reglab/statecodes huggingface dataset:
2023 Florida Statutes › Title XXXVII - Insurance › Chapter 636 - Prepaid Limited Health Service Organizations and Discount Plan Organizations › Part I - Prepaid Limited Health Service Organizations (Ss. 636.002-636.067) › 636.033 - Certain words prohibited in name of organization.

636.033 Certain words prohibited in name of organization.—
(1) No entity certificated as a prepaid limited health service organization, other than a licensed insurer or health maintenance organization insofar as its name is concerned, may use in its name, contracts, or literature any of the words “insurance,” “casualty,” “surety,” “mutual,” or “HMO,” or any other words descriptive of the insurance, casualty, HMO, or surety business or deceptively similar to the name or description of any insurance, HMO, or surety corporation doing business in the state.
(2) No person, entity, or health care plan not certificated under the provisions of this act may use in its name, logo, contracts, or literature the phrase “prepaid limited health services contract” or the initials “PLHSC” to imply, directly or indirectly, that it is a prepaid limited health service organization or hold itself out to be a prepaid limited health service organization.
History.—s. 26, ch. 93-148.
2023 Florida Statutes › Title XXXVII - Insurance › Chapter 636 - Prepaid Limited Health Service Organizations and Discount Plan Organizations › Part I - Prepaid Limited Health Service Organizations (Ss. 636.002-636.067) › 636.034 - Extension of benefits.

636.034 Extension of benefits.—Every prepaid limited health services contract must provide that termination of the contract by the prepaid limited health service organization is without prejudice to any continuous loss which commenced while the contract was in force. Extension of benefits beyond the period the contract was in force must be until the specific treatment or procedure undertaken upon any subscriber has been completed or for 90 days, whichever is the lesser period of time.
History.—s. 27, ch. 93-148.
2023 Florida Statutes › Title XXXVII - Insurance › Chapter 636 - Prepaid Limited Health Service Organizations and Discount Plan Organizations › Part I - Prepaid Limited Health Service Organizations (Ss. 636.002-636.067) › 636.036 - Administrative, provider, and management contracts.

636.036 Administrative, provider, and management contracts.—
(1) The office may require a prepaid limited health service organization to submit any contract for administrative services, contract with a provider physician, contract for management services, or contract with an affiliated entity to the office if the office has information that the prepaid limited health service organization has entered into a contract which requires it to pay a fee which is unreasonably high in relation to the service provided.
(2) After review of a contract, the office may order the prepaid limited health service organization to cancel the contract if it determines that the fees to be paid by the prepaid limited health service organization under the contract are so unreasonably high as compared with similar contracts entered into by the prepaid limited health service organization in similar circumstances that the contract is detrimental to the subscribers, stockholders, investors, or creditors of the prepaid limited health service organization.
(3) All contracts for administrative services, management services, or provider services or contracts with affiliated entities, entered into or renewed by a prepaid limited health service organization on or after October 1, 1993, must contain a provision that the contract will be canceled upon issuance of an order by the office pursuant to this section.
History.—s. 29, ch. 93-148; s. 1534, ch. 2003-261.
2023 Florida Statutes › Title XXXVII - Insurance › Chapter 636 - Prepaid Limited Health Service Organizations and Discount Plan Organizations › Part I - Prepaid Limited Health Service Organizations (Ss. 636.002-636.067) › 636.037 - Contract providers.

636.037 Contract providers.—Each prepaid limited health service organization must, upon the request of the office, file financial statements for all contract providers of limited health care services who have assumed through capitation or other means more than 10 percent of the health care risks of the prepaid limited health service organization.
History.—s. 30, ch. 93-148; s. 1535, ch. 2003-261.
2023 Florida Statutes › Title XXXVII - Insurance › Chapter 636 - Prepaid Limited Health Service Organizations and Discount Plan Organizations › Part I - Prepaid Limited Health Service Organizations (Ss. 636.002-636.067) › 636.038 - Complaint system; annual report.

636.038 Complaint system; annual report.—
(1) Every prepaid limited health service organization must establish and maintain a complaint system providing reasonable procedures for resolving written complaints initiated by enrollees and providers. This section does not preclude an enrollee or a provider from filing a complaint with the department or office or limit the department’s or office’s ability to investigate such complaints.
(2) Every prepaid limited health service organization shall report annually to the department and office the total number of grievances handled, a categorization of the cases underlying the grievances, and the final disposition of the grievances.
History.—s. 31, ch. 93-148; s. 2, ch. 98-156; s. 1536, ch. 2003-261.
2023 Florida Statutes › Title XXXVII - Insurance › Chapter 636 - Prepaid Limited Health Service Organizations and Discount Plan Organizations › Part I - Prepaid Limited Health Service Organizations (Ss. 636.002-636.067) › 636.039 - Examination by the office.

