December 08, 2019
Print This PagePrint This Page

  *
Session:
Bill #:
Session:
Chamber: View Search Tips
Search Term:
Year: View Search Tips
Search Term:
Senate Bill 2910

Senate Bill sb2910

CODING: Words stricken are deletions; words underlined are additions.
    Florida Senate - 2004                                  SB 2910

    By Senator Peaden





    2-1470-04

  1                      A bill to be entitled

  2         An act relating to health care; creating the

  3         Florida Health Insurance Plan to provide health

  4         insurance for certain residents; providing for

  5         a board to supervise and control the plan;

  6         providing for a plan of operation to establish

  7         operating procedures; providing powers of the

  8         plan and of the board; providing for reports;

  9         providing liability of the plan; providing for

10         audits; prescribing eligibility requirements;

11         prohibiting unfair referrals to the plan;

12         providing for a plan administrator and its term

13         limits and duties; providing for funding the

14         plan; prescribing benefits; providing annual

15         and cumulative maximum benefits; providing for

16         tax exemption; creating the Small Employers

17         Access Program; prescribing eligibility

18         requirements; providing for administration of

19         the program; providing qualifications and

20         duties of insurers; providing for reports;

21         prescribing benefits; providing for an advisory

22         council; creating a Statewide Electronic

23         Medical Records Advisory Panel and providing

24         its powers and duties; amending s. 381.026,

25         F.S.; requiring disclosure of certain financial

26         information to patients by health care

27         facilities or providers; amending s. 395.301,

28         F.S.; requiring disclosure of certain financial

29         information to patients of licensed hospitals

30         and similar facilities; amending s. 408.909,

31         F.S.; redefining the term "health flex plan

                                  1

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






    Florida Senate - 2004                                  SB 2910
    2-1470-04




 1         entity"; revising guidelines for review of

 2         health flex plan applications; amending s.

 3         627.610, F.S.; revising applicability of

 4         provisions relating to health insurance policy

 5         and annuity contract forms; creating s.

 6         627.64101, F.S.; requiring certain insurers to

 7         make available coverage for disorders or

 8         conditions involving speech, language,

 9         swallowing, and hearing and hearing aid and

10         earmold benefits; creating s. 627.6421, F.S.;

11         requiring the offering of standardized

12         policies; amending s. 627.6487, F.S.;

13         redefining the term "eligible individual" for

14         purposes of guaranteed availability of

15         coverage; creating s. 627.66912, F.S.;

16         requiring certain insurers to make available

17         coverage for disorders or conditions involving

18         speech, language, swallowing, and hearing and

19         hearing aid and earmold benefits; amending s.

20         627.6699, F.S.; redefining the term "modified

21         community rating" for purposes of the Employee

22         Health Care Access Act; revising provisions

23         relating to premium rates; amending s. 636.003,

24         F.S.; redefining the term "prepaid limited

25         health service organization"; amending s.

26         641.31, F.S.; requiring certain health

27         maintenance organizations to make available

28         coverage for disorders or conditions involving

29         speech, language, swallowing, and hearing and

30         hearing aid and earmold benefits; providing

31         effective dates.

                                  2

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






    Florida Senate - 2004                                  SB 2910
    2-1470-04




 1  

 2         WHEREAS, the Legislature finds that 2.8 million

 3  Floridians do not have access to health insurance coverage,

 4  and

 5         WHEREAS, often this lack of health insurance coverage

 6  is because premiums are not affordable, and

 7         WHEREAS, the Legislature finds that many small

 8  employers are unable to provide health insurance to their

 9  employees because of rising health care premiums, and

10         WHEREAS, it is the intent of the Legislature to

11  stabilize Florida's health insurance markets and make them

12  more competitive, and

13         WHEREAS, it is the intent of the Legislature to provide

14  access to health coverage for more of Florida's small

15  employers, and

16         WHEREAS, it is the intent of the Legislature to provide

17  access to health coverage to Florida's uninsurables, and

18         WHEREAS, it is the intent of the Legislature to make

19  health insurance affordable by bringing about reductions in

20  costs to all of Florida's insureds, NOW, THEREFORE,

21  

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

23  

24         Section 1.  There is created the Florida Health

25  Insurance Plan.

26         (1)  DEFINITIONS.--As used in this section, the term:

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

28         (b)  "Governor" means the Governor of the State of

29  Florida.

30         (c)  "Office" means the Office of Insurance Regulation

31  of the Financial Services Commission.

                                  3

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






    Florida Senate - 2004                                  SB 2910
    2-1470-04




 1         (d)  "Dependent" means a resident spouse or resident

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

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

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

 5  disabled and dependent upon the parent.

 6         (e)  "Director" means the Director of the Office of

 7  Insurance Regulation.

 8         (f)  "Health insurance" means any hospital or medical

 9  expense incurred policy, health maintenance organization

10  subscriber contract pursuant to chapter 641, Florida Statutes,

11  or any other health care plan or arrangement that pays for or

12  furnishes medical or health care services whether by insurance

13  or otherwise. The term does not include short term, accident,

14  dental-only, vision-only, fixed indemnity, limited benefit or

15  credit insurance, coverage issued as a supplement to liability

16  insurance, insurance arising out of a workers' compensation or

17  similar law, automobile medical-payment insurance, or

18  insurance under which benefits are payable with or without

19  regard to fault and which is statutorily required to be

20  contained in any liability insurance policy or equivalent

21  self-insurance.

22         (g)  "Insurer" means any entity that provides health

23  insurance in this state. For purposes of this act, the term

24  includes an insurance company with a valid certificate in

25  accordance with chapter 624, Florida Statutes, or a health

26  maintenance organization with a valid certificate of authority

27  in accordance with parts I and III of chapter 641, Florida

28  Statutes; prepaid health clinic authorized to transact

29  business in this state pursuant to part II of chapter 641,

30  Florida Statutes; multiple employer welfare arrangement

31  authorized to transact business in this state pursuant to

                                  4

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






    Florida Senate - 2004                                  SB 2910
    2-1470-04




 1  sections 624.436-624.45, Florida Statutes; or fraternal

 2  benefit society providing health benefits to its members as

 3  authorized pursuant to chapter 632, Florida Statutes.

 4         (h)  "Medicare" means coverage under both Parts A and B

 5  of Title XVIII of the Social Security Act, 42 U.S.C. 1395 et

 6  seq., as amended.

 7         (i)  "Medicaid" means coverage under Titles XIX and XXI

 8  of the Social Security Act.

 9         (j)  "Participating insurer" means any insurer

10  providing health insurance to residents of this state.

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

12  institution, organization, or person that furnishes health

13  care services and is licensed or otherwise authorized to

14  practice in this state.

15         (l)  "Plan" means the Florida Health Insurance Plan as

16  created in this section.

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

18  and operating rules and procedures adopted by the board

19  pursuant to this act.

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

21  legally domiciled in this state for a period of at least 30

22  days.

23         (2)  OPERATION OF THE PLAN.--

24         (a)  The plan shall be managed during full

25  implementation of this act by a three-member team appointed by

26  the Governor. The director shall head the team.

27         (b)  Following full implementation, the plan shall

28  operate subject to the supervision and control of the board.

29  The board shall consist of the director or his or her

30  designated representative, who shall serve as a member of the

31  board and shall be its chairperson, and an additional eight

                                  5

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






    Florida Senate - 2004                                  SB 2910
    2-1470-04




 1  members appointed by the Governor. A majority of the board

 2  must be composed of individuals who are not representatives of

 3  insurers or health care providers.

 4         (c)  The initial board members shall be appointed as

 5  follows: one-third of the members to serve a term of 2 years

 6  each; one-third of the members to serve a term of 3 years

 7  each; and one-third of the members to serve a term of 4 years

 8  each. Subsequent board members shall serve for a term of 3

 9  years. A board member's term shall continue until his or her

10  successor is appointed.

11         (d)  Vacancies in the board shall be filled by the

12  Governor. Board members may be removed by the Governor for

13  cause.

