Florida Senate - 2011 COMMITTEE AMENDMENT
Bill No. SPB 7096
Senate . House
Comm: FAV .
The Committee on Budget (Alexander) recommended the following:
1 Senate Amendment (with title amendment)
4 Delete lines 474 - 771
5 and insert:
6 (a)1. A member participating in this health insurance plan
7 option shall be eligible to receive an employer contribution
8 into the employee’s health savings account from the State
9 Employees Health Insurance Trust Fund in an amount to be
10 determined by the Legislature. A member is not eligible for an
11 employer contribution upon termination of employment. For the
2010-2011 fiscal year, the state’s monthly
13 contribution for employees having individual coverage shall be
14 $41.66 and the monthly contribution for employees having family
15 coverage shall be $83.33.
16 2. A member participating in this health insurance plan
17 option shall be eligible to deposit the member’s own funds into
18 a health savings account.
19 (b) The monthly premiums paid by the employer for a member
20 participating in this health insurance plan option shall include
21 an amount equal to the monthly employer contribution authorized
22 by the Legislature for that fiscal year.
23 (c) The health savings accounts shall be administered in
24 accordance with the requirements and limitations of federal
25 provisions relating to the Medicare Prescription Drug,
26 Improvement, and Modernization Act of 2003.
27 Section 2. Section 110.12302, Florida Statutes, is
29 Section 3. Section 110.12303, Florida Statutes, is created
30 to read:
31 110.12303 Health insurance risk pool.—
32 (1) For the 2012 plan year, the department shall establish
33 a single health insurance risk pool for the state group
34 insurance plans. Contribution determinations made pursuant to s.
35 110.123(5)(a) shall consider relative plan values; however, such
36 determinations may encourage enrollment in consumer-directed
38 (2) For the 2013 plan year and for each plan year
39 thereafter, the department shall establish a single health
40 insurance risk pool for each of the following groups
41 participating in the state group insurance plans:
42 (a) Active employees;
43 (b) Retirees not eligible for Medicare; and
44 (c) Retirees eligible for Medicare.
46 Contribution determinations made pursuant to s. 110.123(5)(a)
47 shall consider relative plan values; however, such
48 determinations may encourage enrollment in consumer-directed
50 Section 4. Subsections (1), (2), and (3) of section
51 110.12315, Florida Statutes, are amended to read:
52 110.12315 Prescription drug program.—The state employees’
53 prescription drug program is established. This program shall be
54 administered by the Department of Management Services, according
55 to the terms and conditions of the plan as established by the
56 relevant provisions of the annual General Appropriations Act and
57 implementing legislation, subject to the following conditions:
58 (1) The Department of Management Services shall allow
59 prescriptions written by health care providers under the plan to
60 be filled by any licensed pharmacy pursuant to contractual
61 claims-processing provisions. Nothing in This section does not
62 prohibit may be construed as prohibiting a mail order
63 prescription drug program distinct from the service provided by
64 retail pharmacies.
65 (2) In providing for reimbursement of pharmacies for
66 prescription medicines dispensed to members of the state group
67 health insurance plan and their dependents under the state
68 employees’ prescription drug program:
69 (a) Retail pharmacies participating in the program must be
70 reimbursed at a uniform rate and subject to uniform conditions,
71 according to applicable network agreements and the terms and
72 conditions of the plan.
73 (b) There shall be a 30-day supply limit for prescription
74 card purchases and 90-day supply limit for mail order or mail
75 order prescription drug purchases. The Department of Management
76 Services may implement a 90-day supply limit program at select
77 retail pharmacies if the department finds that it is in the best
78 financial interest of the program.
79 (c) The current pharmacy dispensing fee shall be negotiated
80 in accordance with best industry practices remains in effect.
81 (3) The Department of Management Services shall establish
82 the reimbursement schedule for prescription pharmaceuticals
83 dispensed under the program. Reimbursement rates for a
84 prescription pharmaceutical must be based on the cost of the
85 generic equivalent drug if a generic equivalent exists, unless
86 the physician prescribing the pharmaceutical clearly states on
87 the prescription that the brand name drug is medically necessary
88 or that the drug product is included on the formulary of drug
89 products that may not be interchanged as provided in chapter
90 465, in which case reimbursement must be based on the cost of
91 the brand name drug as specified in the reimbursement schedule
92 adopted by the Department of Management Services.
93 Notwithstanding the any other provision of this subsection, the
94 department may require that a generic or formulary brand
95 prescription be filled before dispensing an alternative within
96 any therapeutic class.
97 Section 5. Subsection (1) of section 112.0801, Florida
98 Statutes, is amended to read:
99 112.0801 Group insurance; participation by retired
101 (1) Any state agency, county, municipality, special
102 district, community college, or district school board which
103 provides life, health, accident, hospitalization, or annuity
104 insurance, or all of any kinds of such insurance, for its
105 officers and employees and their dependents upon a group
106 insurance plan or self-insurance plan shall allow all former
107 personnel who have retired prior to October 1, 1987, as well as
108 those who retire on or after such date, and their eligible
109 dependents, the option of continuing to participate in such
110 group insurance plan or self-insurance plan. Retirees and their
111 eligible dependents shall be offered the same health and
112 hospitalization insurance coverage as is offered to active
113 employees at a premium cost of no more than the premium cost
114 applicable to active employees. For the retired employees and
115 their eligible dependents, the cost of any such continued
116 participation in any type of plan or any of the cost thereof may
117 be paid by the employer or by the retired employees. To
118 determine health and hospitalization plan costs, the employer
119 shall commingle the claims experience of the retiree group with
120 the claims experience of the active employees; and, for other
121 types of coverage, the employer may commingle the claims
122 experience of the retiree group with the claims experience of
123 active employees. Retirees covered under Medicare may be
124 experience-rated separately from the retirees not covered by
125 Medicare and from active employees, provided that the total
126 premium does not exceed that of the active group and coverage is
127 basically the same as for the active group.