636.039 Examination by the office.—The office shall examine the affairs, transactions, accounts, business records, and assets of any prepaid limited health service organization, in the same manner and subject to the same terms and conditions that apply to insurers under part II of chapter 624, as often as it deems it expedient for the protection of the people of this state, but not less frequently than once every 3 years. In lieu of making its own financial examination, the office may accept an independent certified public accountant’s audit report prepared on a statutory accounting basis consistent with this act. However, except when the medical records are requested and copies furnished pursuant to s. 456.057, medical records of individuals and records of physicians providing service under contract to the prepaid limited health service organization are not subject to audit, but may be subject to subpoena by court order upon a showing of good cause. For the purpose of examinations, the office may administer oaths to and examine the officers and agents of a prepaid limited health service organization concerning its business and affairs. The expenses of examination of each prepaid limited health service organization by the office are subject to the same terms and conditions as apply to insurers under part II of chapter 624. Expenses of all examinations of a prepaid limited health service organization may never exceed a maximum of $20,000 for any 1-year period.
History.—s. 32, ch. 93-148; s. 160, ch. 98-166; s. 221, ch. 2000-160; s. 1537, ch. 2003-261.
2023 Florida Statutes › Title XXXVII - Insurance › Chapter 636 - Prepaid Limited Health Service Organizations and Discount Plan Organizations › Part I - Prepaid Limited Health Service Organizations (Ss. 636.002-636.067) › 636.042 - Assets, liabilities, and investments.

636.042 Assets, liabilities, and investments.—Section 641.35 applies in its entirety to determine what assets, liabilities, and investments are acceptable for a prepaid limited health service organization.
History.—s. 33, ch. 93-148.
2023 Florida Statutes › Title XXXVII - Insurance › Chapter 636 - Prepaid Limited Health Service Organizations and Discount Plan Organizations › Part I - Prepaid Limited Health Service Organizations (Ss. 636.002-636.067) › 636.044 - Agent licensing.

636.044 Agent licensing.—
(1) With respect to a prepaid limited health services contract, a person may not, unless licensed and appointed as a health insurance agent in accordance with the applicable provisions of the insurance code:
(a) Solicit contracts or procure applications; or
(b) Engage or hold herself or himself out as engaging in the business of analyzing or abstracting prepaid limited health services contracts or of counseling or advising or giving opinions to persons relative to such contracts other than as a consulting actuary advising a prepaid limited health service organization or as a salaried bona fide full-time employee so counseling and advising her or his employer relative to coverage for the employer and her or his employees.
(2) All qualifications, disciplinary provisions, licensing and appointment procedures, fees, and related matters contained in the insurance code which apply to the appointment of health insurance agents by insurers also apply to prepaid limited health service organizations and to persons appointed by prepaid limited health service organizations as their agents.
(3) Examination, licensure, or appointment is not required of any regular salaried officer or employee of a prepaid limited health service organization who devotes substantially all of her or his services to activities other than the solicitation of prepaid limited health service organization contracts from the public and who receives no commission or other compensation directly dependent upon the solicitation of such contracts.
(4) As used in this section, the term “salaried” refers to basic remuneration and does not include commissions, bonuses, or any other compensatory measures.
(5) A person registered as a seller of travel under s. 559.928 is not required to be licensed under this section in order to sell prepaid limited health service contracts that cover the cost of transportation provided by an air ambulance service licensed pursuant to s. 401.251. The prepaid limited health service contract for such coverage is, however, subject to all applicable provisions of this chapter.
History.—s. 35, ch. 93-148; s. 488, ch. 97-102; s. 2, ch. 2006-173.
2023 Florida Statutes › Title XXXVII - Insurance › Chapter 636 - Prepaid Limited Health Service Organizations and Discount Plan Organizations › Part I - Prepaid Limited Health Service Organizations (Ss. 636.002-636.067) › 636.045 - Minimum surplus requirements.

636.045 Minimum surplus requirements.—
(1) Each prepaid limited health service organization must at all times maintain a minimum surplus in an amount which is the greater of $150,000 or 10 percent of total liabilities.
(2) The office may not issue a certificate of authority unless the prepaid limited health service organization has a minimum surplus in an amount of $150,000 or 10 percent of liabilities, whichever is the greater amount.
(3) A prepaid limited health service organization that is authorized in this state and one or more other states, jurisdictions, or countries is subject to ss. 624.4085 and 624.40851.
History.—s. 36, ch. 93-148; s. 21, ch. 2000-209; s. 1539, ch. 2003-261; s. 15, ch. 2014-101.
2023 Florida Statutes › Title XXXVII - Insurance › Chapter 636 - Prepaid Limited Health Service Organizations and Discount Plan Organizations › Part I - Prepaid Limited Health Service Organizations (Ss. 636.002-636.067) › 636.046 - Insolvency protection.

