FL S0638

Amends the definition of "life and health insurer" to include health maintenance organizations (HMOs) authorized only in Florida, effective January 1, 2019, with an exception for prepaid limited health service organizations authorized only in Florida.

Establishes a maximum premium to surplus ratio of 10 to 1 for HMOs, calculated using the formula: (actual or projected gross written premium + actual or projected risk revenue) × 0.80, divided by current or projected surplus.

Requires HMOs to base projected annual gross written premium on actual writings from the current calendar year, prior calendar year, or both.

Authorizes the Office of Insurance Regulation to either suspend an HMO's certificate of authority or establish a maximum annual gross premium limit if the premium to surplus ratio is exceeded, unless the HMO demonstrates the excess does not endanger its financial condition or policyholder interests.

Exempts HMOs with surplus exceeding $40 million and written health maintenance contracts in each of the preceding 5 calendar years from the premium to surplus ratio requirements.