ENROLLED
       2016 Legislature                           CS for CS for SB 1170
       
       
       
       
       
       
                                                             20161170er
    1  
    2         An act relating to health plan regulatory
    3         administration; amending s. 112.08, F.S.; authorizing
    4         local governmental units to contract for certain group
    5         insurance with a corporation not for profit whose
    6         membership consists of specified local governmental
    7         units; adding such a corporation not for profit as an
    8         alternative entity that a local governmental unit must
    9         contract with to administer certain insurance plans;
   10         amending s. 408.909, F.S.; redefining the terms
   11         “health care coverage” and “health flex plan
   12         coverage”; amending s. 409.817, F.S.; deleting a
   13         provision authorizing group insurance plans to impose
   14         a certain preexisting condition exclusion; amending s.
   15         624.123, F.S.; conforming a cross-reference; amending
   16         s. 626.88, F.S.; revising the definition of the term
   17         “administrator”; amending s. 627.402, F.S.; redefining
   18         the term “nongrandfathered health plan”; amending s.
   19         627.411, F.S.; deleting a provision relating to a
   20         minimum loss ratio standard for specified health
   21         insurance coverage; deleting provisions specifying
   22         certain incurred claims; amending s. 627.6011, F.S.,
   23         conforming a cross-reference; amending s. 627.602,
   24         F.S.; conforming a cross-reference; amending s.
   25         627.642, F.S.; revising the policies to which certain
   26         outline of coverage requirements apply; amending s.
   27         627.6425, F.S.; redefining the term “individual health
   28         insurance”; revising applicability; amending s.
   29         627.6487, F.S.; redefining terms; repealing s.
   30         627.64871, F.S., relating to certification of
   31         coverage; amending s. 627.6512, F.S.; revising a
   32         provision specifying that certain sections of the
   33         Florida Insurance Code do not apply to a group health
   34         insurance policy as that policy relates to specified
   35         benefits, under certain circumstances; amending s.
   36         627.6513, F.S.; excluding applicability as to certain
   37         types of benefits or coverages; amending s. 627.6561,
   38         F.S.; conforming a cross-reference; revising
   39         conditions under which an insurer may impose a
   40         preexisting condition exclusion; deleting the
   41         definition of the term “creditable coverage”; removing
   42         certain requirements relating to creditable coverage
   43         to conform to changes made by the act; amending s.
   44         627.6562, F.S.; redefining the term “creditable
   45         coverage”; providing exceptions and applicability;
   46         amending s. 627.65626, F.S.; conforming a cross
   47         reference; amending s. 627.6699, F.S.; redefining
   48         terms; deleting a provision that requires a certain
   49         health benefit plan to comply with specified
   50         preexisting condition provisions; amending s.
   51         627.6741, F.S.; conforming cross-references;
   52         conforming a provision to changes made by the act;
   53         amending s. 641.31, F.S.; deleting a provision
   54         specifying that a law restricting or limiting
   55         deductibles, coinsurance, copayments, or annual or
   56         lifetime maximum payments may not apply to a certain
   57         health maintenance organization contract; conforming a
   58         cross-reference; amending s. 641.31071, F.S.;
   59         conforming a cross-reference; deleting the definition
   60         of the term “creditable coverage”; removing certain
   61         requirements relating to creditable coverage to
   62         conform to changes made by the act; amending s.
   63         641.31074; requiring a health maintenance organization
   64         that issues a health insurance contract, rather than a
   65         group health insurance contract, to renew or continue
   66         in force such coverage at the contract holder’s
   67         option; revising conditions under which a health
   68         maintenance organization may discontinue offering a
   69         particular contract form; adding to the conditions
   70         under which a health maintenance organization may, at
   71         the time of coverage renewal, modify coverage for a
   72         product offered; amending s. 641.312, F.S.; conforming
   73         a cross-reference; providing an effective date.
   74          
   75  Be It Enacted by the Legislature of the State of Florida:
   76  
   77         Section 1. Paragraph (a) of subsection (2) of section
   78  112.08, Florida Statutes, is amended to read:
   79         112.08 Group insurance for public officers, employees, and
   80  certain volunteers; physical examinations.—
   81         (2)(a) Notwithstanding any general law or special act to
   82  the contrary, every local governmental unit is authorized to
   83  provide and pay out of its available funds for all or part of
   84  the premium for life, health, accident, hospitalization, legal
   85  expense, or annuity insurance, or all or any kinds of such
   86  insurance, for the officers and employees of the local
   87  governmental unit and for health, accident, hospitalization, and
   88  legal expense insurance for the dependents of such officers and
   89  employees upon a group insurance plan and, to that end, to enter
   90  into contracts with insurance companies or professional
   91  administrators to provide such insurance or with a corporation
   92  not for profit whose membership consists entirely of local
   93  governmental units authorized to enter into risk management
   94  consortiums under this subsection. Before entering any contract
   95  for insurance, the local governmental unit shall advertise for
   96  competitive bids; and such contract shall be let upon the basis
   97  of such bids. If a contracting health insurance provider becomes
   98  financially impaired as determined by the Office of Insurance
   99  Regulation of the Financial Services Commission or otherwise
  100  fails or refuses to provide the contracted-for coverage or
  101  coverages, the local government may purchase insurance, enter
  102  into risk management programs, or contract with third-party
  103  administrators and may make such acquisitions by advertising for
  104  competitive bids or by direct negotiations and contract. The
  105  local governmental unit may undertake simultaneous negotiations
  106  with those companies which have submitted reasonable and timely
  107  bids and are found by the local governmental unit to be fully
  108  qualified and capable of meeting all servicing requirements.
  109  Each local governmental unit may self-insure any plan for
  110  health, accident, and hospitalization coverage or enter into a
  111  risk management consortium to provide such coverage, subject to
  112  approval based on actuarial soundness by the Office of Insurance
  113  Regulation; and each shall contract with an insurance company or
  114  professional administrator qualified and approved by the office
  115  or with a corporation not for profit whose membership consists
  116  entirely of local governmental units authorized to enter into a
  117  risk management consortium under this subsection to administer
  118  such a plan.
  119         Section 2. Paragraph (d) of subsection (2) of section
  120  408.909, Florida Statutes, is amended to read:
  121         408.909 Health flex plans.—
  122         (2) DEFINITIONS.—As used in this section, the term:
  123         (d) “Health care coverage” or “health flex plan coverage”
  124  means health care services that are covered as benefits under an
  125  approved health flex plan or that are otherwise provided, either
  126  directly or through arrangements with other persons, via a
  127  health flex plan on a prepaid per capita basis or on a prepaid
  128  aggregate fixed-sum basis. The terms may also include one or
  129  more of the excepted benefits under s. 627.6513(1)-(13) s.
  130  627.6561(5)(b), the benefits under s. 627.6561(5)(c), if offered
  131  separately, or the benefits under s. 627.6561(5)(d), if offered
  132  as independent, noncoordinated benefits.
  133         Section 3. Section 409.817, Florida Statutes, is amended to
  134  read:
  135         409.817 Approval of health benefits coverage; financial
  136  assistance.—In order for health insurance coverage to qualify
  137  for premium assistance payments for an eligible child under ss.
  138  409.810-409.821, the health benefits coverage must:
  139         (1) Be certified by the Office of Insurance Regulation of
  140  the Financial Services Commission under s. 409.818 as meeting,
  141  exceeding, or being actuarially equivalent to the benchmark
  142  benefit plan;
  143         (2) Be guarantee issued;
  144         (3) Be community rated;
  145         (4) Not impose any preexisting condition exclusion for
  146  covered benefits; however, group health insurance plans may
  147  permit the imposition of a preexisting condition exclusion, but
  148  only insofar as it is permitted under s. 627.6561;
  149         (5) Comply with the applicable limitations on premiums and
  150  cost sharing in s. 409.816;
  151         (6) Comply with the quality assurance and access standards
  152  developed under s. 409.820; and
  153         (7) Establish periodic open enrollment periods, which may
  154  not occur more frequently than quarterly.
