reglab/housing_qa huggingface dataset:
FL Stat § 627.6417 (2021)
2021 Florida Statutes|Title XXXVII - Insurance|Chapter 627 - Insurance Rates and Contracts|Part VI - Health Insurance Policies (Ss. 627.601-627.64995)|627.6417 - Coverage for surgical procedures and devices incident to mastectomy.

627.6417 Coverage for surgical procedures and devices incident to mastectomy.—(1) Any health insurance policy that provides coverage for mastectomies must also provide coverage for prosthetic devices and breast reconstructive surgery incident to the mastectomy. The insurer may charge an appropriate additional premium for the coverage required by this subsection. The coverage for prosthetic devices and breast reconstructive surgery shall be subject to any deductible and coinsurance conditions and all other terms and conditions applicable to other benefits. Breast reconstructive surgery must be in a manner chosen by the treating physician, consistent with prevailing medical standards, and in consultation with the patient.(2) As used in this section, the term “mastectomy” means the removal of all or part of the breast for medically necessary reasons as determined by a licensed physician, and the term “breast reconstructive surgery” means surgery to reestablish symmetry between the two breasts.(3) This section does not apply to disability income, specified disease other than cancer, or hospital indemnity policies.History.—ss. 2, 4, ch. 87-262; s. 4, ch. 88-269; ss. 58, 114, ch. 92-318; s. 1, ch. 97-48.
FL Stat § 627.64172 (2021)
2021 Florida Statutes|Title XXXVII - Insurance|Chapter 627 - Insurance Rates and Contracts|Part VI - Health Insurance Policies (Ss. 627.601-627.64995)|627.64172 - Requirements with respect to breast cancer and routine followup care.

627.64172 Requirements with respect to breast cancer and routine followup care.—Routine followup care to determine whether a breast cancer has recurred in a person who has been previously determined to be free of breast cancer does not constitute medical advice, diagnosis, care, or treatment for purposes of determining preexisting conditions, unless evidence of breast cancer is found during or as a result of the followup care.History.—s. 3, ch. 97-48.
FL Stat § 627.6418 (2021)
2021 Florida Statutes|Title XXXVII - Insurance|Chapter 627 - Insurance Rates and Contracts|Part VI - Health Insurance Policies (Ss. 627.601-627.64995)|627.6418 - Coverage for mammograms.

627.6418 Coverage for mammograms.—(1) An accident or health insurance policy issued, amended, delivered, or renewed in this state must provide coverage for at least the following:(a) A baseline mammogram for any woman who is 35 years of age or older, but younger than 40 years of age.(b) A mammogram every 2 years for any woman who is 40 years of age or older, but younger than 50 years of age, or more frequently based on the patient’s physician’s recommendation.(c) A mammogram every year for any woman who is 50 years of age or older.(d) One or more mammograms a year, based upon a physician’s recommendation, for any woman who is at risk for breast cancer because of a personal or family history of breast cancer, because of having a history of biopsy-proven benign breast disease, because of having a mother, sister, or daughter who has or has had breast cancer, or because a woman has not given birth before the age of 30.(2) Except as provided in paragraph (1)(b), for mammograms done more frequently than every 2 years for women 40 years of age or older but younger than 50 years of age, the coverage required by subsection (1) applies, with or without a physician prescription, if the insured obtains a mammogram in an office, facility, or health testing service that uses radiological equipment registered with the Department of Health for breast cancer screening. The coverage is subject to the deductible and coinsurance provisions applicable to outpatient visits, and is also subject to all other terms and conditions applicable to other benefits. This section does not affect any requirements or prohibitions relating to who may perform, analyze, or interpret a mammogram or the persons to whom the results of a mammogram may be furnished or released.(3) This section does not apply to disability income, specified disease, or hospital indemnity policies.(4) Every insurer subject to the requirements of this section shall make available to the policyholder as part of the application, for an appropriate additional premium, the coverage required in this section without such coverage being subject to the deductible or coinsurance provisions of the policy.History.—s. 4, ch. 88-269; s. 125, ch. 92-33; s. 6, ch. 95-188; s. 260, ch. 99-8; s. 89, ch. 2006-1.
FL Stat § 627.6419 (2021)
2021 Florida Statutes|Title XXXVII - Insurance|Chapter 627 - Insurance Rates and Contracts|Part VI - Health Insurance Policies (Ss. 627.601-627.64995)|627.6419 - Requirements with respect to breast cancer.

