summary
Introduced
02/05/2025
02/05/2025
In Committee
02/12/2025
02/12/2025
Crossed Over
Passed
Dead
06/16/2025
06/16/2025
Introduced Session
2025 Regular Session
Bill Summary
An act relating to coverage for out-of-network ground ambulance emergency services; creating s. 627.42398, F.S.; defining the terms "ambulance service provider" and "nonparticipating ambulance service provider"; requiring certain health insurers to reimburse nonparticipating ambulance service providers at a specified rate for providing ground ambulance services; providing that certain payments by the insured constitute an accord and satisfaction, and a release, of certain claims; prohibiting certain cost- sharing responsibilities paid from exceeding a certain amount; providing that an ambulance service provider and certain claims are subject to certain provisions; amending 627.6699, F.S.; requiring a small employer carrier to comply with certain provisions; creating s. 641.31078, F.S.; defining the terms "ambulance service provider" and "out-of-network ambulance service provider"; requiring certain health maintenance contracts to require a health maintenance organization to reimburse out-of-network ambulance service providers at a specified rate for providing covered services; providing that certain payments by the subscriber constitute an accord and satisfaction, and a release, of certain claims; prohibiting certain hb425-00 cost-sharing responsibilities paid from exceeding a certain amount; providing that an ambulance service is considered a provider and certain claims are subject to certain provisions; providing an effective date.
AI Summary
This bill establishes new regulations for ground ambulance services in Florida, specifically addressing how health insurers and health maintenance organizations (HMOs) must reimburse out-of-network or nonparticipating ambulance service providers. The legislation requires insurers to reimburse these providers at the lowest of three rates: the local government-approved rate, 325% of the Medicare rate for the same services in the same geographic area, or the ambulance service provider's billed charges. The bill also ensures that patients' out-of-pocket costs for out-of-network ambulance services cannot exceed what they would pay for in-network services. When a patient pays their copayment, coinsurance, or deductible, this payment fully satisfies the financial obligation for the ambulance services. The law applies to both individual and group health insurance policies and health maintenance contracts, including those for small employers, and will take effect on January 1, 2026. The primary goal of the bill is to protect patients from unexpected high costs when receiving emergency ground ambulance services from providers outside their insurance network.
Committee Categories
Business and Industry, Health and Social Services
Sponsors (1)
Last Action
Died in Commerce Committee (on 06/16/2025)
Official Document
bill text
bill summary
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bill summary
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bill summary
| Document Type | Source Location |
|---|---|
| State Bill Page | https://www.flsenate.gov/Session/Bill/2025/425 |
| Analysis - Health Care Facilities & Systems Subcommittee (Post-Meeting) | https://www.flsenate.gov/Session/Bill/2025/425/Analyses/h0425a.HFS.PDF |
| Analysis - Health Care Facilities & Systems Subcommittee (Post-Meeting) | https://www.flsenate.gov/Session/Bill/2025/425/Analyses/h0425.HFS.PDF |
| BillText | https://www.flsenate.gov/Session/Bill/2025/425/BillText/Filed/PDF |
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