Florida Statutes Part I - Prepaid Limited Health Service Organizations (Ss. 636.002-636.067)

• 636.002 - Short Title.
  Sections 1-57, chapter 93-148, Laws of Florida, may be cited as the “Prepaid Limited Health Service Organization Act of Florida.”History.—s. 1, ch. 93-148.
• 636.003 - Definitions.
  As used in this act, the term:(1) “Capitation” means the fixed amount paid by a prepaid limited health service organization to a health care provider under...
• 636.004 - Applicability Of Other Laws.
  Except as provided in this act, prepaid limited health service organizations are governed by the provisions of this act and are exempt from the Florida...
• 636.005 - Incorporation Required; Exceptions.
  (1) On or after October 1, 1993, any entity that has not yet obtained a certificate of authority to operate a prepaid limited health service organization...
• 636.006 - Insurance Business Not Authorized.
  Nothing in the Florida Insurance Code or this act authorizes any prepaid limited health service organization to transact any insurance business other than that specifically...
• 636.007 - Certificate Of Authority Required.
  A person, corporation, partnership, or other entity may not operate a prepaid limited health service organization in this state without obtaining and maintaining a certificate...
• 636.008 - Application For Certificate Of Authority.
  Before any entity may operate a prepaid limited health service organization, it must obtain a certificate of authority from the office. An application for a...
• 636.009 - Issuance Of Certificate Of Authority; Denial.
  (1) Following receipt of an application filed pursuant to s. 636.008, the office shall review such application and notify the applicant of any deficiencies contained therein....
• 636.012 - Continued Eligibility For Certificate Of Authority.
  In order to maintain its eligibility for a certificate of authority, a prepaid limited health service organization must continue to meet all conditions required to...
• 636.0145 - Certain Entities Contracting With Medicaid.
  An entity that is providing comprehensive inpatient and outpatient mental health care services to certain Medicaid recipients in Hillsborough, Highlands, Hardee, Manatee, and Polk Counties...
• 636.015 - Language Used In Contracts And Advertisements; Translations.
  (1)(a) All contracts or forms must be printed in English.(b) If the negotiations leading up to the effectuation of a prepaid limited health service organization contract are...
• 636.0155 - Disclosures Required In Contracts And Marketing Materials.
  All prepaid limited health services contracts, marketing materials, and literature printed after October 1, 1997, must disclose in boldfaced type the name of the organization...
• 636.016 - Prepaid Limited Health Service Contracts.
  For any entity licensed prior to October 1, 1993, all subscriber contracts in force at such time shall be in compliance with this section upon...
• 636.017 - Rates And Charges.
  (1) The rates charged by any prepaid limited health service organization to its subscribers shall not be excessive, inadequate, or unfairly discriminatory. The commission or office...
• 636.018 - Changes In Rates And Benefits; Material Modifications; Addition Of Limited Health Services.
  (1)(a) No prepaid limited health services contract, certificate of coverage, application, enrollment form, rider, endorsement, and applicable rates to be charged may be delivered in this...
• 636.019 - Additional Contract Contents.
  A prepaid limited health services contract may contain additional provisions not inconsistent with this act which are:(1) Necessary because of the manner in which the organization...
• 636.0201 - Genetic Information Restrictions.
  A prepaid limited health service organization must comply with the provisions of s. 627.4301.History.—s. 4, ch. 97-182.
• 636.022 - Restrictions Upon Expulsion Or Refusal To Issue Or Renew Contract.
  A prepaid limited health service organization may not expel or refuse to renew the coverage of or refuse to enroll any individual member of a...
• 636.023 - Charter; Bylaw Provisions.
  No prepaid limited health services contract may contain any provision purporting to make any portion of the articles of incorporation, charter, bylaws, or other organizational...
• 636.024 - Execution Of Contracts.
  (1) Every prepaid limited health services contract must be executed in the name of and on behalf of the prepaid limited health service organization by its...
• 636.025 - Validity Of Noncomplying Contracts.
  (1) Any prepaid limited health services contract rider, endorsement, attachment, or addendum otherwise valid which contains any condition or provision not in compliance with the requirements...
• 636.026 - Construction Of Contracts.
  Every prepaid limited health services contract must be construed according to the entirety of its terms and conditions as set forth in the contract and...
• 636.027 - Delivery Of Contract.
