HB 1881 2003
1	A bill to be entitled
2	An act relating to state employee health insurance;
3	providing a popular name; amending s. 110.123, F.S.;
4	revising the terms of coverage and payment for officers
5	and employees participating in state employee group health
6	insurance; amending s. 110.161, F.S., specifying that
7	employees of state universities are state employees
8	eligible participating in the state pretax benefits
9	programs; amending s. 1001.74, F.S., adding a cross
10	reference to specify that state university system
11	employees are eligible to participate in the state pretax
12	benefits program; providing an effective date.
13
14	Be It Enacted by the Legislature of the State of Florida:
15
16	Section 1. Paragraphs (e), (i), and (k) of subsection (2),
17	paragraphs (b), (c), (f), (g), and (h) of subsection (3),
18	paragraphs (c), (d), and (e) of subsection (4), paragraph (d) of
19	subsection (5), and paragraph (b) of subsection (8) of section
20	110.123, Florida Statutes, are amended to read:
21	110.123 State group insurance program.--
22	(2) DEFINITIONS.--As used in this section, the term:
23	(e) "Health plan member" means any person participating in
24	athestate group health insurance plan or in a health
25	maintenance organization plan under the state group insurance
26	program, including enrollees and covered dependents thereof.
27	(i) "State group health insurance plan" or "state plan"
28	means anythestate self-insured health insurance plan offered
29	to state officers and employees, retired state officers and
30	employees, and surviving spouses of deceased state officers and
31	employees as provided by lawpursuant to this section.
32	(k) "State group insurance program" or "programs" means
33	the package of insurance plans offered to state officers and
34	employees, retired state officers and employees, and surviving
35	spouses of deceased state officers and employees pursuant to
36	this section, including the state group health insurance plan,
37	health maintenance organization plans, and other plans required
38	or authorized by lawthis section.
39	(3) STATE GROUP INSURANCE PROGRAM.--
40	(b) It is the intent of the Legislature to offer a
41	comprehensive package of health insurance and retirement
42	benefits and a personnel system for state employees which are
43	provided in a cost-efficient and prudent manner, and to allow
44	state employees the option to choose benefit plans which best
45	suit their individual needs. Therefore, the state group
46	insurance program is established which may include anythestate
47	group health insurance plan, health maintenance organization
48	plans, group life insurance plans, group accidental death and
49	dismemberment plans, and group disability insurance plans.
50	Furthermore, the department is additionally authorized to
51	establish and provide as part of the state group insurance
52	program any other group insurance plans or coverage choices
53	which are consistent with benefit plans offered in the open
54	marketthe provisions of this section.
55	(c) Notwithstanding any provision in this section to the
56	contrary, it is the intent of the Legislature that the
57	department shall be responsible for all aspects of the purchase
58	of health care for state employees under the state group health
59	insurance plan and the health maintenance organization plans.
60	Responsibilities shall include, but not be limited to, the
61	development of requests for proposals or invitations to
62	negotiatefor state employee health services, the determination
63	of health care benefits to be provided, and the negotiation of
64	contracts for health care and health care administrative
65	services. Prior to the negotiation of contracts for health care
66	services, the Legislature intends that the department shall
67	develop, with respect to state collective bargaining issues, the
68	health benefits and terms to be included in the state group
69	health insurance program. The department shall adopt rules
70	necessary to perform its responsibilities pursuant to this
71	section. It is the intent of the Legislature that the department
72	shall be responsible for the contract management and day-to-day
73	management of the state employee health insurance program,
74	including, but not limited to, employee enrollment, premium
75	collection, payment to health care providers, and other
76	administrative functions related to the program.
77	(f) Except as provided for in subparagraph (h)2., the
78	amountpercentageof state contribution toward the cost of any
79	plan in the state group insurance program shall be uniform with
80	respect to all state employees in state collective bargaining
81	units participating in the same plan optionor any similar plan.
82	Nothing contained within this section prohibits the development
83	of separate benefit plans for officers and employees exempt from
84	collective bargaining or the development of separate benefit
85	plans for each collective bargaining unit.
86	(g) Participation by individuals in the program shall be
87	available to all state officers, full-time state employees, and
88	part-time state employees; and such participation in the program
89	or any plan thereof shall be voluntary. Participation in the
90	program shall also be available to retired state officers and
91	employees, as defined in paragraph (2)(g), who elect at the time
92	of retirement to continue coverage under the program, but they
93	may elect to continue all or only part of the coverage they had
94	at the time of retirement. A surviving spouse may elect to
95	continue coverage only under athestate group health insurance
96	plan or a health maintenance organization plan.
