HB 7255

A bill to be entitled
2An act relating to the state group insurance program;
3amending s. 110.123, F.S.; providing application of
4definitions; revising definitions; deleting legislative
5intent; enumerating the group insurance plans that may be
6included in the state group insurance program; revising
7duties of the Department of Management Services relating
8to the group insurance program; providing the state
9contribution toward cost of health insurance plans in the
10state group insurance program for specified plan years;
11revising authorized benefits; directing the department to
12contract with a certain number of health maintenance
13organizations under certain circumstances; requiring
14certain data to be reported to the department by health
15maintenance organizations under specified circumstances;
16providing for specified benefit levels for specified plan
17years; repealing certain duties of the department on a
18specified future date; repealing the Florida State
19Employee Wellness Council; amending s. 110.12302, F.S.;
20requiring the department to contract with health
21maintenance organizations with a self-insured plan design
22beginning with a specified plan year; creating s.
23110.12303, F.S.; directing the department to contract with
24an independent benefits manager; providing vendor
25qualifications for the independent benefits manager;
26providing duties of the independent benefits manager;
27providing contract management duties for the department;
28providing duties of the department relating to the state
29group insurance program; creating s. 110.12304, F.S.;
30providing requirements for state and employee
31contributions toward health plan premium costs for a
32specified plan year; providing for adjustments to employee
33salary under certain circumstances; creating s. 110.12305,
34F.S.; requiring the department to establish a single
35health insurance risk pool beginning with a specified plan
36year; requiring the department to contract with multiple
37health maintenance organizations under specified
38circumstances beginning with a specified plan year;
39providing an effective date.
41Be It Enacted by the Legislature of the State of Florida:
43     Section 1.  Subsections (1), (2), and (3), paragraph (b) of
44subsection (4), and subsections (5) and (13) of section 110.123,
45Florida Statutes, are amended to read:
46     110.123  State group insurance program.-
47     (1)  TITLE.-Sections 110.123-110.1239 This section may be
48cited as the "State Group Insurance Program Law."
49     (2)  DEFINITIONS.-As used in ss. 110.123-110.1239 this
50section, the term:
51     (a)  "Department" means the Department of Management
53     (b)  "Enrollee" means all state officers and employees,
54retired state officers and employees, surviving spouses of
55deceased state officers and employees, and terminated employees
56or individuals with continuation coverage who are enrolled in an
57insurance plan offered by the state group insurance program.
58"Enrollee" includes all state university officers and employees,
59retired state university officers and employees, surviving
60spouses of deceased state university officers and employees, and
61terminated state university employees or individuals with
62continuation coverage who are enrolled in an insurance plan
63offered by the state group insurance program.
64     (c)  "Full-time state employees" includes all full-time
65employees of all branches or agencies of state government
66holding salaried positions and paid by state warrant or from
67agency funds, and employees paid from regular salary
68appropriations for 8 months' employment, including university
69personnel on academic contracts, but in no case shall "state
70employee" or "salaried position" include persons paid from
71other-personal-services (OPS) funds. "Full-time employees"
72includes all full-time employees of the state universities.
73     (d)  "Health maintenance organization" or "HMO" means an
74entity certified under part I of chapter 641.
75     (e)  "Health plan member" means any person participating in
76a state group health insurance plan, a TRICARE supplemental
77insurance plan, or a health maintenance organization plan under
78the state group insurance program, including enrollees and
79covered dependents thereof.
80     (f)  "Part-time state employee" means any employee of any
81branch or agency of state government paid by state warrant from
82salary appropriations or from agency funds, and who is employed
83for less than the normal full-time workweek established by the
84department or, if on academic contract or seasonal or other type
85of employment which is less than year-round, is employed for
86less than 8 months during any 12-month period, but in no case
87shall "part-time" employee include a person paid from other-
88personal-services (OPS) funds. "Part-time state employee"
89includes any part-time employee of the state universities.
90     (g)  "Plan year" means a calendar year.
