reglab/housing_qa huggingface dataset:
FL Stat § 627.6561 (2021)
2021 Florida Statutes|Title XXXVII - Insurance|Chapter 627 - Insurance Rates and Contracts|Part VII - Group, Blanket, and Franchise Health Insurance Policies (Ss. 627.651-627.66997)|627.6561 - Preexisting conditions.

627.6561 Preexisting conditions.—(1) As used in this section, the term:(a) “Enrollment date” means, with respect to an individual covered under a group health policy, the date of enrollment of the individual in the plan or coverage or, if earlier, the first day of the waiting period of such enrollment.(b) “Late enrollee” means, with respect to coverage under a group health policy, a participant or beneficiary who enrolls under the policy other than during:1. The first period in which the individual is eligible to enroll under the policy.2. A special enrollment period, as provided under s. 627.65615.(c) “Waiting period” means, with respect to a group health policy and an individual who is a potential participant or beneficiary of the policy, the period that must pass with respect to the individual before the individual is eligible to be covered for benefits under the terms of the policy.(2) Subject to the exceptions specified in subsection (4), an insurer that offers group health insurance coverage may, with respect to a participant or beneficiary, impose a preexisting condition exclusion only if:(a) Such exclusion relates to a physical or mental condition, regardless of the cause of the condition, for which medical advice, diagnosis, care, or treatment was recommended or received within the 6-month period ending on the enrollment date;(b) Such exclusion extends for a period of not more than 12 months, or 18 months in the case of a late enrollee, after the enrollment date; and(c) The period of any such preexisting condition exclusion is reduced by the aggregate of the periods of creditable coverage, as defined in s. 627.6562(3), applicable to the participant or beneficiary as of the enrollment date.(3) Genetic information may not be treated as a condition described in paragraph (2)(a) in the absence of a diagnosis of the condition related to such information.(4)(a) Subject to paragraph (b), an insurer that offers group health insurance coverage may not impose any preexisting condition exclusion in the case of:1. An individual who, as of the last day of the 30-day period beginning with the date of birth, is covered under creditable coverage.2. A child who is adopted or placed for adoption before attaining 18 years of age and who, as of the last day of the 30-day period beginning on the date of the adoption or placement for adoption, is covered under creditable coverage. This provision does not apply to coverage before the date of such adoption or placement for adoption.3. Pregnancy.(b) Subparagraphs (a)1. and 2. do not apply to an individual after the end of the first 63-day period during all of which the individual was not covered under any creditable coverage.History.—s. 130, ch. 92-33; s. 2, ch. 95-364; s. 8, ch. 97-179; s. 1165, ch. 2003-261; s. 16, ch. 2016-194; s. 151, ch. 2020-2.
FL Stat § 627.65612 (2021)
2021 Florida Statutes|Title XXXVII - Insurance|Chapter 627 - Insurance Rates and Contracts|Part VII - Group, Blanket, and Franchise Health Insurance Policies (Ss. 627.651-627.66997)|627.65612 - Limit on preexisting conditions.

627.65612 Limit on preexisting conditions.—(1) As used in this section, the terms “operative date” and “preexisting medical condition” have the same meanings as provided in s. 627.6046.(2)(a) Not later than 30 days after the operative date, and notwithstanding s. 627.6561 or any other law to the contrary, every insurer issuing, delivering, or issuing for delivery comprehensive major medical group health insurance policies in this state shall make at least one comprehensive major medical health insurance policy available to residents in the insurer’s approved service areas of this state, and such insurer may not exclude, limit, deny, or delay coverage under such policy due to one or more preexisting medical conditions.(b) An insurer may not limit or exclude benefits under such policy, including a denial of coverage applicable to an individual as a result of information relating to an individual’s health status before the individual’s effective date of coverage, or if coverage is denied, the date of the denial.(3) The comprehensive major medical health insurance policy that the insurer is required to offer under this section must be a policy that had been actively marketed in this state by the insurer as of the operative date and that was also actively marketed in this state during the year immediately preceding the operative date.History.—s. 8, ch. 2019-129.
FL Stat § 627.65625 (2021)
2021 Florida Statutes|Title XXXVII - Insurance|Chapter 627 - Insurance Rates and Contracts|Part VII - Group, Blanket, and Franchise Health Insurance Policies (Ss. 627.651-627.66997)|627.65625 - Prohibiting discrimination against individual participants and beneficiaries based on health status.

