(1) A preexisting condition provision may not exclude coverage for a period beyond 24 months following the individual’s effective date of coverage and may relate only to:
(a) Conditions that, during the 24-month period immediately preceding the effective date of coverage, had manifested themselves in such a manner as would cause an ordinarily prudent person to seek medical advice, diagnosis, care, or treatment or for which medical advice, diagnosis, care, or treatment was recommended or received; or
(b) A pregnancy existing on the effective date of coverage.
(2) In determining whether a preexisting condition provision applies to an eligible insured or dependent, credit must be given for the time the person was covered under previous coverage if the previous coverage was similar to or exceeded the coverage provided under the new policy and if the previous coverage was continuous to a date not more than 62 days before the effective date of the new coverage, exclusive of any applicable waiting period under the plan.
(3) This section does not apply to short-term health insurance, provided that it is clearly disclosed to the applicant in the advertising and application, in 14-point contrasting type, that “This policy does not meet the definition of qualifying previous coverage or qualifying existing coverage as defined in 1s. 627.6699. As a result, if purchased in lieu of a conversion policy or other group coverage, you may have to meet a preexisting condition requirement when renewing or purchasing other coverage.”
(4) This section does not apply to disability income insurance or income replacement insurance coverage.
History.—s. 1, ch. 96-223; s. 3, ch. 2019-129.
1Note.—Former s. 627.6699(3)(r), which defined the terms “qualifying previous coverage” and “qualifying existing coverage,” was deleted by s. 15, ch. 97-179.
Structure Florida Statutes
Chapter 627 - Insurance Rates and Contracts
Part VI - Health Insurance Policies (Ss. 627.601-627.64995)
627.6011 - Mandated coverages.
627.602 - Scope, format of policy.
627.604 - Nonresident insured.
627.6041 - Children with disabilities; continuation of coverage.
627.6043 - Notification of cancellation, nonrenewal, or change in rates.
627.6044 - Use of a specific methodology for payment of claims.
627.6045 - Preexisting condition.
627.6046 - Limit on preexisting conditions.
627.605 - Required provisions; captions, omissions, substitutions.
627.6056 - Coverage for ambulatory surgical center service.
627.606 - Entire contract; changes.
627.607 - Time limit on certain defenses.
627.613 - Time of payment of claims.
627.615 - Physical examination, autopsy.
627.617 - Change of beneficiary.
627.618 - Optional policy provisions.
627.619 - Change of occupation.
627.620 - Misstatement of age or sex.
627.621 - Other insurance with this insurer.
627.622 - Insurance with other insurers.
627.623 - Insurance with other insurers; other benefits.
627.624 - Relation of earnings to insurance.
627.6265 - Cancellation or nonrenewal prohibited.
627.627 - Conformity with statutes.
627.629 - Intoxicants and narcotics.
627.630 - Order of certain provisions.
627.631 - Third-party ownership.
627.632 - Requirements of other jurisdictions.
627.633 - Other policy provisions.
627.636 - Industrial health insurance.
627.637 - Construction of noncomplying contracts.
627.638 - Direct payment for hospital, medical services.
627.6385 - Disclosures to policyholders; calculations of cost sharing.
627.6387 - Shared savings incentive program.
627.639 - Application signed by agent.
627.640 - Filing of classifications and rates.
627.6401 - Refunds for persons age 64.
627.6402 - Insurance rebates for healthy lifestyles.
627.64025 - Advanced practice registered nurse services.
627.6403 - Payment of acupuncture benefits to certified acupuncturists.
627.6405 - Decreasing inappropriate utilization of emergency care.
627.6408 - Diabetes treatment services.
627.6409 - Coverage for osteoporosis screening, diagnosis, treatment, and management.
627.641 - Coverage for newborn children.
627.6416 - Coverage for child health supervision services.
627.6417 - Coverage for surgical procedures and devices incident to mastectomy.
627.64171 - Coverage for length of stay and outpatient postsurgical care.
627.64172 - Requirements with respect to breast cancer and routine followup care.
627.6418 - Coverage for mammograms.
627.6419 - Requirements with respect to breast cancer.
627.64193 - Required coverage for cleft lip and cleft palate.
627.64195 - Requirements for opioid coverage.
627.64196 - Medication synchronization.
627.64197 - Coverage for organ transplants.
627.642 - Outline of coverage.
627.6425 - Renewability of individual coverage.
627.6426 - Short-term health insurance.
627.643 - Uniform minimum standards.
627.644 - Discrimination against handicapped prohibited.
627.645 - Denial of health insurance claims restricted.
627.646 - Conversion on termination of eligibility.
627.647 - Standard health claim form.
627.6471 - Contracts for reduced rates of payment; limitations; coinsurance and deductibles.
627.6472 - Exclusive provider organizations.
627.6473 - Combined preferred provider and exclusive provider policies.
627.64731 - Leasing, renting, or granting access to a participating provider.
627.6474 - Provider contracts.
627.64741 - Pharmacy benefit manager contracts.
627.6475 - Individual reinsurance pool.
627.6487 - Guaranteed availability of individual health insurance coverage to eligible individuals.
627.64995 - Restrictions on use of state and federal funds for state exchanges.