House Bill hb1439e1
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HB 1439, First Engrossed
1 A bill to be entitled
2 An act relating to health insurance; amending
3 s. 627.410, F.S.; exempting group health
4 insurance policies insuring groups of a certain
5 size from rate filing requirements; providing
6 alternative rate filing requirements for
7 insurers with less than a specified number of
8 nationwide policyholders or members; amending
9 s. 627.411, F.S.; revising the grounds for the
10 disapproval of insurance policy forms;
11 providing that a health insurance policy form
12 may be disapproved if it results in certain
13 rate increases; specifying allowable new
14 business rates and renewal rates if rate
15 increases exceed certain levels; authorizing
16 the Department of Insurance to determine
17 medical trend for purposes of approving rate
18 filings; amending s. 627.6515, F.S.; providing
19 additional experience requirements and
20 limitations for out-of-state groups; providing
21 construction; amending s. 627.6699, F.S.;
22 revising a definition; allowing carriers to
23 separate the experience of small employer
24 groups with fewer than two employees; revising
25 the rating factors that may be used by small
26 employer carriers; amending s. 627.9408, F.S.;
27 authorizing the department to adopt by rule
28 certain provisions of the Long-Term Care
29 Insurance Model Regulation, as adopted by the
30 National Association of Insurance
31 Commissioners; amending s. 641.31, F.S.;
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1 exempting contracts of group health maintenance
2 organizations covering a specified number of
3 persons from the requirements of filing with
4 the department; providing alternative rate
5 filing requirements for organizations with less
6 than a specified number of subscribers;
7 amending s. 641.3155, F.S.; specifying
8 nonapplication of certain provisions to certain
9 claims; providing for certain health flex
10 plans; providing legislative intent; providing
11 definitions; providing for a pilot program for
12 health flex plans for certain uninsured
13 persons; providing criteria; exempting approved
14 health flex plans from certain licensing
15 requirements; providing criteria for
16 eligibility to enroll in a health flex plan;
17 requiring health flex plan providers to
18 maintain certain records; providing
19 requirements for denial, nonrenewal, or
20 cancellation of coverage; specifying that
21 coverage under an approved health flex plan is
22 not an entitlement; providing for civil actions
23 against health plan entities by the Agency for
24 Health Care Administration under certain
25 circumstances; providing legislative findings;
26 creating the Workgroup on Out of State Group
27 Policies; providing for membership; providing
28 purposes; requiring recommendations for
29 proposed legislation; providing an effective
30 date.
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HB 1439, First Engrossed
1 Be It Enacted by the Legislature of the State of Florida:
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3 Section 1. Paragraph (a) of subsection (6) of section
4 627.410, Florida Statutes, is amended, and paragraph (f) is
5 added to subsection (7) of said section, to read:
6 627.410 Filing, approval of forms.--
7 (6)(a) An insurer shall not deliver or issue for
8 delivery or renew in this state any health insurance policy
9 form until it has filed with the department a copy of every
10 applicable rating manual, rating schedule, change in rating
11 manual, and change in rating schedule; if rating manuals and
12 rating schedules are not applicable, the insurer must file
13 with the department applicable premium rates and any change in
14 applicable premium rates. This paragraph does not apply to
15 group health insurance policies insuring groups of 51 or more
16 persons, except for Medicare supplement insurance, long-term
17 care insurance, and any coverage under which the increase in
18 claims costs over the lifetime of the contract due to
19 advancing age or duration is prefunded in the premium.
20 (7)
21 (f) Insurers with fewer than 1,000 nationwide
22 policyholders or insured group members or subscribers covered
23 under any form or pooled group of forms with health insurance
24 coverage, as described in s. 627.6561(5)(a)2., excluding
25 Medicare supplement insurance coverage under part VIII, at the
26 time of a rate filing made pursuant to subparagraph (b)1., may
27 file for an annual rate increase limited to medical trend as
28 adopted by the department pursuant to s. 627.411(5). The
29 filing is in lieu of the actuarial memorandum required for a
30 rate filing prescribed by paragraph (6)(b). The filing must
31 include forms adopted by the department and a certification by
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1 an officer of the company that the filing includes all similar
2 forms.
