HOUSE AMENDMENT Bill No. SB 2020
1	CHAMBER ACTION
2	Senate House
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12	Representative Farkas offered the following:
13	Amendment (with title amendment)
14	Remove everything after the enacting clause, and insert:
15	Section 1. Subsections (7) is added to section 395.301,
16	Florida Statutes, to read:
17	395.301 Itemized patient bill; form and content prescribed
18	by the agency.--
19	(7)(a) Each licensed facility not operated by the state
20	shall make available to the public on its Internet website or by
21	other electronic means a list of charges and codes, and a
22	description of services of the top 100 diagnosis-related groups
23	discharged from the hospital for that year using the CMS grouper
24	applicable to that year and the top 100 outpatient occasions of
25	diagnostic and therapeutic procedures performed using the
26	Healthcare Common Procedure Coding System. For purposes of this
27	paragraph, the term "CMS grouper" means a system of
28	classification used by the Centers for Medicare and Medicaid
29	Services to assign an inpatient discharge into a diagnosis-
30	related group based on diagnosis codes, procedure codes, and
31	demographic information. The facility shall place a notice in
32	the reception areas that such information is available
33	electronically. The facility's list of charges and codes and the
34	description of services shall be consistent with federal
35	electronic transmission uniform standards under the Health
36	Insurance Portability and Accountability Act (HIPAA). Changes to
37	the data shall be posted and updated electronically at least 30
38	days prior to implementation.
39	(b) A health care facility shall, upon request, furnish a
40	patient, prior to provision of medical services, a reasonable
41	estimate of charges for such services. Such estimate shall not
42	preclude the health care provider or health care facility from
43	exceeding the estimate or making additional charges based on
44	changes in the patient’s condition or treatment needs.
45	(c) A licensed facility not operated by the state shall
46	make available to a patient, or a payor acting on behalf of the
47	patient, the records that are necessary to verify the accuracy
48	of the patient’s bill or payor’s claim related to such patient’s
49	bill within a reasonable time after a request. The verification
50	information must be made available in the facility’s offices.
51	Such records shall be available to the patient or payor prior to
52	and after payment of the bill or claim. The facility may not
53	charge the patient or payor for making such verification records
54	available, except the facility may charge its usual charge for
55	providing copies of records as specified in s. 395.3025.
56	Section 2. Paragraph (e) of subsection (2), subsection
57	(3), paragraph(c) of subsection (5), and subsection (10) of
58	section 408.909, Florida Statutes, are amended to read:
59	408.909 Health flex plans.--
60	(2) DEFINITIONS.--As used in this section, the term:
61	(e) "Health flex plan" means a health plan approved under
62	subsection (3) which guarantees payment for specified health
63	care coverage provided to the enrollee who purchases coverage
64	directly from the plan or through a small business purchasing
65	arrangement sponsored by a local government.
66	(3) PILOT PROGRAM.--The agency and the department shall
67	each approve or disapprove health flex plans that provide health
68	care coverage for eligible participants who reside in the three
69	areas of the state that have the highest number of uninsured
70	persons, as identified in the Florida Health Insurance Study
71	conducted by the agency and in Indian River County. A health
72	flex plan may limit or exclude benefits otherwise required by
73	law for insurers offering coverage in this state, may cap the
74	total amount of claims paid per year per enrollee, may limit the
75	number of enrollees or the term of coverage, or may take any
76	combination of those actions.
77	(a) The agency shall develop guidelines for the review of
78	applications for health flex plans and shall disapprove or
79	withdraw approval of plans that do not meet or no longer meet
80	minimum standards for quality of care and access to care.
81	(b) The department shall develop guidelines for the review
82	of health flex plan applications and shall disapprove or shall
83	withdraw approval of plans that:
84	1. Contain any ambiguous, inconsistent, or misleading
85	provisions or any exceptions or conditions that deceptively
86	affect or limit the benefits purported to be assumed in the
87	general coverage provided by the health flex plan;
88	2. Provide benefits that are unreasonable in relation to
89	the premium charged or contain provisions that are unfair or
90	inequitable or contrary to the public policy of this state, that
91	encourage misrepresentation, or that result in unfair
92	discrimination in sales practices; or
93	3. Cannot demonstrate that the health flex plan is
94	financially sound and that the applicant is able to underwrite
95	or finance the health care coverage provided.
