HOUSE AMENDMENT
Bill No. HB 1439
Amendment No. 01 (for drafter's use only)
CHAMBER ACTION
Senate House
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5 ORIGINAL STAMP BELOW
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11 The Committee on Fiscal Policy & Resources offered the
12 following:
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14 Amendment (with title amendment)
15 On page 2, line 1,
16 remove from the bill: everything after the enacting clause,
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18 and insert in lieu thereof:
19 Section 1. Paragraph (a) of subsection (6) of section
20 627.410, Florida Statutes, is amended, and paragraph (f) is
21 added to subsection (7) of said section, to read:
22 627.410 Filing, approval of forms.--
23 (6)(a) An insurer shall not deliver or issue for
24 delivery or renew in this state any health insurance policy
25 form until it has filed with the department a copy of every
26 applicable rating manual, rating schedule, change in rating
27 manual, and change in rating schedule; if rating manuals and
28 rating schedules are not applicable, the insurer must file
29 with the department applicable premium rates and any change in
30 applicable premium rates. This paragraph does not apply to
31 group health insurance policies insuring groups of 51 or more
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HOUSE AMENDMENT
Bill No. HB 1439
Amendment No. 01 (for drafter's use only)
1 persons, except for Medicare supplement insurance, long-term
2 care insurance, and any coverage under which the increase in
3 claims costs over the lifetime of the contract due to
4 advancing age or duration is prefunded in the premium.
5 (7)
6 (f) Insurers with fewer than 1,000 nationwide
7 policyholders or insured group members or subscribers covered
8 under any form or pooled group of forms with health insurance
9 coverage, as described in s. 627.6561(5)(a)2., excluding
10 Medicare supplement insurance coverage under part VIII, at the
11 time of a rate filing made pursuant to subparagraph (b)1., may
12 file for an annual rate increase limited to medical trend as
13 adopted by the department pursuant to s. 627.411(5). The
14 filing is in lieu of the actuarial memorandum required for a
15 rate filing prescribed by paragraph (6)(b). The filing must
16 include forms adopted by the department and a certification by
17 an officer of the company that the filing includes all similar
18 forms.
19 Section 2. Section 627.411, Florida Statutes, is
20 amended to read:
21 627.411 Grounds for disapproval.--
22 (1) The department shall disapprove any form filed
23 under s. 627.410, or withdraw any previous approval thereof,
24 only if the form:
25 (a) Is in any respect in violation of, or does not
26 comply with, this code.
27 (b) Contains or incorporates by reference, where such
28 incorporation is otherwise permissible, any inconsistent,
29 ambiguous, or misleading clauses, or exceptions and conditions
30 which deceptively affect the risk purported to be assumed in
31 the general coverage of the contract.
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HOUSE AMENDMENT
Bill No. HB 1439
Amendment No. 01 (for drafter's use only)
1 (c) Has any title, heading, or other indication of its
2 provisions which is misleading.
3 (d) Is printed or otherwise reproduced in such manner
4 as to render any material provision of the form substantially
5 illegible.
6 (e) Is for health insurance, and:
7 1. Provides benefits that which are unreasonable in
8 relation to the premium charged;,
9 2. Contains provisions that which are unfair or
10 inequitable or contrary to the public policy of this state or
11 that which encourage misrepresentation;, or
12 3. Contains provisions that which apply rating
13 practices that which result in premium escalations that are
14 not viable for the policyholder market or result in unfair
15 discrimination pursuant to s. 626.9541(1)(g)2.; in sales
16 practices.
17 4. Results in an actuarially justified rate increase
18 that includes the insurer reducing the portion of the premium
19 used to pay claims from the loss-ratio standard certified in
20 the last actuarial certification filed by the insurer, which
21 rate increase is in excess of the actuarially justified rate
22 increase without such loss-ratio change, by an amount
23 exceeding the greater of 50 percent of annual medical trend or
24 5 percent;
25 5. Results in an actuarially justified rate increase
26 that includes the insurer changing established rate
27 relationships between insureds or types of coverage, which
28 rate increase is in excess of the actuarially justified rate
29 increase without such relationship change, to any insured by
30 an amount exceeding the greater of 50 percent of annual
31 medical trend or 5 percent;
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HOUSE AMENDMENT
Bill No. HB 1439
Amendment No. 01 (for drafter's use only)
1 6. Results in an actuarially justified rate increase
2 that is in excess of the greater of 150 percent of annual
3 medical trend or 10 percent attributed to the insurer not
4 complying with the annual filing requirements of s. 627.410(7)
5 or department rule adopted under s. 641.31; or
6 7. Results in an actuarially justified rate increase
7 that is in excess of the greater of 150 percent of annual
8 medical trend or 10 percent on a form or block of pooled forms
9 in which no form is currently available for sale. This
10 provision does not apply to prestandardized Medicare
11 supplement forms.
