Fla. Stat. 627.6487
Guaranteed availability of individual health insurance coverage to eligible individuals

(1)

Subject to the requirements of this section, each health insurance issuer that offers individual health insurance coverage in this state may not, with respect to an eligible individual who desires to enroll in individual health insurance coverage:Decline to offer such coverage to, or deny enrollment of, such individual; orImpose any preexisting condition exclusion with respect to such coverage. For purposes of this section, the term “preexisting condition” means, with respect to coverage, a limitation of benefits relating to a condition based on the fact that the condition was present before the date of enrollment for such coverage, whether or not any medical advice, diagnosis, care, or treatment was recommended or received before such date.

(a)

Decline to offer such coverage to, or deny enrollment of, such individual; or

(b)

Impose any preexisting condition exclusion with respect to such coverage. For purposes of this section, the term “preexisting condition” means, with respect to coverage, a limitation of benefits relating to a condition based on the fact that the condition was present before the date of enrollment for such coverage, whether or not any medical advice, diagnosis, care, or treatment was recommended or received before such date.

(2)

For the purposes of this section:“Health insurance issuer” and “issuer” mean an authorized insurer or a health maintenance organization.“Individual health insurance” means health insurance, as defined in s. 624.603, which is offered to an individual, including certificates of coverage offered to individuals in this state as part of a group policy issued to an association outside this state, but the term does not include short-term limited duration insurance or excepted benefits specified in s. 627.6513(1)-(14).

(a)

“Health insurance issuer” and “issuer” mean an authorized insurer or a health maintenance organization.

(b)

“Individual health insurance” means health insurance, as defined in s. 624.603, which is offered to an individual, including certificates of coverage offered to individuals in this state as part of a group policy issued to an association outside this state, but the term does not include short-term limited duration insurance or excepted benefits specified in s. 627.6513(1)-(14).

(3)

For the purposes of this section, the term “eligible individual” means an individual:
For whom, as of the date on which the individual seeks coverage under this section, the aggregate of the periods of creditable coverage, as defined in s. 627.6562(3), is 18 or more months; and
Whose most recent prior creditable coverage was under a group health plan, governmental plan, or church plan, or health insurance coverage offered in connection with any such plan; or
Whose most recent prior creditable coverage was under an individual plan issued in this state by a health insurer or health maintenance organization, which coverage is terminated due to the insurer or health maintenance organization becoming insolvent or discontinuing the offering of all individual coverage in the State of Florida, or due to the insured no longer living in the service area in the State of Florida of the insurer or health maintenance organization that provides coverage through a network plan in the State of Florida;
Who is not eligible for coverage under:
A group health plan, as defined in s. 2791 of the Public Health Service Act;
A conversion policy or contract issued by an authorized insurer or health maintenance organization under s. 627.6675 or s. 641.3921, respectively, offered to an individual who is no longer eligible for coverage under either an insured or self-insured employer plan;
Part A or part B of Title XVIII of the Social Security Act; or
A state plan under Title XIX of such act, or any successor program, and does not have other health insurance coverage;
With respect to whom the most recent coverage within the coverage period described in paragraph (a) was not terminated based on a factor described in s. 627.6571(2)(a) or (b), relating to nonpayment of premiums or fraud, unless such nonpayment of premiums or fraud was due to acts of an employer or person other than the individual;Who, having been offered the option of continuation coverage under a COBRA continuation provision or under s. 627.6692, elected such coverage; andWho, if the individual elected such continuation provision, has exhausted such continuation coverage under such provision or program.

(a)1.

For whom, as of the date on which the individual seeks coverage under this section, the aggregate of the periods of creditable coverage, as defined in s. 627.6562(3), is 18 or more months; and
Whose most recent prior creditable coverage was under a group health plan, governmental plan, or church plan, or health insurance coverage offered in connection with any such plan; or
Whose most recent prior creditable coverage was under an individual plan issued in this state by a health insurer or health maintenance organization, which coverage is terminated due to the insurer or health maintenance organization becoming insolvent or discontinuing the offering of all individual coverage in the State of Florida, or due to the insured no longer living in the service area in the State of Florida of the insurer or health maintenance organization that provides coverage through a network plan in the State of Florida;
(a)1. For whom, as of the date on which the individual seeks coverage under this section, the aggregate of the periods of creditable coverage, as defined in s. 627.6562(3), is 18 or more months; and
2.a. Whose most recent prior creditable coverage was under a group health plan, governmental plan, or church plan, or health insurance coverage offered in connection with any such plan; orb. Whose most recent prior creditable coverage was under an individual plan issued in this state by a health insurer or health maintenance organization, which coverage is terminated due to the insurer or health maintenance organization becoming insolvent or discontinuing the offering of all individual coverage in the State of Florida, or due to the insured no longer living in the service area in the State of Florida of the insurer or health maintenance organization that provides coverage through a network plan in the State of Florida;
2.a. Whose most recent prior creditable coverage was under a group health plan, governmental plan, or church plan, or health insurance coverage offered in connection with any such plan; or
b. Whose most recent prior creditable coverage was under an individual plan issued in this state by a health insurer or health maintenance organization, which coverage is terminated due to the insurer or health maintenance organization becoming insolvent or discontinuing the offering of all individual coverage in the State of Florida, or due to the insured no longer living in the service area in the State of Florida of the insurer or health maintenance organization that provides coverage through a network plan in the State of Florida;

