HOUSE AMENDMENT Bill No. SB 2020
1	CHAMBER ACTION
2	Senate House
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12	Representative Farkas offered the following:
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14	Amendment (with title amendment)
15	Remove everything after the enacting clause, and insert:
16	Section 1. Subsections (7) is added to section 395.301,
17	Florida Statutes, to read:
18	395.301 Itemized patient bill; form and content prescribed
19	by the agency.--
20	(7)(a) Each licensed facility not operated by the state
21	shall make available to the public on its Internet website or by
22	other electronic means a list of charges and codes and a
23	description of services of the top 100 diagnosis-related groups
24	discharged from the hospital for that year using the CMS grouper
25	applicable to that year and the top 100 outpatient occasions of
26	diagnostic and therapeutic procedures performed using the
27	Healthcare Common Procedure Coding System. For purposes of this
28	paragraph, the term "CMS grouper" means a system of
29	classification used by the Centers for Medicare and Medicaid
30	Services to assign an inpatient discharge into a diagnosis-
31	related group based on diagnosis codes, procedure codes, and
32	demographic information. The facility shall place a notice in
33	the reception areas that such information is available
34	electronically. The facility's list of charges and codes and the
35	description of services shall be consistent with federal
36	electronic transmission uniform standards under the Health
37	Insurance Portability and Accountability Act (HIPAA). Changes to
38	the data shall be posted and updated electronically at least 30
39	days prior to implementation.
40	(b) A health care facility shall, upon request, furnish a
41	patient, prior to provision of medical services, a reasonable
42	estimate of charges for such services. Such estimate shall not
43	preclude the health care provider or health care facility from
44	exceeding the estimate or making additional charges based on
45	changes in the patient’s condition or treatment needs.
46	(c) A licensed facility not operated by the state shall
47	make available to a patient, or a payor acting on behalf of the
48	patient, the records that are necessary to verify the accuracy
49	of the patient’s bill or payor’s claim related to such patient’s
50	bill within a reasonable time after a request. The verification
51	information must be made available in the facility’s offices.
52	Such records shall be available to the patient or payor prior to
53	and after payment of the bill or claim. The facility may not
54	charge the patient or payor for making such verification records
55	available, except the facility may charge its usual charge for
56	providing copies of records as specified in s. 395.3025.
57	Section 2. Paragraph (e) of subsection (2), subsection
58	(3), paragraph(c) of subsection (5), and subsection (10) of
59	section 408.909, Florida Statutes, are amended to read:
60	408.909 Health flex plans.--
61	(2) DEFINITIONS.--As used in this section, the term:
62	(e) "Health flex plan" means a health plan approved under
63	subsection (3) which guarantees payment for specified health
64	care coverage provided to the enrollee who purchases coverage
65	directly from the plan or through a small business purchasing
66	arrangement sponsored by a local government.
67	(3) PILOT PROGRAM.--The agency and the department shall
68	each approve or disapprove health flex plans that provide health
69	care coverage for eligible participants who reside in the three
70	areas of the state that have the highest number of uninsured
71	persons, as identified in the Florida Health Insurance Study
72	conducted by the agency and in Indian River County. A health
73	flex plan may limit or exclude benefits otherwise required by
74	law for insurers offering coverage in this state, may cap the
75	total amount of claims paid per year per enrollee, may limit the
76	number of enrollees or the term of coverage, or may take any
77	combination of those actions.
78	(a) The agency shall develop guidelines for the review of
79	applications for health flex plans and shall disapprove or
80	withdraw approval of plans that do not meet or no longer meet
81	minimum standards for quality of care and access to care.
82	(b) The department shall develop guidelines for the review
83	of health flex plan applications and shall disapprove or shall
84	withdraw approval of plans that:
85	1. Contain any ambiguous, inconsistent, or misleading
86	provisions or any exceptions or conditions that deceptively
87	affect or limit the benefits purported to be assumed in the
88	general coverage provided by the health flex plan;
89	2. Provide benefits that are unreasonable in relation to
90	the premium charged or contain provisions that are unfair or
91	inequitable or contrary to the public policy of this state, that
92	encourage misrepresentation, or that result in unfair
93	discrimination in sales practices; or
94	3. Cannot demonstrate that the health flex plan is
95	financially sound and that the applicant is able to underwrite
96	or finance the health care coverage provided.