96	(c) The agency and the department may adopt rules as
97	needed to administer this section.
98	(5) ELIGIBILITY.--Eligibility to enroll in an approved
99	health flex plan is limited to residents of this state who:
100	(c) Are not covered by a private insurance policy and are
101	not eligible for coverage through a public health insurance
102	program, such as Medicare or Medicaid, or another public health
103	care program, such as KidCare, and have not been covered at any
104	time during the past 6 months, except that a small business
105	purchasing arrangement sponsored by a local government may limit
106	enrollment to residents of this state who have not been covered
107	at any time during the past 12 months; and
108	(10) EXPIRATION.--This section expires July 1, 20082004.
109	Section 3. Paragraph (b) of subsection (6) of section
110	627.410, Florida Statutes, is amended to read:
111	627.410 Filing, approval of forms.--
112	(6)
113	(b) The department may establish by rule, for each type of
114	health insurance form, procedures to be used in ascertaining the
115	reasonableness of benefits in relation to premium rates and may,
116	by rule, exempt from any requirement of paragraph (a) any health
117	insurance policy form or type thereof (as specified in such
118	rule) to which form or type such requirements may not be
119	practically applied or to which form or type the application of
120	such requirements is not desirable or necessary for the
121	protection of the public. A law restricting or limiting
122	deductibles, coinsurance, copayments, or annual or lifetime
123	maximum payments shall not apply to any health plan policy
124	offered or delivered to an individual or to a group of 51 or
125	more persons that provides coverage as described in s.
126	627.6561(5)(a)2.With respect to any health insurance policy
127	form or type thereof which is exempted by rule from any
128	requirement of paragraph (a), premium rates filed pursuant to
129	ss. 627.640 and 627.662 shall be for informational purposes.
130	Section 4. Effective July 1, 2004, section 627.6410,
131	Florida Statutes, is amended to read:
132	627.6410 Optional coverage for speech, language,
133	swallowing, and hearing disorders.--
134	(1) Insurers issuing individual health insurance policies
135	in this state shall make available to the policyholder as part
136	of the application for any such policy of insurance, for an
137	appropriate additional premium, the benefits or levels of
138	benefits specified in the December 1999 Florida Medicaid Therapy
139	Services Handbook for genetic or congenital disorders or
140	conditions involving speech, language, swallowing, and hearing
141	and a hearing aid and earmolds benefit at the level of benefits
142	specified in the January 2001 Florida Medicaid Hearing Services
143	Handbook.
144	(2) This section does not apply to specified accident,
145	specified disease, hospital indemnity, limited benefit,
146	disability income, or long-term care insurance policies.
147	(3) Such optional coverage is not required to be offered
148	when substantially similar benefits are included in the policy
149	of insurance issued to the policyholder.
150	(4) This section does not require or prohibit the use of a
151	provider network.
152	(5) This section does not prohibit an insurer from
153	requiring prior authorization for the benefits under this
154	section.
155	Section 5. Paragraph (b) of subsection (3) of section
156	627.6487, Florida Statutes, is amended, and paragraph (c) is
157	added to subsection (4) of said section, to read:
158	627.6487 Guaranteed availability of individual health
159	insurance coverage to eligible individuals.--
160	(3) For the purposes of this section, the term "eligible
161	individual" means an individual:
162	(b) Who is not eligible for coverage under:
163	1. A group health plan, as defined in s. 2791 of the
164	Public Health Service Act;
165	2. A conversion policy or contract issued by an authorized
166	insurer or health maintenance organization under s. 627.6675 or
167	s. 641.3921, respectively, offered to an individual who is no
168	longer eligible for coverage under either an insured or self-
169	insured group healthemployer plan or group health insurance
170	policy;
171	3. Part A or part B of Title XVIII of the Social Security
172	Act; or
173	4. A state plan under Title XIX of such act, or any
174	successor program, and does not have other health insurance
175	coverage;
176	(4)
177	(c) If the individual’s most recent period of creditable
178	coverage was earned in a state other than this state, an insurer
179	issuing a policy that complies with paragraph (a) may impose a
180	surcharge or charge a premium for such policy equal to that
181	permitted in the state in which such creditable coverage was
182	earned.
