Florida Senate - 2013                             CS for SB 1842
       
       
       
       By the Committees on Appropriations; and Banking and Insurance
       
       
       
       
       576-04708A-13                                         20131842c1
    1                        A bill to be entitled                      
    2         An act relating to health insurance; creating s.
    3         624.25, F.S.; providing that a provision of the
    4         Florida Insurance Code applies unless it conflicts
    5         with a provision of the Patient Protection and
    6         Affordable Care Act (PPACA); creating s. 624.26, F.S.;
    7         authorizing the Office of Insurance Regulation to
    8         review forms and perform market conduct examinations
    9         for compliance with PPACA and to report potential
   10         violations to the federal Department of Health and
   11         Human Services; authorizing the Division of Consumer
   12         Services of the Department of Financial Services to
   13         respond to complaints related to PPACA and to report
   14         violations to the office and the Department of Health
   15         and Human Services; providing that certain
   16         determinations by the office or the Department of
   17         Financial Services are not subject to certain
   18         challenges under ch. 120, F.S.; amending s. 624.34,
   19         F.S.; conforming provisions to changes made by this
   20         act with respect to the registration of navigators
   21         under the Florida Insurance Code; providing a
   22         directive to the Division of Law Revision and
   23         Information; creating s. 626.995, F.S.; providing the
   24         scope of part XII, ch. 626, F.S.; creating s.
   25         626.9951, F.S.; providing definitions; creating s.
   26         626.9952, F.S.; requiring the registration of
   27         navigators with the Department of Financial Services;
   28         providing the purpose for such registration; creating
   29         s. 626.9953, F.S.; providing qualifications for
   30         registration; providing for submission of a written
   31         application; specifying fees; requiring an applicant
   32         to submit fingerprints and pay a processing fee;
   33         creating s. 626.9954, F.S.; specifying criteria for
   34         disqualification from registration; authorizing the
   35         department to adopt rules establishing disqualifying
   36         time periods; creating s. 626.9955, F.S.; requiring
   37         the department to have a publicly available list of
   38         navigators and to report certain information to the
   39         exchange; creating s. 626.9956, F.S.; requiring a
   40         navigator to notify the department of a change of
   41         specified identifying information; creating s.
   42         626.9957, F.S.; prohibiting specified conduct;
   43         providing grounds for denial, suspension, or
   44         revocation of registration; providing for
   45         administrative fines and other disciplinary actions;
   46         creating s. 626.9958, F.S.; authorizing the department
   47         to adopt rules; amending s. 627.402, F.S.; providing
   48         definitions for “grandfathered health plan,”
   49         “nongrandfathered health plan,” and “PPACA”; amending
   50         s. 627.410, F.S.; providing an exception to the
   51         prohibition against an insurer issuing a new policy
   52         form after discontinuing the availability of a similar
   53         policy form when the form does not comply with PPACA;
   54         requiring the experience of grandfathered health plans
   55         and nongrandfathered health plans to be separated;
   56         providing that nongrandfathered health plans are not
   57         subject to rate review or approval by the office;
   58         specifying that such rates for such health plans must
   59         be filed with the office and are exempt from other
   60         specified rate requirements; requiring insurers and
   61         health maintenance organizations issuing such health
   62         plans to include a notice of the estimated impact of
   63         PPACA on monthly premiums with the first issuance or
   64         renewal of the policy; requiring the Financial
   65         Services Commission to adopt the notice format by
   66         rule; requiring the notice to be filed with the office
   67         for informational purposes; providing for the
   68         calculation of the estimated premium impact, which
   69         must be included in the notice; requiring the office,
   70         in consultation with the department, to develop a
   71         summary of the impact to be made available on their
   72         respective websites; providing for future repeal;
   73         amending s. 627.411, F.S.; providing that grounds for
   74         disapproval of rates do not apply to nongrandfathered
   75         health plans; providing for future repeal of this
   76         provision; amending s. 627.6425, F.S.; allowing an
   77         insurer to nonrenew coverage only for all
   78         nongrandfathered health plans under certain
   79         conditions; amending s. 627.6484, F.S.; providing that
   80         coverage for policyholders of the Florida
   81         Comprehensive Health Association terminates on a
   82         specified date; requiring the association to provide
   83         specified assistance to policyholders in obtaining
   84         other health insurance coverage; requiring the
   85         association to notify policyholders of termination of
   86         coverage and information on how to obtain other
   87         coverage; requiring the association to determine the
   88         amount of a final assessment or to refund any surplus
   89         funds to member insurers, and to otherwise complete
   90         program responsibilities; repealing s. 627.64872,
   91         related to the Florida Health Insurance Plan;
   92         providing for the future repeal of ss. 627.648,
   93         627.6482, 627.6484, 627.6486, 627.6488, 627.6489,
   94         627.649, 627.6492, 627.6494, 627.6496, 627.6498, and
   95         627.6499, F.S., relating to the Florida Comprehensive
   96         Health Association; amending s. 627.6571, F.S.;
   97         allowing an insurer to nonrenew coverage only for all
   98         nongrandfathered health plans under certain
   99         conditions; amending s. 627.6675, F.S.; specifying
  100         conditions for nonrenewal of a conversion policy;
  101         amending s. 627.6699, F.S.; adding and revising
  102         definitions used in the Employee Health Care Access
  103         Act; providing that a small employer carrier is not
  104         required to use gender as a rating factor for a
  105         nongrandfathered health plan; requiring carriers to
  106         separate the experience of grandfathered health plans
  107         and nongrandfathered health plans for determining
  108         rates; amending s. 641.31, F.S.; providing that
  109         nongrandfathered health plans are not subject to rate
  110         review or approval by the office; providing for future
  111         repeal of this provision; amending s. 641.3922, F.S.;
  112         specifying conditions for nonrenewal of a health
  113         maintenance organization conversion contract;
  114         providing an appropriation; providing effective dates.
  115  
  116  Be It Enacted by the Legislature of the State of Florida:
  117  
  118         Section 1. Section 624.25, Florida Statutes, is created to
  119  read:
  120         624.25 Patient Protection and Affordable Care Act.—A
  121  provision of the Florida Insurance Code, or rule adopted
  122  pursuant to the code, applies unless such provision or rule
  123  prevents the application of a provision of PPACA. As used in
  124  this section, the term “PPACA” has the same meaning as provided
  125  in s. 627.402.
  126         Section 2. Section 624.26, Florida Statutes, is created to
  127  read:
  128         624.26Collaborative arrangement with the Department of
  129  Health and Human Services.—
  130         (1) As used in this section, the term “PPACA” has the same
  131  meaning as provided in s. 627.402.
  132         (2) When reviewing forms filed by health insurers or health
  133  maintenance organizations pursuant to s. 627.410 or s. 641.31(3)
  134  for compliance with state law, the office may also review such
  135  forms for compliance with PPACA. If the office determines that a
  136  form does not comply with PPACA, the office shall inform the
  137  insurer or organization of the reason for noncompliance. If the
  138  office determines that a form ultimately used by an insurer or
  139  organization does not comply with PPACA, the office may report
  140  such potential violation to the federal Department of Health and
  141  Human Services. The review of forms by the office under this
  142  subsection does not include review of the rates, rating
  143  practices, or the relationship of benefits to the rates.
  144         (3) When performing market conduct examinations or
  145  investigations of health insurers or health maintenance
  146  organizations as authorized under s. 624.307, s. 624.3161, or s.
