Fla. Stat. 627.643
Uniform minimum standards


(1)

The commission shall adopt rules which establish minimum standards for the general content of forms of individual and family health insurance policies. The rules must include terms of renewability, initial and subsequent conditions of eligibility, termination of insurance, probationary periods, exclusions, limitations, and reductions. The minimum standards are in addition to, and must comply with, the individual health insurance policy provisions provided in part II and in this part.

(2)

The commission shall adopt rules which establish minimum standards of benefits and identification for each of the following categories of coverage in individual and family accident and health insurance policy forms, other than conversion policy forms:Basic hospital expense insurance.Basic medical expense insurance.Basic surgical expense insurance.Hospital confinement indemnity insurance.Major medical expense insurance.Disability income protection insurance.Accident-only insurance.Limited benefit insurance.Supplemental insurance.Home health care coverage.Nonconventional coverage.

This subsection does not preclude the issuance of a policy which combines two or more of the categories of coverage enumerated in paragraphs (a)-(e). This subsection does not preclude the issuance of a policy that does not meet the prescribed minimum standards for categories of coverage in paragraphs (a)-(g) if the office determines that the policy is either experimental in nature or is demonstrated to be a type of coverage that fulfills a reasonable need of the person or persons to be insured. Any policy not meeting the minimum standards that is approved by the office must be identified as to category only as prescribed by the office.

(a)

Basic hospital expense insurance.

(b)

Basic medical expense insurance.

(c)

Basic surgical expense insurance.

(d)

Hospital confinement indemnity insurance.

(e)

Major medical expense insurance.

(f)

Disability income protection insurance.

(g)

Accident-only insurance.

(h)

Limited benefit insurance.

(i)

Supplemental insurance.

(j)

Home health care coverage.

(k)

Nonconventional coverage.

(3)

The office may, within the time provided by law for the disapproval of an individual or family form of accident or health insurance, disapprove any form if it finds that the form does not comply with applicable law or it finds that the form is unjust, unfair, or inequitable to the policyholder, any insured, or any beneficiary. In acting upon any submission, the office shall consider whether the benefits afforded under the submitted policy or benefit form fulfill a reasonable need of a policyholder.

Source: Section 627.643 — Uniform minimum standards, https://www.­flsenate.­gov/Laws/Statutes/2024/0627.­643 (accessed Aug. 7, 2025).

627.601
Scope of this part
627.602
Scope, format of policy
627.603
Death benefits
627.604
Nonresident insured
627.605
Required provisions
627.606
Entire contract
627.607
Time limit on certain defenses
627.608
Grace period
627.609
Reinstatement
627.610
Notice of claim
627.611
Claim forms
627.612
Proof of loss
627.613
Time of payment of claims
627.614
Payment of claims
627.615
Physical examination, autopsy
627.616
Legal actions
627.617
Change of beneficiary
627.618
Optional policy provisions
627.619
Change of occupation
627.620
Misstatement of age or sex
627.621
Other insurance with this insurer
627.622
Insurance with other insurers
627.623
Insurance with other insurers
627.624
Relation of earnings to insurance
627.625
Unpaid premiums
627.627
Conformity with statutes
627.628
Illegal occupation
627.629
Intoxicants and narcotics
627.630
Order of certain provisions
627.631
Third-party ownership
627.632
Requirements of other jurisdictions
627.633
Other policy provisions
627.634
Age limit
627.635
Excess insurance
627.636
Industrial health insurance
627.637
Construction of noncomplying contracts
627.638
Direct payment for hospital, medical services
627.639
Application signed by agent
627.640
Filing of classifications and rates
627.641
Coverage for newborn children
627.642
Outline of coverage
627.643
Uniform minimum standards
627.644
Discrimination against handicapped prohibited
627.645
Denial of health insurance claims restricted
627.646
Conversion on termination of eligibility
627.647
Standard health claim form
627.6011
Mandated coverages
627.6041
Children with disabilities
627.6043
Notification of cancellation, nonrenewal, or change in rates
627.6044
Use of a specific methodology for payment of claims
627.6045
Preexisting condition
627.6046
Limit on preexisting conditions
627.6056
Coverage for ambulatory surgical center service
627.6131
Payment of claims
627.6141
Denial of claims
627.6265
Cancellation or nonrenewal prohibited
627.6385
Disclosures to policyholders
627.6387
Shared savings incentive program
627.6401
Refunds for persons age 64
627.6402
Insurance rebates for healthy lifestyles
627.6403
Payment of acupuncture benefits to certified acupuncturists
627.6405
Decreasing inappropriate utilization of emergency care
627.6406
Maternity care
627.6407
Massage
627.6408
Diabetes treatment services
627.6409
Coverage for osteoporosis screening, diagnosis, treatment, and management
627.6415
Coverage for natural-born, adopted, and foster children
627.6416
Coverage for child health supervision services
627.6417
Coverage for surgical procedures and devices incident to mastectomy
627.6418
Coverage for mammograms
627.6419
Requirements with respect to breast cancer
627.6425
Renewability of individual coverage
627.6426
Short-term health insurance
627.6471
Contracts for reduced rates of payment
627.6472
Exclusive provider organizations
627.6473
Combined preferred provider and exclusive provider policies
627.6474
Provider contracts
627.6475
Individual reinsurance pool
627.6487
Guaranteed availability of individual health insurance coverage to eligible individuals
627.64025
Advanced practice registered nurse services
627.64171
Coverage for length of stay and outpatient postsurgical care
627.64172
Requirements with respect to breast cancer and routine followup care
627.64193
Required coverage for cleft lip and cleft palate
627.64194
Coverage requirements for services provided by nonparticipating providers
627.64195
Requirements for opioid coverage
627.64196
Medication synchronization
627.64197
Coverage for organ transplants
627.64725
Health maintenance organization or exclusive provider organization
627.64731
Leasing, renting, or granting access to a participating provider
627.64741
Pharmacy benefit manager contracts
627.64995
Restrictions on use of state and federal funds for state exchanges

Current through Fall 2025

§ 627.643. Unif. minimum standards's source at flsenate​.gov