SENATE AMENDMENT
Bill No. CS/HB 913, 2nd Eng.
Amendment No. ___ Barcode 920184
CHAMBER ACTION
Senate House
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11 Senator Pruitt moved the following amendment to amendment
12 (913362):
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14 Senate Amendment (with title amendment)
15 On page 79, lines 14 - 17, delete those lines
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17 and insert: subscriber to a contracted licensed
18 ophthalmologist.
19 Section 27. Effective July 1, 2002, subsections (12),
20 (15), and (16) of section 627.6482, Florida Statutes, are
21 amended to read:
22 627.6482 Definitions.--As used in ss.
23 627.648-627.6498, the term:
24 (12) "Premium" means the entire cost of an insurance
25 plan, including the administrative fee, the risk assumption
26 charge, and, in the instance of a minimum premium plan or
27 stop-loss coverage, the incurred claims whether or not such
28 claims are paid directly by the insurer. "Premium" shall not
29 include a health maintenance organization's annual earned
30 premium revenue for Medicare and Medicaid contracts for any
31 assessment due for calendar years 1990 and 1991. For
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Bill No. CS/HB 913, 2nd Eng.
Amendment No. ___ Barcode 920184
1 assessments due for calendar year 1992 and subsequent years, a
2 health maintenance organization's annual earned premium
3 revenue for Medicare and Medicaid contracts is subject to
4 assessments unless the department determines that the health
5 maintenance organization has made a reasonable effort to amend
6 its Medicare or Medicaid government contract for 1992 and
7 subsequent years to provide reimbursement for any assessment
8 on Medicare or Medicaid premiums paid by the health
9 maintenance organization and the contract does not provide for
10 such reimbursement.
11 (15) "Federal poverty level" means the most current
12 federal poverty guidelines, as established by the federal
13 Department of Health and Human Services and published in the
14 Federal Register, and in effect on the date of the policy and
15 its annual renewal.
16 (16) "Family income" means the adjusted gross income,
17 as defined in s. 62 of the United States Internal Revenue
18 Code, of all members of a household.
19 Section 28. Effective July 1, 2002, section 627.6486,
20 Florida Statutes, is amended to read:
21 627.6486 Eligibility.--
22 (1) Except as provided in subsection (2), any resident
23 of this state shall be eligible for coverage under the plan,
24 including:
25 (a) The insured's spouse.
26 (b) Any dependent unmarried child of the insured, from
27 the moment of birth. Subject to the provisions of s.
28 627.6041, such coverage shall terminate at the end of the
29 premium period in which the child marries, ceases to be a
30 dependent of the insured, or attains the age of 19, whichever
31 occurs first. However, if the child is a full-time student at
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SENATE AMENDMENT
Bill No. CS/HB 913, 2nd Eng.
Amendment No. ___ Barcode 920184
1 an accredited institution of higher learning, the coverage may
2 continue while the child remains unmarried and a full-time
3 student, but not beyond the premium period in which the child
4 reaches age 23.
5 (c) The former spouse of the insured whose coverage
6 would otherwise terminate because of annulment or dissolution
7 of marriage, if the former spouse is dependent upon the
8 insured for financial support. The former spouse shall have
9 continued coverage and shall not be subject to waiting periods
10 because of the change in policyholder status.
11 (2)(a) The board or administrator shall require
12 verification of residency and shall require any additional
13 information or documentation, or statements under oath, when
14 necessary to determine residency upon initial application and
15 for the entire term of the policy.
16 (b) No person who is currently eligible for health
17 care benefits under Florida's Medicaid program is eligible for
18 coverage under the plan unless:
19 1. He or she has an illness or disease which requires
20 supplies or medication which are covered by the association
21 but are not included in the benefits provided under Florida's
22 Medicaid program in any form or manner; and
23 2. He or she is not receiving health care benefits or
24 coverage under Florida's Medicaid program.
25 (c) No person who is covered under the plan and
26 terminates the coverage is again eligible for coverage.
