Florida Senate - 2019 COMMITTEE AMENDMENT
Bill No. SB 1180
Ì287190-Î287190
LEGISLATIVE ACTION
Senate . House
Comm: RCS .
03/18/2019 .
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The Committee on Banking and Insurance (Mayfield) recommended
the following:
1 Senate Amendment
2
3 Delete lines 30 - 140
4 and insert:
5 drug that the insured’s treating physician determines is
6 medically necessary:
7 (a) Remove the prescription drug from its list of covered
8 drugs during the policy year unless the United States Food and
9 Drug Administration has issued a statement about the drug which
10 calls into question the clinical safety of the drug or the
11 manufacturer of the drug has notified the United States Food and
12 Drug Administration of a manufacturing discontinuance or
13 potential discontinuance of the drug as required by s. 506C of
14 the Federal Food, Drug, and Cosmetic Act, 21 U.S.C. s. 356c.
15 (b) Reclassify the drug to a more restrictive drug tier or
16 increase the amount that an insured must pay for a copayment,
17 coinsurance, or deductible for prescription drug benefits or
18 reclassify the drug to a higher cost-sharing tier during the
19 policy year.
20 (2) This section does not:
21 (a) Prohibit the addition of prescription drugs to the list
22 of drugs covered under the policy during the policy year.
23 (b) Apply to a grandfathered health plan as defined in s.
24 627.402 or to benefits set forth in s. 627.6513(1)-(14).
25 (c) Alter or amend s. 465.025, which provides conditions
26 under which a pharmacist may substitute a generically equivalent
27 drug product for a brand name drug product.
28 (d) Alter or amend s. 465.0252, which provides conditions
29 under which a pharmacist may dispense a substitute biological
30 product for the prescribed biological product.
31 (e) Apply to a Medicaid managed care plan under part IV of
32 chapter 409.
33 Section 2. Paragraph (e) of subsection (5) of section
34 627.6699, Florida Statutes, is amended to read:
35 627.6699 Employee Health Care Access Act.—
36 (5) AVAILABILITY OF COVERAGE.—
37 (e) All health benefit plans issued under this section must
38 comply with the following conditions:
39 1. For employers who have fewer than two employees, a late
40 enrollee may be excluded from coverage for no longer than 24
41 months if he or she was not covered by creditable coverage
42 continually to a date not more than 63 days before the effective
43 date of his or her new coverage.
44 2. Any requirement used by a small employer carrier in
45 determining whether to provide coverage to a small employer
46 group, including requirements for minimum participation of
47 eligible employees and minimum employer contributions, must be
48 applied uniformly among all small employer groups having the
49 same number of eligible employees applying for coverage or
50 receiving coverage from the small employer carrier, except that
51 a small employer carrier that participates in, administers, or
52 issues health benefits pursuant to s. 381.0406 which do not
53 include a preexisting condition exclusion may require as a
54 condition of offering such benefits that the employer has had no
55 health insurance coverage for its employees for a period of at
56 least 6 months. A small employer carrier may vary application of
57 minimum participation requirements and minimum employer
58 contribution requirements only by the size of the small employer
59 group.
60 3. In applying minimum participation requirements with
61 respect to a small employer, a small employer carrier shall not
62 consider as an eligible employee employees or dependents who
63 have qualifying existing coverage in an employer-based group
64 insurance plan or an ERISA qualified self-insurance plan in
65 determining whether the applicable percentage of participation
66 is met. However, a small employer carrier may count eligible
67 employees and dependents who have coverage under another health
68 plan that is sponsored by that employer.
69 4. A small employer carrier shall not increase any
70 requirement for minimum employee participation or any
71 requirement for minimum employer contribution applicable to a
72 small employer at any time after the small employer has been
73 accepted for coverage, unless the employer size has changed, in
74 which case the small employer carrier may apply the requirements
75 that are applicable to the new group size.
76 5. If a small employer carrier offers coverage to a small
77 employer, it must offer coverage to all the small employer’s
78 eligible employees and their dependents. A small employer
79 carrier may not offer coverage limited to certain persons in a
80 group or to part of a group, except with respect to late
81 enrollees.
82 6. A small employer carrier may not modify any health
83 benefit plan issued to a small employer with respect to a small
84 employer or any eligible employee or dependent through riders,
85 endorsements, or otherwise to restrict or exclude coverage for
86 certain diseases or medical conditions otherwise covered by the
87 health benefit plan.
88 7. An initial enrollment period of at least 30 days must be
89 provided. An annual 30-day open enrollment period must be
90 offered to each small employer’s eligible employees and their
91 dependents. A small employer carrier must provide special
92 enrollment periods as required by s. 627.65615.
93 8. A small employer carrier must limit changes to
94 prescription drug formularies as required by s. 627.42393.
95 Section 3. Subsection (36) of section 641.31, Florida
96 Statutes, is amended to read:
97 641.31 Health maintenance contracts.—
98 (36) A health maintenance organization may increase the
99 copayment for any benefit, or delete, amend, or limit any of the
100 benefits to which a subscriber is entitled under the group
101 contract only, upon written notice to the contract holder at
102 least 45 days in advance of the time of coverage renewal. The
103 health maintenance organization may amend the contract with the
104 contract holder, with such amendment to be effective immediately
105 at the time of coverage renewal. The written notice to the
106 contract holder must shall specifically identify any deletions,
107 amendments, or limitations to any of the benefits provided in
108 the group contract during the current contract period which will
109 be included in the group contract upon renewal. This subsection
110 does not apply to any increases in benefits. The 45-day notice
111 requirement does shall not apply if benefits are amended,
112 deleted, or limited at the request of the contract holder.
113 (a) Other than at the time of coverage renewal, a health
114 maintenance contract that provides medical, major medical, or
115 similar comprehensive coverage may not, while the subscriber is
116 taking a prescription drug that the subscriber’s treating
117 physician determines is medically necessary: