HOUSE AMENDMENT Bill No. HB 1573 CS
1	CHAMBER ACTION
2	Senate House
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12	Representative Stargel offered the following:
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14	Amendment to Amendment (209863) (with directory and title
15	amendments)
16	Between lines 618-619, insert:
17	Section 25. Subsection (2) of section 627.6515, Florida
18	Statutes, is amended, and subsections (9), (10), and (11) are
19	added to said section, to read:
20	627.6515 Out-of-state groups.--
21	(2) This part does not apply to a group health insurance
22	policy issued or delivered outside this state under which a
23	resident of this state is provided coverage if the master policy
24	met the filing requirements of the state of policy situs and was
25	available for sale in the state of policy situs and:
26	(a) The policy is issued to an employee group the
27	composition of which is substantially as described in s.
28	627.653; a labor union group or association group the
29	composition of which is substantially as described in s.
30	627.654; an additional group the composition of which is
31	substantially as described in s. 627.656; a group insured under
32	a blanket health policy when the composition of the group is
33	substantially in compliance with s. 627.659; a group insured
34	under a franchise health policy when the composition of the
35	group is substantially in compliance with s. 627.663; an
36	association group to cover persons associated in any other
37	common group, which common group is formed primarily for
38	purposes other than providing insurance; a group that is
39	established primarily for the purpose of providing group
40	insurance, provided the benefits are reasonable in relation to
41	the premiums charged thereunder and the issuance of the group
42	policy has resulted, or will result, in economies of
43	administration; or a group of insurance agents of an insurer,
44	which insurer is the policyholder;
45	(b) Certificates evidencing coverage under the policy are
46	issued to residents of this state and contain in contrasting
47	color and not less than 10-point type the following statement:
48	"The benefits of the policy providing your coverage are governed
49	primarily by the law of a state other than Florida"; and
50	(c) The policy provides the benefits specified in ss.
51	627.419, 627.6574, 627.6575, 627.6579, 627.6612, 627.66121,
52	627.66122, 627.6613, 627.667, 627.6675, 627.6691, and 627.66911
53	(d) Applications for certificates of coverage offered to
54	residents of this state contain in contrasting color and not
55	less than 12-point type the following statement on the same page
56	as the applicant signature: “This policy is primarily governed
57	by the laws of {insert state where the master policy is filed}.
58	As a result, all of the rating laws applicable to policies filed
59	in Florida do not apply to this coverage, which may result in
60	increases in your premium at renewal that would not be
61	permissible under a Florida-approved policy. Any purchase of
62	individual health insurance should be considered carefully, as
63	future medical conditions may make it impossible to qualify for
64	another individual health policy. For information concerning
65	individual health coverage under a Florida-approved policy,
66	consult your agent or the Florida Department of Financial
67	Services.” The provisions of this paragraph only apply to group
68	certificates for health insurance coverage, as described in s.
69	627.6561(5) (a) 2., which require individual underwriting to
70	determine coverage eligibility for an individual or premium
71	rates to be charged to an individual.
72	(9)(a) For purposes of this section, any insurer that
73	issues any group health benefit plan, as defined in s. 627.6699
74	(3)(k), except for policies issued to provide coverage to groups
75	of persons all of whom are in the same or functionally related
76	licensed professions, and providing coverage only to such
77	licensed professionals, their employees or their dependents, to
78	a resident of this state requiring individual underwriting to
79	determine eligibility for coverage or initial premiums rates to
80	be charged, shall not take into account the individual claims
81	experience or any change in the personal health status of a
82	covered person that occurs after the initial issuance of the
83	health benefit plan to determine his or her renewal premium
84	rates. No premium increase, including a reduced premium
85	increasing the form of a discount, may be implemented for an
86	insured individual under existing group health plan coverage
87	subsequent to the initial effective date of coverage under such
88	policy or certificate to the extent that such reduction in
89	benefits is determined based upon a change in a health-status
90	related factor of the individual insured or the past or
91	prospective claim experience of the individual insured. No
92	modifications to contractual terms and conditions may be
93	implemented for an insured individual under existing group
94	health coverage subsequent to the initial effective date of
95	coverage under such policy or certificate to the extent that
96	such modifications to contractual terms and conditions are
97	determined based upon a change in a health-status related factor
98	of the individual insured or the past or prospective claim
99	experience of the individual insured. Nothing in this section
100	shall be construed to require uniform premium rates, to restrict
101	the use of any rating factors, or to restrict experience-based
102	renewal premium rating practices that are applied to all
103	individual insureds by a particular health benefit plan or group
104	of health benefit plans The stated intent and purpose of this
105	subsection is to prohibit renewal premium practices that are
106	based exclusively upon a covered person’s individual claim
107	experience or a change in a covered person’s personal health
108	status. A certification shall be made by a qualified actuary
109	who is a member of the Society of Actuaries or the American
110	Academy of Actuaries and who is qualified in the area of health
111	insurance that the insurer’s premium structure complies with
112	this subsection.
