House Bill 0147

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    Florida House of Representatives - 2000                 HB 147

        By Representatives Effman and Wasserman Schultz






  1                      A bill to be entitled

  2         An act relating to health insurance; creating

  3         the "Equity in Prescription Insurance and

  4         Contraceptive Coverage Act"; providing

  5         legislative findings and intent; providing

  6         requirements with respect to plans provided by

  7         religious health plan sponsors; creating ss.

  8         627.64061, 627.65741, F.S., and amending

  9         641.31, F.S.; requiring certain health

10         insurance policies and health maintenance

11         contracts to provide coverage for prescription

12         oral contraceptives; amending s. 627.6515,

13         F.S.; applying certain requirements for group

14         coverage to out-of-state groups; amending s.

15         627.6699, F.S.; applying certain requirements

16         for group coverage relating to prescription

17         oral contraceptives to small employer carriers

18         issuing health benefit plans; providing an

19         effective date.

20

21  Be It Enacted by the Legislature of the State of Florida:

22

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

24  Prescription Insurance and Contraceptive Coverage Act."

25         Section 2.  Legislative findings and intent.--

26         (1)  The Legislature finds that:

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

28  this state are unintended.

29         (b)  Contraceptive services are part of basic health

30  care, allowing families to both adequately space desired

31  pregnancies and avoid unintended pregnancy.

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  1         (c)  Contraceptives are highly cost effective, yielding

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

  3         (d)  By reducing rates of unintended pregnancy,

  4  contraceptives help reduce the need for abortions.

  5         (e)  Unintended pregnancies lead to higher rates of

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

  7  threaten the economic viability of families.

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

  9  on private employment-related insurance to cover their medical

10  expenses.

11         (g)  Most private insurers cover prescription drugs,

12  but many exclude coverage for prescription contraceptives.

13         (h)  The lack of contraceptive coverage in health

14  insurance policies places many effective forms of

15  contraceptives beyond the financial reach of many women,

16  leading to unintended pregnancies.

17         (2)  Therefore, the Legislature determines that

18  enactment of this bill constitutes an important state

19  interest.

20         Section 3.  Option for plans and policyholders of plans

21  provided by religious health plan sponsors.

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

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

24  religious health plan sponsor may provide a health plan that

25  does not provide benefits for prescription oral contraceptives

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

27  religious corporation, association, or society referred to in

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

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

30  individual health care service plan contract or a group health

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

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

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

  3  religious organization that is not organized for private

  4  profit, if the provision of prescription oral contraceptives

  5  under such sections is inconsistent with the religious beliefs

  6  of the organization. 

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

  8  construed as authorizing the exclusion of coverage under a

  9  health plan of prescription oral contraceptives necessary to

10  preserve the life or health of the patient.

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

12  "religious health plan sponsor" means a health plan sponsor

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

14  the Employee Retirement Income Security Act of 1974.

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

16  coverage for chemically induced abortions.

17         Section 4.  Section 627.64061, Florida Statutes, is

18  created to read:

19         627.64061  Coverage for prescription

20  contraceptives.--Any health insurance policy that provides

21  coverage for outpatient prescription drugs shall cover

22  prescription oral contraceptives approved by the federal Food

23  and Drug Administration and prescribed by a practitioner

24  authorized by state licensure to prescribe such medication.

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

26  the same contract terms, including copayments and deductibles,

27  as any other prescription drug.

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

29  627.6515, Florida Statutes, is amended to read:

30         627.6515  Out-of-state groups.--

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

  2  insurance policy issued or delivered outside this state under

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

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

  5  627.419, 627.6574, 627.65741, 627.6575, 627.6579, 627.6612,

  6  627.66121, 627.66122, 627.6613, 627.667, 627.6675, 627.6691,

  7  and 627.66911.

  8         Section 6.  Section 627.65741, Florida Statutes, is

  9  created to read:

10         627.65741  Coverage for prescription

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

12  insurance policy that provides coverage for outpatient

13  prescription drugs shall cover prescription oral

14  contraceptives approved by the federal Food and Drug

15  Administration and prescribed by a practitioner authorized by

16  state licensure to prescribe such medication.  Coverage must

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

18  contract terms, including copayments and deductibles, as any

19  other prescription drug.

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

21  627.6699, Florida Statutes, is amended to read:

22         627.6699  Employee Health Care Access Act.--

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

24  PLANS.--

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

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

27  a standard health benefit plan and a basic health benefit plan

28  that meets the criteria set forth in this section.

