HB 1573 2003
1	CHAMBER ACTION
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6	The Committee on Health Care recommends the following:
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8	Committee Substitute
9	Remove the entire bill and insert:
10	A bill to be entitled
11	An act relating to health insurance; amending s. 395.301,
12	F.S.; requiring certain licensed facilities to make certain
13	information public electronically; requiring notice;
14	requiring an electronic link to an agency website;
15	requiring certain health care facilities to provide
16	patients with reasonable estimates of prospective charges;
17	amending s. 408.909, F.S.; revising a definition;
18	authorizing plans to limit the term of coverage; extending
19	the required period without coverage before participation
20	eligibility; authorizing a business purchasing arrangement
21	sponsored by a local government subject to specified
22	limitations; extending a program expiration date; amending
23	s. 627.410, F.S.; exempting individuals and certain groups
24	from laws restricting or limiting coinsurance, copayments,
25	or annual or lifetime maximum payments; creating s.
26	627.6410, F.S.; providing for optional coverage in health
27	insurance policies for speech, language, swallowing, and
28	hearing disorders; providing exclusion; providing
29	exceptions; providing a limitation; amending s. 627.6487,
30	F.S.; revising a definition of "eligible individual" for
31	purposes of availability of individual health insurance
32	coverage; authorizing insurers to impose certain surcharges
33	or premium charges for creditable coverage earned in
34	certain states; amending s. 627.6561, F.S.; requiring
35	additional information in a certification relating to
36	certain creditable coverage for purposes of eligibility for
37	exclusion from preexisting condition requirements; amending
38	s. 627.667, F.S.; deleting a limitation on certain
39	application of extension of benefits provisions; creating
40	s. 627.66912, F.S.; providing for optional coverage in
41	group, blanket, and franchise health insurance policies for
42	speech, language, swallowing, and hearing disorders;
43	providing exclusion; providing exceptions; providing a
44	limitation; amending s. 627.6692, F.S.; extending a time
45	period for continuation of certain coverage under group
46	health plans; amending s. 627.6699, F.S.; revising certain
47	definitions; revising enrollment period criteria for
48	certain health benefit plans; requiring small employers to
49	provide certain health benefit plan information to
50	employees; providing a limitation; revising certain rate
51	adjustment criteria; authorizing separation of experience
52	of certain small employer groups for certain purposes;
53	amending s. 641.31, F.S.; specifying nonapplication of
54	certain health maintenance contract filing requirements to
55	certain group health insurance policies, with exceptions;
56	requiring health maintenance organizations to make available
57	coverage for certain speech, language, swallowing, and
58	hearing disorders or conditions, subject to certain
59	criteria and limits; creating s. 641.31075, F.S.; providing
60	compliance requirements for health maintenance
61	organizations replacing certain coverages; amending s.
62	641.3111, F.S.; providing additional requirements for
63	extension of benefits under group health maintenance
64	contracts; amending s. 641.54, F.S.; requiring health
65	maintenance organizations to provide specific information
66	to subscribers; providing severability; providing an
67	effective date.
68
69	Be It Enacted by the Legislature of the State of Florida:
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71	Section 1. Subsections (7) and (8) are added to section
72	395.301, Florida Statutes, to read:
73	395.301 Itemized patient bill; form and content prescribed
74	by the agency.--
75	(7) Each licensed facility not operated by the state shall
76	make available to the public on its Internet website or by other
77	electronic means a list of charges for the top 20 percent of the
78	most frequently used charge items in each hospital’s charge
79	master for both inpatient and outpatient services. The list
80	shall be updated monthly. The facility shall place a notice in
81	the reception areas that such information is available
82	electronically and the website address and provide an electronic
83	link to the agency's website to determine the average charge per
84	diagnosis-related groups that is available.
85	(8) Each licensed facility not operated by the state
86	shall, upon request of a prospective patient prior to the
87	provision of medical services, provide a reasonable estimate of
88	charges for the proposed service. Such estimate shall not
89	preclude the actual charges from exceeding the estimate based on
90	changes in the patient’s medical condition or the treatment
91	needs of the patient as determined by the attending and
92	consulting physicians.