636.046 Insolvency protection.—
(1) Except as required in subsection (2), each prepaid limited health service organization must deposit with the department cash or securities of the type eligible under s. 641.35 which must have at all times a market value in the amount set forth in this subsection. The amount of the deposit shall be reviewed annually or more often as the office deems necessary. The market value of the deposit must be $50,000.
(2)(a) If securities or assets deposited by a prepaid limited health service organization under this act are subject to material fluctuations in market value, the office may in its discretion require the organization to deposit and maintain on deposit additional securities or assets in an amount as may be reasonably necessary to assure that the deposit will at all times have a market value of not less than the amount specified under this section.
(b) If for any reason the market value of assets and securities of a prepaid limited health service organization held on deposit under this act falls below the amount required, the organization must promptly deposit other or additional assets or securities eligible for deposit sufficient to cure the deficiency. If the prepaid limited health service organization has failed to cure the deficiency within 30 days after receipt of notice by certified mail from the office, the office may revoke the certificate of authority of the prepaid limited health service organization.
(c) A prepaid limited health service organization may, at its option, deposit assets or securities in an amount exceeding its deposit required or otherwise permitted under this act for the purpose of absorbing fluctuations in the value of securities and assets deposited and to facilitate the exchange and substitution of securities and assets. During the solvency of the prepaid limited health service organization any excess must be released to the organization upon its request. During the insolvency of the prepaid limited health service organization, any excess deposit may be released only as provided in s. 625.62.
(3) All income from deposits belongs to the depositing prepaid limited health service organization and must be paid to it as it becomes available.
History.—s. 37, ch. 93-148; s. 1540, ch. 2003-261.
2023 Florida Statutes › Title XXXVII - Insurance › Chapter 636 - Prepaid Limited Health Service Organizations and Discount Plan Organizations › Part I - Prepaid Limited Health Service Organizations (Ss. 636.002-636.067) › 636.047 - Officers’ and employees’ fidelity bond.

636.047 Officers’ and employees’ fidelity bond.—
(1) A prepaid limited health service organization must maintain in force a fidelity bond in its own name on its officers and employees, in an amount not less than $50,000 or in any other amount prescribed by the commission. Except as otherwise provided by this subsection, the bond must be issued by an insurance company that is licensed to do business in this state.
(2) In lieu of the bond specified in subsection (1), a prepaid limited health service organization may deposit with the department cash or securities or other investments of the types set forth in s. 636.042. Such a deposit must be maintained in joint custody with the department in the amount and subject to the same conditions required for a bond under this subsection.
History.—s. 38, ch. 93-148; s. 1541, ch. 2003-261.
2023 Florida Statutes › Title XXXVII - Insurance › Chapter 636 - Prepaid Limited Health Service Organizations and Discount Plan Organizations › Part I - Prepaid Limited Health Service Organizations (Ss. 636.002-636.067) › 636.049 - Administrative penalty in lieu of suspension or revocation.

636.049 Administrative penalty in lieu of suspension or revocation.—In lieu of suspending or revoking a certificate of authority, or when no penalty is specifically provided, whenever any prepaid limited health service organization or other person, corporation, partnership, or entity subject to this act has been found to have violated any provision of this act, the office or department, within its respective regulatory jurisdiction, may:
(1) Issue and cause to be served upon the organization, person, or entity charged with the violation a copy of such findings and an order requiring such organization, person, or entity to cease and desist from engaging in the act or practice which constitutes the violation.
(2) Impose a monetary penalty of not less than $100 for each violation, but not to exceed an aggregate penalty of $100,000.
History.—s. 40, ch. 93-148; s. 1543, ch. 2003-261.
2023 Florida Statutes › Title XXXVII - Insurance › Chapter 636 - Prepaid Limited Health Service Organizations and Discount Plan Organizations › Part I - Prepaid Limited Health Service Organizations (Ss. 636.002-636.067) › 636.052 - Civil remedy.

636.052 Civil remedy.—In any civil action brought to enforce the terms and conditions of a prepaid limited health service organization contract, the prevailing party is entitled to recover reasonable attorney’s fees and court costs. This section does not authorize a civil action against the office or its employees or against the Agency for Health Care Administration, its employees, or the secretary of that agency.
History.—s. 41, ch. 93-148; s. 263, ch. 99-8; s. 1544, ch. 2003-261; s. 132, ch. 2004-5.
2023 Florida Statutes › Title XXXVII - Insurance › Chapter 636 - Prepaid Limited Health Service Organizations and Discount Plan Organizations › Part I - Prepaid Limited Health Service Organizations (Ss. 636.002-636.067) › 636.053 - Injunction.

636.053 Injunction.—In addition to the penalties and other enforcement provisions of this act, the office and department, subject to their respective jurisdiction, are vested with the power to seek both temporary and permanent injunctive relief when:
(1) A prepaid limited health service organization is being operated by any person or entity without a subsisting certificate of authority.
(2) Any person, entity, or prepaid limited health service organization has engaged in any activity prohibited by this act or any rule adopted pursuant thereto.
(3) Any prepaid limited health service organization, person, or entity is renewing, issuing, or delivering a prepaid limited health services contract without a subsisting certificate of authority.
The office’s or department’s authority to seek injunctive relief is not conditioned on having conducted any proceeding pursuant to chapter 120.
History.—s. 42, ch. 93-148; s. 11, ch. 97-93; s. 1545, ch. 2003-261.
2023 Florida Statutes › Title XXXVII - Insurance › Chapter 636 - Prepaid Limited Health Service Organizations and Discount Plan Organizations › Part I - Prepaid Limited Health Service Organizations (Ss. 636.002-636.067) › 636.054 - Payment of judgment by prepaid limited health service organization.

