2016 Florida Statutes
TITLE XXXVII - INSURANCE
Chapter 627 - INSURANCE RATES AND CONTRACTS
Part VII - GROUP, BLANKET, AND FRANCHISE HEALTH INSURANCEPOLICIES (ss. 627.651-627.66997)
627.6562 - Dependent coverage.
627.6562 Dependent coverage.—
(1) If an insurer offers coverage under a group, blanket, or franchise health insurance policy that insures dependent children of the policyholder or certificateholder, the policy must insure a dependent child of the policyholder or certificateholder at least until the end of the calendar year in which the child reaches the age of 25, if the child meets all of the following:
(a) The child is dependent upon the policyholder or certificateholder for support.
(b) The child is living in the household of the policyholder or certificateholder, or the child is a full-time or part-time student.
(2) A policy that is subject to the requirements of subsection (1) must also offer the policyholder or certificateholder the option to insure a child of the policyholder or certificateholder at least until the end of the calendar year in which the child reaches the age of 30, if the child:
(a) Is unmarried and does not have a dependent of his or her own;
(b) Is a resident of this state or a full-time or part-time student; and
(c) Is not provided coverage as a named subscriber, insured, enrollee, or covered person under any other group, blanket, or franchise health insurance policy or individual health benefits plan, or is not entitled to benefits under Title XVIII of the Social Security Act.
(3) If, pursuant to subsection (2), a child is provided coverage under the parent’s policy after the end of the calendar year in which the child reaches age 25 and coverage for the child is subsequently terminated, the child is not eligible to be covered under the parent’s policy unless the child was continuously covered by other creditable coverage without a gap in coverage of more than 63 days.
(a) For the purposes of this subsection, the term “creditable coverage” means, with respect to an individual, coverage of the individual under any of the following:
1. A group health plan, as defined in s. 2791 of the Public Health Service Act.
2. Health insurance coverage consisting of medical care provided directly through insurance or reimbursement or otherwise, and including terms and services paid for as medical care, under any hospital or medical service policy or certificate, hospital or medical service plan contract, or health maintenance contract offered by a health insurance issuer.
3. Part A or Part B of Title XVIII of the Social Security Act.
4. Title XIX of the Social Security Act, other than coverage consisting solely of benefits under s. 1928.
5. Title 10 U.S.C. chapter 55.
6. A medical care program of the Indian Health Service or of a tribal organization.
7. The 1Florida Comprehensive Health Association or another state health benefit risk pool.
8. A health plan offered under 5 U.S.C. chapter 89.
9. A public health plan as defined by rules adopted by the commission. To the greatest extent possible, such rules must be consistent with regulations adopted by the United States Department of Health and Human Services.
10. A health benefit plan under s. 5(e) of the Peace Corps Act, 22 U.S.C. s. 2504(e).
(b) Creditable coverage does not include coverage that consists of one or more, or any combination thereof, of the following excepted benefits:
1. Coverage only for accident insurance, or disability income insurance, or any combination thereof.
2. Coverage issued as a supplement to liability insurance.
3. Liability insurance, including general liability insurance and automobile liability insurance.
4. Workers’ compensation or similar insurance.
5. Automobile medical payment insurance.
6. Credit-only insurance.
7. Coverage for onsite medical clinics, including prepaid health clinics under part II of chapter 641.
8. Other similar insurance coverage specified in rules adopted by the commission under which benefits for medical care are secondary or incidental to other insurance benefits. To the extent possible, such rules must be consistent with regulations adopted by the United States Department of Health and Human Services.
(c) The following benefits are not subject to the creditable coverage requirements, if offered separately:
1. Limited scope dental or vision benefits.
2. Benefits for long-term care, nursing home care, home health care, community-based care, or any combination thereof.
3. Other similar, limited benefits specified in rules adopted by the commission.
(d) The following benefits are not subject to creditable coverage requirements if offered as independent, noncoordinated benefits:
1. Coverage only for a specified disease or illness.
2. Hospital indemnity or other fixed indemnity insurance.
(e) Benefits provided through a Medicare supplemental health insurance policy, as defined under s. 1882(g)(1) of the Social Security Act, coverage supplemental to the coverage provided under 10 U.S.C. chapter 55, and similar supplemental coverage provided to coverage under a group health plan are not considered creditable coverage if offered as a separate insurance policy.
(4) This section does not:
(a) Affect or preempt an insurer’s right to medically underwrite or charge the appropriate premium;
(b) Require coverage for services provided to a dependent before October 1, 2008;
(c) Require an employer to pay all or part of the cost of coverage provided for a dependent under this section; or
(d) Prohibit an insurer or health maintenance organization from increasing the limiting age for dependent coverage to age 30 in policies or contracts issued or renewed prior to the effective date of this act.
(5) This section does not apply to accident only, specified disease, disability income, Medicare supplement, or long-term care insurance policies.
History.—s. 131, ch. 92-33; s. 9, ch. 2008-32; s. 153, ch. 2014-17; s. 17, ch. 2016-194.
1Note.—Section 627.6488, which created the Florida Comprehensive Health Association, was repealed by s. 20, ch. 2013-101, effective October 1, 2015; the repeal was confirmed by s. 13, ch. 2016-11.
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