House Bill hb1439
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Florida House of Representatives - 2001 HB 1439
By Representative Berfield
1 A bill to be entitled
2 An act relating to health insurance; amending
3 s. 627.410, F.S.; requiring certain group
4 certificates for health insurance coverage to
5 be subject to the requirements for individual
6 health insurance policies; exempting group
7 health insurance policies insuring groups of a
8 certain size from rate filing requirements;
9 providing alternative rate filing requirements
10 for insurers with less than a specified number
11 of nationwide policyholders or members;
12 amending s. 627.411, F.S.; revising the grounds
13 for the disapproval of insurance policy forms;
14 providing that a health insurance policy form
15 may be disapproved if it results in certain
16 rate increases; specifying allowable new
17 business rates and renewal rates if rate
18 increases exceed certain levels; authorizing
19 the Department of Insurance to determine
20 medical trend for purposes of approving rate
21 filings; amending s. 627.6487, F.S.; revising
22 the types of policies that individual health
23 insurers must offer to persons eligible for
24 guaranteed individual health insurance
25 coverage; prohibiting individual health
26 insurers from applying discriminatory
27 underwriting or rating practices to eligible
28 individuals; amending s. 627.6515, F.S.;
29 requiring that coverage issued to a state
30 resident under certain group health insurance
31 policies issued outside the state be subject to
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1 the requirements for individual health
2 insurance policies; amending s. 627.6699, F.S.;
3 revising definitions used in the Employee
4 Health Care Access Act; allowing carriers to
5 separate the experience of small employer
6 groups with fewer than two employees; revising
7 the rating factors that may be used by small
8 employer carriers; amending s. 627.6741, F.S.;
9 requiring that insurers offer Medicare
10 supplement policies to certain individuals;
11 amending s. 627.9408, F.S.; authorizing the
12 department to adopt by rule certain provisions
13 of the Long-Term Care Insurance Model
14 Regulation, as adopted by the National
15 Association of Insurance Commissioners;
16 amending s. 641.31, F.S.; exempting contracts
17 of group health maintenance organizations
18 covering a specified number of persons from the
19 requirements of filing with the department;
20 specifying the standards for department
21 approval and disapproval of a change in rates
22 by a health maintenance organization; providing
23 alternative rate filing requirements for
24 organizations with less than a specified number
25 of subscribers; providing an effective date.
26
27 Be It Enacted by the Legislature of the State of Florida:
28
29 Section 1. Subsection (1) and paragraph (a) of
30 subsection (6) of section 627.410, Florida Statutes, are
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1 amended, and paragraph (f) is added to subsection (7) of that
2 section, to read:
3 627.410 Filing, approval of forms.--
4 (1) No basic insurance policy or annuity contract
5 form, or application form where written application is
6 required and is to be made a part of the policy or contract,
7 or group certificates issued under a master contract delivered
8 in this state, or printed rider or endorsement form or form of
9 renewal certificate, shall be delivered or issued for delivery
10 in this state, unless the form has been filed with the
11 department at its offices in Tallahassee by or in behalf of
12 the insurer which proposes to use such form and has been
13 approved by the department. This provision does not apply to
14 surety bonds or to policies, riders, endorsements, or forms of
15 unique character which are designed for and used with relation
16 to insurance upon a particular subject (other than as to
17 health insurance), or which relate to the manner of
18 distribution of benefits or to the reservation of rights and
19 benefits under life or health insurance policies and are used
20 at the request of the individual policyholder, contract
21 holder, or certificateholder. As to group insurance policies
22 effectuated and delivered outside this state but covering
23 persons resident in this state, the group certificates to be
24 delivered or issued for delivery in this state shall be filed
25 with the department for information purposes only, except that
26 group certificates for health insurance coverage, as described
27 in s. 627.6561(5)(a)2., which require individual underwriting
28 to determine coverage eligibility or premium rates to be
29 charged, shall be considered policies issued on an individual
30 basis and are subject to and must comply with the Florida
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1 Insurance Code in the same manner as individual health
2 insurance policies issued in this state.
