HB 7255

1	A bill to be entitled
2	An act relating to the state group insurance program;
3	amending s. 110.123, F.S.; providing application of
4	definitions; revising definitions; deleting legislative
5	intent; enumerating the group insurance plans that may be
6	included in the state group insurance program; revising
7	duties of the Department of Management Services relating
8	to the group insurance program; providing the state
9	contribution toward cost of health insurance plans in the
10	state group insurance program for specified plan years;
11	revising authorized benefits; directing the department to
12	contract with a certain number of health maintenance
13	organizations under certain circumstances; requiring
14	certain data to be reported to the department by health
15	maintenance organizations under specified circumstances;
16	providing for specified benefit levels for specified plan
17	years; repealing certain duties of the department on a
18	specified future date; repealing the Florida State
19	Employee Wellness Council; amending s. 110.12302, F.S.;
20	requiring the department to contract with health
21	maintenance organizations with a self-insured plan design
22	beginning with a specified plan year; creating s.
23	110.12303, F.S.; directing the department to contract with
24	an independent benefits manager; providing vendor
25	qualifications for the independent benefits manager;
26	providing duties of the independent benefits manager;
27	providing contract management duties for the department;
28	providing duties of the department relating to the state
29	group insurance program; creating s. 110.12304, F.S.;
30	providing requirements for state and employee
31	contributions toward health plan premium costs for a
32	specified plan year; providing for adjustments to employee
33	salary under certain circumstances; creating s. 110.12305,
34	F.S.; requiring the department to establish a single
35	health insurance risk pool beginning with a specified plan
36	year; requiring the department to contract with multiple
37	health maintenance organizations under specified
38	circumstances beginning with a specified plan year;
39	providing an effective date.
40
41	Be It Enacted by the Legislature of the State of Florida:
42
43	Section 1.  Subsections (1), (2), and (3), paragraph (b) of
44	subsection (4), and subsections (5) and (13) of section 110.123,
45	Florida Statutes, are amended to read:
46	110.123  State group insurance program.-
47	(1)  TITLE.-Sections 110.123-110.1239 This section may be
48	cited as the "State Group Insurance Program Law."
49	(2)  DEFINITIONS.-As used in ss. 110.123-110.1239 this
50	section, the term:
51	(a)  "Department" means the Department of Management
52	Services.
53	(b)  "Enrollee" means all state officers and employees,
54	retired state officers and employees, surviving spouses of
55	deceased state officers and employees, and terminated employees
56	or individuals with continuation coverage who are enrolled in an
57	insurance plan offered by the state group insurance program.
58	"Enrollee" includes all state university officers and employees,
59	retired state university officers and employees, surviving
60	spouses of deceased state university officers and employees, and
61	terminated state university employees or individuals with
62	continuation coverage who are enrolled in an insurance plan
63	offered by the state group insurance program.
64	(c)  "Full-time state employees" includes all full-time
65	employees of all branches or agencies of state government
66	holding salaried positions and paid by state warrant or from
67	agency funds, and employees paid from regular salary
68	appropriations for 8 months' employment, including university
69	personnel on academic contracts, but in no case shall "state
70	employee" or "salaried position" include persons paid from
71	other-personal-services (OPS) funds. "Full-time employees"
72	includes all full-time employees of the state universities.
73	(d)  "Health maintenance organization" or "HMO" means an
74	entity certified under part I of chapter 641.
75	(e)  "Health plan member" means any person participating in
76	a state group health insurance plan, a TRICARE supplemental
77	insurance plan, or a health maintenance organization plan under
78	the state group insurance program, including enrollees and
79	covered dependents thereof.
80	(f)  "Part-time state employee" means any employee of any
81	branch or agency of state government paid by state warrant from
82	salary appropriations or from agency funds, and who is employed
83	for less than the normal full-time workweek established by the
84	department or, if on academic contract or seasonal or other type
85	of employment which is less than year-round, is employed for
86	less than 8 months during any 12-month period, but in no case
87	shall "part-time" employee include a person paid from other-
88	personal-services (OPS) funds. "Part-time state employee"
89	includes any part-time employee of the state universities.
90	(g)  "Plan year" means a calendar year.
91	(h)(g)  "Retired state officer or employee" or "retiree"
92	means any state or state university officer or employee who
93	retires under a state retirement system or a state optional
94	annuity or retirement program or is placed on disability
95	retirement, and who was insured under the state group insurance
96	program at the time of retirement, and who begins receiving
97	retirement benefits immediately after retirement from state or
98	state university office or employment. In addition to these
99	requirements, any state officer or state employee who retires
100	under the Public Employee Optional Retirement Program
101	established under part II of chapter 121 shall be considered a
102	"retired state officer or employee" or "retiree" as used in this
103	section if he or she:
104	1.  Meets the age and service requirements to qualify for
105	normal retirement as set forth in s. 121.021(29); or
106	2.  Has attained the age specified by s. 72(t)(2)(A)(i) of
107	the Internal Revenue Code and has 6 years of creditable service.
