SENATE AMENDMENT
Bill No. CS for SB 2750
Amendment No. ___ Barcode 290810
CHAMBER ACTION
Senate House
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04/30/2003 06:25 PM .
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11 Senator Posey moved the following amendment:
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13 Senate Amendment (with title amendment)
14 On page 86, line 31,
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16 insert:
17 Section 62. Paragraph (b) of subsection (6) of section
18 627.410, Florida Statutes, is amended to read:
19 627.410 Filing, approval of forms.--
20 (6)
21 (b) The department may establish by rule, for each
22 type of health insurance form, procedures to be used in
23 ascertaining the reasonableness of benefits in relation to
24 premium rates and may, by rule, exempt from any requirement of
25 paragraph (a) any health insurance policy form or type thereof
26 (as specified in such rule) to which form or type such
27 requirements may not be practically applied or to which form
28 or type the application of such requirements is not desirable
29 or necessary for the protection of the public. A law
30 restricting or limiting deductibles, coinsurance, copayments,
31 or annual or lifetime maximum payments shall not apply to any
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Amendment No. ___ Barcode 290810
1 health plan policy offered or delivered to an individual or to
2 a group of 51 or more persons that provides coverage as
3 described in s. 627.6561(5)(a)2. With respect to any health
4 insurance policy form or type thereof which is exempted by
5 rule from any requirement of paragraph (a), premium rates
6 filed pursuant to ss. 627.640 and 627.662 shall be for
7 informational purposes.
8 Section 63. Subsection (3) of section 627.6487,
9 Florida Statutes, is amended, and paragraph (c) is added to
10 subsection (4) of that section, to read:
11 627.6487 Guaranteed availability of individual health
12 insurance coverage to eligible individuals.--
13 (3) For the purposes of this section, the term
14 "eligible individual" means an individual:
15 (a)1. For whom, as of the date on which the individual
16 seeks coverage under this section, the aggregate of the
17 periods of creditable coverage, as defined in s. 627.6561(5)
18 and (6), is 18 or more months; and
19 2.a. Whose most recent prior creditable coverage was
20 under a group health plan, governmental plan, or church plan,
21 or health insurance coverage offered in connection with any
22 such plan; or
23 b. Whose most recent prior creditable coverage was
24 under an individual plan issued in this state by a health
25 insurer or health maintenance organization, which coverage is
26 terminated due to the insurer or health maintenance
27 organization becoming insolvent or discontinuing the offering
28 of all individual coverage in the State of Florida, or due to
29 the insured no longer living in the service area in the State
30 of Florida of the insurer or health maintenance organization
31 that provides coverage through a network plan in the State of
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Bill No. CS for SB 2750
Amendment No. ___ Barcode 290810
1 Florida;
2 (b) Who is not eligible for coverage under:
3 1. A group health plan, as defined in s. 2791 of the
4 Public Health Service Act;
5 2. A conversion policy or contract issued by an
6 authorized insurer or health maintenance organization under s.
7 627.6675 or s. 641.3921, respectively, offered to an
8 individual who is no longer eligible for coverage under either
9 an insured or self-insured group health employer plan or
10 group health insurance policy;
11 3. Part A or part B of Title XVIII of the Social
12 Security Act; or
13 4. A state plan under Title XIX of such act, or any
14 successor program, and does not have other health insurance
15 coverage;
16 (c) With respect to whom the most recent coverage
17 within the coverage period described in paragraph (a) was not
18 terminated based on a factor described in s. 627.6571(2)(a) or
19 (b), relating to nonpayment of premiums or fraud, unless such
20 nonpayment of premiums or fraud was due to acts of an employer
21 or person other than the individual;
22 (d) Who, having been offered the option of
23 continuation coverage under a COBRA continuation provision or
24 under s. 627.6692, elected such coverage; and
25 (e) Who, if the individual elected such continuation
26 provision, has exhausted such continuation coverage under such
27 provision or program.
28 (4)
29 (c) If the individual's most recent period of
30 creditable coverage was earned in a state other than this
31 state, an insurer issuing a policy that complies with
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1 paragraph (a) may impose a surcharge or charge a premium for
2 such policy equal to that permitted in the state in which such
3 creditable coverage was earned.
4 Section 64. Paragraph (c) of subsection (8) of section
5 627.6561, Florida Statutes, is amended to read:
6 627.6561 Preexisting conditions.--
7 (8)
8 (c) The certification described in this section is a
9 written certification that must include:
10 1. The period of creditable coverage of the individual
11 under the policy and the coverage, if any, under such COBRA
12 continuation provision or continuation pursuant to s.
13 627.6692.; and
14 2. The waiting period, if any, imposed with respect to
15 the individual for any coverage under such policy.