3 Section 2. Section 627.411, Florida Statutes, is
4 amended to read:
5 627.411 Grounds for disapproval.--
6 (1) The department shall disapprove any form filed
7 under s. 627.410, or withdraw any previous approval thereof,
8 only if the form:
9 (a) Is in any respect in violation of, or does not
10 comply with, this code.
11 (b) Contains or incorporates by reference, where such
12 incorporation is otherwise permissible, any inconsistent,
13 ambiguous, or misleading clauses, or exceptions and conditions
14 which deceptively affect the risk purported to be assumed in
15 the general coverage of the contract.
16 (c) Has any title, heading, or other indication of its
17 provisions which is misleading.
18 (d) Is printed or otherwise reproduced in such manner
19 as to render any material provision of the form substantially
20 illegible.
21 (e) Is for health insurance, and:
22 1. Provides benefits that which are unreasonable in
23 relation to the premium charged;,
24 2. Contains provisions that which are unfair or
25 inequitable or contrary to the public policy of this state or
26 that which encourage misrepresentation;, or
27 3. Contains provisions that which apply rating
28 practices that which result in premium escalations that are
29 not viable for the policyholder market or result in unfair
30 discrimination pursuant to s. 626.9541(1)(g)2.; in sales
31 practices.
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1 4. Results in an actuarially justified rate increase
2 that includes the insurer reducing the portion of the premium
3 used to pay claims from the loss-ratio standard certified in
4 the last actuarial certification filed by the insurer, which
5 rate increase is in excess of the actuarially justified rate
6 increase without such loss-ratio change, by an amount
7 exceeding the greater of 50 percent of annual medical trend or
8 5 percent;
9 5. Results in an actuarially justified rate increase
10 that includes the insurer changing established rate
11 relationships between insureds or types of coverage, which
12 rate increase is in excess of the actuarially justified rate
13 increase without such relationship change, to any insured by
14 an amount exceeding the greater of 50 percent of annual
15 medical trend or 5 percent;
16 6. Results in an actuarially justified rate increase
17 that is in excess of the greater of 150 percent of annual
18 medical trend or 10 percent attributed to the insurer not
19 complying with the annual filing requirements of s. 627.410(7)
20 or department rule adopted under s. 641.31; or
21 7. Results in an actuarially justified rate increase
22 that is in excess of the greater of 150 percent of annual
23 medical trend or 10 percent on a form or block of pooled forms
24 in which no form is currently available for sale. This
25 provision does not apply to prestandardized Medicare
26 supplement forms.
27 (f) Excludes coverage for human immunodeficiency virus
28 infection or acquired immune deficiency syndrome or contains
29 limitations in the benefits payable, or in the terms or
30 conditions of such contract, for human immunodeficiency virus
31 infection or acquired immune deficiency syndrome which are
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1 different than those which apply to any other sickness or
2 medical condition.
3 (2) In determining whether the benefits are reasonable
4 in relation to the premium charged, the department, in
5 accordance with reasonable actuarial techniques, shall
6 consider:
7 (a) Past loss experience and prospective loss
8 experience within and without this state.
9 (b) Allocation of expenses.
10 (c) Risk and contingency margins, along with
11 justification of such margins.
12 (d) Acquisition costs.
13 (3) If the renewal rate increase to existing insureds
14 at the time of the rate filing would exceed the indicated
15 levels based on the conditions in subparagraph (1)(e)4.,
16 subparagraph (1)(e)5., or subparagraph (1)(e)6., the insurer
17 may file for approval of a higher new business rate schedule
18 for new insureds and a rate increase of the amount that is
19 actuarially justified by the aggregate data without such
20 condition, plus the greater of 50 percent of annual medical
21 trend or 5 percent for existing insureds. Future annual rate
22 increases for the existing insureds at the time of the
23 exercise of this provision is limited to the greater of 150
24 percent of the rate increase approved for new insureds, the
25 greater of 150 percent of medical trend, or 10 percent, until
26 the rate schedules converge. The application of this
27 subsection is not a violation of s. 627.410(6)(d).