627.6419 Requirements with respect to breast cancer.—(1) An insurer may not deny the issuance or renewal of, or cancel, a policy of accident insurance or health insurance, nor include any exception or exclusion of benefits in a policy solely because the insured has been diagnosed as having a fibrocystic condition or a nonmalignant lesion that demonstrates a predisposition, or solely due to the family history of the insured related to breast cancer, or solely due to any combination of these factors, unless the condition is diagnosed through a breast biopsy that demonstrates an increased disposition to developing breast cancer.(2) An insurer may not deny the issuance or renewal of, or cancel, a policy of accident insurance or health insurance, nor include any exception or exclusion of benefits in a policy solely due to breast cancer, if the insured has been free from breast cancer for more than 2 years before the applicant’s request for health insurance coverage.(3) This section also applies to a policy of group, blanket, or franchise accident or health insurance and to a contract or evidence of coverage issued by a health maintenance organization.History.—s. 59, ch. 92-318; s. 7, ch. 95-188; s. 4, ch. 97-48; s. 2, ch. 97-182.
FL Stat § 627.64193 (2021)
2021 Florida Statutes|Title XXXVII - Insurance|Chapter 627 - Insurance Rates and Contracts|Part VI - Health Insurance Policies (Ss. 627.601-627.64995)|627.64193 - Required coverage for cleft lip and cleft palate.

627.64193 Required coverage for cleft lip and cleft palate.—A health insurance policy that covers a child under the age of 18 must provide coverage for treatment of cleft lip and cleft palate for the child. The coverage must include medical, dental, speech therapy, audiology, and nutrition services only if such services are prescribed by the treating physician or surgeon and such physician or surgeon certifies that such services are medically necessary and consequent to treatment of the cleft lip or cleft palate. The coverage required by this section is subject to terms and conditions applicable to other benefits. This section does not apply to specified-accident, specified-disease, hospital indemnity, limited benefit disability income, or long-term care insurance policies.History.—s. 1, ch. 98-66.
FL Stat § 627.64195 (2021)
2021 Florida Statutes|Title XXXVII - Insurance|Chapter 627 - Insurance Rates and Contracts|Part VI - Health Insurance Policies (Ss. 627.601-627.64995)|627.64195 - Requirements for opioid coverage.

627.64195 Requirements for opioid coverage.—(1) DEFINITIONS.—As used in this section, the term:(a) “Abuse-deterrent opioid analgesic drug product” means a brand or generic opioid analgesic drug product approved by the United States Food and Drug Administration with an abuse-deterrence labeling claim that indicates the drug product is expected to deter abuse.(b) “Opioid analgesic drug product” means a drug product in the opioid analgesic drug class prescribed to treat moderate to severe pain or other conditions in immediate-release, extended-release, or long-acting form regardless of whether or not combined with other drug substances to form a single drug product or dosage form.(2) COVERAGE REQUIREMENTS.—A health insurance policy that provides coverage for abuse-deterrent opioid analgesic drug products:(a) May impose a prior authorization requirement for an abuse-deterrent opioid analgesic drug product only if the policy imposes the same prior authorization requirement for each opioid analgesic drug product without an abuse-deterrence labeling claim.(b) May not require use of an opioid analgesic drug product without an abuse-deterrence labeling claim before authorizing the use of an abuse-deterrent opioid analgesic drug product.History.—s. 1, ch. 2016-112.
FL Stat § 627.64196 (2021)
2021 Florida Statutes|Title XXXVII - Insurance|Chapter 627 - Insurance Rates and Contracts|Part VI - Health Insurance Policies (Ss. 627.601-627.64995)|627.64196 - Medication synchronization.

