CS for CS for SB 322                            Second Engrossed
       
       
       
       
       
       
       
       
       2019322e2
       
    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; revising font size for
   18         disclosure; creating ss. 627.6046 and 627.65612, F.S.;
   19         defining the terms “operative date” and “preexisting
   20         medical condition” with respect to individual and
   21         group health insurance policies, respectively;
   22         requiring insurers, contingent upon the occurrence of
   23         either of two specified events, to make at least one
   24         comprehensive major medical health insurance policy
   25         available to certain individuals within a specified
   26         timeframe; prohibiting such insurers from excluding,
   27         limiting, denying, or delaying coverage under such
   28         policy due to preexisting medical conditions;
   29         requiring such policy to have been actively marketed
   30         on a specified date and during a certain timeframe
   31         before that date; providing applicability; creating
   32         ss. 627.6426 and 627.6525, F.S.; defining the term
   33         “short-term health insurance”; providing disclosure
   34         requirements for short-term health insurance policies;
   35         amending s. 627.654, F.S.; revising requirements for
   36         association and small employer policies; providing
   37         construction; amending s. 641.31, F.S.; defining the
   38         terms “operative date” and “preexisting medical
   39         condition” with respect to health maintenance
   40         contracts; requiring health maintenance organizations,
   41         contingent upon the occurrence of either of two
   42         specified events, to make at least one comprehensive
   43         major medical health maintenance contract available to
   44         certain individuals within a specified timeframe;
   45         prohibiting such health maintenance organizations from
   46         excluding, limiting, denying, or delaying coverage
   47         under such contract due to preexisting medical
   48         conditions; requiring such contract to have been
   49         actively marketed on a specified date and during a
   50         certain timeframe before that date; defining the terms
   51         “EHB-benchmark plan” and “office”; requiring the
   52         office to conduct a study evaluating this state’s
   53         current benchmark plan for essential health benefits
   54         under PPACA and options for changing the benchmark
   55         plan for future plan years; requiring the office, in
   56         conducting the study, to consider plans and certain
   57         benefits used by other states and to compare costs
   58         with those of this state; requiring the office to
   59         solicit and consider proposed health plans from health
   60         insurers and health maintenance organizations in
   61         developing recommendations; requiring the office, by a
   62         certain date, to provide a report with certain
   63         recommendations and a certain analysis to the Governor
   64         and the Legislature; providing for severability;
   65         providing an effective date.
   66          
   67  Be It Enacted by the Legislature of the State of Florida:
   68  
   69         Section 1. Paragraph (b) of subsection (1) of section
   70  624.438, Florida Statutes, is amended to read:
   71         624.438 General eligibility.—
   72         (1) To meet the requirements for issuance of a certificate
   73  of authority and to maintain a multiple-employer welfare
   74  arrangement, an arrangement:
   75         (b)1. Must be established by a trade association, industry
   76  association, or professional association of employers or
   77  professionals, or a bona fide group as defined in 29 C.F.R. part
   78  2510.3-5 which has a constitution or bylaws specifically stating
   79  its purpose and which has been organized and maintained in good
   80  faith for a continuous period of 1 year for purposes in addition
   81  to other than that of obtaining or providing insurance.
   82         2. Must not combine member employers from disparate trades,
   83  industries, or professions as defined by the appropriate
   84  licensing agencies, and must not combine member employers from
   85  more than one of the employer categories defined in sub
   86  subparagraphs a.-c.
   87         1.a. A trade association consists of member employers who
   88  are in the same trade as recognized by the appropriate licensing
   89  agency.
   90         2.b. An industry association consists of member employers
   91  who are in the same major group code, as defined by the Standard
   92  Industrial Classification Manual issued by the federal Office of
   93  Management and Budget, unless restricted by subparagraph 1. sub
   94  subparagraph a. or subparagraph 3 sub-subparagraph c.
   95         3.c. A professional association consists of member
   96  employers who are of the same profession as recognized by the
   97  appropriate licensing agency.
   98  
   99  The requirements of this paragraph subparagraph do not apply to
  100  an arrangement licensed before prior to April 1, 1995,
  101  regardless of the nature of its business. However, an
  102  arrangement exempt from the requirements of this paragraph
  103  subparagraph may not expand the nature of its business beyond
  104  that set forth in the articles of incorporation of its
  105  sponsoring association as of April 1, 1995, except as authorized
  106  in this paragraph subparagraph.
  107         Section 2. Section 627.443, Florida Statutes, is created to
  108  read:
  109         627.443 Essential health benefits.—
  110         (1) As used in this section, the term:
  111         (a) “EHB-benchmark plan” has the same meaning as provided
  112  in 45 C.F.R. s. 156.20.
