Florida Senate - 2026 SB 1354
By Senator Garcia
36-01414A-26 20261354__
1 A bill to be entitled
2 An act relating to small employer health insurance;
3 amending s. 627.6699, F.S.; deleting and revising
4 definitions; deleting provisions relating to the
5 creation of the Florida Small Employer Health
6 Reinsurance Program; amending ss. 627.642, 627.6475,
7 627.657, and 627.66997, F.S.; conforming cross
8 references; providing an effective date.
9
10 Be It Enacted by the Legislature of the State of Florida:
11
12 Section 1. Paragraphs (b), (p), (q), and (s) of subsection
13 (3), paragraph (d) of subsection (9), paragraphs (b) and (c) of
14 subsection (10), and subsection (11) of section 627.6699,
15 Florida Statutes, are amended to read:
16 627.6699 Employee Health Care Access Act.—
17 (3) DEFINITIONS.—As used in this section, the term:
18 (b) “Board” means the board of directors of the program.
19 (p) “Plan of operation” means the plan of operation of the
20 program, including articles, bylaws, and operating rules,
21 adopted by the board under subsection (11).
22 (q) “Program” means the Florida Small Employer Carrier
23 Reinsurance Program created under subsection (11).
24 (p)(s) “Reinsuring carrier” means a small employer carrier
25 that elects to comply with reinsurance the requirements set
26 forth in subsection (11).
27 (9) SMALL EMPLOYER CARRIER’S ELECTION TO BECOME A RISK
28 ASSUMING CARRIER OR A REINSURING CARRIER.—
29 (d) A small employer carrier that elects to cease
30 participating as a reinsuring carrier and to become a risk
31 assuming carrier is prohibited from reinsuring or continuing to
32 reinsure any small employer health benefits plan under
33 subsection (11) as soon as the carrier becomes a risk-assuming
34 carrier and must pay a prorated assessment based upon business
35 issued as a reinsuring carrier for any portion of the year that
36 the business was reinsured. A small employer carrier that elects
37 to cease participating as a risk-assuming carrier and to become
38 a reinsuring carrier is permitted to reinsure small employer
39 health benefit plans under the terms set forth in subsection
40 (11) and must pay a prorated assessment based upon business
41 issued as a reinsuring carrier for any portion of the year that
42 the business was reinsured.
43 (10) ELECTION PROCESS TO BECOME A RISK-ASSUMING CARRIER.—
44 (b) In determining whether to approve an application by a
45 small employer carrier to become a risk-assuming carrier, the
46 office shall consider:
47 1. The carrier’s financial ability to support the
48 assumption of the risk of small employer groups.
49 2. The carrier’s history of rating and underwriting small
50 employer groups.
51 3. The carrier’s commitment to market fairly to all small
52 employers in the state or its service area, as applicable.
53 4. The carrier’s ability to assume and manage the risk of
54 enrolling small employer groups without the protection of the
55 reinsurance program provided in subsection (11).
56 (c) A small employer carrier that becomes a risk-assuming
57 carrier pursuant to this subsection is not subject to
58 reinsurance the assessment provisions of subsection (11).
59 (11) SMALL EMPLOYER HEALTH REINSURANCE PROGRAM.—
60 (a) There is created a nonprofit entity to be known as the
61 “Florida Small Employer Health Reinsurance Program.”
62 (b)1. The program shall operate subject to the supervision
63 and control of the board.
64 2. Effective upon this act becoming a law, the board shall
65 consist of the director of the office or his or her designee,
66 who shall serve as the chairperson, and 13 additional members
67 who are representatives of carriers and insurance agents and are
68 appointed by the director of the office and serve as follows:
69 a. Five members shall be representatives of health insurers
70 licensed under chapter 624 or chapter 641. Two members shall be
71 agents who are actively engaged in the sale of health insurance.
72 Four members shall be employers or representatives of employers.
73 One member shall be a person covered under an individual health
74 insurance policy issued by a licensed insurer in this state. One
75 member shall represent the Agency for Health Care Administration
76 and shall be recommended by the Secretary of Health Care
77 Administration.
78 b. A member appointed under this subparagraph shall serve a
79 term of 4 years and shall continue in office until the member’s
80 successor takes office, except that, in order to provide for
81 staggered terms, the director of the office shall designate two
82 of the initial appointees under this subparagraph to serve terms
83 of 2 years and shall designate three of the initial appointees
84 under this subparagraph to serve terms of 3 years.
