CS/CS/HB 1335 2023
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hb1335-02-c2
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
A bill to be entitled 1
An act relating to the payment of health insurance 2
claims; amending ss. 627.6131 and 641.3155, F.S.; 3
prohibiting a health insurer or health maintenance 4
organization from retroactively denying a claim at any 5
time because of ineligibility of the insured or 6
subscriber, respectively; specifying an exception; 7
requiring a health insurer or health maintenance 8
organization to provide accurate information to a 9
provider about an insurer's or a subscriber's grace 10
period status; authorizing a health insurer or health 11
maintenance organization to recoup payment 12
retroactively within a specified timeframe if such 13
accurate information is given to the provider; 14
providing applicability of the prohibition to policies 15
or contracts entered into or renewed on or after a 16
specified date; providing nonapplicability of the 17
prohibition to Medicaid managed care plans; providing 18
an effective date. 19
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Be It Enacted by the Legislature o f the State of Florida: 21
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Section 1. Subsection (11) of section 627.6131, Florida 23
Statutes, is amended to read: 24
627.6131 Payment of claims. — 25
CS/CS/HB 1335 2023
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
(11) A health insurer may not retroactively deny a claim 26
because of insured ineligibility at any time, except that a 27
health insurer may retroactively deny a claim for insured 28
ineligibility within 1 year after the date of payment of the 29
claim if the provider was convicted of fraud under s. 817.234. A 30
health insurer may not retroactively deny a claim because of 31
insured ineligibility for services rendered during an applicable 32
grace period if the health insurer verified the insured's 33
eligibility before or at the time of treatment and provided an 34
authorization number. Information regarding whether the insured 35
is in a grace period must be readily available at the time the 36
health insurer provides authorization. A health insurer may 37
recoup payment for an improperly adjudicated claim arising from 38
premium nonpayment if the provider was given accurate 39
information regarding t he insured's grace period status and the 40
recoupment request is made within 30 days after the end of the 41
grace period. This subsection applies to policies entered into 42
or renewed on or after January 1, 2024 more than 1 year after 43
the date of payment of the claim. 44
Section 2. Subsection (10) of section 641.3155, Florida 45
Statutes, is amended to read: 46
641.3155 Prompt payment of claims. — 47
(10) A health maintenance organization may not 48
retroactively deny a claim because of subscriber ineligibility 49
at any time, except that a health maintenance organization may 50
CS/CS/HB 1335 2023
CODING: Words stricken are deletions; words underlined are additions.
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
retroactively deny a claim for subscriber ineligibility within 1 51
year after the date of payment of the claim if the provider was 52
convicted of fraud under s. 817.234. A health maintenance 53
organization may not retroactively deny a claim because of 54
subscriber ineligibility for services rendered during an 55
applicable grace period if the health maintenance organization 56
verified the subscriber's eligibility before or at the time of 57
treatment and provided an aut horization number. Information 58
regarding whether the subscriber is in a grace period must be 59
readily available at the time the health maintenance 60
organization provides authorization. A health maintenance 61
organization may recoup payment for an improperly ad judicated 62
claim arising from premium nonpayment if the provider was given 63
accurate information regarding the subscriber's grace period 64
status and the recoupment request is made within 30 days after 65
the end of the grace period. This subsection applies to 66
contracts entered into or renewed on or after January 1, 2024. 67
This subsection does not apply to Medicaid managed care plans 68
under part IV of chapter 409 more than 1 year after the date of 69
payment of the claim . 70
Section 3. This act shall take effect July 1, 2023. 71