  155         Section 4. Paragraph (b) of subsection (1) of section
  156  624.123, Florida Statutes, is amended to read:
  157         624.123 Certain international health insurance policies;
  158  exemption from code.—
  159         (1) International health insurance policies and
  160  applications may be solicited and sold in this state at any
  161  international airport to a resident of a foreign country. Such
  162  international health insurance policies shall be solicited and
  163  sold only by a licensed health insurance agent and underwritten
  164  only by an admitted insurer. For purposes of this subsection:
  165         (b) “International health insurance policy” means health
  166  insurance, as provided defined in s. 627.6562(3)(a)2. s.
  167  627.6561(5)(a)2., which is offered to an individual, covering
  168  only a resident of a foreign country on an annual basis.
  169         Section 5. Paragraph (t) is added to subsection (1) of
  170  section 626.88, Florida Statutes, to read:
  171         626.88 Definitions.—For the purposes of this part, the
  172  term:
  173         (1) “Administrator” is any person who directly or
  174  indirectly solicits or effects coverage of, collects charges or
  175  premiums from, or adjusts or settles claims on residents of this
  176  state in connection with authorized commercial self-insurance
  177  funds or with insured or self-insured programs which provide
  178  life or health insurance coverage or coverage of any other
  179  expenses described in s. 624.33(1) or any person who, through a
  180  health care risk contract as defined in s. 641.234 with an
  181  insurer or health maintenance organization, provides billing and
  182  collection services to health insurers and health maintenance
  183  organizations on behalf of health care providers, other than any
  184  of the following persons:
  185         (t) A corporation not for profit whose membership consists
  186  entirely of local governmental units authorized to enter into
  187  risk management consortiums under s. 112.08.
  188  
  189  A person who provides billing and collection services to health
  190  insurers and health maintenance organizations on behalf of
  191  health care providers shall comply with the provisions of ss.
  192  627.6131, 641.3155, and 641.51(4).
  193         Section 6. Subsection (2) of section 627.402, Florida
  194  Statutes, is amended to read:
  195         627.402 Definitions.—As used in this part, the term:
  196         (2) “Nongrandfathered health plan” is a health insurance
  197  policy or health maintenance organization contract that is not a
  198  grandfathered health plan and does not provide the benefits or
  199  coverages specified under s. 627.6513(1)-(14) s. 627.6561(5)(b)
  200  (e).
  201         Section 7. Subsection (3) of section 627.411, Florida
  202  Statutes, is amended to read:
  203         627.411 Grounds for disapproval.—
  204         (3)(a) For health insurance coverage as described in s.
  205  627.6561(5)(a)2., the minimum loss ratio standard of incurred
  206  claims to earned premium for the form shall be 65 percent.
  207         (b) Incurred claims are claims occurring within a fixed
  208  period, whether or not paid during the same period, under the
  209  terms of the policy period.
  210         1. Claims include scheduled benefit payments or services
  211  provided by a provider or through a provider network for dental,
  212  vision, disability, and similar health benefits.
  213         2. Claims do not include state assessments, taxes, company
  214  expenses, or any expense incurred by the company for the cost of
  215  adjusting and settling a claim, including the review,
  216  qualification, oversight, management, or monitoring of a claim
  217  or incentives or compensation to providers for other than the
  218  provisions of health care services.
  219         3. A company may at its discretion include costs that are
  220  demonstrated to reduce claims, such as fraud intervention
  221  programs or case management costs, which are identified in each
  222  filing, are demonstrated to reduce claims costs, and do not
  223  result in increasing the experience period loss ratio by more
  224  than 5 percent.
  225         4. For scheduled claim payments, such as disability income
  226  or long-term care, the incurred claims shall be the present
  227  value of the benefit payments discounted for continuance and
  228  interest.
  229         Section 8. Section 627.6011, Florida Statutes, is amended
  230  to read:
  231         627.6011 Mandated coverages.—Mandatory health benefits
  232  regulated under this chapter are not intended to apply to the
  233  types of health benefit plans listed in s. 627.6513(1)-(14) s.
  234  627.6561(5)(b)-(e), issued in any market, unless specifically
  235  designated otherwise. For purposes of this section, the term
  236  “mandatory health benefits” means those benefits set forth in
  237  ss. 627.6401-627.64193, and any other mandatory treatment or
  238  health coverages or benefits enacted on or after July 1, 2012.
  239         Section 9. Paragraph (h) of subsection (1) of section
  240  627.602, Florida Statutes, is amended to read:
  241         627.602 Scope, format of policy.—
  242         (1) Each health insurance policy delivered or issued for
  243  delivery to any person in this state must comply with all
  244  applicable provisions of this code and all of the following
  245  requirements:
  246         (h) Section 641.312 and the provisions of the Employee
  247  Retirement Income Security Act of 1974, as implemented by 29
  248  C.F.R. s. 2560.503-1, relating to internal grievances. This
  249  paragraph does not apply to a health insurance policy that is
  250  subject to the Subscriber Assistance Program under s. 408.7056
  251  or to the types of benefits or coverages provided under s.
  252  627.6513(1)-(14) s. 627.6561(5)(b)-(e) issued in any market.
  253         Section 10. Subsection (1) of section 627.642, Florida
  254  Statutes, is amended to read:
  255         627.642 Outline of coverage.—
  256         (1) A policy offering benefits defined in s. 627.6513(1)-
  257  (14) may not No individual or family accident and health
  258  insurance policy shall be delivered, or issued for delivery, in
  259  this state unless:
  260         (a) It is accompanied by an appropriate outline of
  261  coverage; or
  262         (b) An appropriate outline of coverage is completed and
  263  delivered to the applicant at the time application is made, and
  264  an acknowledgment of receipt or certificate of delivery of such
  265  outline is provided to the insurer with the application.
  266  
  267  In the case of a direct response, such as a written application
  268  to the insurance company from an applicant, the outline of
  269  coverage shall accompany the policy when issued.
  270         Section 11. Subsections (1), (6), and (7) of section
  271  627.6425, Florida Statutes, are amended, to read:
  272         627.6425 Renewability of individual coverage.—
  273         (1) Except as otherwise provided in this section, an
  274  insurer that provides individual health insurance coverage to an
  275  individual shall renew or continue in force such coverage at the
  276  option of the individual. For the purpose of this section, the
  277  term “individual health insurance” means health insurance
  278  coverage, as described in s. 624.603 s. 627.6561(5)(a)2.,
  279  offered to an individual in this state, including certificates
  280  of coverage offered to individuals in this state as part of a
  281  group policy issued to an association outside this state, but
  282  the term does not include short-term limited duration insurance
  283  or excepted benefits specified in s. 627.6513(1)-(14) subsection
  284  (6) or subsection (7).
  285         (6) The requirements of this section do not apply to any
  286  health insurance coverage in relation to its provision of
  287  excepted benefits described in s. 627.6561(5)(b).
  288         (7) The requirements of this section do not apply to any
  289  health insurance coverage in relation to its provision of
  290  excepted benefits described in s. 627.6561(5)(c), (d), or (e),
  291  if the benefits are provided under a separate policy,
  292  certificate, or contract of insurance.
  293         Section 12. Paragraph (b) of subsection (2) and subsection
  294  (3) of section 627.6487, Florida Statutes, are amended to read:
  295         627.6487 Guaranteed availability of individual health
  296  insurance coverage to eligible individuals.—
  297         (2) For the purposes of this section:
  298         (b) “Individual health insurance” means health insurance,
  299  as defined in s. 624.603 s. 627.6561(5)(a)2., which is offered
  300  to an individual, including certificates of coverage offered to
  301  individuals in this state as part of a group policy issued to an
  302  association outside this state, but the term does not include
  303  short-term limited duration insurance or excepted benefits
  304  specified in s. 627.6513(1)-(14) s. 627.6561(5)(b) or, if the
  305  benefits are provided under a separate policy, certificate, or
  306  contract, the term does not include excepted benefits specified
  307  in s. 627.6561(5)(c), (d), or (e).
  308         (3) For the purposes of this section, the term “eligible
  309  individual” means an individual:
  310         (a)1. For whom, as of the date on which the individual
  311  seeks coverage under this section, the aggregate of the periods
  312  of creditable coverage, as defined in s. 627.6562(3) s.
