HOUSE AMENDMENT Bill No. HB 1573 CS
1	CHAMBER ACTION
2	Senate House
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12	Representative Llorente offered the following:
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14	Amendment (with title amendment)
15	Between lines 618 and 619, insert:
16	Section 15. Section 627.6042, Florida Statutes, is created
17	to read:
18	627.6042 Dependent coverage.--
19	(1) If an insurer offers coverage that insures dependent
20	children of the policyholder or certificateholder, the policy
21	must insure a dependent child of the policyholder or
22	certificateholder at least until the end of the calendar year in
23	which the child reaches the age of 25, if the child meets all of
24	the following:
25	(a) The child is dependent upon the policyholder or
26	certificateholder for support.
27	(b) The child is living in the household of the
28	policyholder or certificateholder or the child is a full-time or
29	part-time student.
30	(2) Nothing in this section affects or preempts an
31	insurer's right to medically underwrite or charge the
32	appropriate premium.
33	Section 16. Section 627.60425, Florida Statutes, is
34	created to read:
35	627.60425 Binding arbitration requirement
36	limitations.--Notwithstanding any other provision of law, except
37	s. 624.155, an individual, blanket, group life, or group health
38	insurance policy; health maintenance organization subscriber
39	contract; prepaid limited health organization subscriber
40	contract; or any life or health insurance policy or certificate
41	delivered or issued for delivery, including out-of-state group
42	plans pursuant to s. 627.5515 or s. 627.6515 covering residents
43	of this state, to any resident of this state shall not require
44	the submission of disputes between the parties to the policy,
45	contract, or plan to binding arbitration unless the applicant
46	has indicated that the same policy, contract, or plan was
47	offered and rejected and that the binding arbitration provision
48	was fully explained to the applicant and willingly accepted.
49	Section 17. Section 627.6044, Florida Statutes, is amended
50	to read:
51	627.6044 Use of a specific methodology for payment of
52	claims.--
53	(1) Each insurance policy that provides for payment of
54	claims to nonnetwork providers that is less than the payment of
55	the provider's billed charges to the insured, excluding
56	deductible, coinsurance, and copay amounts, shall:
57	(a) Provide benefits prior to deductible, coinsurance, and
58	copay amounts for using a nonnetwork provider that are at least
59	equal to the amount that would have been allowed had the insured
60	used a network provider but are not in excess of the actual
61	billed charges.
62	(b) Where there are multiple network providers in the
63	geographical area in which the services were provided or, if
64	none, the closest geographic area, the carrier may use an
65	averaging method of the contracted amounts but not less than the
66	80th percentile of all network contracted amounts in the
67	geographic area.
68
69	For purposes of this subsection, the term "network providers"
70	means those providers for which an insured will not be
71	responsible for any balance payment for services provided by
72	such provider, excluding deductible, coinsurance, and copay
73	amountsbased on a specific methodology, including, but not
74	limited to, usual and customary charges, reasonable and
75	customary charges, or charges based upon the prevailing rate in
76	the community, shall specify the formula or criteria used by the
77	insurer in determining the amount to be paid.
78	(2) Each insurer issuing a policy that provides for
79	payment of claims based on a specific methodology shall provide
80	to an insured, upon her or his written request, an estimate of
81	the amount the insurer will pay for a particular medical
82	procedure or service. The estimate may be in the form of a range
83	of payments or an average payment and may specify that the
84	estimate is based on the assumption of a particular service
85	code. The insurer may require the insured to provide detailed
86	information regarding the procedure or service to be performed,
87	including the procedure or service code number provided by the
88	health care provider and the health care provider's estimated
89	charge.An insurer that provides an insured with a good faith
90	estimate is not bound by the estimate. However, a pattern of
91	providing estimates that vary significantly from the ultimate
92	insurance payment constitutes a violation of this code.
93	(3) The method used for determining the payment of claims
94	shall be included in filings made pursuant to s. 627.410(6) and
95	may not be changed unless such change is filed under s.
