Florida Statutes
Part I - Health Maintenance Organizations (Ss. 641.17-641.3923)
641.31072 - Special enrollment periods.


(1) A health maintenance organization that issues a group health insurance policy shall permit an employee who is eligible, but not enrolled, for coverage under the terms of the contract, or a dependent of such an employee if the dependent is eligible but not enrolled for coverage under such terms, to enroll for coverage under the terms of the contract if each of the following conditions is met:
(a) The employee or dependent was covered under a group health plan or had health insurance coverage at the time coverage was previously offered to the employee or dependent. For the purpose of this section, the terms “group health plan” and “health insurance coverage” have the same meaning ascribed in s. 2791 of the Public Health Service Act.
(b) The employee stated in writing at such time that coverage under a group health plan or health insurance coverage was the reason for declining enrollment, but only if the plan sponsor or health maintenance organization, if applicable, required such a statement at such time and provided the employee with notice of such requirement and the consequences of such requirement at such time.
(c) The employee’s or dependent’s coverage described in paragraph (a):
1. Was under a COBRA continuation provision or continuation pursuant to s. 627.6692, and the coverage under such provision was exhausted; or
2. Was not under such a provision and the coverage was terminated as a result of loss of eligibility for the coverage, including legal separation, divorce, death, termination of employment, or reduction in the number of hours of employment, or the coverage was terminated as a result of the termination of employer contributions toward such coverage.

(d) Under the terms of the contract, the employee requests such enrollment not later than 30 days after the date of exhaustion of coverage described in subparagraph (c)1., or termination or employer contribution described in subparagraph (c)2.

(2) For dependent beneficiaries, if:
(a) A group health maintenance organization contract makes coverage available with respect to a dependent of an individual;
(b) The individual is a participant under the contract, or has met any waiting period applicable to becoming a participant under the contract, and is eligible to be enrolled under the contract but for a failure to enroll during a previous enrollment period; and
(c) A person becomes such a dependent of the individual through marriage, birth, or adoption or placement for adoption,
the health maintenance organization shall provide for a dependent special enrollment period described in subsection (3) during which the person, or, if not otherwise enrolled, the individual, may be enrolled under the plan as a dependent of the individual, and in the case of the birth or adoption of a child, the spouse of the individual may be enrolled as a dependent of the individual if such spouse is otherwise eligible for coverage.

(3) A dependent special enrollment period under subsection (2) shall be a period of not less than 30 days and shall begin on the later of:
(a) The date dependent coverage is made available; or
(b) The date of the marriage, birth, or adoption or placement for adoption described in paragraph (2)(c).

(4) If an individual seeks to enroll a dependent during the first 30 days of such a dependent special enrollment period, the coverage of the dependent shall become effective:
(a) In the case of marriage, not later than the first day of the first month beginning after the date the completed request for enrollment is received.
(b) In the case of a dependent’s birth, as of the date of such birth.
(c) In the case of a dependent’s adoption or placement for adoption, the date of such adoption or placement for adoption.

History.—s. 26, ch. 97-179.

Structure Florida Statutes

Florida Statutes

Title XXXVII - Insurance

Chapter 641 - Health Care Service Programs

Part I - Health Maintenance Organizations (Ss. 641.17-641.3923)

641.17 - Short title.

641.18 - Declaration of legislative intent, findings, and purposes.

641.183 - Statutory accounting procedures; transition provisions.

641.185 - Health maintenance organization subscriber protections.

641.19 - Definitions.

641.201 - Applicability of other laws.

641.2011 - Insurance holding companies.

641.2015 - Incorporation required.

641.2017 - Insurance business not authorized.

641.2018 - Limited coverage for home health care authorized.

641.20185 - High-deductible contracts for medical savings accounts.

641.2019 - Provider service network certificate of authority.

641.21 - Application for certificate.

641.215 - Conditions precedent to issuance or maintenance of certificate of authority; effect of bankruptcy proceedings.

641.217 - Minority recruitment and retention plans required.

641.22 - Issuance of certificate of authority.

641.221 - Continued eligibility for certificate of authority.

641.225 - Surplus requirements.

641.2261 - Application of solvency requirements to provider-sponsored organizations and Medicaid provider service networks.

