December 11, 2019
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Senate Bill 2910

Senate Bill sb2910c1

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    Florida Senate - 2004                           CS for SB 2910

    By the Committee on Health, Aging, and Long-Term Care; and
    Senator Peaden




    317-2321-04

  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 that a benefit

22         plan approved by the Office of Insurance

23         Regulation may be issued to small employers

24         with up to 25 employees by specified persons;

25         providing for an advisory council; creating a

26         Statewide Electronic Medical Records Task Force

27         and providing its powers and duties; amending

28         s. 381.026, F.S.; requiring disclosure of

29         certain financial information to patients by

30         health care facilities or providers; amending

31         s. 395.301, F.S.; requiring disclosure of

                                  1

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    Florida Senate - 2004                           CS for SB 2910
    317-2321-04




 1         certain financial information to patients of

 2         licensed hospitals and similar facilities;

 3         amending s. 408.909, F.S.; redefining the term

 4         "health flex plan entity"; revising guidelines

 5         for review of health flex plan applications;

 6         amending s. 627.410, F.S.; revising

 7         applicability of provisions relating to health

 8         insurance policy and annuity contract forms;

 9         amending s. 627.6487, F.S.; redefining the term

10         "eligible individual" for purposes of

11         guaranteed availability of coverage; amending

12         s. 636.003, F.S.; redefining the term "prepaid

13         limited health service organization"; providing

14         effective dates.

15  

16         WHEREAS, the Legislature finds that 2.8 million

17  Floridians do not have access to health insurance coverage,

18  and

19         WHEREAS, often this lack of health insurance coverage

20  is because premiums are not affordable, and

21         WHEREAS, the Legislature finds that many small

22  employers are unable to provide health insurance to their

23  employees because of rising health care premiums, and

24         WHEREAS, it is the intent of the Legislature to

25  stabilize Florida's health insurance markets and make them

26  more competitive, and

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

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

29  employers, and

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

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

                                  2

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    Florida Senate - 2004                           CS for SB 2910
    317-2321-04




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

 2  health insurance affordable by bringing about reductions in

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

 4  

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

 6  

 7         Section 1.  There is created the Florida Health

 8  Insurance Plan.

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

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

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

12  Florida.

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

14  of the Financial Services Commission.

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

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

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

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

19  disabled and dependent upon the parent.

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

21  Insurance Regulation.

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

23  expense incurred policy, health maintenance organization

24  subscriber contract pursuant to chapter 641, Florida Statutes,

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

26  furnishes medical or health care services whether by insurance

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

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

29  credit insurance; disability income insurance; coverage for

30  onsite medical clinics; insurance coverage specified in

31  federal regulations issued pursuant to Pub. L. No. 104-191,

                                  3

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    Florida Senate - 2004                           CS for SB 2910
    317-2321-04




 1  under which benefits for medical care are secondary or

 2  incidental to other insurance benefits; benefits for long-term

 3  care, nursing home care, home health care, community-based

 4  care, or any combination thereof, or other similar, limited

 5  benefits specified in federal regulations issued pursuant to

 6  Pub. L. No. 104-191; benefits provided under a separate

 7  policy, certificate, or contract of insurance, where there is

 8  no coordination between the provision of the benefits and any

 9  exclusion of benefits under any group health plan maintained

10  by the same plan sponsor, and the benefits are paid with

11  respect to an event without regard to whether benefits are

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

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

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

15  other fixed indemnity insurance; coverage offered as a

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

17  as Medicare supplemental health insurance as defined under s.

18  1882(g)(1) of the Social Security Act; coverage supplemental

19  to the coverage provided under Chapter 55 of Title 10, United

20  States Code (Civilian Health and Medical Program of the

21  Uniformed Services (CHAMPUS); similar supplemental coverage

22  provided to coverage under a group health plan; coverage

23  issued as a supplement to liability insurance; insurance

24  arising out of a workers' compensation or similar law;

25  automobile medical-payment insurance; or insurance under which

26  benefits are payable with or without regard to fault and which

27  is statutorily required to be contained in any liability

28  insurance policy or equivalent self-insurance.