91     (h)(g)  "Retired state officer or employee" or "retiree"
92means any state or state university officer or employee who
93retires under a state retirement system or a state optional
94annuity or retirement program or is placed on disability
95retirement, and who was insured under the state group insurance
96program at the time of retirement, and who begins receiving
97retirement benefits immediately after retirement from state or
98state university office or employment. In addition to these
99requirements, any state officer or state employee who retires
100under the Public Employee Optional Retirement Program
101established under part II of chapter 121 shall be considered a
102"retired state officer or employee" or "retiree" as used in this
103section if he or she:
104     1.  Meets the age and service requirements to qualify for
105normal retirement as set forth in s. 121.021(29); or
106     2.  Has attained the age specified by s. 72(t)(2)(A)(i) of
107the Internal Revenue Code and has 6 years of creditable service.
108     (i)(h)  "State agency" or "agency" means any branch,
109department, or agency of state government. "State agency" or
110"agency" includes any state university for purposes of this
111section only.
112     (j)(i)  "State group health insurance plan or plans" or
113"state plan or plans" mean the state self-insured health
114insurance plan or plans, including self-insured health
115maintenance organization plans, offered to state officers and
116employees, retired state officers and employees, and surviving
117spouses of deceased state officers and employees pursuant to
118this section.
119     (j)  "State-contracted HMO" means any health maintenance
120organization under contract with the department to participate
121in the state group insurance program.
122     (k)  "State group insurance program" or "programs" means
123the package of insurance plans offered to state officers and
124employees, retired state officers and employees, and surviving
125spouses of deceased state officers and employees pursuant to
126this section, including the state group health insurance plan or
127plans, health maintenance organization plans, TRICARE
128supplemental insurance plans, and other plans required or
129authorized by law.
130     (l)  "State officer" means any constitutional state
131officer, any elected state officer paid by state warrant, or any
132appointed state officer who is commissioned by the Governor and
133who is paid by state warrant.
134     (m)  "Surviving spouse" means the widow or widower of a
135deceased state officer, full-time state employee, part-time
136state employee, or retiree if such widow or widower was covered
137as a dependent under the state group health insurance plan, a
138TRICARE supplemental insurance plan, or a health maintenance
139organization plan established pursuant to this section at the
140time of the death of the deceased officer, employee, or retiree.
141"Surviving spouse" also means any widow or widower who is
142receiving or eligible to receive a monthly state warrant from a
143state retirement system as the beneficiary of a state officer,
144full-time state employee, or retiree who died prior to July 1,
1451979. For the purposes of this section, any such widow or
146widower shall cease to be a surviving spouse upon his or her
148     (n)  "TRICARE supplemental insurance plan" means the
149Department of Defense Health Insurance Program for eligible
150members of the uniformed services authorized by 10 U.S.C. s.
153     (a)  The Division of State Group Insurance is created
154within the Department of Management Services.
155     (b)  It is the intent of the Legislature to offer a
156comprehensive package of health insurance and retirement
157benefits and a personnel system for state employees which are
158provided in a cost-efficient and prudent manner, and to allow
159state employees the option to choose benefit plans which best
160suit their individual needs. Therefore,
161     (a)  The state group insurance program is established,
162which may include the state group health insurance plan or
163plans, health maintenance organization plans, group life
164insurance plans, TRICARE supplemental insurance plans, group
165accidental death and dismemberment plans, and group disability
166insurance plans, and. Furthermore, the department is
167additionally authorized to establish and provide as part of the
168state group insurance program any other group insurance plans or
169coverage choices that are consistent with the provisions of this
171     (b)(c)  Notwithstanding any provision in this section to
172the contrary, it is the intent of the Legislature that The
173department shall be responsible for specific duties related to
174the state group insurance program, including the competitive
175procurement of such contracts as may be necessary to implement
176the state group insurance program all aspects of the purchase of
177health care for state employees under the state group health
178insurance plan or plans, TRICARE supplemental insurance plans,
179and the health maintenance organization plans. Responsibilities
180shall include, but not be limited to, the development of
181requests for proposals or invitations to negotiate for state
182employee health services, the determination of health care
183benefits to be provided, and the negotiation of contracts for
184health care and health care administrative services. Prior to
185the negotiation of contracts for health care services, the
186Legislature intends that the department shall develop, with
187respect to state collective bargaining issues, the health
188benefits and terms to be included in the state group health
189insurance program. The department shall adopt rules necessary to
190perform its responsibilities pursuant to this section. It is the
191intent of the Legislature that The department shall be
192responsible for the contract management and day-to-day
193management of the state employee health insurance program,
194including, but not limited to, employee enrollment, premium
195collection, payment to health care providers, and other
196administrative functions described in s. 110.12303(6) related to
197the program.
