Senate Bill 1752er

    ENROLLED

    1998 Legislature                                CS for SB 1752



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  2         An act relating to health insurance; amending

  3         s. 636.016, F.S.; requiring prepaid limited

  4         health service contracts to provide certain

  5         information; requiring prepaid limited health

  6         service organizations to provide certain

  7         information; amending s. 636.038, F.S.;

  8         requiring prepaid limited health service

  9         organizations to report certain information

10         annually; providing an effective date.

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12  Be It Enacted by the Legislature of the State of Florida:

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14         Section 1.  Subsection (3) of section 636.016, Florida

15  Statutes, is amended, and subsection (13) is added to said

16  section, to read:

17         636.016  Prepaid limited health service contracts.--For

18  any entity licensed prior to October 1, 1993, all subscriber

19  contracts in force at such time shall be in compliance with

20  this section upon renewal of such contract.

21         (3)  The documents provided pursuant to subsection (2)

22  must have a clear and understandable description of the method

23  used by the prepaid limited health service organization for

24  resolving subscriber grievances and, for such documents

25  printed after October 1, 1998, must contain the address of the

26  department and the department's toll-free consumer hotline.

27         (13)  Each prepaid limited health service organization

28  shall make available to all subscribers, upon request, a

29  description of the authorization and referral process for

30  services or a description of the process used to analyze the

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CODING: Words stricken are deletions; words underlined are additions.




    ENROLLED

    1998 Legislature                                CS for SB 1752



  1  qualifications and credentials of providers under contract

  2  with the organization.

  3         Section 2.  Section 636.038, Florida Statutes, is

  4  amended to read:

  5         636.038  Complaint system.--

  6         (1)  Every prepaid limited health service organization

  7  must establish and maintain a complaint system providing

  8  reasonable procedures for resolving written complaints

  9  initiated by enrollees and providers.  This section does not

10  preclude an enrollee or a provider from filing a complaint

11  with the department or limit the department's ability to

12  investigate such complaints.

13         (2)  Every prepaid limited health service organization

14  shall report annually to the department the total number of

15  grievances handled, a categorization of the cases underlying

16  the grievances, and the final disposition of the grievances.

17         Section 3.  This act shall take effect October 1, 1998.

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