Senate Bill sb2514
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Florida Senate - 2005 SB 2514
By Senator Fasano
11-1311A-05
1 A bill to be entitled
2 An act relating to health insurance; amending
3 s. 408.909, F.S.; requiring disapproval of
4 health flex plans that cannot be shown to meet
5 general eligibility standards for insurer
6 certificate of authority; amending s. 627.411,
7 F.S.; prescribing a limit on rate increases for
8 closed forms; amending s. 627.413, F.S.;
9 authorizing insurers and health maintenance
10 organizations to issue high deductible
11 insurance plans that meet certain criteria;
12 creating s. 627.4141, F.S.; prohibiting
13 mandatory arbitration clauses in life insurance
14 and health insurance policies; amending s.
15 627.6487, F.S.; redefining the term "eligible
16 individual" for purposes of guaranteed
17 availability of individual health insurance
18 coverage to eligible individuals; amending s.
19 627.64872, F.S.; revising definitions relating
20 to the Florida Health Insurance Plan; providing
21 for the Commissioner of Insurance Regulation to
22 serve on the plan's board of directors;
23 deleting obsolete provisions relating to an
24 interim report; revising qualifications for
25 eligibility; revising sources of additional
26 revenue for the plan; prescribing a limit on
27 health care provider reimbursement; amending s.
28 627.6515, F.S.; providing that out-of-state
29 group health insurance policies are subject to
30 the prohibition on mandatory arbitration
31 clauses; amending s. 627.6692, F.S.; extending
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1 time limits for giving certain notice with
2 respect to health insurance coverage
3 continuation; amending s. 627.6699, F.S.;
4 requiring health insurance small employer
5 carriers to offer high deductible insurance
6 plans that meet certain criteria;
7 reconstituting the board of the Florida Small
8 Employer Health Reinsurance Program; changing
9 the date by which the board must take certain
10 actions; prescribing duties of the board with
11 respect to advising the Office of Insurance
12 Regulation and other entities on health
13 insurance issues; amending s. 641.27, F.S.;
14 increasing the interval at which the office
15 must examine health maintenance organizations;
16 deleting authority of the office to accept a
17 report of an independent certified public
18 accountant; deleting a limit on examination
19 expenses; amending s. 641.31, F.S.; providing
20 that health maintenance organization contracts
21 are subject to the prohibition on mandatory
22 arbitration clauses; providing applicability;
23 providing an effective date.
24
25 Be It Enacted by the Legislature of the State of Florida:
26
27 Section 1. Paragraph (b) of subsection (3) of section
28 408.909, Florida Statutes, is amended to read:
29 408.909 Health flex plans.--
30 (3) PROGRAM.--The agency and the office shall each
31 approve or disapprove health flex plans that provide health
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1 care coverage for eligible participants. A health flex plan
2 may limit or exclude benefits otherwise required by law for
3 insurers offering coverage in this state, may cap the total
4 amount of claims paid per year per enrollee, may limit the
5 number of enrollees, or may take any combination of those
6 actions. A health flex plan offering may include the option of
7 a catastrophic plan supplementing the health flex plan.
8 (b) The office shall develop guidelines for the review
9 of health flex plan applications and provide regulatory
10 oversight of health flex plan advertisement and marketing
11 procedures. The office shall disapprove or shall withdraw
12 approval of plans that:
13 1. Contain any ambiguous, inconsistent, or misleading
14 provisions or any exceptions or conditions that deceptively
15 affect or limit the benefits purported to be assumed in the
16 general coverage provided by the health flex plan;
17 2. Provide benefits that are unreasonable in relation
18 to the premium charged or contain provisions that are unfair
19 or inequitable or contrary to the public policy of this state,
20 that encourage misrepresentation, or that result in unfair
21 discrimination in sales practices; or
22 3. Cannot demonstrate that the health flex plan is
23 financially sound and that the applicant is able to underwrite
24 or finance the health care coverage provided; or.
25 4. Cannot demonstrate that the applicant and its
26 management are in compliance with the standards required under
27 s. 624.404(3).
28 Section 2. Subsection (4) is added to section 627.411,
29 Florida Statutes, to read:
30 627.411 Grounds for disapproval.--
31
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1 (4) Notwithstanding subsections (1) and (2), an annual
2 rate increase for a closed form, or a closed block of forms
3 with similar benefits, may not exceed medical trend. For
4 purposes of this subsection, the term "closed" means that the
5 form, or all forms within the block of pooled forms, has not
6 been actively offered for sale by the insurer in the previous
7 12 months.
8 Section 3. Subsection (6) is added to section 627.413,
9 Florida Statutes, to read:
10 627.413 Contents of policies, in general;
11 identification.--
12 (6) Notwithstanding any other provision of the Florida
13 Insurance Code which is in conflict with the federal
14 requirements for a health savings account qualified high
15 deductible health plan, an insurer or health maintenance
16 organization subject to part I of chapter 641 which is
17 authorized to issue health insurance in this state may offer
18 for sale an individual or group policy or contract that
19 provides for a high deductible plan that meets the federal
20 requirements of a health savings account plan and that is
21 offered in conjunction with a health savings account.
22 Section 4. Section 627.4141, Florida Statutes, is
23 created to read:
24 627.4141 Mandatory arbitration clauses prohibited.--An
25 insurer or health maintenance organization may not deliver or
26 issue for delivery a life or health insurance policy,
27 including a group life or health contract or certificate of
28 coverage issued to a resident of this state, or a health
29 maintenance contract in this state which contains a provision
30 requiring the resolution of claims or disputes between the
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1 insured and the insurer or health maintenance organization
2 through the use of mandatory binding arbitration.
3 Section 5. Subsection (3) of section 627.6487, Florida
4 Statutes, is amended to read:
5 627.6487 Guaranteed availability of individual health
6 insurance coverage to eligible individuals.--
7 (3) For the purposes of this section, the term
8 "eligible individual" means an individual:
9 (a)1. For whom, as of the date on which the individual
10 seeks coverage under this section, the aggregate of the
11 periods of creditable coverage, as defined in s. 627.6561(5)
12 and (6), is 18 or more months; and
13 2.a. Whose most recent prior creditable coverage was
14 under a group health plan, governmental plan, or church plan,
15 or health insurance coverage offered in connection with any
16 such plan; or
17 b. Whose most recent prior creditable coverage was
18 under an individual plan issued in this state by a health
19 insurer or health maintenance organization, which coverage is
20 terminated due to the insurer or health maintenance
21 organization becoming insolvent or discontinuing the offering
22 of all individual coverage in the State of Florida, or due to
23 the insured no longer living in the service area in the State
24 of Florida of the insurer or health maintenance organization
25 that provides coverage through a network plan in the State of
26 Florida; or
27 c. Whose most recent creditable coverage was with the
28 Florida Health Insurance Plan specified in s. 627.64872, which
29 coverage is terminated due to inadequate funding of the
30 Florida Health Insurance Plan as provided in s. 627.64872(15);
31 (b) Who is not eligible for coverage under:
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1 1. A group health plan, as defined in s. 2791 of the
2 Public Health Service Act;
3 2. A conversion policy or contract issued by an
4 authorized insurer or health maintenance organization under s.