108	(i)(h)  "State agency" or "agency" means any branch,
109	department, or agency of state government. "State agency" or
110	"agency" includes any state university for purposes of this
111	section only.
112	(j)(i)  "State group health insurance plan or plans" or
113	"state plan or plans" mean the state self-insured health
114	insurance plan or plans, including self-insured health
115	maintenance organization plans, offered to state officers and
116	employees, retired state officers and employees, and surviving
117	spouses of deceased state officers and employees pursuant to
118	this section.
119	(j)  "State-contracted HMO" means any health maintenance
120	organization under contract with the department to participate
121	in the state group insurance program.
122	(k)  "State group insurance program" or "programs" means
123	the package of insurance plans offered to state officers and
124	employees, retired state officers and employees, and surviving
125	spouses of deceased state officers and employees pursuant to
126	this section, including the state group health insurance plan or
127	plans, health maintenance organization plans, TRICARE
128	supplemental insurance plans, and other plans required or
129	authorized by law.
130	(l)  "State officer" means any constitutional state
131	officer, any elected state officer paid by state warrant, or any
132	appointed state officer who is commissioned by the Governor and
133	who is paid by state warrant.
134	(m)  "Surviving spouse" means the widow or widower of a
135	deceased state officer, full-time state employee, part-time
136	state employee, or retiree if such widow or widower was covered
137	as a dependent under the state group health insurance plan, a
138	TRICARE supplemental insurance plan, or a health maintenance
139	organization plan established pursuant to this section at the
140	time of the death of the deceased officer, employee, or retiree.
141	"Surviving spouse" also means any widow or widower who is
142	receiving or eligible to receive a monthly state warrant from a
143	state retirement system as the beneficiary of a state officer,
144	full-time state employee, or retiree who died prior to July 1,
145	1979. For the purposes of this section, any such widow or
146	widower shall cease to be a surviving spouse upon his or her
147	remarriage.
148	(n)  "TRICARE supplemental insurance plan" means the
149	Department of Defense Health Insurance Program for eligible
150	members of the uniformed services authorized by 10 U.S.C. s.
151	1097.
152	(3)  STATE GROUP INSURANCE PROGRAM.-
153	(a)  The Division of State Group Insurance is created
154	within the Department of Management Services.
155	(b)  It is the intent of the Legislature to offer a
156	comprehensive package of health insurance and retirement
157	benefits and a personnel system for state employees which are
158	provided in a cost-efficient and prudent manner, and to allow
159	state employees the option to choose benefit plans which best
160	suit their individual needs. Therefore,
161	(a)  The state group insurance program is established,
162	which may include the state group health insurance plan or
163	plans, health maintenance organization plans, group life
164	insurance plans, TRICARE supplemental insurance plans, group
165	accidental death and dismemberment plans, and group disability
166	insurance plans, and. Furthermore, the department is
167	additionally authorized to establish and provide as part of the
168	state group insurance program any other group insurance plans or
169	coverage choices that are consistent with the provisions of this
170	section.
171	(b)(c)  Notwithstanding any provision in this section to
172	the contrary, it is the intent of the Legislature that The
173	department shall be responsible for specific duties related to
174	the state group insurance program, including the competitive
175	procurement of such contracts as may be necessary to implement
176	the state group insurance program all aspects of the purchase of
177	health care for state employees under the state group health
178	insurance plan or plans, TRICARE supplemental insurance plans,
179	and the health maintenance organization plans. Responsibilities
180	shall include, but not be limited to, the development of
181	requests for proposals or invitations to negotiate for state
182	employee health services, the determination of health care
183	benefits to be provided, and the negotiation of contracts for
184	health care and health care administrative services. Prior to
185	the negotiation of contracts for health care services, the
186	Legislature intends that the department shall develop, with
187	respect to state collective bargaining issues, the health
188	benefits and terms to be included in the state group health
189	insurance program. The department shall adopt rules necessary to
190	perform its responsibilities pursuant to this section. It is the
191	intent of the Legislature that The department shall be
192	responsible for the contract management and day-to-day
193	management of the state employee health insurance program,
194	including, but not limited to, employee enrollment, premium
195	collection, payment to health care providers, and other
196	administrative functions described in s. 110.12303(6) related to
197	the program.