97	(h)1. A person eligible to participate in the state group
98	insurance program may be authorized by rules adopted by the
99	department, in lieu of participating in athestate group health
100	insurance plan, to exercise an option to elect membership in a
101	health maintenance organization plan which is under contract
102	with the state in accordance with criteria established by this
103	section and by said rules. The offer of optional membership in a
104	health maintenance organization plan permitted by this paragraph
105	may be limited or conditioned by rule as may be necessary to
106	meet the requirements of state and federal laws.
107	2. The department shall contract with health maintenance
108	organizations seeking to participate in the state group
109	insurance program through a request for proposal or other
110	procurement process, as developed by the Department of
111	Management Services and determined to be appropriate.
112	a. The department shall establish a schedule of minimum
113	benefits for health maintenance organization coverage, and that
114	schedule shall include: physician services; inpatient and
115	outpatient hospital services; emergency medical services,
116	including out-of-area emergency coverage; diagnostic laboratory
117	and diagnostic and therapeutic radiologic services; mental
118	health, alcohol, and chemical dependency treatment services
119	meeting the minimum requirements of state and federal law;
120	skilled nursing facilities and services; prescription drugs;
121	age-based and gender-based wellness benefitsand other benefits
122	as may be required by the department. Additional services may be
123	provided subject to the contract between the department and the
124	HMO.
125	b. The department may establish uniform deductibles,
126	copayments, coverage tiers,or coinsurance schedules for all
127	participating HMO plans.
128	c. The department may require detailed information from
129	each health maintenance organization participating in the
130	procurement process, including information pertaining to
131	organizational status, experience in providing prepaid health
132	benefits, accessibility of services, financial stability of the
133	plan, quality of management services, accreditation status,
134	quality of medical services, network access and adequacy,
135	performance measurement, ability to meet the department's
136	reporting requirements, and the actuarial basis of the proposed
137	rates and other data determined by the director to be necessary
138	for the evaluation and selection of health maintenance
139	organization plans and negotiation of appropriate rates for
140	these plans. Upon receipt of proposals by health maintenance
141	organization plans and the evaluation of those proposals, the
142	department may enter into negotiations with all of the plans or
143	a subset of the plans, as the department determines appropriate.
144	Nothing shall preclude the department from negotiating regional
145	or statewide contracts with health maintenance organization
146	plans when this is cost-effective and when the department
147	determines that the plan offers high value to enrollees.
148	d. The department may limit the number of HMOs that it
149	contracts with in each service area based on the nature of the
150	bids the department receives, the number of state employees in
151	the service area, or any unique geographical characteristics of
152	the service area. The department shall establish by rule service
153	areas throughout the state.
154	e. All persons participating in the state group insurance
155	program who are required to contribute towards a total state
156	group health premium shall be subject to a specificthe same
157	dollar contribution which may vary depending upon the plan
158	option selectedregardless of whether the enrollee enrolls in
159	the state group health insurance plan or in an HMO plan.
160	3. The department is authorized to negotiate and to
161	contract with specialty psychiatric hospitals for mental health
162	benefits, on a regional basis, for alcohol, drug abuse, and
163	mental and nervous disorders. The department may establish,
164	subject to the approval of the Legislature pursuant to
165	subsection (5), any such regional plan upon completion of an
166	actuarial study to determine any impact on plan benefits and
167	premiums.
168	4. In addition to contracting pursuant to subparagraph 2.,
169	the department mayshallenter into contract with any HMO to
170	participate in the state group insurance program which:
171	a. Serves greater than 5,000 recipients on a prepaid basis
172	under the Medicaid program;
173	b. Does not currently meet the 25-percent non-
174	Medicare/non-Medicaid enrollment composition requirement
175	established by the Department of Health excluding participants
176	enrolled in the state group insurance program;
177	c. Meets the minimum benefit package and copayments and
178	deductibles contained in sub-subparagraphs 2.a. and b.;
179	d. Is willing to participate in the state group insurance
180	program at a cost of premiums that is not greater than 95
181	percent of the cost of HMO premiums accepted by the department
182	in each service area; and
183	e. Meets the minimum surplus requirements of s. 641.225.