28 (4) If a rate filing changes the established rate
29 relationship between insureds, the aggregate effect of such
30 change shall be revenue neutral. The change to the new
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1 relationship shall be phased in under this subsection over a
2 period not to exceed 3 years, as approved by the department.
3 (5) In determining medical trend for application of
4 subparagraphs (1)(e)4., 5., 6., and 7., the department shall
5 semiannually determine medical trend for each health care
6 market, using reasonable actuarial techniques and standards.
7 The trend must be adopted by the department by rule and
8 determined as follows:
9 (a) Trend must be determined separately for medical
10 expense; preferred provider organization; Medicare supplement;
11 health maintenance organization; and other coverage for
12 individual, small group, and large group, where applicable.
13 (b) The department shall survey insurers and health
14 maintenance organizations currently issuing products and
15 representing at least an 80-percent market share based on
16 premiums earned in the state for the most recent calendar year
17 for each of the categories specified in paragraph (a).
18 (c) Trend must be computed as the average annual
19 medical trend approved for the carriers surveyed, giving
20 appropriate weight to each carrier's statewide market share of
21 earned premiums.
22 (d) The annual trend is the annual change in claims
23 cost per unit of exposure. Trend includes the combined effect
24 of medical provider price changes, new medical procedures, and
25 technology and cost shifting.
26 Section 3. Subsection (9) is added to section
27 627.6515, Florida Statutes, to read:
28 627.6515 Out-of-state groups.--
29 (9) For purposes of this section, any insurer that
30 issues any group health insurance policy or group certificate
31 for health insurance to a resident of this state and requires
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1 individual underwriting to determine coverage eligibility or
2 premium rates to be charged shall combine the experience of
3 all association-based group policies or association-based
4 group certificates which are substantially similar with
5 respect to type and level of benefits and marketing method
6 issued in this state after the policy form has been in force
7 for a period of 5 years to calculate uniform percentage rate
8 increases. For purposes of this section, policy forms that
9 have different cost-sharing arrangements or different riders
10 are considered to be different policy forms. Nothing in this
11 subsection shall be construed to require uniform rates for
12 policies or certificates after their fifth duration, it being
13 the intent and purpose of this law to require uniform
14 percentage rate increases for such policies or certificates.
15 Furthermore, nothing in this subsection shall be construed to
16 eliminate changes in rates by age for attained age policies or
17 certificates. The provisions of this subsection shall apply to
18 policies or certificates issued after July 1, 2001. For
19 purposes of this subsection, a group health policy or group
20 certificate for health insurance means any hospital or medical
21 policy or certificate, hospital or medical service plan
22 contract, or health maintenance organization subscriber
23 contract. The term does not include accident-only, specified
24 disease, individual hospital indemnity, credit, dental-only,
25 vision-only, Medicare supplement, long-term care, or
26 disability income insurance; similar supplemental plans
27 provided under a separate policy, certificate, or contract of
28 insurance, which cannot duplicate coverage under an underlying
29 health plan and are specifically designed to fill gaps in the
30 underlying health plan, coinsurance, or deductibles; coverage
31 issued as a supplement to liability insurance; workers'
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1 compensation or similar insurance; or automobile
2 medical-payment insurance.
