Amendment
Bill No. 0805

Amendment No. 446541

CHAMBER ACTION
Senate		House
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1	Representatives Benson, H. Gibson, Baxley, Galvano, Kendrick,
2	Garcia, Negron, and Bean offered the following:
3
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
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,

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