96	627.410(6).
97	(4) Any policy that provides that the insured is
98	responsible for the balance of a claim amount, excluding
99	deductible, coinsurance, and copay amounts, must disclose such
100	feature on the face of the policy or certificate and such
101	feature must be included in any outline of coverage provided to
102	the insured.
103	Section 18. Subsections (1) and (4) of section 627.6415,
104	Florida Statutes, are amended to read:
105	627.6415 Coverage for natural-born, adopted, and foster
106	children; children in insured's custodial care.--
107	(1) A health insurance policy that provides coverage for a
108	member of the family of the insured shall, as to the family
109	member's coverage, provide that the health insurance benefits
110	applicable to children of the insured also apply to an adopted
111	child or a foster child of the insured placed in compliance with
112	chapter 63, prior to the child's 18th birthday,from the moment
113	of placement in the residence of the insured. Except in the case
114	of a foster child, the policy may not exclude coverage for any
115	preexisting condition of the child. In the case of a newborn
116	child, coverage begins at the moment of birth if a written
117	agreement to adopt the child has been entered into by the
118	insured prior to the birth of the child, whether or not the
119	agreement is enforceable. This section does not require coverage
120	for an adopted child who is not ultimately placed in the
121	residence of the insured in compliance with chapter 63.
122	(4) In order to increase access to postnatal, infant, and
123	pediatric health care for all children placed in court-ordered
124	custody, including foster children, all health insurance
125	policies that provide coverage for a member of the family of the
126	insured shall, as to such family member's coverage, also provide
127	that the health insurance benefits applicable for children shall
128	be payable with respect to a foster child or other child in
129	court-ordered temporary or other custody of the insured, prior
130	to the child's 18th birthday.
131	Section 19. Paragraph (a) of subsection (5), paragraph (c)
132	of subsection (6), and paragraphs (b), (c), and (e) of
133	subsection (7) of section 627.6475, Florida Statutes, are
134	amended to read:
135	627.6475 Individual reinsurance pool.--
136	(5) ISSUER'S ELECTION TO BECOME A RISK-ASSUMING CARRIER.--
137	(a) Each health insurance issuer that offers individual
138	health insurance must elect to become a risk-assuming carrier or
139	a reinsuring carrier for purposes of this section. Each such
140	issuer must make an initial election, binding through December
141	31, 1999. The issuer's initial election must be made no later
142	than October 31, 1997. By October 31, 1997, all issuers must
143	file a final election, which is binding for 2 years, from
144	January 1, 1998, through December 31, 1999, after whichan
145	election that shall be binding indefinitely or until modified or
146	withdrawnfor a period of 5 years. The department may permit an
147	issuer to modify its election at any time for good cause shown,
148	after a hearing.
149	(6) ELECTION PROCESS TO BECOME A RISK-ASSUMING CARRIER.--
150	(c) The department shall provide public notice of an
151	issuer's filing adesignation of election under this subsection
152	to become a risk-assuming carrier and shall provide at least a
153	21-day period for public comment upon receipt of such filing
154	prior to making a decision on the election. The department shall
155	hold a hearing on the election at the request of the issuer.
156	(7) INDIVIDUAL HEALTH REINSURANCE PROGRAM.--
157	(b) A reinsuring carrier may reinsure with the program
158	coverage of an eligible individual, subject to each of the
159	following provisions:
160	1. A reinsuring carrier may reinsure an eligible
161	individual within 9060days after commencement of the coverage
162	of the eligible individual.
163	2. The program may not reimburse a participating carrier
164	with respect to the claims of a reinsured eligible individual
165	until the carrier has paid incurred claims of an amount equal to
166	the participating carrier’s selected deductible levelat least
167	$5,000 in a calendar year for benefits covered by the program.
168	In addition, the reinsuring carrier is responsible for 10
169	percent of the next $50,000 and 5 percent of the next $100,000
170	of incurred claims during a calendar year, and the program shall
171	reinsure the remainder.