  147  641.3905 for compliance with state law, the office may include
  148  compliance with PPACA within the scope of such examination or
  149  investigation. If the office determines that an insurer’s or
  150  organization’s operations do not comply with PPACA, the office
  151  shall inform the insurer or organization of the reason for such
  152  determination. If the insurer or organization does not take
  153  action to comply with PPACA, the office may report such
  154  potential violation to the federal Department of Health and
  155  Human Resources.
  156         (4) The department’s Division of Consumer Services may
  157  respond to complaints by consumers relating to a requirement of
  158  PPACA as authorized under s. 20.121(2)(h), and report apparent
  159  or potential violations to the office and to the federal
  160  Department of Health and Human Services.
  161         (5) A determination made by the office or department
  162  pursuant to this section regarding compliance with PPACA does
  163  not constitute a determination that affects the substantial
  164  interests of any party for purposes of chapter 120.
  165         Section 3. Subsection (2) of section 624.34, Florida
  166  Statutes, is amended to read:
  167         624.34 Authority of Department of Law Enforcement to accept
  168  fingerprints of, and exchange criminal history records with
  169  respect to, certain persons.—
  170         (2) The Department of Law Enforcement may accept
  171  fingerprints of individuals who apply for a license as an agent,
  172  customer representative, adjuster, service representative,
  173  navigator, or managing general agent or the fingerprints of the
  174  majority owner, sole proprietor, partners, officers, and
  175  directors of a corporation or other legal entity that applies
  176  for licensure with the department or office under the provisions
  177  of the Florida Insurance Code.
  178         Section 4. The Division of Law Revision and Information is
  179  directed to create part XII of chapter 626, Florida Statutes,
  180  consisting of ss. 626.995-626.9958, Florida Statutes, and to
  181  entitle that part “Navigators.”
  182         Section 5. Section 626.995, Florida Statutes, is created to
  183  read:
  184         626.995 Scope of part.-This part applies only to
  185  navigators.
  186         Section 6. Section 626.9951, Florida Statutes, is created
  187  to read:
  188         626.9951 Definitions.-As used in this part, the term:
  189         (1) “Exchange” means an exchange established for this state
  190  under PPACA.
  191         (2) “Financial services business” means a financial
  192  activity regulated by the Department of Financial Services, the
  193  Office of Insurance Regulation, or the Office of Financial
  194  Regulation.
  195         (3) “Navigator” means an individual authorized by an
  196  exchange to serve as a navigator, or who works on behalf of an
  197  entity authorized by an exchange to serve as a navigator,
  198  pursuant to 42 U.S.C. s. 18031(i)(1), who facilitates the
  199  selection of a qualified health plan through the exchange and
  200  performs any other duties specified under 42 U.S.C. s.
  201  18031(i)(3).
  202         (4) “PPACA” has the same meaning as in s. 627.402.
  203         Section 7. Section 626.9952, Florida Statutes, is created
  204  to read:
  205         626.9952 Registration required; purpose.-
  206         (1) Beginning August 1, 2013, an individual may not act as,
  207  offer to act as, or advertise any service as a navigator unless
  208  registered with the department under this part.
  209         (2) The purpose of registration is to identify qualified
  210  individuals to assist the insurance-buying public in selecting a
  211  qualified health plan through an exchange by providing fair,
  212  accurate, and impartial information regarding qualified health
  213  plans and the availability of premium tax credits and cost
  214  sharing reductions for such plans, and to protect the public
  215  from unauthorized activities or conduct.
  216         Section 8. Section 626.9953, Florida Statutes, is created
  217  to read:
  218         626.9953 Qualifications for registration; application
  219  required.-
  220         (1) The department may not approve the registration of an
  221  individual as a navigator who is found by the department to be
  222  untrustworthy or incompetent, and who does not meet the
  223  following requirements:
  224         (a) Is a natural person at least 18 years of age;
  225         (b) Is a United States citizen or legal alien who possesses
  226  work authorization from the United States Bureau of Citizenship
  227  and Immigration Services;
  228         (c) Has successfully completed all training for a navigator
  229  as required by the federal government or the exchange.
  230         (2) To be registered as a navigator, an applicant must
  231  submit a sworn, signed, written application to the department on
  232  a form prescribed by the department, meet the qualifications for
  233  registration as a navigator, and make payment in advance of all
  234  applicable fees. Individuals previously disqualified must apply
  235  for reinstatement using the same procedures required for initial
  236  registration.
  237         (3) The applicant must set forth all of the following
  238  information in the application:
  239         (a) His or her full name, age, social security number,
  240  residence address, business address, mailing address, contact
  241  telephone numbers, including a business telephone number if
  242  applicable, and e-mail address.
  243         (b) Whether he or she has been refused a financial services
  244  license or has voluntarily surrendered or has had his or her
  245  financial services license suspended or revoked in this or any
  246  other state.
  247         (c) His or her native language.
  248         (d) His or her highest level of education.
  249         (e) A statement of acknowledgement of conduct that is
  250  prohibited under this part and the penalties associated with
  251  such conduct.
  252         (f) Certification that the training required by the federal
  253  government or the exchange has been successfully completed.
  254         (g) Such additional information as the department may deem
  255  proper to enable it to determine the character, experience,
  256  ability, and other qualifications of the applicant to
  257  participate as a registered navigator.
  258         (4) Each application must be accompanied by payment of a
  259  nonrefundable $50 application filing fee to be deposited in the
  260  Insurance Regulatory Trust Fund.
  261         (5) An applicant must submit a set of his or her
  262  fingerprints to the department and pay the processing fee
  263  established under s. 624.501(24). The department shall submit
  264  the applicants’ fingerprints to the Department of Law
  265  Enforcement for processing state criminal history records checks
  266  and local criminal records checks through local law enforcement
  267  agencies and for forwarding to the Federal Bureau of
  268  Investigation for national criminal history records checks. The
  269  fingerprints shall be taken by a law enforcement agency, a
  270  designated examination center, or another department-approved
  271  entity. The department may not approve an application for
  272  registration as a navigator if fingerprints have not been
  273  submitted.
  274         (6) In addition to information requested in the
  275  application, the department may propound any reasonable
  276  interrogatories to an applicant relating to the applicant’s
  277  qualifications, residence, prospective place of business, and
  278  any other matters that, in the opinion of the department, are
  279  deemed necessary or advisable for the protection of the public
  280  and to ascertain the applicant’s qualifications. In addition to
  281  the submission of fingerprints for criminal background
  282  screening, the department may make such further investigations
  283  as it may deem advisable of the applicant’s character,
  284  experience, background, and fitness for registration as
  285  specified under this part.
  286         (7) Pursuant to the federal Personal Responsibility and
  287  Work Opportunity Reconciliation Act of 1996, an applicant must
  288  provide his or her social security number in accordance with
  289  subsection (3) for the purpose of administering the Title IV-D
  290  program for child support enforcement.
  291         Section 9. Section 626.9954, Florida Statutes, is created
  292  to read:
  293         626.9954 Disqualification from registration.—
  294         (1) As used in this section, the terms “felony of the first
  295  degree” and “capital felony” include all felonies so designated
  296  by the laws of this state, as well as any felony so designated
  297  in the jurisdiction in which the plea is entered or judgment is
  298  rendered.
  299         (2)An applicant who commits a felony of the first degree;
  300  a capital felony; a felony involving money laundering, fraud, or
  301  embezzlement; or a felony directly related to the financial
  302  services business is permanently barred from applying for
  303  registration under this part. This bar applies to convictions,
  304  guilty pleas, or nolo contendere pleas, regardless of
  305  adjudication, by an applicant.
