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Senate Bill 2554

Senate Bill sb2554

CODING: Words stricken are deletions; words underlined are additions.
    Florida Senate - 2005                                  SB 2554

    By Senator Peaden





    2-1588-05

  1                      A bill to be entitled

  2         An act relating to health insurance; amending

  3         s. 627.6487, F.S.; redefining the term

  4         "eligible individual" for purposes of

  5         guaranteed availability of individual health

  6         insurance coverage to eligible individuals;

  7         amending s. 627.64872, F.S.; revising

  8         definitions relating to the Florida Health

  9         Insurance Plan; providing for the Commissioner

10         of Insurance Regulation to serve on the plan's

11         board of directors; deleting obsolete

12         provisions relating to an interim report;

13         revising qualifications for eligibility;

14         revising sources of additional revenue for the

15         plan; prescribing a limit on health care

16         provider reimbursement; providing an effective

17         date.

18  

19  Be It Enacted by the Legislature of the State of Florida:

20  

21         Section 1.  Subsection (3) of section 627.6487, Florida

22  Statutes, is amended to read:

23         627.6487  Guaranteed availability of individual health

24  insurance coverage to eligible individuals.--

25         (3)  For the purposes of this section, the term

26  "eligible individual" means an individual:

27         (a)1.  For whom, as of the date on which the individual

28  seeks coverage under this section, the aggregate of the

29  periods of creditable coverage, as defined in s. 627.6561(5)

30  and (6), is 18 or more months; and

31  

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    Florida Senate - 2005                                  SB 2554
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 1         2.a.  Whose most recent prior creditable coverage was

 2  under a group health plan, governmental plan, or church plan,

 3  or health insurance coverage offered in connection with any

 4  such plan; or

 5         b.  Whose most recent prior creditable coverage was

 6  under an individual plan issued in this state by a health

 7  insurer or health maintenance organization, which coverage is

 8  terminated due to the insurer or health maintenance

 9  organization becoming insolvent or discontinuing the offering

10  of all individual coverage in the State of Florida, or due to

11  the insured no longer living in the service area in the State

12  of Florida of the insurer or health maintenance organization

13  that provides coverage through a network plan in the State of

14  Florida; or

15         c.  Whose most recent creditable coverage was with the

16  Florida Health Insurance Plan specified in s. 627.64872, which

17  coverage is terminated due to inadequate funding of the

18  Florida Health Insurance Plan as provided in s. 627.64872(15);

19         (b)  Who is not eligible for coverage under:

20         1.  A group health plan, as defined in s. 2791 of the

21  Public Health Service Act;

22         2.  A conversion policy or contract issued by an

23  authorized insurer or health maintenance organization under s.

24  627.6675 or s. 641.3921, respectively, offered to an

25  individual who is no longer eligible for coverage under either

26  an insured or self-insured employer plan;

27         3.  Part A or part B of Title XVIII of the Social

28  Security Act; or

29         4.  A state plan under Title XIX of such act, or any

30  successor program, and does not have other health insurance

31  coverage; or

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    Florida Senate - 2005                                  SB 2554
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 1         5.  The Florida Health Insurance Plan as specified in

 2  s. 627.64872 and such plan is accepting new enrollment;

 3         (c)  With respect to whom the most recent coverage

 4  within the coverage period described in paragraph (a) was not

 5  terminated based on a factor described in s. 627.6571(2)(a) or

 6  (b), relating to nonpayment of premiums or fraud, unless such

 7  nonpayment of premiums or fraud was due to acts of an employer

 8  or person other than the individual;

 9         (d)  Who, having been offered the option of

10  continuation coverage under a COBRA continuation provision or

11  under s. 627.6692, elected such coverage; and

12         (e)  Who, if the individual elected such continuation

13  provision, has exhausted such continuation coverage under such

14  provision or program.

15         Section 2.  Subsections (2), (3), (6), (9), and (15) of

16  section 627.64872, Florida Statutes, are amended, present

17  subsection (20) of that section is renumbered as subsection

18  (21), and a new subsection (20) is added to that section to

19  read:

20         627.64872  Florida Health Insurance Plan.--

21         (2)  DEFINITIONS.--As used in this section:

22         (a)  "Board" means the board of directors of the plan.