85 3. The director of the office may remove a member for
86 cause.
87 4. Vacancies on the board shall be filled in the same
88 manner as the original appointment for the unexpired portion of
89 the term.
90 (c)1. The board shall submit to the office a plan of
91 operation to assure the fair, reasonable, and equitable
92 administration of the program. The board may at any time submit
93 to the office any amendments to the plan that the board finds to
94 be necessary or suitable.
95 2. The office shall, after notice and hearing, approve the
96 plan of operation if it determines that the plan submitted by
97 the board is suitable to assure the fair, reasonable, and
98 equitable administration of the program and provides for the
99 sharing of program gains and losses equitably and
100 proportionately in accordance with paragraph (j).
101 3. The plan of operation, or any amendment thereto, becomes
102 effective upon written approval of the office.
103 (d) The plan of operation must, among other things:
104 1. Establish procedures for handling and accounting for
105 program assets and moneys and for an annual fiscal reporting to
106 the office.
107 2. Establish procedures for selecting an administering
108 carrier and set forth the powers and duties of the administering
109 carrier.
110 3. Establish procedures for reinsuring risks.
111 4. Establish procedures for collecting assessments from
112 participating carriers to provide for claims reinsured by the
113 program and for administrative expenses, other than amounts
114 payable to the administrative carrier, incurred or estimated to
115 be incurred during the period for which the assessment is made.
116 5. Provide for any additional matters at the discretion of
117 the board.
118 (e) The board shall recommend to the office market conduct
119 requirements and other requirements for carriers and agents,
120 including requirements relating to:
121 1. Registration by each carrier with the office of its
122 intention to be a small employer carrier under this section;
123 2. Publication by the office of a list of all small
124 employer carriers, including a requirement applicable to agents
125 and carriers that a health benefit plan may not be sold by a
126 carrier that is not identified as a small employer carrier;
127 3. The availability of a broadly publicized, toll-free
128 telephone number for access by small employers to information
129 concerning this section;
130 4. Periodic reports by carriers and agents concerning
131 health benefit plans issued; and
132 5. Methods concerning periodic demonstration by small
133 employer carriers and agents that they are marketing or issuing
134 health benefit plans to small employers.
135 (f) The program has the general powers and authority
136 granted under the laws of this state to insurance companies and
137 health maintenance organizations licensed to transact business,
138 except the power to issue health benefit plans directly to
139 groups or individuals. In addition thereto, the program has
140 specific authority to:
141 1. Enter into contracts as necessary or proper to carry out
142 the provisions and purposes of this act, including the authority
143 to enter into contracts with similar programs of other states
144 for the joint performance of common functions or with persons or
145 other organizations for the performance of administrative
146 functions.
147 2. Sue or be sued, including taking any legal action
148 necessary or proper for recovering any assessments and penalties
149 for, on behalf of, or against the program or any carrier.
150 3. Take any legal action necessary to avoid the payment of
151 improper claims against the program.
152 4. Issue reinsurance policies, in accordance with the
153 requirements of this act.
154 5. Establish rules, conditions, and procedures for
155 reinsurance risks under the program participation.
156 6. Establish actuarial functions as appropriate for the
157 operation of the program.
158 7. Assess participating carriers in accordance with
159 paragraph (j), and make advance interim assessments as may be
160 reasonable and necessary for organizational and interim
161 operating expenses. Interim assessments shall be credited as
162 offsets against any regular assessments due following the close
163 of the calendar year.
164 8. Appoint appropriate legal, actuarial, and other
165 committees as necessary to provide technical assistance in the
166 operation of the program, and in any other function within the
167 authority of the program.
168 9. Borrow money to effect the purposes of the program. Any
169 notes or other evidences of indebtedness of the program which
170 are not in default constitute legal investments for carriers and
171 may be carried as admitted assets.
172 10. To the extent necessary, increase the $5,000 deductible
173 reinsurance requirement to adjust for the effects of inflation.
