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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. § 641.448 Penalty for violation of cease and desist order
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Any person, entity, or prepaid health clinic that violates a cease and desist order of the office under s. 641.446 while such order is in effect, after notice and hearing as provided in s. 641.445, is subject, at the discretion of the office, to any one or more of the following:(…
Fla. Stat. § 641.45 Revocation or cancellation of certificate of authority; suspension of authority to enroll new subscribers; terms of suspension
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(1) The maintenance of a valid and current Health Care Provider Certificate issued pursuant to part III of this chapter is a condition of the maintenance of a valid and current certificate of authority issued by the office to operate a prepaid health clinic. Revocation or nonrene…
Fla. Stat. § 641.452 Administrative penalty in lieu of suspension or revocation of certificate of authority
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The office may, in lieu of suspension or revocation of a certificate of authority, levy an administrative penalty in an amount not more than $10,000 for each violation by a prepaid health clinic. In levying such fine, the office shall consider the number of members and total reve…
Fla. Stat. § 641.453 Civil liability
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Showing 2,101–2,150 of 2,278

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The provisions of this part are cumulative to the rights under the general civil law and common law, and no action of the office shall abrogate such rights to damages or other relief in any court.History.—ss. 10, 11, ch. 84-313; ss. 187, 188, ch. 91-108; s. 4, ch. 91-429; s. 1621…

Fla. Stat. § 641.454 Civil action to enforce prepaid health clinic contract; attorney’s fees; court costs

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In any civil action brought to enforce the terms and conditions of a prepaid health clinic contract, the prevailing party is entitled to recover reasonable attorney’s fees and court costs. This section shall not be construed to authorize a civil action against the commission or o…

Fla. Stat. § 641.455 Disposition of moneys collected under this part

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Fees, administrative penalties, examination expenses, and other sums collected by the office under this part shall be deposited to the credit of the Insurance Regulatory Trust Fund; however, fees, examination expenses, and other sums collected by, or allocated to, the Agency for …

Fla. Stat. § 641.457 Exemption for certain operational prepaid health clinics

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The provisions of this part do not apply to those prepaid health clinics providing the services defined in ss. 641.40-641.459, which clinics have been continuously engaged in providing such services since January 1, 1947, provided that any prepaid health clinic claiming an exempt…

Fla. Stat. § 641.459 Construction and relationship to other laws

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(1) Except as provided in this part, the Florida Insurance Code, as defined in s. 624.01, does not apply to prepaid health clinics certificated under this part; and prepaid health clinics certificated under this part are not subject to part I of this chapter.(2) The solicitation …

Fla. Stat. § 641.47 Definitions

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As used in this part, the term:(1) “Adverse determination” means a coverage determination by an organization that an admission, availability of care, continued stay, or other health care service has been reviewed and, based upon the information provided, does not meet the organiz…

Fla. Stat. § 641.48 Purpose and application of part

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The purpose of this part is to ensure that health maintenance organizations and prepaid health clinics deliver high-quality health care to their subscribers. To achieve this purpose, this part requires all such organizations to obtain a health care provider certificate from the a…

Fla. Stat. § 641.49 Certification of health maintenance organization and prepaid health clinic as health care providers; application procedure

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(1) No person or governmental unit shall establish, conduct, or maintain a health maintenance organization or a prepaid health clinic in this state without first obtaining a health care provider certificate under this part.(2) The office shall not issue a certificate of authority…

Fla. Stat. § 641.495 Requirements for issuance and maintenance of certificate

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(1) The agency shall issue a health care provider certificate to an applicant filing a completed application in conformity with ss. 641.48 and 641.49, upon payment of the prescribed fee, and upon the agency’s being satisfied that the applicant has the ability to provide quality o…

Fla. Stat. § 641.51 Quality assurance program; second medical opinion requirement

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(1) The organization shall ensure that the health care services provided to subscribers shall be rendered under reasonable standards of quality of care consistent with the prevailing standards of medical practice in the community.(2) Each organization shall have an ongoing intern…

Fla. Stat. § 641.511 Subscriber grievance reporting and resolution requirements

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(1) Every organization must have a grievance procedure available to its subscribers for the purpose of addressing complaints and grievances. Every organization must notify its subscribers that a subscriber must submit a grievance within 1 year after the date of occurrence of the …

Fla. Stat. § 641.512 Accreditation and external quality assurance assessment

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(1)(a) To promote the quality of health care services provided by health maintenance organizations and prepaid health clinics in this state, the office shall require each health maintenance organization and prepaid health clinic to be accredited within 1 year of the organization’…

Fla. Stat. § 641.513 Requirements for providing emergency services and care

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(1) In providing for emergency services and care as a covered service, a health maintenance organization may not:(a) Require prior authorization for the receipt of prehospital transport or treatment or for emergency services and care.(b) Indicate that emergencies are covered only…

Fla. Stat. § 641.514 Coverage for air ambulance services

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1(1) As used in this section, the term:(a) “Air ambulance service” has the same meaning as provided in s. 401.23.(b) “Health maintenance organization” has the same meaning as provided in s. 641.19(12).(c) “Reasonable reimbursement” means reimbursement that considers the direct co…