97	(c) The agency and the department may adopt rules as
98	needed to administer this section.
99	(5) ELIGIBILITY.--Eligibility to enroll in an approved
100	health flex plan is limited to residents of this state who:
101	(c) Are not covered by a private insurance policy and are
102	not eligible for coverage through a public health insurance
103	program, such as Medicare or Medicaid, or another public health
104	care program, such as KidCare, and have not been covered at any
105	time during the past 6 months, except that a small business
106	purchasing arrangement sponsored by a local government may limit
107	enrollment to residents of this state who have not been covered
108	at any time during the past 12 months; and
109	(10) EXPIRATION.--This section expires July 1, 20082004.
110	Section 3. Paragraph (b) of subsection (6) of section
111	627.410, Florida Statutes, is amended to read:
112	627.410 Filing, approval of forms.--
113	(6)
114	(b) The department may establish by rule, for each type of
115	health insurance form, procedures to be used in ascertaining the
116	reasonableness of benefits in relation to premium rates and may,
117	by rule, exempt from any requirement of paragraph (a) any health
118	insurance policy form or type thereof (as specified in such
119	rule) to which form or type such requirements may not be
120	practically applied or to which form or type the application of
121	such requirements is not desirable or necessary for the
122	protection of the public. A law restricting or limiting
123	deductibles, coinsurance, copayments, or annual or lifetime
124	maximum payments shall not apply to any health plan policy
125	offered or delivered to an individual or to a group of 51 or
126	more persons that provides coverage as described in s.
127	627.6561(5)(a)2.With respect to any health insurance policy
128	form or type thereof which is exempted by rule from any
129	requirement of paragraph (a), premium rates filed pursuant to
130	ss. 627.640 and 627.662 shall be for informational purposes.
131	Section 4. Effective July 1, 2004, section 627.6410,
132	Florida Statutes, is amended to read:
133	627.6410 Optional coverage for speech, language,
134	swallowing, and hearing disorders.--
135	(1) Insurers issuing individual health insurance policies
136	in this state shall make available to the policyholder as part
137	of the application for any such policy of insurance, for an
138	appropriate additional premium, the benefits or levels of
139	benefits specified in the December 1999 Florida Medicaid Therapy
140	Services Handbook for genetic or congenital disorders or
141	conditions involving speech, language, swallowing, and hearing
142	and a hearing aid and earmolds benefit at the level of benefits
143	specified in the January 2001 Florida Medicaid Hearing Services
144	Handbook.
145	(2) This section does not apply to specified accident,
146	specified disease, hospital indemnity, limited benefit,
147	disability income, or long-term care insurance policies.
148	(3) Such optional coverage is not required to be offered
149	when substantially similar benefits are included in the policy
150	of insurance issued to the policyholder.
151	(4) This section does not require or prohibit the use of a
152	provider network.
153	(5) This section does not prohibit an insurer from
154	requiring prior authorization for the benefits under this
155	section.
156	Section 5. Paragraph (b) of subsection (3) of section
157	627.6487, Florida Statutes, is amended, and paragraph (c) is
158	added to subsection (4) of said section, to read:
159	627.6487 Guaranteed availability of individual health
160	insurance coverage to eligible individuals.--
161	(3) For the purposes of this section, the term "eligible
162	individual" means an individual:
163	(b) Who is not eligible for coverage under:
164	1. A group health plan, as defined in s. 2791 of the
165	Public Health Service Act;
166	2. A conversion policy or contract issued by an authorized
167	insurer or health maintenance organization under s. 627.6675 or
168	s. 641.3921, respectively, offered to an individual who is no
169	longer eligible for coverage under either an insured or self-
170	insured group healthemployer plan or group health insurance
171	policy;
172	3. Part A or part B of Title XVIII of the Social Security
173	Act; or
174	4. A state plan under Title XIX of such act, or any
175	successor program, and does not have other health insurance
176	coverage;
177	(4)
178	(c) If the individual’s most recent period of creditable
179	coverage was earned in a state other than this state, an insurer
180	issuing a policy that complies with paragraph (a) may impose a
181	surcharge or charge a premium for such policy equal to that
182	permitted in the state in which such creditable coverage was
183	earned.