  306         (3)For all other crimes not described in subsection (2),
  307  the department may adopt rules establishing the process and
  308  application of disqualifying periods including:
  309         (a)A 15-year disqualifying period for all felonies
  310  involving moral turpitude which are not specifically included in
  311  subsection (2).
  312         (b)A 7-year disqualifying period for all felonies not
  313  specifically included in subsection (2) or paragraph (a).
  314         (c)A 7-year disqualifying period for all misdemeanors
  315  directly related to the financial services business.
  316         (4)The department may adopt rules providing additional
  317  disqualifying periods due to the commitment of multiple crimes
  318  and other factors reasonably related to the applicant’s criminal
  319  history. The rules must provide for mitigating and aggravating
  320  factors. However, mitigation may not result in a disqualifying
  321  period of less than 7 years and may not mitigate the
  322  disqualifying periods in paragraph (3)(b) or paragraph (3)(c).
  323         (5)For purposes of this section, the disqualifying periods
  324  begin upon the applicant’s final release from supervision or
  325  upon completion of the applicant’s criminal sentence, including
  326  the payment of fines, restitution, and court costs for the crime
  327  for which the disqualifying period applies.
  328         (6)After the disqualifying period has been met, the burden
  329  is on the applicant to demonstrate to the satisfaction of the
  330  department that he or she has been rehabilitated and does not
  331  pose a risk to the insurance-buying public and is otherwise
  332  qualified for registration.
  333         (7)Section 112.011 does not apply to an applicant for
  334  registration as a navigator.
  335         Section 10. Section 626.9955, Florida Statutes, is created
  336  to read:
  337         626.9955 Registered navigator list.—Upon approval of an
  338  application for registration under this part, the department
  339  shall add the name of the registrant to its publicly available
  340  list of registered navigators in order for operators of an
  341  exchange and other interested parties to validate a navigator’s
  342  registration.
  343         Section 11. Section 626.9956, Florida Statutes, is created
  344  to read:
  345         626.9956 Notice of change of registrant information.—A
  346  navigator must notify the department, in writing, within 30 days
  347  after a change of name, residence address, principal business
  348  street address, mailing address, contact telephone number,
  349  including a business telephone number, or e-mail address.
  350  Failure to notify the department within the required time is
  351  subject to a fine of up to $250 for the first offense, and a
  352  fine of at least $500 or suspension or revocation for a
  353  subsequent offense. The department may adopt rules to administer
  354  and enforce this section.
  355         Section 12. Section 626.9957, Florida Statutes, is created
  356  to read:
  357         626.9957 Conduct prohibited; denial, revocation, or
  358  suspension of registration.—
  359         (1) As provided in s. 626.112, only a person licensed as an
  360  insurance agent or customer representative may engage in the
  361  solicitation of insurance. A person who engages in the
  362  solicitation of insurance as described in s. 626.112(1) without
  363  such license is subject to the penalties provided under s.
  364  626.112(9).
  365         (2) Whether licensed by the department as an agent or
  366  customer representative, a navigator may not perform any of the
  367  following while acting as a navigator:
  368         (a) Solicit, negotiate, or sell health insurance; or
  369         (b) Recommend the purchase of a particular health plan or
  370  represent one health plan as preferable over another.
  371         (3) A navigator may not:
  372         (a) Recommend the purchase, assist with enrollment, or
  373  provide services related to health benefit plans or products not
  374  offered through the exchange other than providing information
  375  about Medicaid and the Children’s Health Insurance Program
  376  (CHIP).
  377         (b) Recommend or assist with the cancellation of insurance
  378  coverage purchased outside the exchange; or
  379         (c) Receive compensation or anything of value from an
  380  insurer, health plan, business, or consumer in connection with
  381  performing the activities of a navigator, other than from the
  382  exchange or an entity or individual who has received a navigator
  383  grant pursuant to 45 C.F.R. s. 155.210.
  384         (4) The department may deny an application for registration
  385  as a navigator or suspend or revoke the registration of a
  386  navigator if it finds that any one or more of the following
  387  grounds exist:
  388         (a) Violation of this part or any applicable provision of
  389  this chapter.
  390         (b) Violation of department order or rule.
  391         (c) Having been the subject of disciplinary or other
  392  adverse action by the federal government or an exchange as a
  393  result of a violation of any provision of PPACA.
  394         (d) Lack one or more of the qualifications required under
  395  this part.
  396         (e) Material misstatement, misrepresentation, or fraud in
  397  obtaining or attempting to obtain registration under this part.
  398         (f) Any cause for which issuance of the registration could
  399  have been refused if it had existed and been known to the
  400  department.
  401         (g) Having been found guilty or having pled guilty or nolo
  402  contendere to a felony or a crime punishable by imprisonment of
  403  1 or more years under the law of the United States or any state
  404  thereof or under the law of any country, without regard to
  405  whether a judgment of conviction has been entered by the court
  406  having jurisdiction of such cases.
  407         (h) Failure to inform the department in writing within 30
  408  days after pleading guilty or nolo contendere to, or being
  409  convicted or found guilty of, any felony or crime punishable by
  410  imprisonment of 1 or more years under the law of the United
  411  States or of any state thereof, or under the law of any other
  412  country without regard to whether a judgment of conviction has
  413  been entered by the court having jurisdiction of the case.
  414         (i)Violating or knowingly aiding, assisting, procuring,
  415  advising, or abetting another in violating the insurance code or
  416  any order or rule of the department, commission, or office.
  417         (j) Failure to comply with any civil, criminal, or
  418  administrative action taken by the child support enforcement
  419  program under Title IV-D of the Social Security Act, 42 U.S.C.
  420  ss. 651 et seq., to determine paternity or to establish, modify,
  421  enforce, or collect support.
  422         (5) If the department finds that one or more grounds exist
  423  for the suspension or revocation of a navigator’s registration,
  424  the department may, in lieu of or in addition to suspension or
  425  revocation, impose upon the registrant an administrative penalty
  426  of up to $500, or if the department finds willful misconduct or
  427  a willful violation, an administrative penalty of up to $3,500.
  428         (6) A person who acts as a navigator without being
  429  registered under this part is subject to an administrative
  430  penalty of up to $1,500.
  431         (7)(a) Pursuant to s. 120.569, the department may issue a
  432  cease and desist order or an immediate final order to cease and
  433  desist to any person who violates this section.
  434         (b) A person who violates, or assists in the violation of,
  435  an order of the department while such order is in effect, is, at
  436  the discretion of the department, subject to:
  437         1. A monetary penalty of up to $50,000; or
  438         2. Suspension or revocation of such person’s registration.
  439         (8) If a navigator registered under this part enters a plea
  440  of guilty or nolo contendere, or is convicted by a court of a
  441  violation of this code or a felony, the registration of such
  442  individual shall be immediately revoked by the department. The
  443  individual may subsequently request a hearing pursuant to ss.
  444  120.569 and 120.57, which shall be expedited by the department.
  445  The sole issue at the hearing shall be whether the revocation of
  446  registration should be rescinded because such individual was not
  447  in fact convicted of a violation of this code or a felony.
  448         (9) An order by the department suspending the registration
  449  of a navigator must specify the period during which the
  450  suspension is to be in effect, which may not exceed 2 years. The
  451  registration shall remain suspended during the period specified,
  452  subject to rescission or modification of the order by the
  453  department, or modification or reversal by the court, before
  454  expiration of the suspension period. A registration that has
  455  been suspended may not be reinstated except upon the filing and
  456  approval of an application for reinstatement; however, the
  457  department may not approve an application for reinstatement if
  458  it finds that the circumstance or circumstances for which the
  459  registration was suspended still exist or are likely to recur.