29         2.  For purposes of this subsection, the terms

30  "standard health benefit plan" and "basic health benefit plan"

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  1  mean policies or contracts that a small employer carrier

  2  offers to eligible small employers that contain:

  3         a.  An exclusion for services that are not medically

  4  necessary or that are not covered preventive health services;

  5  and

  6         b.  A procedure for preauthorization by the small

  7  employer carrier, or its designees.

  8         3.  A small employer carrier may include the following

  9  managed care provisions in the policy or contract to control

10  costs:

11         a.  A preferred provider arrangement or exclusive

12  provider organization or any combination thereof, in which a

13  small employer carrier enters into a written agreement with

14  the provider to provide services at specified levels of

15  reimbursement or to provide reimbursement to specified

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

17  small employer carrier must contain a provision under which

18  the parties agree that the insured individual or covered

19  member has no obligation to make payment for any medical

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

21  medically necessary.  A carrier may use preferred provider

22  arrangements or exclusive provider arrangements to the same

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

24  small employers.

25         b.  A procedure for utilization review by the small

26  employer carrier or its designees.

27

28  This subparagraph does not prohibit a small employer carrier

29  from including in its policy or contract additional managed

30  care and cost containment provisions, subject to the approval

31  of the department, which have potential for controlling costs

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

  2  insureds or subscribers.  The carrier may use such provisions

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

  4  not issued to small employers.

  5         4.  The standard health benefit plan shall include:

  6         a.  Coverage for inpatient hospitalization;

  7         b.  Coverage for outpatient services;

  8         c.  Coverage for newborn children pursuant to s.

  9  627.6575;

10         d.  Coverage for child care supervision services

11  pursuant to s. 627.6579;

12         e.  Coverage for adopted children upon placement in the

13  residence pursuant to s. 627.6578;

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

15         g.  Coverage for handicapped children pursuant to s.

16  627.6615;

17         h.  Emergency or urgent care out of the geographic

18  service area; and

19         i.  Coverage for services provided by a hospice

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

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

22  treating a covered illness.

23         5.  The standard health benefit plan and the basic

24  health benefit plan may include a schedule of benefit

25  limitations for specified services and procedures.  If the

26  committee develops such a schedule of benefits limitation for

27  the standard health benefit plan or the basic health benefit

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

29  the employer an option for increasing the benefit schedule

30  amounts by 4 percent annually.

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

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

  3  health benefit plan shall place additional restrictions on the

  4  benefits and utilization and may also impose additional cost

  5  containment measures.

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

  7  627.65741, 627.6612, 627.66121, 627.66122, 627.6616, 627.6618,

  8  627.668, and 627.66911 apply to the standard health benefit

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

10  notwithstanding said provisions, the plans may specify limits

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

12  reasonable and do not discriminate against any type of

13  provider.

14         8.  Each small employer carrier that provides for

15  inpatient and outpatient services by allopathic hospitals may

16  provide as an option of the insured similar inpatient and

17  outpatient services by hospitals accredited by the American

18  Osteopathic Association when such services are available and

19  the osteopathic hospital agrees to provide the service.

20         Section 8.  Subsection (39) is added to section 641.31,

21  Florida Statutes, to read:

22         641.31  Health maintenance contracts.--

23         (39)  Health maintenance contracts that provide

24  coverage for outpatient prescription drugs shall cover

25  prescription oral contraceptives approved by the federal Food

26  and Drug Administration and prescribed by a practitioner

27  authorized by state licensure to prescribe such medication

28  when such practitioner is under the organization's direct

29  employ or under contract or other arrangement with the

30  organization to provide health care services to subscribers.

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

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

  2  prescription medication.

  3         Section 9.  This act shall take effect October 1, 2000.

  4

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  6                          SENATE SUMMARY

  7    Creates the Equity in Prescription Insurance and
      Contraceptive Coverage Act. Provides legislative findings
  8    and intent. Provides that a health maintenance contract,
      a health insurance policy, and any group, franchise,
  9    accident, or health insurance policy that provides
      coverage for outpatient prescription drugs must cover
10    prescription oral contraceptives. Authorizes a religious
      health plan sponsor to provide a health plan that does
11    not provide benefits for prescription oral contraceptives
      contrary to its beliefs.
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