Fla. Stat. § 641.515 Investigation by the agency

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(1) The agency shall investigate further any quality of care issue contained in recommendations and reports submitted pursuant to s. 641.511. The agency shall also investigate further any information that indicates that the organization does not meet accreditation standards or th…

Fla. Stat. § 641.52 Revocation of certificate; suspension of new enrollment; suspension of the health care provider certificate; administrative fine; notice of action to the office; penalty for use of unlicensed providers

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(1) The agency may suspend the authority of an organization to enroll new subscribers or revoke the health care provider certificate of any organization, or order compliance within a time certain, if it finds that any of the following conditions exist:(a) The organization is in s…

Fla. Stat. § 641.54 Information disclosure

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(1) Every health maintenance organization shall maintain a current list, by geographic area, of all hospitals which are routinely and regularly used by the organization, indicating to which hospitals the organization may refer particular subscribers for nonemergency services. The…

Fla. Stat. § 641.545 Subscriber risk assessments; requirements

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The agency shall require an organization, when providing services to Medicaid subscribers, to attempt, at least twice if necessary, to contact each new Medicaid subscriber within 3 months after the Medicaid subscriber enrolls, in order to perform a health risk assessment. The hea…

Fla. Stat. § 641.55 Internal risk management program

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(1) Every organization certified under this part shall, as a part of its administrative functions, establish an internal risk management program which shall include the following components:(a) The investigation and analysis of the frequency and causes of general categories and s…

Fla. Stat. § 641.56 Rulemaking authority

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The Agency for Health Care Administration has authority to adopt rules pursuant to ss. 120.536(1) and 120.54 to implement the provisions of this part conferring duties upon it.History.—ss. 24, 27, ch. 87-236; ss. 187, 188, ch. 91-108; s. 91, ch. 91-282; s. 4, ch. 91-429; s. 38, c…

Fla. Stat. § 641.57 Disposition of moneys collected under this part

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Fees, administrative penalties, examination expenses, and other sums collected by the Agency for Health Care Administration under this part shall be deposited to the credit of the Health Care Trust Fund to be administered by the agency and shall be used to defray the expenses of …

Fla. Stat. § 641.58 Regulatory assessment; levy and amount; use of funds; tax returns; penalty for failure to pay

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(1) In addition to any other license or excise tax now or hereafter imposed, and such taxes as may be imposed under other statutes, there is hereby assessed and imposed upon every organization authorized to engage in business in this state, an annual regulatory assessment not to …

Fla. Stat. § 641.59 Psychotherapeutic services; records and reports

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A health maintenance organization or prepaid health clinic, as defined in this chapter, must maintain strict confidentiality against unauthorized or inadvertent disclosure of confidential information to persons inside or outside the health maintenance organization or prepaid heal…

Fla. Stat. § 641.61 Subscriber satisfaction assessment

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Each organization must establish systems for:(1) Assessing subscriber satisfaction with providers, particularly primary care physicians;(2) Sharing subscriber-satisfaction indicators and scores with providers;(3) Publicly acknowledging providers with high positive subscriber-sati…

Fla. Stat. § 641.62 Chronic diseases among subscriber populations

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Each organization must:(1) Annually study its subscriber population to determine the most prevalent chronic diseases of its subscribers, design intervention strategies to reduce the morbidities and mortalities associated with at least two prevalent chronic diseases, measure the o…

Fla. Stat. § 642.011 Short title

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Sections 642.011-642.049 may be cited as the “Legal Expense Insurance Act.”History.—s. 1, ch. 79-103; s. 2, ch. 81-318; ss. 20, 21, ch. 83-278; ss. 6, 7, ch. 93-147.

Fla. Stat. § 642.013 Purpose

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The purpose of ss. 642.011-642.049 is to authorize certification and regulation of certain organizations which provide programs for the payment of the costs of legal services or provide legal services.History.—s. 1, ch. 79-103; s. 2, ch. 81-318; ss. 20, 21, ch. 83-278; ss. 6, 7, …

Fla. Stat. § 642.015 Definitions

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As used in ss. 642.011-642.049, the term:(1) “Gross written premiums” means the total amount of premiums paid by the consumer for the entire period of the legal expense insurance contract, including commissions.(2) “Insurer” means any person authorized to conduct a life or casual…

Fla. Stat. § 642.016 Chapter exclusive; applicability of other laws

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Except as provided in this chapter, legal expense insurance corporations shall be governed by this chapter and shall be exempt from all other provisions of the Florida Insurance Code.History.—ss. 29, 52, ch. 85-321; ss. 6, 7, ch. 93-147.