174 (g) A reinsuring carrier may reinsure with the program
175 coverage of an eligible employee of a small employer, or any
176 dependent of such an employee, subject to each of the following
177 provisions:
178 1. Except in the case of a late enrollee, a reinsuring
179 carrier may reinsure an eligible employee or dependent within 60
180 days after the commencement of the coverage of the small
181 employer. A newly employed eligible employee or dependent of a
182 small employer may be reinsured within 60 days after the
183 commencement of his or her coverage.
184 2. A small employer carrier may reinsure an entire employer
185 group within 60 days after the commencement of the group’s
186 coverage under the plan.
187 3. The program may not reimburse a participating carrier
188 with respect to the claims of a reinsured employee or dependent
189 until the carrier has paid incurred claims of at least $5,000 in
190 a calendar year for benefits covered by the program. In
191 addition, the reinsuring carrier shall be responsible for 10
192 percent of the next $50,000 and 5 percent of the next $100,000
193 of incurred claims during a calendar year and the program shall
194 reinsure the remainder.
195 4. The board annually shall adjust the initial level of
196 claims and the maximum limit to be retained by the carrier to
197 reflect increases in costs and utilization within the standard
198 market for health benefit plans within the state. The adjustment
199 shall not be less than the annual change in the medical
200 component of the “Consumer Price Index for All Urban Consumers”
201 of the Bureau of Labor Statistics of the Department of Labor,
202 unless the board proposes and the office approves a lower
203 adjustment factor.
204 5. A small employer carrier may terminate reinsurance for
205 all reinsured employees or dependents on any plan anniversary.
206 6. The premium rate charged for reinsurance by the program
207 to a health maintenance organization that is approved by the
208 Secretary of Health and Human Services as a federally qualified
209 health maintenance organization pursuant to 42 U.S.C. s.
210 300e(c)(2)(A) and that, as such, is subject to requirements that
211 limit the amount of risk that may be ceded to the program, which
212 requirements are more restrictive than subparagraph 3., shall be
213 reduced by an amount equal to that portion of the risk, if any,
214 which exceeds the amount set forth in subparagraph 3. which may
215 not be ceded to the program.
216 7. The board may consider adjustments to the premium rates
217 charged for reinsurance by the program for carriers that use
218 effective cost containment measures, including high-cost case
219 management, as defined by the board.
220 8. A reinsuring carrier shall apply its case-management and
221 claims-handling techniques, including, but not limited to,
222 utilization review, individual case management, preferred
223 provider provisions, other managed care provisions or methods of
224 operation, consistently with both reinsured business and
225 nonreinsured business.
226 (h)1. The board, as part of the plan of operation, shall
227 establish a methodology for determining premium rates to be
228 charged by the program for reinsuring small employers and
229 individuals pursuant to this section. The methodology shall
230 include a system for classification of small employers that
231 reflects the types of case characteristics commonly used by
232 small employer carriers in the state. The methodology shall
233 provide for the development of basic reinsurance premium rates,
234 which shall be multiplied by the factors set for them in this
235 paragraph to determine the premium rates for the program. The
236 basic reinsurance premium rates shall be established by the
237 board, subject to the approval of the office. The premium rates
238 set by the board may vary by geographical area, as determined
239 under this section, to reflect differences in cost. The
240 multiplying factors must be established as follows:
241 a. The entire group may be reinsured for a rate that is 1.5
242 times the rate established by the board.
243 b. An eligible employee or dependent may be reinsured for a
244 rate that is 5 times the rate established by the board.
245 2. The board periodically shall review the methodology
246 established, including the system of classification and any
247 rating factors, to assure that it reasonably reflects the claims
248 experience of the program. The board may propose changes to the
249 rates which shall be subject to the approval of the office.
250 (i) If a health benefit plan for a small employer issued in
251 accordance with this subsection is entirely or partially
252 reinsured with the program, the premium charged to the small
253 employer for any rating period for the coverage issued must be
254 consistent with the requirements relating to premium rates set
255 forth in this section.
256 (j)1. Before July 1 of each calendar year, the board shall
257 determine and report to the office the program net loss for the
258 previous year, including administrative expenses for that year,
259 and the incurred losses for the year, taking into account
260 investment income and other appropriate gains and losses.