16 3. A statement that the creditable coverage was
17 provided under a group health plan, a group or individual
18 health insurance policy, or a health maintenance organization
19 contract, the state in which such coverage was provided, and
20 whether or not such individual was eligible for a conversion
21 policy under such coverage.
22 Section 65. Subsection (6) of section 627.667, Florida
23 Statutes, is amended to read:
24 627.667 Extension of benefits.--
25 (6) This section also applies to holders of group
26 certificates which are renewed, delivered, or issued for
27 delivery to residents of this state under group policies
28 effectuated or delivered outside this state, unless a
29 succeeding carrier under a group policy has agreed to assume
30 liability for the benefits.
31 Section 66. Paragraph (e) of subsection (5) of section
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1 627.6692, Florida Statutes, is amended to read:
2 627.6692 Florida Health Insurance Coverage
3 Continuation Act.--
4 (5) CONTINUATION OF COVERAGE UNDER GROUP HEALTH
5 PLANS.--
6 (e)1. A covered employee or other qualified
7 beneficiary who wishes continuation of coverage must pay the
8 initial premium and elect such continuation in writing to the
9 insurance carrier issuing the employer's group health plan
10 within 63 30 days after receiving notice from the insurance
11 carrier under paragraph (d). Subsequent premiums are due by
12 the grace period expiration date. The insurance carrier or
13 the insurance carrier's designee shall process all elections
14 promptly and provide coverage retroactively to the date
15 coverage would otherwise have terminated. The premium due
16 shall be for the period beginning on the date coverage would
17 have otherwise terminated due to the qualifying event. The
18 first premium payment must include the coverage paid to the
19 end of the month in which the first payment is made. After
20 the election, the insurance carrier must bill the qualified
21 beneficiary for premiums once each month, with a due date on
22 the first of the month of coverage and allowing a 30-day grace
23 period for payment.
24 2. Except as otherwise specified in an election, any
25 election by a qualified beneficiary shall be deemed to include
26 an election of continuation of coverage on behalf of any other
27 qualified beneficiary residing in the same household who would
28 lose coverage under the group health plan by reason of a
29 qualifying event. This subparagraph does not preclude a
30 qualified beneficiary from electing continuation of coverage
31 on behalf of any other qualified beneficiary.
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1 Section 67. Paragraphs (h) and (u) of subsection (3)
2 and paragraph (b) of subsection (6) of section 627.6699,
3 Florida Statutes, are amended to read: 627.6699 Employee
4 Health Care Access Act.--
5 (3) DEFINITIONS.--As used in this section, the term:
6 (h) "Eligible employee" means an employee who works
7 full time, having a normal workweek of 25 or more hours and is
8 paid wages or a salary at least equal to the federal minimum
9 hourly wage applicable to such employee, and who has met any
10 applicable waiting-period requirements or other requirements
11 of this act. The term includes a self-employed individual, a
12 sole proprietor, a partner of a partnership, or an independent
13 contractor, if the sole proprietor, partner, or independent
14 contractor is included as an employee under a health benefit
15 plan of a small employer, but does not include a part-time,
16 temporary, or substitute employee.
17 (u) "Self-employed individual" means an individual or
18 sole proprietor who derives his or her income from a trade or
19 business carried on by the individual or sole proprietor which
20 necessitates that the individual file federal income tax
21 forms, with supporting schedules and accompanying income
22 reporting forms results in taxable income as indicated on IRS
23 Form 1040, schedule C or F, and which generated taxable income
24 in one of the 2 previous years.
25 (6) RESTRICTIONS RELATING TO PREMIUM RATES.--
26 (b) For all small employer health benefit plans that
27 are subject to this section and are issued by small employer
28 carriers on or after January 1, 1994, premium rates for health
29 benefit plans subject to this section are subject to the
30 following:
31 1. Small employer carriers must use a modified
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Amendment No. ___ Barcode 290810
1 community rating methodology in which the premium for each
2 small employer must be determined solely on the basis of the
3 eligible employee's and eligible dependent's gender, age,
4 family composition, tobacco use, or geographic area as
5 determined under paragraph (5)(j) and in which the premium may
6 be adjusted as permitted by this paragraph.
7 2. Rating factors related to age, gender, family
8 composition, tobacco use, or geographic location may be
9 developed by each carrier to reflect the carrier's experience.
10 The factors used by carriers are subject to department review
11 and approval.
12 3. Small employer carriers may not modify the rate for
13 a small employer for 12 months from the initial issue date or
14 renewal date, unless the composition of the group changes or
15 benefits are changed. However, a small employer carrier may
16 modify the rate one time prior to 12 months after the initial
17 issue date for a small employer who enrolls under a previously
18 issued group policy that has a common anniversary date for all
19 employers covered under the policy if:
20 a. The carrier discloses to the employer in a clear
21 and conspicuous manner the date of the first renewal and the
22 fact that the premium may increase on or after that date.
