CS for CS for SB 322                             First Engrossed
       
       
       
       
       
       
       
       
       2019322e1
       
    1                        A bill to be entitled                      
    2         An act relating to health plans; amending s. 624.438,
    3         F.S.; revising eligibility requirements for multiple
    4         employer welfare arrangements; creating s. 627.443,
    5         F.S.; defining the terms “EHB-benchmark plan” and
    6         “PPACA”; authorizing health insurers and health
    7         maintenance organizations to create new health
    8         insurance policies and health maintenance contracts
    9         meeting certain criteria for essential health benefits
   10         under the federal Patient Protection and Affordable
   11         Care Act (PPACA); providing that such criteria may be
   12         met by certain means; providing construction;
   13         providing that such policies and contracts created by
   14         health insurers and health maintenance organizations
   15         may be submitted to the Office of Insurance Regulation
   16         for certain purposes; amending s. 627.6045, F.S.;
   17         revising applicability of requirements relating to
   18         preexisting conditions; revising the font size for a
   19         certain disclosure; creating s. 627.6046, F.S.;
   20         defining the terms “operative date” and “preexisting
   21         medical condition” with respect to individual health
   22         insurance policies; requiring certain insurers,
   23         contingent upon the occurrence of either of two
   24         specified events, to make at least one comprehensive
   25         major medical health insurance policy available to all
   26         residents of this state within a specified timeframe;
   27         prohibiting such insurers from excluding, limiting,
   28         denying, or delaying coverage under such policies due
   29         to preexisting medical conditions; requiring such
   30         policies to have been actively marketed on a specified
   31         date and during a certain timeframe before that date;
   32         providing applicability; amending s. 627.6425, F.S.;
   33         revising the definition of the term “individual health
   34         insurance” relating to renewability of individual
   35         coverage; creating ss. 627.6426 and 627.6525, F.S.;
   36         defining the term “short-term health insurance”;
   37         providing disclosure requirements for short-term
   38         individual, group, blanket, and franchise health
   39         insurance policies; amending s. 627.654, F.S.;
   40         revising requirements for, and applicability relating
   41         to, association and small employer policies; creating
   42         s. 627.65612, F.S.; defining the terms “operative
   43         date” and “preexisting medical condition” with respect
   44         to group health insurance policies; requiring certain
   45         insurers, contingent upon the occurrence of either of
   46         two specified events, to make at least one
   47         comprehensive major medical health insurance policy
   48         available to all residents of this state within a
   49         specified timeframe; prohibiting such insurers from
   50         excluding, limiting, denying, or delaying coverage
   51         under such policies due to preexisting medical
   52         conditions; requiring such policies to have been
   53         actively marketed on a specified date and during a
   54         certain timeframe before that date; providing
   55         applicability; amending s. 641.31, F.S.; defining the
   56         terms “operative date” and “preexisting medical
   57         condition” with respect to health maintenance
   58         contracts; requiring health maintenance organizations,
   59         contingent upon the occurrence of either of two
   60         specified events, to make at least one comprehensive
   61         major medical health maintenance contract available to
   62         all residents of this state within a specified
   63         timeframe; prohibiting such health maintenance
   64         organizations from excluding, limiting, denying, or
   65         delaying coverage under such contracts due to
   66         preexisting medical conditions; requiring such
   67         contracts to have been actively marketed on a
   68         specified date and during a certain timeframe before
   69         that date; defining the terms “EHB-benchmark plan” and
   70         “office”; requiring the office to conduct a study
   71         evaluating this state’s current benchmark plan for
   72         essential health benefits under PPACA and options for
   73         changing the benchmark plan for future plan years;
   74         requiring the office, in conducting the study, to
   75         consider plans and certain benefits used by other
   76         states and to compare costs with those of this state;
   77         requiring the office to solicit and consider proposed
   78         health plans from health insurers and health
   79         maintenance organizations in developing
   80         recommendations; requiring the office, by a certain
   81         date, to provide a report with certain recommendations
   82         and a certain analysis to the Governor and the
   83         Legislature; providing for severability; providing
   84         effective dates.
