CODING: Words stricken are deletions; words underlined are additions.
SENATE AMENDMENT
Bill No. CS for SB 2516
Amendment No.
CHAMBER ACTION
Senate House
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11 Senator Meek moved the following amendment:
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13 Senate Amendment (with title amendment)
14 On page 10, between lines 26 and 27,
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16 insert:
17 Section 10. Subsections (1), (6), (7), and (8) of
18 section 627.410, Florida Statutes, 1998 Supplement, are
19 amended to read:
20 627.410 Filing, approval of forms.--
21 (1) No basic insurance policy or annuity contract
22 form, or application form where written application is
23 required and is to be made a part of the policy or contract,
24 or group certificates issued under a master contract delivered
25 in this state, or printed rider or endorsement form or form of
26 renewal certificate, shall be delivered or issued for delivery
27 in this state, unless the form has been filed with the
28 department at its offices in Tallahassee by or in behalf of
29 the insurer which proposes to use such form and has been
30 approved by the department. This provision does not apply to:
31 (a) Surety bonds or to specially rated inland marine
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1 risks, or
2 (b) Policies, riders, endorsements, or forms of unique
3 character which are designed for and used with relation to
4 insurance upon a particular subject (other than as to
5 individual or small group health insurance), or which relate
6 to the manner of distribution of benefits or to the
7 reservation of rights and benefits under life or health
8 insurance policies and are used at the request of the
9 individual policyholder, contract holder, or
10 certificateholder. As to group insurance policies effectuated
11 and delivered outside this state but covering persons resident
12 in this state, the group certificates to be delivered or
13 issued for delivery in this state shall be filed with the
14 department for information purposes only.
15 (6)(a) An insurer shall not deliver or issue for
16 delivery or renew in this state any health insurance policy
17 form until it has filed with the department a copy of every
18 applicable rating manual, rating schedule, change in rating
19 manual, and change in rating schedule; if rating manuals and
20 rating schedules are not applicable, the insurer must file
21 with the department applicable premium rates and any change in
22 applicable premium rates. This provision does not apply to
23 rating manuals, rating schedules, changes in rating manuals or
24 schedules, or if rating manuals or schedules are not
25 applicable, to premium rates or changes in such rates,
26 relating to policies, riders, endorsements, or forms of unique
27 character which are designed for and used with relation to
28 insurance upon a particular subject or to benefits under group
29 health insurance policies insuring 51 or more persons and are
30 used at the request of the individual policyholder, contract
31 holder, or certificate holder.
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1 (b) The department may establish by rule, for each
2 type of health insurance form, procedures to be used in
3 ascertaining the reasonableness of benefits in relation to
4 premium rates and may, by rule, exempt from any requirement of
5 paragraph (a) any health insurance policy form or type thereof
6 (as specified in such rule) to which form or type such
7 requirements may not be practically applied or to which form
8 or type the application of such requirements is not desirable
9 or necessary for the protection of the public. With respect to
10 any health insurance policy form or type thereof which is
11 exempted by rule from any requirement of paragraph (a),
12 premium rates filed pursuant to ss. 627.640 and 627.662 shall
13 be for informational purposes.
14 (c) Every filing made pursuant to this subsection
15 shall be made within the same time period provided in, and
16 shall be deemed to be approved under the same conditions as
17 those provided in, subsection (2).
18 (d) Every filing made pursuant to this subsection,
19 except disability income policies and accidental death
20 policies, shall be prohibited from applying the following
21 rating practices:
22 1. Select and ultimate premium schedules.
23 2. Premium class definitions which classify insured
24 based on year of issue or duration since issue.
25 3. Attained age premium structures on policy forms
26 under which more than 50 percent of the policies are issued to
27 persons age 65 or over.
28 (e) Except as provided in subparagraph 1., an insurer
29 shall continue to make available for purchase any individual
30 policy form issued on or after October 1, 1993. A policy form
31 shall not be considered to be available for purchase unless
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1 the insurer has actively offered it for sale in the previous
2 12 months.