93	Section 2. Paragraph (e) of subsection (2), subsection
94	(3), paragraph(c) of subsection (5), and subsection (10) of
95	section 408.909, Florida Statutes, are amended to read:
96	408.909 Health flex plans.--
97	(2) DEFINITIONS.--As used in this section, the term:
98	(e) "Health flex plan" means a health plan approved under
99	subsection (3) which guarantees payment for specified health
100	care coverage provided to the enrollee who purchases coverage
101	directly from the plan or through a small business purchasing
102	arrangement sponsored by a local government.
103	(3) PILOT PROGRAM.--The agency and the department shall
104	each approve or disapprove health flex plans that provide health
105	care coverage for eligible participants who reside in the three
106	areas of the state that have the highest number of uninsured
107	persons, as identified in the Florida Health Insurance Study
108	conducted by the agency and in Indian River County. A health
109	flex plan may limit or exclude benefits otherwise required by
110	law for insurers offering coverage in this state, may cap the
111	total amount of claims paid per year per enrollee, may limit the
112	number of enrollees or the term of coverage, or may take any
113	combination of those actions.
114	(a) The agency shall develop guidelines for the review of
115	applications for health flex plans and shall disapprove or
116	withdraw approval of plans that do not meet or no longer meet
117	minimum standards for quality of care and access to care.
118	(b) The department shall develop guidelines for the review
119	of health flex plan applications and shall disapprove or shall
120	withdraw approval of plans that:
121	1. Contain any ambiguous, inconsistent, or misleading
122	provisions or any exceptions or conditions that deceptively
123	affect or limit the benefits purported to be assumed in the
124	general coverage provided by the health flex plan;
125	2. Provide benefits that are unreasonable in relation to
126	the premium charged or contain provisions that are unfair or
127	inequitable or contrary to the public policy of this state, that
128	encourage misrepresentation, or that result in unfair
129	discrimination in sales practices; or
130	3. Cannot demonstrate that the health flex plan is
131	financially sound and that the applicant is able to underwrite
132	or finance the health care coverage provided.
133	(c) The agency and the department may adopt rules as
134	needed to administer this section.
135	(5) ELIGIBILITY.--Eligibility to enroll in an approved
136	health flex plan is limited to residents of this state who:
137	(c) Are not covered by a private insurance policy and are
138	not eligible for coverage through a public health insurance
139	program, such as Medicare or Medicaid, or another public health
140	care program, such as KidCare, and have not been covered at any
141	time during the past 6 months, except that a small business
142	purchasing arrangement sponsored by a local government may limit
143	enrollment to residents of this state who have not been covered
144	at any time during the past 12 months; and
145	(10) EXPIRATION.--This section expires July 1, 20082004.
146	Section 3. Paragraph (b) of subsection (6) of section
147	627.410, Florida Statutes, is amended to read:
148	627.410 Filing, approval of forms.--
149	(6)
150	(b) The department may establish by rule, for each type of
151	health insurance form, procedures to be used in ascertaining the
152	reasonableness of benefits in relation to premium rates and may,
153	by rule, exempt from any requirement of paragraph (a) any health
154	insurance policy form or type thereof (as specified in such
155	rule) to which form or type such requirements may not be
156	practically applied or to which form or type the application of
157	such requirements is not desirable or necessary for the
158	protection of the public. A law restricting or limiting
159	deductibles, coinsurance, copayments, or annual or lifetime
160	maximum payments shall not apply to any health plan policy
161	offered or delivered to an individual or to a group of 51 or
162	more persons that provides coverage as described in s.
163	627.6561(5)(a)2.With respect to any health insurance policy
164	form or type thereof which is exempted by rule from any
165	requirement of paragraph (a), premium rates filed pursuant to
166	ss. 627.640 and 627.662 shall be for informational purposes.
167	Section 4. Section 627.6410, Florida Statutes, is created
168	to read:
169	627.6410 Optional coverage for speech, language,
170	swallowing, and hearing disorders.--
171	(1) Insurers issuing individual health insurance policies
172	in this state shall make available to the policyholder as part
173	of the application for any such policy of insurance, for an
174	appropriate additional premium, the benefits or levels of
175	benefits specified in the December 1999 Florida Medicaid Therapy
176	Services Handbook for genetic or congenital disorders or
177	conditions involving speech, language, swallowing, and hearing
178	and a hearing aid and earmolds benefit at the level of benefits
179	specified in the January 2001 Florida Medicaid Hearing Services
180	Handbook.
181	(2) This section does not apply to specified accident,
182	specified disease, hospital indemnity, limited benefit,
183	disability income, or long-term care insurance policies.
184	(3) Such optional coverage is not required to be offered
185	when substantially similar benefits are included in the policy
186	of insurance issued to the policyholder.
187	(4) This section does not require or prohibit the use of a
188	provider network.
189	(5) This section does not prohibit an insurer from
190	requiring prior authorization for the benefits under this
191	section.
192	Section 5. Paragraph (b) of subsection (3) of section
193	627.6487, Florida Statutes, is amended, and paragraph (c) is
194	added to subsection (4) of said section, to read:
195	627.6487 Guaranteed availability of individual health
196	insurance coverage to eligible individuals.--
197	(3) For the purposes of this section, the term "eligible
198	individual" means an individual:
199	(b) Who is not eligible for coverage under:
200	1. A group health plan, as defined in s. 2791 of the
201	Public Health Service Act;
202	2. A conversion policy or contract issued by an authorized
203	insurer or health maintenance organization under s. 627.6675 or
204	s. 641.3921, respectively, offered to an individual who is no
205	longer eligible for coverage under either an insured or self-
206	insured group healthemployer plan or group health insurance
207	policy;
208	3. Part A or part B of Title XVIII of the Social Security
209	Act; or
210	4. A state plan under Title XIX of such act, or any
211	successor program, and does not have other health insurance
212	coverage;
213	(4)
214	(c) If the individual’s most recent period of creditable
215	coverage was earned in a state other than this state, an insurer
216	issuing a policy that complies with paragraph (a) may impose a
217	surcharge or charge a premium for such policy equal to that
218	permitted in the state in which such creditable coverage was
219	earned.
220	Section 6. Paragraph (c) of subsection (8) of section
221	627.6561, Florida Statutes, is amended to read:
222	627.6561 Preexisting conditions.--
223	(8)
224	(c) The certification described in this section is a
225	written certification that must include:
226	1. The period of creditable coverage of the individual
227	under the policy and the coverage, if any, under such COBRA
228	continuation provision or continuation pursuant to s. 627.6692.;
229	and
230	2. The waiting period, if any, imposed with respect to the
231	individual for any coverage under such policy.
232	3. A statement that the creditable coverage was provided
233	under a group health plan, a group or individual health
234	insurance policy, or a health maintenance organization contract,
235	the state in which such coverage was provided, and whether or
236	not such individual was eligible for a conversion policy under
237	such coverage.
238	Section 7. Subsection (6) of section 627.667, Florida
239	Statutes, is amended to read:
240	627.667 Extension of benefits.--
241	(6) This section also applies to holders of group
242	certificates which are renewed, delivered, or issued for
243	delivery to residents of this state under group policies
244	effectuated or delivered outside this state, unless a succeeding
245	carrier under a group policy has agreed to assume liability for
246	the benefits.
247	Section 8. Section 627.66912, Florida Statutes, is created
248	to read:
249	627.66912 Optional coverage for speech, language,
250	swallowing, and hearing disorders.--
251	(1) Insurers issuing group health insurance policies in
252	this state shall make available to the policyholder as part of
253	the application for any such policy of insurance, for an
254	appropriate additional premium, the benefits or levels of
255	benefits specified in the December 1999 Florida Medicaid Therapy
256	Services Handbook for genetic or congenital disorders or
257	conditions involving speech, language, swallowing, and hearing
258	and a hearing aid and earmolds benefit at the level of benefits
259	specified in the January 2001 Florida Medicaid Hearing Services
260	Handbook.
261	(2) This section does not apply to specified accident,
262	specified disease, hospital indemnity, limited benefit,
263	disability income, or long-term care insurance policies.
264	(3) Such optional coverage is not required to be offered
265	when substantially similar benefits are included in the policy
266	of insurance issued to the policyholder.
267	(4) This section does not require or prohibit the use of a
268	provider network.
269	(5) This section does not prohibit an insurer from
270	requiring prior authorization for the benefits under this
271	section.
272	Section 9. Paragraph (e) of subsection (5) of section
273	627.6692, Florida Statutes, is amended to read:
274	627.6692 Florida Health Insurance Coverage Continuation
275	Act.--
276	(5) CONTINUATION OF COVERAGE UNDER GROUP HEALTH PLANS.--
277	(e)1. A covered employee or other qualified beneficiary
278	who wishes continuation of coverage must pay the initial premium
279	and elect such continuation in writing to the insurance carrier
280	issuing the employer's group health plan within 6330days after
281	receiving notice from the insurance carrier under paragraph (d).