  113         (b) “PPACA” has the same meaning as in s. 627.402.
  114         (2) A health insurer or health maintenance organization
  115  issuing or delivering an individual or a group health insurance
  116  policy or health maintenance contract in this state may create a
  117  new health insurance policy or health maintenance contract that:
  118         (a) Must include at least one service or coverage under
  119  each of the 10 essential health benefits categories under 42
  120  U.S.C. s. 18022(b) which are required under PPACA;
  121         (b) May fulfill the requirement in paragraph (a) by
  122  selecting one or more services or coverages for each of the
  123  required categories from the list of essential health benefits
  124  required by any single state or multiple states; and
  125         (c) May comply with paragraphs (a) and (b) by selecting one
  126  or more services or coverages from any one or more of the
  127  required categories of essential health benefits from one state
  128  or multiple states.
  129         (3) This section specifically authorizes an insurer or
  130  health maintenance organization to include any combination of
  131  services or coverages required by any one or a combination of
  132  states to provide the 10 categories of essential health benefits
  133  required under PPACA in a policy or contract issued in this
  134  state.
  135         (4) Health insurance policies and health maintenance
  136  contracts created by health insurers and health maintenance
  137  organizations under this section:
  138         (a) May be submitted to the office for consideration as
  139  part of the office’s study of this state’s essential health
  140  benefits benchmark plan; and
  141         (b) May also be submitted to the office for evaluation as
  142  equivalent to the current state EHB-benchmark plan or to any
  143  EHB-benchmark plan created in the future.
  144         Section 3. Subsection (3) of section 627.6045, Florida
  145  Statutes, is amended to read:
  146         627.6045 Preexisting condition.—A health insurance policy
  147  must comply with the following:
  148         (3) This section does not apply to short-term, nonrenewable
  149  health insurance policies of no more than a 6-month policy term,
  150  provided that it is clearly disclosed to the applicant in the
  151  advertising and application, in 14-point 10-point contrasting
  152  type, that “This policy does not meet the definition of
  153  qualifying previous coverage or qualifying existing coverage as
  154  defined in s. 627.6699. As a result, if purchased in lieu of a
  155  conversion policy or other group coverage, you may have to meet
  156  a preexisting condition requirement when renewing or purchasing
  157  other coverage.”
  158         Section 4. Section 627.6046, Florida Statutes, is created
  159  to read:
  160         627.6046 Limit on preexisting conditions.—
  161         (1) As used in this section, the term:
  162         (a) “Operative date” means the date on which either of the
  163  following occurs with respect to the Patient Protection and
  164  Affordable Care Act, Pub. L. No. 111-148, as amended by the
  165  Health Care and Education Reconciliation Act of 2010, Pub. L.
  166  No. 111-152 (PPACA):
  167         1. A federal law is enacted which expressly repeals PPACA;
  168  or
  169         2. PPACA is invalidated by the United States Supreme Court.
  170         (b) “Preexisting medical condition” means a condition that
  171  was present before the effective date of coverage under a
  172  policy, whether or not any medical advice, diagnosis, care, or
  173  treatment was recommended or received before the effective date
  174  of coverage. The term includes a condition identified as a
  175  result of a preenrollment questionnaire or physical examination
  176  given to the individual, or review of medical records relating
  177  to the preenrollment period.
  178         (2)(a) Not later than 30 days after the operative date, and
  179  notwithstanding s. 627.6045 or any other law to the contrary,
  180  every insurer issuing, delivering, or issuing for delivery
  181  comprehensive major medical individual health insurance policies
  182  in this state shall make at least one comprehensive major
  183  medical health insurance policy available to residents in the
  184  insurer’s approved service areas of this state, and such insurer
  185  may not exclude, limit, deny, or delay coverage under such
  186  policy due to one or more preexisting medical conditions.
  187         (b) An insurer may not limit or exclude benefits under such
  188  policy, including a denial of coverage applicable to an
  189  individual as a result of information relating to an
  190  individual’s health status before the individual’s effective
  191  date of coverage, or if coverage is denied, the date of the
  192  denial.
  193         (3) The comprehensive major medical health insurance policy
  194  that the insurer is required to offer under this section must be
  195  a policy that had been actively marketed in this state by the
  196  insurer as of the operative date and that was also actively
  197  marketed in this state during the year immediately preceding the
  198  operative date.
