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





                                                   HOUSE AMENDMENT

                                  Bill No. CS for SB 312, 2nd Eng.

    Amendment No.     (for drafter's use only)

                            CHAMBER ACTION
              Senate                               House
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 4                                                                

 5                                           ORIGINAL STAMP BELOW

 6

 7

 8

 9

10                                                                

11  Representative(s) Albright Feeney, Arnall, and Boyd offered

12  the following:

13

14         Amendment (with title amendment) 

15         On page 2, line 2,

16

17  and insert in lieu thereof:

18         Section 1.  Paragraph (n) of subsection (3), paragraph

19  (c) of subsection (5) and paragraphs (b) and (d) of subsection

20  (6) of section 627.6699, Florida Statutes, 1998 Supplement,

21  are amended to read:

22         627.6699  Employee Health Care Access Act.--

23         (3)  DEFINITIONS.--As used in this section, the term:

24         (n)  "Modified community rating" means a method used to

25  develop carrier premiums which spreads financial risk across a

26  large population and allows adjustments for age, gender,

27  family composition, tobacco usage, and geographic area as

28  determined under paragraph (5)(j), claims experience, health

29  status, or duration of coverage as permitted under

30  subparagraph (6)(b)5. and administrative and acquisition

31  expenses as permitted under subparagraph (6)(b)6 (5)(k).

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                                                   HOUSE AMENDMENT

                                  Bill No. CS for SB 312, 2nd Eng.

    Amendment No.     (for drafter's use only)





 1         (5)  AVAILABILITY OF COVERAGE.--

 2         (c)  Every small employer carrier must, as a condition

 3  of transacting business in this state:

 4         1.  Beginning July January 1, 1999 1994, offer and

 5  issue all small employer health benefit plans on a

 6  guaranteed-issue basis to every eligible small employer, with

 7  2 3 to 50 eligible employees, that elects to be covered under

 8  such plan, agrees to make the required premium payments, and

 9  satisfies the other provisions of the plan. A rider for

10  additional or increased benefits may be medically underwritten

11  and may only be added to the standard health benefit plan.

12  The increased rate charged for the additional or increased

13  benefit must be rated in accordance with this section.

14         2.  Beginning August 1, 1999 April 15, 1994, offer and

15  issue basic and standard small employer health benefit plans

16  on a guaranteed-issue basis, during a 31-day open enrollment

17  period of August 1 through August 31 of each year, to every

18  eligible small employer, with less than one or two eligible

19  employees, which small employer is not formed primarily for

20  the purposes of buying health insurance, which elects to be

21  covered under such plan, agrees to make the required premium

22  payments, and satisfies the other provisions of the plan.

23  Coverage provided pursuant to this subparagraph shall begin on

24  October 1 of the same year as the date of enrollment, unless

25  the small employer carrier and the small employer mutually

26  agree to a different date. A rider for additional or increased

27  benefits may be medically underwritten and may only be added

28  to the standard health benefit plan.  The increased rate

29  charged for the additional or increased benefit must be rated

30  in accordance with this section. For purposes of this

31  subparagraph, a person, his or her spouse, and his or her

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                                                   HOUSE AMENDMENT

                                  Bill No. CS for SB 312, 2nd Eng.

    Amendment No.     (for drafter's use only)





 1  dependent children shall constitute a single eligible employee

 2  if such person and spouse are employed by the same small

 3  employer.

 4         3.  Offer to eligible small employers the standard and

 5  basic health benefit plans.

 6

 7  This paragraph subparagraph does not limit a carrier's ability

 8  to offer other health benefit plans to small employers if the

 9  standard and basic health benefit plans are offered and

10  rejected.

11         (6)  RESTRICTIONS RELATING TO PREMIUM RATES.--

12         (b)  For all small employer health benefit plans that

13  are subject to this section and are issued by small employer

14  carriers on or after January 1, 1994, premium rates for health

15  benefit plans subject to this section are subject to the

16  following:

17         1.  Small employer carriers must use a modified

18  community rating methodology in which the premium for each

19  small employer must be determined solely on the basis of the

20  eligible employee's and eligible dependent's gender, age,

21  family composition, tobacco use, or geographic area as

22  determined under paragraph (5)(j) and in which the premium may

23  be adjusted as permittted by subparagraphs 6. and 7 (5)(k).