23         (b)  "Commissioner" means the Commissioner of Insurance

24  Regulation.

25         (c)(b)  "Dependent" means a resident spouse or resident

26  unmarried child under the age of 19 years, a child who is a

27  student under the age of 25 years and who is financially

28  dependent upon the parent, or a child of any age who is

29  disabled and dependent upon the parent.

30         (c)  "Director" means the Director of the Office of

31  Insurance Regulation.

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    Florida Senate - 2005                                  SB 2554
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 1         (d)  "Health insurance" means any hospital or medical

 2  expense incurred policy or health maintenance organization

 3  subscriber contract pursuant to chapter 641. The term does not

 4  include short-term, accident, dental-only, vision-only,

 5  fixed-indemnity, limited-benefit, or credit insurance;

 6  disability income insurance; coverage for onsite medical

 7  clinics; insurance coverage specified in federal regulations

 8  issued pursuant to Pub. L. No. 104-191, under which benefits

 9  for medical care are secondary or incidental to other

10  insurance benefits; benefits for long-term care, nursing home

11  care, home health care, community-based care, or any

12  combination thereof, or other similar, limited benefits

13  specified in federal regulations issued pursuant to Pub. L.

14  No. 104-191; benefits provided under a separate policy,

15  certificate, or contract of insurance, under which there is no

16  coordination between the provision of the benefits and any

17  exclusion of benefits under any group health plan maintained

18  by the same plan sponsor and the benefits are paid with

19  respect to an event without regard to whether benefits are

20  provided with respect to such an event under any group health

21  plan maintained by the same plan sponsor, such as for coverage

22  only for a specified disease or illness; hospital indemnity or

23  other fixed indemnity insurance; coverage offered as a

24  separate policy, certificate, or contract of insurance, such

25  as Medicare supplemental health insurance as defined under s.

26  1882(g)(1) of the Social Security Act; coverage supplemental

27  to the coverage provided under chapter 55 of Title 10, U.S.C.,

28  the Civilian Health and Medical Program of the Uniformed

29  Services (CHAMPUS); similar supplemental coverage provided to

30  coverage under a group health plan; coverage issued as a

31  supplement to liability insurance; insurance arising out of a

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    Florida Senate - 2005                                  SB 2554
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 1  workers' compensation or similar law; automobile medical

 2  payment insurance; or insurance under which benefits are

 3  payable with or without regard to fault and which is

 4  statutorily required to be contained in any liability

 5  insurance policy or equivalent self-insurance.

 6         (e)  "Implementation" means the effective date after

 7  the first meeting of the board when legal authority and

 8  administrative ability exists for the board to subsume the

 9  transfer of all statutory powers, duties, functions, assets,

10  records, personnel, and property of the Florida Comprehensive

11  Health Association as specified in s. 627.6488.

12         (f)  "Insurer" means any entity that provides health

13  insurance in this state. For purposes of this section, insurer

14  includes an insurance company with a valid certificate in

15  accordance with chapter 624, a health maintenance organization

16  with a valid certificate of authority in accordance with part

17  I or part III of chapter 641, a prepaid health clinic

18  authorized to transact business in this state pursuant to part

19  II of chapter 641, multiple employer welfare arrangements

20  authorized to transact business in this state pursuant to ss.

21  624.436-624.45, or a fraternal benefit society providing

22  health benefits to its members as authorized pursuant to

23  chapter 632.

24         (g)  "Medicare" means coverage under both Parts A and B

25  of Title XVIII of the Social Security Act, 42 U.S.C. ss. 1395

26  et seq., as amended.

27         (h)  "Medicaid" means coverage under Title XIX of the

28  Social Security Act.

29         (i)  "Office" means the Office of Insurance Regulation

30  of the Financial Services Commission.

31  

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    Florida Senate - 2005                                  SB 2554
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 1         (j)  "Participating insurer" means any insurer

 2  providing health insurance to citizens of this state.

 3         (k)  "Provider" means any physician, hospital, or other

 4  institution, organization, or person that furnishes health

 5  care services and is licensed or otherwise authorized to

 6  practice in the state.

 7         (l)  "Plan" means the Florida Health Insurance Plan

 8  created in subsection (1).

 9         (m)  "Plan of operation" means the articles, bylaws,

10  and operating rules and procedures adopted by the board

11  pursuant to this section.

