(1) A group health insurance policy or health care services plan contract that is delivered or issued for delivery in this state and that provides that coverage of a dependent child of an employee or other member of the covered group terminates upon attainment of the limiting age for dependent children specified in the policy or contract must also provide in substance that attainment of the limiting age does not terminate the coverage of the child while the child continues to be both:
(a) Incapable of self-sustaining employment by reason of an intellectual or physical disability.
(b) Chiefly dependent upon the employee or member for support and maintenance.
(2) If a claim is denied under a policy or contract for the stated reason that the child has attained the limiting age for dependent children specified in the policy or contract, the notice of denial must state that the certificateholder or subscriber has the burden of establishing that the child continues to meet the criteria specified in subsection (1).
History.—s. 1, ch. 70-187; s. 3, ch. 76-168; s. 1, ch. 77-457; ss. 2, 3, ch. 81-318; ss. 511, 523, 809(2nd), ch. 82-243; s. 79, ch. 82-386; s. 19, ch. 83-288; ss. 136, 149, ch. 92-33; s. 114, ch. 92-318; s. 20, ch. 2013-162.
Structure Florida Statutes
Chapter 627 - Insurance Rates and Contracts
Part VII - Group, Blanket, and Franchise Health Insurance Policies (Ss. 627.651-627.66997)
627.651 - Group contracts and plans of self-insurance must meet group requirements.
627.6512 - Exemption of certain group health insurance policies.
627.6515 - Out-of-state groups.
627.652 - Group health insurance; definitions.
627.6525 - Short-term health insurance.
627.654 - Labor union, association, and small employer health alliance groups.
627.6551 - Teacher and student groups.
627.6561 - Preexisting conditions.
627.65612 - Limit on preexisting conditions.
627.65615 - Special enrollment periods.
627.6562 - Dependent coverage.
627.65626 - Insurance rebates for healthy lifestyles.
627.6563 - Full-time employment defined.
627.657 - Provisions of group health insurance policies.
627.6571 - Guaranteed renewability of coverage.
627.6572 - Pharmacy benefit manager contracts.
627.65735 - Nondiscrimination of coverage for surgical procedures.
627.65736 - Coverage for organ transplants.
627.65745 - Diabetes treatment services.
627.6575 - Coverage for newborn children.
627.65755 - Dental procedures; anesthesia and hospitalization coverage.
627.6579 - Coverage for child health supervision services.
627.658 - Use of dividends, refunds, rate reductions, commissions, service fees; premium rates.
627.659 - Blanket health insurance; eligible groups.
627.660 - Conditions and provisions of blanket health insurance policies.
627.661 - School accident insurance claims; policy service.
627.6612 - Coverage for surgical procedures and devices incident to mastectomy.
627.66121 - Coverage for length of stay and outpatient postsurgical care.
627.66122 - Requirements with respect to breast cancer and routine followup care.
627.6613 - Coverage for mammograms.
627.6615 - Children with disabilities; continuation of coverage under group policy.
627.6616 - Coverage for ambulatory surgical center service.
627.6617 - Coverage for home health care services.
627.6618 - Payment of acupuncture benefits to certified acupuncturists.
627.662 - Other provisions applicable.
627.6621 - Advanced practice registered nurse services.
627.663 - Franchise health insurance.
627.664 - Assignment of incidents of ownership in group, blanket, or franchise health policies.
627.6645 - Notification of cancellation, expiration, nonrenewal, or change in rates.
627.6646 - Cancellation or nonrenewal prohibited.
627.6648 - Shared savings incentive program.
627.667 - Extension of benefits.
627.6675 - Conversion on termination of eligibility.
627.668 - Optional coverage for mental and nervous disorders required; exception.
627.6686 - Coverage for individuals with autism spectrum disorder required; exception.
627.669 - Optional coverage required for substance abuse impaired persons; exception.
627.6691 - Coverage for osteoporosis screening, diagnosis, treatment, and management.
627.66911 - Required coverage for cleft lip and cleft palate.
627.6692 - Florida Health Insurance Coverage Continuation Act.
627.6699 - Employee Health Care Access Act.
627.66996 - Restrictions on use of state and federal funds for state exchanges.