198	(d)1.  Notwithstanding the provisions of chapter 287 and
199	the authority of the department, for the purpose of protecting
200	the health of, and providing medical services to, state
201	employees participating in the state group insurance program,
202	the department may contract to retain the services of
203	professional administrators for the state group insurance
204	program. The agency shall follow good purchasing practices of
205	state procurement to the extent practicable under the
206	circumstances.
207	(c)1.2.  Each vendor in a major procurement, and any other
208	vendor if the department deems it necessary to protect the
209	state's financial interests, shall, at the time of executing any
210	contract with the department, post an appropriate bond with the
211	department in an amount determined by the department to be
212	adequate to protect the state's interests but not higher than
213	the full amount estimated to be paid annually to the vendor
214	under the contract.
215	2.3.  Each major contract entered into by the department
216	pursuant to this section shall contain a provision for payment
217	of liquidated damages to the department for material
218	noncompliance by a vendor with a contract provision. The
219	department may require a liquidated damages provision in any
220	contract if the department deems it necessary to protect the
221	state's financial interests.
222	3.4.  The provisions of s. 120.57(3) apply to the
223	department's contracting process, except:
224	a.  A formal written protest of any decision, intended
225	decision, or other action subject to protest shall be filed
226	within 72 hours after receipt of notice of the decision,
227	intended decision, or other action.
228	b.  As an alternative to any provision of s. 120.57(3), the
229	department may proceed with the bid selection or contract award
230	process if the director of the department sets forth, in
231	writing, particular facts and circumstances which demonstrate
232	the necessity of continuing the procurement process or the
233	contract award process in order to avoid a substantial
234	disruption to the provision of any scheduled insurance services.
235	(d)(e)  The Department of Management Services and the
236	Division of State Group Insurance may not prohibit or limit any
237	properly licensed insurer, health maintenance organization,
238	prepaid limited health services organization, or insurance agent
239	from competing for any insurance product or plan purchased,
240	provided, or endorsed by the department or the division on the
241	basis of the compensation arrangement used by the insurer or
242	organization for its agents.
243	(e)1.(f)  For plan years that begin before January 1, 2013
244	Except as provided for in subparagraph (h)2., the state
245	contribution toward the cost of any plan in the state group
246	insurance program shall be uniform with respect to all state
247	employees in a state collective bargaining unit participating in
248	the same coverage tier in the same plan. This section does not
249	prohibit the development of separate benefit plans for officers
250	and employees exempt from the career service or the development
251	of separate benefit plans for each collective bargaining unit.
252	2.  For the plan year that begins on January 1, 2013, the
253	state contribution toward the cost of any health insurance plan
254	in the state group insurance program shall be as provided in s.
255	110.12304. This section does not prohibit the development of
256	separate benefit plans for officers and employees exempt from
257	the career service or the development of separate benefit plans
258	for each collective bargaining unit.
259	(f)(g)  Participation by individuals in the program is
260	available to all state officers, full-time state employees, and
261	part-time state employees; and such participation in the program
262	or any plan is voluntary. Participation in the program is also
263	available to retired state officers and employees, as defined in
264	paragraph (2)(h)(g), who elect at the time of retirement to
265	continue coverage under the program, but they may elect to
266	continue all or only part of the coverage they had at the time
267	of retirement. A surviving spouse may elect to continue coverage
268	only under a state group health insurance plan, a TRICARE
269	supplemental insurance plan, or a health maintenance
270	organization plan.
271	(g)(h)1.  A person eligible to participate in the state
272	group insurance program may be authorized by rules adopted by
273	the department to select any benefits and coverage that may be
274	offered to qualified persons as authorized by the Legislature
275	and approved in accordance with applicable federal regulations,
276	in lieu of participating in the state group health insurance
277	plan, to exercise an option to elect membership in a health
278	maintenance organization plan which is under contract with the
279	state in accordance with criteria established by this section
280	and by said rules. The offer of optional membership in a health
281	maintenance organization plan permitted by this paragraph may be
282	limited or conditioned by rule as may be necessary to meet the
283	requirements of state and federal laws.
284	2.  For the plan years beginning in January 2012 and
285	January 2013, the department shall contract with health
286	maintenance organizations seeking to participate in the state
287	group insurance program through a competitive request for
288	proposal or other procurement process consistent with s.
289	110.12302, as developed by the Department of Management Services
290	and determined to be appropriate.