12 (f) Excludes coverage for human immunodeficiency virus
13 infection or acquired immune deficiency syndrome or contains
14 limitations in the benefits payable, or in the terms or
15 conditions of such contract, for human immunodeficiency virus
16 infection or acquired immune deficiency syndrome which are
17 different than those which apply to any other sickness or
18 medical condition.
19 (2) In determining whether the benefits are reasonable
20 in relation to the premium charged, the department, in
21 accordance with reasonable actuarial techniques, shall
22 consider:
23 (a) Past loss experience and prospective loss
24 experience within and without this state.
25 (b) Allocation of expenses.
26 (c) Risk and contingency margins, along with
27 justification of such margins.
28 (d) Acquisition costs.
29 (3) If the renewal rate increase to existing insureds
30 at the time of the rate filing would exceed the indicated
31 levels based on the conditions in subparagraph (1)(e)4.,
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HOUSE AMENDMENT
Bill No. HB 1439
Amendment No. 01 (for drafter's use only)
1 subparagraph (1)(e)5., or subparagraph (1)(e)6., the insurer
2 may file for approval of a higher new business rate schedule
3 for new insureds and a rate increase of the amount that is
4 actuarially justified by the aggregate data without such
5 condition, plus the greater of 50 percent of annual medical
6 trend or 5 percent for existing insureds. Future annual rate
7 increases for the existing insureds at the time of the
8 exercise of this provision is limited to the greater of 150
9 percent of the rate increase approved for new insureds, the
10 greater of 150 percent of medical trend, or 10 percent, until
11 the rate schedules converge. The application of this
12 subsection is not a violation of s. 627.410(6)(d).
13 (4) If a rate filing changes the established rate
14 relationship between insureds, the aggregate effect of such
15 change shall be revenue neutral. The change to the new
16 relationship shall be phased in under this subsection over a
17 period not to exceed 3 years, as approved by the department.
18 (5) In determining medical trend for application of
19 subparagraphs (1)(e)4., 5., 6., and 7., the department shall
20 semiannually determine medical trend for each health care
21 market, using reasonable actuarial techniques and standards.
22 The trend must be adopted by the department by rule and
23 determined as follows:
24 (a) Trend must be determined separately for medical
25 expense; preferred provider organization; Medicare supplement;
26 health maintenance organization; and other coverage for
27 individual, small group, and large group, where applicable.
28 (b) The department shall survey insurers and health
29 maintenance organizations currently issuing products and
30 representing at least an 80-percent market share based on
31 premiums earned in the state for the most recent calendar year
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HOUSE AMENDMENT
Bill No. HB 1439
Amendment No. 01 (for drafter's use only)
1 for each of the categories specified in paragraph (a).
2 (c) Trend must be computed as the average annual
3 medical trend approved for the carriers surveyed, giving
4 appropriate weight to each carrier's statewide market share of
5 earned premiums.
6 (d) The annual trend is the annual change in claims
7 cost per unit of exposure. Trend includes the combined effect
8 of medical provider price changes, new medical procedures, and
9 technology and cost shifting.
10 Section 3. Subsection (9) is added to section
11 627.6515, Florida Statutes, to read:
12 627.6515 Out-of-state groups.--
13 (9) For purposes of this section, any insurer that
14 issues any group health insurance policy or group certificate
15 for health insurance to a resident of this state and requires
16 individual underwriting to determine coverage eligibility or
17 premium rates to be charged shall combine the experience of
18 all association-based group policies or association-based
19 group certificates which are substantially similar with
20 respect to type and level of benefits and marketing method
21 issued in this state after the policy form has been in force
22 for a period of 5 years to calculate uniform percentage rate
23 increases. For purposes of this section, policy forms that
24 have different cost-sharing arrangements or different riders
25 are considered to be different policy forms. Nothing in this
26 subsection shall be construed to require uniform rates for
27 policies or certificates after their fifth duration, it being
28 the intent and purpose of this law to require uniform
29 percentage rate increases for such policies or certificates.
