641.3915 – Health maintenance organization anti-fraud plans and investigative units.
641.3915 Health maintenance organization anti-fraud plans and investigative units.—Each authorized health maintenance organization and applicant for a certificate of authority shall comply with the provisions of ss. 626.989 and 626.9891 as though such organization or applicant were an authorized insurer. History.—s. 4, ch. 99-204; ss. 4, 14, ch. 2017-178.
641.3917 – Civil liability.
641.3917 Civil liability.—The provisions of this part are cumulative to rights under the general civil and common law, and no action of the department or office shall abrogate such rights to damage or other relief in any court. History.—ss. 42, 47, ch. 85-177; ss. 187, 188, ch. 91-108; s. 4, ch. 91-429; s. 1597, ch. 2003-261.
641.3921 – Conversion on termination of eligibility.
641.3921 Conversion on termination of eligibility.—A group health maintenance contract delivered or issued for delivery in this state by a health maintenance organization shall provide that a subscriber or covered dependent whose coverage under the group health maintenance contract has been terminated for any reason, including discontinuance of the group health maintenance contract in its entirety […]
641.3922 – Conversion contracts; conditions.
641.3922 Conversion contracts; conditions.—Issuance of a converted contract shall be subject to the following conditions: (1) TIME LIMIT.—Written application for the converted contract shall be made and the first premium paid to the health maintenance organization not later than 63 days after such termination. However, if termination was the result of failure to pay any required premium […]
641.3923 – Discrimination against providers prohibited.
641.3923 Discrimination against providers prohibited.—A health maintenance organization may not discriminate with respect to participation as to any advanced practice registered nurse licensed pursuant to s. 464.012, who is acting within the scope of such license, solely on the basis of such license. This section may not be construed to prohibit a plan from including providers […]
641.38 – Operational health maintenance organizations; issuance of certificate.
641.38 Operational health maintenance organizations; issuance of certificate.—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 organization. History.—s. 23, ch. 72-264; s. […]
641.3111 – Extension of benefits.
641.3111 Extension of benefits.— (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 predicated upon the continuous total disability of the subscriber […]
641.312 – Scope.
641.312 Scope.—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 to the types of benefits or coverages provided under s. 627.6513(1)-(14) issued in any market. […]
641.313 – Health maintenance contracts; cancer treatment parity; orally administered cancer treatment medications.
641.313 Health maintenance contracts; cancer treatment parity; orally administered cancer treatment medications.— (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 standards of practice. […]
641.314 – Pharmacy benefit manager contracts.
641.314 Pharmacy benefit manager contracts.— (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 charges, if any. (b) “Pharmacy benefit manager” means a person or entity doing […]