What State Law Requires a Group Plan to Cover in Florida

Florida’s group coverage mandates live in Part VII of Chapter 627 of the Florida Statutes, and reading them is not the same as reading their headings. Florida’s mandates include maternity care services, newborn coverage from the moment of birth, child health supervision, mammograms, mastectomy-related reconstruction, home health care, osteoporosis, cleft lip and cleft palate, diabetes equipment and self-management training, dependent-child coverage to a stated age, and more. But three structural facts decide what any of that means for your plan, and all three sit in subsections rather than catchlines. One section headed “required” excludes small-employer plans in its own definition. Two sections headed “required” require only an offer. And one subsection of the small-group statute qualifies every mandate in the chapter.

Read the definition subsection before you read the heading

Florida statutes are drafted with the scope of a duty in a definition, not in the title over it. That is not a quirk; it is the normal shape, and it is why a summary of Florida mandates written from catchlines is unreliable. The discipline it forces is simple: for any Florida coverage section, find the subsection that defines the plan the section reaches and the subsection that qualifies it, and only then read the duty. Applied to Part VII, that changes the answer for a small-employer plan in at least three places — and the rest of this post is those three places plus what survives them.

The autism section is a mandate and a non-mandate in one sentence

Fla. Stat. § 627.6686 carries the catchline “Coverage for individuals with autism spectrum disorder required; exception.” Its duty, at § 627.6686(3), is substantial: a health insurance plan issued or renewed on or after April 1, 2009 “shall provide coverage to an eligible individual for” well-baby and well-child screening for diagnosing autism spectrum disorder, and treatment of autism spectrum disorder and Down syndrome “through speech therapy, occupational therapy, physical therapy, and applied behavior analysis.”

Then read § 627.6686(2)(d), which defines what a “health insurance plan” is for purposes of that duty: “‘Health insurance plan’ means a group health insurance policy or group health benefit plan offered by an insurer which includes the state group insurance program provided under s. 110.123. The term does not include any health insurance plan offered in the individual market, any health insurance plan that is individually underwritten, or any health insurance plan provided to a small employer.”

One definition doing two opposite things. It expressly includes Florida’s state group insurance program under s. 110.123, making § 627.6686 a genuine public-employer mandate, and expressly excludes any plan provided to a small employer, making the same section a non-mandate for a Florida small-group plan.

Both of the obvious summaries are therefore wrong. “Florida requires group plans to cover autism treatment” is false of a small-employer plan; “Florida doesn’t require autism coverage” is false of Florida, because the state’s own employee plan is named in the text. Carry the habit rather than the fact: the heading said required, the definition said who.

Two sections headed “required” require only an offer

Fla. Stat. § 627.668 is headed “Optional coverage for mental and nervous disorders required; exception,” and § 627.669 “Optional coverage required for substance abuse impaired persons; exception.” Both headings contain the word required. Neither requires a plan to contain the benefit.

Section 627.668(1) requires every insurer, health maintenance organization and nonprofit hospital and medical service plan corporation transacting group health insurance in Florida to “make available to the policyholder as part of the application,” for an appropriate additional premium, the benefits specified in subsection (2) for the care and treatment of mental and nervous disorders — subject to the applicant’s right “to select any alternative benefits or level of benefits as may be offered by the insurer.” Section 627.669(1) uses the same construction for substance abuse impaired persons, and § 627.669(2)(b)1. confines the benefits to “covered individuals in a group health plan.”

The correct sentence for both is must be offered to you, never must be covered. The carrier’s duty is to put it on the application; the decision is the policyholder’s, which means it is yours and it is a line item worth looking for rather than assuming.

There is a vintage point here too. Both sections were last substantively amended in 2013, and their internal day and dollar limits predate federal mental health parity requirements — so those limits are not a description of what a modern plan covers, and this post prints none of them. What does describe a fully-insured small-group plan today is the federal essential health benefits package, which carries “mental health and substance use disorder services, including behavioral health treatment” as a category under 45 CFR 156.110.

One subsection qualifies every mandate in this post

Fla. Stat. § 627.6699(15)(a), headed “APPLICABILITY OF OTHER STATE LAWS,” sits inside the small-group statute rather than inside the mandates it governs. It reads: “Except as expressly provided in this section, a law requiring coverage for a specific health care service or benefit, or a law requiring reimbursement, utilization, or consideration of a specific category of licensed health care practitioner, does not apply to a limited benefit policy or contract offered or delivered to a small employer unless that law is made expressly applicable to such policies or contracts. A law restricting or limiting deductibles, coinsurance, copayments, or annual or lifetime maximum payments does not apply to any health plan policy offered or delivered to a small employer unless such law is made expressly applicable to such policy or contract.”

Two different reaches in two sentences. The first carves service-specific mandates out of a limited benefit policy offered to a small employer; the second is broader, reaching any small-employer health plan policy. Florida defines the narrower term at § 627.6699(3)(m) as a policy providing coverage “for a specifically named disease or diseases, a specifically named accident, or a specifically named limited market that fulfills an experimental or reasonable need, such as the small group market.”

Every mandate sentence in the rest of this post should therefore be read with a silent tail attached: in a policy that is not a limited benefit policy.

One Florida mandate answers that qualifier head-on. Fla. Stat. § 627.65745(1) requires that “a health insurance policy or group health insurance policy sold in this state, including a health benefit plan issued pursuant to s. 627.6699, must provide coverage for all medically appropriate and necessary equipment, supplies, and diabetes outpatient self-management training and educational services used to treat diabetes,” on a physician’s certification of necessity. It names § 627.6699 expressly — the one thing § 627.6699(15)(a) says makes a mandate reach.