  313  627.6561(5) and (6), is 18 or more months; and
  314         2.a. Whose most recent prior creditable coverage was under
  315  a group health plan, governmental plan, or church plan, or
  316  health insurance coverage offered in connection with any such
  317  plan; or
  318         b. Whose most recent prior creditable coverage was under an
  319  individual plan issued in this state by a health insurer or
  320  health maintenance organization, which coverage is terminated
  321  due to the insurer or health maintenance organization becoming
  322  insolvent or discontinuing the offering of all individual
  323  coverage in the State of Florida, or due to the insured no
  324  longer living in the service area in the State of Florida of the
  325  insurer or health maintenance organization that provides
  326  coverage through a network plan in the State of Florida;
  327         (b) Who is not eligible for coverage under:
  328         1. A group health plan, as defined in s. 2791 of the Public
  329  Health Service Act;
  330         2. A conversion policy or contract issued by an authorized
  331  insurer or health maintenance organization under s. 627.6675 or
  332  s. 641.3921, respectively, offered to an individual who is no
  333  longer eligible for coverage under either an insured or self
  334  insured employer plan;
  335         3. Part A or part B of Title XVIII of the Social Security
  336  Act; or
  337         4. A state plan under Title XIX of such act, or any
  338  successor program, and does not have other health insurance
  339  coverage;
  340         (c) With respect to whom the most recent coverage within
  341  the coverage period described in paragraph (a) was not
  342  terminated based on a factor described in s. 627.6571(2)(a) or
  343  (b), relating to nonpayment of premiums or fraud, unless such
  344  nonpayment of premiums or fraud was due to acts of an employer
  345  or person other than the individual;
  346         (d) Who, having been offered the option of continuation
  347  coverage under a COBRA continuation provision or under s.
  348  627.6692, elected such coverage; and
  349         (e) Who, if the individual elected such continuation
  350  provision, has exhausted such continuation coverage under such
  351  provision or program.
  352         Section 13. Section 627.64871, Florida Statutes, is
  353  repealed.
  354         Section 14. Section 627.6512, Florida Statutes, is amended
  355  to read:
  356         627.6512 Exemption of certain group health insurance
  357  policies.—Sections 627.6561, 627.65615, 627.65625, and 627.6571
  358  do not apply to:
  359         (1) any group insurance policy in relation to its provision
  360  of excepted benefits described in s. 627.6513(1)-(14)
  361  627.6561(5)(b).
  362         (2)Any group health insurance policy in relation to its
  363  provision of excepted benefits described in s. 627.6561(5)(c),
  364  if the benefits:
  365         (a)Are provided under a separate policy, certificate, or
  366  contract of insurance; or
  367         (b)Are otherwise not an integral part of the policy.
  368         (3)Any group health insurance policy in relation to its
  369  provision of excepted benefits described in s. 627.6561(5)(d),
  370  if all of the following conditions are met:
  371         (a)The benefits are provided under a separate policy,
  372  certificate, or contract of insurance;
  373         (b)There is no coordination between the provision of such
  374  benefits and any exclusion of benefits under any group policy
  375  maintained by the same policyholder; and
  376         (c)Such benefits are paid with respect to an event without
  377  regard to whether benefits are provided with respect to such an
  378  event under any group health policy maintained by the same
  379  policyholder.
  380         (4)Any group health policy in relation to its provision of
  381  excepted benefits described in s. 627.6561(5)(e), if the
  382  benefits are provided under a separate policy, certificate, or
  383  contract of insurance.
  384         Section 15. Section 627.6513, Florida Statutes, is amended
  385  to read:
  386         627.6513 Scope.—Section 641.312 and the provisions of the
  387  Employee Retirement Income Security Act of 1974, as implemented
  388  by 29 C.F.R. s. 2560.503-1, relating to internal grievances,
  389  apply to all group health insurance policies issued under this
  390  part. This section does not apply to a group health insurance
  391  policy that is subject to the Subscriber Assistance Program in
  392  s. 408.7056 or to: the types of benefits or coverages provided
  393  under s. 627.6561(5)(b)-(e) issued in any market.
  394         (1)Coverage only for accident insurance, or disability
  395  income insurance, or any combination thereof.
  396         (2)Coverage issued as a supplement to liability insurance.
  397         (3)Liability insurance, including general liability
  398  insurance and automobile liability insurance.
  399         (4)Workers’ compensation or similar insurance.
  400         (5)Automobile medical payment insurance.
  401         (6)Credit-only insurance.
  402         (7)Coverage for onsite medical clinics, including prepaid
  403  health clinics under part II of chapter 641.
  404         (8)Other similar insurance coverage, specified in rules
  405  adopted by the commission, under which benefits for medical care
  406  are secondary or incidental to other insurance benefits. To the
  407  extent possible, such rules must be consistent with regulations
  408  adopted by the United States Department of Health and Human
  409  Services.
  410         (9)Limited scope dental or vision benefits, if offered
  411  separately.
  412         (10)Benefits for long-term care, nursing home care, home
  413  health care, or community-based care, or any combination
  414  thereof, if offered separately.
  415         (11)Other similar, limited benefits, if offered
  416  separately, as specified in rules adopted by the commission.
  417         (12)Coverage only for a specified disease or illness, if
  418  offered as independent, noncoordinated benefits.
  419         (13)Hospital indemnity or other fixed indemnity insurance,
  420  if offered as independent, noncoordinated benefits.
  421         (14)Benefits provided through a Medicare supplemental
  422  health insurance policy, as defined under s. 1882(g)(1) of the
  423  Social Security Act, coverage supplemental to the coverage
  424  provided under 10 U.S.C. chapter 55, and similar supplemental
  425  coverage provided to coverage under a group health plan, which
  426  are offered as a separate insurance policy and as independent,
  427  noncoordinated benefits.
  428         Section 16. Section 627.6561, Florida Statutes, is amended
  429  to read:
  430         627.6561 Preexisting conditions.—
  431         (1) As used in this section, the term:
  432         (a) “Enrollment date” means, with respect to an individual
  433  covered under a group health policy, the date of enrollment of
  434  the individual in the plan or coverage or, if earlier, the first
  435  day of the waiting period of such enrollment.
  436         (b) “Late enrollee” means, with respect to coverage under a
  437  group health policy, a participant or beneficiary who enrolls
  438  under the policy other than during:
  439         1. The first period in which the individual is eligible to
  440  enroll under the policy.
  441         2. A special enrollment period, as provided under s.
  442  627.65615.
  443         (c) “Waiting period” means, with respect to a group health
  444  policy and an individual who is a potential participant or
  445  beneficiary of the policy, the period that must pass with
  446  respect to the individual before the individual is eligible to
  447  be covered for benefits under the terms of the policy.
  448         (2) Subject to the exceptions specified in subsection (4),
  449  an insurer that offers group health insurance coverage may, with
  450  respect to a participant or beneficiary, impose a preexisting
  451  condition exclusion only if:
  452         (a) Such exclusion relates to a physical or mental
  453  condition, regardless of the cause of the condition, for which
  454  medical advice, diagnosis, care, or treatment was recommended or
  455  received within the 6-month period ending on the enrollment
  456  date;
  457         (b) Such exclusion extends for a period of not more than 12
  458  months, or 18 months in the case of a late enrollee, after the
  459  enrollment date; and
  460         (c) The period of any such preexisting condition exclusion
  461  is reduced by the aggregate of the periods of creditable
  462  coverage, as defined in s. 627.6562(3) subsection (5),
  463  applicable to the participant or beneficiary as of the
  464  enrollment date.
  465         (3) Genetic information may not be treated as a condition
  466  described in paragraph (2)(a) in the absence of a diagnosis of
  467  the condition related to such information.
  468         (4)(a) Subject to paragraph (b), an insurer that offers
  469  group health insurance coverage may not impose any preexisting
  470  condition exclusion in the case of:
  471         1. An individual who, as of the last day of the 30-day
  472  period beginning with the date of birth, is covered under
  473  creditable coverage.
  474         2. A child who is adopted or placed for adoption before
  475  attaining 18 years of age and who, as of the last day of the 30
  476  day period beginning on the date of the adoption or placement
  477  for adoption, is covered under creditable coverage. This
  478  provision does not apply to coverage before the date of such
  479  adoption or placement for adoption.
