Florida Senate - 2005 SENATOR AMENDMENT
Bill No. CS for CS for SB 1660
Barcode 675004
CHAMBER ACTION
Senate House
.
.
1 1/AD/2R .
05/04/2005 04:04 PM .
2 .
.
3 .
.
4 ______________________________________________________________
5
6
7
8
9
10 ______________________________________________________________
11 Senator Fasano moved the following amendment:
12
13 Senate Amendment (with title amendment)
14 Delete everything after the enacting clause
15
16 and insert:
17 Section 1. Paragraph (l) of subsection (3) of section
18 408.05, Florida Statutes, is amended to read:
19 408.05 State Center for Health Statistics.--
20 (3) COMPREHENSIVE HEALTH INFORMATION SYSTEM.--In order
21 to produce comparable and uniform health information and
22 statistics, the agency shall perform the following functions:
23 (l) Develop, in conjunction with the State
24 Comprehensive Health Information System Advisory Council, and
25 implement a long-range plan for making available performance
26 outcome and financial data that will allow consumers to
27 compare health care services. The performance outcomes and
28 financial data the agency must make available shall include,
29 but is not limited to, pharmaceuticals, physicians, health
30 care facilities, and health plans and managed care entities.
31 The agency shall submit the initial plan to the Governor, the
1
7:57 PM 05/03/05 s1660c2d-11-k6f
Florida Senate - 2005 SENATOR AMENDMENT
Bill No. CS for CS for SB 1660
Barcode 675004
1 President of the Senate, and the Speaker of the House of
2 Representatives by January March 1, 2006 2005, and shall
3 update the plan and report on the status of its implementation
4 annually thereafter. The agency shall also make the plan and
5 status report available to the public on its Internet website.
6 As part of the plan, the agency shall identify the process and
7 timeframes for implementation, any barriers to implementation,
8 and recommendations of changes in the law that may be enacted
9 by the Legislature to eliminate the barriers. As preliminary
10 elements of the plan, the agency shall:
11 1. Make available performance outcome and patient
12 charge data collected from health care facilities pursuant to
13 s. 408.061(1)(a) and (2). The agency shall determine which
14 conditions and procedures, performance outcomes, and patient
15 charge data to disclose based upon input from the council.
16 When determining which conditions and procedures are to be
17 disclosed, the council and the agency shall consider variation
18 in costs, variation in outcomes, and magnitude of variations
19 and other relevant information. When determining which
20 performance outcomes to disclose, the agency:
21 a. Shall consider such factors as volume of cases;
22 average patient charges; average length of stay; complication
23 rates; mortality rates; and infection rates, among others,
24 which shall be adjusted for case mix and severity, if
25 applicable.
26 b. May consider such additional measures that are
27 adopted by the Centers for Medicare and Medicaid Studies,
28 National Quality Forum, the Joint Commission on Accreditation
29 of Healthcare Organizations, the Agency for Healthcare
30 Research and Quality, or a similar national entity that
31 establishes standards to measure the performance of health
2
7:57 PM 05/03/05 s1660c2d-11-k6f
Florida Senate - 2005 SENATOR AMENDMENT
Bill No. CS for CS for SB 1660
Barcode 675004
1 care providers, or by other states.
2
3 When determining which patient charge data to disclose, the
4 agency shall consider such measures as average charge, average
5 net revenue per adjusted patient day, average cost per
6 adjusted patient day, and average cost per admission, among
7 others.
8 2. Make available performance measures, benefit
9 design, and premium cost data from health plans licensed
10 pursuant to chapter 627 or chapter 641. The agency shall
11 determine which performance outcome and member and subscriber
12 cost data to disclose, based upon input from the council. When
13 determining which data to disclose, the agency shall consider
14 information that may be required by either individual or group
15 purchasers to assess the value of the product, which may
16 include membership satisfaction, quality of care, current
17 enrollment or membership, coverage areas, accreditation
18 status, premium costs, plan costs, premium increases, range of
19 benefits, copayments and deductibles, accuracy and speed of
20 claims payment, credentials of physicians, number of
21 providers, names of network providers, and hospitals in the
22 network. Health plans shall make available to the agency any
23 such data or information that is not currently reported to the
24 agency or the office.