3 (6)(a) An insurer shall not deliver or issue for
4 delivery or renew in this state any health insurance policy
5 form until it has filed with the department a copy of every
6 applicable rating manual, rating schedule, change in rating
7 manual, and change in rating schedule; if rating manuals and
8 rating schedules are not applicable, the insurer must file
9 with the department applicable premium rates and any change in
10 applicable premium rates. This paragraph does not apply to
11 group health insurance policies insuring groups of 51 or more
12 persons, except for Medicare supplement insurance, long-term
13 care insurance, and any coverage under which the increase in
14 claim costs over the lifetime of the contract due to advancing
15 age or duration is prefunded in the premium.
16 (7)
17 (f) Insurers with fewer than 1,000 nationwide
18 policyholders or insured group members or subscribers covered
19 under any form or pooled group of forms with health insurance
20 coverage, as described in s. 627.6561(5)(a)2., excluding
21 Medicare supplement insurance coverage under part VIII, at the
22 time of a rate filing made pursuant to subparagraph (b)1., may
23 file for an annual rate increase limited to medical trend as
24 adopted by the department pursuant to s. 627.411(4). The
25 filing is in lieu of the actuarial memorandum required for a
26 rate filing prescribed by paragraph (6)(b). The filing must
27 include forms adopted by the department and a certification by
28 an officer of the company that the filing includes all similar
29 forms.
30 Section 2. Section 627.411, Florida Statutes, is
31 amended to read:
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1 627.411 Grounds for disapproval.--
2 (1) The department shall disapprove any form filed
3 under s. 627.410, or withdraw any previous approval thereof,
4 only if the form:
5 (a) Is in any respect in violation of, or does not
6 comply with, this code.
7 (b) Contains or incorporates by reference, where such
8 incorporation is otherwise permissible, any inconsistent,
9 ambiguous, or misleading clauses, or exceptions and conditions
10 which deceptively affect the risk purported to be assumed in
11 the general coverage of the contract.
12 (c) Has any title, heading, or other indication of its
13 provisions which is misleading.
14 (d) Is printed or otherwise reproduced in such manner
15 as to render any material provision of the form substantially
16 illegible.
17 (e) Is for health insurance, and:
18 1. Provides benefits that which are unreasonable in
19 relation to the premium charged;,
20 2. Contains provisions that which are unfair or
21 inequitable or contrary to the public policy of this state or
22 that which encourage misrepresentation;, or
23 3. Contains provisions that which apply rating
24 practices that which result in premium escalations that are
25 not viable for the policyholder market or result in unfair
26 discrimination pursuant to s. 626.9541(1)(g)2.; in sales
27 practices.
28 4. Results in an actuarially justified rate increase
29 that includes the insurer reducing the portion of the premium
30 used to pay claims from the loss-ratio standard certified in
31 the last actuarial certification filed by the insurer, which
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1 rate increase is in excess of the actuarially justified rate
2 increase without such loss-ratio change, by an amount
3 exceeding the greater of 50 percent of annual medical trend or
4 5 percent;
5 5. Results in an actuarially justified rate increase
6 that includes the insurer changing established rate
7 relationships between insureds or types of coverage, which
8 rate increase is in excess of the actuarially justified rate
9 increase without such relationship change, to any insured by
10 an amount exceeding the greater of 50 percent of annual
11 medical trend or 5 percent;
12 6. Results in an actuarially justified rate increase
13 that is in excess of the greater of 150 percent of annual
14 medical trend or 10 percent attributed to the insurer not
15 complying with the annual filing requirements of s. 627.410(7)
16 or department rule adopted under s. 641.31; or
17 7. Results in an actuarially justified rate increase
18 that is in excess of the greater of 150 percent of annual
19 medical trend or 10 percent on a form or block of pooled forms
20 in which no form is currently available for sale.
21 (f) Excludes coverage for human immunodeficiency virus
22 infection or acquired immune deficiency syndrome or contains
23 limitations in the benefits payable, or in the terms or
24 conditions of such contract, for human immunodeficiency virus
25 infection or acquired immune deficiency syndrome which are
26 different than those which apply to any other sickness or
27 medical condition.
