Senate Bill sb2554
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Florida Senate - 2005 SB 2554
By Senator Peaden
2-1588-05
1 A bill to be entitled
2 An act relating to health insurance; amending
3 s. 627.6487, F.S.; redefining the term
4 "eligible individual" for purposes of
5 guaranteed availability of individual health
6 insurance coverage to eligible individuals;
7 amending s. 627.64872, F.S.; revising
8 definitions relating to the Florida Health
9 Insurance Plan; providing for the Commissioner
10 of Insurance Regulation to serve on the plan's
11 board of directors; deleting obsolete
12 provisions relating to an interim report;
13 revising qualifications for eligibility;
14 revising sources of additional revenue for the
15 plan; prescribing a limit on health care
16 provider reimbursement; providing an effective
17 date.
18
19 Be It Enacted by the Legislature of the State of Florida:
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21 Section 1. Subsection (3) of section 627.6487, Florida
22 Statutes, is amended to read:
23 627.6487 Guaranteed availability of individual health
24 insurance coverage to eligible individuals.--
25 (3) For the purposes of this section, the term
26 "eligible individual" means an individual:
27 (a)1. For whom, as of the date on which the individual
28 seeks coverage under this section, the aggregate of the
29 periods of creditable coverage, as defined in s. 627.6561(5)
30 and (6), is 18 or more months; and
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1 2.a. Whose most recent prior creditable coverage was
2 under a group health plan, governmental plan, or church plan,
3 or health insurance coverage offered in connection with any
4 such plan; or
5 b. Whose most recent prior creditable coverage was
6 under an individual plan issued in this state by a health
7 insurer or health maintenance organization, which coverage is
8 terminated due to the insurer or health maintenance
9 organization becoming insolvent or discontinuing the offering
10 of all individual coverage in the State of Florida, or due to
11 the insured no longer living in the service area in the State
12 of Florida of the insurer or health maintenance organization
13 that provides coverage through a network plan in the State of
14 Florida; or
15 c. Whose most recent creditable coverage was with the
16 Florida Health Insurance Plan specified in s. 627.64872, which
17 coverage is terminated due to inadequate funding of the
18 Florida Health Insurance Plan as provided in s. 627.64872(15);
19 (b) Who is not eligible for coverage under:
20 1. A group health plan, as defined in s. 2791 of the
21 Public Health Service Act;
22 2. A conversion policy or contract issued by an
23 authorized insurer or health maintenance organization under s.
24 627.6675 or s. 641.3921, respectively, offered to an
25 individual who is no longer eligible for coverage under either
26 an insured or self-insured employer plan;
27 3. Part A or part B of Title XVIII of the Social
28 Security Act; or
29 4. A state plan under Title XIX of such act, or any
30 successor program, and does not have other health insurance
31 coverage; or
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1 5. The Florida Health Insurance Plan as specified in
2 s. 627.64872 and such plan is accepting new enrollment;
3 (c) With respect to whom the most recent coverage
4 within the coverage period described in paragraph (a) was not
5 terminated based on a factor described in s. 627.6571(2)(a) or
6 (b), relating to nonpayment of premiums or fraud, unless such
7 nonpayment of premiums or fraud was due to acts of an employer
8 or person other than the individual;
9 (d) Who, having been offered the option of
10 continuation coverage under a COBRA continuation provision or
11 under s. 627.6692, elected such coverage; and
12 (e) Who, if the individual elected such continuation
13 provision, has exhausted such continuation coverage under such
14 provision or program.
15 Section 2. Subsections (2), (3), (6), (9), and (15) of
16 section 627.64872, Florida Statutes, are amended, present
17 subsection (20) of that section is renumbered as subsection
18 (21), and a new subsection (20) is added to that section to
19 read:
20 627.64872 Florida Health Insurance Plan.--
21 (2) DEFINITIONS.--As used in this section:
22 (a) "Board" means the board of directors of the plan.
23 (b) "Commissioner" means the Commissioner of Insurance
24 Regulation.
25 (c)(b) "Dependent" means a resident spouse or resident
26 unmarried child under the age of 19 years, a child who is a
27 student under the age of 25 years and who is financially
28 dependent upon the parent, or a child of any age who is
29 disabled and dependent upon the parent.