3 Section 4. Paragraph (n) of subsection (3) and
4 paragraph (b) of subsection (6) of section 627.6699, Florida
5 Statutes, are amended to read:
6 627.6699 Employee Health Care Access Act.--
7 (3) DEFINITIONS.--As used in this section, the term:
8 (n) "Modified community rating" means a method used to
9 develop carrier premiums which spreads financial risk across a
10 large population; allows the use of separate rating factors
11 for age, gender, family composition, tobacco usage, and
12 geographic area as determined under paragraph (5)(j); and
13 allows adjustments for: claims experience, health status, or
14 duration of coverage as permitted under subparagraph (6)(b)5.;
15 and administrative and acquisition expenses as permitted under
16 subparagraph (6)(b)5. A carrier may separate the experience of
17 small employer groups with less than 2 eligible employees from
18 the experience of small employer groups with 2 through 50
19 eligible employees.
20 (6) RESTRICTIONS RELATING TO PREMIUM RATES.--
21 (b) For all small employer health benefit plans that
22 are subject to this section and are issued by small employer
23 carriers on or after January 1, 1994, premium rates for health
24 benefit plans subject to this section are subject to the
25 following:
26 1. Small employer carriers must use a modified
27 community rating methodology in which the premium for each
28 small employer must be determined solely on the basis of the
29 eligible employee's and eligible dependent's gender, age,
30 family composition, tobacco use, or geographic area as
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1 determined under paragraph (5)(j) and in which the premium may
2 be adjusted as permitted by subparagraphs 6. 5. and 7. 6.
3 2. Rating factors related to age, gender, family
4 composition, tobacco use, or geographic location may be
5 developed by each carrier to reflect the carrier's experience.
6 The factors used by carriers are subject to department review
7 and approval.
8 3. If the modified community rate is determined from
9 two experience pools as authorized by paragraph (3)(n), the
10 rate to be charged to small employer groups of less than 2
11 eligible employees may not exceed 150 percent of the rate
12 determined for groups of 2 through 50 eligible employees;
13 however, the carrier may charge excess losses of the less than
14 2 eligible employee experience pool to the experience pool of
15 the 2 through 50 eligible employees so that all losses are
16 allocated and the 150-percent rate limit on the less than 2
17 eligible employee experience pool is maintained.
18 4.3. Small employer carriers may not modify the rate
19 for a small employer for 12 months from the initial issue date
20 or renewal date, unless the composition of the group changes
21 or benefits are changed. However, a small employer carrier may
22 modify the rate one time prior to 12 months after the initial
23 issue date for a small employer who enrolls under a previously
24 issued group policy that has a common anniversary date for all
25 employers covered under the policy if:
26 a. The carrier discloses to the employer in a clear
27 and conspicuous manner the date of the first renewal and the
28 fact that the premium may increase on or after that date.
29 b. The insurer demonstrates to the department that
30 efficiencies in administration are achieved and reflected in
31 the rates charged to small employers covered under the policy.
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1 5.4. A carrier may issue a group health insurance
2 policy to a small employer health alliance or other group
3 association with rates that reflect a premium credit for
4 expense savings attributable to administrative activities
5 being performed by the alliance or group association if such
6 expense savings are specifically documented in the insurer's
7 rate filing and are approved by the department. Any such
8 credit may not be based on different morbidity assumptions or
9 on any other factor related to the health status or claims
10 experience of any person covered under the policy. Nothing in
11 this subparagraph exempts an alliance or group association
12 from licensure for any activities that require licensure under
13 the insurance code. A carrier issuing a group health insurance
14 policy to a small employer health alliance or other group
15 association shall allow any properly licensed and appointed
16 agent of that carrier to market and sell the small employer
17 health alliance or other group association policy. Such agent
18 shall be paid the usual and customary commission paid to any
19 agent selling the policy.
