HB 425 2025
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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 VE S
A bill to be entitled 1
An act relating to coverage for out -of-network ground 2
ambulance emergency services; creating s. 627.42398, 3
F.S.; defining the terms "ambulance service provider" 4
and "nonparticipating ambulance service provider"; 5
requiring certain health insurers to reimbur se 6
nonparticipating ambulance service providers at a 7
specified rate for providing ground ambulance 8
services; providing that certain payments by the 9
insured constitute an accord and satisfaction, and a 10
release, of certain claims; prohibiting certain cost -11
sharing responsibilities paid from exceeding a certain 12
amount; providing that an ambulance service provider 13
and certain claims are subject to certain provisions; 14
amending 627.6699, F.S.; requiring a small employer 15
carrier to comply with certain provisions; c reating s. 16
641.31078, F.S.; defining the terms "ambulance service 17
provider" and "out-of-network ambulance service 18
provider"; requiring certain health maintenance 19
contracts to require a health maintenance organization 20
to reimburse out-of-network ambulance service 21
providers at a specified rate for providing covered 22
services; providing that certain payments by the 23
subscriber constitute an accord and satisfaction, and 24
a release, of certain claims; prohibiting certain 25
HB 425 2025
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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 VE S
cost-sharing responsibilities paid from exce eding a 26
certain amount; providing that an ambulance service is 27
considered a provider and certain claims are subject 28
to certain provisions; providing an effective date. 29
30
Be It Enacted by the Legislature of the State of Florida: 31
32
Section 1. Section 627.42398, Florida Statutes, is created 33
to read: 34
627.42398 Coverage for nonparticipating ambulance 35
services.— 36
(1) As used in this section, the term: 37
(a) "Ambulance service provider" means a ground ambulance 38
service licensed pursuant to s. 401.25. 39
(b) "Nonparticipating ambulance service provider" means a 40
provider that is not a preferred provider as defined in s. 41
627.6471(1) or a provider that is not an exclusive provider as 42
defined in s. 627.6472(1)(c). 43
(2) A health insurer that offers an indiv idual or group 44
health insurance policy providing major medical coverage that 45
includes coverage for ground ambulance services must reimburse a 46
nonparticipating ambulance service provider for providing such 47
covered ambulance services at a rate that is the lo west of the 48
following: 49
(a) The rate set or approved, whether in contract, in 50
HB 425 2025
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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 VE S
ordinance, or otherwise, by a local governmental entity in the 51
jurisdiction in which the covered ground ambulance services 52
originated. 53
(b) Three hundred twenty -five percent of the current 54
published rate for ground ambulance services as established by 55
the Centers for Medicare and Medicaid Services under Title XVIII 56
of the Social Security Act for the same services provided in the 57
same geographic area. 58
(c) The ambulance service provider's billed charges. 59
(3) Payment in full by the insured of his or her 60
applicable copayment, coinsurance, or deductible constitutes an 61
accord and satisfaction, and a release, of any claim for 62
additional moneys owed by the insured to the health insur er or 63
to any person or entity in connection with the ground ambulance 64
services. 65
(4) Copayment, coinsurance, deductible, and other cost -66
sharing responsibilities paid for a nonparticipating ambulance 67
service provider's covered services may not exceed the 68
copayment, coinsurance, deductible, and other cost -sharing 69
responsibilities for a preferred provider as defined in s. 70
627.6471(1) or a provider that is not an exclusive provider as 71
defined in s. 627.6472(1)(c) for covered services. 72
(5) An ambulance servic e provider is considered a provider 73
subject to s. 627.6131, and the claims of the provider are 74
subject to s. 627.6131. 75
HB 425 2025
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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 VE S
Section 2. Paragraph (h) is added to subsection (5) of 76
section 627.6699, Florida Statutes, to read: 77
627.6699 Employee Health Care Access Act.— 78
(5) AVAILABILITY OF COVERAGE. — 79
(h) A small employer carrier must comply with the 80
reimbursement provisions of s. 627.42398 relating to 81
nonparticipating ambulance service providers. 82
Section 3. Section 641.31078, Florida Statutes, is crea ted 83
to read: 84
641.31078 Coverage for out -of-network ambulance services. — 85
(1) As used in this section, the term: 86
(a) "Ambulance service provider" means a ground ambulance 87
service licensed pursuant to s. 401.25. 88
(b) "Out-of-network ambulance service p rovider" means a 89
provider that is not under contract with a health maintenance 90
organization. 91
(2) A health maintenance contract that offers individual 92
or group major medical coverage that includes coverage for 93
ground ambulance services must require a heal th maintenance 94
organization to reimburse an out -of-network ambulance service 95
provider for providing covered ambulance services at a rate that 96
is the lowest of the following: 97
(a) The rate set or approved, whether in contract, in 98
ordinance, or otherwise, b y a local governmental entity in the 99
jurisdiction in which the covered services originated. 100
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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 VE S
(b) Three hundred twenty -five percent of the current 101
published rate for ground ambulance services as established by 102
the Centers for Medicare and Medicaid Services under Title XVIII 103
of the Social Security Act for the same service provided in the 104
same geographic area. 105
(c) The ambulance service provider's billed charges. 106
(3) Payment in full by the subscriber of his or her 107
applicable copayment, coinsurance, or dedu ctible constitutes an 108
accord and satisfaction, and a release, of any claim for 109
additional moneys owed by the subscriber to the health 110
maintenance organization or to any person or entity in 111
connection with the ground ambulance services. 112
(4) Copayment, coinsurance, deductible, and other cost -113
sharing responsibilities paid for an out -of-network ambulance 114
service provider's covered services may not exceed the in -115
network copayment, coinsurance, deductible, and other cost -116
sharing responsibilities for covered ser vices received by the 117
subscriber. 118
(5) An ambulance service provider is considered a 119
provider, and the claims of the provider are subject to s. 120
641.3155. 121
Section 4. This act shall take effect January 1, 2026. 122