HB 0053

CS

CHAMBER ACTION

1	The Committee on Insurance recommends the following:
2
3	Committee Substitute
4	Remove the entire bill and insert:
5	A bill to be entitled
6	An act relating to affordable health insurance in rural
7	counties; amending s. 112.08, F.S.; providing legislative
8	findings; providing for a pilot self-insurance program;
9	authorizing a rural health network in Monroe County to
10	establish a self-insurance plan for certain purposes;
11	providing program requirements; providing for approval by
12	the Office of Insurance Regulation of the Financial
13	Services Commission; requiring an evaluation and report to
14	the Legislature by January 1, 2006; providing an effective
15	date.
16
17	Be It Enacted by the Legislature of the State of Florida:
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19	Section 1.  Paragraph (b) of subsection (2) of section
20	112.08, Florida Statutes, is amended, and paragraph (d) is added
21	to said subsection, to read:
22	112.08  Group insurance for public officers, employees, and
23	certain volunteers; physical examinations.--
24	(2)
25	(b)  In order to obtain approval from the Office of
26	Insurance Regulation of any self-insured plan for health,
27	accident, and hospitalization coverage, each local governmental
28	unit or consortium shall submit its plan along with a
29	certification as to the actuarial soundness of the plan, which
30	certification is prepared by an actuary who is a member of the
31	Society of Actuaries or the American Academy of Actuaries. The
32	Office of Insurance Regulation shall not approve the plan unless
33	it determines that the plan is designed to provide sufficient
34	revenues to pay current and future liabilities, as determined
35	according to generally accepted actuarial principles. After
36	implementation of an approved plan, each local governmental unit
37	or consortium shall annually submit to the Office of Insurance
38	Regulation a report which includes a statement prepared by an
39	actuary who is a member of the Society of Actuaries or the
40	American Academy of Actuaries as to the actuarial soundness of
41	the plan. The report is due 90 days after the close of the
42	fiscal year of the plan. The report shall consist of, but is not
43	limited to:
44	1.  The adequacy of contribution rates in meeting the level
45	of benefits provided and the changes, if any, needed in the
46	contribution rates to achieve or preserve a level of funding
47	deemed adequate to enable payment of the benefit amounts
48	provided under the plan and a valuation of present assets, based
49	on statement value, and prospective assets and liabilities of
50	the plan and the extent of any unfunded accrued liabilities.
51	2.  A plan to amortize any unfunded liabilities and a
52	description of actions taken to reduce unfunded liabilities.
53	3.  A description and explanation of actuarial assumptions.
54	4.  A schedule illustrating the amortization of any
55	unfunded liabilities.
56	5.  A comparative review illustrating the level of funds
57	available to the plan from rates, investment income, and other
58	sources realized over the period covered by the report with the
59	assumptions used.
60	6.  A statement by the actuary that the report is complete
61	and accurate and that in the actuary's opinion the techniques
62	and assumptions used are reasonable and meet the requirements
63	and intent of this subsection.
64	7.  Other factors or statements as required by the office
65	Department of Insurance in order to determine the actuarial
66	soundness of the plan.
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68	All assumptions used in the report shall be based on recognized
69	actuarial principles acceptable to the Office of Insurance
70	Regulation. The office shall review the report and shall notify
71	the administrator of the plan and each entity participating in
72	the plan, as identified by the administrator, of any actuarial
73	deficiencies. Each local governmental unit is responsible for
74	payment of valid claims of its employees that are not paid
75	within 60 days after receipt by the plan administrator or
76	consortium.
77	(d)  Pilot program; Monroe County.--
78	1.  The Legislature has determined that insurers and
79	managed care organizations are unable to provide adequate or
80	affordable health insurance coverage in rural counties and other
81	isolated areas of the state. It is therefore necessary to
82	explore alternatives for making affordable health insurance
83	coverage available in rural counties and other similar areas of
84	the state.
85	2.  An entity in Monroe County, established pursuant to s.
86	381.0406, may, through a nonprofit corporation, establish a
87	self-insurance plan approved by the office in accordance with
88	paragraph (b) to insure residents of a rural county or similar
89	area if the residents are unable to obtain adequate or
90	affordable health insurance coverage. Premiums charged by the
91	self-insurance plan for participating residents or employers
92	shall be actuarially sound. In reviewing such a self-insurance
93	plan, the office shall consult with the Department of Health to
94	confirm that the program is consistent with the purpose and
95	scope of chapter 381.
96	3.  The entity in Monroe County that establishes this
97	program shall, in addition to the reporting requirements set
98	forth in paragraph (b), prepare an evaluation of the pilot
99	program, including recommendations for the future of the
100	program, and submit the report to the Governor, the President of
101	the Senate, the Speaker of the House of Representatives, the
102	Department of Health, and the office no later than January 1,
103	2006.
104	Section 2.  This act shall take effect upon becoming a law.

CODING: Words stricken are deletions; words underlined are additions.