27 (d) No person on whose behalf the plan has paid out
28 $500,000 in covered benefits is eligible for coverage under
29 the plan.
30 (e) The coverage of any person who ceases to meet the
31 eligibility requirements of this section may be terminated
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Bill No. CS/HB 913, 2nd Eng.
Amendment No. ___ Barcode 920184
1 immediately. If such person again becomes eligible for
2 subsequent coverage under the plan, any previous claims
3 payments shall be applied towards the $500,000 lifetime
4 maximum benefit and any limitation relating to preexisting
5 conditions in effect at the time such person again becomes
6 eligible shall apply to such person. However, no such person
7 may again become eligible for coverage after June 30, 1991.
8 (f) No person is eligible for coverage under the plan
9 unless such person has been rejected by two insurers for
10 coverage substantially similar to the plan coverage and no
11 insurer has been found through the market assistance plan
12 pursuant to s. 627.6484 that is willing to accept the
13 application. As used in this paragraph, "rejection" includes
14 an offer of coverage with a material underwriting restriction
15 or an offer of coverage at a rate greater than the association
16 plan rate.
17 (g) No person is eligible for coverage under the plan
18 if such person has, on the date of issue of coverage under the
19 plan, substantially similar coverage under another contract or
20 policy, unless such coverage is provided pursuant to the
21 Consolidated Omnibus Budget Reconciliation Act of 1985, Pub.
22 L. No. 99-272, 100 Stat. 82 (1986) (COBRA), as amended, and
23 scheduled to end at a time certain and the person meets all
24 other requirements of eligibility. Coverage provided by the
25 association shall be secondary to any coverage provided by an
26 insurer pursuant to COBRA.
27 (h) All eligible persons who are classified as
28 high-risk individuals pursuant to s. 627.6498(4)(a)4. shall,
29 upon application or renewal, agree to be placed in a case
30 management system when it is determined by the board and the
31 plan case manager that such system will be cost-effective and
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SENATE AMENDMENT
Bill No. CS/HB 913, 2nd Eng.
Amendment No. ___ Barcode 920184
1 provide quality care to the individual.
2 Section 29. Effective July 1, 2002, subsection (3) of
3 section 627.6487, Florida Statutes, is amended to read:
4 627.6487 Guaranteed availability of individual health
5 insurance coverage to eligible individuals.--
6 (3) For the purposes of this section, the term
7 "eligible individual" means an individual:
8 (a)1. For whom, as of the date on which the individual
9 seeks coverage under this section, the aggregate of the
10 periods of creditable coverage, as defined in s. 627.6561(5)
11 and (6), is 18 or more months; and
12 2.a. Whose most recent prior creditable coverage was
13 under a group health plan, governmental plan, or church plan,
14 or health insurance coverage offered in connection with any
15 such plan; or
16 b. Whose most recent prior creditable coverage was
17 under an individual plan issued in this state by a health
18 insurer or health maintenance organization, which coverage is
19 terminated due to the insurer or health maintenance
20 organization becoming insolvent or discontinuing the offering
21 of all individual coverage in the State of Florida, or due to
22 the insured no longer living in the service area in the State
23 of Florida of the insurer or health maintenance organization
24 that provides coverage through a network plan in the State of
25 Florida;
26 (b) Who is not eligible for coverage under:
27 1. A group health plan, as defined in s. 2791 of the
28 Public Health Service Act;
29 2. A conversion policy or contract issued by an
30 authorized insurer or health maintenance organization under s.
31 627.6675 or s. 641.3921, respectively, offered to an
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Bill No. CS/HB 913, 2nd Eng.