30 Furthermore, nothing in this subsection shall be construed to
31 eliminate changes in rates by age for attained age policies or
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HOUSE AMENDMENT
Bill No. HB 1439
Amendment No. 01 (for drafter's use only)
1 certificates. The provisions of this subsection shall apply to
2 policies or certificates issued after July 1, 2001. For
3 purposes of this subsection, a group health policy or group
4 certificate for health insurance means any hospital or medical
5 policy or certificate, hospital or medical service plan
6 contract, or health maintenance organization subscriber
7 contract. The term does not include accident-only, specified
8 disease, individual hospital indemnity, credit, dental-only,
9 vision-only, Medicare supplement, long-term care, or
10 disability income insurance; similar supplemental plans
11 provided under a separate policy, certificate, or contract of
12 insurance, which cannot duplicate coverage under an underlying
13 health plan and are specifically designed to fill gaps in the
14 underlying health plan, coinsurance, or deductibles; coverage
15 issued as a supplement to liability insurance; workers'
16 compensation or similar insurance; or automobile
17 medical-payment insurance.
18 Section 4. Paragraph (n) of subsection (3) and
19 paragraph (b) of subsection (6) of section 627.6699, Florida
20 Statutes, are amended to read:
21 627.6699 Employee Health Care Access Act.--
22 (3) DEFINITIONS.--As used in this section, the term:
23 (n) "Modified community rating" means a method used to
24 develop carrier premiums which spreads financial risk across a
25 large population; allows the use of separate rating factors
26 for age, gender, family composition, tobacco usage, and
27 geographic area as determined under paragraph (5)(j); and
28 allows adjustments for: claims experience, health status, or
29 duration of coverage as permitted under subparagraph (6)(b)5.;
30 and administrative and acquisition expenses as permitted under
31 subparagraph (6)(b)5. A carrier may separate the experience of
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HOUSE AMENDMENT
Bill No. HB 1439
Amendment No. 01 (for drafter's use only)
1 small employer groups with less than 2 eligible employees from
2 the experience of small employer groups with 2 through 50
3 eligible employees.
4 (6) RESTRICTIONS RELATING TO PREMIUM RATES.--
5 (b) For all small employer health benefit plans that
6 are subject to this section and are issued by small employer
7 carriers on or after January 1, 1994, premium rates for health
8 benefit plans subject to this section are subject to the
9 following:
10 1. Small employer carriers must use a modified
11 community rating methodology in which the premium for each
12 small employer must be determined solely on the basis of the
13 eligible employee's and eligible dependent's gender, age,
14 family composition, tobacco use, or geographic area as
15 determined under paragraph (5)(j) and in which the premium may
16 be adjusted as permitted by subparagraphs 6. 5. and 7. 6.
17 2. Rating factors related to age, gender, family
18 composition, tobacco use, or geographic location may be
19 developed by each carrier to reflect the carrier's experience.
20 The factors used by carriers are subject to department review
21 and approval.
22 3. If the modified community rate is determined from
23 two experience pools as authorized by paragraph (3)(n), the
24 rate to be charged to small employer groups of less than 2
25 eligible employees may not exceed 150 percent of the rate
26 determined for groups of 2 through 50 eligible employees;
27 however, the carrier may charge excess losses of the less than
28 2 eligible employee experience pool to the experience pool of
29 the 2 through 50 eligible employees so that all losses are
30 allocated and the 150-percent rate limit on the less than 2
31 eligible employee experience pool is maintained.
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HOUSE AMENDMENT
Bill No. HB 1439
Amendment No. 01 (for drafter's use only)
1 4.3. Small employer carriers may not modify the rate
2 for a small employer for 12 months from the initial issue date
3 or renewal date, unless the composition of the group changes
4 or benefits are changed. However, a small employer carrier may
5 modify the rate one time prior to 12 months after the initial
6 issue date for a small employer who enrolls under a previously
7 issued group policy that has a common anniversary date for all
8 employers covered under the policy if:
9 a. The carrier discloses to the employer in a clear
10 and conspicuous manner the date of the first renewal and the
11 fact that the premium may increase on or after that date.
