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Florida Administrative Code (Last Updated: October 28, 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) Each HMO shall comply with the requirements of Section 11641.31(9), F.S. 13If the HMO does not require pre-enrollment for newborns, newborn coverage will commence from the moment of birth in accordance with the subscriber contract.
37(2) If the HMO does have a pre-enrollment requirement, the subscriber must be allowed to pre-enroll the newborn up to the moment of birth. The HMO must notify the subscriber of any pre-enrollment requirement, both in the subscriber contract and handbook. Additionally, the HMO should emphasize the pre-enrollment requirements after the subscriber or covered family member is known by the HMO to be pregnant.
101(3) Failure to comply with pre-enrollment procedures shall require the newborn to be enrolled during the subscriber’s next open enrollment period.
122(4) Coverage for adopted children shall be provided pursuant to the requirements enumerated in Section 137641.31(17), F.S.
139Specific Authority 141641.36 FS. 143Law Implemented 145641.31(9), 146(17) FS. History–New 2-22-88, Amended 10-25-89, Formerly 4-31.045, Amended 5-28-92, Formerly 4-191.045.