  460  An application for reinstatement is also subject to
  461  disqualification and waiting periods before approval on the same
  462  grounds that apply to applications for registration under s.
  463  626.9954.
  464         (10)An individual whose registration has been revoked may
  465  not apply for registration as a navigator until 2 years after
  466  the effective date of such revocation or, if judicial review of
  467  such revocation is sought, within 2 years after the date of the
  468  final court order or decree affirming the revocation.
  469         (11) Revocation or suspension of the registration of a
  470  navigator under this part shall be immediately reported by the
  471  department to the operator of the exchange. An individual whose
  472  registration has been revoked or suspended may not act as, offer
  473  to act as, or advertise any service as a navigator until the
  474  department reinstates such registration.
  475         (12)The department may adopt rules establishing specific
  476  penalties against registrants in accordance with this section.
  477  The purpose of revocation or suspension is to provide a
  478  sufficient penalty to deter behavior incompatible with the
  479  public health, safety, and welfare. The imposition of a
  480  revocation or the duration of a suspension shall be based on the
  481  type of conduct and the likelihood that the propensity to commit
  482  further illegal conduct has been overcome at the time of
  483  eligibility for reinstatement. The length of suspension may be
  484  adjusted based on aggravating or mitigating factors established
  485  by rule and consistent with this purpose.
  486         Section 13. Section 626.9958, Florida Statutes, is created
  487  to read:
  488         626.9958 Rulemaking.—The department may adopt rules to
  489  administer this part.
  490         Section 14. Section 627.402, Florida Statutes, is amended
  491  to read:
  492         627.402 Definitions; specified certificates not included.
  493  As used in this part, the term:
  494         (1) “Grandfathered health plan” has the same meaning as
  495  provided in 42 U.S.C. s. 18011, subject to the conditions for
  496  maintaining status as a grandfathered health plan specified in
  497  regulations adopted by the federal Department of Health and
  498  Human Services in 45 C.F.R. s. 147.140.
  499         (2) “Nongrandfathered health plan” is a health insurance
  500  policy or health maintenance organization contract that is not a
  501  grandfathered health plan and does not provide the benefits or
  502  coverages specified under s. 627.6561(5)(b)-(e).
  503         (3)(1) “Policy” means a written contract of insurance or
  504  written agreement for or effecting insurance, or the certificate
  505  thereof, by whatever name called, and includes all clauses,
  506  riders, endorsements, and papers that which are a part thereof.
  507         (2) The term word “certificate” as used in this subsection
  508  section does not include certificates as to group life or health
  509  insurance or as to group annuities issued to individual
  510  insureds.
  511         (4) “PPACA” means the Patient Protection and Affordable
  512  Care Act, Pub. L. No. 111-148, as amended by the Health Care and
  513  Education Reconciliation Act of 2010, Pub. L. No. 111-152, and
  514  regulations adopted pursuant to those acts.
  515         Section 15. Subsections (2), (6), and (7) of section
  516  627.410, Florida Statutes, are amended, and subsection (9) is
  517  added to that section, to read:
  518         627.410 Filing, approval of forms.—
  519         (2) Every such filing must be made at least not less than
  520  30 days in advance of any such use or delivery. At the
  521  expiration of the such 30 days, the form so filed will be deemed
  522  approved unless prior thereto it has been affirmatively approved
  523  or disapproved by order of the office. The approval of any such
  524  form by the office constitutes a waiver of any unexpired portion
  525  of such waiting period. The office may extend by not more than
  526  an additional 15 days the period within which it may so
  527  affirmatively approve or disapprove any such form by up to 15
  528  days, by giving notice of such extension before expiration of
  529  the initial 30-day period. At the expiration of any such
  530  extended period as so extended, and in the absence of such prior
  531  affirmative approval or disapproval, any such form shall be
  532  deemed approved.
  533         (6)(a) An insurer may shall not deliver, or issue for
  534  delivery, or renew in this state any health insurance policy
  535  form until it has filed with the office a copy of every
  536  applicable rating manual, rating schedule, change in rating
  537  manual, and change in rating schedule; if rating manuals and
  538  rating schedules are not applicable, the insurer must file with
  539  the office applicable premium rates and any change in applicable
  540  premium rates. This paragraph does not apply to group health
  541  insurance policies, effectuated and delivered in this state,
  542  insuring groups of 51 or more persons, except for Medicare
  543  supplement insurance, long-term care insurance, and any coverage
  544  under which the increase in claim costs over the lifetime of the
  545  contract due to advancing age or duration is prefunded in the
  546  premium.
  547         (b) The commission may establish by rule, for each type of
  548  health insurance form, procedures to be used in ascertaining the
  549  reasonableness of benefits in relation to premium rates and may,
  550  by rule, exempt from any requirement of paragraph (a) any health
  551  insurance policy form or type thereof, (as specified in such
  552  rule,) to which form or type such requirements may not be
  553  practically applied or to which form or type the application of
  554  such requirements is not desirable or necessary for the
  555  protection of the public. With respect to any health insurance
  556  policy form or type thereof which is exempted by rule from any
  557  requirement of paragraph (a), premium rates filed pursuant to
  558  ss. 627.640 and 627.662 are shall be for informational purposes.
  559         (c) Every filing made pursuant to this subsection shall be
  560  made within the same time period provided in, and shall be
  561  deemed to be approved under the same conditions, as those
  562  provided in, subsection (2).
  563         (d) Every filing made pursuant to this subsection, except
  564  disability income policies and accidental death policies, are
  565  shall be prohibited from applying the following rating
  566  practices:
  567         1. Select and ultimate premium schedules.
  568         2. Premium class definitions that which classify insured
  569  based on year of issue or duration since issue.
  570         3. Attained age premium structures on policy forms under
  571  which more than 50 percent of the policies are issued to persons
  572  age 65 or over.
  573         (e) Except as provided in subparagraph 1., an insurer shall
  574  continue to make available for purchase any individual policy
  575  form issued on or after October 1, 1993. A policy form is shall
  576  not be considered to be available for purchase unless the
  577  insurer has actively offered it for sale during in the previous
  578  12 months.
  579         1. An insurer may discontinue the availability of a policy
  580  form if the insurer provides its decision to the office in
  581  writing its decision at least 30 days before prior to
  582  discontinuing the availability of the form of the policy or
  583  certificate. After receipt of the notice by the office, the
  584  insurer may shall no longer offer for sale the policy form or
  585  certificate form for sale in this state.
  586         2. An insurer that discontinues the availability of a
  587  policy form pursuant to subparagraph 1. may shall not file for
  588  approval a new policy form providing similar benefits similar to
  589  as the discontinued form for a period of 5 years after the
  590  insurer provides notice to the office of the discontinuance. The
  591  period of discontinuance may be reduced if the office determines
  592  that a shorter period is appropriate. The requirements of this
  593  subparagraph do not apply to the discontinuance of a policy form
  594  because it does not comply with PPACA.
  595         3. The experience of all policy forms providing similar
  596  benefits shall be combined for all rating purposes, except that
  597  the experience of grandfathered health plans and
  598  nongrandfathered health plans shall be separated.
  599         (7)(a) Each insurer subject to the requirements of
  600  subsection (6) shall make an annual filing with the office
  601  within no later than 12 months after its previous filing,
  602  demonstrating the reasonableness of benefits in relation to
  603  premium rates. The office, After receiving a request to be
  604  exempted from the provisions of this section, the office may,
  605  for good cause due to insignificant numbers of policies in force
  606  or insignificant premium volume, exempt a company, by line of
  607  coverage, from filing rates or rate certification as required by
  608  this section.