12         (n)  "Resident" means an individual who has been

13  legally domiciled in this state for a period of at least 6

14  months and who physically resides in this state not less than

15  185 days a year.

16         (3)  BOARD OF DIRECTORS.--

17         (a)  The plan shall operate subject to the supervision

18  and control of the board. The board shall consist of the

19  commissioner director or his or her designated representative,

20  who shall serve as a member of the board and shall be its

21  chair, and an additional eight members, five of whom shall be

22  appointed by the Governor, at least two of whom shall be

23  individuals not representative of insurers or health care

24  providers, one of whom shall be appointed by the President of

25  the Senate, one of whom shall be appointed by the Speaker of

26  the House of Representatives, and one of whom shall be

27  appointed by the Chief Financial Officer.

28         (b)  The term to be served on the board by the

29  commissioner Director of the Office of Insurance Regulation

30  shall be determined by continued employment in such position.

31  The remaining initial board members shall serve for a period

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    Florida Senate - 2005                                  SB 2554
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 1  of time as follows: two members appointed by the Governor and

 2  the members appointed by the President of the Senate and the

 3  Speaker of the House of Representatives shall serve a term of

 4  2 years; and three members appointed by the Governor and the

 5  Chief Financial Officer shall serve a term of 4 years.

 6  Subsequent board members shall serve for a term of 3 years. A

 7  board member's term shall continue until his or her successor

 8  is appointed.

 9         (c)  Vacancies on the board shall be filled by the

10  appointing authority, such authority being the Governor, the

11  President of the Senate, the Speaker of the House of

12  Representatives, or the Chief Financial Officer. The

13  appointing authority may remove board members for cause.

14         (d)  The commissioner director, or his or her

15  recognized representative, shall be responsible for any

16  organizational requirements necessary for the initial meeting

17  of the board which shall take place no later than September 1,

18  2004.

19         (e)  Members shall not be compensated in their capacity

20  as board members but shall be reimbursed for reasonable

21  expenses incurred in the necessary performance of their duties

22  in accordance with s. 112.061.

23         (f)  The board shall submit to the Financial Services

24  Commission a plan of operation for the plan and any amendments

25  thereto necessary or suitable to ensure the fair, reasonable,

26  and equitable administration of the plan. The plan of

27  operation shall ensure that the plan qualifies to apply for

28  any available funding from the Federal Government that adds to

29  the financial viability of the plan. The plan of operation

30  shall become effective upon approval in writing by the

31  Financial Services Commission consistent with the date on

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    Florida Senate - 2005                                  SB 2554
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 1  which the coverage under this section must be made available.

 2  If the board fails to submit a suitable plan of operation

 3  within 1 year after implementation the appointment of the

 4  board of directors, or at any time thereafter fails to submit

 5  suitable amendments to the plan of operation, the Financial

 6  Services Commission shall adopt such rules as are necessary or

 7  advisable to effectuate the provisions of this section. Such

 8  rules shall continue in force until modified by the office or

 9  superseded by a plan of operation submitted by the board and

10  approved by the Financial Services Commission.

11         (6)  INTERIM REPORT; ANNUAL REPORT.--

12         (a)  By no later than December 1, 2004, the board shall

13  report to the Governor, the President of the Senate, and the

14  Speaker of the House of Representatives the results of an

15  actuarial study conducted by the board to determine,

16  including, but not limited to:

17         1.  The impact the creation of the plan will have on

18  the small group insurance market and the individual market on

19  premiums paid by insureds. This shall include an estimate of

20  the total anticipated aggregate savings for all small

21  employers in the state.

22         2.  The number of individuals the pool could reasonably

23  cover at various funding levels, specifically, the number of

24  people the pool may cover at each of those funding levels.

25         3.  A recommendation as to the best source of funding

26  for the anticipated deficits of the pool.

27         4.  The effect on the individual and small group market

28  by including in the Florida Health Insurance Plan persons

29  eligible for coverage under s. 627.6487, as well as the cost

30  of including these individuals.

31  

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    Florida Senate - 2005                                  SB 2554
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 1  The board shall take no action to implement the Florida Health

 2  Insurance Plan, other than the completion of the actuarial

 3  study authorized in this paragraph, until funds are

 4  appropriated for startup cost and any projected deficits.