172	3. The board shall annually adjust the initial level of
173	claims and the maximum limit to be retained by the carrier to
174	reflect increases in costs and utilization within the standard
175	market for health benefit plans within the state. The adjustment
176	may not be less than the annual change in the medical component
177	of the "Commerce Price Index for All Urban Consumers" of the
178	Bureau of Labor Statistics of the United States Department of
179	Labor, unless the board proposes and the department approves a
180	lower adjustment factor.
181	4. A reinsuring carrier may terminate reinsurance for all
182	reinsured eligible individuals on any plan anniversary.
183	5. The premium rate charged for reinsurance by the program
184	to a health maintenance organization that is approved by the
185	Secretary of Health and Human Services as a federally qualified
186	health maintenance organization pursuant to 42 U.S.C. s.
187	300e(c)(2)(A) and that, as such, is subject to requirements that
188	limit the amount of risk that may be ceded to the program, which
189	requirements are more restrictive than subparagraph 2., shall be
190	reduced by an amount equal to that portion of the risk, if any,
191	which exceeds the amount set forth in subparagraph 2., which may
192	not be ceded to the program.
193	6. The board may consider adjustments to the premium rates
194	charged for reinsurance by the program or carriers that use
195	effective cost-containment measures, including high-cost case
196	management, as defined by the board.
197	7. A reinsuring carrier shall apply its case-management
198	and claims-handling techniques, including, but not limited to,
199	utilization review, individual case management, preferred
200	provider provisions, other managed-care provisions, or methods
201	of operation consistently with both reinsured business and
202	nonreinsured business.
203	(c)1. The board, as part of the plan of operation, shall
204	establish a methodology for determining premium rates to be
205	charged by the program for reinsuring eligible individuals
206	pursuant to this section. The methodology must include a system
207	for classifying individuals which reflects the types of case
208	characteristics commonly used by carriers in this state. The
209	methodology must provide for the development of basic
210	reinsurance premium rates, which shall be multiplied by the
211	factors set for them in this paragraph to determine the premium
212	rates for the program. The basic reinsurance premium rates shall
213	be established by the board, subject to the approval of the
214	department, and shall be set at levels that reasonably
215	approximate gross premiums charged to eligible individuals for
216	individual health insurance by health insurance issuers. The
217	premium rates set by the board may vary by geographical area, as
218	determined under this section, to reflect differences in cost.
219	An eligible individual may be reinsured for a rate that is five
220	times the rate established by the board.
221	2. The board shall periodically review the methodology
222	established, including the system of classification and any
223	rating factors, to ensure that it reasonably reflects the claims
224	experience of the program. The board may propose changes to the
225	rates that are subject to the approval of the department.
226	(e)1. Before SeptemberMarch1 of each calendar year, the
227	board shall determine and report to the department the program
228	net loss in the individual account for the previous year,
229	including administrative expenses for that year and the incurred
230	losses for that year, taking into account investment income and
231	other appropriate gains and losses.
232	2. Any net loss in the individual account for the year
233	shall be recouped by assessing the carriers as follows:
234	a. The operating losses of the program shall be assessed
235	in the following order subject to the specified limitations. The
236	first tier of assessments shall be made against reinsuring
237	carriers in an amount that may not exceed 5 percent of each
238	reinsuring carrier's premiums for individual health insurance.
239	If such assessments have been collected and additional moneys
240	are needed, the board shall make a second tier of assessments in
241	an amount that may not exceed 0.5 percent of each carrier's
242	health benefit plan premiums.
243	b. Except as provided in paragraph (f), risk-assuming
244	carriers are exempt from all assessments authorized pursuant to
245	this section. The amount paid by a reinsuring carrier for the
246	first tier of assessments shall be credited against any
247	additional assessments made.
