Florida Statutes
Title XXXVII - Insurance
Chapter 641 - Health Care Service Programs

641.215 - Conditions precedent to issuance or maintenance of certificate of authority; effect of bankruptcy proceedings. - (1) As a condition precedent to the issuance or maintenance...

641.217 - Minority recruitment and retention plans required. - (1) Any entity contracting with the Agency for Health Care...

641.22 - Issuance of certificate of authority. - (1) As a condition precedent to the issuance of any...

641.221 - Continued eligibility for certificate of authority. - (1) In order to maintain its eligibility for a certificate...

641.225 - Surplus requirements. - (1) Each health maintenance organization shall at all times maintain...

641.2261 - Application of solvency requirements to provider-sponsored organizations and Medicaid provider service networks. - (1) The solvency requirements of ss. 1855 and 1856 of...

641.227 - Rehabilitation Administrative Expense Fund. - (1) The office shall not issue or permit to exist...

641.228 - Florida Health Maintenance Organization Consumer Assistance Plan. - (1) The office shall not issue a certificate to any...

641.23 - Revocation or cancellation of certificate of authority; suspension of enrollment of new subscribers; terms of suspension. - (1) The maintenance of a valid and current health care...

641.234 - Administrative, provider, and management contracts. - (1) The office may require a health maintenance organization to...

641.2342 - Contract providers. - History.—ss. 9, 24, ch. 88-388; ss. 187, 188, ch. 91-108;...

641.25 - Administrative penalty in lieu of suspension or revocation. - History.—s. 9, ch. 72-264; s. 3, ch. 76-168; s. 1,...

641.255 - Acquisition, merger, or consolidation. - (1) Every acquisition of a health maintenance organization shall be...

641.26 - Annual and quarterly reports. - (1) Every health maintenance organization shall, annually within 3 months...

641.261 - Other reporting requirements. - (1) Each authorized health maintenance organization shall provide records and...

641.27 - Examination by the department. - (1) The office shall examine the affairs, transactions, accounts, business...

641.28 - Civil remedy. - History.—s. 12, ch. 72-264; s. 3, ch. 76-168; s. 1,...

641.281 - Injunction. - (1) A health maintenance organization is being operated by any...

641.282 - Payment of judgment by health maintenance organization. - History.—ss. 16, 47, ch. 85-177; ss. 187, 188, ch. 91-108;...

641.284 - Liquidation, rehabilitation, reorganization, and conservation; exclusive methods of remedy. - History.—ss. 118, 188, ch. 91-108; s. 4, ch. 91-429; s....

641.285 - Insolvency protection. - (1) Each health maintenance organization shall deposit with the department...

641.286 - Levy upon deposit limited. - History.—ss. 18, 47, ch. 85-177; ss. 187, 188, ch. 91-108;...

641.29 - Fees. - (1) For filing a copy of its application for a...

641.30 - Construction and relationship to other laws. - (1) Every health maintenance organization shall accept the claim form...

641.3005 - Application of ch. 85-177. - History.—s. 48, ch. 85-177; s. 1, ch. 86-286; ss. 187,...

641.3007 - HIV infection and AIDS for contract purposes. - (1) PURPOSE.—The purpose of this section is to prohibit unfair...

641.305 - Language used in contracts and advertisements; translations. - (1)(a) All health maintenance contracts or forms shall be printed...

641.309 - Standards for marketing to persons eligible for Medicare. - (1) Every health maintenance organization marketing coverage to Medicare participants...

641.31 - Health maintenance contracts. - (1) Any entity issued a certificate and otherwise in compliance...

641.3101 - Additional contract contents. - (1) Necessary, on account of the manner in which the...

641.31015 - Health maintenance organization or exclusive provider organization; disclosure of terms and conditions of plan. - History.—s. 8, ch. 96-223. 1Note.—Also published at s. 627.64725.

