Florida Statutes 627.443 – Essential health benefits
Current as of: 2024 | Check for updates
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(1) As used in this section, the term:
(a) “EHB-benchmark plan” has the same meaning as provided in 45 C.F.R. 156.20.
Terms Used In Florida Statutes 627.443
- Contract: A legal written agreement that becomes binding when signed.
- Policy: means a written contract of insurance or written agreement for or effecting insurance, or the certificate thereof, by whatever name called, and includes all clauses, riders, endorsements, and papers that are a part thereof. See Florida Statutes 627.402
- PPACA: means the Patient Protection and Affordable Care Act, Pub. See Florida Statutes 627.402
(b) “PPACA” has the same meaning as in s. 627.402.
(2) A health insurer or health maintenance organization issuing or delivering an individual or a group health insurance policy or health maintenance contract in this state may create a new health insurance policy or health maintenance contract that:
(a) Must include at least one service or coverage under each of the 10 essential health benefits categories under 42 U.S.C. § 18022(b) which are required under PPACA;
(b) May fulfill the requirement in paragraph (a) by selecting one or more services or coverages for each of the required categories from the list of essential health benefits required by any single state or multiple states; and
(c) May comply with paragraphs (a) and (b) by selecting one or more services or coverages from any one or more of the required categories of essential health benefits from one state or multiple states.
(3) This section specifically authorizes an insurer or health maintenance organization to include any combination of services or coverages required by any one state or a combination of states to provide the 10 categories of essential health benefits required under PPACA in a policy or contract issued in this state.
(4) Health insurance policies and health maintenance contracts created by health insurers and health maintenance organizations under this section:
(a) May be submitted to the office for consideration as part of the office’s study of this state’s essential health benefits benchmark plan; and
(b) May also be submitted to the office for evaluation as equivalent to the current state EHB-benchmark plan or to any EHB-benchmark plan created in the future.