198     (d)1.  Notwithstanding the provisions of chapter 287 and
199the authority of the department, for the purpose of protecting
200the health of, and providing medical services to, state
201employees participating in the state group insurance program,
202the department may contract to retain the services of
203professional administrators for the state group insurance
204program. The agency shall follow good purchasing practices of
205state procurement to the extent practicable under the
207     (c)1.2.  Each vendor in a major procurement, and any other
208vendor if the department deems it necessary to protect the
209state's financial interests, shall, at the time of executing any
210contract with the department, post an appropriate bond with the
211department in an amount determined by the department to be
212adequate to protect the state's interests but not higher than
213the full amount estimated to be paid annually to the vendor
214under the contract.
215     2.3.  Each major contract entered into by the department
216pursuant to this section shall contain a provision for payment
217of liquidated damages to the department for material
218noncompliance by a vendor with a contract provision. The
219department may require a liquidated damages provision in any
220contract if the department deems it necessary to protect the
221state's financial interests.
222     3.4.  The provisions of s. 120.57(3) apply to the
223department's contracting process, except:
224     a.  A formal written protest of any decision, intended
225decision, or other action subject to protest shall be filed
226within 72 hours after receipt of notice of the decision,
227intended decision, or other action.
228     b.  As an alternative to any provision of s. 120.57(3), the
229department may proceed with the bid selection or contract award
230process if the director of the department sets forth, in
231writing, particular facts and circumstances which demonstrate
232the necessity of continuing the procurement process or the
233contract award process in order to avoid a substantial
234disruption to the provision of any scheduled insurance services.
235     (d)(e)  The Department of Management Services and the
236Division of State Group Insurance may not prohibit or limit any
237properly licensed insurer, health maintenance organization,
238prepaid limited health services organization, or insurance agent
239from competing for any insurance product or plan purchased,
240provided, or endorsed by the department or the division on the
241basis of the compensation arrangement used by the insurer or
242organization for its agents.
243     (e)1.(f)  For plan years that begin before January 1, 2013
244Except as provided for in subparagraph (h)2., the state
245contribution toward the cost of any plan in the state group
246insurance program shall be uniform with respect to all state
247employees in a state collective bargaining unit participating in
248the same coverage tier in the same plan. This section does not
249prohibit the development of separate benefit plans for officers
250and employees exempt from the career service or the development
251of separate benefit plans for each collective bargaining unit.
252     2.  For the plan year that begins on January 1, 2013, the
253state contribution toward the cost of any health insurance plan
254in the state group insurance program shall be as provided in s.
255110.12304. This section does not prohibit the development of
256separate benefit plans for officers and employees exempt from
257the career service or the development of separate benefit plans
258for each collective bargaining unit.
259     (f)(g)  Participation by individuals in the program is
260available to all state officers, full-time state employees, and
261part-time state employees; and such participation in the program
262or any plan is voluntary. Participation in the program is also
263available to retired state officers and employees, as defined in
264paragraph (2)(h)(g), who elect at the time of retirement to
265continue coverage under the program, but they may elect to
266continue all or only part of the coverage they had at the time
267of retirement. A surviving spouse may elect to continue coverage
268only under a state group health insurance plan, a TRICARE
269supplemental insurance plan, or a health maintenance
270organization plan.
271     (g)(h)1.  A person eligible to participate in the state
272group insurance program may be authorized by rules adopted by
273the department to select any benefits and coverage that may be
274offered to qualified persons as authorized by the Legislature
275and approved in accordance with applicable federal regulations,
276in lieu of participating in the state group health insurance
277plan, to exercise an option to elect membership in a health
278maintenance organization plan which is under contract with the
279state in accordance with criteria established by this section
280and by said rules. The offer of optional membership in a health
281maintenance organization plan permitted by this paragraph may be
282limited or conditioned by rule as may be necessary to meet the
283requirements of state and federal laws.
284     2.  For the plan years beginning in January 2012 and
285January 2013, the department shall contract with health
286maintenance organizations seeking to participate in the state
287group insurance program through a competitive request for
288proposal or other procurement process consistent with s.
289110.12302, as developed by the Department of Management Services
290and determined to be appropriate.
