House Bill 2343
CODING: Words stricken are deletions; words underlined are additions.
Florida House of Representatives - 2000 HB 2343
By Representative R. Diaz de la Portilla
1 A bill to be entitled
2 An act relating to health maintenance
3 organizations; amending s. 641.305, F.S.;
4 providing for translating contracts,
5 certificates, and member handbooks into other
6 languages under certain circumstances; amending
7 s. 641.31, F.S.; specifying application of
8 certain language translation requirements to
9 contracts, certificates, member handbooks, and
10 grievance procedures; amending s. 641.31015,
11 F.S.; requiring certain disclosures to comply
12 with language translation requirements;
13 amending s. 641.3102, F.S.; prohibiting
14 discrimination based upon certain factors;
15 amending s. 641.3903, F.S.; making failure to
16 provide translations an unfair and deceptive
17 practice; providing an effective date.
18
19 Be It Enacted by the Legislature of the State of Florida:
20
21 Section 1. Paragraph (b) of subsection (1) of section
22 641.305, Florida Statutes, is amended to read:
23 641.305 Language used in contracts and advertisements;
24 translations.--
25 (1)
26 (b) If the negotiations by a health maintenance
27 organization with a member leading up to the effectuation of a
28 health maintenance contract are conducted in a language other
29 than English, or if requested by the subscriber, an individual
30 member of a subscriber group, or a potential enrollee, the
31 health maintenance organization shall supply to the member or
1
CODING: Words stricken are deletions; words underlined are additions.
Florida House of Representatives - 2000 HB 2343
737-106-00
1 potential enrollee a written translation of the contract,
2 certificate, and member handbook, as applicable, which
3 translation accurately reflects the substance of the contract
4 and is in the language used to negotiate the contract or as
5 otherwise requested by the subscriber or potential enrollee.
6 The written translation shall be affixed to and shall become a
7 part of the contract or form. Any such translation shall be
8 furnished to the department as part of the filing of the
9 health maintenance contract form. No translation of a health
10 maintenance contract form shall be approved by the department
11 unless the translation accurately reflects the substance of
12 the health maintenance contract form in translation.
13 Section 2. Subsection (1), paragraph (a) of subsection
14 (3), and subsections (4) and (5) of section 641.31, Florida
15 Statutes, are amended to read:
16 641.31 Health maintenance contracts.--
17 (1) Any entity issued a certificate and otherwise in
18 compliance with this part may enter into contracts in this
19 state to provide an agreed-upon set of comprehensive health
20 care services to subscribers in exchange for a prepaid per
21 capita sum or a prepaid aggregate fixed sum. Each subscriber
22 shall be given a copy of the applicable health maintenance
23 contract, certificate, or member handbook. Whichever document
24 is provided to a subscriber shall contain all of the
25 provisions and disclosures required by this section and shall
26 comply with s. 641.305.
27 (3)(a) If a health maintenance organization desires to
28 amend any contract with its subscribers or any certificate or
29 member handbook, or desires to change any basic health
30 maintenance contract, certificate, grievance procedure, or
31 member handbook form, or application form where written
2
CODING: Words stricken are deletions; words underlined are additions.
Florida House of Representatives - 2000 HB 2343
737-106-00
1 application is required and is to be made a part of the
2 contract, or printed amendment, addendum, rider, or
3 endorsement form or form of renewal certificate, it may do so,
4 upon filing with the department the proposed change or
5 amendment. A copy of such proposed change shall be furnished
6 to the subscriber in the same language as the contract,
7 certificate, and member handbook, as required by s. 641.305.
8 Any proposed change shall be effective immediately, subject to
9 disapproval by the department. Following receipt of notice of
10 such disapproval or withdrawal of approval, no health
11 maintenance organization shall issue or use any form
12 disapproved by the department or as to which the department
13 has withdrawn approval.
14 (4) Every health maintenance contract, certificate, or
15 member handbook shall clearly state all of the services to
16 which a subscriber is entitled under the contract and must
17 include a clear and understandable statement of any
18 limitations on the services or kinds of services to be
19 provided, including any copayment feature or schedule of
20 benefits required by the contract or by any insurer or entity
21 which is underwriting any of the services offered by the
22 health maintenance organization. The contract, certificate,
23 or member handbook shall also state where and in what manner
24 the comprehensive health care services may be obtained and
25 shall comply with s. 641.305.
26 (5) Every subscriber shall receive a clear and
27 understandable description of the method of the health
28 maintenance organization for resolving subscriber grievances,
29 and the method shall be set forth in the contract,
30 certificate, and member handbook. The organization shall also
31 furnish, at the time of initial enrollment and when necessary
3
CODING: Words stricken are deletions; words underlined are additions.