25 3. Determine the method and format for public
26 disclosure of data reported pursuant to this paragraph. The
27 agency shall make its determination based upon input from the
28 Comprehensive Health Information System Advisory Council. At a
29 minimum, the data shall be made available on the agency's
30 Internet website in a manner that allows consumers to conduct
31 an interactive search that allows them to view and compare the
3
7:57 PM 05/03/05 s1660c2d-11-k6f
Florida Senate - 2005 SENATOR AMENDMENT
Bill No. CS for CS for SB 1660
Barcode 675004
1 information for specific providers. The website must include
2 such additional information as is determined necessary to
3 ensure that the website enhances informed decisionmaking among
4 consumers and health care purchasers, which shall include, at
5 a minimum, appropriate guidance on how to use the data and an
6 explanation of why the data may vary from provider to
7 provider. The data specified in subparagraph 1. shall be
8 released no later than January 1, 2006, for the reporting of
9 infection rates, and no later than October 1, 2005, for
10 mortality rates and complication rates March 1, 2005. The data
11 specified in subparagraph 2. shall be released no later than
12 October March 1, 2006.
13 Section 2. Paragraph (b) of subsection (3) of section
14 408.909, Florida Statutes, is amended to read:
15 408.909 Health flex plans.--
16 (3) PROGRAM.--The agency and the office shall each
17 approve or disapprove health flex plans that provide health
18 care coverage for eligible participants. A health flex plan
19 may limit or exclude benefits otherwise required by law for
20 insurers offering coverage in this state, may cap the total
21 amount of claims paid per year per enrollee, may limit the
22 number of enrollees, or may take any combination of those
23 actions. A health flex plan offering may include the option of
24 a catastrophic plan supplementing the health flex plan.
25 (b) The office shall develop guidelines for the review
26 of health flex plan applications and provide regulatory
27 oversight of health flex plan advertisement and marketing
28 procedures. The office shall disapprove or shall withdraw
29 approval of plans that:
30 1. Contain any ambiguous, inconsistent, or misleading
31 provisions or any exceptions or conditions that deceptively
4
7:57 PM 05/03/05 s1660c2d-11-k6f
Florida Senate - 2005 SENATOR AMENDMENT
Bill No. CS for CS for SB 1660
Barcode 675004
1 affect or limit the benefits purported to be assumed in the
2 general coverage provided by the health flex plan;
3 2. Provide benefits that are unreasonable in relation
4 to the premium charged or contain provisions that are unfair
5 or inequitable or contrary to the public policy of this state,
6 that encourage misrepresentation, or that result in unfair
7 discrimination in sales practices; or
8 3. Cannot demonstrate that the health flex plan is
9 financially sound and that the applicant is able to underwrite
10 or finance the health care coverage provided; or
11 4. Cannot demonstrate that the applicant and its
12 management are in compliance with the standards required under
13 s. 624.404(3).
14 Section 3. Effective upon this act becoming a law,
15 subsection (4) is added to section 627.411, Florida Statutes,
16 to read:
17 627.411 Grounds for disapproval.--
18 (4) Notwithstanding subsections (1) and (2), an annual
19 rate increase for a closed long-term care insurance policy
20 form or limited benefit policy form as defined in s. 627.9404,
21 or a closed block of such forms with similar benefits, may not
22 exceed medical trend. For purposes of this subsection, the
23 term "closed" means that the form, or all forms within the
24 block of pooled forms, has not been actively offered for sale
25 by the insurer in the previous 12 months.
26 Section 4. Subsection (6) is added to section 627.413,
27 Florida Statutes, to read:
28 627.413 Contents of policies, in general;
29 identification.--
30 (6) Notwithstanding any other provision of the Florida
31 Insurance Code that is in conflict with federal requirements
5
7:57 PM 05/03/05 s1660c2d-11-k6f
Florida Senate - 2005 SENATOR AMENDMENT
Bill No. CS for CS for SB 1660
Barcode 675004
1 for a health savings account qualified high-deductible health
2 plan, an insurer, or a health maintenance organization subject
3 to part I of chapter 641, which is authorized to issue health
4 insurance in this state may offer for sale an individual or
5 group policy or contract that provides for a high-deductible
6 plan that meets the federal requirements of a health savings
7 account plan and which is offered in conjunction with a health
8 savings account.
9 Section 5. Subsection (2) of section 627.638, Florida
10 Statutes, is amended to read:
11 627.638 Direct payment for hospital, medical
12 services.--
13 (2) Whenever, in any health insurance claim form, an
14 insured specifically authorizes payment of benefits directly
15 to any recognized hospital or physician, the insurer shall
16 make such payment to the designated provider of such services,
17 unless otherwise provided in the insurance contract. The
18 insurance contract may not prohibit, and claims forms must
19 provide an option for, the payment of benefits directly to a
20 licensed hospital, physician, or dentist for care provided
21 pursuant to s. 395.1041. The insurer may require written
22 attestation of assignment of benefits. Payment to the provider
23 from the insurer may not be more than the amount that the
24 insurer would otherwise have paid without the assignment.
