CODING: Words stricken are deletions; words underlined are additions.
HOUSE AMENDMENT
hbd-032 Bill No. HB 687
Amendment No. (for drafter's use only)
CHAMBER ACTION
Senate House
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5 ORIGINAL STAMP BELOW
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11 Representative(s) Farkas offered the following:
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13 Amendment (with title amendment)
14 On page 1, line 16,
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16 insert:
17 Section 1. Subsection (1) of section 408.7056, Florida
18 Statutes, is amended to read:
19 408.7056 Statewide Provider and Subscriber Assistance
20 Program.--
21 (1) As used in this section, the term:
22 (a) "Agency" means the Agency for Health Care
23 Administration.
24 (b) "Department" means the Department of Insurance.
25 (c) "Grievance procedure" means an established set of
26 rules that specify a process for appeal of an organizational
27 decision.
28 (d) "Health care provider" or "provider" means a
29 state-licensed or state-authorized facility, a facility
30 principally supported by a local government or by funds from a
31 charitable organization that holds a current exemption from
1
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HOUSE AMENDMENT
hbd-032 Bill No. HB 687
Amendment No. (for drafter's use only)
1 federal income tax under s. 501(c)(3) of the Internal Revenue
2 Code, a licensed practitioner, a county health department
3 established under part I of chapter 154, a prescribed
4 pediatric extended care center defined in s. 400.902, a
5 federally supported primary care program such as a migrant
6 health center or a community health center authorized under s.
7 329 or s. 330 of the United States Public Health Services Act
8 that delivers health care services to individuals, or a
9 community facility that receives funds from the state under
10 the Community Alcohol, Drug Abuse, and Mental Health Services
11 Act and provides mental health services to individuals.
12 (e)(a) "Managed care entity" means a health
13 maintenance organization or a prepaid health clinic certified
14 under chapter 641, a prepaid health plan authorized under s.
15 409.912, or an exclusive provider organization certified under
16 s. 627.6472.
17 (f)(b) "Panel" means a statewide provider and
18 subscriber assistance panel selected as provided in subsection
19 (11).
20 Section 2. Section 627.654, Florida Statutes, is
21 amended to read:
22 627.654 Labor union, and association, and small
23 employer health alliance groups.--
24 (1)(a) A group of individuals may be insured under a
25 policy issued to an association, including a labor union,
26 which association has a constitution and bylaws and not less
27 than 25 individual members and which has been organized and
28 has been maintained in good faith for a period of 1 year for
29 purposes other than that of obtaining insurance, or to the
30 trustees of a fund established by such an association, which
31 association or trustees shall be deemed the policyholder,
2
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HOUSE AMENDMENT
hbd-032 Bill No. HB 687
Amendment No. (for drafter's use only)
1 insuring at least 15 individual members of the association for
2 the benefit of persons other than the officers of the
3 association, the association or trustees.
4 (b) A small employer, as defined in s. 627.6699 and
5 including the employer's eligible employees and the spouses
6 and dependents of such employees, may be insured under a
7 policy issued to a small employer health alliance by a carrier
8 as defined in s. 627.6699. A small employer health alliance
9 must be organized as a not-for-profit corporation under
10 chapter 617. Notwithstanding any other law, if a small
11 employer member of an alliance loses eligibility to purchase
12 health care through the alliance solely because the business
13 of the small employer member expands to more than 50 and fewer
14 than 75 eligible employees, the small employer member may, at
15 its next renewal date, purchase coverage through the alliance
16 for not more than 1 additional year. A small employer health
17 alliance shall establish conditions of participation in the
18 alliance by a small employer, including, but not limited to:
19 1. Assurance that the small employer is not formed for
20 the purpose of securing health benefit coverage.
21 2. Assurance that the employees of a small employer
22 have not been added for the purpose of securing health benefit
23 coverage.
24 (2) No such policy of insurance as defined in
25 subsection (1) may be issued to any such association or
26 alliance, unless all individual members of such association,
27 or all small employer members of an alliance, or all of any
28 class or classes thereof, are declared eligible and acceptable
29 to the insurer at the time of issuance of the policy.