184	Section 6. Paragraph (c) of subsection (8) of section
185	627.6561, Florida Statutes, is amended to read:
186	627.6561 Preexisting conditions.--
187	(8)
188	(c) The certification described in this section is a
189	written certification that must include:
190	1. The period of creditable coverage of the individual
191	under the policy and the coverage, if any, under such COBRA
192	continuation provision or continuation pursuant to s. 627.6692.;
193	and
194	2. The waiting period, if any, imposed with respect to the
195	individual for any coverage under such policy.
196	3. A statement that the creditable coverage was provided
197	under a group health plan, a group or individual health
198	insurance policy, or a health maintenance organization contract,
199	the state in which such coverage was provided, and whether or
200	not such individual was eligible for a conversion policy under
201	such coverage.
202	Section 7. Subsection (6) of section 627.667, Florida
203	Statutes, is amended to read:
204	627.667 Extension of benefits.--
205	(6) This section also applies to holders of group
206	certificates which are renewed, delivered, or issued for
207	delivery to residents of this state under group policies
208	effectuated or delivered outside this state, unless a succeeding
209	carrier under a group policy has agreed to assume liability for
210	the benefits.
211	Section 8. Effective July 1, 2004, section 627.66912,
212	Florida Statutes, is created to read:
213	627.66912 Optional coverage for speech, language,
214	swallowing, and hearing disorders.--
215	(1) Insurers issuing group health insurance policies in
216	this state shall make available to the policyholder as part of
217	the application for any such policy of insurance, for an
218	appropriate additional premium, the benefits or levels of
219	benefits specified in the December 1999 Florida Medicaid Therapy
220	Services Handbook for genetic or congenital disorders or
221	conditions involving speech, language, swallowing, and hearing
222	and a hearing aid and earmolds benefit at the level of benefits
223	specified in the January 2001 Florida Medicaid Hearing Services
224	Handbook.
225	(2) This section does not apply to specified accident,
226	specified disease, hospital indemnity, limited benefit,
227	disability income, or long-term care insurance policies.
228	(3) Such optional coverage is not required to be offered
229	when substantially similar benefits are included in the policy
230	of insurance issued to the policyholder.
231	(4) This section does not require or prohibit the use of a
232	provider network.
233	(5) This section does not prohibit an insurer from
234	requiring prior authorization for the benefits under this
235	section.
236	Section 9. Paragraph (e) of subsection (5) of section
237	627.6692, Florida Statutes, is amended to read:
238	627.6692 Florida Health Insurance Coverage Continuation
239	Act.--
240	(5) CONTINUATION OF COVERAGE UNDER GROUP HEALTH PLANS.--
241	(e)1. A covered employee or other qualified beneficiary
242	who wishes continuation of coverage must pay the initial premium
243	and elect such continuation in writing to the insurance carrier
244	issuing the employer's group health plan within 6330days after
245	receiving notice from the insurance carrier under paragraph (d).
246	Subsequent premiums are due by the grace period expiration date.
247	The insurance carrier or the insurance carrier's designee shall
248	process all elections promptly and provide coverage
249	retroactively to the date coverage would otherwise have
250	terminated. The premium due shall be for the period beginning on
251	the date coverage would have otherwise terminated due to the
252	qualifying event. The first premium payment must include the
253	coverage paid to the end of the month in which the first payment
254	is made. After the election, the insurance carrier must bill the
255	qualified beneficiary for premiums once each month, with a due
256	date on the first of the month of coverage and allowing a 30-day
257	grace period for payment.
