CS for SB 422 First Engrossed 2013422e1 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 a health maintenance 6 contract that provides coverage for cancer treatment 7 medications provide coverage for orally administered 8 cancer treatment medications on a basis no less 9 favorable than that required by the policy or contract 10 for intravenously administered or injected cancer 11 treatment medications; prohibiting insurers, health 12 maintenance organizations, and certain other entities 13 from engaging in specified actions to avoid compliance 14 with this act; amending s. 627.6515, F.S.; adding a 15 cross-reference to conform to changes made by the act; 16 providing an effective date. 17 18 Be It Enacted by the Legislature of the State of Florida: 19 20 Section 1. This act may be cited as the “Cancer Treatment 21 Fairness Act.” 22 Section 2. Section 627.42391, Florida Statutes, is created 23 to read: 24 627.42391 Cancer treatment parity; orally administered 25 cancer treatment medications.— 26 (1) As used in this section, the term: 27 (a) “Cancer treatment medication” means medication 28 prescribed by a treating physician who determines that the 29 medication is medically necessary to kill or slow the growth of 30 cancerous cells in a manner consistent with nationally accepted 31 standards of practice. 32 (b) “Cost sharing” includes copayments, coinsurance, dollar 33 limits, and deductibles imposed on the covered person. 34 (2) Beginning January 1, 2014, an individual or group 35 insurance policy, including a policy issued to a small employer 36 as defined in s. 627.6699, delivered, issued for delivery, 37 renewed, amended, or continued in this state which provides 38 medical, major medical, or similar comprehensive coverage and 39 includes coverage for cancer treatment medications, must also 40 cover prescribed, orally administered cancer treatment 41 medications and may not apply cost-sharing requirements for 42 prescribed, orally administered cancer treatment medications 43 which are less favorable to the covered person than cost-sharing 44 requirements for intravenous or injected cancer treatment 45 medications covered under the policy. 46 (3) An insurer that provides a policy 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 a policy in effect on July 1, 2013, 50 in order 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 July 1, 2013, in order to 66 comply with this section. 67 Section 3. Section 641.313, Florida Statutes, is created to 68 read: 69 641.313 Cancer treatment parity; orally administered cancer 70 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) Beginning January 1, 2014, a health maintenance 80 contract, including a contract issued to a small employer as 81 defined in s. 627.6699, delivered, issued for delivery, renewed, 82 amended, or continued in this state which provides medical, 83 major medical, or similar comprehensive coverage and includes 84 coverage for cancer treatment medications, must also cover 85 prescribed, orally administered cancer treatment medications and 86 may not apply cost-sharing requirements for prescribed, orally 87 administered cancer treatment medications which are less 88 favorable to the covered person than cost-sharing requirements 89 for intravenous or injected cancer treatment medications covered 90 under the contract. 91 (3) A health maintenance organization that provides a 92 contract described in subsection (2), and any participating 93 entity through which the health maintenance organization offers 94 health services, may not: 95 (a) Vary the terms of a contract in effect on July 1, 2013, 96 in order to avoid compliance with this section. 97 (b) Provide any incentive, including, but not limited to, a 98 monetary incentive, or impose treatment limitations to encourage 99 a covered person to accept less than the minimum protections 100 available under this section. 101 (c) Penalize a health care practitioner or reduce or limit 102 the compensation of a health care practitioner for recommending 103 or providing services or care to a covered person as required 104 under this section. 105 (d) Provide any incentive, including, but not limited to, a 106 monetary incentive, to induce a health care practitioner to 107 provide care or services that do not comply with this section. 108 (e) Change the classification of any intravenous or 109 injected cancer treatment medication or increase the amount of 110 cost sharing applicable to any intravenous or injected cancer 111 treatment medication in effect on July 1, 2013, in order to 112 comply with this section. 113 Section 4. Subsection (2) of section 627.6515, Florida 114 Statutes, is amended to read: 115 627.6515 Out-of-state groups.