Senate Bill sb1006c1
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Florida Senate - 2003 CS for SB 1006
By the Committee on Governmental Oversight and Productivity
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1 A bill to be entitled
2 An act relating to state employee health
3 insurance; amending s. 110.123, F.S.; revising
4 the terms of coverage and payment for officers
5 and employees participating in state employee
6 group health insurance; amending s. 110.161,
7 F.S.; providing eligibility for state
8 universities in the pretax benefits program;
9 amending s. 1001.74, F.S.; providing
10 eligibility for universities in the pretax
11 benefits program; providing an effective date.
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13 Be It Enacted by the Legislature of the State of Florida:
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15 Section 1. Paragraphs (e), (i), and (k) of subsection
16 (2), paragraphs (b), (c), (f), (g), and (h) of subsection (3),
17 paragraphs (c), (d), and (e) of subsection (4), paragraph (d)
18 of subsection (5), and paragraph (b) of subsection (8) of
19 section 110.123, Florida Statutes, are amended to read:
20 110.123 State group insurance program.--
21 (2) DEFINITIONS.--As used in this section, the term:
22 (e) "Health plan member" means any person
23 participating in a the state group health insurance plan or in
24 a health maintenance organization plan under the state group
25 insurance program, including enrollees and covered dependents
26 thereof.
27 (i) "State group health insurance plans plan" or
28 "state plans plan" mean means the state self-insured health
29 insurance plans plan offered to state officers and employees,
30 retired state officers and employees, and surviving spouses of
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1 deceased state officers and employees as provided by law
2 pursuant to this section.
3 (k) "State group insurance program" or "programs"
4 means the package of insurance plans offered to state officers
5 and employees, retired state officers and employees, and
6 surviving spouses of deceased state officers and employees
7 pursuant to this section, including the state group health
8 insurance plan, health maintenance organization plans, and
9 other plans required or authorized by law this section.
10 (3) STATE GROUP INSURANCE PROGRAM.--
11 (b) It is the intent of the Legislature to offer a
12 comprehensive package of health insurance and retirement
13 benefits and a personnel system for state employees which are
14 provided in a cost-efficient and prudent manner, and to allow
15 state employees the option to choose benefit plans which best
16 suit their individual needs. Therefore, the state group
17 insurance program is established which may include the state
18 group health insurance plans plan, health maintenance
19 organization plans, group life insurance plans, group
20 accidental death and dismemberment plans, and group disability
21 insurance plans. Furthermore, the department is additionally
22 authorized to establish and provide as part of the state group
23 insurance program any other group insurance plans or coverage
24 choices that which are consistent with benefit plans offered
25 in the open market the provisions of this section.
26 (c) Notwithstanding any provision in this section to
27 the contrary, it is the intent of the Legislature that the
28 department shall be responsible for all aspects of the
29 purchase of health care for state employees under the state
30 group health insurance plan and the health maintenance
31 organization plans. Responsibilities shall include, but not be
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1 limited to, the development of requests for proposals or
2 invitations to negotiate for state employee health services,
3 the determination of health care benefits to be provided, and
4 the negotiation of contracts for health care and health care
5 administrative services. Prior to the negotiation of
6 contracts for health care services, the Legislature intends
7 that the department shall develop, with respect to state
8 collective bargaining issues, the health benefits and terms to
9 be included in the state group health insurance program. The
10 department shall adopt rules necessary to perform its
11 responsibilities pursuant to this section. It is the intent
12 of the Legislature that the department shall be responsible
13 for the contract management and day-to-day management of the
14 state employee health insurance program, including, but not
15 limited to, employee enrollment, premium collection, payment
16 to health care providers, and other administrative functions
17 related to the program.
18 (f) Except as provided for in subparagraph (h)2., the
19 amount percentage of state contribution toward the cost of any
20 plan in the state group insurance program shall be uniform
21 with respect to all state employees in state collective
22 bargaining units participating in the same plan option or any
23 similar plan. Nothing contained within this section prohibits
24 the development of separate benefit plans for officers and
25 employees exempt from collective bargaining or the development
26 of separate benefit plans for each collective bargaining unit.
27 (g) Participation by individuals in the program shall
28 be available to all state officers, full-time state employees,
29 and part-time state employees; and such participation in the
30 program or any plan thereof shall be voluntary. Participation
31 in the program shall also be available to retired state
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1 officers and employees, as defined in paragraph (2)(g), who
2 elect at the time of retirement to continue coverage under the
3 program, but they may elect to continue all or only part of
4 the coverage they had at the time of retirement. A surviving
5 spouse may elect to continue coverage only under a the state
6 group health insurance plan or a health maintenance
7 organization plan.