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

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

31  includes an insurance company with a valid certificate in

                                  4

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    Florida Senate - 2004                           CS for SB 2910
    317-2321-04




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

 2  maintenance organization with a valid certificate of authority

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

 4  Statutes; prepaid health clinic authorized to transact

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

 6  Florida Statutes; multiple employer welfare arrangement

 7  authorized to transact business in this state pursuant to

 8  sections 624.436-624.45, Florida Statutes; or fraternal

 9  benefit society providing health benefits to its members as

10  authorized pursuant to chapter 632, Florida Statutes.

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

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

13  seq., as amended.

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

15  of the Social Security Act.

16         (j)  "Participating insurer" means any insurer

17  providing health insurance to residents of this state.

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

19  institution, organization, or person that furnishes health

20  care services and is licensed or otherwise authorized to

21  practice in this state.

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

23  created in this section.

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

25  and operating rules and procedures adopted by the board

26  pursuant to this act.

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

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

29  days.

30         (2)  OPERATION OF THE PLAN.--

31  

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    Florida Senate - 2004                           CS for SB 2910
    317-2321-04




 1         (a)  The plan shall be managed during full

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

 3  the Governor. The director shall head the team.

 4         (b)  Following full implementation, the plan shall

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

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

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

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

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

10  must be composed of individuals who are not representatives of

11  insurers or health care providers.

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

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

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

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

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

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

18  successor is appointed.

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

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

21  cause.

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

23  as board members but shall be reimbursed for reasonable

24  expenses incurred in the necessary performance of their duties

25  in accordance with section 112.061, Florida Statutes.

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

27  operation for the plan and any amendments thereto necessary or

28  suitable to assure the fair, reasonable, and equitable

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

30  that the plan qualifies to apply for any available funding

31  from the Federal Government which adds to the financial

                                  6

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    Florida Senate - 2004                           CS for SB 2910
    317-2321-04




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

 2  effective upon approval in writing by the Governor consistent

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

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

 5  of operation within 180 days after the appointment of the

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

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

 8  adopt and promulgate such rules as are necessary or advisable

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

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

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

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

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

14         (b)  Establish procedures for selecting an

15  administrator in accordance with subsection (13).

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

17  management of the board, for administrative expenses.

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

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

20  plan administrator.

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

22  existence of the plan, the eligibility requirements, and

23  procedures for enrollment and to maintain public awareness of

24  the plan.

25         (f)  Establish procedures under which applicants and

26  participants may have grievances reviewed by a grievance

27  committee appointed by the board. The grievances shall be

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

29  committee's recommendation for grievance resolution. The board

30  shall retain all written grievances regarding the plan for at

31  least 3 years.

                                  7

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    Florida Senate - 2004                           CS for SB 2910
    317-2321-04




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

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

 3  obligations under this act.

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

 5  general powers and authority granted under the laws of this

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

 7  specific authority to:

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

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

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

11  enter into contracts with similar plans of other states for

12  the joint performance of common administrative functions, or

13  with persons or other organizations for the performance of

14  administrative functions;

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

16  recover or collect assessments due the plan;

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

18         1.  To avoid payment of improper claims against the

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

20         2.  To recover any amounts erroneously or improperly

21  paid by the plan;

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

23  of mistake of fact or law; or

24         4.  To recover other amounts due the plan.

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

26  schedules, rate adjustments, expense allowances, agents'

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

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

29  rate schedules may be adjusted for appropriate factors such as

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

31  

                                  8

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    Florida Senate - 2004                           CS for SB 2910
    317-2321-04




 1  take into consideration appropriate factors in accordance with

 2  established actuarial and underwriting practices;

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

 4  requirements of this act;

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

 6  and other committees as necessary to provide technical

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

 8  its policyholders regarding health savings accounts (HSAs),

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

10  authority of the plan;

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

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

13  default shall be legal investments for insurers and may be

14  carried as admitted assets;

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

16         (i)  Prepare and distribute certificate of eligibility

17  forms and enrollment instruction forms to insurance producers

18  and to the general public;

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

20  plan;

21         (k)  Provide for and employ cost containment measures

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

23  screening, second surgical opinion, concurrent utilization

24  review, and individual case management for the purpose of

25  making the plan more cost effective;

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

27  the delivery of cost effective health care services, including

28  establishing or contracting with preferred provider

29  organizations, health maintenance organizations, and other

30  limited network provider arrangements; and

31  

                                  9

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    Florida Senate - 2004                           CS for SB 2910
    317-2321-04




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

 2  necessary or convenient for the implementation of this act and

 3  the operation of the plan.

