HOUSE AMENDMENT Bill No. HB 999 CS
1	CHAMBER ACTION
2	Senate House
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12	Representative Negron offered the following:
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14	Amendment (with title amendment)
15	Remove line(s) 136-327, and insert:
16	Section 2. Paragraph (g) of subsection (1) of section
17	626.9541, Florida Statutes, is amended to read:
18	626.9541 Unfair methods of competition and unfair or
19	deceptive acts or practices defined.--
20	(1) UNFAIR METHODS OF COMPETITION AND UNFAIR OR DECEPTIVE
21	ACTS.--The following are defined as unfair methods of
22	competition and unfair or deceptive acts or practices:
23	(g) Unfair discrimination.--
24	1. Knowingly making or permitting any unfair
25	discrimination between individuals of the same actuarially
26	supportable class and equal expectation of life, in the rates
27	charged for any life insurance or annuity contract, in the
28	dividends or other benefits payable thereon, or in any other of
29	the terms and conditions of such contract.
30	2. Knowingly making or permitting any unfair
31	discrimination between individuals of the same actuarially
32	supportable class, as determined at the original time of
33	issuance of the coverage,and essentially the same hazard, in
34	the amount of premium, policy fees, or rates charged for any
35	policy or contract of accident, disability, or health insurance,
36	in the benefits payable thereunder, in any of the terms or
37	conditions of such contract, or in any other manner whatever.
38	3. For a health insurer, life insurer, disability insurer,
39	property and casualty insurer, automobile insurer, or managed
40	care provider to underwrite a policy, or refuse to issue,
41	reissue, or renew a policy, refuse to pay a claim, cancel or
42	otherwise terminate a policy, or increase rates based upon the
43	fact that an insured or applicant who is also the proposed
44	insured has made a claim or sought or should have sought medical
45	or psychological treatment in the past for abuse, protection
46	from abuse, or shelter from abuse, or that a claim was caused in
47	the past by, or might occur as a result of, any future assault,
48	battery, or sexual assault by a family or household member upon
49	another family or household member as defined in s. 741.28. A
50	health insurer, life insurer, disability insurer, or managed
51	care provider may refuse to underwrite, issue, or renew a policy
52	based on the applicant's medical condition, but shall not
53	consider whether such condition was caused by an act of abuse.
54	For purposes of this section, the term "abuse" means the
55	occurrence of one or more of the following acts:
56	a. Attempting or committing assault, battery, sexual
57	assault, or sexual battery;
58	b. Placing another in fear of imminent serious bodily
59	injury by physical menace;
60	c. False imprisonment;
61	d. Physically or sexually abusing a minor child; or
62	e. An act of domestic violence as defined in s. 741.28.
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64	This subparagraph does not prohibit a property and casualty
65	insurer or an automobile insurer from excluding coverage for
66	intentional acts by the insured if such exclusion does not
67	constitute an act of unfair discrimination as defined in this
68	paragraph.
69	Section 3. Subsection (2) of section 627.6515, Florida
70	Statutes, is amended, and subsections (9) and (10) are added to
71	said section, to read:
72	627.6515 Out-of-state groups.--
73	(2) Except as provided in this part,this part does not
74	apply to a group health insurance policy issued or delivered
75	outside this state under which a resident of this state is
76	provided coverage if:
77	(a) The policy is issued to an employee group the
78	composition of which is substantially as described in s.
79	627.653; a labor union group or association group the
80	composition of which is substantially as described in s.
81	627.654; an additional group the composition of which is
82	substantially as described in s. 627.656; a group insured under
83	a blanket health policy when the composition of the group is
84	substantially in compliance with s. 627.659; a group insured
85	under a franchise health policy when the composition of the
86	group is substantially in compliance with s. 627.663; an
87	association group to cover persons associated in any other
88	common group, which common group is formed primarily for
89	purposes other than providing insurance; a group that is
90	established primarily for the purpose of providing group
91	insurance, provided the benefits are reasonable in relation to
92	the premiums charged thereunder and the issuance of the group
93	policy has resulted, or will result, in economies of
94	administration; or a group of insurance agents of an insurer,
95	which insurer is the policyholder;
96	(b) Certificates evidencing coverage under the policy are
97	issued to residents of this state and contain in contrasting
98	color and not less than 10-point type the following statement:
99	"The benefits of the policy providing your coverage are governed
100	primarily by the law of a state other than Florida"; and
101	(c) The policy provides the benefits specified in ss.
