CODING: Words stricken are deletions; words underlined are additions.
HOUSE AMENDMENT
Bill No. CS/HB 913, 1st Eng.
Amendment No. ___ (for drafter's use only)
CHAMBER ACTION
Senate House
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5 ORIGINAL STAMP BELOW
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11 Representative(s) Farkas offered the following:
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13 Amendment (with title amendment)
14 On page 8, line 6, through page 10, line 20,
15 remove: all of said lines
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17 and insert:
18 4. The standard health benefit plan and any flexible
19 benefit policy or contract shall include:
20 a. Coverage for inpatient hospitalization;
21 b. Coverage for outpatient services;
22 c. Coverage for newborn children pursuant to s.
23 627.6575;
24 d. Coverage for child care supervision services
25 pursuant to s. 627.6579;
26 e. Coverage for adopted children upon placement in the
27 residence pursuant to s. 627.6578;
28 f. Coverage for mammograms pursuant to s. 627.6613;
29 g. Coverage for handicapped children pursuant to s.
30 627.6615;
31 h. Emergency or urgent care out of the geographic
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HOUSE AMENDMENT
Bill No. CS/HB 913, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 service area; and
2 i. Coverage for services provided by a hospice
3 licensed under s. 400.602 in cases where such coverage would
4 be the most appropriate and the most cost-effective method for
5 treating a covered illness.
6 5. The standard health benefit plan and the basic
7 health benefit plan may include a schedule of benefit
8 limitations for specified services and procedures. If the
9 committee develops such a schedule of benefits limitation for
10 the standard health benefit plan or the basic health benefit
11 plan, a small employer carrier offering the plan must offer
12 the employer an option for increasing the benefit schedule
13 amounts by 4 percent annually.
14 6. The basic health benefit plan shall include all of
15 the benefits specified in subparagraph 4.; however, the basic
16 health benefit plan shall place additional restrictions on the
17 benefits and utilization and may also impose additional cost
18 containment measures.
19 7. Sections 627.419(2), (3), and (4), 627.6574,
20 627.6612, 627.66121, 627.66122, 627.6616, 627.6618, 627.668,
21 and 627.66911 apply to the standard health benefit plan, to
22 any flexible benefit policy or contract, and to the basic
23 health benefit plan. However, notwithstanding said provisions,
24 the plans may specify limits on the number of authorized
25 treatments, if such limits are reasonable and do not
26 discriminate against any type of provider.
27 8. Each small employer carrier that provides for
28 inpatient and outpatient services by allopathic hospitals may
29 provide as an option of the insured similar inpatient and
30 outpatient services by hospitals accredited by the American
31 Osteopathic Association when such services are available and
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HOUSE AMENDMENT
Bill No. CS/HB 913, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 the osteopathic hospital agrees to provide the service.
2 (c) If a small employer rejects, in writing, the
3 standard health benefit plan and the basic health benefit
4 plan, the small employer carrier may offer the small employer
5 a flexible limited benefit policy or contract.
6 (d)1. Upon offering coverage under a standard health
7 benefit plan, a basic health benefit plan, or a flexible
8 limited benefit policy or contract for any small employer, the
9 small employer carrier shall disclose in writing to the
10 provide such employer group with a written statement that
11 contains, at a minimum:
12 a. An explanation of those mandated benefits and
13 providers that are not covered by the policy or contract;
14 a.b. An outline of coverage together explanation of
15 the managed care and cost control features of the policy or
16 contract, along with all appropriate mailing addresses and
17 telephone numbers to be used by insureds in seeking
18 information or authorization.; and
19 b.c. An explanation of The primary and preventive care
20 features of the policy or contract.
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22 Such disclosure statement must be presented in a clear and
23 understandable form and format and must be separate from the
24 policy or certificate or evidence of coverage provided to the
25 employer group.
26 2. Before a small employer carrier issues a standard
27 health benefit plan, a basic health benefit plan, or a limited
28 benefit policy or contract, it must obtain from the
29 prospective policyholder a signed written statement in which
30 the prospective policyholder:
31 a. Certifies as to eligibility for coverage under the
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hcs0005 12:13 pm 00913-0052-231925
HOUSE AMENDMENT
Bill No. CS/HB 913, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 standard health benefit plan, basic health benefit plan, or
2 limited benefit policy or contract;
3 c.b. Acknowledges The limited nature of the coverage
4 and an understanding of the managed care and cost control
5 features of the policy or contract.
6 c. Acknowledges that if misrepresentations are made
7 regarding eligibility for coverage under a standard health
8 benefit plan, a basic health benefit plan, or a limited
9 benefit policy or contract, the person making such
10 misrepresentations forfeits coverage provided by the policy or
11 contract; and
12 2.d. If a flexible benefit policy or contract limited
13 plan is requested, the prospective policyholder must
14 acknowledge in writing acknowledges that he or she the
15 prospective policyholder had been offered, at the time of
16 application for the insurance policy or contract, the
17 opportunity to purchase any health benefit plan offered by the
18 carrier and that the prospective policyholder had rejected
19 that coverage.
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21 A copy of such written statement shall be provided to the
22 prospective policyholder no later than at the time of delivery
23 of the policy or contract, and the original of such written
24 statement shall be retained in the files of the small employer
25 carrier for the period of time that the policy or contract
26 remains in effect or for 5 years, whichever period is longer.
27 3. Any material statement made by an applicant for
28 coverage under a health benefit plan which falsely certifies
29 as to the applicant's eligibility for coverage serves as the
30 basis for terminating coverage under the policy or contract.
31 3.4. Each marketing communication that is intended to
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HOUSE AMENDMENT
Bill No. CS/HB 913, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 be used in the marketing of a health benefit plan in this
2 state must be submitted for review by the department prior to
3 use and must contain the disclosures stated in this
4 subsection.
5 4. The contract, policy, and certificates evidencing
6 coverage under a flexible benefit policy or contract and the
7 application for coverage under such plans must state in not
8 less than 10-point type on the first page in contrasting color
9 the following: "The benefits provided by this health plan are
10 limited and may not cover all of your medical needs. You
11 should carefully review the benefits offered under this health
12 plan."
13 (e) A small employer carrier may not use any policy,
14 contract, form, or rate under this section, including
15 applications, enrollment forms, policies, contracts,
16 certificates, evidences of coverage, riders, amendments,
17 endorsements, and disclosure forms, until the carrier insurer
18 has filed it with the department and the department has
19 approved it under ss. 627.410, and 627.411, and 641.31 and
20 this section.
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