627.64196 Medication synchronization.—(1) A health insurer issuing or delivering in this state an individual or a group health insurance policy that provides prescription drug coverage shall offer medication synchronization to allow an insured to align at least once in a plan year the refill dates for prescription drugs covered by the policy. The insurer shall implement a process for dispensing prescription drugs to an insured for the purpose of aligning the refill dates of such drugs, and such medication synchronization may be available only through a network pharmacy. A controlled substance, a prescription drug dispensed in an unbreakable package, or a multidose unit of a prescription drug may not be partially filled for the purpose of aligning refill dates. The insurer shall pay a full dispensing fee to the network pharmacy for each partial refill of a covered prescription drug dispensed to align refill dates, unless otherwise agreed to by the plan and the network pharmacy at the time an insured requests medication synchronization. The insurer shall prorate the cost-sharing obligations of the insured for each partial refill of a covered prescription drug dispensed to align refill dates. This section applies to policies renewed or entered into on or after January 1, 2018.(2) Notwithstanding subsection (1), an alternate process used by an insurer which includes early refill dates, refill overrides, and access on the insurer’s public website to the terms and conditions of such a process is deemed to comply with the requirements of this section.History.—s. 1, ch. 2017-94.
FL Stat § 627.64197 (2021)
2021 Florida Statutes|Title XXXVII - Insurance|Chapter 627 - Insurance Rates and Contracts|Part VI - Health Insurance Policies (Ss. 627.601-627.64995)|627.64197 - Coverage for organ transplants.

627.64197 Coverage for organ transplants.—A health insurance policy issued, delivered, or renewed on or after July 1, 2020, in this state by an insurer which provides coverage for organ transplants on an expense-incurred basis may not deny coverage for an organ transplant solely on the basis of an insured’s disability. This section may not be construed to require such insurer to provide coverage for an organ transplant that is not medically necessary. For purposes of this section, the term “organ transplant” has the same meaning as in s. 765.523.History.—s. 2, ch. 2020-139.
FL Stat § 627.6426 (2021)
2021 Florida Statutes|Title XXXVII - Insurance|Chapter 627 - Insurance Rates and Contracts|Part VI - Health Insurance Policies (Ss. 627.601-627.64995)|627.6426 - Short-term health insurance.

627.6426 Short-term health insurance.—(1) For purposes of this part, the term “short-term health insurance” means health insurance coverage provided by an issuer with an expiration date specified in the contract that is less than 12 months after the original effective date of the contract and, taking into account renewals or extensions, has a duration not to exceed 36 months in total.(2) All contracts for short-term health insurance entered into by an issuer and an individual seeking coverage shall include the following disclosure:“This coverage is not required to comply with certain federal market requirements for health insurance, principally those contained in the Patient Protection and Affordable Care Act. Be sure to check your policy carefully to make sure you are aware of any exclusions or limitations regarding coverage of preexisting conditions or health benefits (such as hospitalization, emergency services, maternity care, preventive care, prescription drugs, and mental health and substance use disorder services). Your policy might also have lifetime and/or annual dollar limits on health benefits. If this coverage expires or you lose eligibility for this coverage, you might have to wait until an open enrollment period to get other health insurance coverage.”History.—s. 5, ch. 2019-129.
FL Stat § 627.643 (2021)
2021 Florida Statutes|Title XXXVII - Insurance|Chapter 627 - Insurance Rates and Contracts|Part VI - Health Insurance Policies (Ss. 627.601-627.64995)|627.643 - Uniform minimum standards.

627.643 Uniform minimum standards.—(1) The commission shall adopt rules which establish minimum standards for the general content of forms of individual and family health insurance policies. The rules must include terms of renewability, initial and subsequent conditions of eligibility, termination of insurance, probationary periods, exclusions, limitations, and reductions. The minimum standards are in addition to, and must comply with, the individual health insurance policy provisions provided in part II and in this part.(2) The commission shall adopt rules which establish minimum standards of benefits and identification for each of the following categories of coverage in individual and family accident and health insurance policy forms, other than conversion policy forms:(a) Basic hospital expense insurance.(b) Basic medical expense insurance.(c) Basic surgical expense insurance.(d) Hospital confinement indemnity insurance.(e) Major medical expense insurance.(f) Disability income protection insurance.(g) Accident-only insurance.(h) Limited benefit insurance.(i) Supplemental insurance.(j) Home health care coverage.(k) Nonconventional coverage.This subsection does not preclude the issuance of a policy which combines two or more of the categories of coverage enumerated in paragraphs (a)-(e). This subsection does not preclude the issuance of a policy that does not meet the prescribed minimum standards for categories of coverage in paragraphs (a)-(g) if the office determines that the policy is either experimental in nature or is demonstrated to be a type of coverage that fulfills a reasonable need of the person or persons to be insured. Any policy not meeting the minimum standards that is approved by the office must be identified as to category only as prescribed by the office.(3) The office may, within the time provided by law for the disapproval of an individual or family form of accident or health insurance, disapprove any form if it finds that the form does not comply with applicable law or it finds that the form is unjust, unfair, or inequitable to the policyholder, any insured, or any beneficiary. In acting upon any submission, the office shall consider whether the benefits afforded under the submitted policy or benefit form fulfill a reasonable need of a policyholder.History.—s. 1, ch. 74-281; s. 3, ch. 76-168; s. 1, ch. 77-174; s. 1, ch. 77-457; ss. 2, 3, ch. 81-318; ss. 492, 497, 809(2nd), ch. 82-243; s. 79, ch. 82-386; ss. 60, 114, ch. 92-318; s. 1152, ch. 2003-261.
FL Stat § 627.644 (2021)
2021 Florida Statutes|Title XXXVII - Insurance|Chapter 627 - Insurance Rates and Contracts|Part VI - Health Insurance Policies (Ss. 627.601-627.64995)|627.644 - Discrimination against handicapped prohibited.

