Florida Statutes
Fla. Stat. § 627.4234 (2025)
Health insurance cost containment provisions required.
✓ 2025 Florida Statutes — current through the 2025 Regular Session
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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.
Notes of Decisions
Cited in 2
cases, 2001–2016 · leading case: In Re Managed Care Litig., 135 F. Supp. 2d 1253 (S.D. Fla. 2001).
In Re Managed Care Litig., 135 F. Supp. 2d 1253 (S.D. Fla. 2001). “, Fla. Stat. § 627.4234 (Health care plans “must contain one or more .”
Kondell v. Blue Cross & Blue Shield of Florida, Inc., 187 F. Supp. 3d 1348 (S.D. Fla. 2016). “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.”
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