Medicare Supplement Insurance

Forms

The Office promulgates forms to facilitate the transfer of information from the insurance entities to the Office. These forms have information required by Florida statutes and rules.

Each form has an official form number, which pertains to the agency that generated the form, the area within that agency, and the numeric order of the form being issued. For example, the 11th form issued by the Applications Coordination section would be numbered OIR-C1-11.

Code	OIR Unit
A1	Property & Casualty Financial Oversight
A2	Life & Health Financial Oversight
A3	Specialty Product Review
B1	Property & Casualty Product Review
B2	Life & Health Product Review
B3	Market Investigations
C1	Applications Coordination
D0	Forms with cross-unit usage

OIR-B2-MSR Medicare Supplement Refund Calculation Form

OIR-B2-MSB-I -- Reporting Forms for the Calculation of Benchmark Loss Ratio since Inception (Individual)

OIR-B2-MSB-G -- Reporting Forms for the Calculation of Benchmark Loss Ratio since Inception (Group)

OIR-B2-1354 Medicare Supplement Application Checklist

OIR-B2-1355 Medicare Supplement Contract Checklist

OIR-B2-1620 Medicare Supplement Advertisement Checklist

OIR-B2-1621 Medicare Supplement Outline of Coverage Checklist

 

 

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