5 627.6675 or s. 641.3921, respectively, offered to an
6 individual who is no longer eligible for coverage under either
7 an insured or self-insured employer plan;
8 3. Part A or part B of Title XVIII of the Social
9 Security Act; or
10 4. A state plan under Title XIX of such act, or any
11 successor program, and does not have other health insurance
12 coverage; or
13 5. The Florida Health Insurance Plan as specified in
14 s. 627.64872 and such plan is accepting new enrollment;
15 (c) With respect to whom the most recent coverage
16 within the coverage period described in paragraph (a) was not
17 terminated based on a factor described in s. 627.6571(2)(a) or
18 (b), relating to nonpayment of premiums or fraud, unless such
19 nonpayment of premiums or fraud was due to acts of an employer
20 or person other than the individual;
21 (d) Who, having been offered the option of
22 continuation coverage under a COBRA continuation provision or
23 under s. 627.6692, elected such coverage; and
24 (e) Who, if the individual elected such continuation
25 provision, has exhausted such continuation coverage under such
26 provision or program.
27 Section 6. Subsections (2), (3), (6), (9), and (15) of
28 section 627.64872, Florida Statutes, are amended, present
29 subsection (20) of that section is renumbered as subsection
30 (21), and a new subsection (20) is added to that section to
31 read:
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1 627.64872 Florida Health Insurance Plan.--
2 (2) DEFINITIONS.--As used in this section:
3 (a) "Board" means the board of directors of the plan.
4 (b) "Commissioner" means the Commissioner of Insurance
5 Regulation.
6 (c)(b) "Dependent" means a resident spouse or resident
7 unmarried child under the age of 19 years, a child who is a
8 student under the age of 25 years and who is financially
9 dependent upon the parent, or a child of any age who is
10 disabled and dependent upon the parent.
11 (c) "Director" means the Director of the Office of
12 Insurance Regulation.
13 (d) "Health insurance" means any hospital or medical
14 expense incurred policy or health maintenance organization
15 subscriber contract pursuant to chapter 641. The term does not
16 include short-term, accident, dental-only, vision-only,
17 fixed-indemnity, limited-benefit, or credit insurance;
18 disability income insurance; coverage for onsite medical
19 clinics; insurance coverage specified in federal regulations
20 issued pursuant to Pub. L. No. 104-191, under which benefits
21 for medical care are secondary or incidental to other
22 insurance benefits; benefits for long-term care, nursing home
23 care, home health care, community-based care, or any
24 combination thereof, or other similar, limited benefits
25 specified in federal regulations issued pursuant to Pub. L.
26 No. 104-191; benefits provided under a separate policy,
27 certificate, or contract of insurance, under which there is no
28 coordination between the provision of the benefits and any
29 exclusion of benefits under any group health plan maintained
30 by the same plan sponsor and the benefits are paid with
31 respect to an event without regard to whether benefits are
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1 provided with respect to such an event under any group health
2 plan maintained by the same plan sponsor, such as for coverage
3 only for a specified disease or illness; hospital indemnity or
4 other fixed indemnity insurance; coverage offered as a
5 separate policy, certificate, or contract of insurance, such
6 as Medicare supplemental health insurance as defined under s.
7 1882(g)(1) of the Social Security Act; coverage supplemental
8 to the coverage provided under chapter 55 of Title 10, U.S.C.,
9 the Civilian Health and Medical Program of the Uniformed
10 Services (CHAMPUS); similar supplemental coverage provided to
11 coverage under a group health plan; coverage issued as a
12 supplement to liability insurance; insurance arising out of a
13 workers' compensation or similar law; automobile medical
14 payment insurance; or insurance under which benefits are
15 payable with or without regard to fault and which is
16 statutorily required to be contained in any liability
17 insurance policy or equivalent self-insurance.
18 (e) "Implementation" means the effective date after
19 the first meeting of the board when legal authority and
20 administrative ability exists for the board to subsume the
21 transfer of all statutory powers, duties, functions, assets,
22 records, personnel, and property of the Florida Comprehensive
23 Health Association as specified in s. 627.6488.
24 (f) "Insurer" means any entity that provides health
25 insurance in this state. For purposes of this section, insurer
26 includes an insurance company with a valid certificate in
27 accordance with chapter 624, a health maintenance organization
28 with a valid certificate of authority in accordance with part
29 I or part III of chapter 641, a prepaid health clinic
30 authorized to transact business in this state pursuant to part
31 II of chapter 641, multiple employer welfare arrangements
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1 authorized to transact business in this state pursuant to ss.
2 624.436-624.45, or a fraternal benefit society providing
3 health benefits to its members as authorized pursuant to
4 chapter 632.
5 (g) "Medicare" means coverage under both Parts A and B
6 of Title XVIII of the Social Security Act, 42 U.S.C. ss. 1395
7 et seq., as amended.
8 (h) "Medicaid" means coverage under Title XIX of the
9 Social Security Act.
10 (i) "Office" means the Office of Insurance Regulation
11 of the Financial Services Commission.
12 (j) "Participating insurer" means any insurer
13 providing health insurance to citizens of this state.
14 (k) "Provider" means any physician, hospital, or other
15 institution, organization, or person that furnishes health
16 care services and is licensed or otherwise authorized to
17 practice in the state.
18 (l) "Plan" means the Florida Health Insurance Plan
19 created in subsection (1).
20 (m) "Plan of operation" means the articles, bylaws,
21 and operating rules and procedures adopted by the board
22 pursuant to this section.
23 (n) "Resident" means an individual who has been
24 legally domiciled in this state for a period of at least 6
25 months and who physically resides in this state not less than
26 185 days a year.
27 (3) BOARD OF DIRECTORS.--
28 (a) The plan shall operate subject to the supervision
29 and control of the board. The board shall consist of the
30 commissioner director or his or her designated representative,
31 who shall serve as a member of the board and shall be its
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1 chair, and an additional eight members, five of whom shall be
2 appointed by the Governor, at least two of whom shall be
3 individuals not representative of insurers or health care
4 providers, one of whom shall be appointed by the President of
5 the Senate, one of whom shall be appointed by the Speaker of
6 the House of Representatives, and one of whom shall be
7 appointed by the Chief Financial Officer.