Florida House of Representatives - 2000 HB 2343
737-106-00
1 due to substantial changes to the grievance process a separate
2 and additional communication prepared or approved by the
3 department notifying the contract holder of a group contract
4 or subscriber of an individual contract of their rights and
5 responsibilities under the grievance process. Such description
6 of the grievance process and any separate and additional
7 communication as provided in this section shall be furnished
8 to the subscriber in the same language as the contract,
9 certificate, and member handbook, as required by s. 641.305.
10 Section 3. Section 641.31015, Florida Statutes, is
11 amended to read:
12 641.31015 Health maintenance organization or exclusive
13 provider organization; disclosure of terms and conditions of
14 plan.--Each health maintenance organization or exclusive
15 provider organization shall provide prospective enrollees with
16 written information about the terms and conditions of the plan
17 in accordance with ss. s. 641.31(4) and 641.305 so that the
18 prospective enrollees can make informed decisions about
19 accepting a managed-care system of health care delivery;
20 however, information about where, in what manner, and from
21 whom the comprehensive health care services or specific health
22 care services can be obtained need be disclosed only upon
23 request by the prospective enrollee. All marketing materials
24 distributed by the health maintenance organization or
25 exclusive provider organization must contain a notice in
26 boldfaced type which states that the information required
27 under this section is available to the prospective enrollee
28 upon request.
29 Section 4. Section 641.3102, Florida Statutes, is
30 amended to read:
31
4
CODING: Words stricken are deletions; words underlined are additions.
Florida House of Representatives - 2000 HB 2343
737-106-00
1 641.3102 Restrictions upon expulsion or refusal to
2 issue or renew contract.--
3 (1) A health maintenance organization that offers
4 individual health maintenance contracts in this state may not
5 decline to offer coverage to an eligible individual as
6 required in s. 627.6487. A health maintenance organization
7 shall not expel or refuse to renew the coverage of, or refuse
8 to enroll, any individual on the basis of race, color, creed,
9 ethnicity, national origin, sex, marital status, place of
10 residence, lawful occupation, mental or physical disability,
11 genetic information, or source of payment of the individual.
12 A health maintenance organization shall not expel or refuse to
13 renew the coverage of any individual on the basis of the age,
14 health status, health care needs, or prospective costs of
15 health care services of the individual.
16 (2) A health maintenance organization shall not expel
17 or refuse to renew the coverage of, or refuse to enroll, any
18 individual member of a subscriber group on the basis of the
19 race, color, creed, marital status, sex, ethnicity, religion,
20 place of residence, lawful occupation, mental or physical
21 disability, genetic information, source of payment, or
22 national origin of the subscriber or individual. A health
23 maintenance organization shall not expel or refuse to renew
24 the coverage of any individual member of a subscriber group on
25 the basis of the age, health status, health care needs, or
26 prospective costs of health care services of the subscriber or
27 individual. Nothing in this section shall prohibit a health
28 maintenance organization from requiring that, as a condition
29 of continued eligibility for membership, dependents of a
30 subscriber, upon reaching a specified age, convert to a
31 converted contract or that individuals entitled to have
5
CODING: Words stricken are deletions; words underlined are additions.
Florida House of Representatives - 2000 HB 2343
737-106-00
1 payments for health costs made under Title XVIII of the United
2 States Social Security Act, as amended, be issued a health
3 maintenance contract for Medicare beneficiaries so long as the
4 health maintenance organization is authorized to issue health
5 maintenance contracts for Medicare beneficiaries.
6 Section 5. Subsection (15) is added to section
7 641.3903, Florida Statutes, to read:
8 641.3903 Unfair methods of competition and unfair or
9 deceptive acts or practices defined.--The following are
10 defined as unfair methods of competition and unfair or
11 deceptive acts or practices:
12 (15) FAILURE TO PROVIDE TRANSLATIONS TO NON-ENGLISH
13 SPEAKING PERSONS.--Failure to provide translations of health
14 maintenance organization contracts, certificates, member
15 handbooks, and other information as required by this part.
16 Section 6. This act shall take effect July 1, 2000.
17
18 *****************************************
19 HOUSE SUMMARY
20
Provides for translating health maintenance organization
21 contracts, certificates, and member handbooks into
languages other than English, applies language
22 translation requirements to grievance procedures and
required disclosures, prohibits discrimination in
23 contract coverage and renewals based upon stated factors,
and makes failure to provide translations an unfair and
24 deceptive practice. See bill for details.
25
26
27
28
29
30
31
6