Florida Senate - 2018                                     SB 162
       
       
        
       By Senator Steube
       
       
       
       
       
       23-00002-18                                            2018162__
    1                        A bill to be entitled                      
    2         An act relating to the payment of health care claims;
    3         amending s. 627.6131, F.S.; prohibiting a health
    4         insurer from retroactively denying a claim under
    5         specified circumstances; providing applicability;
    6         amending s. 641.3155, F.S.; prohibiting a health
    7         maintenance organization from retroactively denying a
    8         claim under specified circumstances; providing
    9         applicability; providing an effective date.
   10          
   11  Be It Enacted by the Legislature of the State of Florida:
   12  
   13         Section 1. Subsection (11) of section 627.6131, Florida
   14  Statutes, is amended to read:
   15         627.6131 Payment of claims.—
   16         (11) A health insurer may not retroactively deny a claim
   17  because of insured ineligibility:
   18         (a) At any time, if the health insurer verified the
   19  eligibility of an insured at the time of treatment and provided
   20  an authorization number. This paragraph applies to policies
   21  entered into or renewed on or after January 1, 2019.
   22         (b) More than 1 year after the date of payment of the
   23  claim.
   24         Section 2. Subsection (10) of section 641.3155, Florida
   25  Statutes, is amended to read:
   26         641.3155 Prompt payment of claims.—
   27         (10) A health maintenance organization may not
   28  retroactively deny a claim because of subscriber ineligibility:
   29         (a) At any time, if the health maintenance organization
   30  verified the eligibility of a subscriber at the time of
   31  treatment and provided an authorization number. This paragraph
   32  applies to contracts entered into or renewed on or after January
   33  1, 2019. This paragraph does not apply to Medicaid managed care
   34  plans pursuant to part IV of chapter 409.
   35         (b) More than 1 year after the date of payment of the
   36  claim.
   37         Section 3. This act shall take effect July 1, 2018.