102	627.419, 627.6574, 627.6575, 627.6579, 627.6612, 627.66121,
103	627.66122, 627.6613, 627.667, 627.6675, 627.6691, and 627.66911;
104	and
105	(d) Applications for certificates of coverage offered to
106	residents of this state contain in contrasting color and not
107	less than 12-point type the following statement on the same page
108	as the applicant signature: “This policy is primarily governed
109	by the laws of {insert state where the master policy is filed}.
110	As a result, all of the rating laws applicable to policies filed
111	in Florida do not apply to this coverage, which may result in
112	increases in your premium at renewal that would not be
113	permissible under a Florida-approved policy. Any purchase of
114	individual health insurance should be considered carefully, as
115	future medical conditions may make it impossible to qualify for
116	another individual health policy. For information concerning
117	individual health coverage under a Florida-approved policy,
118	consult your agent or the Florida Department of Financial
119	Services”. The provisions of this paragraph only apply to group
120	certificates providing health insurance coverage which require
121	individual underwriting to determine coverage eligibility for an
122	individual or premium rates to be charged to an individual
123	except for the following:
124	1. Policies issued to provide coverage to groups of
125	persons all of whom are in the same or functionally related
126	licensed professions, and providing coverage only to such
127	licensed professionals, their employees or their dependents;
128	2. Policies providing coverage to small employers as
129	defined by s. 627.6699. Such policies shall be subject to, and
130	governed by, the provisions of s. %_%1%_%;
131	3. Policies issued to a bona fide association, as defined
132	by s.%_%2%_%(5), provided that there is a person or board acting
133	as a fiduciary for the benefit of the members; such association
134	is not owned, controlled by, or otherwiseassociated with the
135	insurance company; or
136	4. Any accidental death, accidental death and
137	dismemberment, accident-only, vision-only, dental-only, hospital
138	indemnity-only, hospital accident-only, cancer, specified
139	disease, Medicare supplement, products that supplement Medicare,
140	long-term care, or disability income insurance, similar
141	supplemental plans provided under a separate policy,
142	certificate, or contract of insurance, which cannot duplicate
143	coverage under an underlying health plan, coinsurance, or
144	deductibles; coverage issued as a supplement to workers’
145	compensation or similar insurance; or automobile medical-payment
146	insurance.
147	(9) Any insured shall be able to terminate membership or
148	affiliation with the group to whom the master policy is issued.
149	An insured that elects to terminate his membership or
150	affiliation with the group, shall provide written notice to the
151	insurer. Upon providing such notice, the member shall be
152	entitled to the rights and options provided by s. 627.6675.
153	(10) Any pricing structure that results or is reasonably
154	expected to result in rate escalations resulting in a death
155	spiral, which is a rate escalation caused by segmenting healthy
156	and unhealthy lives resulting in an ultimate pool of primarily
157	less healthy insureds is considered a predatory pricing
158	structure and constitutes unfair discrimination as provided in
159	s. 626.9541(1)(g). The Financial Services Commission may, by
160	rule, define other unfairly discriminatory or predatory health
161	insurance rating practices.
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163	================= T I T L E A M E N D M E N T =================
164	Remove line(s) 13-24, and insert:
165	exemptions; amending s. 626.9541, F.S.; relating to unfair
166	discrimination; amending s. 627.6515, F.S.; providing for
167	disclosure and exceptions thereto and clarifies applicability to
168	out-of-state group policies; prohibits predatory pricing;
169	authorizes Office of Insurance Regulation to adopt rules;
170	clarifies applicability of group conversion provisions;
171	providing an effective datre.