12 b. The insurer demonstrates to the department that
13 efficiencies in administration are achieved and reflected in
14 the rates charged to small employers covered under the policy.
15 5.4. A carrier may issue a group health insurance
16 policy to a small employer health alliance or other group
17 association with rates that reflect a premium credit for
18 expense savings attributable to administrative activities
19 being performed by the alliance or group association if such
20 expense savings are specifically documented in the insurer's
21 rate filing and are approved by the department. Any such
22 credit may not be based on different morbidity assumptions or
23 on any other factor related to the health status or claims
24 experience of any person covered under the policy. Nothing in
25 this subparagraph exempts an alliance or group association
26 from licensure for any activities that require licensure under
27 the insurance code. A carrier issuing a group health insurance
28 policy to a small employer health alliance or other group
29 association shall allow any properly licensed and appointed
30 agent of that carrier to market and sell the small employer
31 health alliance or other group association policy. Such agent
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HOUSE AMENDMENT
Bill No. HB 1439
Amendment No. 01 (for drafter's use only)
1 shall be paid the usual and customary commission paid to any
2 agent selling the policy.
3 6.5. Any adjustments in rates for claims experience,
4 health status, or duration of coverage may not be charged to
5 individual employees or dependents. For a small employer's
6 policy, such adjustments may not result in a rate for the
7 small employer which deviates more than 15 percent from the
8 carrier's approved rate. Any such adjustment must be applied
9 uniformly to the rates charged for all employees and
10 dependents of the small employer. A small employer carrier may
11 make an adjustment to a small employer's renewal premium, not
12 to exceed 10 percent annually, due to the claims experience,
13 health status, or duration of coverage of the employees or
14 dependents of the small employer. Semiannually, small group
15 carriers shall report information on forms adopted by rule by
16 the department, to enable the department to monitor the
17 relationship of aggregate adjusted premiums actually charged
18 policyholders by each carrier to the premiums that would have
19 been charged by application of the carrier's approved modified
20 community rates. If the aggregate resulting from the
21 application of such adjustment exceeds the premium that would
22 have been charged by application of the approved modified
23 community rate by 5 percent for the current reporting period,
24 the carrier shall limit the application of such adjustments
25 only to minus adjustments beginning not more than 60 days
26 after the report is sent to the department. For any subsequent
27 reporting period, if the total aggregate adjusted premium
28 actually charged does not exceed the premium that would have
29 been charged by application of the approved modified community
30 rate by 5 percent, the carrier may apply both plus and minus
31 adjustments. A small employer carrier may provide a credit to
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HOUSE AMENDMENT
Bill No. HB 1439
Amendment No. 01 (for drafter's use only)
1 a small employer's premium based on administrative and
2 acquisition expense differences resulting from the size of the
3 group. Group size administrative and acquisition expense
4 factors may be developed by each carrier to reflect the
5 carrier's experience and are subject to department review and
6 approval.
7 7.6. A small employer carrier rating methodology may
8 include separate rating categories for one dependent child,
9 for two dependent children, and for three or more dependent
10 children for family coverage of employees having a spouse and
11 dependent children or employees having dependent children
12 only. A small employer carrier may have fewer, but not
13 greater, numbers of categories for dependent children than
14 those specified in this subparagraph.
15 8.7. Small employer carriers may not use a composite
16 rating methodology to rate a small employer with fewer than 10
17 employees. For the purposes of this subparagraph, a "composite
18 rating methodology" means a rating methodology that averages
19 the impact of the rating factors for age and gender in the
20 premiums charged to all of the employees of a small employer.
21 Section 5. Section 627.9408, Florida Statutes, is
22 amended to read:
23 627.9408 Rules.--
24 (1) The department may has authority to adopt rules
25 pursuant to ss. 120.536(1) and 120.54 to administer implement
26 the provisions of this part.
