Senate Bill 0958
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2000 SB 958
By Senator King
8-344-00 See HB
1 A bill to be entitled
2 An act relating to prepaid limited health
3 service organizations; amending ss. 636.003 and
4 636.016, F.S.; providing for services of
5 nonpanel providers; providing an effective
6 date.
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8 Be It Enacted by the Legislature of the State of Florida:
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10 Section 1. Subsection (9) of section 636.003, Florida
11 Statutes, is amended to read:
12 636.003 Definitions.--As used in this act, the term:
13 (9) "Prepaid limited health service organization"
14 means any person, corporation, partnership, or any other
15 entity which, in return for a prepayment, undertakes to
16 provide or arrange for, or provide access to, the provision of
17 a limited health service to enrollees through a an exclusive
18 panel of providers. Prepaid limited health service
19 organization does not include:
20 (a) An entity otherwise authorized pursuant to the
21 laws of this state to indemnify for any limited health
22 service;
23 (b) A provider or entity when providing limited health
24 services pursuant to a contract with a prepaid limited health
25 service organization, a health maintenance organization, a
26 health insurer, or a self-insurance plan; or
27 (c) Any person who, in exchange for fees, dues,
28 charges or other consideration, provides access to a limited
29 health service provider without assuming any responsibility
30 for payment for the limited health service or any portion
31 thereof.
1
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2000 SB 958
8-344-00 See HB
1 Section 2. Subsections (2) and (8) of section 636.016,
2 Florida Statutes, are amended to read:
3 636.016 Prepaid limited health service contracts.--For
4 any entity licensed prior to October 1, 1993, all subscriber
5 contracts in force at such time shall be in compliance with
6 this section upon renewal of such contract.
7 (2) Every prepaid limited health service organization
8 shall provide each subscriber a contract, a certificate,
9 membership card, or member handbook which must clearly state
10 all of the services to which a subscriber is entitled under
11 the contract and must include a clear and understandable
12 statement of any limitations on the services or kinds of
13 services to be provided, including any copayment feature,
14 limitations on services being received from a nonpanel
15 provider, or schedule of benefits required by the contract or
16 by any insurer or entity which is underwriting any of the
17 services offered by the prepaid limited health service
18 organization. The contract, certificate, provider listing, or
19 member handbook must also state where and in what manner the
20 health services may be obtained.
21 (8) Each document provided pursuant to subsection (2)
22 must state that emergency services, if any, will be provided
23 to subscribers in emergency situations not permitting
24 treatment through the prepaid limited health service
25 organization providers, without prior notification to and
26 approval of the organization. The prepaid limited health
27 services document must contain a definition of emergency
28 services, describe procedures for determination by the prepaid
29 limited health service organization of whether the services
30 qualify for reimbursement as emergency services, and contain
31 specific examples of what does constitute an emergency.
2
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2000 SB 958
8-344-00 See HB
1 Nothing in this subsection is intended to otherwise prohibit
2 the prepaid limited health service organization from
3 authorizing services from a nonpanel provider.
4 Section 3. This act shall take effect October 1, 2000.
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7 HOUSE SUMMARY
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Provides for authorization by a prepaid limited health
9 service organization of services provided by nonpanel
providers.
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