Senate Bill sb1008
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Florida Senate - 2002 SB 1008
By Senator Peaden
1-856-02
1 A bill to be entitled
2 An act relating to health flex plans; providing
3 legislative findings and intent; defining
4 terms; providing for a pilot program for health
5 flex plans for certain uninsured persons;
6 providing criteria for approval of health flex
7 plans; delineating the responsibilities of the
8 Agency for Health Care Administration and the
9 Department of Insurance; exempting approved
10 health flex plans from certain regulatory
11 requirements; providing criteria for
12 eligibility to enroll in a health flex plan;
13 requiring health flex plan entities to maintain
14 certain records; providing requirements for
15 denial, nonrenewal, or cancellation of
16 coverage; specifying that coverage under an
17 approved health flex plan is not an
18 entitlement; requiring an evaluation and
19 report; providing for expiration; providing an
20 effective date.
21
22 Be It Enacted by the Legislature of the State of Florida:
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24 Section 1. Health flex plans.--
25 (1) INTENT.--The Legislature finds that a significant
26 proportion of the residents of this state are unable to obtain
27 affordable health insurance coverage. Therefore, it is the
28 intent of the Legislature to expand the availability of health
29 care options for low-income uninsured state residents by
30 encouraging health insurers, health maintenance organizations,
31 health care provider-sponsored organizations, local
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Florida Senate - 2002 SB 1008
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1 governments, health care districts, or other public or private
2 community-based organizations to develop alternative
3 approaches to traditional health insurance which emphasize
4 coverage for basic and preventive health care services. To the
5 maximum extent possible, these options should be coordinated
6 with existing governmental or community-based health services
7 programs in a manner that is consistent with the objectives
8 and requirements of such programs.
9 (2) DEFINITIONS.--As used in this section, the term:
10 (a) "Agency" means the Agency for Health Care
11 Administration.
12 (b) "Department" means the Department of Insurance.
13 (c) "Enrollee" means an individual who has been
14 determined to be eligible for and is receiving health care
15 coverage under a health flex plan approved under this section.
16 (d) "Health care coverage" or "health flex plan
17 coverage" means health care services that are covered as
18 benefits under an approved health flex plan or that are
19 otherwise provided, either directly or through arrangements
20 with other persons, via health flex plan health care services
21 on a prepaid per-capita basis or on a prepaid aggregate
22 fixed-sum basis.
23 (e) "Health flex plan" means a health plan approved
24 under subsection (3) which guarantees payment for specified
25 health care coverage provided to the enrollee.
26 (f) "Health flex plan entity" means a health insurer,
27 health maintenance organization, health care
28 provider-sponsored organization, local government, health care
29 district, or other public or private community-based
30 organization that develops and implements an approved health
31 flex plan and is responsible for administering the health flex
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Florida Senate - 2002 SB 1008
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1 plan and paying all claims for health flex plan coverage by
2 enrollees of the health flex plan.
3 (3) PILOT PROGRAM.--The agency and the department
4 shall each approve or disapprove health flex plans that
5 provide health care coverage for eligible participants in the
6 three areas of the state which the agency designates as having
7 the highest number of uninsured persons, as determined by the
8 Florida Health Insurance Study. A health flex plan may limit
9 or exclude benefits otherwise required by law for insurers
10 offering coverage in this state, may cap the total amount of
11 claims paid per year per enrollee, may limit the number of
12 enrollees, or may take any combination of those actions.
13 (a) The agency shall develop guidelines for the review
14 of applications for health flex plans and shall disapprove or
15 withdraw approval of plans that do not meet or no longer meet
16 minimum standards for quality of care and access to care.
17 (b) The department shall develop guidelines for the
18 review of health flex plan applications and shall disapprove
19 or shall withdraw approval of plans that:
20 1. Contain any ambiguous, inconsistent, or misleading
21 provisions or any exceptions or conditions that deceptively
22 affect or limit the benefits purported to be assumed in the
23 general coverage provided by the health flex plan;
24 2. Provide benefits that are unreasonable in relation
25 to the premium charged or contain provisions that are unfair
26 or inequitable or contrary to the public policy of this state,
27 that encourage misrepresentation, or that result in unfair
28 discrimination in sales practices; or
29 3. Cannot demonstrate that the health flex plan is
30 financially sound and that the applicant is able to underwrite
31 or finance the health care coverage provided.
