(1) Every health insurance policy providing hospital or medical expense coverage hereafter delivered or issued for delivery in this state or under which benefits are altered, modified, or amended shall contain a provision that, if the insurance on a person covered under the policy ceases because of the termination of such person’s eligibility for coverage prior to his or her becoming eligible for Medicare or Medicaid benefits, then such person shall be entitled to have issued to him or her by the insurer, without evidence of insurability, a policy of health insurance, either individual or family, whichever is appropriate, provided application for the policy is made and the first premium is paid to the insurer within 31 days after such termination, and provided further that:
(a) The coverage under the policy shall be in an amount equal to or, at the option of the insured, less than the amount of health insurance which ceases because of such termination.
(b) The premium on the policy shall be at the insurer’s then customary rate applicable to such policies, to the class of risk to which such person then belongs, and to his or her age attained on the effective date of the policy.
(c) The policy of health insurance will not result in overinsurance on the basis of the company underwriting standards at the time of issue.
(d) The policy of health insurance may be reduced by the amount of any benefits paid for the same injury or same sickness under the prior policy.
(e) The policy of health insurance may exclude any condition excluded by the prior policy.
(2) An insurer shall offer maternity benefits and dental benefits if those benefits were provided in the policy.
(3) The provisions of this section shall be effectuated in such a way as to result in continuous coverage during the 31-day period for such insured.
(4) This section does not apply to disability income, Medicare supplement, accident only, hospital indemnity, specified disease, limited benefit, nonconventional, or excess policies.
History.—s. 1, ch. 78-385; s. 2, ch. 81-318; ss. 495, 497, 809(2nd), ch. 82-243; ss. 60, 79, ch. 82-386; s. 3, ch. 90-249; s. 114, ch. 92-318; s. 345, ch. 97-102.
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.