8 (h)1. A person eligible to participate in the state
9 group insurance program may be authorized by rules adopted by
10 the department, in lieu of participating in a the state group
11 health insurance plan, to exercise an option to elect
12 membership in a health maintenance organization plan which is
13 under contract with the state in accordance with criteria
14 established by this section and by said rules. The offer of
15 optional membership in a health maintenance organization plan
16 permitted by this paragraph may be limited or conditioned by
17 rule as may be necessary to meet the requirements of state and
18 federal laws.
19 2. The department shall contract with health
20 maintenance organizations seeking to participate in the state
21 group insurance program through a request for proposal or
22 other procurement process, as developed by the Department of
23 Management Services and determined to be appropriate.
24 a. The department shall establish a schedule of
25 minimum benefits for health maintenance organization coverage,
26 and that schedule shall include: physician services; inpatient
27 and outpatient hospital services; emergency medical services,
28 including out-of-area emergency coverage; diagnostic
29 laboratory and diagnostic and therapeutic radiologic services;
30 mental health, alcohol, and chemical dependency treatment
31 services meeting the minimum requirements of state and federal
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1 law; skilled nursing facilities and services; prescription
2 drugs; age-based and gender-based wellness benefit; and other
3 benefits as may be required by the department. Additional
4 services may be provided subject to the contract between the
5 department and the HMO.
6 b. The department may establish uniform deductibles,
7 copayments, coverage tiers, or coinsurance schedules for all
8 participating HMO plans.
9 c. The department may require detailed information
10 from each health maintenance organization participating in the
11 procurement process, including information pertaining to
12 organizational status, experience in providing prepaid health
13 benefits, accessibility of services, financial stability of
14 the plan, quality of management services, accreditation
15 status, quality of medical services, network access and
16 adequacy, performance measurement, ability to meet the
17 department's reporting requirements, and the actuarial basis
18 of the proposed rates and other data determined by the
19 director to be necessary for the evaluation and selection of
20 health maintenance organization plans and negotiation of
21 appropriate rates for these plans. Upon receipt of proposals
22 by health maintenance organization plans and the evaluation of
23 those proposals, the department may enter into negotiations
24 with all of the plans or a subset of the plans, as the
25 department determines appropriate. Nothing shall preclude the
26 department from negotiating regional or statewide contracts
27 with health maintenance organization plans when this is
28 cost-effective and when the department determines that the
29 plan offers high value to enrollees.
30 d. The department may limit the number of HMOs that it
31 contracts with in each service area based on the nature of the
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1 bids the department receives, the number of state employees in
2 the service area, or any unique geographical characteristics
3 of the service area. The department shall establish by rule
4 service areas throughout the state.
5 e. All persons participating in the state group
6 insurance program who are required to contribute towards a
7 total state group health premium shall be subject to a
8 specific the same dollar contribution that may vary depending
9 upon the plan option selected regardless of whether the
10 enrollee enrolls in a the state group health insurance plan or
11 in an HMO plan.
12 3. The department is authorized to negotiate and to
13 contract with specialty psychiatric hospitals for mental
14 health benefits, on a regional basis, for alcohol, drug abuse,
15 and mental and nervous disorders. The department may
16 establish, subject to the approval of the Legislature pursuant
17 to subsection (5), any such regional plan upon completion of
18 an actuarial study to determine any impact on plan benefits
19 and premiums.
20 4. In addition to contracting pursuant to subparagraph
21 2., the department may shall enter into contract with any HMO
22 to participate in the state group insurance program which:
23 a. Serves greater than 5,000 recipients on a prepaid
24 basis under the Medicaid program;
25 b. Does not currently meet the 25-percent
26 non-Medicare/non-Medicaid enrollment composition requirement
27 established by the Department of Health excluding participants
28 enrolled in the state group insurance program;
29 c. Meets the minimum benefit package and copayments
30 and deductibles contained in sub-subparagraphs 2.a. and b.;
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1 d. Is willing to participate in the state group
2 insurance program at a cost of premiums that is not greater
3 than 95 percent of the cost of HMO premiums accepted by the
4 department in each service area; and
5 e. Meets the minimum surplus requirements of s.
6 641.225.
