CODING: Words stricken are deletions; words underlined are additions.
HOUSE AMENDMENT
Bill No. HB 111
Amendment No. ___ (for drafter's use only)
CHAMBER ACTION
Senate House
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11 Representative(s) Seiler offered the following:
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13 Substitute Amendment for Amendment (822643) (with title
14 amendment)
15 Remove everything after the enacting clause
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17 and insert:
18 Section 1. Health flex plans.--
19 (1) INTENT.--The Legislature finds that a significant
20 proportion of state residents are not able to obtain
21 affordable health insurance coverage. Therefore, it is the
22 intent of the Legislature to expand the availability of health
23 care options for lower-income uninsured state residents by
24 encouraging health insurers, health maintenance organizations,
25 health care provider-sponsored organizations, local
26 governments, health care districts, or other public or private
27 community-based organizations to develop alternative
28 approaches to traditional health insurance which emphasize
29 coverage for basic and preventive health care services. To
30 the maximum extent possible these options should be
31 coordinated with existing governmental or community-based
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HOUSE AMENDMENT
Bill No. HB 111
Amendment No. ___ (for drafter's use only)
1 health services programs in a manner which is consistent with
2 the objectives and requirements of such programs.
3 (2) DEFINITIONS.--As used in this section, the term:
4 (a) "Agency" means the Agency for Health Care
5 Administration.
6 (b) "Department" means the Department of Insurance.
7 (c) "Enrollee" means an individual who has been
8 determined eligible for and is receiving health care coverage
9 under a health flex plan approved under this section.
10 (d) "Health care coverage" or "health flex plan
11 coverage" means health care services covered as benefits under
12 an approved health flex plan or that are otherwise provided,
13 either directly or through arrangements with other persons,
14 via health flex plan health care services on a prepaid per
15 capita basis or on a prepaid aggregate fixed-sum basis.
16 (e) "Health flex plan" means a health plan approved
17 under subsection (3) which guarantees payment for specified
18 health care coverage provided to the enrollee.
19 (f) "Health flex plan entity" means a health insurer,
20 health maintenance organization, health care
21 provider-sponsored organization, local government, health care
22 district, or other public or private community-based
23 organization which develops and implements an approved health
24 flex plan and is responsible for administering the health flex
25 plan and paying all claims for health flex plan coverage by
26 enrollees of the health flex plan.
27 (3) PILOT PROGRAM.--The agency and the department
28 shall each approve or disapprove health flex plans which
29 provide health care coverage for eligible participants
30 residing in the 3 service areas of the state with the highest
31 number of uninsured as identified in the Florida Health
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HOUSE AMENDMENT
Bill No. HB 111
Amendment No. ___ (for drafter's use only)
1 Insurance Study conducted by the agency. A health flex plan
2 may limit or exclude benefits otherwise required by law for
3 insurers offering coverage in this state, cap the total amount
4 of claims paid per year per enrollee, limit the number of
5 enrollees, or any combination of the foregoing.
6 (a) The agency shall develop guidelines for the review
7 of health flex plan applications and shall not approve or
8 shall withdraw approval of plans which do not or no longer
9 meet minimum quality of care and access to care standards.
10 (b) The department shall develop guidelines for the
11 review of health flex plan applications and shall not approve
12 or shall withdraw approval of plans which:
13 1. Contain any ambiguous, inconsistent or misleading
14 provisions, or exceptions or conditions that deceptively
15 affect or limit the benefits purported to be assumed in the
16 general coverage provided by the health flex plan;
17 2. Provide benefits that are unreasonable in relation
18 to the premium charged, contain provisions that are unfair or
19 inequitable or contrary to the public policy of this state,
20 that encourage misrepresentation, or that result in unfair
21 discrimination in sales practices; or
22 3. Cannot demonstrate that the health flex plan is
23 financially sound and that the applicant has the ability to
24 underwrite or finance the health care coverage provided.
25 (c) The agency and the department are each authorized
26 to adopt rules as needed to implement this section.
27 (4) LICENSE NOT REQUIRED.--A health flex plan approved
28 under this section shall not be subject to the licensing
29 requirements of the Florida Insurance Code or chapter 641,
30 Florida Statutes, relating to health maintenance
31 organizations, unless expressly made applicable. However, for
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HOUSE AMENDMENT
Bill No. HB 111
Amendment No. ___ (for drafter's use only)
1 the purposes of prohibiting unfair trade practices health flex
2 plans shall be considered insurance subject to the applicable
3 provisions of part IX of chapter 626, Florida Statutes, except
4 as otherwise provided in this section.
