House Bill hb0051E

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




    Florida House of Representatives - 2002                HB 51-E

        By Representative Murman






  1                      A bill to be entitled

  2         An act relating to health flex plans; providing

  3         legislative findings and intent; providing

  4         definitions; providing for a pilot program for

  5         health flex plans for certain uninsured

  6         persons; providing criteria for approval of

  7         health flex plans; delineating the

  8         responsibilities of the Agency for Health Care

  9         Administration and the Department of Insurance;

10         exempting approved health flex plans from

11         certain regulatory requirements; providing

12         criteria for eligibility to enroll in a health

13         flex plan; requiring health flex plan entities

14         to maintain certain records; providing

15         requirements for denial, nonrenewal, or

16         cancellation of coverage; specifying that

17         coverage under an approved health flex plan is

18         not an entitlement; requiring an evaluation and

19         report; providing for subsequent repeal;

20         providing an effective date.

21  

22  Be It Enacted by the Legislature of the State of Florida:

23  

24         Section 1.  Health flex plans.--

25         (1)  INTENT.--The Legislature finds that a significant

26  proportion of state residents are not able to obtain

27  affordable health insurance coverage.  Therefore, it is the

28  intent of the Legislature to expand the availability of health

29  care options for lower-income uninsured state residents by

30  encouraging health insurers, health maintenance organizations,

31  health care provider-sponsored organizations, local

                                  1

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






    Florida House of Representatives - 2002                HB 51-E

    583-239A-02E






 1  governments, health care districts, or other public or private

 2  community-based organizations to develop alternative

 3  approaches to traditional health insurance which emphasize

 4  coverage for basic and preventive health care services.  To

 5  the maximum extent possible these options should be

 6  coordinated with existing governmental or community-based

 7  health services programs in a manner which is consistent with

 8  the objectives and requirements of such programs.

 9         (2)  DEFINITIONS.--As used in this section, the term:

10         (a)  "Agency" means the Agency for Health Care

11  Administration.

12         (b)  "Department" means the Department of Insurance.

13         (c)  "Enrollee" means an individual who has been

14  determined eligible for and is receiving health care coverage

15  under a health flex plan approved under this section.

16         (d)  "Health care coverage" or "health flex plan

17  coverage" means health care services covered as benefits under

18  an approved health flex plan or that are otherwise provided,

19  either directly or through arrangements with other persons,

20  via health flex plan health care services on a prepaid per

21  capita basis or on a prepaid aggregate fixed-sum basis.

22         (e)  "Health flex plan" means a health plan approved

23  under subsection (3) which guarantees payment for specified

24  health care coverage provided to the enrollee.

25         (f)  "Health flex plan entity" means a health insurer,

26  health maintenance organization, health care

27  provider-sponsored organization, local government, health care

28  district, or other public or private community-based

29  organization which develops and implements an approved health

30  flex plan and is responsible for administering the health flex

31  

                                  2

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






    Florida House of Representatives - 2002                HB 51-E

    583-239A-02E






 1  plan and paying all claims for health flex plan coverage by

 2  enrollees of the health flex plan.

 3         (3)  PILOT PROGRAM.--The agency and the department

 4  shall each approve or disapprove health flex plans which

 5  provide health care coverage for eligible participants

 6  residing in the three service areas of the state with the

 7  highest number of uninsured persons as identified in the

 8  Florida Health Insurance Study conducted by the agency.  A

 9  health flex plan may limit or exclude benefits otherwise

10  required by law for insurers offering coverage in this state,

11  cap the total amount of claims paid per year per enrollee,

12  limit the number of enrollees, or any combination of the

13  foregoing.

14         (a)  The agency shall develop guidelines for the review

15  of health flex plan applications and shall not approve or

16  shall withdraw approval of plans which do not or no longer

17  meet minimum quality of care and access to care standards.