25 Section 6. Section 627.6402, Florida Statutes, is
26 amended to read:
27 627.6402 Insurance rebates for healthy lifestyles.--
28 (1) Any rate, rating schedule, or rating manual for an
29 individual health insurance policy filed with the office may
30 shall provide for an appropriate rebate of premiums paid in
31 the last calendar year when the individual covered by such
6
7:57 PM 05/03/05 s1660c2d-11-k6f
Florida Senate - 2005 SENATOR AMENDMENT
Bill No. CS for CS for SB 1660
Barcode 675004
1 plan is enrolled in and maintains participation in any health
2 wellness, maintenance, or improvement program approved by the
3 health plan. The rebate may be based on premiums paid in the
4 last calendar year or the last policy year. The individual
5 must provide evidence of demonstrative maintenance or
6 improvement of the individual's health status as determined by
7 assessments of agreed-upon health status indicators between
8 the individual and the health insurer, including, but not
9 limited to, reduction in weight, body mass index, and smoking
10 cessation. Any rebate provided by the health insurer is
11 presumed to be appropriate unless credible data demonstrates
12 otherwise, or unless such rebate program requires the insured
13 to incur costs to qualify for the rebate which equal or exceed
14 the value of the rebate, but in no event shall the rebate not
15 exceed 10 percent of paid premiums.
16 (2) The premium rebate authorized by this section
17 shall be effective for an insured on an annual basis, unless
18 the individual fails to maintain or improve his or her health
19 status while participating in an approved wellness program, or
20 credible evidence demonstrates that the individual is not
21 participating in the approved wellness program.
22 Section 7. Section 627.65626, Florida Statutes, is
23 amended to read:
24 627.65626 Insurance rebates for healthy lifestyles.--
25 (1) Any rate, rating schedule, or rating manual for a
26 health insurance policy that provides creditable coverage as
27 defined in s. 627.6561(5) filed with the office shall provide
28 for an appropriate rebate of premiums paid in the last policy
29 year, contract year, or calendar year when the majority of
30 members of a health plan have enrolled and maintained
31 participation in any health wellness, maintenance, or
7
7:57 PM 05/03/05 s1660c2d-11-k6f
Florida Senate - 2005 SENATOR AMENDMENT
Bill No. CS for CS for SB 1660
Barcode 675004
1 improvement program offered by the group policyholder and
2 health plan employer. The rebate may be based upon premiums
3 paid in the last calendar year or policy year. The group
4 employer must provide evidence of demonstrative maintenance or
5 improvement of the enrollees' health status as determined by
6 assessments of agreed-upon health status indicators between
7 the policyholder employer and the health insurer, including,
8 but not limited to, reduction in weight, body mass index, and
9 smoking cessation. The group or health insurer may contract
10 with a third-party administrator to assemble and report the
11 health status required in this subsection between the
12 policyholder and the health insurer. Any rebate provided by
13 the health insurer is presumed to be appropriate unless
14 credible data demonstrates otherwise, or unless the rebate
15 program requires the insured to incur costs to qualify for the
16 rebate which equal or exceeds the value of the rebate, but the
17 rebate may shall not exceed 10 percent of paid premiums.
18 (2) The premium rebate authorized by this section
19 shall be effective for an insured on an annual basis unless
20 the number of participating members on the policy renewal
21 anniversary employees becomes less than the majority of the
22 members employees eligible for participation in the wellness
23 program.
24 Section 8. Paragraphs (d) and (j) of subsection (5) of
25 section 627.6692, Florida Statutes, are amended to read:
26 627.6692 Florida Health Insurance Coverage
27 Continuation Act.--
28 (5) CONTINUATION OF COVERAGE UNDER GROUP HEALTH
29 PLANS.--
30 (d)1. A qualified beneficiary must give written notice
31 to the insurance carrier within 63 30 days after the
8
7:57 PM 05/03/05 s1660c2d-11-k6f
Florida Senate - 2005 SENATOR AMENDMENT
Bill No. CS for CS for SB 1660
Barcode 675004
1 occurrence of a qualifying event. Unless otherwise specified
2 in the notice, a notice by any qualified beneficiary
3 constitutes notice on behalf of all qualified beneficiaries.
