Florida Administrative Code
69 - DEPARTMENT OF FINANCIAL SERVICES
69O - OIR - Insurance Regulation
Chapter 69O-191 - HEALTH MAINTENANCE ORGANIZATIONS
Section 69O-191.045 - Newborn and Adopted Children Coverage
Current through Reg. 50, No. 187; September 24, 2024
(1) Each HMO shall comply with the requirements of Section 641.31(9), F.S. If the HMO does not require pre-enrollment for newborns, newborn coverage will commence from the moment of birth in accordance with the subscriber contract.
(2) If the HMO does have a pre-enrollment requirement, the subscriber must be allowed to pre-enroll the newborn up to the moment of birth. The HMO must notify the subscriber of any pre-enrollment requirement, both in the subscriber contract and handbook. Additionally, the HMO should emphasize the pre-enrollment requirements after the subscriber or covered family member is known by the HMO to be pregnant.
(3) Failure to comply with pre-enrollment procedures shall require the newborn to be enrolled during the subscriber's next open enrollment period.
(4) Coverage for adopted children shall be provided pursuant to the requirements enumerated in Section 641.31(17), F.S.
Rulemaking Authority 641.36 FS. Law Implemented 641.31(9), (17) FS.
New 2-22-88, Amended 10-25-89, Formerly 4-31.045, Amended 5-28-92, Formerly 4-191.045.