8 (b) The term to be served on the board by the
9 commissioner Director of the Office of Insurance Regulation
10 shall be determined by continued employment in such position.
11 The remaining initial board members shall serve for a period
12 of time as follows: two members appointed by the Governor and
13 the members appointed by the President of the Senate and the
14 Speaker of the House of Representatives shall serve a term of
15 2 years; and three members appointed by the Governor and the
16 Chief Financial Officer shall serve a term of 4 years.
17 Subsequent board members shall serve for a term of 3 years. A
18 board member's term shall continue until his or her successor
19 is appointed.
20 (c) Vacancies on the board shall be filled by the
21 appointing authority, such authority being the Governor, the
22 President of the Senate, the Speaker of the House of
23 Representatives, or the Chief Financial Officer. The
24 appointing authority may remove board members for cause.
25 (d) The commissioner director, or his or her
26 recognized representative, shall be responsible for any
27 organizational requirements necessary for the initial meeting
28 of the board which shall take place no later than September 1,
29 2004.
30 (e) Members shall not be compensated in their capacity
31 as board members but shall be reimbursed for reasonable
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1 expenses incurred in the necessary performance of their duties
2 in accordance with s. 112.061.
3 (f) The board shall submit to the Financial Services
4 Commission a plan of operation for the plan and any amendments
5 thereto necessary or suitable to ensure the fair, reasonable,
6 and equitable administration of the plan. The plan of
7 operation shall ensure that the plan qualifies to apply for
8 any available funding from the Federal Government that adds to
9 the financial viability of the plan. The plan of operation
10 shall become effective upon approval in writing by the
11 Financial Services Commission consistent with the date on
12 which the coverage under this section must be made available.
13 If the board fails to submit a suitable plan of operation
14 within 1 year after implementation the appointment of the
15 board of directors, or at any time thereafter fails to submit
16 suitable amendments to the plan of operation, the Financial
17 Services Commission shall adopt such rules as are necessary or
18 advisable to effectuate the provisions of this section. Such
19 rules shall continue in force until modified by the office or
20 superseded by a plan of operation submitted by the board and
21 approved by the Financial Services Commission.
22 (6) INTERIM REPORT; ANNUAL REPORT.--
23 (a) By no later than December 1, 2004, the board shall
24 report to the Governor, the President of the Senate, and the
25 Speaker of the House of Representatives the results of an
26 actuarial study conducted by the board to determine,
27 including, but not limited to:
28 1. The impact the creation of the plan will have on
29 the small group insurance market and the individual market on
30 premiums paid by insureds. This shall include an estimate of
31
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1 the total anticipated aggregate savings for all small
2 employers in the state.
3 2. The number of individuals the pool could reasonably
4 cover at various funding levels, specifically, the number of
5 people the pool may cover at each of those funding levels.
6 3. A recommendation as to the best source of funding
7 for the anticipated deficits of the pool.
8 4. The effect on the individual and small group market
9 by including in the Florida Health Insurance Plan persons
10 eligible for coverage under s. 627.6487, as well as the cost
11 of including these individuals.
12
13 The board shall take no action to implement the Florida Health
14 Insurance Plan, other than the completion of the actuarial
15 study authorized in this paragraph, until funds are
16 appropriated for startup cost and any projected deficits.
17 (b) No later than December 1, 2005, and annually
18 thereafter, the board shall submit to the Governor, the
19 President of the Senate, the Speaker of the House of
20 Representatives, and the substantive legislative committees of
21 the Legislature a report which includes an independent
22 actuarial study to determine, including, but not be limited
23 to:
24 (a)1. The impact the creation of the plan has on the
25 small group and individual insurance market, specifically on
26 the premiums paid by insureds. This shall include an estimate
27 of the total anticipated aggregate savings for all small
28 employers in the state.
29 (b)2. The actual number of individuals covered at the
30 current funding and benefit level, the projected number of
31 individuals that may seek coverage in the forthcoming fiscal
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1 year, and the projected funding needed to cover anticipated
2 increase or decrease in plan participation.
3 3. A recommendation as to the best source of funding
4 for the anticipated deficits of the pool.
5 (c)4. A summarization of the activities of the plan in
6 the preceding calendar year, including the net written and
7 earned premiums, plan enrollment, the expense of
8 administration, and the paid and incurred losses.
9 (d)5. A review of the operation of the plan as to
10 whether the plan has met the intent of this section.
11 (9) ELIGIBILITY.--
12 (a) Any individual person who is and continues to be a
13 resident of this state shall be eligible for coverage under
14 the plan if:
15 1. Evidence is provided that the person received
16 notices of rejection or refusal to issue substantially similar
17 coverage for health reasons from at least two health insurers
18 or health maintenance organizations. A rejection or refusal by
19 an insurer offering only stop-loss, excess of loss, or
20 reinsurance coverage with respect to the applicant shall not
21 be sufficient evidence under this paragraph.
22 2. The person is enrolled in the Florida Comprehensive
23 Health Association as of the date the plan is implemented.
24 3. The person is an eligible individual as defined in
25 s. 627.6487(3), excluding s. 627.6487(3)(b)5.
26 (b) Each resident dependent of a person who is
27 eligible for coverage under the plan shall also be eligible
28 for such coverage.
29 (c) A person shall not be eligible for coverage under
30 the plan if:
31
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1 1. The person has or obtains health insurance coverage
2 substantially similar to or more comprehensive than a plan
3 policy, or would be eligible to obtain such coverage, unless a
4 person may maintain other coverage for the period of time the
5 person is satisfying any preexisting condition waiting period
6 under a plan policy or may maintain plan coverage for the
7 period of time the person is satisfying a preexisting
8 condition waiting period under another health insurance policy
9 intended to replace the plan policy.
10 2. The person is determined to be eligible for health
11 care benefits under Medicaid, Medicare, the state's children's
12 health insurance program, or any other federal, state, or
13 local government program that provides health benefits;
14 3. The person voluntarily terminated plan coverage
15 unless 12 months have elapsed since such termination;
16 4. The person is an inmate or resident of a public
17 institution; or
18 5. The person's premiums are paid for or reimbursed
19 under any government-sponsored program or by any government
20 agency, or health care provider, or
21 health-care-provider-sponsored or affiliated organization.
22 (d) Coverage shall cease:
23 1. On the date a person is no longer a resident of
24 this state;
25 2. On the date a person requests coverage to end;
26 3. Upon the death of the covered person;
27 4. On the date state law requires cancellation or
28 nonrenewal of the policy; or
29 5. At the option of the plan, 30 days after the plan
30 makes any inquiry concerning the person's eligibility or place
31 of residence to which the person does not reply; or.
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1 6. Upon failure of the insured to pay for continued
2 coverage.