4 The written notice must inform the insurance carrier of the
5 occurrence and type of the qualifying event giving rise to the
6 potential election by a qualified beneficiary of continuation
7 of coverage under the group health plan issued by that
8 insurance carrier, except that in cases where the covered
9 employee has been involuntarily discharged, the nature of such
10 discharge need not be disclosed. The written notice must, at a
11 minimum, identify the employer, the group health plan number,
12 the name and address of all qualified beneficiaries, and such
13 other information required by the insurance carrier under the
14 terms of the group health plan or the commission by rule, to
15 the extent that such information is known by the qualified
16 beneficiary.
17 2. Within 14 days after the receipt of written notice
18 under subparagraph 1., the insurance carrier shall send each
19 qualified beneficiary by certified mail an election and
20 premium notice form, approved by the office, which form must
21 provide for the qualified beneficiary's election or
22 nonelection of continuation of coverage under the group health
23 plan and the applicable premium amount due after the election
24 to continue coverage. This subparagraph does not require
25 separate mailing of notices to qualified beneficiaries
26 residing in the same household, but requires a separate
27 mailing for each separate household.
28 (j) Notwithstanding paragraph (b), if a qualified
29 beneficiary in the military reserve or National Guard has
30 elected to continue coverage and is thereafter called to
31 active duty and the coverage under the group plan is
9
7:57 PM 05/03/05 s1660c2d-11-k6f
Florida Senate - 2005 SENATOR AMENDMENT
Bill No. CS for CS for SB 1660
Barcode 675004
1 terminated by the beneficiary or the carrier due to the
2 qualified beneficiary becoming eligible for TRICARE (the
3 health care program provided by the United States Defense
4 Department), the 18-month period or such other applicable
5 maximum time period for which the qualified beneficiary would
6 otherwise be entitled to continue coverage is tolled during
7 the time that he or she is covered under the TRICARE program.
8 Within 63 30 days after the federal TRICARE coverage
9 terminates, the qualified beneficiary may elect to continue
10 coverage under the group health plan, retroactively to the
11 date coverage terminated under TRICARE, for the remainder of
12 the 18-month period or such other applicable time period,
13 subject to termination of coverage at the earliest of the
14 conditions specified in paragraph (b).
15 Section 9. Paragraph (a) of subsection (4), paragraph
16 (c) of subsection (5), and paragraphs (b) and (j) of
17 subsection (11) of section 627.6699, Florida Statutes, are
18 amended, and paragraph (o) is added to subsection (11) of that
19 section, to read:
20 627.6699 Employee Health Care Access Act.--
21 (4) APPLICABILITY AND SCOPE.--
22 (a)1. This section applies to a health benefit plan
23 that provides coverage to employees of a small employer in
24 this state, unless the coverage policy is marketed directly to
25 the individual employee, and the employer does not contribute
26 directly or indirectly to participate in the collection or
27 distribution of premiums or facilitate the administration of
28 the coverage policy in any manner. For the purposes of this
29 paragraph, an employer is not deemed to be contributing to the
30 premiums or facilitating the administration of coverage if the
31 employer does not contribute to the premium and merely
10
7:57 PM 05/03/05 s1660c2d-11-k6f
Florida Senate - 2005 SENATOR AMENDMENT
Bill No. CS for CS for SB 1660
Barcode 675004
1 collects the premiums for coverage from an employee's wages or
2 salary through payroll deduction and submits payment for the
3 premiums of one or more employees in a lump sum to a carrier.
4 2. A carrier authorized to issue group or individual
5 health benefit plans under this chapter or chapter 641 may
6 offer coverage as described in this paragraph to individual
7 employees without being subject to this section if the
8 employer has not had a group health benefit plan in place in
9 the prior 6 months. A carrier authorized to issue group or
10 individual health benefit plans under this chapter or chapter
11 641 may offer coverage as described in this paragraph to
12 employees that are not eligible employees as defined in this
13 section, whether or not the small employer has a group health
14 benefit plan in place. A carrier that offers coverage as
15 described in this paragraph must provide a cancellation notice
16 to the primary insured at least 10 days prior to canceling the
17 coverage for nonpayment of premium.
18 (5) AVAILABILITY OF COVERAGE.--
19 (c) Every small employer carrier must, as a condition
20 of transacting business in this state:
21 1. Offer and issue all small employer health benefit
22 plans on a guaranteed-issue basis to every eligible small
23 employer, with 2 to 50 eligible employees, that elects to be
24 covered under such plan, agrees to make the required premium
25 payments, and satisfies the other provisions of the plan. A
26 rider for additional or increased benefits may be medically
27 underwritten and may only be added to the standard health
28 benefit plan. The increased rate charged for the additional or
29 increased benefit must be rated in accordance with this
30 section.