3 1. An insurer may discontinue the availability of a
4 policy form if the insurer provides to the department in
5 writing its decision at least 30 days prior to discontinuing
6 the availability of the form of the policy or certificate.
7 After receipt of the notice by the department, the insurer
8 shall no longer offer for sale the policy form or certificate
9 form in this state.
10 2. An insurer that discontinues the availability of a
11 policy form pursuant to subparagraph 1. shall not file for
12 approval a new policy form providing similar benefits as the
13 discontinued form for a period of 5 years after the insurer
14 provides notice to the department of the discontinuance. The
15 period of discontinuance may be reduced if the department
16 determines that a shorter period is appropriate.
17 2.3. The experience of an individual accident and
18 health insurance all policy form that is no longer being
19 marketed in this state, except for policies rated pursuant to
20 a loss ratio guarantee under subsection (8), shall be combined
21 with the experience of at least one other individual accident
22 and health insurance policy form forms providing similar
23 benefits, as determined by the insurer, which is still being
24 marketed in the state by the same insurer, unless the insurer
25 has no other policy form providing similar benefits, as
26 determined by the insurer, which is still being marketed in
27 the state shall be combined for all rating purposes.
28 3. Each individual accident and health insurer that
29 discontinues the availability of a policy form and that has no
30 other policy form providing similar benefits which is still
31 being marketed in the state shall offer every existing insured
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1 who is currently paying premiums under the discontinued policy
2 form the option to apply for coverage under any individual
3 accident and health insurance policy form which is still being
4 marketed in the state by the same insurer. Individuals who
5 fail to satisfy the insurer's underwriting guidelines or
6 standards for issuance of a replacement policy shall be issued
7 coverage if they apply for such replacement coverage within
8 180 days' written notice to the insured persons from the
9 insurer, without regard to health status or claims experience.
10 However, individuals who apply for the replacement coverage
11 described in this subparagraph who fail to satisfy the
12 insurer's underwriting guidelines or standards may be charged
13 a premium rate not to exceed 140 percent of the standard
14 premium rate charged by the insurer for the coverage. The
15 replacement coverage described in this subparagraph shall
16 waive any preexisting condition limitations or waiting periods
17 satisfied under the preceding, discontinued policy form.
18 4. For purposes of this paragraph an individual
19 accident and health insurance policy form shall be deemed to
20 provide similar benefits to another individual accident and
21 health insurance policy form if the forms are of the same
22 type, e.g. major medical; hospital/surgical; disability; home
23 health care; long-term care, and at least 70 percent of the
24 benefits provided by one form are also provided by the other.
25 (7)(a) Each insurer subject to the requirements of
26 subsection (6) shall make an annual filing with the department
27 no later than 12 months after its previous filing,
28 establishing demonstrating the reasonableness of benefits in
29 relation to premium rates. The department, after receiving a
30 request to be exempted from the provisions of this section,
31 may, for good cause due to insignificant numbers of policies
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1 in force or insignificant premium volume, exempt a company, by
2 line of coverage, from filing rates or rate certification as
3 required by this section.
4 (b) The filing required by this subsection shall be
5 satisfied by one of the following methods:
6 1. A rate filing prepared by an actuary which contains
7 documentation establishing demonstrating the reasonableness of
8 benefits in relation to premiums charged in accordance with
9 the applicable rating laws and rules promulgated by the
10 department. For premium rate changes, benefits shall be deemed
11 reasonable in relation to premium charged if both of the
12 following loss ratios meet or exceed the standards established
13 in s. 627.411(2).
14 a. The anticipated loss ratio over the entire future
15 period for which the revised rates are computed to provide
16 coverage; and
17 b. The lifetime anticipated loss ratio derived by
18 dividing the amount determined under sub-sub-subparagraph (I)
19 by the amount determined under sub-sub-subparagraph (II):
20 (I) The sum of the accumulated benefits from the
21 original effective date of the form to the effective date of
22 the revision, and the present value of future benefits.
