CS/HB 177

1	A bill to be entitled
2	An act relating to health insurance; amending s. 627.4236,
3	F.S.; revising the definition of the term "bone marrow
4	transplant"; amending ss. 627.642, 627.657, and 641.31,
5	F.S.; requiring an identification card containing
6	specified information to be given to insureds under health
7	benefit plans and group health insurance policies and
8	persons having health care services through health
9	maintenance contracts; creating s. 627.4108, F.S.;
10	authorizing life or health insurers or health maintenance
11	organizations to offer to groups a credit reflecting
12	demonstrable administrative savings resulting from
13	efficiencies under specified conditions; providing
14	applicability; authorizing the Financial Services
15	Commission to establish certain rules; amending s.
16	408.909, F.S.; clarifying licensure provisions for health
17	flex plans; revising criteria for eligibility for
18	enrollment in a health flex plan; creating s. 445.015,
19	F.S.; establishing a small business health insurance plan
20	grant program; providing purposes of the grant program;
21	providing conditions for use of grant funds; providing
22	duties of the Agency for Workforce Innovation and the
23	Office of Insurance Regulation; requiring a report to the
24	Governor and Legislature; providing an appropriation;
25	repealing s. 468.807, F.S., relating to temporary licenses
26	for orthotists and prosthetists; providing applicability;
27	providing effective dates.
28
29	Be It Enacted by the Legislature of the State of Florida:
30
31	Section 1.  Subsection (1) of section 627.4236, Florida
32	Statutes, is amended to read:
33	627.4236  Coverage for bone marrow transplant procedures.--
34	(1)  As used in this section, the term "bone marrow
35	transplant" means human blood precursor cells administered to a
36	patient to restore normal hematological and immunological
37	functions following ablative or nonablative therapy with
38	curative or life-prolonging intent. Human blood precursor cells
39	may be obtained from the patient in an autologous transplant or
40	from a medically acceptable related or unrelated donor, and may
41	be derived from bone marrow, circulating blood, or a combination
42	of bone marrow and circulating blood. If chemotherapy is an
43	integral part of the treatment involving bone marrow
44	transplantation, the term "bone marrow transplant" includes both
45	the transplantation and the chemotherapy.
46	Section 2.  Subsection (3) is added to section 627.642,
47	Florida Statutes, to read:
48	627.642  Outline of coverage.--
49	(3)  In addition to the outline of coverage, a policy as
50	specified in s. 627.6699(3)(k) must be accompanied by an
51	identification card that contains, at a minimum:
52	(a)  The name of the organization issuing the policy or the
53	name of the organization administering the policy, whichever
54	applies.
55	(b)  The name of the contract holder.
56	(c)  The type of plan only if the plan is filed in the
57	state, an indication that the plan is self-funded, or the name
58	of the network.
59	(d)  The member identification number, contract number, and
60	policy or group number, if applicable.
61	(e)  A contact phone number or electronic address for
62	authorizations.
63	(f)  A phone number or electronic address whereby the
64	covered person or hospital, physician, or other person rendering
65	services covered by the policy may determine if the plan is
66	insured and may obtain a benefits verification in order to
67	estimate patient financial responsibility, in compliance with
68	privacy rules under the Health Insurance Portability and
69	Accountability Act.
70	(g)  The national plan identifier, in accordance with the
71	compliance date set forth by the federal Department of Health
72	and Human Services.
73
74	The identification card must present the information in a
75	readily identifiable manner or, alternatively, the information
76	may be embedded on the card and available through magnetic
77	stripe or smart card. The information may also be provided
78	through other electronic technology.
79	Section 3.  Present subsection (2) of section 627.657,
80	Florida Statutes, is renumbered as subsection (3), and a new
81	subsection (2) is added to that section to read:
82	627.657  Provisions of group health insurance policies.--
83	(2)  The medical policy as specified in s. 627.6699(3)(k)
84	must be accompanied by an identification card that contains, at
85	a minimum:
86	(a)  The name of the organization issuing the policy or
87	name of the organization administering the policy, whichever
88	applies.
89	(b)  The name of the certificateholder.
90	(c)  The type of plan only if the plan is filed in the
91	state, an indication that the plan is self-funded, or the name
92	of the network.
93	(d)  The member identification number, contract number, and
94	policy or group number, if applicable.