  609         (a)(b) The filing required by this subsection shall be
  610  satisfied by one of the following methods:
  611         1. A rate filing prepared by an actuary which contains
  612  documentation demonstrating the reasonableness of benefits in
  613  relation to premiums charged in accordance with the applicable
  614  rating laws and rules adopted promulgated by the commission.
  615         2. If no rate change is proposed, a filing that which
  616  consists of a certification by an actuary that benefits are
  617  reasonable in relation to premiums currently charged in
  618  accordance with applicable laws and rules promulgated by the
  619  commission.
  620         (b)(c) As used in this section, the term “actuary” means an
  621  individual who is a member of the Society of Actuaries or the
  622  American Academy of Actuaries. If an insurer does not employ or
  623  otherwise retain the services of an actuary, the insurer’s
  624  certification shall be prepared by insurer personnel or
  625  consultants who have with a minimum of 5 years’ experience in
  626  insurance ratemaking. The chief executive officer of the insurer
  627  shall review and sign the certification indicating his or her
  628  agreement with its conclusions.
  629         (c)(d) If at the time a filing is required under this
  630  section an insurer is in the process of completing a rate
  631  review, the insurer may apply to the office for an extension of
  632  up to an additional 30 days in which to make the filing. The
  633  request for extension must be received by the office by no later
  634  than the date the filing is due.
  635         (d)(e) If an insurer fails to meet the filing requirements
  636  of this subsection and does not submit the filing within 60 days
  637  after following the date the filing is due, the office may, in
  638  addition to any other penalty authorized by law, order the
  639  insurer to discontinue the issuance of policies for which the
  640  required filing was not made, until such time as the office
  641  determines that the required filing is properly submitted.
  642         (9) For plan years 2014 and 2015, nongrandfathered health
  643  plans for the individual or small group market are not subject
  644  to rate review or approval by the office. An insurer or health
  645  maintenance organization issuing or renewing such health plans
  646  shall file rates and any change in rates with the office as
  647  required by paragraph (6)(a), but the filing and rates are not
  648  subject to subsection (2), paragraphs (b), (c), or (d) of
  649  subsection (6), or subsection (7).
  650         (a) For each individual and small group nongrandfathered
  651  health plan, an insurer or health maintenance organization shall
  652  include a notice describing or illustrating the estimated impact
  653  of PPACA on monthly premiums with the delivery of the policy or
  654  contract or, upon renewal, the premium renewal notice. The
  655  notice must be in a format established by rule of the
  656  commission. The format must specify how the information required
  657  under paragraph (b) is to be described or illustrated, and may
  658  allow for specified variations from such requirements in order
  659  to provide a more accurate and meaningful disclosure of the
  660  estimated impact of PPACA on monthly premiums, as determined by
  661  the commission. All notices shall be submitted to the office for
  662  informational purposes by September 1, 2013. The notice is
  663  required only for the first issuance or renewal of the policy or
  664  contract on or after January 1, 2014.
  665         (b) The information provided in the notice shall be based
  666  on the statewide average premium for the policy or contract for
  667  the bronze, silver, gold, or platinum level plan, whichever is
  668  applicable to the policy or contract, and provide an estimate of
  669  the following effects of PPACA requirements:
  670         1. The dollar amount of the premium which is attributable
  671  to the impact of guaranteed issuance of coverage. This estimate
  672  must include, but is not required to itemize, the impact of the
  673  requirement that rates be based on factors unrelated to health
  674  status, how the individual coverage mandate and subsidies
  675  provided in the health insurance exchange established in this
  676  state pursuant to PPACA affect the impact of guaranteed issuance
  677  of coverage, and estimated reinsurance credits.
  678         2. The dollar amount of the premium which is attributable
  679  to fees, taxes, and assessments.
  680         3. For individual policies or contracts, the dollar amount
  681  of the premium increase or decrease from the premium that would
  682  have otherwise been due which is attributable to the combined
  683  impact of the requirement that rates for age be limited to a 3
  684  to-1 ratio and the prohibition against using gender as a rating
  685  factor. This estimate must be displayed for the average rates
  686  for male and female insureds, respectively, for the following
  687  three age categories: age 21 years to 29 years, age 30 years to
  688  54 years, and age 55 years to 64 years.
  689         4. The dollar amount which is attributable to the
  690  requirement that essential health benefits be provided and to
  691  meet the required actuarial value for the product, as compared
  692  to the statewide average premium for the policy or contract for
  693  the plan issued by that insurer or organization that has the
  694  highest enrollment in the individual or small group market on
  695  July 1, 2013, whichever is applicable. The statewide average
  696  premiums for the plan that has the highest enrollment must
  697  include all policyholders, including those that have health
  698  conditions that increase the standard premium.
  699         (c) The office, in consultation with the department, shall
  700  develop a summary of the estimated impact of PPACA on monthly
  701  premiums as contained in the notices submitted by insurers and
  702  health maintenance organizations, which must be available on the
  703  respective websites of the office and department by October 1,
  704  2013.
  705         (d) This subsection is repealed on March 1, 2015.
  706         Section 16. Subsection (4) is added to section 627.411,
  707  Florida Statutes, to read:
  708         627.411 Grounds for disapproval.—
  709         (4) The provisions of this section which apply to rates,
  710  rating practices, or the relationship of benefits to the premium
  711  charged do not apply to nongrandfathered health plans described
  712  in s. 627.410(9). This subsection is repealed on March 1, 2015.
  713         Section 17. Paragraph (a) of subsection (3) of section
  714  627.6425, Florida Statutes, is amended to read:
  715         627.6425 Renewability of individual coverage.—
  716         (3)(a) If In any case in which an insurer decides to
  717  discontinue offering a particular policy form for health
  718  insurance coverage offered in the individual market, coverage
  719  under such form may be discontinued by the insurer only if:
  720         1. The insurer provides notice to each covered individual
  721  provided coverage under this policy form in the individual
  722  market of such discontinuation at least 90 days before prior to
  723  the date of the nonrenewal of such coverage;
  724         2. The insurer offers to each individual in the individual
  725  market provided coverage under this policy form the option to
  726  purchase any other individual health insurance coverage
  727  currently being offered by the insurer for individuals in such
  728  market in the state; and
  729         3. In exercising the option to discontinue coverage of a
  730  this policy form and in offering the option of coverage under
  731  subparagraph 2., the insurer acts uniformly without regard to
  732  any health-status-related factor of enrolled individuals or
  733  individuals who may become eligible for such coverage. If a
  734  policy form covers both grandfathered and nongrandfathered
  735  health plans, an insurer may nonrenew coverage only for the
  736  nongrandfathered health plans, in which case the requirements of
  737  subparagraphs 1. and 2. apply only to the nongrandfathered
  738  health plans. As used in this subparagraph, the terms
  739  “grandfathered health plan” and “nongrandfathered health plan”
  740  have the same meaning as provided in s. 627.402.
  741         Section 18. Section 627.6484, Florida Statutes, is amended
  742  to read:
  743         627.6484 Dissolution of association; termination of
  744  enrollment; availability of other coverage.—
  745         (1) The association shall accept applications for insurance
  746  only until June 30, 1991, after which date no further
  747  applications may be accepted.
  748         (2) Coverage for each policyholder of the association
  749  terminates at midnight, June 30, 2014, or on the date that
  750  health insurance coverage is effective with another insurer,
  751  whichever occurs first, and such terminated coverage may not be
  752  renewed.