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8 The department is authorized to contract with HMOs that meet
9 the requirements of sub-subparagraphs a.-d. prior to the open
10 enrollment period for state employees. The department is not
11 required to renew the contract with the HMOs as set forth in
12 this paragraph more than twice. Thereafter, the HMOs shall be
13 eligible to participate in the state group insurance program
14 only through the request for proposal or invitation to
15 negotiate process described in subparagraph 2.
16 5. All enrollees in a the state group health insurance
17 plan or any health maintenance organization plan shall have
18 the option of changing to any other health plan which is
19 offered by the state within any open enrollment period
20 designated by the department. Open enrollment shall be held at
21 least once each calendar year.
22 6. When a contract between a treating provider and the
23 state-contracted health maintenance organization is terminated
24 for any reason other than for cause, each party shall allow
25 any enrollee for whom treatment was active to continue
26 coverage and care when medically necessary, through completion
27 of treatment of a condition for which the enrollee was
28 receiving care at the time of the termination, until the
29 enrollee selects another treating provider, or until the next
30 open enrollment period offered, whichever is longer, but no
31 longer than 6 months after termination of the contract. Each
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1 party to the terminated contract shall allow an enrollee who
2 has initiated a course of prenatal care, regardless of the
3 trimester in which care was initiated, to continue care and
4 coverage until completion of postpartum care. This does not
5 prevent a provider from refusing to continue to provide care
6 to an enrollee who is abusive, noncompliant, or in arrears in
7 payments for services provided. For care continued under this
8 subparagraph, the program and the provider shall continue to
9 be bound by the terms of the terminated contract. Changes made
10 within 30 days before termination of a contract are effective
11 only if agreed to by both parties.
12 7. Any HMO participating in the state group insurance
13 program shall submit health care utilization and cost data to
14 the department, in such form and in such manner as the
15 department shall require, as a condition of participating in
16 the program. The department shall enter into negotiations
17 with its contracting HMOs to determine the nature and scope of
18 the data submission and the final requirements, format,
19 penalties associated with noncompliance, and timetables for
20 submission. These determinations shall be adopted by rule.
21 8. The department may establish and direct, with
22 respect to collective bargaining issues, a comprehensive
23 package of insurance benefits that may include supplemental
24 health and life coverage, dental care, long-term care, vision
25 care, and other benefits it determines necessary to enable
26 state employees to select from among benefit options that best
27 suit their individual and family needs.
28 a. Based upon a desired benefit package, the
29 department shall issue a request for proposal or invitation to
30 negotiate for health insurance providers interested in
31 participating in the state group insurance program, and the
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1 department shall issue a request for proposal or invitation to
2 negotiate for insurance providers interested in participating
3 in the non-health-related components of the state group
4 insurance program. Upon receipt of all proposals, the
5 department may enter into contract negotiations with insurance
6 providers submitting bids or negotiate a specially designed
7 benefit package. Insurance providers offering or providing
8 supplemental coverage as of May 30, 1991, which qualify for
9 pretax benefit treatment pursuant to s. 125 of the Internal
10 Revenue Code of 1986, with 5,500 or more state employees
11 currently enrolled may be included by the department in the
12 supplemental insurance benefit plan established by the
13 department without participating in a request for proposal,
14 submitting bids, negotiating contracts, or negotiating a
15 specially designed benefit package. These contracts shall
16 provide state employees with the most cost-effective and
17 comprehensive coverage available; however, no state or agency
18 funds shall be contributed toward the cost of any part of the
19 premium of such supplemental benefit plans. With respect to
20 dental coverage, the division shall include in any
21 solicitation or contract for any state group dental program
22 made after July 1, 2001, a comprehensive indemnity dental plan
23 option which offers enrollees a completely unrestricted choice
24 of dentists. If a dental plan is endorsed, or in some manner
25 recognized as the preferred product, such plan shall include a
26 comprehensive indemnity dental plan option which provides
27 enrollees with a completely unrestricted choice of dentists.
28 b. Pursuant to the applicable provisions of s.
29 110.161, and s. 125 of the Internal Revenue Code of 1986, the
30 department shall enroll in the pretax benefit program those
31 state employees who voluntarily elect coverage in any of the
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1 supplemental insurance benefit plans as provided by
2 sub-subparagraph a.
3 c. Nothing herein contained shall be construed to
4 prohibit insurance providers from continuing to provide or
5 offer supplemental benefit coverage to state employees as
6 provided under existing agency plans.