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

15  as board members but shall be reimbursed for reasonable

16  expenses incurred in the necessary performance of their duties

17  in accordance with section 112.061, Florida Statutes.

18         (f)  The board shall submit to the Governor a plan of

19  operation for the plan and any amendments thereto necessary or

20  suitable to assure the fair, reasonable, and equitable

21  administration of the plan. The plan of operation shall ensure

22  that the plan qualifies to apply for any available funding

23  from the Federal Government which adds to the financial

24  viability of the plan. The plan of operation shall become

25  effective upon approval in writing by the Governor consistent

26  with the date on which the coverage under this act must be

27  made available. If the board fails to submit a suitable plan

28  of operation within 180 days after the appointment of the

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

30  suitable amendments to the plan of operation, the office shall

31  adopt and promulgate such rules as are necessary or advisable

                                  6

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






    Florida Senate - 2004                                  SB 2910
    2-1470-04




 1  to effectuate this section. Such rules shall continue in force

 2  until modified by the office or superseded by a plan of

 3  operation submitted by the board and approved by the Governor.

 4         (3)  PLAN OF OPERATION.--The plan of operation shall:

 5         (a)  Establish procedures for operation of the plan.

 6         (b)  Establish procedures for selecting an

 7  administrator in accordance with subsection (13).

 8         (c)  Establish procedures to create a fund, under

 9  management of the board, for administrative expenses.

10         (d)  Establish procedures for the handling, accounting,

11  and auditing of assets, moneys, and claims of the plan and the

12  plan administrator.

13         (e)  Develop and implement a program to publicize the

14  existence of the plan, the eligibility requirements, and

15  procedures for enrollment and to maintain public awareness of

16  the plan.

17         (f)  Establish procedures under which applicants and

18  participants may have grievances reviewed by a grievance

19  committee appointed by the board. The grievances shall be

20  reported to the board after completion of the review, with the

21  committee's recommendation for grievance resolution. The board

22  shall retain all written grievances regarding the plan for at

23  least 3 years.

24         (g)  Provide for other matters as are necessary and

25  proper for the execution of the board's powers, duties, and

26  obligations under this act.

27         (4)  POWERS OF THE PLAN.--The plan shall have the

28  general powers and authority granted under the laws of this

29  state to health insurers and, in addition thereto, the

30  specific authority to:

31  

                                  7

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






    Florida Senate - 2004                                  SB 2910
    2-1470-04




 1         (a)  Enter into such contracts as are necessary or

 2  proper to carry out the provisions and purposes of this act,

 3  including the authority, with the approval of the Governor, to

 4  enter into contracts with similar plans of other states for

 5  the joint performance of common administrative functions, or

 6  with persons or other organizations for the performance of

 7  administrative functions;

 8         (b)  Take any legal actions necessary or proper to

 9  recover or collect assessments due the plan;

10         (c)  Take such legal action as is necessary:

11         1.  To avoid payment of improper claims against the

12  plan or the coverage provided by or through the plan;

13         2.  To recover any amounts erroneously or improperly

14  paid by the plan;

15         3.  To recover any amounts paid by the plan as a result

16  of mistake of fact or law; or

17         4.  To recover other amounts due the plan.

18         (d)  Establish and modify as appropriate, rates, rate

19  schedules, rate adjustments, expense allowances, agents'

20  referral fees, claim reserve formulas, and any other actuarial

21  functions appropriate to the operation of the plan. Rates and

22  rate schedules may be adjusted for appropriate factors such as

23  age, sex, and geographic variation in claim cost and shall

24  take into consideration appropriate factors in accordance with

25  established actuarial and underwriting practices;

26         (e)  Issue policies of insurance in accordance with the

27  requirements of this act;

28         (f)  Appoint appropriate legal, actuarial, investment,

29  and other committees as necessary to provide technical

30  assistance in the operation of the plan, develop and educate

31  its policyholders regarding health savings accounts (HSAs),

                                  8

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






    Florida Senate - 2004                                  SB 2910
    2-1470-04




 1  policy and contract design, and any other function within the

 2  authority of the plan;

 3         (g)  Borrow money to effect the purposes of the plan.

 4  Any notes or other evidence of indebtedness of the plan not in

 5  default shall be legal investments for insurers and may be

 6  carried as admitted assets;

 7         (h)  Employ and fix the compensation of employees;

 8         (i)  Prepare and distribute certificate of eligibility

 9  forms and enrollment instruction forms to insurance producers

10  and to the general public;

11         (j)  Provide for reinsurance of risks incurred by the

12  plan;

13         (k)  Provide for and employ cost containment measures

14  and requirements, including, but not limited to, preadmission

15  screening, second surgical opinion, concurrent utilization

16  review, and individual case management for the purpose of

17  making the plan more cost effective;

18         (l)  Design, use, contract, or otherwise arrange for

19  the delivery of cost effective health care services, including

20  establishing or contracting with preferred provider

21  organizations, health maintenance organizations, and other

22  limited network provider arrangements; and

23         (m)  Adopt such bylaws, policies, and procedures as are

24  necessary or convenient for the implementation of this act and

25  the operation of the plan.

26         (5)  INTERIM REPORT.--No later than December 1, 2004,

27  the Transition Team shall submit a report to the Governor, the

28  President of the Senate, and the Speaker of the House of

29  Representatives, which includes an independent actuarial study

30  to determine, including, but not be limited to, the following

31  issues:

                                  9

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






    Florida Senate - 2004                                  SB 2910
    2-1470-04




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

 2  the small group insurance market on premiums paid by insureds.

 3  This shall include an estimate of the total anticipated

 4  aggregate savings for all small employers in the state.

 5         2.  How many people the pool could reasonably cover at

 6  various funding levels and specifically how many people the

 7  pool could cover at each of those funding levels.

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

 9  for the anticipated deficits of the pool.

10         (6)  ANNUAL REPORT.--The board shall make an annual

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

12  Speaker of the House of Representatives. The report shall

13  summarize the activities of the plan in the preceding calendar

14  year, including the net written and earned premiums, plan

15  enrollment, the expense of administration, and the paid and

16  incurred losses.

17         (7)  EVALUATION REPORT.--The board shall report to the

18  Governor, the President of the Senate, and the Speaker of the

19  House of Representatives 3 years after commencement of

20  operations of the plan whether or nor the plan has met the

21  intent of this act.

22         (8)  LIABILITY OF THE PLAN.--Neither the board nor its

23  employees shall be liable for any obligations of the plan. No

24  member or employee of the board is liable, and no cause of

25  action of any nature may arise against them, for any act or

26  omission related to the performance of their powers and duties

27  under this act, unless such act or omission constitutes

28  willful or wanton misconduct. The board may provide in its

29  bylaws or rules for indemnification of, and legal

30  representation for, its members and employees.

31  

                                  10

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






    Florida Senate - 2004                                  SB 2910
    2-1470-04




 1         (9)  AUDITED FINANCIAL STATEMENT.--No later than June 1

 2  following the close of each calendar year the plan shall

 3  submit to the Governor an audited financial statement,

 4  prepared in accordance with Statutory Accounting Principles as

 5  adopted by the National Association of Insurance

 6  Commissioners.

 7         (10)  ADDITIONAL POWERS OF THE BOARD.--The board is

 8  authorized to open up the plan to all eligible individual

 9  persons as defined in subsection (11) for whom the estimated

10  loss ratio is 100 percent or less. The Governor may establish

11  additional powers and duties of the board to implement this

12  act.