28 (2) In determining whether the benefits are reasonable
29 in relation to the premium charged, the department, in
30 accordance with reasonable actuarial techniques, shall
31 consider:
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1 (a) Past loss experience and prospective loss
2 experience within and without this state.
3 (b) Allocation of expenses.
4 (c) Risk and contingency margins, along with
5 justification of such margins.
6 (d) Acquisition costs.
7 (3) If the renewal rate increase to existing insureds
8 at the time of the rate filing would exceed the indicated
9 levels based on the conditions in subparagraph (1)(e)4.,
10 subparagraph (1)(e)5., or subparagraph (1)(e)6., the insurer
11 may file for approval of a higher new business rate schedule
12 for new insureds and a rate increase of the amount that is
13 actuarially justified by the aggregate data without such
14 condition, plus the greater of 50 percent of annual medical
15 trend or 5 percent for existing insureds. Future annual rate
16 increases for the existing insureds at the time of the
17 exercise of this provision is limited to the greater of 150
18 percent of the rate increase approved for new insureds, the
19 greater of 150 percent of medical trend, or 10 percent, until
20 the rate schedules converge. The application of this
21 subsection is not a violation of s. 627.410(6)(d).
22 (4) If a rate filing changes the established rate
23 relationship between insureds, the aggregate effect of such
24 change shall be revenue neutral. The change to the new
25 relationship shall be phased in over a period not to exceed 3
26 years, as approved by the department.
27 (5) In determining medical trend for application of
28 subparagraphs (1)(e)4., 5., 6., and 7., the department shall
29 semiannually determine medical trend for each health care
30 market, using reasonable actuarial techniques and standards.
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1 The trend must be adopted by the department by rule and
2 determined as follows:
3 (a) Trend must be determined separately for medical
4 expense; preferred provider organization; Medicare supplement;
5 health maintenance organization; and other coverage for
6 individual, small group, and large group, where applicable.
7 (b) The department shall survey insurers and health
8 maintenance organizations currently issuing products and
9 representing at least an 80-percent market share based on
10 premiums earned in the state for the most recent calendar year
11 for each of the categories specified in paragraph (a).
12 (c) Trend must be computed as the average annual
13 medical trend approved for the carriers surveyed, giving
14 appropriate weight to each carrier's statewide market share of
15 earned premiums.
16 (d) The annual trend is the annual change in claims
17 cost per unit of exposure. Trend includes the combined effect
18 of medical provider price changes, new medical procedures, and
19 technology and cost shifting.
20 Section 3. Subsections (4) and (8) of section
21 627.6487, Florida Statutes, are amended to read:
22 627.6487 Guaranteed availability of individual health
23 insurance coverage to eligible individuals.--
24 (4)(a) The health insurance issuer may elect to limit
25 the coverage offered under subsection (1) if the issuer offers
26 at least two different policy forms of health insurance
27 coverage, both of which:
28 1. Are designed for, made generally available to,
29 actively marketed to, and enroll both eligible and other
30 individuals by the issuer; and
31 2. Meet the requirement of paragraph (b).
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2 For purposes of this subsection, policy forms that have
3 different cost-sharing arrangements or different riders are
4 considered to be different policy forms.
5 (b) The requirement of this subsection is met for
6 health insurance coverage policy forms offered by an issuer in
7 the individual market if the issuer offers the basic and
8 standard health benefit plans as established pursuant to s.
9 627.6699(12). policy forms for individual health insurance
10 coverage with the largest, and next to largest, premium volume
11 of all such policy forms offered by the issuer in this state
12 or applicable marketing or service area, as prescribed in
13 rules adopted by the department, in the individual market in
14 the period involved. To the greatest extent possible, such
15 rules must be consistent with regulations adopted by the
16 United States Department of Health and Human Services.
17 (8) This section does not:
18 (a) Restrict the issuer from applying the same
19 nondiscriminatory underwriting and rating practices that are
20 applied by the issuer to other individuals applying for
21 coverage amount of the premium rates that an issuer may charge
22 an individual for individual health insurance coverage; or
23 (b) Prevent a health insurance issuer that offers
24 individual health insurance coverage from establishing premium
25 discounts or rebates or modifying otherwise applicable
26 copayments or deductibles in return for adherence to programs
27 of health promotion and disease prevention.
