Fla. Stat. 627.6474
Provider contracts


(1)

A health insurer may not require a contracted health care practitioner as defined in s. 456.001(4) to accept the terms of other health care practitioner contracts with the insurer or any other insurer, or health maintenance organization, under common management and control with the insurer, including Medicare and Medicaid practitioner contracts and those authorized by s. 627.6471, s. 627.6472, s. 636.035, or s. 641.315, except for a practitioner in a group practice as defined in s. 456.053 who must accept the terms of a contract negotiated for the practitioner by the group, as a condition of continuation or renewal of the contract. Any contract provision that violates this section is void. A violation of this subsection is not subject to the criminal penalty specified in s. 624.15.

(2)

A contract between a health insurer and a dentist licensed under chapter 466 for the provision of services to an insured may not contain a provision that requires the dentist to provide services to the insured under such contract at a fee set by the health insurer unless such services are covered services under the applicable contract. As used in this subsection, the term “covered services” means dental care services for which a reimbursement is available under the insured’s contract, or for which a reimbursement would be available but for the application of contractual limitations such as deductibles, coinsurance, waiting periods, annual or lifetime maximums, frequency limitations, alternative benefit payments, or any other limitation.

(3)(a)

A health insurer may not require an ophthalmologist licensed pursuant to chapter 458 or chapter 459 or an optometrist licensed pursuant to chapter 463 to join a network solely for the purpose of credentialing the licensee for another insurer’s vision network. This paragraph does not prevent a health insurer from entering into a contract with another insurer’s vision care plan to use the vision network.A health insurer may not restrict an ophthalmologist licensed pursuant to chapter 458 or chapter 459, an optometrist licensed pursuant to chapter 463, or an optician licensed pursuant to part I of chapter 484 to specific suppliers of materials or optical laboratories. This paragraph does not restrict a health insurer in determining specific amounts of coverage or reimbursement for the use of network or out-of-network suppliers or laboratories.A health insurer’s online vision care network provider directory must be updated monthly to reflect the vision care providers currently participating in the health insurer’s network.A knowing violation of paragraph (a) or paragraph (b) constitutes an unfair insurance trade practice under s. 626.9541(1)(d).

(3)(a)

A health insurer may not require an ophthalmologist licensed pursuant to chapter 458 or chapter 459 or an optometrist licensed pursuant to chapter 463 to join a network solely for the purpose of credentialing the licensee for another insurer’s vision network. This paragraph does not prevent a health insurer from entering into a contract with another insurer’s vision care plan to use the vision network.

(b)

A health insurer may not restrict an ophthalmologist licensed pursuant to chapter 458 or chapter 459, an optometrist licensed pursuant to chapter 463, or an optician licensed pursuant to part I of chapter 484 to specific suppliers of materials or optical laboratories. This paragraph does not restrict a health insurer in determining specific amounts of coverage or reimbursement for the use of network or out-of-network suppliers or laboratories.

(c)

A health insurer’s online vision care network provider directory must be updated monthly to reflect the vision care providers currently participating in the health insurer’s network.

(d)

A knowing violation of paragraph (a) or paragraph (b) constitutes an unfair insurance trade practice under s. 626.9541(1)(d).

Source: Section 627.6474 — Provider contracts, https://www.­flsenate.­gov/Laws/Statutes/2024/0627.­6474 (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

§ 627.6474. Provider contracts's source at flsenate​.gov