636.054 Payment of judgment by prepaid limited health service organization.—Except as otherwise ordered by the court or as mutually agreed upon by the parties, every judgment or decree entered in any court against any prepaid limited health service organization for the recovery of money must be fully satisfied within 60 days after the entry thereof, or, in the case of an appeal from such judgment or decree, within 60 days after the affirmance of the judgment or decree by the appellate court.
History.—s. 43, ch. 93-148.
2023 Florida Statutes › Title XXXVII - Insurance › Chapter 636 - Prepaid Limited Health Service Organizations and Discount Plan Organizations › Part I - Prepaid Limited Health Service Organizations (Ss. 636.002-636.067) › 636.055 - Levy upon deposit limited.

636.055 Levy upon deposit limited.—No judgment creditor or other claimant, other than the office or department, of a prepaid limited health service organization shall have the right to levy upon any of the assets or securities held in this state as a deposit under s. 636.046.
History.—s. 44, ch. 93-148; s. 1546, ch. 2003-261.
2023 Florida Statutes › Title XXXVII - Insurance › Chapter 636 - Prepaid Limited Health Service Organizations and Discount Plan Organizations › Part I - Prepaid Limited Health Service Organizations (Ss. 636.002-636.067) › 636.056 - Rehabilitation, conservation, liquidation, or reorganization; exclusive methods of remedy.

636.056 Rehabilitation, conservation, liquidation, or reorganization; exclusive methods of remedy.—
(1) A delinquency proceeding under part I of chapter 631 or supervision pursuant to ss. 624.80-624.87 constitute the sole and exclusive means of liquidating, reorganizing, rehabilitating, or conserving a prepaid limited health service organization.
(2) No prepaid limited health service organization is subject to the laws and regulations governing insurance or health maintenance organization insolvency guaranty funds. No insurance insolvency guaranty fund may provide protection to any individuals entitled to receive limited health services from a prepaid limited health service organization for services related to a prepaid limited health service contract.
History.—s. 45, ch. 93-148; s. 1547, ch. 2003-261.
2023 Florida Statutes › Title XXXVII - Insurance › Chapter 636 - Prepaid Limited Health Service Organizations and Discount Plan Organizations › Part I - Prepaid Limited Health Service Organizations (Ss. 636.002-636.067) › 636.057 - Fees.

636.057 Fees.—Every prepaid limited health service organization subject to this act must pay to the office the following fees:
(1) For filing an application for a certificate of authority or amendment thereto: $500.
(2) For filing each annual report: $200.
(3) For each renewal of certificate of authority: $500.
History.—s. 46, ch. 93-148; s. 1548, ch. 2003-261.
2023 Florida Statutes › Title XXXVII - Insurance › Chapter 636 - Prepaid Limited Health Service Organizations and Discount Plan Organizations › Part I - Prepaid Limited Health Service Organizations (Ss. 636.002-636.067) › 636.058 - Investigative power of department and office.

636.058 Investigative power of department and office.—The department and office, within their respective regulatory jurisdictions, have the power to examine and investigate the affairs of every person, entity, or prepaid limited health service organization in order to determine whether the person, entity, or prepaid limited health service organization is operating in accordance with the provisions of this act or has been or is engaged in any unfair method of competition or in any unfair or deceptive act or practice prohibited by s. 641.3903. The office also has the powers enumerated in ss. 641.3907, 641.3909, and 641.3913.
History.—s. 47, ch. 93-148; s. 1549, ch. 2003-261.
2023 Florida Statutes › Title XXXVII - Insurance › Chapter 636 - Prepaid Limited Health Service Organizations and Discount Plan Organizations › Part I - Prepaid Limited Health Service Organizations (Ss. 636.002-636.067) › 636.059 - Unfair methods of competition, unfair or deceptive acts or practices defined.

636.059 Unfair methods of competition, unfair or deceptive acts or practices defined.—For the purposes of defining unfair methods of competition, unfair or deceptive acts or practices, the provisions of s. 641.3903 apply to a prepaid limited health service organization.
History.—s. 48, ch. 93-148.
2023 Florida Statutes › Title XXXVII - Insurance › Chapter 636 - Prepaid Limited Health Service Organizations and Discount Plan Organizations › Part I - Prepaid Limited Health Service Organizations (Ss. 636.002-636.067) › 636.062 - Appeals from the office or department.

636.062 Appeals from the office or department.—Any person, entity, or prepaid limited health service organization subject to an order of the office or department under s. 641.3909 or s. 641.3913 may obtain a review of the order by filing an appeal therefrom in accordance with the provisions and procedures for appeal under s. 120.68.
History.—s. 49, ch. 93-148; s. 1550, ch. 2003-261.
2023 Florida Statutes › Title XXXVII - Insurance › Chapter 636 - Prepaid Limited Health Service Organizations and Discount Plan Organizations › Part I - Prepaid Limited Health Service Organizations (Ss. 636.002-636.067) › 636.063 - Civil liability.