  480         3. Pregnancy.
  481         (b) Subparagraphs 1. and 2. do not apply to an individual
  482  after the end of the first 63-day period during all of which the
  483  individual was not covered under any creditable coverage.
  484         (5)(a)The term, “creditable coverage,” means, with respect
  485  to an individual, coverage of the individual under any of the
  486  following:
  487         1.A group health plan, as defined in s. 2791 of the Public
  488  Health Service Act.
  489         2.Health insurance coverage consisting of medical care,
  490  provided directly, through insurance or reimbursement, or
  491  otherwise and including terms and services paid for as medical
  492  care, under any hospital or medical service policy or
  493  certificate, hospital or medical service plan contract, or
  494  health maintenance contract offered by a health insurance
  495  issuer.
  496         3.Part A or part B of Title XVIII of the Social Security
  497  Act.
  498         4.Title XIX of the Social Security Act, other than
  499  coverage consisting solely of benefits under s. 1928.
  500         5.Chapter 55 of Title 10, United States Code.
  501         6.A medical care program of the Indian Health Service or
  502  of a tribal organization.
  503         7.The Florida Comprehensive Health Association or another
  504  state health benefit risk pool.
  505         8.A health plan offered under chapter 89 of Title 5,
  506  United States Code.
  507         9.A public health plan as defined by rules adopted by the
  508  commission. To the greatest extent possible, such rules must be
  509  consistent with regulations adopted by the United States
  510  Department of Health and Human Services.
  511         10.A health benefit plan under s. 5(e) of the Peace Corps
  512  Act (22 U.S.C. s. 2504(e)).
  513         (b)Creditable coverage does not include coverage that
  514  consists solely of one or more or any combination thereof of the
  515  following excepted benefits:
  516         1.Coverage only for accident, or disability income
  517  insurance, or any combination thereof.
  518         2.Coverage issued as a supplement to liability insurance.
  519         3.Liability insurance, including general liability
  520  insurance and automobile liability insurance.
  521         4.Workers’ compensation or similar insurance.
  522         5.Automobile medical payment insurance.
  523         6.Credit-only insurance.
  524         7.Coverage for onsite medical clinics, including prepaid
  525  health clinics under part II of chapter 641.
  526         8.Other similar insurance coverage, specified in rules
  527  adopted by the commission, under which benefits for medical care
  528  are secondary or incidental to other insurance benefits. To the
  529  extent possible, such rules must be consistent with regulations
  530  adopted by the United States Department of Health and Human
  531  Services.
  532         (c)The following benefits are not subject to the
  533  creditable coverage requirements, if offered separately:
  534         1.Limited scope dental or vision benefits.
  535         2.Benefits for long-term care, nursing home care, home
  536  health care, community-based care, or any combination thereof.
  537         3.Such other similar, limited benefits as are specified in
  538  rules adopted by the commission.
  539         (d)The following benefits are not subject to creditable
  540  coverage requirements if offered as independent, noncoordinated
  541  benefits:
  542         1.Coverage only for a specified disease or illness.
  543         2.Hospital indemnity or other fixed indemnity insurance.
  544         (e)Benefits provided through a Medicare supplemental
  545  health insurance, as defined under s. 1882(g)(1) of the Social
  546  Security Act, coverage supplemental to the coverage provided
  547  under chapter 55 of Title 10, United States Code, and similar
  548  supplemental coverage provided to coverage under a group health
  549  plan are not considered creditable coverage if offered as a
  550  separate insurance policy.
  551         (6)(a)A period of creditable coverage may not be counted,
  552  with respect to enrollment of an individual under a group health
  553  plan, if, after such period and before the enrollment date,
  554  there was a 63-day period during all of which the individual was
  555  not covered under any creditable coverage.
  556         (b)Any period during which an individual is in a waiting
  557  period for any coverage under a group health plan or for group
  558  health insurance coverage may not be taken into account in
  559  determining the 63-day period under paragraph (a) or paragraph
  560  (4)(b).
  561         (7)(a)Except as otherwise provided under paragraph (b), an
  562  insurer shall count a period of creditable coverage without
  563  regard to the specific benefits covered under the period.
  564         (b)An insurer may elect to count, as creditable coverage,
  565  coverage of benefits within each of several classes or
  566  categories of benefits specified in rules adopted by the
  567  commission rather than as provided under paragraph (a). To the
  568  extent possible, such rules must be consistent with regulations
  569  adopted by the United States Department of Health and Human
  570  Services. Such election shall be made on a uniform basis for all
  571  participants and beneficiaries. Under such election, an insurer
  572  shall count a period of creditable coverage with respect to any
  573  class or category of benefits if any level of benefits is
  574  covered within such class or category.
  575         (c)In the case of an election with respect to an insurer
  576  under paragraph (b), the insurer shall:
  577         1.Prominently state in 10-point type or larger in any
  578  disclosure statements concerning the policy, and state to each
  579  certificateholder at the time of enrollment under the policy,
  580  that the insurer has made such election; and
  581         2.Include in such statements a description of the effect
  582  of this election.
  583         (8)(a)Periods of creditable coverage with respect to an
  584  individual shall be established through presentation of
  585  certifications described in this subsection or in such other
  586  manner as is specified in rules adopted by the commission. To
  587  the extent possible, such rules must be consistent with
  588  regulations adopted by the United States Department of Health
  589  and Human Services.
  590         (b)An insurer that offers group health insurance coverage
  591  shall provide the certification described in paragraph (a):
  592         1.At the time an individual ceases to be covered under the
  593  plan or otherwise becomes covered under a COBRA continuation
  594  provision or continuation pursuant to s. 627.6692.
  595         2.In the case of an individual becoming covered under a
  596  COBRA continuation provision or pursuant to s. 627.6692, at the
  597  time the individual ceases to be covered under such a provision.
  598         3.Upon the request on behalf of an individual made not
  599  later than 24 months after the date of cessation of the coverage
  600  described in this paragraph.
  601  
  602  The certification under subparagraph 1. may be provided, to the
  603  extent practicable, at a time consistent with notices required
  604  under any applicable COBRA continuation provision or
  605  continuation pursuant to s. 627.6692.
  606         (c)The certification described in this section is a
  607  written certification that must include:
  608         1.The period of creditable coverage of the individual
  609  under the policy and the coverage, if any, under such COBRA
  610  continuation provision or continuation pursuant to s. 627.6692;
  611  and
  612         2.The waiting period, if any, imposed with respect to the
  613  individual for any coverage under such policy.
  614         (d)In the case of an election described in subsection (7)
  615  by an insurer, if the insurer enrolls an individual for coverage
  616  under the plan and the individual provides a certification of
  617  coverage of the individual, as provided in this subsection:
  618         1.Upon request of such insurer, the insurer that issued
  619  the certification provided by the individual shall promptly
  620  disclose to such requesting plan or insurer information on
  621  coverage of classes and categories of health benefits available
  622  under such insurer’s plan or coverage.
  623         2.Such insurer may charge the requesting insurer for the
  624  reasonable cost of disclosing such information.
  625         (e)The commission shall adopt rules to prevent an
  626  insurer’s failure to provide information under this subsection
  627  with respect to previous coverage of an individual from
  628  adversely affecting any subsequent coverage of the individual
  629  under another group health plan or health insurance coverage. To
  630  the greatest extent possible, such rules must be consistent with
  631  regulations adopted by the United States Department of Health
  632  and Human Services.
  633         (9)(a)Except as provided in paragraph (b), no period
  634  before July 1, 1996, shall be taken into account in determining
  635  creditable coverage.
  636         (b)The commission shall adopt rules that provide a process
  637  whereby individuals who need to establish creditable coverage
  638  for periods before July 1, 1996, and who would have such
  639  coverage credited but for paragraph (a), may be given credit for
  640  creditable coverage for such periods through the presentation of
  641  documents or other means. To the greatest extent possible, such
  642  rules must be consistent with regulations adopted by the United
  643  States Department of Health and Human Services.
  644         (10)Except as otherwise provided in this subsection,
  645  paragraph (8)(b) applies to events that occur on or after July
  646  1, 1996.
