Consent Order imposing funding, reporting, and compliance conditions on Gold Kidney of Florida, Inc.
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This Consent Order documents the Florida Office of Insurance Regulation's approval of Gold Kidney of Florida, Inc.'s 2025 Medicare Advantage service area expansion and imposes funding, reporting, and compliance requirements on the licensee; it applies to Gold Kidney of Florida, Inc. as a Florida-licensed HMO.
Financial and Compliance Conditions
Financial prefunding and reporting conditions
Conditions Gold Kidney must meet upon execution of the Consent Order:
Confirmation and documentation must be provided by September 30, 2024, before open enrollment begins.
ALL of the following
- If it is determined actual losses exceed projected losses initially represented in the PROJECTIONS, provide a plan for funding actual losses within 5 business days of the determination
- Provide the required additional funding within 45 days of the quarter end
- File documentation evidencing sufficient funding in the corresponding quarterly or annual financial statement filing by the required filing deadlines
- Provide revised financial projections with the quarterly or annual financial statement filing by the required filing deadlines
Office review
- The Office may reconsider the funding of losses on a quarterly basis once Gold Kidney demonstrates two consecutive annual financial statements reflecting positive net income
Obligations and Deadlines for Gold Kidney
Fund projected 2025 losses, report funding, and meet escalation timelines if projections are exceeded
Prefund all projected losses for contract year 2025 based on the submitted PROJECTIONS and confirm receipt of that funding by providing documentation evidencing sufficient funding has been received by September 30, 2024 (before open enrollment). If actual losses are determined to exceed projected losses for 2024 and going forward, provide (1) a plan for funding actual losses within 5 business days of the determination; (2) the required additional funding within 45 days of the quarter end; (3) documentation evidencing sufficient funding filed with the corresponding quarterly or annual financial statement by the required filing deadlines; and (4) revised financial projections with the quarterly or annual filing by the required filing deadlines. Failure to adhere to these terms may result in the OFFICE suspending, revoking, or taking other administrative action against Gold Kidney's Certificate of Authority.
- Prefund all projected 2025 losses and confirm receipt with documentary evidence by September 30, 2024 (before open enrollment).
- If actual losses exceed projections: provide funding plan within 5 business days of determination.
- If actual losses exceed projections: provide additional required funding within 45 days of the quarter end.
- File documentation evidencing sufficient funding with the corresponding quarterly or annual financial statement by required filing deadlines.
- Submit revised financial projections with the quarterly or annual filing by required filing deadlines.
- Request any change to deadlines or requirements in writing at least 5 business days prior to a deadline; noncompliance may prompt suspension, revocation, or other administrative action under Fla. Stat. §§120.569(2)(n) and 120.60(6).
Defined Terms
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