636.063 Civil liability.—The provisions of this act are cumulative to rights under the general civil and common law, and no action of the office or department abrogates such rights to damage or other relief in any court.
History.—s. 50, ch. 93-148; s. 1551, ch. 2003-261.
2023 Florida Statutes › Title XXXVII - Insurance › Chapter 636 - Prepaid Limited Health Service Organizations and Discount Plan Organizations › Part I - Prepaid Limited Health Service Organizations (Ss. 636.002-636.067) › 636.064 - Confidentiality.

636.064 Confidentiality.—
(1) Any information pertaining to the diagnosis, treatment, or health of any enrollee of a prepaid limited health service organization is confidential and exempt from the provisions of s. 119.07(1) and s. 24(a), Art. I of the State Constitution and shall only be available pursuant to specific written consent of the enrollee, or as otherwise provided by law. With respect to any information pertaining to the diagnosis, treatment, or health of any enrollee or applicant, a prepaid limited health service organization is entitled to claim any statutory privileges against disclosure which the provider who furnished such information to the prepaid limited health service organization is entitled to claim.
(2) Any proprietary financial information contained in contracts entered into with providers by prepaid limited health service organizations is confidential and exempt from the provisions of s. 119.07(1) and s. 24(a), Art. I of the State Constitution.
(3) Any information obtained or produced by the department or office pursuant to an examination or investigation is confidential and exempt from the provisions of s. 119.07(1) and s. 24(a), Art. I of the State Constitution until the examination report has been filed pursuant to s. 624.319 or until such investigation is completed or ceases to be active. For purposes of this subsection, an investigation is considered “active” while such investigation is being conducted by the department or office with a reasonable, good faith belief that it may lead to the filing of administrative, civil, or criminal proceedings. An investigation does not cease to be active if the department or office is proceeding with reasonable dispatch and there is a good faith belief that action may be initiated by the department or office or other administrative or law enforcement agency. Except for active criminal intelligence or criminal investigative information, as defined in s. 119.011; personal financial and medical information; information that would defame or cause unwarranted damage to the good name or reputation of an individual; information that would impair the safety and financial soundness of the licensee or affiliated party; proprietary financial information; or information that would reveal the identity of a confidential source, all information obtained by the department or office pursuant to an examination or investigation shall be available after the examination report has been filed or the investigation is completed or ceases to be active.
History.—s. 51, ch. 93-148; s. 1, ch. 95-134; s. 398, ch. 96-406; s. 1552, ch. 2003-261.
2023 Florida Statutes › Title XXXVII - Insurance › Chapter 636 - Prepaid Limited Health Service Organizations and Discount Plan Organizations › Part I - Prepaid Limited Health Service Organizations (Ss. 636.002-636.067) › 636.065 - Acquisitions.

636.065 Acquisitions.—Each prepaid limited health service organization is subject to the provisions of s. 628.4615.
History.—s. 52, ch. 93-148.
2023 Florida Statutes › Title XXXVII - Insurance › Chapter 636 - Prepaid Limited Health Service Organizations and Discount Plan Organizations › Part I - Prepaid Limited Health Service Organizations (Ss. 636.002-636.067) › 636.066 - Taxes imposed.

636.066 Taxes imposed.—
(1) The premiums, contributions, and assessments received by prepaid limited health service organizations are subject to the tax imposed by s. 624.509. The Department of Revenue shall administer this section pursuant to s. 624.5092 and may adopt rules to implement this section.
(2) Beginning January 1, 1994, the tax shall be imposed on all premiums, contributions, and assessments for limited health services.
History.—s. 53, ch. 93-148; s. 69, ch. 99-5.
2023 Florida Statutes › Title XXXVII - Insurance › Chapter 636 - Prepaid Limited Health Service Organizations and Discount Plan Organizations › Part I - Prepaid Limited Health Service Organizations (Ss. 636.002-636.067) › 636.067 - Rules.

636.067 Rules.—The commission may adopt rules pursuant to ss. 120.536(1) and 120.54 to implement the provisions of this act. A violation of any such rule subjects the violator to the provisions of s. 636.048.
History.—s. 54, ch. 93-148; s. 213, ch. 98-200; s. 1553, ch. 2003-261.
2023 Florida Statutes › Title XXXVII - Insurance › Chapter 636 - Prepaid Limited Health Service Organizations and Discount Plan Organizations › Part II - Discount Plan Organizations (Ss. 636.202-636.244) › 636.202 - Definitions.