20 6.5. Any adjustments in rates for claims experience,
21 health status, or duration of coverage may not be charged to
22 individual employees or dependents. For a small employer's
23 policy, such adjustments may not result in a rate for the
24 small employer which deviates more than 15 percent from the
25 carrier's approved rate. Any such adjustment must be applied
26 uniformly to the rates charged for all employees and
27 dependents of the small employer. A small employer carrier may
28 make an adjustment to a small employer's renewal premium, not
29 to exceed 10 percent annually, due to the claims experience,
30 health status, or duration of coverage of the employees or
31 dependents of the small employer. Semiannually, small group
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1 carriers shall report information on forms adopted by rule by
2 the department, to enable the department to monitor the
3 relationship of aggregate adjusted premiums actually charged
4 policyholders by each carrier to the premiums that would have
5 been charged by application of the carrier's approved modified
6 community rates. If the aggregate resulting from the
7 application of such adjustment exceeds the premium that would
8 have been charged by application of the approved modified
9 community rate by 5 percent for the current reporting period,
10 the carrier shall limit the application of such adjustments
11 only to minus adjustments beginning not more than 60 days
12 after the report is sent to the department. For any subsequent
13 reporting period, if the total aggregate adjusted premium
14 actually charged does not exceed the premium that would have
15 been charged by application of the approved modified community
16 rate by 5 percent, the carrier may apply both plus and minus
17 adjustments. A small employer carrier may provide a credit to
18 a small employer's premium based on administrative and
19 acquisition expense differences resulting from the size of the
20 group. Group size administrative and acquisition expense
21 factors may be developed by each carrier to reflect the
22 carrier's experience and are subject to department review and
23 approval.
24 7.6. A small employer carrier rating methodology may
25 include separate rating categories for one dependent child,
26 for two dependent children, and for three or more dependent
27 children for family coverage of employees having a spouse and
28 dependent children or employees having dependent children
29 only. A small employer carrier may have fewer, but not
30 greater, numbers of categories for dependent children than
31 those specified in this subparagraph.
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1 8.7. Small employer carriers may not use a composite
2 rating methodology to rate a small employer with fewer than 10
3 employees. For the purposes of this subparagraph, a "composite
4 rating methodology" means a rating methodology that averages
5 the impact of the rating factors for age and gender in the
6 premiums charged to all of the employees of a small employer.
7 Section 5. Section 627.9408, Florida Statutes, is
8 amended to read:
9 627.9408 Rules.--
10 (1) The department may has authority to adopt rules
11 pursuant to ss. 120.536(1) and 120.54 to administer implement
12 the provisions of this part.
13 (2) The department may adopt by rule the provisions of
14 the Long-Term Care Insurance Model Regulation adopted by the
15 National Association of Insurance Commissioners in the second
16 quarter of the year 2000 which are not in conflict with the
17 Florida Insurance Code.
18 Section 6. Paragraph (b) of subsection (3) of section
19 641.31, Florida Statutes, is amended, and paragraph (f) is
20 added to said subsection, to read:
21 641.31 Health maintenance contracts.--
22 (3)
23 (b) Any change in the rate is subject to paragraph (d)
24 and requires at least 30 days' advance written notice to the
25 subscriber. In the case of a group member, there may be a
26 contractual agreement with the health maintenance organization
27 to have the employer provide the required notice to the
28 individual members of the group. This paragraph does not apply
29 to a group contract covering 51 or more persons unless the
30 rate is for any coverage under which the increase in claim
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1 costs over the lifetime of the contract due to advancing age
2 or duration is prefunded in the premium.
3 (f) A health maintenance organization with fewer than
4 1,000 covered subscribers under all individual or group
5 contracts, at the time of a rate filing, may file for an
6 annual rate increase limited to annual medical trend, as
7 adopted by the department. The filing is in lieu of the
8 actuarial memorandum otherwise required for the rate filing.
9 The filing must include forms adopted by the department and a
10 certification by an officer of the company that the filing
11 includes all similar forms.
