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Florida Statutes, Title XXXVII

Florida/Statutes

← All Florida coverage

Title XXXVII, Insurance

19 chapters · 2,278 sections in this title.

All chapters in Title XXXVII2,278 Ch 627, Insurance Rates and Contracts626 Ch 626, Insurance Field Representatives and …368 Ch 624, Insurance Code: Administration and G…222 Ch 641, Health Care Service Programs165 Ch 634, Warranty Associations154 Ch 631, Insurer Insolvency; Guaranty of Payment150 Ch 628, Stock and Mutual Insurers; Holding C…100 Ch 633, Fire Prevention and Control89 Ch 636, Prepaid Limited Health Service Organ…79 Ch 625, Accounting, Investments, and Deposit…78 Ch 651, Continuing Care Contracts54 Ch 648, Bail Bond Agents49 Ch 629, Reciprocal Insurers35 Ch 632, Fraternal Benefit Societies35

2,278 sections·Filtered byTitle XXXVII✕

Fla. Stat. § 641.3005 Application of ch. 85-177
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This act shall take effect October 1, 1985, and shall apply to all health maintenance organizations that have obtained certificates of authority before, on, or after this date, unless otherwise provided in this act. Any provision of this act necessitating a change in a health mai…
Fla. Stat. § 641.3007 HIV infection and AIDS for contract purposes
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(1) PURPOSE.—The purpose of this section is to prohibit unfair practices in a health maintenance organization contract with respect to exposure to the human immunodeficiency virus infection and related matters, and thereby reduce the possibility that a health maintenance organiza…
Fla. Stat. § 641.305 Language used in contracts and advertisements; translations
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(1)(a) All health maintenance contracts or forms shall be printed in English.(b) If the negotiations by a health maintenance organization with a member leading up to the effectuation of a health maintenance contract are conducted in a language other than English, the health maint…
Fla. Stat. § 641.309 Standards for marketing to persons eligible for Medicare
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(1) Every health maintenance organization marketing coverage to Medicare participants or persons eligible for Medicare in this state, directly or through its agents, shall:(a) Establish marketing procedures to assure that any comparison of benefits between Medicare or any other h…

Showing 2,001–2,050 of 2,278

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Fla. Stat. § 641.31 Health maintenance contracts

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(1) Any entity issued a certificate and otherwise in compliance with this part may enter into contracts in this state to provide an agreed-upon set of comprehensive health care services to subscribers in exchange for a prepaid per capita sum or a prepaid aggregate fixed sum. Each…

Fla. Stat. § 641.3101 Additional contract contents

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A health maintenance contract may contain additional provisions not inconsistent with this part which are:(1) Necessary, on account of the manner in which the organization is constituted or operated, in order to state the rights and obligations of the parties to the contract; or(…

Fla. Stat. § 641.31015 Health maintenance organization or exclusive provider organization; disclosure of terms and conditions of plan

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1Each health maintenance organization or exclusive provider organization shall provide prospective enrollees with written information about the terms and conditions of the plan in accordance with s. 641.31(4) so that the prospective enrollees can make informed decisions about acc…

Fla. Stat. § 641.3102 Restrictions upon expulsion or refusal to issue or renew contract

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(1) A health maintenance organization that offers individual health maintenance contracts in this state may not decline to offer coverage to an eligible individual as required in s. 627.6487.(2) A health maintenance organization shall not expel or refuse to renew the coverage of,…

Fla. Stat. § 641.3103 Charter, bylaw provisions

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No health maintenance contract shall contain any provision purporting to make any portion of the articles of incorporation, charter, bylaws, or other organizational document of the health maintenance organization a part of the contract unless the provision is set forth in full in…

Fla. Stat. § 641.3104 Execution of contracts

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(1) Every health maintenance contract shall be executed in the name of and on behalf of the health maintenance organization by its officer, attorney in fact, employee, or representative duly authorized by the organization.(2) A facsimile signature of any executing individual may …