291	a.  For the 2012 plan year, the department shall establish
292	a schedule of minimum benefits for health maintenance
293	organization coverage, and that schedule shall include all
294	services covered by participating health maintenance
295	organizations in the 2011 plan year. For the 2013 plan year,
296	subject to legislative approval, the department shall, in
297	consultation with the independent benefits manager, establish a
298	schedule of minimum benefits for health maintenance organization
299	coverage, and that schedule shall be consistent with the benefit
300	levels described in paragraph (j): physician services; inpatient
301	and outpatient hospital services; emergency medical services,
302	including out-of-area emergency coverage; diagnostic laboratory
303	and diagnostic and therapeutic radiologic services; mental
304	health, alcohol, and chemical dependency treatment services
305	meeting the minimum requirements of state and federal law;
306	skilled nursing facilities and services; prescription drugs;
307	age-based and gender-based wellness benefits; and other benefits
308	as may be required by the department. Additional services may be
309	provided subject to the contract between the department and the
310	HMO. As used in this paragraph, the term "age-based and gender-
311	based wellness benefits" includes aerobic exercise, education in
312	alcohol and substance abuse prevention, blood cholesterol
313	screening, health risk appraisals, blood pressure screening and
314	education, nutrition education, program planning, safety belt
315	education, smoking cessation, stress management, weight
316	management, and women's health education.
317	b.  For the plan year beginning January 2012, the
318	department may establish uniform deductibles, copayments,
319	coverage tiers, or coinsurance schedules for all participating
320	HMO plans.
321	c.  The department may require detailed information from
322	each health maintenance organization participating in the
323	procurement process, including information pertaining to
324	organizational status, experience in providing prepaid health
325	benefits, accessibility of services, financial stability of the
326	plan, quality of management services, accreditation status,
327	quality of medical services, network access and adequacy,
328	performance measurement, ability to meet the department's
329	reporting requirements, and the actuarial basis of the proposed
330	rates and other data determined by the director to be necessary
331	for the evaluation and selection of health maintenance
332	organization plans and negotiation of appropriate rates for
333	these plans. Upon receipt of proposals by health maintenance
334	organization plans and the evaluation of those proposals, the
335	department may negotiate enter into negotiations with all of the
336	plans or a subset of the plans, as the department determines
337	appropriate. Nothing shall preclude The department may negotiate
338	from negotiating regional or statewide contracts with health
339	maintenance organization plans when this is cost-effective and
340	when the department determines that the plan offers high value
341	to enrollees.
342	d.  The department may limit the number of HMOs that it
343	contracts with in each service area based on the nature of the
344	bids the department receives, the number of state employees in
345	the service area, or any unique geographical characteristics of
346	the service area. The department shall establish by rule service
347	areas throughout the state. For the 2012 and 2013 plan years,
348	the department shall contract in each defined service area with
349	no fewer than the same number of HMOs as it contracted with at
350	the beginning of the 2011 plan year.
351	e.  All persons participating in the state group insurance
352	program may be required to contribute towards a total state
353	group health premium that may vary depending upon the plan and
354	coverage tier selected by the enrollee and the level of state
355	contribution authorized by the Legislature.
356	3.  The department is authorized to negotiate and to
357	contract with specialty psychiatric hospitals for mental health
358	benefits, on a regional basis, for alcohol, drug abuse, and
359	mental and nervous disorders. The department may establish,
360	subject to the approval of the Legislature pursuant to
361	subsection (5), any such regional plan upon completion of an
362	actuarial study to determine any impact on plan benefits and
363	premiums.
364	4.  In addition to contracting pursuant to subparagraph 2.,
365	the department may enter into contract with any HMO to
366	participate in the state group insurance program which:
367	a.  Serves greater than 5,000 recipients on a prepaid basis
368	under the Medicaid program;
369	b.  Does not currently meet the 25-percent non-
370	Medicare/non-Medicaid enrollment composition requirement
371	established by the Department of Health excluding participants
372	enrolled in the state group insurance program;
373	c.  Meets the minimum benefit package and copayments and
374	deductibles contained in sub-subparagraphs 2.a. and b.;
375	d.  Is willing to participate in the state group insurance
376	program at a cost of premiums that is not greater than 95
377	percent of the cost of HMO premiums accepted by the department
378	in each service area; and
379	e.  Meets the minimum surplus requirements of s. 641.225.
380
381	The department is authorized to contract with HMOs that meet the
382	requirements of sub-subparagraphs a.-d. prior to the open
383	enrollment period for state employees. The department is not
384	required to renew the contract with the HMOs as set forth in
385	this paragraph more than twice. Thereafter, the HMOs shall be
386	eligible to participate in the state group insurance program
387	only through the request for proposal or invitation to negotiate
388	process described in subparagraph 2.