113	(b) If an insurer has ever utilized the renewal premium
114	adjustments prohibited above, the insurer must file new renewal
115	premium rates with the department for informational purposes
116	only. The new rates must eliminate the effects of the prohibited
117	renewal premium adjustments on a revenue neutral basis. This new
118	renewal premium rate filing must be accompanied by a
119	certification by a qualified actuary who is a member of the
120	Society of Actuaries or the American Academy of Actuaries that
121	the filing complies with the requirements of this act. The
122	filing must be made within 90 days after the effective day of
123	this act. The new renewal premium rates must be implemented
124	within 90 days after the filing. This provision shall not
125	prohibit adjustments in an individual’s premiums in lieu of a
126	rescission that would be allowed under applicable law due to a
127	fraudulent or material misstatement in an application or based
128	upon changes required by law, benefit changes requested by the
129	insured, or a requested reinstatement of lapsed coverage.
130	(c) For purposes of this subsection, group health benefit
131	plan means any hospital or medical policy, hospital or medical
132	service plan contract, or health maintenance organization
133	subscriber contract. The term does not include accidental death,
134	accidental death and dismemberment, accident-only, vision-only,
135	dental-only, hospital indemnity, hospital accident, cancer,
136	specified disease, Medicare supplement, products that supplement
137	Medicare, long-term care, or disability income insurance,
138	similar supplemental plans provided under a separate policy,
139	certificate, or contract of insurance, which can not duplicate
140	coverage under an underlying health plan and are specifically
141	designed to fill gaps in the underlying health plan,
142	coinsurance, or deductibles; coverage issued as a supplement to
143	liability insurance, worker's compensation or similar insurance,
144	or automobile medical-payment insurance.
145	(d) For purposes of this subsection, any insurer that
146	issues any group health benefit plan as defined in s.
147	627.6699(3)(k), except for policies issued to provide coverage
148	to groups of persons of whom are in the same or functionally
149	related licensed professions, and providing coverage only to
150	such licensed professionals, their employees or their
151	dependents, under which a resident of this state is provided
152	coverage which has been in force for a period of three years,
153	and which applies individual underwriting to determine
154	eligibility or premium rates charged, shall not increase premium
155	rate tables charged to a resident of this state by a percentage
156	greater than the percentage increases applied to premium rate
157	tables charged to a resident of this state for coverage which
158	has been in force for a period of three years under any
159	substantially similar group health benefit plan. The commission
160	may adopt rules to establish the meaning of “substantially
161	similar benefits.” During the first 3 years of coverage, the
162	percentage increase in the premium rate charged to an individual
163	member of an association group for a new rating period may not
164	exceed the sum of the following:
165	1. The percentage change in the new business premium rate
166	measured from the first day of the prior rating period to the
167	first day of the new rating period. In the case of a carrier
168	which is not issuing new health benefit plans covering members
169	of an association group, the carrier shall use the percentage
170	change in the base premium rate.
171	2. An adjustment, not to exceed 20 percent annually and
172	adjusted pro-rata for rating period of less than one year, due
173	to the claim experience, health status or duration of coverage
174	of all individuals with coverage under health benefit plans with
175	the same or similar benefits.
176	3. Any adjustment due to change in coverage or change in
177	the case characteristic of the insured individuals. “Case
178	characteristics” mean demographic or other relevant
179	characteristics of individuals which are considered by the
180	carrier in the determination of premium rates, which may
181	include, but are not limited to, age, gender, geography, family
182	composition, occupation, tobacco-usage, and healthy lifestyle
183	discounts. Case characteristics shall not include claim
184	experience, health status and duration of coverage since issue.
185
186	Nothing herein shall be construed to require uniform rates for
187	substantially similar policies or certificates after their third
188	year of duration, it being the intent and purpose of this law to
189	require uniform maximum percentage rate increases for such
190	policies or certificates issued after the effective date of this
191	subsection. This subsection shall apply to all policies issued
192	or renewed after the effective date of this act. A certification
193	shall be made by a qualified actuary who is a member of the
194	Society of Actuaries or the American Academy of Actuaries and
195	who is qualified in the area of health insurance that the
196	insurer’s premium structure complies with this subsection.
197	(e) For purposes of this subsection, group health benefit
198	plan means any hospital or medical policy, hospital or medical
199	service plan contract, or health maintenance organization
200	subscriber contract. The term does not include accidental
201	death, accidental death and dismemberment, accident-only,
202	vision-only, dental only, hospital indemnity, hospital accident,
203	cancer, specified disease, Medicare supplement, products that
204	supplement Medicare, long-term care, or disability income
205	insurance, similar supplemental plans provided under a separate
206	policy, certificate, or contract of insurance, which can not
207	duplicate coverage under an underlying health plan and are
208	specifically designed to fill gaps in the underlying health
209	plan, coinsurance, or deductibles; coverage issued as a
210	supplement to liability insurance; worker’s compensation, or
211	similar insurance; or automobile medical payment insurance.