641.3102 - Restrictions upon expulsion or refusal to issue or renew contract. - (1) A health maintenance organization that offers individual health maintenance...

641.3103 - Charter, bylaw provisions. - History.—ss. 25, 47, ch. 85-177; ss. 187, 188, ch. 91-108;...

641.3104 - Execution of contracts. - (1) Every health maintenance contract shall be executed in the...

641.3105 - Validity of noncomplying contracts. - (1) Any health maintenance contract, rider, endorsement, attachment, or addendum...

641.3106 - Construction of contracts. - History.—ss. 28, 47, ch. 85-177; ss. 187, 188, ch. 91-108;...

641.3107 - Delivery of contract; definitions. - (1) A health maintenance contract, certificate of coverage, endorsements and...

641.31071 - Preexisting conditions. - (1) As used in this section, the term: (a) “Enrollment...

641.31072 - Special enrollment periods. - (1) A health maintenance organization that issues a group health...

641.31073 - Prohibiting discrimination against individual participants and beneficiaries based on health status. - (1) Subject to subsection (2), a health maintenance organization that...

641.31074 - Guaranteed renewability of coverage. - (1) Except as otherwise provided in this section, a health...

641.31075 - Advanced practice registered nurse services. - History.—s. 32, ch. 2020-9.

641.31076 - Shared savings incentive program. - (1) This section and ss. 627.6387 and 627.6648 may be...

641.31077 - Coverage for organ transplants. - History.—s. 4, ch. 2020-139.

641.3108 - Notice of cancellation of contract. - (1) Except for nonpayment of premium or termination of eligibility,...

641.31085 - Disclosures to subscribers; coverage of behavioral health care services. - (1) A health maintenance organization shall make all of the...

641.31094 - Nondiscrimination of coverage for certain surgical procedures involving bones or joints. - History.—s. 5, ch. 96-361.

641.31095 - Coverage for mammograms. - (1) Every health maintenance contract issued or renewed on or...

641.31096 - Requirements with respect to breast cancer and routine followup care. - History.—s. 11, ch. 97-48.

641.31097 - Decreasing inappropriate utilization of emergency care. - (1) The Legislature finds and declares it to be of...

641.31098 - Coverage for individuals with developmental disabilities. - (1) This section and s. 627.6686 may be cited as...

641.31099 - Restrictions on use of state and federal funds for state exchanges. - (1) A health maintenance contract under which coverage is purchased...

641.3111 - Extension of benefits. - (1) Every group health maintenance contract shall provide that termination...

641.312 - Scope. - History.—s. 13, ch. 2012-44; s. 108, ch. 2013-15; s. 24,...

641.313 - Health maintenance contracts; cancer treatment parity; orally administered cancer treatment medications. - (1) As used in this section, the term: (a) “Cancer...

641.314 - Pharmacy benefit manager contracts. - (1) As used in this section, the term: (a) “Maximum...

641.315 - Provider contracts. - (1) Each contract between a health maintenance organization and a...

641.3154 - Organization liability; provider billing prohibited. - (1) If a health maintenance organization is liable for services...

641.3155 - Prompt payment of claims. - (1) As used in this section, the term “claim” for...

641.3156 - Treatment authorization; payment of claims. - (1) A health maintenance organization must pay any hospital-service or...

641.316 - Fiscal intermediary services. - (1) It is the intent of the Legislature, through the...

641.32 - Acceptable payments. - History.—s. 16, ch. 72-264; s. 3, ch. 76-168; s. 1,...

641.33 - Certain words prohibited in name of organization. - (1) No entity certificated as a health maintenance organization, other...

641.35 - Assets, liabilities, and investments. - (1) ASSETS.—In any determination of the financial condition of a...

641.36 - Adoption of rules; penalty for violation. - History.—s. 20, ch. 72-264; s. 3, ch. 76-168; s. 1,...

641.365 - Dividends. - (1)(a) A health maintenance organization shall not pay any dividend...

