HB 0597

CS

CHAMBER ACTION

1	The Insurance Committee recommends the following:
2
3	Council/Committee Substitute
4	Remove the entire bill and insert:
5	A bill to be entitled
6	An act relating to cystic fibrosis treatment; amending s.
7	627.6515, F.S; including within an exclusion from
8	provisions applying to out-of-state groups group policies
9	providing health coverage for cystic fibrosis; creating s.
10	627.6614, F.S.; requiring a group health insurance policy
11	to cover services needed to treat cystic fibrosis as
12	authorized by a physician; amending s. 641.31, F.S.;
13	requiring a contract by a health maintenance organization
14	to cover services needed to treat cystic fibrosis as
15	authorized by a physician; providing a legislative finding
16	of fulfillment of an important state interest; providing
17	application; providing an effective date.
18
19	WHEREAS, cystic fibrosis is a genetic disease that
20	adversely affects the respiratory system and the digestive
21	system, and
22	WHEREAS, only half of those suffering with cystic fibrosis
23	live to the age of 32, and
24	WHEREAS, the treatments for individuals with cystic
25	fibrosis include ingesting pancreatic enzymes or a wide
26	assortment of nutritional supplements, frequent postural
27	draining to clear the respiratory system, or using a feeding
28	tube to provide sustenance, and
29	WHEREAS, insurance companies oftentimes do not fully cover
30	the costs associated with treating cystic fibrosis, a fatal
31	disease, NOW, THEREFORE,
32
33	Be It Enacted by the Legislature of the State of Florida:
34
35	Section 1.  Subsection (2) of section 627.6515, Florida
36	Statutes, is amended to read:
37	627.6515  Out-of-state groups.--
38	(2)  Except as otherwise provided in this part, this part
39	does not apply to a group health insurance policy issued or
40	delivered outside this state under which a resident of this
41	state is provided coverage if:
42	(a)  The policy is issued to an employee group the
43	composition of which is substantially as described in s.
44	627.653; a labor union group or association group the
45	composition of which is substantially as described in s.
46	627.654; an additional group the composition of which is
47	substantially as described in s. 627.656; a group insured under
48	a blanket health policy when the composition of the group is
49	substantially in compliance with s. 627.659; a group insured
50	under a franchise health policy when the composition of the
51	group is substantially in compliance with s. 627.663; an
52	association group to cover persons associated in any other
53	common group, which common group is formed primarily for
54	purposes other than providing insurance; a group that is
55	established primarily for the purpose of providing group
56	insurance, provided the benefits are reasonable in relation to
57	the premiums charged thereunder and the issuance of the group
58	policy has resulted, or will result, in economies of
59	administration; or a group of insurance agents of an insurer,
60	which insurer is the policyholder.;
61	(b)  Certificates evidencing coverage under the policy are
62	issued to residents of this state and contain in contrasting
63	color and not less than 10-point type the following statement:
64	"The benefits of the policy providing your coverage are governed
65	primarily by the law of a state other than Florida".; and
66	(c)  The policy provides the benefits specified in ss.
67	627.419, 627.6574, 627.6575, 627.6579, 627.6612, 627.66121,
68	627.66122, 627.6613, 627.6614, 627.667, 627.6675, 627.6691, and
69	627.66911.
70	(d)  Applications for certificates of coverage offered to
71	residents of this state must contain, in contrasting color and
72	not less than 12-point type, the following statement on the same
73	page as the applicant's signature:
74
75	"This policy is primarily governed by the laws of
76	...insert state where the master policy is if
77	filed.... As a result, all of the rating laws
78	applicable to policies filed in this state do not
79	apply to this coverage, which may result in increases
80	in your premium at renewal that would not be
81	permissible under a Florida-approved policy. Any
82	purchase of individual health insurance should be
83	considered carefully, as future medical conditions may
84	make it impossible to qualify for another individual
85	health policy. For information concerning individual
86	health coverage under a Florida-approved policy,
87	consult your agent or the Florida Department of
88	Financial Services."
89
90	This paragraph applies only to group certificates providing
91	health insurance coverage which require individualized
92	underwriting to determine coverage eligibility for an individual
93	or premium rates to be charged to an individual except for the
94	following:
95	1.  Policies issued to provide coverage to groups of
96	persons all of whom are in the same or functionally related
97	licensed professions, and providing coverage only to such
98	licensed professionals, their employees, or their dependents;
99	2.  Policies providing coverage to small employers as
100	defined by s. 627.6699. Such policies shall be subject to, and
101	governed by, the provisions of s. 627.6699;
102	3.  Policies issued to a bona fide association, as defined
103	by s. 627.6571(5), provided that there is a person or board
104	acting as a fiduciary for the benefit of the members, and such
105	association is not owned, controlled by, or otherwise associated
106	with the insurance company; or
107	4.  Any accidental death, accidental death and
108	dismemberment, accident-only, vision-only, dental-only, hospital
109	indemnity-only, hospital accident-only, cancer, specified
110	disease, Medicare supplement, products that supplement Medicare,
111	long-term care, or disability income insurance, or similar
112	supplemental plans provided under a separate policy,
113	certificate, or contract of insurance, which cannot duplicate
114	coverage under an underlying health plan, coinsurance, or
115	deductibles or coverage issued as a supplement to workers'
116	compensation or similar insurance, or automobile medical-payment
117	insurance.
118	Section 2.  Section 627.6614, Florida Statutes, is created
119	to read:
120	627.6614  Cystic fibrosis treatment services.--A group
121	health insurance policy sold in this state must provide coverage
122	for all medically necessary chest physiotherapy provided by a
123	respiratory therapist licensed under part V of chapter 468, home
124	health care, equipment, supplies, and enteral formulas described
125	in s. 627.42395 used to treat cystic fibrosis if the patient's
126	treating physician or a physician authorized by the insurer who
127	specializes in the treatment of cystic fibrosis certifies that
128	such services are medically necessary. The insurer may require
129	the policyholder to be responsible for any deductible or
130	copayment that generally applies under the policy.
131	Section 3.  Present subsections (36), (37), (38), (39), and
132	(40) of section 641.31, Florida Statutes, are renumbered as
133	subsections (37), (38), (39), (40), and (41), respectively, and
134	new subsection (36) is added to said section to read:
135	641.31  Health maintenance contracts.--
136	(36)  A group health maintenance contract sold in this
137	state must provide coverage for all medically necessary chest
138	physiotherapy provided by a respiratory therapist licensed under
139	part V of chapter 468 and home health care, equipment, supplies,
140	and enteral formulas described in s. 627.42395 used to treat
141	cystic fibrosis if the patient's treating physician or a
142	physician authorized by the health maintenance organization who
143	specializes in the treatment of cystic fibrosis certifies that
144	such services are medically necessary. The health maintenance
145	organization may require the subscriber to be responsible for
146	any deductible or copayment that generally applies under the
147	contract.
148	Section 4.  The Legislature finds that this act fulfills an
149	important state interest.
150	Section 5.  This act shall take effect October 1, 2005, and
151	applies to all policies and contracts issued or renewed on or
152	after that date.

CODING: Words stricken are deletions; words underlined are additions.