636.202 Definitions.—As used in this part, the term:
(1) “Discount plan” means a business arrangement or contract in which a person, in exchange for fees, dues, charges, or other consideration, provides access for plan members to providers of medical services and the right to receive medical services from those providers at a discount. The term does not include any product regulated under chapter 627, chapter 641, or part I of this chapter; any medical services provided through a telecommunications medium that does not offer a discount to the plan member for those medical services; or any plan that does not charge a fee to plan members. Until June 30, 2018, a discount plan may also be referred to as a discount medical plan.
(2) “Discount plan organization” means an entity that, in exchange for fees, dues, charges, or other consideration, provides access for plan members to providers of medical services and the right to receive medical services from those providers at a discount. Until June 30, 2018, a discount plan organization may also be referred to as a discount medical plan organization.
(3) “Marketer” means a person or entity that markets, promotes, sells, or distributes a discount plan, including a private label entity that places its name on and markets or distributes a discount plan but does not operate a discount plan.
(4) “Medical services” means any care, service, or treatment of illness or dysfunction of, or injury to, the human body, including, but not limited to, physician care, inpatient care, hospital surgical services, emergency services, ambulance services, dental care services, vision care services, mental health services, substance abuse services, chiropractic services, podiatric care services, laboratory services, and medical equipment and supplies. The term does not include pharmaceutical supplies or prescriptions.
(5) “Member” means any person who pays fees, dues, charges, or other consideration for the right to receive the purported benefits of a discount plan.
(6) “Provider” means any person or institution that is contracted, directly or indirectly, with a discount plan organization to provide medical services to members.
(7) “Provider network” means an entity that negotiates on behalf of more than one provider with a discount plan organization to provide medical services to members.
History.—s. 31, ch. 2004-297; s. 1, ch. 2005-232; s. 2, ch. 2016-240; s. 3, ch. 2017-112.
2023 Florida Statutes › Title XXXVII - Insurance › Chapter 636 - Prepaid Limited Health Service Organizations and Discount Plan Organizations › Part II - Discount Plan Organizations (Ss. 636.202-636.244) › 636.205 - Issuance of license; denial.

636.205 Issuance of license; denial.—
(1) Following receipt of an application filed pursuant to s. 636.204, the office shall review the application and notify the applicant of any deficiencies contained therein. The office shall issue a license to an applicant who has filed a completed application pursuant to s. 636.204 upon payment of the fees specified in s. 636.204 and upon the office being satisfied that the following conditions are met:
(a) The requirements of s. 636.204 have been fulfilled.
(b) The entity has the required minimum capital requirements.
(c) The ownership, control, and management of the entity are competent and trustworthy and possess managerial experience that would make the proposed operation beneficial to the subscribers. The office may not grant or continue to grant authority to transact the business of a discount plan organization in this state at any time during which the office has good reason to believe that the ownership, control, or management of the organization includes any person whose business operations are or have been marked by business practices or conduct that is detrimental to the public, stockholders, investors, or creditors.
(d) The discount plan organization has a complaint procedure that will facilitate the resolution of subscriber grievances and that includes both formal and informal steps available within the organization.
(e) Any deficiencies identified by the office have been corrected.
(f) All requirements of this part have been met.
(2) If the application for a license is denied, the office shall notify the applicant and shall specify the reasons for denial in the notice.
History.—s. 3, ch. 2005-232; s. 17, ch. 2017-112.
2023 Florida Statutes › Title XXXVII - Insurance › Chapter 636 - Prepaid Limited Health Service Organizations and Discount Plan Organizations › Part II - Discount Plan Organizations (Ss. 636.202-636.244) › 636.206 - Examinations and investigations.

636.206 Examinations and investigations.—
(1) The office may examine or investigate the business and affairs of any discount plan organization. The office may order any discount plan organization or applicant to produce any records, books, files, advertising and solicitation materials, or other information and may take statements under oath to determine whether the discount plan organization or applicant is in violation of the law or is acting contrary to the public interest. The expenses incurred in conducting any examination or investigation must be paid by the discount plan organization or applicant. Examinations and investigations must be conducted as provided in chapter 624. For the duration of the agreement with a member, and for 5 years thereafter, a discount plan organization must maintain an accurate record of each member, including the membership materials provided to the member, the discount plan issued to the member, and the charges billed and paid by the member, in a form accessible to the office during an examination or investigation.
(2) Failure by the discount plan organization to pay the expenses incurred under subsection (1) is grounds for denial or revocation.
History.—s. 31, ch. 2004-297; s. 4, ch. 2005-232; s. 5, ch. 2017-112.
2023 Florida Statutes › Title XXXVII - Insurance › Chapter 636 - Prepaid Limited Health Service Organizations and Discount Plan Organizations › Part II - Discount Plan Organizations (Ss. 636.202-636.244) › 636.207 - Applicability of part.

636.207 Applicability of part.—Except as otherwise provided in this part, discount plan organizations are governed by this part and are exempt from the Florida Insurance Code unless specifically referenced.
History.—s. 5, ch. 2005-232; s. 18, ch. 2017-112.
2023 Florida Statutes › Title XXXVII - Insurance › Chapter 636 - Prepaid Limited Health Service Organizations and Discount Plan Organizations › Part II - Discount Plan Organizations (Ss. 636.202-636.244) › 636.208 - Fees; charges; reimbursement.

