Fla. Admin. Code R. 69O-149.206

Current through Reg. 50, No. 253; December 31, 2024

Section 69O-149.206 - Preferred Provider/Exclusive Provider Standard Risk Rates

(1) The table below provides the standard annual risk rates for PPO/EPO plans for the FCHA and Standard Health Benefit Plan. The 200% standard risk rate referenced in section 627.6675(3)(a), F.S., is determined by multiplying each value in the table by the factor 2.0.

(2) To determine the rate for a particular county, multiply the rate schedule below by the appropriate area factor.

(3) Standard risk rates for coverage providing benefits coordinating with or otherwise considering coverage under Medicare, parts A and B, shall be determined by multiplying the standard risk rates identified herein by .278.

(4) Standard risk rates for coverage providing benefits as defined in section 627.6498, F.S. (FCHA plan), shall multiply the standard risk rates identified herein by .96.

STANDARD HEALTH BENEFIT PLAN
Age	Male	Female	County	Area Factor
0	$2,269.71	$2,205.88	Alachua	0.70
1	$2,269.71	$2,205.88	Baker	0.78
2	$1,862.25	$1,831.86	Bay	0.80
3	$1,646.48	$1,616.10	Bradford	0.82
4	$1,524.94	$1,464.16	Brevard	0.93
5	$1,464.16	$1,339.66	Broward	1.41
6	$1,400.43	$1,218.11	Calhoun	0.75
7	$1,339.66	$1,126.95	Charlotte	0.95
8	$1,278.88	$1,032.73	Citrus	0.72
9	$1,248.50	$1,032.73	Clay	0.80
10	$1,278.88	$1,063.12	Collier	0.93
11	$1,309.27	$1,126.95	Columbia	0.80
12	$1,339.66	$1,218.11	Dade	1.30
13	$1,445.38	$1,401.89	De Soto	0.74
14	$1,569.89	$1,526.40	Dixie	0.69
15	$1,661.05	$1,647.95	Duval	0.94
16	$1,782.60	$1,769.49	Escambia	0.77
17	$1,846.43	$1,868.63	Flagler	0.86
18	$1,677.62	$1,731.60	Franklin	0.75
19	$1,729.06	$1,833.53	Gadsden	0.75
20	$1,779.55	$1,938.77	Gilchrist	0.75
21	$1,856.45	$2,067.93	Glades	0.98
22	$1,911.43	$2,205.39	Gulf	0.76
23	$1,963.55	$2,315.98	Hamilton	0.77
24	$2,015.45	$2,431.51	Hardee	0.80
25	$2,067.34	$2,528.50	Hendry	0.97
26	$2,119.01	$2,592.34	Hernando	0.85
27	$2,176.62	$2,653.36	Highlands	0.71
28	$2,257.50	$2,718.82	Hillsborough	0.82
29	$2,316.80	$2,786.17	Holmes	0.75
30	$2,372.69	$2,833.44	Indian River	0.92
31	$2,436.98	$2,879.75	Jackson	0.77
32	$2,506.76	$2,954.83	Jefferson	0.75
33	$2,578.54	$3,031.05	Lafayette	0.78
34	$2,649.40	$3,082.98	Lake	0.90
35	$2,741.76	$3,134.92	Lee	0.97
36	$2,816.34	$3,188.48	Leon	0.79
37	$2,898.23	$3,246.48	Levy	0.80
38	$2,974.23	$3,279.60	Liberty	0.75
39	$3,052.57	$3,329.10	Madison	0.79
40	$3,129.28	$3,390.47	Manatee	0.91
41	$3,201.52	$3,480.97	Marion	0.77
42	$3,307.34	$3,602.71	Martin	0.94
43	$3,405.57	$3,738.45	Monroe	1.30
44	$3,504.04	$3,875.01	Nassau	0.85
45	$3,620.45	$4,027.23	Okaloosa	0.76
46	$3,743.36	$4,186.98	Okeechobee	0.97
47	$3,867.57	$4,332.64	Orange	0.90
48	$4,044.14	$4,487.03	Osceola	0.91
49	$4,254.26	$4,647.82	Palm Beach	1.00
50	$4,484.29	$4,817.80	Pasco	0.90
51	$4,712.62	$4,964.22	Pinellas	0.87
52	$4,992.07	$5,108.97	Polk	0.84
53	$5,243.22	$5,219.95	Putnam	0.81
54	$5,532.82	$5,375.90	St. Johns	0.77
55	$5,798.51	$5,533.46	St. Lucie	0.99
56	$6,114.18	$5,718.08	Santa Rosa	0.77
57	$6,471.97	$5,933.22	Sarasota	0.76
58	$6,819.70	$6,156.54	Seminole	0.92
59	$7,192.79	$6,400.67	Sumter	0.81
60	$7,454.79	$6,678.58	Suwannee	0.82
61	$7,701.77	$6,911.27	Taylor	0.79
62	$7,900.57	$7,143.56	Union	0.79
63	$8,070.52	$7,316.73	Volusia	0.92
64	$8,206.71	$7,426.21	Wakulla	0.75
65	$8,758.12	$7,836.62	Walton	0.76
66	$8,793.24	$7,867.77	Washington	0.76
67	$8,851.33	$7,900.07
68	$8,929.30	$7,940.58
69	$9,007.04	$7,983.68
70	$9,085.01	$8,023.71
71	$9,162.51	$8,064.69
72	$9,244.24	$8,109.88
73	$9,318.22	$8,145.70
74	$9,388.96	$8,183.89
75	$9,463.41	$8,224.62
76	$9,537.41	$8,257.64
77	$9,611.39	$8,296.75
78	$9,648.63	$8,348.73
79	$9,685.87	$8,400.24

Fla. Admin. Code Ann. R. 69O-149.206

Rulemaking Authority 624.308, 627.6675(3)(c) FS. Law Implemented 624.307(1), 627.6498(4), 627.6675(3), 641.3922(3) FS.

New 3-2-00, Amended 4-2-01, 4-17-02, 1-20-03, Formerly 4-149.206, Amended 5-18-04, 5-22-05, 6-1-06, 8-23-07, 10-29-08.