23 (II) The sum of the accumulated premiums from the
24 original effective date of the form to the effective date of
25 the revision, and the present value of future premiums, which
26 present values shall be taken over the entire period for which
27 the revised rates are computed to provide coverage and which
28 accumulated benefits and premiums shall include an explicit
29 estimate of actual benefits and premiums from the last date an
30 accounting has been made to the effective date of the
31 revision.
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1
2 Interest shall be used in the calculation of these accumulated
3 benefits and premiums and present values in the calculation
4 of the loss ratio. For purposes of sub-sub-subparagraph (I),
5 the present value of benefits may, at the insurer's option,
6 include recognition of the policy reserve as a benefit
7 (addition), or the present value of premiums may, at the
8 insurer's option, include recognition of the policy reserve as
9 a deduction. Anticipated loss ratios lower than those
10 indicated in sub-sub-subparagraphs (I) and (II) will require
11 justification based on special circumstances that may be
12 applicable. Examples of coverages that may require special
13 consideration are accident only, short-term nonrenewable,
14 specified peril, and other special risks. Examples of other
15 factors that may require special consideration are marketing
16 methods; giving due consideration to acquistion and
17 administration costs and premium mode; extraordinary expenses;
18 high risk of claims fluctuation because of low loss frequency
19 or the catastrophic or experimental nature of the coverage;
20 product features such as long elimination periods, high
21 deductibles, and high maximum limits; and the industrial or
22 debit method of distribution.
23 2. If no rate change is proposed, a filing which
24 consists of a certification by an actuary that benefits are
25 reasonable in relation to premiums currently charged in
26 accordance with the loss ratio standards established in this
27 section and s. 627.411(2) applicable laws and rules
28 promulgated by the department.
29 (c) As used in this section, the term "actuary" means
30 an individual who is a member of the Society of Actuaries or
31 the American Academy of Actuaries. If an insurer does not
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1 employ or otherwise retain the services of an actuary, the
2 insurer's certification shall be prepared by insurer personnel
3 or consultants with a minimum of 5 years' experience in
4 insurance ratemaking. The chief executive officer of the
5 insurer shall review and sign the certification indicating his
6 or her agreement with its conclusions.
7 (d) If at the time a filing is required under this
8 section an insurer is in the process of completing a rate
9 review, the insurer may apply to the department for an
10 extension of up to an additional 30 days in which to make the
11 filing. The request for extension must be received by the
12 department in its offices in Tallahassee no later than the
13 date the filing is due.
14 (e) If an insurer fails to meet the filing
15 requirements of this subsection and does not submit the filing
16 within 60 days following the date the filing is due, the
17 department may, in addition to any other penalty authorized by
18 law, order the insurer to discontinue the issuance of policies
19 for which the required filing was not made, until such time as
20 the department determines that the required filing is properly
21 submitted.
22 (8)(a) For the purposes of subsections (6) and (7) and
23 s. 627.411, benefits of an individual accident and health
24 insurance policy form, including Medicare supplement policies
25 as defined in s. 627.672, when authorized by rules adopted by
26 the department, and excluding long-term care insurance
27 policies as defined in s. 627.9404, and other policy forms
28 under which more than 50 percent of the policies are issued to
29 individuals age 65 and over, are deemed to comply with the
30 provisions cited in this section to be reasonable in relation
31 to premium rates if the rates are filed pursuant to a loss
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1 ratio guarantee and both the initial rates and the durational
2 and lifetime loss ratios have been approved by the department,
3 and such benefits shall continue to be deemed reasonable for
4 renewal rates while the insurer complies with such guarantee,
5 provided the currently expected lifetime loss ratio is not
6 more than 5 percent less than the filed lifetime loss ratio as
7 certified to by an actuary. The department shall have the
8 right to bring an administrative action should it deem that
9 the lifetime loss ratio will not be met. For Medicare
10 supplement filings, the department may withdraw a previously
11 approved filing which was made pursuant to a loss ratio
12 guarantee if it determines that the filing is not in
13 compliance with ss. 627.671-627.675 or the currently expected
14 lifetime loss ratio is less than the filed lifetime loss ratio
15 as certified by an actuary in the initial guaranteed loss
16 ratio filing. If this section conflicts with ss.
