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





                                                  SENATE AMENDMENT

    Bill No. CS/HB 903, 1st Eng.

    Amendment No.    

                            CHAMBER ACTION
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10                                                                

11  Senator Kurth moved the following amendment:

12

13         Senate Amendment (with title amendment) 

14         On page 1, line 1

15

16  insert:

17         Section 1.  This act may be cited as the "Equity in

18  Prescription Insurance and Contraceptive Coverage Act of

19  1999."

20         Section 2.  Legislative findings and intent.--

21         (1)  The Legislature finds that:

22         (a)  Each year, more than half of all pregnancies in

23  this state are unintended.

24         (b)  Contraceptive services are part of basic health

25  care, allowing families to both adequately space desired

26  pregnancies and avoid unintended pregnancy.

27         (c)  Contraceptives are highly cost effective, yielding

28  from $4 to $14 dollars in savings for every dollar expended.

29         (d)  By reducing rates of unintended pregnancy,

30  contraceptives help reduce the need for abortions.

31         (e)  Unintended pregnancies lead to higher rates of

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                                                  SENATE AMENDMENT

    Bill No. CS/HB 903, 1st Eng.

    Amendment No.    





 1  infant mortality, low birth weight, and maternal morbidity and

 2  threaten the economic viability of families.

 3         (f)  Most women in this state of childbearing age rely

 4  on private employment-related insurance to cover their medical

 5  expenses.

 6         (g)  Most private insurers cover prescription drugs,

 7  but many exclude coverage for prescription contraceptives.

 8         (h)  The lack of contraceptive coverage in health

 9  insurance policies places many effective forms of

10  contraceptives beyond the financial reach of many women,

11  leading to unintended pregnancies.

12         (2)  Therefore, the Legislature determines that

13  enactment of this bill constitutes an important state

14  interest.

15         Section 3.  Option for plans and policyholders of plans

16  provided by religious health plan sponsors.

17         (1)  GENERAL RULE.--Notwithstanding any other provision

18  of section 627.64061 or section 627.65741, Florida Statutes, a

19  religious health plan sponsor may provide a health plan that

20  does not provide benefits for prescription oral contraceptives

21  that are contrary to the religious tenets of the religion or

22  religious corporation, association, or society referred to in

23  subsection (3). Further, the requirements of section 627.64061

24  or section 627.65741, Florida Statutes, shall not apply to an

25  individual health care service plan contract or a group health

26  care service plan contract purchased by an employer that is a

27  religious health plan sponsor, including, but not limited to,

28  any church, religious school, religious association, or other

29  religious organization that is not organized for private

30  profit, if the provision of prescription oral contraceptives

31  under such sections is inconsistent with the religious beliefs

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                                                  SENATE AMENDMENT

    Bill No. CS/HB 903, 1st Eng.

    Amendment No.    





 1  of the organization. 

 2         (2)  EXCEPTION.--Nothing in this section shall be

 3  construed as authorizing the exclusion of coverage under a

 4  health plan of prescription oral contraceptives necessary to

 5  preserve the life or health of the patient.

 6         (3)  DEFINITION.--As used in this section, the term

 7  "religious health plan sponsor" means a health plan sponsor

 8  that meets the definition of "church plan" under s. 3(33) of

 9  the Employee Retirement Income Security Act of 1974.

10         (4)  Nothing in this act shall be construed to require

11  coverage for chemically induced abortions.

12         Section 4.  Section 627.64061, Florida Statutes, is

13  created to read:

14         627.64061  Coverage for prescription

15  contraceptives.--Any health insurance policy that provides

16  coverage for outpatient prescription drugs shall cover

17  prescription oral contraceptives approved by the federal Food

18  and Drug Administration and prescribed by a practitioner

19  authorized by state licensure to prescribe such medication.

20  Coverage must be provided to the same extent and subject to

21  the same contract terms, including copayments and deductibles,

22  as any other prescription drug.

23         Section 5.  Paragraph (c) of subsection (2) of section

24  627.6515, Florida Statutes, 1998 Supplement, is amended to

25  read:

26         627.6515  Out-of-state groups.--

27         (2)  This part does not apply to a group health

28  insurance policy issued or delivered outside this state under

29  which a resident of this state is provided coverage if:

30         (c)  The policy provides the benefits specified in ss.

31  627.419, 627.6574, 627.65741, 627.6575, 627.6579, 627.6612,

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                                                  SENATE AMENDMENT

    Bill No. CS/HB 903, 1st Eng.

    Amendment No.    





 1  627.66121, 627.66122, 627.6613, 627.667, 627.6675, 627.6691,

 2  and 627.66911.

 3         Section 6.  Section 627.65741, Florida Statutes, is

 4  created to read:

 5         627.65741  Coverage for prescription

 6  contraceptives.--Any group, franchise, accident, or health

 7  insurance policy that provides coverage for outpatient

 8  prescription drugs shall cover prescription oral

 9  contraceptives approved by the federal Food and Drug

10  Administration and prescribed by a practitioner authorized by

11  state licensure to prescribe such medication.  Coverage must

12  be provided to the same extent and subject to the same

13  contract terms, including copayments and deductibles, as any

14  other prescription drug.

15         Section 7.  Paragraph (b) of subsection (12) of section

16  627.6699, Florida Statutes, 1998 Supplement, is amended to

17  read:

18         627.6699  Employee Health Care Access Act.--

19         (12)  STANDARD, BASIC, AND LIMITED HEALTH BENEFIT

20  PLANS.--

21         (b)1.  Each small employer carrier issuing new health

22  benefit plans shall offer to any small employer, upon request,

23  a standard health benefit plan and a basic health benefit plan

24  that meets the criteria set forth in this section.