95	(e)  A contact phone number or electronic address for
96	authorizations.
97	(f)  A phone number or electronic address whereby the
98	covered person or hospital, physician, or other person rendering
99	services covered by the policy may determine if the plan is
100	insured and may obtain a benefits verification in order to
101	estimate patient financial responsibility, in compliance with
102	privacy rules under the Health Insurance Portability and
103	Accountability Act.
104	(g)  The national plan identifier, in accordance with the
105	compliance date set forth by the federal Department of Health
106	and Human Services.
107
108	The identification card must present the information in a
109	readily identifiable manner or, alternatively, the information
110	may be embedded on the card and available through magnetic
111	stripe or smart card. The information may also be provided
112	through other electronic technology.
113	Section 4.  Subsection (41) is added to section 641.31,
114	Florida Statutes, to read:
115	641.31  Health maintenance contracts.--
116	(41)  The contract, certificate, or member handbook must be
117	accompanied by an identification card that contains, at a
118	minimum:
119	(a)  The name of the organization offering the contract or
120	name of the organization administering the contract, whichever
121	applies.
122	(b)  The name of the subscriber.
123	(c)  A statement that the health plan is a health
124	maintenance organization. Only a health plan with a certificate
125	of authority issued under this chapter may be identified as a
126	health maintenance organization.
127	(d)  The member identification number, contract number, and
128	group number, if applicable.
129	(e)  A contact phone number or electronic address for
130	authorizations.
131	(f)  A phone number or electronic address whereby the
132	covered person or hospital, physician, or other person rendering
133	services covered by the contract may determine if the plan is
134	insured and may obtain a benefits verification in order to
135	estimate patient financial responsibility, in compliance with
136	privacy rules under the Health Insurance Portability and
137	Accountability Act.
138	(g)  The national plan identifier, in accordance with the
139	compliance date set forth by the federal Department of Health
140	and Human Services.
141
142	The identification card must present the information in a
143	readily identifiable manner or, alternatively, the information
144	may be embedded on the card and available through magnetic
145	stripe or smart card. The information may also be provided
146	through other electronic technology.
147	Section 5.  Effective July 1, 2007, section 627.4108,
148	Florida Statutes, is created to read:
149	627.4108  Credit for administrative efficiencies.--A life
150	or health insurer or health maintenance organization may offer
151	to groups a credit reflecting demonstrable administrative
152	savings resulting from efficiencies that occur when two or more
153	life or health insurance products, or a health maintenance
154	organization contract and one or more life or health insurance
155	products, are purchased from the insurer or its affiliated
156	companies or health maintenance organization. The insurer or
157	health maintenance organization shall be required to demonstrate
158	to the office that the proposed credit is reasonable, does not
159	exceed the administrative savings, and is offered in a
160	nondiscriminatory manner. Such demonstration may be submitted
161	for approval separate from any premium rate filing. In no event
162	shall such credit, resulting in reduction of revenue, be
163	reflected in the experience used in rate filings. The commission
164	may establish by rule procedures to be used in ascertaining the
165	appropriate amount and reasonableness of the credit in relation
166	to the administrative savings and to ensure that it is offered
167	in a nondiscriminatory manner.
168	Section 6.  Effective July 1, 2007, subsection (5) of
169	section 408.909, Florida Statutes, is amended, and paragraph (d)
170	is added to subsection (3) of that section, to read:
171	408.909  Health flex plans.--
172	(3)  PROGRAM.--The agency and the office shall each approve
173	or disapprove health flex plans that provide health care
174	coverage for eligible participants. A health flex plan may limit
175	or exclude benefits otherwise required by law for insurers
176	offering coverage in this state, may cap the total amount of
177	claims paid per year per enrollee, may limit the number of
178	enrollees, or may take any combination of those actions. A
179	health flex plan offering may include the option of a
180	catastrophic plan supplementing the health flex plan.