   85          
   86  Be It Enacted by the Legislature of the State of Florida:
   87  
   88         Section 1. Effective July 1, 2019, paragraph (b) of
   89  subsection (1) of section 624.438, Florida Statutes, is amended
   90  to read:
   91         624.438 General eligibility.—
   92         (1) To meet the requirements for issuance of a certificate
   93  of authority and to maintain a multiple-employer welfare
   94  arrangement, an arrangement:
   95         (b)1. Must be established by a bona fide group trade
   96  association, industry association, or professional association
   97  of employers as defined in 29 C.F.R. s. 2510.3-5 or
   98  professionals which has a constitution or bylaws specifically
   99  stating its purpose and which has been organized and maintained
  100  in good faith for a continuous period of 1 year for purposes in
  101  addition to other than that of obtaining or providing insurance.
  102         2.Must not combine member employers from disparate trades,
  103  industries, or professions as defined by the appropriate
  104  licensing agencies, and must not combine member employers from
  105  more than one of the employer categories defined in sub
  106  subparagraphs a.-c.
  107         a.A trade association consists of member employers who are
  108  in the same trade as recognized by the appropriate licensing
  109  agency.
  110         b.An industry association consists of member employers who
  111  are in the same major group code, as defined by the Standard
  112  Industrial Classification Manual issued by the federal Office of
  113  Management and Budget, unless restricted by sub-subparagraph a.
  114  or sub-subparagraph c.
  115         c.A professional association consists of member employers
  116  who are of the same profession as recognized by the appropriate
  117  licensing agency.
  118  
  119  The requirements of this paragraph subparagraph do not apply to
  120  an arrangement licensed before prior to April 1, 1995,
  121  regardless of the nature of its business. However, an
  122  arrangement exempt from the requirements of this paragraph
  123  subparagraph may not expand the nature of its business beyond
  124  that set forth in the articles of incorporation of its
  125  sponsoring association as of April 1, 1995, except as authorized
  126  in this paragraph subparagraph.
  127         Section 2. Section 627.443, Florida Statutes, is created to
  128  read:
  129         627.443 Essential health benefits.—
  130         (1) As used in this section, the term:
  131         (a)“EHB-benchmark plan” has the same meaning as provided
  132  in 45 C.F.R. s. 156.20.
  133         (b)“PPACA” has the same meaning as in s. 627.402.
  134         (2) A health insurer or health maintenance organization
  135  issuing or delivering an individual or a group health insurance
  136  policy or health maintenance contract in this state may create a
  137  new health insurance policy or health maintenance contract that:
  138         (a) Must include at least one service or coverage under
  139  each of the 10 essential health benefits categories under 42
  140  U.S.C. s. 18022(b) which are required under PPACA;
  141         (b) May fulfill the requirement in paragraph (a) by
  142  selecting one or more services or coverages for each of the
  143  required categories from the list of essential health benefits
  144  required by any single state or multiple states; and
  145         (c) May comply with paragraphs (a) and (b) by selecting one
  146  or more services or coverages from any one or more of the
  147  required categories of essential health benefits from one state
  148  or multiple states.
  149         (3) This section specifically authorizes an insurer or
  150  health maintenance organization to include any combination of
  151  services or coverages required by any one or a combination of
  152  states to provide the 10 categories of essential health benefits
  153  required under PPACA in a policy or contract issued in this
  154  state.
  155         (4)Health insurance policies and health maintenance
  156  contracts created by health insurers and health maintenance
  157  organizations under this section:
  158         (a) May be submitted to the office for consideration as
  159  part of the office’s study of this state’s essential health
  160  benefits benchmark plan; and
  161         (b) May also be submitted to the office for evaluation as
  162  equivalent to the current state EHB-benchmark plan or to any
  163  EHB-benchmark plan created in the future.
  164         Section 3. Effective July 1, 2019, subsection (3) of
  165  section 627.6045, Florida Statutes, is amended to read:
  166         627.6045 Preexisting condition.—A health insurance policy
  167  must comply with the following:
  168         (3) This section does not apply to short-term, nonrenewable
  169  health insurance policies of no more than a 6-month policy term,
  170  provided that it is clearly disclosed to the applicant in the
  171  advertising and application, in 14-point 10-point contrasting
  172  type, that “This policy does not meet the definition of
  173  qualifying previous coverage or qualifying existing coverage as
  174  defined in s. 627.6699. As a result, if purchased in lieu of a
  175  conversion policy or other group coverage, you may have to meet
  176  a preexisting condition requirement when renewing or purchasing
  177  other coverage.”