128 Section 6. (1) For the period July 1, 2011, through
129 December 31, 2012, the Department of Management Services shall
130 administer the plans and benefits provided under the state group
131 insurance program consistent with the following parameters:
132 (a) The state group insurance program shall include a
133 health insurance standard plan, a state group health insurance
134 high-deductible plan, a state-contracted health maintenance
135 organization standard plan, and a state-contracted health
136 maintenance organization high-deductible plan. Beginning January
137 1, 2012, the health insurance portion of the state group
138 insurance program shall be self-insured for active employees and
139 retirees not eligible for Medicare, and may be self-insured for
140 retirees eligible for Medicare.
141 (b) The benefits provided under each of the plans shall be
142 those benefits as provided in the current State Employees’ PPO
143 Plan Group Health Insurance Plan Booklet and Benefit Document,
144 current health maintenance organization contracts, and other
145 health insurance benefits that are approved by the Legislature.
146 (c) The high-deductible plans shall continue to include an
147 integrated health savings account. Such plans and accounts shall
148 be administered in accordance with the requirements and
149 limitations of federal provisions relating to the Medicare
150 Prescription Drug, Improvement, and Modernization Act of 2003.
151 The state shall make a monthly contribution to an employee’s
152 health savings account to the extent authorized in s.
153 110.123(12), Florida Statutes.
154 (2) For the 2012 plan year and each plan year thereafter,
155 the Department of Management Services shall develop a program of
156 health insurance options and enrollee contribution requirements
157 consistent with s. 110.123(5), Florida Statutes. Options shall
158 encourage and promote enrollee health plan choices and positive
159 behavior to promote the health and well-being of health plan
160 members and to encourage appropriate plan utilization. The
161 division shall determine the level of premiums necessary to
162 fully fund the state group health insurance program for the next
163 fiscal year. The Legislature shall provide in the General
164 Appropriations Act a premium schedule.
165 Section 7. The premiums charged under the state group
166 insurance program for health insurance authorized in s. 110.123,
167 Florida Statutes, shall be as follows:
168 (1) STATE CONTRIBUTION.—
169 (a) Effective July 1, 2011, for the coverage period
170 beginning August 1, 2011, the state contribution toward the cost
171 of any plan in the state group health insurance program which is
172 paid by the executive, legislative, and judicial branches on
173 behalf of participating employees, shall be, for individual
174 coverage, the total actuarial cost for the lowest cost plan
175 offered by the department for individual coverage and shall be,
176 for family coverage, the total actuarial cost for the lowest
177 cost plan offered by the department for family coverage, less
178 the employee contribution in subsection (2).
179 (b) Effective July 1, 2011, for the coverage period
180 beginning August 1, 2011, the state contribution toward the cost
181 of any plan in the state group health insurance program which is
182 paid by the executive, legislative, and judicial branches on
183 behalf of each employee enrolled in the spouse program shall be
184 one-half the total actuarial cost for the lowest cost plan
185 offered by the department for family coverage, less the employee
186 contribution in subsection (2).
187 (2) EMPLOYEE CONTRIBUTION.—
188 (a) For employees not participating in the spouse program:
189 1. Effective July 1, 2011, for the coverage period
190 beginning August 1, 2011, the employee contribution toward the
191 cost of a standard plan in the state group health insurance
192 program shall be $50 per month for individual coverage, and $200
193 per month for family coverage, plus the difference between the
194 state contribution and the cost of the plan selected.
195 2. Effective July 1, 2011, for the coverage period
196 beginning August 1, 2011, the employee contribution toward the
197 cost of a high-deductible plan in the state group health
198 insurance program shall continue at $15 per month for individual
199 coverage and $64.30 per month for family coverage, plus the
200 difference between the state contribution and the cost of the
201 plan selected.
202 (b) For employees participating in the spouse program in
203 accordance with section 60P-2.0036, Florida Administrative Code:
204 1. Effective July 1, 2011, for the coverage period
205 beginning August 1, 2011, the employee contribution toward the
206 cost of a standard plan in the state group health insurance
207 program shall be $100 per month for family coverage, plus the
208 difference between the state contribution and the cost of the
209 plan selected.
210 2. Effective July 1, 2011, for the coverage period
211 beginning August 1, 2011, the employee contribution toward the
212 cost of a high-deductible health plan in the state group health
213 insurance program shall be $32.15 per month for family coverage,
214 plus the difference between the state contribution and the cost
215 of the plan selected.
216 (3) STATE RETIREE ELIGIBLE FOR MEDICARE.—Effective July 1,
217 2011, for the coverage period beginning August 1, 2011, a
218 Medicare participant who participates in the state group
219 insurance program shall pay a monthly premium set in the General
220 Appropriations Act.
221 (4) STATE RETIREE NOT ELIGIBLE FOR MEDICARE.—Effective July
222 1, 2011, for the coverage period beginning August 1, 2011, the
223 monthly premium for a retiree who is not eligible for Medicare
224 but who participates in any plan offered through the state group
225 insurance program shall be set in the General Appropriations
228 ================= T I T L E A M E N D M E N T ================
229 And the title is amended as follows:
230 Delete lines 11 - 13
231 and insert:
232 incentive programs; providing for state contributions
233 to health insurance coverage for employees and their
234 families for the 2011-2012 fiscal year; repealing s.