248	c. The board shall equitably assess reinsuring carriers
249	for operating losses of the individual account based on market
250	share. The board shall annually assess each carrier a portion of
251	the operating losses of the individual account. The first tier
252	of assessments shall be determined by multiplying the operating
253	losses by a fraction, the numerator of which equals the
254	reinsuring carrier's earned premium pertaining to direct
255	writings of individual health insurance in the state during the
256	calendar year for which the assessment is levied, and the
257	denominator of which equals the total of all such premiums
258	earned by reinsuring carriers in the state during that calendar
259	year. The second tier of assessments shall be based on the
260	premiums that all carriers, except risk-assuming carriers,
261	earned on all health benefit plans written in this state. The
262	board may levy interim assessments against reinsuring carriers
263	to ensure the financial ability of the plan to cover claims
264	expenses and administrative expenses paid or estimated to be
265	paid in the operation of the plan for the calendar year prior to
266	the association's anticipated receipt of annual assessments for
267	that calendar year. Any interim assessment is due and payable
268	within 30 days after receipt by a carrier of the interim
269	assessment notice. Interim assessment payments shall be credited
270	against the carrier's annual assessment. Health benefit plan
271	premiums and benefits paid by a carrier that are less than an
272	amount determined by the board to justify the cost of collection
273	may not be considered for purposes of determining assessments.
274	d. Subject to the approval of the department, the board
275	shall adjust the assessment formula for reinsuring carriers that
276	are approved as federally qualified health maintenance
277	organizations by the Secretary of Health and Human Services
278	pursuant to 42 U.S.C. s. 300e(c)(2)(A) to the extent, if any,
279	that restrictions are placed on them which are not imposed on
280	other carriers.
281	3. Before SeptemberMarch1 of each year, the board shall
282	determine and file with the department an estimate of the
283	assessments needed to fund the losses incurred by the program in
284	the individual account for the previous calendar year.
285	4. If the board determines that the assessments needed to
286	fund the losses incurred by the program in the individual
287	account for the previous calendar year will exceed the amount
288	specified in subparagraph 2., the board shall evaluate the
289	operation of the program and report its findings and
290	recommendations to the department in the format established in
291	s. 627.6699(11) for the comparable report for the small employer
292	reinsurance program.
293	Section 20. Subsection (4) of section 627.651, Florida
294	Statutes, is amended to read:
295	627.651 Group contracts and plans of self-insurance must
296	meet group requirements.--
297	(4) This section does not apply to any plan which is
298	established or maintained by an individual employer in
299	accordance with the Employee Retirement Income Security Act of
300	1974, Pub. L. No. 93-406, or to a multiple-employer welfare
301	arrangement as defined in s. 624.437(1), except that a multiple-
302	employer welfare arrangement shall comply with ss. 627.419,
303	627.657, 627.6575, 627.6578, 627.6579, 627.6612, 627.66121,
304	627.66122, 627.6615, 627.6616, and 627.662(8)(7). This
305	subsection does not allow an authorized insurer to issue a group
306	health insurance policy or certificate which does not comply
307	with this part.
308	Section 21. Section 627.662, Florida Statutes, is amended
309	to read:
310	627.662 Other provisions applicable.--The following
311	provisions apply to group health insurance, blanket health
312	insurance, and franchise health insurance:
313	(1) Section 627.569, relating to use of dividends,
314	refunds, rate reductions, commissions, and service fees.
315	(2) Section 627.602(1)(f) and (2), relating to
316	identification numbers and statement of deductible provisions.
317	(3) Section 627.6044, relating to the use of specific
318	methodology for payment of claims.
319	(4)(3)Section 627.635, relating to excess insurance.
320	(5)(4)Section 627.638, relating to direct payment for
321	hospital or medical services.
322	(6)(5)Section 627.640, relating to filing and
323	classification of rates.
324	(7)(6)Section 627.613, relating to timely payment of
325	claims, or s. 627.6131, relating to payment of claims, whichever
326	is applicable.
327	(8)(7)Section 627.645(1), relating to denial of claims.