3 (e) Except under the circumstances described in this
4 subsection, coverage of a person who ceases to meet the
5 eligibility requirements of this subsection shall be
6 terminated at the end of the policy period for which the
7 necessary premiums have been paid.
8 (15) FUNDING OF THE PLAN.--
9 (a) Premiums.--
10 1. The plan shall establish premium rates for plan
11 coverage as provided in this section. Separate schedules of
12 premium rates based on age, sex, and geographical location may
13 apply for individual risks. Premium rates and schedules shall
14 be submitted to the office for approval prior to use.
15 2. Initial rates for plan coverage shall be limited to
16 no more than 200 300 percent of rates established for
17 individual standard risks as specified in s. 627.6675(3)(c).
18 Subject to the limits provided in this paragraph, subsequent
19 rates shall be established to provide fully for the expected
20 costs of claims, including recovery of prior losses, expenses
21 of operation, investment income of claim reserves, and any
22 other cost factors subject to the limitations described
23 herein, but in no event shall premiums exceed the 200-percent
24 300-percent rate limitation provided in this section.
25 Notwithstanding the 200-percent 300-percent rate limitation,
26 sliding scale premium surcharges based upon the insured's
27 income may apply to all enrollees.
28 (b) Sources of additional revenue.--Any deficit
29 incurred by the plan shall be primarily funded through amounts
30 appropriated by the Legislature from general revenue sources,
31 including, but not limited to, a portion of the amount of
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1 annual growth in existing net insurance premium taxes in an
2 amount not less than the anticipated losses and reserve
3 requirements for existing policyholders. The board shall
4 operate the plan in such a manner that the estimated cost of
5 providing health insurance during any fiscal year will not
6 exceed total income the plan expects to receive from policy
7 premiums and funds appropriated by the Legislature, including
8 any interest on investments. After determining the amount of
9 funds appropriated to the board for a fiscal year, the board
10 shall estimate the number of new policies it believes the plan
11 has the financial capacity to insure during that year so that
12 costs do not exceed income. The board shall take steps
13 necessary to ensure that plan enrollment does not exceed the
14 number of residents it has estimated it has the financial
15 capacity to insure.
16 (c) In the event of inadequate funding, the board may
17 cancel policies on a nondiscriminatory basis as necessary to
18 remedy the situation. A policy may not be canceled if a
19 covered individual under that policy is currently on claim.
20 (20) PROVIDER REIMBURSEMENT.--Notwithstanding any
21 statute to the contrary, the maximum reimbursement rate to
22 health care providers for all covered, medically necessary
23 services shall be 100 percent of Medicare's allowed payment
24 amount for that particular provider and service. All providers
25 licensed in this state shall accept assignment of plan
26 benefits and consider the Medicare allowed payment amount as
27 payment in full.
28 Section 7. Subsection (2) of section 627.6515, Florida
29 Statutes, is amended to read:
30 627.6515 Out-of-state groups.--
31
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1 (2) Except as otherwise provided in this part, this
2 part does not apply to a group health insurance policy issued
3 or delivered outside this state under which a resident of this
4 state is provided coverage if:
5 (a) The policy is issued to an employee group the
6 composition of which is substantially as described in s.
7 627.653; a labor union group or association group the
8 composition of which is substantially as described in s.
9 627.654; an additional group the composition of which is
10 substantially as described in s. 627.656; a group insured
11 under a blanket health policy when the composition of the
12 group is substantially in compliance with s. 627.659; a group
13 insured under a franchise health policy when the composition
14 of the group is substantially in compliance with s. 627.663;
15 an association group to cover persons associated in any other
16 common group, which common group is formed primarily for
17 purposes other than providing insurance; a group that is
18 established primarily for the purpose of providing group
19 insurance, provided the benefits are reasonable in relation to
20 the premiums charged thereunder and the issuance of the group
21 policy has resulted, or will result, in economies of
22 administration; or a group of insurance agents of an insurer,
23 which insurer is the policyholder;
24 (b) Certificates evidencing coverage under the policy
25 are issued to residents of this state and contain in
26 contrasting color and not less than 10-point type the
27 following statement: "The benefits of the policy providing
28 your coverage are governed primarily by the law of a state
29 other than Florida"; and
30 (c) The policy provides the benefits specified in ss.
31 627.419, 627.6574, 627.6575, 627.6579, 627.6612, 627.66121,
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1 627.66122, 627.6613, 627.667, 627.6675, 627.6691, and
2 627.66911 and is in compliance with s. 627.4141; and.
3 (d) Applications for certificates of coverage offered
4 to residents of this state must contain, in contrasting color
5 and not less than 12-point type, the following statement on
6 the same page as the applicant's signature:
7
8 "This policy is primarily governed by the laws
9 of ...insert state where the master policy if
10 filed.... As a result, all of the rating laws
11 applicable to policies filed in this state do
12 not apply to this coverage, which may result in
13 increases in your premium at renewal that would
14 not be permissible under a Florida-approved
15 policy. Any purchase of individual health
16 insurance should be considered carefully, as
17 future medical conditions may make it
18 impossible to qualify for another individual
19 health policy. For information concerning
20 individual health coverage under a
21 Florida-approved policy, consult your agent or
22 the Florida Department of Financial Services."
23
24 This paragraph applies only to group certificates providing
25 health insurance coverage which require individualized
26 underwriting to determine coverage eligibility for an
27 individual or premium rates to be charged to an individual
28 except for the following:
29 1. Policies issued to provide coverage to groups of
30 persons all of whom are in the same or functionally related
31
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1 licensed professions, and providing coverage only to such
2 licensed professionals, their employees, or their dependents;
3 2. Policies providing coverage to small employers as
4 defined by s. 627.6699. Such policies shall be subject to, and
5 governed by, the provisions of s. 627.6699;
6 3. Policies issued to a bona fide association, as
7 defined by s. 627.6571(5), provided that there is a person or
8 board acting as a fiduciary for the benefit of the members,
9 and such association is not owned, controlled by, or otherwise
10 associated with the insurance company; or
11 4. Any accidental death, accidental death and
12 dismemberment, accident-only, vision-only, dental-only,
13 hospital indemnity-only, hospital accident-only, cancer,
14 specified disease, Medicare supplement, products that
15 supplement Medicare, long-term care, or disability income
16 insurance, or similar supplemental plans provided under a
17 separate policy, certificate, or contract of insurance, which
18 cannot duplicate coverage under an underlying health plan,
19 coinsurance, or deductibles or coverage issued as a supplement
20 to workers' compensation or similar insurance, or automobile
21 medical-payment insurance.
