Chapter 636 Prepaid Limited Health Service Organizations And Discount Medical Plan Organizations
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...
- §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.
Notwithstanding the requirements of s. 409.912(4)(b), an entity that is providing comprehensive inpatient and outpatient mental health care services to certain Medicaid recipients in Hillsborough,...
- §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...
- §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...
- §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...
- §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....
- §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...
- §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...
Part II - Discount Medical Plan Organizations (ss. 636.202-636.244)
- §636.202 Definitions.
As used in this part, the term: (1) "Discount medical plan" means a business arrangement or contract in which a person, in exchange for fees, dues,...
- §636.204 License required.
(1) Before doing business in this state as a discount medical plan organization, an entity must be a corporation, a limited liability company, or a limited...
- §636.205 Issuance of license; denial.
(1) Following receipt of an application filed pursuant to s. 636.204, the office shall review the application and notify the applicant of any deficiencies contained therein....
- §636.206 Examinations and investigations.
(1) The office may examine or investigate the business and affairs of any discount medical plan organization. The office may order any discount medical plan organization...
- §636.207 Applicability of part.
Except as otherwise provided in this part, discount medical plan organizations are governed by the provisions of this part and are exempt from the Florida...
- §636.208 Fees; charges; reimbursement.
(1) A discount medical plan organization may charge a periodic charge as well as a reasonable one-time processing fee for a discount medical plan. (2) If the...
- §636.210 Prohibited activities of a discount medical plan organization.
(1) A discount medical plan organization may not: (a) Use in its advertisements, marketing material, brochures, and discount cards the term "insurance" except as otherwise provided in...
- §636.212 Disclosures.
The following disclosures must be made in writing to any prospective member and must be on the first page of any advertisements, marketing materials, or...
- §636.214 Provider agreements.
(1) All providers offering medical services to members under a discount medical plan must provide such services pursuant to a written agreement. The agreement may be...
- §636.216 Charge or form filings.
(1) All charges to members must be filed with the office and any charge to members greater than $30 per month or $360 per year must...
- §636.218 Annual reports.
(1) Each discount medical plan organization must file with the office, within 3 months after the end of each fiscal year, an annual report. (2) Such reports...
- §636.220 Minimum capital requirements.
(1) Each discount medical plan organization must at all times maintain a net worth of at least $150,000. (2) The office may not issue a license unless...
- §636.222 Suspension or revocation of license; suspension of enrollment of new members; terms of suspension.
(1) The office may suspend the authority of a discount medical plan organization to enroll new members, revoke any license issued to a discount medical plan...
- §636.223 Administrative penalty.
In lieu of suspending or revoking a certificate of authority whenever any discount medical plan organization has been found to have violated any provision of...
- §636.224 Notice of change of name or address of discount medical plan organization.
Each discount medical plan organization must provide the office at least 30 days' advance notice of any change in the discount medical plan organization's name,...
- §636.226 Provider name listing.
Each discount medical plan organization must maintain an up-to-date list of the names and addresses of the providers with which it has contracted, on an...
- §636.228 Marketing of discount medical plans.
(1) All advertisements, marketing materials, brochures, and discount cards used by marketers must be approved in writing for such use by the discount medical plan organization....
- §636.230 Bundling discount medical plans with other products.
When a marketer or discount medical plan organization sells a discount medical plan together with any other product, the fees for the discount medical plan...
- §636.232 Rules.
The commission may adopt rules to administer this part, including rules for the licensing of discount medical plan organizations; establishing standards for evaluating forms, advertisements,...
- §636.234 Service of process on a discount medical plan organization.
Sections 624.422 and 624.423 apply to a discount medical plan organization as if the discount medical plan organization were an insurer. History.--s. 31, ch. 2004-297....
- §636.236 Surety bond or security deposit.
(1) Each discount medical plan organization licensed pursuant to the provisions of this part must maintain in force a surety bond in its own name in...
- §636.238 Penalties for violation of this part.
(1) Except as provided in subsection (2), a person who willfully violates any provision of this part commits a misdemeanor of the second degree, punishable as...
- §636.240 Injunctions.
(1) In addition to the penalties and other enforcement provisions of this part, the office may seek both temporary and permanent injunctive relief when: (a) A discount...
- §636.244 Unlicensed discount medical plan organizations.
The provisions of ss. 626.901-626.912 apply to the activities of an unlicensed discount medical plan organization as if the unlicensed discount medical plan organization were...