  178         Section 4. Effective July 1, 2019, section 627.6046,
  179  Florida Statutes, is created to read:
  180         627.6046 Limit on preexisting conditions.—
  181         (1)As used in this section, the term:
  182         (a) “Operative date” means the date on which either of the
  183  following occurs with respect to the Patient Protection and
  184  Affordable Care Act, Pub. L. No. 111-148, as amended by the
  185  Health Care and Education Reconciliation Act of 2010, Pub. L.
  186  No. 111-152 (PPACA):
  187         1. A federal law is enacted which expressly repeals PPACA;
  188  or
  189         2. PPACA is invalidated by the United States Supreme Court.
  190         (b) “Preexisting medical condition” means a condition that
  191  was present before the effective date of coverage under a
  192  policy, whether or not any medical advice, diagnosis, care, or
  193  treatment was recommended or received before the effective date
  194  of coverage. The term includes a condition identified as a
  195  result of a preenrollment questionnaire or physical examination
  196  given to the individual, or review of medical records relating
  197  to the preenrollment period.
  198         (2)(a)Not later than 30 days after the operative date, and
  199  notwithstanding s. 627.6045 or any other law to the contrary,
  200  every insurer issuing, delivering, or issuing for delivery
  201  comprehensive major medical individual health insurance policies
  202  in this state shall make at least one comprehensive major
  203  medical health insurance policy available to all residents of
  204  this state, and such insurer may not exclude, limit, deny, or
  205  delay coverage under such policy due to one or more preexisting
  206  medical conditions.
  207         (b)An insurer may not limit or exclude benefits under such
  208  policy, including a denial of coverage applicable to an
  209  individual as a result of information relating to an
  210  individual’s health status before the individual’s effective
  211  date of coverage, or if coverage is denied, the date of the
  212  denial.
  213         (3)The comprehensive major medical health insurance policy
  214  that the insurer is required to offer under this section must be
  215  a policy that had been actively marketed in this state by the
  216  insurer as of the operative date and that was also actively
  217  marketed in this state during the year immediately preceding the
  218  operative date.
  219         (4) This section does not apply to an insurer that issues
  220  only limited benefit, disability income, specified disease,
  221  Medicare supplement, or hospital indemnity policies in this
  222  state.
  223         Section 5. Effective July 1, 2019, subsection (1) of
  224  section 627.6425, Florida Statutes, is amended to read:
  225         627.6425 Renewability of individual coverage.—
  226         (1) Except as otherwise provided in this section, an
  227  insurer that provides individual health insurance coverage to an
  228  individual shall renew or continue in force such coverage at the
  229  option of the individual. For the purpose of this section, the
  230  term “individual health insurance” means health insurance
  231  coverage, as described in s. 624.603, offered to an individual
  232  in this state, including certificates of coverage offered to
  233  individuals in this state as part of a group policy issued to an
  234  association outside this state, but the term does not include
  235  short-term limited duration insurance or excepted benefits
  236  specified in s. 627.6513(1)-(14).
  237         Section 6. Effective July 1, 2019, section 627.6426,
  238  Florida Statutes, is created to read:
  239         627.6426Short-term health insurance.—
  240         (1)For purposes of this part, the term “short-term health
  241  insurance” means health insurance coverage provided by an issuer
  242  with an expiration date specified in the contract which is less
  243  than 12 months after the original effective date of the contract
  244  and, taking into account renewals or extensions, has a duration
  245  not to exceed 36 months in total.
  246         (2)All contracts for short-term health insurance entered
  247  into by an issuer and an individual seeking coverage shall
  248  include the following disclosure:
  249  
  250  “This coverage is not required to comply with certain federal
  251  market requirements for health insurance, principally those
  252  contained in the Patient Protection and Affordable Care Act. Be
  253  sure to check your policy carefully to make sure you are aware
  254  of any exclusions or limitations regarding coverage of
  255  preexisting conditions or health benefits (such as
  256  hospitalization, emergency services, maternity care, preventive
  257  care, prescription drugs, and mental health and substance use
  258  disorder services). Your policy might also have lifetime and/or
  259  annual dollar limits on health benefits. If this coverage
  260  expires or you lose eligibility for this coverage, you might
  261  have to wait until an open enrollment period to get other health
  262  insurance coverage.”