627.65625 Prohibiting discrimination against individual participants and beneficiaries based on health status.—(1) Subject to subsection (2), an insurer that offers a group health insurance policy may not establish rules for eligibility, including continued eligibility, of an individual to enroll under the terms of the policy based on any of the following health-status-related factors in relation to the individual or a dependent of the individual:(a) Health status.(b) Medical condition, including physical and mental illnesses.(c) Claims experience.(d) Receipt of health care.(e) Medical history.(f) Genetic information.(g) Evidence of insurability, including conditions arising out of acts of domestic violence.(h) Disability.(2) Subsection (1) does not:(a) Require an insurer to provide particular benefits other than those provided under the terms of such plan or coverage.(b) Prevent such a plan or coverage from establishing limitations or restrictions on the amount, level, extent, or nature of the benefits or coverage for similarly situated individuals enrolled in the plan or coverage.(3) For purposes of subsection (1), rules for eligibility to enroll under a policy include rules for defining any applicable waiting periods of enrollment.(4)(a) An insurer that offers health insurance coverage may not require any individual, as a condition of enrollment or continued enrollment under the policy, to pay a premium or contribution that is greater than such premium or contribution for a similarly situated individual enrolled under the policy on the basis of any health-status-related factor in relation to the individual or to an individual enrolled under the policy as a dependent of the individual.(b) This subsection does not:1. Restrict the amount that an employer may be charged for coverage under a group health insurance policy; or2. Prevent an insurer that offers group health insurance coverage from establishing premium discounts or rebates or modifying otherwise applicable copayments or deductibles in return for adherence to programs of health promotion and disease prevention.History.—s. 10, ch. 97-179.
FL Stat § 627.65626 (2021)
2021 Florida Statutes|Title XXXVII - Insurance|Chapter 627 - Insurance Rates and Contracts|Part VII - Group, Blanket, and Franchise Health Insurance Policies (Ss. 627.651-627.66997)|627.65626 - Insurance rebates for healthy lifestyles.

627.65626 Insurance rebates for healthy lifestyles.—(1) Any rate, rating schedule, or rating manual for a health insurance policy that provides creditable coverage as defined in s. 627.6562(3) filed with the office shall provide for an appropriate rebate of premiums paid in the last policy year, contract year, or calendar year when the majority of members of a health plan have enrolled and maintained participation in any health wellness, maintenance, or improvement program offered by the group policyholder and health plan. The rebate may be based upon premiums paid in the last calendar year or policy year. The group must provide evidence of demonstrative maintenance or improvement of the enrollees’ health status as determined by assessments of agreed-upon health status indicators between the policyholder and the health insurer, including, but not limited to, reduction in weight, body mass index, and smoking cessation. The group or health insurer may contract with a third-party administrator to assemble and report the health status required in this subsection between the policyholder and the health insurer. Any rebate provided by the health insurer is presumed to be appropriate unless credible data demonstrates otherwise, or unless the rebate program requires the insured to incur costs to qualify for the rebate which equal or exceed the value of the rebate, but the rebate may not exceed 10 percent of paid premiums.(2) The premium rebate authorized by this section shall be effective for an insured on an annual basis unless the number of participating members on the policy renewal anniversary becomes less than the majority of the members eligible for participation in the wellness program.History.—s. 32, ch. 2004-297; s. 6, ch. 2005-231; s. 18, ch. 2016-194.
FL Stat § 627.6563 (2021)
2021 Florida Statutes|Title XXXVII - Insurance|Chapter 627 - Insurance Rates and Contracts|Part VII - Group, Blanket, and Franchise Health Insurance Policies (Ss. 627.651-627.66997)|627.6563 - Full-time employment defined.