Amendment No. ___ Barcode 920184
1 individual who is no longer eligible for coverage under either
2 an insured or self-insured employer plan;
3 3. Part A or part B of Title XVIII of the Social
4 Security Act; or
5 4. A state plan under Title XIX of such act, or any
6 successor program, and does not have other health insurance
7 coverage;
8 (c) With respect to whom the most recent coverage
9 within the coverage period described in paragraph (a) was not
10 terminated based on a factor described in s. 627.6571(2)(a) or
11 (b), relating to nonpayment of premiums or fraud, unless such
12 nonpayment of premiums or fraud was due to acts of an employer
13 or person other than the individual;
14 (d) Who, having been offered the option of
15 continuation coverage under a COBRA continuation provision or
16 under s. 627.6692, elected such coverage; and
17 (e) Who, if the individual elected such continuation
18 provision, has exhausted such continuation coverage under such
19 provision or program.
20 Section 30. Effective July 1, 2002, section 627.6488,
21 Florida Statutes, is amended to read:
22 627.6488 Florida Comprehensive Health Association.--
23 (1) There is created a nonprofit legal entity to be
24 known as the "Florida Comprehensive Health Association." All
25 insurers, as a condition of doing business, shall be members
26 of the association.
27 (2)(a) The association shall operate subject to the
28 supervision and approval of a three-member board of directors.
29 The board of directors shall be appointed by the Insurance
30 Commissioner as follows:
31 1. The chair of the board shall be the Insurance
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Bill No. CS/HB 913, 2nd Eng.
Amendment No. ___ Barcode 920184
1 Commissioner or his or her designee.
2 2. One representative of policyholders who is not
3 associated with the medical profession, a hospital, or an
4 insurer.
5 3. One representative of insurers.
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7 The administrator or his or her affiliate shall not be a
8 member of the board. Any board member appointed by the
9 commissioner may be removed and replaced by him or her at any
10 time without cause.
11 (b) All board members, including the chair, shall be
12 appointed to serve for staggered 3-year terms beginning on a
13 date as established in the plan of operation.
14 (c) The board of directors shall have the power to
15 employ or retain such persons as are necessary to perform the
16 administrative and financial transactions and responsibilities
17 of the association and to perform other necessary and proper
18 functions not prohibited by law.
19 (d) Board members may be reimbursed from moneys of the
20 association for actual and necessary expenses incurred by them
21 as members, but may not otherwise be compensated for their
22 services.
23 (e) There shall be no liability on the part of, and no
24 cause of action of any nature shall arise against, any member
25 insurer, or its agents or employees, agents or employees of
26 the association, members of the board of directors of the
27 association, or the departmental representatives for any act
28 or omission taken by them in the performance of their powers
29 and duties under this act, unless such act or omission by such
30 person is in intentional disregard of the rights of the
31 claimant.
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SENATE AMENDMENT
Bill No. CS/HB 913, 2nd Eng.
Amendment No. ___ Barcode 920184
1 (f) Meetings of the board are subject to s. 286.011.
2 (3) The association shall adopt a plan pursuant to
3 this act and submit its articles, bylaws, and operating rules
4 to the department for approval. If the association fails to
5 adopt such plan and suitable articles, bylaws, and operating
6 rules within 180 days after the appointment of the board, the
7 department shall adopt rules to effectuate the provisions of
8 this act; and such rules shall remain in effect until
9 superseded by a plan and articles, bylaws, and operating rules
10 submitted by the association and approved by the department.
11 (4) The association shall:
12 (a) Establish administrative and accounting procedures
13 for the operation of the association.
14 (b) Establish procedures under which applicants and
15 participants in the plan may have grievances reviewed by an
16 impartial body and reported to the board.
17 (c) Select an administrator in accordance with s.
18 627.649.
19 (d) Collect assessments from all insurers to provide
20 for operating losses incurred or estimated to be incurred
21 during the period for which the assessment is made. The level
22 of payments shall be established by the board, as formulated
23 in s. 627.6492(1). Annual assessment of the insurers for each
24 calendar year shall occur as soon thereafter as the operating
25 results of the plan for the calendar year and the earned
26 premiums of insurers being assessed for that year are known.
27 Annual assessments are due and payable within 30 days of
28 receipt of the assessment notice by the insurer.
29 (e) Require that all policy forms issued by the
30 association conform to standard forms developed by the
31 association. The forms shall be approved by the department.
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Bill No. CS/HB 913, 2nd Eng.
