Florida Senate - 2015 SB 1498 By Senator Soto 14-01193B-15 20151498__ 1 A bill to be entitled 2 An act relating to health insurance exchanges; 3 providing a short title; creating s. 641.81, F.S.; 4 providing legislative findings and intent; defining 5 terms; requiring the Agency for Health Care 6 Administration to establish the Florida Health Access 7 Marketplace; requiring the agency to establish the 8 Small Business Health Options Program (SHOP); 9 providing contracting and rulemaking authority; 10 authorizing the marketplace to contract with certain 11 entities; defining “eligible entity”; authorizing the 12 agency to adopt rules; providing for information 13 sharing and confidentiality; providing for insurance 14 coverage availability; providing for the 15 responsibilities and duties of the marketplace; 16 providing for health benefit plan certification; 17 requiring the marketplace to certify certain health 18 benefit plans; providing a contingent effective date. 19 20 Be It Enacted by the Legislature of the State of Florida: 21 22 Section 1. This act may be cited as the “Florida Health 23 Access Marketplace Act”. 24 Section 2. Section 641.81, Florida Statutes, is created to 25 read: 26 641.81 Florida Health Access Marketplace.— 27 (1) INTENT.—The Legislature finds that a historically 28 significant proportion of the residents of this state have been 29 unable to obtain affordable health insurance coverage. The 30 Legislature also finds that increasing access to affordable, 31 quality health care is beneficial to the health and well-being 32 of all of the state’s residents, is necessary for the state’s 33 economic vitality, and provides a substantial boost to the 34 business activity of the state. The Legislature recognizes that 35 more than 1.6 million hardworking residents of this state 36 purchased health insurance for 2015 on the Affordable Care Act 37 federal health insurance exchange. The Legislature also 38 recognizes that 93 percent, or nearly all, of those residents 39 received tax credits that averaged $297 per person each month. 40 The Legislature finds that the United States Supreme Court is 41 scheduled to render a decision that may affect the availability 42 of those tax credits to residents of this state after the end of 43 Florida’s 2015 Regular Session. The Legislature also finds that 44 the Court may decide that only those individuals who buy health 45 insurance policies on state-based exchanges are eligible for the 46 federal tax credits. The Legislature recognizes that should the 47 Court issue such a ruling, more than 1 million residents of this 48 state could be at substantial risk of losing their access to 49 affordable health care and the economy of this state may lose an 50 estimated $4.75 billion in subsidy spending, when the loss of 51 both premium tax credits and cost-sharing assistance are 52 considered. Therefore, in order to preserve the ability of 53 residents of this state to qualify for the federal tax credits 54 and in order to keep those tax credits operative in the state’s 55 economy and available to residents of this state in need of 56 affordable health insurance, it is the intent of the 57 Legislature, contingent upon a ruling by the United States 58 Supreme Court that only state-based exchange policy purchasers 59 are eligible for federal tax credits and subsidies, to establish 60 a state-based health insurance exchange, pursuant to s. 1311 of 61 the Affordable Care Act. 62 (2) DEFINITIONS.—As used in this section, the term: 63 (a) “Affordable Care Act” means the federal Patient 64 Protection and Affordable Care Act, Pub. L. No. 111-148. 65 (b) “Agency” means the Agency for Health Care 66 Administration. 67 (c) “Health benefit plan” means a policy, contract, 68 certificate, or agreement offered or issued by a health carrier 69 to provide, deliver, arrange for, pay for, or reimburse any of 70 the costs of health care services. The term “health benefit 71 plan” does not include: 72 1. Coverage only for accident or disability income 73 insurance or any combination of accident or disability income 74 insurance. 75 2. Coverage issued as a supplement to liability insurance. 76 3. Liability insurance, including general liability 77 insurance and automobile liability insurance. 78 4. Workers’ compensation or similar insurance. 79 5. Automobile medical payment insurance. 80 6. Credit-only insurance. 81 7. Coverage for on-site medical clinics. 