Commercial HMOs

Florida's commercial health maintenance organizations (HMOs) are dually regulated by the Agency for Health Care Administration (Agency), Bureau of Managed Health Care (BMHC) and the Department of Financial Services Office of Insurance Regulation (DFS), Office of Insurance Regulation (OIR). The BMHC monitors quality of care-related issues and the OIR monitors financial and contractual issues. To become a commercially licensed HMO, an organization must receive a certificate of authority (COA) from the OIR and a health care provider certificate (HCPC) from the BMHC.

OIRs information and requirements for health plans can be accessed at the following links:

The Health Care Services Unit (HCSU) within the BMHC is responsible for conducting the folllowing reviews as applicable to HMOs, Prepaid Health Clinics (PHCs) and Exclusive Provider Organizations (EPOs): initial HCPCs, biannual renewal HCPCs, expansion affidavits, annual risk management and tri-annual accreditation organizations approved by the Agency. Onsite surveys are conducted for all initial applications involving HMOs and PHCs.

Tracking national accreditation status and individual complaints identified from the risk management reviews allows the unit to monitor activity of health plans to ensure compliance with current regulation.

For information concerning Agency health plan requirements, please visit "Commercial Provider Information".

For information on purchasing insurance coverage and to verify the license of agents and companies, please contact the Consumer Services Unit of the OIR or call 1-877-693-5236, out of state call 1-850-413-3089. For additional information on HMOs, please visit the following:

Medicare HMOs

Medicare HMOs are federal programs regulated by the Centers for Medicare and Medicaid Services , or CMS.



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