  263         Section 7. Effective July 1, 2019, section 627.6525,
  264  Florida Statutes, is created to read:
  265         627.6525Short-term health insurance.—
  266         (1)For purposes of this part, the term “short-term health
  267  insurance” means a group, blanket, or franchise policy of health
  268  insurance coverage provided by an issuer with an expiration date
  269  specified in the contract which is less than 12 months after the
  270  original effective date of the contract and, taking into account
  271  renewals or extensions, has a duration not to exceed 36 months
  272  in total.
  273         (2)All contracts for short-term health insurance entered
  274  into by an issuer and a party seeking coverage shall include the
  275  following disclosure:
  276  
  277  “This coverage is not required to comply with certain federal
  278  market requirements for health insurance, principally those
  279  contained in the Patient Protection and Affordable Care Act. Be
  280  sure to check your policy carefully to make sure you are aware
  281  of any exclusions or limitations regarding coverage of
  282  preexisting conditions or health benefits (such as
  283  hospitalization, emergency services, maternity care, preventive
  284  care, prescription drugs, and mental health and substance use
  285  disorder services). Your policy might also have lifetime and/or
  286  annual dollar limits on health benefits. If this coverage
  287  expires or you lose eligibility for this coverage, you might
  288  have to wait until an open enrollment period to get other health
  289  insurance coverage.”
  290         Section 8. Effective July 1, 2019, subsection (1) of
  291  section 627.654, Florida Statutes, is amended to read:
  292         627.654 Labor union, association, and small employer health
  293  alliance groups.—
  294         (1)(a) A bona fide group or association of employers, as
  295  defined in 29 C.F.R. s. 2510.3-5, or a group of individuals may
  296  be insured under a policy issued to an association, including a
  297  labor union, which association has a constitution and bylaws and
  298  not less than 25 individual members and which has been organized
  299  and has been maintained in good faith for a period of 1 year for
  300  purposes in addition to other than that of obtaining insurance,
  301  or to the trustees of a fund established by such an association,
  302  which association or trustees shall be deemed the policyholder,
  303  insuring at least 15 individual members of the association for
  304  the benefit of persons other than the officers of the
  305  association, the association, or trustees.
  306         (b) A small employer, as defined in s. 627.6699 and
  307  including the employer’s eligible employees and the spouses and
  308  dependents of such employees, may be insured under a policy
  309  issued to a small employer health alliance by a carrier as
  310  defined in s. 627.6699. A small employer health alliance must be
  311  organized as a not-for-profit corporation under chapter 617.
  312  Notwithstanding any other law, if a small employer member of an
  313  alliance loses eligibility to purchase health care through the
  314  alliance solely because the business of the small employer
  315  member expands to more than 50 and fewer than 75 eligible
  316  employees, the small employer member may, at its next renewal
  317  date, purchase coverage through the alliance for not more than 1
  318  additional year. A small employer health alliance shall
  319  establish conditions of participation in the alliance by a small
  320  employer, including, but not limited to:
  321         1.Assurance that the small employer is not formed for the
  322  purpose of securing health benefit coverage.
  323         2.Assurance that the employees of a small employer have
  324  not been added for the purpose of securing health benefit
  325  coverage.
  326         Section 9. Effective July 1, 2019, section 627.65612,
  327  Florida Statutes, is created to read:
  328         627.65612Limit on preexisting conditions.—
  329         (1) As used in this section, the terms “operative date” and
  330  “preexisting medical condition” have the same meanings as
  331  provided in s. 627.6046.
  332         (2)(a) Not later than 30 days after the operative date, and
  333  notwithstanding s. 627.6561 or any other law to the contrary,
  334  every insurer issuing, delivering, or issuing for delivery
  335  comprehensive major medical group health insurance policies in
  336  this state shall make at least one comprehensive major medical
  337  health insurance policy available to all residents of this
  338  state, and such insurer may not exclude, limit, deny, or delay
  339  coverage under such policy due to one or more preexisting
  340  medical conditions.