212	(11) Any person insured under a certificate issued through
213	a group health benefit plan who voluntarily terminates such
214	certificate shall not be eligible for coverage under any other
215	group health insurance policy issued by the same insurer to that
216	same association for a period of six months from the date such
217	certificate was terminated, unless such new policy is available
218	to all other insureds under the existing policy without regard
219	to health status and at the same rate for all similarly situated
220	individuals. This subsection shall not apply to short-term
221	limited duration health insurance or to new coverage options
222	made available as a result of a change in law subsequent to the
223	initial issuance of a certificate.
224	Section 26. Paragraph (a) of subsection (6) of section
225	627.410, Florida Statutes, is amended to read:
226	627.410 Filing, approval of forms.--
227	(6)(a) An insurer shall not deliver or issue for delivery
228	or renew in this state any health insurance policy form until it
229	has filed with the department a copy of every applicable rating
230	manual, rating schedule, change in rating manual, and change in
231	rating schedule; if rating manuals and rating schedules are not
232	applicable, the insurer must file with the department applicable
233	premium rates and any change in applicable premium rates.
234	(b) This subsectionparagraphdoes not apply to group
235	health insurance policies:,
236	1.Effectuated and delivered in this state, insuring
237	groups of 51 or more persons, except for Medicare supplement
238	insurance, long-term care insurance, and any coverage under
239	which the increase in claim costs over the lifetime of the
240	contract due to advancing age or duration is prefunded in the
241	premium.
242	2.a. Effectuated and delivered outside this state, but
243	covering residents of this state, except for policies issued to
244	provide coverage to groups of persons all of whom are in the
245	same or functionally related licensed professions, and providing
246	coverage only to such licensed professionals, their employees or
247	their dependents, if the insurer meet the requirements of s.
248	627.6515, files its rates with the Office of Insurance
249	Regulation for information purposes only, and the filing of
250	rates is accompanied by an actuarial certification that the loss
251	ratios for the certificates delivered or issue for delivery in
252	this state meet or exceed a loss ratio in each year following
253	the third year of duration for incurred claims to earned premium
254	of 65 percent for group policies, and certificates reflecting
255	coverage thereunder, issued on or after the effective date of
256	this Act. The 65 percent loss ratio does not apply to accidental
257	death, accidental death and dismemberment, accident-only,
258	vision-only, dental only, hospital indemnity, hospital accident,
259	cancer, specified disease, or disability income insurance,
260	similar supplemental plans provided under a separate policy,
261	certificate, or contract of insurance, which can not duplicate
262	coverage under an underlying health plan and are specifically
263	designed to fill gaps in the underlying health plan,
264	coinsurance, or deductibles; coverage issued as a supplement to
265	liability insurance; worker’s compensation, or similar
266	insurance; or automobile medical payment insurance.
267	b. As used in this subsection, the actuarial certification
268	shall be made by a qualified actuary who is a member of the
269	Society of Actuaries or the American Academy of Actuaries and
270	who is qualified in the area of health insurance.
271	b. For purposes of this subsection, group health insurance
272	policy means any hospital or medical policy, hospital or medical
273	service plan contract, or health maintenance organization
274	subscriber contract.  The term does not include accidental
275	death, accidental death and dismemberment, accident-only,
276	vision-only, dental-only, hospital indemnity, hospital accident,
277	cancer, specified disease, limited-benefit, disability income
278	insurance, or similar supplemental plans provided under a
279	separate policy, certificate, or contract of insurance, which
280	can not duplicate coverage under an underlying health plan and
281	are specifically designed to fill gaps in the underlying health
282	plan, coinsurance, or deductibles; coverage issued as a
283	supplement to liability insurance; worker's compensation, or
284	similar insurance; or automobile medical-payment insurance."
285	3. Effectuated and delivered to a bona fide association
286	which means, with respect to health insurance coverage offered
287	in a State, an association which:
288	a. Has been actively in existence for at least 5 years.
289	b. Has been formed and maintained in good faith for
290	purposes other than obtaining insurance.
291	c. Does not condition membership in the association on any
292	health status-related factor relating to an individual,
293	including an employee of an employer or a dependent of an
294	employee.
295	d. Makes health insurance coverage offered through the
296	association available to all members regardless of any health
297	status-related factor relating to such members, or individuals
298	eligible for coverage through a member.
299	e. Does not make health insurance coverage offered through
300	the association available other than in connection with a member
301	of the association.
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305	================= T I T L E A M E N D M E N T =================
306	Remove line(s) 66, and insert:
307	to subscribers; amending s. 627.6515, F.S.; limiting application
308	of certain provisions to group health insurance policies issued
309	or delivered outside the state; providing requirements for
310	certain applications for certificates of coverage; specifying
311	requirements, criteria, and limitations on issuing group health
312	benefit plans; authorizing the commission to adopt rules;
313	providing premium rate increase limitations; providing
314	construction; providing definitions; limiting coverage
315	eligibility under certain circumstances; amending s. 627.410,
316	F.S.; providing additional limitations on applications to group
317	health insurance policies; providing definitions; providing an
318	effective date.