258	2. Except as otherwise specified in an election, any
259	election by a qualified beneficiary shall be deemed to include
260	an election of continuation of coverage on behalf of any other
261	qualified beneficiary residing in the same household who would
262	lose coverage under the group health plan by reason of a
263	qualifying event. This subparagraph does not preclude a
264	qualified beneficiary from electing continuation of coverage on
265	behalf of any other qualified beneficiary.
266	Section 10. Paragraphs (h) and (u) of subsection (3),
267	paragraph(c) of subsection (5), and paragraph (b) of
268	subsection(6) of section 627.6699, Florida Statutes, are
269	amended, and paragraph (k) is added to subsection (5) of said
270	section, to read:
271	627.6699 Employee Health Care Access Act.--
272	(3) DEFINITIONS.--As used in this section, the term:
273	(h) "Eligible employee" means an employee who works full
274	time, having a normal workweek of 25 or more hours and is paid
275	wages or a salary at least equal to the federal minimum hourly
276	wage applicable to such employee, and who has met any applicable
277	waiting-period requirements or other requirements of this act.
278	The term includes a self-employed individual, a sole proprietor,
279	a partner of a partnership, or an independent contractor, if the
280	sole proprietor, partner, or independent contractor is included
281	as an employee under a health benefit plan of a small employer,
282	but does not include a part-time, temporary, or substitute
283	employee.
284	(u) "Self-employed individual" means an individual or sole
285	proprietor who derives his or her income from a trade or
286	business carried on by the individual or sole proprietor which
287	necessitates that the individual file federal income tax forms,
288	with supporting schedules and accompanying income reporting
289	formsresults in taxable income as indicated on IRS Form 1040,
290	schedule C or F, and which generated taxable income in one of
291	the 2 previous years.
292	(5) AVAILABILITY OF COVERAGE.--
293	(c) Every small employer carrier must, as a condition of
294	transacting business in this state:
295	1. Beginning July 1, 2000, offer and issue all small
296	employer health benefit plans on a guaranteed-issue basis to
297	every eligible small employer, with 2 to 50 eligible employees,
298	that elects to be covered under such plan, agrees to make the
299	required premium payments, and satisfies the other provisions of
300	the plan. A rider for additional or increased benefits may be
301	medically underwritten and may only be added to the standard
302	health benefit plan. The increased rate charged for the
303	additional or increased benefit must be rated in accordance with
304	this section.
305	2. Beginning July 1, 2000, and until July 31, 2001, offer
306	and issue basic and standard small employer health benefit plans
307	on a guaranteed-issue basis to every eligible small employer
308	which is eligible for guaranteed renewal, has less than two
309	eligible employees, is not formed primarily for the purpose of
310	buying health insurance, elects to be covered under such plan,
311	agrees to make the required premium payments, and satisfies the
312	other provisions of the plan. A rider for additional or
313	increased benefits may be medically underwritten and may be
314	added only to the standard benefit plan. The increased rate
315	charged for the additional or increased benefit must be rated in
316	accordance with this section. For purposes of this subparagraph,
317	a person, his or her spouse, and his or her dependent children
318	shall constitute a single eligible employee if that person and
319	spouse are employed by the same small employer and either one
320	has a normal work week of less than 25 hours.
321	3. Beginning June 1, 2004August 1, 2001, offer and issue
322	basic and standard small employer health benefit plans on a
323	guaranteed-issue basis, during a 30-day open enrollment period
324	of June 1 through June 30 and during a31-day open enrollment
325	period of DecemberAugust 1 through DecemberAugust31 of each
326	year, to every eligible small employer, with fewer than two
327	eligible employees, which small employer is not formed primarily
328	for the purpose of buying health insurance and which elects to
329	be covered under such plan, agrees to make the required premium
330	payments, and satisfies the other provisions of the plan.
331	Coverage provided under this subparagraph shall begin 60 days
332	afteron October 1 of the same year asthe date of enrollment,
333	unless the small employer carrier and the small employer agree
334	to a different date. A rider for additional or increased
335	benefits may be medically underwritten and may only be added to
336	the standard health benefit plan. The increased rate charged for
337	the additional or increased benefit must be rated in accordance
338	with this section. For purposes of this subparagraph, a person,
339	his or her spouse, and his or her dependent children constitute
340	a single eligible employee if that person and spouse are
341	employed by the same small employer and either that person or
342	his or her spouse has a normal work week of less than 25 hours.
343	4. This paragraph does not limit a carrier's ability to
344	offer other health benefit plans to small employers if the
345	standard and basic health benefit plans are offered and
346	rejected.
347	(k) Beginning January 1, 2004, every small employer shall
348	provide, on an annual basis, information on at least three
349	different health benefit plans for employees. Nothing in this
350	paragraph shall be construed as requiring a small employer to
351	provide the health benefit plan or contribute to the cost of
352	such plan. Nothing in this paragraph shall be construed as
353	requiring a small employer or an individual carrier to offer
354	these health plan benefits on a guaranteed-issue basis.
355	(6) RESTRICTIONS RELATING TO PREMIUM RATES.--
356	(b) For all small employer health benefit plans that are
357	subject to this section and are issued by small employer
358	carriers on or after January 1, 1994, premium rates for health
359	benefit plans subject to this section are subject to the
360	following:
361	1. Small employer carriers must use a modified community
362	rating methodology in which the premium for each small employer
363	must be determined solely on the basis of the eligible
364	employee's and eligible dependent's gender, age, family
365	composition, tobacco use, or geographic area as determined under
366	paragraph (5)(j) and in which the premium may be adjusted as
367	permitted by this paragraph.
368	2. Rating factors related to age, gender, family
369	composition, tobacco use, or geographic location may be
370	developed by each carrier to reflect the carrier's experience.
371	The factors used by carriers are subject to department review
372	and approval.
373	3. Small employer carriers may not modify the rate for a
374	small employer for 12 months from the initial issue date or
375	renewal date, unless the composition of the group changes or
376	benefits are changed. However, a small employer carrier may
377	modify the rate one time prior to 12 months after the initial
378	issue date for a small employer who enrolls under a previously
379	issued group policy that has a common anniversary date for all
380	employers covered under the policy if:
381	a. The carrier discloses to the employer in a clear and
382	conspicuous manner the date of the first renewal and the fact
383	that the premium may increase on or after that date.
384	b. The insurer demonstrates to the department that
385	efficiencies in administration are achieved and reflected in the
386	rates charged to small employers covered under the policy.
387	4. A carrier may issue a group health insurance policy to
388	a small employer health alliance or other group association with
389	rates that reflect a premium credit for expense savings
390	attributable to administrative activities being performed by the
391	alliance or group association if such expense savings are
392	specifically documented in the insurer's rate filing and are
393	approved by the department. Any such credit may not be based on
394	different morbidity assumptions or on any other factor related
395	to the health status or claims experience of any person covered
396	under the policy. Nothing in this subparagraph exempts an
397	alliance or group association from licensure for any activities
398	that require licensure under the insurance code. A carrier
399	issuing a group health insurance policy to a small employer
400	health alliance or other group association shall allow any
401	properly licensed and appointed agent of that carrier to market
402	and sell the small employer health alliance or other group
403	association policy. Such agent shall be paid the usual and
404	customary commission paid to any agent selling the policy.
405	5. Any adjustments in rates for claims experience, health
406	status, or duration of coverage may not be charged to individual
407	employees or dependents. For a small employer's policy, such
408	adjustments may not result in a rate for the small employer
409	which deviates more than 15 percent from the carrier's approved
410	rate. Any such adjustment must be applied uniformly to the rates
411	charged for all employees and dependents of the small employer.
412	A small employer carrier may make an adjustment to a small
413	employer's renewal premium, not to exceed 10 percent annually,
414	due to the claims experience, health status, or duration of
415	coverage of the employees or dependents of the small employer.
416	Semiannually, small group carriers shall report information on
417	forms adopted by rule by the department, to enable the
418	department to monitor the relationship of aggregate adjusted
419	premiums actually charged policyholders by each carrier to the
420	premiums that would have been charged by application of the
421	carrier's approved modified community rates. If the aggregate
422	resulting from the application of such adjustment exceeds the
423	premium that would have been charged by application of the
424	approved modified community rate by 35percent for the current
425	reporting period, the carrier shall limit the application of
426	such adjustments only to minus adjustments beginning not more
427	than 60 days after the report is sent to the department. For any
428	subsequent reporting period, if the total aggregate adjusted
429	premium actually charged does not exceed the premium that would
430	have been charged by application of the approved modified
431	community rate by 35percent, the carrier may apply both plus
432	and minus adjustments. A small employer carrier may provide a
433	credit to a small employer's premium based on administrative and
434	acquisition expense differences resulting from the size of the
435	group. Group size administrative and acquisition expense factors
436	may be developed by each carrier to reflect the carrier's
437	experience and are subject to department review and approval.
438	6. A small employer carrier rating methodology may include
439	separate rating categories for one dependent child, for two
440	dependent children, and for three or more dependent children for
441	family coverage of employees having a spouse and dependent
442	children or employees having dependent children only. A small
443	employer carrier may have fewer, but not greater, numbers of
444	categories for dependent children than those specified in this
445	subparagraph.
446	7. Small employer carriers may not use a composite rating
447	methodology to rate a small employer with fewer than 10
448	employees. For the purposes of this subparagraph, a "composite
449	rating methodology" means a rating methodology that averages the
450	impact of the rating factors for age and gender in the premiums
451	charged to all of the employees of a small employer.
452	8.a. A carrier may separate the experience of small
453	employer groups with less than 2 eligible employees from the
454	experience of small employer groups with 2-50 eligible employees
455	for purposes of determining an alternative modified community
456	rating.
457	b. If a carrier separates the experience of small employer
458	groups as provided in sub-subparagraph a., the rate to be
459	charged to small employer groups of less than 2 eligible
460	employees may not exceed 150 percent of the rate determined for
461	small employer groups of 2-50 eligible employees. However, the
462	carrier may charge excess losses of the experience pool
463	consisting of small employer groups with less than 2 eligible
464	employees to the experience pool consisting of small employer
465	groups with 2-50 eligible employees so that all losses are
466	allocated and the 150-percent rate limit on the experience pool
467	consisting of small employer groups with less than 2 eligible
468	employees is maintained. Notwithstanding s. 627.411(1), the rate
469	to be charged to a small employer group of fewer than 2 eligible
470	employees, insured as of July 1, 2002, may be up to 125 percent
471	of the rate determined for small employer groups of 2-50
472	eligible employees for the first annual renewal and 150 percent
473	for subsequent annual renewals.
474	9. In addition to the separation allowed under sub-
475	subparagraph 8.a., a carrier may also separate the experience of
476	small employer groups of 1-50 eligible employees using a health
477	reimbursement arrangement, as defined in Internal Revenue
478	Service Notice 2002-45, 2002-28 Internal Revenue Bulletin 93,
479	and Revenue Ruling 2002-41, 2002-28 Internal Revenue Bulletin
480	75, from the experience of small employer groups of 1-50
481	eligible employees not using such a health reimbursement
482	arrangement for purposes of determining an alternative modified
483	community rating.
484	Section 11. Subsection (2) and paragraph (d) of subsection
485	(3) of section 641.31, Florida Statutes, are amended, and
486	subsections (40) and (41) are added to said section, to read:
487	641.31 Health maintenance contracts.--
488	(2) The rates charged by any health maintenance
489	organization to its subscribers shall not be excessive,
490	inadequate, or unfairly discriminatory or follow a rating
491	methodology that is inconsistent, indeterminate, or ambiguous or
492	encourages misrepresentation or misunderstanding. A law
493	restricting or limiting deductibles, coinsurance, copayments, or
494	annual or lifetime maximum payments shall not apply to any
495	health maintenance organization contract offered or delivered to
496	an individual or a group of 51 or more persons that provides
497	coverage as described in s. 641.31071(5)(a)2.The department, in
498	accordance with generally accepted actuarial practice as applied
499	to health maintenance organizations, may define by rule what
500	constitutes excessive, inadequate, or unfairly discriminatory
501	rates and may require whatever information it deems necessary to
502	determine that a rate or proposed rate meets the requirements of
503	this subsection.
504	(3)
505	(d) Any change in rates charged for the contract must be
506	filed with the department not less than 30 days in advance of
507	the effective date. At the expiration of such 30 days, the rate
508	filing shall be deemed approved unless prior to such time the
509	filing has been affirmatively approved or disapproved by order
510	of the department. The approval of the filing by the department
511	constitutes a waiver of any unexpired portion of such waiting
512	period. The department may extend by not more than an additional
513	15 days the period within which it may so affirmatively approve
514	or disapprove any such filing, by giving notice of such
515	extension before expiration of the initial 30-day period. At the
516	expiration of any such period as so extended, and in the absence
517	of such prior affirmative approval or disapproval, any such
518	filing shall be deemed approved. This paragraph does not apply
519	to group health contracts effectuated and delivered in this
520	state insuring groups of 51 or more persons, except for Medicare
521	supplement insurance, long-term care insurance, and any coverage
522	under which the increase in claims costs over the lifetime of
523	the contract due to advancing age or duration is refunded in the
524	premium.
525	(40) Health maintenance organizations shall make available
526	to the contract holder as part of the application for any such
527	contract, for an appropriate additional premium, the benefits or
528	level of benefits specified in the December 1999 Florida
529	Medicaid Therapy Services Handbook for genetic or congenital
530	disorders or conditions involving speech, language, swallowing,
531	and hearing and a hearing aid and earmolds benefit at the level
532	of benefits specified in the January 2001 Florida Medicaid
533	Hearing Services Handbook.
534	(a) Such optional coverage is not required to be offered
535	when substantially similar benefits are included in the contract
536	issued to the subscriber.
537	(b) This subsection does not require or prohibit the use
538	of a provider network.
539	(c) This subsection does not prohibit an organization from
540	requiring prior authorization for the benefits under this
541	subsection.
542	(d) This subsection does not apply to health maintenance
543	organizations issuing individual coverage to fewer than 50,000
544	members.
545	(e) This subsection shall take effect July 1, 2004.
546	(41) Every health maintenance organization shall make
547	available to its subscribers the estimated co-pay, co-insurance,
548	or deductible, whichever is applicable, for any covered service,
549	the status of the subscriber's maximum annual out-of-pocket
550	payments for a covered individual or family, and the status of
551	the subscriber's maximum lifetime benefit. Each health
552	maintenance organization shall, upon request of a subscriber,
553	provide an estimate of the amount the health maintenance
554	organization will pay for a particular medical procedure or
555	service. The estimate may be in the form of a range of payments
556	or an average payment. A health maintenance organization that
557	provides a subscriber with a good faith estimate is not bound by
558	the estimate.
559	Section 12. Section 641.31075, Florida Statutes, is
560	created to read:
561	641.31075 Requirements for replacing health coverage.--Any
562	health maintenance organization that is replacing any other
563	group health coverage with its group health maintenance coverage
564	shall comply with s. 627.666.
565	Section 13. Subsection (1) of section 641.3111, Florida
566	Statutes, is amended to read:
567	641.3111 Extension of benefits.--
568	(1) Every group health maintenance contract shall provide
569	that termination of the contract shall be without prejudice to
570	any continuous loss which commenced while the contract was in
571	force, but any extension of benefits beyond the period the
572	contract was in force may be predicated upon the continuous
573	total disability of the subscriber and may be limited to payment
574	for the treatment of a specific accident or illness incurred
575	while the subscriber was a member. The extension is required
576	regardless of whether the group contract holder or other entity
577	secures replacement coverage from a new insurer or health
578	maintenance organization or foregoes the provision of coverage.
579	The required provision must provide for continuation of contract
580	benefits in connection with the treatment of a specific accident
581	or illness incurred while the contract was in effect.Such
582	extension of benefits may be limited to the occurrence of the
583	earliest of the following events:
584	(a) The expiration of 12 months.
