1 | Representatives Benson, H. Gibson, Baxley, Galvano, Kendrick, |
2 | Garcia, Negron, and Bean offered the following: |
3 |
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4 | Amendment (with title amendment) |
5 | Between line(s) 116 and 117, insert: |
6 | Section 4. Section 627.668, Florida Statutes, is amended |
7 | to read: |
8 | 627.668 Optional coverage for mental and nervous disorders |
9 | required; exception.-- |
10 | (1) Every insurer, health maintenance organization, and |
11 | nonprofit hospital and medical service plan corporation |
12 | transacting group health insurance or providing prepaid health |
13 | care in this state shall make available to the policyholder as |
14 | part of the application, for an appropriate additional premium |
15 | under a group hospital and medical expense-incurred insurance |
16 | policy, under a group prepaid health care contract, and under a |
17 | group hospital and medical service plan contract, the benefits |
18 | or level of benefits specified in subsection (2) for the |
19 | necessary care and treatment of mental and nervous disorders, as |
20 | defined in the standard nomenclature of the American Psychiatric |
21 | Association, subject to the right of the applicant for a group |
22 | policy or contract to select any alternative benefits or level |
23 | of benefits as may be offered by the insurer, health maintenance |
24 | organization, or service plan corporation provided that, if |
25 | alternate inpatient, outpatient, or partial hospitalization |
26 | benefits are selected, such benefits shall not be less than the |
27 | level of benefits required under subsection (2) paragraph |
28 | (2)(a), paragraph (2)(b), or paragraph (2)(c), respectively. |
29 | (2) Under group policies or contracts, inpatient hospital |
30 | benefits, partial hospitalization benefits, and outpatient |
31 | benefits consisting of durational limits, dollar amounts, |
32 | deductibles, and coinsurance factors shall not be less favorable |
33 | than for physical illness generally, except that: |
34 | (a) Inpatient benefits may be limited to not less than 30 |
35 | days per benefit year as defined in the policy or contract. If |
36 | inpatient hospital benefits are provided beyond 30 days per |
37 | benefit year, the durational limits, dollar amounts, and |
38 | coinsurance factors thereto need not be the same as applicable |
39 | to physical illness generally. |
40 | (b) Outpatient benefits may be limited to $1,000 for |
41 | consultations with a licensed physician, a psychologist licensed |
42 | pursuant to chapter 490, a mental health counselor licensed |
43 | pursuant to chapter 491, a marriage and family therapist |
44 | licensed pursuant to chapter 491, and a clinical social worker |
45 | licensed pursuant to chapter 491. If benefits are provided |
46 | beyond the $1,000 per benefit year, the durational limits, |
47 | dollar amounts, and coinsurance factors thereof need not be the |
48 | same as applicable to physical illness generally. |
49 | (c) Partial hospitalization benefits shall be provided |
50 | under the direction of a licensed physician. For purposes of |
51 | this part, the term "partial hospitalization services" is |
52 | defined as those services offered by a program accredited by the |
53 | Joint Commission on Accreditation of Hospitals (JCAH) or in |
54 | compliance with equivalent standards. Alcohol rehabilitation |
55 | programs accredited by the Joint Commission on Accreditation of |
56 | Hospitals or approved by the state and licensed drug abuse |
57 | rehabilitation programs shall also be qualified providers under |
58 | this section. In any benefit year, if partial hospitalization |
59 | services or a combination of inpatient and partial |
60 | hospitalization are utilized, the total benefits paid for all |
61 | such services shall not exceed the cost of 30 days of inpatient |
62 | hospitalization for psychiatric services, including physician |
63 | fees, which prevail in the community in which the partial |
64 | hospitalization services are rendered. If partial |
65 | hospitalization services benefits are provided beyond the limits |
66 | set forth in this paragraph, the durational limits, dollar |
67 | amounts, and coinsurance factors thereof need not be the same as |
68 | those applicable to physical illness generally. |
69 | (3) In the case of a group health plan that offers a |
70 | participant or beneficiary two or more benefit package options |
71 | under the plan, the requirements of this section shall be |
72 | applied separately with respect to each such option. |
73 | (4)(3) Insurers must maintain strict confidentiality |
74 | regarding psychiatric and psychotherapeutic records submitted to |
75 | an insurer for the purpose of reviewing a claim for benefits |
76 | payable under this section. These records submitted to an |
77 | insurer are subject to the limitations of s. 456.057, relating |
78 | to the furnishing of patient records. |
79 | Section 5. Subsection (2) of section 636.204, Florida |
80 | Statutes, is amended to read: |
81 | 636.204 License required.-- |
82 | (2) An application for a license to operate as a discount |
83 | medical plan organization must be filed with the office on a |
84 | form prescribed by the commission. Such application must be |
85 | sworn to by an officer or authorized representative of the |
86 | applicant and be accompanied by the following, if applicable: |
