CODING: Words stricken are deletions; words underlined are additions.





                                                  SENATE AMENDMENT

    Bill No. CS for SB 232

    Amendment No.    

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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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24  ================ T I T L E   A M E N D M E N T ===============

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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                                                  SENATE AMENDMENT

    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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