eLaws of Florida

  SECTION 627.6562. Dependent coverage.  


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  • 1(1) 2If an insurer offers coverage under a group, blanket, or franchise health insurance policy that insures dependent children of the policyholder or certificateholder, the policy must insure a dependent child of the policyholder or certificateholder at least until the end of the calendar year in which the child reaches the age of 25, if the child meets all of the following:
    63(a) 64The child is dependent upon the policyholder or certificateholder for support.
    75(b) 76The child is living in the household of the policyholder or certificateholder, or the child is a full-time or part-time student.
    97(2) 98A policy that is subject to the requirements of subsection (1) must also offer the policyholder or certificateholder the option to insure a child of the policyholder or certificateholder at least until the end of the calendar year in which the child reaches the age of 30, if the child:
    148(a) 149Is unmarried and does not have a dependent of his or her own;
    162(b) 163Is a resident of this state or a full-time or part-time student; and
    176(c) 177Is not provided coverage as a named subscriber, insured, enrollee, or covered person under any other group, blanket, or franchise health insurance policy or individual health benefits plan, or is not entitled to benefits under Title XVIII of the Social Security Act.
    219(3) 220If, pursuant to subsection (2), a child is provided coverage under the parent’s policy after the end of the calendar year in which the child reaches age 25 and coverage for the child is subsequently terminated, the child is not eligible to be covered under the parent’s policy unless the child was continuously covered by other creditable coverage without a gap in coverage of more than 63 days.
    288(a) 289For the purposes of this subsection, the term “creditable coverage” means, with respect to an individual, coverage of the individual under any of the following:
    3141. 315A group health plan, as defined in s. 2791 of the Public Health Service Act.
    3302. 331Health insurance coverage consisting of medical care provided directly through insurance or reimbursement or otherwise, and including terms and services paid for as medical care, under any hospital or medical service policy or certificate, hospital or medical service plan contract, or health maintenance contract offered by a health insurance issuer.
    3813. 382Part A or Part B of Title XVIII of the Social Security Act.
    3954. 396Title XIX of the Social Security Act, other than coverage consisting solely of benefits under s. 1928.
    4135. 414Title 10 U.S.C. chapter 55.
    4196. 420A medical care program of the Indian Health Service or of a tribal organization.
    4347. 435A state health benefit risk pool.
    4418. 442A health plan offered under 5 U.S.C. chapter 89.
    4519. 452A public health plan as defined by rules adopted by the commission. To the greatest extent possible, such rules must be consistent with regulations adopted by the United States Department of Health and Human Services.
    48710. 488A health benefit plan under s. 5(e) of the Peace Corps Act, 22 U.S.C. s. 2504(e).
    504(b) 505Creditable coverage does not include coverage that consists of one or more, or any combination thereof, of the following excepted benefits:
    5261. 527Coverage only for accident insurance, or disability income insurance, or any combination thereof.
    5402. 541Coverage issued as a supplement to liability insurance.
    5493. 550Liability insurance, including general liability insurance and automobile liability insurance.
    5604. 561Workers’ compensation or similar insurance.
    5665. 567Automobile medical payment insurance.
    5716. 572Credit-only insurance.
    5747. 575Coverage for onsite medical clinics, including prepaid health clinics under part II of chapter 641.
    5908. 591Other similar insurance coverage specified in rules adopted by the commission under which benefits for medical care are secondary or incidental to other insurance benefits. To the extent possible, such rules must be consistent with regulations adopted by the United States Department of Health and Human Services.
    638(c) 639The following benefits are not subject to the creditable coverage requirements, if offered separately:
    6531. 654Limited scope dental or vision benefits.
    6602. 661Benefits for long-term care, nursing home care, home health care, community-based care, or any combination thereof.
    6773. 678Other similar, limited benefits specified in rules adopted by the commission.
    689(d) 690The following benefits are not subject to creditable coverage requirements if offered as independent, noncoordinated benefits:
    7061. 707Coverage only for a specified disease or illness.
    7152. 716Hospital indemnity or other fixed indemnity insurance.
    723(e) 724Benefits provided through a Medicare supplemental health insurance policy, as defined under s. 1882(g)(1) of the Social Security Act, coverage supplemental to the coverage provided under 10 U.S.C. chapter 55, and similar supplemental coverage provided to coverage under a group health plan are not considered creditable coverage if offered as a separate insurance policy.
    778(4) 779This section does not:
    783(a) 784Affect or preempt an insurer’s right to medically underwrite or charge the appropriate premium;
    798(b) 799Require coverage for services provided to a dependent before October 1, 2008;
    811(c) 812Require an employer to pay all or part of the cost of coverage provided for a dependent under this section; or
    833(d) 834Prohibit an insurer or health maintenance organization from increasing the limiting age for dependent coverage to age 30 in policies or contracts issued or renewed prior to the effective date of this act.
    867(5) 868This section does not apply to accident only, specified disease, disability income, Medicare supplement, or long-term care insurance policies.
History.-s. 131, ch. 92-33; s. 9, ch. 2008-32; s. 153, ch. 2014-17; s. 17, ch. 2016-194; s. 41, ch. 2017-3.

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