HOUSE AMENDMENT
Bill No. HB 1439, 1st Eng.
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) Rich, Gannon, Lerner, Joyner, Sobel, Cusack,
12 Bendross-Mindingall, Romeo, Ausley and Detert offered the
13 following:
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15 Amendment (with title amendment)
16 On page 3, line 2,
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18 insert:
19 Section 1. Section 627.64191, Florida Statutes, is
20 created to read:
21 627.64191 Compliance with decisions of the United
22 States Equal Employment Opportunity Commission.--The benefits,
23 exclusions, and limitations of individual health insurance
24 policies must comply with and be consistent with the decisions
25 of the United States Equal Employment Opportunity Commission
26 which hold that the exclusion or limitation of a specific
27 benefit violates Title VII of the Civil Rights Act of 1964, as
28 amended by the Pregnancy Discrimination Act of 1978. The
29 department must determine such compliance in approving form
30 filings under ss. 627.410 and 627.411, based on decisions
31 rendered by the United States Equal Employment Opportunity
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HOUSE AMENDMENT
Bill No. HB 1439, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 Commission before January 1, 2001.
2 Section 2. Section 627.65741, Florida Statutes, is
3 created to read:
4 627.65741 Compliance with decisions of the United
5 States Equal Employment Opportunity Commission.--The benefits,
6 exclusions, and limitations of group health insurance policies
7 must comply with and be consistent with the decisions of the
8 United States Equal Employment Opportunity Commission which
9 hold that the exclusion or limitation of a specific benefit
10 violates Title VII of the Civil Rights Act of 1964, as amended
11 by the Pregnancy Discrimination Act of 1978. The department
12 must determine such compliance in approving form filings under
13 ss. 627.410 and 627.411, based on decisions rendered by the
14 United States Equal Employment Opportunity Commission before
15 January 1, 2001.
16 Section 3. Paragraph (b) of subsection (12) of section
17 627.6699, Florida Statutes, is amended to 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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HOUSE AMENDMENT
Bill No. HB 1439, 1st Eng.
Amendment No. ___ (for drafter's use only)
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.
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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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HOUSE AMENDMENT
Bill No. HB 1439, 1st Eng.
Amendment No. ___ (for drafter's use only)
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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HOUSE AMENDMENT
Bill No. HB 1439, 1st Eng.
Amendment No. ___ (for drafter's use only)
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 4. Subsection (40) is added to section 641.31,
15 Florida Statutes, to read:
16 641.31 Health maintenance contracts.--
17 (40) The benefits, exclusions, and limitations of
18 organization contracts must comply with and be consistent with
19 the decisions of the United States Equal Employment
20 Opportunity Commission which hold that the exclusion or
21 limitation of a specific benefit violates Title VII of the
22 Civil Rights Act of 1964, as amended by the Pregnancy
23 Discrimination Act of 1978. The department must determine such
24 compliance in approving form filings under this section, based
25 on decisions rendered by the United States Equal Employment
26 Opportunity Commission before January 1, 2001.
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29 ================ T I T L E A M E N D M E N T ===============
30 And the title is amended as follows:
31 On page 1, line 2, after the semicolon
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HOUSE AMENDMENT
Bill No. HB 1439, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 insert:
2 creating ss. 627.64191, 627.65741, F.S.;
3 requiring individual and group health insurance
4 policies to comply with decisions of the United
5 States Equal Employment Opportunity Commission
6 with respect to exclusions that violate Title
7 VII of the Civil Rights Act, as amended;
8 requiring the Department of Insurance to make
9 such determination when approving policy forms;
10 amending ss. 627.6699, 641.31, F.S.; requiring
11 standard and basic health benefit plans issued
12 by small employer carriers and health
13 maintenance contracts to comply with decisions
14 of the United States Equal Employment
15 Opportunity Commission with respect to
16 exclusions that violate Title VII of the Civil
17 Rights Act, as amended; requiring the
18 Department of Insurance to make such
19 determination when approving policy forms;
20 providing for application;
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