Florida – Health Insurance Premium Rate Review Law

If you buy health insurance on the individual market, without help from an employer, you may want to know what Florida is doing to protect you from unfair and unnecessary premium rate increases. Here’s a summary of the Florida laws that govern rate increases.

If you buy health insurance on the individual market, without help from an employer, you may want to know what Florida is doing to protect you from unfair and unnecessary premium rate increases.  Here’s a summary of the Florida laws that govern rate increases.

  • Florida does require insurers to obtain prior approval of individual market rate increases before they go into effect.
  • Insurers must file rate increase requests with the Office of Insurance Regulation, and regulators have 30 days to approve or disapprove the revised rates, although the period often is extended to 45 days. Rates increases are deemed approved if regulators do not act with the 30 (or 45) day period. FLA. STAT. ANN. §§ 627.640, 627.410(6); FLA. ADMIN. CODE ANN. r. 69O-149.002. Requests for rate hikes must include detailed data and justifications for the increases. Admin Code 69O-149.006
  • Benefits must be reasonable in relation to premiums. Benefits are considered reasonable under this standard if premiums are not excessive, inadequate, nor unfairly discriminatory. The OIR will consider all information in a rate filing when determining if these requirements are met; however, premiums are not excessive if a rate increase will result in a minimum medical loss ratio determined by a statutory formula. FLA. ADMIN. CODE ANN. r. 69O-149.005.
  • Insurers may not close blocks (discontinue sale of a policy) unless notice is given to the Commissioner and “experience of all policy forms providing similar benefits shall be combined for all rating purposes.” 627.410.
  • The Office of Insurance Regulation makes rate filings, including supporting documents, publicly available online in a searchable database, although some portions of the filings are considered company trade secrets, and therefore not disclosed.

Information is based on review of state statutes and regulations and, in some case, interviews or emails with state insurance departments.

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