Amendment No. ___ Barcode 920184
1 (f) Develop and implement a program to publicize the
2 existence of the plan, the eligibility requirements for the
3 plan, and the procedures for enrollment in the plan and to
4 maintain public awareness of the plan.
5 (g) Design and employ cost containment measures and
6 requirements which may include preadmission certification,
7 home health care, hospice care, negotiated purchase of medical
8 and pharmaceutical supplies, and individual case management.
9 (h) Contract with preferred provider organizations and
10 health maintenance organizations giving due consideration to
11 the preferred provider organizations and health maintenance
12 organizations which have contracted with the state group
13 health insurance program pursuant to s. 110.123. If
14 cost-effective and available in the county where the
15 policyholder resides, the board, upon application or renewal
16 of a policy, shall place a high-risk individual, as
17 established under s. 627.6498(4)(a)4., with the plan case
18 manager who shall determine the most cost-effective quality
19 care system or health care provider and shall place the
20 individual in such system or with such health care provider.
21 If cost-effective and available in the county where the
22 policyholder resides, the board, with the consent of the
23 policyholder, may place a low-risk or medium-risk individual,
24 as established under s. 627.6498(4)(a)4., with the plan case
25 manager who may determine the most cost-effective quality care
26 system or health care provider and shall place the individual
27 in such system or with such health care provider. Prior to and
28 during the implementation of case management, the plan case
29 manager shall obtain input from the policyholder, parent, or
30 guardian.
31 (i) Make a report to the Governor, the President of
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Bill No. CS/HB 913, 2nd Eng.
Amendment No. ___ Barcode 920184
1 the Senate, the Speaker of the House of Representatives, and
2 the Minority Leaders of the Senate and the House of
3 Representatives not later than October 1 of each year. The
4 report shall summarize the activities of the plan for the
5 12-month period ending July 1 of that year, including
6 then-current data and estimates as to net written and earned
7 premiums, the expense of administration, and the paid and
8 incurred losses for the year. The report shall also include
9 analysis and recommendations for legislative changes regarding
10 utilization review, quality assurance, an evaluation of the
11 administrator of the plan, access to cost-effective health
12 care, and cost containment/case management policy and
13 recommendations concerning the opening of enrollment to new
14 entrants as of July 1, 1992.
15 (j) Make a report to the Governor, the Insurance
16 Commissioner, the President of the Senate, the Speaker of the
17 House of Representatives, and the Minority Leaders of the
18 Senate and House of Representatives, not later than 45 days
19 after the close of each calendar quarter, which includes, for
20 the prior quarter, current data and estimates of net written
21 and earned premiums, the expenses of administration, and the
22 paid and incurred losses. The report shall identify any
23 statutorily mandated program that has not been fully
24 implemented by the board.
25 (k) To facilitate preparation of assessments and for
26 other purposes, the board shall direct preparation of annual
27 audited financial statements for each calendar year as soon as
28 feasible following the conclusion of that calendar year, and
29 shall, within 30 days after rendition of such statements, file
30 with the department the annual report containing such
31 information as required by the department to be filed on March
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Bill No. CS/HB 913, 2nd Eng.
Amendment No. ___ Barcode 920184
1 1 of each year.
2 (l) Employ a plan case manager or managers to
3 supervise and manage the medical care or coordinate the
4 supervision and management of the medical care, with the
5 administrator, of specified individuals. The plan case
6 manager, with the approval of the board, shall have final
7 approval over the case management for any specific individual.
8 (5) The association may:
9 (a) Exercise powers granted to insurers under the laws
10 of this state.
11 (b) Sue or be sued.
12 (c) In addition to imposing annual assessments under
13 paragraph (4)(d), levy interim assessments against insurers to
14 ensure the financial ability of the plan to cover claims
15 expenses and administrative expenses paid or estimated to be
16 paid in the operation of the plan for a calendar year prior to
17 the association's anticipated receipt of annual assessments
18 for that calendar year. Any interim assessment shall be due
19 and payable within 30 days of receipt by an insurer of an
20 interim assessment notice. Interim assessment payments shall
21 be credited against the insurer's annual assessment.