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

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

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

 7  Representatives, which includes an independent actuarial study

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

 9  issues:

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

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

12  This shall include an estimate of the total anticipated

13  aggregate savings for all small employers in the state.

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

15  various funding levels and specifically how many people the

16  pool could cover at each of those funding levels.

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

18  for the anticipated deficits of the pool.

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

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

21  Speaker of the House of Representatives. The report shall

22  summarize the activities of the plan in the preceding calendar

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

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

25  incurred losses.

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

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

28  House of Representatives 3 years after commencement of

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

30  intent of this act.

31  

                                  10

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    Florida Senate - 2004                           CS for SB 2910
    317-2321-04




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

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

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

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

 5  omission related to the performance of their powers and duties

 6  under this act, unless such act or omission constitutes

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

 8  bylaws or rules for indemnification of, and legal

 9  representation for, its members and employees.

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

11  following the close of each calendar year the plan shall

12  submit to the Governor an audited financial statement,

13  prepared in accordance with Statutory Accounting Principles as

14  adopted by the National Association of Insurance

15  Commissioners.

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

17  authorized to open up the plan to all eligible individual

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

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

20  additional powers and duties of the board to implement this

21  act.

22         (11)  ELIGIBILITY.--

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

24  resident of this state is eligible for plan coverage if

25  evidence is provided of:

26         1.  A notice of rejection or refusal to issue

27  substantially similar insurance for health reasons by one

28  insurer;

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

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

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

                                  11

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    Florida Senate - 2004                           CS for SB 2910
    317-2321-04




 1  reinsurance coverage with respect to the applicant is not

 2  sufficient evidence under this paragraph; or

 3         3.  That person's eligibility for individual coverage

 4  in accordance with the Health Insurance Accountability and

 5  Portability Act (HIPAA).

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

 7  health conditions for which a person shall be eligible for

 8  plan coverage without applying for health insurance pursuant

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

10  history of any medical or health conditions on the list

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

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

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

14  may be amended as appropriate.

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

16  eligible for plan coverage is also eligible for plan coverage.

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

18  plan if:

19         1.  The person has or obtains health insurance coverage

20  substantially similar to or more comprehensive than a plan

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

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

23  person is satisfying any preexisting condition waiting period

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

25  period of time the person is satisfying a preexisting

26  condition waiting period under another health insurance policy

27  intended to replace the plan policy;

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

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

30  local government program that provides health benefits;

31  

                                  12

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    Florida Senate - 2004                           CS for SB 2910
    317-2321-04




 1         3.  The person has previously terminated plan coverage

 2  unless 12 months have lapsed since such termination;

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

 4  behalf of the person;

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

 6  institution; or

 7         6.  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, except as an otherwise

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

11  government agency or health care provider.

12         (e)  Coverage shall cease:

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

14  this state;

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

16         3.  Upon the death of the covered person;

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

18  policy; or

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

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

21  of residence to which the person does not reply.

22         (f)  Except under the circumstances described in this

23  subsection, a person who ceases to meet the eligibility

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

25  the policy period for which the necessary premiums have been

26  paid.

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

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

29  626, Florida Statutes, or section 641.3901, Florida Statutes,

30  for an insurer, health maintenance organization, insurance

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

                                  13

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    Florida Senate - 2004                           CS for SB 2910
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 1  an individual employee to the plan, or arrange for an

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

 3  separating that employee from group health insurance coverage

 4  provided in connection with the employee's employment.

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

 6  through a competitive bidding process a plan administrator to

 7  administer the plan. The board shall evaluate bids submitted

 8  based on criteria established by the board, which shall

 9  include:

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

11  health insurance coverage to individuals;

12         (b)  The efficiency and timeliness of the plan

13  administrator's claim-processing procedures;

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

15  plan;

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

17  effective cost containment programs and procedures and to

18  administer the plan in a cost efficient manner; and

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

20  administrator.