291     a.  For the 2012 plan year, the department shall establish
292a schedule of minimum benefits for health maintenance
293organization coverage, and that schedule shall include all
294services covered by participating health maintenance
295organizations in the 2011 plan year. For the 2013 plan year,
296subject to legislative approval, the department shall, in
297consultation with the independent benefits manager, establish a
298schedule of minimum benefits for health maintenance organization
299coverage, and that schedule shall be consistent with the benefit
300levels described in paragraph (j): physician services; inpatient
301and outpatient hospital services; emergency medical services,
302including out-of-area emergency coverage; diagnostic laboratory
303and diagnostic and therapeutic radiologic services; mental
304health, alcohol, and chemical dependency treatment services
305meeting the minimum requirements of state and federal law;
306skilled nursing facilities and services; prescription drugs;
307age-based and gender-based wellness benefits; and other benefits
308as may be required by the department. Additional services may be
309provided subject to the contract between the department and the
310HMO. As used in this paragraph, the term "age-based and gender-
311based wellness benefits" includes aerobic exercise, education in
312alcohol and substance abuse prevention, blood cholesterol
313screening, health risk appraisals, blood pressure screening and
314education, nutrition education, program planning, safety belt
315education, smoking cessation, stress management, weight
316management, and women's health education.
317     b.  For the plan year beginning January 2012, the
318department may establish uniform deductibles, copayments,
319coverage tiers, or coinsurance schedules for all participating
320HMO plans.
321     c.  The department may require detailed information from
322each health maintenance organization participating in the
323procurement process, including information pertaining to
324organizational status, experience in providing prepaid health
325benefits, accessibility of services, financial stability of the
326plan, quality of management services, accreditation status,
327quality of medical services, network access and adequacy,
328performance measurement, ability to meet the department's
329reporting requirements, and the actuarial basis of the proposed
330rates and other data determined by the director to be necessary
331for the evaluation and selection of health maintenance
332organization plans and negotiation of appropriate rates for
333these plans. Upon receipt of proposals by health maintenance
334organization plans and the evaluation of those proposals, the
335department may negotiate enter into negotiations with all of the
336plans or a subset of the plans, as the department determines
337appropriate. Nothing shall preclude The department may negotiate
338from negotiating regional or statewide contracts with health
339maintenance organization plans when this is cost-effective and
340when the department determines that the plan offers high value
341to enrollees.
342     d.  The department may limit the number of HMOs that it
343contracts with in each service area based on the nature of the
344bids the department receives, the number of state employees in
345the service area, or any unique geographical characteristics of
346the service area. The department shall establish by rule service
347areas throughout the state. For the 2012 and 2013 plan years,
348the department shall contract in each defined service area with
349no fewer than the same number of HMOs as it contracted with at
350the beginning of the 2011 plan year.
351     e.  All persons participating in the state group insurance
352program may be required to contribute towards a total state
353group health premium that may vary depending upon the plan and
354coverage tier selected by the enrollee and the level of state
355contribution authorized by the Legislature.
356     3.  The department is authorized to negotiate and to
357contract with specialty psychiatric hospitals for mental health
358benefits, on a regional basis, for alcohol, drug abuse, and
359mental and nervous disorders. The department may establish,
360subject to the approval of the Legislature pursuant to
361subsection (5), any such regional plan upon completion of an
362actuarial study to determine any impact on plan benefits and
364     4.  In addition to contracting pursuant to subparagraph 2.,
365the department may enter into contract with any HMO to
366participate in the state group insurance program which:
367     a.  Serves greater than 5,000 recipients on a prepaid basis
368under the Medicaid program;
369     b.  Does not currently meet the 25-percent non-
370Medicare/non-Medicaid enrollment composition requirement
371established by the Department of Health excluding participants
372enrolled in the state group insurance program;
373     c.  Meets the minimum benefit package and copayments and
374deductibles contained in sub-subparagraphs 2.a. and b.;
375     d.  Is willing to participate in the state group insurance
376program at a cost of premiums that is not greater than 95
377percent of the cost of HMO premiums accepted by the department
378in each service area; and
379     e.  Meets the minimum surplus requirements of s. 641.225.
381The department is authorized to contract with HMOs that meet the
382requirements of sub-subparagraphs a.-d. prior to the open
383enrollment period for state employees. The department is not
384required to renew the contract with the HMOs as set forth in
385this paragraph more than twice. Thereafter, the HMOs shall be
386eligible to participate in the state group insurance program
387only through the request for proposal or invitation to negotiate
388process described in subparagraph 2.
