(1) In addition to any other requirements imposed by law, each self-insurance policy as authorized under s. 627.357 or s. 624.462 or insurance policy providing coverage for claims arising out of the rendering of, or the failure to render, medical care or services, including those of the Florida Medical Malpractice Joint Underwriting Association, shall include:
(a) A clause requiring the insured to cooperate fully in the review process prescribed under s. 766.106 if a notice of intent to file a claim for medical malpractice is made against the insured.
(b)1. A clause clearly stating whether or not the insured has the exclusive right to veto any offer of admission of liability and for arbitration pursuant to s. 766.106, settlement offer, or offer of judgment if the offer is within policy limits. An insurer or self-insurer shall not make or conclude, without the permission of the insured, any offer of admission of liability and for arbitration pursuant to s. 766.106, settlement offer, or offer of judgment, if such offer is outside the policy limits. However, any offer for admission of liability and for arbitration made under s. 766.106, settlement offer, or offer of judgment made by an insurer or self-insurer shall be made in good faith and in the best interest of the insured.
2. If the policy contains a clause stating the insured does not have the exclusive right to veto any offer or admission of liability and for arbitration made pursuant to s. 766.106, settlement offer, or offer of judgment, the insurer or self-insurer shall provide to the insured or the insured’s legal representative by certified mail, return receipt requested, a copy of the final offer of admission of liability and for arbitration made pursuant to s. 766.106, settlement offer, or offer of judgment and at the same time such offer is provided to the claimant. A copy of any final agreement reached between the insurer and claimant shall also be provided to the insured or his or her legal representative by certified mail, return receipt requested, not more than 10 days after affecting such agreement.
(c) A clause requiring the insurer or self-insurer to notify the insured no less than 90 days prior to the effective date of cancellation of the policy or contract and, in the event of a determination by the insurer or self-insurer not to renew the policy or contract, to notify the insured no less than 90 days prior to the end of the policy or contract period. If cancellation or nonrenewal is due to nonpayment or loss of license, 10 days’ notice is required.
(d) A clause requiring the insurer or self-insurer to notify the insured no less than 60 days prior to the effective date of a rate increase. The provisions of s. 627.4133 shall apply to such notice and to the failure of the insurer to provide such notice to the extent not in conflict with this section.
(2) Each insurer covered by this section may require the insured to be a member in good standing, i.e., not subject to expulsion or suspension, of a duly recognized state or local professional society of health care providers which maintains a medical review committee. No professional society shall expel or suspend a member solely because he or she participates in a health maintenance organization licensed under part I of chapter 641.
(3) This section shall apply to all policies issued or renewed after October 1, 2003.
History.—ss. 6, 44, ch. 85-175; s. 5, ch. 86-287; s. 114, ch. 92-318; s. 23, ch. 95-211; s. 1, ch. 96-361; s. 1733, ch. 97-102; s. 29, ch. 99-3; s. 43, ch. 2003-416; s. 9, ch. 2011-233; s. 149, ch. 2020-2.
Structure Florida Statutes
Chapter 627 - Insurance Rates and Contracts
Part II - The Insurance Contract (Ss. 627.401-627.444)
627.4025 - Residential coverage and hurricane coverage defined.
627.4035 - Payment of premiums; claims.
627.404 - Insurable interest; personal insurance.
627.405 - Insurable interest; property.
627.406 - Power to contract; purchase of insurance by or for minor.
627.407 - Alteration of application.
627.408 - Application as evidence.
627.4085 - Insurer name, agent name, and license identification number required on application.
627.409 - Representations in applications; warranties.
627.4091 - Specific reasons for denial, cancellation, or nonrenewal.
627.40951 - Standard personal lines residential insurance policy.
627.410 - Filing, approval of forms.
627.4101 - Credit insurance enrollment forms.
627.4102 - Informational filing of forms.
627.4105 - Life and health insurance; reduced premiums upon rigorous physical examination.
627.411 - Grounds for disapproval.
627.412 - Standard provisions, in general.
627.413 - Contents of policies, in general; identification.
627.4131 - Telephone number required.
627.4132 - Stacking of coverages prohibited.
627.4133 - Notice of cancellation, nonrenewal, or renewal premium.
627.4135 - Casualty insurance contracts subject to general provisions for insurance contracts.
627.4136 - Nonjoinder of insurers.
627.4137 - Disclosure of certain information required.
627.4138 - Wrap-up insurance policies for nonpublic construction projects.
627.414 - Additional policy contents.
627.4143 - Outline of coverage.
627.4145 - Readable language in insurance policies.
627.4147 - Medical malpractice insurance contracts.
627.4148 - Medical malpractice insurers; required offer of coverage limits.
627.41495 - Public notice of medical malpractice rate filings.
627.415 - Charter, bylaw provisions.
627.416 - Execution of policies.
627.417 - Underwriters’ and combination policies.
627.418 - Validity of noncomplying contracts.
627.419 - Construction of policies.
627.4195 - Health insurance; claims for payment of psychotherapeutic services; confidentiality.
627.4205 - Coverage identification number required.
627.4215 - Disclosures to policyholders; coverage of behavioral health care services.
627.422 - Assignment of policies or post-loss benefits.
627.423 - Payment discharges insurer.
627.4232 - Health insurance out-of-hospital benefits.
627.4233 - Total disability defined.
627.4234 - Health insurance cost containment provisions required.
627.4235 - Coordination of benefits.
627.4236 - Coverage for bone marrow transplant procedures.
627.4237 - Sickness disability or disability due to sickness.
627.4238 - Health insurer examinations.
627.4239 - Coverage for use of drugs in treatment of cancer.
627.42392 - Prior authorization.
627.42393 - Step-therapy protocol.
627.42395 - Coverage for certain prescription and nonprescription enteral formulas.
627.42396 - Reimbursement for telehealth services.
627.42397 - Coverage for air ambulance services.
627.424 - Minor may give acquittance.
627.425 - Forms for proof of loss to be furnished.
627.426 - Claims administration.
627.4265 - Payment of settlement.
627.427 - Payment of judgment by insurer; penalty for failure.
627.429 - Medical tests for HIV infection and AIDS for insurance purposes.
627.4295 - Dental procedures; anesthesia and hospitalization coverage.
627.4301 - Genetic information for insurance purposes.
627.4302 - Identification cards for processing prescription drug claims.
627.43141 - Notice of change in policy terms.
627.441 - Commercial general liability policies; coverage to contractors for completed operations.
627.442 - Insurance contracts.