Florida Senate - 2019 COMMITTEE AMENDMENT
Bill No. SB 418
Ì166758YÎ166758
LEGISLATIVE ACTION
Senate . House
Comm: RCS .
03/25/2019 .
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The Committee on Banking and Insurance (Simpson) recommended the
following:
1 Senate Amendment (with title amendment)
2
3 Delete everything after the enacting clause
4 and insert:
5 Section 1. Study of state essential health benefits
6 benchmark plan; report.—
7 (1) As used in this section, the term:
8 (a) “EHB-benchmark plan” has the same meaning as provided
9 in 45 C.F.R. s. 156.20.
10 (b) “Office” means the Office of Insurance Regulation.
11 (2) The office shall conduct a study to evaluate this
12 state’s current EHB-benchmark plan for nongrandfathered
13 individual and group health plans and options for changing the
14 EHB-benchmark plan pursuant to 45 C.F.R. s. 156.111 for future
15 plan years. In conducting the study, the office shall:
16 (a) Consider EHB-benchmark plans and benefits under the 10
17 essential health benefits categories established under 45 C.F.R.
18 s. 156.110(a) which are used by the other 49 states;
19 (b) Compare the costs of benefits within such categories
20 and overall costs of EHB-benchmark plans used by other states
21 with the costs of benefits within the categories and overall
22 costs of the current EHB-benchmark plan of this state; and
23 (c) Solicit and consider proposed individual and group
24 health plans from health insurers and health maintenance
25 organizations in developing recommendations for changes to the
26 current EHB-benchmark plan.
27 (3) By October 30, 2019, the office shall submit a report
28 to the Governor, the President of the Senate, and the Speaker of
29 the House of Representatives which must include recommendations
30 for changing the current EHB-benchmark plan to provide
31 comprehensive care at a lower cost than this state’s current
32 EHB-benchmark plan. In its report, the office shall provide an
33 analysis as to whether proposed health plans it receives under
34 paragraph (2)(c) meet the requirements for an EHB-benchmark plan
35 under 45 C.F.R. s. 156.111(b).
36 (4) Health plans created by health insurers and health
37 maintenance organizations under this section:
38 (a) May be submitted to the office for consideration as
39 part of the study under this section; and
40 (b) May also be submitted to the office for evaluation as
41 equivalent to the current state EHB-benchmark plan or to any
42 EHB-benchmark plan created in the future.
43 Section 2. Section 627.443, Florida Statutes, is created to
44 read:
45 627.443 Essential health benefits.—
46 (1) As used in this section, the term:
47 (a) “EHB-benchmark plan” has the same meaning as provided
48 in 45 C.F.R. s. 156.20.
49 (b) “PPACA” has the same meaning as in s. 627.402.
50 (2) A health insurer or health maintenance organization
51 issuing or delivering an individual or a group health insurance
52 policy or health maintenance contract in this state may create a
53 new health insurance policy or health maintenance contract that:
54 (a) Must include at least one service or coverage under
55 each of the 10 essential health benefits categories under 42
56 U.S.C. s. 18022(b) which are required under PPACA;
57 (b) May fulfill the requirement in paragraph (a) by
58 selecting one or more services or coverages for each of the
59 required categories from the list of essential health benefits
60 required by any single state or multiple states; and
61 (c) May comply with paragraphs (a) and (b) by selecting one
62 or more services or coverages from any one or more of the
63 required categories of essential health benefits from one state
64 or multiple states.
65 (3) This section specifically authorizes an insurer or
66 health maintenance organization to include any combination of
67 services or coverages required by any one or a combination of
68 states to provide the 10 categories of essential health benefits
69 required under PPACA in a policy or contract issued in this
70 state.
71 (4) Health insurance policies and health maintenance
72 contracts created by health insurers and health maintenance
73 organizations under this section:
74 (a) May be submitted to the office for consideration as
75 part of the office’s study of this state’s essential health
76 benefits benchmark plan; and
77 (b) May also be submitted to the office for evaluation as
78 equivalent to the current state EHB-benchmark plan or to any
79 EHB-benchmark plan created in the future.
80 Section 3. This act shall take effect upon becoming a law.
81
82 ================= T I T L E A M E N D M E N T ================
83 And the title is amended as follows:
84 Delete everything before the enacting clause
85 and insert:
86 A bill to be entitled
87 An act relating to essential health benefits under
88 health plans; defining the terms “EHB-benchmark plan”
89 and “office”; requiring the Office of Insurance
90 Regulation to conduct a study evaluating this state’s
91 current benchmark plan for essential health benefits
92 under the federal Patient Protection and Affordable
93 Care Act (PPACA) and options for changing the
94 benchmark plan for future plan years; requiring the
95 office, in conducting the study, to consider plans and
96 certain benefits used by other states and compare
97 costs with those of this state; requiring the office
98 to solicit and consider proposed health plans from
99 health insurers and health maintenance organizations
100 in developing recommendations; requiring the office,
101 by a certain date, to provide a report with certain
102 recommendations and a certain analysis to the Governor
103 and the Legislature; providing that health plans
104 created by health insurers and health maintenance
105 organizations may be submitted to the office for
106 certain purposes; creating s. 627.443, F.S.; defining
107 the terms “EHB-benchmark plan” and “PPACA”;
108 authorizing health insurers and health maintenance
109 organizations to create new health insurance policies
110 and health maintenance contracts meeting certain
111 criteria for essential health benefits under PPACA;
112 providing that such criteria may be met by certain
113 means; providing construction; providing that such
114 policies and contracts created by health insurers and
115 health maintenance organizations may be submitted to
116 the office for certain purposes; providing an
117 effective date.