389     3.5.  All enrollees in a state group health insurance plan,
390a TRICARE supplemental insurance plan, or any health maintenance
391organization plan have the option of changing to any other
392health plan that is offered by the state within any open
393enrollment period designated by the department. Open enrollment
394shall be held at least once each calendar year.
395     4.6.  When a contract between a treating provider and the
396state-contracted health maintenance organization is terminated
397for any reason other than for cause, each party shall allow any
398enrollee for whom treatment was active to continue coverage and
399care when medically necessary, through completion of treatment
400of a condition for which the enrollee was receiving care at the
401time of the termination, until the enrollee selects another
402treating provider, or until the next open enrollment period
403offered, whichever is longer, but no longer than 6 months after
404termination of the contract. Each party to the terminated
405contract shall allow an enrollee who has initiated a course of
406prenatal care, regardless of the trimester in which care was
407initiated, to continue care and coverage until completion of
408postpartum care. This does not prevent a provider from refusing
409to continue to provide care to an enrollee who is abusive,
410noncompliant, or in arrears in payments for services provided.
411For care continued under this subparagraph, the program and the
412provider shall continue to be bound by the terms of the
413terminated contract. Changes made within 30 days before
414termination of a contract are effective only if agreed to by
415both parties.
416     5.7.  Any HMO participating in the state group insurance
417program shall submit health care utilization and cost data to
418the department, in such form and in such manner as the
419department shall require, as a condition of participating in the
420program. For any HMO that participated in the program prior to
421January 2012 and is selected to participate in the 2012 or 2013
422plan year, health care utilization and cost data for at least
423the last contract period shall be submitted to the department
424before a contract is entered into for the 2012 or 2013 plan
425year. The department shall enter into negotiations with its
426contracting HMOs to determine the nature and scope of the data
427submission and the final requirements, format, penalties
428associated with noncompliance, and timetables for submission.
429These determinations shall be adopted by rule.
430     6.8.  The department may establish and direct, with respect
431to collective bargaining issues, a comprehensive package of
432insurance benefits that may include supplemental health and life
433coverage, dental care, long-term care, vision care, and other
434benefits it determines necessary to enable state employees to
435select from among benefit options that best suit their
436individual and family needs.
437     a.  Based upon a desired benefit package, the department
438shall issue a request for proposal or invitation to negotiate
439for health insurance providers interested in participating in
440the state group insurance program, and the department shall
441issue a request for proposal or invitation to negotiate for
442insurance providers interested in participating in the non-
443health-related components of the state group insurance program.
444Upon receipt of all proposals, the department may enter into
445contract negotiations with insurance providers submitting bids
446or negotiate a specially designed benefit package. Insurance
447providers offering or providing supplemental coverage as of May
44830, 1991, which qualify for pretax benefit treatment pursuant to
449s. 125 of the Internal Revenue Code of 1986, with 5,500 or more
450state employees currently enrolled may be included by the
451department in the supplemental insurance benefit plan
452established by the department without participating in a request
453for proposal, submitting bids, negotiating contracts, or
454negotiating a specially designed benefit package. These
455contracts shall provide state employees with the most cost-
456effective and comprehensive coverage available; however, no
457state or agency funds may not shall be contributed toward the
458cost of any part of the premium of such supplemental benefit
459plans. With respect to dental coverage, the division shall
460include in any solicitation or contract for any state group
461dental program made after July 1, 2001, a comprehensive
462indemnity dental plan option which offers enrollees a completely
463unrestricted choice of dentists. If a dental plan is endorsed,
464or in some manner recognized as the preferred product, such plan
465shall include a comprehensive indemnity dental plan option which
466provides enrollees with a completely unrestricted choice of
468     b.  Pursuant to the applicable provisions of s. 110.161,
469and s. 125 of the Internal Revenue Code of 1986, the department
470shall enroll in the pretax benefit program those state employees
471who voluntarily elect coverage in any of the supplemental
472insurance benefit plans as provided by sub-subparagraph a.
473     c.  This section may not Nothing herein contained shall be
474construed to prohibit insurance providers from continuing to
475provide or offer supplemental benefit coverage to state
476employees as provided under existing agency plans.