30 (c) "Director" means the Director of the Office of
31 Insurance Regulation.
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1 (d) "Health insurance" means any hospital or medical
2 expense incurred policy or health maintenance organization
3 subscriber contract pursuant to chapter 641. The term does not
4 include short-term, accident, dental-only, vision-only,
5 fixed-indemnity, limited-benefit, or credit insurance;
6 disability income insurance; coverage for onsite medical
7 clinics; insurance coverage specified in federal regulations
8 issued pursuant to Pub. L. No. 104-191, under which benefits
9 for medical care are secondary or incidental to other
10 insurance benefits; benefits for long-term care, nursing home
11 care, home health care, community-based care, or any
12 combination thereof, or other similar, limited benefits
13 specified in federal regulations issued pursuant to Pub. L.
14 No. 104-191; benefits provided under a separate policy,
15 certificate, or contract of insurance, under which there is no
16 coordination between the provision of the benefits and any
17 exclusion of benefits under any group health plan maintained
18 by the same plan sponsor and the benefits are paid with
19 respect to an event without regard to whether benefits are
20 provided with respect to such an event under any group health
21 plan maintained by the same plan sponsor, such as for coverage
22 only for a specified disease or illness; hospital indemnity or
23 other fixed indemnity insurance; coverage offered as a
24 separate policy, certificate, or contract of insurance, such
25 as Medicare supplemental health insurance as defined under s.
26 1882(g)(1) of the Social Security Act; coverage supplemental
27 to the coverage provided under chapter 55 of Title 10, U.S.C.,
28 the Civilian Health and Medical Program of the Uniformed
29 Services (CHAMPUS); similar supplemental coverage provided to
30 coverage under a group health plan; coverage issued as a
31 supplement to liability insurance; insurance arising out of a
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1 workers' compensation or similar law; automobile medical
2 payment insurance; or insurance under which benefits are
3 payable with or without regard to fault and which is
4 statutorily required to be contained in any liability
5 insurance policy or equivalent self-insurance.
6 (e) "Implementation" means the effective date after
7 the first meeting of the board when legal authority and
8 administrative ability exists for the board to subsume the
9 transfer of all statutory powers, duties, functions, assets,
10 records, personnel, and property of the Florida Comprehensive
11 Health Association as specified in s. 627.6488.
12 (f) "Insurer" means any entity that provides health
13 insurance in this state. For purposes of this section, insurer
14 includes an insurance company with a valid certificate in
15 accordance with chapter 624, a health maintenance organization
16 with a valid certificate of authority in accordance with part
17 I or part III of chapter 641, a prepaid health clinic
18 authorized to transact business in this state pursuant to part
19 II of chapter 641, multiple employer welfare arrangements
20 authorized to transact business in this state pursuant to ss.
21 624.436-624.45, or a fraternal benefit society providing
22 health benefits to its members as authorized pursuant to
23 chapter 632.
24 (g) "Medicare" means coverage under both Parts A and B
25 of Title XVIII of the Social Security Act, 42 U.S.C. ss. 1395
26 et seq., as amended.
27 (h) "Medicaid" means coverage under Title XIX of the
28 Social Security Act.
29 (i) "Office" means the Office of Insurance Regulation
30 of the Financial Services Commission.
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1 (j) "Participating insurer" means any insurer
2 providing health insurance to citizens of this state.
3 (k) "Provider" means any physician, hospital, or other
4 institution, organization, or person that furnishes health
5 care services and is licensed or otherwise authorized to
6 practice in the state.
7 (l) "Plan" means the Florida Health Insurance Plan
8 created in subsection (1).
9 (m) "Plan of operation" means the articles, bylaws,
10 and operating rules and procedures adopted by the board
11 pursuant to this section.
12 (n) "Resident" means an individual who has been
13 legally domiciled in this state for a period of at least 6
14 months and who physically resides in this state not less than
15 185 days a year.
16 (3) BOARD OF DIRECTORS.--
17 (a) The plan shall operate subject to the supervision
18 and control of the board. The board shall consist of the
19 commissioner director or his or her designated representative,
20 who shall serve as a member of the board and shall be its
21 chair, and an additional eight members, five of whom shall be
22 appointed by the Governor, at least two of whom shall be
23 individuals not representative of insurers or health care
24 providers, one of whom shall be appointed by the President of
25 the Senate, one of whom shall be appointed by the Speaker of
26 the House of Representatives, and one of whom shall be
27 appointed by the Chief Financial Officer.
28 (b) The term to be served on the board by the
29 commissioner Director of the Office of Insurance Regulation
30 shall be determined by continued employment in such position.
