Amendment
Bill No. 0805
Amendment No. 446541
CHAMBER ACTION
Senate House
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1Representatives Benson, H. Gibson, Baxley, Galvano, Kendrick,
2Garcia, 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
7to read:
8     627.668  Optional coverage for mental and nervous disorders
9required; exception.--
10     (1)  Every insurer, health maintenance organization, and
11nonprofit hospital and medical service plan corporation
12transacting group health insurance or providing prepaid health
13care in this state shall make available to the policyholder as
14part of the application, for an appropriate additional premium
15under a group hospital and medical expense-incurred insurance
16policy, under a group prepaid health care contract, and under a
17group hospital and medical service plan contract, the benefits
18or level of benefits specified in subsection (2) for the
19necessary care and treatment of mental and nervous disorders, as
20defined in the standard nomenclature of the American Psychiatric
21Association, subject to the right of the applicant for a group
22policy or contract to select any alternative benefits or level
23of benefits as may be offered by the insurer, health maintenance
24organization, or service plan corporation provided that, if
25alternate inpatient, outpatient, or partial hospitalization
26benefits are selected, such benefits shall not be less than the
27level 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
30benefits, partial hospitalization benefits, and outpatient
31benefits consisting of durational limits, dollar amounts,
32deductibles, and coinsurance factors shall not be less favorable
33than for physical illness generally, except that:
34     (a)  Inpatient benefits may be limited to not less than 30
35days per benefit year as defined in the policy or contract. If
36inpatient hospital benefits are provided beyond 30 days per
37benefit year, the durational limits, dollar amounts, and
38coinsurance factors thereto need not be the same as applicable
39to physical illness generally.
40     (b)  Outpatient benefits may be limited to $1,000 for
41consultations with a licensed physician, a psychologist licensed
42pursuant to chapter 490, a mental health counselor licensed
43pursuant to chapter 491, a marriage and family therapist
44licensed pursuant to chapter 491, and a clinical social worker
45licensed pursuant to chapter 491. If benefits are provided
46beyond the $1,000 per benefit year, the durational limits,
47dollar amounts, and coinsurance factors thereof need not be the
48same as applicable to physical illness generally.
49     (c)  Partial hospitalization benefits shall be provided
50under the direction of a licensed physician. For purposes of
51this part, the term "partial hospitalization services" is
52defined as those services offered by a program accredited by the
53Joint Commission on Accreditation of Hospitals (JCAH) or in
54compliance with equivalent standards. Alcohol rehabilitation
55programs accredited by the Joint Commission on Accreditation of
56Hospitals or approved by the state and licensed drug abuse
57rehabilitation programs shall also be qualified providers under
58this section. In any benefit year, if partial hospitalization
59services or a combination of inpatient and partial
60hospitalization are utilized, the total benefits paid for all
61such services shall not exceed the cost of 30 days of inpatient
62hospitalization for psychiatric services, including physician
63fees, which prevail in the community in which the partial
64hospitalization services are rendered. If partial
65hospitalization services benefits are provided beyond the limits
66set forth in this paragraph, the durational limits, dollar
67amounts, and coinsurance factors thereof need not be the same as
68those applicable to physical illness generally.
69     (3)  In the case of a group health plan that offers a
70participant or beneficiary two or more benefit package options
71under the plan, the requirements of this section shall be
72applied separately with respect to each such option.
73     (4)(3)  Insurers must maintain strict confidentiality
74regarding psychiatric and psychotherapeutic records submitted to
75an insurer for the purpose of reviewing a claim for benefits
76payable under this section. These records submitted to an
77insurer are subject to the limitations of s. 456.057, relating
78to the furnishing of patient records.
79     Section 5.  Subsection (2) of section 636.204, Florida
80Statutes, is amended to read:
81     636.204  License required.--
82     (2)  An application for a license to operate as a discount
83medical plan organization must be filed with the office on a
84form prescribed by the commission. Such application must be
85sworn to by an officer or authorized representative of the
86applicant and be accompanied by the following, if applicable:
87     (a)  A copy of the applicant's articles of incorporation or
88other organizing documents, including all amendments.
