632.861 – Prescription drug charges.
632.861 Prescription drug charges. (1) Definitions. In this section: (a) “Disability insurance policy” has the meaning given in s. 632.895 (1) (a). (b) “Enrollee” means an individual who is covered under a disability insurance policy or a self-insured health plan. (c) “Pharmacy benefit manager” has the meaning given in s. 632.865 (1) (c). (d) “Prescription […]
632.865 – Pharmacy benefit managers.
632.865 Pharmacy benefit managers. (1) Definitions. In this section: (ae) “Health benefit plan” has the meaning given in s. 632.745 (11). (ak) “Health care provider” has the meaning given in s. 146.81 (1). (aw) “Pharmacist” has the meaning given in s. 450.01 (15). (b) “Pharmacy” means an entity licensed under s. 450.06 or 450.065. (c) […]
632.866 – Step therapy protocols.
632.866 Step therapy protocols. (1) Definitions. In this section: (a) “Clinical practice guideline” means a systematically developed statement to assist decision making by health care providers and patients about appropriate health care for specific clinical circumstances and conditions. (b) “Clinical review criteria” means written screening procedures, decision abstracts, clinical protocols, and clinical practice guidelines used […]
632.867 – Oral and injected chemotherapy.
632.867 Oral and injected chemotherapy. (1) Definitions. In this section: (a) “Chemotherapy” means drugs and biologics that kill cancer cells directly, including antineoplastics, biologic response modifiers, hormone therapy, and monoclonal antibodies, and that are used to do any of the following: 1. Cure a specific cancer. 2. Control tumor growth when cure is not possible. […]
632.87 – Restrictions on health care services.
632.87 Restrictions on health care services. (1) No insurer may refuse to provide or pay for benefits for health care services provided by a licensed health care professional on the ground that the services were not rendered by a physician as defined in s. 990.01 (28), unless the contract clearly excludes services by such practitioners, […]
632.845 – Prohibiting refusal to cover services because liability policy may cover.
632.845 Prohibiting refusal to cover services because liability policy may cover. (1) In this section, “health care plan” has the meaning given in s. 628.36 (2) (a) 1. (2) An insurer that provides coverage under a health care plan may not refuse to cover health care services that are provided to an insured under the […]
632.85 – Coverage without prior authorization for treatment of an emergency medical condition.
632.85 Coverage without prior authorization for treatment of an emergency medical condition. (1) In this section: (a) “Emergency medical condition” means a medical condition that manifests itself by acute symptoms of sufficient severity, including severe pain, to lead a prudent layperson who possesses an average knowledge of health and medicine to reasonably conclude that a […]
632.853 – Coverage of drugs and devices.
632.853 Coverage of drugs and devices. A health care plan, as defined in s. 628.36 (2) (a) 1., or a self-insured health plan, as defined in s. 632.85 (1) (c), that provides coverage of only certain specified prescription drugs or devices shall develop a process through which a physician may present medical evidence to obtain […]
632.855 – Requirements if experimental treatment limited.
632.855 Requirements if experimental treatment limited. (1) Definitions. In this section: (a) “Health care plan” has the meaning given in s. 628.36 (2) (a) 1. (b) “Self-insured health plan” has the meaning given in s. 632.85 (1) (c). (2) Disclosure of limitations. Subject to s. 632.87 (6), a health care plan or a self-insured health […]
632.857 – Explanation required for restriction or termination of coverage.
632.857 Explanation required for restriction or termination of coverage. If an insurer restricts or terminates an insured’s coverage for the treatment of a condition or complaint and, as a result, the insured becomes liable for payment for all of his or her treatment for the condition or complaint, the insurer shall provide on the explanation […]