13         (11)  ELIGIBILITY.--

14         (a)  Any individual person who is and continues to be a

15  resident of this state is eligible for plan coverage if

16  evidence is provided of:

17         1.  A notice of rejection or refusal to issue

18  substantially similar insurance for health reasons by one

19  insurer;

20         2.  A refusal by an insurer to issue insurance except

21  at a rate exceeding the plan rate. A rejection or refusal by

22  an insurer offering only stoploss, excess of loss, or

23  reinsurance coverage with respect to the applicant is not

24  sufficient evidence under this paragraph; or

25         3.  That person's eligibility for individual coverage

26  in accordance with the Health Insurance Accountability and

27  Portability Act (HIPAA).

28         (b)  The board may promulgate a list of medical or

29  health conditions for which a person shall be eligible for

30  plan coverage without applying for health insurance pursuant

31  to paragraph (a). Persons who can demonstrate the existence or

                                  11

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






    Florida Senate - 2004                                  SB 2910
    2-1470-04




 1  history of any medical or health conditions on the list

 2  promulgated by the board shall not be required to provide the

 3  evidence specified in paragraph (a). The list shall be

 4  effective on the first day of the operation of the plan and

 5  may be amended as appropriate.

 6         (c)  Each resident dependent of a person who is

 7  eligible for plan coverage is also eligible for plan coverage.

 8         (d)  A person is not eligible for coverage under the

 9  plan if:

10         1.  The person has or obtains health insurance coverage

11  substantially similar to or more comprehensive than a plan

12  policy, or would be eligible to obtain coverage, unless a

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

14  person is satisfying any preexisting condition waiting period

15  under a plan policy, and may maintain plan coverage for the

16  period of time the person is satisfying a preexisting

17  condition waiting period under another health insurance policy

18  intended to replace the plan policy;

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

20  care benefits under Medicaid or any other federal, state, or

21  local government program that provides health benefits;

22         3.  The person has previously terminated plan coverage

23  unless 12 months have lapsed since such termination;

24         4.  The plan has paid out $1 million in benefits on

25  behalf of the person;

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

27  institution; or

28         6.  The person's premiums are paid for or reimbursed

29  under any government-sponsored program or by any government

30  agency or health care provider, except as an otherwise

31  

                                  12

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






    Florida Senate - 2004                                  SB 2910
    2-1470-04




 1  qualifying full-time employee, or dependent thereof, of a

 2  government agency or health care provider.

 3         (e)  Coverage shall cease:

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

 5  this state;

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

 7         3.  Upon the death of the covered person;

 8         4.  On the date state law requires cancellation of the

 9  policy; or

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

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

12  of residence to which the person does not reply.

13         (f)  Except under the circumstances described in this

14  subsection, a person who ceases to meet the eligibility

15  requirements of this section may be terminated at the end of

16  the policy period for which the necessary premiums have been

17  paid.

18         (12)  UNFAIR REFERRAL TO PLAN.--It shall constitute an

19  unfair trade practice for the purposes of part IX of chapter

20  626, Florida Statutes, or section 641.3901, Florida Statutes,

21  for an insurer, health maintenance organization, insurance

22  agent, insurance broker, or third-party administrator to refer

23  an individual employee to the plan, or arrange for an

24  individual employee to apply to the plan, for the purpose of

25  separating that employee from group health insurance coverage

26  provided in connection with the employee's employment.

27         (13)  PLAN ADMINISTRATOR.--The board shall select

28  through a competitive bidding process a plan administrator to

29  administer the plan. The board shall evaluate bids submitted

30  based on criteria established by the board, which shall

31  include:

                                  13

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






    Florida Senate - 2004                                  SB 2910
    2-1470-04




 1         (a)  The plan administrator's proven ability to handle

 2  health insurance coverage to individuals;

 3         (b)  The efficiency and timeliness of the plan

 4  administrator's claim-processing procedures;

 5         (c)  An estimate of total charges for administering the

 6  plan;

 7         (d)  The plan administrator's ability to apply

 8  effective cost containment programs and procedures and to

 9  administer the plan in a cost efficient manner; and

10         (e)  The financial condition and stability of the plan

11  administrator.

12  

13  The administrator shall be either an insurer, a health

14  maintenance organization or a third-party administrator, or

15  another organization duly authorized pursuant to the Florida

16  Insurance Code.

17         (14)  ADMINISTRATOR TERM LIMITS.--The plan

18  administrator shall serve for a period specified in the

19  contract between the plan and the plan administrator, subject

20  to removal for cause and subject to any terms, conditions, and

21  limitations of the contract between the plan and the plan

22  administrator. At least 1 year before the expiration of each

23  period of service by a plan administrator, the board shall

24  invite eligible entities, including the current plan

25  administrator, to submit bids to serve as the plan

26  administrator. Selection of the plan administrator for each

27  succeeding period shall be made at least 6 months before the

28  end of the current period.

29         (15)  DUTIES OF THE PLAN ADMINISTRATOR.--The plan

30  administrator shall perform such functions relating to the

31  plan as are assigned to it, including, but not limited to:

                                  14

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






    Florida Senate - 2004                                  SB 2910
    2-1470-04




 1         (a)  Determination of eligibility;

 2         (b)  Payment of claims;

 3         (c)  Establishment of a premium billing procedure for

 4  collection of premiums from persons covered under the plan;

 5  and

 6         (d)  Other necessary functions to assure timely payment

 7  of benefits to covered persons under the plan.

 8  

 9  The plan administer shall submit regular reports to the board

10  regarding the operation of the plan. The frequency, content,

11  and form of the reports shall be specified in the contract

12  between the board and the plan administrator. On March 1

13  following the close of each calendar year, the plan

14  administrator shall determine net written and earned premiums,

15  the expense of administration, and the paid and incurred

16  losses for the year and report this information to the board

17  and the Governor on a form prescribed by the Governor.

18         (16)  PAYMENT OF THE PLAN ADMINISTRATOR.--The plan

19  administrator shall be paid as provided in the contract

20  between the plan and the plan administrator.

21         (17)  FUNDING OF THE PLAN.--

22         (a)  Premiums.--

23         1.  The plan shall establish premium rates for plan

24  coverage as provided in subparagraph 2. Separate schedules of

25  premium rates based on age, sex, and geographical location may

26  apply for individual risks. Premium rates and schedules shall

27  be submitted to the office for approval before use.

28         2.  The plan, in conjunction with the office, shall

29  determine a standard risk rate by considering the premium

30  rates charged by other insurers offering health insurance

31  coverage to individuals. The standard risk rate shall be

                                  15

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






    Florida Senate - 2004                                  SB 2910
    2-1470-04




 1  established using reasonable actuarial techniques and shall

 2  reflect anticipated experience and expenses for such coverage.

 3  Initial rates for plan coverage shall not be less than 200

 4  percent of rates established as applicable for individual

 5  standard risks. The plan shall also develop a sliding scale

 6  premium surcharge based upon the insured's income. Subject to

 7  the limits provided in this paragraph, subsequent rates shall

 8  be established to provide fully for the expected costs of

 9  claims, including recovery of prior losses, expenses of

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

11  cost factors subject to the limitations described herein.

12         (b)  Sources of additional revenue.--Any deficit

13  incurred by the plan shall be funded through amounts

14  appropriated by the Legislature from general revenue sources,

15  including, but not limited to, a portion of the annual growth

16  in existing net insurance premium taxes. The board shall

17  operate the plan in such a manner that the estimated cost of

18  providing health insurance during any fiscal year will not

19  exceed total income the plan expects to receive from policy

20  premiums and funds appropriated by the Legislature, including

21  any interest on investments. After determining the amount of

22  funds appropriated to it for a fiscal year, the board shall

23  estimate the number of new policies it believes the plan has

24  the financial capacity to insure during that year so that

25  costs do not exceed income. The board shall take steps

26  necessary to assure that plan enrollment does not exceed the

27  number of residents it has estimated it has the financial

28  capacity to insure.

29         (18)  BENEFITS.--

30         (a)  The benefits provided shall be the same as the

31  standard and basic plans for small employers as outlined in

                                  16

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






    Florida Senate - 2004                                  SB 2910
    2-1470-04




 1  section 627.6699, Florida Statutes. The board may also

 2  establish an option of alternative coverage such as

 3  catastrophic coverage that includes a minimum level of primary

 4  care coverage.