389	3.5.  All enrollees in a state group health insurance plan,
390	a TRICARE supplemental insurance plan, or any health maintenance
391	organization plan have the option of changing to any other
392	health plan that is offered by the state within any open
393	enrollment period designated by the department. Open enrollment
394	shall be held at least once each calendar year.
395	4.6.  When a contract between a treating provider and the
396	state-contracted health maintenance organization is terminated
397	for any reason other than for cause, each party shall allow any
398	enrollee for whom treatment was active to continue coverage and
399	care when medically necessary, through completion of treatment
400	of a condition for which the enrollee was receiving care at the
401	time of the termination, until the enrollee selects another
402	treating provider, or until the next open enrollment period
403	offered, whichever is longer, but no longer than 6 months after
404	termination of the contract. Each party to the terminated
405	contract shall allow an enrollee who has initiated a course of
406	prenatal care, regardless of the trimester in which care was
407	initiated, to continue care and coverage until completion of
408	postpartum care. This does not prevent a provider from refusing
409	to continue to provide care to an enrollee who is abusive,
410	noncompliant, or in arrears in payments for services provided.
411	For care continued under this subparagraph, the program and the
412	provider shall continue to be bound by the terms of the
413	terminated contract. Changes made within 30 days before
414	termination of a contract are effective only if agreed to by
415	both parties.
416	5.7.  Any HMO participating in the state group insurance
417	program shall submit health care utilization and cost data to
418	the department, in such form and in such manner as the
419	department shall require, as a condition of participating in the
420	program. For any HMO that participated in the program prior to
421	January 2012 and is selected to participate in the 2012 or 2013
422	plan year, health care utilization and cost data for at least
423	the last contract period shall be submitted to the department
424	before a contract is entered into for the 2012 or 2013 plan
425	year. The department shall enter into negotiations with its
426	contracting HMOs to determine the nature and scope of the data
427	submission and the final requirements, format, penalties
428	associated with noncompliance, and timetables for submission.
429	These determinations shall be adopted by rule.
430	6.8.  The department may establish and direct, with respect
431	to collective bargaining issues, a comprehensive package of
432	insurance benefits that may include supplemental health and life
433	coverage, dental care, long-term care, vision care, and other
434	benefits it determines necessary to enable state employees to
435	select from among benefit options that best suit their
436	individual and family needs.
437	a.  Based upon a desired benefit package, the department
438	shall issue a request for proposal or invitation to negotiate
439	for health insurance providers interested in participating in
440	the state group insurance program, and the department shall
441	issue a request for proposal or invitation to negotiate for
442	insurance providers interested in participating in the non-
443	health-related components of the state group insurance program.
444	Upon receipt of all proposals, the department may enter into
445	contract negotiations with insurance providers submitting bids
446	or negotiate a specially designed benefit package. Insurance
447	providers offering or providing supplemental coverage as of May
448	30, 1991, which qualify for pretax benefit treatment pursuant to
449	s. 125 of the Internal Revenue Code of 1986, with 5,500 or more
450	state employees currently enrolled may be included by the
451	department in the supplemental insurance benefit plan
452	established by the department without participating in a request
453	for proposal, submitting bids, negotiating contracts, or
454	negotiating a specially designed benefit package. These
455	contracts shall provide state employees with the most cost-
456	effective and comprehensive coverage available; however, no
457	state or agency funds may not shall be contributed toward the
458	cost of any part of the premium of such supplemental benefit
459	plans. With respect to dental coverage, the division shall
460	include in any solicitation or contract for any state group
461	dental program made after July 1, 2001, a comprehensive
462	indemnity dental plan option which offers enrollees a completely
463	unrestricted choice of dentists. If a dental plan is endorsed,
464	or in some manner recognized as the preferred product, such plan
465	shall include a comprehensive indemnity dental plan option which
466	provides enrollees with a completely unrestricted choice of
467	dentists.
468	b.  Pursuant to the applicable provisions of s. 110.161,
469	and s. 125 of the Internal Revenue Code of 1986, the department
470	shall enroll in the pretax benefit program those state employees
471	who voluntarily elect coverage in any of the supplemental
472	insurance benefit plans as provided by sub-subparagraph a.
473	c.  This section may not Nothing herein contained shall be
474	construed to prohibit insurance providers from continuing to
475	provide or offer supplemental benefit coverage to state
476	employees as provided under existing agency plans.
477	(h)(i)  The benefits of the insurance authorized by this
478	section are shall not be in lieu of any benefits payable under
479	chapter 440, the Workers' Compensation Law, and. the insurance
480	authorized by this section does law shall not be deemed to
481	constitute insurance to secure workers' compensation benefits as
482	required by chapter 440.