28 Section 4. Subsection (9) is added to section
29 627.6515, Florida Statutes, to read:
30 627.6515 Out-of-state groups.--
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1 (9) Notwithstanding any other provision of this
2 section, any group health insurance policy or group
3 certificate for health insurance, as described in s.
4 627.6561(5)(a)2., which is issued to a resident of this state
5 and requires individual underwriting to determine coverage
6 eligibility or premium rates to be charged shall be considered
7 a policy issued on an individual basis and is subject to and
8 must comply with the Florida Insurance Code in the same manner
9 as individual insurance policies issued in this state.
10 Section 5. Paragraphs (i) and (n) of subsection (3)
11 and paragraph (b) of subsection (6) of section 627.6699,
12 Florida Statutes, are amended to read:
13 627.6699 Employee Health Care Access Act.--
14 (3) DEFINITIONS.--As used in this section, the term:
15 (i) "Established geographic area" means the county or
16 counties, or any portion of a county or counties, within which
17 the carrier provides or arranges for health care services to
18 be available to its insureds, members, or subscribers.
19 (n) "Modified community rating" means a method used to
20 develop carrier premiums which spreads financial risk across a
21 large population; allows the use of separate rating factors
22 for age, gender, family composition, tobacco usage, and
23 geographic area as determined under paragraph (5)(j); and
24 allows adjustments for: claims experience, health status, or
25 duration of coverage as permitted under subparagraph (6)(b)5.;
26 and administrative and acquisition expenses as permitted under
27 subparagraph (6)(b)5. A carrier may separate the experience of
28 small employer groups with less than two eligible employees
29 from the experience of small employer groups with two through
30 50 eligible employees.
31 (6) RESTRICTIONS RELATING TO PREMIUM RATES.--
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1 (b) For all small employer health benefit plans that
2 are subject to this section and are issued by small employer
3 carriers on or after January 1, 1994, premium rates for health
4 benefit plans subject to this section are subject to the
5 following:
6 1. Small employer carriers must use a modified
7 community rating methodology in which the premium for each
8 small employer must be determined solely on the basis of the
9 eligible employee's and eligible dependent's gender, age,
10 family composition, tobacco use, or geographic area as
11 determined under paragraph (5)(j) and in which the premium may
12 be adjusted as permitted by subparagraphs 6. 5. and 7. 6.
13 2. Rating factors related to age, gender, family
14 composition, tobacco use, or geographic location may be
15 developed by each carrier to reflect the carrier's experience.
16 The factors used by carriers are subject to department review
17 and approval.
18 3. If the modified community rate is determined from
19 two experience pools as authorized by paragraph (5)(n), the
20 rate to be charged to small employer groups of less than two
21 eligible employees may not exceed 150 percent of the rate
22 determined for groups of two through 50 eligible employees;
23 however, the carrier may charge excess losses of the
24 less-than-two-eligible-employee experience pool to the
25 experience pool of the two through 50 eligible employees so
26 that all losses are allocated and the 150-percent rate limit
27 on the less-than-two-eligible-employee experience pool is
28 maintained.
29 4.3. Small employer carriers may not modify the rate
30 for a small employer for 12 months from the initial issue date
31 or renewal date, unless the composition of the group changes
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1 or benefits are changed. However, a small employer carrier may
2 modify the rate one time prior to 12 months after the initial
3 issue date for a small employer who enrolls under a previously
4 issued group policy that has a common anniversary date for all
5 employers covered under the policy if:
6 a. The carrier discloses to the employer in a clear
7 and conspicuous manner the date of the first renewal and the
8 fact that the premium may increase on or after that date.
9 b. The insurer demonstrates to the department that
10 efficiencies in administration are achieved and reflected in
11 the rates charged to small employers covered under the policy.