184
185	The department is authorized to contract with HMOs that meet the
186	requirements of sub-subparagraphs a.-d. prior to the open
187	enrollment period for state employees. The department is not
188	required to renew the contract with the HMOs as set forth in
189	this paragraph more than twice. Thereafter, the HMOs shall be
190	eligible to participate in the state group insurance program
191	only through the request for proposal or invitation to negotiate
192	process described in subparagraph 2.
193	5. All enrollees in anythestate group health insurance
194	plan or any health maintenance organization plan shall have the
195	option of changing to any other health plan which is offered by
196	the state within any open enrollment period designated by the
197	department. Open enrollment shall be held at least once each
198	calendar year.
199	6. When a contract between a treating provider and the
200	state-contracted health maintenance organization is terminated
201	for any reason other than for cause, each party shall allow any
202	enrollee for whom treatment was active to continue coverage and
203	care when medically necessary, through completion of treatment
204	of a condition for which the enrollee was receiving care at the
205	time of the termination, until the enrollee selects another
206	treating provider, or until the next open enrollment period
207	offered, whichever is longer, but no longer than 6 months after
208	termination of the contract. Each party to the terminated
209	contract shall allow an enrollee who has initiated a course of
210	prenatal care, regardless of the trimester in which care was
211	initiated, to continue care and coverage until completion of
212	postpartum care. This does not prevent a provider from refusing
213	to continue to provide care to an enrollee who is abusive,
214	noncompliant, or in arrears in payments for services provided.
215	For care continued under this subparagraph, the program and the
216	provider shall continue to be bound by the terms of the
217	terminated contract. Changes made within 30 days before
218	termination of a contract are effective only if agreed to by
219	both parties.
220	7. Any HMO participating in the state group insurance
221	program shall submit health care utilization and cost data to
222	the department, in such form and in such manner as the
223	department shall require, as a condition of participating in the
224	program. The department shall enter into negotiations with its
225	contracting HMOs to determine the nature and scope of the data
226	submission and the final requirements, format, penalties
227	associated with noncompliance, and timetables for submission.
228	These determinations shall be adopted by rule.
229	8. The department may establish and direct, with respect
230	to collective bargaining issues, a comprehensive package of
231	insurance benefits that may include supplemental health and life
232	coverage, dental care, long-term care, vision care, and other
233	benefits it determines necessary to enable state employees to
234	select from among benefit options that best suit their
235	individual and family needs.
236	a. Based upon a desired benefit package, the department
237	shall issue a request for proposal or invitation to negotiate
238	for health insurance providers interested in participating in
239	the state group insurance program, and the department shall
240	issue a request for proposal or invitation to negotiatefor
241	insurance providers interested in participating in the non-
242	health-related components of the state group insurance program.
243	Upon receipt of all proposals, the department may enter into
244	contract negotiations with insurance providers submitting bids
245	or negotiate a specially designed benefit package. Insurance
246	providers offering or providing supplemental coverage as of May
247	30, 1991, which qualify for pretax benefit treatment pursuant to
248	s. 125 of the Internal Revenue Code of 1986, with 5,500 or more
249	state employees currently enrolled may be included by the
250	department in the supplemental insurance benefit plan
251	established by the department without participating in a request
252	for proposal, submitting bids, negotiating contracts, or
253	negotiating a specially designed benefit package. These
254	contracts shall provide state employees with the most cost-
255	effective and comprehensive coverage available; however, no
256	state or agency funds shall be contributed toward the cost of
257	any part of the premium of such supplemental benefit plans. With
258	respect to dental coverage, the division shall include in any
259	solicitation or contract for any state group dental program made
260	after July 1, 2001, a comprehensive indemnity dental plan option
261	which offers enrollees a completely unrestricted choice of
262	dentists. If a dental plan is endorsed, or in some manner
263	recognized as the preferred product, such plan shall include a
264	comprehensive indemnity dental plan option which provides
265	enrollees with a completely unrestricted choice of dentists.
266	b. Pursuant to the applicable provisions of s. 110.161,
267	and s. 125 of the Internal Revenue Code of 1986, the department
268	shall enroll in the pretax benefit program those state employees
269	who voluntarily elect coverage in any of the supplemental
270	insurance benefit plans as provided by sub-subparagraph a.
271	c. Nothing herein contained shall be construed to prohibit
272	insurance providers from continuing to provide or offer
273	supplemental benefit coverage to state employees as provided
274	under existing agency plans.
275	(4) PAYMENT OF PREMIUMS; CONTRIBUTION BY STATE; LIMITATION
276	ON ACTIONS TO PAY AND COLLECT PREMIUMS.--
277	(c) During each policy or budget year, no state agency
278	shall contribute a greater dollar amountpercentageof the
279	premium cost for its officers or employees for any plan option
280	type of coverageunder the state group insurance program than
281	any other agency, nor shall any greater dollar amountpercentage
282	contributionof premium cost be made for employees in one state
283	collective bargaining unit than for those in any other state
284	collective bargaining unit.
285	(d) The state contribution for a part-time permanent state
286	employee who elects to participate in the program shall be
287	prorated so that the amountpercentageof the cost contributed
288	for the part-time permanent employee bears that relation to the
289	amountpercentageof cost contributed for a similar full-time
290	employee that the part-time employee's normal workday bears to a
291	full-time employee's normal workday.
292	(e) No state contribution for the cost of any part of the
293	premium shall be made for retirees or surviving spouses for any
294	type of coverage under the state group insurance program.
295	However, any state agency that employs a full-time law
296	enforcement officer, correctional officer, or correctional
297	probation officer who is killed or suffers catastrophic injury
298	in the line of duty as provided in s. 112.19, or a full-time
299	firefighter who is killed or suffers catastrophic injury in the
300	line of duty as provided in s. 112.191, shall pay the entire
301	premium of the state group health insurance plan selectedfor
302	the employee's surviving spouse until remarried, and for each
303	dependent child of the employee, subject to the conditions and
304	limitations set forth in s. 112.19 or s. 112.191, as applicable.
305	(5) DEPARTMENT POWERS AND DUTIES.--The department is
306	responsible for the administration of the state group insurance
307	program. The department shall initiate and supervise the program
308	as established by this section and shall adopt such rules as are
309	necessary to perform its responsibilities. To implement this
310	program, the department shall, with prior approval by the
311	Legislature:
312	(d) With respect to anythestate group health insurance
313	plan, be authorized to require copayments with respect to all
314	providers under the plan.
315
316	Final decisions concerning enrollment, the existence of
317	coverage, or covered benefits under the state group insurance
318	program shall not be delegated or deemed to have been delegated
319	by the department.
320	(8) COVERAGE FOR LEGISLATIVE MEMBERS AND EMPLOYEES.--
321	(b) Effective July 1, 1999, any legislative member who
322	terminates his or her elected service after July 1, 1999, after
323	having vested in the state retirement system, may purchase
324	coverage in athestate group health insurance plan at the same
325	premium cost as that for retirees and surviving spouses. Such
326	legislators may also elect to continue coverage under the group
327	term life insurance program prevailing for current members at
328	the premium cost in effect for that plan.
329	Section 2. Subsection (2) of section 110.161, Florida
330	Statutes, is amended to read:
331	110.161 State employees; pretax benefits program.--
332	(2) As used in this section, "employee" means any
333	individual filling an authorized and established position in the
334	executive, legislative, or judicial branch of the state,
335	including the employees of the State Board of Administration and
336	the state universities.
337	Section 3. Subsection (19) of section 1001.74, Florida
338	Statutes, is amended to read:
339	1001.74 Powers and duties of university boards of
340	trustees.--
341	(19) Each board of trustees shall establish the personnel
342	program for all employees of the university, including the
343	president, pursuant to the provisions of chapter 1012 and, in
344	accordance with rules and guidelines of the State Board of
345	Education, including: compensation and other conditions of
346	employment, recruitment and selection, nonreappointment,
347	standards for performance and conduct, evaluation, benefits and
348	hours of work, leave policies, recognition and awards,
349	inventions and works, travel, learning opportunities, exchange
350	programs, academic freedom and responsibility, promotion,
351	assignment, demotion, transfer, tenure and permanent status,
352	ethical obligations and conflicts of interest, restrictive
353	covenants, disciplinary actions, complaints, appeals and
354	grievance procedures, and separation and termination from
355	employment. The Department of Management Services shall retain
356	authority over state university employees for programs
357	established in ss. 110.123, 110.1232, 110.1234, and 110.1238,
358	and 110.161and in chapters 121, 122, and 238.
359	Section 4. This act shall take effect July 1, 2003.