17 627.671-627.675, ss. 627.671-627.675 shall control.
18 (b) The renewal premium rates shall be deemed to be
19 approved upon filing with the department if the filing is
20 accompanied by the most current approved loss ratio guarantee.
21 The loss ratio guarantee shall be in writing, shall be signed
22 by an officer of the insurer, and shall contain at least:
23 1. A recitation of the anticipated lifetime and
24 durational target loss ratios contained in the actuarial
25 memorandum filed with the policy form when it was originally
26 approved. The durational target loss ratios shall be
27 calculated for 1-year experience periods. If statutory
28 changes have rendered any portion of such actuarial memorandum
29 obsolete, the loss ratio guarantee shall also include an
30 amendment to the actuarial memorandum reflecting current law
31 and containing new lifetime and durational loss ratio targets.
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1 2. A guarantee that the applicable loss ratios for the
2 experience period in which the new rates will take effect, and
3 for each experience period thereafter until new rates are
4 filed, will meet the loss ratios referred to in subparagraph
5 1.
6 3. A guarantee that the applicable loss ratio results
7 for the experience period will be independently audited at the
8 insurer's expense. The audit shall be performed in the second
9 calendar quarter of the year following the end of the
10 experience period, and the audited results shall be reported
11 to the department no later than the end of such quarter. The
12 department shall establish by rule the minimum information
13 reasonably necessary to be included in the report. The audit
14 shall be done in accordance with accepted accounting and
15 actuarial principles.
16 4. A guarantee that affected policyholders in this
17 state shall be issued a proportional refund, based on the
18 premium earned, of the amount necessary to bring the
19 applicable experience period loss ratio up to the durational
20 target loss ratio referred to in subparagraph 1. The refund
21 shall be made to all policyholders in this state who are
22 insured under the applicable policy form as of the last day of
23 the experience period, except that no refund need be made to a
24 policyholder in an amount less than $10. Refunds less than $10
25 shall be aggregated and paid pro rata to the policyholders
26 receiving refunds. The refund shall include interest at the
27 then-current variable loan interest rate for life insurance
28 policies established by the National Association of Insurance
29 Commissioners, from the end of the experience period until the
30 date of payment. Payments shall be made during the third
31 calendar quarter of the year following the experience period
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1 for which a refund is determined to be due. However, no
2 refunds shall be made until 60 days after the filing of the
3 audit report in order that the department has adequate time to
4 review the report.
5 5. A guarantee that if the applicable loss ratio
6 exceeds the durational target loss ratio for that experience
7 period by more than 20 percent, provided there are at least
8 2,000 policyholders on the form nationwide or, if not, then
9 accumulated each calendar year until 2,000 policyholder years
10 is reached, the insurer, if directed by the department, shall
11 withdraw the policy form for the purposes of issuing new
12 policies.
13 (c) As used in this subsection:
14 1. "Loss ratio" means the ratio of incurred claims to
15 earned premium.
16 2. "Applicable loss ratio" means the loss ratio
17 attributable solely to this state if there are 2,000 or more
18 policyholders in the state. If there are 500 or more
19 policyholders in this state but less than 2,000, it is the
20 linear interpolation of the nationwide loss ratio and the loss
21 ratio for this state. If there are less than 500
22 policyholders in this state, it is the nationwide loss ratio;
23 however, if there are less than 2,000 policyholder years
24 nationwide, the experience must be accumulated until the end
25 of the calendar year in which 2,000 policyholder years are
26 obtained.
27 3. "Experience period" means the period, ordinarily a
28 calendar year, for which a loss ratio guarantee is calculated.
29 (d) The department shall not disapprove or withdraw
30 any previous approval of any individual accident and health
31 insurance form pursuant to s. 627.411(1)(e) if rates have been
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1 filed as provided in this subsection.