Florida’s mandates include these, in the form the statutes write them

Most of Part VII is drafted as a condition rather than a command: if a policy covers something, then it must also cover, or may not limit, something related. That decides whether a mandate can put a benefit into a plan or only finish one.

Around maternity and children, a policy “which provides coverage for maternity care must also cover” certified nurse-midwives, licensed midwives and licensed birth centers, may not limit a maternity and newborn stay below what is medically necessary, and must provide postdelivery care (§ 627.6574). A policy that covers a family member must pay children’s benefits for a newborn “from the moment of birth” (§ 627.6575), must extend them to an adopted or foster child “from the moment of placement in the residence” (§ 627.6578(1)), and must “include coverage for child health supervision services from the moment of birth to age 16 years,” exempt “from any deductible provisions” in the policy (§ 627.6579(1)).

Around cancer care, a policy providing coverage for mastectomies “must also provide coverage for prosthetic devices and breast reconstructive surgery incident to the mastectomy” (§ 627.6612(1)); a policy covering breast cancer treatment may not limit inpatient mastectomy coverage below what the treating physician finds medically necessary and must cover outpatient postsurgical followup care (§ 627.66121); and § 627.66122 keeps routine followup care for recurrence out of any preexisting-condition determination. Mammography is free-standing: § 627.6613(1) requires coverage of at least a baseline mammogram for a woman 35 years of age or older but younger than 40, one every 2 years for a woman 40 years of age or older but younger than 50, and one every year for a woman 50 years of age or older — while subsection (3) adds an offer duty on top, that the insurer make that same coverage available as part of the application free of the policy’s deductible or coinsurance. One section, two duty forms.

Other requirements need no precondition. Section 627.6617(1) requires a group policy on an expense-incurred basis to “provide coverage for home health care by a home health care agency licensed pursuant to part III of chapter 400,” with multiple-employer welfare arrangements and the state health plan carved out at § 627.6617(4). Section 627.6691 requires a policy issued, amended, delivered or renewed after October 1, 1996 to cover “the medically necessary diagnosis and treatment of osteoporosis for high-risk individuals.” Section 627.66911 requires a policy “that covers a child under the age of 18” to cover treatment of cleft lip and cleft palate, including medical, dental, speech therapy, audiology and nutrition services.

And several rules protect coverage a plan already has. A policy covering bone or joint procedures may not discriminate against similar jaw and facial procedures that are medically necessary (§ 627.65735). A policy providing organ transplant coverage, issued or renewed on or after July 1, 2020, “may not deny coverage for an organ transplant solely on the basis of an insured’s disability” (§ 627.65736). A policy covering general anesthesia and hospitalization may not preclude that coverage for necessary dental care given to a covered person under 8 years of age, or to one whose medical conditions create undue risk (§ 627.65755). A policy that ends dependent coverage at a limiting age must continue it for a child who remains incapable of self-sustaining employment by reason of disability and chiefly dependent on the employee for support (§ 627.6615(1)). This is not the whole of Part VII and it is not offered as a count — it is what the sections themselves say.

Provider-parity rules are about who may deliver a covered service

A separate group of Florida rules never adds a benefit and is easily mistaken for one. Section 627.6618 provides that a group policy “that provides coverage for acupuncture shall cover the services of an acupuncturist certified pursuant to chapter 457 under the same conditions that apply to services of a licensed physician,” and § 627.6619 provides that a policy “that provides coverage for massage shall also cover the services of persons licensed to practice massage therapy” under chapter 480 on a physician’s prescription.

Section 627.6621 runs the other way, as a prohibition: a group, blanket or franchise policy delivered, issued or renewed on or after January 1, 2021 “may not require an insured to receive services from an advanced practice registered nurse registered under s. 464.0123 in place of a physician.” For a small-employer plan, § 627.6699(5)(g) carries the identical rule inside the small-group statute — exactly the sort of express applicability § 627.6699(15)(a) is asking about.

One Part VII duty here falls on the employer rather than the carrier: § 627.6577(1) provides that any employer contributing to a plan giving dental coverage only through an exclusive list of dentists “shall provide an alternative to enable the insured to have a free choice of dentist,” contributing an equal dollar amount toward whichever alternative the insured elects.

Finally, § 627.6572(2) is a mandate about a contract rather than a benefit: a contract between a health insurer and a pharmacy benefit manager “must require” the manager to update maximum allowable cost pricing information at least every 7 calendar days. It shapes what a plan does without being a covered service, and should be labeled that way rather than counted as a benefit mandate.

The federal layer under all of it, and what this record does not settle

Florida’s mandates sit on top of a federal floor rather than in place of one. 45 CFR 147.150(a) requires an issuer offering coverage in the individual or small group market to ensure it includes the essential health benefits package, and 45 CFR 156.110 sets out the categories it is built from — ambulatory, emergency, hospital, maternity and newborn, mental health and substance use disorder, prescription drug, rehabilitative and habilitative, laboratory, preventive and chronic disease management, and pediatric services including oral and vision care — with “an appropriate balance among the EHB categories” required. Metal tiers describe actuarial value, not benefit richness: a bronze and a platinum plan work from the same category list.

Two limits, stated rather than hidden. No Florida Administrative Code rule was retrieved, so anything depending on a rule rather than a statute is outside this post — and several of these sections do grant rulemaking authority. And the statutory text here comes from the 2026 Florida Statutes as published by the Florida Senate, whose own system carries the disclaimer that the information “is unverified” and directs readers to the journals or printed bills for official purposes. The 2026 session was not checked.

If a specific benefit matters to your group, the question to put to a carrier in writing is narrow: does this policy contain it, is it an offer you have to elect, and is the policy a limited benefit policy for purposes of Fla. Stat. § 627.6699(15)(a)?