183	Section 6. Paragraph (c) of subsection (8) of section
184	627.6561, Florida Statutes, is amended to read:
185	627.6561 Preexisting conditions.--
186	(8)
187	(c) The certification described in this section is a
188	written certification that must include:
189	1. The period of creditable coverage of the individual
190	under the policy and the coverage, if any, under such COBRA
191	continuation provision or continuation pursuant to s. 627.6692.;
192	and
193	2. The waiting period, if any, imposed with respect to the
194	individual for any coverage under such policy.
195	3. A statement that the creditable coverage was provided
196	under a group health plan, a group or individual health
197	insurance policy, or a health maintenance organization contract,
198	the state in which such coverage was provided, and whether or
199	not such individual was eligible for a conversion policy under
200	such coverage.
201	Section 7. Subsection (6) of section 627.667, Florida
202	Statutes, is amended to read:
203	627.667 Extension of benefits.--
204	(6) This section also applies to holders of group
205	certificates which are renewed, delivered, or issued for
206	delivery to residents of this state under group policies
207	effectuated or delivered outside this state, unless a succeeding
208	carrier under a group policy has agreed to assume liability for
209	the benefits.
210	Section 8. Effective July 1, 2004, section 627.66912,
211	Florida Statutes, is created to read:
212	627.66912 Optional coverage for speech, language,
213	swallowing, and hearing disorders.--
214	(1) Insurers issuing group health insurance policies in
215	this state shall make available to the policyholder as part of
216	the application for any such policy of insurance, for an
217	appropriate additional premium, the benefits or levels of
218	benefits specified in the December 1999 Florida Medicaid Therapy
219	Services Handbook for genetic or congenital disorders or
220	conditions involving speech, language, swallowing, and hearing
221	and a hearing aid and earmolds benefit at the level of benefits
222	specified in the January 2001 Florida Medicaid Hearing Services
223	Handbook.
224	(2) This section does not apply to specified accident,
225	specified disease, hospital indemnity, limited benefit,
226	disability income, or long-term care insurance policies.
227	(3) Such optional coverage is not required to be offered
228	when substantially similar benefits are included in the policy
229	of insurance issued to the policyholder.
230	(4) This section does not require or prohibit the use of a
231	provider network.
232	(5) This section does not prohibit an insurer from
233	requiring prior authorization for the benefits under this
234	section.
235	Section 9. Paragraph (e) of subsection (5) of section
236	627.6692, Florida Statutes, is amended to read:
237	627.6692 Florida Health Insurance Coverage Continuation
238	Act.--
239	(5) CONTINUATION OF COVERAGE UNDER GROUP HEALTH PLANS.--
240	(e)1. A covered employee or other qualified beneficiary
241	who wishes continuation of coverage must pay the initial premium
242	and elect such continuation in writing to the insurance carrier
243	issuing the employer's group health plan within 6330days after
244	receiving notice from the insurance carrier under paragraph (d).
245	Subsequent premiums are due by the grace period expiration date.
246	The insurance carrier or the insurance carrier's designee shall
247	process all elections promptly and provide coverage
248	retroactively to the date coverage would otherwise have
249	terminated. The premium due shall be for the period beginning on
250	the date coverage would have otherwise terminated due to the
251	qualifying event. The first premium payment must include the
252	coverage paid to the end of the month in which the first payment
253	is made. After the election, the insurance carrier must bill the
254	qualified beneficiary for premiums once each month, with a due
255	date on the first of the month of coverage and allowing a 30-day
256	grace period for payment.
