Florida Senate - 2025 SB 704 By Senator Bradley 6-00906-25 2025704__ Page 1 of 5 CODING: Words stricken are deletions; words underlined are additions. A bill to be entitled 1

An act relating to coverage for ground ambulance 2 emergency services; creating s. 627.42398, F.S.; 3 defining the terms “ambulance service provider” and 4 “nonparticipating ambulance service provider”; 5 requiring certain health insurers to reimburse 6 nonparticipating ambulance service providers at the 7 lowest of specified rates for providing ground 8 ambulance services; providing that certain payments by 9 the insured constitute an accord and satisfaction and 10 a release of certain claims; providing that certain 11 cost-sharing responsibilities paid for 12 nonparticipating providers’ covered services may not 13 exceed a certain amount; providing that ambulance 14 service providers are considered to be providers 15 subject to specified provisions and that certain 16 claims are subject to those provisions; amending s. 17 627.6699, F.S.; requiring small employer carriers to 18 comply with specified reimbursement provisions; 19 creating s. 641.31078, F.S.; defining the terms 20 “ambulance service provider” and “out-of-network 21 ambulance service provider”; requiring certain health 22 maintenance contracts to require a health maintenance 23 organization to reimburse out-of-network ambulance 24 service providers at the lowest of specified rates for 25 providing covered ambulance services; providing that 26 certain payments by the subscriber constitute an 27 accord and satisfaction and a release of certain 28 claims; providing that certain cost sharing 29

Florida Senate - 2025 SB 704 6-00906-25 2025704__ Page 2 of 5 CODING: Words stricken are deletions; words underlined are additions. responsibilities paid for out-of-network ambulance 30 service providers’ covered services may not exceed 31 such responsibilities for covered services received by 32 subscribers; providing that an ambulance service is 33 considered a provider and that certain claims are 34 subject to certain provisions; providing an effective 35 date. 36 37 Be It Enacted by the Legislature of the State of Florida: 38 39

Section

Section 627.42398, Florida Statutes, is created 40 to read: 41 627.42398 Coverage for nonparticipating ambulance service 42 provider services.— 43

(1) As used in this section, the term: 44 (a) “Ambulance service provider” means a ground ambulance 45 service licensed pursuant to s. 401.25. 46 (b) “Nonparticipating ambulance service provider” means a 47 provider that is not a preferred provider as defined in s. 48 627.6471 or a provider that is not an exclusive provider as 49 defined in s. 627.6472(1)(c). 50

(2) A health insurer that offers an individual or group 51 health insurance policy providing major medical coverage that 52 includes coverage for ground ambulance services must reimburse a 53 nonparticipating ambulance service provider for providing such 54 covered ambulance services at a rate that is the lowest of the 55 following: 56 (

a) The rate set or approved, whether in contract, in 57 ordinance, or otherwise, by a local governmental entity in the 58

Florida Senate - 2025 SB 704 6-00906-25 2025704__ Page 3 of 5 CODING: Words stricken are deletions; words underlined are additions. jurisdiction in which the covered ground ambulance services 59 originated. 60 (

b) Three hundred twenty-five percent of the current 61 published rate for ground ambulance services as established by 62 the federal Centers for Medicare and Medicaid Services under 63 Title XVIII of the Social Security Act for the same services 64 provided in the same geographic area. 65 (

c) The ambulance service provider’s billed charges. 66

(3) Payment in full by the insured of his or her applicable 67 copayment, coinsurance, or deductible constitutes an accord and 68 satisfaction and release of any claim for additional moneys owed 69 by the insured to the health insurer or to any person or entity 70 in connection with the ground ambulance services. 71

(4) Copayment, coinsurance, deductible, and other cost-72 sharing responsibilities paid for a nonparticipating ambulance 73 service provider’s covered services may not exceed the 74 copayment, coinsurance, deductible, and other cost-sharing 75 responsibilities for a preferred provider as defined in s. 76 627.6471 or a provider that is not an exclusive provider as 77 defined in s. 627.6472(1)(

c) for covered services. 78

(5) An ambulance service provider is considered a provider 79 subject to s. 627.6131, and the claims of the provider are 80 subject to that section. 81

Section 2. Paragraph (

h) is added to subsection (5) of 82

section 627.6699, Florida Statutes, to read: 83 627.6699 Employee Health Care Access Act.— 84

(5) AVAILABILITY OF COVERAGE.— 85 (

h) A small employer carrier shall comply with the 86 reimbursement provisions of s. 627.42398 relating to 87

Florida Senate - 2025 SB 704 6-00906-25 2025704__ Page 4 of 5 CODING: Words stricken are deletions; words underlined are additions. nonparticipating ambulance service providers. 88

Section

Section 641.31078, Florida Statutes, is created 89 to read: 90 641.31078 Coverage for out-of-network ambulance service 91 provider services.— 92

(1) As used in this section, the term: 93 (a) “Ambulance service provider” means a ground ambulance 94 service licensed pursuant to s. 401.25. 95 (b) “Out-of-network ambulance service provider” means a 96 provider that is not under contract with a health maintenance 97 organization. 98

(2) A health maintenance organization that offers a 99 contract providing individual or group major medical coverage 100 that includes coverage for ground ambulance services must 101 require a health maintenance organization to reimburse an out-102 of-network ambulance service provider for providing covered 103 ambulance services at a rate that is the lowest of the 104 following: 105 (

a) The rate set or approved, whether in contract, in 106 ordinance, or otherwise, by a local governmental entity in the 107 jurisdiction in which the covered services originated. 108 (

b) Three hundred twenty-five percent of the current 109 published rate for ground ambulance services as established by 110 the federal Centers for Medicare and Medicaid Services under 111 Title XVIII of the Social Security Act for the same service 112 provided in the same geographic area. 113 (

c) The ambulance service provider’s billed charges. 114

(3) Payment in full by the subscriber of his or her 115 applicable copayment, coinsurance, or deductible constitutes an 116

Florida Senate - 2025 SB 704 6-00906-25 2025704__ Page 5 of 5 CODING: Words stricken are deletions; words underlined are additions. accord and satisfaction and release of any claim for additional 117 moneys owed by the subscriber to the health maintenance 118 organization or to any person or entity in connection with the 119 ground ambulance services. 120

(4) Copayment, coinsurance, deductible, and other cost-121 sharing responsibilities paid for an out-of-network ambulance 122 service provider’s covered services may not exceed the in-123 network copayment, coinsurance, deductible, and other cost-124 sharing responsibilities for covered services received by the 125 subscriber. 126

(5) An ambulance service provider is considered a provider 127 subject to s. 641.3155, and the claims of the provider are 128 subject to that section. 129

Section 4. This act shall take effect January 1, 2026. 130