CopyPublished | District Court of Appeal of Florida | 1992 Fla. App. LEXIS 6475
...e., a provider who does not have an “affiliated provider contract,” or a provider who is not in any way associated with the HMO, i.e., a non-contract provider. Based on the ambiguity of the term, the court properly looked at the context in which section
641.285(5)(a), Florida Statutes, was written to determine the meaning of the term “unaffiliated provider.” See In re Order on Prosecution of Criminal Appeals by Tenth Judicial Circuit Public Defender,
561 So.2d 1130, 1137 (Fla.1990) (wher...
...Zimmerman,
372 So.2d 431 (Fla.1979); Deltona Corp. v. Florida Public Service Com’n,
220 So.2d 905 (Fla.1969) (the court may look to the legislative intent and purpose of the statute where plain meaning of statute is unclear). At the time the term “unaffiliated provider” was used in section
641.285(5)(a), there was no other reference to “unaffiliated provider” in the Florida Statutes....
...remiums have been paid, at no additional cost to members (see the first clause of § 110.108(a)(l)(iv)). There were no objections to the proposal and it has been adopted. 50 Fed.Reg. 6172 (February 14, 1985). In 1985, the Florida Legislature amended section 641.285(5)(a), Florida Statutes, to include a requirement for the same three classes of benefits provided in the 1975 code: (1) continuation of benefits for the duration of the contract period for which payment has been made, (2) continuation...
...s that applicable state law provides that members of the HMO may not be liable for payment of any fees [not just the fees of affiliated providers] which are the legal obligation of the HMOs, 42 CFR § 110.108 (3)(ii) (1985); and (3) the provision in section 641.285, Florida Statutes, which allows for insolvency coverage as an alternative to the deposit requirement of section 641.285(1). In Florida, insolvency coverage is only one of several alternatives to meet the requirements of section 641.285, Florida Statutes. See § 641.285, Fla.Stat....
...Contract providers, unlike non-contract providers, may be required by provisions in their contract to guarantee the continuation of health care services, in the event of insolvency of the HMO, until the end of the contract period for which payment has been made. See § 641.285(5)(a)2, Fla.Stat., supra note 4....
...he Reinsurer Contract between _ (hereinafter "Reinsurer”) and _ (hereinafter "HMO”), and is intended to provide a contingency for insolvency with the purview of O.H.M.O. regulation 42 CFR 110.108(A)(1)(IV) and 42 CFR 110.108(A)(3)(B) and Chapter 641.285, Florida Statutes....
...of the HMO; (B) Insurance, acceptable to the Secretary; (C) Financial reserves, acceptable to the Secretary, that are held for the HMO and restricted for use only in the event of insolvency; or (D) Any other arrangements acceptable to the Secretary. Section 641.285, Florida Statutes (1985), provides various methods of insolvency protection an HMO may use to insure the protection of its subscribers. Section 641.285(5)(a) provides: 5(a) The requirements of this section do not apply to an applying or licensed health maintenance organization which has a plan, approved by the department, for handling insolvency which provides for continuation of ben...
...he management of the health maintenance organization and affiliate in the management of the health maintenance organization or the affiliate. This definition of "affiliate” was used in a different context than the term “unaffiliated provider" in section 641.285(5)(a) and does not effect the definition of that term....