257	2. Except as otherwise specified in an election, any
258	election by a qualified beneficiary shall be deemed to include
259	an election of continuation of coverage on behalf of any other
260	qualified beneficiary residing in the same household who would
261	lose coverage under the group health plan by reason of a
262	qualifying event. This subparagraph does not preclude a
263	qualified beneficiary from electing continuation of coverage on
264	behalf of any other qualified beneficiary.
265	Section 10. Paragraphs (h) and (u) of subsection (3),
266	paragraph(c) of subsection (5), and paragraph (b) of
267	subsection(6) of section 627.6699, Florida Statutes, are
268	amended, and paragraph (k) is added to subsection (5) of said
269	section, to read:
270	627.6699 Employee Health Care Access Act.--
271	(3) DEFINITIONS.--As used in this section, the term:
272	(h) "Eligible employee" means an employee who works full
273	time, having a normal workweek of 25 or more hours and is paid
274	wages or a salary at least equal to the federal minimum hourly
275	wage applicable to such employee, and who has met any applicable
276	waiting-period requirements or other requirements of this act.
277	The term includes a self-employed individual, a sole proprietor,
278	a partner of a partnership, or an independent contractor, if the
279	sole proprietor, partner, or independent contractor is included
280	as an employee under a health benefit plan of a small employer,
281	but does not include a part-time, temporary, or substitute
282	employee.
283	(u) "Self-employed individual" means an individual or sole
284	proprietor who derives his or her income from a trade or
285	business carried on by the individual or sole proprietor which
286	necessitates that the individual file federal income tax forms,
287	with supporting schedules and accompanying income reporting
288	formsresults in taxable income as indicated on IRS Form 1040,
289	schedule C or F, and which generated taxable income in one of
290	the 2 previous years.
291	(5) AVAILABILITY OF COVERAGE.--
292	(c) Every small employer carrier must, as a condition of
293	transacting business in this state:
294	1. Beginning July 1, 2000, offer and issue all small
295	employer health benefit plans on a guaranteed-issue basis to
296	every eligible small employer, with 2 to 50 eligible employees,
297	that elects to be covered under such plan, agrees to make the
298	required premium payments, and satisfies the other provisions of
299	the plan. A rider for additional or increased benefits may be
300	medically underwritten and may only be added to the standard
301	health benefit plan. The increased rate charged for the
302	additional or increased benefit must be rated in accordance with
303	this section.
304	2. Beginning July 1, 2000, and until July 31, 2001, offer
305	and issue basic and standard small employer health benefit plans
306	on a guaranteed-issue basis to every eligible small employer
307	which is eligible for guaranteed renewal, has less than two
308	eligible employees, is not formed primarily for the purpose of
309	buying health insurance, elects to be covered under such plan,
310	agrees to make the required premium payments, and satisfies the
311	other provisions of the plan. A rider for additional or
312	increased benefits may be medically underwritten and may be
313	added only to the standard benefit plan. The increased rate
314	charged for the additional or increased benefit must be rated in
315	accordance with this section. For purposes of this subparagraph,
316	a person, his or her spouse, and his or her dependent children
317	shall constitute a single eligible employee if that person and
318	spouse are employed by the same small employer and either one
319	has a normal work week of less than 25 hours.
320	3. Beginning June 1, 2004August 1, 2001, offer and issue
321	basic and standard small employer health benefit plans on a
322	guaranteed-issue basis, during a 30-day open enrollment period
323	of June 1 through June 30 and during a31-day open enrollment
324	period of DecemberAugust 1 through DecemberAugust31 of each
325	year, to every eligible small employer, with fewer than two
326	eligible employees, which small employer is not formed primarily
327	for the purpose of buying health insurance and which elects to
328	be covered under such plan, agrees to make the required premium
329	payments, and satisfies the other provisions of the plan.
330	Coverage provided under this subparagraph shall begin 60 days
331	afteron October 1 of the same year asthe date of enrollment,
332	unless the small employer carrier and the small employer agree
333	to a different date. A rider for additional or increased
334	benefits may be medically underwritten and may only be added to
335	the standard health benefit plan. The increased rate charged for
336	the additional or increased benefit must be rated in accordance
337	with this section. For purposes of this subparagraph, a person,
338	his or her spouse, and his or her dependent children constitute
339	a single eligible employee if that person and spouse are
340	employed by the same small employer and either that person or
341	his or her spouse has a normal work week of less than 25 hours.