282	Subsequent premiums are due by the grace period expiration date.
283	The insurance carrier or the insurance carrier's designee shall
284	process all elections promptly and provide coverage
285	retroactively to the date coverage would otherwise have
286	terminated. The premium due shall be for the period beginning on
287	the date coverage would have otherwise terminated due to the
288	qualifying event. The first premium payment must include the
289	coverage paid to the end of the month in which the first payment
290	is made. After the election, the insurance carrier must bill the
291	qualified beneficiary for premiums once each month, with a due
292	date on the first of the month of coverage and allowing a 30-day
293	grace period for payment.
294	2. Except as otherwise specified in an election, any
295	election by a qualified beneficiary shall be deemed to include
296	an election of continuation of coverage on behalf of any other
297	qualified beneficiary residing in the same household who would
298	lose coverage under the group health plan by reason of a
299	qualifying event. This subparagraph does not preclude a
300	qualified beneficiary from electing continuation of coverage on
301	behalf of any other qualified beneficiary.
302	Section 10. Paragraphs (h) and (u) of subsection (3),
303	paragraph(c) of subsection (5), and paragraph (b) of
304	subsection(6) of section 627.6699, Florida Statutes, are
305	amended, and paragraph (k) is added to subsection (5) of said
306	section, to read:
307	627.6699 Employee Health Care Access Act.--
308	(3) DEFINITIONS.--As used in this section, the term:
309	(h) "Eligible employee" means an employee who works full
310	time, having a normal workweek of 25 or more hours and is paid
311	wages or a salary at least equal to the federal minimum hourly
312	wage applicable to such employee, and who has met any applicable
313	waiting-period requirements or other requirements of this act.
314	The term includes a self-employed individual, a sole proprietor,
315	a partner of a partnership, or an independent contractor, if the
316	sole proprietor, partner, or independent contractor is included
317	as an employee under a health benefit plan of a small employer,
318	but does not include a part-time, temporary, or substitute
319	employee.
320	(u) "Self-employed individual" means an individual or sole
321	proprietor who derives his or her income from a trade or
322	business carried on by the individual or sole proprietor which
323	necessitates that the individual file federal income tax forms,
324	with supporting schedules and accompanying income reporting
325	forms, or federal income tax extensions of time to file forms
326	with the Internal Revenue Service for the most recent tax year
327	results in taxable income as indicated on IRS Form 1040,
328	schedule C or F, and which generated taxable income in one of
329	the 2 previous years.
330	(5) AVAILABILITY OF COVERAGE.--
331	(c) Every small employer carrier must, as a condition of
332	transacting business in this state:
333	1. Beginning July 1, 2000, offer and issue all small
334	employer health benefit plans on a guaranteed-issue basis to
335	every eligible small employer, with 2 to 50 eligible employees,
336	that elects to be covered under such plan, agrees to make the
337	required premium payments, and satisfies the other provisions of
338	the plan. A rider for additional or increased benefits may be
339	medically underwritten and may only be added to the standard
340	health benefit plan. The increased rate charged for the
341	additional or increased benefit must be rated in accordance with
342	this section.
343	2. Beginning July 1, 2000, and until July 31, 2001, offer
344	and issue basic and standard small employer health benefit plans
345	on a guaranteed-issue basis to every eligible small employer
346	which is eligible for guaranteed renewal, has less than two
347	eligible employees, is not formed primarily for the purpose of
348	buying health insurance, elects to be covered under such plan,
349	agrees to make the required premium payments, and satisfies the
350	other provisions of the plan. A rider for additional or
351	increased benefits may be medically underwritten and may be
352	added only to the standard benefit plan. The increased rate
353	charged for the additional or increased benefit must be rated in
354	accordance with this section. For purposes of this subparagraph,
355	a person, his or her spouse, and his or her dependent children
356	shall constitute a single eligible employee if that person and
357	spouse are employed by the same small employer and either one
358	has a normal work week of less than 25 hours.