23 b. The insurer demonstrates to the department that
24 efficiencies in administration are achieved and reflected in
25 the rates charged to small employers covered under the policy.
26 4. A carrier may issue a group health insurance policy
27 to a small employer health alliance or other group association
28 with rates that reflect a premium credit for expense savings
29 attributable to administrative activities being performed by
30 the alliance or group association if such expense savings are
31 specifically documented in the insurer's rate filing and are
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1 approved by the department. Any such credit may not be based
2 on different morbidity assumptions or on any other factor
3 related to the health status or claims experience of any
4 person covered under the policy. Nothing in this subparagraph
5 exempts an alliance or group association from licensure for
6 any activities that require licensure under the insurance
7 code. A carrier issuing a group health insurance policy to a
8 small employer health alliance or other group association
9 shall allow any properly licensed and appointed agent of that
10 carrier to market and sell the small employer health alliance
11 or other group association policy. Such agent shall be paid
12 the usual and customary commission paid to any agent selling
13 the policy.
14 5. Any adjustments in rates for claims experience,
15 health status, or duration of coverage may not be charged to
16 individual employees or dependents. For a small employer's
17 policy, such adjustments may not result in a rate for the
18 small employer which deviates more than 15 percent from the
19 carrier's approved rate. Any such adjustment must be applied
20 uniformly to the rates charged for all employees and
21 dependents of the small employer. A small employer carrier may
22 make an adjustment to a small employer's renewal premium, not
23 to exceed 10 percent annually, due to the claims experience,
24 health status, or duration of coverage of the employees or
25 dependents of the small employer. Semiannually, small group
26 carriers shall report information on forms adopted by rule by
27 the department, to enable the department to monitor the
28 relationship of aggregate adjusted premiums actually charged
29 policyholders by each carrier to the premiums that would have
30 been charged by application of the carrier's approved modified
31 community rates. If the aggregate resulting from the
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1 application of such adjustment exceeds the premium that would
2 have been charged by application of the approved modified
3 community rate by 5 percent for the current reporting period,
4 the carrier shall limit the application of such adjustments
5 only to minus adjustments beginning not more than 60 days
6 after the report is sent to the department. For any subsequent
7 reporting period, if the total aggregate adjusted premium
8 actually charged does not exceed the premium that would have
9 been charged by application of the approved modified community
10 rate by 5 percent, the carrier may apply both plus and minus
11 adjustments. A small employer carrier may provide a credit to
12 a small employer's premium based on administrative and
13 acquisition expense differences resulting from the size of the
14 group. Group size administrative and acquisition expense
15 factors may be developed by each carrier to reflect the
16 carrier's experience and are subject to department review and
17 approval.
18 6. A small employer carrier rating methodology may
19 include separate rating categories for one dependent child,
20 for two dependent children, and for three or more dependent
21 children for family coverage of employees having a spouse and
22 dependent children or employees having dependent children
23 only. A small employer carrier may have fewer, but not
24 greater, numbers of categories for dependent children than
25 those specified in this subparagraph.
26 7. Small employer carriers may not use a composite
27 rating methodology to rate a small employer with fewer than 10
28 employees. For the purposes of this subparagraph, a "composite
29 rating methodology" means a rating methodology that averages
30 the impact of the rating factors for age and gender in the
31 premiums charged to all of the employees of a small employer.
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1 8.a. A carrier may separate the experience of small
2 employer groups with less than 2 eligible employees from the
3 experience of small employer groups with 2-50 eligible
4 employees for purposes of determining an alternative modified
5 community rating.
6 b. If a carrier separates the experience of small
7 employer groups as provided in sub-subparagraph a., the rate
8 to be charged to small employer groups of less than 2 eligible
9 employees may not exceed 150 percent of the rate determined
10 for small employer groups of 2-50 eligible employees. However,
11 the carrier may charge excess losses of the experience pool
12 consisting of small employer groups with less than 2 eligible
13 employees to the experience pool consisting of small employer
14 groups with 2-50 eligible employees so that all losses are
15 allocated and the 150-percent rate limit on the experience
16 pool consisting of small employer groups with less than 2
17 eligible employees is maintained. Notwithstanding s.
18 627.411(1), the rate to be charged to a small employer group
19 of fewer than 2 eligible employees, insured as of July 1,
20 2002, may be up to 125 percent of the rate determined for
21 small employer groups of 2-50 eligible employees for the first
22 annual renewal and 150 percent for subsequent annual renewals.
