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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. § 627.636 Industrial health insurance
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Industrial health insurance is that form of individual health insurance for which the premium is payable weekly. No policy of industrial health insurance may be delivered or issued for delivery in this state unless it has printed thereon the words “industrial policy” or “weekly p…
Fla. Stat. § 627.637 Construction of noncomplying contracts
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If any insurer writes or issues in this state any health insurance contract, as contemplated by this chapter, and the form of such contract is not authorized by or in conformity with the provisions of this chapter, the contract shall nevertheless be a valid and binding contract o…
Fla. Stat. § 627.638 Direct payment for hospital, medical services
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(1) Any health insurance policy insuring against loss or expense due to hospital confinement or to medical and related services may provide for payment of benefits directly to any recognized hospital, licensed ambulance provider, doctor, or other person who provided the services,…
Fla. Stat. § 627.6385 Disclosures to policyholders; calculations of cost sharing
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(1) Each health insurer shall make available on its website:(a) A method for policyholders to estimate their copayments, deductibles, and other cost-sharing responsibilities for health care services and procedures. Such method of making an estimate shall be based on service bundl…

Showing 951–1,000 of 2,278

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Fla. Stat. § 627.6387 Shared savings incentive program

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(1) This section and ss. 627.6648 and 641.31076 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 …

Fla. Stat. § 627.639 Application signed by agent

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If the application for a health insurance policy is to be made a part of the contract of insurance, the insurer’s agent who completed the application shall sign the same in the capacity of soliciting agent.History.—s. 582, ch. 59-205; s. 3, ch. 76-168; s. 1, ch. 77-457; ss. 2, 3,…

Fla. Stat. § 627.640 Filing of classifications and rates

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An insurer shall not deliver or issue for delivery in this state any health insurance policy until it has filed with the office a copy of any applicable classification of risks and premium rates.History.—s. 583, ch. 59-205; ss. 13, 35, ch. 69-106; s. 3, ch. 76-168; s. 1, ch. 77-4…

Fla. Stat. § 627.6401 Refunds for persons age 64

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If an insured who has reached his or her 64th birthday but who is not yet 65 years of age pays an annual or semiannual premium that would otherwise pay for coverage beyond his or her 65th birthday, such person shall be entitled to an appropriate refund of unearned premium from th…

Fla. Stat. § 627.6402 Insurance rebates for healthy lifestyles

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(1) Any rate, rating schedule, or rating manual for an individual health insurance policy filed with the office may provide for an appropriate rebate of premiums paid in the last year when the individual covered by such plan is enrolled in and maintains participation in any healt…

Fla. Stat. § 627.64025 Advanced practice registered nurse services

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A health insurance policy that provides major medical coverage and that is delivered, issued, or renewed in this state on or after January 1, 2021, may not require an insured to receive services from an advanced practice registered nurse registered under s. 464.0123 in place of a…

Fla. Stat. § 627.6403 Payment of acupuncture benefits to certified acupuncturists

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Any policy of individual health insurance that provides coverage for acupuncture shall cover the services of an acupuncturist certified pursuant to chapter 457 under the same conditions that apply to services of a licensed physician.History.—ss. 1, 3, ch. 87-176; s. 114, ch. 92-3…

Fla. Stat. § 627.6405 Decreasing inappropriate utilization of emergency care

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(1) A health insurer shall post on its website, and update annually, information regarding appropriate utilization of emergency care services which shall include, but need not be limited to:(a) A list of alternative urgent care contracted providers;(b) The types of services offer…

Fla. Stat. § 627.6406 Maternity care

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(1) Any policy of health insurance which provides coverage for maternity care must also cover the services of certified nurse-midwives and midwives licensed pursuant to chapter 467, and the services of birth centers licensed under ss. 383.30-383.332.(2) An insurer issuing a healt…

Fla. Stat. § 627.6407 Massage

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Any policy of health insurance that provides coverage for massage shall also cover the services of persons licensed to practice massage therapy pursuant to chapter 480, where the massage therapy, as defined in chapter 480, has been prescribed by a physician licensed under chapter…

Fla. Stat. § 627.6408 Diabetes treatment services

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(1) A health insurance policy or group health insurance policy sold in this state must provide coverage for all medically appropriate and necessary equipment, supplies, and diabetes outpatient self-management training and educational services used to treat diabetes, if the patien…

Fla. Stat. § 627.6409 Coverage for osteoporosis screening, diagnosis, treatment, and management

