summary
Introduced
02/13/2025
02/13/2025
In Committee
02/25/2025
02/25/2025
Crossed Over
Passed
Dead
06/16/2025
06/16/2025
Introduced Session
2025 Regular Session
Bill Summary
An act relating to coverage for 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 the lowest of specified rates for providing ground ambulance services; providing that certain payments by the insured constitute an accord and satisfaction and a release of certain claims; providing that certain cost-sharing responsibilities paid for nonparticipating providers’ covered services may not exceed a certain amount; providing that ambulance service providers are considered to be providers subject to specified provisions and that certain claims are subject to those provisions; amending s. 627.6699, F.S.; requiring small employer carriers to comply with specified reimbursement 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 the lowest of specified rates for providing covered ambulance services; providing that certain payments by the subscriber constitute an accord and satisfaction and a release of certain claims; providing that certain cost sharing responsibilities paid for out-of-network ambulance service providers’ covered services may not exceed such responsibilities for covered services received by subscribers; providing that an ambulance service is considered a provider and that certain claims are subject to certain provisions; providing an effective date.
AI Summary
This bill addresses coverage for ground ambulance emergency services in Florida by establishing new regulations for health insurers and health maintenance organizations (HMOs) regarding reimbursement of out-of-network ambulance service providers. The legislation defines "ambulance service providers" as ground ambulance services licensed under state law and creates specific reimbursement guidelines that require insurers to pay nonparticipating providers at the lowest of three rates: the rate set by local government, 325% of the Medicare rate for the same services in the same geographic area, or the provider's billed charges. The bill ensures that patients' out-of-pocket costs for out-of-network ambulance services cannot exceed the costs for in-network services, and stipulates that when a patient pays their copayment, coinsurance, or deductible, it constitutes full payment and releases any additional claims. The legislation applies to both individual and group health insurance policies and health maintenance organization contracts, and includes small employer carriers. The new rules are designed to protect patients from unexpected high medical bills for emergency ground ambulance services and provide a standardized reimbursement framework for ambulance providers. The bill is set to take effect on January 1, 2026, giving insurers and healthcare providers time to adapt to the new requirements.
Sponsors (1)
Last Action
Died in Banking and Insurance (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/2025/704 |
| BillText | https://www.flsenate.gov/Session/Bill/2025/704/BillText/Filed/HTML |
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