261 2. Any net loss for the year shall be recouped by
262 assessment of the carriers, as follows:
263 a. The operating losses of the program shall be assessed in
264 the following order subject to the specified limitations. The
265 first tier of assessments shall be made against reinsuring
266 carriers in an amount which shall not exceed 5 percent of each
267 reinsuring carrier’s premiums from health benefit plans covering
268 small employers. If such assessments have been collected and
269 additional moneys are needed, the board shall make a second tier
270 of assessments in an amount which shall not exceed 0.5 percent
271 of each carrier’s health benefit plan premiums. Except as
272 provided in paragraph (m), risk-assuming carriers are exempt
273 from all assessments authorized pursuant to this section. The
274 amount paid by a reinsuring carrier for the first tier of
275 assessments shall be credited against any additional assessments
276 made.
277 b. The board shall equitably assess carriers for operating
278 losses of the plan based on market share. The board shall
279 annually assess each carrier a portion of the operating losses
280 of the plan. The first tier of assessments shall be determined
281 by multiplying the operating losses by a fraction, the numerator
282 of which equals the reinsuring carrier’s earned premium
283 pertaining to direct writings of small employer health benefit
284 plans in the state during the calendar year for which the
285 assessment is levied, and the denominator of which equals the
286 total of all such premiums earned by reinsuring carriers in the
287 state during that calendar year. The second tier of assessments
288 shall be based on the premiums that all carriers, except risk
289 assuming carriers, earned on all health benefit plans written in
290 this state. The board may levy interim assessments against
291 carriers to ensure the financial ability of the plan to cover
292 claims expenses and administrative expenses paid or estimated to
293 be paid in the operation of the plan for the calendar year prior
294 to the association’s anticipated receipt of annual assessments
295 for that calendar year. Any interim assessment is due and
296 payable within 30 days after receipt by a carrier of the interim
297 assessment notice. Interim assessment payments shall be credited
298 against the carrier’s annual assessment. Health benefit plan
299 premiums and benefits paid by a carrier that are less than an
300 amount determined by the board to justify the cost of collection
301 may not be considered for purposes of determining assessments.
302 c. Subject to the approval of the office, the board shall
303 make an adjustment to the assessment formula for reinsuring
304 carriers that are approved as federally qualified health
305 maintenance organizations by the Secretary of Health and Human
306 Services pursuant to 42 U.S.C. s. 300e(c)(2)(A) to the extent,
307 if any, that restrictions are placed on them that are not
308 imposed on other small employer carriers.
309 3. Before July 1 of each year, the board shall determine
310 and file with the office an estimate of the assessments needed
311 to fund the losses incurred by the program in the previous
312 calendar year.
313 4. If the board determines that the assessments needed to
314 fund the losses incurred by the program in the previous calendar
315 year will exceed the amount specified in subparagraph 2., the
316 board shall evaluate the operation of the program and report its
317 findings, including any recommendations for changes to the plan
318 of operation, to the office within 180 days following the end of
319 the calendar year in which the losses were incurred. The
320 evaluation shall include an estimate of future assessments, the
321 administrative costs of the program, the appropriateness of the
322 premiums charged and the level of carrier retention under the
323 program, and the costs of coverage for small employers. If the
324 board fails to file a report with the office within 180 days
325 following the end of the applicable calendar year, the office
326 may evaluate the operations of the program and implement such
327 amendments to the plan of operation the office deems necessary
328 to reduce future losses and assessments.
329 5. If assessments exceed the amount of the actual losses
330 and administrative expenses of the program, the excess shall be
331 held as interest and used by the board to offset future losses
332 or to reduce program premiums. As used in this paragraph, the
333 term “future losses” includes reserves for incurred but not
334 reported claims.
335 6. Each carrier’s proportion of the assessment shall be
336 determined annually by the board, based on annual statements and
337 other reports considered necessary by the board and filed by the
338 carriers with the board.
339 7. Provision shall be made in the plan of operation for the
340 imposition of an interest penalty for late payment of an
341 assessment.