21  

22  The administrator shall be either an insurer, a health

23  maintenance organization or a third-party administrator, or

24  another organization duly authorized pursuant to the Florida

25  Insurance Code.

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

27  administrator shall serve for a period specified in the

28  contract between the plan and the plan administrator, subject

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

30  limitations of the contract between the plan and the plan

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

                                  14

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    Florida Senate - 2004                           CS for SB 2910
    317-2321-04




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

 2  invite eligible entities, including the current plan

 3  administrator, to submit bids to serve as the plan

 4  administrator. Selection of the plan administrator for each

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

 6  end of the current period.

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

 8  administrator shall perform such functions relating to the

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

10         (a)  Determination of eligibility;

11         (b)  Payment of claims;

12         (c)  Establishment of a premium billing procedure for

13  collection of premiums from persons covered under the plan;

14  and

15         (d)  Other necessary functions to assure timely payment

16  of benefits to covered persons under the plan.

17  

18  The plan administer shall submit regular reports to the board

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

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

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

22  following the close of each calendar year, the plan

23  administrator shall determine net written and earned premiums,

24  the expense of administration, and the paid and incurred

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

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

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

28  administrator shall be paid as provided in the contract

29  between the plan and the plan administrator.

30         (17)  FUNDING OF THE PLAN.--

31         (a)  Premiums.--

                                  15

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    Florida Senate - 2004                           CS for SB 2910
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 1         1.  The plan shall establish premium rates for plan

 2  coverage as provided in subparagraph 2. Separate schedules of

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

 4  apply for individual risks. Premium rates and schedules shall

 5  be submitted to the office for approval before use.

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

 7  determine a standard risk rate by considering the premium

 8  rates charged by other insurers offering health insurance

 9  coverage to individuals. The standard risk rate shall be

10  established using reasonable actuarial techniques and shall

11  reflect anticipated experience and expenses for such coverage.

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

13  percent of rates established as applicable for individual

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

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

16  the limits provided in this paragraph, subsequent rates shall

17  be established to provide fully for the expected costs of

18  claims, including recovery of prior losses, expenses of

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

20  cost factors subject to the limitations described herein.

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

22  incurred by the plan shall be funded through amounts

23  appropriated by the Legislature from general revenue sources,

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

25  in existing net insurance premium taxes. The board shall

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

27  providing health insurance during any fiscal year will not

28  exceed total income the plan expects to receive from policy

29  premiums and funds appropriated by the Legislature, including

30  any interest on investments. After determining the amount of

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

                                  16

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    Florida Senate - 2004                           CS for SB 2910
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 1  estimate the number of new policies it believes the plan has

 2  the financial capacity to insure during that year so that

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

 4  necessary to assure that plan enrollment does not exceed the

 5  number of residents it has estimated it has the financial

 6  capacity to insure.

 7         (18)  BENEFITS.--

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

 9  standard and basic plans for small employers as outlined in

10  section 627.6699, Florida Statutes. The board may also

11  establish an option of alternative coverage such as

12  catastrophic coverage that includes a minimum level of primary

13  care coverage.

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

15  take into consideration the levels of health insurance

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

17  deemed appropriate and adopt benefit levels, deductibles,

18  co-payments, coinsurance factors, exclusions and limitations

19  determined to be generally reflective of and commensurate with

20  health insurance provided through a representative number of

21  large employers in the state.

22         (c)  The board may adjust any deductibles and

23  coinsurance factors annually according to the Medical

24  Component of the Consumer Price Index.

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

26  incurred during the first 6 months following the effective

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

28  care, or treatment was recommended or received during the

29  6-month period immediately preceding the effective date of

30  coverage.

31  

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 1         2.  Such preexisting condition exclusions shall be

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

 3  been satisfied under any prior health insurance coverage that

 4  was involuntarily terminated, provided that application for

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

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

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

 8  coverage was terminated and the applicant is not eligible for

 9  continuation or conversion rights that would provide coverage

10  substantially similar to plan coverage.

11         (19)  NONDUPLICATION OF BENEFITS.--

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

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

14  available. Benefits otherwise payable under plan coverage

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

16  other health insurance and by all hospital and medical expense

17  benefits paid or payable under any workers' compensation

18  coverage, automobile medical payment or liability insurance

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

20  hospital or medical benefits paid or payable under or provided

21  pursuant to any state or federal law or program.

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

23  eligible person for the recovery of the amount of benefits

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

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

26  recoverable under this paragraph.

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

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

29  lifetime.

30  

31  

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

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

 3  apply for federal tax exemption.

 4         Section 2.  There is created the Small Employers Access

 5  Program.

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

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

 8  of the Department of Financial Services.

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

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

11  term includes an insurance company holding a certificate of

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

13  health maintenance organization holding a certificate of

14  authority pursuant to chapter 641, Florida Statutes, which

15  qualifies to provide coverage to small employer groups

16  pursuant to section 627.6699, Florida Statutes.

17         (c)  "Participating insurer" means any insurer

18  providing health insurance to small employers which has been

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

20  designated region.

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

22  created by this section.

23         (e)  "Fair commission" means a commission structure

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

25  out the intent of this section.

26         (2)  ELIGIBILITY.--

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

28  participate.

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

30  is also eligible.

31  

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

 2  hospital located in a rural community as defined in section

 3  288.0656(2)(b), Florida Statutes.

 4         (d)  Nursing home employees may participate.

 5         (e)  A small employer group that ceases to meet the

 6  eligibility requirements of this section may be terminated at

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

 8  have been paid.

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

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

11  to provide coverage to small employers within established

12  geographical areas of this state. The office may develop

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

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

15  from developing, in conjunction with insurers, regions

16  different from those used by the Healthy Kids Corporation if

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

18  intentions of this act. The office shall evaluate bids

19  submitted based upon criteria established by the office, which

20  shall include, but are not limited to:

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

22  insurance coverage to small employer groups;

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

24  claim-processing procedures;

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

26  containment programs and procedures and to administer the

27  program in a cost-efficient manner; and

28         (d)  The financial condition and stability of the

29  insurer. The office may use any financial information

30  available to it through its regulatory duties to make this

31  evaluation.

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

 2  duly authorized insurer or health maintenance organization.

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

 4  and implement a program to publicize the existence of the

 5  program, the eligibility requirements, procedures for

 6  enrollment, and:

 7         (a)  Maintain employer awareness of the program.

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

 9  effective health care services.

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

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

12  employees and dependents.

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

14  between the office and the insurer subject to removal for

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

16  the contract between the office and the insurer as are

17  specified in the request for proposal.

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

19  3 years. At least 6 months before the expiration of each

20  contract period, the office shall invite eligible entities,

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

22  insurer for a designated geographic area. Selection of the

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

24  months before the end of the current period.

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

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

27  determine net written and earned premiums, the expense of

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

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

30  by the office.

31  

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

 2  permit or allow any licensed and duly appointed health

 3  insurance agent residing in the designated region to submit

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

 5  commission if coverage is written. The agency must be

 6  appointed to at least one insurer.

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

 8  as the standard and basic plans for small employers as

 9  outlined in section 627.6699, Florida Statutes, except that

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

11  establish an option of alternative coverage such as

12  catastrophic coverage that includes a minimum level of primary

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

14  the intent of this act.

15         (10)  ALTERNATIVE COVERAGE.--Any benefit plan approved

16  by the office may be issued to small employer groups with up

17  to 25 employees by any insurer licensed under chapter 627,

18  Florida Statutes, or health maintenance organization licensed

19  under chapter 641, Florida Statutes.

20         (11)  ANNUAL REPORTING.--The office shall make an

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

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

23  shall summarize the activities of the program in the preceding

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

25  program enrollment, the expense of administration, and the

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

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

28  year.

29         (12)  ADVISORY COUNCIL.--The office, in conjunction

30  with representatives of each of the regional insurers,

31  provider groups, and small employer representatives, and a

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 1  person designated by the Governor shall meet at least annually

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

 3  and recommend incentives to the Governor and the Legislature

 4  which will encourage employer participation in the program.

 5         Section 3.  There is created a Statewide Electronic

 6  Medical Records Task Force to serve as a body of experts to

 7  guide the Agency for Health Care Administration in the

 8  development of policy related to electronic medical records

 9  and the technology required for sharing clinical information

10  among caregivers.

11         (1)  The agency shall provide staff support to the task

12  force and may enter into contracts as are necessary or proper

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

14  assisting the task force in the creation of the Electronic

15  Medical Records System.

16         (2)  The task force shall be appointed by the Governor.