483	(i)(j)  Notwithstanding the provisions of paragraph (e) (f)
484	requiring uniform contributions, and for the 2011-2012 2010-2011
485	fiscal year only, the state contribution toward the cost of any
486	plan in the state group insurance plan shall be the difference
487	between the overall premium and the employee contribution. This
488	subsection expires June 30, 2012 2011.
489	(j)  Beginning with the 2013 plan year, benefits offered in
490	the state group health insurance program shall be the following:
491	1.  Platinum Level benefits, which are actuarially
492	equivalent to 90 percent of the benefits covered in the 2012
493	plan year.
494	2.  Gold Level benefits, which are actuarially equivalent
495	to 80 percent of the benefits covered in the 2012 plan year.
496	3.  Silver Level benefits, which are actuarially equivalent
497	to 70 percent of the benefits covered in the 2012 plan year.
498	4.  Bronze Level benefits, which are actuarially equivalent
499	to 60 percent of the benefits covered in the 2012 plan year.
500	(4)  PAYMENT OF PREMIUMS; CONTRIBUTION BY STATE; LIMITATION
501	ON ACTIONS TO PAY AND COLLECT PREMIUMS.-
502	(b)  If a state officer or full-time state employee selects
503	membership in a health maintenance organization as authorized by
504	paragraph (3)(g)(h), the officer or employee is entitled to a
505	state contribution toward individual and dependent membership as
506	provided by the Legislature through the appropriations act.
507	(5)  DEPARTMENT POWERS AND DUTIES.-The department is
508	responsible for the administration of the state group insurance
509	program. The department shall initiate and supervise the program
510	as established by this section and shall adopt such rules as are
511	necessary to perform its responsibilities. To implement this
512	program, the department shall, with prior approval by the
513	Legislature:
514	(a)  Determine the benefits to be provided and the
515	contributions to be required for the state group insurance
516	program. Such determinations, whether for a contracted plan or a
517	self-insurance plan pursuant to paragraph (c), do not constitute
518	rules within the meaning of s. 120.52 or final orders within the
519	meaning of s. 120.52. Any physician's fee schedule used in the
520	health and accident plan shall not be available for inspection
521	or copying by medical providers or other persons not involved in
522	the administration of the program. However, in the determination
523	of the design of the program, the department shall consider
524	existing and complementary benefits provided by the Florida
525	Retirement System and the Social Security System.
526	(b)  Prepare, in cooperation with the Office of Insurance
527	Regulation of the Financial Services Commission, the
528	specifications necessary to implement the program.
529	(c)  Competitively procure a contract on a competitive
530	proposal basis with an insurance carrier or carriers, or
531	professional administrator, determined by the Office of
532	Insurance Regulation of the Financial Services Commission to be
533	fully qualified, financially sound, and capable of meeting all
534	servicing requirements. Alternatively, the department may self-
535	insure any plan or plans contained in the state group insurance
536	program subject to approval based on actuarial soundness by the
537	Office of Insurance Regulation. The department may contract with
538	an insurance company or professional administrator qualified and
539	approved by the Office of Insurance Regulation to administer
540	such plan. Before entering into any contract, the department
541	shall advertise for competitive proposals, and such contract
542	shall be let upon the consideration of the benefits provided in
543	relationship to the cost of such benefits. In the selection of a
544	third-party administrator determining which entity to contract
545	with, the department shall, at a minimum, consider: the entity's
546	previous experience and expertise in administering group
547	insurance programs of the type it proposes to administer; the
548	entity's ability to specifically perform its contractual
549	obligations in this state and other governmental jurisdictions;
550	the entity's anticipated administrative costs and claims
551	experience; the entity's capability to adequately provide
552	service coverage and sufficient number of experienced and
553	qualified personnel in the areas of claims processing,
554	recordkeeping, and underwriting, as determined by the
555	department; the entity's accessibility to state employees and
556	providers; the financial solvency of the entity, using accepted
557	business sector measures of financial performance. The
558	department may contract for medical services which will improve
559	the health or reduce medical costs for employees who participate
560	in the state group insurance plan.
561	(d)  With respect to a state group health insurance plan,
562	be authorized to require copayments with respect to all
563	providers under the plan.
564	(e)  Have authority to establish a voluntary program for
565	comprehensive health maintenance, which may include health
566	educational components and health appraisals.
567	(f)  With respect to any contract with an insurance carrier
568	or carriers or professional administrator entered into by the
569	department, require that the state and the enrollees be held
570	harmless and indemnified for any financial loss caused by the
571	failure of the insurance carrier or professional administrator
572	to comply with the terms of the contract.