641.227 - Rehabilitation Administrative Expense Fund.

641.228 - Florida Health Maintenance Organization Consumer Assistance Plan.

641.23 - Revocation or cancellation of certificate of authority; suspension of enrollment of new subscribers; terms of suspension.

641.234 - Administrative, provider, and management contracts.

641.2342 - Contract providers.

641.25 - Administrative penalty in lieu of suspension or revocation.

641.255 - Acquisition, merger, or consolidation.

641.26 - Annual and quarterly reports.

641.261 - Other reporting requirements.

641.27 - Examination by the department.

641.28 - Civil remedy.

641.281 - Injunction.

641.282 - Payment of judgment by health maintenance organization.

641.284 - Liquidation, rehabilitation, reorganization, and conservation; exclusive methods of remedy.

641.285 - Insolvency protection.

641.286 - Levy upon deposit limited.

641.29 - Fees.

641.30 - Construction and relationship to other laws.

641.3005 - Application of ch. 85-177.

641.3007 - HIV infection and AIDS for contract purposes.

641.305 - Language used in contracts and advertisements; translations.

641.309 - Standards for marketing to persons eligible for Medicare.

641.31 - Health maintenance contracts.

641.3101 - Additional contract contents.

641.31015 - Health maintenance organization or exclusive provider organization; disclosure of terms and conditions of plan.

641.3102 - Restrictions upon expulsion or refusal to issue or renew contract.

641.3103 - Charter, bylaw provisions.

641.3104 - Execution of contracts.

641.3105 - Validity of noncomplying contracts.

641.3106 - Construction of contracts.

641.3107 - Delivery of contract; definitions.

641.31071 - Preexisting conditions.

641.31072 - Special enrollment periods.

641.31073 - Prohibiting discrimination against individual participants and beneficiaries based on health status.

641.31074 - Guaranteed renewability of coverage.

641.31075 - Advanced practice registered nurse services.

641.31076 - Shared savings incentive program.

641.31077 - Coverage for organ transplants.

641.3108 - Notice of cancellation of contract.

641.31085 - Disclosures to subscribers; coverage of behavioral health care services.

641.31094 - Nondiscrimination of coverage for certain surgical procedures involving bones or joints.

641.31095 - Coverage for mammograms.

641.31096 - Requirements with respect to breast cancer and routine followup care.

641.31097 - Decreasing inappropriate utilization of emergency care.

641.31098 - Coverage for individuals with developmental disabilities.

641.31099 - Restrictions on use of state and federal funds for state exchanges.

641.3111 - Extension of benefits.

641.312 - Scope.

641.313 - Health maintenance contracts; cancer treatment parity; orally administered cancer treatment medications.

641.314 - Pharmacy benefit manager contracts.

641.315 - Provider contracts.

641.3154 - Organization liability; provider billing prohibited.

641.3155 - Prompt payment of claims.

641.3156 - Treatment authorization; payment of claims.

641.316 - Fiscal intermediary services.

641.32 - Acceptable payments.

641.33 - Certain words prohibited in name of organization.

641.35 - Assets, liabilities, and investments.

641.36 - Adoption of rules; penalty for violation.

641.365 - Dividends.

641.37 - Prohibited activities; penalties.

641.38 - Operational health maintenance organizations; issuance of certificate.

641.385 - Order to discontinue certain advertising.

641.386 - Agent licensing and appointment required; exceptions.

641.39001 - Soliciting or accepting new or renewal health maintenance contracts by insolvent or impaired health maintenance organization prohibited; penalty.

641.3901 - Unfair methods of competition and unfair or deceptive acts or practices prohibited.

641.3903 - Unfair methods of competition and unfair or deceptive acts or practices defined.

641.3905 - General powers and duties of the department and office.

641.3907 - Defined unfair practices; hearings, witnesses, appearances, production of books, and service of process.

641.3909 - Cease and desist and penalty orders.

641.3911 - Appeals from the department or office.

641.3913 - Penalty for violation of cease and desist orders.

641.3915 - Health maintenance organization anti-fraud plans and investigative units.

641.3917 - Civil liability.

641.3921 - Conversion on termination of eligibility.

641.3922 - Conversion contracts; conditions.

641.3923 - Discrimination against providers prohibited.