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Florida Statutes § 641.185

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“Health maintenance organization subscriber protections under the insurance law”

Health maintenance organizations must comply with the following requirements:

  • Health maintenance organization enrollees must receive continuity of care, even after a health care provider is no longer with the health maintenance organization.
  • An enrollee must be given the flexibility to transfer to another health maintenance organization, regardless of health status.
  • An enrollee should be eligible for coverage without discrimination based on health status.
  • A health maintenance organization offering group plans must provide coverage for preexisting conditions.
  • A health maintenance organization must have a process for enrollee grievances and appeals and allow for external appeals by an independent state external review organization.
  • A health maintenance organization must notify enrollees in writing of a rate change at least 30 days in advance.
  •  A health maintenance organization must provide enrollees a copy of their health maintenance organization contract or member handbook.  


Current as of June 2015