Section 69O-149.022 - Forms Adopted(1) The forms adopted in subsection (2), below, shall be used, as applicable, by insurers making form filings for life and accident insurance, annuities, and health insurance. All the forms in subsections (2) and (3), below, are hereby adopted and incorporated by reference. All forms are available and may be printed from the Office's website: www.floir.com.(2)(c) Health Checklists. 1. OIR-B2-1616, "Blanket Application Checklist," Rev. 1/05.2. OIR-B2-535, "Blanket Health Contract Checklist," Rev. 1/04.3. OIR-B2-527, "Debtor Group Application Checklist," Rev. 1/04.4. OIR-B2-529, "Debtor Group Contract Checklist," Rev. 1/04.5. OIR-B2-528, "Florida Additional Information Checklist for Debtor Group," Rev. 8/03.6. OIR-B2-1607, "Discount Medical Plan Organization (DMPO) Contract and Application Checklist," 9/04.7. OIR-B2-539, "Excess-Specific and Aggregate Checklist," Rev. 1/04.8. OIR-B2-540, "Informational Memorandum Checklist - Florida Excess Specific and Aggregate - Section 624.406, F.S.," Rev. 1/04.9. OIR-B2-1356, "Florida HMO Contract Checklist," Rev. 1/04.10. OIR-B2-1617, "Florida HMO Individual Application Checklist," 1/05.11. OIR-B2-1618, "Florida HMO Master Group Application Checklist," 1/05.12. OIR-B2-536, "Franchise Health Application Checklist," Rev. 1/04.13. OIR-B2-538, "Franchise Health Contract Checklist," Rev. 1/04.14. OIR-B2-537, "Franchise Health Outline of Coverage Checklist," Rev. 1/04.15. OIR-B2-525, "Group Health Application Checklist - Employers, Labor Unions, Association Groups and Additional Groups," Rev. 1/04.16. OIR-B2-526, "Group Health Contract Checklist - Employers, Labor Unions, Association Groups and Additional Groups," Rev. 1/04.17. OIR-B2-520, "Individual Health Application Checklist," Rev. 1/04.18. OIR-B2-523, "Individual Health Contract Checklist," Rev. 1/04.19. OIR-B2-521, "Individual Health Outline of Coverage Checklist," Rev. 1/04.20. OIR-B2-1619, "Long Term Care Advertisement Checklist," 1/05.21. OIR-B2-541, "Long Term Care Application Checklist," Rev. 1/04.22. OIR-B2-543, "Long Term Care Contract Checklist," Rev. 1/04.23. OIR-B2-542, "Long Term Care Outline of Coverage Checklist," Rev. 1/04.24. OIR-B2-1620, "Medicare Supplement Advertisement Checklist," 1/05.25. OIR-B2-1354, "Medicare Supplement Application Checklist," Rev. 1/04.26. OIR-B2-1355, "Medicare Supplement Contract Checklist," Rev. 1/04.27. OIR-B2-1621, "Medicare Supplement Outline of Coverage," 1/05.28. OIR-B2-524, "Out-of-State Group Health Checklist," Rev. 1/04.29. OIR-B2-1353, "Pre-Paid Limited Benefit Contract Checklist," Rev. 1/04.30. OIR-B2-1359, "Pre-Paid Limited Benefit Conversion Application Checklist," Rev. 1/04.31. OIR-B2-1358, "Pre-Paid Limited Benefit Group Application Checklist," Rev. 1/04.32. OIR-B2-1360, "Pre-Paid Limited Benefit Individual Application Checklist," Rev. 1/04.33. OIR-B2-1622, "Small Group Advertisement Checklist," 1/05.34. OIR-B2-1357, "Florida Small Group Health Checklist for Indemnity Plans Other Than Standard and Basic," Rev. 1/04.(d) Life Checklists. 1. OIR-B2-1624, "Credit Disability Policy Checklist," 1/05.2. OIR-B2-1625, "Credit Life or Disability Application Checklist," 1/05.3. OIR-B2-1626, "Credit Life Policy Checklist," 1/05.4. OIR-B2-1367, "Endorsements, Amendments & Riders Checklist," Rev. 1/04.5. OIR-B2-1627, "Group Annuity Enrollment Application Checklist," 1/05.6. OIR-B2-1628, "Group Life Enrollment Application Checklist," 1/05.7. OIR-B2-1363, "Group Non-Variable Annuity Contract Checklist," Rev. 1/04.8. OIR-B2-1349, "Group Non-Variable Annuity Enrollment Application Checklist," Rev. 