627.644 Discrimination against handicapped prohibited.—No health insurer shall refuse to provide, or shall charge unfairly discriminatory rates for, health insurance coverage for a person solely because the person is mentally or physically handicapped. Nothing in this section should be construed as requiring an insurer to provide insurance coverage against a handicap which the applicant or policyholder has already sustained.History.—s. 1, ch. 76-127; s. 3, ch. 76-168; s. 1, ch. 77-457; ss. 2, 3, ch. 81-318; ss. 493, 497, 809(2nd), ch. 82-243; s. 79, ch. 82-386; s. 114, ch. 92-318.
FL Stat § 627.645 (2021)
2021 Florida Statutes|Title XXXVII - Insurance|Chapter 627 - Insurance Rates and Contracts|Part VI - Health Insurance Policies (Ss. 627.601-627.64995)|627.645 - Denial of health insurance claims restricted.

627.645 Denial of health insurance claims restricted.—(1) A claim for payment under a health insurance policy or self-insured program of health benefits for treatment, care, or services in a licensed hospital that is accredited by an accrediting organization whose standards incorporate comparable regulations required by this state may not be denied because such hospital lacks major surgical facilities and is primarily of a rehabilitative nature, if such rehabilitation is specifically for treatment of physical disability.(2) No claim for payment under a health insurance policy for medical care or treatment of a child in a licensed hospital which is nonprofit; which primarily provides diagnosis, treatment, or care for patients whose physical functions or movements are impaired by accident, disease, or congenital deformity; and which accepts patients for treatment without regard to race, color, national origin, sex, religion, or affiliation shall be denied because the hospital does not have facilities for major surgery or because the treatment and care are primarily of a charitable nature.History.—s. 1, ch. 77-32; s. 12, ch. 78-106; ss. 1, 3, ch. 80-33; s. 2, ch. 81-318; ss. 494, 497, 809(2nd), ch. 82-243; s. 79, ch. 82-386; s. 114, ch. 92-318; s. 11, ch. 2013-93.Note.—Former s. 391.11.
FL Stat § 627.646 (2021)
2021 Florida Statutes|Title XXXVII - Insurance|Chapter 627 - Insurance Rates and Contracts|Part VI - Health Insurance Policies (Ss. 627.601-627.64995)|627.646 - Conversion on termination of eligibility.