328	(9)(8)Section 627.6471, relating to preferred provider
329	organizations.
330	(10)(9)Section 627.6472, relating to exclusive provider
331	organizations.
332	(11)(10)Section 627.6473, relating to combined preferred
333	provider and exclusive provider policies.
334	(12)(11)Section 627.6474, relating to provider contracts.
335	Section 22. Section 627.911, Florida Statutes, is amended
336	to read:
337	627.911 Scope of this part.--Any insurer or health
338	maintenance organizationtransacting insurance in this state
339	shall report information as required by this part.
340	Section 23. Section 627.9175, Florida Statutes, is amended
341	to read:
342	627.9175 Reports of information on health insurance.--
343	(1) Each authorized health insurer or health maintenance
344	organization shall submit annually to the department information
345	concerningas to policies of individual health insurance
346	coverage being issued or currently in force in this state. The
347	information shall include information related to premium, number
348	of policies, and covered lives for such policies and other
349	information necessary to analyze trends in enrollment, premiums,
350	and claim costs.
351	(2) The required information shall be broken down by
352	market segment, to include:
353	(a) Health insurance issuer, company, contact person, or
354	agent.
355	(b) All health insurance products issued or in force,
356	including, but not limited to:
357	1. Direct premiums earned.
358	2. Direct losses incurred.
359	3. Direct premiums earned for new business issued during
360	the year.
361	4. Number of policies.
362	5. Number of certificates.
363	6. Number of total covered lives.
364	(a) A summary of typical benefits, exclusions, and
365	limitations for each type of individual policy form currently
366	being issued in the state. The summary shall include, as
367	appropriate:
368	1. The deductible amount;
369	2. The coinsurance percentage;
370	3. The out-of-pocket maximum;
371	4. Outpatient benefits;
372	5. Inpatient benefits; and
373	6. Any exclusions for preexisting conditions.
374
375	The department shall determine other appropriate benefits,
376	exclusions, and limitations to be reported for inclusion in the
377	consumer's guide published pursuant to this section.
378	(b) A schedule of rates for each type of individual policy
379	form reflecting typical variations by age, sex, region of the
380	state, or any other applicable factor which is in use and is
381	determined to be appropriate for inclusion by the department.
382
383	The department shall provide by rule a uniform format for the
384	submission of this information in order to allow for meaningful
385	comparisons of premiums charged for comparable benefits.
386	(3) The department may adopt rules to administer this
387	section, including, but not limited to, rules governing
388	compliance and provisions implementing electronic methodologies
389	for use in furnishing such records or documents. The commission
390	may by rule specify a uniform format for the submission of this
391	information in order to allow for meaningful comparisonsshall
392	publish annually a consumer's guide which summarizes and
393	compares the information required to be reported under this
394	subsection.
395	(2)(a) Every insurer transacting health insurance in this
396	state shall report annually to the department, not later than
397	April 1, information relating to any measure the insurer has
398	implemented or proposes to implement during the next calendar
399	year for the purpose of containing health insurance costs or
400	cost increases. The reports shall identify each measure and the
401	forms to which the measure is applied, shall provide an
402	explanation as to how the measure is used, and shall provide an
403	estimate of the cost effect of the measure.
404	(b) The department shall promulgate forms to be used by
405	insurers in reporting information pursuant to this subsection
406	and shall utilize such forms to analyze the effects of health
407	care cost containment programs used by health insurers in this
408	state.
409	(c) The department shall analyze the data reported under
410	this subsection and shall annually make available to the public
411	a summary of its findings as to the types of cost containment
412	measures reported and the estimated effect of these measures.
413	Section 24. Section 627.9403, Florida Statutes, is amended
414	to read:
415	627.9403 Scope.--The provisions of this part shall apply
416	to long-term care insurance policies delivered or issued for
417	delivery in this state, and to policies delivered or issued for
418	delivery outside this state to the extent provided in s.