2 Section 11. Section 627.411, Florida Statutes, is
3 amended to read:
4 627.411 Grounds for Disapproval of forms.--
5 (1) The department shall disapprove any insurance
6 policy form that must be filed under s. 627.410, or withdraw
7 any previous approval thereof, only if the form:
8 (a) Is in any respect in violation of, or does not
9 comply with, this code.
10 (b) Contains or incorporates by reference, where such
11 incorporation is otherwise permissible, any inconsistent,
12 ambiguous, or misleading clauses, or exceptions and conditions
13 which deceptively affect the risk purported to be assumed in
14 the general coverage of the contract.
15 (c) Has any title, heading, or other indication of its
16 provisions which is misleading.
17 (d) Is printed or otherwise reproduced in such manner
18 as to render any material provision of the form substantially
19 illegible.
20 (e)1. Is for health insurance, and provides benefits
21 which are unreasonable in relation to the premium charged; or,
22 2. Contains provisions that constitute unfair
23 discrimination pursuant to s. 626.9541(1)(g), which are unfair
24 or inequitable as contrary to the public policy of this state
25 or which encourages misrepresentation or which apply rating
26 practices which result in premium escalations that are not
27 viable for the policyholder market or result in unfair
28 discrimination in sales practices.
29 (f) Excludes coverage for human immunodeficiency virus
30 infection or acquired immune deficiency syndrome or contains
31 limitations in the benefits payable, or in the terms or
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1 conditions of such contract, for human immunodeficiency virus
2 infection or acquired immune deficiency syndrome which are
3 different than those which apply to any other sickness or
4 medical condition.
5 (2) In determining whether the Benefits are deemed
6 reasonable in relation to the premium charged if premium rates
7 are neither excessive nor inadequate., the department, in
8 accordance with reasonable actuarial techniques, shall
9 consider:
10 (a) Past loss experience and prospective loss
11 experience within and without this state.
12 (b) Allocation of expenses.
13 (c) Risk and contingency margins, along with
14 justification of such margins.
15 (d) Acquisition costs.
16 (a) Premium rates are not excessive if the insurer
17 demonstrates, in accordance with generally accepted standards
18 of actuarial practice, satisfaction of the following minimum
19 anticipated loss ratios.
20 1. Loss Ratio Table, Individual Policies for the Line
21 of Business Indicated.--
22 a. Medical Expenses.--
23 Renewal Clause Loss Ratio
24 Noncancelable 55 percent
25 Nonrenewable 60 percent
26 Guaranteed Renewable 65 percent
27 All others 70 percent
28 b. Medical Indemnity, Loss of Income.--
29 Renewal Clause Loss Ratio
30 Noncancelable 50 percent
31 Nonrenewable 55 percent
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1 Guaranteed Renewable 60 percent
2 All others 65 percent
3 2. Loss Ratio Table, Group Policies.--
4 a. Group Medical Expense.--
5 Group Size Loss Ratio
6 Fewer than 51 certificates 65 percent
7 51 through 500 certificates 70 percent
8 All others 75 percent
9 b. Group Medical Indemnity or Any Group Policy with
10 and Average Annual Premium per Certificate of Less Than
11 $1,000.--
12 Group Size Loss Ratio
13 Fewer than 51 certificates 57.5 percent
14 51 through 500 certificates 62.5 percent
15 All others 67.5 percent
16 3. Group conversion insurance, other than
17 long-term-care insurance and Medicare supplement insurance,
18 issued on either a group or an individual basis, shall have a
19 loss ratio of not less than 120 percent, subject to the limits
20 described in s. 627.6675.
21 4. The lifetime loss ratios in subparagraphs 1. and 2.
22 may be adjusted in accordance with the following formula:
23
24 R' = (A - 25I) R/A
25
26 where:
27 R = the loss ratio from subparagraphs 1. and 2.;
28 A = the average annualized premium per individual policy or
29 per group certificate;
30 I = (CPI-U, year N-1)/103.9;
31 R' = the adjusted loss ratio.
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1
2 R' cannot be more than 10 percentage points less than R nor
3 less than 50 percent, except that R' cannot be less than 45
4 percent as to accident only non-cancellable policies. The
5 CPI-U is the consumer price index for all urban consumers, for
6 all items and for all regions of the U. S. combined, as
7 determined by the U. S. Department of Labor, Bureau of
8 Statistics as of September of each year. Year N-1 is the
9 calendar year immediately preceding the calendar year (N) in
10 which the rate filing is submitted in Florida.