(b)

Who is not eligible for coverage under:A group health plan, as defined in s. 2791 of the Public Health Service Act;A conversion policy or contract issued by an authorized insurer or health maintenance organization under s. 627.6675 or s. 641.3921, respectively, offered to an individual who is no longer eligible for coverage under either an insured or self-insured employer plan;Part A or part B of Title XVIII of the Social Security Act; orA state plan under Title XIX of such act, or any successor program, and does not have other health insurance coverage;
1. A group health plan, as defined in s. 2791 of the Public Health Service Act;
2. A conversion policy or contract issued by an authorized insurer or health maintenance organization under s. 627.6675 or s. 641.3921, respectively, offered to an individual who is no longer eligible for coverage under either an insured or self-insured employer plan;
3. Part A or part B of Title XVIII of the Social Security Act; or
4. A state plan under Title XIX of such act, or any successor program, and does not have other health insurance coverage;

(c)

With respect to whom the most recent coverage within the coverage period described in paragraph (a) was not terminated based on a factor described in s. 627.6571(2)(a) or (b), relating to nonpayment of premiums or fraud, unless such nonpayment of premiums or fraud was due to acts of an employer or person other than the individual;

(d)

Who, having been offered the option of continuation coverage under a COBRA continuation provision or under s. 627.6692, elected such coverage; and

(e)

Who, if the individual elected such continuation provision, has exhausted such continuation coverage under such provision or program.

(4)(a)

The health insurance issuer may elect to limit the coverage offered under subsection (1) if the issuer offers at least two different policy forms of health insurance coverage, both of which:
Are designed for, made generally available to, actively marketed to, and enroll both eligible and other individuals by the issuer; and
Meet the requirement of paragraph (b).

For purposes of this subsection, policy forms that have different cost-sharing arrangements or different riders are considered to be different policy forms.

The requirement of this subsection is met for health insurance coverage policy forms offered by an issuer in the individual market if the issuer offers the policy forms for individual health insurance coverage with the largest, and next to largest, premium volume of all such policy forms offered by the issuer in this state or applicable marketing or service area, as prescribed in rules adopted by the commission, in the individual market in the period involved. To the greatest extent possible, such rules must be consistent with regulations adopted by the United States Department of Health and Human Services.

(4)(a)

The health insurance issuer may elect to limit the coverage offered under subsection (1) if the issuer offers at least two different policy forms of health insurance coverage, both of which:Are designed for, made generally available to, actively marketed to, and enroll both eligible and other individuals by the issuer; andMeet the requirement of paragraph (b).

For purposes of this subsection, policy forms that have different cost-sharing arrangements or different riders are considered to be different policy forms.

1. Are designed for, made generally available to, actively marketed to, and enroll both eligible and other individuals by the issuer; and
2. Meet the requirement of paragraph (b).

(b)

The requirement of this subsection is met for health insurance coverage policy forms offered by an issuer in the individual market if the issuer offers the policy forms for individual health insurance coverage with the largest, and next to largest, premium volume of all such policy forms offered by the issuer in this state or applicable marketing or service area, as prescribed in rules adopted by the commission, in the individual market in the period involved. To the greatest extent possible, such rules must be consistent with regulations adopted by the United States Department of Health and Human Services.

(5)(a)

In the case of a health insurance issuer that offers individual health insurance coverage through a network plan, the issuer may:
Limit the individuals who may be enrolled under such coverage to those who live, reside, or work within the service area for such network plan; and
Within the service area of such plan, deny such coverage to such individuals if the issuer has demonstrated to the office that:
It will not have the capacity to deliver services adequately to additional individual enrollees because of its obligations to existing group contract holders and enrollees and individual enrollees; and
It is applying this paragraph uniformly to individuals without regard to any health-status-related factor of such individuals and without regard to whether the individuals are eligible individuals.
An issuer, upon denying individual health insurance coverage in any service area in accordance with subparagraph (a)2., may not offer coverage in the individual market within such service area for a period of 180 days after such coverage is denied.

