direCT priMarY Care: noT insuranCe
Health Care law Section
Chairs: T.J. Ferrante – Foley & Lardner LLP & Kevin Rudolph – Shriners Hospitals for Children
on March 23, 2018,
Florida became the
24th state to pass
legislation that
D
expressly exempts dpC
agreements from the
state’s insurance code.
irect Primary Care
(DPC) is an alternative
health care model
gaining traction in
Florida and throughout the U.S.
Unlike traditional health care
models, DPC does not accept
insurance but instead charges
patient “members” a fixed monthly
fee that covers a range of primary
care services.
On March 23, 2018, Florida
became the 24th state to pass
legislation that expressly exempts
DPC agreements from the state’s
insurance code. Under Florida’s
DPC law, which went into effect
on July 1, 2018, “A direct primary
care agreement does not constitute
insurance and is not subject to the
Florida Insurance Code. The act
of entering into a direct primary
care agreement does not constitute
the business of insurance and is
not subject to the Florida Insurance
Code.” Notably, because a DPC
agreement is not considered
“insurance,” DPC practices are not
subject to often onerous Insurance
Code requirements, such as
obtaining a certificate of authority
or license. See generally, §§ 624.401
et seq., Fla. Stat.
DPC agreements cover
preventative “primary care
services,” which are defined under
the statute to include “screening,
assessment, diagnosis, and
treatment of a patient conducted
within the competency and
training of the primary care
provider for the purpose of
promoting health or detecting
and managing disease or injury.”
Patients are still encouraged to
obtain some form of insurance for
potential catastrophic events, such
as car accidents or life-threatening
emergencies that fall outside the
scope of primary care services.
The law provides minimum
requirements that must be included
in a DPC agreement. Section
624.27, Florida Statutes, provides
that DPC agreements must be
in writing, must be signed by
the primary care provider and
the patient, patient’s employer,
or patient’s legal representative,
and must:
• Provide a 30-day advanced
notice termination provision.
Agreement may also provide
for immediate termination
due to a violation of the
physician-patient relationship
or a breach of the terms of
the agreement.
• Describe the scope of primary
care services that are covered
by the monthly fee.
• Specify the monthly fee and
any fees for primary care
services not covered by the
monthly fee.
• Specify the duration of the
agreement and any automatic
renewal provisions.
Continued on page 41
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40
MAR - APR 2019
|
HCBA LAWYER