30 (3) Any such policy issued under paragraph (1)(a) may
31 insure the spouse or dependent children with or without the
3
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HOUSE AMENDMENT
hbd-032 Bill No. HB 687
Amendment No. (for drafter's use only)
1 member being insured.
2 (4) A single master policy issued to an association,
3 labor union, or small employer health alliance may include
4 more than one health plan from the same insurer or affiliated
5 insurer group as alternatives for an employer, employee, or
6 member to select.
7 Section 3. Paragraph (f) of subsection (2), paragraph
8 (b) of subsection (4), and subsection (6) of section 627.6571,
9 Florida Statutes, are amended to read:
10 627.6571 Guaranteed renewability of coverage.--
11 (2) An insurer may nonrenew or discontinue a group
12 health insurance policy based only on one or more of the
13 following conditions:
14 (f) In the case of health insurance coverage that is
15 made available only through one or more bona fide associations
16 as defined in subsection (5) or through one or more small
17 employer health alliances as described in s. 627.654(1)(b),
18 the membership of an employer in the association or in the
19 small employer health alliance, on the basis of which the
20 coverage is provided, ceases, but only if such coverage is
21 terminated under this paragraph uniformly without regard to
22 any health-status-related factor that relates to any covered
23 individuals.
24 (4) At the time of coverage renewal, an insurer may
25 modify the health insurance coverage for a product offered:
26 (b) In the small-group market if, for coverage that is
27 available in such market other than only through one or more
28 bona fide associations as defined in subsection (5) or through
29 one or more small employer health alliances as described in s.
30 627.654(1)(b), such modification is consistent with s.
31 627.6699 and effective on a uniform basis among group health
4
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HOUSE AMENDMENT
hbd-032 Bill No. HB 687
Amendment No. (for drafter's use only)
1 plans with that product.
2 (6) In applying this section in the case of health
3 insurance coverage that is made available by an insurer in the
4 small-group market or large-group market to employers only
5 through one or more associations or through one or more small
6 employer health alliances as described in s. 627.654(1)(b), a
7 reference to "policyholder" is deemed, with respect to
8 coverage provided to an employer member of the association, to
9 include a reference to such employer.
10 Section 4. Paragraph (h) of subsection (5), paragraph
11 (b) of subsection (6), and paragraph (a) of subsection (12) of
12 section 627.6699, Florida Statutes, are amended to read:
13 627.6699 Employee Health Care Access Act.--
14 (5) AVAILABILITY OF COVERAGE.--
15 (h) All health benefit plans issued under this section
16 must comply with the following conditions:
17 1. For employers who have fewer than two employees, a
18 late enrollee may be excluded from coverage for no longer than
19 24 months if he or she was not covered by creditable coverage
20 continually to a date not more than 63 days before the
21 effective date of his or her new coverage.
22 2. Any requirement used by a small employer carrier in
23 determining whether to provide coverage to a small employer
24 group, including requirements for minimum participation of
25 eligible employees and minimum employer contributions, must be
26 applied uniformly among all small employer groups having the
27 same number of eligible employees applying for coverage or
28 receiving coverage from the small employer carrier, except
29 that a small employer carrier that participates in,
30 administers, or issues health benefits pursuant to s. 381.0406
31 which do not include a preexisting condition exclusion may
5
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HOUSE AMENDMENT
hbd-032 Bill No. HB 687
Amendment No. (for drafter's use only)
1 require as a condition of offering such benefits that the
2 employer has had no health insurance coverage for its
3 employees for a period of at least 6 months. A small employer
4 carrier may vary application of minimum participation
5 requirements and minimum employer contribution requirements
6 only by the size of the small employer group.
7 3. In applying minimum participation requirements with
8 respect to a small employer, a small employer carrier shall
9 not consider as an eligible employee employees or dependents
10 who have qualifying existing coverage in an employer-based
11 group insurance plan or an ERISA qualified self-insurance plan
12 in determining whether the applicable percentage of
13 participation is met. However, a small employer carrier may
14 count eligible employees and dependents who have coverage
15 under another health plan that is sponsored by that employer
16 except if such plan is offered pursuant to s. 408.706.
17 4. A small employer carrier shall not increase any
18 requirement for minimum employee participation or any
19 requirement for minimum employer contribution applicable to a
20 small employer at any time after the small employer has been
21 accepted for coverage, unless the employer size has changed,
22 in which case the small employer carrier may apply the
23 requirements that are applicable to the new group size.