  647         (a)In no case is a certification required to be provided
  648  under paragraph (8)(b) prior to June 1, 1997.
  649         (b)In the case of an event that occurred on or after July
  650  1, 1996, and before October 1, 1996, a certification is not
  651  required to be provided under paragraph (8)(b), unless an
  652  individual, with respect to whom the certification is required
  653  to be made, requests such certification in writing.
  654         (11)In the case of an individual who seeks to establish
  655  creditable coverage for any period for which certification is
  656  not required because it relates to an event that occurred before
  657  July 1, 1996:
  658         (a)The individual may present other creditable coverage in
  659  order to establish the period of creditable coverage.
  660         (b)An insurer is not subject to any penalty or enforcement
  661  action with respect to the insurer’s crediting, or not
  662  crediting, such coverage if the insurer has sought to comply in
  663  good faith with applicable provisions of this section.
  664         (12)For purposes of subsection (9), any plan amendment
  665  made pursuant to a collective bargaining agreement relating to
  666  the plan which amends the plan solely to conform to any
  667  requirement of this section may not be treated as a termination
  668  of such collective bargaining agreement.
  669         (13)This section does not apply to any health insurance
  670  coverage in relation to its provision of excepted benefits
  671  described in paragraph (5)(b).
  672         (14)This section does not apply to any health insurance
  673  coverage in relation to its provision of excepted benefits
  674  described in paragraphs (5)(c), (d), or (e), if the benefits are
  675  provided under a separate policy, certificate, or contract of
  676  insurance.
  677         (15)This section applies to health insurance coverage
  678  offered, sold, issued, renewed, or in effect on or after July 1,
  679  1997.
  680         Section 17. Subsection (3) of section 627.6562, Florida
  681  Statutes, is amended to read:
  682         627.6562 Dependent coverage.—
  683         (3) If, pursuant to subsection (2), a child is provided
  684  coverage under the parent’s policy after the end of the calendar
  685  year in which the child reaches age 25 and coverage for the
  686  child is subsequently terminated, the child is not eligible to
  687  be covered under the parent’s policy unless the child was
  688  continuously covered by other creditable coverage without a gap
  689  in coverage of more than 63 days.
  690         (a) For the purposes of this subsection, the term
  691  “creditable coverage” means, with respect to an individual,
  692  coverage of the individual under any of the following: has the
  693  same meaning as provided in s. 627.6561(5).
  694         1.A group health plan, as defined in s. 2791 of the Public
  695  Health Service Act.
  696         2.Health insurance coverage consisting of medical care
  697  provided directly through insurance or reimbursement or
  698  otherwise, and including terms and services paid for as medical
  699  care, under any hospital or medical service policy or
  700  certificate, hospital or medical service plan contract, or
  701  health maintenance contract offered by a health insurance
  702  issuer.
  703         3.Part A or part B of Title XVIII of the Social Security
  704  Act.
  705         4.Title XIX of the Social Security Act, other than
  706  coverage consisting solely of benefits under s. 1928.
  707         5.Title 10 U.S.C. chapter 55.
  708         6.A medical care program of the Indian Health Service or
  709  of a tribal organization.
  710         7.The Florida Comprehensive Health Association or another
  711  state health benefit risk pool.
  712         8.A health plan offered under 5 U.S.C. chapter 89.
  713         9.A public health plan as defined by rules adopted by the
  714  commission. To the greatest extent possible, such rules must be
  715  consistent with regulations adopted by the United States
  716  Department of Health and Human Services.
  717         10.A health benefit plan under s. 5(e) of the Peace Corps
  718  Act, 22 U.S.C. s. 2504(e).
  719         (b)Creditable coverage does not include coverage that
  720  consists of one or more, or any combination thereof, of the
  721  following excepted benefits:
  722         1.Coverage only for accident insurance, or disability
  723  income insurance, or any combination thereof.
  724         2.Coverage issued as a supplement to liability insurance.
  725         3.Liability insurance, including general liability
  726  insurance and automobile liability insurance.
  727         4.Workers’ compensation or similar insurance.
  728         5.Automobile medical payment insurance.
  729         6.Credit-only insurance.
  730         7.Coverage for onsite medical clinics, including prepaid
  731  health clinics under part II of chapter 641.
  732         8.Other similar insurance coverage specified in rules
  733  adopted by the commission under which benefits for medical care
  734  are secondary or incidental to other insurance benefits. To the
  735  extent possible, such rules must be consistent with regulations
  736  adopted by the United States Department of Health and Human
  737  Services.
  738         (c)The following benefits are not subject to the
  739  creditable coverage requirements, if offered separately:
  740         1.Limited scope dental or vision benefits.
  741         2.Benefits for long-term care, nursing home care, home
  742  health care, community-based care, or any combination thereof.
  743         3.Other similar, limited benefits specified in rules
  744  adopted by the commission.
  745         (d)The following benefits are not subject to creditable
  746  coverage requirements if offered as independent, noncoordinated
  747  benefits:
  748         1.Coverage only for a specified disease or illness.
  749         2.Hospital indemnity or other fixed indemnity insurance.
  750         (e)Benefits provided through a Medicare supplemental
  751  health insurance policy, as defined under s. 1882(g)(1) of the
  752  Social Security Act, coverage supplemental to the coverage
  753  provided under 10 U.S.C. chapter 55, and similar supplemental
  754  coverage provided to coverage under a group health plan are not
  755  considered creditable coverage if offered as a separate
  756  insurance policy.
  757         Section 18. Subsection (1) of section 627.65626, Florida
  758  Statutes, is amended to read:
  759         627.65626 Insurance rebates for healthy lifestyles.—
  760         (1) Any rate, rating schedule, or rating manual for a
  761  health insurance policy that provides creditable coverage as
  762  defined in s. 627.6562(3) 627.6561(5) filed with the office
  763  shall provide for an appropriate rebate of premiums paid in the
  764  last policy year, contract year, or calendar year when the
  765  majority of members of a health plan have enrolled and
  766  maintained participation in any health wellness, maintenance, or
  767  improvement program offered by the group policyholder and health
  768  plan. The rebate may be based upon premiums paid in the last
  769  calendar year or policy year. The group must provide evidence of
  770  demonstrative maintenance or improvement of the enrollees’
  771  health status as determined by assessments of agreed-upon health
  772  status indicators between the policyholder and the health
  773  insurer, including, but not limited to, reduction in weight,
  774  body mass index, and smoking cessation. The group or health
  775  insurer may contract with a third-party administrator to
  776  assemble and report the health status required in this
  777  subsection between the policyholder and the health insurer. Any
  778  rebate provided by the health insurer is presumed to be
  779  appropriate unless credible data demonstrates otherwise, or
  780  unless the rebate program requires the insured to incur costs to
  781  qualify for the rebate which equal or exceed the value of the
  782  rebate, but the rebate may not exceed 10 percent of paid
  783  premiums.
  784         Section 19. Paragraphs (e) and (l) of subsection (3) and
  785  paragraph (d) of subsection (5) of section 627.6699, Florida
  786  Statutes, are amended to read:
  787         627.6699 Employee Health Care Access Act.—
  788         (3) DEFINITIONS.—As used in this section, the term:
  789         (e) “Creditable coverage” has the same meaning as provided
  790  ascribed in s. 627.6562(3) 627.6561.
  791         (l) “Late enrollee” means an eligible employee or dependent
  792  who, with respect to coverage under a group health policy, is a
  793  participant or beneficiary who enrolls under the policy other
  794  than during:
  795         1.The first period in which the individual is eligible to
  796  enroll under the policy.
  797         2.A special enrollment period, as provided under s.
  798  627.65615 as defined under s. 627.6561(1)(b).
  799         (5) AVAILABILITY OF COVERAGE.—
  800         (d) A health benefit plan covering small employers, issued
  801  or renewed on or after January 1, 1994, must comply with the
  802  following conditions:
  803         1. All health benefit plans must be offered and issued on a
  804  guaranteed-issue basis. Additional or increased benefits may
  805  only be offered by riders.