419	627.9406, by an insurer, a fraternal benefit society as defined
420	in s. 632.601, a health maintenance organization as defined in
421	s. 641.19, a prepaid health clinic as defined in s. 641.402, or
422	a multiple-employer welfare arrangement as defined in s.
423	624.437. A policy which is advertised, marketed, or offered as a
424	long-term care policy and as a Medicare supplement policy shall
425	meet the requirements of this part and the requirements of ss.
426	627.671-627.675 and, to the extent of a conflict, be subject to
427	the requirement that is more favorable to the policyholder or
428	certificateholder. The provisions of this part shall not apply
429	to a continuing care contract issued pursuant to chapter 651 and
430	shall not apply to guaranteed renewable policies issued prior to
431	October 1, 1988. Any limited benefit policy that limits coverage
432	to care in a nursing home or to one or more lower levels of care
433	required or authorized to be provided by this part or by
434	department rule must meet all requirements of this part that
435	apply to long-term care insurance policies, except ss.
436	627.9407(3)(c) and (d), (9), (10)(f), and (12) and 627.94073(2).
437	If the limited benefit policy does not provide coverage for care
438	in a nursing home, but does provide coverage for one or more
439	lower levels of care, the policy shall also be exempt from the
440	requirements of s. 627.9407(3)(d).
441	Section 25. Paragraph (b) of subsection (1) of section
442	641.185, Florida Statutes, is amended to read:
443	641.185 Health maintenance organization subscriber
444	protections.--
445	(1) With respect to the provisions of this part and part
446	III, the principles expressed in the following statements shall
447	serve as standards to be followed by the Department of Insurance
448	and the Agency for Health Care Administration in exercising
449	their powers and duties, in exercising administrative
450	discretion, in administrative interpretations of the law, in
451	enforcing its provisions, and in adopting rules:
452	(b) A health maintenance organization subscriber should
453	receive quality health care from a broad panel of providers,
454	including referrals, preventive care pursuant to s. 641.402(1),
455	emergency screening and services pursuant to ss. 641.31(13)(12)
456	and 641.513, and second opinions pursuant to s. 641.51.
457	Section 26. Section 641.3101, Florida Statutes, is amended
458	to read:
459	641.3101 Additional contract contents.--
460	(1)A health maintenance contract may contain additional
461	provisions not inconsistent with this part which are:
462	(a)(1)Necessary, on account of the manner in which the
463	organization is constituted or operated, in order to state the
464	rights and obligations of the parties to the contract; or
465	(b)(2)Desired by the organization and neither prohibited
466	by law nor in conflict with any provisions required to be
467	included therein.
468	(2) A health maintenance contract that uses a specific
469	methodology for payment of claims shall comply with s. 627.6044.
470	Section 27. Section 641.31025, Florida Statutes, is
471	created to read:
472	641.31025 Specific reasons for denial of coverage.--The
473	denial of an application for a health maintenance organization
474	contract must be accompanied by the specific reasons for the
475	denial, including, but not limited to, the specific underwriting
476	reasons, if applicable.
477	Section 28. Subsection (4) of section 627.651, Florida
478	Statutes, is amended to read:
479	627.651 Group contracts and plans of self-insurance must
480	meet group requirements.--
481	(4) This section does not apply to any plan which is
482	established or maintained by an individual employer in
483	accordance with the Employee Retirement Income Security Act of
484	1974, Pub. L. No. 93-406, or to a multiple-employer welfare
485	arrangement as defined in s. 624.437(1), except that a multiple-
486	employer welfare arrangement shall comply with ss. 627.419,
487	627.657, 627.6575, 627.6578, 627.6579, 627.6612, 627.66121,
488	627.66122, 627.6615, 627.6616, and 627.662(8)(7). This
489	subsection does not allow an authorized insurer to issue a group
490	health insurance policy or certificate which does not comply
491	with this part.
