Source: http://www.healthinfolaw.org/state-topics/10,64/f_topics
Timestamp: 2018-01-23 19:48:40
Document Index: 640125479

Matched Legal Cases: ['§ 627', '§ 636', '§ 641', '§ 408', '§ 627', '§ 624', '§ 626', '§ 627', '§ 641', '§ 627', '§ 627', '§ 627', '§ 627', '§ 636', '§ 636', '§ 641', '§ 641', '§ 627', '§ 59', '§ 59', '§ 59', '§ 624', '§ 626', '§ 627', '§ 627', '§ 627', '§ 627', '§ 627', '§ 627', '§ 627', '§ 627', '§ 627', '§ 627', '§ 627', '§ 627', '§ 627', '§ 636', '§ 636', '§ 636', '§ 636', '§ 641', '§ 641', '§ 641', '§ 641', '§627']

Private Insurance Data Requirements in Florida | Health Information & the Law
Private Insurance Data Requirements in Florida
Each health maintenance organization or exclusive provider organization must provide prospective enrollees with written information about the terms and conditions of the plan so that they can make informed decisions about choosing a health insurance plan.1
Every prepaid limited health service organization2 and health maintenance organization3 must establish a complaint system providing procedures for resolving written complaints by enrollees and providers. The Agency for Health Care Administration’s Subscriber Program is a program established to provide assistance to health maintenance organization or prepaid health clinic enrollees who received an adverse determination of their grievances.4
A health insurance policy must comply with the Employee Retirement Income Security Act’s provisions regarding internal grievances.5
Personal financial and health information about health insurance enrollees held by the Department of Financial Services or the Office of Insurance Regulation are confidential.6 The Office of Insurance Regulation must adopt rules requiring health insurers and health maintenance organizations to comply with the federal Health Insurance Portability and Affordability Act and privacy rules promulgated by the National Association of Insurance Commissioners.7
Genetic information may not be used by a health insurer to cancel, limit, or deny coverage or establish premium rates.8 A health maintenance organization may not discriminate against an individual who has HIV/AIDS by excluding or limiting coverage.9
An individual health insurance policy10 and group health insurance policy11 preexisting condition provision must comply with specific statutory requirements. A small employer carrier may not include a preexisting condition exclusion as a condition of coverage.12
The Office of Insurance Regulation may examine each health insurer that operates in Florida to ensure compliance with state laws.13 Each prepaid limited health service organization,14 discount medical plan,15 health maintenance organization,16 prepaid health clinic17 must annually file with the Office of Insurance Regulation a financial report for the prior fiscal year.
Each health insurer must make available on its website a link to the performance outcome and financial data that is published by the Agency for Health Care Administration.18
1. Florida Statutes § 627.64725
2. Florida Statutes § 636.038
3. Florida Statutes §§ 641.31; 641.185
4. Florida Statutes § 408.7056
5. Florida Statutes §§ 627.602; 627.6513
6. Florida Statutes §§ 624.23; 627.429; 627.4195
7. Florida Statutes § 626.9651
8. Florida Statutes §§ 627.4301; 636.0201; 641.438
9. Florida Statutes § 641.3007
10. Florida Statutes §§ 627.6045; 627.6415
11. Florida Statutes §§ 627.6561; 627.6578; 627.65625; 641.31071; 641.31073
12. Florida Statutes § 627.6699
13. Florida Statutes §§ 627.4238; 636.039; 641.27; 641.54
14. Florida Statutes § 636.043
15. Florida Statutes § 636.218
16. Florida Statutes § 641.26
17. Florida Statutes § 641.41
18. Florida Statutes § 627.64995
Private Insurance Data Requirements Florida Administrative Code § 59B-13.001 “Reporting instructions under the Agency for Health Care Administration regulations” A health maintenance organization must annually...
Florida Administrative Code § 59B-13.003 “Uniform data specifications under the Agency for Health Care Administration regulations” Each health maintenance organization must...
Florida Administrative Code § 59B-13.005 “Penalties for report deficiencies under the Agency for Health Care Administration regulations” A health maintenance organization that...
Florida Statutes § 624.23 “Public records exemption under the insurance law” Personal financial and health information about health insurance enrollees held by the...
Florida Statutes § 626.9651 “Privacy under the insurance law” The Office of Insurance Regulation must adopt rules requiring health insurers and health maintenance...
Florida Statutes § 627.4195 “Health insurance, claims for payment of psychotherapeutic services, and confidentiality under the insurance law” An insurer must...
Florida Statutes § 627.4238 “Health insurer examinations under the insurance law” The Office of Insurance Regulation may examine each health insurer that operates in...
Florida Statutes § 627.429 “Medical tests for HIV infection and AIDS for insurance purposes under the insurance law” (4)(f) Insurers must maintain strict...
Florida Statutes § 627.4301 “Genetic information for insurance purposes under the insurance law” Genetic information may not be used by a health insurer to cancel,...
Florida Statutes § 627.602 “Scope, format of policy under the insurance law” A health insurance policy must comply with the Employee Retirement Income Security Act...
Florida Statutes § 627.6045 “Preexisting condition under the insurance law” A health insurance policy’s preexisting condition provision may not exclude...
Florida Statutes § 627.6415 “Coverage for natural-born, adopted, and foster children; children in insured’s custodial care under the insurance law” A health...
Florida Statutes § 627.64725 “Health maintenance organization or exclusive provider organization; disclosure of terms and conditions of plan under the insurance law”...
Florida Statutes § 627.6513 “Scope under the insurance law” Group health insurance policies must comply with the Employee Retirement Income Security Act’s...
Florida Statutes § 627.6561 “Preexisting conditions under the insurance law” A group health policy may impose a preexisting condition exclusion only if: The...
Florida Statutes § 627.65625 “Prohibiting discrimination against individual participants and beneficiaries based on health status under the insurance law” A group...
Florida Statutes § 627.6578 “Coverage for natural-born, adopted, and foster children; children in insured’s custodial care under the insurance law” A group...
Florida Statutes § 627.6699 “Employee Health Care Access Act under the insurance law” Every small employer carrier must offer small employer health benefit plans on...
Florida Statutes § 636.0201 “Genetic information restrictions under the Prepaid Limited Health Service Organization Act of Florida” A prepaid limited health service...
Florida Statutes § 636.038 “Complaint system; annual report under the Prepaid Limited Health Service Organization Act of Florida” Every prepaid limited health...
Florida Statutes § 636.039 “Examination by the office under the Prepaid Limited Health Service Organization Act of Florida” The Office of Insurance Regulation must...
Florida Statutes § 636.043 “Annual, quarterly, and miscellaneous reports under the Prepaid Limited Health Service Organization Act of Florida” Each prepaid limited...
Florida Statutes § 641.31071 “Preexisting conditions under the Health Maintenance Organization Act” A group health maintenance organization may impose a preexisting...
Florida Statutes § 641.31073 “Prohibiting discrimination against individual participants and beneficiaries based on health status under the Health Maintenance Organization...
Florida Statutes § 641.41 “Annual report of prepaid health clinic; administrative penalty under the Prepaid Health Clinic Act” Each prepaid health clinic must...
Florida Statutes § 641.438 “Genetic information restrictions under the Prepaid Health Clinic Act” A prepaid health clinic must comply with FL Stat. §627.4301,...