FL H1335

Prohibits health insurers and health maintenance organizations from retroactively denying claims based on insured or subscriber ineligibility at any time, with limited exceptions.

Allows retroactive claim denial only within 1 year after payment if the provider was convicted of fraud under section 817.234.

Prohibits retroactive denial for services rendered during a grace period if the insurer verified eligibility before or at time of treatment and provided an authorization number, and requires grace period information be readily available at time of authorization.

Permits insurers and HMOs to recoup improperly adjudicated claims arising from premium nonpayment if the provider received accurate grace period information and recoupment is requested within 30 days after the grace period ends.

Applies to policies and contracts entered into or renewed on or after January 1, 2024, with an exception exempting Medicaid managed care plans; effective date is July 1, 2023.