(5)(a)

In the case of a health insurance issuer that offers individual health insurance coverage through a network plan, the issuer may:Limit the individuals who may be enrolled under such coverage to those who live, reside, or work within the service area for such network plan; andWithin the service area of such plan, deny such coverage to such individuals if the issuer has demonstrated to the office that:
It will not have the capacity to deliver services adequately to additional individual enrollees because of its obligations to existing group contract holders and enrollees and individual enrollees; and
It is applying this paragraph uniformly to individuals without regard to any health-status-related factor of such individuals and without regard to whether the individuals are eligible individuals.
1. Limit the individuals who may be enrolled under such coverage to those who live, reside, or work within the service area for such network plan; and
2. Within the service area of such plan, deny such coverage to such individuals if the issuer has demonstrated to the office that:a. It will not have the capacity to deliver services adequately to additional individual enrollees because of its obligations to existing group contract holders and enrollees and individual enrollees; andb. It is applying this paragraph uniformly to individuals without regard to any health-status-related factor of such individuals and without regard to whether the individuals are eligible individuals.
a. It will not have the capacity to deliver services adequately to additional individual enrollees because of its obligations to existing group contract holders and enrollees and individual enrollees; and
b. It is applying this paragraph uniformly to individuals without regard to any health-status-related factor of such individuals and without regard to whether the individuals are eligible individuals.

(b)

An issuer, upon denying individual health insurance coverage in any service area in accordance with subparagraph (a)2., may not offer coverage in the individual market within such service area for a period of 180 days after such coverage is denied.

(6)(a)

A health insurance issuer may deny individual health insurance coverage to an eligible individual if the issuer has demonstrated to the office that:
It does not have the financial reserves necessary to underwrite additional coverage; and
It is applying this paragraph uniformly to all individuals in the individual market in this state consistent with the laws of this state and without regard to any health-status-related factor of such individuals and without regard to whether the individuals are eligible individuals.
An issuer, upon denying individual health insurance coverage in any service area in accordance with paragraph (a), may not offer such coverage in the individual market within such service area for a period of 180 days after the date such coverage is denied or until the issuer has demonstrated to the office that the issuer has sufficient financial reserves to underwrite additional coverage, whichever occurs later.

(6)(a)

A health insurance issuer may deny individual health insurance coverage to an eligible individual if the issuer has demonstrated to the office that:It does not have the financial reserves necessary to underwrite additional coverage; andIt is applying this paragraph uniformly to all individuals in the individual market in this state consistent with the laws of this state and without regard to any health-status-related factor of such individuals and without regard to whether the individuals are eligible individuals.
1. It does not have the financial reserves necessary to underwrite additional coverage; and
2. It is applying this paragraph uniformly to all individuals in the individual market in this state consistent with the laws of this state and without regard to any health-status-related factor of such individuals and without regard to whether the individuals are eligible individuals.

(b)

An issuer, upon denying individual health insurance coverage in any service area in accordance with paragraph (a), may not offer such coverage in the individual market within such service area for a period of 180 days after the date such coverage is denied or until the issuer has demonstrated to the office that the issuer has sufficient financial reserves to underwrite additional coverage, whichever occurs later.

(7)(a)

Subsection (1) does not require that a health insurance issuer that offers health insurance coverage only in connection with group health plans or through one or more bona fide associations, as defined in s. 627.6571(5), or both, offer such health insurance coverage in the individual market.A health insurance issuer that offers health insurance coverage in connection with group health plans is not deemed to be a health insurance issuer offering individual health insurance coverage solely because such issuer offers a conversion policy.

(7)(a)

Subsection (1) does not require that a health insurance issuer that offers health insurance coverage only in connection with group health plans or through one or more bona fide associations, as defined in s. 627.6571(5), or both, offer such health insurance coverage in the individual market.

(b)

A health insurance issuer that offers health insurance coverage in connection with group health plans is not deemed to be a health insurance issuer offering individual health insurance coverage solely because such issuer offers a conversion policy.

(8)

This section does not:Restrict the amount of the premium rates that an issuer may charge an individual for individual health insurance coverage; orPrevent a health insurance issuer that offers individual health insurance coverage from establishing premium discounts or rebates or modifying otherwise applicable copayments or deductibles in return for adherence to programs of health promotion and disease prevention.

(a)

Restrict the amount of the premium rates that an issuer may charge an individual for individual health insurance coverage; or

(b)

Prevent a health insurance issuer that offers individual health insurance coverage from establishing premium discounts or rebates or modifying otherwise applicable copayments or deductibles in return for adherence to programs of health promotion and disease prevention.

(9)

Each health insurance issuer that offers individual health insurance coverage to an eligible individual shall elect to become a risk-assuming carrier or a reinsuring carrier, as provided by s. 627.6475.

(10)

This section applies to individual health insurance coverage offered on or after January 1, 1998. An individual who would have been eligible for coverage on July 1, 1997, shall be eligible for coverage on January 1, 1998, and shall remain eligible for the same period of time after January 1, 1998, that the individual would have remained eligible for coverage after July 1, 1997.

Source: Section 627.6487 — Guaranteed availability of individual health insurance coverage to eligible individuals, https://www.­flsenate.­gov/Laws/Statutes/2024/0627.­6487 (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

§ 627.6487. Guaranteed availability of individual health insurance coverage to eligible individuals's source at flsenate​.gov