22 Section 8. Paragraphs (d) and (j) of subsection (5) of
23 section 627.6692, Florida Statutes, are amended to read:
24 627.6692 Florida Health Insurance Coverage
25 Continuation Act.--
26 (5) CONTINUATION OF COVERAGE UNDER GROUP HEALTH
27 PLANS.--
28 (d)1. A qualified beneficiary must give written notice
29 to the insurance carrier within 63 30 days after the
30 occurrence of a qualifying event. Unless otherwise specified
31 in the notice, a notice by any qualified beneficiary
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1 constitutes notice on behalf of all qualified beneficiaries.
2 The written notice must inform the insurance carrier of the
3 occurrence and type of the qualifying event giving rise to the
4 potential election by a qualified beneficiary of continuation
5 of coverage under the group health plan issued by that
6 insurance carrier, except that in cases where the covered
7 employee has been involuntarily discharged, the nature of such
8 discharge need not be disclosed. The written notice must, at a
9 minimum, identify the employer, the group health plan number,
10 the name and address of all qualified beneficiaries, and such
11 other information required by the insurance carrier under the
12 terms of the group health plan or the commission by rule, to
13 the extent that such information is known by the qualified
14 beneficiary.
15 2. Within 14 days after the receipt of written notice
16 under subparagraph 1., the insurance carrier shall send each
17 qualified beneficiary by certified mail an election and
18 premium notice form, approved by the office, which form must
19 provide for the qualified beneficiary's election or
20 nonelection of continuation of coverage under the group health
21 plan and the applicable premium amount due after the election
22 to continue coverage. This subparagraph does not require
23 separate mailing of notices to qualified beneficiaries
24 residing in the same household, but requires a separate
25 mailing for each separate household.
26 (j) Notwithstanding paragraph (b), if a qualified
27 beneficiary in the military reserve or National Guard has
28 elected to continue coverage and is thereafter called to
29 active duty and the coverage under the group plan is
30 terminated by the beneficiary or the carrier due to the
31 qualified beneficiary becoming eligible for TRICARE (the
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1 health care program provided by the United States Defense
2 Department), the 18-month period or such other applicable
3 maximum time period for which the qualified beneficiary would
4 otherwise be entitled to continue coverage is tolled during
5 the time that he or she is covered under the TRICARE program.
6 Within 63 30 days after the federal TRICARE coverage
7 terminates, the qualified beneficiary may elect to continue
8 coverage under the group health plan, retroactively to the
9 date coverage terminated under TRICARE, for the remainder of
10 the 18-month period or such other applicable time period,
11 subject to termination of coverage at the earliest of the
12 conditions specified in paragraph (b).
13 Section 9. Paragraph (c) of subsection (5) and
14 subsection (11) of section 627.6699, Florida Statutes, are
15 amended to read:
16 627.6699 Employee Health Care Access Act.--
17 (5) AVAILABILITY OF COVERAGE.--
18 (c) Every small employer carrier must, as a condition
19 of transacting business in this state:
20 1. Offer and issue all small employer health benefit
21 plans on a guaranteed-issue basis to every eligible small
22 employer, with 2 to 50 eligible employees, that elects to be
23 covered under such plan, agrees to make the required premium
24 payments, and satisfies the other provisions of the plan. A
25 rider for additional or increased benefits may be medically
26 underwritten and may only be added to the standard health
27 benefit plan. The increased rate charged for the additional or
28 increased benefit must be rated in accordance with this
29 section.
30 2. In the absence of enrollment availability in the
31 Florida Health Insurance Plan, offer and issue basic and
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1 standard small employer health benefit plans, and a
2 high-deductible plan that meets the requirements of a health
3 savings account plan as defined by federal law, on a
4 guaranteed-issue basis, during a 31-day open enrollment period
5 of August 1 through August 31 of each year, to every eligible
6 small employer, with fewer than two eligible employees, which
7 small employer is not formed primarily for the purpose of
8 buying health insurance and which elects to be covered under
9 such plan, agrees to make the required premium payments, and
10 satisfies the other provisions of the plan. Coverage provided
11 under this subparagraph shall begin on October 1 of the same
12 year as the date of enrollment, unless the small employer
13 carrier and the small employer agree to a different date. A
14 rider for additional or increased benefits may be medically
15 underwritten and may only be added to the standard health
16 benefit plan. The increased rate charged for the additional or
17 increased benefit must be rated in accordance with this
18 section. For purposes of this subparagraph, a person, his or
19 her spouse, and his or her dependent children constitute a
20 single eligible employee if that person and spouse are
21 employed by the same small employer and either that person or
22 his or her spouse has a normal work week of less than 25
23 hours. Any right to an open enrollment of health benefit
24 coverage for groups of fewer than two employees, pursuant to
25 this section, shall remain in full force and effect in the
26 absence of the availability of new enrollment into the Florida
27 Health Insurance Plan.
28 3. This paragraph does not limit a carrier's ability
29 to offer other health benefit plans to small employers if the
30 standard and basic health benefit plans are offered and
31 rejected.
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1 (11) SMALL EMPLOYER HEALTH REINSURANCE PROGRAM.--
2 (a) There is created a nonprofit entity to be known as
3 the "Florida Small Employer Health Reinsurance Program."
4 (b)1. The program shall operate subject to the
5 supervision and control of the board.
6 2. Effective upon this act becoming a law, the board
7 shall consist of the director of the office or his or her
8 designee, who shall serve as the chairperson, and 13
9 additional members who are representatives of carriers and
10 insurance agents and are appointed by the director of the
11 office and serve as follows:
12 a. Five members must be representatives of health
13 insurers licensed under chapters 624 and 641. Two members must
14 be agents who are actively engaged in the sale of health
15 insurance. Four members must be employers or representatives.
16 One member must be a person covered under an individual health
17 insurance policy issued by an insurer licensed in this state.
18 One member must represent the Agency for Health Care
19 Administration and be recommended by the secretary. The
20 director of the office shall include representatives of small
21 employer carriers subject to assessment under this subsection.
22 If two or more carriers elect to be risk-assuming carriers,
23 the membership must include at least two representatives of
24 risk-assuming carriers; if one carrier is risk-assuming, one
25 member must be a representative of such carrier. At least one
26 member must be a carrier who is subject to the assessments,
27 but is not a small employer carrier. Subject to such
28 restrictions, at least five members shall be selected from
29 individuals recommended by small employer carriers pursuant to
30 procedures provided by rule of the commission. Three members
31 shall be selected from a list of health insurance carriers
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1 that issue individual health insurance policies. At least two
2 of the three members selected must be reinsuring carriers. Two
3 members shall be selected from a list of insurance agents who
4 are actively engaged in the sale of health insurance.
