Florida Regulations 69O-191.035: Co-Payments
Current as of: 2024 | Check for updates
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(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.
(2) The contract shall clearly define the co-payment required to be paid by the subscriber/member.
(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.
(4) In the case of a high deductible contract, as defined in Florida Statutes § 641.20185, the deductible established under the contract must be satisfied before the application of any co-payments.
Rulemaking Authority 641.36 FS. Law Implemented 641.19(18), 641.20185, 641.31(4) FS. History-New 5-28-92, Amended 8-15-02, Formerly 4-191.035.
Terms Used In Florida Regulations 69O-191.035
- Contract: A legal written agreement that becomes binding when signed.
- Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
(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.
(4) In the case of a high deductible contract, as defined in Florida Statutes § 641.20185, the deductible established under the contract must be satisfied before the application of any co-payments.
Rulemaking Authority 641.36 FS. Law Implemented 641.19(18), 641.20185, 641.31(4) FS. History-New 5-28-92, Amended 8-15-02, Formerly 4-191.035.