31 2. In the absence of enrollment availability in the
11
7:57 PM 05/03/05 s1660c2d-11-k6f
Florida Senate - 2005 SENATOR AMENDMENT
Bill No. CS for CS for SB 1660
Barcode 675004
1 Florida Health Insurance Plan, offer and issue basic and
2 standard small employer health benefit plans and a
3 high-deductible plan that meets the requirements of a health
4 savings account plan or health reimbursement account as
5 defined by federal law, on a guaranteed-issue basis, during a
6 31-day open enrollment period of August 1 through August 31 of
7 each year, to every eligible small employer, with fewer than
8 two eligible employees, which small employer is not formed
9 primarily for the purpose of buying health insurance and which
10 elects to be covered under such plan, agrees to make the
11 required premium payments, and satisfies the other provisions
12 of the plan. Coverage provided under this subparagraph shall
13 begin on October 1 of the same year as the date of enrollment,
14 unless the small employer carrier and the small employer agree
15 to a different date. A rider for additional or increased
16 benefits may be medically underwritten and may only be added
17 to the standard health benefit plan. The increased rate
18 charged for the additional or increased benefit must be rated
19 in accordance with this section. For purposes of this
20 subparagraph, a person, his or her spouse, and his or her
21 dependent children constitute a single eligible employee if
22 that person and spouse are employed by the same small employer
23 and either that person or his or her spouse has a normal work
24 week of less than 25 hours. Any right to an open enrollment of
25 health benefit coverage for groups of fewer than two
26 employees, pursuant to this section, shall remain in full
27 force and effect in the absence of the availability of new
28 enrollment into the Florida Health Insurance Plan.
29 3. This paragraph does not limit a carrier's ability
30 to offer other health benefit plans to small employers if the
31 standard and basic health benefit plans are offered and
12
7:57 PM 05/03/05 s1660c2d-11-k6f
Florida Senate - 2005 SENATOR AMENDMENT
Bill No. CS for CS for SB 1660
Barcode 675004
1 rejected.
2 (11) SMALL EMPLOYER HEALTH REINSURANCE PROGRAM.--
3 (b)1. The program shall operate subject to the
4 supervision and control of the board.
5 2. Effective upon this act becoming a law, the board
6 shall consist of the director of the office or his or her
7 designee, who shall serve as the chairperson, and 13
8 additional members who are representatives of carriers and
9 insurance agents and are appointed by the director of the
10 office and serve as follows:
11 a. Five members shall be representatives of health
12 insurers licensed under chapter 624 or chapter 641. Two
13 members shall be agents who are actively engaged in the sale
14 of health insurance. Four members shall be employers or
15 representatives of employers. One member shall be a person
16 covered under an individual health insurance policy issued by
17 a licensed insurer in this state. One member shall represent
18 the Agency for Health Care Administration and shall be
19 recommended by the Secretary of Health Care Administration.
20 The director of the office shall include representatives of
21 small employer carriers subject to assessment under this
22 subsection. If two or more carriers elect to be risk-assuming
23 carriers, the membership must include at least two
24 representatives of risk-assuming carriers; if one carrier is
25 risk-assuming, one member must be a representative of such
26 carrier. At least one member must be a carrier who is subject
27 to the assessments, but is not a small employer carrier.
28 Subject to such restrictions, at least five members shall be
29 selected from individuals recommended by small employer
30 carriers pursuant to procedures provided by rule of the
31 commission. Three members shall be selected from a list of
13
7:57 PM 05/03/05 s1660c2d-11-k6f
Florida Senate - 2005 SENATOR AMENDMENT
Bill No. CS for CS for SB 1660
Barcode 675004
1 health insurance carriers that issue individual health
2 insurance policies. At least two of the three members selected
3 must be reinsuring carriers. Two members shall be selected
4 from a list of insurance agents who are actively engaged in
5 the sale of health insurance.
6 b. A member appointed under this subparagraph shall
7 serve a term of 4 years and shall continue in office until the
8 member's successor takes office, except that, in order to
9 provide for staggered terms, the director of the office shall
10 designate two of the initial appointees under this
11 subparagraph to serve terms of 2 years and shall designate
12 three of the initial appointees under this subparagraph to
13 serve terms of 3 years.
14 3. The director of the office may remove a member for
15 cause.
16 4. Vacancies on the board shall be filled in the same
17 manner as the original appointment for the unexpired portion
18 of the term.
19 5. The director of the office may require an entity
20 that recommends persons for appointment to submit additional
21 lists of recommended appointees.
22 (j)1. Before July March 1 of each calendar year, the
23 board shall determine and report to the office the program net
24 loss for the previous year, including administrative expenses
25 for that year, and the incurred losses for the year, taking
26 into account investment income and other appropriate gains and
27 losses.