22 (d) Prepare or contract for a performance audit of the
23 administrator of the association.
24 (6) The department shall examine and investigate the
25 association in the manner provided in part II of chapter 624.
26 Section 31. Effective July 1, 2002, paragraph (b) of
27 subsection (3) of section 627.649, Florida Statutes, is
28 amended to read:
29 627.649 Administrator.--
30 (3) The administrator shall:
31 (b) Pay an agent's referral fee as established by the
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Bill No. CS/HB 913, 2nd Eng.
Amendment No. ___ Barcode 920184
1 board to each insurance agent who refers an applicant to the
2 plan, if the applicant's application is accepted. The selling
3 or marketing of plans shall not be limited to the
4 administrator or its agents. The referral fees shall be paid
5 by the administrator from moneys received as premiums for the
6 plan.
7 Section 32. Effective July 1, 2002, section 627.6492,
8 Florida Statutes, is amended to read:
9 627.6492 Participation of insurers.--
10 (1)(a) As a condition of doing business in this state
11 an insurer shall pay an assessment to the board, in the amount
12 prescribed by this section. For operating losses incurred on
13 July 1, 1991, and thereafter, each insurer shall annually be
14 assessed by the board in the following calendar year a portion
15 of such incurred operating losses of the plan; such portion
16 shall be determined by multiplying such operating losses by a
17 fraction, the numerator of which equals the insurer's earned
18 premium pertaining to direct writings of health insurance in
19 the state during the calendar year preceding that for which
20 the assessment is levied, and the denominator of which equals
21 the total of all such premiums earned by participating
22 insurers in the state during such calendar year.
23 (b) For operating losses incurred from July 1, 1991,
24 through December 31, 1991, the total of all assessments upon a
25 participating insurer shall not exceed .375 percent of such
26 insurer's health insurance premiums earned in this state
27 during 1990. For operating losses incurred in 1992 and
28 thereafter, the total of all assessments upon a participating
29 insurer shall not exceed 1 percent of such insurer's health
30 insurance premium earned in this state during the calendar
31 year preceding the year for which the assessments were levied.
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Bill No. CS/HB 913, 2nd Eng.
Amendment No. ___ Barcode 920184
1 (c) For operating losses incurred from October 1,
2 1990, through June 30, 1991, the board shall assess each
3 insurer in the amount and manner prescribed by chapter 90-334,
4 Laws of Florida. The maximum assessment against an insurer, as
5 provided in such act, shall apply separately to the claims
6 incurred in 1990 (October 1 through December 31) and the
7 claims incurred in 1991 (January 1 through June 30). For
8 operating losses incurred on January 1, 1991, through June 30,
9 1991, the maximum assessment against an insurer shall be
10 one-half of the amount of the maximum assessment specified for
11 such insurer in former s. 627.6492(1)(b), 1990 Supplement, as
12 amended by chapter 90-334, Laws of Florida.
13 (d) All rights, title, and interest in the assessment
14 funds collected shall vest in this state. However, all of
15 such funds and interest earned shall be used by the
16 association to pay claims and administrative expenses.
17 (2) If assessments and other receipts by the
18 association, board, or administrator exceed the actual losses
19 and administrative expenses of the plan, the excess shall be
20 held at interest and used by the board to offset future
21 losses. As used in this subsection, the term "future losses"
22 includes reserves for claims incurred but not reported.
23 (3) Each insurer's assessment shall be determined
24 annually by the association based on annual statements and
25 other reports deemed necessary by the association and filed
26 with it by the insurer. Any deficit incurred under the plan
27 shall be recouped by assessments against participating
28 insurers by the board in the manner provided in subsection
29 (1); and the insurers may recover the assessment in the normal
30 course of their respective businesses without time limitation.
31 Section 33. Effective July 1, 2002, section 627.6498,
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Bill No. CS/HB 913, 2nd Eng.