12 5.4. A carrier may issue a group health insurance
13 policy to a small employer health alliance or other group
14 association with rates that reflect a premium credit for
15 expense savings attributable to administrative activities
16 being performed by the alliance or group association if such
17 expense savings are specifically documented in the insurer's
18 rate filing and are approved by the department. Any such
19 credit may not be based on different morbidity assumptions or
20 on any other factor related to the health status or claims
21 experience of any person covered under the policy. Nothing in
22 this subparagraph exempts an alliance or group association
23 from licensure for any activities that require licensure under
24 the insurance code. A carrier issuing a group health insurance
25 policy to a small employer health alliance or other group
26 association shall allow any properly licensed and appointed
27 agent of that carrier to market and sell the small employer
28 health alliance or other group association policy. Such agent
29 shall be paid the usual and customary commission paid to any
30 agent selling the policy.
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1 6.5. Any adjustments in rates for claims experience,
2 health status, or duration of coverage may not be charged to
3 individual employees or dependents. For a small employer's
4 policy, such adjustments may not result in a rate for the
5 small employer which deviates more than 15 percent from the
6 carrier's approved rate. Any such adjustment must be applied
7 uniformly to the rates charged for all employees and
8 dependents of the small employer. A small employer carrier may
9 make an adjustment to a small employer's renewal premium, not
10 to exceed 10 percent annually, due to the claims experience,
11 health status, or duration of coverage of the employees or
12 dependents of the small employer. Semiannually, small group
13 carriers shall report information on forms adopted by rule by
14 the department, to enable the department to monitor the
15 relationship of aggregate adjusted premiums actually charged
16 policyholders by each carrier to the premiums that would have
17 been charged by application of the carrier's approved modified
18 community rates. If the aggregate resulting from the
19 application of such adjustment exceeds the premium that would
20 have been charged by application of the approved modified
21 community rate by 5 percent for the current reporting period,
22 the carrier shall limit the application of such adjustments
23 only to minus adjustments beginning not more than 60 days
24 after the report is sent to the department. For any subsequent
25 reporting period, if the total aggregate adjusted premium
26 actually charged does not exceed the premium that would have
27 been charged by application of the approved modified community
28 rate by 5 percent, the carrier may apply both plus and minus
29 adjustments. A small employer carrier may provide a credit to
30 a small employer's premium based on administrative and
31 acquisition expense differences resulting from the size of the
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1 group. Group size administrative and acquisition expense
2 factors may be developed by each carrier to reflect the
3 carrier's experience and are subject to department review and
4 approval.
5 7.6. A small employer carrier rating methodology may
6 include separate rating categories for one dependent child,
7 for two dependent children, and for three or more dependent
8 children for family coverage of employees having a spouse and
9 dependent children or employees having dependent children
10 only. A small employer carrier may have fewer, but not
11 greater, numbers of categories for dependent children than
12 those specified in this subparagraph.
13 8.7. Small employer carriers may not use a composite
14 rating methodology to rate a small employer with fewer than 10
15 employees. For the purposes of this subparagraph, a "composite
16 rating methodology" means a rating methodology that averages
17 the impact of the rating factors for age and gender in the
18 premiums charged to all of the employees of a small employer.
19 Section 6. Subsection (1) of section 627.6741, Florida
20 Statutes, is amended to read:
21 627.6741 Issuance, cancellation, nonrenewal, and
22 replacement.--
23 (1) An insurer issuing Medicare supplement policies in
24 this state shall offer the opportunity of enrolling in a
25 Medicare supplement policy, without conditioning the issuance
26 or effectiveness of the policy on, and without discriminating
27 in the price of the policy based on, the medical or health
28 status or receipt of health care by the individual:
29 (a) To any individual who is 65 years of age or older,
30 or under 65 years of age and eligible for Medicare by reason
31 of disability, and who resides in this state, upon the request
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1 of the individual during the 6-month period beginning with the
2 first month in which the individual has attained 65 years of
3 age and is enrolled in Medicare part B, or the first month in
4 which the individual is eligible for Medicare by reason of
5 disability and is enrolled in Medicare part B; or
6 (b) To any individual who is 65 years of age or older,
7 or under 65 years of age and eligible for Medicare by reason
8 of disability, and is enrolled in Medicare part B, who resides
9 in this state, upon the request of the individual during the
10 2-month period following termination of coverage under a group
11 health insurance policy.
