(1) The office may require a prepaid limited health service organization to submit any contract for administrative services, contract with a provider physician, contract for management services, or contract with an affiliated entity to the office if the office has information that the prepaid limited health service organization has entered into a contract which requires it to pay a fee which is unreasonably high in relation to the service provided.
(2) After review of a contract, the office may order the prepaid limited health service organization to cancel the contract if it determines that the fees to be paid by the prepaid limited health service organization under the contract are so unreasonably high as compared with similar contracts entered into by the prepaid limited health service organization in similar circumstances that the contract is detrimental to the subscribers, stockholders, investors, or creditors of the prepaid limited health service organization.
(3) All contracts for administrative services, management services, or provider services or contracts with affiliated entities, entered into or renewed by a prepaid limited health service organization on or after October 1, 1993, must contain a provision that the contract will be canceled upon issuance of an order by the office pursuant to this section.
History.—s. 29, ch. 93-148; s. 1534, ch. 2003-261.
Structure Florida Statutes
Chapter 636 - Prepaid Limited Health Service Organizations and Discount Plan Organizations
Part I - Prepaid Limited Health Service Organizations (Ss. 636.002-636.067)
636.004 - Applicability of other laws.
636.005 - Incorporation required; exceptions.
636.006 - Insurance business not authorized.
636.007 - Certificate of authority required.
636.008 - Application for certificate of authority.
636.009 - Issuance of certificate of authority; denial.
636.012 - Continued eligibility for certificate of authority.
636.0145 - Certain entities contracting with Medicaid.
636.015 - Language used in contracts and advertisements; translations.
636.0155 - Disclosures required in contracts and marketing materials.
636.016 - Prepaid limited health service contracts.
636.019 - Additional contract contents.
636.0201 - Genetic information restrictions.
636.022 - Restrictions upon expulsion or refusal to issue or renew contract.
636.023 - Charter; bylaw provisions.
636.024 - Execution of contracts.
636.025 - Validity of noncomplying contracts.
636.026 - Construction of contracts.
636.027 - Delivery of contract.
636.028 - Notice of cancellation of contract.
636.029 - Construction and relationship with other laws.
636.032 - Acceptable payments.
636.033 - Certain words prohibited in name of organization.
636.034 - Extension of benefits.
636.035 - Provider arrangements.
636.036 - Administrative, provider, and management contracts.
636.038 - Complaint system; annual report.
636.039 - Examination by the office.
636.042 - Assets, liabilities, and investments.
636.043 - Annual, quarterly, and miscellaneous reports.
636.045 - Minimum surplus requirements.
636.046 - Insolvency protection.
636.047 - Officers’ and employees’ fidelity bond.
636.049 - Administrative penalty in lieu of suspension or revocation.
636.054 - Payment of judgment by prepaid limited health service organization.
636.055 - Levy upon deposit limited.
636.056 - Rehabilitation, conservation, liquidation, or reorganization; exclusive methods of remedy.
636.058 - Investigative power of department and office.
636.059 - Unfair methods of competition, unfair or deceptive acts or practices defined.