Fla. Stat. § 636.002
Short title
Sections 1-57, chapter 93-148, Laws of Florida, may be cited as the “Prepaid Limited Health Service Organization Act of Florida.”
Florida Statutes Chapter 636 — PREPAID LIMITED HEALTH SERVICE ORGANIZATIONS AND DISCOUNT PLAN ORGANIZATIONS
Florida · statute · Fla. Stat. ch. 636 · 79 active provisions
Fla. Stat. § 636.003
Definitions
As used in this act, the term:(1) “Capitation” means the fixed amount paid by a prepaid limited health service organization to a health care provider under contract with the prepaid limited health service organization in exchange for the rendering of covered limited health services.(2) “Enrollee” means an individual, i…
Fla. Stat. § 636.004
Applicability of other laws
Except as provided in this act, prepaid limited health service organizations are governed by the provisions of this act and are exempt from the Florida Insurance Code unless specifically referenced.
Fla. Stat. § 636.005
Incorporation required; exceptions
(1) On or after October 1, 1993, any entity that has not yet obtained a certificate of authority to operate a prepaid limited health service organization in this state must be incorporated.(2) A prepaid limited health service organization may be organized as a profit or nonprofit corporation.(3) A prepaid limited healt…
Fla. Stat. § 636.006
Insurance business not authorized
Nothing in the Florida Insurance Code or this act authorizes any prepaid limited health service organization to transact any insurance business other than that specifically authorized by this act, or otherwise to engage in any other type of insurance unless it is authorized under a certificate of authority issued by th…
Fla. Stat. § 636.007
Certificate of authority required
A person, corporation, partnership, or other entity may not operate a prepaid limited health service organization in this state without obtaining and maintaining a certificate of authority from the office pursuant to this act. A political subdivision of this state which is operating an emergency medical services system…
Fla. Stat. § 636.008
Application for certificate of authority
Before any entity may operate a prepaid limited health service organization, it must obtain a certificate of authority from the office. An application for a certificate of authority to operate a prepaid limited health service organization must be filed with the office on a form prescribed by the commission. Such applic…
Fla. Stat. § 636.009
Issuance of certificate of authority; denial
(1) Following receipt of an application filed pursuant to s. 636.008, the office shall review such application and notify the applicant of any deficiencies contained therein. The office shall issue a certificate of authority to an applicant who has filed a completed application in conformity with s. 636.008, upon payme…
Fla. Stat. § 636.012
Continued eligibility for certificate of authority
In order to maintain its eligibility for a certificate of authority, a prepaid limited health service organization must continue to meet all conditions required to be met under this act and the rules adopted thereunder for the initial application for and issuance of its certificate of authority under ss. 636.008 and 63…
Fla. Stat. § 636.0145
Certain entities contracting with Medicaid
An entity that is providing comprehensive inpatient and outpatient mental health care services to certain Medicaid recipients in Hillsborough, Highlands, Hardee, Manatee, and Polk Counties through a capitated, prepaid arrangement pursuant to the federal waiver provided for in s. 409.905(5) must become licensed under th…
Fla. Stat. § 636.015
Language used in contracts and advertisements; translations
(1)(a) All contracts or forms must be printed in English.(b) If the negotiations leading up to the effectuation of a prepaid limited health service organization contract are conducted in a language other than English, the prepaid limited health service organization must supply to the member a written translation of the…
Fla. Stat. § 636.0155
Disclosures required in contracts and marketing materials
All prepaid limited health services contracts, marketing materials, and literature printed after October 1, 1997, must disclose in boldfaced type the name of the organization and disclose that the organization is a prepaid limited health service organization licensed under this chapter.
Fla. Stat. § 636.016
Prepaid limited health service contracts
For any entity licensed prior to October 1, 1993, all subscriber contracts in force at such time shall be in compliance with this section upon renewal of such contract.(1) Any entity issued a certificate of authority and otherwise in compliance with this act may enter into contracts in this state to provide an agreed-u…
Fla. Stat. § 636.017
Rates and charges
(1) The rates charged by any prepaid limited health service organization to its subscribers shall not be excessive, inadequate, or unfairly discriminatory. The commission or office may require whatever information it deems necessary to determine that a rate or proposed rate meets the requirements of this section.(2) In…
Fla. Stat. § 636.018
Changes in rates and benefits; material modifications; addition of limited health services
(1)(a) No prepaid limited health services contract, certificate of coverage, application, enrollment form, rider, endorsement, and applicable rates to be charged may be delivered in this state unless the forms and rates have been filed with the office by or on behalf of the prepaid limited health service organization a…
Fla. Stat. § 636.019
Additional contract contents
A prepaid limited health services contract may contain additional provisions not inconsistent with this act which are:(1) Necessary because of the manner in which the organization is constituted or operated in order to state the rights and obligations of the parties to the contract; or(2) Desired by the organization an…
Fla. Stat. § 636.0201
Genetic information restrictions
A prepaid limited health service organization must comply with the provisions of s. 627.4301.
Fla. Stat. § 636.022
Restrictions upon expulsion or refusal to issue or renew contract
A prepaid limited health service organization may not expel or refuse to renew the coverage of or refuse to enroll any individual member of a subscriber group on the basis of the race, color, creed, handicap, marital status, sex, or national origin of the subscriber or individual. A prepaid limited health service organ…
Fla. Stat. § 636.023
Charter; bylaw provisions
No prepaid limited health services contract may contain any provision purporting to make any portion of the articles of incorporation, charter, bylaws, or other organizational document of the prepaid limited health service organization a part of the contract unless the provision is set forth in full in the contract. An…
Fla. Stat. § 636.024
Execution of contracts
(1) Every prepaid limited health services contract must be executed in the name of and on behalf of the prepaid limited health service organization by its officer, attorney in fact, employee, or representative duly authorized by the organization.(2) A facsimile signature of any executing individual may be used in lieu…
Fla. Stat. § 636.025
Validity of noncomplying contracts
(1) Any prepaid limited health services contract rider, endorsement, attachment, or addendum otherwise valid which contains any condition or provision not in compliance with the requirements of this act is not thereby rendered invalid, but must be construed and applied in accordance with such conditions and provisions…
Fla. Stat. § 636.026
Construction of contracts
Every prepaid limited health services contract must be construed according to the entirety of its terms and conditions as set forth in the contract and as amplified, extended, or modified by any application, endorsement, attachment, or addendum.
Fla. Stat. § 636.027
Delivery of contract
Unless delivered upon execution or issuance, a prepaid limited health services contract, certificate of coverage, or member handbook must be mailed or delivered to the subscriber or, in the case of a group prepaid limited health services contract, to the employer or other person who will hold the contract on behalf of…
Fla. Stat. § 636.028
Notice of cancellation of contract
Except for nonpayment of premium or termination of eligibility, a prepaid limited health service organization may not cancel or otherwise terminate or fail to renew a prepaid limited health services contract without giving the subscriber at least 45 days’ notice in writing of the cancellation, termination, or nonrenewa…
Fla. Stat. § 636.029
Construction and relationship with other laws
(1) No other provision of the insurance code applies to a prepaid limited health service organization unless such an organization is specifically mentioned therein.(2) Except as provided in this act, the insurance code does not apply to prepaid limited health service organizations certificated under this act. Any perso…
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