Each health maintenance organization or exclusive provider organization must provide prospective enrollees with written information about the terms and conditions of the plan so that they can make informed decisions about choosing a health insurance plan.1

Every prepaid limited health service organization2 and health maintenance organization3 must establish a complaint system providing procedures for resolving written complaints by enrollees and providers. The Agency for Health Care Administration’s Subscriber Program is a program established to provide assistance to health maintenance organization or prepaid health clinic enrollees who received an adverse determination of their grievances.4

A health insurance policy must comply with the Employee Retirement Income Security Act’s provisions regarding internal grievances.5

Personal financial and health information about health insurance enrollees held by the Department of Financial Services or the Office of Insurance Regulation are confidential.6 The Office of Insurance Regulation must adopt rules requiring health insurers and health maintenance organizations to comply with the federal Health Insurance Portability and Affordability Act and privacy rules promulgated by the National Association of Insurance Commissioners.7

Genetic information may not be used by a health insurer to cancel, limit, or deny coverage or establish premium rates.8 A health maintenance organization may not discriminate against an individual who has HIV/AIDS by excluding or limiting coverage.9

An individual health insurance policy10 and group health insurance policy11 preexisting condition provision must comply with specific statutory requirements. A small employer carrier may not include a preexisting condition exclusion as a condition of coverage.12

The Office of Insurance Regulation may examine each health insurer that operates in Florida to ensure compliance with state laws.13 Each prepaid limited health service organization,14 discount medical plan,15 health maintenance organization,16 prepaid health clinic17 must annually file with the Office of Insurance Regulation a financial report for the prior fiscal year.

Each health insurer must make available on its website a link to the performance outcome and financial data that is published by the Agency for Health Care Administration.18