  753         (3) The association must provide assistance to each
  754  policyholder concerning how to obtain health insurance coverage.
  755  Such assistance must include the identification of insurers and
  756  health maintenance organizations offering coverage in the
  757  individual market, including inside and outside of the health
  758  insurance exchange established in this state pursuant to PPACA
  759  as defined in s. 627.402, a basic explanation of the levels of
  760  coverage available, and specific information relating to local
  761  and online sources from which a policyholder may obtain detailed
  762  policy and premium comparisons and directly obtain coverage.
  763         (4) The association shall provide written notice to all
  764  policyholders by September 1, 2013, which informs each
  765  policyholder with respect to:
  766         (a) The date that coverage with the association is
  767  terminated and that such coverage may not be renewed.
  768         (b) The opportunity for the policyholder to obtain
  769  individual health insurance coverage on a guaranteed-issue
  770  basis, regardless of the policyholder’s health status, from any
  771  health insurer or health maintenance organization that offers
  772  coverage in the individual market, including the dates of open
  773  enrollment periods for obtaining such coverage.
  774         (c) How to access coverage through the health insurance
  775  exchange established for this state and the potential for
  776  obtaining reduced premiums and cost-sharing provisions depending
  777  on the policyholder’s family income level.
  778         (d) Contact information for a representative of the
  779  association who is able to provide additional information about
  780  obtaining individual health insurance coverage both inside and
  781  outside of the Health Insurance Exchange.
  782         (5) After termination of coverage, the association must
  783  continue to receive and process timely submitted claims in
  784  accordance with the laws of this state.
  785         (6) By March 15, 2015, the association must determine the
  786  final assessment to be collected from insurers for funding
  787  claims and administrative expenses of the association or, if
  788  surplus funds remain, determine the refund amount to be provided
  789  to each insurer based on the same pro rata formula used in
  790  determining each insurer’s assessment.
  791         (7) By September 1, 2015, the board must:
  792         (a) Complete performance of all program responsibilities.
  793         (b) Sell or otherwise dispose of all physical assets of the
  794  association.
  795         (c) Make a final accounting of the finances of the
  796  association.
  797         (d) Transfer all records to the Department of Financial
  798  Services, which shall serve as custodian of such records.
  799         (e) Execute a legal dissolution of the association and
  800  report such action to the Chief Financial Officer, the Insurance
  801  Commissioner, the President of the Senate, and the Speaker of
  802  the House of Representatives. Upon receipt of an application for
  803  insurance, the association shall issue coverage for an eligible
  804  applicant. When appropriate, the administrator shall forward a
  805  copy of the application to a market assistance plan created by
  806  the office, which shall conduct a diligent search of the private
  807  marketplace for a carrier willing to accept the application.
  808         (2) The office shall, after consultation with the health
  809  insurers licensed in this state, adopt a market assistance plan
  810  to assist in the placement of risks of Florida Comprehensive
  811  Health Association applicants. All health insurers and health
  812  maintenance organizations licensed in this state shall
  813  participate in the plan.
  814         (3) Guidelines for the use of such program shall be a part
  815  of the association’s plan of operation. The guidelines shall
  816  describe which types of applications are to be exempt from
  817  submission to the market assistance plan. An exemption shall be
  818  based upon a determination that due to a specific health
  819  condition an applicant is ineligible for coverage in the
  820  standard market. The guidelines shall also describe how the
  821  market assistance plan is to be conducted, and how the periodic
  822  reviews to depopulate the association are to be conducted.
  823         (4) If a carrier is found through the market assistance
  824  plan, the individual shall apply to that company. If the
  825  individual’s application is accepted, association coverage shall
  826  terminate upon the effective date of the coverage with the
  827  private carrier. For the purpose of applying a preexisting
  828  condition limitation or exclusion, any carrier accepting a risk
  829  pursuant to this section shall provide coverage as if it began
  830  on the date coverage was effectuated on behalf of the
  831  association, and shall be indemnified by the association for
  832  claims costs incurred as a result of utilizing such effective
  833  date.
  834         (5) The association shall establish a policyholder
  835  assistance program by July 1, 1991, to assist in placing
  836  eligible policyholders in other coverage programs, including
  837  Medicare and Medicaid.
  838         Section 19. Section 627.64872, Florida Statutes, is
  839  repealed.
  840         Section 20. Effective October 1, 2015, sections 627.648,
  841  627.6482, 627.6484, 627.6486, 627.6488, 627.6489, 627.649,
  842  627.6492, 627.6494, 627.6496, 627.6498, and 627.6499, Florida
  843  Statutes, are repealed.
  844         Section 21. Paragraph (a) of subsection (3) of section
  845  627.6571, Florida Statutes, is amended to read:
  846         627.6571 Guaranteed renewability of coverage.—
  847         (3)(a) An insurer may discontinue offering a particular
  848  policy form of group health insurance coverage offered in the
  849  small-group market or large-group market only if:
  850         1. The insurer provides notice to each policyholder
  851  provided coverage under of this policy form in such market, and
  852  to participants and beneficiaries covered under such coverage,
  853  of such discontinuation at least 90 days before prior to the
  854  date of the nonrenewal of such coverage;
  855         2. The insurer offers to each policyholder provided
  856  coverage under of this policy form in such market the option to
  857  purchase all, or in the case of the large-group market, any
  858  other health insurance coverage currently being offered by the
  859  insurer in such market; and
  860         3. In exercising the option to discontinue coverage of this
  861  form and in offering the option of coverage under subparagraph
  862  2., the insurer acts uniformly without regard to the claims
  863  experience of those policyholders or any health-status-related
  864  factor that relates to any participants or beneficiaries covered
  865  or new participants or beneficiaries who may become eligible for
  866  such coverage. If a policy form covers both grandfathered and
  867  nongrandfathered health plans, an insurer may nonrenew coverage
  868  only for nongrandfathered health plans, in which case the
  869  requirements of subparagraphs 1. and 2. apply only to the
  870  nongrandfathered health plans. As used in this subparagraph, the
  871  terms “grandfathered health planand “nongrandfathered health
  872  plan” have the same meanings as provided in s. 627.402.
  873         Section 22. Subsection (6) and paragraph (b) of subsection
  874  (7) of section 627.6675, Florida Statutes, are amended to read:
  875         627.6675 Conversion on termination of eligibility.—Subject
  876  to all of the provisions of this section, a group policy
  877  delivered or issued for delivery in this state by an insurer or
  878  nonprofit health care services plan that provides, on an
  879  expense-incurred basis, hospital, surgical, or major medical
  880  expense insurance, or any combination of these coverages, shall
  881  provide that an employee or member whose insurance under the
  882  group policy has been terminated for any reason, including
  883  discontinuance of the group policy in its entirety or with
  884  respect to an insured class, and who has been continuously
  885  insured under the group policy, and under any group policy
  886  providing similar benefits that the terminated group policy
  887  replaced, for at least 3 months immediately prior to
  888  termination, shall be entitled to have issued to him or her by
  889  the insurer a policy or certificate of health insurance,
  890  referred to in this section as a “converted policy.” A group
  891  insurer may meet the requirements of this section by contracting
  892  with another insurer, authorized in this state, to issue an
  893  individual converted policy, which policy has been approved by
  894  the office under s. 627.410. An employee or member shall not be
  895  entitled to a converted policy if termination of his or her
  896  insurance under the group policy occurred because he or she
  897  failed to pay any required contribution, or because any
  898  discontinued group coverage was replaced by similar group
  899  coverage within 31 days after discontinuance.