11 5. Blanket insurance is exempt from the loss ratios
12 described in subparagraphs 1.-3. The minimum loss ratio for
13 blanket insurance is 65 percent.
14 6. Medicare supplement and long-term-care insurance
15 are exempt from the loss ratios described in subparagraphs
16 1.-3. The minimum loss ratios for Medicare supplement
17 insurance must be established in accordance with s. 627.674.
18 Benefits under long-term care insurance policies shall be
19 deemed reasonable in relation to premiums provided the
20 expected loss ratio is at least 60 percent, calculated in a
21 manner which provides for adequate reserving of the long-term
22 care insurance risk. In determining the expected loss ratio,
23 the Insurance Department shall adopt rules consistent with the
24 Long-Term Care Model Regulation as approved by the National
25 Association of Insurance Commissioners in July 1998.
26 (b) Premium rates are not inadequate if the insurer
27 demonstrates, in accordance with generally accepted standards
28 of actuarial practice, that the sum of premium income and
29 investment income, minus the sum of benefit payments,
30 expenses, taxes, and contingency margins is greater than zero.
31 Section 12. Subsection (6) is added to section
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1 626.883, Florida Statutes, to read:
2 626.883 Administrator as intermediary; collections
3 held in fiduciary capacity; establishment of account;
4 disbursement; payments on behalf of insurer.--
5 (6) All payments to a health care provider by a fiscal
6 intermediary for noncapitated providers must include an
7 explanation of services being reimbursed which includes, at a
8 minimum, the patient's name, the date of service, the
9 procedure code, the amount of reimbursement, and the
10 identification of the plan on whose behalf the payment is
11 being made. For capitated providers, the statement of
12 services must include the number of patients covered by the
13 contract, the rate per patient, the total amount of the
14 payment, and the identification of the plan on whose behalf
15 the payment is being made.
16 Section 13. Paragraph (a) of subsection (2) of section
17 641.316, Florida Statutes, 1998 Supplement, is amended to
18 read:
19 641.316 Fiscal intermediary services.--
20 (2)(a) The term "fiduciary" or "fiscal intermediary
21 services" means reimbursements received or collected on behalf
22 of health care professionals for services rendered, patient
23 and provider accounting, financial reporting and auditing,
24 receipts and collections management, compensation and
25 reimbursement disbursement services, or other related
26 fiduciary services pursuant to health care professional
27 contracts with health maintenance organizations. All payments
28 to a health care provider by a fiscal intermediary for
29 noncapitated providers must include an explanation of services
30 being reimbursed which includes, at a minimum, the patient's
31 name, the date of service, the procedure code, the amount of
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1 reimbursement, and the identification of the plan on whose
2 behalf the payment is being made. For capitated providers,
3 the statement of services must include the number of patients
4 covered by the contract, the rate per patient, the total
5 amount of the payment, and the identification of the plan on
6 whose behalf the payment is being made.
7
8 (Redesignate subsequent sections.)
9
10
11 ================ T I T L E A M E N D M E N T ===============
12 And the title is amended as follows:
13 On page 1, line 2, delete that line
14
15 and insert:
16 An act relating to health insurance; amending
17 s. 627.410, F.S.; modifying rate filing
18 requirements for approval of health insurance
19 policy forms by the Department of Insurance;
20 amending s. 627.411, F.S.; providing guidelines
21 for determining when benefits are considered
22 reasonable in relation to the premium charged
23 for purposes of disapproval of health insurance
24 policy forms by the department; amending s.
25 626.883, F.S.; relating to payments on behalf
26 of insurer; amending s. 641.316, F.S.; relating
27 to payments to a health care provider; amending
28 s.
29
30
31
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