Fla. Stat. § 641.3105 Validity of noncomplying contracts

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(1) Any health maintenance contract, rider, endorsement, attachment, or addendum otherwise valid which contains any condition or provision not in compliance with the requirements of this part shall not be thereby rendered invalid, but shall be construed and applied in accordance …

Fla. Stat. § 641.3106 Construction of contracts

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Every health maintenance contract shall be construed according to the entirety of its terms and conditions as set forth in the contract and as amplified, extended, or modified by any application therefor or any rider, endorsement, attachment, or addendum thereto.History.—ss. 28, …

Fla. Stat. § 641.3107 Delivery of contract; definitions

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(1) A health maintenance contract, certificate of coverage, endorsements and riders, or member handbook shall be mailed, delivered, or otherwise provided to the subscriber or, in the case of a group health maintenance contract, to the employer or other person who will hold the co…

Fla. Stat. § 641.31071 Preexisting conditions

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(1) As used in this section, the term:(a) “Enrollment date” means, with respect to an individual covered under a group health maintenance organization contract, the date of enrollment of the individual in the plan or coverage or, if earlier, the first day of the waiting period of…

Fla. Stat. § 641.31072 Special enrollment periods

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(1) A health maintenance organization that issues a group health insurance policy shall permit an employee who is eligible, but not enrolled, for coverage under the terms of the contract, or a dependent of such an employee if the dependent is eligible but not enrolled for coverag…

Fla. Stat. § 641.31073 Prohibiting discrimination against individual participants and beneficiaries based on health status

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(1) Subject to subsection (2), a health maintenance organization that offers group health insurance coverage may not establish rules for eligibility, including continued eligibility, of an individual to enroll under the terms of the contract based on any of the following health-s…

Fla. Stat. § 641.31074 Guaranteed renewability of coverage

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(1) Except as otherwise provided in this section, a health maintenance organization that issues a health insurance contract must renew or continue in force such coverage at the option of the contract holder.(2) A health maintenance organization may nonrenew or discontinue a contr…

Fla. Stat. § 641.31075 Advanced practice registered nurse services

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A health maintenance contract that is delivered, issued, or renewed in this state on or after January 1, 2021, may not require a subscriber to receive services from an advanced practice registered nurse registered under s. 464.0123 in place of a physician.History.—s. 32, ch. 2020…

Fla. Stat. § 641.31076 Shared savings incentive program

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(1) This section and ss. 627.6387 and 627.6648 may be cited as the “Patient Savings Act.”(2) As used in this section, the term:(a) “Health care provider” means a hospital or facility licensed under chapter 395; an entity licensed under chapter 400; a health care practitioner as d…

Fla. Stat. § 641.31077 Coverage for organ transplants

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A health maintenance contract issued or renewed on or after July 1, 2020, in this state by a health maintenance organization which provides coverage for organ transplants may not deny coverage for an organ transplant solely on the basis of a subscriber’s disability. This section …

Fla. Stat. § 641.3108 Notice of cancellation of contract

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(1) Except for nonpayment of premium or termination of eligibility, no health maintenance organization may cancel or otherwise terminate or fail to renew a health maintenance contract without giving the subscriber at least 45 days’ notice in writing of the cancellation, terminati…

Fla. Stat. § 641.31085 Disclosures to subscribers; coverage of behavioral health care services

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(1) A health maintenance organization shall make all of the following information available on its website:(a) The federal and state requirements for coverage of behavioral health care services.(b) Contact information for the Division of Consumer Services of the department, inclu…

Fla. Stat. § 641.31094 Nondiscrimination of coverage for certain surgical procedures involving bones or joints

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No health maintenance contract or policy which provides coverage for any diagnostic or surgical procedure involving bones or joints of the skeleton shall discriminate against coverage for any similar diagnostic or surgical procedure involving bones or joints of the jaw and facial…