82 8. Insurance coverage as specified in federal regulations 83 issued pursuant to the federal Health Insurance Portability and 84 Accountability Act of 1996, Pub. L. No. 104-191 (HIPAA of 1996), 85 under which benefits for health care services are secondary or 86 incidental to other insurance benefits. 87 9. The following benefits, if they are provided under a 88 separate policy, certificate, or contract of insurance or are 89 otherwise not an integral part of the plan: 90 a. Limited scope dental or vision benefits. 91 b. Benefits for long-term care, nursing home care, home 92 health care, community-based care or any combination of those 93 benefits. 94 c. Limited benefits as specified in federal regulations 95 issued pursuant to the federal HIPAA of 1996. 96 d. Coverage only for a specified disease or illness. 97 e. Hospital indemnity or other fixed indemnity insurance. 98 f. Medicare supplemental health insurance policies as 99 defined under the Social Security Act, 42 U.S.C. s. 1882(g)(1), 100 whether provided individually or under a group health plan. 101 g. Coverage supplemental to the coverage provided under 10 102 U.S.C. ch. 55, whether provided individually or under a group 103 health plan. 104 (d) “Health carrier” or “carrier” means: 105 1. An insurance company licensed in accordance with the 106 Florida Insurance Code to provide health insurance. 107 2. A health maintenance organization licensed pursuant to 108 the Florida Insurance Code. 109 3. A preferred provider administrator registered under the 110 Florida Insurance Code. 111 4. A nonprofit hospital or medical service organization or 112 health benefit plan licensed pursuant to Title XXIX or the 113 Florida Insurance Code. 114 (e) “Marketplace” means the Florida Health Access 115 Marketplace established in this section pursuant to s. 1311 of 116 the Affordable Care Act. 117 (f) “Qualified employer” means a small employer that elects 118 to make its full-time employees and, at the option of the 119 employer, some or all of its part-time employees eligible for 120 one or more qualified health plans or qualified stand-alone 121 dental benefit plans offered through the SHOP exchange and that: 122 1. Has its principal place of business in this state and 123 elects to provide coverage through the SHOP exchange to all of 124 its eligible employees, wherever employed; or 125 2. Elects to provide coverage through the SHOP exchange to 126 all of its eligible employees who are principally employed in 127 this state. 128 (g) “Qualified health plan” means a health benefit plan 129 that has in effect a certification that the plan meets the 130 criteria for certification described in this section and s. 131 1311(c) of the Affordable Care Act. 132 (h) “Qualified individual” means an individual, including a 133 minor, who: 134 1. Is seeking to enroll in a qualified health plan or 135 qualified stand-alone dental benefit plan offered to individuals 136 through the marketplace; 137 2. Resides in this state within the meaning of the 138 Affordable Care Act; 139 3. At the time of enrollment, is not incarcerated, other 140 than incarceration pending the disposition of charges; and 141 4. Is, and is reasonably expected to be, for the entire 142 period for which enrollment is sought, a citizen or national of 143 the United States or an alien lawfully present in the United 144 States. 145 (i) “Qualified stand-alone dental benefit plan” means a 146 stand-alone dental benefit plan that has been certified in 147 accordance with subsection (8). 148 (j) “SHOP exchange” means the Small Business Health Options 149 Program established pursuant to subsection (3). 150 (k) “Small employer” means an employer that employed an 151 average of not more than 100 employees during the preceding 152 calendar year. For purposes of this paragraph: 153 1. All persons treated as a single employer under the 154 Internal Revenue Code, 26 U.S.C. s. 414(b), (c), (m) or (o), 155 must be treated as a single employer. 156 2. A successor employer and a predecessor employer, under 157 the Internal Revenue Code, 26 U.S.C. s. 414, must be treated as 158 a single employer. 159 3. All employees must be counted, including part-time 160 employees and employees who are not eligible for coverage 161 through the employer. 