627.646 Conversion on termination of eligibility.—(1) Every health insurance policy providing hospital or medical expense coverage hereafter delivered or issued for delivery in this state or under which benefits are altered, modified, or amended shall contain a provision that, if the insurance on a person covered under the policy ceases because of the termination of such person’s eligibility for coverage prior to his or her becoming eligible for Medicare or Medicaid benefits, then such person shall be entitled to have issued to him or her by the insurer, without evidence of insurability, a policy of health insurance, either individual or family, whichever is appropriate, provided application for the policy is made and the first premium is paid to the insurer within 31 days after such termination, and provided further that:(a) The coverage under the policy shall be in an amount equal to or, at the option of the insured, less than the amount of health insurance which ceases because of such termination.(b) The premium on the policy shall be at the insurer’s then customary rate applicable to such policies, to the class of risk to which such person then belongs, and to his or her age attained on the effective date of the policy.(c) The policy of health insurance will not result in overinsurance on the basis of the company underwriting standards at the time of issue.(d) The policy of health insurance may be reduced by the amount of any benefits paid for the same injury or same sickness under the prior policy.(e) The policy of health insurance may exclude any condition excluded by the prior policy.(2) An insurer shall offer maternity benefits and dental benefits if those benefits were provided in the policy.(3) The provisions of this section shall be effectuated in such a way as to result in continuous coverage during the 31-day period for such insured.(4) This section does not apply to disability income, Medicare supplement, accident only, hospital indemnity, specified disease, limited benefit, nonconventional, or excess policies.History.—s. 1, ch. 78-385; s. 2, ch. 81-318; ss. 495, 497, 809(2nd), ch. 82-243; ss. 60, 79, ch. 82-386; s. 3, ch. 90-249; s. 114, ch. 92-318; s. 345, ch. 97-102.
FL Stat § 627.647 (2021)
2021 Florida Statutes|Title XXXVII - Insurance|Chapter 627 - Insurance Rates and Contracts|Part VI - Health Insurance Policies (Ss. 627.601-627.64995)|627.647 - Standard health claim form.

627.647 Standard health claim form.—(1) The commission shall prescribe a standard health claim form to be used by all hospitals and a standard health claim form to be used by all physicians, dentists, and pharmacists. Such forms shall be in a format that allows for the use of generally accepted coding systems by providers in order to facilitate the processing of claims. Such forms shall provide for the disclosure by the claimant of the name, policy number, and address of every insurance policy which may cover the claimant with respect to the submitted claim except those policies specified in s. 627.4235(5). The required information on diagnosis, dental procedures, medical procedures, services, date of service, supplies, and fees may also be met by an attachment to the appropriate physician claim form. However, for the purpose of filing Medicaid claims, such attachments shall be prohibited. Such standard health claim forms shall be accepted by all insurers and all agencies, departments, and divisions of the state.(2) This section does not apply to claims submitted by electronic or electromechanical means, except that such claims must include disclosure of every insurance policy which may cover the claimant with respect to the submitted claim.History.—s. 1, ch. 77-46; s. 1, ch. 79-175; s. 2, ch. 81-318; ss. 496(1st), 497, 809(2nd), ch. 82-243; s. 79, ch. 82-386; s. 1, ch. 88-30; s. 114, ch. 92-318; s. 1153, ch. 2003-261.Note.—Former s. 627.6111.
FL Stat § 627.64725 (2021)
2021 Florida Statutes|Title XXXVII - Insurance|Chapter 627 - Insurance Rates and Contracts|Part VI - Health Insurance Policies (Ss. 627.601-627.64995)|627.64725 - Health maintenance organization or exclusive provider organization; disclosure of terms and conditions of plan.

1627.64725 Health maintenance organization or exclusive provider organization; disclosure of terms and conditions of plan.—Each health maintenance organization or exclusive provider organization shall provide prospective enrollees with written information about the terms and conditions of the plan in accordance with s. 641.31(4) so that the prospective enrollees can make informed decisions about accepting a managed-care system of health care delivery; however, information about where, in what manner, and from whom the comprehensive health care services or specific health care services can be obtained need be disclosed only upon request by the prospective enrollee. All marketing materials distributed by the health maintenance organization or exclusive provider organization must contain a notice in boldfaced type which states that the information required under this section is available to the prospective enrollee upon request.History.—s. 8, ch. 96-223.1Note.—Also published at s. 641.31015.
FL Stat § 627.6473 (2021)
2021 Florida Statutes|Title XXXVII - Insurance|Chapter 627 - Insurance Rates and Contracts|Part VI - Health Insurance Policies (Ss. 627.601-627.64995)|627.6473 - Combined preferred provider and exclusive provider policies.

627.6473 Combined preferred provider and exclusive provider policies.—An insurer may issue a policy that provides coverage for certain benefits through a preferred provider network and other benefits through an exclusive provider network. With regard to the coverage provided through a preferred provider network, the requirements of s. 627.6471 apply, and with regard to the coverage provided through an exclusive provider network, the requirements of s. 627.6472 apply.History.—s. 128, ch. 92-33.