Florida Senate - 2014                                    SB 1570
       
       
        
       By Senator Sachs
       
       
       
       
       
       34-00735-14                                           20141570__
    1                        A bill to be entitled                      
    2         An act relating to health insurance; amending ss.
    3         627.410, 627.411, and 641.31, F.S.; deleting
    4         provisions that exempt certain nongrandfathered health
    5         plans from rate review or approval by the Office of
    6         Insurance Regulation for a specified period; providing
    7         an effective date.
    8          
    9  Be It Enacted by the Legislature of the State of Florida:
   10  
   11         Section 1. Subsection (9) of section 627.410, Florida
   12  Statutes, is amended to read:
   13         627.410 Filing, approval of forms.—
   14         (9) For plan years 2014 and 2015, nongrandfathered health
   15  plans for the individual or small group market are not subject
   16  to rate review or approval by the office. An insurer or health
   17  maintenance organization issuing or renewing such health plans
   18  shall file rates and any change in rates with the office as
   19  required by paragraph (6)(a), but the filing and rates are not
   20  subject to subsection (2); paragraph (6)(b), paragraph (6)(c),
   21  or paragraph (6)(d); or subsection (7).
   22         (a) For each individual and small group nongrandfathered
   23  health plan, an insurer or health maintenance organization shall
   24  include a notice describing or illustrating the estimated impact
   25  of PPACA on monthly premiums with the delivery of the policy or
   26  contract or, upon renewal, the premium renewal notice. The
   27  notice must be in a format established by rule of the
   28  commission. The format must specify how the information required
   29  under paragraph (b) is to be described or illustrated, and may
   30  allow for specified variations from such requirements in order
   31  to provide a more accurate and meaningful disclosure of the
   32  estimated impact of PPACA on monthly premiums, as determined by
   33  the commission. All notices shall be submitted to the office for
   34  informational purposes by September 1, 2013. The notice is
   35  required only for the first issuance or renewal of the policy or
   36  contract on or after January 1, 2014.
   37         (b) The information provided in the notice shall be based
   38  on the statewide average premium for the policy or contract for
   39  the bronze, silver, gold, or platinum level plan, whichever is
   40  applicable to the policy or contract, and provide an estimate of
   41  the following effects of PPACA requirements:
   42         1. The dollar amount of the premium which is attributable
   43  to the impact of guaranteed issuance of coverage. This estimate
   44  must include, but is not required to itemize, the impact of the
   45  requirement that rates be based on factors unrelated to health
   46  status, how the individual coverage mandate and subsidies
   47  provided in the health insurance exchange established in this
   48  state pursuant to PPACA affect the impact of guaranteed issuance
   49  of coverage, and estimated reinsurance credits.
   50         2. The dollar amount of the premium which is attributable
   51  to fees, taxes, and assessments.
   52         3. For individual policies or contracts, the dollar amount
   53  of the premium increase or decrease from the premium that would
   54  have otherwise been due which is attributable to the combined
   55  impact of the requirement that rates for age be limited to a 3
   56  to-1 ratio and the prohibition against using gender as a rating
   57  factor. This estimate must be displayed for the average rates
   58  for male and female insureds, respectively, for the following
   59  three age categories: age 21 years to 29 years, age 30 years to
   60  54 years, and age 55 years to 64 years.
   61         4. The dollar amount which is attributable to the
   62  requirement that essential health benefits be provided and to
   63  meet the required actuarial value for the product, as compared
   64  to the statewide average premium for the policy or contract for
   65  the plan issued by that insurer or organization that has the
   66  highest enrollment in the individual or small group market on
   67  July 1, 2013, whichever is applicable. The statewide average
   68  premiums for the plan that has the highest enrollment must
   69  include all policyholders, including those that have health
   70  conditions that increase the standard premium.
   71         (c) The office, in consultation with the department, shall
   72  develop a summary of the estimated impact of PPACA on monthly
   73  premiums as contained in the notices submitted by insurers and
   74  health maintenance organizations, which must be available on the
   75  respective websites of the office and department by October 1,
   76  2013.
   77         (d) This subsection is repealed on March 1, 2015.
   78         Section 2. Subsection (4) of section 627.411, Florida
   79  Statutes, is amended to read:
   80         627.411 Grounds for disapproval.—
   81         (4) The provisions of this section which apply to rates,
   82  rating practices, or the relationship of benefits to the premium
   83  charged do not apply to nongrandfathered health plans described
   84  in s. 627.410(9). This subsection is repealed on March 1, 2015.
   85         Section 3. Paragraph (f) of subsection (3) of section
   86  641.31, Florida Statutes, is amended to read:
   87         641.31 Health maintenance contracts.—
   88         (3)
   89         (f)1. For plan years 2014 and 2015, nongrandfathered health
   90  plans for the individual or small group market are not subject
   91  to rate review or approval by the office. A health maintenance
   92  organization that issues or renews a nongrandfathered health
   93  plan is subject to s. 627.410(9). As used in this paragraph, the
   94  terms “PPACA” and “nongrandfathered health plan” have the same
   95  meanings as those terms are defined in s. 627.402.
   96         2. This paragraph is repealed effective March 1, 2015.
   97         Section 4. This act shall take effect upon becoming a law.