492	Section 29. Subsection (1) of section 641.2018, Florida
493	Statutes, is amended to read:
494	641.2018 Limited coverage for home health care
495	authorized.--
496	(1) Notwithstanding other provisions of this chapter, a
497	health maintenance organization may issue a contract that limits
498	coverage to home health care services only. The organization and
499	the contract shall be subject to all of the requirements of this
500	part that do not require or otherwise apply to specific benefits
501	other than home care services. To this extent, all of the
502	requirements of this part apply to any organization or contract
503	that limits coverage to home care services, except the
504	requirements for providing comprehensive health care services as
505	provided in ss. 641.19(4), (12), and (13), and 641.31(1), except
506	ss. 641.31(9),(13)(12), (17),(18), (19), (20), (21), and (24)
507	and 641.31095.
508	Section 30. Section 641.3107, Florida Statutes, is amended
509	to read:
510	641.3107 Delivery of contract.--Unless delivered upon
511	execution or issuance, a health maintenance contract,
512	certificate of coverage, or member handbook shall be mailed or
513	delivered to the subscriber or, in the case of a group health
514	maintenance contract, to the employer or other person who will
515	hold the contract on behalf of the subscriber group within 10
516	working days from approval of the enrollment form by the health
517	maintenance organization or by the effective date of coverage,
518	whichever occurs first. However, if the employer or other person
519	who will hold the contract on behalf of the subscriber group
520	requires retroactive enrollment of a subscriber, the
521	organization shall deliver the contract, certificate, or member
522	handbook to the subscriber within 10 days after receiving notice
523	from the employer of the retroactive enrollment. This section
524	does not apply to the delivery of those contracts specified in
525	s. 641.31(14)(13).
526	Section 31. Subsection (4) of section 641.513, Florida
527	Statutes, is amended to read:
528	641.513 Requirements for providing emergency services and
529	care.--
530	(4) A subscriber may be charged a reasonable copayment, as
531	provided in s. 641.31(13)(12), for the use of an emergency room.
532
533
534	================= T I T L E A M E N D M E N T =================
535	Remove line(s) 66, and insert:
536	to subscribers; creating s. 627.6042, F.S.; requiring policies
537	of insurers offering coverage of dependent children to maintain
538	such coverage until a child reaches age 25, under certain
539	circumstances; providing application; creating s. 627.60425,
540	F.S.; providing limitations on certain binding arbitration
541	requirements; amending s. 627.6044, F.S.; providing for payment
542	of claims to nonnetwork providers under specified conditions;
543	providing a definition; requiring the method used for
544	determining payment of claims to be included in filings;
545	providing for disclosure; amending s. 627.6415, F.S.; deleting
546	an 18th birthday age limitation on application of certain
547	dependent coverage requirements; amending s. 627.6475, F.S.;
548	revising risk-assuming carrier election requirements and
549	procedures; revising certain criteria and limitations under the
550	individual health reinsurance program; amending s. 627.651,
551	F.S.; correcting a cross reference; amending s. 627.662, F.S.;
552	revising a list of provisions applicable to group, blanket, or
553	franchise health insurance to include use of specific
554	methodology for payment of claims provisions; amending ss.
555	627.911 and 627.9175, F.S.; applying certain information
556	reporting requirements to health maintenance organizations;
557	revising health insurance information requirements and criteria;
558	authorizing the department to adopt rules; deleting an annual
559	report requirement; amending s. 627.9403, F.S.; deleting an
560	exemption for limited benefit policies from a long-term care
561	insurance restriction relating to nursing home care; amending s.
562	641.185, F.S.; correcting a cross reference; amending s.
563	641.3101, F.S.; providing a compliance requirement for health
564	maintenance contracts using a specific payment of claims
565	methodology; creating s. 641.31025, F.S.; requiring specific
566	reasons for denial of coverage under a health maintenance
567	organization contract; amending ss. 627.651, 641.2018, 641.3107,
568	and 641.513, F.S.; correcting cross references; providing
569	severability; providing an
570