24 5. If a small employer carrier offers coverage to a
25 small employer, it must offer coverage to all the small
26 employer's eligible employees and their dependents. A small
27 employer carrier may not offer coverage limited to certain
28 persons in a group or to part of a group, except with respect
29 to late enrollees.
30 6. A small employer carrier may not modify any health
31 benefit plan issued to a small employer with respect to a
6
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HOUSE AMENDMENT
hbd-032 Bill No. HB 687
Amendment No. (for drafter's use only)
1 small employer or any eligible employee or dependent through
2 riders, endorsements, or otherwise to restrict or exclude
3 coverage for certain diseases or medical conditions otherwise
4 covered by the health benefit plan.
5 7. An initial enrollment period of at least 30 days
6 must be provided. An annual 30-day open enrollment period
7 must be offered to each small employer's eligible employees
8 and their dependents. A small employer carrier must provide
9 special enrollment periods as required by s. 627.65615.
10 (6) RESTRICTIONS RELATING TO PREMIUM RATES.--
11 (b) For all small employer health benefit plans that
12 are subject to this section and are issued by small employer
13 carriers on or after January 1, 1994, premium rates for health
14 benefit plans subject to this section are subject to the
15 following:
16 1. Small employer carriers must use a modified
17 community rating methodology in which the premium for each
18 small employer must be determined solely on the basis of the
19 eligible employee's and eligible dependent's gender, age,
20 family composition, tobacco use, or geographic area as
21 determined under paragraph (5)(j).
22 2. Rating factors related to age, gender, family
23 composition, tobacco use, or geographic location may be
24 developed by each carrier to reflect the carrier's experience.
25 The factors used by carriers are subject to department review
26 and approval.
27 3. Small employer carriers may not modify the rate for
28 a small employer for 12 months from the initial issue date or
29 renewal date, unless the composition of the group changes or
30 benefits are changed. However, a small employer carrier may
31 modify the rate one time prior to 12 months after the initial
7
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HOUSE AMENDMENT
hbd-032 Bill No. HB 687
Amendment No. (for drafter's use only)
1 issue date for a small employer who enrolls under a previously
2 issued group policy that has a common anniversary date for all
3 employers covered under the policy if:
4 a. The carrier discloses to the employer in a clear
5 and conspicuous manner the date of the first renewal and the
6 fact that the premium may increase on or after that date.
7 b. The insurer demonstrates to the department that
8 efficiencies in administration are achieved and reflected in
9 the rates charged to small employers covered under the policy.
10 4. A carrier may issue a group health insurance policy
11 to a small employer health alliance or other group association
12 with rates that reflect a premium credit for expense savings
13 attributable to administrative activities being performed by
14 the alliance or group association if such expense savings are
15 specifically documented in the insurer's rate filing and are
16 approved by the department. Any such credit may not be based
17 on different morbidity assumptions or on any other factor
18 related to the health status or claims experience of any
19 person covered under the policy. Nothing in this subparagraph
20 exempts an alliance or group association from licensure for
21 any activities that require licensure under the Insurance
22 Code. A carrier issuing a group health insurance policy to a
23 small employer health alliance or other group association
24 shall allow any properly licensed and appointed agent of that
25 carrier to market and sell the small employer health alliance
26 or other group association policy. Such agent shall be paid
27 the usual and customary commission paid to any agent selling
28 the policy. Carriers participating in the alliance program, in
29 accordance with ss. 408.70-408.706, may apply a different
30 community rate to business written in that program.
31 (12) STANDARD, BASIC, AND LIMITED HEALTH BENEFIT
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HOUSE AMENDMENT
hbd-032 Bill No. HB 687
Amendment No. (for drafter's use only)
1 PLANS.--
2 (a)1. By May 15, 1993, the commissioner shall appoint
3 a health benefit plan committee composed of four
4 representatives of carriers which shall include at least two
5 representatives of HMOs, at least one of which is a staff
6 model HMO, two representatives of agents, four representatives
7 of small employers, and one employee of a small employer. The
8 carrier members shall be selected from a list of individuals
9 recommended by the board. The commissioner may require the
10 board to submit additional recommendations of individuals for
11 appointment. As alliances are established under s. 408.702,
12 each alliance shall also appoint an additional member to the
13 committee.