Fla. Stat. § 641.31095 Coverage for mammograms

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(1) Every health maintenance contract issued or renewed on or after January 1, 1996, shall provide coverage for at least the following:(a) A baseline mammogram for any woman who is 35 years of age or older, but younger than 40 years of age.(b) A mammogram every 2 years for any wo…

Fla. Stat. § 641.31096 Requirements with respect to breast cancer and routine followup care

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Routine followup care to determine whether a breast cancer has recurred in a person who has been previously determined to be free of breast cancer does not constitute medical advice, diagnosis, care, or treatment for purposes of determining preexisting conditions unless evidence …

Fla. Stat. § 641.31097 Decreasing inappropriate utilization of emergency care

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(1) The Legislature finds and declares it to be of vital importance that emergency services and care be provided by hospitals and physicians to every person in need of such care, but with the double-digit increases in health insurance premiums, health care providers and insurers …

Fla. Stat. § 641.31098 Coverage for individuals with developmental disabilities

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(1) This section and s. 627.6686 may be cited as the “Steven A. Geller Autism Coverage Act.”(2) As used in this section, the term:(a) “Applied behavior analysis” means the design, implementation, and evaluation of environmental modifications, using behavioral stimuli and conseque…

Fla. Stat. § 641.31099 Restrictions on use of state and federal funds for state exchanges

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(1) A health maintenance contract under which coverage is purchased in whole or in part with any state or federal funds through an exchange created pursuant to the federal Patient Protection and Affordable Care Act, Pub. L. No. 111-148, may not provide coverage for an abortion as…

Fla. Stat. § 641.3111 Extension of benefits

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(1) Every group health maintenance contract shall provide that termination of the contract shall be without prejudice to any continuous loss which commenced while the contract was in force, but any extension of benefits beyond the period the contract was in force may be predicate…

Fla. Stat. § 641.312 Scope

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The Office of Insurance Regulation may adopt rules to administer the National Association of Insurance Commissioners’ Uniform Health Carrier External Review Model Act, issued by the National Association of Insurance Commissioners and dated April 2010. This section does not apply …

Fla. Stat. § 641.313 Health maintenance contracts; cancer treatment parity; orally administered cancer treatment medications

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(1) As used in this section, the term:(a) “Cancer treatment medication” means medication prescribed by a treating physician who determines that the medication is medically necessary to kill or slow the growth of cancerous cells in a manner consistent with nationally accepted stan…

Fla. Stat. § 641.314 Pharmacy benefit manager contracts

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(1) As used in this section, the term:(a) “Maximum allowable cost” means the per-unit amount that a pharmacy benefit manager reimburses a pharmacist for a prescription drug, excluding dispensing fees, prior to the application of copayments, coinsurance, and other cost-sharing cha…

Fla. Stat. § 641.315 Provider contracts

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(1) Each contract between a health maintenance organization and a provider of health care services must be in writing and must contain a provision that the subscriber is not liable to the provider for any services for which the health maintenance organization is liable as specifi…

Fla. Stat. § 641.3154 Organization liability; provider billing prohibited

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(1) If a health maintenance organization is liable for services rendered to a subscriber by a provider, regardless of whether a contract exists between the organization and the provider, the organization is liable for payment of fees to the provider and the subscriber is not liab…

Fla. Stat. § 641.3155 Prompt payment of claims

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(1) As used in this section, the term “claim” for a noninstitutional provider means a paper or electronic billing instrument submitted to the health maintenance organization’s designated location that consists of the HCFA 1500 data set, or its successor, that has all mandatory en…

Fla. Stat. § 641.3156 Treatment authorization; payment of claims

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(1) A health maintenance organization must pay any hospital-service or referral-service claim for treatment for an eligible subscriber which was authorized by a provider empowered by contract with the health maintenance organization to authorize or direct the patient’s utilizatio…

Fla. Stat. § 641.316 Fiscal intermediary services

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(1) It is the intent of the Legislature, through the adoption of this section, to ensure the financial soundness of fiscal intermediary services organizations established to develop, manage, and administer the business affairs of health care professional providers such as medical…