641.37 - Prohibited activities; penalties. - (1) Any person or entity which knowingly renews, issues, or...

641.38 - Operational health maintenance organizations; issuance of certificate. - History.—s. 23, ch. 72-264; s. 3, ch. 76-168; s. 1,...

641.385 - Order to discontinue certain advertising. - History.—s. 8, ch. 84-313; s. 188, ch. 91-108; s. 4,...

641.386 - Agent licensing and appointment required; exceptions. - (1) With respect to a health maintenance contract, no person...

641.39001 - Soliciting or accepting new or renewal health maintenance contracts by insolvent or impaired health maintenance organization prohibited; penalty. - (1) Whether or not delinquency proceedings as to a health...

641.3901 - Unfair methods of competition and unfair or deceptive acts or practices prohibited. - History.—ss. 35, 47, ch. 85-177; ss. 187, 188, ch. 91-108;...

641.3903 - Unfair methods of competition and unfair or deceptive acts or practices defined. - (1) MISREPRESENTATION AND FALSE ADVERTISING OF HEALTH MAINTENANCE CONTRACTS.—Knowingly making,...

641.3905 - General powers and duties of the department and office. - History.—ss. 37, 47, ch. 85-177; ss. 128, 187, 188, ch....

641.3907 - Defined unfair practices; hearings, witnesses, appearances, production of books, and service of process. - (1) Whenever the department or office has reason to believe...

641.3909 - Cease and desist and penalty orders. - (1) Suspension or revocation of the health maintenance organization’s certificate...

641.3911 - Appeals from the department or office. - History.—ss. 40, 47, ch. 85-177; ss. 187, 188, ch. 91-108;...

641.3913 - Penalty for violation of cease and desist orders. - (1) A monetary penalty of not more than $200,000 as...

641.3915 - Health maintenance organization anti-fraud plans and investigative units. - History.—s. 4, ch. 99-204; ss. 4, 14, ch. 2017-178.

641.3917 - Civil liability. - History.—ss. 42, 47, ch. 85-177; ss. 187, 188, ch. 91-108;...

641.3921 - Conversion on termination of eligibility. - (1) Failure to pay any required premium or contribution unless...

641.3922 - Conversion contracts; conditions. - (1) TIME LIMIT.—Written application for the converted contract shall be...

641.3923 - Discrimination against providers prohibited. - History.—s. 2, ch. 98-285; s. 77, ch. 2018-106.

Part II - Prepaid Health Clinics (Ss. 641.40-641.459)

641.40 - Short title. - History.—ss. 10, 11, ch. 84-313; ss. 187, 188, ch. 91-108;...

641.401 - Declaration of legislative intent, findings, and purposes. - (1) Faced with the continuation of mounting health care costs,...

641.4015 - Part exclusive; applicability of other laws. - History.—ss. 27, 50, ch. 85-321; ss. 187, 188, ch. 91-108;...

641.402 - Definitions. - (1) “Basic services” includes any of the following: emergency care,...

641.403 - Rulemaking authority. - History.—ss. 10, 11, ch. 84-313; s. 13, ch. 87-236; ss....

641.405 - Application for certificate of authority to operate prepaid health clinic. - (1) No person may operate a prepaid health clinic without...

641.406 - Issuance of certificate of authority. - (1) As a condition precedent to the issuance of any...

641.4065 - Insurance business not authorized. - History.—ss. 28, 50, ch. 85-321; ss. 187, 188, ch. 91-108;...

641.407 - Minimum surplus. - (1) Each prepaid health clinic shall have and maintain minimum...

641.408 - Use of certain words prohibited in the name of a prepaid health clinic. - (1) No person issued a certificate of authority as a...

641.409 - Insolvency protection. - (1) Every prepaid health clinic shall comply with one of...

641.4091 - Levy upon deposit; limitation. - History.—ss. 40, 50, ch. 85-321; ss. 187, 188, ch. 91-108;...

