Florida Administrative Code
69 - DEPARTMENT OF FINANCIAL SERVICES
69O - OIR - Insurance Regulation
Chapter 69O-191 - HEALTH MAINTENANCE ORGANIZATIONS
Section 69O-191.035 - Co-Payments
Current through Reg. 50, No. 187; September 24, 2024
(1) If required, co-payments will be paid when health care services and benefits are rendered. The HMO or contracted provider may assess the usual co-payment when a subscriber fails to keep a physician office visit or appointment, provided this is a standard procedure and a prior reminder was issued to the subscriber of the scheduled appointment.
(2) The contract shall clearly define the co-payment required to be paid by the subscriber/member.
(3) The contract shall clearly define any cost sharing features, the financial responsibility of the subscriber/member, and how the subscriber/member obligation is determined.
(4) In the case of a high deductible contract, as defined in Section 641.20185, F.S., the deductible established under the contract must be satisfied before the application of any co-payments.
Rulemaking Authority 641.36 FS. Law Implemented 641.19(18), 641.20185, 641.31(4) FS.
New 5-28-92, Amended 8-15-02, Formerly 4-191.035.