18         (b)  The department shall develop guidelines for the

19  review of health flex plan applications and shall not approve

20  or shall withdraw approval of plans which:

21         1.  Contain any ambiguous, inconsistent, or misleading

22  provisions, or exceptions or conditions that deceptively

23  affect or limit the benefits purported to be assumed in the

24  general coverage provided by the health flex plan;

25         2.  Provide benefits that are unreasonable in relation

26  to the premium charged or contain provisions that are unfair

27  or inequitable or contrary to the public policy of this state,

28  that encourage misrepresentation, or that result in unfair

29  discrimination in sales practices; or

30  

31  

                                  3

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






    Florida House of Representatives - 2002                HB 51-E

    583-239A-02E






 1         3.  Cannot demonstrate that the health flex plan is

 2  financially sound and that the applicant has the ability to

 3  underwrite or finance the health care coverage provided.

 4         (c)  The agency and the department are each authorized

 5  to adopt rules as needed to implement this section.

 6         (4)  LICENSE NOT REQUIRED.--A health flex plan approved

 7  under this section shall not be subject to the licensing

 8  requirements of the Florida Insurance Code or chapter 641,

 9  Florida Statutes, relating to health maintenance

10  organizations, unless expressly made applicable.  However, for

11  the purposes of prohibiting unfair trade practices, health

12  flex plans shall be considered insurance subject to the

13  applicable provisions of part IX of chapter 626, Florida

14  Statutes, except as otherwise provided in this section.

15         (5)  ELIGIBILITY.--Eligibility to enroll in an approved

16  health flex plan is limited to residents of this state who:

17         (a)  Are 64 years of age or younger.

18         (b)  Have a family income equal to or less than 200

19  percent of the federal poverty level.

20         (c)  Are not covered by a private insurance policy and

21  are not eligible for coverage through a public health

22  insurance program such as Medicare or Medicaid, or another

23  public health care program, such as Kidcare, and have not been

24  covered at any time during the past 6 months.

25         (d)  Have applied for health care coverage through an

26  approved health flex plan and agree to make any payments

27  required for participation, including periodic payments or

28  payments due at the time health care services are provided.

29         (6)  RECORDS.--Every health flex plan shall maintain

30  enrollment data, reasonable records of its loss, expense, and

31  claims experience, and shall make such records reasonably

                                  4

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






    Florida House of Representatives - 2002                HB 51-E

    583-239A-02E






 1  available to enable the department to monitor and determine

 2  the financial viability of the health flex plan, as necessary.

 3  Provider networks and total enrollment by area shall be

 4  reported to the agency biannually to enable the agency to

 5  monitor access to care.

 6         (7)  NOTICE.--The denial of coverage by a health flex

 7  plan, or nonrenewal or cancellation of coverage, must be

 8  accompanied by the specific reasons for denial, nonrenewal, or

 9  cancellation.  Notice of nonrenewal or cancellation must be

10  provided at least 45 days in advance of such nonrenewal or

11  cancellation, except that 10 days' written notice shall be

12  given for cancellation due to nonpayment of premiums.  If the

13  health flex plan fails to give the required notice, the health

14  flex plan coverage shall remain in effect until notice is

15  appropriately given.

16         (8)  NONENTITLEMENT.--Coverage under an approved health

17  flex plan is not an entitlement and no cause of action shall

18  arise against the state, local government entity, or other

19  political subdivision of this state or the agency for failure

20  to make coverage available to eligible persons under this

21  section.

22         (9)  PROGRAM EVALUATION.--The agency and the department

23  shall evaluate the pilot program and its impact on the

24  entities that seek approval as health flex plans, the number

25  of enrollees, the scope of health care coverage offered under

26  a health flex plan, and an assessment of the health flex plans

27  and their potential applicability in other settings and

28  jointly submit a report to the Governor, the President of the

29  Senate, and the Speaker of the House of Representatives no

30  later than January 1, 2004.

31  

                                  5

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






    Florida House of Representatives - 2002                HB 51-E

    583-239A-02E






 1         (10)  REPEAL.--Unless specifically reenacted by the

 2  Legislature, this section is repealed July 1, 2004.

 3         Section 2.  This act shall take effect July 1, 2002.

 4  

 5            *****************************************

 6                          HOUSE SUMMARY

 7  
      Creates a pilot program, designated health flex plans, to
 8    provide health care coverage for uninsured persons under
      the oversight of the Agency for Health Care
 9    Administration. See bill for details.

10  

11  

12  

13  

14  

15  

16  

17  

18  

19  

20  

21  

22  

23  

24  

25  

26  

27  

28  

29  

30  

31  

                                  6

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