627.6563 Full-time employment defined.—Upon the request of the policyholder, a group, blanket, or franchise health insurance policy issued or delivered in this state that provides coverage to an employer for the benefit of its employees shall include in the definition of “full-time employee” an employee who has a normal workweek of 25 or more hours. This section does not prohibit an insurer from excluding coverage for a temporary or substitute employee.History.—s. 132, ch. 92-33.
FL Stat § 627.6572 (2021)
2021 Florida Statutes|Title XXXVII - Insurance|Chapter 627 - Insurance Rates and Contracts|Part VII - Group, Blanket, and Franchise Health Insurance Policies (Ss. 627.651-627.66997)|627.6572 - Pharmacy benefit manager contracts.

627.6572 Pharmacy benefit manager contracts.—(1) As used in this section, the term:(a) “Maximum allowable cost” means the per-unit amount that a pharmacy benefit manager reimburses a pharmacist for a prescription drug, excluding dispensing fees, prior to the application of copayments, coinsurance, and other cost-sharing charges, if any.(b) “Pharmacy benefit manager” means a person or entity doing business in this state which contracts to administer or manage prescription drug benefits on behalf of a health insurer to residents of this state.(2) A contract between a health insurer and a pharmacy benefit manager must require that the pharmacy benefit manager:(a) Update maximum allowable cost pricing information at least every 7 calendar days.(b) Maintain a process that will, in a timely manner, eliminate drugs from maximum allowable cost lists or modify drug prices to remain consistent with changes in pricing data used in formulating maximum allowable cost prices and product availability.(3) A contract between a health insurer and a pharmacy benefit manager must prohibit the pharmacy benefit manager from limiting a pharmacist’s ability to disclose whether the cost-sharing obligation exceeds the retail price for a covered prescription drug, and the availability of a more affordable alternative drug, pursuant to s. 465.0244.(4) A contract between a health insurer and a pharmacy benefit manager must prohibit the pharmacy benefit manager from requiring an insured to make a payment for a prescription drug at the point of sale in an amount that exceeds the lesser of:(a) The applicable cost-sharing amount; or(b) The retail price of the drug in the absence of prescription drug coverage.(5) This section applies to contracts entered into or renewed on or after July 1, 2018.History.—s. 5, ch. 2018-91.
FL Stat § 627.65735 (2021)
2021 Florida Statutes|Title XXXVII - Insurance|Chapter 627 - Insurance Rates and Contracts|Part VII - Group, Blanket, and Franchise Health Insurance Policies (Ss. 627.651-627.66997)|627.65735 - Nondiscrimination of coverage for surgical procedures.

627.65735 Nondiscrimination of coverage for surgical procedures.—No group, franchise, or blanket health insurance contract or policy which provides coverage on a group or individual basis for any diagnostic or surgical procedure involving bones or joints of the skeleton shall discriminate against coverage for any similar diagnostic or surgical procedure involving bones or joints of the jaw and facial region, if, under accepted medical standards, such procedure or surgery is medically necessary to treat conditions caused by congenital or developmental deformity, disease, or injury. This section shall not be construed to affect any other coverage under this part or to restrict the scope of coverage under any policy, plan, or contract. Nothing in this section shall be construed to discourage appropriate nonsurgical procedures or to prohibit the continued coverage of nonsurgical procedures in the treatment of a bone or joint of the jaw and facial region. Furthermore, nothing in this section requires coverage for care or treatment of the teeth or gums, for intraoral prosthetic devices, or for surgical procedures for cosmetic purposes. This section does not apply to accident-only disability income, specified disease, hospital indemnity, credit, Medicare supplement, or long-term care insurance policies.History.—s. 4, ch. 96-361.
FL Stat § 627.65736 (2021)
2021 Florida Statutes|Title XXXVII - Insurance|Chapter 627 - Insurance Rates and Contracts|Part VII - Group, Blanket, and Franchise Health Insurance Policies (Ss. 627.651-627.66997)|627.65736 - Coverage for organ transplants.

627.65736 Coverage for organ transplants.—A group health insurance policy delivered, issued, or renewed on or after July 1, 2020, in this state by an insurer or nonprofit health care services plan 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 or nonprofit health care service plan 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. 3, ch. 2020-139.
FL Stat § 627.65745 (2021)
2021 Florida Statutes|Title XXXVII - Insurance|Chapter 627 - Insurance Rates and Contracts|Part VII - Group, Blanket, and Franchise Health Insurance Policies (Ss. 627.651-627.66997)|627.65745 - Diabetes treatment services.

