CODING: Words stricken are deletions; words underlined are additions.
SENATE AMENDMENT
Bill No. CS for SB 232
Amendment No.
CHAMBER ACTION
Senate House
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11 Senator Brown-Waite moved the following amendment:
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13 Senate Amendment (with title amendment)
14 On page 3, between lines 19 and 20,
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16 insert:
17 Section 4. Effective July 1, 1999, and applicable to
18 policies and contracts issued or renewed on or after that
19 date, subsections (2) and (3) of section 641.31, Florida
20 Statutes, are amended to read:
21 641.31 Health maintenance contracts.--
22 (2) The rates charged by any health maintenance
23 organization to its subscribers shall not be excessive,
24 inadequate, or unfairly discriminatory or follow a rating
25 methodology that is inconsistent, indeterminate, or ambiguous
26 or encourages misrepresentation or misunderstanding. The
27 department, in accordance with generally accepted actuarial
28 practice as applied to health maintenance organizations, may
29 define by rule what constitutes excessive, inadequate, or
30 unfairly discriminatory rates and may require whatever
31 information it deems necessary to determine that a rate or
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SENATE AMENDMENT
Bill No. CS for SB 232
Amendment No.
1 proposed rate meets the requirements of this subsection.
2 (3)(a) If a health maintenance organization desires to
3 amend any contract with its subscribers or any certificate or
4 member handbook, or desires to change any rate charged for the
5 contract or to change any basic health maintenance contract,
6 certificate, grievance procedure, or member handbook form, or
7 application form where written application is required and is
8 to be made a part of the contract, or printed amendment,
9 addendum, rider, or endorsement form or form of renewal
10 certificate, it may do so, upon filing with the department the
11 proposed change or, amendment, or change in rates. Any
12 proposed change shall be effective immediately, subject to
13 disapproval by the department. Following receipt of notice of
14 such disapproval or withdrawal of approval, no health
15 maintenance organization shall issue or use any form or rate
16 disapproved by the department or as to which the department
17 has withdrawn approval.
18 (b) Any change in the rate is subject to paragraph (d)
19 and requires at least 30 days' advance written notice to the
20 subscriber. In the case of a group member, there may be a
21 contractual agreement with the health maintenance organization
22 to have the employer provide the required notice to the
23 individual members of the group.
24 (c)(b) The department shall disapprove any form filed
25 under this subsection, or withdraw any previous approval
26 thereof, if the form:
27 1. Is in any respect in violation of, or does not
28 comply with, any provision of this part or rule adopted
29 thereunder.
30 2. Contains or incorporates by reference, where such
31 incorporation is otherwise permissible, any inconsistent,
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SENATE AMENDMENT
Bill No. CS for SB 232
Amendment No.
1 ambiguous, or misleading clauses or exceptions and conditions
2 which deceptively affect the risk purported to be assumed in
3 the general coverage of the contract.
4 3. Has any title, heading, or other indication of its
5 provisions which is misleading.
6 4. Is printed or otherwise reproduced in such a manner
7 as to render any material provision of the form substantially
8 illegible.
9 5. Contains provisions which are unfair, inequitable,
10 or contrary to the public policy of this state or which
11 encourage misrepresentation.
12 6. Charges rates that are determined by the department
13 to be inadequate, excessive, or unfairly discriminatory, or
14 the rating methodology followed by the health maintenance
15 organization is determined by the department to be
16 inconsistent, indeterminate, ambiguous, or encouraging
17 misrepresentation or misunderstanding. Use of the rating
18 methodology must be discontinued immediately upon disapproval
19 unless the health maintenance organization seeks
20 administrative relief. If a new rating methodology is filed
21 with the department, the premiums determined by such newly
22 filed rating methodology may apply prospectively only to new
23 or renewal business written on or after the effective date of
24 the responsive filing made by the health maintenance
25 organization.
26 6.7. Excludes coverage for human immunodeficiency
27 virus infection or acquired immune deficiency syndrome or
28 contains limitations in the benefits payable, or in the terms
29 or conditions of such contract, for human immunodeficiency
30 virus infection or acquired immune deficiency syndrome which
31 are different than those which apply to any other sickness or
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SENATE AMENDMENT
Bill No. CS for SB 232
Amendment No.
1 medical condition.
2 (d) Any change in rates charged for the contract must
3 be filed with the department not less than 30 days in advance
4 of the effective date. At the expiration of such 30 days, the
5 rate filing shall be deemed approved unless prior to such time
6 the filing has been affirmatively approved or disapproved by
7 order of the department. The approval of the filing by the
8 department constitutes a waiver of any unexpired portion of
9 such waiting period. The department may extend by not more
10 than an additional 15 days the period within which it may so
11 affirmatively approve or disapprove any such filing, by giving
12 notice of such extension before expiration of the initial
13 30-day period. At the expiration of any such period as so
14 extended, and in the absence of such prior affirmative
15 approval or disapproval, any such filing shall be deemed
16 approved.
17 (e)(c) It is not the intent of this subsection to
18 restrict unduly the right to modify rates in the exercise of
19 reasonable business judgment.
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21 (Redesignate subsequent sections.)
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25 And the title is amended as follows:
26 On page 1, line 13, following the semicolon
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28 insert:
29 amending s. 641.31, F.S.; revising the
30 procedures and standards for rate changes made
31 by an organization; deleting current provisions
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Bill No. CS for SB 232
Amendment No.
1 that allow rate changes to be implemented
2 immediately upon filing with the Department of
3 Insurance, subject to disapproval; requiring
4 rate changes to be filed with the department a
5 specified time period prior to use; providing
6 that a filing is deemed approved after a
7 certain time period absent affirmative approval
8 or disapproval by the department; making
9 conforming changes;
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