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. (1) Definition;
2. (2) Eligibility requirements for enrollment, including waiting periods for receiving services and any other limitations;
3. (3) Health care services to be provided;
4. (4) Renewal, re-enrollment, termination, cancellation, and disenrollment conditions;
5. (5) Provisions for adding new family members;
6. (6) Benefits for newborn and adopted children;
7. (7) Grace period;
8. (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. (9) Provisions relating to pre-existing conditions, if applicable; NOTE: Pre-existing conditions cannot be excluded for longer than two years;
10. (10) Provisions relating to coordination of benefits;
11. (11) Provisions relating to subrogation;
12. (12) Any applicable arbitration provisions which shall state that any arbitration is voluntary and shall be conducted pursuant to chapter 682, F.S.;
13. (13) Conversion and extension of benefits privileges;
14. (14) Subscriber grievance procedures, formal and informal; and,
15. (15) Any applicable co-payments.

Rulemaking Authority 636.067 FS. Law Implemented 636.016, 636.027, 636.028 FS. History–New 11-15-94, Formerly 4-203.028.