23 9. In addition to the separation allowed under
24 sub-subparagraph 8.a., a carrier may also separate the
25 experience of small employer groups of 1-50 eligible employees
26 using a health reimbursement arrangement, as defined in
27 Internal Revenue Service Notice 2002-45, 2002-28 Internal
28 Revenue Bulletin 93, and Revenue Ruling 2002-41, 2002-28
29 Internal Revenue Bulletin 75, from the experience of small
30 employer groups of 1-50 eligible employees not using such a
31 health reimbursement arrangement for purposes of determining
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1 an alternative modified community rating.
2 Section 68. Subsection (2) and paragraph (d) of
3 subsection (3) of section 641.31, Florida Statutes, are
4 amended to read:
5 641.31 Health maintenance contracts.--
6 (2) The rates charged by any health maintenance
7 organization to its subscribers shall not be excessive,
8 inadequate, or unfairly discriminatory or follow a rating
9 methodology that is inconsistent, indeterminate, or ambiguous
10 or encourages misrepresentation or misunderstanding. A law
11 restricting or limiting deductibles, coinsurance, copayments,
12 or annual or lifetime maximum payments shall not apply to any
13 health maintenance organization contract offered or delivered
14 to an individual or a group of 51 or more persons that
15 provides coverage as described in s. 641.31071(5)(a)2. The
16 department, in accordance with generally accepted actuarial
17 practice as applied to health maintenance organizations, may
18 define by rule what constitutes excessive, inadequate, or
19 unfairly discriminatory rates and may require whatever
20 information it deems necessary to determine that a rate or
21 proposed rate meets the requirements of this subsection.
22 (3)
23 (d) Any change in rates charged for the contract must
24 be filed with the department not less than 30 days in advance
25 of the effective date. At the expiration of such 30 days, the
26 rate filing shall be deemed approved unless prior to such time
27 the filing has been affirmatively approved or disapproved by
28 order of the department. The approval of the filing by the
29 department constitutes a waiver of any unexpired portion of
30 such waiting period. The department may extend by not more
31 than an additional 15 days the period within which it may so
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1 affirmatively approve or disapprove any such filing, by giving
2 notice of such extension before expiration of the initial
3 30-day period. At the expiration of any such period as so
4 extended, and in the absence of such prior affirmative
5 approval or disapproval, any such filing shall be deemed
6 approved. This paragraph does not apply to group health
7 contracts effectuated and delivered in this state insuring
8 groups of 51 or more persons, except for Medicare supplement
9 insurance, long-term care insurance, and any coverage under
10 which the increase in claims costs over the lifetime of the
11 contract due to advancing age or duration is refunded in the
12 premium.
13 Section 69. Subsection (22) is added to section
14 641.19, Florida Statutes, to read:
15 641.19 Definitions.--As used in this part, the term:
16 (22) "Specialty" or "specialist" shall not include the
17 services by a physician licensed under chapter 460.
18 Section 70. If any provision of this act or the
19 application thereof to any person or circumstance is held
20 invalid, the invalidity does not affect other provisions or
21 applications of this act which can be given effect without the
22 invalid provision or application, and to this end the
23 provisions of this act are declared severable.
24
25 (Redesignate subsequent sections.)
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27
28 ================ T I T L E A M E N D M E N T ===============
29 And the title is amended as follows:
30 On page 8, line 30, following the semicolon
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1 insert:
2 amending s. 627.410, F.S.; exempting
3 individuals and certain groups from laws
4 restricting or limiting coinsurance,
5 copayments, or annual or lifetime maximum
6 payments; amending s. 627.6487, F.S.; revising
7 a definition of "eligible individual" for
8 purposes of availability of individual health
9 insurance coverage; authorizing insurers to
10 impose certain surcharges or premium charges
11 for creditable coverage earned in certain
12 states; amending s. 627.6561, F.S.; requiring
13 additional information in a certification
14 relating to certain creditable coverage for
15 purposes of eligibility for exclusion from
16 preexisting condition requirements; amending s.
17 627.667, F.S.; deleting a limitation on certain
18 application of extension of benefits
19 provisions; amending s. 627.6692, F.S.;
20 extending a time period for continuation of
21 certain coverage under group health plans;
22 amending s. 627.6699, F.S.; revising certain
23 definitions; authorizing separation of
24 experience of certain small employer groups for
25 certain purposes; amending s. 641.31, F.S.;
26 specifying nonapplication of certain health
27 maintenance contract filing requirements to
28 certain group health insurance policies, with
29 exceptions; amending s. 641.19, F.S.; defining
30 the term "specialty" or "specialist" to exclude
31 services by a chiropractic physician; providing
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