573	(g)  With respect to any contract with an insurance carrier
574	or carriers, or professional administrator entered into by the
575	department, require that the carrier or professional
576	administrator provide written notice to individual enrollees if
577	any payment due to any health care provider of the enrollee
578	remains unpaid beyond a period of time as specified in the
579	contract.
580	(h)  Have authority to establish other voluntary programs
581	to be funded on a pretax contribution basis or on a posttax
582	contribution basis, as the department determines.
583	(i)  Contract with a single custodian to provide services
584	necessary to implement and administer the health savings
585	accounts authorized in subsection (12).
586
587	Final decisions concerning enrollment, the existence of
588	coverage, or covered benefits under the state group insurance
589	program may shall not be delegated or deemed to have been
590	delegated by the department. This subsection expires January 1,
591	2014.
592	(13)  FLORIDA STATE EMPLOYEE WELLNESS COUNCIL.-
593	(a)  There is created within the department the Florida
594	State Employee Wellness Council.
595	(b)  The council shall be an advisory body to the
596	department to provide health education information to employees
597	and to assist the department in developing minimum benefits for
598	all health care providers when providing age-based and gender-
599	based wellness benefits.
600	(c)  The council shall be composed of nine members
601	appointed by the Governor. When making appointments to the
602	council, the Governor shall appoint persons who are residents of
603	the state and who are highly knowledgeable concerning, active
604	in, and recognized leaders in the health and medical field, at
605	least one of whom must be an employee of the state. Council
606	members shall equitably represent the broadest spectrum of the
607	health industry and the geographic areas of the state. Not more
608	than one member of the council may be from any one company,
609	organization, or association.
610	(d)1.  Council members shall be appointed to 4-year terms,
611	except that the initial terms shall be staggered. The Governor
612	shall appoint three members to 2-year terms, three members to 3-
613	year terms, and three members to 4-year terms.
614	2.  A member's absence from three consecutive meetings
615	shall result in his or her automatic removal from the council. A
616	vacancy on the council shall be filled for the remainder of the
617	unexpired term.
618	(e)  The council shall annually elect from its membership
619	one member to serve as chair of the council and one member to
620	serve as vice chair.
621	(f)  The first meeting of the council shall be called by
622	the chair not more than 60 days after the council members are
623	appointed by the Governor. The council shall thereafter meet at
624	least once quarterly and may meet more often as necessary. The
625	department shall provide staff assistance to the council which
626	shall include, but not be limited to, keeping records of the
627	proceedings of the council and serving as custodian of all
628	books, documents, and papers filed with the council.
629	(g)  A majority of the members of the council constitutes a
630	quorum.
631	(h)  Members of the council shall serve without
632	compensation, but are entitled to reimbursement for per diem and
633	travel expenses as provided in s. 112.061 while performing their
634	duties.
635	(i)  The council shall:
636	1.  Work to encourage participation in wellness programs by
637	state employees. The council may prepare informational programs
638	and brochures for state agencies and employees.
639	2.  In consultation with the department, develop standards
640	and criteria for age-based and gender-based wellness programs.
641	Section 2.  Section 110.12302, Florida Statutes, is amended
642	to read:
643	110.12302  Costing options for plan designs required for
644	contract solicitation; best value recommendations; required plan
645	design.-
646	(1)  For the state group insurance program, the Department
647	of Management Services shall require costing options for both
648	fully insured and self-insured plan designs, or some combination
649	thereof, as part of the department's solicitation for health
650	maintenance organization contracts. Prior to contracting, the
651	department shall recommend to the Legislature, no later than
652	February 1, 2011, the best value to the State group insurance
653	program relating to health maintenance organizations.
654	(2)  Beginning with the 2012 plan year, the department may
655	only contract with health maintenance organizations for a self-
656	insured plan design. In implementing this subsection, the
657	department shall ensure that no fewer health maintenance
658	organizations participate in the state group insurance program
659	than participated in each service area in the 2011 plan year.
660	Section 3.  Section 110.12303, Florida Statutes, is created
661	to read:
662	110.12303  Independent benefits manager.-
663	(1)  The department shall competitively procure an
664	independent benefits manager. The department shall initiate the
665	procurement no later than August 1, 2011.
666	(2)  The independent benefits manager may not:
667	(a)  Be owned or controlled by any HMO or insurer.
668	(b)  Have an ownership interest in any HMO or insurer.
669	(c)  Have any direct or indirect financial interest in any
670	HMO or insurer.
671	(3)  The independent benefits manager must have substantial
672	experience in the design and administration of employee benefit
673	programs for large employers and public employers, including
674	experience administering plans that qualify as cafeteria plans
675	pursuant to s. 125 of the Internal Revenue Code.
