Section 69O-203.028 - Certificate and Member Handbook StandardsWhen 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:
(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;(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.Fla. Admin. Code Ann. R. 69O-203.028
Rulemaking Authority 636.067 FS. Law Implemented 636.016, 636.027, 636.028 FS.
New 11-15-94, Formerly 4-203.028.New 11-15-94, Formerly 4-203.028.