Fla. Stat. § 627.446

Current through the 2024 Legislative Session

Section 627.446 - Advanced explanation of benefits

Section 17, ch. 2024-183, provides that "[t]he changes made by this act to s. 627.446, Florida Statutes, relating to advanced explanation of benefits, are not effective until the United States Department of Health and Human Services, the United States Department of Labor, and the United States Department of the Treasury issue final rules pertaining to advanced explanation of benefits required by section 2799A-1(f) of the Public Health Services [Act] and good faith estimates required by section 2799B-6 of the Public Health Services Act. The Office of Insurance Regulation shall notify the Division of Law Revision upon the promulgation of the final rule pertaining to advanced explanation of benefits."

(1) As used in this section, the term "health insurer" means a health insurer issuing individual or group coverage or a health maintenance organization issuing coverage through an individual or a group contract.

(2) Each health insurer shall prepare an advanced explanation of benefits upon receiving a patient estimate from a facility pursuant to s. 395.301(1). The health insurer must provide the advanced explanation of benefits to the insured no later than 1 business day after receiving the patient estimate from the facility or, in the case of a service scheduled at least 10 business days in advance, no later than 3 business days after receiving such estimate. The health insurer must provide an advanced explanation of benefits to the insured no later than 3 business days after the date on which the health insurer receives a request from the insured.

(3) At a minimum, the advanced explanation of benefits must include detailed coverage and cost-sharing information pursuant to the No Surprises Act, Title I of Division BB of the Consolidated Appropriations Act, 2021, Pub. L. No. 116-260.

Fla. Stat. § 627.446

s. 6, ch. 2024-183.

Added by 2024 Fla. Laws, ch. 183,s 6, eff. 7/1/2024.

See 2024 Fla. Laws, ch. 183, s 17.