1/04.9. OIR-B2-1488, "Group Term Life Policy Checklist," Rev. 1/04.10. OIR-B2-1345, "Group Universal Life Policy Checklist," Rev. 1/04.11. OIR-B2-1365, "Group Variable Annuity Contract Checklist," Rev. 1/04.12. OIR-B2-1342, "Group Variable Annuity Enrollment Application Checklist," Rev. 1/04.13. OIR-B2-1629, "Group Variable Life Enrollment Application Checklist," 1/05.14. OIR-B2-1489, "Group Variable Life Policy Checklist," Rev. 1/04.15. OIR-B2-1490, "Group Whole Life Policy Checklist," Rev. 1/04.16. OIR-B2-1630, "Individual Fraternal Life Application Checklist," 1/05.17. OIR-B2-1631, "Individual Fraternal Non-Variable Annuity Application Checklist," 1/05.18. OIR-B2-1632, "Individual Fraternal Non-Variable Annuity Contract Checklist," 1/05.19. OIR-B2-1382, "Individual Fraternal Term Life Policy Checklist," Rev. 1/04.20. OIR-B2-1491, "Individual Fraternal Universal Life Policy Checklist," Rev. 1/05.21. OIR-B2-1633, "Individual Fraternal Variable Annuity Application Checklist," 1/05.22. OIR-B2-1634, "Individual Fraternal Variable Annuity Contract Checklist," 1/05.23. OIR-B2-1635, "Individual Fraternal Variable Life Application Checklist," 1/05.24. OIR-B2-1636, "Individual Fraternal Variable Life Policy Checklist," 1/05.25. OIR-B2-1314, "Individual Fraternal Whole Life Policy Checklist," Rev. 1/04.26. OIR-B2-1346, "Individual Life Application Checklist," Rev. 1/04.27. OIR-B2-1637, "Individual Non-Variable Annuity Application Checklist," 1/05.28. OIR-B2-1352, "Individual Non-Variable Annuity Contract Checklist," Rev. 1/04.29. OIR-B2-1493, "Individual Term Life Policy Checklist," Rev. 1/04.30. OIR-B2-1494, "Individual Universal Life Policy Checklist," Rev. 1/04.31. OIR-B2-1348, "Individual Variable Annuity Application Checklist," Rev. 1/04.32. OIR-B2-1364, "Individual Variable Annuity Contract Checklist," Rev. 1/04.33. OIR-B2-1638, "Individual Variable Life Application Checklist," 1/05.34. OIR-B2-1384, "Individual Variable Life Policy Checklist," Rev. 1/04.35. OIR-B2-1496, "Individual Whole Life Policy Checklist," Rev. 1/04.36. OIR-B2-1350, "Master Group Application Checklist," Rev. 1/04.37. OIR-B2-1639, "Out-of-State Group Life Enrollment Application Checklist," 1/05.38. OIR-B2-1640, "Out-of-State Group Non-Variable Annuity Contract Checklist," 1/05.39. OIR-B2-1641, "Out-of-State Group Non-Variable Annuity Enrollment Application Checklist," 1/05.40. OIR-B2-1328, "Out-of-State Group Term Life Policy Checklist," Rev. 1/05.41. OIR-B2-1330, "Out-of-State Group Universal Life Policy Checklist," Rev. 1/05.42. OIR-B2-1642, "Out-of-State Group Variable Annuity Contract Checklist," 1/05.43. OIR-B2-1644, "Out-of-State Group Variable Annuity Enrollment Application Checklist," 1/05.44. OIR-B2-1643, "Out-of-State Group Variable Life Enrollment Application Checklist," 1/05.45. OIR-B2-1343, "Out-of-State Group Variable Life Policy Checklist," Rev. 1/05.46. OIR-B2-1329, "Out-of-State Group Whole Life Policy Checklist," Rev. 1/05.47. OIR-B2-1646, "Viatical Contract Checklist," 3/05.48. OIR-B2-1647, "Viatical Settlement Escrow Form Checklist," 3/05.49. OIR-B2-1648, "Viatical Settlement Purchase Agreement Checklist," 3/05.50. OIR-B2-1649, "Viatical Settlement Related Form Checklist," 3/05.Fla. Admin. Code Ann. R. 69O-149.022
Rulemaking Authority 624.308, 627.410(9) FS. Law Implemented 624.424(1)(c), 627.410, 636.216, 627.410(9) FS.
New 10-29-91, Amended 5-15-96, 4-4-02, 5-2-02, 6-19-03, Formerly 4-149.022, Amended 4-7-05, 1-12-06, 1-28-13, 12-10-2013.New 10-29-91, Amended 5-15-96, 4-4-02, 5-2-02, 6-19-03, Formerly 4-149.022, Amended 4-7-05, 1-12-06, 1-28-13, 12-10-13.