636.208 Fees; charges; reimbursement.—
(1) A discount plan organization may charge a periodic charge as well as a reasonable one-time processing fee for a discount plan.
(2)(a) If the member cancels his or her membership in the discount plan organization within the first 30 days after the effective date of enrollment in the plan, the member shall receive a reimbursement of all periodic charges upon return of the discount card to the discount plan organization.
(b) If the member cancels his or her membership in the discount plan organization after the first 30 days, the discount plan organization:
1. Must cancel the membership on or before 30 days after receipt of the member’s cancellation request.
2. May not charge the member any fees after the effective date of the cancellation of the membership.
3. Must provide a pro rata reimbursement of periodic charges made for months after the cancellation date.
(c) If the member cancels his or her membership in the discount plan organization consistent with the open enrollment rules established by an employer or association for a plan having an open enrollment period, the member shall receive a pro rata reimbursement of all periodic charges upon return of the discount card to the discount plan organization.
(3) If the discount plan organization cancels a membership for any reason other than nonpayment of fees by the member, the discount plan organization must make a pro rata reimbursement of all periodic charges to the member.
(4) In addition to the reimbursement of periodic charges for the reasons stated in subsections (2) and (3), a discount plan organization shall also reimburse the member for any portion of a one-time processing fee that exceeds $30 per year.
History.—s. 31, ch. 2004-297; s. 6, ch. 2005-232; s. 6, ch. 2017-112.
2023 Florida Statutes › Title XXXVII - Insurance › Chapter 636 - Prepaid Limited Health Service Organizations and Discount Plan Organizations › Part II - Discount Plan Organizations (Ss. 636.202-636.244) › 636.210 - Prohibited activities of a discount plan organization.

636.210 Prohibited activities of a discount plan organization.—
(1) A discount plan organization may not:
(a) Use in its advertisements, marketing material, brochures, and discount cards the term “insurance” except as otherwise provided in this part or as a disclaimer of any relationship between discount plan organization benefits and insurance;
(b) Use in its advertisements, marketing material, brochures, and discount cards the terms “health plan,” “coverage,” “copay,” “copayments,” “preexisting conditions,” “guaranteed issue,” “premium,” “PPO,” “preferred provider organization,” or other terms in a manner that could reasonably mislead a person into believing the discount plan was health insurance;
(c) Have restrictions on free access to plan providers, including, but not limited to, waiting periods and notification periods; or
(d) Pay providers any fees for medical services.
(2) A discount plan organization may not collect or accept money from a member for payment to a provider for specific medical services furnished or to be furnished to the member unless the organization has an active certificate of authority from the office to act as an administrator.
History.—s. 31, ch. 2004-297; s. 7, ch. 2005-232; s. 19, ch. 2017-112.
2023 Florida Statutes › Title XXXVII - Insurance › Chapter 636 - Prepaid Limited Health Service Organizations and Discount Plan Organizations › Part II - Discount Plan Organizations (Ss. 636.202-636.244) › 636.212 - Disclosures.

636.212 Disclosures.—A discount plan organization or marketer must provide disclosures to a prospective member and the prospective member must acknowledge the acceptance of such disclosures before enrolling in a discount plan. A discount plan organization or marketer may make additional disclosures to those described in subsection (1).
(1) A disclosure must include:
(a) That the plan is not insurance.
(b) That the plan provides discounts at certain health care providers for medical services.
(c) That the plan does not make payments directly to the providers of medical services.
(d) That the plan member is obligated to pay for all health care services but will receive a discount from those health care providers who have contracted with the discount plan organization.
(e) The name and address of the licensed discount plan organization.
(2) The first page of any written advertisements, marketing materials, or brochures relating to a discount plan must include the required disclosures in subsection (1). The first page is the page that first includes the information that describes benefits of the discount plan. The disclosures must be printed in not less than 12-point type.
(3) Disclosures provided by electronic means must include disclosures required in subsection (1). The disclosures must be in a font size and color that is readable.
(4) Disclosures made by telephone must include the disclosures in subsection (1) and the prospective or new member must be provided with written disclosures in accordance with subsection (2) in the initial written materials provided.
History.—s. 31, ch. 2004-297; s. 8, ch. 2005-232; s. 7, ch. 2017-112.
2023 Florida Statutes › Title XXXVII - Insurance › Chapter 636 - Prepaid Limited Health Service Organizations and Discount Plan Organizations › Part II - Discount Plan Organizations (Ss. 636.202-636.244) › 636.214 - Provider agreements.

636.214 Provider agreements.—
(1) All providers offering medical services to members under a discount plan must provide such services pursuant to a written agreement. The agreement may be entered into directly by the provider or by a provider network to which the provider belongs.
(2) A provider agreement between a discount plan organization and a provider must provide the following:
(a) A list of the services and products to be provided at a discount.
(b) The amount or amounts of the discounts or, alternatively, a fee schedule which reflects the provider’s discounted rates.
(c) A statement that the provider will not charge members more than the discounted rates.
(3) A provider agreement between a discount plan organization and a provider network must require that the provider network have written agreements with its providers which:
(a) Contain the terms described in subsection (2).
(b) Authorize the provider network to contract with the discount plan organization on behalf of the provider.
(c) Require the network to maintain an up-to-date list of its contracted providers and to provide that list on a monthly basis to the discount plan organization.
(4) The discount plan organization shall maintain a copy of each active provider agreement into which it has entered.
History.—s. 31, ch. 2004-297; s. 9, ch. 2005-232; s. 8, ch. 2017-112.
2023 Florida Statutes › Title XXXVII - Insurance › Chapter 636 - Prepaid Limited Health Service Organizations and Discount Plan Organizations › Part II - Discount Plan Organizations (Ss. 636.202-636.244) › 636.216 - Written agreement.