28 2. Any net loss for the year shall be recouped by
29 assessment of the carriers, as follows:
30 a. The operating losses of the program shall be
31 assessed in the following order subject to the specified
14
7:57 PM 05/03/05 s1660c2d-11-k6f
Florida Senate - 2005 SENATOR AMENDMENT
Bill No. CS for CS for SB 1660
Barcode 675004
1 limitations. The first tier of assessments shall be made
2 against reinsuring carriers in an amount which shall not
3 exceed 5 percent of each reinsuring carrier's premiums from
4 health benefit plans covering small employers. If such
5 assessments have been collected and additional moneys are
6 needed, the board shall make a second tier of assessments in
7 an amount which shall not exceed 0.5 percent of each carrier's
8 health benefit plan premiums. Except as provided in paragraph
9 (n), risk-assuming carriers are exempt from all assessments
10 authorized pursuant to this section. The amount paid by a
11 reinsuring carrier for the first tier of assessments shall be
12 credited against any additional assessments made.
13 b. The board shall equitably assess carriers for
14 operating losses of the plan based on market share. The board
15 shall annually assess each carrier a portion of the operating
16 losses of the plan. The first tier of assessments shall be
17 determined by multiplying the operating losses by a fraction,
18 the numerator of which equals the reinsuring carrier's earned
19 premium pertaining to direct writings of small employer health
20 benefit plans in the state during the calendar year for which
21 the assessment is levied, and the denominator of which equals
22 the total of all such premiums earned by reinsuring carriers
23 in the state during that calendar year. The second tier of
24 assessments shall be based on the premiums that all carriers,
25 except risk-assuming carriers, earned on all health benefit
26 plans written in this state. The board may levy interim
27 assessments against carriers to ensure the financial ability
28 of the plan to cover claims expenses and administrative
29 expenses paid or estimated to be paid in the operation of the
30 plan for the calendar year prior to the association's
31 anticipated receipt of annual assessments for that calendar
15
7:57 PM 05/03/05 s1660c2d-11-k6f
Florida Senate - 2005 SENATOR AMENDMENT
Bill No. CS for CS for SB 1660
Barcode 675004
1 year. Any interim assessment is due and payable within 30 days
2 after receipt by a carrier of the interim assessment notice.
3 Interim assessment payments shall be credited against the
4 carrier's annual assessment. Health benefit plan premiums and
5 benefits paid by a carrier that are less than an amount
6 determined by the board to justify the cost of collection may
7 not be considered for purposes of determining assessments.
8 c. Subject to the approval of the office, the board
9 shall make an adjustment to the assessment formula for
10 reinsuring carriers that are approved as federally qualified
11 health maintenance organizations by the Secretary of Health
12 and Human Services pursuant to 42 U.S.C. s. 300e(c)(2)(A) to
13 the extent, if any, that restrictions are placed on them that
14 are not imposed on other small employer carriers.
15 3. Before July March 1 of each year, the board shall
16 determine and file with the office an estimate of the
17 assessments needed to fund the losses incurred by the program
18 in the previous calendar year.
19 4. If the board determines that the assessments needed
20 to fund the losses incurred by the program in the previous
21 calendar year will exceed the amount specified in subparagraph
22 2., the board shall evaluate the operation of the program and
23 report its findings, including any recommendations for changes
24 to the plan of operation, to the office within 180 90 days
25 following the end of the calendar year in which the losses
26 were incurred. The evaluation shall include an estimate of
27 future assessments, the administrative costs of the program,
28 the appropriateness of the premiums charged and the level of
29 carrier retention under the program, and the costs of coverage
30 for small employers. If the board fails to file a report with
31 the office within 180 90 days following the end of the
16
7:57 PM 05/03/05 s1660c2d-11-k6f
Florida Senate - 2005 SENATOR AMENDMENT
Bill No. CS for CS for SB 1660
Barcode 675004
1 applicable calendar year, the office may evaluate the
2 operations of the program and implement such amendments to the
3 plan of operation the office deems necessary to reduce future
4 losses and assessments.
5 5. If assessments exceed the amount of the actual
6 losses and administrative expenses of the program, the excess
7 shall be held as interest and used by the board to offset
8 future losses or to reduce program premiums. As used in this
9 paragraph, the term "future losses" includes reserves for
10 incurred but not reported claims.
11 6. Each carrier's proportion of the assessment shall
12 be determined annually by the board, based on annual
13 statements and other reports considered necessary by the board
14 and filed by the carriers with the board.