342 8. A carrier may seek, from the office, a deferment, in
343 whole or in part, from any assessment made by the board. The
344 office may defer, in whole or in part, the assessment of a
345 carrier if, in the opinion of the office, the payment of the
346 assessment would place the carrier in a financially impaired
347 condition. If an assessment against a carrier is deferred, in
348 whole or in part, the amount by which the assessment is deferred
349 may be assessed against the other carriers in a manner
350 consistent with the basis for assessment set forth in this
351 section. The carrier receiving such deferment remains liable to
352 the program for the amount deferred and is prohibited from
353 reinsuring any individuals or groups in the program if it fails
354 to pay assessments.
355 (k) Neither the participation in the program as reinsuring
356 carriers, the establishment of rates, forms, or procedures, nor
357 any other joint or collective action required by this act, may
358 be the basis of any legal action, criminal or civil liability,
359 or penalty against the program or any of its carriers either
360 jointly or separately.
361 (l) The board shall monitor compliance with this section,
362 including the market conduct of small employer carriers, and
363 shall report to the office any unfair trade practices and
364 misleading or unfair conduct by a small employer carrier that
365 has been reported to the board by agents, consumers, or any
366 other person. The office shall investigate all reports and, upon
367 a finding of noncompliance with this section or of unfair or
368 misleading practices, shall take action against the small
369 employer carrier as permitted under the insurance code or
370 chapter 641. The board is not given investigatory or regulatory
371 powers, but must forward all reports of cases or abuse or
372 misrepresentation to the office.
373 (m) Notwithstanding paragraph (j), the administrative
374 expenses of the program shall be recouped by assessment of risk
375 assuming carriers and reinsuring carriers and such amounts shall
376 not be considered part of the operating losses of the plan for
377 the purposes of this paragraph. Each carrier’s portion of such
378 administrative expenses shall be determined by multiplying the
379 total of such administrative expenses by a fraction, the
380 numerator of which equals the carrier’s earned premium
381 pertaining to direct writing of small employer health benefit
382 plans in the state during the calendar year for which the
383 assessment is levied, and the denominator of which equals the
384 total of such premiums earned by all carriers in the state
385 during such calendar year.
386 (n) The board shall advise the office, the Agency for
387 Health Care Administration, the department, other executive
388 departments, and the Legislature on health insurance issues.
389 Specifically, the board shall:
390 1. Provide a forum for stakeholders, consisting of
391 insurers, employers, agents, consumers, and regulators, in the
392 private health insurance market in this state.
393 2. Review and recommend strategies to improve the
394 functioning of the health insurance markets in this state with a
395 specific focus on market stability, access, and pricing.
396 3. Make recommendations to the office for legislation
397 addressing health insurance market issues and provide comments
398 on health insurance legislation proposed by the office.
399 4. Meet at least three times each year. One meeting shall
400 be held to hear reports and to secure public comment on the
401 health insurance market, to develop any legislation needed to
402 address health insurance market issues, and to provide comments
403 on health insurance legislation proposed by the office.
404 5. Issue a report to the office on the state of the health
405 insurance market by September 1 each year. The report shall
406 include recommendations for changes in the health insurance
407 market, results from implementation of previous recommendations,
408 and information on health insurance markets.
409 Section 2. Subsection (3) of section 627.642, Florida
410 Statutes, is amended to read:
411 627.642 Outline of coverage.—
412 (3) In addition to the outline of coverage, a policy as
413 specified in s. 627.6699(3)(j) s. 627.6699(3)(k) must be
414 accompanied by an identification card that contains, at a
415 minimum:
416 (a) The name of the organization issuing the policy or the
417 name of the organization administering the policy, whichever
418 applies.
419 (b) The name of the contract holder.
420 (c) The type of plan only if the plan is filed in the
421 state, an indication that the plan is self-funded, or the name
422 of the network.
423 (d) The member identification number, contract number, and
424 policy or group number, if applicable.
425 (e) A contact phone number or electronic address for
426 authorizations and admission certifications.
427 (f) A phone number or electronic address whereby the
428 covered person or hospital, physician, or other person rendering
429 services covered by the policy may obtain benefits verification
430 and information in order to estimate patient financial
431 responsibility, in compliance with privacy rules under the
432 Health Insurance Portability and Accountability Act.
433 (g) The national plan identifier, in accordance with the
434 compliance date set forth by the federal Department of Health
435 and Human Services.