Amendment No. ___ Barcode 920184
1 Florida Statutes, is amended to read:
2 627.6498 Minimum benefits coverage; exclusions;
3 premiums; deductibles.--
4 (1) COVERAGE OFFERED.--
5 (a) The plan shall offer in a semiannually renewable
6 policy the coverage specified in this section for each
7 eligible person. For applications accepted on or after June 7,
8 1991, but before July 1, 1991, coverage shall be effective on
9 July 1, 1991, and shall be renewable on January 1, 1992, and
10 every 6 months thereafter. Policies in existence on June 7,
11 1991, shall, upon renewal, be for a term of less than 6 months
12 that terminates and becomes subject to subsequent renewal on
13 the next succeeding January 1 or July 1, whichever is sooner.
14 (b) If an eligible person is also eligible for
15 Medicare coverage, the plan shall not pay or reimburse any
16 person for expenses paid by Medicare.
17 (c) Any person whose health insurance coverage is
18 involuntarily terminated for any reason other than nonpayment
19 of premium may apply for coverage under the plan. If such
20 coverage is applied for within 60 days after the involuntary
21 termination and if premiums are paid for the entire period of
22 coverage, the effective date of the coverage shall be the date
23 of termination of the previous coverage.
24 (d) The plan shall provide that, upon the death or
25 divorce of the individual in whose name the contract was
26 issued, every other person then covered in the contract may
27 elect within 60 days to continue under the same or a different
28 contract.
29 (e) No coverage provided to a person who is eligible
30 for Medicare benefits shall be issued as a Medicare supplement
31 policy as defined in s. 627.672.
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Amendment No. ___ Barcode 920184
1 (2) BENEFITS.--
2 (a) The plan shall offer major medical expense
3 coverage similar to that provided by the state group health
4 insurance program as defined in s. 110.123 except as specified
5 in subsection (3) to every eligible person who is not eligible
6 for Medicare. Major medical expense coverage offered under the
7 plan shall pay an eligible person's covered expenses, subject
8 to limits on the deductible and coinsurance payments
9 authorized under subsection (4), up to a lifetime limit of
10 $500,000 per covered individual. The maximum limit under this
11 paragraph shall not be altered by the board, and no
12 actuarially equivalent benefit may be substituted by the
13 board.
14 (b) The plan shall provide that any policy issued to a
15 person eligible for Medicare shall be separately rated to
16 reflect differences in experience reasonably expected to occur
17 as a result of Medicare payments.
18 (3) COVERED EXPENSES.--The coverage to be issued by
19 the association shall be patterned after the state group
20 health insurance program as defined in s. 110.123, including
21 its benefits, exclusions, and other limitations, except as
22 otherwise provided in this act. The plan may cover the cost
23 of experimental drugs which have been approved for use by the
24 Food and Drug Administration on an experimental basis if the
25 cost is less than the usual and customary treatment. Such
26 coverage shall only apply to those insureds who are in the
27 case management system upon the approval of the insured, the
28 case manager, and the board.
29 (4) PREMIUMS, DEDUCTIBLES, AND COINSURANCE.--
30 (a) The plan shall provide for annual deductibles for
31 major medical expense coverage in the amount of $1,000 or any
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Amendment No. ___ Barcode 920184
1 higher amounts proposed by the board and approved by the
2 department, plus the benefits payable under any other type of
3 insurance coverage or workers' compensation. The schedule of
4 premiums and deductibles shall be established by the
5 association. With regard to any preferred provider arrangement
6 utilized by the association, the deductibles provided in this
7 paragraph shall be the minimum deductibles applicable to the
8 preferred providers and higher deductibles, as approved by the
9 department, may be applied to providers who are not preferred
10 providers.
11 1. Separate schedules of premium rates based on age
12 may apply for individual risks.
13 2. Rates are subject to approval by the department.
14 3. Standard risk rates for coverages issued by the
15 association shall be established by the department, pursuant
16 to s. 627.6675(3).
