FL H0681

Creates section 627.64194 establishing requirements for health insurance coverage of emergency services, prohibiting prior authorization requirements regardless of whether provider is participating or nonparticipating.

Requires emergency service coverage to impose the same coinsurance, copayment, and benefit limitations on nonparticipating providers as on participating providers.

Mandates reimbursement to nonparticipating providers at the greater of: negotiated amounts with uncontracted providers, usual and customary community rates, or Medicare allowable amounts, reduced only by applicable copayments or coinsurance.

Prohibits nonparticipating providers from collecting or attempting to collect any amounts in excess of the specified reimbursement limits.

Amends section 641.513 to revise HMO reimbursement methodology for emergency services provided by noncontracted providers, changing the standard from "greater" to "lesser" of three reimbursement options and requiring mutual agreement within 60 days of claim submission.

Effective date: October 1, 2015.