676	(4)  The independent benefits manager shall:
677	(a)  Provide an ongoing assessment of trends in benefits
678	and employer-sponsored insurance that affect the state group
679	insurance program.
680	(b)  Conduct comprehensive analysis of the state group
681	insurance program, including available benefits, coverage
682	options, and claims experience.
683	(c)  Evaluate designs for the state group insurance
684	program, including a full cafeteria plan, an employer-sponsored
685	multicarrier exchange plan, and alternatives to and variations
686	of these designs.
687	(d)  Identify and establish appropriate adjustment
688	procedures necessary to respond to any risk segmentation that
689	may occur when increased choices are offered to employees.
690	(e)  Submit recommendations for any modifications to the
691	state group insurance program no later than January 1 of each
692	year.
693	(f)  Establish a transition plan for assuming the
694	responsibilities described in subsection (5).
695	(g)  Develop a plan to convert the state group insurance
696	program to a defined contribution plan. The plan shall be
697	submitted to the Legislature by January 1, 2013, and include
698	recommendations for:
699	1.  An implementation timeline for conversion as of the
700	2014 plan year or an explanation of the factors that prevent
701	implementation by 2014 and a timeline for conversion in the 2015
702	plan year.
703	2.  Employer and employee contribution policies, including
704	provisions that reward and incentivize nonsmoking and other
705	healthy lifestyle choices.
706	3.  Steps necessary for maintaining or improving total
707	employee compensation levels when a transition to a defined
708	contribution plan is initiated.
709	4.  Establishing an employment-based benefits exchange or
710	implementing a full cafeteria plan to provide a variety of plan
711	and benefit options.
712	5.  Securing the appropriate federal approval for plan
713	revisions.
714	(h)  Subject to approval by the Legislature, direct and
715	implement the plan described in paragraph (g).
716	(5)  Notwithstanding s. 110.123 and beginning no later than
717	the 2013 plan year, the independent benefits manager shall:
718	(a)  Manage the state group insurance program, including
719	negotiation and supervision of contracts and other
720	administrative functions as may be necessary.
721	(b)  If the Legislature authorizes the creation of a state
722	employee benefits exchange, certify health insurance plans,
723	health maintenance organizations, and other providers eligible
724	to participate.
725	(c)  If the Legislature authorizes the implementation of a
726	full cafeteria plan, supervise the procurement process and
727	conduct the contract negotiations with providers that are
728	necessary for their participation in defined service areas.
729	(d)  Develop and implement wellness initiatives for
730	enrollees.
731	(e)  Provide enrollee education and decision support tools,
732	including an online interface, to assist enrollees in choosing
733	benefit plans that best suit their individual needs.
734	(f)  Ensure compliance with applicable federal and state
735	regulations.
736	(6)  The department shall manage the contract with the
737	independent benefits manager and shall provide financial
738	management of the program, including financial and budget
739	oversight of program operations, management of vendor payments
740	and premium administration, analyzing and forecasting of program
741	revenues and expenditures, monitoring of financial compliance of
742	contractors, and auditing.
743	Section 4.  Section 110.12304, Florida Statutes, is created
744	to read:
745	110.12304  State and employee contributions toward health
746	plan premium cost.-
747	(1)  For the 2013 plan year, the state's share of
748	contribution toward the cost of the health plan shall be:
749	(a)  Platinum Level: 90 percent for an individual plan and
750	86 percent for a family plan.
751	(b)  Gold Level: 85 percent for an individual or a family
752	plan.
753	(c)  Silver Level: 80 percent for an individual or a family
754	plan.
755	(d)  Bronze Level: 75 percent for an individual or a family
756	plan.
757	(2)  The employee shall pay the remaining cost of the plan
758	premium; however, if the employee chooses a Gold, Silver, or
759	Bronze Level plan, the employee's salary shall be increased by
760	60 percent of the difference between the premium for the
761	employee's selected plan and the premium for a Platinum Level
762	plan.
763	Section 5.  Section 110.12305, Florida Statutes, is created
764	to read:
765	110.12305  Health insurance risk pool.-
766	(1)  For the 2012 plan year and for each plan year
767	thereafter, the department shall establish a single health
768	insurance risk pool for the state group insurance plans.
769	(2)  For the 2012 plan year and for each plan year
770	thereafter, the department shall continue to contract with
771	multiple health maintenance organizations in each service area
772	based on the nature of the bids the department receives, the
773	number of state employees in the service area, or any unique
774	geographical characteristics of the service area.
775	Section 6.  This act shall take effect July 1, 2011.

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