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Florida Statutes § 641.54

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“Information disclosure under the insurance law”

Each health maintenance organization must provide the Office of Insurance Regulation and enrollees, upon request, with a list of all hospitals and physicians that have a contract to provide health care services to the health maintenance organization’s enrollees. The list must also include a description of the authorization and referral process and the process used to determine the medical necessity of a service.

Each health maintenance organization must disclose the following information to enrollees upon request:

  • A description of the health maintenance organization’s quality assurance program;
  • Policies relating to prescription drug benefits;
  • Policies relating to the confidentiality and disclosure of enrollees’ medical records;
  • The process used for approving or denying experimental medical treatments;
  • Policies and procedures for addressing the needs of non-English speaking enrollees; and
  • The process used to examine the qualifications of all providers.

Each health maintenance organization must provide its enrollees the estimate copay, coinsurance percentage, or deductible for any covered services, the status of the enrollee’s maximum annual out-of-pocket payments, and the status of the enrollee’s maximum lifetime benefit.

Each health maintenance organization’s website must make available a link regarding performance outcomes and financial data that is published by the Agency for Health Care Administration.

Current as of June 2015