27 (2) The department may adopt by rule the provisions of
28 the Long-Term Care Insurance Model Regulation adopted by the
29 National Association of Insurance Commissioners in the second
30 quarter of the year 2000 which are not in conflict with the
31 Florida Insurance Code.
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HOUSE AMENDMENT
Bill No. HB 1439
Amendment No. 01 (for drafter's use only)
1 Section 6. Paragraph (b) of subsection (3) of section
2 641.31, Florida Statutes, is amended, and paragraph (f) is
3 added to said subsection, to read:
4 641.31 Health maintenance contracts.--
5 (3)
6 (b) Any change in the rate is subject to paragraph (d)
7 and requires at least 30 days' advance written notice to the
8 subscriber. In the case of a group member, there may be a
9 contractual agreement with the health maintenance organization
10 to have the employer provide the required notice to the
11 individual members of the group. This paragraph does not apply
12 to a group contract covering 51 or more persons unless the
13 rate is for any coverage under which the increase in claim
14 costs over the lifetime of the contract due to advancing age
15 or duration is prefunded in the premium.
16 (f) A health maintenance organization with fewer than
17 1,000 covered subscribers under all individual or group
18 contracts, at the time of a rate filing, may file for an
19 annual rate increase limited to annual medical trend, as
20 adopted by the department. The filing is in lieu of the
21 actuarial memorandum otherwise required for the rate filing.
22 The filing must include forms adopted by the department and a
23 certification by an officer of the company that the filing
24 includes all similar forms.
25 Section 7. Paragraphs (a) and (b) of subsection (1) of
26 section 641.3155, Florida Statutes, are amended to read:
27 641.3155 Payment of claims.--
28 (1)(a) As used in this section, the term "clean claim"
29 for a noninstitutional provider means a claim submitted on a
30 HCFA 1500 form which has no defect or impropriety, including
31 lack of required substantiating documentation for
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HOUSE AMENDMENT
Bill No. HB 1439
Amendment No. 01 (for drafter's use only)
1 noncontracted providers and suppliers, or particular
2 circumstances requiring special treatment which prevent timely
3 payment from being made on the claim. A claim may not be
4 considered not clean solely because a health maintenance
5 organization refers the claim to a medical specialist within
6 the health maintenance organization for examination. If
7 additional substantiating documentation, such as the medical
8 record or encounter data, is required from a source outside
9 the health maintenance organization, the claim is considered
10 not clean. This paragraph does not apply to claims which
11 include potential coordination of benefits for third-party
12 liability or subrogation, as evidenced by the information
13 provided on the claim form related to coordination of
14 benefits. This definition of "clean claim" is repealed on the
15 effective date of rules adopted by the department which define
16 the term "clean claim."
17 (b) Absent a written definition that is agreed upon
18 through contract, the term "clean claim" for an institutional
19 claim is a properly and accurately completed paper or
20 electronic billing instrument that consists of the UB-92 data
21 set or its successor with entries stated as mandatory by the
22 National Uniform Billing Committee. This paragraph does not
23 apply to claims which include potential coordination of
24 benefits for third-party liability or subrogation, as
25 evidenced by the information provided on the claim form
26 related to coordination of benefits.
27 Section 8. Health flex plans.--
28 (1) INTENT.--The Legislature finds that a significant
29 portion of the residents of this state are not able to obtain
30 affordable health insurance coverage. Therefore, it is the
31 intent of the Legislature to expand the availability of health
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HOUSE AMENDMENT
Bill No. HB 1439
Amendment No. 01 (for drafter's use only)
1 care options for lower income uninsured state residents by
2 encouraging health insurers, health maintenance organizations,
3 health care provider sponsored organizations, local
4 governments, health care districts, or other public or private
5 community-based organizations to develop alternative
6 approaches to traditional health insurance which emphasize
7 coverage for basic and preventive health care services. To
8 the maximum extent possible, such options should be
9 coordinated with existing governmental or community-based
10 health services programs in a manner that is consistent with
11 the objectives and requirements of such programs.
12 (2) DEFINITIONS.--As used in this section:
13 (a) "Agency" means the Agency for Health Care
14 Administration.
15 (b) "Approved plan" means a health flex plan approved
16 under subsection (3) which guarantees payment by the health
17 plan entity for specified health care services provided to the
18 enrollee.
19 (c) "Enrollee" means an individual who has been
20 determined eligible for and is receiving health benefits under
21 a health flex plan approved under this section.
22 (d) "Health care coverage" means payment for health
23 care services covered as benefits under an approved plan or
24 that otherwise provides, either directly or through
25 arrangements with other persons, covered health care services
26 on a prepaid per-capita basis or on a prepaid aggregate
27 fixed-sum basis.