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1 (c) The agency and the department may adopt rules as
2 needed to implement this section.
3 (4) LICENSE NOT REQUIRED.--Neither the licensing
4 requirements of the Florida Insurance Code nor chapter 641,
5 Florida Statutes, relating to health maintenance
6 organizations, is applicable to a health flex plan approved
7 under this section, unless expressly made applicable. However,
8 for the purpose of prohibiting unfair trade practices, health
9 flex plans are considered to be insurance subject to the
10 applicable provisions of part IX of chapter 626, Florida
11 Statutes, except as otherwise provided in this section.
12 (5) ELIGIBILITY.--Eligibility to enroll in an approved
13 health flex plan is limited to residents of this state who:
14 (a) Are 64 years of age or younger;
15 (b) Have a family income equal to or less than 200
16 percent of the federal poverty level;
17 (c) Are not covered by a private insurance policy and
18 are not eligible for coverage through a public health
19 insurance program, such as Medicare or Medicaid, or another
20 public health care program, such as KidCare, and have not been
21 covered at any time during the past 6 months; and
22 (d) Have applied for health care coverage through an
23 approved health flex plan and have agreed to make any payments
24 required for participation, including periodic payments or
25 payments due at the time health care services are provided.
26 (6) RECORDS.--Each health flex plan shall maintain
27 enrollment data and reasonable records of its losses,
28 expenses, and claims experience and shall make those records
29 reasonably available to enable the department to monitor and
30 determine the financial viability of the health flex plan, as
31 necessary. Provider networks and total enrollment by area
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1 shall be reported to the agency biannually to enable the
2 agency to monitor access to care.
3 (7) NOTICE.--The denial of coverage by a health flex
4 plan, or the nonrenewal or cancellation of coverage, must be
5 accompanied by the specific reasons for denial, nonrenewal, or
6 cancellation. Notice of nonrenewal or cancellation must be
7 provided at least 45 days in advance of the nonrenewal or
8 cancellation, except that 10 days' written notice must be
9 given for cancellation due to nonpayment of premiums. If the
10 health flex plan fails to give the required notice, the health
11 flex plan coverage must remain in effect until notice is
12 appropriately given.
13 (8) NONENTITLEMENT.--Coverage under an approved health
14 flex plan is not an entitlement, and a cause of action does
15 not arise against the state, a local government entity, or any
16 other political subdivision of this state, or against the
17 agency, for failure to make coverage available to eligible
18 persons under this section.
19 (9) PROGRAM EVALUATION.--The agency and the department
20 shall evaluate the pilot program and its effect on the
21 entities that seek approval as health flex plans, the number
22 of enrollees, the scope of health care coverage offered under
23 a health flex plan, and an assessment of the health flex plans
24 and their potential applicability in other settings and shall,
25 by January 1, 2004, jointly submit a report to the Governor,
26 the President of the Senate, and the Speaker of the House of
27 Representatives.
28 (10) EXPIRATION.--This section expires July 1, 2004.
29 Section 2. This act shall take effect July 1, 2002.
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2 SENATE SUMMARY
3 Provides for a pilot program for health flex plans for
certain uninsured persons. Provides legislative findings
4 and intent and defines terms. Provides criteria for
approval of health flex plans. Delineates the
5 responsibilities of the Agency for Health Care
Administration and the Department of Insurance. Exempts
6 approved health flex plans from certain regulatory
requirements. Provides criteria for eligibility to enroll
7 in a health flex plan. Requires health flex plan entities
to maintain certain records. Provides requirements for
8 denial, nonrenewal, or cancellation of coverage.
Specifies that coverage under an approved health flex
9 plan is not an entitlement or a basis for legal action.
Requires an evaluation of the pilot program and a report
10 to the Governor and to legislative leaders.
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