24         2.  Rating factors related to age, gender, family

25  composition, tobacco use, or geographic location may be

26  developed by each carrier to reflect the carrier's experience.

27  The factors used by carriers are subject to department review

28  and approval.

29         3.  Small employer carriers may not modify the rate for

30  a small employer for 12 months from the initial issue date or

31  renewal date, unless the composition of the group changes or

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                                                   HOUSE AMENDMENT

                                  Bill No. CS for SB 312, 2nd Eng.

    Amendment No.     (for drafter's use only)





 1  benefits are changed.

 2         4.  Carriers participating in the alliance program, in

 3  accordance with ss. 408.700-408.707, may apply a different

 4  community rate to business written in that program.

 5         5.  Any adjustments in rates for claims experience,

 6  health status, and duration of coverage may not be charged to

 7  individual employees or dependents. For a small employer's

 8  policy, such adjustments may not result in a rate for the

 9  small employer which deviates more than 15 percent from the

10  carrier's approved rate. Any such adjustment must be applied

11  uniformly to the rates charged for all employees and

12  dependents of the small employer. A small employer carrier may

13  make an adjustment to a small employer's renewal premium, not

14  to exceed 10 percent annually, due to the claims experience,

15  health status, or duration of coverage of the employees or

16  dependents of the small employer. A small employer carrier may

17  not make an adjustment which exceeds 5 percent to a small

18  employer's renewal premium due to health status. Semiannually,

19  small group carriers shall report information on forms adopted

20  by rules by the department to enable the department to monitor

21  the relationship of aggregate adjusted premiums actually

22  charged policyholders by each carrier to the premiums that

23  would have been charged by application of the carrier's

24  approved modified community rates. If the aggregate premium

25  resulting from the application of such adjustment exceeds the

26  premium that would have been charged by application of the

27  approved modified community rate by 5 percent for the current

28  reporting period, the carrier shall limit the application of

29  such adjustments to only minus adjustments beginning not more

30  than 60 days after the report is sent to the department. For

31  any subsequent reporting period, if the total aggregate

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                                                   HOUSE AMENDMENT

                                  Bill No. CS for SB 312, 2nd Eng.

    Amendment No.     (for drafter's use only)





 1  adjusted premium actually charged does not exceed by 5 percent

 2  the premium that would have been charged by application of the

 3  approved modified community rate, the carrier may apply both

 4  plus and minus adjustments.

 5         6.  A small employer carrier may provide a credit to a

 6  small employer's premium based on administrative and

 7  acquisition expense differences resulting from the size of the

 8  group. Group size administrative and acquisition expense

 9  factors may be developed by each carrier to reflect the

10  carrier's experience and are subject to department review and

11  approval.

12         7.  A small employer carrier rating methodology may

13  include separate rating categories for one dependent child,

14  for two dependent children, and three or more dependent

15  children for family coverage of employees having a spouse and

16  dependent children or employees having dependent children

17  only. A small employer carrier may have fewer, but not

18  greater, numbers of categories for dependent children than

19  those specified in this subparagraph.

20         8.  Small employer carriers may not use a composite

21  rating methodology to rate a small employer with fewer than 10

22  employees. For the purposes of this subparagraph a "composite

23  rating methodology" means a rating methodology that averages

24  the impact of the rating factors for age and gender in the

25  premiums charged to all of the employees of a small employer.

26         (d)  Notwithstanding s. 627.401(2), this section and

27  ss. 627.410 and 627.411 apply to any health benefit plan

28  provided by a small employer carrier that is an insurer, and

29  this section and s. 641.31 apply to any health benefit

30  provided by a small employer carrier that is a health

31  maintenance organization, that provides coverage to one or

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                                                   HOUSE AMENDMENT

                                  Bill No. CS for SB 312, 2nd Eng.

    Amendment No.     (for drafter's use only)





 1  more employees of a small employer regardless of where the

 2  policy, certificate, or contract is issued or delivered, if

 3  the health benefit plan covers employees or their covered

 4  dependents who are residents of this state.

 5

 6

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

 8  And the title is amended as follows:

 9         On page 1, line 2,

10

11  after the semicolon insert:

12         to the Employee Health Care Access Act;

13         amending s. 627.6699, F.S.; revising a

14         definition; revising and updating provisions

15         requiring small employer carriers to offer and

16         issue certain health benefit plans; providing

17         additional restrictions on premium rates for

18         certain health benefit plans;

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