28 (e) "Health plan entity" means a health insurer,
29 health maintenance organization, health care provider
30 sponsored organization, local government, health care
31 districts, or other public or private community-based
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HOUSE AMENDMENT
Bill No. HB 1439
Amendment No. 01 (for drafter's use only)
1 organization that develops and implements an approved plan and
2 is responsible for financing and paying all claims by
3 enrollees of the plan.
4 (3) PILOT PROGRAM.--The agency and the Department of
5 Insurance shall jointly approve or disapprove health flex
6 plans which provide health care coverage for eligible
7 participants residing in the three areas of the state having
8 the highest number of uninsured residents as determined by the
9 agency. A plan may limit or exclude benefits otherwise
10 required by law for insurers offering coverage in this state,
11 cap the total amount of claims paid in 1 year per enrollee, or
12 limit the number of enrollees covered. The agency and the
13 Department of Insurance shall not approve or shall withdraw
14 approval of a plan which:
15 (a) Contains any ambiguous, inconsistent, or
16 misleading provisions, or exceptions or conditions that
17 deceptively affect or limit the benefits purported to be
18 assumed in the general coverage provided by the plan;
19 (b) Provides benefits that are unreasonable in
20 relation to the premium charged, contains provisions that are
21 unfair or inequitable or contrary to the public policy of this
22 state or that encourage misrepresentation, or result in unfair
23 discrimination in sales practices; or
24 (c) Cannot demonstrate that the plan is financially
25 sound and the applicant has the ability to underwrite or
26 finance the benefits provided.
27 (4) LICENSE NOT REQUIRED.--A health flex plan approved
28 under this section shall not be subject to the licensing
29 requirements of the Florida Insurance Code or chapter 641,
30 Florida Statutes, relating to health maintenance
31 organizations, unless expressly made applicable. However, for
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HOUSE AMENDMENT
Bill No. HB 1439
Amendment No. 01 (for drafter's use only)
1 the purposes of prohibiting unfair trade practices, health
2 flex plans shall be considered insurance subject to the
3 applicable provisions of part IX of chapter 626, Florida
4 Statutes, except as otherwise provided in this section.
5 (5) ELIGIBILITY.--Eligibility to enroll in an approved
6 health flex plan is limited to residents of this state who:
7 (a) Are 64 years of age or younger;
8 (b) Have a family income equal to or less than 200
9 percent of the federal poverty level;
10 (c) Are not covered by a private insurance policy and
11 are not eligible for coverage through a public health
12 insurance program such as Medicare or Medicaid, or other
13 public health care program, including, but not limited to,
14 Kidcare, and have not been covered at any time during the past
15 6 months; and
16 (d) Have applied for health care benefits through an
17 approved health flex plan and agree to make any payments
18 required for participation, including, but not limited to,
19 periodic payments and payments due at the time health care
20 services are provided.
21 (6) RECORDS.--Every health flex plan provider shall
22 maintain reasonable records of its loss, expense, and claims
23 experience and shall make such records reasonably available to
24 enable the agency and the Department of Insurance to monitor
25 and determine the financial viability of the plan, as
26 necessary.
27 (7) NOTICE.--The denial of coverage by the health plan
28 entity shall be accompanied by the specific reasons for
29 denial, nonrenewal, or cancellation. Notice of nonrenewal or
30 cancellation shall be provided at least 45 days in advance of
31 such nonrenewal or cancellation except that 10 days' written
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HOUSE AMENDMENT
Bill No. HB 1439
Amendment No. 01 (for drafter's use only)
1 notice shall be given for cancellation due to nonpayment of
2 premiums. If the health plan entity fails to give the
3 required notice, the plan shall remain in effect until notice
4 is appropriately given.
5 (8) NONENTITLEMENT.--Coverage under an approved health
6 flex plan is not an entitlement and no cause of action shall
7 arise against the state, local governmental entity, or other
8 political subdivision of this state or the agency for failure
9 to make coverage available to eligible persons under this
10 section.
11 (9) CIVIL ACTIONS.--In addition to an administrative
12 action initiated under subsection (4), the agency may seek any
13 remedy provided by law, including, but not limited to, the
14 remedies provided in s. 812.035, Florida Statutes, if the
15 agency finds that a health plan entity has engaged in any act
16 resulting in injury to an enrollee covered by a plan approved
17 under this section.