87 | (a) A copy of the applicant's articles of incorporation or |
88 | other organizing documents, including all amendments. |
89 | (b) A copy of the applicant's bylaws. |
90 | (c) A list of the names, addresses, official positions, |
91 | and biographical information of the individuals who are |
92 | responsible for conducting the applicant's affairs, including, |
93 | but not limited to, all members of the board of directors, board |
94 | of trustees, executive committee, or other governing board or |
95 | committee, the officers, contracted management company |
96 | personnel, and any person or entity owning or having the right |
97 | to acquire 10 percent or more of the voting securities of the |
98 | applicant. Such listing must fully disclose the extent and |
99 | nature of any contracts or arrangements between any individual |
100 | who is responsible for conducting the applicant's affairs and |
101 | the discount medical plan organization, including any possible |
102 | conflicts of interest. |
103 | (d) A complete biographical statement, on forms prescribed |
104 | by the commission, an independent investigation report, and a |
105 | set of fingerprints, as provided in chapter 624, with respect to |
106 | each individual identified under paragraph (c). |
107 | (e) A statement generally describing the applicant, its |
108 | facilities and personnel, and the medical services to be |
109 | offered. |
110 | (f) A copy of the form of all contracts made or to be made |
111 | between the applicant and any providers or provider networks |
112 | regarding the provision of medical services to members. |
113 | (g) A copy of the form of any contract made or arrangement |
114 | to be made between the applicant and any person listed in |
115 | paragraph (c). |
116 | (h) A copy of the form of any contract made or to be made |
117 | between the applicant and any person, corporation, partnership, |
118 | or other entity for the performance on the applicant's behalf of |
119 | any function, including, but not limited to, marketing, |
120 | administration, enrollment, investment management, and |
121 | subcontracting for the provision of health services to members. |
122 | (i) A copy of the applicant's most recent financial |
123 | statements audited by an independent certified public |
124 | accountant. An applicant that is a subsidiary of a parent entity |
125 | that is publicly traded and that prepares audited financial |
126 | statements reflecting the consolidated operations of the parent |
127 | entity and the subsidiary may petition the office to accept, in |
128 | lieu of the audited financial statement of the applicant, the |
129 | audited financial statement of the parent entity and a written |
130 | guaranty by the parent entity that the minimum capital |
131 | requirements of the applicant required by this part will be met |
132 | by the parent entity. |
133 | (i)(j) A description of the proposed method of marketing. |
134 | (j)(k) A description of the subscriber complaint |
135 | procedures to be established and maintained. |
136 | (k)(l) The fee for issuance of a license. |
137 | (l)(m) Such other information as the commission or office |
138 | may reasonably require to make the determinations required by |
139 | this part. |
140 | Section 6. Subsection (1) of section 636.206, Florida |
141 | Statutes, is amended to read: |
142 | 636.206 Examinations and investigations.-- |
143 | (1) The office may examine or investigate the business and |
144 | affairs of any discount medical plan organization if the |
145 | commissioner has reason to believe that the discount medical |
146 | plan organization is not complying with the requirements of this |
147 | act. The office may order any discount medical plan organization |
148 | or applicant to produce any records, books, files, advertising |
149 | and solicitation materials, or other information and may take |
150 | statements under oath to determine whether the discount medical |
151 | plan organization or applicant is in violation of the law or is |
152 | acting contrary to the public interest. The expenses incurred in |
153 | conducting any examination or investigation must be paid by the |
154 | discount medical plan organization or applicant. Examinations |
155 | and investigations must be conducted as provided in chapter 624. |
156 | Section 7. Subsection (1) of section 636.210, Florida |
157 | Statutes, is amended to read: |
158 | 636.210 Prohibited activities of a discount medical plan |
159 | organization.-- |
160 | (1) A discount medical plan organization may not: |
161 | (a) Use in its advertisements, marketing material, |
162 | brochures, and discount cards the term "insurance" except as |
163 | otherwise provided in this part or as a disclaimer of any |
164 | relationship between discount medical plan organization benefits |
165 | and insurance; |
166 | (b) Use in its advertisements, marketing material, |
167 | brochures, and discount cards the terms "health plan," |
168 | "coverage," "copay," "copayments," "preexisting conditions," |
169 | "guaranteed issue," "premium," "PPO," "preferred provider |
170 | organization," or other terms in a manner that could reasonably |
171 | mislead a person into believing the discount medical plan was |
172 | health insurance; |
173 | (c) Have restrictions on free access to plan providers, |
174 | except for hospital services, including, but not limited to, |