7 (4) PAYMENT OF PREMIUMS; CONTRIBUTION BY STATE;
8 LIMITATION ON ACTIONS TO PAY AND COLLECT PREMIUMS.--
9 (c) During each policy or budget year, no state agency
10 shall contribute a greater dollar amount percentage of the
11 premium cost for its officers or employees for any plan option
12 type of coverage under the state group insurance program than
13 any other agency, nor shall any greater dollar amount
14 percentage contribution of premium cost be made for employees
15 in one state collective bargaining unit than for those in any
16 other state collective bargaining unit.
17 (d) The state contribution for a part-time permanent
18 state employee who elects to participate in the program shall
19 be prorated so that the amount percentage of the cost
20 contributed for the part-time permanent employee bears that
21 relation to the amount percentage of cost contributed for a
22 similar full-time employee that the part-time employee's
23 normal workday bears to a full-time employee's normal workday.
24 (e) No state contribution for the cost of any part of
25 the premium shall be made for retirees or surviving spouses
26 for any type of coverage under the state group insurance
27 program. However, any state agency that employs a full-time
28 law enforcement officer, correctional officer, or correctional
29 probation officer who is killed or suffers catastrophic injury
30 in the line of duty as provided in s. 112.19, or a full-time
31 firefighter who is killed or suffers catastrophic injury in
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1 the line of duty as provided in s. 112.191, shall pay the
2 entire premium of the state group health insurance plan
3 selected for the employee's surviving spouse until remarried,
4 and for each dependent child of the employee, subject to the
5 conditions and limitations set forth in s. 112.19 or s.
6 112.191, as applicable.
7 (5) DEPARTMENT POWERS AND DUTIES.--The department is
8 responsible for the administration of the state group
9 insurance program. The department shall initiate and
10 supervise the program as established by this section and shall
11 adopt such rules as are necessary to perform its
12 responsibilities. To implement this program, the department
13 shall, with prior approval by the Legislature:
14 (d) With respect to the state group health insurance
15 plans plan, be authorized to require copayments with respect
16 to all providers under the plan.
17 (8) COVERAGE FOR LEGISLATIVE MEMBERS AND EMPLOYEES.--
18 (b) Effective July 1, 1999, any legislative member who
19 terminates his or her elected service after July 1, 1999,
20 after having vested in the state retirement system, may
21 purchase coverage in a the state group health insurance plan
22 at the same premium cost as that for retirees and surviving
23 spouses. Such legislators may also elect to continue coverage
24 under the group term life insurance program prevailing for
25 current members at the premium cost in effect for that plan.
26 Section 2. Subsection (2) of section 110.161, Florida
27 Statutes, is amended to read:
28 110.161 State employees; pretax benefits program.--
29 (2) As used in this section, "employee" means any
30 individual filling an authorized and established position in
31 the executive, legislative, or judicial branch of the state,
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1 including the employees of the State Board of Administration
2 and the state universities.
3 Section 3. Subsection (19) of section 1001.74, Florida
4 Statutes, is amended to read:
5 1001.74 Powers and duties of university boards of
6 trustees.--
7 (19) Each board of trustees shall establish the
8 personnel program for all employees of the university,
9 including the president, pursuant to the provisions of chapter
10 1012 and, in accordance with rules and guidelines of the State
11 Board of Education, including: compensation and other
12 conditions of employment, recruitment and selection,
13 nonreappointment, standards for performance and conduct,
14 evaluation, benefits and hours of work, leave policies,
15 recognition and awards, inventions and works, travel, learning
16 opportunities, exchange programs, academic freedom and
17 responsibility, promotion, assignment, demotion, transfer,
18 tenure and permanent status, ethical obligations and conflicts
19 of interest, restrictive covenants, disciplinary actions,
20 complaints, appeals and grievance procedures, and separation
21 and termination from employment. The Department of Management
22 Services shall retain authority over state university
23 employees for programs established in ss. 110.123, 110.161,
24 110.1232, 110.1234, and 110.1238 and in chapters 121, 122, and
25 238.
26 Section 4. This act shall take effect July 1, 2003.
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1 STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
COMMITTEE SUBSTITUTE FOR
2 SB 1006
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4 The Committee Substitute amends s. 110.123, F.S., to permit
the setting of a funding policy for state employee group
5 health insurance in a location other than in that chapter;
provides for age- and gender-based wellness benefits and
6 coverage tiers for future plan changes; permits continued
eligibility for insurance coverage by the state universities;
7 authorizes the use of the Invitation to Negotiate process for
future procurements; shifts cost sharing arrangements from a
8 percentage to a fixed dollar amount; and permits the
development of more than one indemnity plan offering.
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