1. (1) The following forms are hereby adopted and incorporated by reference:

   1. (a) Form OIR-B2-570 (12/03) “General Information on Self-Funded Health Benefit Plans”;
   2. (b) Form OIR-B2-571 (12/03) “New Plan Operating Projections for Self-Funded Health Benefit Plans”;
   3. (c) Form OIR-B2-572 (12/03) “Annual Report of Self-Funded Health Benefit Plans”;
   4. (d) Form OIR-B2-573 (12/03) “Operating Projections for Self-Funded Health Benefit Plans”;
   5. (e) Form OIR-B2-574 (12/03) “General Information and Surplus Statement for Self-Funded Health Benefit Plans”;
2. (2) The above forms are hereby adopted and incorporated by reference.
3. (3) All forms are available and may be printed from the Office website: “http://www.floir.com/iportal.”

Rulemaking Authority 112.08(6) FS. Law Implemented 112.08 FS. History–New 5-18-04.