 5         (b)  In establishing the plan coverage, the board shall

 6  take into consideration the levels of health insurance

 7  provided in the state and such medical economic factors as are

 8  deemed appropriate and adopt benefit levels, deductibles,

 9  co-payments, coinsurance factors, exclusions and limitations

10  determined to be generally reflective of and commensurate with

11  health insurance provided through a representative number of

12  large employers in the state.

13         (c)  The board may adjust any deductibles and

14  coinsurance factors annually according to the Medical

15  Component of the Consumer Price Index.

16         (d)1.  Plan coverage shall exclude charges or expenses

17  incurred during the first 6 months following the effective

18  date of coverage for any condition for which medical advice,

19  care, or treatment was recommended or received during the

20  6-month period immediately preceding the effective date of

21  coverage.

22         2.  Such preexisting condition exclusions shall be

23  waived to the extent that similar exclusions, if any, have

24  been satisfied under any prior health insurance coverage that

25  was involuntarily terminated, provided that application for

26  pool coverage is made not later than 63 days following such

27  involuntary termination; and, in such case, coverage in the

28  plan shall be effective from the date on which such prior

29  coverage was terminated and the applicant is not eligible for

30  continuation or conversion rights that would provide coverage

31  substantially similar to plan coverage.

                                  17

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






    Florida Senate - 2004                                  SB 2910
    2-1470-04




 1         (19)  NONDUPLICATION OF BENEFITS.--

 2         (a)  The plan shall be payer of last resort of benefits

 3  whenever any other benefit or source of third-party payment is

 4  available. Benefits otherwise payable under plan coverage

 5  shall be reduced by all amounts paid or payable through any

 6  other health insurance and by all hospital and medical expense

 7  benefits paid or payable under any workers' compensation

 8  coverage, automobile medical payment or liability insurance

 9  whether provided on the basis of fault or nonfault, and by any

10  hospital or medical benefits paid or payable under or provided

11  pursuant to any state or federal law or program.

12         (b)  The plan shall have a cause of action against an

13  eligible person for the recovery of the amount of benefits

14  paid that are not for covered expenses. Benefits due from the

15  plan may be reduced or refused as a set-off against any amount

16  recoverable under this paragraph.

17         (20)  ANNUAL AND MAXIMUM BENEFITS.--Maximum benefits

18  shall be limited to $75,000 annually and $1 million per

19  lifetime.

20         (21)  TAXATION.--The plan established pursuant to this

21  act shall be exempt from any and all taxes. The plan shall

22  apply for federal tax exemption.

23         Section 2.  There is created The Small Employers Access

24  Program.

25         (1)  DEFINITIONS.--As used in this section, the term:

26         (a)  "Office" means the Office of Insurance Regulation

27  of the Department of Financial Services.

28         (b)  "Insurer" means any entity that provides health

29  insurance in this state. For purposes of this section, the

30  term includes an insurance company holding a certificate of

31  authority pursuant to chapter 624, Florida Statutes, or a

                                  18

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






    Florida Senate - 2004                                  SB 2910
    2-1470-04




 1  health maintenance organization holding a certificate of

 2  authority pursuant to chapter 641, Florida Statutes, which

 3  qualifies to provide coverage to small employer groups

 4  pursuant to section 627.6699, Florida Statutes.

 5         (c)  "Participating insurer" means any insurer

 6  providing health insurance to small employers which has been

 7  selected by the office in accordance with this section for its

 8  designated region.

 9         (d)  "Program" means the Small Employer Access Program

10  created by this section.

11         (e)  "Fair Commission" means a commission structure

12  determined by the office and the insurers, which will carry

13  out the intent of this section.

14         (2)  ELIGIBILITY.--

15         (a)  Any small employer group up to 25 employees may

16  participate.

17         (b)  Each dependent of a person eligible for coverage

18  is also eligible.

19         (c)  Any municipality, county, school district, or

20  hospital located in a rural community as defined in section

21  288.0656(2)(b), Florida Statutes.

22         (d)  A small employer group that ceases to meet the

23  eligibility requirements of this section may be terminated at

24  the end of the policy period for which the necessary premiums

25  have been paid.

26         (3)  ADMINISTRATION.--The office shall by competitive

27  bid, in accordance with current state law, select an insurer

28  to provide coverage to small employers within established

29  geographical areas of this state. The office may develop

30  exclusive regions for the program similar to those used by the

31  Healthy Kids Corporation. However, the office is not precluded

                                  19

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






    Florida Senate - 2004                                  SB 2910
    2-1470-04




 1  from developing, in conjunction with insurers, regions

 2  different from those used by the Healthy Kids Corporation if

 3  the office deems that such a region will carry out the

 4  intentions of this act. The office shall evaluate bids

 5  submitted based upon criteria established by the office, which

 6  shall include, but are not limited to:

 7         (a)  The insurer's proven ability to provide health

 8  insurance coverage to small employer groups;

 9         (b)  The efficiency and timeliness of the insurer's

10  claim-processing procedures;

11         (c)  The insurer's ability to apply effective cost

12  containment programs and procedures and to administer the

13  program in a cost-efficient manner; and

14         (d)  The financial condition and stability of the

15  insurer. The office may use any financial information

16  available to it through its regulatory duties to make this

17  evaluation.

18         (4)  INSURER QUALIFICATIONS.--The insurer shall be a

19  duly authorized insurer or health maintenance organization.

20         (5)  DUTIES OF THE INSURER.--The insurer shall develop

21  and implement a program to publicize the existence of the

22  program, the eligibility requirements, procedures for

23  enrollment, and

24         (a)  Maintain employer awareness of the program.

25         (b)  Demonstrate the ability to use delivery of cost

26  effective health care services.

27         (c)  Encourage, educate, advise, and administer the

28  effective use of health savings accounts (HSAs) by covered

29  employees and dependents.

30         (d)  Serve for a period specified in the contract

31  between the office and the insurer subject to removal for

                                  20

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






    Florida Senate - 2004                                  SB 2910
    2-1470-04




 1  cause and subject to any terms, conditions, and limitations of

 2  the contract between the office and the insurer as are

 3  specified in the request for proposal.

 4         (6)  CONTRACT TERM.--The contract term shall not exceed

 5  3 years. At least 6 months before the expiration of each

 6  contract period, the office shall invite eligible entities,

 7  including the current insurer, to submit bids to serve as the

 8  insurer for a designated geographic area. Selection of the

 9  insurer for the succeeding period must be made at least 3

10  months before the end of the current period.

11         (7)  INSURER REPORTING REQUIREMENTS.--On March 1,

12  following the close of each calendar year, the insurer shall

13  determine net written and earned premiums, the expense of

14  administration, and the paid and incurred losses for the year

15  and report this information to the office on a form prescribed

16  by the office.

17         (8)  APPLICATION REQUIREMENTS.--The insurer shall

18  permit or allow any licensed and duly appointed health

19  insurance agent residing in the designated region to submit

20  applications for coverage, and such agent shall be paid a fair

21  commission if coverage is written. The agency must be

22  appointed to at least one insurer.

23         (9)  BENEFITS.--The benefits provided shall be the same

24  as the standard and basic plans for small employers as

25  outlined in section 627.6699, Florida Statutes, except that

26  the insurer, with the approval of the office, may also

27  establish an option of alternative coverage such as

28  catastrophic coverage that includes a minimum level of primary

29  care coverage or other such benefit plan, which will carry out

30  the intent of this act.

31  

                                  21

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






    Florida Senate - 2004                                  SB 2910
    2-1470-04




 1         (10)  ANNUAL REPORTING.--The office shall make an

 2  annual report to the Governor, the President of the Senate,

 3  and the Speaker of the House of Representatives. The report

 4  shall summarize the activities of the program in the preceding

 5  calendar year, including the net written and earned premiums,

 6  program enrollment, the expense of administration, and the

 7  paid and incurred losses. The report shall be submitted no

 8  later than March 15 following the close of the prior calendar

 9  year.