627.65745 Diabetes treatment services.—(1) A health insurance policy or group health insurance policy sold in this state, including a health benefit plan issued pursuant to s. 627.6699, must provide coverage for all medically appropriate and necessary equipment, supplies, and diabetes outpatient self-management training and educational services used to treat diabetes, if the patient’s treating physician or a physician who specializes in the treatment of diabetes certifies that such services are necessary.(2) The policy or health benefit plan may require that diabetes outpatient self-management training and educational services be provided under the direct supervision of a certified diabetes educator or a board-certified endocrinologist. The policy or health benefit plan may further require that nutrition counseling be provided by a licensed dietitian.(3) The Agency for Health Care Administration shall adopt standards for diabetes outpatient self-management training and educational services, taking into consideration standards approved by the American Diabetes Association.History.—s. 3, ch. 95-268; s. 2, ch. 96-279.
FL Stat § 627.65755 (2021)
2021 Florida Statutes|Title XXXVII - Insurance|Chapter 627 - Insurance Rates and Contracts|Part VII - Group, Blanket, and Franchise Health Insurance Policies (Ss. 627.651-627.66997)|627.65755 - Dental procedures; anesthesia and hospitalization coverage.

627.65755 Dental procedures; anesthesia and hospitalization coverage.—For purposes of this section, dental treatment or surgery shall be considered necessary when the dental condition is likely to result in a medical condition if left untreated. Any group, blanket, or franchise health insurance policy issued or issued for delivery in this state which provides coverage for general anesthesia and hospitalization services to a covered person shall not preclude such coverage in assuring the safe delivery of necessary dental care provided to a covered person who:(1) Is under 8 years of age and is determined by a licensed dentist, and the child’s physician licensed under chapter 458 or chapter 459, to require necessary dental treatment in a hospital or ambulatory surgical center due to a significantly complex dental condition or a developmental disability in which patient management in the dental office has proved to be ineffective; or(2) Has one or more medical conditions that would create significant or undue medical risk for the individual in the course of delivery of any necessary dental treatment or surgery if not rendered in a hospital or ambulatory surgical center.As provided herein, all terms and conditions of the covered person’s health insurance policy shall apply to such services, and this section does not require coverage for the diagnosis or treatment of dental disease. An insurer may require prior authorization for general anesthesia and hospital services required under this section in the same manner the insurer requires prior authorization for hospitalization for other covered services. This section shall not apply to Medicare supplement, long-term care, disability, limited benefit, accident only, or specified disease policies.History.—s. 3, ch. 98-312.
FL Stat § 627.6577 (2021)
2021 Florida Statutes|Title XXXVII - Insurance|Chapter 627 - Insurance Rates and Contracts|Part VII - Group, Blanket, and Franchise Health Insurance Policies (Ss. 627.651-627.66997)|627.6577 - Dental care.

627.6577 Dental care.—(1) Any employer, group, or organization that pays or contributes to the premium of a group health insurance plan or dental service plan corporation which provides dental coverage only upon the condition that services be rendered by an exclusive list of dentists or groups of dentists shall provide an alternative to enable the insured to have a free choice of dentist. The employer, group, or organization shall pay or contribute an equal dollar amount toward either alternative elected by the insured. The provisions of this section do not require the commingling of costs and claims experience between the two alternative plans.(2) Each insurer or dental service plan corporation in this state that transacts group insurance or provides prepaid health care which includes dental care only upon the condition that services be rendered by an exclusive list of dentists or groups of dentists shall advise the employer, group, or organization of the requirements of subsection (1) during the course of marketing or renewal of such health care policies.(3) This section does not apply to contracts entered into pursuant to part I of chapter 641.History.—s. 1, ch. 84-301; s. 1, ch. 85-65; s. 36, ch. 92-78; s. 114, ch. 92-318; s. 28, ch. 95-211.
FL Stat § 627.6579 (2021)
2021 Florida Statutes|Title XXXVII - Insurance|Chapter 627 - Insurance Rates and Contracts|Part VII - Group, Blanket, and Franchise Health Insurance Policies (Ss. 627.651-627.66997)|627.6579 - Coverage for child health supervision services.

