(1) Every prepaid limited health service organization must establish and maintain a complaint system providing reasonable procedures for resolving written complaints initiated by enrollees and providers. This section does not preclude an enrollee or a provider from filing a complaint with the department or office or limit the department’s or office’s ability to investigate such complaints.
(2) Every prepaid limited health service organization shall report annually to the department and office the total number of grievances handled, a categorization of the cases underlying the grievances, and the final disposition of the grievances.
History.—s. 31, ch. 93-148; s. 2, ch. 98-156; s. 1536, 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.