31 The remaining initial board members shall serve for a period
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1 of time as follows: two members appointed by the Governor and
2 the members appointed by the President of the Senate and the
3 Speaker of the House of Representatives shall serve a term of
4 2 years; and three members appointed by the Governor and the
5 Chief Financial Officer shall serve a term of 4 years.
6 Subsequent board members shall serve for a term of 3 years. A
7 board member's term shall continue until his or her successor
8 is appointed.
9 (c) Vacancies on the board shall be filled by the
10 appointing authority, such authority being the Governor, the
11 President of the Senate, the Speaker of the House of
12 Representatives, or the Chief Financial Officer. The
13 appointing authority may remove board members for cause.
14 (d) The commissioner director, or his or her
15 recognized representative, shall be responsible for any
16 organizational requirements necessary for the initial meeting
17 of the board which shall take place no later than September 1,
18 2004.
19 (e) Members shall not be compensated in their capacity
20 as board members but shall be reimbursed for reasonable
21 expenses incurred in the necessary performance of their duties
22 in accordance with s. 112.061.
23 (f) The board shall submit to the Financial Services
24 Commission a plan of operation for the plan and any amendments
25 thereto necessary or suitable to ensure the fair, reasonable,
26 and equitable administration of the plan. The plan of
27 operation shall ensure that the plan qualifies to apply for
28 any available funding from the Federal Government that adds to
29 the financial viability of the plan. The plan of operation
30 shall become effective upon approval in writing by the
31 Financial Services Commission consistent with the date on
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1 which the coverage under this section must be made available.
2 If the board fails to submit a suitable plan of operation
3 within 1 year after implementation the appointment of the
4 board of directors, or at any time thereafter fails to submit
5 suitable amendments to the plan of operation, the Financial
6 Services Commission shall adopt such rules as are necessary or
7 advisable to effectuate the provisions of this section. Such
8 rules shall continue in force until modified by the office or
9 superseded by a plan of operation submitted by the board and
10 approved by the Financial Services Commission.
11 (6) INTERIM REPORT; ANNUAL REPORT.--
12 (a) By no later than December 1, 2004, the board shall
13 report to the Governor, the President of the Senate, and the
14 Speaker of the House of Representatives the results of an
15 actuarial study conducted by the board to determine,
16 including, but not limited to:
17 1. The impact the creation of the plan will have on
18 the small group insurance market and the individual market on
19 premiums paid by insureds. This shall include an estimate of
20 the total anticipated aggregate savings for all small
21 employers in the state.
22 2. The number of individuals the pool could reasonably
23 cover at various funding levels, specifically, the number of
24 people the pool may cover at each of those funding levels.
25 3. A recommendation as to the best source of funding
26 for the anticipated deficits of the pool.
27 4. The effect on the individual and small group market
28 by including in the Florida Health Insurance Plan persons
29 eligible for coverage under s. 627.6487, as well as the cost
30 of including these individuals.
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1 The board shall take no action to implement the Florida Health
2 Insurance Plan, other than the completion of the actuarial
3 study authorized in this paragraph, until funds are
4 appropriated for startup cost and any projected deficits.
5 (b) No later than December 1, 2005, and annually
6 thereafter, the board shall submit to the Governor, the
7 President of the Senate, the Speaker of the House of
8 Representatives, and the substantive legislative committees of
9 the Legislature a report which includes an independent
10 actuarial study to determine, including, but not be limited
11 to:
12 (a)1. The impact the creation of the plan has on the
13 small group and individual insurance market, specifically on
14 the premiums paid by insureds. This shall include an estimate
15 of the total anticipated aggregate savings for all small
16 employers in the state.
17 (b)2. The actual number of individuals covered at the
18 current funding and benefit level, the projected number of
19 individuals that may seek coverage in the forthcoming fiscal
20 year, and the projected funding needed to cover anticipated
21 increase or decrease in plan participation.
22 3. A recommendation as to the best source of funding
23 for the anticipated deficits of the pool.
24 (c)4. A summarization of the activities of the plan in
25 the preceding calendar year, including the net written and
26 earned premiums, plan enrollment, the expense of
27 administration, and the paid and incurred losses.
28 (d)5. A review of the operation of the plan as to
29 whether the plan has met the intent of this section.
30 (9) ELIGIBILITY.--
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1 (a) Any individual person who is and continues to be a
2 resident of this state shall be eligible for coverage under
3 the plan if:
4 1. Evidence is provided that the person received
5 notices of rejection or refusal to issue substantially similar
6 coverage for health reasons from at least two health insurers
7 or health maintenance organizations. A rejection or refusal by
8 an insurer offering only stop-loss, excess of loss, or
9 reinsurance coverage with respect to the applicant shall not
10 be sufficient evidence under this paragraph.
