CODING: Words stricken are deletions; words underlined are additions.



                                                   HOUSE AMENDMENT

                                      Bill No. CS/HB 913, 1st Eng.

    Amendment No. 10 (for drafter's use only)

                            CHAMBER ACTION
              Senate                               House
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  4  ______________________________________________________________

  5                                           ORIGINAL STAMP BELOW

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10  ______________________________________________________________

11  Representative(s) Farkas offered the following:

12

13         Amendment 

14         On page 8, line 10, through page 12, line 6,

15  remove:  all of said lines

16

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  provide such employer group with a written statement that

23  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 together explanation of

27  the managed care and cost control features of the policy or

28  contract, along with all appropriate mailing addresses and

29  telephone numbers to be used by insureds in seeking

30  information or authorization.; and

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

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    File original & 9 copies    03/11/02
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                                                   HOUSE AMENDMENT

                                      Bill No. CS/HB 913, 1st Eng.

    Amendment No. 10 (for drafter's use only)





  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 an understanding of the managed care and cost control

17  features of the policy or contract.

18         d.  A listing of specific health care services or

19  benefits enumerated in ss. 627.6574, 627.66121, 627.66122,

20  627.6616, 627.6618, 627.668, 627.66911, and 627.6699(12)(b)4.,

21  not provided as a covered service or benefit.;

22         c.  Acknowledges that if misrepresentations are made

23  regarding eligibility for coverage under a standard health

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

25  benefit policy or contract, the person making such

26  misrepresentations forfeits coverage provided by the policy or

27  contract; and

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

29  plan is requested, the prospective policyholder must

30  acknowledge in writing acknowledges that he or she the

31  prospective policyholder had been offered, at the time of

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    File original & 9 copies    03/11/02
    hcs0005                     02:35 pm         00913-0052-753975




                                                   HOUSE AMENDMENT

                                      Bill No. CS/HB 913, 1st Eng.

    Amendment No. 10 (for drafter's use only)





  1  application for the insurance policy or contract, the

  2  opportunity to purchase any health benefit plan offered by the

  3  carrier and that the prospective policyholder had rejected

  4  that coverage.

  5

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

  7  prospective policyholder no later than at the time of delivery

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

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

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

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

12         3.  Any material statement made by an applicant for

13  coverage under a health benefit plan which falsely certifies

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

15  basis for terminating coverage under the policy or contract.

16         3.4.  Each marketing communication that is intended to

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

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

19  use and must contain the disclosures stated in this

20  subsection.

21         4.  The contract, policy, and certificates evidencing

22  coverage under a flexible benefit policy or contract and the

23  application for coverage under such plans must state in not

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

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

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

27  should carefully review the benefits offered under this health

28  plan."

29         (e)  A small employer carrier may not use any policy,

30  contract, form, or rate under this section, including

31  applications, enrollment forms, policies, contracts,

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    File original & 9 copies    03/11/02
    hcs0005                     02:35 pm         00913-0052-753975




                                                   HOUSE AMENDMENT

                                      Bill No. CS/HB 913, 1st Eng.

    Amendment No. 10 (for drafter's use only)





  1  certificates, evidences of coverage, riders, amendments,

  2  endorsements, and disclosure forms, until the carrier insurer

  3  has filed it with the department and the department has

  4  approved it under ss. 627.410, and 627.411, and 641.31 and

  5  this section.

  6         (f)  A flexible benefit policy or contract must have an

  7  annual maximum benefit of $10,000 or greater and such benefit

  8  shall be disclosed in 10-point type in contrasting color.

  9         (g)  A mandatory offer for catastrophic coverage shall

10  be provided by the carriers to employers whenever a flexible

11  benefit policy or contract is offered.

12         (h)  An insurer may not condition the payment of

13  benefits offered under a flexible policy, in whole or in part,

14  on the use of exclusive providers of an exclusive provider

15  organization certified under s. 627.6472.

16         (15)  APPLICABILITY OF OTHER STATE LAWS.--

17         (a)  Except as expressly provided in this section, a

18  law requiring coverage for a specific health care service or

19  benefit, or a law requiring reimbursement, utilization, or

20  consideration of a specific category of licensed health care

21  practitioner, does not apply to a standard or basic health

22  benefit plan policy or contract or a flexible limited benefit

23  policy or contract offered or delivered to a small employer

24  unless that law is made expressly applicable to such policies

25  or contracts. A law restricting or limiting deductibles,

26  coinsurance, copayments, or annual or lifetime maximum

27  payments does not apply to any health plan policy, including a

28  standard or basic health benefit plan policy or contract or a

29  flexible benefit policy or contract, offered or delivered to a

30  small employer unless such law is made expressly applicable to

31  such policy or contract. The provisions of s. 627.419(2), (3),

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    File original & 9 copies    03/11/02
    hcs0005                     02:35 pm         00913-0052-753975




                                                   HOUSE AMENDMENT

                                      Bill No. CS/HB 913, 1st Eng.

    Amendment No. 10 (for drafter's use only)





  1  and (4) apply to a flexible benefit policy or contract offered

  2  or delivered to a small employer.

  3         (b)  Except as provided in this section, a standard or

  4  basic health benefit plan policy or contract or flexible

  5  limited benefit policy or contract offered to a small employer

  6  is not subject to any provision of this code which:

  7         1.  Inhibits a small employer carrier from contracting

  8  with providers or groups of providers with respect to health

  9  care services or benefits;

10         2.  Imposes any restriction on a small employer

11  carrier's ability to negotiate with providers regarding the

12  level or method of reimbursing care or services provided under

13  a health benefit plan; or

14         3.  Requires a small employer carrier to either include

15  a specific provider or class of providers when contracting for

16  health care services or benefits or to exclude any class of

17  providers that is generally authorized by statute to provide

18  such care.

19         (c)  Any second tier assessment paid by a carrier

20  pursuant to paragraph (11)(j) may be credited against

21  assessments levied against the carrier pursuant to s.

22  627.6494.

23         (d)  Notwithstanding chapter 641, a health maintenance

24  organization is authorized to issue contracts providing

25  benefits equal to the standard health benefit plan, the basic

26  health benefit plan, and the flexible limited benefit policy

27  or contract

28

29

30

31

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    File original & 9 copies    03/11/02
    hcs0005                     02:35 pm         00913-0052-753975