627.6579 Coverage for child health supervision services.—(1) All group, blanket, or franchise health insurance policies providing coverage on an expense-incurred basis which provide coverage for a family member of the certificateholder or subscriber must, as to such family member’s coverage, also provide that the health insurance benefits applicable for children include coverage for child health supervision services from the moment of birth to age 16 years. Such services must be exempt from any deductible provisions that are in force in such policies or contracts.(2) As used in this section, the term “child health supervision services” means physician-delivered or physician-supervised services that include, at a minimum, benefit coverage for services delivered at the intervals and scope stated in this section.(a) Child health supervision services must include periodic visits which shall include a history, a physical examination, a developmental assessment and anticipatory guidance, and appropriate immunizations and laboratory tests. Such services and periodic visits shall be provided in accordance with prevailing medical standards consistent with the Recommendations for Preventive Pediatric Health Care of the American Academy of Pediatrics.(b) Minimum benefits may be limited to one visit payable to one provider for all of the services provided at each visit cited in this section.(3) This section does not apply to disability income, specified disease, Medicare supplement, or hospital indemnity policies.History.—ss. 3, 6, ch. 86-122; s. 1, ch. 88-329; s. 114, ch. 92-318; s. 2, ch. 97-166.
FL Stat § 627.658 (2021)
2021 Florida Statutes|Title XXXVII - Insurance|Chapter 627 - Insurance Rates and Contracts|Part VII - Group, Blanket, and Franchise Health Insurance Policies (Ss. 627.651-627.66997)|627.658 - Use of dividends, refunds, rate reductions, commissions, service fees; premium rates.

627.658 Use of dividends, refunds, rate reductions, commissions, service fees; premium rates.—(1) Section 627.569 also applies to group health insurance policies.(2) An insurer may issue a group health insurance policy at a premium rate less than the usual rate or premium for an individual insurance policy.History.—s. 590, ch. 59-205; s. 3, ch. 76-168; s. 1, ch. 77-457; ss. 2, 3, ch. 81-318; ss. 508, 523, 809(2nd), ch. 82-243; s. 79, ch. 82-386; s. 114, ch. 92-318.
FL Stat § 627.660 (2021)
2021 Florida Statutes|Title XXXVII - Insurance|Chapter 627 - Insurance Rates and Contracts|Part VII - Group, Blanket, and Franchise Health Insurance Policies (Ss. 627.651-627.66997)|627.660 - Conditions and provisions of blanket health insurance policies.

627.660 Conditions and provisions of blanket health insurance policies.—(1) An individual application shall not be required from a person covered under a blanket health insurance policy or contract, nor shall it be necessary for the insurer to furnish such person a certificate, except as provided in subsection (6).(2) Any benefit under a blanket health policy shall be payable as provided in s. 627.614.(3) No such policy shall contain any provision relative to notice or proof of loss, to the time for paying benefits, or to the time within which suit may be brought on the policy, which provision is less favorable to the individuals insured than would be permitted by the comparable provision required for individual health insurance policies.(4) The provisions of part VI of this chapter do not apply to blanket health insurance policies, but no such policy shall contain any provision relative to notice or proof of loss, to the time for paying benefits, or to the time within which suit may be brought on the policy, which provision is less favorable to the individuals insured than would be permitted by the comparable provision required for individual health insurance policies.(5) Nothing contained in s. 627.659 or in this section shall be deemed to affect the legal liability of policyholders for the death or injury to any person insured under a blanket disability policy.(6) The insurer shall issue, or cause to be issued, to each insured person covered under a policy issued pursuant to s. 627.659(3) a written certificate setting forth the essential features of the insurance coverage. The certificate shall be subject to filing and approval in accordance with ss. 627.410 and 627.640.History.—s. 592, ch. 59-205; s. 3, ch. 65-10; ss. 13, 35, ch. 69-106; s. 3, ch. 76-168; s. 1, ch. 77-457; ss. 2, 3, ch. 81-318; ss. 510, 523, 809(2nd), ch. 82-243; s. 79, ch. 82-386; s. 114, ch. 92-318.