636.029 – Construction and relationship with other laws.
636.029 Construction and relationship with other laws.— (1) No other provision of the insurance code applies to a prepaid limited health service organization unless such an organization is specifically mentioned therein. (2) Except as provided in this act, the insurance code does not apply to prepaid limited health service organizations certificated under this act. Any person, entity, or […]
636.032 – Acceptable payments.
636.032 Acceptable payments.—Each prepaid limited health service organization may accept from government agencies, corporations, groups, or individuals payments covering all or part of the cost of contracts entered into between the prepaid limited health service organization and its subscribers. History.—s. 25, ch. 93-148.
636.033 – Certain words prohibited in name of organization.
636.033 Certain words prohibited in name of organization.— (1) No entity certificated as a prepaid limited health service organization, other than a licensed insurer or health maintenance organization insofar as its name is concerned, may use in its name, contracts, or literature any of the words “insurance,” “casualty,” “surety,” “mutual,” or “HMO,” or any other words descriptive […]
636.034 – Extension of benefits.
636.034 Extension of benefits.—Every prepaid limited health services contract must provide that termination of the contract by the prepaid limited health service organization is without prejudice to any continuous loss which commenced while the contract was in force. Extension of benefits beyond the period the contract was in force must be until the specific treatment or […]
636.035 – Provider arrangements.
636.035 Provider arrangements.— (1) Whenever a contract exists between a prepaid limited health service organization and a provider, and the organization fails to meet its obligations to pay fees for services already rendered to a subscriber who is in good standing, the prepaid limited health service organization is liable for such fee or fees rather than the […]
636.036 – Administrative, provider, and management contracts.
636.036 Administrative, provider, and management contracts.— (1) The office may require a prepaid limited health service organization to submit any contract for administrative services, contract with a provider physician, contract for management services, or contract with an affiliated entity to the office if the office has information that the prepaid limited health service organization has entered into […]
636.037 – Contract providers.
636.037 Contract providers.—Each prepaid limited health service organization must, upon the request of the office, file financial statements for all contract providers of limited health care services who have assumed through capitation or other means more than 10 percent of the health care risks of the prepaid limited health service organization. History.—s. 30, ch. 93-148; s. […]
636.038 – Complaint system; annual report.
636.038 Complaint system; annual report.— (1) Every prepaid limited health service organization must establish and maintain a complaint system providing reasonable procedures for resolving written complaints initiated by enrollees and providers. This section does not preclude an enrollee or a provider from filing a complaint with the department or office or limit the department’s or office’s ability […]
636.039 – Examination by the office.
636.039 Examination by the office.—The office shall examine the affairs, transactions, accounts, business records, and assets of any prepaid limited health service organization, in the same manner and subject to the same terms and conditions that apply to insurers under part II of chapter 624, as often as it deems it expedient for the protection of […]
636.042 – Assets, liabilities, and investments.
636.042 Assets, liabilities, and investments.—Section 641.35 applies in its entirety to determine what assets, liabilities, and investments are acceptable for a prepaid limited health service organization. History.—s. 33, ch. 93-148.