10         (11)  ADVISORY COUNCIL.--The office, in conjunction

11  with representatives of each of the regional insurers,

12  provider groups, and small employer representatives, and a

13  person designated by the Governor shall meet at least annually

14  to review the operations of the program, suggest improvements,

15  and recommend incentives to the Governor and the Legislature

16  which will encourage employer participation in the program.

17         Section 3.  There is created a Statewide Electronic

18  Medical Records Advisory Panel to serve as a body of experts

19  to guide the Agency for Health Care Administration in the

20  development of policy related to electronic medical records

21  and the technology required for sharing clinical information

22  among caregivers.

23         (1)  The agency shall provide staff support to the

24  panel and may enter into contracts as are necessary or proper

25  to carry out the provisions and purposes of this act,

26  assisting the advisory panel in the creation of the Electronic

27  Medical Records System.

28         (2)  The advisory panel shall be appointed by the

29  Governor.

30         (3)  The panel shall meet at least quarterly and advise

31  the Governor, the Legislature, and the agency regarding:

                                  22

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






    Florida Senate - 2004                                  SB 2910
    2-1470-04




 1         (a)  Public and private sector initiatives related to

 2  electronic medical records and communication systems for the

 3  sharing of clinical information among caregivers;

 4         (b)  Regulatory barriers that interfere with the

 5  sharing of clinical information among caregivers;

 6         (c)  Investment incentives to promote the use of

 7  recommended technologies by health care providers;

 8         (d)  Educational strategies to promote the use of

 9  recommended technologies by health care providers; and

10         (e)  Standards for public access to facilitate

11  transparency in pricing, costs, and quality.

12         (4)  By November 30, 2004, and annually thereafter, the

13  advisory panel shall provide to the Office of the Governor,

14  the President of the Senate, and the Speaker of the House of

15  Representatives, a status report to include any

16  recommendations and an implementation plan to include, but not

17  limited to, estimated costs, capital investment requirements,

18  recommended investment incentives, initial committed provider

19  participation by region, standards of functionality and

20  features, marketing plan, and implementation schedules for key

21  components.

22         (5)  Members of the advisory panel shall serve without

23  compensation but shall be entitled to receive reimbursement

24  for per diem and travel expenses as provided in section

25  112.061, Florida Statutes.

26         (6)  The sum of $2 million is appropriated from the

27  General Revenue Fund to the Agency for Health Care

28  Administration for funding activities relative to the

29  Statewide Electronic Advisory Panel.

30         (7)  Unless otherwise reenacted by the Legislature, the

31  advisory panel is abolished effective July 1, 2007.

                                  23

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






    Florida Senate - 2004                                  SB 2910
    2-1470-04




 1         Section 4.  Paragraph (c) of subsection (4) and

 2  subsection (6) of section 381.026, Florida Statutes, are

 3  amended to read:

 4         381.026  Florida Patient's Bill of Rights and

 5  Responsibilities.--

 6         (4)  RIGHTS OF PATIENTS.--Each health care facility or

 7  provider shall observe the following standards:

 8         (c)  Financial information and disclosure.--

 9         1.  A patient has the right to be given, upon request,

10  by the responsible provider, his or her designee, or a

11  representative of the health care facility full information

12  and necessary counseling on the availability of known

13  financial resources for the patient's health care.

14         2.  A health care provider or a health care facility

15  shall, upon request, disclose to each patient who is eligible

16  for Medicare, in advance of treatment, whether the health care

17  provider or the health care facility in which the patient is

18  receiving medical services accepts assignment under Medicare

19  reimbursement as payment in full for medical services and

20  treatment rendered in the health care provider's office or

21  health care facility.

22         3.  A health care provider or a health care facility

23  shall, upon request, furnish a patient, prior to provision of

24  medical services, a reasonable estimate of charges for such

25  services.  Such reasonable estimate shall not preclude the

26  health care provider or health care facility from exceeding

27  the estimate or making additional charges based on changes in

28  the patient's condition or treatment needs.

29         4.  Each licensed facility not operated by the state

30  shall make available to the public on its Internet website or

31  by other electronic means package prices for each of the top

                                  24

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






    Florida Senate - 2004                                  SB 2910
    2-1470-04




 1  50 most used elective inpatient and outpatient procedures. The

 2  package pricing shall include all hospital-related services

 3  and shall include separate estimates of costs for professional

 4  fees charged by independent contractor physicians or physician

 5  groups. The licensed facility shall also make available to the

 6  public on its Internet website or by other electronic means

 7  each of the top 50 most used inpatient and outpatient

 8  procedures. Such list shall be updated quarterly. The facility

 9  shall place a notice in the reception areas that such

10  information is available electronically and the website

11  address. The licensed facility may indicate that the package

12  pricing is based on a compilation of charges for the average

13  patient and that each patient's bill may vary from the average

14  depending upon the severity of illness and individual

15  resources consumed. The licensed facility may also indicate

16  that the package pricing is negotiable based upon the

17  patient's health plan and the ability to pay. The agency shall

18  develop rules for implementation of a uniform mechanism for

19  reporting this information on the facility's website.

20         5.4.  A patient has the right to receive a copy of an

21  itemized bill upon request.  A patient has a right to be given

22  an explanation of charges upon request.

23         (6)  SUMMARY OF RIGHTS AND RESPONSIBILITIES.--Any

24  health care provider who treats a patient in an office or any

25  health care facility licensed under chapter 395 that provides

26  emergency services and care or outpatient services and care to

27  a patient, or admits and treats a patient, shall adopt and

28  make available to the patient, in writing, a statement of the

29  rights and responsibilities of patients, including the

30  following:

31  

                                  25

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






    Florida Senate - 2004                                  SB 2910
    2-1470-04




 1              SUMMARY OF THE FLORIDA PATIENT'S BILL

 2                  OF RIGHTS AND RESPONSIBILITIES

 3  

 4         Florida law requires that your health care provider or

 5  health care facility recognize your rights while you are

 6  receiving medical care and that you respect the health care

 7  provider's or health care facility's right to expect certain

 8  behavior on the part of patients.  You may request a copy of

 9  the full text of this law from your health care provider or

10  health care facility.  A summary of your rights and

11  responsibilities follows:

12         A patient has the right to be treated with courtesy and

13  respect, with appreciation of his or her individual dignity,

14  and with protection of his or her need for privacy.

15         A patient has the right to a prompt and reasonable

16  response to questions and requests.

17         A patient has the right to know who is providing

18  medical services and who is responsible for his or her care.

19         A patient has the right to know what patient support

20  services are available, including whether an interpreter is

21  available if he or she does not speak English.

22         A patient has the right to know what rules and

23  regulations apply to his or her conduct.

24         A patient has the right to be given by the health care

25  provider information concerning diagnosis, planned course of

26  treatment, alternatives, risks, and prognosis.

27         A patient has the right to refuse any treatment, except

28  as otherwise provided by law.

29         A patient has the right to be given, upon request, full

30  information and necessary counseling on the availability of

31  known financial resources for his or her care.

                                  26

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






    Florida Senate - 2004                                  SB 2910
    2-1470-04




 1         A patient who is eligible for Medicare has the right to

 2  know, upon request and in advance of treatment, whether the

 3  health care provider or health care facility accepts the

 4  Medicare assignment rate.

 5         A patient has the right to receive, upon request, prior

 6  to treatment, a reasonable estimate of charges for medical

 7  care.

 8         A patient has the right to receive, upon request, prior

 9  to treatment, a reasonable estimate of charges for the

10  proposed service.

11         A patient has the right to receive a copy of a

12  reasonably clear and understandable, itemized bill and, upon

13  request, to have the charges explained.

14         A patient has the right to impartial access to medical

15  treatment or accommodations, regardless of race, national

16  origin, religion, handicap, or source of payment.

17         A patient has the right to treatment for any emergency

18  medical condition that will deteriorate from failure to

19  provide treatment.