15 7. Provision shall be made in the plan of operation
16 for the imposition of an interest penalty for late payment of
17 an assessment.
18 8. A carrier may seek, from the office, a deferment,
19 in whole or in part, from any assessment made by the board.
20 The office may defer, in whole or in part, the assessment of a
21 carrier if, in the opinion of the office, the payment of the
22 assessment would place the carrier in a financially impaired
23 condition. If an assessment against a carrier is deferred, in
24 whole or in part, the amount by which the assessment is
25 deferred may be assessed against the other carriers in a
26 manner consistent with the basis for assessment set forth in
27 this section. The carrier receiving such deferment remains
28 liable to the program for the amount deferred and is
29 prohibited from reinsuring any individuals or groups in the
30 program if it fails to pay assessments.
31 (o) The board shall advise the office, the Agency for
17
7:57 PM 05/03/05 s1660c2d-11-k6f
Florida Senate - 2005 SENATOR AMENDMENT
Bill No. CS for CS for SB 1660
Barcode 675004
1 Health Care Administration, the department, other executive
2 departments, and the Legislature on health insurance issues.
3 Specifically, the board shall:
4 1. Provide a forum for stakeholders, consisting of
5 insurers, employers, agents, consumers, and regulators, in the
6 private health insurance market in this state.
7 2. Review and recommend strategies to improve the
8 functioning of the health insurance markets in this state with
9 a specific focus on market stability, access, and pricing.
10 3. Make recommendations to the office for legislation
11 addressing health insurance market issues and provide comments
12 on health insurance legislation proposed by the office.
13 4. Meet at least three times each year. One meeting
14 shall be held to hear reports and to secure public comment on
15 the health insurance market, to develop any legislation needed
16 to address health insurance market issues, and to provide
17 comments on health insurance legislation proposed by the
18 office.
19 5. Issue a report to the office on the state of the
20 health insurance market by September 1 each year. The report
21 shall include recommendations for changes in the health
22 insurance market, results from implementation of previous
23 recommendations, and information on health insurance markets.
24 Section 10. Subsection (1) of section 641.27, Florida
25 Statutes, is amended to read:
26 641.27 Examination by the department.--
27 (1) The office shall examine the affairs,
28 transactions, accounts, business records, and assets of any
29 health maintenance organization as often as it deems it
30 expedient for the protection of the people of this state, but
31 not less frequently than once every 5 3 years. In lieu of
18
7:57 PM 05/03/05 s1660c2d-11-k6f
Florida Senate - 2005 SENATOR AMENDMENT
Bill No. CS for CS for SB 1660
Barcode 675004
1 making its own financial examination, the office may accept an
2 independent certified public accountant's audit report
3 prepared on a statutory accounting basis consistent with this
4 part. However, except when the medical records are requested
5 and copies furnished pursuant to s. 456.057, medical records
6 of individuals and records of physicians providing service
7 under contract to the health maintenance organization shall
8 not be subject to audit, although they may be subject to
9 subpoena by court order upon a showing of good cause. For the
10 purpose of examinations, the office may administer oaths to
11 and examine the officers and agents of a health maintenance
12 organization concerning its business and affairs. The
13 examination of each health maintenance organization by the
14 office shall be subject to the same terms and conditions as
15 apply to insurers under chapter 624. In no event shall
16 expenses of all examinations exceed a maximum of $50,000
17 $20,000 for any 1-year period. Any rehabilitation,
18 liquidation, conservation, or dissolution of a health
19 maintenance organization shall be conducted under the
20 supervision of the department, which shall have all power with
21 respect thereto granted to it under the laws governing the
22 rehabilitation, liquidation, reorganization, conservation, or
23 dissolution of life insurance companies.
24 Section 11. Subsection (40) of section 641.31, Florida
25 Statutes, is amended to read:
26 641.31 Health maintenance contracts.--
27 (40)(a) Any group rate, rating schedule, or rating
28 manual for a health maintenance organization policy, which
29 provides creditable coverage as defined in s. 627.6561(5),
30 filed with the office shall provide for an appropriate rebate
31 of premiums paid in the last policy year, contract year, or
19
7:57 PM 05/03/05 s1660c2d-11-k6f
Florida Senate - 2005 SENATOR AMENDMENT
Bill No. CS for CS for SB 1660
Barcode 675004
1 calendar year when the majority of members of a health
2 individual covered by such plan are is enrolled in and
3 maintained maintains participation in any health wellness,
4 maintenance, or improvement program offered by the group
5 contract holder approved by the health plan. The group
6 individual must provide evidence of demonstrative maintenance
7 or improvement of his or her health status as determined by
8 assessments of agreed-upon health status indicators between
9 the group individual and the health insurer, including, but
10 not limited to, reduction in weight, body mass index, and
11 smoking cessation. Any rebate provided by the health
12 maintenance organization insurer is presumed to be appropriate
13 unless credible data demonstrates otherwise, or unless the
14 rebate program requires the insured to incur costs to qualify
15 for the rebate which equals or exceeds the value of the rebate
16 but the rebate may shall not exceed 10 percent of paid
17 premiums.