 5         (b)  No later than December 1, 2005, and annually

 6  thereafter, the board shall submit to the Governor, the

 7  President of the Senate, the Speaker of the House of

 8  Representatives, and the substantive legislative committees of

 9  the Legislature a report which includes an independent

10  actuarial study to determine, including, but not be limited

11  to:

12         (a)1.  The impact the creation of the plan has on the

13  small group and individual insurance market, specifically on

14  the premiums paid by insureds. This shall include an estimate

15  of the total anticipated aggregate savings for all small

16  employers in the state.

17         (b)2.  The actual number of individuals covered at the

18  current funding and benefit level, the projected number of

19  individuals that may seek coverage in the forthcoming fiscal

20  year, and the projected funding needed to cover anticipated

21  increase or decrease in plan participation.

22         3.  A recommendation as to the best source of funding

23  for the anticipated deficits of the pool.

24         (c)4.  A summarization of the activities of the plan in

25  the preceding calendar year, including the net written and

26  earned premiums, plan enrollment, the expense of

27  administration, and the paid and incurred losses.

28         (d)5.  A review of the operation of the plan as to

29  whether the plan has met the intent of this section.

30         (9)  ELIGIBILITY.--

31  

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    Florida Senate - 2005                                  SB 2554
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 1         (a)  Any individual person who is and continues to be a

 2  resident of this state shall be eligible for coverage under

 3  the plan if:

 4         1.  Evidence is provided that the person received

 5  notices of rejection or refusal to issue substantially similar

 6  coverage for health reasons from at least two health insurers

 7  or health maintenance organizations. A rejection or refusal by

 8  an insurer offering only stop-loss, excess of loss, or

 9  reinsurance coverage with respect to the applicant shall not

10  be sufficient evidence under this paragraph.

11         2.  The person is enrolled in the Florida Comprehensive

12  Health Association as of the date the plan is implemented.

13         3.  The person is an eligible individual as defined in

14  s. 627.6487(3), excluding s. 627.6487(3)(b)5.

15         (b)  Each resident dependent of a person who is

16  eligible for coverage under the plan shall also be eligible

17  for such coverage.

18         (c)  A person shall not be eligible for coverage under

19  the plan if:

20         1.  The person has or obtains health insurance coverage

21  substantially similar to or more comprehensive than a plan

22  policy, or would be eligible to obtain such coverage, unless a

23  person may maintain other coverage for the period of time the

24  person is satisfying any preexisting condition waiting period

25  under a plan policy or may maintain plan coverage for the

26  period of time the person is satisfying a preexisting

27  condition waiting period under another health insurance policy

28  intended to replace the plan policy.

29         2.  The person is determined to be eligible for health

30  care benefits under Medicaid, Medicare, the state's children's

31  

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    Florida Senate - 2005                                  SB 2554
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 1  health insurance program, or any other federal, state, or

 2  local government program that provides health benefits;

 3         3.  The person voluntarily terminated plan coverage

 4  unless 12 months have elapsed since such termination;

 5         4.  The person is an inmate or resident of a public

 6  institution; or

 7         5.  The person's premiums are paid for or reimbursed

 8  under any government-sponsored program or by any government

 9  agency, or health care provider, or

10  health-care-provider-sponsored or affiliated organization.

11         (d)  Coverage shall cease:

12         1.  On the date a person is no longer a resident of

13  this state;

14         2.  On the date a person requests coverage to end;

15         3.  Upon the death of the covered person;

16         4.  On the date state law requires cancellation or

17  nonrenewal of the policy; or

18         5.  At the option of the plan, 30 days after the plan

19  makes any inquiry concerning the person's eligibility or place

20  of residence to which the person does not reply; or.

21         6.  Upon failure of the insured to pay for continued

22  coverage.

23         (e)  Except under the circumstances described in this

24  subsection, coverage of a person who ceases to meet the

25  eligibility requirements of this subsection shall be

26  terminated at the end of the policy period for which the

27  necessary premiums have been paid.

28         (15)  FUNDING OF THE PLAN.--

29         (a)  Premiums.--

30         1.  The plan shall establish premium rates for plan

31  coverage as provided in this section. Separate schedules of

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    Florida Senate - 2005                                  SB 2554
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 1  premium rates based on age, sex, and geographical location may

 2  apply for individual risks. Premium rates and schedules shall

 3  be submitted to the office for approval prior to use.