5 b. A member appointed under this subparagraph shall
6 serve a term of 4 years and shall continue in office until the
7 member's successor takes office, except that, in order to
8 provide for staggered terms, the director of the office shall
9 designate two of the initial appointees under this
10 subparagraph to serve terms of 2 years and shall designate
11 three of the initial appointees under this subparagraph to
12 serve terms of 3 years.
13 3. The director of the office may remove a member for
14 cause.
15 4. Vacancies on the board shall be filled in the same
16 manner as the original appointment for the unexpired portion
17 of the term.
18 5. The director of the office may require an entity
19 that recommends persons for appointment to submit additional
20 lists of recommended appointees.
21 (c)1. The board shall submit to the office a plan of
22 operation to assure the fair, reasonable, and equitable
23 administration of the program. The board may at any time
24 submit to the office any amendments to the plan that the board
25 finds to be necessary or suitable.
26 2. The office shall, after notice and hearing, approve
27 the plan of operation if it determines that the plan submitted
28 by the board is suitable to assure the fair, reasonable, and
29 equitable administration of the program and provides for the
30 sharing of program gains and losses equitably and
31 proportionately in accordance with paragraph (j).
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1 3. The plan of operation, or any amendment thereto,
2 becomes effective upon written approval of the office.
3 (d) The plan of operation must, among other things:
4 1. Establish procedures for handling and accounting
5 for program assets and moneys and for an annual fiscal
6 reporting to the office.
7 2. Establish procedures for selecting an administering
8 carrier and set forth the powers and duties of the
9 administering carrier.
10 3. Establish procedures for reinsuring risks.
11 4. Establish procedures for collecting assessments
12 from participating carriers to provide for claims reinsured by
13 the program and for administrative expenses, other than
14 amounts payable to the administrative carrier, incurred or
15 estimated to be incurred during the period for which the
16 assessment is made.
17 5. Provide for any additional matters at the
18 discretion of the board.
19 (e) The board shall recommend to the office market
20 conduct requirements and other requirements for carriers and
21 agents, including requirements relating to:
22 1. Registration by each carrier with the office of its
23 intention to be a small employer carrier under this section;
24 2. Publication by the office of a list of all small
25 employer carriers, including a requirement applicable to
26 agents and carriers that a health benefit plan may not be sold
27 by a carrier that is not identified as a small employer
28 carrier;
29 3. The availability of a broadly publicized, toll-free
30 telephone number for access by small employers to information
31 concerning this section;
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1 4. Periodic reports by carriers and agents concerning
2 health benefit plans issued; and
3 5. Methods concerning periodic demonstration by small
4 employer carriers and agents that they are marketing or
5 issuing health benefit plans to small employers.
6 (f) The program has the general powers and authority
7 granted under the laws of this state to insurance companies
8 and health maintenance organizations licensed to transact
9 business, except the power to issue health benefit plans
10 directly to groups or individuals. In addition thereto, the
11 program has specific authority to:
12 1. Enter into contracts as necessary or proper to
13 carry out the provisions and purposes of this act, including
14 the authority to enter into contracts with similar programs of
15 other states for the joint performance of common functions or
16 with persons or other organizations for the performance of
17 administrative functions.
18 2. Sue or be sued, including taking any legal action
19 necessary or proper for recovering any assessments and
20 penalties for, on behalf of, or against the program or any
21 carrier.
22 3. Take any legal action necessary to avoid the
23 payment of improper claims against the program.
24 4. Issue reinsurance policies, in accordance with the
25 requirements of this act.
26 5. Establish rules, conditions, and procedures for
27 reinsurance risks under the program participation.
28 6. Establish actuarial functions as appropriate for
29 the operation of the program.
30 7. Assess participating carriers in accordance with
31 paragraph (j), and make advance interim assessments as may be
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1 reasonable and necessary for organizational and interim
2 operating expenses. Interim assessments shall be credited as
3 offsets against any regular assessments due following the
4 close of the calendar year.
5 8. Appoint appropriate legal, actuarial, and other
6 committees as necessary to provide technical assistance in the
7 operation of the program, and in any other function within the
8 authority of the program.
9 9. Borrow money to effect the purposes of the program.
10 Any notes or other evidences of indebtedness of the program
11 which are not in default constitute legal investments for
12 carriers and may be carried as admitted assets.
13 10. To the extent necessary, increase the $5,000
14 deductible reinsurance requirement to adjust for the effects
15 of inflation.
16 (g) A reinsuring carrier may reinsure with the program
17 coverage of an eligible employee of a small employer, or any
18 dependent of such an employee, subject to each of the
19 following provisions:
20 1. With respect to a standard and basic health care
21 plan, the program must reinsure the level of coverage
22 provided; and, with respect to any other plan, the program
23 must reinsure the coverage up to, but not exceeding, the level
24 of coverage provided under the standard and basic health care
25 plan.
26 2. Except in the case of a late enrollee, a reinsuring
27 carrier may reinsure an eligible employee or dependent within
28 60 days after the commencement of the coverage of the small
29 employer. A newly employed eligible employee or dependent of a
30 small employer may be reinsured within 60 days after the
31 commencement of his or her coverage.
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1 3. A small employer carrier may reinsure an entire
2 employer group within 60 days after the commencement of the
3 group's coverage under the plan. The carrier may choose to
4 reinsure newly eligible employees and dependents of the
5 reinsured group pursuant to subparagraph 1.
6 4. The program may not reimburse a participating
7 carrier with respect to the claims of a reinsured employee or
8 dependent until the carrier has paid incurred claims of at
9 least $5,000 in a calendar year for benefits covered by the
10 program. In addition, the reinsuring carrier shall be
11 responsible for 10 percent of the next $50,000 and 5 percent
12 of the next $100,000 of incurred claims during a calendar year
13 and the program shall reinsure the remainder.
14 5. The board annually shall adjust the initial level
15 of claims and the maximum limit to be retained by the carrier
16 to reflect increases in costs and utilization within the
17 standard market for health benefit plans within the state. The
18 adjustment shall not be less than the annual change in the
19 medical component of the "Consumer Price Index for All Urban
20 Consumers" of the Bureau of Labor Statistics of the Department
21 of Labor, unless the board proposes and the office approves a
22 lower adjustment factor.
23 6. A small employer carrier may terminate reinsurance
24 for all reinsured employees or dependents on any plan
25 anniversary.
26 7. The premium rate charged for reinsurance by the
27 program to a health maintenance organization that is approved
28 by the Secretary of Health and Human Services as a federally
29 qualified health maintenance organization pursuant to 42
30 U.S.C. s. 300e(c)(2)(A) and that, as such, is subject to
31 requirements that limit the amount of risk that may be ceded
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1 to the program, which requirements are more restrictive than
2 subparagraph 4., shall be reduced by an amount equal to that
3 portion of the risk, if any, which exceeds the amount set
4 forth in subparagraph 4. which may not be ceded to the
5 program.