14 2. The committee shall develop changes to the form and
15 level of coverages for the standard health benefit plan and
16 the basic health benefit plan, and shall submit the forms, and
17 levels of coverages to the department by September 30, 1993.
18 The department must approve such forms and levels of coverages
19 by November 30, 1993, and may return the submissions to the
20 committee for modification on a schedule that allows the
21 department to grant final approval by November 30, 1993.
22 3. The plans shall comply with all of the requirements
23 of this subsection.
24 4. The plans must be filed with and approved by the
25 department prior to issuance or delivery by any small employer
26 carrier.
27 5. After approval of the revised health benefit plans,
28 if the department determines that modifications to a plan
29 might be appropriate, the commissioner shall appoint a new
30 health benefit plan committee in the manner provided in
31 subparagraph 1. to submit recommended modifications to the
9
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HOUSE AMENDMENT
hbd-032 Bill No. HB 687
Amendment No. (for drafter's use only)
1 department for approval.
2 Section 5. Subsection (1) of section 240.2995, Florida
3 Statutes, is amended to read:
4 240.2995 University health services support
5 organizations.--
6 (1) Each state university is authorized to establish
7 university health services support organizations which shall
8 have the ability to enter into, for the benefit of the
9 university academic health sciences center, arrangements with
10 other entities as providers for accountable health
11 partnerships, as defined in s. 408.701, and providers in other
12 integrated health care systems or similar entities. To the
13 extent required by law or rule, university health services
14 support organizations shall become licensed as insurance
15 companies, pursuant to chapter 624, or be certified as health
16 maintenance organizations, pursuant to chapter 641.
17 University health services support organizations shall have
18 sole responsibility for the acts, debts, liabilities, and
19 obligations of the organization. In no case shall the state
20 or university have any responsibility for such acts, debts,
21 liabilities, and obligations incurred or assumed by university
22 health services support organizations.
23 Section 6. Paragraph (a) of subsection (2) of section
24 240.2996, Florida Statutes, is amended to read:
25 240.2996 University health services support
26 organization; confidentiality of information.--
27 (2) The following university health services support
28 organization's records and information are confidential and
29 exempt from the provisions of s. 119.07(1) and s. 24(a), Art.
30 I of the State Constitution:
31 (a) Contracts for managed care arrangements, as
10
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HOUSE AMENDMENT
hbd-032 Bill No. HB 687
Amendment No. (for drafter's use only)
1 managed care is defined in s. 408.701, under which the
2 university health services support organization provides
3 health care services, including preferred provider
4 organization contracts, health maintenance organization
5 contracts, alliance network arrangements, and exclusive
6 provider organization contracts, and any documents directly
7 relating to the negotiation, performance, and implementation
8 of any such contracts for managed care arrangements or
9 alliance network arrangements. As used in this paragraph, the
10 term "managed care" means systems or techniques generally used
11 by third-party payors or their agents to affect access to and
12 control payment for health care services. Managed-care
13 techniques most often include one or more of the following:
14 prior, concurrent, and retrospective review of the medical
15 necessity and appropriateness of services or site of services;
16 contracts with selected health care providers; financial
17 incentives or disincentives related to the use of specific
18 providers, services, or service sites; controlled access to
19 and coordination of services by a case manager; and payor
20 efforts to identify treatment alternatives and modify benefit
21 restrictions for high-cost patient care.
22
23 The exemptions in this subsection are subject to the Open
24 Government Sunset Review Act of 1995 in accordance with s.
25 119.15 and shall stand repealed on October 2, 2001, unless
26 reviewed and saved from repeal through reenactment by the
27 Legislature.
28 Section 7. Paragraph (b) of subsection (8) of section
29 240.512, Florida Statutes, is amended to read:
30 240.512 H. Lee Moffitt Cancer Center and Research
31 Institute.--There is established the H. Lee Moffitt Cancer
11
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HOUSE AMENDMENT
hbd-032 Bill No. HB 687
Amendment No. (for drafter's use only)
