Florida Regulations 69O-153.004: Disclosure of Agreements
Current as of: 2024 | Check for updates
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A health care provider shall disclose a pre-provision of services agreement by one of the following methods:
(1) Attaching a copy of the agreement to the claim form;
(2) Attaching a statement that discloses the agreement and the specific terms thereof;
(3) Attaching a copy of the policy which provides for the waiver of all or some portion of a deductible or co-payment for employees of the hospital and others and a representation that the waiver is authorized by the policy as to that provider;
(4) Disclosure on the Office’s approved uniform claim form when modified to effectuate such disclosure in a uniform manner as to all claims.
Specific Authority 626.9611, 641.36 FS. Law Implemented 624.307(1), 626.9541(1)(u), 641.3903(11) FS. History-New 2-28-90, Formerly 4-86.004, 4-153.004.
(1) Attaching a copy of the agreement to the claim form;
(2) Attaching a statement that discloses the agreement and the specific terms thereof;
(3) Attaching a copy of the policy which provides for the waiver of all or some portion of a deductible or co-payment for employees of the hospital and others and a representation that the waiver is authorized by the policy as to that provider;
(4) Disclosure on the Office’s approved uniform claim form when modified to effectuate such disclosure in a uniform manner as to all claims.
Specific Authority 626.9611, 641.36 FS. Law Implemented 624.307(1), 626.9541(1)(u), 641.3903(11) FS. History-New 2-28-90, Formerly 4-86.004, 4-153.004.