20         A patient has the right to know if medical treatment is

21  for purposes of experimental research and to give his or her

22  consent or refusal to participate in such experimental

23  research.

24         A patient has the right to express grievances regarding

25  any violation of his or her rights, as stated in Florida law,

26  through the grievance procedure of the health care provider or

27  health care facility which served him or her and to the

28  appropriate state licensing agency.

29         A patient is responsible for providing to the health

30  care provider, to the best of his or her knowledge, accurate

31  and complete information about present complaints, past

                                  27

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






    Florida Senate - 2004                                  SB 2910
    2-1470-04




 1  illnesses, hospitalizations, medications, and other matters

 2  relating to his or her health.

 3         A patient is responsible for reporting unexpected

 4  changes in his or her condition to the health care provider.

 5         A patient is responsible for reporting to the health

 6  care provider whether he or she comprehends a contemplated

 7  course of action and what is expected of him or her.

 8         A patient is responsible for following the treatment

 9  plan recommended by the health care provider.

10         A patient is responsible for keeping appointments and,

11  when he or she is unable to do so for any reason, for

12  notifying the health care provider or health care facility.

13         A patient is responsible for his or her actions if he

14  or she refuses treatment or does not follow the health care

15  provider's instructions.

16         A patient is responsible for assuring that the

17  financial obligations of his or her health care are fulfilled

18  as promptly as possible.

19         A patient is responsible for following health care

20  facility rules and regulations affecting patient care and

21  conduct.

22         Section 5.  Subsections (7) and (8) are added to

23  section 395.301, Florida Statutes, to read:

24         395.301  Itemized patient bill; form and content

25  prescribed by the agency.--

26         (7)  Each licensed facility not operated by the state

27  shall make available to the public on its Internet website or

28  by other electronic means package prices for each of the top

29  50 most used elective inpatient and outpatient procedures. The

30  package pricing shall include all hospital-related services

31  and shall include separate estimates of costs for professional

                                  28

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






    Florida Senate - 2004                                  SB 2910
    2-1470-04




 1  fees charged by independent contractor physicians or physician

 2  groups. The licensed facility shall also make available to the

 3  public on its Internet website or by other electronic means

 4  the top 50 most used procedures in both the inpatient and

 5  outpatient settings. The list shall be updated quarterly. The

 6  facility shall place a notice in the reception areas that such

 7  information is available electronically and the website

 8  address. The licensed facility may indicate that the package

 9  pricing is based on a compilation of charges for the average

10  patient and that each patient's bill may vary from the average

11  depending upon the severity of illness and individual

12  resources consumed. The licensed facility may also indicate

13  that the package pricing is negotiable based upon the

14  patient's health plan and the ability to pay. The agency shall

15  develop rules for implementation of a uniform mechanism for

16  reporting this information on the facility's website.

17         (8)  Each licensed facility not operated by the state

18  shall, upon request of a prospective patient prior to the

19  provision of medical services, provide a reasonable estimate

20  of charges for the proposed service. Such estimate shall not

21  preclude the actual charges from exceeding the estimate based

22  on changes in the patient's medical condition or the treatment

23  needs of the patient as determined by the attending and

24  consulting physicians.

25         Section 6.  Paragraph (f) of subsection (2) and

26  subsections (3) and (9) of section 408.909, Florida Statutes,

27  are amended to read:

28         408.909  Health flex plans.--

29         (2)  DEFINITIONS.--As used in this section, the term:

30         (f)  "Health flex plan entity" means a health insurer,

31  health maintenance organization,

                                  29

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






    Florida Senate - 2004                                  SB 2910
    2-1470-04




 1  health-care-provider-sponsored organization, local government,

 2  health care district, or other public or private

 3  community-based organization, or public-private partnership

 4  that develops and implements an approved health flex plan and

 5  is responsible for administering the health flex plan and

 6  paying all claims for health flex plan coverage by enrollees

 7  of the health flex plan.

 8         (3)  PILOT PROGRAM.--The agency and the office shall

 9  each approve or disapprove health flex plans that provide

10  health care coverage for eligible participants who reside in

11  the three areas of the state that have the highest number of

12  uninsured persons, as identified in the Florida Health

13  Insurance Study conducted by the agency and in Indian River

14  County. A health flex plan may limit or exclude benefits

15  otherwise required by law for insurers offering coverage in

16  this state, may cap the total amount of claims paid per year

17  per enrollee, may limit the number of enrollees, or may take

18  any combination of those actions.

19         (a)  The agency shall develop guidelines for the review

20  of applications for health flex plans and shall disapprove or

21  withdraw approval of plans that do not meet or no longer meet

22  minimum standards for quality of care and access to care. The

23  agency shall ensure that the health flex plans follow

24  standardized grievance procedures similar to those required of

25  health maintenance organizations.

26         (b)  The office shall develop guidelines for the review

27  of health flex plan applications and provide regulatory

28  oversight of health flex plan advertisement and marketing

29  procedures. The office shall disapprove or shall withdraw

30  approval of plans that:

31  

                                  30

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






    Florida Senate - 2004                                  SB 2910
    2-1470-04




 1         1.  Contain any ambiguous, inconsistent, or misleading

 2  provisions or any exceptions or conditions that deceptively

 3  affect or limit the benefits purported to be assumed in the

 4  general coverage provided by the health flex plan;

 5         2.  Provide benefits that are unreasonable in relation

 6  to the premium charged or contain provisions that are unfair

 7  or inequitable or contrary to the public policy of this state,

 8  that encourage misrepresentation, or that result in unfair

 9  discrimination in sales practices; or

10         3.  Cannot demonstrate that the health flex plan is

11  financially sound and that the applicant is able to underwrite

12  or finance the health care coverage provided.

13         (c)  The agency and the Financial Services Commission

14  may adopt rules as needed to administer this section.

15         (9)  PROGRAM EVALUATION.--The agency and the office

16  shall evaluate the pilot program and its effect on the

17  entities that seek approval as health flex plans, on the

18  number of enrollees, and on the scope of the health care

19  coverage offered under a health flex plan; shall provide an

20  assessment of the health flex plans and their potential

21  applicability in other settings; shall use health flex plans

22  to gather more information to evaluate low-income consumer

23  driven benefit packages; and shall, by January 1, 2004,

24  jointly submit a report to the Governor, the President of the

25  Senate, and the Speaker of the House of Representatives.

26         Section 7.  Paragraph (a) of subsection (6) of section

27  627.610, Florida Statutes, is amended to read:

28         627.410  Filing, approval of forms.--

29         (6)(a)  An insurer shall not deliver or issue for

30  delivery or renew in this state any health insurance policy

31  form until it has filed with the office a copy of every

                                  31

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






    Florida Senate - 2004                                  SB 2910
    2-1470-04




 1  applicable rating manual, rating schedule, change in rating

 2  manual, and change in rating schedule; if rating manuals and

 3  rating schedules are not applicable, the insurer must file

 4  with the order applicable premium rates and any change in

 5  applicable premium rates. This paragraph does not apply to

 6  group health insurance policies, effectuated and delivered in

 7  this state, insuring groups of 26 51 or more persons, except

 8  for Medicare supplement insurance, long-term care insurance,

 9  and any coverage under which the increase in claim costs over

10  the lifetime of the contract due to advancing age or duration

11  is prefunded in the premium.

12         Section 8.  Section 627.64101, Florida Statutes, is

13  created to read:

14         627.64101  Optional coverage for speech, language,

15  swallowing, and hearing disorders.--

16         (1)  Insurers issuing individual health insurance

17  policies in this state shall make available to the

18  policyholder as part of the application for any such policy of

19  insurance, for an appropriate additional premium, the benefits

20  or levels of benefits specified in the December 1999 Florida

21  Medicaid Therapy Services Handbook for genetic or congenital

22  disorders or conditions involving speech, language,

23  swallowing, and hearing and a hearing aid and earmolds benefit

24  at the level of benefits specified in the January 2001 Florida

25  Medicaid Hearing Services Handbook.

26         (2)  This section does not apply to specified-accident,

27  specified-disease, hospital indemnity, limited benefit,

28  disability income, or long-term care insurance policies.