342	4. This paragraph does not limit a carrier's ability to
343	offer other health benefit plans to small employers if the
344	standard and basic health benefit plans are offered and
345	rejected.
346	(k) Beginning January 1, 2004, every small employer shall
347	provide, on an annual basis, information on at least three
348	different health benefit plans for employees. Nothing in this
349	paragraph shall be construed as requiring a small employer to
350	provide the health benefit plan or contribute to the cost of
351	such plan. Nothing in this paragraph shall be construed as
352	requiring a small employer or an individual carrier to offer
353	these health plan benefits on a guaranteed-issue basis.
354	(6) RESTRICTIONS RELATING TO PREMIUM RATES.--
355	(b) For all small employer health benefit plans that are
356	subject to this section and are issued by small employer
357	carriers on or after January 1, 1994, premium rates for health
358	benefit plans subject to this section are subject to the
359	following:
360	1. Small employer carriers must use a modified community
361	rating methodology in which the premium for each small employer
362	must be determined solely on the basis of the eligible
363	employee's and eligible dependent's gender, age, family
364	composition, tobacco use, or geographic area as determined under
365	paragraph (5)(j) and in which the premium may be adjusted as
366	permitted by this paragraph.
367	2. Rating factors related to age, gender, family
368	composition, tobacco use, or geographic location may be
369	developed by each carrier to reflect the carrier's experience.
370	The factors used by carriers are subject to department review
371	and approval.
372	3. Small employer carriers may not modify the rate for a
373	small employer for 12 months from the initial issue date or
374	renewal date, unless the composition of the group changes or
375	benefits are changed. However, a small employer carrier may
376	modify the rate one time prior to 12 months after the initial
377	issue date for a small employer who enrolls under a previously
378	issued group policy that has a common anniversary date for all
379	employers covered under the policy if:
380	a. The carrier discloses to the employer in a clear and
381	conspicuous manner the date of the first renewal and the fact
382	that the premium may increase on or after that date.
383	b. The insurer demonstrates to the department that
384	efficiencies in administration are achieved and reflected in the
385	rates charged to small employers covered under the policy.
386	4. A carrier may issue a group health insurance policy to
387	a small employer health alliance or other group association with
388	rates that reflect a premium credit for expense savings
389	attributable to administrative activities being performed by the
390	alliance or group association if such expense savings are
391	specifically documented in the insurer's rate filing and are
392	approved by the department. Any such credit may not be based on
393	different morbidity assumptions or on any other factor related
394	to the health status or claims experience of any person covered
395	under the policy. Nothing in this subparagraph exempts an
396	alliance or group association from licensure for any activities
397	that require licensure under the insurance code. A carrier
398	issuing a group health insurance policy to a small employer
399	health alliance or other group association shall allow any
400	properly licensed and appointed agent of that carrier to market
401	and sell the small employer health alliance or other group
402	association policy. Such agent shall be paid the usual and
403	customary commission paid to any agent selling the policy.
404	5. Any adjustments in rates for claims experience, health
405	status, or duration of coverage may not be charged to individual
406	employees or dependents. For a small employer's policy, such
407	adjustments may not result in a rate for the small employer
408	which deviates more than 15 percent from the carrier's approved
409	rate. Any such adjustment must be applied uniformly to the rates
410	charged for all employees and dependents of the small employer.
411	A small employer carrier may make an adjustment to a small
412	employer's renewal premium, not to exceed 10 percent annually,
413	due to the claims experience, health status, or duration of
414	coverage of the employees or dependents of the small employer.