 4         2.  Initial rates for plan coverage shall be limited to

 5  no more than 200 300 percent of rates established for

 6  individual standard risks as specified in s. 627.6675(3)(c).

 7  Subject to the limits provided in this paragraph, subsequent

 8  rates shall be established to provide fully for the expected

 9  costs of claims, including recovery of prior losses, expenses

10  of operation, investment income of claim reserves, and any

11  other cost factors subject to the limitations described

12  herein, but in no event shall premiums exceed the 200-percent

13  300-percent rate limitation provided in this section.

14  Notwithstanding the 200-percent 300-percent rate limitation,

15  sliding scale premium surcharges based upon the insured's

16  income may apply to all enrollees.

17         (b)  Sources of additional revenue.--

18         1.  Any deficit incurred by the plan shall be primarily

19  funded through amounts appropriated by the Legislature from

20  general revenue sources, including, but not limited to, a

21  portion of the annual growth in existing net insurance premium

22  taxes. The board shall operate the plan in such a manner that

23  the estimated cost of providing health insurance during any

24  fiscal year will not exceed total income the plan expects to

25  receive from policy premiums and funds assessed appropriated

26  by the Legislature, including any interest on investments.

27  After determining the amount of funds available appropriated

28  to the board for a fiscal year, the board shall estimate the

29  number of new policies it believes the plan has the financial

30  capacity to insure during that year so that costs do not

31  exceed income. The board shall take steps necessary to ensure

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    Florida Senate - 2005                                  SB 2554
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 1  that plan enrollment does not exceed the number of residents

 2  it has estimated it has the financial capacity to insure. In

 3  the event of inadequate funding, the board may cancel policies

 4  on a nondiscriminatory basis as necessary to remedy the

 5  situation. A policy may not be canceled if a covered

 6  individual under that policy is currently on claim.

 7         2.  As a condition of doing business in this state, an

 8  insurer shall pay an assessment to the board in the amount

 9  prescribed by this section. Each insurer shall annually be

10  assessed by the board a percentage of the insurer's earned

11  premium pertaining to direct writings of health insurance in

12  the state during the calendar year preceding that for which

13  the assessment is levied. Such percentage shall equal the

14  percentage that the anticipated incurred operating losses of

15  the plan for the upcoming fiscal year represent of all earned

16  premium pertaining to direct writings of health insurance in

17  the state during the calendar year preceding that for which

18  the assessment is levied.

19         3.  The total of all assessments under this paragraph

20  upon an insurer may not exceed 1 percent of such insurer's

21  health insurance premium earned in this state during the

22  calendar year preceding the year for which the assessments

23  were levied.

24         4.  All rights, title, and interest in the assessment

25  funds collected under this paragraph shall vest in this state.

26  However, of all such funds and interest earned shall be used

27  by the plan to pay claims and administrative expenses.

28         (c)  If assessments and other receipts by the plan,

29  board, or plan administrator exceed the actual losses and and

30  administrative expenses of the plan, the excess shall be held

31  in interest and used by the board to offset future losses. As

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 1  used in this subsection, the term "future losses" including

 2  reserves for claims incurred but not reported.

 3         (d)  Each insurer's assessment shall be determined

 4  annually by the board or plan administrator based on annual

 5  statements and other reports deemed necessary by the board or

 6  plan administrator and filed with the board or plan

 7  administrator by the insurer.

 8         (e)  Insurance may recover the assessment in the normal

 9  course of their respective businesses by including the

10  percentage, as indicated in subparagraph (b)2., as a claim

11  cost in determining rates.

12         (20)  PROVIDER REIMBURSEMENT.--Notwithstanding any law

13  to the contrary, the maximum reimbursement rate to health care

14  providers for all covered, medically necessary services shall

15  be 100 percent of Medicare's allowed payment amount for that

16  particular provider and service. All providers licensed in

17  this state shall accept assignment of plan benefits and

18  consider the Medicare allowed payment amount as payment in

19  full.