162 4. If an employer was not in existence throughout the 163 preceding calendar year, the determination of whether that 164 employer is a small employer must be based on the average number 165 of employees reasonably expected to be employed by that employer 166 on business days in the current calendar year. 167 5. An employer that makes enrollment in qualified health 168 plans or qualified stand-alone dental benefit plans available to 169 its employees through the SHOP exchange, and, in a subsequent 170 calendar year, would cease to be a small employer by reason of 171 an increase in the number of its employees, must continue to be 172 treated as a small employer for purposes of this section as long 173 as the employer continuously makes enrollment through the SHOP 174 exchange available to its employees. 175 (l) “Stand-alone dental benefit plan” means a policy, 176 contract, certificate, or agreement offered or issued by a 177 carrier to provide, deliver, arrange for, pay for, or reimburse 178 any of the costs of limited scope dental benefits meeting the 179 requirements of s. 9832(c)(2)(A) of the Internal Revenue Code of 180 1986. 181 (3) MARKETPLACE ESTABLISHED; PURPOSES.—The agency shall 182 establish the Florida Health Access Marketplace to function as a 183 health insurance exchange, pursuant to the Affordable Care Act, 184 to facilitate the purchase and sale of qualified health plans 185 and qualified stand-alone dental benefit plans in the individual 186 market in this state and to provide for the establishment of a 187 Small Business Health Options Program to assist qualified 188 employers in this state in facilitating the enrollment of their 189 employees in qualified health plans and qualified stand-alone 190 dental benefit plans offered in the small group market. The 191 purpose of the marketplace is to reduce the number of uninsured 192 individuals, provide a transparent marketplace and consumer 193 education, and assist individuals with access to programs, 194 premium tax credits, and cost-sharing reductions. It is also the 195 purpose of the marketplace to maximize the receipt of federal 196 funds, including those available pursuant to the Affordable Care 197 Act. 198 (4) CONTRACTING AND RULEMAKING AUTHORITY.—The marketplace 199 may contract with an eligible entity for any of its functions as 200 described in this section. For the purposes of this subsection, 201 “eligible entity” includes, but is not limited to, any program 202 or entity, public or private, that has experience in individual 203 and small group health insurance or benefit administration or 204 other experience relevant to the services needed to carry out 205 the purposes of this section, except that a health carrier or 206 the affiliate of a health carrier is not an eligible entity. The 207 agency may adopt rules as necessary for the proper 208 administration and enforcement of this section under the Florida 209 Administrative Procedure Act. 210 (5) INFORMATION SHARING; CONFIDENTIALITY.—The marketplace 211 may enter into information-sharing agreements with federal and 212 state agencies and other states’ exchanges to carry out its 213 responsibilities under this section. Such agreements must 214 include adequate protections with respect to the confidentiality 215 of the information to be shared and comply with all state and 216 federal laws, rules and regulations. 217 (6) AVAILABILITY OF COVERAGE.— 218 (a) The marketplace shall make qualified health plans and 219 qualified stand-alone dental benefit plans available to 220 qualified individuals and qualified employers no later than 221 January 1, 2017. The marketplace may enroll qualified 222 individuals and qualified employers beginning on or after 223 September 1, 2016. 224 (b) The marketplace may not make available any health 225 benefit plan that is not a qualified health plan or any stand 226 alone dental benefit plan that is not a qualified stand-alone 227 dental benefit plan. 228 (c) The marketplace shall allow a health carrier to offer a 229 qualified stand-alone dental benefit plan through the 230 marketplace, either separately or in conjunction with a 231 qualified health plan, if the plan provides pediatric dental 232 benefits meeting the requirements of s. 1302(b)(1)(J) of the 233 Affordable Care Act. This paragraph does not prohibit a carrier 234 from offering other dental benefit plans consistent with the 235 requirements of subsection (8) of this section. 236 (d) The marketplace or a carrier offering qualified health 237 plans or qualified stand-alone dental benefit plans through the 238 marketplace may not charge an individual a fee or penalty for 239 termination of coverage if the individual enrolls in another 240 type of minimum essential coverage because the individual has 241 become newly eligible for that coverage or because the 242 individual’s employer-sponsored coverage has become affordable 243 under the standards of s. 1401 of the Affordable Care Act. 244 (e) The agency may standardize qualified health plans to be 245 offered through the marketplace. 