12 Section 7. Paragraphs (a) and (b) of subsection (1) of
13 section 641.3155, Florida Statutes, are amended to read:
14 641.3155 Payment of claims.--
15 (1)(a) As used in this section, the term "clean claim"
16 for a noninstitutional provider means a claim submitted on a
17 HCFA 1500 form which has no defect or impropriety, including
18 lack of required substantiating documentation for
19 noncontracted providers and suppliers, or particular
20 circumstances requiring special treatment which prevent timely
21 payment from being made on the claim. A claim may not be
22 considered not clean solely because a health maintenance
23 organization refers the claim to a medical specialist within
24 the health maintenance organization for examination. If
25 additional substantiating documentation, such as the medical
26 record or encounter data, is required from a source outside
27 the health maintenance organization, the claim is considered
28 not clean. This paragraph does not apply to claims which
29 include potential coordination of benefits for third-party
30 liability or subrogation, as evidenced by the information
31 provided on the claim form related to coordination of
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1 benefits. This definition of "clean claim" is repealed on the
2 effective date of rules adopted by the department which define
3 the term "clean claim."
4 (b) Absent a written definition that is agreed upon
5 through contract, the term "clean claim" for an institutional
6 claim is a properly and accurately completed paper or
7 electronic billing instrument that consists of the UB-92 data
8 set or its successor with entries stated as mandatory by the
9 National Uniform Billing Committee. This paragraph does not
10 apply to claims which include potential coordination of
11 benefits for third-party liability or subrogation, as
12 evidenced by the information provided on the claim form
13 related to coordination of benefits.
14 Section 8. Health flex plans.--
15 (1) INTENT.--The Legislature finds that a significant
16 portion of the residents of this state are not able to obtain
17 affordable health insurance coverage. Therefore, it is the
18 intent of the Legislature to expand the availability of health
19 care options for lower income uninsured state residents by
20 encouraging health insurers, health maintenance organizations,
21 health care provider sponsored organizations, local
22 governments, health care districts, or other public or private
23 community-based organizations to develop alternative
24 approaches to traditional health insurance which emphasize
25 coverage for basic and preventive health care services. To
26 the maximum extent possible, such options should be
27 coordinated with existing governmental or community-based
28 health services programs in a manner that is consistent with
29 the objectives and requirements of such programs.
30 (2) DEFINITIONS.--As used in this section:
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1 (a) "Agency" means the Agency for Health Care
2 Administration.
3 (b) "Approved plan" means a health flex plan approved
4 under subsection (3) which guarantees payment by the health
5 plan entity for specified health care services provided to the
6 enrollee.
7 (c) "Enrollee" means an individual who has been
8 determined eligible for and is receiving health benefits under
9 a health flex plan approved under this section.
10 (d) "Health care coverage" means payment for health
11 care services covered as benefits under an approved plan or
12 that otherwise provides, either directly or through
13 arrangements with other persons, covered health care services
14 on a prepaid per-capita basis or on a prepaid aggregate
15 fixed-sum basis.
16 (e) "Health plan entity" means a health insurer,
17 health maintenance organization, health care provider
18 sponsored organization, local government, health care
19 districts, or other public or private community-based
20 organization that develops and implements an approved plan and
21 is responsible for financing and paying all claims by
22 enrollees of the plan.
23 (3) PILOT PROGRAM.--The agency and the Department of
24 Insurance shall jointly approve or disapprove health flex
25 plans which provide health care coverage for eligible
26 participants residing in the three areas of the state having
27 the highest number of uninsured residents as determined by the
28 agency. A plan may limit or exclude benefits otherwise
29 required by law for insurers offering coverage in this state,
30 cap the total amount of claims paid in 1 year per enrollee, or
31 limit the number of enrollees covered. The agency and the
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1 Department of Insurance shall not approve or shall withdraw
2 approval of a plan which:
3 (a) Contains any ambiguous, inconsistent, or
4 misleading provisions, or exceptions or conditions that
5 deceptively affect or limit the benefits purported to be
6 assumed in the general coverage provided by the plan;
7 (b) Provides benefits that are unreasonable in
8 relation to the premium charged, contains provisions that are
9 unfair or inequitable or contrary to the public policy of this
10 state or that encourage misrepresentation, or result in unfair
11 discrimination in sales practices; or
12 (c) Cannot demonstrate that the plan is financially
13 sound and the applicant has the ability to underwrite or
14 finance the benefits provided.