25         2.  For purposes of this subsection, the terms

26  "standard health benefit plan" and "basic health benefit plan"

27  mean policies or contracts that a small employer carrier

28  offers to eligible small employers that contain:

29         a.  An exclusion for services that are not medically

30  necessary or that are not covered preventive health services;

31  and

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                                                  SENATE AMENDMENT

    Bill No. CS/HB 903, 1st Eng.

    Amendment No.    





 1         b.  A procedure for preauthorization by the small

 2  employer carrier, or its designees.

 3         3.  A small employer carrier may include the following

 4  managed care provisions in the policy or contract to control

 5  costs:

 6         a.  A preferred provider arrangement or exclusive

 7  provider organization or any combination thereof, in which a

 8  small employer carrier enters into a written agreement with

 9  the provider to provide services at specified levels of

10  reimbursement or to provide reimbursement to specified

11  providers. Any such written agreement between a provider and a

12  small employer carrier must contain a provision under which

13  the parties agree that the insured individual or covered

14  member has no obligation to make payment for any medical

15  service rendered by the provider which is determined not to be

16  medically necessary.  A carrier may use preferred provider

17  arrangements or exclusive provider arrangements to the same

18  extent as allowed in group products that are not issued to

19  small employers.

20         b.  A procedure for utilization review by the small

21  employer carrier or its designees.

22

23  This subparagraph does not prohibit a small employer carrier

24  from including in its policy or contract additional managed

25  care and cost containment provisions, subject to the approval

26  of the department, which have potential for controlling costs

27  in a manner that does not result in inequitable treatment of

28  insureds or subscribers.  The carrier may use such provisions

29  to the same extent as authorized for group products that are

30  not issued to small employers.

31         4.  The standard health benefit plan shall include:

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                                                  SENATE AMENDMENT

    Bill No. CS/HB 903, 1st Eng.

    Amendment No.    





 1         a.  Coverage for inpatient hospitalization;

 2         b.  Coverage for outpatient services;

 3         c.  Coverage for newborn children pursuant to s.

 4  627.6575;

 5         d.  Coverage for child care supervision services

 6  pursuant to s. 627.6579;

 7         e.  Coverage for adopted children upon placement in the

 8  residence pursuant to s. 627.6578;

 9         f.  Coverage for mammograms pursuant to s. 627.6613;

10         g.  Coverage for handicapped children pursuant to s.

11  627.6615;

12         h.  Emergency or urgent care out of the geographic

13  service area; and

14         i.  Coverage for services provided by a hospice

15  licensed under s. 400.602 in cases where such coverage would

16  be the most appropriate and the most cost-effective method for

17  treating a covered illness.

18         5.  The standard health benefit plan and the basic

19  health benefit plan may include a schedule of benefit

20  limitations for specified services and procedures.  If the

21  committee develops such a schedule of benefits limitation for

22  the standard health benefit plan or the basic health benefit

23  plan, a small employer carrier offering the plan must offer

24  the employer an option for increasing the benefit schedule

25  amounts by 4 percent annually.

26         6.  The basic health benefit plan shall include all of

27  the benefits specified in subparagraph 4.; however, the basic

28  health benefit plan shall place additional restrictions on the

29  benefits and utilization and may also impose additional cost

30  containment measures.

31         7.  Sections 627.419(2), (3), and (4), 627.6574,

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                                                  SENATE AMENDMENT

    Bill No. CS/HB 903, 1st Eng.

    Amendment No.    





 1  627.65741, 627.6612, 627.66121, 627.66122, 627.6616, 627.6618,

 2  627.668, and 627.66911 apply to the standard health benefit

 3  plan and to the basic health benefit plan. However,

 4  notwithstanding said provisions, the plans may specify limits

 5  on the number of authorized treatments, if such limits are

 6  reasonable and do not discriminate against any type of

 7  provider.

 8         8.  Each small employer carrier that provides for

 9  inpatient and outpatient services by allopathic hospitals may

10  provide as an option of the insured similar inpatient and

11  outpatient services by hospitals accredited by the American

12  Osteopathic Association when such services are available and

13  the osteopathic hospital agrees to provide the service.

14         Section 8.  Subsection (36) is added to section 641.31,

15  Florida Statutes, 1998 Supplement, to read:

16         641.31  Health maintenance contracts.--

17         (36)  Health maintenance contracts that provide

18  coverage for outpatient prescription drugs shall cover

19  prescription oral contraceptives approved by the federal Food

20  and Drug Administration and prescribed by a practitioner

21  authorized by state licensure to prescribe such medication

22  when such practitioner is under the organization's direct

23  employ or under contract or other arrangement with the

24  organization to provide health care services to subscribers.

25  Coverage must be provided to the same extent and subject to

26  the same contract terms, including copayments, as any other

27  prescription medication.

28

29  (Redesignate subsequent sections.)

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                                                  SENATE AMENDMENT

    Bill No. CS/HB 903, 1st Eng.

    Amendment No.    





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

 2  And the title is amended as follows:

 3         On page 1, lines 2 and 3, delete those lines

 4

 5  and insert:

 6         An act relating to health insurance; creating

 7         the "Equity in Contraceptive Coverage Act of

 8         1999"; providing legislative findings and

 9         intent; providing requirements with respect to

10         plans provided by religious health plan

11         sponsors; creating ss. 627.64061, 627.65741,

12         F.S., and amending 641.31, F.S.; requiring

13         certain health insurance policies and health

14         maintenance contracts to provide coverage for

15         prescription oral contraceptives; amending s.

16         627.6515, F.S.; applying certain requirements

17         for group coverage to out-of-state groups;

18         amending s. 627.6699, F.S.; applying certain

19         requirements for group coverage to coverage for

20         small employers; amending s. 627.6699, F.S.;

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