359	3. Beginning June 1, 2004August 1, 2001, offer and issue
360	basic and standard small employer health benefit plans on a
361	guaranteed-issue basis, during a 30-day open enrollment period
362	of June 1 through June 30 and during a31-day open enrollment
363	period of DecemberAugust 1 through DecemberAugust31 of each
364	year, to every eligible small employer, with fewer than two
365	eligible employees, which small employer is not formed primarily
366	for the purpose of buying health insurance and which elects to
367	be covered under such plan, agrees to make the required premium
368	payments, and satisfies the other provisions of the plan.
369	Coverage provided under this subparagraph shall begin 60 days
370	afteron October 1 of the same year asthe date of enrollment,
371	unless the small employer carrier and the small employer agree
372	to a different date. A rider for additional or increased
373	benefits may be medically underwritten and may only be added to
374	the standard health benefit plan. The increased rate charged for
375	the additional or increased benefit must be rated in accordance
376	with this section. For purposes of this subparagraph, a person,
377	his or her spouse, and his or her dependent children constitute
378	a single eligible employee if that person and spouse are
379	employed by the same small employer and either that person or
380	his or her spouse has a normal work week of less than 25 hours.
381	4. This paragraph does not limit a carrier's ability to
382	offer other health benefit plans to small employers if the
383	standard and basic health benefit plans are offered and
384	rejected.
385	(k) Beginning January 1, 2004, every small employer shall
386	provide, on an annual basis, information on at least three
387	different health benefit plans for employees. Nothing in this
388	paragraph shall be construed as requiring a small employer to
389	provide the health benefit plan or contribute to the cost of
390	such plan. Nothing in this paragraph shall be construed as
391	requiring a small employer or an individual carrier to offer
392	these health plan benefits on a guaranteed-issue basis.
393	(6) RESTRICTIONS RELATING TO PREMIUM RATES.--
394	(b) For all small employer health benefit plans that are
395	subject to this section and are issued by small employer
396	carriers on or after January 1, 1994, premium rates for health
397	benefit plans subject to this section are subject to the
398	following:
399	1. Small employer carriers must use a modified community
400	rating methodology in which the premium for each small employer
401	must be determined solely on the basis of the eligible
402	employee's and eligible dependent's gender, age, family
403	composition, tobacco use, or geographic area as determined under
404	paragraph (5)(j) and in which the premium may be adjusted as
405	permitted by this paragraph.
406	2. Rating factors related to age, gender, family
407	composition, tobacco use, or geographic location may be
408	developed by each carrier to reflect the carrier's experience.
409	The factors used by carriers are subject to department review
410	and approval.
411	3. Small employer carriers may not modify the rate for a
412	small employer for 12 months from the initial issue date or
413	renewal date, unless the composition of the group changes or
414	benefits are changed. However, a small employer carrier may
415	modify the rate one time prior to 12 months after the initial
416	issue date for a small employer who enrolls under a previously
417	issued group policy that has a common anniversary date for all
418	employers covered under the policy if:
419	a. The carrier discloses to the employer in a clear and
420	conspicuous manner the date of the first renewal and the fact
421	that the premium may increase on or after that date.
422	b. The insurer demonstrates to the department that
423	efficiencies in administration are achieved and reflected in the
424	rates charged to small employers covered under the policy.
425	4. A carrier may issue a group health insurance policy to
426	a small employer health alliance or other group association with
427	rates that reflect a premium credit for expense savings
428	attributable to administrative activities being performed by the
429	alliance or group association if such expense savings are
430	specifically documented in the insurer's rate filing and are
431	approved by the department. Any such credit may not be based on
432	different morbidity assumptions or on any other factor related
433	to the health status or claims experience of any person covered
434	under the policy. Nothing in this subparagraph exempts an
435	alliance or group association from licensure for any activities
436	that require licensure under the insurance code. A carrier
437	issuing a group health insurance policy to a small employer
438	health alliance or other group association shall allow any
439	properly licensed and appointed agent of that carrier to market
440	and sell the small employer health alliance or other group
441	association policy. Such agent shall be paid the usual and
442	customary commission paid to any agent selling the policy.
443	5. Any adjustments in rates for claims experience, health
444	status, or duration of coverage may not be charged to individual
445	employees or dependents. For a small employer's policy, such
446	adjustments may not result in a rate for the small employer
447	which deviates more than 15 percent from the carrier's approved
448	rate. Any such adjustment must be applied uniformly to the rates
449	charged for all employees and dependents of the small employer.
