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) 28-135, and insert:
16	Section 1. Paragraph (e) of subsection (1) of section
17	627.411, Florida Statutes, is amended, and subsection (3) is
18	added to said section, to read:
19	627.411 Grounds for disapproval.--
20	(1) The department shall disapprove any form filed under
21	s. 627.410, or withdraw any previous approval thereof, only if
22	the form:
23	(e) Is for health insurance and:
24	1. Provides benefits thatwhichare unreasonable in
25	relation to the premium charged;,
26	2. Contains provisions thatwhichare unfair or
27	inequitable or contrary to the public policy of this state or
28	thatwhich encourage misrepresentation;,or
29	3. Contains provisions thatwhich apply rating practices
30	thatwhich result in premium escalations that are not viable for
31	the policyholder market or result in unfair discrimination
32	pursuant to s. 626.9541(1)(g)2.in sales practices.
33	(3)(a) For health insurance coverage as described in s.
34	627.6561(5)(a)2., the minimum loss ratio standard of incurred
35	claims to earned premium for the form shall be 65 percent.
36	(b) Incurred claims are claims occurring within a fixed
37	period, whether or not paid during the same period, under the
38	terms of the policy period.
39	1. Claims include scheduled benefit payments, or services
40	provided by a provider or through a provider network for dental,
41	vision, disability, and similar health benefits.
42	2. Claims do not include state assessments, taxes,
43	company expenses, or any expense incurred by the company for the
44	cost of adjusting and settling a claim, including the review,
45	qualification, oversight, management, or monitoring of a claim
46	or incentives or compensation to providers for other than the
47	provisions of health care services.
48	3. A company may at its discretion include costs that are
49	demonstrated to reduce claims, such as fraud intervention
50	programs or case management costs, which are identified in each
51	filing, are demonstrated to reduce claims costs, and do not
52	result in increasing the experience period loss ratio by more
53	than 5 percent.
54	4. For scheduled claim payments, such as disability
55	income or long-term care, the incurred claims shall be the
56	present value of the benefit payments discounted for continuance
57	and interest.
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59	================= T I T L E A M E N D M E N T =================
60	Remove line(s) 11-13, and insert:
61	An act relating to health insurance; amending s. 627.411,
62	F.S.; providing conditions for disapproval of health
63	insurance forms by the Office of Insurance Regulation;
64	amending s. 627.6515, F.S.; revising