246 (7) DUTIES AND RESPONSIBILITIES OF THE MARKETPLACE.—The 247 marketplace shall: 248 (a) Implement procedures, consistent with guidelines 249 developed under this section and s. 1311(c) of the Affordable 250 Care Act, for the certification, recertification, and 251 decertification of health benefit plans as qualified health 252 plans and of stand-alone dental benefit plans as qualified 253 stand-alone dental benefit plans. 254 (b) Provide for the operation of a toll-free telephone 255 hotline to respond to requests for assistance, which includes 256 the opportunity for live customer service. 257 (c) Make available enrollment periods as provided under s. 258 1311(c)(6) of the Affordable Care Act. 259 (d) Maintain a publicly accessible website through which 260 enrollees and prospective enrollees of qualified health plans 261 and qualified stand-alone dental benefit plans may obtain 262 standardized comparative information on such plans. 263 (e) Assign a rating to each qualified health plan offered 264 through the marketplace in accordance with the rating system 265 developed under s. 1311(c)(3) of the Affordable Care Act and 266 determine each qualified health plan’s level of coverage in 267 accordance with regulations issued under s. 1302(d)(2)(A) of the 268 Affordable Care Act. 269 (f) Use a standardized format for presenting health and 270 dental benefit options in the marketplace, including the use of 271 the uniform outline of coverage established under the Public 272 Health Service Act, 42 U.S.C. s. 300gg-15 (2010). 273 (g) In accordance with s. 1413 of the Affordable Care Act, 274 inform individuals of eligibility requirements for the Medicaid 275 program under Title XIX of the United States Social Security 276 Act, the State Children’s Health Insurance Program under Title 277 XXI of the United States Social Security Act, or under any 278 applicable state or local public program and if, through 279 screening of an application by the marketplace, the marketplace 280 determines that an individual is eligible for any such program, 281 enroll the individual in that program. 282 (h) Determine the criteria and process for eligibility, 283 enrollment, and disenrollment of enrollees and potential 284 enrollees in the marketplace and coordinate that process with 285 the state and local government entities administering other 286 health care coverage programs, in order to ensure consistent 287 eligibility and enrollment processes and seamless transitions 288 between coverages. To the extent possible, the agency shall 289 encourage the use of existing infrastructure and capacity from 290 other state agencies. 291 (i) Determine the minimum requirements a carrier must meet 292 to be considered for participation in the marketplace and the 293 standards and criteria for selecting qualified health plans to 294 be offered through the marketplace which are in the best 295 interests of qualified individuals and qualified employers. The 296 agency shall consistently and uniformly apply these 297 requirements, standards, and criteria to all carriers offering 298 qualified health plans through the marketplace and, if relevant, 299 shall apply those requirements, standards, and criteria to 300 carriers offering qualified stand-alone dental benefit plans or 301 other dental benefit plans through the marketplace. In the 302 course of selectively contracting for health care coverage 303 offered to qualified individuals and qualified employers through 304 the marketplace, the agency shall seek to contract with carriers 305 so as to provide health care coverage choices that offer the 306 optimal combination of choice, value, quality and service. In 307 its evaluation of the quality of health care coverage offered by 308 a carrier, the agency shall consider comparative health care 309 quality information and assessments. 