  Unless delivered upon execution or issuance, a prepaid limited health services contract, certificate of coverage, or member handbook must be mailed or delivered to the...
• 636.028 - Notice Of Cancellation Of Contract.
  Except for nonpayment of premium or termination of eligibility, a prepaid limited health service organization may not cancel or otherwise terminate or fail to renew...
• 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...
• 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...
• 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,...
• 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...
• 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...
• 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...
• 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...
• 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....
• 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...
• 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.
• 636.043 - Annual, Quarterly, And Miscellaneous Reports.
  (1) Each prepaid limited health service organization must file with the office annually, within 3 months after the end of its fiscal year, a report verified...
• 636.044 - Agent Licensing.
  (1) With respect to a prepaid limited health services contract, a person may not, unless licensed and appointed as a health insurance agent in accordance with...
• 636.045 - Minimum Surplus Requirements.
  (1) Each prepaid limited health service organization must at all times maintain a minimum surplus in an amount which is the greater of $150,000 or 10...
• 636.046 - Insolvency Protection.
  (1) Except as required in subsection (2), each prepaid limited health service organization must deposit with the department cash or securities of the type eligible under...
• 636.047 - Officers’ And Employees’ Fidelity Bond.
  (1) A prepaid limited health service organization must maintain in force a fidelity bond in its own name on its officers and employees, in an amount...
• 636.048 - Suspension Or Revocation Of Certificate Of Authority; Suspension Of Enrollment Of New Subscribers; Terms Of Suspension.
  (1) The office may suspend the authority of a prepaid limited health service organization to enroll new subscribers or revoke any certificate issued to a prepaid...
• 636.049 - Administrative Penalty In Lieu Of Suspension Or Revocation.
  In lieu of suspending or revoking a certificate of authority, or when no penalty is specifically provided, whenever any prepaid limited health service organization or...
• 636.052 - Civil Remedy.
  In any civil action brought to enforce the terms and conditions of a prepaid limited health service organization contract, the prevailing party is entitled to...
• 636.053 - Injunction.
  In addition to the penalties and other enforcement provisions of this act, the office and department, subject to their respective jurisdiction, are vested with the...
• 636.054 - Payment Of Judgment By Prepaid Limited Health Service Organization.
  Except as otherwise ordered by the court or as mutually agreed upon by the parties, every judgment or decree entered in any court against any...
• 636.055 - Levy Upon Deposit Limited.
  No judgment creditor or other claimant, other than the office or department, of a prepaid limited health service organization shall have the right to levy...
• 636.056 - Rehabilitation, Conservation, Liquidation, Or Reorganization; Exclusive Methods Of Remedy.
  (1) A delinquency proceeding under part I of chapter 631 or supervision pursuant to ss. 624.80-624.87 constitute the sole and exclusive means of liquidating, reorganizing, rehabilitating,...
• 636.057 - Fees.
  Every prepaid limited health service organization subject to this act must pay to the office the following fees:(1) For filing an application for a certificate of...
• 636.058 - Investigative Power Of Department And Office.
  The department and office, within their respective regulatory jurisdictions, have the power to examine and investigate the affairs of every person, entity, or prepaid limited...
• 636.059 - Unfair Methods Of Competition, Unfair Or Deceptive Acts Or Practices Defined.
  For the purposes of defining unfair methods of competition, unfair or deceptive acts or practices, the provisions of s. 641.3903 apply to a prepaid limited...
• 636.062 - Appeals From The Office Or Department.
  Any person, entity, or prepaid limited health service organization subject to an order of the office or department under s. 641.3909 or s. 641.3913 may...
• 636.063 - Civil Liability.
  The provisions of this act are cumulative to rights under the general civil and common law, and no action of the office or department abrogates...
• 636.064 - Confidentiality.
  (1) Any information pertaining to the diagnosis, treatment, or health of any enrollee of a prepaid limited health service organization is confidential and exempt from the...
• 636.065 - Acquisitions.
  Each prepaid limited health service organization is subject to the provisions of s. 628.4615.History.—s. 52, ch. 93-148.
• 636.066 - Taxes Imposed.
  (1) The premiums, contributions, and assessments received by prepaid limited health service organizations are subject to the tax imposed by s. 624.509. The Department of Revenue...
• 636.067 - Rules.
  The commission may adopt rules pursuant to ss. 120.536(1) and 120.54 to implement the provisions of this act. A violation of any such rule subjects...

Last modified: September 23, 2016