Florida Statute 627.4234 - Full Text and Legal Analysis

627.4234 Health insurance cost containment provisions required.—A health insurance policy or health care services plan which provides medical, hospital, or surgical expense coverage delivered or issued for delivery in this state must contain one or more of the following procedures or provisions to contain health insurance costs or cost increases:

(1) Coinsurance.

(2) Deductible amounts.

(3) Utilization review.

(4) Audits of provider bills to verify that services and supplies billed were furnished and that proper charges were made.

(5) Scheduled benefits.

(6) Benefits for preadmission testing.

(7) Any lawful measure or combination of measures for which the insurer provides to the office information demonstrating that the measure or combination of measures is reasonably expected to have an effect toward containing health insurance costs or cost increases.

History.—ss. 4, 10, ch. 84-235; ss. 40, 114, ch. 92-318; s. 1121, ch. 2003-261.

Cases Citing F.S. 627.4234

Fla. Stat. § 627.4234 (2026) Copy Cite Official Site Syfertize CourtListener Amendments
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·In Re Managed Care Litig., 135 F. Supp. 2d 1253 (S.D. Fla. 2001).
Cited 11 times | Published | District Court, S.D. Florida | 2001 U.S. Dist. LEXIS 7776, 2001 WL 220108
...§ 1012(b). The Defendants point to statutes from California, Florida and Texas which specifically authorize cost-containment processes by insurance companies, regulate these practices and provide grievance procedures for claims review. See, e.g., Fla. Stat. § 627.4234 (Health care plans "must contain one or more ......
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Cited as authority(citing case) (2021)
phrase: "rule_authority"
Cited as authority(citing case) (2020)
phrase: "rule_authority"
Cited as authorityHerrera-Edwards (2017)
phrase: "rule_authority"
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Kondell v. Blue Cross & Blue Shield of Florida, Inc., 187 F. Supp. 3d 1348 (S.D. Fla. 2016).
Cited 1 times | Published | District Court, S.D. Florida | 2016 U.S. Dist. LEXIS 91838, 2016 WL 3554922
...w programs.” See supra at 6. Finally, the Court notes that such “utilization management and utilization review programs” constitute one type of the cost-containment procedures and provisions required under Florida insurance law. See Fla. Stat. § 627.4234 (including “utilization review” among the list of cost-containment procedures and provisions required under Florida law in all health insurance policies)....

This Florida statute resource is curated by Graham W. Syfert, Esq., a Jacksonville, Florida personal injury and workers' compensation attorney (Florida Bar No. 39104). Attorney Syfert regularly handles Chapter 627 matters in the context of insurance coverage law and represents clients throughout Northeast Florida. For legal consultation, call 904-383-7448.

Florida/Georgia Personal Injury & Workers Compensation

Cases Citing F.S. 627.4234

·In Re Managed Care Litig., 135 F. Supp. 2d 1253 (S.D. Fla. 2001).

Kondell v. Blue Cross & Blue Shield of Florida, Inc., 187 F. Supp. 3d 1348 (S.D. Fla. 2016).