415	Semiannually, small group carriers shall report information on
416	forms adopted by rule by the department, to enable the
417	department to monitor the relationship of aggregate adjusted
418	premiums actually charged policyholders by each carrier to the
419	premiums that would have been charged by application of the
420	carrier's approved modified community rates. If the aggregate
421	resulting from the application of such adjustment exceeds the
422	premium that would have been charged by application of the
423	approved modified community rate by 35percent for the current
424	reporting period, the carrier shall limit the application of
425	such adjustments only to minus adjustments beginning not more
426	than 60 days after the report is sent to the department. For any
427	subsequent reporting period, if the total aggregate adjusted
428	premium actually charged does not exceed the premium that would
429	have been charged by application of the approved modified
430	community rate by 35percent, the carrier may apply both plus
431	and minus adjustments. A small employer carrier may provide a
432	credit to a small employer's premium based on administrative and
433	acquisition expense differences resulting from the size of the
434	group. Group size administrative and acquisition expense factors
435	may be developed by each carrier to reflect the carrier's
436	experience and are subject to department review and approval.
437	6. A small employer carrier rating methodology may include
438	separate rating categories for one dependent child, for two
439	dependent children, and for three or more dependent children for
440	family coverage of employees having a spouse and dependent
441	children or employees having dependent children only. A small
442	employer carrier may have fewer, but not greater, numbers of
443	categories for dependent children than those specified in this
444	subparagraph.
445	7. Small employer carriers may not use a composite rating
446	methodology to rate a small employer with fewer than 10
447	employees. For the purposes of this subparagraph, a "composite
448	rating methodology" means a rating methodology that averages the
449	impact of the rating factors for age and gender in the premiums
450	charged to all of the employees of a small employer.
451	8.a. A carrier may separate the experience of small
452	employer groups with less than 2 eligible employees from the
453	experience of small employer groups with 2-50 eligible employees
454	for purposes of determining an alternative modified community
455	rating.
456	b. If a carrier separates the experience of small employer
457	groups as provided in sub-subparagraph a., the rate to be
458	charged to small employer groups of less than 2 eligible
459	employees may not exceed 150 percent of the rate determined for
460	small employer groups of 2-50 eligible employees. However, the
461	carrier may charge excess losses of the experience pool
462	consisting of small employer groups with less than 2 eligible
463	employees to the experience pool consisting of small employer
464	groups with 2-50 eligible employees so that all losses are
465	allocated and the 150-percent rate limit on the experience pool
466	consisting of small employer groups with less than 2 eligible
467	employees is maintained. Notwithstanding s. 627.411(1), the rate
468	to be charged to a small employer group of fewer than 2 eligible
469	employees, insured as of July 1, 2002, may be up to 125 percent
470	of the rate determined for small employer groups of 2-50
471	eligible employees for the first annual renewal and 150 percent
472	for subsequent annual renewals.
473	9. In addition to the separation allowed under sub-
474	subparagraph 8.a., a carrier may also separate the experience of
475	small employer groups of 1-50 eligible employees using a health
476	reimbursement arrangement, as defined in Internal Revenue
477	Service Notice 2002-45, 2002-28 Internal Revenue Bulletin 93,
478	and Revenue Ruling 2002-41, 2002-28 Internal Revenue Bulletin
479	75, from the experience of small employer groups of 1-50
480	eligible employees not using such a health reimbursement
481	arrangement for purposes of determining an alternative modified
482	community rating.
483	Section 11. Subsection (2) and paragraph (d) of subsection
484	(3) of section 641.31, Florida Statutes, are amended, and
485	subsections (40) and (41) are added to said section, to read:
486	641.31 Health maintenance contracts.--
487	(2) The rates charged by any health maintenance
488	organization to its subscribers shall not be excessive,
489	inadequate, or unfairly discriminatory or follow a rating
490	methodology that is inconsistent, indeterminate, or ambiguous or
491	encourages misrepresentation or misunderstanding. A law
492	restricting or limiting deductibles, coinsurance, copayments, or
493	annual or lifetime maximum payments shall not apply to any
494	health maintenance organization contract offered or delivered to
495	an individual or a group of 51 or more persons that provides
496	coverage as described in s. 641.31071(5)(a)2.The department, in
497	accordance with generally accepted actuarial practice as applied
498	to health maintenance organizations, may define by rule what
499	constitutes excessive, inadequate, or unfairly discriminatory
500	rates and may require whatever information it deems necessary to
501	determine that a rate or proposed rate meets the requirements of
502	this subsection.
