| 1 | Representative Mahon offered the following: |
| 2 |
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| 3 | Amendment (with title amendment) |
| 4 | Remove lines 153-184 and insert: |
| 5 | Section 2. Paragraph (b) of subsection (3) and subsection |
| 6 | (5) of section 408.909, Florida Statutes, are amended to read: |
| 7 | 408.909 Health flex plans.-- |
| 8 | (3) PROGRAM.--The agency and the office shall each approve |
| 9 | or disapprove health flex plans that provide health care |
| 10 | coverage for eligible participants. A health flex plan may limit |
| 11 | or exclude benefits otherwise required by law for insurers |
| 12 | offering coverage in this state, may cap the total amount of |
| 13 | claims paid per year per enrollee, may limit the number of |
| 14 | enrollees, or may take any combination of those actions. A |
| 15 | health flex plan offering may include the option of a |
| 16 | catastrophic plan supplementing the health flex plan. |
| 17 | (b) The office shall develop guidelines for the review of |
| 18 | health flex plan applications and provide regulatory oversight |
| 19 | of health flex plan advertisement and marketing procedures. The |
| 20 | office shall disapprove or shall withdraw approval of plans |
| 21 | that: |
| 22 | 1. Contain any ambiguous, inconsistent, or misleading |
| 23 | provisions or any exceptions or conditions that deceptively |
| 24 | affect or limit the benefits purported to be assumed in the |
| 25 | general coverage provided by the health flex plan; |
| 26 | 2. Provide benefits that are unreasonable in relation to |
| 27 | the premium charged or contain provisions that are unfair or |
| 28 | inequitable or contrary to the public policy of this state, that |
| 29 | encourage misrepresentation, or that result in unfair |
| 30 | discrimination in sales practices; or |
| 31 | 3. Cannot demonstrate that the health flex plan is |
| 32 | financially sound and that the applicant is able to underwrite |
| 33 | or finance the health care coverage provided; or |
| 34 | 4. Cannot demonstrate that the applicant and its |
| 35 | management are in compliance with the standards required |
| 36 | pursuant to s. 624.404(3). |
| 37 | (5) ELIGIBILITY.--Eligibility to enroll in an approved |
| 38 | health flex plan is limited to residents of this state who: |
| 39 | (a)1. Are 64 years of age or younger; |
| 40 | 2.(b) Have a family income equal to or less than 300 200 |
| 41 | percent of the federal poverty level; |
| 42 | 3.(c) Are eligible under a federally approved Medicaid |
| 43 | demonstration waiver and reside in Palm Beach County or Miami- |
| 44 | Dade County; |
| 45 | 4.(d) Are not covered by a private insurance policy and |
| 46 | are not eligible for coverage through a public health insurance |
| 47 | program, such as Medicare or Medicaid, unless specifically |
| 48 | authorized under subparagraph 3. paragraph (c), or another |
| 49 | public health care program, such as KidCare, and have not been |
| 50 | covered at any time during the past 6 months. However, the 6- |
| 51 | month waiting period is waived for individuals who lose their |
| 52 | Medicaid eligibility, provided all other eligibility |
| 53 | requirements of this section are met; and |
| 54 | 5.(e) Have applied for health care coverage through an |
| 55 | approved health flex plan and have agreed to make any payments |
| 56 | required for participation, including periodic payments or |
| 57 | payments due at the time health care services are provided; or. |
| 58 | (b) Are employees of a business that: |
| 59 | 1. Has 100 or fewer employees; |
| 60 | 2. Offers a health flex plan to its employees; |
| 61 | 3. Pays a portion of the premium for the health flex plan |
| 62 | on behalf of its employees; |
| 63 | 4. Has not otherwise offered health insurance benefits in |
| 64 | the previous 12 months; and |
| 65 | 5. Has a workforce in which 75 percent of the employees |
| 66 | meet all the eligibility criteria in paragraph (a). |
| 67 |
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| 68 | ================ T I T L E A M E N D M E N T ============= |
| 69 | Remove line 14 and insert: |
| 70 | flex plans; revising eligibility criteria for residents of |
| 71 | the state enrolling in an approved health flex plan; |
| 72 | amending s. 627.413, F.S.; authorizing |