1 Center and Research Institute at the University of South
2 Florida.
3 (8)
4 (b) Proprietary confidential business information is
5 confidential and exempt from the provisions of s. 119.07(1)
6 and s. 24(a), Art. I of the State Constitution. However, the
7 Auditor General and Board of Regents, pursuant to their
8 oversight and auditing functions, must be given access to all
9 proprietary confidential business information upon request and
10 without subpoena and must maintain the confidentiality of
11 information so received. As used in this paragraph, the term
12 "proprietary confidential business information" means
13 information, regardless of its form or characteristics, which
14 is owned or controlled by the not-for-profit corporation or
15 its subsidiaries; is intended to be and is treated by the
16 not-for-profit corporation or its subsidiaries as private and
17 the disclosure of which would harm the business operations of
18 the not-for-profit corporation or its subsidiaries; has not
19 been intentionally disclosed by the corporation or its
20 subsidiaries unless pursuant to law, an order of a court or
21 administrative body, a legislative proceeding pursuant to s.
22 5, Art. III of the State Constitution, or a private agreement
23 that provides that the information may be released to the
24 public; and which is information concerning:
25 1. Internal auditing controls and reports of internal
26 auditors;
27 2. Matters reasonably encompassed in privileged
28 attorney-client communications;
29 3. Contracts for managed-care arrangements, as managed
30 care is defined in s. 408.701, including preferred provider
31 organization contracts, health maintenance organization
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HOUSE AMENDMENT
hbd-032 Bill No. HB 687
Amendment No. (for drafter's use only)
1 contracts, and exclusive provider organization contracts, and
2 any documents directly relating to the negotiation,
3 performance, and implementation of any such contracts for
4 managed-care arrangements;
5 4. Bids or other contractual data, banking records,
6 and credit agreements the disclosure of which would impair the
7 efforts of the not-for-profit corporation or its subsidiaries
8 to contract for goods or services on favorable terms;
9 5. Information relating to private contractual data,
10 the disclosure of which would impair the competitive interest
11 of the provider of the information;
12 6. Corporate officer and employee personnel
13 information;
14 7. Information relating to the proceedings and records
15 of credentialing panels and committees and of the governing
16 board of the not-for-profit corporation or its subsidiaries
17 relating to credentialing;
18 8. Minutes of meetings of the governing board of the
19 not-for-profit corporation and its subsidiaries, except
20 minutes of meetings open to the public pursuant to subsection
21 (9);
22 9. Information that reveals plans for marketing
23 services that the corporation or its subsidiaries reasonably
24 expect to be provided by competitors;
25 10. Trade secrets as defined in s. 688.002, including
26 reimbursement methodologies or rates; or
27 11. The identity of donors or prospective donors of
28 property who wish to remain anonymous or any information
29 identifying such donors or prospective donors. The anonymity
30 of these donors or prospective donors must be maintained in
31 the auditor's report.
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HOUSE AMENDMENT
hbd-032 Bill No. HB 687
Amendment No. (for drafter's use only)
1
2 As used in this paragraph, the term "managed care" means
3 systems or techniques generally used by third-party payors or
4 their agents to affect access to and control payment for
5 health care services. Managed-care techniques most often
6 include one or more of the following: prior, concurrent, and
7 retrospective review of the medical necessity and
8 appropriateness of services or site of services; contracts
9 with selected health care providers; financial incentives or
10 disincentives related to the use of specific providers,
11 services, or service sites; controlled access to and
12 coordination of services by a case manager; and payor efforts
13 to identify treatment alternatives and modify benefit
14 restrictions for high-cost patient care.
15 Section 8. Subsection (14) of section 381.0406,
16 Florida Statutes, is amended to read:
17 381.0406 Rural health networks.--
18 (14) NETWORK FINANCING.--Networks may use all sources
19 of public and private funds to support network activities.
20 Nothing in this section prohibits networks from becoming
21 managed care providers, or accountable health partnerships,
22 provided they meet the requirements for an accountable health
23 partnership as specified in s. 408.706.