11 2. The person is enrolled in the Florida Comprehensive
12 Health Association as of the date the plan is implemented.
13 3. The person is an eligible individual as defined in
14 s. 627.6487(3), excluding s. 627.6487(3)(b)5.
15 (b) Each resident dependent of a person who is
16 eligible for coverage under the plan shall also be eligible
17 for such coverage.
18 (c) A person shall not be eligible for coverage under
19 the plan if:
20 1. The person has or obtains health insurance coverage
21 substantially similar to or more comprehensive than a plan
22 policy, or would be eligible to obtain such coverage, unless a
23 person may maintain other coverage for the period of time the
24 person is satisfying any preexisting condition waiting period
25 under a plan policy or may maintain plan coverage for the
26 period of time the person is satisfying a preexisting
27 condition waiting period under another health insurance policy
28 intended to replace the plan policy.
29 2. The person is determined to be eligible for health
30 care benefits under Medicaid, Medicare, the state's children's
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1 health insurance program, or any other federal, state, or
2 local government program that provides health benefits;
3 3. The person voluntarily terminated plan coverage
4 unless 12 months have elapsed since such termination;
5 4. The person is an inmate or resident of a public
6 institution; or
7 5. The person's premiums are paid for or reimbursed
8 under any government-sponsored program or by any government
9 agency, or health care provider, or
10 health-care-provider-sponsored or affiliated organization.
11 (d) Coverage shall cease:
12 1. On the date a person is no longer a resident of
13 this state;
14 2. On the date a person requests coverage to end;
15 3. Upon the death of the covered person;
16 4. On the date state law requires cancellation or
17 nonrenewal of the policy; or
18 5. At the option of the plan, 30 days after the plan
19 makes any inquiry concerning the person's eligibility or place
20 of residence to which the person does not reply; or.
21 6. Upon failure of the insured to pay for continued
22 coverage.
23 (e) Except under the circumstances described in this
24 subsection, coverage of a person who ceases to meet the
25 eligibility requirements of this subsection shall be
26 terminated at the end of the policy period for which the
27 necessary premiums have been paid.
28 (15) FUNDING OF THE PLAN.--
29 (a) Premiums.--
30 1. The plan shall establish premium rates for plan
31 coverage as provided in this section. Separate schedules of
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1 premium rates based on age, sex, and geographical location may
2 apply for individual risks. Premium rates and schedules shall
3 be submitted to the office for approval prior to use.
4 2. Initial rates for plan coverage shall be limited to
5 no more than 200 300 percent of rates established for
6 individual standard risks as specified in s. 627.6675(3)(c).
7 Subject to the limits provided in this paragraph, subsequent
8 rates shall be established to provide fully for the expected
9 costs of claims, including recovery of prior losses, expenses
10 of operation, investment income of claim reserves, and any
11 other cost factors subject to the limitations described
12 herein, but in no event shall premiums exceed the 200-percent
13 300-percent rate limitation provided in this section.
14 Notwithstanding the 200-percent 300-percent rate limitation,
15 sliding scale premium surcharges based upon the insured's
16 income may apply to all enrollees.
17 (b) Sources of additional revenue.--
18 1. Any deficit incurred by the plan shall be primarily
19 funded through amounts appropriated by the Legislature from
20 general revenue sources, including, but not limited to, a
21 portion of the annual growth in existing net insurance premium
22 taxes. The board shall operate the plan in such a manner that
23 the estimated cost of providing health insurance during any
24 fiscal year will not exceed total income the plan expects to
25 receive from policy premiums and funds assessed appropriated
26 by the Legislature, including any interest on investments.
27 After determining the amount of funds available appropriated
28 to the board for a fiscal year, the board shall estimate the
29 number of new policies it believes the plan has the financial
30 capacity to insure during that year so that costs do not
31 exceed income. The board shall take steps necessary to ensure
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1 that plan enrollment does not exceed the number of residents
2 it has estimated it has the financial capacity to insure. In
3 the event of inadequate funding, the board may cancel policies
4 on a nondiscriminatory basis as necessary to remedy the
5 situation. A policy may not be canceled if a covered
6 individual under that policy is currently on claim.