310 (j) Provide, in each region of the state, a choice of 311 qualified health plans at each of the levels of coverage 312 contained in s. 1302(d) and (e) of the Affordable Care Act. 313 (k) Require, as a condition of participation in the 314 marketplace, carriers to fairly and affirmatively offer, market, 315 and sell in the marketplace at least one product within each of 316 the levels of coverage contained in s. 1302(d) and (e) of the 317 Affordable Care Act. The agency may require carriers to offer 318 additional products within each of the levels of coverage. This 319 paragraph does not apply to a carrier that solely offers 320 supplemental coverage in the marketplace or that solely offers a 321 qualified stand-alone dental benefit plan. 322 (l) Require, as a condition of participation in the 323 marketplace, carriers selling products outside the marketplace 324 to fairly and affirmatively offer, market, and sell all products 325 made available to individuals and small employers in the 326 marketplace to individuals and small employers, respectively, 327 purchasing coverage outside the marketplace. 328 (m) Establish and make available by electronic means and by 329 a toll-free telephone number a calculator to determine the 330 actual cost of coverage after application of any premium tax 331 credit under s. 1401 of the Affordable Care Act or any cost 332 sharing reduction under s. 1402 of the Affordable Care Act. 333 (n) Establish a SHOP exchange through which qualified 334 employers may access coverage for their employees, enabling any 335 qualified employer to specify a level of coverage or amount of 336 contribution toward coverage so that any of its employees may 337 enroll in any qualified health plan or qualified stand-alone 338 dental benefit plan offered through the SHOP exchange at the 339 specified level of coverage. 340 (o) Perform duties related to determining eligibility for 341 premium tax credits, reduced cost sharing, and individual 342 responsibility requirement exemptions. 343 (p) Review the rate of premium growth within the 344 marketplace and outside the marketplace and consider the 345 information in developing recommendations on whether to continue 346 limiting qualified employer status to small employers. 347 (q) Credit the amount of any free choice voucher to the 348 monthly premium of the health benefit plan in which an employee 349 is enrolled, in accordance with s. 10108 of the Affordable Care 350 Act, and collect the amount credited from the offering qualified 351 employer. 352 (r) Report on the operation of the marketplace, beginning 353 January 1, 2018, and annually thereafter, to the Governor, the 354 Chief Financial Officer, the President of the Senate, the 355 Speaker of the House of Representatives, and the standing 356 committees of the Senate and the House of Representatives having 357 jurisdiction over appropriations and financial affairs, 358 insurance and financial services matters, and health and human 359 services matters. The report must include an accurate accounting 360 of all activities, receipts and expenditures of the marketplace. 361 (8) HEALTH BENEFIT PLAN CERTIFICATION.— 362 (a) The marketplace shall certify a health benefit plan as 363 a qualified health plan if: 364 1. The health benefit plan provides the essential health 365 benefits package described in s. 1302(a) of the Affordable Care 366 Act, except that the plan is not required to provide essential 367 benefits that duplicate the minimum benefits of qualified stand 368 alone dental benefit plans, as provided in paragraph (e), if: 369 a. The marketplace has determined that at least one 370 qualified stand-alone dental benefit plan is available to 371 supplement the plan’s coverage; and 372 b. The carrier makes prominent disclosure at the time it 373 offers the plan, in a form approved by the marketplace, that the 374 plan does not provide the full range of essential pediatric 375 dental benefits and that qualified stand-alone dental benefit 376 plans providing those benefits and other dental benefits not 377 covered by the plan are offered through the marketplace; 378 2. The premium rates and contract language have been 379 approved by the agency; 380 3. The health benefit plan provides at least a bronze level 381 of coverage, as determined pursuant to s. 1302(d)(1)(A) of the 382 Affordable Care Act for catastrophic plans, and will be offered 383 only to individuals eligible for catastrophic coverage; 384 4. The health benefit plan’s cost-sharing requirements do 385 not exceed the limits established under s. 1302(c)(1) of the 386 Affordable Care Act and, if the plan is offered through the SHOP 387 exchange, the plan’s deductible does not exceed the limits 388 established under s. 1302(c)(2) of the Affordable Care Act; 389 5. The health carrier offering the health benefit plan: 390 a. Is licensed and in good standing to offer health 391 insurance coverage in this state; 392 b. Offers at least one qualified health plan in the silver 393 level and at least