17         (3)  The task force shall meet at least quarterly and

18  advise the Governor, the Legislature, and the agency

19  regarding:

20         (a)  Public and private sector initiatives related to

21  electronic medical records and communication systems for the

22  sharing of clinical information among caregivers;

23         (b)  Regulatory barriers that interfere with the

24  sharing of clinical information among caregivers;

25         (c)  Investment incentives to promote the use of

26  recommended technologies by health care providers;

27         (d)  Educational strategies to promote the use of

28  recommended technologies by health care providers; and

29         (e)  Standards for public access to facilitate

30  transparency in pricing, costs, and quality.

31  

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

 2  task force shall provide to the Office of the Governor, the

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

 4  Representatives, a status report to include any

 5  recommendations and an implementation plan to include, but not

 6  limited to, estimated costs, capital investment requirements,

 7  recommended investment incentives, initial committed provider

 8  participation by region, standards of functionality and

 9  features, marketing plan, and implementation schedules for key

10  components.

11         (5)  Members of the task force shall serve without

12  compensation but shall be entitled to receive reimbursement

13  for per diem and travel expenses as provided in section

14  112.061, Florida Statutes.

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

16  General Revenue Fund to the Agency for Health Care

17  Administration for funding activities relative to the

18  Statewide Electronic Medical Records Task Force.

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

20  task force is abolished effective July 1, 2007.

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

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

23  amended to read:

24         381.026  Florida Patient's Bill of Rights and

25  Responsibilities.--

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

27  provider shall observe the following standards:

28         (c)  Financial information and disclosure.--

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

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

31  representative of the health care facility full information

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 1  and necessary counseling on the availability of known

 2  financial resources for the patient's health care.

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

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

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

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

 7  receiving medical services accepts assignment under Medicare

 8  reimbursement as payment in full for medical services and

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

10  health care facility.

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

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

13  medical services, a reasonable estimate of charges for such

14  services.  Such reasonable estimate shall not preclude the

15  health care provider or health care facility from exceeding

16  the estimate or making additional charges based on changes in

17  the patient's condition or treatment needs.

18         4.  Each licensed facility not operated by the state

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

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

21  50 most used elective inpatient and outpatient procedures. The

22  package pricing shall include all hospital-related services

23  and shall include separate estimates of costs for professional

24  fees charged by independent contractor physicians or physician

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

26  public on its Internet website or by other electronic means

27  each of the top 50 most used inpatient and outpatient

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

29  shall place a notice in the reception areas that such

30  information is available electronically and the website

31  address. The licensed facility may indicate that the package

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

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

 3  depending upon the severity of illness and individual

 4  resources consumed. The licensed facility may also indicate

 5  that the package pricing is negotiable based upon the

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

 7  develop rules for implementation of a uniform mechanism for

 8  reporting this information on the facility's website.

 9         5.4.  A patient has the right to receive a copy of an

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

11  an explanation of charges upon request.

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

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

14  health care facility licensed under chapter 395 that provides

15  emergency services and care or outpatient services and care to

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

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

18  rights and responsibilities of patients, including the

19  following:

20  

21              SUMMARY OF THE FLORIDA PATIENT'S BILL

22                  OF RIGHTS AND RESPONSIBILITIES

23  

24         Florida law requires that your health care provider or

25  health care facility recognize your rights while you are

26  receiving medical care and that you respect the health care

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

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

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

30  health care facility.  A summary of your rights and

31  responsibilities follows:

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

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

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

 4         A patient has the right to a prompt and reasonable

 5  response to questions and requests.

 6         A patient has the right to know who is providing

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

 8         A patient has the right to know what patient support

 9  services are available, including whether an interpreter is

10  available if he or she does not speak English.

11         A patient has the right to know what rules and

12  regulations apply to his or her conduct.

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

14  provider information concerning diagnosis, planned course of

15  treatment, alternatives, risks, and prognosis.

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

17  as otherwise provided by law.

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

19  information and necessary counseling on the availability of

20  known financial resources for his or her care.

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

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

23  health care provider or health care facility accepts the

24  Medicare assignment rate.

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

26  to treatment, a reasonable estimate of charges for medical

27  care.

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

29  to treatment, a reasonable estimate of charges for the

30  proposed service.

31  

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

 2  reasonably clear and understandable, itemized bill and, upon

 3  request, to have the charges explained.

