Florida Statutes 631.817 – Eligibility
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(1) Except as provided in subsection (2), any person of this state who has lost their health care coverage provided in an HMO due to insolvency shall be eligible to obtain coverage as provided herein. Eligible persons include all persons who were eligible to receive health care services under that subscriber‘s contract with the HMO.
(2)(a) A person shall cease to be covered by the plan after the plan has provided $300,000 in covered benefits for that person.
Terms Used In Florida Statutes 631.817
- Board: means the board of directors of the plan. See Florida Statutes 631.814
- Contract: A legal written agreement that becomes binding when signed.
- Date of insolvency: means the effective date of an order of liquidation entered by a court of competent jurisdiction. See Florida Statutes 631.814
- 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
- Health care services: means comprehensive health care services as defined in…. See Florida Statutes 631.814
- HMO: means a health maintenance organization possessing a valid certificate of authority issued by the office pursuant to part I of chapter 641. See Florida Statutes 631.814
- Person: means any individual, corporation, partnership, association, or voluntary organization. See Florida Statutes 631.814
- Plan: means the Florida Health Maintenance Organization Consumer Assistance Plan created by this part. See Florida Statutes 631.814
- Subscriber: means any resident of this state who is enrolled for benefits provided by an HMO and who makes premium payments or for whom premium payments are made. See Florida Statutes 631.814
(b) A person shall cease to be covered by the plan upon failure to pay, or failure to have paid on their behalf, premiums as set by the board. Coverage shall cease following a reasonable grace period as set by the board.
(c) A person shall cease to be covered by the plan 6 months after the date of insolvency; however, if, at the time the plan’s responsibility would otherwise cease under this paragraph, the person is under treatment for an injury that occurred or an illness that was diagnosed while the person was covered by the insolvent HMO or the plan, the plan shall remain responsible for treatment of such injury or illness until treatment has been completed or until the conditions specified in paragraph (a) or paragraph (b) have been met.