  341         (b)An insurer may not limit or exclude benefits under such
  342  policy, including a denial of coverage applicable to an
  343  individual as a result of information relating to an
  344  individual’s health status before the individual’s effective
  345  date of coverage, or if coverage is denied, the date of the
  346  denial.
  347         (3)The comprehensive major medical health insurance policy
  348  that the insurer is required to offer under this section must be
  349  a policy that had been actively marketed in this state by the
  350  insurer as of the operative date and that was also actively
  351  marketed in this state during the year immediately preceding the
  352  operative date.
  353         (4) This section does not apply to an insurer issuing only
  354  limited benefit, disability income, specified disease, Medicare
  355  supplement, or hospital indemnity policies in this state.
  356         Section 10. Effective July 1, 2019, subsection (45) is
  357  added to section 641.31, Florida Statutes, to read:
  358         641.31 Health maintenance contracts.—
  359         (45)(a) As used in this subsection, the terms “operative
  360  date” and “preexisting medical condition” have the same meanings
  361  as provided in s. 627.6046.
  362         (b)Not later than 30 days after the operative date, and
  363  notwithstanding s. 641.31071 or any other law to the contrary,
  364  every health maintenance organization issuing, delivering, or
  365  issuing for delivery individual or group contracts in this state
  366  shall make at least one comprehensive major medical health
  367  maintenance contract available to all residents of this state,
  368  and such health maintenance organization may not exclude, limit,
  369  deny, or delay coverage under such contract due to one or more
  370  preexisting medical conditions. A health maintenance
  371  organization may not limit or exclude benefits under such
  372  contract, including a denial of coverage applicable to an
  373  individual as a result of information relating to an
  374  individual’s health status before the individual’s effective
  375  date of coverage, or if coverage is denied, the date of the
  376  denial.
  377         (c)The comprehensive major medical health maintenance
  378  contract the health maintenance organization is required to
  379  offer under this section must be a contract that had been
  380  actively marketed in this state by the health maintenance
  381  organization as of the operative date and that was also actively
  382  marketed in this state during the year immediately preceding the
  383  operative date.
  384         Section 11. Study of state essential health benefits
  385  benchmark plan; report.—
  386         (1)As used in this section, the term:
  387         (a)“EHB-benchmark plan” has the same meaning as provided
  388  in 45 C.F.R. s. 156.20.
  389         (b)“Office” means the Office of Insurance Regulation.
  390         (2)The office shall conduct a study to evaluate this
  391  state’s current EHB-benchmark plan for nongrandfathered
  392  individual and group health plans and options for changing the
  393  EHB-benchmark plan pursuant to 45 C.F.R. s. 156.111 for future
  394  plan years. In conducting the study, the office shall:
  395         (a)Consider EHB-benchmark plans and benefits under the 10
  396  essential health benefits categories established under 45 C.F.R.
  397  s. 156.110(a) which are used by the other 49 states;
  398         (b)Compare the costs of benefits within such categories
  399  and overall costs of EHB-benchmark plans used by other states
  400  with the costs of benefits within the categories and overall
  401  costs of the current EHB-benchmark plan of this state; and
  402         (c)Solicit and consider proposed individual and group
  403  health plans from health insurers and health maintenance
  404  organizations in developing recommendations for changes to the
  405  current EHB-benchmark plan.
  406         (3)By October 30, 2019, the office shall submit a report
  407  to the Governor, the President of the Senate, and the Speaker of
  408  the House of Representatives which must include recommendations
  409  for changing the current EHB-benchmark plan to provide
  410  comprehensive care at a lower cost than this state’s current
  411  EHB-benchmark plan. In its report, the office shall provide an
  412  analysis as to whether proposed health plans it receives under
  413  paragraph (2)(c) meet the requirements for an EHB-benchmark plan
  414  under 45 C.F.R. s. 156.111(b).
  415         Section 12. If any provision of this act or its application
  416  to any person or circumstance is held invalid, the invalidity
  417  does not affect other provisions or applications of the act
  418  which can be given effect without the invalid provision or
  419  application, and to this end the provisions of this act are
  420  severable.
  421         Section 13. Except as otherwise expressly provided in this
  422  act, this act shall take effect upon becoming a law.