89     (b)  A copy of the applicant's bylaws.
90     (c)  A list of the names, addresses, official positions,
91and biographical information of the individuals who are
92responsible for conducting the applicant's affairs, including,
93but not limited to, all members of the board of directors, board
94of trustees, executive committee, or other governing board or
95committee, the officers, contracted management company
96personnel, and any person or entity owning or having the right
97to acquire 10 percent or more of the voting securities of the
98applicant. Such listing must fully disclose the extent and
99nature of any contracts or arrangements between any individual
100who is responsible for conducting the applicant's affairs and
101the discount medical plan organization, including any possible
102conflicts of interest.
103     (d)  A complete biographical statement, on forms prescribed
104by the commission, an independent investigation report, and a
105set of fingerprints, as provided in chapter 624, with respect to
106each individual identified under paragraph (c).
107     (e)  A statement generally describing the applicant, its
108facilities and personnel, and the medical services to be
109offered.
110     (f)  A copy of the form of all contracts made or to be made
111between the applicant and any providers or provider networks
112regarding the provision of medical services to members.
113     (g)  A copy of the form of any contract made or arrangement
114to be made between the applicant and any person listed in
115paragraph (c).
116     (h)  A copy of the form of any contract made or to be made
117between the applicant and any person, corporation, partnership,
118or other entity for the performance on the applicant's behalf of
119any function, including, but not limited to, marketing,
120administration, enrollment, investment management, and
121subcontracting for the provision of health services to members.
122     (i)  A copy of the applicant's most recent financial
123statements audited by an independent certified public
124accountant. An applicant that is a subsidiary of a parent entity
125that is publicly traded and that prepares audited financial
126statements reflecting the consolidated operations of the parent
127entity and the subsidiary may petition the office to accept, in
128lieu of the audited financial statement of the applicant, the
129audited financial statement of the parent entity and a written
130guaranty by the parent entity that the minimum capital
131requirements of the applicant required by this part will be met
132by the parent entity.
133     (i)(j)  A description of the proposed method of marketing.
134     (j)(k)  A description of the subscriber complaint
135procedures 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
138may reasonably require to make the determinations required by
139this part.
140     Section 6.  Subsection (1) of section 636.206, Florida
141Statutes, is amended to read:
142     636.206  Examinations and investigations.--
143     (1)  The office may examine or investigate the business and
144affairs of any discount medical plan organization if the
145commissioner has reason to believe that the discount medical
146plan organization is not complying with the requirements of this
147act. The office may order any discount medical plan organization
148or applicant to produce any records, books, files, advertising
149and solicitation materials, or other information and may take
150statements under oath to determine whether the discount medical
151plan organization or applicant is in violation of the law or is
152acting contrary to the public interest. The expenses incurred in
153conducting any examination or investigation must be paid by the
154discount medical plan organization or applicant. Examinations
155and investigations must be conducted as provided in chapter 624.
156     Section 7.  Subsection (1) of section 636.210, Florida
157Statutes, is amended to read:
158     636.210  Prohibited activities of a discount medical plan
159organization.--
160     (1)  A discount medical plan organization may not:
161     (a)  Use in its advertisements, marketing material,
162brochures, and discount cards the term "insurance" except as
163otherwise provided in this part or as a disclaimer of any
164relationship between discount medical plan organization benefits
165and insurance;
166     (b)  Use in its advertisements, marketing material,
167brochures, and discount cards the terms "health plan,"
168"coverage," "copay," "copayments," "preexisting conditions,"
169"guaranteed issue," "premium," "PPO," "preferred provider
170organization," or other terms in a manner that could reasonably
171mislead a person into believing the discount medical plan was
172health insurance;
173     (c)  Have restrictions on free access to plan providers,
174except for hospital services, including, but not limited to,
175waiting periods and notification periods; or
176     (d)  Pay providers any fees for medical services.