29         (3)  Such optional coverage is not required to be

30  offered when substantially similar benefits are included in

31  the policy of insurance issued to the policyholder.

                                  32

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






    Florida Senate - 2004                                  SB 2910
    2-1470-04




 1         (4)  This section does not require or prohibit the use

 2  of a provider network.

 3         (5)  This section does no prohibit an insurer from

 4  requiring prior authorization for the benefits under this

 5  section.

 6         Section 9.  Section 627.6421, Florida Statutes, is

 7  created to read:

 8         627.6421  Required standardized policy offering.--

 9         (1)  Beginning January 1, 2005, every authorized

10  insurer or health maintenance organization issuing a health

11  benefit plan as defined in s. 627.6699(3)(k) to individuals in

12  this state, including certificates of coverage offered to

13  individuals in this state as part of a group policy issued to

14  an association outside this state, must, as a condition of

15  transacting business in this state, offer to the prospective

16  individual insured or prospective subscriber a standard health

17  benefit plan and a basic health benefit plan as created

18  pursuant to s. 627.6699(12). Such health issuer shall offer a

19  standard health benefit plan or a basic health benefit plan to

20  every individual who meets the issuer's underwriting criteria,

21  agrees to make the required premium payments under such plan,

22  and agrees to satisfy the other provisions of the plan.

23         (2)  If an individual rejects, in writing, the standard

24  health benefit plan and the basic health benefit plan, the

25  insurer or health maintenance organization may offer the

26  individual any other policy or contract filed and approved by

27  the state for issuance to individuals.

28         Section 10.  Subsection (3) of section 627.6487,

29  Florida Statutes, is amended to read:

30         627.6487  Guaranteed availability of individual health

31  insurance coverage to eligible individuals.--

                                  33

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






    Florida Senate - 2004                                  SB 2910
    2-1470-04




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

 2  "eligible individual" means an individual:

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

 4  seeks coverage under this section, the aggregate of the

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

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

 7         2.a.  Whose most recent prior creditable coverage was

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

 9  or health insurance coverage offered in connection with any

10  such plan; or

11         b.  Whose most recent prior creditable coverage was

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

13  insurer or health maintenance organization, which coverage is

14  terminated due to the insurer or health maintenance

15  organization becoming insolvent or discontinuing the offering

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

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

18  of Florida of the insurer or health maintenance organization

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

20  Florida;

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

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

23  Public Health Service Act;

24         2.  A conversion policy or contract issued by an

25  authorized insurer or health maintenance organization under s.

26  627.6675 or s. 641.3921, respectively, offered to an

27  individual who is no longer eligible for coverage under either

28  an insured or self-insured employer plan;

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

30  Security Act; or

31  

                                  34

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






    Florida Senate - 2004                                  SB 2910
    2-1470-04




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

 2  successor program, and does not have other health insurance

 3  coverage; or

 4         5.  The Florida Health Insurance Plan as specified in

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

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

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

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

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

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

11  or person other than the individual;

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

13  continuation coverage under a COBRA continuation provision or

14  under s. 627.6692, elected such coverage; and

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

16  provision, has exhausted such continuation coverage under such

17  provision or program.

18         Section 11.  Section 627.66912, Florida Statutes, is

19  created to read:

20         627.66912  Optional coverage for speech, language,

21  swallowing, and hearing disorders.--

22         (1)  Insures issuing group health insurance policies in

23  this stage shall make available to the policyholder as part of

24  the application for any such policy of insurance, for an

25  appropriate additional premium, the benefits or levels of

26  benefits specified in the December 1999 Florida Medicaid

27  Therapy Services Handbook for genetic or congenital disorders

28  or conditions involving speech, language, swallowing, and

29  hearing and a hearing aid and earmolds benefits at the level

30  of benefit specified in the January 2001 Florida Medicaid

31  Hearing Services Handbook.

                                  35

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






    Florida Senate - 2004                                  SB 2910
    2-1470-04




 1         (2)  This ection does not apply to specified-accident,

 2  specified-disease, hospital indemnity, limited benefit,

 3  disability income, or long-term care insurance policies.

 4         (3)  Such optional coverage is not required to be

 5  offered when substantially similar benefits are included in

 6  the policy of insurance issued to the policyholder.

 7         (4)  This section does not require or prohibit the use

 8  of a provider network.

 9         (5)  This section does not prohibit an insurer from

10  requiring prior authorization for the benefits under this

11  section.

12         Section 12.  Paragraph (n) of subsection (3) and

13  paragraph (b) of subsection (6) of section 627.6699, Florida

14  Statutes, are amended to read:

15         627.6699  Employee Health Care Access Act.--

16         (3)  DEFINITIONS.--As used in this section, the term:

17         (n)  "Modified community rating" means a method used to

18  develop carrier premiums which spreads financial risk across a

19  large population; allows the use of separate rating factors

20  for age, gender, family composition, tobacco usage, and

21  geographic area as determined under paragraph (5)(j); and

22  allows adjustments for: claims experience, health status, or

23  duration of coverage as permitted under subparagraph (6)(b)5.;

24  and administrative and acquisition expenses as permitted under

25  subparagraph (6)(b)5.

26         (6)  RESTRICTIONS RELATING TO PREMIUM RATES.--

27         (b)  For all small employer health benefit plans that

28  are subject to this section and are issued by small employer

29  carriers on or after January 1, 1994, premium rates for health

30  benefit plans subject to this section are subject to the

31  following:

                                  36

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






    Florida Senate - 2004                                  SB 2910
    2-1470-04




 1         1.  Small employer carriers must use a modified

 2  community rating methodology in which the premium for each

 3  small employer must be determined solely on the basis of the

 4  eligible employee's and eligible dependent's gender, age,

 5  family composition, tobacco use, or geographic area as

 6  determined under paragraph (5)(j) and in which the premium may

 7  be adjusted as permitted by this paragraph.

 8         2.  Rating factors related to age, gender, family

 9  composition, tobacco use, or geographic location may be

10  developed by each carrier to reflect the carrier's experience.

11  The factors used by carriers are subject to office review and

12  approval.

13         3.  Small employer carriers may not modify the rate for

14  a small employer for 12 months from the initial issue date or

15  renewal date, unless the composition of the group changes or

16  benefits are changed. However, a small employer carrier may

17  modify the rate one time prior to 12 months after the initial

18  issue date for a small employer who enrolls under a previously

19  issued group policy that has a common anniversary date for all

20  employers covered under the policy if:

21         a.  The carrier discloses to the employer in a clear

22  and conspicuous manner the date of the first renewal and the

23  fact that the premium may increase on or after that date.

24         b.  The insurer demonstrates to the office that

25  efficiencies in administration are achieved and reflected in

26  the rates charged to small employers covered under the policy.

27         4.  A carrier may issue a group health insurance policy

28  to a small employer health alliance or other group association

29  with rates that reflect a premium credit for expense savings

30  attributable to administrative activities being performed by

31  the alliance or group association if such expense savings are

                                  37

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






    Florida Senate - 2004                                  SB 2910
    2-1470-04




 1  specifically documented in the insurer's rate filing and are

 2  approved by the office.  Any such credit may not be based on

 3  different morbidity assumptions or on any other factor related

 4  to the health status or claims experience of any person

 5  covered under the policy. Nothing in this subparagraph exempts

 6  an alliance or group association from licensure for any

 7  activities that require licensure under the insurance code. A

 8  carrier issuing a group health insurance policy to a small

 9  employer health alliance or other group association shall

10  allow any properly licensed and appointed agent of that

11  carrier to market and sell the small employer health alliance

12  or other group association policy. Such agent shall be paid

13  the usual and customary commission paid to any agent selling

14  the policy.