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13 A Medicare supplement policy issued to an individual under
14 paragraph (a) or paragraph (b) may not exclude benefits based
15 on a preexisting condition if the individual has a continuous
16 period of creditable coverage, as defined in s. 627.6561(5),
17 of at least 6 months as of the date of application for
18 coverage. Paragraphs (a) and (b) do not apply to end-stage
19 renal disease beneficiaries before they attain 65 years of
20 age. For those individuals otherwise eligible under paragraph
21 (a) or paragraph (b) who first enrolled in Medicare part B
22 before July 1, 2001, the 6-month period shall begin on July 1,
23 2001. A Medicare supplemental policy issued to an individual
24 under paragraph (a) or paragraph (b) who is less than 65 years
25 of age and who is eligible for Medicare by reason of
26 disability shall be issued at the premium rate for persons 65
27 years of age.
28 Section 7. Section 627.9408, Florida Statutes, is
29 amended to read:
30 627.9408 Rules.--
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1 (1) The department may has authority to adopt rules
2 pursuant to ss. 120.536(1) and 120.54 to administer implement
3 the provisions of this part.
4 (2) The department may adopt by rule the provisions of
5 the Long-Term Care Insurance Model Regulation adopted by the
6 National Association of Insurance Commissioners in the second
7 quarter of the year 2000 which are not in conflict with the
8 Florida Insurance Code.
9 Section 8. Paragraphs (b) and (d) of subsection (3) of
10 section 641.31, Florida Statutes, are amended, and paragraph
11 (f) is added to that subsection, to read:
12 641.31 Health maintenance contracts.--
13 (3)
14 (b) Any change in the rate is subject to paragraph (d)
15 and requires at least 30 days' advance written notice to the
16 subscriber. In the case of a group member, there may be a
17 contractual agreement with the health maintenance organization
18 to have the employer provide the required notice to the
19 individual members of the group. This paragraph does not apply
20 to a group contract covering 51 or more persons unless the
21 rate is for any coverage under which the increase in claim
22 costs over the lifetime of the contract due to advancing age
23 or duration is prefunded in the premium.
24 (d) Any change in rates charged for the contract must
25 be filed with the department not less than 30 days in advance
26 of the effective date. At the expiration of such 30 days, the
27 rate filing shall be deemed approved unless prior to such time
28 the filing has been affirmatively approved or disapproved by
29 order of the department pursuant to s. 627.411. The approval
30 of the filing by the department constitutes a waiver of any
31 unexpired portion of such waiting period. The department may
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1 extend by not more than an additional 15 days the period
2 within which it may so affirmatively approve or disapprove any
3 such filing, by giving notice of such extension before
4 expiration of the initial 30-day period. At the expiration of
5 any such period as so extended, and in the absence of such
6 prior affirmative approval or disapproval, any such filing
7 shall be deemed approved.
8 (f) A health maintenance organization with fewer than
9 1,000 covered subscribers under all individual or group
10 contracts, at the time of a rate filing, may file for an
11 annual rate increase limited to annual medical trend, as
12 adopted by the department. The filing is in lieu of the
13 actuarial memorandum otherwise required for the rate filing.
14 The filing must include forms adopted by the department and a
15 certification by an officer of the company that the filing
16 includes all similar forms.
17 Section 9. This act shall take effect July 1, 2001.
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20 SENATE SUMMARY
21 Revises various provisions of the Florida Insurance Code
relating to health insurance. Revises requirements for
22 group insurance policies issued outside the state.
Authorizes certain insurers to file for annual rate
23 increases based on medical trend. Provides requirements
for the Department of Insurance in determining medical
24 trend. Revises provisions of the Employee Health Care
Access Act. Authorizes carriers to revise the factors
25 used to establish premium rates. Requires insurers to
issue Medicare supplement policies to persons under 65
26 years of age who are eligible for Medicare by reason of
disability. Authorizes certain health maintenance
27 organizations to file for rate increases based on medical
trend. (See bill for details.)
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