one plan in the gold level as described in s. 394 1302(d)(1)(B) and (d)(1)(C) of the Affordable Care Act, 395 respectively, through each component of the marketplace in which 396 the carrier participates. As used in this sub-subparagraph, 397 “component” means the SHOP exchange and the marketplace; 398 c. Offers at least one qualified health plan that provides 399 the essential health benefits package described in s. 1302(a) of 400 the Affordable Care Act without benefits that duplicate the 401 minimum dental benefits of stand-alone dental benefit plans, if 402 the marketplace has determined that at least one qualified 403 stand-alone dental benefit plan is available through the 404 marketplace to supplement the qualified health plan’s coverage; 405 d. Charges the same premium rate for each qualified health 406 plan without regard to whether the plan is offered through the 407 marketplace and without regard to whether the plan is offered 408 directly from the carrier or through an insurance producer; 409 e. As required by subsection (6), does not charge any fees 410 or penalties for termination of coverage; and 411 f. Complies with the regulations developed under s. 1311(c) 412 of the Affordable Care Act and such other requirements as the 413 marketplace may establish; 414 6. The health benefit plan meets the requirements of 415 certification as adopted by agency rules and by regulations 416 adopted under s. 1311(c) of the Affordable Care Act, which 417 include, but are not limited to, minimum standards in the areas 418 of marketing practices, network adequacy, essential community 419 providers in underserved areas, accreditation, quality 420 improvement, uniform enrollment forms, and descriptions of 421 coverage and information on quality measures for health benefit 422 plan performance; and 423 7. The agency determines that making the health benefit 424 plan available through the marketplace is in the interest of 425 qualified individuals and qualified employers. 426 (b) The marketplace may not exclude a health benefit plan: 427 1. On the basis that the health benefit plan is a fee-for 428 service plan; 429 2. Through the imposition of premium price controls by the 430 marketplace; or 431 3. On the basis that the health benefit plan provides 432 treatments necessary to prevent patients’ deaths in 433 circumstances in which the marketplace determines the treatments 434 are inappropriate or too costly. 435 (c) The marketplace shall require each health carrier 436 seeking certification of a health benefit plan as a qualified 437 health plan to: 438 1. Submit a justification for any premium rate increase 439 before implementation of that increase. The carrier shall 440 prominently post the information concerning the justification on 441 its publicly accessible website. The marketplace shall take this 442 information, along with the information and the recommendations 443 provided to the marketplace under the Public Health Service Act, 444 42 U.S.C. s. 300gg-94 (2010), into consideration when 445 determining whether to allow the carrier to make health benefit 446 plans available through the marketplace. 447 2. Make available to the public and submit to the 448 marketplace accurate, transparent, and timely disclosure of the 449 following: 450 a. Claims payment policies and practices. 451 b. Periodic financial disclosures. 452 c. Data on enrollment. 453 d. Data on disenrollment. 454 e. Data on the number of claims that are denied. 455 f. Data on rating practices. 456 g. Information on cost sharing and payments with respect to 457 any out-of-network coverage. 458 h. Information on enrollee and participant rights under 459 Title I of the Affordable Care Act. 460 461 The information required in this subparagraph must be provided 462 in plain language, as that term is defined in s. 1311(e)(3)(B) 463 of the Affordable Care Act. 464 3. Make available to an individual, in a timely manner upon 465 the request of the individual, the amount of cost sharing, 466 including deductibles, copayments, and coinsurance, under the 467 individual’s plan or coverage that the individual would be 468 responsible for paying with respect to the furnishing of a 469 specific item or service by a participating provider. At a 470 minimum, this information must be made available to the 471 individual through a publicly accessible website and through 472 other means for an individual without access to the Internet. 