477     (h)(i)  The benefits of the insurance authorized by this
478section are shall not be in lieu of any benefits payable under
479chapter 440, the Workers' Compensation Law, and. the insurance
480authorized by this section does law shall not be deemed to
481constitute insurance to secure workers' compensation benefits as
482required by chapter 440.
483     (i)(j)  Notwithstanding the provisions of paragraph (e) (f)
484requiring uniform contributions, and for the 2011-2012 2010-2011
485fiscal year only, the state contribution toward the cost of any
486plan in the state group insurance plan shall be the difference
487between the overall premium and the employee contribution. This
488subsection expires June 30, 2012 2011.
489     (j)  Beginning with the 2013 plan year, benefits offered in
490the state group health insurance program shall be the following:
491     1.  Platinum Level benefits, which are actuarially
492equivalent to 90 percent of the benefits covered in the 2012
493plan year.
494     2.  Gold Level benefits, which are actuarially equivalent
495to 80 percent of the benefits covered in the 2012 plan year.
496     3.  Silver Level benefits, which are actuarially equivalent
497to 70 percent of the benefits covered in the 2012 plan year.
498     4.  Bronze Level benefits, which are actuarially equivalent
499to 60 percent of the benefits covered in the 2012 plan year.
502     (b)  If a state officer or full-time state employee selects
503membership in a health maintenance organization as authorized by
504paragraph (3)(g)(h), the officer or employee is entitled to a
505state contribution toward individual and dependent membership as
506provided by the Legislature through the appropriations act.
507     (5)  DEPARTMENT POWERS AND DUTIES.-The department is
508responsible for the administration of the state group insurance
509program. The department shall initiate and supervise the program
510as established by this section and shall adopt such rules as are
511necessary to perform its responsibilities. To implement this
512program, the department shall, with prior approval by the
514     (a)  Determine the benefits to be provided and the
515contributions to be required for the state group insurance
516program. Such determinations, whether for a contracted plan or a
517self-insurance plan pursuant to paragraph (c), do not constitute
518rules within the meaning of s. 120.52 or final orders within the
519meaning of s. 120.52. Any physician's fee schedule used in the
520health and accident plan shall not be available for inspection
521or copying by medical providers or other persons not involved in
522the administration of the program. However, in the determination
523of the design of the program, the department shall consider
524existing and complementary benefits provided by the Florida
525Retirement System and the Social Security System.
526     (b)  Prepare, in cooperation with the Office of Insurance
527Regulation of the Financial Services Commission, the
528specifications necessary to implement the program.
529     (c)  Competitively procure a contract on a competitive
530proposal basis with an insurance carrier or carriers, or
531professional administrator, determined by the Office of
532Insurance Regulation of the Financial Services Commission to be
533fully qualified, financially sound, and capable of meeting all
534servicing requirements. Alternatively, the department may self-
535insure any plan or plans contained in the state group insurance
536program subject to approval based on actuarial soundness by the
537Office of Insurance Regulation. The department may contract with
538an insurance company or professional administrator qualified and
539approved by the Office of Insurance Regulation to administer
540such plan. Before entering into any contract, the department
541shall advertise for competitive proposals, and such contract
542shall be let upon the consideration of the benefits provided in
543relationship to the cost of such benefits. In the selection of a
544third-party administrator determining which entity to contract
545with, the department shall, at a minimum, consider: the entity's
546previous experience and expertise in administering group
547insurance programs of the type it proposes to administer; the
548entity's ability to specifically perform its contractual
549obligations in this state and other governmental jurisdictions;
550the entity's anticipated administrative costs and claims
551experience; the entity's capability to adequately provide
552service coverage and sufficient number of experienced and
553qualified personnel in the areas of claims processing,
554recordkeeping, and underwriting, as determined by the
555department; the entity's accessibility to state employees and
556providers; the financial solvency of the entity, using accepted
557business sector measures of financial performance. The
558department may contract for medical services which will improve
559the health or reduce medical costs for employees who participate
560in the state group insurance plan.
561     (d)  With respect to a state group health insurance plan,
562be authorized to require copayments with respect to all
563providers under the plan.
564     (e)  Have authority to establish a voluntary program for
565comprehensive health maintenance, which may include health
566educational components and health appraisals.
567     (f)  With respect to any contract with an insurance carrier
568or carriers or professional administrator entered into by the
569department, require that the state and the enrollees be held
570harmless and indemnified for any financial loss caused by the
571failure of the insurance carrier or professional administrator
572to comply with the terms of the contract.