18 Section 9. The Legislature finds that the
19 affordability and availability of health insurance is one of
20 the most important and complex issues in this state and that
21 coverage issued to a state resident under group health
22 insurance policies issued outside the state is an important
23 factor in meeting the needs of the citizens of this state.
24 The Legislature also finds that it is important to ensure that
25 those policies are adequately regulated in order to maintain
26 the quality of the coverage offered to citizens of this state.
27 Therefore, the Workgroup on Out of State Group Policies is
28 hereby created to study the regulatory environment in which
29 these policies are now offered and recommend any statutory
30 changes that may be necessary to maintain the quality of the
31 insurance offered in this state. There shall be four members
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HOUSE AMENDMENT
Bill No. HB 1439
Amendment No. 01 (for drafter's use only)
1 from the House of Representatives appointed by the Speaker of
2 the House of Representatives and four members from the Senate
3 appointed by the President of the Senate. The group shall
4 begin its meetings by July 1, 2001, and complete its meetings
5 by November 15, 2001. Recommendations for suggested
6 legislation shall be delivered to the Speaker of the House of
7 Representatives and the President of the Senate by December
8 15, 2001. At its first meeting, the group shall elect a chair
9 from among its members.
10 Section 10. This act shall take effect July 1, 2001.
11
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14 And the title is amended as follows:
15 On page 1, line 2, through page 2, line 25,
16 remove from the title of the bill: all of said lines,
17
18 and insert in lieu thereof:
19 An act relating to health insurance; amending
20 s. 627.410, F.S.; exempting group health
21 insurance policies insuring groups of a certain
22 size from rate filing requirements; providing
23 alternative rate filing requirements for
24 insurers with less than a specified number of
25 nationwide policyholders or members; amending
26 s. 627.411, F.S.; revising the grounds for the
27 disapproval of insurance policy forms;
28 providing that a health insurance policy form
29 may be disapproved if it results in certain
30 rate increases; specifying allowable new
31 business rates and renewal rates if rate
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HOUSE AMENDMENT
Bill No. HB 1439
Amendment No. 01 (for drafter's use only)
1 increases exceed certain levels; authorizing
2 the Department of Insurance to determine
3 medical trend for purposes of approving rate
4 filings; amending s. 627.6515, F.S.; providing
5 additional experience requirements and
6 limitations for out-of-state groups; providing
7 construction; amending s. 627.6699, F.S.;
8 revising a definition; allowing carriers to
9 separate the experience of small employer
10 groups with fewer than two employees; revising
11 the rating factors that may be used by small
12 employer carriers; amending s. 627.9408, F.S.;
13 authorizing the department to adopt by rule
14 certain provisions of the Long-Term Care
15 Insurance Model Regulation, as adopted by the
16 National Association of Insurance
17 Commissioners; amending s. 641.31, F.S.;
18 exempting contracts of group health maintenance
19 organizations covering a specified number of
20 persons from the requirements of filing with
21 the department; providing alternative rate
22 filing requirements for organizations with less
23 than a specified number of subscribers;
24 amending s. 641.3155, F.S.; specifying
25 nonapplication of certain provisions to certain
26 claims; providing for certain health flex
27 plans; providing legislative intent; providing
28 definitions; providing for a pilot program for
29 health flex plans for certain uninsured
30 persons; providing criteria; exempting approved
31 health flex plans from certain licensing
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hft0006 06:31 pm 01439-fpr -211363
HOUSE AMENDMENT
Bill No. HB 1439
Amendment No. 01 (for drafter's use only)
1 requirements; providing criteria for
2 eligibility to enroll in a health flex plan;
3 requiring health flex plan providers to
4 maintain certain records; providing
5 requirements for denial, nonrenewal, or
6 cancellation of coverage; specifying that
7 coverage under an approved health flex plan is
8 not an entitlement; providing for civil actions
9 against health plan entities by the Agency for
10 Health Care Administration under certain
11 circumstances; providing legislative findings;
12 creating the Workgroup on Out of State Group
13 Policies; providing for membership; providing
14 purposes; requiring recommendations for
15 proposed legislation; providing an effective
16 date.
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