  806         2.Paragraph (c) applies to health benefit plans issued to
  807  a small employer who has two or more eligible employees and to
  808  health benefit plans that are issued to a small employer who has
  809  fewer than two eligible employees and that cover an employee who
  810  has had creditable coverage continually to a date not more than
  811  63 days before the effective date of the new coverage.
  812         2.3. For health benefit plans that are issued to a small
  813  employer who has fewer than two employees and that cover an
  814  employee who has not been continually covered by creditable
  815  coverage within 63 days before the effective date of the new
  816  coverage, preexisting condition provisions must not exclude
  817  coverage for a period beyond 24 months following the employee’s
  818  effective date of coverage and may relate only to:
  819         a. Conditions that, during the 24-month period immediately
  820  preceding the effective date of coverage, had manifested
  821  themselves in such a manner as would cause an ordinarily prudent
  822  person to seek medical advice, diagnosis, care, or treatment or
  823  for which medical advice, diagnosis, care, or treatment was
  824  recommended or received; or
  825         b. A pregnancy existing on the effective date of coverage.
  826         Section 20. Subsection (1) and paragraph (c) of subsection
  827  (2) of section 627.6741, Florida Statutes, are amended to read:
  828         627.6741 Issuance, cancellation, nonrenewal, and
  829  replacement.—
  830         (1)(a) An insurer issuing Medicare supplement policies in
  831  this state shall offer the opportunity of enrolling in a
  832  Medicare supplement policy, without conditioning the issuance or
  833  effectiveness of the policy on, and without discriminating in
  834  the price of the policy based on, the medical or health status
  835  or receipt of health care by the individual:
  836         1. To any individual who is 65 years of age or older, or
  837  under 65 years of age and eligible for Medicare by reason of
  838  disability or end-stage renal disease, and who resides in this
  839  state, upon the request of the individual during the 6-month
  840  period beginning with the first month in which the individual
  841  has attained 65 years of age and is enrolled in Medicare Part B,
  842  or is eligible for Medicare by reason of a disability or end
  843  stage renal disease, and is enrolled in Medicare Part B; or
  844         2. To any individual who is 65 years of age or older, or
  845  under 65 years of age and eligible for Medicare by reason of a
  846  disability or end-stage renal disease, who is enrolled in
  847  Medicare Part B, and who resides in this state, upon the request
  848  of the individual during the 2-month period following
  849  termination of coverage under a group health insurance policy.
  850         (b) The 6-month period to enroll in a Medicare supplement
  851  policy for an individual who is under 65 years of age and is
  852  eligible for Medicare by reason of disability or end-stage renal
  853  disease and otherwise eligible under subparagraph (a)1. or
  854  subparagraph (a)2. and first enrolled in Medicare Part B before
  855  October 1, 2009, begins on October 1, 2009.
  856         (c) A company that has offered Medicare supplement policies
  857  to individuals under 65 years of age who are eligible for
  858  Medicare by reason of disability or end-stage renal disease
  859  before October 1, 2009, may, for one time only, effect a rate
  860  schedule change that redefines the age bands of the premium
  861  classes without activating the period of discontinuance required
  862  by s. 627.410(6)(e)2.
  863         (d) As a part of an insurer’s rate filings, before and
  864  including the insurer’s first rate filing for a block of policy
  865  forms in 2015, notwithstanding the provisions of s.
  866  627.410(6)(e)3., an insurer shall consider the experience of the
  867  policies or certificates for the premium classes including
  868  individuals under 65 years of age and eligible for Medicare by
  869  reason of disability or end-stage renal disease separately from
  870  the balance of the block so as not to affect the other premium
  871  classes. For filings in such time period only, credibility of
  872  that experience shall be as follows: if a block of policy forms
  873  has 1,250 or more policies or certificates in force in the age
  874  band including ages under 65 years of age, full or 100-percent
  875  credibility shall be given to the experience; and if fewer than
  876  250 policies or certificates are in force, no or zero-percent
  877  credibility shall be given. Linear interpolation shall be used
  878  for in-force amounts between the low and high values. Florida
  879  only experience shall be used if it is 100-percent credible. If
  880  Florida-only experience is not 100-percent credible, a
  881  combination of Florida-only and nationwide experience shall be
  882  used. If Florida-only experience is zero-percent credible,
  883  nationwide experience shall be used. The insurer may file its
  884  initial rates and any rate adjustment based upon the experience
  885  of these policies or certificates or based upon expected claim
  886  experience using experience data of the same company, other
  887  companies in the same or other states, or using data publicly
  888  available from the Centers for Medicaid and Medicare Services if
  889  the insurer’s combined Florida and nationwide experience is not
  890  100-percent credible, separate from the balance of all other
  891  Medicare supplement policies.
  892  
  893  A Medicare supplement policy issued to an individual under
  894  subparagraph (a)1. or subparagraph (a)2. may not exclude
  895  benefits based on a preexisting condition if the individual has
  896  a continuous period of creditable coverage, as defined in s.
  897  627.6562(3) 627.6561(5), of at least 6 months as of the date of
  898  application for coverage.
  899         (2) For both individual and group Medicare supplement
  900  policies:
  901         (c) If a Medicare supplement policy or certificate replaces
  902  another Medicare supplement policy or certificate or creditable
  903  coverage as defined in s. 627.6562(3) 627.6561(5), the replacing
  904  insurer shall waive any time periods applicable to preexisting
  905  conditions, waiting periods, elimination periods, and
  906  probationary periods in the new Medicare supplement policy for
  907  similar benefits to the extent such time was spent under the
  908  original policy, subject to the requirements of s. 627.6561(6)
  909  (11).
  910         Section 21. Subsection (2) and paragraph (a) of subsection
  911  (40) of section 641.31, Florida Statutes, are amended to read:
  912         641.31 Health maintenance contracts.—
  913         (2) The rates charged by any health maintenance
  914  organization to its subscribers shall not be excessive,
  915  inadequate, or unfairly discriminatory or follow a rating
  916  methodology that is inconsistent, indeterminate, or ambiguous or
  917  encourages misrepresentation or misunderstanding. A law
  918  restricting or limiting deductibles, coinsurance, copayments, or
  919  annual or lifetime maximum payments shall not apply to any
  920  health maintenance organization contract that provides coverage
  921  as described in s. 641.31071(5)(a)2., offered or delivered to an
  922  individual or a group of 51 or more persons. The commission, in
  923  accordance with generally accepted actuarial practice as applied
  924  to health maintenance organizations, may define by rule what
  925  constitutes excessive, inadequate, or unfairly discriminatory
  926  rates and may require whatever information it deems necessary to
  927  determine that a rate or proposed rate meets the requirements of
  928  this subsection.
  929         (40)(a) Any group rate, rating schedule, or rating manual
  930  for a health maintenance organization policy, which provides
  931  creditable coverage as defined in s. 627.6562(3) 627.6561(5),
  932  filed with the office shall provide for an appropriate rebate of
  933  premiums paid in the last policy year, contract year, or
  934  calendar year when the majority of members of a health plan are
  935  enrolled in and have maintained participation in any health
  936  wellness, maintenance, or improvement program offered by the
  937  group contract holder. The group must provide evidence of
  938  demonstrative maintenance or improvement of his or her health
  939  status as determined by assessments of agreed-upon health status
  940  indicators between the group and the health insurer, including,
  941  but not limited to, reduction in weight, body mass index, and
  942  smoking cessation. Any rebate provided by the health maintenance
  943  organization is presumed to be appropriate unless credible data
  944  demonstrates otherwise, or unless the rebate program requires
  945  the insured to incur costs to qualify for the rebate which
  946  equals or exceeds the value of the rebate but the rebate may not
  947  exceed 10 percent of paid premiums.
  948         Section 22. Section 641.31071, Florida Statutes, is amended
  949  to read:
  950         641.31071 Preexisting conditions.—
  951         (1) As used in this section, the term:
  952         (a) “Enrollment date” means, with respect to an individual
  953  covered under a group health maintenance organization contract,
  954  the date of enrollment of the individual in the plan or coverage
  955  or, if earlier, the first day of the waiting period of such
  956  enrollment.
  957         (b) “Late enrollee” means, with respect to coverage under a
  958  group health maintenance organization contract, a participant or
  959  beneficiary who enrolls under the contract other than during:
  960         1. The first period in which the individual is eligible to
  961  enroll under the plan.