6 8. The board may consider adjustments to the premium
7 rates charged for reinsurance by the program for carriers that
8 use effective cost containment measures, including high-cost
9 case management, as defined by the board.
10 9. A reinsuring carrier shall apply its
11 case-management and claims-handling techniques, including, but
12 not limited to, utilization review, individual case
13 management, preferred provider provisions, other managed care
14 provisions or methods of operation, consistently with both
15 reinsured business and nonreinsured business.
16 (h)1. The board, as part of the plan of operation,
17 shall establish a methodology for determining premium rates to
18 be charged by the program for reinsuring small employers and
19 individuals pursuant to this section. The methodology shall
20 include a system for classification of small employers that
21 reflects the types of case characteristics commonly used by
22 small employer carriers in the state. The methodology shall
23 provide for the development of basic reinsurance premium
24 rates, which shall be multiplied by the factors set for them
25 in this paragraph to determine the premium rates for the
26 program. The basic reinsurance premium rates shall be
27 established by the board, subject to the approval of the
28 office, and shall be set at levels which reasonably
29 approximate gross premiums charged to small employers by small
30 employer carriers for health benefit plans with benefits
31 similar to the standard and basic health benefit plan. The
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1 premium rates set by the board may vary by geographical area,
2 as determined under this section, to reflect differences in
3 cost. The multiplying factors must be established as follows:
4 a. The entire group may be reinsured for a rate that
5 is 1.5 times the rate established by the board.
6 b. An eligible employee or dependent may be reinsured
7 for a rate that is 5 times the rate established by the board.
8 2. The board periodically shall review the methodology
9 established, including the system of classification and any
10 rating factors, to assure that it reasonably reflects the
11 claims experience of the program. The board may propose
12 changes to the rates which shall be subject to the approval of
13 the office.
14 (i) If a health benefit plan for a small employer
15 issued in accordance with this subsection is entirely or
16 partially reinsured with the program, the premium charged to
17 the small employer for any rating period for the coverage
18 issued must be consistent with the requirements relating to
19 premium rates set forth in this section.
20 (j)1. Before July March 1 of each calendar year, the
21 board shall determine and report to the office the program net
22 loss for the previous year, including administrative expenses
23 for that year, and the incurred losses for the year, taking
24 into account investment income and other appropriate gains and
25 losses.
26 2. Any net loss for the year shall be recouped by
27 assessment of the carriers, as follows:
28 a. The operating losses of the program shall be
29 assessed in the following order subject to the specified
30 limitations. The first tier of assessments shall be made
31 against reinsuring carriers in an amount which shall not
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1 exceed 5 percent of each reinsuring carrier's premiums from
2 health benefit plans covering small employers. If such
3 assessments have been collected and additional moneys are
4 needed, the board shall make a second tier of assessments in
5 an amount which shall not exceed 0.5 percent of each carrier's
6 health benefit plan premiums. Except as provided in paragraph
7 (n), risk-assuming carriers are exempt from all assessments
8 authorized pursuant to this section. The amount paid by a
9 reinsuring carrier for the first tier of assessments shall be
10 credited against any additional assessments made.
11 b. The board shall equitably assess carriers for
12 operating losses of the plan based on market share. The board
13 shall annually assess each carrier a portion of the operating
14 losses of the plan. The first tier of assessments shall be
15 determined by multiplying the operating losses by a fraction,
16 the numerator of which equals the reinsuring carrier's earned
17 premium pertaining to direct writings of small employer health
18 benefit plans in the state during the calendar year for which
19 the assessment is levied, and the denominator of which equals
20 the total of all such premiums earned by reinsuring carriers
21 in the state during that calendar year. The second tier of
22 assessments shall be based on the premiums that all carriers,
23 except risk-assuming carriers, earned on all health benefit
24 plans written in this state. The board may levy interim
25 assessments against carriers to ensure the financial ability
26 of the plan to cover claims expenses and administrative
27 expenses paid or estimated to be paid in the operation of the
28 plan for the calendar year prior to the association's
29 anticipated receipt of annual assessments for that calendar
30 year. Any interim assessment is due and payable within 30
31 days after receipt by a carrier of the interim assessment
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1 notice. Interim assessment payments shall be credited against
2 the carrier's annual assessment. Health benefit plan premiums
3 and benefits paid by a carrier that are less than an amount
4 determined by the board to justify the cost of collection may
5 not be considered for purposes of determining assessments.
6 c. Subject to the approval of the office, the board
7 shall make an adjustment to the assessment formula for
8 reinsuring carriers that are approved as federally qualified
9 health maintenance organizations by the Secretary of Health
10 and Human Services pursuant to 42 U.S.C. s. 300e(c)(2)(A) to
11 the extent, if any, that restrictions are placed on them that
12 are not imposed on other small employer carriers.
13 3. Before July March 1 of each year, the board shall
14 determine and file with the office an estimate of the
15 assessments needed to fund the losses incurred by the program
16 in the previous calendar year.
17 4. If the board determines that the assessments needed
18 to fund the losses incurred by the program in the previous
19 calendar year will exceed the amount specified in subparagraph
20 2., the board shall evaluate the operation of the program and
21 report its findings, including any recommendations for changes
22 to the plan of operation, to the office within 180 90 days
23 following the end of the calendar year in which the losses
24 were incurred. The evaluation shall include an estimate of
25 future assessments, the administrative costs of the program,
26 the appropriateness of the premiums charged and the level of
27 carrier retention under the program, and the costs of coverage
28 for small employers. If the board fails to file a report with
29 the office within 180 90 days following the end of the
30 applicable calendar year, the office may evaluate the
31 operations of the program and implement such amendments to the
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1 plan of operation the office deems necessary to reduce future
2 losses and assessments.
3 5. If assessments exceed the amount of the actual
4 losses and administrative expenses of the program, the excess
5 shall be held as interest and used by the board to offset
6 future losses or to reduce program premiums. As used in this
7 paragraph, the term "future losses" includes reserves for
8 incurred but not reported claims.
9 6. Each carrier's proportion of the assessment shall
10 be determined annually by the board, based on annual
11 statements and other reports considered necessary by the board
12 and filed by the carriers with the board.
13 7. Provision shall be made in the plan of operation
14 for the imposition of an interest penalty for late payment of
15 an assessment.
16 8. A carrier may seek, from the office, a deferment,
17 in whole or in part, from any assessment made by the board.