503	(3)
504	(d) Any change in rates charged for the contract must be
505	filed with the department not less than 30 days in advance of
506	the effective date. At the expiration of such 30 days, the rate
507	filing shall be deemed approved unless prior to such time the
508	filing has been affirmatively approved or disapproved by order
509	of the department. The approval of the filing by the department
510	constitutes a waiver of any unexpired portion of such waiting
511	period. The department may extend by not more than an additional
512	15 days the period within which it may so affirmatively approve
513	or disapprove any such filing, by giving notice of such
514	extension before expiration of the initial 30-day period. At the
515	expiration of any such period as so extended, and in the absence
516	of such prior affirmative approval or disapproval, any such
517	filing shall be deemed approved. This paragraph does not apply
518	to group health contracts effectuated and delivered in this
519	state insuring groups of 51 or more persons, except for Medicare
520	supplement insurance, long-term care insurance, and any coverage
521	under which the increase in claims costs over the lifetime of
522	the contract due to advancing age or duration is refunded in the
523	premium.
524	(40) Health maintenance organizations shall make available
525	to the contract holder as part of the application for any such
526	contract, for an appropriate additional premium, the benefits or
527	level of benefits specified in the December 1999 Florida
528	Medicaid Therapy Services Handbook for genetic or congenital
529	disorders or conditions involving speech, language, swallowing,
530	and hearing and a hearing aid and earmolds benefit at the level
531	of benefits specified in the January 2001 Florida Medicaid
532	Hearing Services Handbook.
533	(a) Such optional coverage is not required to be offered
534	when substantially similar benefits are included in the contract
535	issued to the subscriber.
536	(b) This subsection does not require or prohibit the use
537	of a provider network.
538	(c) This subsection does not prohibit an organization from
539	requiring prior authorization for the benefits under this
540	subsection.
541	(d) This subsection does not apply to health maintenance
542	organizations issuing individual coverage to fewer than 50,000
543	members.
544	(e) This subsection shall take effect July 1, 2004.
545	(41) Every health maintenance organization shall make
546	available to its subscribers the estimated co-pay, co-insurance,
547	or deductible, whichever is applicable, for any covered service,
548	the status of the subscriber's maximum annual out-of-pocket
549	payments for a covered individual or family, and the status of
550	the subscriber's maximum lifetime benefit. Each health
551	maintenance organization shall, upon request of a subscriber,
552	provide an estimate of the amount the health maintenance
553	organization will pay for a particular medical procedure or
554	service. The estimate may be in the form of a range of payments
555	or an average payment. A health maintenance organization that
556	provides a subscriber with a good faith estimate is not bound by
557	the estimate.
558	Section 12. Section 641.31075, Florida Statutes, is
559	created to read:
560	641.31075 Requirements for replacing health coverage.--Any
561	health maintenance organization that is replacing any other
562	group health coverage with its group health maintenance coverage
563	shall comply with s. 627.666.
564	Section 13. Subsection (1) of section 641.3111, Florida
565	Statutes, is amended to read:
566	641.3111 Extension of benefits.--
567	(1) Every group health maintenance contract shall provide
568	that termination of the contract shall be without prejudice to
569	any continuous loss which commenced while the contract was in
570	force, but any extension of benefits beyond the period the
571	contract was in force may be predicated upon the continuous
572	total disability of the subscriber and may be limited to payment
573	for the treatment of a specific accident or illness incurred
574	while the subscriber was a member. The extension is required
575	regardless of whether the group contract holder or other entity
576	secures replacement coverage from a new insurer or health
577	maintenance organization or foregoes the provision of coverage.
578	The required provision must provide for continuation of contract
579	benefits in connection with the treatment of a specific accident
580	or illness incurred while the contract was in effect.Such
581	extension of benefits may be limited to the occurrence of the
582	earliest of the following events:
583	(a) The expiration of 12 months.