573     (g)  With respect to any contract with an insurance carrier
574or carriers, or professional administrator entered into by the
575department, require that the carrier or professional
576administrator provide written notice to individual enrollees if
577any payment due to any health care provider of the enrollee
578remains unpaid beyond a period of time as specified in the
580     (h)  Have authority to establish other voluntary programs
581to be funded on a pretax contribution basis or on a posttax
582contribution basis, as the department determines.
583     (i)  Contract with a single custodian to provide services
584necessary to implement and administer the health savings
585accounts authorized in subsection (12).
587Final decisions concerning enrollment, the existence of
588coverage, or covered benefits under the state group insurance
589program may shall not be delegated or deemed to have been
590delegated by the department. This subsection expires January 1,
593     (a)  There is created within the department the Florida
594State Employee Wellness Council.
595     (b)  The council shall be an advisory body to the
596department to provide health education information to employees
597and to assist the department in developing minimum benefits for
598all health care providers when providing age-based and gender-
599based wellness benefits.
600     (c)  The council shall be composed of nine members
601appointed by the Governor. When making appointments to the
602council, the Governor shall appoint persons who are residents of
603the state and who are highly knowledgeable concerning, active
604in, and recognized leaders in the health and medical field, at
605least one of whom must be an employee of the state. Council
606members shall equitably represent the broadest spectrum of the
607health industry and the geographic areas of the state. Not more
608than one member of the council may be from any one company,
609organization, or association.
610     (d)1.  Council members shall be appointed to 4-year terms,
611except that the initial terms shall be staggered. The Governor
612shall appoint three members to 2-year terms, three members to 3-
613year terms, and three members to 4-year terms.
614     2.  A member's absence from three consecutive meetings
615shall result in his or her automatic removal from the council. A
616vacancy on the council shall be filled for the remainder of the
617unexpired term.
618     (e)  The council shall annually elect from its membership
619one member to serve as chair of the council and one member to
620serve as vice chair.
621     (f)  The first meeting of the council shall be called by
622the chair not more than 60 days after the council members are
623appointed by the Governor. The council shall thereafter meet at
624least once quarterly and may meet more often as necessary. The
625department shall provide staff assistance to the council which
626shall include, but not be limited to, keeping records of the
627proceedings of the council and serving as custodian of all
628books, documents, and papers filed with the council.
629     (g)  A majority of the members of the council constitutes a
631     (h)  Members of the council shall serve without
632compensation, but are entitled to reimbursement for per diem and
633travel expenses as provided in s. 112.061 while performing their
635     (i)  The council shall:
636     1.  Work to encourage participation in wellness programs by
637state employees. The council may prepare informational programs
638and brochures for state agencies and employees.
639     2.  In consultation with the department, develop standards
640and criteria for age-based and gender-based wellness programs.
641     Section 2.  Section 110.12302, Florida Statutes, is amended
642to read:
643     110.12302  Costing options for plan designs required for
644contract solicitation; best value recommendations; required plan
646     (1)  For the state group insurance program, the Department
647of Management Services shall require costing options for both
648fully insured and self-insured plan designs, or some combination
649thereof, as part of the department's solicitation for health
650maintenance organization contracts. Prior to contracting, the
651department shall recommend to the Legislature, no later than
652February 1, 2011, the best value to the State group insurance
653program relating to health maintenance organizations.
654     (2)  Beginning with the 2012 plan year, the department may
655only contract with health maintenance organizations for a self-
656insured plan design. In implementing this subsection, the
657department shall ensure that no fewer health maintenance
658organizations participate in the state group insurance program
659than participated in each service area in the 2011 plan year.
660     Section 3.  Section 110.12303, Florida Statutes, is created
661to read:
662     110.12303  Independent benefits manager.-
663     (1)  The department shall competitively procure an
664independent benefits manager. The department shall initiate the
665procurement no later than August 1, 2011.
666     (2)  The independent benefits manager may not:
667     (a)  Be owned or controlled by any HMO or insurer.
668     (b)  Have an ownership interest in any HMO or insurer.
669     (c)  Have any direct or indirect financial interest in any
670HMO or insurer.
671     (3)  The independent benefits manager must have substantial
672experience in the design and administration of employee benefit
673programs for large employers and public employers, including
674experience administering plans that qualify as cafeteria plans
675pursuant to s. 125 of the Internal Revenue Code.
