Senate Bill sb2020

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    Florida Senate - 2003                                  SB 2020

    By Senator Peaden





    2-1500-03

  1                      A bill to be entitled

  2         An act relating to health flex plans; amending

  3         s. 408.909, F.S.; revising the definition of

  4         the term "health flex plans"; authorizing plans

  5         to limit the term of coverage; extending the

  6         required period without coverage before one is

  7         eligible to participate; extending the

  8         expiration date for the program; providing an

  9         effective date.

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11  Be It Enacted by the Legislature of the State of Florida:

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13         Section 1.  Subsections (2), (3), (5), and (10) of

14  section 408.909, Florida Statutes, are amended to read:

15         408.909  Health flex plans.--

16         (2)  DEFINITIONS.--As used in this section, the term:

17         (a)  "Agency" means the Agency for Health Care

18  Administration.

19         (b)  "Department" means the Department of Insurance.

20         (c)  "Enrollee" means an individual who has been

21  determined to be eligible for and is receiving health care

22  coverage under a health flex plan approved under this section.

23         (d)  "Health care coverage" or "health flex plan

24  coverage" means health care services that are covered as

25  benefits under an approved health flex plan or that are

26  otherwise provided, either directly or through arrangements

27  with other persons, via a health flex plan on a prepaid per

28  capita basis or on a prepaid aggregate fixed-sum basis.

29         (e)  "Health flex plan" means a health plan approved

30  under subsection (3) which guarantees payment for specified

31  health care coverage provided to the enrollee who purchases

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    Florida Senate - 2003                                  SB 2020
    2-1500-03




 1  coverage directly from the plan or through a small business

 2  purchasing arrangement sponsored by a local government.

 3         (f)  "Health flex plan entity" means a health insurer,

 4  health maintenance organization,

 5  health-care-provider-sponsored organization, local government,

 6  health care district, or other public or private

 7  community-based organization that develops and implements an

 8  approved health flex plan and is responsible for administering

 9  the health flex plan and paying all claims for health flex

10  plan coverage by enrollees of the health flex plan.

11         (3)  PILOT PROGRAM.--The agency and the department

12  shall each approve or disapprove health flex plans that

13  provide health care coverage for eligible participants who

14  reside in the three areas of the state that have the highest

15  number of uninsured persons, as identified in the Florida

16  Health Insurance Study conducted by the agency and in Indian

17  River County. A health flex plan may limit or exclude benefits

18  otherwise required by law for insurers offering coverage in

19  this state, may cap the total amount of claims paid per year

20  per enrollee, may limit the number of enrollees or the term of

21  coverage, or may take any combination of those actions.

22         (a)  The agency shall develop guidelines for the review

23  of applications for health flex plans and shall disapprove or

24  withdraw approval of plans that do not meet or no longer meet

25  minimum standards for quality of care and access to care.

26         (b)  The department shall develop guidelines for the

27  review of health flex plan applications and shall disapprove

28  or shall withdraw approval of plans that:

29         1.  Contain any ambiguous, inconsistent, or misleading

30  provisions or any exceptions or conditions that deceptively

31  

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    Florida Senate - 2003                                  SB 2020
    2-1500-03




 1  affect or limit the benefits purported to be assumed in the

 2  general coverage provided by the health flex plan;

 3         2.  Provide benefits that are unreasonable in relation

 4  to the premium charged or contain provisions that are unfair

 5  or inequitable or contrary to the public policy of this state,

 6  that encourage misrepresentation, or that result in unfair

 7  discrimination in sales practices; or

 8         3.  Cannot demonstrate that the health flex plan is

 9  financially sound and that the applicant is able to underwrite

10  or finance the health care coverage provided.

11         (c)  The agency and the department may adopt rules as

12  needed to administer this section.

13         (5)  ELIGIBILITY.--Eligibility to enroll in an approved

14  health flex plan is limited to residents of this state who:

15         (a)  Are 64 years of age or younger;

16         (b)  Have a family income equal to or less than 200

17  percent of the federal poverty level;

18         (c)  Are not covered by a private insurance policy and

19  are not eligible for coverage through a public health

20  insurance program, such as Medicare or Medicaid, or another

21  public health care program, such as KidCare, and have not been

22  covered at any time during the past 12 6 months; and

23         (d)  Have applied for health care coverage through an

24  approved health flex plan and have agreed to make any payments

25  required for participation, including periodic payments or

26  payments due at the time health care services are provided.

27         (10)  EXPIRATION.--This section expires July 1, 2008

28  2004.

29         Section 2.  This act shall take effect July 1, 2003.

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    Florida Senate - 2003                                  SB 2020
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 2                          SENATE SUMMARY

 3    Revises provisions relating to health flex plans. Revises
      a definition. Authorizes plans to limit the term of
 4    coverage. Extends a qualification period and extends the
      term of the program.
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