636.216 Written agreement.—There must be a written agreement between the discount plan organization and the member specifying the benefits under the discount plan and complying with the disclosure requirements of this part.
History.—s. 31, ch. 2004-297; s. 10, ch. 2005-232; s. 9, ch. 2017-112.
2023 Florida Statutes › Title XXXVII - Insurance › Chapter 636 - Prepaid Limited Health Service Organizations and Discount Plan Organizations › Part II - Discount Plan Organizations (Ss. 636.202-636.244) › 636.218 - Annual reports.

636.218 Annual reports.—
(1) Each discount plan organization shall file with the office, within 3 months after the end of each fiscal year, an annual report.
(2) Such reports must be on forms prescribed by the commission and must include:
(a) Audited financial statements prepared in accordance with generally accepted accounting principles certified by an independent certified public accountant, including the organization’s balance sheet, income statement, and statement of changes in cash flow for the preceding year. An organization that is a subsidiary of a parent entity that is publicly traded and that prepares audited financial statements reflecting the consolidated operations of the parent entity and the organization may petition the office to accept, in lieu of the audited financial statement of the organization, the audited financial statement of the parent entity and a written guaranty by the parent entity that the minimum capital requirements of the organization required by this part will be met by the parent entity.
(b) If different from the initial application or the last annual report, a list of the names and residence addresses of all persons responsible for the conduct of the organization’s affairs, together with a disclosure of the extent and nature of any contracts or arrangements between such persons and the discount plan organization, including any possible conflicts of interest.
(c) The number of discount plan members in the state.
(d) Such other information relating to the performance of the discount plan organization as is reasonably required by the commission or office.
(3) Every discount plan organization that fails to file an annual report in the form and within the time required by this section shall forfeit up to $500 for each day for the first 10 days during which the neglect continues and shall forfeit up to $1,000 for each day after the first 10 days during which the neglect continues; and, upon notice by the office to that effect, the organization’s authority to enroll new members or to do business in this state ceases while such default continues. The office shall deposit all sums collected by the office under this section to the credit of the Insurance Regulatory Trust Fund. The office may not collect more than $50,000 for each report.
History.—s. 31, ch. 2004-297; s. 11, ch. 2005-232; s. 20, ch. 2017-112.
2023 Florida Statutes › Title XXXVII - Insurance › Chapter 636 - Prepaid Limited Health Service Organizations and Discount Plan Organizations › Part II - Discount Plan Organizations (Ss. 636.202-636.244) › 636.220 - Minimum capital requirements.

636.220 Minimum capital requirements.—
(1) Each discount plan organization shall at all times maintain a net worth of at least $150,000.
(2) The office may not issue a license unless the discount plan organization has a net worth of at least $150,000.
History.—s. 31, ch. 2004-297; s. 21, ch. 2017-112.
2023 Florida Statutes › Title XXXVII - Insurance › Chapter 636 - Prepaid Limited Health Service Organizations and Discount Plan Organizations › Part II - Discount Plan Organizations (Ss. 636.202-636.244) › 636.222 - Suspension or revocation of license; suspension of enrollment of new members; terms of suspension.

636.222 Suspension or revocation of license; suspension of enrollment of new members; terms of suspension.—
(1) The office may suspend the authority of a discount plan organization to enroll new members, revoke any license issued to a discount plan organization, or order compliance if the office finds that any of the following conditions exist:
(a) The organization is not operating in compliance with this part.
(b) The organization does not have the minimum net worth as required by this part.
(c) The organization has advertised, merchandised, or attempted to merchandise its services in such a manner as to misrepresent its services or capacity for service or has engaged in deceptive, misleading, or unfair practices with respect to advertising or merchandising.
(d) The organization is not fulfilling its obligations as a discount plan organization.
(e) The continued operation of the organization would be hazardous to its members.
(2) If the office has cause to believe that grounds for the suspension or revocation of a license exist, the office must notify the discount plan organization in writing specifically stating the grounds for suspension or revocation and shall pursue a hearing on the matter in accordance with chapter 120.
(3) When the license of a discount plan organization is surrendered or revoked, such organization must proceed, immediately following the effective date of the order of revocation, to wind up its affairs transacted under the license. The organization may not engage in any further advertising, solicitation, collecting of fees, or renewal of contracts.
(4) The office shall, in its order suspending the authority of a discount plan organization to enroll new members, specify the period during which the suspension is to be in effect and the conditions, if any, which must be met by the discount plan organization before reinstatement of its license to enroll new members. The order of suspension is subject to rescission or modification by further order of the office before the expiration of the suspension period. Reinstatement may not be made unless requested by the discount plan organization; however, the office may not grant reinstatement if it finds that the circumstances for which the suspension occurred still exist or are likely to recur.
History.—s. 31, ch. 2004-297; s. 22, ch. 2017-112.