585	(b) Such time as the member is no longer totally disabled.
586	(c) A succeeding carrier elects to provide replacement
587	coverage without limitation as to the disability condition.
588	(d) The maximum benefits payable under the contract have
589	been paid.
590	Section 14. Subsection (22) is added to section 641.19,
591	Florida Statutes, to read:
592	641.19 Definitions.--As used in this part, the term:
593	(22) "Specialty" or "specialist" shall not include the
594	services by a physician licensed under chapter 460.
595	Section 15. If any provision of this act or the
596	application thereof to any person or circumstance is held
597	invalid, the invalidity shall not affect other provisions or
598	applications of the act which can be given effect without the
599	invalid provision or application, and to this end the provisions
600	of this act are declared severable.
601	Section 16. Except as otherwise provided herein, this act
602	shall take effect upon becoming a law.
603
604	================= T I T L E A M E N D M E N T =================
605
606	Remove the entire title, and insert:
607
608	A bill to be entitled
609	An act relating to health insurance; amending s. 395.301,
610	F.S.; requiring health care providers and facilities to
611	provide prospective patients with reasonable estimates of
612	prospective charges; requiring certain licensed facilities
613	to make available to payors certain records; providing that
614	the facility may not charge for making records available
615	but may charge a specified amount for providing copies;
616	amending s. 408.909, F.S.; revising a definition;
617	authorizing plans to limit the term of coverage; extending
618	the required period without coverage before participation
619	eligibility; authorizing a business purchasing arrangement
620	sponsored by a local government subject to specified
621	limitations; extending a program expiration date; amending
622	s. 627.410, F.S.; exempting individuals and certain groups
623	from laws restricting or limiting coinsurance, copayments,
624	or annual or lifetime maximum payments; creating s.
625	627.6410, F.S.; providing for optional coverage in health
626	insurance policies for speech, language, swallowing, and
627	hearing disorders; providing exclusion; providing
628	exceptions; providing a limitation; amending s. 627.6487,
629	F.S.; revising a definition of "eligible individual" for
630	purposes of availability of individual health insurance
631	coverage; authorizing insurers to impose certain surcharges
632	or premium charges for creditable coverage earned in
633	certain states; amending s. 627.6561, F.S.; requiring
634	additional information in a certification relating to
635	certain creditable coverage for purposes of eligibility for
636	exclusion from preexisting condition requirements; amending
637	s. 627.667, F.S.; deleting a limitation on certain
638	application of extension of benefits provisions; creating
639	s. 627.66912, F.S.; providing for optional coverage in
640	group, blanket, and franchise health insurance policies for
641	speech, language, swallowing, and hearing disorders;
642	providing exclusion; providing exceptions; providing a
643	limitation; amending s. 627.6692, F.S.; extending a time
644	period for continuation of certain coverage under group
645	health plans; amending s. 627.6699, F.S.; revising certain
646	definitions; revising enrollment period criteria for
647	certain health benefit plans; requiring small employers to
648	provide certain health benefit plan information to
649	employees; providing a limitation; revising certain rate
650	adjustment criteria; authorizing separation of experience
651	of certain small employer groups for certain purposes;
652	amending s. 641.31, F.S.; specifying nonapplication of
653	certain health maintenance contract filing requirements to
654	certain group health insurance policies, with exceptions;
655	requiring health maintenance organizations to make available
656	coverage for certain speech, language, swallowing, and
657	hearing disorders or conditions, subject to certain
658	criteria and limits, effective July 1, 2004; requiring
659	health maintenance organizations to provide specific
660	information to subscribers; creating s. 641.31075, F.S.;
661	providing compliance requirements for health maintenance
662	organizations replacing certain coverages; amending s.
663	641.3111, F.S.; providing additional requirements for
664	extension of benefits under group health maintenance
665	contracts; amending s. 641.19, F.S.; defining the term
666	"specialty" or "specialist" to exclude services by a
667	chiropractic physician; providing severability; providing
668	effective dates.
669