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Florida Administrative Code (Last Updated: July 17, 2024) |
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69. Department of Financial Services |
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69O. OIR – Insurance Regulation |
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69O-191. Health Maintenance Organizations |
1(1) If required, co-payments will be paid when health care services and benefits are rendered. The HMO or contracted provider may assess the usual co-payment when a subscriber fails to keep a physician office visit or appointment, provided this is a standard procedure and a prior reminder was issued to the subscriber of the scheduled appointment.
57(2) The contract shall clearly define the co-payment required to be paid by the subscriber/member.
72(3) The contract shall clearly define any cost sharing features, the financial responsibility of the subscriber/member, and how the subscriber/member obligation is determined.
95(4) In the case of a high deductible contract, as defined in Section 108641.20185, F.S., 110the deductible established under the contract must be satisfied before the application of any co-payments.
125Specific Authority 127641.36 FS. 129Law Implemented 131641.19(18), 132641.20185, 133641.31(4) FS. 135History–New 5-28-92, Amended 8-15-02, Formerly 4-191.035.
