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 […]
641.315 – Provider contracts.
641.315 Provider contracts.— (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 specified in s. 641.3154. (2)(a) For all provider contracts executed […]
641.3154 – Organization liability; provider billing prohibited.
641.3154 Organization liability; provider billing prohibited.— (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 liable for payment of fees to […]
641.3155 – Prompt payment of claims.
641.3155 Prompt payment of claims.— (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 entries for a physician licensed under chapter 458, chapter […]
641.309 – Standards for marketing to persons eligible for Medicare.
641.309 Standards for marketing to persons eligible for Medicare.— (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 health maintenance organization offering such coverage by its agents […]
641.31077 – Coverage for organ transplants.
641.31077 Coverage for organ transplants.—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 may not be construed to require such […]
641.31 – Health maintenance contracts.
641.31 Health maintenance contracts.— (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 subscriber shall be given a copy […]
641.3108 – Notice of cancellation of contract.
641.3108 Notice of cancellation of contract.— (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, termination, or nonrenewal of the contract. The written notice shall […]
641.3101 – Additional contract contents.
641.3101 Additional contract contents.—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 (2) Desired by the organization and neither prohibited by law […]