CODING: Words stricken are deletions; words underlined are additions.House Bill 1785
Florida House of Representatives - 1997 HB 1785
By Representative Peaden
1 A bill to be entitled
2 An act relating to health insurance contracts;
3 amending ss. 627.6416, 627.6579, F.S.; amending
4 the definition of the term "child health
5 supervision services"; amending requirements
6 for such services; providing requirements for
7 the coverage of such services under health
8 insurance policies and under group, blanket, or
9 franchise health insurance policies; amending
10 s. 641.31, F.S.; providing requirements for
11 health maintenance contracts relating to
12 coverage of newborn children and premiums
13 relating thereto; requiring the continuing
14 coverage, past the usual limiting age, of
15 certain dependent children; providing an
16 effective date.
17
18 Be It Enacted by the Legislature of the State of Florida:
19
20 Section 1. Section 627.6416, Florida Statutes, is
21 amended to read:
22 627.6416 Coverage for child health supervision
23 services.--
24 (1) All health insurance policies providing coverage
25 on an expense-incurred basis which provide coverage for a
26 member of a family of the insured or subscriber must shall, as
27 to such family member's coverage, also provide that the health
28 insurance benefits applicable for children include coverage
29 for child health supervision services from the moment of birth
30 to age 18 16 years. Such services must shall be exempt from
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1 any deductible provisions that are which may be in force in
2 such policies or contracts.
3 (2) As used in For purposes of this section, the term
4 "child health supervision services" means physician-delivered
5 or physician-supervised services that which shall include, at
6 a as the minimum, benefit coverage for services delivered at
7 the intervals and scope stated in this section.
8 (a) For purposes of this section, Child health
9 supervision services must shall include periodic 18 visits
10 that are provided in accordance with the current national
11 American Academy of Pediatrics periodicity schedule at
12 approximately the following age intervals: birth, 2 months, 4
13 months, 6 months, 9 months, 12 months, 15 months, 18 months, 2
14 years, 3 years, 4 years, 5 years, 6 years, 8 years, 10 years,
15 12 years, 14 years, and 16 years. Services to be covered at
16 each visit include a history, a physical examination, and a
17 developmental assessment and anticipatory guidance, and
18 appropriate immunizations and laboratory tests, in keeping
19 with current prevailing medical standards.
20 (b) Minimum benefits may be limited to one visit
21 payable to one provider for all of the services provided at
22 each visit cited in this section.
23 (3) This section does not apply to disability income,
24 specified disease, Medicare supplement, or hospital indemnity
25 policies.
26 Section 2. Section 627.6579, Florida Statutes, is
27 amended to read:
28 627.6579 Coverage for child health supervision
29 services.--
30 (1) All group, blanket, or franchise health insurance
31 policies providing coverage on an expense-incurred basis which
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1 provide coverage for a family member of the certificateholder
2 or subscriber must shall, as to such family member's coverage,
3 also provide that the health insurance benefits applicable for
4 children include coverage for child health supervision
5 services from the moment of birth to age 18 16 years. Such
6 services must shall be exempt from any deductible provisions
7 that are which may be in force in such policies or contracts.
8 (2) As used in For purposes of this section, the term
9 "child health supervision services" means physician-delivered
10 or physician-supervised services that which shall include, at
11 a as the minimum, benefit coverage for services delivered at
12 the intervals and scope stated in this section.
13 (a) For purposes of this section, Child health
14 supervision services must shall include periodic 18 visits
15 that are provided in accordance with the current national
16 American Academy of Pediatrics periodicity schedule at
17 approximately the following age intervals: birth, 2 months, 4
18 months, 6 months, 9 months, 12 months, 15 months, 18 months, 2
19 years, 3 years, 4 years, 5 years, 6 years, 8 years, 10 years,
20 12 years, 14 years, and 16 years. Services to be covered at
21 each visit include a history, a physical examination, and a
22 developmental assessment and anticipatory guidance, and
23 appropriate immunizations and laboratory tests, in keeping
24 with current prevailing medical standards.
25 (b) Minimum benefits may be limited to one visit
26 payable to one provider for all of the services provided at
27 each visit cited in this section.
28 (3) This section does not apply to disability income,
29 specified disease, Medicare supplement, or hospital indemnity
30 policies.
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1 Section 3. Subsection (9) of section 641.31, Florida
2 Statutes, 1996 Supplement, is amended, and subsection (29) is
3 added to that section, to read:
4 641.31 Health maintenance contracts.--
5 (9) All health maintenance contracts that which
6 provide coverage, benefits, or services for a member of the
7 family of the subscriber must shall, as to such family
8 member's coverage, benefits, or services, provide also that
9 the coverage, benefits, or services applicable for children
10 must shall be provided with respect to a preenrolled newborn
11 child of the subscriber, or covered family member of the
12 subscriber, from the moment of birth. The coverage, benefits,
13 or services for newborn children must shall consist of
14 coverage for injury or sickness, including the necessary care
15 or treatment of medically diagnosed congenital defects, birth
16 abnormalities, or prematurity, and transportation costs of
17 transportation of the newborn to and from the nearest
18 available appropriate facility that is appropriately staffed
19 and equipped to treat the newborn's condition, if when such
20 transportation is certified by the attending physician as
21 medically necessary to protect the health and safety of the
22 newborn child.
23 (a) A contract may require the subscriber to notify
24 the plan of the birth of a child within a time period, as
25 specified in the contract, of not less than 30 days after the
26 birth. If timely notice is given, a plan may not charge an
27 additional premium for additional coverage of the newborn
28 child for the duration of the notice period. If timely notice
29 is not given, the plan may charge an additional premium from
30 the date of birth. The contract may not deny coverage of the
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1 child due to failure of the subscriber to timely notify the
2 plan of the birth of the child.
3 (b) If the contract does not require the subscriber to
4 notify the plan of the birth of a child within a specified
5 time period, the plan may not deny coverage of the child nor
6 may it retroactively charge the subscriber an additional
7 premium for the child; however, the contract may prospectively
8 charge the member an additional premium for the child if the
9 plan provides at least 45 days' notice of the additional
10 charge.
11 (29) If a health maintenance contract provides that
12 coverage of a dependent child of the subscriber will terminate
13 upon attainment of the limiting age for dependent children
14 which is specified in the contract, the contract must also
15 provide in substance that attainment of the limiting age does
16 not terminate the coverage of the child while the child
17 continues to be both:
18 (a) Incapable of self-sustaining employment by reason
19 of mental retardation or physical handicap, and
20 (b) Chiefly dependent upon the employee or member for
21 support and maintenance.
22 Section 4. This act shall take effect July 1, 1997.
23
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25 SENATE SUMMARY
26 Relates to health insurance contracts. Amends the
definition of the term "child health supervision
27 services." Amends requirements for such services.
Provides requirements for the coverage of such services
28 under health insurance policies and under group, blanket,
or franchise health insurance policies. Provides
29 requirements for health maintenance contracts relating to
coverage of newborn children and premiums relating
30 thereto. Requires the continuing coverage, past the usual
limiting age, of certain dependent children who are
31 incapable of self-sustaining employment.
5