(1) The plan shall submit to the office a proposed plan of operation and any amendments thereto necessary or suitable to assure the fair, reasonable, and equitable administration of the plan. The proposed plan of operation and any amendments thereto shall become effective upon approval in writing by the office.
(2) All member HMOs shall comply with the approved plan of operation.
(3) The plan of operation shall, in addition to requirements enumerated elsewhere in this part:
(a) Establish procedures for handling the assets of the plan.
Terms Used In Florida Statutes 631.820
- Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
- Board: means the board of directors of the plan. See Florida Statutes 631.814
- Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
- Equitable: Pertaining to civil suits in "equity" rather than in "law." In English legal history, the courts of "law" could order the payment of damages and could afford no other remedy. See damages. A separate court of "equity" could order someone to do something or to cease to do something. See, e.g., injunction. In American jurisprudence, the federal courts have both legal and equitable power, but the distinction is still an important one. For example, a trial by jury is normally available in "law" cases but not in "equity" cases. Source: U.S. Courts
- 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
- Plan: means the Florida Health Maintenance Organization Consumer Assistance Plan created by this part. See Florida Statutes 631.814
- writing: includes handwriting, printing, typewriting, and all other methods and means of forming letters and characters upon paper, stone, wood, or other materials. See Florida Statutes 1.01
(b) Establish the amount and method of reimbursing members of the board of directors.
(c) Establish regular places and times for meetings of the board of directors.
(d) Establish procedures for keeping records of all financial transactions of the plan, its agents, and the board of directors.
(e) Establish procedures whereby selections for the board of directors shall be made and submitted to the department.
1(f) Establish any additional procedures for assessments under this part, including procedures to coordinate the administration and collection of member HMO assessments for long-term care insurer impairments and insolvencies with the board of directors of the Florida Life and Health Insurance Guaranty Association.
(g) Contain additional provisions necessary or proper for the execution of the powers and duties of the plan.
(4)1(a) The plan of operation may provide that any or all powers and duties of the plan, except those under ss. 631.818(7)(b) and (c) and 631.819, are delegated to an administrator that may be a corporation, association, or other organization that performs or will perform functions similar to those of this plan, or its equivalent.
(b) The board may select an administrator through a competitive bidding process to administer the plan. The board shall evaluate bids submitted under this subsection based on criteria established by the board, which criteria shall include:
1. The administrator’s proven ability to manage large group health insurance plans and HMOs.
2. The efficiency of the administrator’s claims-paying procedures.
3. An estimate of total charges for administering the plan.
4. Any other reasonable factors as set by the board.
(c) The administrator shall be reimbursed for any payments made on behalf of the plan and shall be paid for its performance of any function of the plan.
(d) A delegation under this subsection shall take effect only with the approval of both the board of directors and the office and may be made only to an administrator which extends protection not substantially less favorable and effective than that provided by this part.