House Bill 0371

    Florida House of Representatives - 2000                 HB 371

        By Representative Ogles






  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.

  7

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

  9

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.

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






    Florida House of Representatives - 2000                 HB 371

    520-201-00






  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.

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






    Florida House of Representatives - 2000                 HB 371

    520-201-00






  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.

  5

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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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