18 (b) The premium rebate authorized by this section
19 shall be effective for a subscriber an insured on an annual
20 basis, unless the number of participating members on the
21 contract renewal anniversary becomes fewer than the majority
22 of the members eligible for participation in the wellness
23 program individual fails to maintain or improve his or her
24 health status while participating in an approved wellness
25 program, or credible evidence demonstrates that the individual
26 is not participating in the approved wellness program.
27 (c) A health maintenance organization that issues
28 individual contracts may offer a premium rebate, as provided
29 under this section, for a healthy lifestyle program.
30 Section 12. Except as otherwise expressly provided in
31 this act and except for this section, which shall take effect
20
7:57 PM 05/03/05 s1660c2d-11-k6f
Florida Senate - 2005 SENATOR AMENDMENT
Bill No. CS for CS for SB 1660
Barcode 675004
1 upon becoming a law, this act shall take effect July 1, 2005,
2 and shall apply to all policies or contracts issued or renewed
3 on or after July 1, 2005.
4
5
6 ================ T I T L E A M E N D M E N T ===============
7 And the title is amended as follows:
8 Delete everything before the enacting clause
9
10 and insert:
11 A bill to be entitled
12 An act relating to health insurance; amending
13 s. 408.05, F.S.; changing the due date for a
14 report from the Agency for Health Care
15 Administration regarding the State Center for
16 Health Statistics; amending s. 408.909, F.S.;
17 providing an additional criterion for the
18 Office of Insurance Regulation to disapprove or
19 withdraw approval of health flex plans;
20 amending s. 627.411, F.S.; limiting rate
21 increases for certain closed insurance policy
22 forms; amending s. 627.413, F.S.; authorizing
23 insurers and health maintenance organizations
24 to offer policies or contracts providing for a
25 high-deductible plan meeting federal
26 requirements and in conjunction with a health
27 savings account; amending s. 627.638, F.S.;
28 revising direct payment provisions for
29 insurers; amending s. 627.6402, F.S.; revising
30 the requirements for the healthy lifestyle
31 premium rebate; amending s. 627.65626, F.S.;
21
7:57 PM 05/03/05 s1660c2d-11-k6f
Florida Senate - 2005 SENATOR AMENDMENT
Bill No. CS for CS for SB 1660
Barcode 675004
1 providing insurance rebates for healthy
2 lifestyles; amending s. 627.6692, F.S.;
3 extending a time period within which eligible
4 employees may apply for continuation of
5 coverage; amending s. 627.6699, F.S.; revising
6 standards for determining applicability of the
7 Employee Health Care Access Act; prescribing
8 acts that may be performed by an employer
9 without being considered contributing to
10 premiums or facilitating administration of a
11 policy; authorizing certain carriers to offer
12 coverage to certain employees without being
13 subject to the act under certain circumstances;
14 requiring a carrier who offers such coverage to
15 provide notice to the primary insured prior to
16 cancellation for nonpayment of premium;
17 revising an availability of coverage provision
18 of the Employee Health Care Access Act;
19 including high-deductible plans meeting federal
20 health savings account plan requirements;
21 revising membership of the board of the small
22 employer health reinsurance program; revising
23 certain reporting dates relating to program
24 losses and assessments; requiring the board to
25 advise executive and legislative entities on
26 health insurance issues; providing
27 requirements; amending s. 641.27, F.S.;
28 increasing the interval at which the office
29 examines health maintenance organizations;
30 deleting authorization for the office to accept
31 an audit report from a certified public
22
7:57 PM 05/03/05 s1660c2d-11-k6f
Florida Senate - 2005 SENATOR AMENDMENT
Bill No. CS for CS for SB 1660
Barcode 675004
1 accountant in lieu of conducting its own
2 examination; increasing an expense limitation;
3 amending s. 641.31, F.S.; providing for an
4 insurance rebate for members in a health
5 wellness program; providing for the rebate to
6 cease under certain conditions; providing
7 effective dates.
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
23
7:57 PM 05/03/05 s1660c2d-11-k6f