Fla. Stat. § 641.32 Acceptable payments

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Each health maintenance organization may accept from governmental agencies, corporations, associations, groups, or individuals payments covering all or part of the cost of contracts entered into between the health maintenance organization and its subscribers.History.—s. 16, ch. 7…

Fla. Stat. § 641.33 Certain words prohibited in name of organization

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(1) No entity certificated as a health maintenance organization, other than a licensed insurer insofar as its name is concerned, shall use in its name, contracts, or literature any of the words “insurance,” “casualty,” “surety,” “mutual,” or any other words descriptive of the ins…

Fla. Stat. § 641.35 Assets, liabilities, and investments

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(1) ASSETS.—In any determination of the financial condition of a health maintenance organization, there shall be allowed as “assets” only those assets that are owned by the health maintenance organization and that consist of:(a) Cash or cash equivalents in the possession of the h…

Fla. Stat. § 641.36 Adoption of rules; penalty for violation

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The commission shall adopt rules necessary to carry out the provisions of this part. The office shall collect and make available all health maintenance organization rules adopted by the commission. Any violation of a rule adopted under this section shall subject the violating ent…

Fla. Stat. § 641.365 Dividends

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(1)(a) A health maintenance organization shall not pay any dividend or distribute cash or other property to stockholders except out of that part of its available and accumulated surplus funds which is derived from realized net operating profits on its business and net realized ca…

Fla. Stat. § 641.37 Prohibited activities; penalties

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(1) Any person or entity which knowingly renews, issues, or delivers any health maintenance contract without first obtaining and thereafter maintaining a certificate of authority is guilty of a felony of the third degree, punishable as provided in s. 775.082 or s. 775.083.(2) Exc…

Fla. Stat. § 641.38 Operational health maintenance organizations; issuance of certificate

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The provisions of this part do not apply to those organizations providing the services defined in ss. 641.17-641.38 which have been continuously engaged in providing such services since January 1, 1947. This exemption shall terminate upon a change in controlling ownership of the …

Fla. Stat. § 641.385 Order to discontinue certain advertising

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If in the opinion of the office any advertisement by a health maintenance organization violates any of the provisions of this part, the department may enter an immediate order requiring that the use of the advertisement be discontinued. If requested by the health maintenance orga…

Fla. Stat. § 641.386 Agent licensing and appointment required; exceptions

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(1) With respect to a health maintenance contract, no person shall, unless licensed and appointed as a health insurance agent in accordance with the applicable provisions of the Florida Insurance Code:(a) Solicit contracts or procure applications; or(b) Engage or hold himself or …

Fla. Stat. § 641.39001 Soliciting or accepting new or renewal health maintenance contracts by insolvent or impaired health maintenance organization prohibited; penalty

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(1) Whether or not delinquency proceedings as to a health maintenance organization have been or are to be initiated, a director or officer of a health maintenance organization, except with the written permission of the office, may not authorize or permit the health maintenance or…

Fla. Stat. § 641.3901 Unfair methods of competition and unfair or deceptive acts or practices prohibited

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No person, entity, or health maintenance organization shall engage in this state in any trade practice which is defined in this part as, or determined pursuant to s. 641.3905 to be, an unfair method of competition or an unfair or deceptive act or practice involving the business o…

Fla. Stat. § 641.3903 Unfair methods of competition and unfair or deceptive acts or practices defined

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The following are defined as unfair methods of competition and unfair or deceptive acts or practices:(1) MISREPRESENTATION AND FALSE ADVERTISING OF HEALTH MAINTENANCE CONTRACTS.—Knowingly making, issuing, or circulating, or causing to be made, issued, or circulated, any estimate,…

Fla. Stat. § 641.3905 General powers and duties of the department and office

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In addition to the powers and duties set forth in s. 624.307, the department and office shall each have the power within its respective regulatory jurisdiction to examine and investigate the affairs of every person, entity, or health maintenance organization in order to determine…