SENATE AMENDMENT

    Bill No. CS for CS for SB's 1286, 1134 & 1008

    Amendment No. ___   Barcode 593600

                            CHAMBER ACTION
              Senate                               House
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  4  ______________________________________________________________

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11  Senator Posey moved the following amendment:

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13         Senate Amendment 

14         On page 38, line 8, through

15            page 40, line 12, delete those lines

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17  and insert:

18         (d)1.  Upon offering coverage under a standard health

19  benefit plan, a basic health benefit plan, or a flexible

20  limited benefit policy or contract for any small employer, the

21  small employer carrier shall disclose in writing to the

22  employer provide such employer group with a written statement

23  that contains, at a minimum:

24         a.  An explanation of those mandated benefits and

25  providers that are not covered by the policy or contract;

26         a.b.  An outline of coverage explanation of the managed

27  care and cost control features of the policy or contract,

28  along with all appropriate mailing addresses and telephone

29  numbers to be used by insureds in seeking information or

30  authorization.; and

31         b.c.  An explanation of The primary and preventive care

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                                                  SENATE AMENDMENT

    Bill No. CS for CS for SB's 1286, 1134 & 1008

    Amendment No. ___   Barcode 593600





  1  features of the policy or contract.

  2

  3  Such disclosure statement must be presented in a clear and

  4  understandable form and format and must be separate from the

  5  policy or certificate or evidence of coverage provided to the

  6  employer group.

  7         2.  Before a small employer carrier issues a standard

  8  health benefit plan, a basic health benefit plan, or a limited

  9  benefit policy or contract, it must obtain from the

10  prospective policyholder a signed written statement in which

11  the prospective policyholder:

12         a.  Certifies as to eligibility for coverage under the

13  standard health benefit plan, basic health benefit plan, or

14  limited benefit policy or contract;

15         c.b.  Acknowledges The limited nature of the coverage

16  and the an understanding of the managed care and cost control

17  features of the policy or contract.;

18         c.  Acknowledges that if misrepresentations are made

19  regarding eligibility for coverage under a standard health

20  benefit plan, a basic health benefit plan, or a limited

21  benefit policy or contract, the person making such

22  misrepresentations forfeits coverage provided by the policy or

23  contract; and

24         2.d.  If a flexible benefit policy or contract limited

25  plan is requested, the prospective policyholder must

26  acknowledge in writing acknowledges that he or she the

27  prospective policyholder had been offered, at the time of

28  application for the insurance policy or contract, the

29  opportunity to purchase any health benefit plan offered by the

30  carrier and that the prospective policyholder had rejected

31  that coverage.

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    3:29 PM   03/15/02                              s1286c2b-15j02




                                                  SENATE AMENDMENT

    Bill No. CS for CS for SB's 1286, 1134 & 1008

    Amendment No. ___   Barcode 593600





  1

  2  A copy of such written statement shall be provided to the

  3  prospective policyholder no later than at the time of delivery

  4  of the policy or contract, and the original of such written

  5  statement shall be retained in the files of the small employer

  6  carrier for the period of time that the policy or contract

  7  remains in effect or for 5 years, whichever period is longer.

  8         3.  Any material statement made by an applicant for

  9  coverage under a health benefit plan which falsely certifies

10  as to the applicant's eligibility for coverage serves as the

11  basis for terminating coverage under the policy or contract.

12         3.4.  Each marketing communication that is intended to

13  be used in the marketing of a health benefit plan in this

14  state must be submitted for review by the department prior to

15  use and must contain the disclosures stated in this

16  subsection.

17         4.  The contract, policy, and certificates evidencing

18  coverage under a flexible benefit policy or contract and the

19  application for coverage under such plans must state in not

20  less than 10-point type on the first page in contrasting color

21  the following: "The benefits provided by this health plan are

22  limited and may not cover all of your medical needs. You

23  should carefully review the benefits offered under this health

24  plan."

25         5.  A line item listing of specific health care

26  services or benefits enumerated under state law which are not

27  provided as a covered service or benefit, as specified in a

28  form or statement adopted by the department by rule.

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