69O-203.028. Certificate and Member Handbook Standards

When certificates or member handbooks are given to the subscriber in lieu of a subscriber contract, the certificate or member handbook shall contain a description of the following: (1) Definition; (2) Eligibility requirements for enrollment, including waiting periods for receiving services and any other limitations; (3) Health care services to be provided; (4) Renewal, re-enrollment, termination, cancellation, and disenrollment conditions; (5) Provisions for adding new family members; (6) Benefits for newborn and adopted children; (7) Grace period; (8) Limitations, exceptions, or exclusions, such as waiting periods, specific conditions not covered, and limitations on length of stay and all other qualifying or limiting features; (9) Provisions relating to pre-existing conditions, if applicable; NOTE: Pre-existing conditions cannot be excluded for longer than two years; (10) Provisions relating to coordination of benefits; (11) Provisions relating to subrogation; (12) Any applicable arbitration provisions which shall state that any arbitration is voluntary and shall be conducted pursuant to chapter 682, F.S.; (13) Conversion and extension of benefits privileges; (14) Subscriber grievance procedures, formal and informal; and, (15) Any applicable co-payments.