473 4. Make a separate disclosure of the price of pediatric 474 dental benefits if the plan provides a comprehensive essential 475 health benefits package described in s. 1302(a) of the 476 Affordable Care Act, as long as the carrier is not required to 477 offer the pediatric dental benefit for sale on the marketplace 478 on a stand-alone basis. 479 (d) The marketplace may not exempt any health carrier 480 seeking certification of a qualified health plan, regardless of 481 the type or size of the carrier, from state licensure or 482 solvency requirements. 483 (e) The provisions of this section that are applicable to 484 qualified health plans also apply to the extent relevant to 485 qualified stand-alone dental benefit plans except as provided in 486 this paragraph or by rules adopted by the marketplace. 487 1. The marketplace may certify a stand-alone dental benefit 488 plan as a qualified stand-alone dental benefit plan if the 489 carrier offering the plan: 490 a. Is licensed and in good standing to offer dental 491 coverage in this state. The carrier need not be licensed to 492 offer other health benefits; 493 b. Offers at least one stand-alone dental benefit plan that 494 includes only the essential pediatric dental benefit requirement 495 of s. 1302(b)(1)(J) of the Affordable Care Act, as long as this 496 requirement does not limit a carrier from providing other stand 497 alone dental benefit plans that are certified by the 498 marketplace; 499 c. Charges the same premium rate for each stand-alone 500 dental benefit plan without regard to whether the plan is 501 offered through the marketplace and without regard to whether 502 the plan is offered directly from the carrier or through an 503 insurance producer; 504 d. Submits the premium rates and contract language to the 505 agency for approval; 506 e. As required by subsection (6), does not charge any fees 507 or penalties for termination of coverage; and 508 f. Complies with any requirements adopted under s. 1311(d) 509 of the Affordable Care Act and any rules adopted by the 510 marketplace pursuant to this section. 511 2. The qualified stand-alone dental benefit plan must be 512 limited to dental and oral health benefits, without 513 substantially duplicating the benefits typically offered by 514 health benefit plans without dental coverage, and must meet the 515 requirements for essential pediatric dental benefits prescribed 516 pursuant to s. 1302(b)(1)(J) of the Affordable Care Act and such 517 other dental benefits as may be specified by rule or regulation. 518 3. Carriers may jointly offer a comprehensive plan through 519 the marketplace in which the dental benefits are provided by a 520 carrier through a qualified stand-alone dental benefit plan and 521 the other benefits are provided by a carrier through a qualified 522 health plan, if the plans are priced separately and are also 523 made available for purchase separately at the same prices. 524 4. The marketplace may not exclude a stand-alone dental 525 benefit plan on the basis that the plan is a fee-for-service 526 plan or through the imposition of premium price controls by the 527 marketplace. 528 (f) In addition to the certification of a qualified stand 529 alone dental benefit plan pursuant to this subsection, the 530 marketplace may certify other stand-alone dental benefit plans, 531 either as part of a qualified health plan or separately, in 532 accordance with this subsection and any rules adopted by the 533 marketplace. 534 535 The marketplace shall apply the criteria of this subsection in a 536 manner that ensures fairness between or among health carriers 537 participating in the marketplace. 538 Section 3. This act shall take effect October 1, 2015, if, 539 before that date, the United States Supreme Court rules in King 540 v. Burwell, Docket Number 14-114, that it is impermissible under 541 the Patient Protection and Affordable Care Act, 42 U.S.C. s. 542 1321, for individuals who purchase coverage through exchanges 543 established by the Federal Government to obtain federal tax 544 credit subsidies or benefits or that individuals who purchase 545 coverage through exchanges established by state governments are 546 the only individuals eligible for federal tax credit subsidies 547 or benefits under the Patient Protection and Affordable Care 548 Act, 42 U.S.C. s. 1321. If the Supreme Court does not enter such 549 a ruling before that date, or rules in King v. Burwell that such 550 subsidies or benefits are available to individuals who purchase 551 coverage through exchanges established by the Federal 552 Government, this act shall not take effect.