Fla. Stat. § 642.017 Exemptions

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The provisions of the Florida Insurance Code do not apply to:(1) Retainer contracts made by attorneys at law with individual clients with fees based on estimates of the nature and amount of services to be provided to the specific client and similar contracts made with a group of …

Fla. Stat. § 642.019 Organization of legal expense insurance corporations

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(1) Any number of corporations or adult natural persons may organize a legal expense insurance corporation under the law of this state relating to corporations generally.(2) The articles of incorporation shall conform to the requirements applicable to corporations, and, in additi…

Fla. Stat. § 642.021 Certificate of authority

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(1) It is unlawful for any person to engage in a legal expense insurance business in this state without a valid certificate of authority issued by the office, pursuant to ss. 642.011-642.049, except that a domestic, foreign, or alien insurer authorized to transact life or casualt…

Fla. Stat. § 642.022 Insurance business not authorized

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Nothing in the Florida Insurance Code or this chapter shall be deemed to authorize any legal expense corporation to transact any insurance business other than that of legal expense insurance or to otherwise engage in any other type of insurance unless it is authorized under a cer…

Fla. Stat. § 642.023 Required deposit or bond

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(1) To assure the faithful performance of its obligations in the event of insolvency, each legal expense insurance corporation, prior to the issuance of its certificate of authority, shall deposit and maintain with the department securities of the type eligible for deposit by ins…

Fla. Stat. § 642.024 Levy upon deposit

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No judgment creditor or other claimant of a legal expense insurance corporation shall have the right to levy upon any of the assets or securities held in this state as a deposit under s. 642.023.History.—ss. 41, 52, ch. 85-321; ss. 6, 7, ch. 93-147.

Fla. Stat. § 642.025 Policy and certificate forms

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(1) Legal expense insurance may be written as individual, group, blanket, or franchise insurance. Each contractual obligation for legal expense insurance shall be evidenced by a policy. Each person insured under a group policy shall be issued a certificate of coverage.(2) No poli…

Fla. Stat. § 642.0261 Net worth required of applicants

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To receive authority to transact legal expense insurance, an applicant applying for a certificate of authority after October 1, 1993, must possess a net worth not less than the greater of:(1) Ten thousand dollars; or(2) Ten percent of the applicant’s total liabilities.History.—ss…

Fla. Stat. § 642.0262 Net worth required to maintain certificate of authority

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To maintain a certificate of authority to transact legal expense insurance, a legal expense insurance corporation must maintain a net worth of not less than the greater of:(1) Ten thousand dollars; or(2) Ten percent of the insurer’s total liabilities.History.—ss. 4, 7, ch. 93-147…

Fla. Stat. § 642.027 Premium rates

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No policy of legal expense insurance may be issued in this state unless the premium rates for the insurance have been filed with and approved by the office. Premium rates shall be established and justified in accordance with generally accepted insurance principles, including, but…

Fla. Stat. § 642.029 Contracts by insurers

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(1) Contracts made between the insurer and participating attorneys, management contracts, or contracts with providers of other services covered by the legal expense insurance policy shall be filed with and approved by the office.(2) An insurer shall annually report to the office …

Fla. Stat. § 642.0301 Filing, license, statement, and miscellaneous fees

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(1) Every legal expense insurance corporation must pay to the office the following fees:(a) Certificate of authority of legal expense insurance corporation. Filing application for original certificate of authority, including all accompanying documents, filing fee..........$250(b)…

Fla. Stat. § 642.032 Provisions of general insurance law applicable to legal expense insurance corporations

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The following provisions of the Florida Insurance Code shall apply to legal expense insurance corporations, to the extent that they are not inconsistent with the provisions of ss. 642.011-642.049:(1) Chapter 624, administration and general provisions.(2) Chapter 625, accounting, …

Fla. Stat. § 642.0331 Grounds for suspension or revocation of certificate

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(1) The certificate of authority of an insurer, whether issued pursuant to this chapter or the insurance code, may be revoked or suspended, or the office may refuse to renew a certificate of authority, if the office determines that the insurer:(a) Has violated any lawful rule or …

Fla. Stat. § 642.0334 Order; notice of suspension or revocation of certificate; effect; publication

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(1) Suspension or revocation of a certificate of authority of an insurer shall be by order of the office mailed to the corporation by registered or certified mail. The office also shall promptly give notice of such suspension or revocation to the sales representatives in this sta…

Fla. Stat. § 642.0336 Duration of suspension; obligations during suspension; reinstatement

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(1) Suspension of an insurer’s certificate of authority shall be for such period, not to exceed 1 year, as is fixed in the order of suspension, unless such suspension or the order upon which the suspension is based is modified, rescinded, or reversed.(2) During the period of susp…

Fla. Stat. § 642.0338 Administrative fine in lieu of suspension or revocation

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(1) If the office finds that one or more grounds exist for the revocation or suspension of a certificate of authority issued under this chapter, the office may, in lieu of such suspension or revocation, impose a fine upon the insurer.(2) With respect to any nonwillful violation, …

Fla. Stat. § 642.034 License and appointment required

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No person may solicit, negotiate, sell, or execute legal expense insurance contracts on behalf of an insurer in this state unless such person is licensed and appointed as a sales representative or is licensed and appointed under the insurance code as a general lines agent. No per…