  962         2. A special enrollment period, as provided under s.
  963  641.31072.
  964         (c) “Waiting period” means, with respect to a group health
  965  maintenance organization contract and an individual who is a
  966  potential participant or beneficiary under the contract, the
  967  period that must pass with respect to the individual before the
  968  individual is eligible to be covered for benefits under the
  969  terms of the contract.
  970         (2) Subject to the exceptions specified in subsection (4),
  971  a health maintenance organization that offers group coverage,
  972  may, with respect to a participant or beneficiary, impose a
  973  preexisting condition exclusion only if:
  974         (a) Such exclusion relates to a physical or mental
  975  condition, regardless of the cause of the condition, for which
  976  medical advice, diagnosis, care, or treatment was recommended or
  977  received within the 6-month period ending on the enrollment
  978  date;
  979         (b) Such exclusion extends for a period of not more than 12
  980  months, or 18 months in the case of a late enrollee, after the
  981  enrollment date; and
  982         (c) The period of any such preexisting condition exclusion
  983  is reduced by the aggregate of the periods of creditable
  984  coverage, as defined in s. 627.6562(3) subsection (5),
  985  applicable to the participant or beneficiary as of the
  986  enrollment date.
  987         (3) Genetic information shall not be treated as a condition
  988  described in paragraph (2)(a) in the absence of a diagnosis of
  989  the condition related to such information.
  990         (4)(a) Subject to paragraph (b), a health maintenance
  991  organization that offers group coverage may not impose any
  992  preexisting condition exclusion in the case of:
  993         1. An individual who, as of the last day of the 30-day
  994  period beginning with the date of birth, is covered under
  995  creditable coverage.
  996         2. A child who is adopted or placed for adoption before
  997  attaining 18 years of age and who, as of the last day of the 30
  998  day period beginning on the date of the adoption or placement
  999  for adoption, is covered under creditable coverage. This
 1000  provision shall not apply to coverage before the date of such
 1001  adoption or placement for adoption.
 1002         3. Pregnancy.
 1003         (b) Subparagraphs (a)1. and 2. do not apply to an
 1004  individual after the end of the first 63-day period during all
 1005  of which the individual was not covered under any creditable
 1006  coverage.
 1007         (5)(a)The term “creditable coverage” means, with respect
 1008  to an individual, coverage of the individual under any of the
 1009  following:
 1010         1.A group health plan, as defined in s. 2791 of the Public
 1011  Health Service Act.
 1012         2.Health insurance coverage consisting of medical care,
 1013  provided directly, through insurance or reimbursement or
 1014  otherwise, and including terms and services paid for as medical
 1015  care, under any hospital or medical service policy or
 1016  certificate, hospital or medical service plan contract, or
 1017  health maintenance contract offered by a health insurance
 1018  issuer.
 1019         3.Part A or part B of Title XVIII of the Social Security
 1020  Act.
 1021         4.Title XIX of the Social Security Act, other than
 1022  coverage consisting solely of benefits under s. 1928.
 1023         5.Chapter 55 of Title 10, United States Code.
 1024         6.A medical care program of the Indian Health Service or
 1025  of a tribal organization.
 1026         7.The Florida Comprehensive Health Association or another
 1027  state health benefit risk pool.
 1028         8.A health plan offered under chapter 89 of Title 5,
 1029  United States Code.
 1030         9.A public health plan as defined by rule of the
 1031  commission. To the greatest extent possible, such rules must be
 1032  consistent with regulations adopted by the United States
 1033  Department of Health and Human Services.
 1034         10.A health benefit plan under s. 5(e) of the Peace Corps
 1035  Act (22 U.S.C. s. 2504(e)).
 1036         (b)Creditable coverage does not include coverage that
 1037  consists solely of one or more or any combination thereof of the
 1038  following excepted benefits:
 1039         1.Coverage only for accident, or disability income
 1040  insurance, or any combination thereof.
 1041         2.Coverage issued as a supplement to liability insurance.
 1042         3.Liability insurance, including general liability
 1043  insurance and automobile liability insurance.
 1044         4.Workers’ compensation or similar insurance.
 1045         5.Automobile medical payment insurance.
 1046         6.Credit-only insurance.
 1047         7.Coverage for onsite medical clinics.
 1048         8.Other similar insurance coverage, specified in rules
 1049  adopted by the commission, under which benefits for medical care
 1050  are secondary or incidental to other insurance benefits. To the
 1051  greatest extent possible, such rules must be consistent with
 1052  regulations adopted by the United States Department of Health
 1053  and Human Services.
 1054         (c)The following benefits are not subject to the
 1055  creditable coverage requirements, if offered separately;
 1056         1.Limited scope dental or vision benefits.
 1057         2.Benefits or long-term care, nursing home care, home
 1058  health care, community-based care, or any combination of these.
 1059         3.Such other similar, limited benefits as are specified in
 1060  rules adopted by the commission. To the greatest extent
 1061  possible, such rules must be consistent with regulations adopted
 1062  by the United States Department of Health and Human Services.
 1063         (d)The following benefits are not subject to creditable
 1064  coverage requirements if offered as independent, noncoordinated
 1065  benefits:
 1066         1.Coverage only for a specified disease or illness.
 1067         2.Hospital indemnity or other fixed indemnity insurance.
 1068         (e)Benefits provided through Medicare supplemental health
 1069  insurance, as defined under s. 1882(g)(1) of the Social Security
 1070  Act, coverage supplemental to the coverage provided under
 1071  chapter 55 of Title 10, United States Code, and similar
 1072  supplemental coverage provided to coverage under a group health
 1073  plan are not considered creditable coverage if offered as a
 1074  separate insurance policy.
 1075         (6)(a)A period of creditable coverage may not be counted,
 1076  with respect to enrollment of an individual under a group health
 1077  maintenance organization contract, if, after such period and
 1078  before the enrollment date, there was a 63-day period during all
 1079  of which the individual was not covered under any creditable
 1080  coverage.
 1081         (b)Any period during which an individual is in a waiting
 1082  period, or in an affiliation period as defined in subsection
 1083  (9), for any coverage under a group health maintenance
 1084  organization contract may not be taken into account in
 1085  determining the 63-day period under paragraph (a) or paragraph
 1086  (4)(b).
 1087         (7)(a)Except as otherwise provided under paragraph (b), a
 1088  health maintenance organization shall count a period of
 1089  creditable coverage without regard to the specific benefits
 1090  covered under the period.
 1091         (b)A health maintenance organization may elect to count as
 1092  creditable coverage, coverage of benefits within each of several
 1093  classes or categories of benefits specified in rules adopted by
 1094  the commission rather than as provided under paragraph (a). Such
 1095  election shall be made on a uniform basis for all participants
 1096  and beneficiaries. Under such election, a health maintenance
 1097  organization shall count a period of creditable coverage with
 1098  respect to any class or category of benefits if any level of
 1099  benefits is covered within such class or category.
 1100         (c)In the case of an election with respect to a health
 1101  maintenance organization under paragraph (b), the organization
 1102  shall:
 1103         1.Prominently state in 10-point type or larger in any
 1104  disclosure statements concerning the contract, and state to each
 1105  enrollee at the time of enrollment under the contract, that the
 1106  organization has made such election; and
 1107         2.Include in such statements a description of the effect
 1108  of this election.
 1109         (8)(a)Periods of creditable coverage with respect to an
 1110  individual shall be established through presentation of
 1111  certifications described in this subsection or in such other
 1112  manner as may be specified in rules adopted by the commission.
 1113         (b)A health maintenance organization that offers group
 1114  coverage shall provide the certification described in paragraph
 1115  (a):
 1116         1.At the time an individual ceases to be covered under the
 1117  plan or otherwise becomes covered under a COBRA continuation
 1118  provision or continuation pursuant to s. 627.6692.
 1119         2.In the case of an individual becoming covered under a
 1120  COBRA continuation provision or pursuant to s. 627.6692, at the
 1121  time the individual ceases to be covered under such a provision.
 1122         3.Upon the request on behalf of an individual made not
 1123  later than 24 months after the date of cessation of the coverage
 1124  described in this paragraph.
