Florida Statute 627.4234 - Full Text and Legal Analysis

The 2025 Florida Statutes

Title XXXVII
INSURANCE

Chapter 627
INSURANCE RATES AND CONTRACTS

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627.4234 Health insurance cost containment provisions required.—A health insurance policy or health care services plan which provides medical, hospital, or surgical expense coverage delivered or issued for delivery in this state must contain one or more of the following procedures or provisions to contain health insurance costs or cost increases:

(1) Coinsurance.

(2) Deductible amounts.

(3) Utilization review.

(4) Audits of provider bills to verify that services and supplies billed were furnished and that proper charges were made.

(5) Scheduled benefits.

(6) Benefits for preadmission testing.

(7) Any lawful measure or combination of measures for which the insurer provides to the office information demonstrating that the measure or combination of measures is reasonably expected to have an effect toward containing health insurance costs or cost increases.

History.—ss. 4, 10, ch. 84-235; ss. 40, 114, ch. 92-318; s. 1121, ch. 2003-261.

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Amendments to 627.4234

Annotations, Discussions, Cases:

Cases Citing Statute 627.4234

Total Results: 2 | Sort by: Relevance | Newest First

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In Re Managed Care Litig., 135 F. Supp. 2d 1253 (S.D. Fla. 2001).

Cited 11 times | Published | District Court, S.D. Florida | 2001 U.S. Dist. LEXIS 7776, 2001 WL 220108

...§ 1012(b). The Defendants point to statutes from California, Florida and Texas which specifically authorize cost-containment processes by insurance companies, regulate these practices and provide grievance procedures for claims review. See, e.g., Fla. Stat. § 627.4234 (Health care plans "must contain one or more ......

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Kondell v. Blue Cross & Blue Shield of Florida, Inc., 187 F. Supp. 3d 1348 (S.D. Fla. 2016).

Cited 1 times | Published | District Court, S.D. Florida | 2016 U.S. Dist. LEXIS 91838, 2016 WL 3554922

...w programs.” See supra at 6. Finally, the Court notes that such “utilization management and utilization review programs” constitute one type of the cost-containment procedures and provisions required under Florida insurance law. See Fla. Stat. § 627.4234 (including “utilization review” among the list of cost-containment procedures and provisions required under Florida law in all health insurance policies)....

This Florida statute resource is curated by Graham W. Syfert, Esq., a Jacksonville, Florida personal injury and workers' compensation attorney. Attorney Syfert regularly works with Chapter 627 in the context of insurance coverage law and represents clients throughout Northeast Florida. For legal consultation, call 904-383-7448.