Florida Statutes Part VI - Health Insurance Policies (Ss. 627.601-627.64995)

• 627.601 - Scope Of This Part.
  Nothing in this part applies to or affects:(1) Any policy of liability insurance or workers’ compensation insurance, with or without supplementary expense coverage.(2) Any group or blanket...
• 627.6011 - Mandated Coverages.
  Mandatory health benefits regulated under this chapter are not intended to apply to the types of health benefit plans listed in s. 627.6561(5)(b)-(e), issued in...
• 627.602 - Scope, Format Of Policy.
  (1) Each health insurance policy delivered or issued for delivery to any person in this state must comply with all applicable provisions of this code and...
• 627.603 - Death Benefits.
  Any health insurance policy may contain a provision for paying a benefit for death from any cause in an amount not exceeding $1,000, which benefit...
• 627.604 - Nonresident Insured.
  If any health insurance policy is issued by an insurer domiciled in this state for delivery to a person residing in another state, and if...
• 627.6041 - Children With Disabilities; Continuation Of Coverage.
  (1) A hospital or medical expense insurance policy or health care services plan contract that is delivered or issued for delivery in this state and that...
• 627.6043 - Notification Of Cancellation, Nonrenewal, Or Change In Rates.
  (1) Any insurer delivering or issuing an individual health insurance policy subject to this part shall give the policyholder at least 45 days’ advance written notice...
• 627.6044 - Use Of A Specific Methodology For Payment Of Claims.
  (1) Each insurance policy that provides for payment of claims based on a specific methodology, including, but not limited to, usual and customary charges, reasonable and...
• 627.6045 - Preexisting Condition.
  A health insurance policy must comply with the following:(1) A preexisting condition provision may not exclude coverage for a period beyond 24 months following the individual’s...
• 627.605 - Required Provisions; Captions, Omissions, Substitutions.
  (1) Except as provided in subsection (2), each such policy delivered or issued for delivery to any person in this state shall contain the provisions specified...
• 627.6056 - Coverage For Ambulatory Surgical Center Service.
  No individual health insurance policy providing coverage on an expense-incurred basis or individual service or indemnity-type contract issued by a nonprofit corporation, of any kind...
• 627.606 - Entire Contract; Changes.
  The contract shall include the following provision:“Entire Contract; Changes: This policy, with the application and attached papers, is the entire contract between the insured and...
• 627.607 - Time Limit On Certain Defenses.
  (1) The contract shall include the following provision:“Time Limit on Certain Defenses: After 2 years from the issue date, only fraudulent misstatements in the application may...
• 627.608 - Grace Period.
  (1) If the insurer reserves the right to refuse renewal, the contract shall include the following provision:“Grace Period: This policy has a   (insert a number not...
• 627.609 - Reinstatement.
  (1) The contract shall include the following provision:“Reinstatement: If the renewal premium is not paid before the grace period ends, the policy will lapse. Later acceptance...
• 627.610 - Notice Of Claim.
  (1) The contract shall include the following provision:“Notice of Claim: Written notice of claim must be given within 20 days after a covered loss starts or...
• 627.611 - Claim Forms.
  The contract shall include the following provision:“Claim Forms: When the insurer receives the notice of claim, it will send the claimant forms for filing proof...
• 627.612 - Proof Of Loss.
  The contract shall include the following provision:“Proof of Loss: If the policy provides for periodic payment for a continuing loss, written proof of loss must...
• 627.613 - Time Of Payment Of Claims.
  (1) The contract shall include the following provision:“Time of Payment of Claims: After receiving written proof of loss, the insurer will pay monthly all benefits then...
• 627.6131 - Payment Of Claims.
  (1) The contract shall include the following provision:“Time of Payment of Claims: After receiving written proof of loss, the insurer will pay monthly all benefits then...
• 627.614 - Payment Of Claims.
  (1) The contract shall include the following provision:“Payment of Claims: Benefits will be paid to the insured. Loss-of-life benefits are payable in accordance with the beneficiary...
• 627.6141 - Denial Of Claims.
  Each claimant, or provider acting for a claimant, who has had a claim denied as not medically necessary must be provided an opportunity for an...
• 627.615 - Physical Examination, Autopsy.
  The contract shall include the following provision:“Physical Examinations and Autopsy: The insurer at its expense has the right to have the insured examined as often...
• 627.616 - Legal Actions.
  The contract shall include the following provision:“Legal Actions: No legal action may be brought to recover on this policy within 60 days after written proof...
• 627.617 - Change Of Beneficiary.
  The contract shall include the following provision:“Change of Beneficiary: The insured can change the beneficiary at any time by giving the insurer written notice. The...
• 627.618 - Optional Policy Provisions.