— 116 (2) Except as otherwise provided in this part, this part 117 does not apply to a group health insurance policy issued or 118 delivered outside this state under which a resident of this 119 state is provided coverage if: 120 (a) The policy is issued to an employee group the 121 composition of which is substantially as described in s. 122 627.653; a labor union group or association group the 123 composition of which is substantially as described in s. 124 627.654; an additional group the composition of which is 125 substantially as described in s. 627.656; a group insured under 126 a blanket health policy when the composition of the group is 127 substantially in compliance with s. 627.659; a group insured 128 under a franchise health policy when the composition of the 129 group is substantially in compliance with s. 627.663; an 130 association group to cover persons associated in any other 131 common group, which common group is formed primarily for 132 purposes other than providing insurance; a group that is 133 established primarily for the purpose of providing group 134 insurance, provided the benefits are reasonable in relation to 135 the premiums charged thereunder and the issuance of the group 136 policy has resulted, or will result, in economies of 137 administration; or a group of insurance agents of an insurer, 138 which insurer is the policyholder; 139 (b) Certificates evidencing coverage under the policy are 140 issued to residents of this state and contain in contrasting 141 color and not less than 10-point type the following statement: 142 “The benefits of the policy providing your coverage are governed 143 primarily by the law of a state other than Florida”; and 144 (c) The policy provides the benefits specified in ss. 145 627.419, 627.42391, 627.6574, 627.6575, 627.6579, 627.6612, 146 627.66121, 627.66122, 627.6613, 627.667, 627.6675, 627.6691, and 147 627.66911, and complies with the requirements of s. 627.66996. 148 (d) Applications for certificates of coverage offered to 149 residents of this state must contain, in contrasting color and 150 not less than 12-point type, the following statement on the same 151 page as the applicant’s signature: 152 153 “This policy is primarily governed by the laws of 154 ...insert state where the master policy if filed.... 155 As a result, all of the rating laws applicable to 156 policies filed in this state do not apply to this 157 coverage, which may result in increases in your 158 premium at renewal that would not be permissible under 159 a Florida-approved policy. Any purchase of individual 160 health insurance should be considered carefully, as 161 future medical conditions may make it impossible to 162 qualify for another individual health policy. For 163 information concerning individual health coverage 164 under a Florida-approved policy, consult your agent or 165 the Florida Department of Financial Services.” 166 167 This paragraph applies only to group certificates providing 168 health insurance coverage which require individualized 169 underwriting to determine coverage eligibility for an individual 170 or premium rates to be charged to an individual except for the 171 following: 172 1. Policies issued to provide coverage to groups of persons 173 all of whom are in the same or functionally related licensed 174 professions, and providing coverage only to such licensed 175 professionals, their employees, or their dependents; 176 2. Policies providing coverage to small employers as 177 defined by s. 627.6699. Such policies shall be subject to, and 178 governed by, the provisions of s. 627.6699; 179 3. Policies issued to a bona fide association, as defined 180 by s. 627.6571(5), provided that there is a person or board 181 acting as a fiduciary for the benefit of the members, and such 182 association is not owned, controlled by, or otherwise associated 183 with the insurance company; or 184 4. Any accidental death, accidental death and 185 dismemberment, accident-only, vision-only, dental-only, hospital 186 indemnity-only, hospital accident-only, cancer, specified 187 disease, Medicare supplement, products that supplement Medicare, 188 long-term care, or disability income insurance, or similar 189 supplemental plans provided under a separate policy, 190 certificate, or contract of insurance, which cannot duplicate 191 coverage under an underlying health plan, coinsurance, or 192 deductibles or coverage issued as a supplement to workers’ 193 compensation or similar insurance, or automobile medical-payment 194 insurance. 195 Section 5. Except as otherwise expressly provided in this 196 act, this act shall take effect July 1, 2013, and applies to 197 policies and contracts issued or renewed on or after that date.