181	(d)  In order to expedite financial determinations and
182	immediately qualify a large base of eligible entities to offer
183	health flex plans, health insurers licensed under chapters 624
184	and 627, fraternal benefit societies licensed under chapter 632,
185	prepaid limited health service organizations licensed under
186	chapter 636, health maintenance organizations licensed under
187	part I of chapter 641, prepaid health clinics licensed under
188	part II of chapter 641, and hospital-owned provider service
189	networks authorized under chapter 409 shall be deemed in
190	compliance with the financial requirements to offer a health
191	flex plan. In addition, any local government or health care
192	district that has the initial operating funds and taxing
193	authority to fulfill its obligations under the proposed health
194	flex plan shall be deemed in compliance with the financial
195	requirements to offer a health flex plan.
196	(5)  ELIGIBILITY.--Eligibility to enroll in an approved
197	health flex plan is limited to residents of this state who:
198	(a)  Are 64 years of age or younger;
199	(b)  Have a family income equal to or less than 250 200
200	percent of the federal poverty level;
201	(c)  Are eligible under a federally approved Medicaid
202	demonstration waiver and reside in Palm Beach County or Miami-
203	Dade County;
204	(d)  Are not covered by a private insurance policy and are
205	not eligible for coverage through a public health insurance
206	program, such as Medicare or Medicaid, unless specifically
207	authorized under paragraph (c), or another public health care
208	program, such as Kidcare, and have not been covered at any time
209	during the past 6 months; and
210	(d)(e)  Have applied for health care coverage through an
211	approved health flex plan and have agreed to make any payments
212	required for participation, including periodic payments or
213	payments due at the time health care services are provided; and
214	(e)  Are either:
215	1.  Not covered by a private insurance policy and not
216	eligible for coverage through a public health insurance program,
217	such as Medicare or Medicaid, unless specifically authorized
218	under paragraph (c), or another public health care program, such
219	as Kidcare, and have not been covered at any time during the
220	past 6 months; or
221	2.  Part of an employer group that is not covered by a
222	private health insurance policy and has not been covered at any
223	time during the past 6 months and in which at least 75 percent
224	of the employees have a family income equal to or less than 250
225	percent of the federal poverty level. If the health flex plan
226	entity is a properly licensed health insurer, health plan, or
227	health maintenance organization, this subparagraph applies when
228	only 50 percent of the employees have a family income equal to
229	or less than 250 percent of the federal poverty level.
230	Section 7.  Effective July 1, 2007, section 445.015,
231	Florida Statutes, is created to read:
232	445.015  Small business health insurance plan grant
233	program.--
234	(1)  The agency shall establish a small business health
235	insurance plan grant program to award, administer, and monitor
236	grants to small employers and small businesses to develop and
237	offer cafeteria health plans that qualify under s. 125 of the
238	Internal Revenue Code and include options such as prepaid health
239	clinic services licensed under part II of chapter 641 for the
240	purpose of improving access to health insurance for uninsured
241	employees. The agency shall give priority to employer proposals
242	that would improve access for previously uninsured employees or
243	include long-term commitments to insure employees. Grant funds
244	shall not be used for ongoing maintenance of the plans or for
245	employer contributions. Health plans may identify and assist
246	eligible small employers and small businesses in obtaining
247	grants. The agency, in consultation with the Office of Insurance
248	Regulation, shall evaluate each project funded by a grant to
249	measure any increases in access to insurance and the long-term
250	viability of such increases. The agency shall design materials
251	and interactive programs to inform small employers and small
252	businesses about such cafeteria health plans and shall provide
253	training to assist small employers and small businesses in
254	developing such plans. Training shall include technical
255	assistance in establishing relationships with health plans and
256	individualized guidance on operational methods and
257	infrastructure that will best support and ensure the long-term
258	success of using these plans.
259	(2)  The agency shall submit a report that documents the
260	specific activities undertaken during the fiscal year pursuant
261	to this section annually to the Governor, the President of the
262	Senate, and the Speaker of the House of Representatives no later
263	than February 1.
264	Section 8.  Effective July 1, 2007, the sum of $250,000 in
265	nonrecurring revenue is appropriated from the General Revenue
266	Fund to the Agency for Workforce Innovation for the 2007-2008
267	fiscal year to award Small Business Health Insurance Plan Grants
268	to eligible businesses.
269	Section 9.  Effective July 1, 2007, section 468.807,
270	Florida Statutes, is repealed.
271	Section 10.  Except as otherwise expressly provided in this
272	act, this act shall take effect January 1, 2008, and shall apply
273	to identification cards issued for policies or certificates
274	issued or renewed on or after that date.

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