641.41 - Annual report of prepaid health clinic; administrative penalty. - (1) Each prepaid health clinic shall file a report with...

641.411 - Other reporting requirements. - (1) Each prepaid health clinic shall provide records and information...

641.412 - Fees. - (1) Every prepaid health clinic shall pay to the office...

641.414 - Investment of funds of prepaid health clinic. - History.—ss. 10, 11, ch. 84-313; ss. 187, 188, ch. 91-108;...

641.416 - Acquisition. - History.—ss. 10, 11, ch. 84-313; ss. 14, 17, ch. 86-250;...

641.418 - Examination of prepaid health clinic by the office. - History.—ss. 10, 11, ch. 84-313; s. 17, ch. 87-236; ss....

641.419 - Rehabilitation, liquidation, conservation, or dissolution of prepaid health clinic. - History.—ss. 10, 11, ch. 84-313; ss. 187, 188, ch. 91-108;...

641.42 - Prepaid health clinic contracts. - (1) Any applicant that has been issued a certificate of...

641.421 - Language used in contracts and advertisements; translations. - (1)(a) All prepaid health clinic contracts or forms shall be...

641.422 - Contract provisions incorporating charter or bylaw provisions. - History.—ss. 10, 11, ch. 84-313; ss. 187, 188, ch. 91-108;...

641.423 - Execution of contracts. - (1) Every prepaid health clinic contract shall be executed in...

641.424 - Validity of noncomplying contracts. - (1) Any prepaid health clinic contract, or contract rider, endorsement,...

641.425 - Construction of contracts. - (1) Every prepaid health clinic contract shall be construed according...

641.426 - Delivery of contract to subscriber. - History.—ss. 10, 11, ch. 84-313; ss. 187, 188, ch. 91-108;...

641.427 - Notice of cancellation, termination, or nonrenewal of contract. - History.—ss. 10, 11, ch. 84-313; ss. 187, 188, ch. 91-108;...

641.428 - Nondiscrimination of coverage for certain surgical procedures involving bones or joints. - History.—s. 6, ch. 96-361.

641.429 - Acceptable payments to prepaid health clinic. - History.—ss. 10, 11, ch. 84-313; ss. 187, 188, ch. 91-108;...

641.43 - Provider contracts. - History.—ss. 10, 11, ch. 84-313; ss. 187, 188, ch. 91-108;...

641.432 - Providers of service; penalty for unauthorized use of providers; interference with judgment prohibited. - (1) Any prepaid health clinic which utilizes the services of...

641.437 - Investigatory power of office. - History.—ss. 10, 11, ch. 84-313; ss. 187, 188, ch. 91-108;...

641.438 - Genetic information restrictions. - History.—s. 6, ch. 97-182.

641.44 - Unfair methods of competition and unfair or deceptive acts or practices prohibited. - History.—ss. 10, 11, ch. 84-313; ss. 187, 188, ch. 91-108;...

641.441 - Unfair methods of competition and unfair or deceptive acts or practices defined. - (1) MISREPRESENTATION AND FALSE ADVERTISING OF PREPAID HEALTH CLINIC CONTRACTS.—Knowingly...

641.442 - Penalty for operation of prepaid health clinic, or issuance, delivery, or renewal of prepaid health clinic contract, without certificate of authority. - History.—ss. 10, 11, ch. 84-313; ss. 187, 188, ch. 91-108;...

641.443 - Temporary restraining orders. - (1) The office is vested with the power to seek...

641.444 - Injunction. - History.—ss. 10, 11, ch. 84-313; ss. 187, 188, ch. 91-108;...

641.445 - Defined practices; hearings, witnesses, appearances, production of books, and service of process. - (1) Whenever the office has reason to believe that a...

641.446 - Cease and desist and penalty orders. - (1) The suspension or revocation of the certificate of authority...