24 Section 9. Paragraph (a) of subsection (2) of section
25 395.3035, Florida Statutes, is amended to read:
26 395.3035 Confidentiality of hospital records and
27 meetings.--
28 (2) The following records and information of any
29 hospital that is subject to chapter 119 and s. 24(a), Art. I
30 of the State Constitution are confidential and exempt from the
31 provisions of s. 119.07(1) and s. 24(a), Art. I of the State
14
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HOUSE AMENDMENT
hbd-032 Bill No. HB 687
Amendment No. (for drafter's use only)
1 Constitution:
2 (a) Contracts for managed care arrangements, as
3 managed care is defined in s. 408.701, under which the public
4 hospital provides health care services, including preferred
5 provider organization contracts, health maintenance
6 organization contracts, exclusive provider organization
7 contracts, and alliance network arrangements, and any
8 documents directly relating to the negotiation, performance,
9 and implementation of any such contracts for managed care or
10 alliance network arrangements. As used in this paragraph, the
11 term "managed care" means systems or techniques generally used
12 by third-party payors or their agents to affect access to and
13 control payment for health care services. Managed-care
14 techniques most often include one or more of the following:
15 prior, concurrent, and retrospective review of the medical
16 necessity and appropriateness of services or site of services;
17 contracts with selected health care providers; financial
18 incentives or disincentives related to the use of specific
19 providers, services, or service sites; controlled access to
20 and coordination of services by a case manager; and payor
21 efforts to identify treatment alternatives and modify benefit
22 restrictions for high-cost patient care.
23 Section 10. Paragraph (b) of subsection (1) of section
24 627.4301, Florida Statutes, is amended to read:
25 627.4301 Genetic information for insurance purposes.--
26 (1) DEFINITIONS.--As used in this section, the term:
27 (b) "Health insurer" means an authorized insurer
28 offering health insurance as defined in s. 624.603, a
29 self-insured plan as defined in s. 624.031, a
30 multiple-employer welfare arrangement as defined in s.
31 624.437, a prepaid limited health service organization as
15
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HOUSE AMENDMENT
hbd-032 Bill No. HB 687
Amendment No. (for drafter's use only)
1 defined in s. 636.003, a health maintenance organization as
2 defined in s. 641.19, a prepaid health clinic as defined in s.
3 641.402, a fraternal benefit society as defined in s. 632.601,
4 an accountable health partnership as defined in s. 408.701, or
5 any health care arrangement whereby risk is assumed.
6 Section 11. Subsection (3) of section 408.70, and
7 sections 408.701, 408.702, 408.703, 408.704, 408.7041,
8 408.7042, 408.7045, 408.7055, and 408.706, Florida Statutes,
9 are repealed.
10
11
12 ================ T I T L E A M E N D M E N T ===============
13 And the title is amended as follows:
14 On page 1, lines 2 and 3,
15 remove from the title of the bill: all of said lines,
16
17 and insert in lieu thereof:
18 An act relating to small employer health
19 insurance; amending s. 408.7056, F.S.;
20 providing additional definitions for the
21 Statewide Provider and Subscriber Assistance
22 Program; amending s. 627.654, F.S.; providing
23 for insuring small employers under policies
24 issued to small employer health alliances;
25 providing requirements for participation;
26 providing limitations; providing for insuring
27 spouses and dependent children; allowing a
28 single master policy to include alternative
29 health plans; amending s. 627.6571, F.S.;
30 including small employer health alliances
31 within policy nonrenewal or discontinuance,
16
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HOUSE AMENDMENT
hbd-032 Bill No. HB 687
Amendment No. (for drafter's use only)
1 coverage modification, and application
2 provisions; amending s. 627.6699, F.S.;
3 revising restrictions relating to premium rates
4 to authorize small employer carriers to modify
5 rates under certain circumstances and to
6 authorize carriers to issue group health
7 insurance policies to small employer health
8 alliances under certain circumstances;
9 requiring carriers issuing a policy to an
10 alliance to allow appointed agents to sell such
11 a policy; amending ss. 240.2995, 240.2996,
12 240.512, 381.0406, 395.3035, and 627.4301,
13 F.S.; conforming cross references; defining the
14 term "managed care"; repealing ss. 408.70(3),
15 408.701, 408.702, 408.703, 408.704, 408.7041,
16 408.7042, 408.7045, 408.7055, and 408.706,
17 F.S., relating to community health purchasing
18 alliances; amending s. 627.6699, F.S.;
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