub-subparagraph 69O-149.006(3)(b)20.b.(V), F.A.C., on a revenue neutral basis as though a level percentage adjustment had been applied.

   5. The experience of policies and policy forms where the rate schedule is not subject to change, such as non-cancellable policy forms and paid up policies, shall not be pooled with policy forms where the rates are subject to change.

   6. The rate increase for a Medicare supplement form may be adjusted, on a revenue neutral basis, to mitigate the impact on the refund credit calculation required for the form pursuant to Rule 69O-156.011, F.A.C., where the company can demonstrate that without such adjustment, the rate increase will result in refunds being required.

2. (b) Credibility. In analyzing the experience of policy forms, and to improve the statistical credibility and predictability of anticipated experience, credible data shall be used.

3. (2) Filing Format for Individual Policies and Group Policies and Certificates.

   1. (a) 1. All filings shall be made in accordance with paragraph (2)(b), below.

      2a. For purposes of the rules in this part and the time periods in Section 627.410, F.S., a filing is considered “filed” with the Office upon the receipt of the material required by paragraph (2)(b), on business days between the hours of 8:00 a.m. and 5:00 p.m. eastern time. Filings received after 5:00 p.m. shall be considered to be received the following business day.

      b. For purposes of the rules in this part, the term “filed” does not mean “approved.” The term “filed” refers to the date on which the filing is filed with the Office and is the date on which the approval process of Section 627.410, F.S., commences.

      c. Filings shall be made on a company distinct basis.

   2. (b) A health insurance rate filing shall consist of the following items:

      1. A brief letter explaining the type and nature of the filing. The letter shall indicate if the filing is for a new policy form, a benefit revision, a rate revision, justification of existing rates, or a resubmission. If the filing is a resubmission, the letter shall indicate the Florida filing number of the prior filing.

      2. Form OIR-B2-1507, “Office of Insurance Regulation Life and Health Forms and Rates Universal Standardized Data Letter” as adopted in Rule 69O-149.022, F.A.C., completely filled out in accordance with Form OIR-B2-1507A, “Office of Insurance Regulation Life and Health Forms and Rates Universal Standardized Data Letter Instruction Sheet” as adopted in Rule 69O-149.022, F.A.C.

      3. The actuarial memorandum, completed as required by Rule 69O-149.006, F.A.C.

      4. Rate pages that define all proposed rates, rating factors and methodologies for determining rates applicable in the state.

      a. For companies that have a complete rate manual on file with the Office, only the pages that are being changed need to be filed, unless requested by the Office.

      b. For Medicare Supplement filings, rates must be submitted through the on-line Medicare Supplement Rate Collection System which is part of the i-file system.

4. (3) Filings shall be submitted electronically to floir.gov/iportal.
5. (4) (a) Every insurer submitting a rate filing shall be notified as to whether the filing has been affirmatively approved by the Office or has been disapproved by the Office within any statutory review period of the date of receipt of the filing.
6. (b) Submissions that do not include the required material to meet the definition of a filing, or that include material that is illegible, shall not be accepted and shall be returned as incomplete without processing.
7. (c) Every insurer submitting a rate filing which does not comply with the requirements of Rules 69O-149.002-.006, F.A.C., or for which the Office determines that additional information is necessary for a proper review, will be notified of the additional information necessary within the statutory limit. Every insurer shall submit the required data by a date certain stated in the clarification letter, to allow the Office sufficient time to perform a proper review. Failure to correct the filing by the date certain in the clarification letter will result in an affirmative disapproval of the filing by the Office.
8. (5) (a) Insurers with fewer than 1,000 Florida policyholders, under any form or pooled group of Medicare supplement, or medical expense forms with coverage meeting the definition of Section 627.6562(3)(a)2., F.S., may, at their option, file a streamlined rate increase filing not exceeding medical trend as provided in subsection (6), below.
9. (b) The number indicated in paragraph (5)(a), above, represents the individual primary insureds and does not include spouses or dependants.
10. (c) For group coverage, the number indicated in paragraph (5)(a), above, represents the individual certificateholders or subscribers.
11. (d) For Medicare supplement business, this provision applies for each type considered separately: Standard, Pre-standard and Select Medicare supplement coverage.

12. (e) The filing:

    1. Shall be made in accordance with paragraph 69O-149.003(2)(b), F.A.C.; and,

    2. Shall provide a certification that the filing includes all forms with similar benefits in lieu of the actuarial memorandum referenced in subparagraph 69O-149.003(2)(b)3., F.A.C.

13. (f) This provision is an option available to the company. The company may choose, at its option, to make a complete filing in accordance with paragraph 69O-149.003(2)(b), F.A.C., including a complete actuarial memorandum in accordance with Rule 69O-149.006, F.A.C.
14. (6) (a) The tables found at HYPERLINK "http://www.floir.com" floir.gov shall apply to filings made pursuant to subsection (5), above. They contain the maximum medical trend for medical expense coverage described in Section 627.6562(3)(a)2., F.S., and the maximum medical trend for Medicare Supplement coverage.
15. (b) A company without fully credible data may, at its option, use an annual medical trend assumption not to exceed the values in the tables referenced in paragraph (6)(a), for the medical trend assumption used in a complete filing made pursuant to paragraph 69O-149.003(2)(b), F.A.C., including the actuarial memorandum required by Rule 69O-149.006, F.A.C., without providing explicit trend justification.
16. (c) Use of an annual medical trend assumption exceeding the maximum medical trend in the tables referenced in paragraph (6)(a), shall be filed pursuant to subparagraph 69O-149.006(3)(b)18., F.A.C.

Rulemaking Authority 624.308(1), 624,424(1)(c), 627.410(6)(b), (e) FS. Law Implemented 119.07(1)(b), 624.307(1), 626.9541(1), 627.410 FS. History–New 7-1-85, Formerly 4-58.03, 4-58.003, Amended 8-23-93, 4-18-94, 8-22-95, 4-4-02, 10-27-02, 6-19-03, Formerly 4-149.003, Amended 5-18-04, 12-22-05, 1-16-08, 10-2-08, 9-15-13, Technical Change 4-15-26.