  199         Section 5. Section 627.6426, Florida Statutes, is created
  200  to read:
  201         627.6426 Short-term health insurance.—
  202         (1) For purposes of this part, the term “short-term health
  203  insurance” means health insurance coverage provided by an issuer
  204  with an expiration date specified in the contract that is less
  205  than 12 months after the original effective date of the contract
  206  and, taking into account renewals or extensions, has a duration
  207  not to exceed 36 months in total.
  208         (2) All contracts for short-term health insurance entered
  209  into by an issuer and an individual seeking coverage shall
  210  include the following disclosure:
  211  
  212  “This coverage is not required to comply with certain federal
  213  market requirements for health insurance, principally those
  214  contained in the Patient Protection and Affordable Care Act. Be
  215  sure to check your policy carefully to make sure you are aware
  216  of any exclusions or limitations regarding coverage of
  217  preexisting conditions or health benefits (such as
  218  hospitalization, emergency services, maternity care, preventive
  219  care, prescription drugs, and mental health and substance use
  220  disorder services). Your policy might also have lifetime and/or
  221  annual dollar limits on health benefits. If this coverage
  222  expires or you lose eligibility for this coverage, you might
  223  have to wait until an open enrollment period to get other health
  224  insurance coverage.”
  225         Section 6. Section 627.6525, Florida Statutes, is created
  226  to read:
  227         627.6525 Short-term health insurance.—
  228         (1) For purposes of this part, the term “short-term health
  229  insurance” means a group, blanket, or franchise policy of health
  230  insurance coverage provided by an issuer with an expiration date
  231  specified in the contract that is less than 12 months after the
  232  original effective date of the contract and, taking into account
  233  renewals or extensions, has a duration not to exceed 36 months
  234  in total.
  235         (2) All contracts for short-term health insurance entered
  236  into by an issuer and a party seeking coverage shall include the
  237  following disclosure:
  238  
  239  “This coverage is not required to comply with certain federal
  240  market requirements for health insurance, principally those
  241  contained in the Patient Protection and Affordable Care Act. Be
  242  sure to check your policy carefully to make sure you are aware
  243  of any exclusions or limitations regarding coverage of
  244  preexisting conditions or health benefits (such as
  245  hospitalization, emergency services, maternity care, preventive
  246  care, prescription drugs, and mental health and substance use
  247  disorder services). Your policy might also have lifetime and/or
  248  annual dollar limits on health benefits. If this coverage
  249  expires or you lose eligibility for this coverage, you might
  250  have to wait until an open enrollment period to get other health
  251  insurance coverage.”
  252         Section 7. Subsection (1) of section 627.654, Florida
  253  Statutes, is amended to read:
  254         627.654 Labor union, association, and small employer health
  255  alliance groups.—
  256         (1)(a) A bona fide group or association of employers, as
  257  defined in 29 C.F.R. part 2510.3-5, or a group of individuals
  258  may be insured under a policy issued to an association,
  259  including a labor union, which association has a constitution
  260  and bylaws and not less than 25 individual members and which has
  261  been organized and has been maintained in good faith for a
  262  period of 1 year for purposes in addition to other than that of
  263  obtaining insurance, or to the trustees of a fund established by
  264  such an association, which association or trustees shall be
  265  deemed the policyholder, insuring at least 15 individual members
  266  of the association for the benefit of persons other than the
  267  officers of the association, the association, or trustees.
  268         (b) A small employer, as defined in s. 627.6699 and
  269  including the employer’s eligible employees and the spouses and
  270  dependents of such employees, may be insured under a policy
  271  issued to a small employer health alliance by a carrier as
  272  defined in s. 627.6699. A small employer health alliance must be
  273  organized as a not-for-profit corporation under chapter 617.
  274  Notwithstanding any other law, if a small employer member of an
  275  alliance loses eligibility to purchase health care through the
  276  alliance solely because the business of the small employer
  277  member expands to more than 50 and fewer than 75 eligible
  278  employees, the small employer member may, at its next renewal
  279  date, purchase coverage through the alliance for not more than 1
  280  additional year. A small employer health alliance shall
  281  establish conditions of participation in the alliance by a small
  282  employer, including, but not limited to:
  283         1. Assurance that the small employer is not formed for the
  284  purpose of securing health benefit coverage.
  285         2. Assurance that the employees of a small employer have
  286  not been added for the purpose of securing health benefit
  287  coverage.
  288         Section 8. Section 627.65612, Florida Statutes, is created
  289  to read:
  290         627.65612 Limit on preexisting conditions.—
  291         (1) As used in this section, the terms “operative date” and
  292  “preexisting medical condition” have the same meanings as
  293  provided in s. 627.6046.
