Amendment
Bill No. 1503
Amendment No. 962387
CHAMBER ACTION
Senate House
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1Representative Mahon offered the following:
2
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
9or disapprove health flex plans that provide health care
10coverage for eligible participants. A health flex plan may limit
11or exclude benefits otherwise required by law for insurers
12offering coverage in this state, may cap the total amount of
13claims paid per year per enrollee, may limit the number of
14enrollees, or may take any combination of those actions. A
15health flex plan offering may include the option of a
16catastrophic plan supplementing the health flex plan.
17     (b)  The office shall develop guidelines for the review of
18health flex plan applications and provide regulatory oversight
19of health flex plan advertisement and marketing procedures. The
20office shall disapprove or shall withdraw approval of plans
21that:
22     1.  Contain any ambiguous, inconsistent, or misleading
23provisions or any exceptions or conditions that deceptively
24affect or limit the benefits purported to be assumed in the
25general coverage provided by the health flex plan;
26     2.  Provide benefits that are unreasonable in relation to
27the premium charged or contain provisions that are unfair or
28inequitable or contrary to the public policy of this state, that
29encourage misrepresentation, or that result in unfair
30discrimination in sales practices; or
31     3.  Cannot demonstrate that the health flex plan is
32financially sound and that the applicant is able to underwrite
33or finance the health care coverage provided; or
34     4.  Cannot demonstrate that the applicant and its
35management are in compliance with the standards required
36pursuant to s. 624.404(3).
37     (5)  ELIGIBILITY.--Eligibility to enroll in an approved
38health 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
41percent of the federal poverty level;
42     3.(c)  Are eligible under a federally approved Medicaid
43demonstration waiver and reside in Palm Beach County or Miami-
44Dade County;
45     4.(d)  Are not covered by a private insurance policy and
46are not eligible for coverage through a public health insurance
47program, such as Medicare or Medicaid, unless specifically
48authorized under subparagraph 3. paragraph (c), or another
49public health care program, such as KidCare, and have not been
50covered at any time during the past 6 months. However, the 6-
51month waiting period is waived for individuals who lose their
52Medicaid eligibility, provided all other eligibility
53requirements of this section are met; and
54     5.(e)  Have applied for health care coverage through an
55approved health flex plan and have agreed to make any payments
56required for participation, including periodic payments or
57payments 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
62on behalf of its employees;
63     4.  Has not otherwise offered health insurance benefits in
64the previous 12 months; and
65     5.  Has a workforce in which 75 percent of the employees
66meet all the eligibility criteria in paragraph (a).
67
68================ T I T L E  A M E N D M E N T =============
69     Remove line 14 and insert:
70flex plans; revising eligibility criteria for residents of
71the state enrolling in an approved health flex plan;
72amending s. 627.413, F.S.; authorizing


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