15         5.  Any adjustments in rates for claims experience,

16  health status, or duration of coverage may not be charged to

17  individual employees or dependents. For a small employer's

18  policy, such adjustments may not result in a rate for the

19  small employer which deviates more than 15 percent from the

20  carrier's approved rate. Any such adjustment must be applied

21  uniformly to the rates charged for all employees and

22  dependents of the small employer. A small employer carrier may

23  make an adjustment to a small employer's renewal premium, not

24  to exceed 10 percent annually, due to the claims experience,

25  health status, or duration of coverage of the employees or

26  dependents of the small employer. Semiannually, small group

27  carriers shall report information on forms adopted by rule by

28  the commission, to enable the office to monitor the

29  relationship of aggregate adjusted premiums actually charged

30  policyholders by each carrier to the premiums that would have

31  been charged by application of the carrier's approved modified

                                  38

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






    Florida Senate - 2004                                  SB 2910
    2-1470-04




 1  community rates. If the aggregate resulting from the

 2  application of such adjustment exceeds the premium that would

 3  have been charged by application of the approved modified

 4  community rate by 5 percent for the current reporting period,

 5  the carrier shall limit the application of such adjustments

 6  only to minus adjustments beginning not more than 60 days

 7  after the report is sent to the office. For any subsequent

 8  reporting period, if the total aggregate adjusted premium

 9  actually charged does not exceed the premium that would have

10  been charged by application of the approved modified community

11  rate by 5 percent, the carrier may apply both plus and minus

12  adjustments. A small employer carrier may provide a credit to

13  a small employer's premium based on administrative and

14  acquisition expense differences resulting from the size of the

15  group. Group size administrative and acquisition expense

16  factors may be developed by each carrier to reflect the

17  carrier's experience and are subject to office review and

18  approval.

19         6.  A small employer carrier rating methodology may

20  include separate rating categories for one dependent child,

21  for two dependent children, and for three or more dependent

22  children for family coverage of employees having a spouse and

23  dependent children or employees having dependent children

24  only. A small employer carrier may have fewer, but not

25  greater, numbers of categories for dependent children than

26  those specified in this subparagraph.

27         7.  Small employer carriers may not use a composite

28  rating methodology to rate a small employer with fewer than 10

29  employees. For the purposes of this subparagraph, a "composite

30  rating methodology" means a rating methodology that averages

31  

                                  39

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






    Florida Senate - 2004                                  SB 2910
    2-1470-04




 1  the impact of the rating factors for age and gender in the

 2  premiums charged to all of the employees of a small employer.

 3         8.a.  A carrier may separate the experience of small

 4  employer groups with less than 2 eligible employees from the

 5  experience of small employer groups with 2-50 eligible

 6  employees for purposes of determining an alternative modified

 7  community rating.

 8         b.  If a carrier separates the experience of small

 9  employer groups as provided in sub-subparagraph a., the rate

10  to be charged to small employer groups of less than 2 eligible

11  employees may not exceed 150 percent of the rate determined

12  for small employer groups of 2-50 eligible employees. However,

13  the carrier may charge excess losses of the experience pool

14  consisting of small employer groups with less than 2 eligible

15  employees to the experience pool consisting of small employer

16  groups with 2-50 eligible employees so that all losses are

17  allocated and the 150-percent rate limit on the experience

18  pool consisting of small employer groups with less than 2

19  eligible employees is maintained. Notwithstanding s.

20  627.411(1), the rate to be charged to a small employer group

21  of fewer than 2 eligible employees, insured as of July 1,

22  2002, may be up to 125 percent of the rate determined for

23  small employer groups of 2-50 eligible employees for the first

24  annual renewal and 150 percent for subsequent annual renewals.

25         Section 13.  Subsection (7) of section 636.003, Florida

26  Statutes, is amended to read:

27         636.003  Definitions.--As used in this act, the term:

28         (7)  "Prepaid limited health service organization"

29  means any person, corporation, partnership, or any other

30  entity which, in return for a prepayment, undertakes to

31  provide or arrange for, or provide access to, the provision of

                                  40

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






    Florida Senate - 2004                                  SB 2910
    2-1470-04




 1  a limited health service to enrollees through an exclusive

 2  panel of providers or undertakes to provide access to any

 3  discounted medical services. Prepaid limited health service

 4  organization does not include:

 5         (a)  An entity otherwise authorized pursuant to the

 6  laws of this state to indemnify for any limited health

 7  service;

 8         (b)  A provider or entity when providing limited health

 9  services pursuant to a contract with a prepaid limited health

10  service organization, a health maintenance organization, a

11  health insurer, or a self-insurance plan; or

12         (c)  Any person who, in exchange for fees, dues,

13  charges or other consideration, provides access to a limited

14  health service provider without assuming any responsibility

15  for payment for the limited health service or any portion

16  thereof; or.

17         (d)  Any plan or program of discounted medical services

18  for which fees, dues, charges, or other consideration paid to

19  the plan by consumers does not exceed $15 per month or $180

20  per year and which in its advertising and contracts:

21         1.  Clearly indicates that the plan is not insurance,

22  that the plan is not obligated to pay any portion of the

23  discounted medical fees, and that the consumer is responsible

24  for paying the full amount of the discounted fees;

25         2.  Does not use the term "affordable health care" or

26  "coverage," or any other term that misrepresents the nature of

27  the program; and

28         3.  Requires a statement beside the provider network on

29  the discount card alerting the network providers and

30  facilities that the cardholder does not have insurance and is

31  

                                  41

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






    Florida Senate - 2004                                  SB 2910
    2-1470-04




 1  merely entitled to the network discount rate for services

 2  provided.

 3         Section 14.  Subsection (40) is added to section

 4  641.31, Florida Statutes, to read:

 5         641.31  Health maintenance contracts.--

 6         (40)  Health maintenance organizations shall make

 7  available to the contract holder as part of the application

 8  for any such contract, for an appropriate additional premium,

 9  the benefits or levels of benefits specified in the December

10  1999 Florida Medicaid Therapy Services Handbook for genetic or

11  congenital disorders or conditions involving speech, language,

12  swallowing, and hearing and a hearing aid and earmolds benefit

13  at the level of benefits specified in the January 2001 Florida

14  Medicaid Hearing Services Handbook.

15         (a)  Such optional coverage is not required to be

16  offered when substantially similar benefits are included in

17  the contract issued to the subscriber.

18         (b)  This section does not require or prohibit the use

19  of a provider network.

20         (c)  This section does not prohibit an organization

21  from requiring prior authorization for the benefits under this

22  subsection.

23         (d)  This subsection does not apply to health

24  maintenance organizations issuing individual coverage to fewer

25  than 50,000 members.

26         Section 15.  Except for this section and sections 5, 8,

27  11, and 14, which shall take effect July 1, 2004, and

28  paragraph (17)(b) of section 1, which shall take effect July

29  1, 2005, this act shall take effect October 1, 2004.

30  

31  

                                  42

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






    Florida Senate - 2004                                  SB 2910
    2-1470-04




 1            *****************************************

 2                          SENATE SUMMARY

 3    Creates or revises a variety of provisions relating to
      health care, including creating a Florida Health
 4    Insurance Plan, a Small Employers Access Program, and a
      Statewide Electronic Medical Records Advisory Panel.
 5    Revises coverages that insurers must make available. (See
      bill for details.)
 6  

 7  

 8  

 9  

10  

11  

12  

13  

14  

15  

16  

17  

18  

19  

20  

21  

22  

23  

24  

25  

26  

27  

28  

29  

30  

31  

                                  43

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

Site Map
Session:   Bills ·   Calendars ·   Bound Journals ·   Citator ·   Search ·   Appropriations ·   Redistricting ·   Bill Information Reports
Committee Publications
Historical Information
Statutes:   Introduction ·   View Statutes ·   Search Statutes
Flsenate.gov
Disclaimer: The information on this system is unverified. The journals or printed bills of the respective chambers should be consulted for official purposes.    Copyright © 2000-2019 State of Florida.     Privacy Statement     Contact Us     Get Acrobat Reader