450	A small employer carrier may make an adjustment to a small
451	employer's renewal premium, not to exceed 10 percent annually,
452	due to the claims experience, health status, or duration of
453	coverage of the employees or dependents of the small employer.
454	Semiannually, small group carriers shall report information on
455	forms adopted by rule by the department, to enable the
456	department to monitor the relationship of aggregate adjusted
457	premiums actually charged policyholders by each carrier to the
458	premiums that would have been charged by application of the
459	carrier's approved modified community rates. If the aggregate
460	resulting from the application of such adjustment exceeds the
461	premium that would have been charged by application of the
462	approved modified community rate by 35percent for the current
463	reporting period, the carrier shall limit the application of
464	such adjustments only to minus adjustments beginning not more
465	than 60 days after the report is sent to the department. For any
466	subsequent reporting period, if the total aggregate adjusted
467	premium actually charged does not exceed the premium that would
468	have been charged by application of the approved modified
469	community rate by 35percent, the carrier may apply both plus
470	and minus adjustments. A small employer carrier may provide a
471	credit to a small employer's premium based on administrative and
472	acquisition expense differences resulting from the size of the
473	group. Group size administrative and acquisition expense factors
474	may be developed by each carrier to reflect the carrier's
475	experience and are subject to department review and approval.
476	6. A small employer carrier rating methodology may include
477	separate rating categories for one dependent child, for two
478	dependent children, and for three or more dependent children for
479	family coverage of employees having a spouse and dependent
480	children or employees having dependent children only. A small
481	employer carrier may have fewer, but not greater, numbers of
482	categories for dependent children than those specified in this
483	subparagraph.
484	7. Small employer carriers may not use a composite rating
485	methodology to rate a small employer with fewer than 10
486	employees. For the purposes of this subparagraph, a "composite
487	rating methodology" means a rating methodology that averages the
488	impact of the rating factors for age and gender in the premiums
489	charged to all of the employees of a small employer.
490	8.a. A carrier may separate the experience of small
491	employer groups with less than 2 eligible employees from the
492	experience of small employer groups with 2-50 eligible employees
493	for purposes of determining an alternative modified community
494	rating.
495	b. If a carrier separates the experience of small employer
496	groups as provided in sub-subparagraph a., the rate to be
497	charged to small employer groups of less than 2 eligible
498	employees may not exceed 150 percent of the rate determined for
499	small employer groups of 2-50 eligible employees. However, the
500	carrier may charge excess losses of the experience pool
501	consisting of small employer groups with less than 2 eligible
502	employees to the experience pool consisting of small employer
503	groups with 2-50 eligible employees so that all losses are
504	allocated and the 150-percent rate limit on the experience pool
505	consisting of small employer groups with less than 2 eligible
506	employees is maintained. Notwithstanding s. 627.411(1), the rate
507	to be charged to a small employer group of fewer than 2 eligible
508	employees, insured as of July 1, 2002, may be up to 125 percent
509	of the rate determined for small employer groups of 2-50
510	eligible employees for the first annual renewal and 150 percent
511	for subsequent annual renewals.
512	9. In addition to the separation allowed under sub-
513	subparagraph 8.a., a carrier may also separate the experience of
514	small employer groups of 1-50 eligible employees using a health
515	reimbursement arrangement, as defined in Internal Revenue
516	Service Notice 2002-45, 2002-28 Internal Revenue Bulletin 93,
517	and Revenue Ruling 2002-41, 2002-28 Internal Revenue Bulletin
518	75, from the experience of small employer groups of 1-50
519	eligible employees not using such a health reimbursement
520	arrangement for purposes of determining an alternative modified
521	community rating.
522	Section 11. Subsection (2) and paragraph (d) of subsection
523	(3) of section 641.31, Florida Statutes, are amended, and
524	subsection (40) is added to said section, to read:
525	641.31 Health maintenance contracts.--
526	(2) The rates charged by any health maintenance
527	organization to its subscribers shall not be excessive,
528	inadequate, or unfairly discriminatory or follow a rating
529	methodology that is inconsistent, indeterminate, or ambiguous or
530	encourages misrepresentation or misunderstanding. A law
531	restricting or limiting deductibles, coinsurance, copayments, or
532	annual or lifetime maximum payments shall not apply to any
533	health maintenance organization contract offered or delivered to
534	an individual or a group of 51 or more persons that provides
535	coverage as described in s. 641.31071(5)(a)2.The department, in
536	accordance with generally accepted actuarial practice as applied
537	to health maintenance organizations, may define by rule what
538	constitutes excessive, inadequate, or unfairly discriminatory
539	rates and may require whatever information it deems necessary to
540	determine that a rate or proposed rate meets the requirements of
541	this subsection.