 4         A patient has the right to impartial access to medical

 5  treatment or accommodations, regardless of race, national

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

 7         A patient has the right to treatment for any emergency

 8  medical condition that will deteriorate from failure to

 9  provide treatment.

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

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

12  consent or refusal to participate in such experimental

13  research.

14         A patient has the right to express grievances regarding

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

16  through the grievance procedure of the health care provider or

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

18  appropriate state licensing agency.

19         A patient is responsible for providing to the health

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

21  and complete information about present complaints, past

22  illnesses, hospitalizations, medications, and other matters

23  relating to his or her health.

24         A patient is responsible for reporting unexpected

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

26         A patient is responsible for reporting to the health

27  care provider whether he or she comprehends a contemplated

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

29         A patient is responsible for following the treatment

30  plan recommended by the health care provider.

31  

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 1         A patient is responsible for keeping appointments and,

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

 3  notifying the health care provider or health care facility.

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

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

 6  provider's instructions.

 7         A patient is responsible for assuring that the

 8  financial obligations of his or her health care are fulfilled

 9  as promptly as possible.

10         A patient is responsible for following health care

11  facility rules and regulations affecting patient care and

12  conduct.

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

14  section 395.301, Florida Statutes, to read:

15         395.301  Itemized patient bill; form and content

16  prescribed by the agency.--

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

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

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

20  50 most used elective inpatient and outpatient procedures. The

21  package pricing shall include all hospital-related services

22  and shall include separate estimates of costs for professional

23  fees charged by independent contractor physicians or physician

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

25  public on its Internet website or by other electronic means

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

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

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

29  information is available electronically and the website

30  address. The licensed facility may indicate that the package

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

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

 2  depending upon the severity of illness and individual

 3  resources consumed. The licensed facility may also indicate

 4  that the package pricing is negotiable based upon the

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

 6  develop rules for implementation of a uniform mechanism for

 7  reporting this information on the facility's website.

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

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

10  provision of medical services, provide a reasonable estimate

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

12  preclude the actual charges from exceeding the estimate based

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

14  needs of the patient as determined by the attending and

15  consulting physicians.

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

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

18  are amended to read:

19         408.909  Health flex plans.--

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

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

22  health maintenance organization,

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

24  health care district, or other public or private

25  community-based organization, or public-private partnership

26  that develops and implements an approved health flex plan and

27  is responsible for administering the health flex plan and

28  paying all claims for health flex plan coverage by enrollees

29  of the health flex plan.

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

31  each approve or disapprove health flex plans that provide

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 1  health care coverage for eligible participants who reside in

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

 3  uninsured persons, as identified in the Florida Health

 4  Insurance Study conducted by the agency and in Indian River

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

 6  otherwise required by law for insurers offering coverage in

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

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

 9  any combination of those actions.

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

11  of applications for health flex plans and shall disapprove or

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

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

14  agency shall ensure that the health flex plans follow

15  standardized grievance procedures similar to those required of

16  health maintenance organizations.

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

18  of health flex plan applications and provide regulatory

19  oversight of health flex plan advertisement and marketing

20  procedures. The office shall disapprove or shall withdraw

21  approval of plans that:

22         1.  Contain any ambiguous, inconsistent, or misleading

23  provisions or any exceptions or conditions that deceptively

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

25  general coverage provided by the health flex plan;

26         2.  Provide benefits that are unreasonable in relation

27  to the premium charged or contain provisions that are unfair

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

29  that encourage misrepresentation, or that result in unfair

30  discrimination in sales practices; or

31  

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 1         3.  Cannot demonstrate that the health flex plan is

 2  financially sound and that the applicant is able to underwrite

 3  or finance the health care coverage provided.

 4         (c)  The agency and the Financial Services Commission

 5  may adopt rules as needed to administer this section.

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

 7  shall evaluate the pilot program and its effect on the

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

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

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

11  assessment of the health flex plans and their potential

12  applicability in other settings; shall use health flex plans

13  to gather more information to evaluate low-income consumer

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

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

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

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

18  627.410, Florida Statutes, is amended to read:

19         627.410  Filing, approval of forms.--

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

21  delivery or renew in this state any health insurance policy

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

23  applicable rating manual, rating schedule, change in rating

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

25  rating schedules are not applicable, the insurer must file

26  with the order applicable premium rates and any change in

27  applicable premium rates. This paragraph does not apply to

28  group health insurance policies, effectuated and delivered in

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

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

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

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

 2  is prefunded in the premium.