  900         (6) OPTIONAL COVERAGE.—The insurer is shall not be required
  901  to issue a converted policy covering any person who is or could
  902  be covered by Medicare. The insurer is shall not be required to
  903  issue or renew a converted policy covering a person if
  904  paragraphs (a) and (b) apply to the person:
  905         (a) If any of the following apply to the person:
  906         1. The person is covered for similar benefits by another
  907  hospital, surgical, medical, or major medical expense insurance
  908  policy or hospital or medical service subscriber contract or
  909  medical practice or other prepayment plan, or by any other plan
  910  or program.
  911         2. The person is eligible for similar benefits, whether or
  912  not actually provided coverage, under any arrangement of
  913  coverage for individuals in a group, whether on an insured or
  914  uninsured basis.
  915         3. Similar benefits are provided for or are available to
  916  the person under any state or federal law.
  917         (b) If the benefits provided under the sources referred to
  918  in subparagraph (a)1. or the benefits provided or available
  919  under the sources referred to in subparagraphs (a)2. and 3.,
  920  together with the benefits provided by the converted policy,
  921  would result in overinsurance according to the insurer’s
  922  standards. The insurer’s standards must bear some reasonable
  923  relationship to actual health care costs in the area in which
  924  the insured lives at the time of conversion and must be filed
  925  with the office before prior to their use in denying coverage.
  926         (7) INFORMATION REQUESTED BY INSURER.—
  927         (b) The converted policy may provide that the insurer may
  928  refuse to renew the policy or the coverage of any person only
  929  for one or more of the following reasons:
  930         1. Either The benefits provided under the sources referred
  931  to in subparagraphs (a)1. and 2. for the person or the benefits
  932  provided or available under the sources referred to in
  933  subparagraph (a)3. for the person, together with the benefits
  934  provided by the converted policy, would result in overinsurance
  935  according to the insurer’s standards on file with the office.
  936  The reason for nonrenewal authorized by this subparagraph is not
  937  required to be contained in the converted policy but must be
  938  provided in writing to the policyholder at least 90 days before
  939  the policy renewal date.
  940         2. The converted policyholder fails to provide the
  941  information requested pursuant to paragraph (a).
  942         3. Fraud or intentional misrepresentation in applying for
  943  any benefits under the converted policy.
  944         4. Other reasons approved by the office.
  945         Section 23. Paragraphs (j) through (w) of subsection (3) of
  946  section 627.6699, Florida Statutes, are redesignated as
  947  paragraphs (k) through (x), respectively, a new paragraph (j) is
  948  added to that subsection, present paragraphs (v) and (w) of that
  949  subsection are amended, and paragraph (b) of subsection (6) is
  950  amended, to read:
  951         627.6699 Employee Health Care Access Act.—
  952         (3) DEFINITIONS.—As used in this section, the term:
  953         (j) “Grandfathered health plan” and “nongrandfathered
  954  health plan” have the same meaning as provided in s. 627.402.
  955         (w)(v) “Small employer” means, in connection with a health
  956  benefit plan with respect to a calendar year and a plan year:,
  957         1. For a grandfathered health plan, any person, sole
  958  proprietor, self-employed individual, independent contractor,
  959  firm, corporation, partnership, or association that is actively
  960  engaged in business, has its principal place of business in this
  961  state, employed an average of at least 1 but not more than 50
  962  eligible employees on business days during the preceding
  963  calendar year, the majority of whom were employed in this state,
  964  employs at least 1 employee on the first day of the plan year,
  965  and is not formed primarily for purposes of purchasing
  966  insurance. In determining the number of eligible employees,
  967  companies that are an affiliated group as defined in s. 1504(a)
  968  of the Internal Revenue Code of 1986, as amended, are considered
  969  a single employer. For purposes of this section, a sole
  970  proprietor, an independent contractor, or a self-employed
  971  individual is considered a small employer only if all of the
  972  conditions and criteria established in this section are met.
  973         2. For a nongrandfathered health plan, any employer that
  974  has its principal place of business in this state, employed an
  975  average of at least 1 but not more than 50 employees on business
  976  days during the preceding calendar year, and employs at least 1
  977  employee on the first day of the plan year. As used in this
  978  subparagraph, the terms “employee” and “employer” have the same
  979  meaning as provided in s. 3 of the Employee Retirement Income
  980  Security Act of 1974, as amended, 29 U.S.C. 1002.
  981         (x)(w) “Small employer carrier” means a carrier that offers
  982  health benefit plans covering eligible employees of one or more
  983  small employers.
  984         (6) RESTRICTIONS RELATING TO PREMIUM RATES.—
  985         (b) For all small employer health benefit plans that are
  986  subject to this section and are issued by small employer
  987  carriers on or after January 1, 1994, premium rates for health
  988  benefit plans subject to this section are subject to the
  989  following:
  990         1. Small employer carriers must use a modified community
  991  rating methodology in which the premium for each small employer
  992  is must be determined solely on the basis of the eligible
  993  employee’s and eligible dependent’s gender, age, family
  994  composition, tobacco use, or geographic area as determined under
  995  paragraph (5)(j) and in which the premium may be adjusted as
  996  permitted by this paragraph. A small employer carrier is not
  997  required to use gender as a rating factor for a nongrandfathered
  998  health plan.
  999         2. Rating factors related to age, gender, family
 1000  composition, tobacco use, or geographic location may be
 1001  developed by each carrier to reflect the carrier’s experience.
 1002  The factors used by carriers are subject to office review and
 1003  approval.
 1004         3. Small employer carriers may not modify the rate for a
 1005  small employer for 12 months from the initial issue date or
 1006  renewal date, unless the composition of the group changes or
 1007  benefits are changed. However, a small employer carrier may
 1008  modify the rate one time within the prior to 12 months after the
 1009  initial issue date for a small employer who enrolls under a
 1010  previously issued group policy that has a common anniversary
 1011  date for all employers covered under the policy if:
 1012         a. The carrier discloses to the employer in a clear and
 1013  conspicuous manner the date of the first renewal and the fact
 1014  that the premium may increase on or after that date.
 1015         b. The insurer demonstrates to the office that efficiencies
 1016  in administration are achieved and reflected in the rates
 1017  charged to small employers covered under the policy.
 1018         4. A carrier may issue a group health insurance policy to a
 1019  small employer health alliance or other group association with
 1020  rates that reflect a premium credit for expense savings
 1021  attributable to administrative activities being performed by the
 1022  alliance or group association if such expense savings are
 1023  specifically documented in the insurer’s rate filing and are
 1024  approved by the office. Any such credit may not be based on
 1025  different morbidity assumptions or on any other factor related
 1026  to the health status or claims experience of any person covered
 1027  under the policy. Nothing in This subparagraph does not exempt
 1028  exempts an alliance or group association from licensure for any
 1029  activities that require licensure under the insurance code. A
 1030  carrier issuing a group health insurance policy to a small
 1031  employer health alliance or other group association shall allow
 1032  any properly licensed and appointed agent of that carrier to
 1033  market and sell the small employer health alliance or other
 1034  group association policy. Such agent shall be paid the usual and
 1035  customary commission paid to any agent selling the policy.
 1036         5. Any adjustments in rates for claims experience, health
 1037  status, or duration of coverage may not be charged to individual
 1038  employees or dependents. For a small employer’s policy, such
 1039  adjustments may not result in a rate for the small employer
 1040  which deviates more than 15 percent from the carrier’s approved
 1041  rate. Any such adjustment must be applied uniformly to the rates
 1042  charged for all employees and dependents of the small employer.