  294         (2)(a) Not later than 30 days after the operative date, and
  295  notwithstanding s. 627.6561 or any other law to the contrary,
  296  every insurer issuing, delivering, or issuing for delivery
  297  comprehensive major medical group health insurance policies in
  298  this state shall make at least one comprehensive major medical
  299  health insurance policy available to residents in the insurer’s
  300  approved service areas of this state, and such insurer may not
  301  exclude, limit, deny, or delay coverage under such policy due to
  302  one or more preexisting medical conditions.
  303         (b) An insurer may not limit or exclude benefits under such
  304  policy, including a denial of coverage applicable to an
  305  individual as a result of information relating to an
  306  individual’s health status before the individual’s effective
  307  date of coverage, or if coverage is denied, the date of the
  308  denial.
  309         (3) The comprehensive major medical health insurance policy
  310  that the insurer is required to offer under this section must be
  311  a policy that had been actively marketed in this state by the
  312  insurer as of the operative date and that was also actively
  313  marketed in this state during the year immediately preceding the
  314  operative date.
  315         Section 9. Subsection (45) is added to section 641.31,
  316  Florida Statutes, to read:
  317         641.31 Health maintenance contracts.—
  318         (45)(a) As used in this subsection, the terms “operative
  319  date” and “preexisting medical condition” have the same meanings
  320  as provided in s. 627.6046.
  321         (b) Not later than 30 days after the operative date, and
  322  notwithstanding s. 641.31071 or any other law to the contrary,
  323  every health maintenance organization issuing, delivering, or
  324  issuing for delivery comprehensive major medical individual or
  325  group contracts in this state shall make at least one
  326  comprehensive major medical health maintenance contract
  327  available to residents in the health maintenance organization’s
  328  approved service areas of this state, and such health
  329  maintenance organization may not exclude, limit, deny, or delay
  330  coverage under such contract due to one or more preexisting
  331  medical conditions. A health maintenance organization may not
  332  limit or exclude benefits under such contract, including a
  333  denial of coverage applicable to an individual as a result of
  334  information relating to an individual’s health status before the
  335  individual’s effective date of coverage, or if coverage is
  336  denied, the date of the denial.
  337         (c) The comprehensive major medical health maintenance
  338  contract the health maintenance organization is required to
  339  offer under this section must be a contract that had been
  340  actively marketed in this state by the health maintenance
  341  organization as of the operative date and that was also actively
  342  marketed in this state during the year immediately preceding the
  343  operative date.
  344         Section 10. Study of state essential health benefits
  345  benchmark plan; report.—
  346         (1) As used in this section, the term:
  347         (a) “EHB-benchmark plan” has the same meaning as provided
  348  in 45 C.F.R. s. 156.20.
  349         (b) “Office” means the Office of Insurance Regulation.
  350         (2) The office shall conduct a study to evaluate this
  351  state’s current EHB-benchmark plan for nongrandfathered
  352  individual and group health plans and options for changing the
  353  EHB-benchmark plan pursuant to 45 C.F.R. s. 156.111 for future
  354  plan years. In conducting the study, the office shall:
  355         (a) Consider EHB-benchmark plans and benefits under the 10
  356  essential health benefits categories established under 45 C.F.R.
  357  s. 156.110(a) which are used by the other 49 states;
  358         (b) Compare the costs of benefits within such categories
  359  and overall costs of EHB-benchmark plans used by other states
  360  with the costs of benefits within the categories and overall
  361  costs of the current EHB-benchmark plan of this state; and
  362         (c) Solicit and consider proposed individual and group
  363  health plans from health insurers and health maintenance
  364  organizations in developing recommendations for changes to the
  365  current EHB-benchmark plan.
  366         (3) By October 30, 2019, the office shall submit a report
  367  to the Governor, the President of the Senate, and the Speaker of
  368  the House of Representatives which must include recommendations
  369  for changing the current EHB-benchmark plan to provide
  370  comprehensive care at a lower cost than this state’s current
  371  EHB-benchmark plan. In its report, the office shall provide an
  372  analysis as to whether proposed health plans it receives under
  373  paragraph (2)(c) meet the requirements for an EHB-benchmark plan
  374  under 45 C.F.R. s. 156.111(b).
  375         Section 11. If any provision of this act or its application
  376  to any person or circumstance is held invalid, the invalidity
  377  does not affect other provisions or applications of the act
  378  which can be given effect without the invalid provision or
  379  application, and to this end the provisions of this act are
  380  severable.
  381         Section 12. This act shall take effect upon becoming a law.