676     (4)  The independent benefits manager shall:
677     (a)  Provide an ongoing assessment of trends in benefits
678and employer-sponsored insurance that affect the state group
679insurance program.
680     (b)  Conduct comprehensive analysis of the state group
681insurance program, including available benefits, coverage
682options, and claims experience.
683     (c)  Evaluate designs for the state group insurance
684program, including a full cafeteria plan, an employer-sponsored
685multicarrier exchange plan, and alternatives to and variations
686of these designs.
687     (d)  Identify and establish appropriate adjustment
688procedures necessary to respond to any risk segmentation that
689may occur when increased choices are offered to employees.
690     (e)  Submit recommendations for any modifications to the
691state group insurance program no later than January 1 of each
693     (f)  Establish a transition plan for assuming the
694responsibilities described in subsection (5).
695     (g)  Develop a plan to convert the state group insurance
696program to a defined contribution plan. The plan shall be
697submitted to the Legislature by January 1, 2013, and include
698recommendations for:
699     1.  An implementation timeline for conversion as of the
7002014 plan year or an explanation of the factors that prevent
701implementation by 2014 and a timeline for conversion in the 2015
702plan year.
703     2.  Employer and employee contribution policies, including
704provisions that reward and incentivize nonsmoking and other
705healthy lifestyle choices.
706     3.  Steps necessary for maintaining or improving total
707employee compensation levels when a transition to a defined
708contribution plan is initiated.
709     4.  Establishing an employment-based benefits exchange or
710implementing a full cafeteria plan to provide a variety of plan
711and benefit options.
712     5.  Securing the appropriate federal approval for plan
714     (h)  Subject to approval by the Legislature, direct and
715implement the plan described in paragraph (g).
716     (5)  Notwithstanding s. 110.123 and beginning no later than
717the 2013 plan year, the independent benefits manager shall:
718     (a)  Manage the state group insurance program, including
719negotiation and supervision of contracts and other
720administrative functions as may be necessary.
721     (b)  If the Legislature authorizes the creation of a state
722employee benefits exchange, certify health insurance plans,
723health maintenance organizations, and other providers eligible
724to participate.
725     (c)  If the Legislature authorizes the implementation of a
726full cafeteria plan, supervise the procurement process and
727conduct the contract negotiations with providers that are
728necessary for their participation in defined service areas.
729     (d)  Develop and implement wellness initiatives for
731     (e)  Provide enrollee education and decision support tools,
732including an online interface, to assist enrollees in choosing
733benefit plans that best suit their individual needs.
734     (f)  Ensure compliance with applicable federal and state
736     (6)  The department shall manage the contract with the
737independent benefits manager and shall provide financial
738management of the program, including financial and budget
739oversight of program operations, management of vendor payments
740and premium administration, analyzing and forecasting of program
741revenues and expenditures, monitoring of financial compliance of
742contractors, and auditing.
743     Section 4.  Section 110.12304, Florida Statutes, is created
744to read:
745     110.12304  State and employee contributions toward health
746plan premium cost.-
747     (1)  For the 2013 plan year, the state's share of
748contribution toward the cost of the health plan shall be:
749     (a)  Platinum Level: 90 percent for an individual plan and
75086 percent for a family plan.
751     (b)  Gold Level: 85 percent for an individual or a family
753     (c)  Silver Level: 80 percent for an individual or a family
755     (d)  Bronze Level: 75 percent for an individual or a family
757     (2)  The employee shall pay the remaining cost of the plan
758premium; however, if the employee chooses a Gold, Silver, or
759Bronze Level plan, the employee's salary shall be increased by
76060 percent of the difference between the premium for the
761employee's selected plan and the premium for a Platinum Level
763     Section 5.  Section 110.12305, Florida Statutes, is created
764to read:
765     110.12305  Health insurance risk pool.-
766     (1)  For the 2012 plan year and for each plan year
767thereafter, the department shall establish a single health
768insurance risk pool for the state group insurance plans.
769     (2)  For the 2012 plan year and for each plan year
770thereafter, the department shall continue to contract with
771multiple health maintenance organizations in each service area
772based on the nature of the bids the department receives, the
773number of state employees in the service area, or any unique
774geographical characteristics of the service area.
775     Section 6.  This act shall take effect July 1, 2011.

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