177     Section 8.  Subsections (1), (3), and (4) of section
178636.216, 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.
181and Any charge to members greater than $30 per month or $360 per
182year for access to healthcare services, other than those
183provided by physicians licensed under chapters 458 and 459 or by
184hospitals licensed under chapter 395, must be approved by the
185office before the charges can be used. Any charge to members
186greater than $60 dollars per month or $720 per year for
187healthcare services that include services provided by physicians
188licensed under chapter 458 and 459 or by hospitals licensed
189under chapter 395 must be approved by the office before the
190charges can be used. The discount medical plan organization has
191the burden of proof that the charges bear a reasonable relation
192to the benefits received by the member.
193     (3)  All forms used, including the written agreement
194pursuant to subsection (2), must first be filed with and
195approved by the office. Every form filed shall be identified by
196a unique form number placed in the lower left corner of each
197form.
198     (4)  A charge or form is considered approved on the 60th
199day after its date of filing unless it has been previously
200disapproved by the office. The office shall disapprove any form
201that does not meet the requirements of this part or that is
202unreasonable, discriminatory, misleading, or unfair. If such
203filing is filings are disapproved, the office shall notify the
204discount medical plan organization and shall specify in the
205notice the reasons for disapproval.
206     Section 9.  Subsection (2) of section 636.218, Florida
207Statutes, is amended to read:
208     636.218  Annual reports.--
209     (2)  Such reports must be on forms prescribed by the
210commission and must include:
211     (a)  Audited financial statements prepared in accordance
212with generally accepted accounting principles certified by an
213independent certified public accountant, including the
214organization's balance sheet, income statement, and statement of
215changes in cash flow for the preceding year. An organization
216that is a subsidiary of a parent entity that is publicly traded
217and that prepares audited financial statements reflecting the
218consolidated operations of the parent entity and the
219organization may petition the office to accept, in lieu of the
220audited financial statement of the organization, the audited
221financial statement of the parent entity and a written guaranty
222by the parent entity that the minimum capital requirements of
223the organization required by this part will be met by the parent
224entity.
225     (a)(b)  If different from the initial application or the
226last annual report, a list of the names and residence addresses
227of all persons responsible for the conduct of the organization's
228affairs, together with a disclosure of the extent and nature of
229any contracts or arrangements between such persons and the
230discount medical plan organization, including any possible
231conflicts of interest.
232     (b)(c)  The number of discount medical plan members in the
233state.
234     (c)(d)  Such other information relating to the performance
235of the discount medical plan organization as is reasonably
236required by the commission or office.
237     Section 10.  Subsection (1) of section 636.220, Florida
238Statutes, is amended to read:
239     636.220  Minimum capital requirements.--
240     (1)  Each discount medical plan organization must at all
241times maintain a net worth of at least $150,000 and each
242discount medical plan organization shall certify in writing
243under oath at licensure and annually that the minimum
244capitalization requirements of this part are satisfied.
245     Section 11.  Section 636.230, Florida Statutes, is
246repealed.
247
248     ======= T I T L E  A M E N D M E N T =======
249     Remove line 15 and insert:
250under group health insurance policies; amending s. 627.668,
251F.S.; revising the benefit level for treatment of mental and
252nervous disorders; amending s. 636.204, F.S.; revising license
253application provisions for discount medical plan organizations;
254amending s. 636.206, F.S.; revising examination and
255investigative authority; amending s. 636.210, F.S.; providing an
256exception to prohibited activities; amending s. 636.216, F.S.;
257providing exception to review of certain charges to members of
258the plan; amending s. 636.218, F.S.; removing certain
259information from the annual report; amending s. 636.220, F.S.;
260revising certain minimum capital requirements of discount
261medical plan organizations; repealing s. 636.230, F.S., relating
262to the bundling of discount medical plans with other products;
263amending s. 641.31,


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