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Any health insurance policy that covers a resident of this state and that is issued, amended, delivered, or renewed in this state after October 1, 1996, must provide coverage for the medically necessary diagnosis and treatment of osteoporosis for high-risk individuals, including,…

Fla. Stat. § 627.641 Coverage for newborn children

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(1) A health insurance policy that provides coverage on an expense-incurred basis for a member of the family of the insured or subscriber shall, as to the family member’s coverage, also provide that the health insurance benefits applicable for children will be payable with respec…

Fla. Stat. § 627.6415 Coverage for natural-born, adopted, and foster children; children in insured’s custodial care

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(1) A health insurance policy that provides coverage for a member of the family of the insured shall, as to the family member’s coverage, provide that the health insurance benefits applicable to children of the insured also apply to an adopted child or a foster child of the insur…

Fla. Stat. § 627.6416 Coverage for child health supervision services

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(1) All health insurance policies providing coverage on an expense-incurred basis which provide coverage for a member of a family of the insured or subscriber must, as to such family member’s coverage, also provide that the health insurance benefits applicable for children includ…

Fla. Stat. § 627.6417 Coverage for surgical procedures and devices incident to mastectomy

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(1) Any health insurance policy that provides coverage for mastectomies must also provide coverage for prosthetic devices and breast reconstructive surgery incident to the mastectomy. The insurer may charge an appropriate additional premium for the coverage required by this subse…

Fla. Stat. § 627.64171 Coverage for length of stay and outpatient postsurgical care

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(1) Any health insurance policy that is issued, amended, delivered, or renewed in this state which provides coverage for breast cancer treatment may not limit inpatient hospital coverage for mastectomies to any period that is less than that determined by the treating physician to…

Fla. Stat. § 627.64172 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. § 627.6418 Coverage for mammograms

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(1) An accident or health insurance policy issued, amended, delivered, or renewed in this state must 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 …

Fla. Stat. § 627.6419 Requirements with respect to breast cancer

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(1) An insurer may not deny the issuance or renewal of, or cancel, a policy of accident insurance or health insurance, nor include any exception or exclusion of benefits in a policy solely because the insured has been diagnosed as having a fibrocystic condition or a nonmalignant …

Fla. Stat. § 627.64193 Required coverage for cleft lip and cleft palate

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A health insurance policy that covers a child under the age of 18 must provide coverage for treatment of cleft lip and cleft palate for the child. The coverage must include medical, dental, speech therapy, audiology, and nutrition services only if such services are prescribed by …

Fla. Stat. § 627.64194 Coverage requirements for services provided by nonparticipating providers; payment collection limitations

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(1) As used in this section, the term:(a) “Emergency services” means emergency services and care, as defined in s. 641.47(8), which are provided in a facility.(b) “Facility” means a licensed facility as defined in s. 395.002(17) and an urgent care center as defined in s. 395.002.…

Fla. Stat. § 627.64195 Requirements for opioid coverage

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(1) DEFINITIONS.—As used in this section, the term:(a) “Abuse-deterrent opioid analgesic drug product” means a brand or generic opioid analgesic drug product approved by the United States Food and Drug Administration with an abuse-deterrence labeling claim that indicates the drug…

Fla. Stat. § 627.64196 Medication synchronization

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(1) A health insurer issuing or delivering in this state an individual or a group health insurance policy that provides prescription drug coverage shall offer medication synchronization to allow an insured to align at least once in a plan year the refill dates for prescription dr…

Fla. Stat. § 627.64197 Coverage for organ transplants

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A health insurance policy issued, delivered, or renewed on or after July 1, 2020, in this state by an insurer which provides coverage for organ transplants on an expense-incurred basis may not deny coverage for an organ transplant solely on the basis of an insured’s disability. T…

Fla. Stat. § 627.642 Outline of coverage

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(1) A policy offering benefits defined in s. 627.6513(1)-(14) may not be delivered, or issued for delivery, in this state unless:(a) It is accompanied by an appropriate outline of coverage; or(b) An appropriate outline of coverage is completed and delivered to the applicant at th…

Fla. Stat. § 627.6425 Renewability of individual coverage

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(1) Except as otherwise provided in this section, an insurer that provides individual health insurance coverage to an individual shall renew or continue in force such coverage at the option of the individual. For the purpose of this section, the term “individual health insurance”…

Fla. Stat. § 627.6426 Short-term health insurance

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(1) For purposes of this part, the term “short-term health insurance” means health insurance coverage provided by an issuer with an expiration date specified in the contract that is less than 12 months after the original effective date of the contract and, taking into account ren…

