408.905 Limitations and exclusions. - Florida Statutes

408.905 Limitations and exclusions.

   (1) The MedAccess program shall not cover benefits that are provided as part of workers’ compensation insurance.

   (2) The MedAccess program shall exclude coverage for preexisting conditions, except pregnancy, during a period of 12 months following the effective date of coverage as long as:

   (a) The condition manifested itself within a period of 6 months before the effective date of coverage; or

   (b) Medical advice or treatment was recommended or received within 6 months before the effective date of coverage.

   (3) In addition to the limitations otherwise provided in ss. 408.901-408.908, the MedAccess program shall not include coverage for outpatient prescription drugs, eyeglasses, dental services, custodial care, or emergency services for nonemergent conditions.

   (4) Any member of the MedAccess program who is determined to be at “high risk” by a participating primary care provider shall, upon renewal, agree to be placed in a case management system when it is determined by the program to be in the best interest of the member and the MedAccess program.

   (5) No person on whose behalf the program has paid out $500,000 in covered benefits is eligible for continued coverage in the MedAccess program.

History. s. 43, ch. 93-129.