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Florida Administrative Code (Last Updated: April 18, 2024) |
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69. Department of Financial Services |
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69O. OIR – Insurance Regulation |
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69O-203. Prepaid Limited Health Service Organizations And Discount Medical Plan Organizations |
1(1) All terms defined in the Prepaid Limited Health Service Organization Act, Chapter 636, F.S., which are used in these rules shall have the same meaning as in the Act.
31(2) Advertising. This includes printed and published material, descriptive literature and sales aids, sales talks and sales materials, booklets, forms and pamphlets, illustrations, depictions and form letters, newspaper, radio, television, or direct mail advertising. This includes any material or information intended to solicit or induce membership or the purchase of a limited health service plan.
86(3) Co-payment. A specific dollar amount or percentage discount as specified in a subscriber contract, except as otherwise provided for by statute, that the subscriber must pay upon receipt of covered health care services.
120(4) Emergency Services. Services which are needed immediately because of an injury or unforeseen medical condition as provided for in the Subscriber Contract.
143(5) PLHSO. Prepaid Limited Health Service Organization shall be abbreviated as PLHSO in these rules.
158(6) Premium. The contracted sum paid by or on behalf of a subscriber or group of subscribers on a prepaid per capita or a prepaid aggregate basis for limited health services rendered by or through the PLHSO.
195(7) Waiting Period. Waiting period shall relate to that period of time which may be specified in the contract and which must follow the date a person is initially covered under the contract before coverage shall become effective as to such person.
237(8) Pre-Existing Condition or Illness. A condition, or symptoms thereof, which was diagnosed and for which the individual received medical advice or treatment from a physician within a 3 month period preceding the effective date of coverage.
274(9) Prepayment. Any premium paid by or on behalf of a subscriber which entitles the subscriber to access to limited health services.
296Rulemaking Authority 298636.067 FS. 300Law Implemented 302636.003, 303636.008, 304636.009, 305636.015, 306636.016 FS. 308History–New 11-15-94, Formerly 4-203.013, Amended 9-29-22.
