CS/HB 591

1	A bill to be entitled
2	An act relating to health insurance; creating ss.
3	627.6404, 627.6572, and 641.31093, F.S.; requiring all
4	antiretroviral agents to be included on health plan
5	formularies; prohibiting access-limiting procedures used
6	to restrict antiretroviral agents prescribed to treat a
7	person with HIV; amending s. 627.6515, F.S.; including
8	reference to such requirements on policies issued by out-
9	of-state groups; providing an effective date.
10
11	Be It Enacted by the Legislature of the State of Florida:
12
13	Section 1.  Section 627.6404, Florida Statutes, is created
14	to read:
15	627.6404  HIV treatment.-Antiretroviral agents prescribed
16	to treat a person with HIV must be included on a health plan
17	formulary and may not be restricted through a requirement for
18	prior authorization, step therapy, or other limitation that
19	limits access to any antiretroviral agent.
20	Section 2.  Subsection (2) of section 627.6515, Florida
21	Statutes, is amended to read:
22	627.6515  Out-of-state groups.-
23	(2)  Except as otherwise provided in this part, this part
24	does not apply to a group health insurance policy issued or
25	delivered outside this state under which a resident of this
26	state is provided coverage if:
27	(a)  The policy is issued to an employee group the
28	composition of which is substantially as described in s.
29	627.653; a labor union group or association group the
30	composition of which is substantially as described in s.
31	627.654; an additional group the composition of which is
32	substantially as described in s. 627.656; a group insured under
33	a blanket health policy when the composition of the group is
34	substantially in compliance with s. 627.659; a group insured
35	under a franchise health policy when the composition of the
36	group is substantially in compliance with s. 627.663; an
37	association group to cover persons associated in any other
38	common group, which common group is formed primarily for
39	purposes other than providing insurance; a group that is
40	established primarily for the purpose of providing group
41	insurance, provided the benefits are reasonable in relation to
42	the premiums charged thereunder and the issuance of the group
43	policy has resulted, or will result, in economies of
44	administration; or a group of insurance agents of an insurer,
45	which insurer is the policyholder.;
46	(b)  Certificates evidencing coverage under the policy are
47	issued to residents of this state and contain in contrasting
48	color and not less than 10-point type the following statement:
49	"The benefits of the policy providing your coverage are governed
50	primarily by the law of a state other than Florida".; and
51	(c)  The policy provides the benefits specified in ss.
52	627.419, 627.6572, 627.6574, 627.6575, 627.6579, 627.6612,
53	627.66121, 627.66122, 627.6613, 627.667, 627.6675, 627.6691, and
54	627.66911.
55	(d)  Applications for certificates of coverage offered to
56	residents of this state must contain, in contrasting color and
57	not less than 12-point type, the following statement on the same
58	page as the applicant's signature:
59
60	"This policy is primarily governed by the laws of ...insert
61	state where the master policy if filed.... As a result, all of
62	the rating laws applicable to policies filed in this state do
63	not apply to this coverage, which may result in increases in
64	your premium at renewal that would not be permissible under a
65	Florida-approved policy. Any purchase of individual health
66	insurance should be considered carefully, as future medical
67	conditions may make it impossible to qualify for another
68	individual health policy. For information concerning individual
69	health coverage under a Florida-approved policy, consult your
70	agent or the Florida Department of Financial Services."
71
72	This paragraph applies only to group certificates providing
73	health insurance coverage which require individualized
74	underwriting to determine coverage eligibility for an individual
75	or premium rates to be charged to an individual except for the
76	following:
77	1.  Policies issued to provide coverage to groups of
78	persons all of whom are in the same or functionally related
79	licensed professions, and providing coverage only to such
80	licensed professionals, their employees, or their dependents;
81	2.  Policies providing coverage to small employers as
82	defined by s. 627.6699. Such policies shall be subject to, and
83	governed by, the provisions of s. 627.6699;
84	3.  Policies issued to a bona fide association, as defined
85	by s. 627.6571(5), provided that there is a person or board
86	acting as a fiduciary for the benefit of the members, and such
87	association is not owned, controlled by, or otherwise associated
88	with the insurance company; or
89	4.  Any accidental death, accidental death and
90	dismemberment, accident-only, vision-only, dental-only, hospital
91	indemnity-only, hospital accident-only, cancer, specified
92	disease, Medicare supplement, products that supplement Medicare,
93	long-term care, or disability income insurance, or similar
94	supplemental plans provided under a separate policy,
95	certificate, or contract of insurance, which cannot duplicate
96	coverage under an underlying health plan, coinsurance, or
97	deductibles or coverage issued as a supplement to workers'
98	compensation or similar insurance, or automobile medical-payment
99	insurance.
100	Section 3.  Section 627.6572, Florida Statutes, is created
101	to read:
102	627.6572  HIV treatment.-Antiretroviral agents prescribed
103	to treat a person with HIV must be included on a health plan
104	formulary and may not be restricted through a requirement for
105	prior authorization, step therapy, or other limitation that
106	limits access to any antiretroviral agent.
107	Section 4.  Section 641.31093, Florida Statutes, is created
108	to read:
109	641.31093  HIV treatment.-Antiretroviral agents prescribed
110	to treat a person with HIV must be included on a health plan
111	formulary and may not be restricted through a requirement for
112	prior authorization, step therapy, or other limitation that
113	limits access to any antiretroviral agent.
114	Section 5.  This act shall take effect July 1, 2010.

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