17 4. The board shall establish separate premium
18 schedules for low-risk individuals, medium-risk individuals,
19 and high-risk individuals and shall revise premium schedules
20 annually beginning January 1999. No rate shall exceed 200
21 percent of the standard risk rate for low-risk individuals,
22 225 percent of the standard risk rate for medium-risk
23 individuals, or 250 percent of the standard risk rate for
24 high-risk individuals. For the purpose of determining what
25 constitutes a low-risk individual, medium-risk individual, or
26 high-risk individual, the board shall consider the anticipated
27 claims payment for individuals based upon an individual's
28 health condition.
29 (b) If the covered costs incurred by the eligible
30 person exceed the deductible for major medical expense
31 coverage selected by the person in a policy year, the plan
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Amendment No. ___ Barcode 920184
1 shall pay in the following manner:
2 1. For individuals placed under case management, the
3 plan shall pay 90 percent of the additional covered costs
4 incurred by the person during the policy year for the first
5 $10,000, after which the plan shall pay 100 percent of the
6 covered costs incurred by the person during the policy year.
7 2. For individuals utilizing the preferred provider
8 network, the plan shall pay 80 percent of the additional
9 covered costs incurred by the person during the policy year
10 for the first $10,000, after which the plan shall pay 90
11 percent of covered costs incurred by the person during the
12 policy year.
13 3. If the person does not utilize either the case
14 management system or the preferred provider network, the plan
15 shall pay 60 percent of the additional covered costs incurred
16 by the person for the first $10,000, after which the plan
17 shall pay 70 percent of the additional covered costs incurred
18 by the person during the policy year.
19 (5) PREEXISTING CONDITIONS.--An association policy may
20 contain provisions under which coverage is excluded during a
21 period of 12 months following the effective date of coverage
22 with respect to a given covered individual for any preexisting
23 condition, as long as:
24 (a) The condition manifested itself within a period of
25 6 months before the effective date of coverage; or
26 (b) Medical advice or treatment was recommended or
27 received within a period of 6 months before the effective date
28 of coverage.
29 (6) OTHER SOURCES PRIMARY.--
30 (a) No amounts paid or payable by Medicare or any
31 other governmental program or any other insurance, or
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Amendment No. ___ Barcode 920184
1 self-insurance maintained in lieu of otherwise statutorily
2 required insurance, may be made or recognized as claims under
3 such policy or be recognized as or towards satisfaction of
4 applicable deductibles or out-of-pocket maximums or to reduce
5 the limits of benefits available.
6 (b) The association has a cause of action against a
7 participant for any benefits paid to the participant which
8 should not have been claimed or recognized as claims because
9 of the provisions of this subsection or because otherwise not
10 covered.
11 Section 34. The Legislature finds that the provisions
12 of this act fulfill an important state interest.
13 Section 35. The amendments in this act to section
14 627.6487, Florida Statutes, shall not take effect unless the
15 Health Care Financing Administration of the U.S. Department of
16 Health and Human Services approves this act as providing an
17 acceptable alternative mechanism, as provided in the Public
18 Health Service Act.
19 Section 36. Section 627.6484, Florida Statutes, is not
20 repealed on January 1, 2003, but is reenacted and shall remain
21 in effect as it appeared in the 2001 Florida Statutes.
22 Section 37. Except as otherwise provided in this act,
23 this act shall take effect October 1, 2002, and shall apply to
24 claims for services rendered after such date.
25
26
27 ================ T I T L E A M E N D M E N T ===============
28 And the title is amended as follows:
29 On page 85, line 26, after the semicolon
30
31 insert:
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SENATE AMENDMENT
Bill No. CS/HB 913, 2nd Eng.
Amendment No. ___ Barcode 920184
1 amending ss. 627.6482, 627.6486, 627.6487,
2 627.6488, 627.649, 627.6492, 627.6498,
3 627.6484, 627.6487, F.S.; reenacting such
4 sections as they appeared in Florida Statutes
5 2001; abrogating the repeal of s. 627.6484,
6 F.S.;
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