  Except as provided in s. 627.605(2), no health insurance policy delivered or issued for delivery to any person in this state shall contain any provision...
• 627.619 - Change Of Occupation.
  There may be a provision as follows:“Change of Occupation: If the insured is injured or contracts sickness after having changed his or her occupation to...
• 627.620 - Misstatement Of Age Or Sex.
  The contract may include the following provision:“Misstatement of Age or Sex: If the age or sex of the insured has been misstated, all amounts payable...
• 627.621 - Other Insurance With This Insurer.
  The contract may include the following provision:“Other Insurance with This Insurer: If two or more health insurance policies, exclusive of guaranteed-issue policies, are issued by...
• 627.622 - Insurance With Other Insurers.
  (1) The contract may include the following provision:“Insurance with Other Insurers: If there is other valid coverage, not with this insurer, providing benefits for the same...
• 627.623 - Insurance With Other Insurers; Other Benefits.
  (1) The contract may include the following provision:“Insurance With Other Insurers: If there is other valid coverage, not with this insurer, providing benefits for the same...
• 627.624 - Relation Of Earnings To Insurance.
  (1) The contract may include the following provision:“Relation of Earnings to Insurance: If the total monthly amount of loss-of-time benefits promised for the same loss under...
• 627.625 - Unpaid Premiums.
  The contract may include the following provision:“Unpaid Premium: Upon the payment of a claim under this policy, any premium then due and unpaid or covered...
• 627.6265 - Cancellation Or Nonrenewal Prohibited.
  Notwithstanding any other provision of law to the contrary, no insurer shall cancel or nonrenew the health insurance policy of any insured because of diagnosis...
• 627.627 - Conformity With Statutes.
  The contract may include the following provision:“Conformity with State Statutes: Any provision of this policy which, on its effective date, is in conflict with the...
• 627.628 - Illegal Occupation.
  The contract may include the following provision:“Illegal Occupation: The insurer will not be liable for any loss which results from the insured committing or attempting...
• 627.629 - Intoxicants And Narcotics.
  The contract may include the following provision:“Intoxicants and Narcotics: The insurer will not be liable for any loss resulting from the insured being drunk or...
• 627.630 - Order Of Certain Provisions.
  The provisions which are the subject of ss. 627.606-627.629, inclusive, shall be printed in the consecutive order of the provisions in such sections; or, at...
• 627.631 - Third-party Ownership.
  The word “insured,” as used in this part, shall not be construed as preventing a person other than the insured with a proper insurable interest...
• 627.632 - Requirements Of Other Jurisdictions.
  (1) Any policy of a foreign or alien insurer, when delivered or issued for delivery to any person in this state, may contain any provision which...
• 627.633 - Other Policy Provisions.
  No policy provision which is not subject to this part shall be less favorable in any respect to the insured or the beneficiary than the...
• 627.634 - Age Limit.
  If any health insurance policy contains a provision establishing, as an age limit or otherwise, a date after which the coverage provided by the policy...
• 627.635 - Excess Insurance.
  (1) No provision of this chapter shall be deemed to prohibit an insurer from issuing a health insurance policy as, or including in a policy a...
• 627.636 - Industrial Health Insurance.
  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...
• 627.637 - Construction Of Noncomplying Contracts.
  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...
• 627.638 - Direct Payment For Hospital, Medical Services.
  (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...
• 627.639 - Application Signed By Agent.
  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...
• 627.640 - Filing Of Classifications And Rates.
  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...
• 627.6401 - Refunds For Persons Age 64.
  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...
• 627.6402 - Insurance Rebates For Healthy Lifestyles.
  (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...
• 627.6403 - Payment Of Acupuncture Benefits To Certified Acupuncturists.
  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...
• 627.6405 - Decreasing Inappropriate Utilization Of Emergency Care.
  (1) The Legislature finds and declares it to be of vital importance that emergency services and care be provided by hospitals and physicians to every person...
• 627.6406 - Maternity Care.
  (1) Any policy of health insurance that provides coverage for maternity care must also cover the services of certified nurse-midwives and midwives licensed pursuant to chapter...
• 627.6407 - Massage.
  Any policy of health insurance that provides coverage for massage shall also cover the services of persons licensed to practice massage pursuant to chapter 480,...
• 627.6408 - Diabetes Treatment Services.
  (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...
• 627.6409 - Coverage For Osteoporosis Screening, Diagnosis, Treatment, And Management.
  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,...
• 627.641 - Coverage For Newborn Children.
  (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...
• 627.6415 - Coverage For Natural-born, Adopted, And Foster Children; Children In Insured’s Custodial Care.
  (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...
• 627.6416 - Coverage For Child Health Supervision Services.
  (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,...
• 627.6417 - Coverage For Surgical Procedures And Devices Incident To Mastectomy.
