Florida Senate - 2013 CS for SB 422 By the Committee on Appropriations; and Senators Benacquisto, Hays, Bradley, Simpson, Bullard, Soto, Gibson, Detert, Ring, Clemens, Negron, Evers, Margolis, Abruzzo, Stargel, Thompson, Flores, Sobel, Hukill, Altman, Smith, Diaz de la Portilla, Braynon, Garcia, and Montford 576-02872-13 2013422c1 1 A bill to be entitled 2 An act relating to cancer treatment; providing a short 3 title; creating ss. 627.42391 and 641.313, F.S.; 4 providing definitions; requiring that an individual or 5 group insurance policy or contract or a health 6 maintenance contract that provides coverage for cancer 7 treatment medications provide coverage for orally 8 administered cancer treatment medications on a basis 9 no less favorable than that required by the policy or 10 contract for intravenously administered or injected 11 cancer treatment medications; prohibiting insurers, 12 health maintenance organizations, and certain other 13 entities from engaging in specified actions to avoid 14 compliance with this act; amending s. 627.6515, F.S.; 15 adding a cross-reference to conform to changes made by 16 the act; providing a directive to the Division of Law 17 Revision and Information; providing an effective date. 18 19 Be It Enacted by the Legislature of the State of Florida: 20 21 Section 1. This act may be cited as the “Cancer Treatment 22 Fairness Act.” 23 Section 2. Section 627.42391, Florida Statutes, is created 24 to read: 25 627.42391 Insurance policies; cancer treatment parity; 26 orally administered cancer treatment medications.— 27 (1) As used in this section, the term: 28 (a) “Cancer treatment medication” means medication 29 prescribed by a treating physician who determines that the 30 medication is medically necessary to kill or slow the growth of 31 cancerous cells in a manner consistent with nationally accepted 32 standards of practice. 33 (b) “Cost sharing” includes copayments, coinsurance, dollar 34 limits, and deductibles imposed on the covered person. 35 (2) An individual or group insurance policy delivered, 36 issued for delivery, renewed, amended, or continued in this 37 state that provides medical, major medical, or similar 38 comprehensive coverage and includes coverage for cancer 39 treatment medications must also cover prescribed, orally 40 administered cancer treatment medications and may not apply 41 cost-sharing requirements for orally administered cancer 42 treatment medications that are less favorable to the covered 43 person than cost-sharing requirements for intravenous or 44 injected cancer treatment medications covered under the policy 45 or contract. 46 (3) An insurer providing a policy or contract described in 47 subsection (2) and any participating entity through which the 48 insurer offers health services may not: 49 (a) Vary the terms of the policy in effect on the effective 50 date of this act to avoid compliance with this section. 51 (b) Provide any incentive, including, but not limited to, a 52 monetary incentive, or impose treatment limitations to encourage 53 a covered person to accept less than the minimum protections 54 available under this section. 55 (c) Penalize a health care practitioner or reduce or limit 56 the compensation of a health care practitioner for recommending 57 or providing services or care to a covered person as required 58 under this section. 59 (d) Provide any incentive, including, but not limited to, a 60 monetary incentive, to induce a health care practitioner to 61 provide care or services that do not comply with this section. 62 (e) Change the classification of any intravenous or 63 injected cancer treatment medication or increase the amount of 64 cost sharing applicable to any intravenous or injected cancer 65 treatment medication in effect on the effective date of this act 66 in order to achieve compliance with this section. 67 Section 3. Section 641.313, Florida Statutes, is created to 68 read: 69 641.313 Health maintenance contracts; cancer treatment 70 parity; orally administered cancer treatment medications.— 71 (1) As used in this section, the term: 72 (a) “Cancer treatment medication” means medication 73 prescribed by a treating physician who determines that the 74 medication is medically necessary to kill or slow the growth of 75 cancerous cells in a manner consistent with nationally accepted 76 standards of practice. 77 (b) “Cost sharing” includes copayments, coinsurance, dollar 78 limits, and deductibles imposed on the covered person. 79 (2) A health maintenance contract delivered, issued for 80 delivery, renewed, amended, or continued in this state that 81 provides medical, major medical, or similar comprehensive 82 coverage and includes coverage for cancer treatment medications 83 must also cover prescribed, orally administered cancer treatment 84 medications and may not apply cost-sharing requirements for 85 orally administered cancer treatment medications that are less 86 favorable to the covered person than cost-sharing requirements 87 for intravenous or injected cancer treatment medications covered 88 under the contract. 89 (3) A health maintenance organization providing a contract 90 described in subsection (2) and any participating entity through 91 which the health maintenance organization offers health services 92 may not: 93 (a) Vary the terms of the policy in effect on the effective 94 date of this act to avoid compliance with this section. 95 (b) Provide any incentive, including, but not limited to, a 96 monetary incentive, or impose treatment limitations to encourage 97 a covered person to accept less than the minimum protections 98 available under this section. 