15 (4) LICENSE NOT REQUIRED.--A health flex plan approved
16 under this section shall not be subject to the licensing
17 requirements of the Florida Insurance Code or chapter 641,
18 Florida Statutes, relating to health maintenance
19 organizations, unless expressly made applicable. However, for
20 the purposes of prohibiting unfair trade practices, health
21 flex plans shall be considered insurance subject to the
22 applicable provisions of part IX of chapter 626, Florida
23 Statutes, except as otherwise provided in this section.
24 (5) ELIGIBILITY.--Eligibility to enroll in an approved
25 health flex plan is limited to residents of this state who:
26 (a) Are 64 years of age or younger;
27 (b) Have a family income equal to or less than 200
28 percent of the federal poverty level;
29 (c) Are not covered by a private insurance policy and
30 are not eligible for coverage through a public health
31 insurance program such as Medicare or Medicaid, or other
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1 public health care program, including, but not limited to,
2 Kidcare, and have not been covered at any time during the past
3 6 months; and
4 (d) Have applied for health care benefits through an
5 approved health flex plan and agree to make any payments
6 required for participation, including, but not limited to,
7 periodic payments and payments due at the time health care
8 services are provided.
9 (6) RECORDS.--Every health flex plan provider shall
10 maintain reasonable records of its loss, expense, and claims
11 experience and shall make such records reasonably available to
12 enable the agency and the Department of Insurance to monitor
13 and determine the financial viability of the plan, as
14 necessary.
15 (7) NOTICE.--The denial of coverage by the health plan
16 entity shall be accompanied by the specific reasons for
17 denial, nonrenewal, or cancellation. Notice of nonrenewal or
18 cancellation shall be provided at least 45 days in advance of
19 such nonrenewal or cancellation except that 10 days' written
20 notice shall be given for cancellation due to nonpayment of
21 premiums. If the health plan entity fails to give the
22 required notice, the plan shall remain in effect until notice
23 is appropriately given.
24 (8) NONENTITLEMENT.--Coverage under an approved health
25 flex plan is not an entitlement and no cause of action shall
26 arise against the state, local governmental entity, or other
27 political subdivision of this state or the agency for failure
28 to make coverage available to eligible persons under this
29 section.
30 (9) CIVIL ACTIONS.--In addition to an administrative
31 action initiated under subsection (4), the agency may seek any
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1 remedy provided by law, including, but not limited to, the
2 remedies provided in s. 812.035, Florida Statutes, if the
3 agency finds that a health plan entity has engaged in any act
4 resulting in injury to an enrollee covered by a plan approved
5 under this section.
6 Section 9. The Legislature finds that the
7 affordability and availability of health insurance is one of
8 the most important and complex issues in this state and that
9 coverage issued to a state resident under group health
10 insurance policies issued outside the state is an important
11 factor in meeting the needs of the citizens of this state.
12 The Legislature also finds that it is important to ensure that
13 those policies are adequately regulated in order to maintain
14 the quality of the coverage offered to citizens of this state.
15 Therefore, the Workgroup on Out of State Group Policies is
16 hereby created to study the regulatory environment in which
17 these policies are now offered and recommend any statutory
18 changes that may be necessary to maintain the quality of the
19 insurance offered in this state. There shall be four members
20 from the House of Representatives appointed by the Speaker of
21 the House of Representatives and four members from the Senate
22 appointed by the President of the Senate. The group shall
23 begin its meetings by July 1, 2001, and complete its meetings
24 by November 15, 2001. Recommendations for suggested
25 legislation shall be delivered to the Speaker of the House of
26 Representatives and the President of the Senate by December
27 15, 2001. At its first meeting, the group shall elect a chair
28 from among its members.
29 Section 10. This act shall take effect July 1, 2001.
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CODING: Words stricken are deletions; words underlined are additions.