Florida Senate - 2011                          SENATOR AMENDMENT
       Bill No. CS/HB 1125, 1st Eng.
                                Barcode 170500                          
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                Floor: 1/R/2R          .         Floor: SA1/RC          
             05/04/2011 05:45 PM       .      05/03/2011 05:32 PM       

       Senator Garcia moved the following:
    1         Senate Amendment 
    3         Delete lines 189 - 284
    4  and insert:
    5  A vendor described in subparagraphs 4.-7. 3.-6. may not sell
    6  products that provide risk-bearing coverage unless that vendor
    7  is authorized under a certificate of authority issued by the
    8  Office of Insurance Regulation and is authorized to provide
    9  coverage in the relevant geographic area under the provisions of
   10  the Florida Insurance Code. Otherwise eligible vendors may be
   11  excluded from participating in the program for deceptive or
   12  predatory practices, financial insolvency, or failure to comply
   13  with the terms of the participation agreement or other standards
   14  set by the corporation.
   15         (e) Any risk-bearing product available under subparagraphs
   16  (d)1.-4. must be approved by the Office of Insurance Regulation.
   17  Any non-risk-bearing product must be approved by the
   18  corporation.
   19         (f)(e) Eligible individuals may voluntarily continue
   20  participation in the program regardless of subsequent changes in
   21  job status or Medicaid eligibility. Individuals who join the
   22  program may participate by complying with the procedures
   23  established by the corporation. These procedures must include,
   24  but are not limited to:
   25         1. Submission of required information.
   26         2. Authorization for payroll deduction.
   27         3. Compliance with federal tax requirements.
   28         4. Arrangements for payment in the event of job changes.
   29         5. Selection of products and services.
   30         (g)(f) Vendors who choose to participate in the program may
   31  enroll by complying with the procedures established by the
   32  corporation. These procedures may must include, but are not
   33  limited to:
   34         1. Submission of required information, including a complete
   35  description of the coverage, services, provider network, payment
   36  restrictions, and other requirements of each product offered
   37  through the program.
   38         2. Execution of an agreement that to make all risk-bearing
   39  products offered through the program are in compliance with the
   40  insurance code and are guaranteed-issue policies, subject to
   41  preexisting condition exclusions established by the corporation.
   42         3. Execution of an agreement that prohibits refusal to sell
   43  any offered non-risk-bearing product to a participant who elects
   44  to buy it.
   45         4. Establishment of product prices based on age, gender,
   46  family composition, and location of the individual participant,
   47  which may include medical underwriting.
   48         5. Arrangements for receiving payment for enrolled
   49  participants.
   50         6. Participation in ongoing reporting processes established
   51  by the corporation.
   52         7. Compliance with grievance procedures established by the
   53  corporation.
   54         (h)(g) Health insurance agents licensed under part IV of
   55  chapter 626 are eligible to voluntarily participate as buyers’
   56  representatives. A buyer’s representative acts on behalf of an
   57  individual purchasing health insurance and health services
   58  through the program by providing information about products and
   59  services available through the program and assisting the
   60  individual with both the decision and the procedure of selecting
   61  specific products. Serving as a buyer’s representative does not
   62  constitute a conflict of interest with continuing
   63  responsibilities as a health insurance agent if the relationship
   64  between each agent and any participating vendor is disclosed
   65  before advising an individual participant about the products and
   66  services available through the program. In order to participate,
   67  a health insurance agent shall comply with the procedures
   68  established by the corporation, including:
   69         1. Completion of training requirements.
   70         2. Execution of a participation agreement specifying the
   71  terms and conditions of participation.
   72         3. Disclosure of any appointments to solicit insurance or
   73  procure applications for vendors participating in the program.
   74         4. Arrangements to receive payment from the corporation for
   75  services as a buyer’s representative.
   76         (5) PRODUCTS.—
   77         (a) The products that may be made available for purchase
   78  through the program include, but are not limited to:
   79         1. Health insurance policies.
   80         2. Health maintenance contracts.
   81         3.2. Limited benefit plans.
   82         4.3. Prepaid clinic services.
   83         5.4. Service contracts.
   84         6.5. Arrangements for purchase of specific amounts and
   85  types of health services and treatments.
   86         7.6. Flexible spending accounts.
   87         (b) Health insurance policies, health maintenance
   88  contracts, limited benefit plans, prepaid service contracts, and
   89  other contracts for services must ensure the availability of
   90  covered services and benefits to participating individuals for
   91  at least 1 full enrollment year.
   92         (c) Products may be offered for multiyear periods provided
   93  the price of the product is specified for the entire period or
   94  for each separately priced segment of the policy or contract.
   95         (d) The corporation shall provide a disclosure form for
   96  consumers to acknowledge their understanding of the nature of,
   97  and any limitations to, the benefits provided by the products
   98  and services being purchased by the consumer.
   99         (e) The corporation must determine that making the plan
  100  available through the program is in the interest of eligible
  101  individuals and eligible employers in the state.
  102         (6) PRICING.—Prices for the products and services sold
  103  through the program must be transparent to participants and
  104  established by the vendors. Risk-bearing product approved by the
  105  Office of Insurance Regulation must be priced pursuant to state
  106  law governing the rates of any insurance product. based on age,
  107  gender, and location