18 The office may defer, in whole or in part, the assessment of a
19 carrier if, in the opinion of the office, the payment of the
20 assessment would place the carrier in a financially impaired
21 condition. If an assessment against a carrier is deferred, in
22 whole or in part, the amount by which the assessment is
23 deferred may be assessed against the other carriers in a
24 manner consistent with the basis for assessment set forth in
25 this section. The carrier receiving such deferment remains
26 liable to the program for the amount deferred and is
27 prohibited from reinsuring any individuals or groups in the
28 program if it fails to pay assessments.
29 (k) Neither the participation in the program as
30 reinsuring carriers, the establishment of rates, forms, or
31 procedures, nor any other joint or collective action required
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1 by this act, may be the basis of any legal action, criminal or
2 civil liability, or penalty against the program or any of its
3 carriers either jointly or separately.
4 (l) The board, as part of the plan of operation, shall
5 develop standards setting forth the manner and levels of
6 compensation to be paid to agents for the sale of basic and
7 standard health benefit plans. In establishing such
8 standards, the board shall take into consideration the need to
9 assure the broad availability of coverages, the objectives of
10 the program, the time and effort expended in placing the
11 coverage, the need to provide ongoing service to the small
12 employer, the levels of compensation currently used in the
13 industry, and the overall costs of coverage to small employers
14 selecting these plans.
15 (m) The board shall monitor compliance with this
16 section, including the market conduct of small employer
17 carriers, and shall report to the office any unfair trade
18 practices and misleading or unfair conduct by a small employer
19 carrier that has been reported to the board by agents,
20 consumers, or any other person. The office shall investigate
21 all reports and, upon a finding of noncompliance with this
22 section or of unfair or misleading practices, shall take
23 action against the small employer carrier as permitted under
24 the insurance code or chapter 641. The board is not given
25 investigatory or regulatory powers, but must forward all
26 reports of cases or abuse or misrepresentation to the office.
27 (n) Notwithstanding paragraph (j), the administrative
28 expenses of the program shall be recouped by assessment of
29 risk-assuming carriers and reinsuring carriers and such
30 amounts shall not be considered part of the operating losses
31 of the plan for the purposes of this paragraph. Each
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1 carrier's portion of such administrative expenses shall be
2 determined by multiplying the total of such administrative
3 expenses by a fraction, the numerator of which equals the
4 carrier's earned premium pertaining to direct writing of small
5 employer health benefit plans in the state during the calendar
6 year for which the assessment is levied, and the denominator
7 of which equals the total of such premiums earned by all
8 carriers in the state during such calendar year.
9 (o) The board shall advise the office, the agency, the
10 department, and other executive and legislative entities on
11 health insurance issues. Specifically, the board shall:
12 1. Provide a forum for stakeholders, including
13 insurers, agents, consumers, and regulators, in the private
14 health insurance market in this state.
15 2. Review and recommend strategies to improve the
16 functioning of the health insurance markets in this state,
17 with a specific focus on market stability, access, and
18 pricing.
19 3. Make recommendations of the office for legislation
20 addressing health insurance market issues and provide comment
21 on health insurance legislation proposed by the office.
22 4. Meet at least three times each year. One meeting
23 shall be held to hear reports and to secure public comment on
24 the health insurance market, to develop any legislation needed
25 to address health insurance market issues, and to provide
26 comment on health insurance legislation proposed by the
27 office.
28 5. By September 1 of each year, issue a report to the
29 office on the state of the health insurance market. The report
30 must include recommendations for changes in the health
31
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1 insurance market, results from implementation of previous
2 recommendations, and information on health insurance markets.
3 Section 10. Subsection (1) of section 641.27, Florida
4 Statutes, is amended to read:
5 641.27 Examination by the department.--
6 (1) The office shall examine the affairs,
7 transactions, accounts, business records, and assets of any
8 health maintenance organization as often as it deems it
9 expedient for the protection of the people of this state, but
10 not less frequently than once every 5 3 years. In lieu of
11 making its own financial examination, the office may accept an
12 independent certified public accountant's audit report
13 prepared on a statutory accounting basis consistent with this
14 part. However, except when the medical records are requested
15 and copies furnished pursuant to s. 456.057, medical records
16 of individuals and records of physicians providing service
17 under contract to the health maintenance organization shall
18 not be subject to audit, although they may be subject to
19 subpoena by court order upon a showing of good cause. For the
20 purpose of examinations, the office may administer oaths to
21 and examine the officers and agents of a health maintenance
22 organization concerning its business and affairs. The
23 examination of each health maintenance organization by the
24 office shall be subject to the same terms and conditions as
25 apply to insurers under chapter 624. In no event shall
26 expenses of all examinations exceed a maximum of $20,000 for
27 any 1-year period. Any rehabilitation, liquidation,
28 conservation, or dissolution of a health maintenance
29 organization shall be conducted under the supervision of the
30 department, which shall have all power with respect thereto
31 granted to it under the laws governing the rehabilitation,
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1 liquidation, reorganization, conservation, or dissolution of
2 life insurance companies.
3 Section 11. Paragraph (c) of subsection (3) of section
4 641.31, Florida Statutes, is amended to read:
5 641.31 Health maintenance contracts.--
6 (3)
7 (c) The office shall disapprove any form filed under
8 this subsection, or withdraw any previous approval thereof, if
9 the form:
10 1. Is in any respect in violation of, or does not
11 comply with, any provision of this part or rule adopted
12 thereunder.
13 2. Contains or incorporates by reference, where such
14 incorporation is otherwise permissible, any inconsistent,
15 ambiguous, or misleading clauses or exceptions and conditions
16 which deceptively affect the risk purported to be assumed in
17 the general coverage of the contract.
18 3. Has any title, heading, or other indication of its
19 provisions which is misleading.
20 4. Is printed or otherwise reproduced in such a manner
21 as to render any material provision of the form substantially
22 illegible.
23 5. Contains provisions which are unfair, inequitable,
24 or contrary to the public policy of this state or which
25 encourage misrepresentation.
26 6. Excludes coverage for human immunodeficiency virus
27 infection or acquired immune deficiency syndrome or contains
28 limitations in the benefits payable, or in the terms or
29 conditions of such contract, for human immunodeficiency virus
30 infection or acquired immune deficiency syndrome which are
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Florida Senate - 2005 SB 2514
11-1311A-05
1 different than those which apply to any other sickness or
2 medical condition.
3 7. Is not in compliance with s. 627.4141.
4 Section 12. This act shall take effect July 1, 2005,
5 and applies to all policies and contracts issued on or after
6 that date.
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9 SENATE SUMMARY
10 Prohibits mandatory arbitration clauses in life insurance
and health insurance policies. Authorizes high deductible
11 health insurance plans that meet certain requirements of
a health savings account. Revises duties of the Office of
12 Insurance Regulation in examinations of health
maintenance organizations. Extends the time within which
13 eligible employees may apply for health insurance
coverage continuation.
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