20         (21)(20)  COMBINING MEMBERSHIP OF THE FLORIDA

21  COMPREHENSIVE HEALTH ASSOCIATION; ASSESSMENT.--

22         (a)1.  Upon implementation of the Florida Health

23  Insurance Plan, the Florida Comprehensive Health Association,

24  as specified in s. 627.6488, is abolished as a separate

25  nonprofit entity and shall be subsumed under the board of

26  directors of the Florida Health Insurance Plan. All

27  individuals actively enrolled in the Florida Comprehensive

28  Health Association shall be enrolled in the plan subject to

29  its rules and requirements, except as otherwise specified in

30  this section. Maximum lifetime benefits paid to an individual

31  in the plan shall not exceed the amount established under

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 1  subsection (16), and benefits previously paid for any

 2  individual by the Florida Comprehensive Health Association

 3  shall be used in the determination of total lifetime benefits

 4  paid under the plan.

 5         2.  All persons enrolled in the Florida Comprehensive

 6  Health Association upon implementation of the Florida Health

 7  Insurance Plan are only eligible for the benefits authorized

 8  under subsection (16). Persons identified by this section

 9  shall convert to the benefits authorized under subsection (16)

10  no later than January 1, 2005.

11         3.  Except as otherwise provided in this section, the

12  administration of the coverage of persons actively enrolled in

13  the Florida Comprehensive Health Association shall operate

14  under the existing plan of operation without modification

15  until the adoption of the new plan of operation for the

16  Florida Health Insurance Plan.

17         (b)1.  As a condition of doing business in this state,

18  an insurer shall pay an assessment to the board in the amount

19  prescribed by this section. For operating losses incurred on

20  or after July 1, 2004, by persons enrolled in the Florida

21  Comprehensive Health Association, each insurer shall annually

22  be assessed by the board in the following calendar year a

23  portion of such incurred operating losses of the plan. Such

24  portion shall be determined by multiplying such operating

25  losses by a fraction, the numerator of which equals the

26  insurer's earned premium pertaining to direct writings of

27  health insurance in the state during the calendar year

28  preceding that for which the assessment is levied, and the

29  denominator of which equals the total of all such premiums

30  earned by insurers in the state during such calendar year.

31  

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 1         2.  The total of all assessments under this paragraph

 2  upon an insurer shall not exceed 1 percent of such insurer's

 3  health insurance premium earned in this state during the

 4  calendar year preceding the year for which the assessments

 5  were levied.

 6         3.  All rights, title, and interest in the assessment

 7  funds collected under this paragraph shall vest in this state.

 8  However, all of such funds and interest earned shall be used

 9  by the plan to pay claims and administrative expenses.

10         (c)  If assessments and other receipts by the plan,

11  board, or plan administrator exceed the actual losses and

12  administrative expenses of the plan, the excess shall be held

13  in interest and used by the board to offset future losses. As

14  used in this subsection, the term "future losses" includes

15  reserves for claims incurred but not reported.

16         (d)  Each insurer's assessment shall be determined

17  annually by the board or plan administrator based on annual

18  statements and other reports deemed necessary by the board or

19  plan administrator and filed with the board or plan

20  administrator by the insurer. Any deficit incurred under the

21  plan by persons previously enrolled in the Florida

22  Comprehensive Health Association shall be recouped by the

23  assessments against insurers by the board or plan

24  administrator in the manner provided in paragraph (b), and the

25  insurers may recover the assessment in the normal course of

26  their respective businesses without time limitation.

27         (e)  If a person actively enrolled in the Florida

28  Comprehensive Health Association after implementation of the

29  plan loses eligibility for participation in the Florida

30  Comprehensive Health Association, such person shall not be

31  

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 1  included in the calculation of the assessment if the person

 2  later regains eligibility for participation in the plan.

 3         (f)  When all persons actively enrolled in the Florida

 4  Comprehensive Health Association as of the date of

 5  implementation of the plan are no longer eligible for

 6  participation in the Florida Comprehensive Health Association,

 7  the board of directors and plan administrator shall no longer

 8  be allowed to assess insurers in this state for incurred

 9  losses in the Florida Comprehensive Health Association.

10         Section 3.  This act shall take effect July 1, 2005.

11  

12            *****************************************

13                          SENATE SUMMARY

14    Revises various provisions relating to health insurance
      and the Florida Health Insurance Plan, including
15    definitions, eligibility requirements, revenue sources,
      and provider reimbursement. (See bill for details.)
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                                  17

CODING: Words stricken are deletions; words underlined are additions.

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