436
437 The identification card must present the information in a
438 readily identifiable manner or, alternatively, the information
439 may be embedded on the card and available through magnetic
440 stripe or smart card. The information may also be provided
441 through other electronic technology.
442 Section 3. Paragraph (a) of subsection (2), paragraphs (a),
443 (e), and (g) of subsection (7), and paragraph (a) of subsection
444 (8) of section 627.6475, Florida Statutes, are amended to read:
445 627.6475 Individual reinsurance pool.—
446 (2) DEFINITIONS.—As used in this section:
447 (a) “Board,” “Carrier,” and “health benefit plan” have the
448 same meaning ascribed in s. 627.6699(3).
449 (7) INDIVIDUAL HEALTH REINSURANCE PROGRAM.—
450 (a) The individual health reinsurance program shall operate
451 subject to the supervision and control of the board of the small
452 employer health reinsurance program established pursuant to s.
453 627.6699(11). The board shall establish a separate, segregated
454 account for eligible individuals reinsured pursuant to this
455 section, which account may not be commingled with the small
456 employer health reinsurance account.
457 (e)1. Before March 1 of each calendar year, the board shall
458 determine and report to the office the program net loss in the
459 individual account for the previous year, including
460 administrative expenses for that year and the incurred losses
461 for that year, taking into account investment income and other
462 appropriate gains and losses.
463 2. Any net loss in the individual account for the year
464 shall be recouped by assessing the carriers as follows:
465 a. The operating losses of the program shall be assessed in
466 the following order subject to the specified limitations. The
467 first tier of assessments shall be made against reinsuring
468 carriers in an amount that may not exceed 5 percent of each
469 reinsuring carrier’s premiums for individual health insurance.
470 If such assessments have been collected and additional moneys
471 are needed, the board shall make a second tier of assessments in
472 an amount that may not exceed 0.5 percent of each carrier’s
473 health benefit plan premiums.
474 b. Except as provided in paragraph (f), risk-assuming
475 carriers are exempt from all assessments authorized pursuant to
476 this section. The amount paid by a reinsuring carrier for the
477 first tier of assessments shall be credited against any
478 additional assessments made.
479 c. The board shall equitably assess reinsuring carriers for
480 operating losses of the individual account based on market
481 share. The board shall annually assess each carrier a portion of
482 the operating losses of the individual account. The first tier
483 of assessments shall be determined by multiplying the operating
484 losses by a fraction, the numerator of which equals the
485 reinsuring carrier’s earned premium pertaining to direct
486 writings of individual health insurance in the state during the
487 calendar year for which the assessment is levied, and the
488 denominator of which equals the total of all such premiums
489 earned by reinsuring carriers in the state during that calendar
490 year. The second tier of assessments shall be based on the
491 premiums that all carriers, except risk-assuming carriers,
492 earned on all health benefit plans written in this state. The
493 board may levy interim assessments against reinsuring carriers
494 to ensure the financial ability of the plan to cover claims
495 expenses and administrative expenses paid or estimated to be
496 paid in the operation of the plan for the calendar year prior to
497 the association’s anticipated receipt of annual assessments for
498 that calendar year. Any interim assessment is due and payable
499 within 30 days after receipt by a carrier of the interim
500 assessment notice. Interim assessment payments shall be credited
501 against the carrier’s annual assessment. Health benefit plan
502 premiums and benefits paid by a carrier that are less than an
503 amount determined by the board to justify the cost of collection
504 may not be considered for purposes of determining assessments.
505 d. Subject to the approval of the office, the board shall
506 adjust the assessment formula for reinsuring carriers that are
507 approved as federally qualified health maintenance organizations
508 by the Secretary of Health and Human Services pursuant to 42
509 U.S.C. s. 300e(c)(2)(A) to the extent, if any, that restrictions
510 are placed on them which are not imposed on other carriers.
511 3. Before March 1 of each year, the board shall determine
512 and file with the office an estimate of the assessments needed
513 to fund the losses incurred by the program in the individual
514 account for the previous calendar year.
515 4. If the board determines that the assessments needed to
516 fund the losses incurred by the program in the individual
517 account for the previous calendar year will exceed the amount
518 specified in subparagraph 2., the board shall evaluate the
519 operation of the program and report its findings and
520 recommendations to the office in the format established in s.