 3         Section 8.  Subsection (3) of section 627.6487, Florida

 4  Statutes, is amended to read:

 5         627.6487  Guaranteed availability of individual health

 6  insurance coverage to eligible individuals.--

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

 8  "eligible individual" means an individual:

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

10  seeks coverage under this section, the aggregate of the

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

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

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

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

15  or health insurance coverage offered in connection with any

16  such plan; or

17         b.  Whose most recent prior creditable coverage was

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

19  insurer or health maintenance organization, which coverage is

20  terminated due to the insurer or health maintenance

21  organization becoming insolvent or discontinuing the offering

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

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

24  of Florida of the insurer or health maintenance organization

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

26  Florida;

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

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

29  Public Health Service Act;

30         2.  A conversion policy or contract issued by an

31  authorized insurer or health maintenance organization under s.

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 1  627.6675 or s. 641.3921, respectively, offered to an

 2  individual who is no longer eligible for coverage under either

 3  an insured or self-insured employer plan;

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

 5  Security Act; or

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

 7  successor program, and does not have other health insurance

 8  coverage; or

 9         5.  The Florida Health Insurance Plan as specified in

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

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

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

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

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

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

16  or person other than the individual;

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

18  continuation coverage under a COBRA continuation provision or

19  under s. 627.6692, elected such coverage; and

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

21  provision, has exhausted such continuation coverage under such

22  provision or program.

23         Section 9.  Subsection (7) of section 636.003, Florida

24  Statutes, is amended to read:

25         636.003  Definitions.--As used in this act, the term:

26         (7)  "Prepaid limited health service organization"

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

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

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

30  a limited health service to enrollees through an exclusive

31  panel of providers or undertakes to provide access to any

                                  34

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






    Florida Senate - 2004                           CS for SB 2910
    317-2321-04




 1  discounted medical services. Prepaid limited health service

 2  organization does not include:

 3         (a)  An entity otherwise authorized pursuant to the

 4  laws of this state to indemnify for any limited health

 5  service;

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

 7  services pursuant to a contract with a prepaid limited health

 8  service organization, a health maintenance organization, a

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

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

11  charges or other consideration, provides access to a limited

12  health service provider without assuming any responsibility

13  for payment for the limited health service or any portion

14  thereof; or.

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

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

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

18  per year and which in its advertising and contracts:

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

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

21  discounted medical fees, and that the consumer is responsible

22  for paying the full amount of the discounted fees;

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

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

25  the program; and

26         3.  Requires a statement beside the provider network on

27  the discount card alerting the network providers and

28  facilities that the cardholder does not have insurance and is

29  merely entitled to the network discount rate for services

30  provided.

31  

                                  35

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






    Florida Senate - 2004                           CS for SB 2910
    317-2321-04




 1         Section 10.  Except for this section and section 5,

 2  which shall take effect July 1, 2004, and paragraph (17)(b) of

 3  section 1, which shall take effect July 1, 2005, this act

 4  shall take effect October 1, 2004.

 5  

 6          STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
                       COMMITTEE SUBSTITUTE FOR
 7                         Senate Bill 2910

 8                                 

 9  The committee substitute differs from SB 2910 in the following
    ways:
10  
    The definition of health insurance for purposes of the Florida
11  Health Insurance Plan, is amended to specify numerous types of
    special insurance that are not insurance under the Plan.
12  
    Insurers are not required to offer optional coverage for
13  speech, language, hearing, and swallowing disorders.

14  Insurers and health maintenance organizations will not be
    required to offer basic and standard policies.
15  
    The bill does not alter provisions for rating adjustments in
16  the Employee Health Care Access Act.

17  The Statewide Electronic Medical Records Advisory Panel
    created by the bill is renamed the Statewide Electronic
18  Medical Records Task Force.

19  Any benefit plan approved by the Office of Insurance
    Regulation may be issued to small employer groups with up to
20  25 employees by any licensed insurer or health maintenance
    organization.
21  

22  

23  

24  

25  

26  

27  

28  

29  

30  

31  

                                  36

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

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