Florida Regulations 69O-203.028: Certificate and Member Handbook Standards
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When certificates or member handbooks are given to the subscriber in lieu of a subscriber contract, the certificate or member handbook shall contain a description of the following:
(1) Definition;
(2) Eligibility requirements for enrollment, including waiting periods for receiving services and any other limitations;
(3) Health care services to be provided;
(4) Renewal, re-enrollment, termination, cancellation, and disenrollment conditions;
(5) Provisions for adding new family members;
(6) Benefits for newborn and adopted children;
(7) Grace period;
(8) Limitations, exceptions, or exclusions, such as waiting periods, specific conditions not covered, and limitations on length of stay and all other qualifying or limiting features;
(9) Provisions relating to pre-existing conditions, if applicable; NOTE: Pre-existing conditions cannot be excluded for longer than two years;
(10) Provisions relating to coordination of benefits;
(11) Provisions relating to subrogation;
(12) Any applicable arbitration provisions which shall state that any arbitration is voluntary and shall be conducted pursuant to chapter 682, F.S.;
(13) Conversion and extension of benefits privileges;
(14) Subscriber grievance procedures, formal and informal; and,
(15) Any applicable co-payments.
Rulemaking Authority 636.067 FS. Law Implemented 636.016, 636.027, 636.028 FS. History-New 11-15-94, Formerly 4-203.028.
Terms Used In Florida Regulations 69O-203.028
- Contract: A legal written agreement that becomes binding when signed.
- Grace period: The number of days you'll have to pay your bill for purchases in full without triggering a finance charge. Source: Federal Reserve
(2) Eligibility requirements for enrollment, including waiting periods for receiving services and any other limitations;
(3) Health care services to be provided;
(4) Renewal, re-enrollment, termination, cancellation, and disenrollment conditions;
(5) Provisions for adding new family members;
(6) Benefits for newborn and adopted children;
(7) Grace period;
(8) Limitations, exceptions, or exclusions, such as waiting periods, specific conditions not covered, and limitations on length of stay and all other qualifying or limiting features;
(9) Provisions relating to pre-existing conditions, if applicable; NOTE: Pre-existing conditions cannot be excluded for longer than two years;
(10) Provisions relating to coordination of benefits;
(11) Provisions relating to subrogation;
(12) Any applicable arbitration provisions which shall state that any arbitration is voluntary and shall be conducted pursuant to chapter 682, F.S.;
(13) Conversion and extension of benefits privileges;
(14) Subscriber grievance procedures, formal and informal; and,
(15) Any applicable co-payments.
Rulemaking Authority 636.067 FS. Law Implemented 636.016, 636.027, 636.028 FS. History-New 11-15-94, Formerly 4-203.028.