 1043  A small employer carrier may make an adjustment to a small
 1044  employer’s renewal premium, up to not to exceed 10 percent
 1045  annually, due to the claims experience, health status, or
 1046  duration of coverage of the employees or dependents of the small
 1047  employer. Semiannually, small group carriers shall report
 1048  information on forms adopted by rule by the commission, to
 1049  enable the office to monitor the relationship of aggregate
 1050  adjusted premiums actually charged policyholders by each carrier
 1051  to the premiums that would have been charged by application of
 1052  the carrier’s approved modified community rates. If the
 1053  aggregate resulting from the application of such adjustment
 1054  exceeds the premium that would have been charged by application
 1055  of the approved modified community rate by 4 percent for the
 1056  current reporting period, the carrier shall limit the
 1057  application of such adjustments only to minus adjustments
 1058  beginning within not more than 60 days after the report is sent
 1059  to the office. For any subsequent reporting period, if the total
 1060  aggregate adjusted premium actually charged does not exceed the
 1061  premium that would have been charged by application of the
 1062  approved modified community rate by 4 percent, the carrier may
 1063  apply both plus and minus adjustments. A small employer carrier
 1064  may provide a credit to a small employer’s premium based on
 1065  administrative and acquisition expense differences resulting
 1066  from the size of the group. Group size administrative and
 1067  acquisition expense factors may be developed by each carrier to
 1068  reflect the carrier’s experience and are subject to office
 1069  review and approval.
 1070         6. A small employer carrier rating methodology may include
 1071  separate rating categories for one dependent child, for two
 1072  dependent children, and for three or more dependent children for
 1073  family coverage of employees having a spouse and dependent
 1074  children or employees having dependent children only. A small
 1075  employer carrier may have fewer, but not greater, numbers of
 1076  categories for dependent children than those specified in this
 1077  subparagraph.
 1078         7. Small employer carriers may not use a composite rating
 1079  methodology to rate a small employer with fewer than 10
 1080  employees. For the purposes of this subparagraph, the term a
 1081  “composite rating methodology” means a rating methodology that
 1082  averages the impact of the rating factors for age and gender in
 1083  the premiums charged to all of the employees of a small
 1084  employer.
 1085         8.a. A carrier may separate the experience of small
 1086  employer groups with fewer less than 2 eligible employees from
 1087  the experience of small employer groups with 2-50 eligible
 1088  employees for purposes of determining an alternative modified
 1089  community rating.
 1090         a.b. If a carrier separates the experience of small
 1091  employer groups as provided in sub-subparagraph a., the rate to
 1092  be charged to small employer groups of fewer less than 2
 1093  eligible employees may not exceed 150 percent of the rate
 1094  determined for small employer groups of 2-50 eligible employees.
 1095  However, the carrier may charge excess losses of the experience
 1096  pool consisting of small employer groups with less than 2
 1097  eligible employees to the experience pool consisting of small
 1098  employer groups with 2-50 eligible employees so that all losses
 1099  are allocated and the 150-percent rate limit on the experience
 1100  pool consisting of small employer groups with less than 2
 1101  eligible employees is maintained.
 1102         b. Notwithstanding s. 627.411(1), the rate to be charged to
 1103  a small employer group of fewer than 2 eligible employees,
 1104  insured as of July 1, 2002, may be up to 125 percent of the rate
 1105  determined for small employer groups of 2-50 eligible employees
 1106  for the first annual renewal and 150 percent for subsequent
 1107  annual renewals.
 1108         9. A carrier shall separate the experience of grandfathered
 1109  health plans from nongrandfathered health plans for determining
 1110  rates.
 1111         Section 24. Paragraph (f) is added to subsection (3) of
 1112  section 641.31, Florida Statutes, to read:
 1113         641.31 Health maintenance contracts.—
 1114         (3)
 1115         (f)1. For plan years 2014 and 2015, nongrandfathered health
 1116  plans for the individual or small group market are not subject
 1117  to rate review or approval by the office. A health maintenance
 1118  organization that issues or renews a nongrandfathered health
 1119  plan is subject to s. 627.410(9). As used in this paragraph, the
 1120  terms “PPACA” and “nongrandfathered health plan” have the same
 1121  meanings as those terms are defined in s. 627.402.
 1122         2. This paragraph is repealed effective March 1, 2015.
 1123         Section 25. Subsection (6) of section 641.3922, Florida
 1124  Statutes, is amended and paragraph (h) is added to subsection
 1125  (7) of that section, to read:
 1126         641.3922 Conversion contracts; conditions.—Issuance of a
 1127  converted contract shall be subject to the following conditions:
 1128         (6) OPTIONAL COVERAGE.—The health maintenance organization
 1129  may shall not be required to issue a converted contract covering
 1130  any person if such person is or could be covered by Medicare,
 1131  Title XVIII of the Social Security Act, as added by the Social
 1132  Security Amendments of 1965, or as later amended or superseded.
 1133  Furthermore, the health maintenance organization is shall not be
 1134  required to issue or renew a converted health maintenance
 1135  contract covering any person if:
 1136         (a)1. The person is covered for similar benefits by another
 1137  hospital, surgical, medical, or major medical expense insurance
 1138  policy or hospital or medical service subscriber contract or
 1139  medical practice or other prepayment plan or by any other plan
 1140  or program;
 1141         2. The person is eligible for similar benefits, whether
 1142  actually or not covered therefor, under any arrangement of
 1143  coverage for individuals in a group, whether on an insured or
 1144  uninsured basis; or
 1145         3. Similar benefits are provided for or are available to
 1146  the person pursuant to or in accordance with the requirements of
 1147  any state or federal law; and
 1148         (b) A converted health maintenance contract may include a
 1149  provision whereby the health maintenance organization may
 1150  request information, in advance of any premium due date of a
 1151  health maintenance contract, of any person covered thereunder as
 1152  to whether:
 1153         1. She or he is covered for similar benefits by another
 1154  hospital, surgical, medical, or major medical expense insurance
 1155  policy or hospital or medical service subscriber contract or
 1156  medical practice or other prepayment plan or by another any
 1157  other plan or program;
 1158         2. She or he is covered for similar benefits under an any
 1159  arrangement of coverage for individuals in a group, whether on
 1160  an insured or uninsured basis; or
 1161         3. Similar benefits are provided for or are available to
 1162  the person pursuant to or in accordance with the requirements of
 1163  any state or federal law.
 1164         (7) REASONS FOR CANCELLATION; TERMINATION.—The converted
 1165  health maintenance contract must contain a cancellation or
 1166  nonrenewability clause providing that the health maintenance
 1167  organization may refuse to renew the contract of any person
 1168  covered thereunder, but cancellation or nonrenewal must be
 1169  limited to one or more of the following reasons:
 1170         (h) The subscriber is covered for similar benefits or
 1171  eligible for similar benefits, or similar benefits are provided
 1172  for or are available to the subscriber as described in paragraph
 1173  (6)(a). The reason for nonrenewal authorized by this paragraph
 1174  is not required to be contained in the converted health
 1175  maintenance contract but must be provided in writing to the
 1176  subscriber at least 90 days before the contract renewal date.
 1177         Section 26. For the 2013-2014 fiscal year, the sums of
 1178  $106,658 in recurring funds and $70,000 in nonrecurring funds
 1179  from the Insurance Regulatory Trust Fund and two full-time
 1180  equivalent positions and associated salary rate of 72,936 are
 1181  appropriated to the Department of Financial Services to
 1182  implement the provisions of this act related to the registration
 1183  of navigators.
 1184         Section 27. Except as otherwise expressly provided in this
 1185  act, this act shall take effect upon becoming a law.