Fla. Stat. § 627.643 Uniform minimum standards

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(1) The commission shall adopt rules which establish minimum standards for the general content of forms of individual and family health insurance policies. The rules must include terms of renewability, initial and subsequent conditions of eligibility, termination of insurance, pr…

Fla. Stat. § 627.644 Discrimination against handicapped prohibited

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No health insurer shall refuse to provide, or shall charge unfairly discriminatory rates for, health insurance coverage for a person solely because the person is mentally or physically handicapped. Nothing in this section should be construed as requiring an insurer to provide ins…

Fla. Stat. § 627.645 Denial of health insurance claims restricted

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(1) A claim for payment under a health insurance policy or self-insured program of health benefits for treatment, care, or services in a licensed hospital that is accredited by an accrediting organization whose standards incorporate comparable regulations required by this state m…

Fla. Stat. § 627.646 Conversion on termination of eligibility

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(1) Every health insurance policy providing hospital or medical expense coverage hereafter delivered or issued for delivery in this state or under which benefits are altered, modified, or amended shall contain a provision that, if the insurance on a person covered under the polic…

Fla. Stat. § 627.647 Standard health claim form

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(1) The commission shall prescribe a standard health claim form to be used by all hospitals and a standard health claim form to be used by all physicians, dentists, and pharmacists. Such forms shall be in a format that allows for the use of generally accepted coding systems by pr…

Fla. Stat. § 627.6471 Contracts for reduced rates of payment; limitations; coinsurance and deductibles

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(1) As used in this section:(a) “Insurer” means an insurer as defined in s. 624.03 or a multiple-employer welfare arrangement as defined in s. 624.437.(b) “Preferred provider” means any licensed health care provider with which the insurer has directly or indirectly contracted for…

Fla. Stat. § 627.6472 Exclusive provider organizations

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(1) As used in this section, the term:(a) “Complaint” means any dissatisfaction expressed by a policyholder concerning an insurer or its network providers.(b) “Emergency care” means medical services provided after the sudden or unexpected onset of a medical condition manifesting …

Fla. Stat. § 627.64725 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. § 627.6473 Combined preferred provider and exclusive provider policies

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An insurer may issue a policy that provides coverage for certain benefits through a preferred provider network and other benefits through an exclusive provider network. With regard to the coverage provided through a preferred provider network, the requirements of s. 627.6471 appl…

Fla. Stat. § 627.64731 Leasing, renting, or granting access to a participating provider

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(1) As used in this section, the term:(a) “Contracting entity” means any person or entity that is engaged in the act of contracting with participating providers and has a direct contract with a participating provider for the delivery of health care services or the selling or assi…

Fla. Stat. § 627.6474 Provider contracts

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(1) A health insurer may not require a contracted health care practitioner as defined in s. 456.001(4) to accept the terms of other health care practitioner contracts with the insurer or any other insurer, or health maintenance organization, under common management and control wi…

Fla. Stat. § 627.64741 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. § 627.6475 Individual reinsurance pool

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(1) PURPOSE.—The purpose of this section is to provide for the establishment of a reinsurance program for coverage of individuals who are eligible for issuance of individual health insurance from a health insurance issuer pursuant to s. 627.6487.(2) DEFINITIONS.—As used in this s…

Fla. Stat. § 627.6487 Guaranteed availability of individual health insurance coverage to eligible individuals

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(1) Subject to the requirements of this section, each health insurance issuer that offers individual health insurance coverage in this state may not, with respect to an eligible individual who desires to enroll in individual health insurance coverage:(a) Decline to offer such cov…

Fla. Stat. § 627.64995 Restrictions on use of state and federal funds for state exchanges

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(1) A health insurance policy 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 def…

Fla. Stat. § 627.651 Group contracts and plans of self-insurance must meet group requirements

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(1) Except as otherwise provided by law, a group health insurance policy or certificate insuring more than one individual delivered or issued for delivery in this state must be delivered or issued for delivery to one of the groups provided for in ss. 627.653-627.656. A plan of se…

Fla. Stat. § 627.6512 Exemption of certain group health insurance policies

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Sections 627.6561, 627.65615, 627.65625, and 627.6571 do not apply to any group insurance policy in relation to its provision of benefits described in s. 627.6513(1)-(14).History.—s. 7, ch. 97-179; s. 14, ch. 2016-194.

Fla. Stat. § 627.6513 Scope

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Section 641.312 and the provisions of the Employee Retirement Income Security Act of 1974, as implemented by 29 C.F.R. s. 2560.503-1, relating to internal grievances, apply to all group health insurance policies issued under this part. This section does not apply to:(1) Coverage …