(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 designation in effect at the time of payment. If none is then in effect, the benefits will be paid to the insured’s estate. Any other benefits unpaid at death may be paid, at the insurer’s option, either to the insured’s beneficiary or estate.”
(2) The following provisions, or either of them, may be included with the foregoing provision at the option of the insurer:
(a) “If benefits are payable to the insured’s estate or a beneficiary who cannot execute a valid release, the insurer can pay benefits up to $3,000 to someone related to the insured or beneficiary by blood or marriage whom the insurer considers to be entitled to the benefits. The insurer will be discharged to the extent of any such payment made in good faith.”
(b) “The insurer may pay all or a portion of any indemnities provided for health care services to the provider, unless the insured directs otherwise in writing by the time proofs of loss are filed. The insurer cannot require that the services be rendered by a particular provider.”
History.—s. 557, ch. 59-205; s. 3, ch. 76-168; s. 1, ch. 77-457; ss. 2, 3, ch. 81-318; ss. 463, 497, 809(2nd), ch. 82-243; s. 79, ch. 82-386; s. 114, ch. 92-318.
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.