175 | waiting periods and notification periods; or |
176 | (d) Pay providers any fees for medical services. |
177 | Section 8. Subsections (1), (3), and (4) of section |
178 | 636.216, Florida Statutes, are amended to read: |
179 | 636.216 Charge or form filings.-- |
180 | (1) All charges to members must be filed with the office. |
181 | and Any charge to members greater than $30 per month or $360 per |
182 | year for access to healthcare services, other than those |
183 | provided by physicians licensed under chapters 458 and 459 or by |
184 | hospitals licensed under chapter 395, must be approved by the |
185 | office before the charges can be used. Any charge to members |
186 | greater than $60 dollars per month or $720 per year for |
187 | healthcare services that include services provided by physicians |
188 | licensed under chapter 458 and 459 or by hospitals licensed |
189 | under chapter 395 must be approved by the office before the |
190 | charges can be used. The discount medical plan organization has |
191 | the burden of proof that the charges bear a reasonable relation |
192 | to the benefits received by the member. |
193 | (3) All forms used, including the written agreement |
194 | pursuant to subsection (2), must first be filed with and |
195 | approved by the office. Every form filed shall be identified by |
196 | a unique form number placed in the lower left corner of each |
197 | form. |
198 | (4) A charge or form is considered approved on the 60th |
199 | day after its date of filing unless it has been previously |
200 | disapproved by the office. The office shall disapprove any form |
201 | that does not meet the requirements of this part or that is |
202 | unreasonable, discriminatory, misleading, or unfair. If such |
203 | filing is filings are disapproved, the office shall notify the |
204 | discount medical plan organization and shall specify in the |
205 | notice the reasons for disapproval. |
206 | Section 9. Subsection (2) of section 636.218, Florida |
207 | Statutes, is amended to read: |
208 | 636.218 Annual reports.-- |
209 | (2) Such reports must be on forms prescribed by the |
210 | commission and must include: |
211 | (a) Audited financial statements prepared in accordance |
212 | with generally accepted accounting principles certified by an |
213 | independent certified public accountant, including the |
214 | organization's balance sheet, income statement, and statement of |
215 | changes in cash flow for the preceding year. An organization |
216 | that is a subsidiary of a parent entity that is publicly traded |
217 | and that prepares audited financial statements reflecting the |
218 | consolidated operations of the parent entity and the |
219 | organization may petition the office to accept, in lieu of the |
220 | audited financial statement of the organization, the audited |
221 | financial statement of the parent entity and a written guaranty |
222 | by the parent entity that the minimum capital requirements of |
223 | the organization required by this part will be met by the parent |
224 | entity. |
225 | (a)(b) If different from the initial application or the |
226 | last annual report, a list of the names and residence addresses |
227 | of all persons responsible for the conduct of the organization's |
228 | affairs, together with a disclosure of the extent and nature of |
229 | any contracts or arrangements between such persons and the |
230 | discount medical plan organization, including any possible |
231 | conflicts of interest. |
232 | (b)(c) The number of discount medical plan members in the |
233 | state. |
234 | (c)(d) Such other information relating to the performance |
235 | of the discount medical plan organization as is reasonably |
236 | required by the commission or office. |
237 | Section 10. Subsection (1) of section 636.220, Florida |
238 | Statutes, is amended to read: |
239 | 636.220 Minimum capital requirements.-- |
240 | (1) Each discount medical plan organization must at all |
241 | times maintain a net worth of at least $150,000 and each |
242 | discount medical plan organization shall certify in writing |
243 | under oath at licensure and annually that the minimum |
244 | capitalization requirements of this part are satisfied. |
245 | Section 11. Section 636.230, Florida Statutes, is |
246 | repealed. |
247 |
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248 | ======= T I T L E A M E N D M E N T ======= |
249 | Remove line 15 and insert: |
250 | under group health insurance policies; amending s. 627.668, |
251 | F.S.; revising the benefit level for treatment of mental and |
252 | nervous disorders; amending s. 636.204, F.S.; revising license |
253 | application provisions for discount medical plan organizations; |
254 | amending s. 636.206, F.S.; revising examination and |
255 | investigative authority; amending s. 636.210, F.S.; providing an |
256 | exception to prohibited activities; amending s. 636.216, F.S.; |
257 | providing exception to review of certain charges to members of |
258 | the plan; amending s. 636.218, F.S.; removing certain |
259 | information from the annual report; amending s. 636.220, F.S.; |
260 | revising certain minimum capital requirements of discount |
261 | medical plan organizations; repealing s. 636.230, F.S., relating |
262 | to the bundling of discount medical plans with other products; |
263 | amending s. 641.31, |