  (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...
• 627.64171 - Coverage For Length Of Stay And Outpatient Postsurgical Care.
  (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...
• 627.64172 - Requirements With Respect To Breast Cancer And Routine Followup Care.
  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...
• 627.6418 - Coverage For Mammograms.
  (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...
• 627.6419 - Requirements With Respect To Breast Cancer.
  (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...
• 627.64193 - Required Coverage For Cleft Lip And Cleft Palate.
  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...
• 627.642 - Outline Of Coverage.
  (1) No individual or family accident and health insurance policy shall be delivered, or issued for delivery, in this state unless:(a) It is accompanied by an appropriate...
• 627.6425 - Renewability Of Individual Coverage.
  (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...
• 627.643 - Uniform Minimum Standards.
  (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...
• 627.644 - Discrimination Against Handicapped Prohibited.
  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...
• 627.645 - Denial Of Health Insurance Claims Restricted.
  (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...
• 627.646 - Conversion On Termination Of Eligibility.
  (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,...
• 627.647 - Standard Health Claim Form.
  (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...
• 627.6471 - Contracts For Reduced Rates Of Payment; Limitations; Coinsurance And Deductibles.
  (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...
• 627.6472 - Exclusive Provider Organizations.
  (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...
• 627.64725 - Health Maintenance Organization Or Exclusive Provider Organization; Disclosure Of Terms And Conditions Of Plan.
  Each health maintenance organization or exclusive provider organization shall provide prospective enrollees with written information about the terms and conditions of the plan in accordance...
• 627.6473 - Combined Preferred Provider And Exclusive Provider Policies.
  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....
• 627.64731 - Leasing, Renting, Or Granting Access To A Participating Provider.
  (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...
• 627.6474 - Provider Contracts.
  (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...
• 627.6475 - Individual Reinsurance Pool.
  (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...
• 627.648 - Florida Comprehensive Health Association Act.
  Sections 627.648-627.6498 may be cited and known as the “Florida Comprehensive Health Association Act.”History.—ss. 496(2nd), 809(2nd), ch. 82-243; s. 79, ch. 82-386; s. 20, ch....
• 627.6482 - Definitions.
  As used in ss. 627.648-627.6498, the term:(1) “Agent” means a person who is licensed to sell health insurance in this state.(2) “Association” means the Florida Comprehensive Health...
• 627.6484 - Dissolution Of Association; Termination Of Enrollment; Availability Of Other Coverage.
  (1) The association shall accept applications for insurance only until June 30, 1991, after which date no further applications may be accepted.(2) Coverage for each policyholder of...
• 627.6486 - Eligibility.
  (1) Except as provided in subsection (2), any resident of this state shall be eligible for coverage under the plan, including:(a) The insured’s spouse.(b) Any dependent unmarried child...
• 627.6487 - Guaranteed Availability Of Individual Health Insurance Coverage To Eligible Individuals.
  (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...
• 627.64871 - Certification Of Coverage.
  (1) Section 627.6561(8) applies to health insurance coverage offered by an insurer in the individual market in the same manner as it applies to health insurance...
• 627.6488 - Florida Comprehensive Health Association.
  (1) There is created a nonprofit legal entity to be known as the “Florida Comprehensive Health Association.” All insurers, as a condition of doing business, shall...
• 627.6489 - Disease Management Program.
  (1) The association may contract with insurers to provide disease management services for insurers that elect to participate in the association disease management program.(2) An insurer that...
• 627.649 - Administrator.
  (1) The board shall select an administrator, through a competitive bidding process, to administer the plan. The board shall evaluate bids submitted under this subsection based...
• 627.6492 - Participation Of Insurers.
  (1)(a) As a condition of doing business in this state an insurer shall pay an assessment to the board, in the amount prescribed by this section....
• 627.6494 - Assessments; Deferment, Limitation.
  (1) Notwithstanding the provisions of s. 624.509, premiums for coverage issued or reinsured through the association shall, as to the association and participating insurers, be exempt...
• 627.6496 - Issuing Of Policies.
  The coverage provided by this plan shall be directly insured by the association, and the policies shall be issued through the administrator pursuant to s....
• 627.6498 - Minimum Benefits Coverage; Exclusions; Premiums; Deductibles.
  (1) COVERAGE OFFERED.—(a) The plan shall offer in a semiannually renewable policy the coverage specified in this section for each eligible person. For applications accepted on or...
• 627.6499 - Reporting By Insurers And Third-party Administrators.
  (1) The office may require any insurer, third-party administrator, or service company to report any information reasonably required to assist the board in assessing insurers as...
• 627.64995 - Restrictions On Use Of State And Federal Funds For State Exchanges.
  (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...

Last modified: September 23, 2016