584	(b) Such time as the member is no longer totally disabled.
585	(c) A succeeding carrier elects to provide replacement
586	coverage without limitation as to the disability condition.
587	(d) The maximum benefits payable under the contract have
588	been paid.
589	Section 14. Subsection (22) is added to section 641.19,
590	Florida Statutes, to read:
591	641.19 Definitions.--As used in this part, the term:
592	(22) "Specialty" or "specialist" shall not include the
593	services by a physician licensed under chapter 460.
594	Section 15. If any provision of this act or the
595	application thereof to any person or circumstance is held
596	invalid, the invalidity shall not affect other provisions or
597	applications of the act which can be given effect without the
598	invalid provision or application, and to this end the provisions
599	of this act are declared severable.
600	Section 16. Except as otherwise provided herein, this act
601	shall take effect upon becoming a law.
602
603	================= T I T L E A M E N D M E N T =================
604
605	Remove the entire title, and insert:
606
607	A bill to be entitled
608	An act relating to health insurance; amending s. 395.301,
609	F.S.; requiring health care providers and facilities to
610	provide prospective patients with reasonable estimates of
611	prospective charges; requiring certain licensed facilities
612	to make available to payors certain records; providing that
613	the facility may not charge for making records available
614	but may charge a specified amount for providing copies;
615	amending s. 408.909, F.S.; revising a definition;
616	authorizing plans to limit the term of coverage; extending
617	the required period without coverage before participation
618	eligibility; authorizing a business purchasing arrangement
619	sponsored by a local government subject to specified
620	limitations; extending a program expiration date; amending
621	s. 627.410, F.S.; exempting individuals and certain groups
622	from laws restricting or limiting coinsurance, copayments,
623	or annual or lifetime maximum payments; creating s.
624	627.6410, F.S.; providing for optional coverage in health
625	insurance policies for speech, language, swallowing, and
626	hearing disorders; providing exclusion; providing
627	exceptions; providing a limitation; amending s. 627.6487,
628	F.S.; revising a definition of "eligible individual" for
629	purposes of availability of individual health insurance
630	coverage; authorizing insurers to impose certain surcharges
631	or premium charges for creditable coverage earned in
632	certain states; amending s. 627.6561, F.S.; requiring
633	additional information in a certification relating to
634	certain creditable coverage for purposes of eligibility for
635	exclusion from preexisting condition requirements; amending
636	s. 627.667, F.S.; deleting a limitation on certain
637	application of extension of benefits provisions; creating
638	s. 627.66912, F.S.; providing for optional coverage in
639	group, blanket, and franchise health insurance policies for
640	speech, language, swallowing, and hearing disorders;
641	providing exclusion; providing exceptions; providing a
642	limitation; amending s. 627.6692, F.S.; extending a time
643	period for continuation of certain coverage under group
644	health plans; amending s. 627.6699, F.S.; revising certain
645	definitions; revising enrollment period criteria for
646	certain health benefit plans; requiring small employers to
647	provide certain health benefit plan information to
648	employees; providing a limitation; revising certain rate
649	adjustment criteria; authorizing separation of experience
650	of certain small employer groups for certain purposes;
651	amending s. 641.31, F.S.; specifying nonapplication of
652	certain health maintenance contract filing requirements to
653	certain group health insurance policies, with exceptions;
654	requiring health maintenance organizations to make available
655	coverage for certain speech, language, swallowing, and
656	hearing disorders or conditions, subject to certain
657	criteria and limits, effective July 1, 2004; requiring
658	health maintenance organizations to provide specific
659	information to subscribers; creating s. 641.31075, F.S.;
660	providing compliance requirements for health maintenance
661	organizations replacing certain coverages; amending s.
662	641.3111, F.S.; providing additional requirements for
663	extension of benefits under group health maintenance
664	contracts; amending s. 641.19, F.S.; defining the term
665	"specialty" or "specialist" to exclude services by a
666	chiropractic physician; providing severability; providing
667	effective dates.
668
669