542	(3)
543	(d) Any change in rates charged for the contract must be
544	filed with the department not less than 30 days in advance of
545	the effective date. At the expiration of such 30 days, the rate
546	filing shall be deemed approved unless prior to such time the
547	filing has been affirmatively approved or disapproved by order
548	of the department. The approval of the filing by the department
549	constitutes a waiver of any unexpired portion of such waiting
550	period. The department may extend by not more than an additional
551	15 days the period within which it may so affirmatively approve
552	or disapprove any such filing, by giving notice of such
553	extension before expiration of the initial 30-day period. At the
554	expiration of any such period as so extended, and in the absence
555	of such prior affirmative approval or disapproval, any such
556	filing shall be deemed approved. This paragraph does not apply
557	to group health contracts effectuated and delivered in this
558	state insuring groups of 51 or more persons, except for Medicare
559	supplement insurance, long-term care insurance, and any coverage
560	under which the increase in claims costs over the lifetime of
561	the contract due to advancing age or duration is refunded in the
562	premium.
563	(40) Health maintenance organizations shall make available
564	to the contract holder as part of the application for any such
565	contract, for an appropriate additional premium, the benefits or
566	level of benefits specified in the December 1999 Florida
567	Medicaid Therapy Services Handbook for genetic or congenital
568	disorders or conditions involving speech, language, swallowing,
569	and hearing and a hearing aid and earmolds benefit at the level
570	of benefits specified in the January 2001 Florida Medicaid
571	Hearing Services Handbook.
572	Section 12. Section 641.31075, Florida Statutes, is
573	created to read:
574	641.31075 Requirements for replacing health coverage.--Any
575	health maintenance organization that is replacing any other
576	group health coverage with its group health maintenance coverage
577	shall comply with s. 627.666.
578	Section 13. Subsection (1) of section 641.3111, Florida
579	Statutes, is amended to read:
580	641.3111 Extension of benefits.--
581	(1) Every group health maintenance contract shall provide
582	that termination of the contract shall be without prejudice to
583	any continuous loss which commenced while the contract was in
584	force, but any extension of benefits beyond the period the
585	contract was in force may be predicated upon the continuous
586	total disability of the subscriber and may be limited to payment
587	for the treatment of a specific accident or illness incurred
588	while the subscriber was a member. The extension is required
589	regardless of whether the group contract holder or other entity
590	secures replacement coverage from a new insurer or health
591	maintenance organization or foregoes the provision of coverage.
592	The required provision must provide for continuation of contract
593	benefits in connection with the treatment of a specific accident
594	or illness incurred while the contract was in effect.Such
595	extension of benefits may be limited to the occurrence of the
596	earliest of the following events:
597	(a) The expiration of 12 months.
598	(b) Such time as the member is no longer totally disabled.
599	(c) A succeeding carrier elects to provide replacement
600	coverage without limitation as to the disability condition.
601	(d) The maximum benefits payable under the contract have
602	been paid.
603	Section 14. Subsection (6) is added to section 641.54,
604	Florida Statutes, to read:
605	641.54 Information disclosure.--
606	(6) Every health maintenance organization shall make
607	available to its subscribers the estimated co-pay, co-insurance,
608	or deductible, whichever is applicable, for any covered service,
609	the status of the subscriber’s maximum annual out-of-pocket
610	payments for a covered individual or family, and the status of
611	the subscriber’s maximum lifetime benefit. Each health
612	maintenance organization shall, upon request of a subscriber,
613	provide an estimate of the amount the health maintenance
614	organization will pay for a particular medical procedure or
615	service. The estimate may be in the form of a range of payments
616	or an average payment. A health maintenance organization that
617	provides a subscriber with a good faith estimate is not bound by
618	the estimate.
619	Section 15. If any provision of this act or the
620	application thereof to any person or circumstance is held
621	invalid, the invalidity shall not affect other provisions or
622	applications of the act which can be given effect without the
623	invalid provision or application, and to this end the provisions
624	of this act are declared severable.
625	Section 16. This act shall take effect upon becoming a
626	law.