99 (c) Penalize a health care practitioner or reduce or limit 100 the compensation of a health care practitioner for recommending 101 or providing services or care to a covered person as required 102 under this section. 103 (d) Provide any incentive, including, but not limited to, a 104 monetary incentive, to induce a health care practitioner to 105 provide care or services that do not comply with this section. 106 (e) Change the classification of any intravenous or 107 injected cancer treatment medication or increase the amount of 108 cost sharing applicable to any intravenous or injected cancer 109 treatment medication in effect on the effective date of this act 110 in order to achieve compliance with this section. 111 Section 4. Subsection (2) of section 627.6515, Florida 112 Statutes, is amended to read: 113 627.6515 Out-of-state groups.— 114 (2) Except as otherwise provided in this part, this part 115 does not apply to a group health insurance policy issued or 116 delivered outside this state under which a resident of this 117 state is provided coverage if: 118 (a) The policy is issued to an employee group the 119 composition of which is substantially as described in s. 120 627.653; a labor union group or association group the 121 composition of which is substantially as described in s. 122 627.654; an additional group the composition of which is 123 substantially as described in s. 627.656; a group insured under 124 a blanket health policy when the composition of the group is 125 substantially in compliance with s. 627.659; a group insured 126 under a franchise health policy when the composition of the 127 group is substantially in compliance with s. 627.663; an 128 association group to cover persons associated in any other 129 common group, which common group is formed primarily for 130 purposes other than providing insurance; a group that is 131 established primarily for the purpose of providing group 132 insurance, provided the benefits are reasonable in relation to 133 the premiums charged thereunder and the issuance of the group 134 policy has resulted, or will result, in economies of 135 administration; or a group of insurance agents of an insurer, 136 which insurer is the policyholder; 137 (b) Certificates evidencing coverage under the policy are 138 issued to residents of this state and contain in contrasting 139 color and not less than 10-point type the following statement: 140 “The benefits of the policy providing your coverage are governed 141 primarily by the law of a state other than Florida”; and 142 (c) The policy provides the benefits specified in ss. 143 627.419, 627.42391, 627.6574, 627.6575, 627.6579, 627.6612, 144 627.66121, 627.66122, 627.6613, 627.667, 627.6675, 627.6691, and 145 627.66911, and complies with the requirements of s. 627.66996. 146 (d) Applications for certificates of coverage offered to 147 residents of this state must contain, in contrasting color and 148 not less than 12-point type, the following statement on the same 149 page as the applicant’s signature: 150 151 “This policy is primarily governed by the laws of 152 ...insert state where the master policy if filed.... 153 As a result, all of the rating laws applicable to 154 policies filed in this state do not apply to this 155 coverage, which may result in increases in your 156 premium at renewal that would not be permissible under 157 a Florida-approved policy. Any purchase of individual 158 health insurance should be considered carefully, as 159 future medical conditions may make it impossible to 160 qualify for another individual health policy. For 161 information concerning individual health coverage 162 under a Florida-approved policy, consult your agent or 163 the Florida Department of Financial Services.” 164 165 This paragraph applies only to group certificates providing 166 health insurance coverage which require individualized 167 underwriting to determine coverage eligibility for an individual 168 or premium rates to be charged to an individual except for the 169 following: 170 1. Policies issued to provide coverage to groups of persons 171 all of whom are in the same or functionally related licensed 172 professions, and providing coverage only to such licensed 173 professionals, their employees, or their dependents; 174 2. Policies providing coverage to small employers as 175 defined by s. 627.6699. Such policies shall be subject to, and 176 governed by, the provisions of s. 627.6699; 177 3. Policies issued to a bona fide association, as defined 178 by s. 627.6571(5), provided that there is a person or board 179 acting as a fiduciary for the benefit of the members, and such 180 association is not owned, controlled by, or otherwise associated 181 with the insurance company; or 182 4. Any accidental death, accidental death and 183 dismemberment, accident-only, vision-only, dental-only, hospital 184 indemnity-only, hospital accident-only, cancer, specified 185 disease, Medicare supplement, products that supplement Medicare, 186 long-term care, or disability income insurance, or similar 187 supplemental plans provided under a separate policy, 188 certificate, or contract of insurance, which cannot duplicate 189 coverage under an underlying health plan, coinsurance, or 190 deductibles or coverage issued as a supplement to workers’ 191 compensation or similar insurance, or automobile medical-payment 192 insurance. 193 Section 5. The Division of Law Revision and Information is 194 directed to replace the phrase “the effective date of this act” 195 wherever it occurs in this act with the date this act takes 196 effect. 197 Section 6. This act shall take effect July 1, 2013.