 1125  
 1126  The certification under subparagraph 1. may be provided, to the
 1127  extent practicable, at a time consistent with notices required
 1128  under any applicable COBRA continuation provision or
 1129  continuation pursuant to s. 627.6692.
 1130         (c)The certification is a written certification of:
 1131         1.The period of creditable coverage of the individual
 1132  under the contract and the coverage, if any, under such COBRA
 1133  continuation provision or continuation pursuant to s. 627.6692;
 1134  and
 1135         2.The waiting period, if any, imposed with respect to the
 1136  individual for any coverage under such contract.
 1137         (d)In the case of an election described in subsection (7)
 1138  by a health maintenance organization, if the organization
 1139  enrolls an individual for coverage under the plan and the
 1140  individual provides a certification of coverage of the
 1141  individual, as provided by this subsection:
 1142         1.Upon request of such health maintenance organization,
 1143  the insurer or health maintenance organization that issued the
 1144  certification provided by the individual shall promptly disclose
 1145  to such requesting organization information on coverage of
 1146  classes and categories of health benefits available under such
 1147  insurer’s or health maintenance organization’s plan or coverage.
 1148         2.Such insurer or health maintenance organization may
 1149  charge the requesting organization for the reasonable cost of
 1150  disclosing such information.
 1151         (e)The commission shall adopt rules to prevent an
 1152  insurer’s or health maintenance organization’s failure to
 1153  provide information under this subsection with respect to
 1154  previous coverage of an individual from adversely affecting any
 1155  subsequent coverage of the individual under another group health
 1156  plan or health maintenance organization coverage.
 1157         (9)(a)A health maintenance organization may provide for an
 1158  affiliation period with respect to coverage through the
 1159  organization only if:
 1160         1.No preexisting condition exclusion is imposed with
 1161  respect to coverage through the organization;
 1162         2.The period is applied uniformly without regard to any
 1163  health-status-related factors; and
 1164         3.Such period does not exceed 2 months or 3 months in the
 1165  case of a late enrollee.
 1166         (b)For the purposes of this section, the term “affiliation
 1167  period” means a period that, under the terms of the coverage
 1168  offered by the health maintenance organization, must expire
 1169  before the coverage becomes effective. The organization is not
 1170  required to provide health care services or benefits during such
 1171  period, and no premium may be charged to the participant or
 1172  beneficiary for any coverage during the period. Such period
 1173  begins on the enrollment date and runs concurrently with any
 1174  waiting period under the plan.
 1175         (c)As an alternative to the method authorized by paragraph
 1176  (a), a health maintenance organization may address adverse
 1177  selection in a method approved by the office.
 1178         (10)(a)Except as provided in paragraph (b), no period
 1179  before July 1, 1996, shall be taken into account in determining
 1180  creditable coverage.
 1181         (b)The commission shall adopt rules that provide a process
 1182  whereby individuals who need to establish creditable coverage
 1183  for periods before July 1, 1996, and who would have such
 1184  coverage credited but for paragraph (a), may be given credit for
 1185  creditable coverage for such periods through the presentation of
 1186  documents or other means.
 1187         (11)Except as otherwise provided in this subsection, the
 1188  requirements of paragraph (8)(b) shall apply to events that
 1189  occur on or after July 1, 1996.
 1190         (a)In no case is a certification required to be provided
 1191  under paragraph (8)(b) prior to June 1, 1997.
 1192         (b)In the case of an event that occurs on or after July 1,
 1193  1996, and before October 1, 1996, a certification is not
 1194  required to be provided under paragraph (8)(b), unless an
 1195  individual, with respect to whom the certification is required
 1196  to be made, requests such certification in writing.
 1197         (12)In the case of an individual who seeks to establish
 1198  creditable coverage for any period for which certification is
 1199  not required because it relates to an event occurring before
 1200  July 1, 1996:
 1201         (a)The individual may present other creditable coverage in
 1202  order to establish the period of creditable coverage.
 1203         (b)A health maintenance organization is not subject to any
 1204  penalty or enforcement action with respect to the organization’s
 1205  crediting, or not crediting, such coverage if the organization
 1206  has sought to comply in good faith with applicable provisions of
 1207  this section.
 1208         (13)For purposes of subsection (10), any plan amendment
 1209  made pursuant to a collective bargaining agreement relating to
 1210  the plan which amends the plan solely to conform to any
 1211  requirement of this section may not be treated as a termination
 1212  of such collective bargaining agreement.
 1213         Section 23. Subsections (1), (3), and (4) of section
 1214  641.31074, Florida Statutes, are amended to read:
 1215         641.31074 Guaranteed renewability of coverage.—
 1216         (1) Except as otherwise provided in this section, a health
 1217  maintenance organization that issues a group health insurance
 1218  contract must renew or continue in force such coverage at the
 1219  option of the contract holder.
 1220         (3)(a) A health maintenance organization may discontinue
 1221  offering a particular contract form for group coverage offered
 1222  in the small group market or large group market only if:
 1223         1. The health maintenance organization provides notice to
 1224  each contract holder provided coverage of this form in such
 1225  market, and participants and beneficiaries covered under such
 1226  coverage, of such discontinuation at least 90 days prior to the
 1227  date of the nonrenewal of such coverage;
 1228         2. The health maintenance organization offers to each
 1229  contract holder provided coverage of this form in such market
 1230  the option to purchase all, or in the case of the large group
 1231  market, any other health insurance coverage currently being
 1232  offered by the health maintenance organization in such market;
 1233  and
 1234         3. In exercising the option to discontinue coverage of this
 1235  form and in offering the option of coverage under subparagraph
 1236  2., the health maintenance organization acts uniformly without
 1237  regard to the claims experience of those contract holders or any
 1238  health-status-related factor that relates to any participants or
 1239  beneficiaries covered or new participants or beneficiaries who
 1240  may become eligible for such coverage.
 1241         (b)1. In any case in which a health maintenance
 1242  organization elects to discontinue offering all coverage in the
 1243  individual market, the small group market, or the large group
 1244  market, or any combination thereof both, in this state, coverage
 1245  may be discontinued by the insurer only if:
 1246         a. The health maintenance organization provides notice to
 1247  the office and to each contract holder, and participants and
 1248  beneficiaries covered under such coverage, of such
 1249  discontinuation at least 180 days prior to the date of the
 1250  nonrenewal of such coverage; and
 1251         b. All health insurance issued or delivered for issuance in
 1252  this state in such market is discontinued and coverage under
 1253  such health insurance coverage in such market is not renewed.
 1254         2. In the case of a discontinuation under subparagraph 1.
 1255  in a market, the health maintenance organization may not provide
 1256  for the issuance of any health maintenance organization contract
 1257  coverage in the market in this state during the 5-year period
 1258  beginning on the date of the discontinuation of the last
 1259  insurance contract not renewed.
 1260         (4) At the time of coverage renewal, a health maintenance
 1261  organization may modify the coverage for a product offered:
 1262         (a) In the large group market; or
 1263         (b) In the small group market if, for coverage that is
 1264  available in such market other than only through one or more
 1265  bona fide associations, as defined in s. 627.6571(5), such
 1266  modification is consistent with s. 627.6699 and effective on a
 1267  uniform basis among group health plans with that product; or
 1268         (c)In the individual market if the modification is
 1269  consistent with the laws of this state and effective on a
 1270  uniform basis among all individuals with that policy form.
 1271         Section 24. Section 641.312, Florida Statutes, is amended
 1272  to read:
 1273         641.312 Scope.—The Office of Insurance Regulation may adopt
 1274  rules to administer the provisions of the National Association
 1275  of Insurance Commissioners’ Uniform Health Carrier External
 1276  Review Model Act, issued by the National Association of
 1277  Insurance Commissioners and dated April 2010. This section does
 1278  not apply to a health maintenance contract that is subject to
 1279  the Subscriber Assistance Program under s. 408.7056 or to the
 1280  types of benefits or coverages provided under s. 627.6513(1)
 1281  (14) s. 627.6561(5)(b)-(e) issued in any market.
 1282         Section 25. This act shall take effect July 1, 2016.