5 (5) ELIGIBILITY.--Eligibility to enroll in an approved
6 health flex plan is limited to Florida residents who:
7 (a) Are 64 years of age or younger;
8 (b) Have a family income equal to or less than 200
9 percent of the federal poverty level;
10 (c) Are not covered by a private insurance policy and
11 are not eligible for coverage through a public health
12 insurance program such as Medicare or Medicaid, or another
13 public health care program, such as KidCare, and have not been
14 covered at any time during the past 6 months; and
15 (d) Have applied for health care coverage through an
16 approved health flex plan and agree to make any payments
17 required for participation, including periodic payments or
18 payments due at the time health care services are provided.
19 (6) RECORDS.--Every health flex plan shall maintain
20 enrollment data, reasonable records of its loss, expense, and
21 claims experience, and shall make such records reasonably
22 available to enable the department to monitor and determine
23 the financial viability of the health flex plan, as necessary.
24 Provider networks and total enrollment by area shall be
25 reported to the agency biannually to enable the agency to
26 monitor access to care.
27 (7) NOTICE.--The denial of coverage by a health flex
28 plan, or nonrenewal or cancellation of coverage, must be
29 accompanied by the specific reasons for denial, nonrenewal, or
30 cancellation. Notice of nonrenewal or cancellation must be
31 provided at least 45 days in advance of such nonrenewal or
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HOUSE AMENDMENT
Bill No. HB 111
Amendment No. ___ (for drafter's use only)
1 cancellation, except that 10 days' written notice shall be
2 given for cancellation due to nonpayment of premiums. If the
3 health flex plan fails to give the required notice, the health
4 flex plan coverage shall remain in effect until notice is
5 appropriately given.
6 (8) NONENTITLEMENT.--Coverage under an approved health
7 flex plan is not an entitlement, and no cause of action shall
8 arise against the state, local government entity or other
9 political subdivision of this state, or the agency for failure
10 to make coverage available to eligible persons under this
11 section.
12 (9) PROGRAM EVALUATION.--The agency and the department
13 shall evaluate the pilot program and its impact on the
14 entities that seek approval as health flex plans, the number
15 of enrollees, the scope of health care coverage offered under
16 a health flex plan, and an assessment of the health flex plans
17 and their potential applicability in other settings, and
18 jointly submit a report to the Governor, the President of the
19 Senate, and the Speaker of the House of Representatives, no
20 later than January 1, 2004.
21 (10) REPEAL.--Unless specifically reenacted by the
22 Legislature, this section shall stand repealed on July 1,
23 2004.
24 Section 2. Paragraph (a) of subsection (2) of section
25 627.6425, Florida Statutes, is amended to read:
26 627.6425 Renewability of individual coverage.--
27 (2) An insurer may nonrenew or discontinue health
28 insurance coverage of an individual in the individual market
29 based only on one or more of the following:
30 (a) The individual has failed to pay premiums, or
31 contributions, or a required copayment payable to the insurer
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HOUSE AMENDMENT
Bill No. HB 111
Amendment No. ___ (for drafter's use only)
1 in accordance with the terms of the health insurance coverage
2 or the insurer has not received timely premium payments. When
3 the copayment is payable to the insurer and exceeds $300, the
4 insurer shall allow the insured up to 90 days after the date
5 of the procedure to pay the required copayment. The insurer
6 shall print, in 10-point type on the Declaration of Benefits
7 page, notification that the insured could be terminated for
8 failure to make any required copayment to the insurer.
9 Section 3. This act shall take effect July 1, 2002.
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12 ================ T I T L E A M E N D M E N T ===============
13 And the title is amended as follows:
14 remove everything before the enacting clause
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16 and insert:
17 A bill to be entitled
18 An act relating to health insurance; providing
19 legislative findings and intent and definitions
20 applicable to health flex plans; providing for
21 a pilot program for health flex plans for
22 certain uninsured persons; providing criteria
23 for approval of health flex plans; delineating
24 the responsibilities of the Agency for Health
25 Care Administration and the Department of
26 Insurance; exempting approved health flex plans
27 from certain regulatory requirements; providing
28 criteria for eligibility to enroll in a health
29 flex plan; requiring health flex plan entities
30 to maintain certain records; providing
31 requirements for denial, nonrenewal, or
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HOUSE AMENDMENT
Bill No. HB 111
Amendment No. ___ (for drafter's use only)
1 cancellation of coverage; specifying that
2 coverage under an approved health flex plan is
3 not an entitlement; requiring an evaluation and
4 report; providing for subsequent repeal;
5 amending s. 627.6425, F.S.; authorizing
6 insurers to nonrenew or discontinue health
7 insurance coverage for failure to pay certain
8 copayments; providing procedures and
9 requirements relating to certain copayments;
10 providing an effective date.
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hbd0011 10:51 am 00111-0092-612133