641.447 - Appeal from order. - History.—ss. 10, 11, ch. 84-313; ss. 187, 188, ch. 91-108;...

641.448 - Penalty for violation of cease and desist order. - (1) A monetary penalty of not more than $50,000 as...

641.45 - Revocation or cancellation of certificate of authority; suspension of authority to enroll new subscribers; terms of suspension. - (1) The maintenance of a valid and current Health Care...

641.452 - Administrative penalty in lieu of suspension or revocation of certificate of authority. - History.—ss. 10, 11, ch. 84-313; s. 20, ch. 87-236; ss....

641.453 - Civil liability. - History.—ss. 10, 11, ch. 84-313; ss. 187, 188, ch. 91-108;...

641.454 - Civil action to enforce prepaid health clinic contract; attorney’s fees; court costs. - History.—ss. 10, 11, ch. 84-313; ss. 187, 188, ch. 91-108;...

641.455 - Disposition of moneys collected under this part. - History.—ss. 10, 11, ch. 84-313; ss. 187, 188, ch. 91-108;...

641.457 - Exemption for certain operational prepaid health clinics. - History.—ss. 10, 11, ch. 84-313; ss. 187, 188, ch. 91-108;...

641.459 - Construction and relationship to other laws. - (1) Except as provided in this part, the Florida Insurance...

Part III - Health Care Services (Ss. 641.47-641.62)

641.47 - Definitions. - (1) “Adverse determination” means a coverage determination by an organization...

641.48 - Purpose and application of part. - History.—ss. 21, 27, ch. 87-236; ss. 187, 188, ch. 91-108;...

641.49 - Certification of health maintenance organization and prepaid health clinic as health care providers; application procedure. - (1) No person or governmental unit shall establish, conduct, or...

641.495 - Requirements for issuance and maintenance of certificate. - (1) The agency shall issue a health care provider certificate...

641.51 - Quality assurance program; second medical opinion requirement. - (1) The organization shall ensure that the health care services...

641.511 - Subscriber grievance reporting and resolution requirements. - (1) Every organization must have a grievance procedure available to...

641.512 - Accreditation and external quality assurance assessment. - (1)(a) To promote the quality of health care services provided...

641.513 - Requirements for providing emergency services and care. - (1) In providing for emergency services and care as a...

641.514 - Coverage for air ambulance services. - (1) As used in this section, the term: (a) “Air...

641.515 - Investigation by the agency. - (1) The agency shall investigate further any quality of care...

641.52 - Revocation of certificate; suspension of new enrollment; suspension of the health care provider certificate; administrative fine; notice of action to the office; penalty for use of unlicensed providers. - (1) The agency may suspend the authority of an organization...

641.54 - Information disclosure. - (1) Every health maintenance organization shall maintain a current list,...

641.545 - Subscriber risk assessments; requirements. - History.—s. 36, ch. 96-199.

641.55 - Internal risk management program. - (1) Every organization certified under this part shall, as a...

641.56 - Rulemaking authority. - History.—ss. 24, 27, ch. 87-236; ss. 187, 188, ch. 91-108;...

641.57 - Disposition of moneys collected under this part. - History.—ss. 25, 27, ch. 87-236; ss. 187, 188, ch. 91-108;...

641.58 - Regulatory assessment; levy and amount; use of funds; tax returns; penalty for failure to pay. - (1) In addition to any other license or excise tax...

641.59 - Psychotherapeutic services; records and reports. - History.—s. 1, ch. 96-180.

641.61 - Subscriber satisfaction assessment. - (1) Assessing subscriber satisfaction with providers, particularly primary care physicians;...

641.62 - Chronic diseases among subscriber populations. - (1) Annually study its subscriber population to determine the most...

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Florida Statutes Title XXXVII - Insurance Chapter 641 - Health Care Service Programs

Florida Statutes
Title XXXVII - Insurance
Chapter 641 - Health Care Service Programs