521 627.6699(11) for the comparable report for the small employer
522 reinsurance program.
523 (g) Except as otherwise provided in this section, the board
524 and the office shall have all powers, duties, and
525 responsibilities with respect to carriers that issue and
526 reinsure individual health insurance, as specified for the board
527 and the office in s. 627.6699(11) with respect to small employer
528 carriers, including, but not limited to, the provisions of s.
529 627.6699(11) relating to:
530 1. Use of assessments that exceed the amount of actual
531 losses and expenses.
532 2. The annual determination of each carrier’s proportion of
533 the assessment.
534 3. Interest for late payment of assessments.
535 4. Authority for the office to approve deferment of an
536 assessment against a carrier.
537 5. Limited immunity from legal actions or carriers.
538 6. Development of standards for compensation to be paid to
539 agents. Such standards shall be limited to those specifically
540 enumerated in s. 627.6699(11)(d) s. 627.6699(12)(d).
541 7. Monitoring compliance by carriers with this section.
542 (8) STANDARDS TO ASSURE FAIR MARKETING.—
543 (a) Each health insurance issuer that offers individual
544 health insurance shall actively market coverage to eligible
545 individuals in the state. The provisions of s. 627.6699(11) s.
546 627.6699(12) that apply to small employer carriers that market
547 policies to small employers shall also apply to health insurance
548 issuers that offer individual health insurance with respect to
549 marketing policies to individuals.
550 Section 4. Subsection (2) of section 627.657, Florida
551 Statutes, is amended to read:
552 627.657 Provisions of group health insurance policies.—
553 (2) The medical policy as specified in s. 627.6699(3)(j) s.
554 627.6699(3)(k) must be accompanied by an identification card
555 that contains, at a minimum:
556 (a) The name of the organization issuing the policy or name
557 of the organization administering the policy, whichever applies.
558 (b) The name of the certificateholder.
559 (c) The type of plan only if the plan is filed in the
560 state, an indication that the plan is self-funded, or the name
561 of the network.
562 (d) The member identification number, contract number, and
563 policy or group number, if applicable.
564 (e) A contact phone number or electronic address for
565 authorizations and admission certifications.
566 (f) A phone number or electronic address whereby the
567 covered person or hospital, physician, or other person rendering
568 services covered by the policy may obtain benefits verification
569 and information in order to estimate patient financial
570 responsibility, in compliance with privacy rules under the
571 Health Insurance Portability and Accountability Act.
572 (g) The national plan identifier, in accordance with the
573 compliance date set forth by the federal Department of Health
574 and Human Services.
575
576 The identification card must present the information in a
577 readily identifiable manner or, alternatively, the information
578 may be embedded on the card and available through magnetic
579 stripe or smart card. The information may also be provided
580 through other electronic technology.
581 Section 5. Subsection (1) of section 627.66997, Florida
582 Statutes, is amended to read:
583 627.66997 Stop-loss insurance.—
584 (1) A self-insured health benefit plan established or
585 maintained by a small employer, as defined in s. 627.6699(3)(s)
586 s. 627.6699(3)(v), is exempt from s. 627.6699 and may use a
587 stop-loss insurance policy issued to the employer. For purposes
588 of this subsection, the term “stop-loss insurance policy” means
589 an insurance policy issued to a small employer which covers the
590 small employer’s obligation for the excess cost of medical care
591 on an equivalent basis per employee provided under a self
592 insured health benefit plan.
593 (a) A small employer stop-loss insurance policy is
594 considered a health insurance policy and is subject to s.
595 627.6699 if the policy has an aggregate attachment point that is
596 lower than the greatest of:
597 1. Two thousand dollars multiplied by the number of
598 employees;
599 2. One hundred twenty percent of expected claims, as
600 determined by the stop-loss insurer in accordance with actuarial
601 standards of practice; or
602 3. Twenty thousand dollars.
603 (b) Once claims under the small employer health benefit
604 plan reach the aggregate attachment point set forth in paragraph
605 (a), the stop-loss insurance policy authorized under this
606 section must cover 100 percent of all claims that exceed the
607 aggregate attachment point.
608 Section 6. This act shall take effect July 1, 2026.