7 2. As a condition of doing business in this state, an
8 insurer shall pay an assessment to the board in the amount
9 prescribed by this section. Each insurer shall annually be
10 assessed by the board a percentage of the insurer's earned
11 premium pertaining to direct writings of health insurance in
12 the state during the calendar year preceding that for which
13 the assessment is levied. Such percentage shall equal the
14 percentage that the anticipated incurred operating losses of
15 the plan for the upcoming fiscal year represent of all earned
16 premium pertaining to direct writings of health insurance in
17 the state during the calendar year preceding that for which
18 the assessment is levied.
19 3. The total of all assessments under this paragraph
20 upon an insurer may not exceed 1 percent of such insurer's
21 health insurance premium earned in this state during the
22 calendar year preceding the year for which the assessments
23 were levied.
24 4. All rights, title, and interest in the assessment
25 funds collected under this paragraph shall vest in this state.
26 However, of all such funds and interest earned shall be used
27 by the plan to pay claims and administrative expenses.
28 (c) If assessments and other receipts by the plan,
29 board, or plan administrator exceed the actual losses and and
30 administrative expenses of the plan, the excess shall be held
31 in interest and used by the board to offset future losses. As
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1 used in this subsection, the term "future losses" including
2 reserves for claims incurred but not reported.
3 (d) Each insurer's assessment shall be determined
4 annually by the board or plan administrator based on annual
5 statements and other reports deemed necessary by the board or
6 plan administrator and filed with the board or plan
7 administrator by the insurer.
8 (e) Insurance may recover the assessment in the normal
9 course of their respective businesses by including the
10 percentage, as indicated in subparagraph (b)2., as a claim
11 cost in determining rates.
12 (20) PROVIDER REIMBURSEMENT.--Notwithstanding any law
13 to the contrary, the maximum reimbursement rate to health care
14 providers for all covered, medically necessary services shall
15 be 100 percent of Medicare's allowed payment amount for that
16 particular provider and service. All providers licensed in
17 this state shall accept assignment of plan benefits and
18 consider the Medicare allowed payment amount as payment in
19 full.
20 (21)(20) COMBINING MEMBERSHIP OF THE FLORIDA
21 COMPREHENSIVE HEALTH ASSOCIATION; ASSESSMENT.--
22 (a)1. Upon implementation of the Florida Health
23 Insurance Plan, the Florida Comprehensive Health Association,
24 as specified in s. 627.6488, is abolished as a separate
25 nonprofit entity and shall be subsumed under the board of
26 directors of the Florida Health Insurance Plan. All
27 individuals actively enrolled in the Florida Comprehensive
28 Health Association shall be enrolled in the plan subject to
29 its rules and requirements, except as otherwise specified in
30 this section. Maximum lifetime benefits paid to an individual
31 in the plan shall not exceed the amount established under
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1 subsection (16), and benefits previously paid for any
2 individual by the Florida Comprehensive Health Association
3 shall be used in the determination of total lifetime benefits
4 paid under the plan.
5 2. All persons enrolled in the Florida Comprehensive
6 Health Association upon implementation of the Florida Health
7 Insurance Plan are only eligible for the benefits authorized
8 under subsection (16). Persons identified by this section
9 shall convert to the benefits authorized under subsection (16)
10 no later than January 1, 2005.
11 3. Except as otherwise provided in this section, the
12 administration of the coverage of persons actively enrolled in
13 the Florida Comprehensive Health Association shall operate
14 under the existing plan of operation without modification
15 until the adoption of the new plan of operation for the
16 Florida Health Insurance Plan.
17 (b)1. As a condition of doing business in this state,
18 an insurer shall pay an assessment to the board in the amount
19 prescribed by this section. For operating losses incurred on
20 or after July 1, 2004, by persons enrolled in the Florida
21 Comprehensive Health Association, each insurer shall annually
22 be assessed by the board in the following calendar year a
23 portion of such incurred operating losses of the plan. Such
24 portion shall be determined by multiplying such operating
25 losses by a fraction, the numerator of which equals the
26 insurer's earned premium pertaining to direct writings of
27 health insurance in the state during the calendar year
28 preceding that for which the assessment is levied, and the
29 denominator of which equals the total of all such premiums
30 earned by insurers in the state during such calendar year.
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1 2. The total of all assessments under this paragraph
2 upon an insurer shall not exceed 1 percent of such insurer's
3 health insurance premium earned in this state during the
4 calendar year preceding the year for which the assessments
5 were levied.
6 3. All rights, title, and interest in the assessment
7 funds collected under this paragraph shall vest in this state.
8 However, all of such funds and interest earned shall be used
9 by the plan to pay claims and administrative expenses.
10 (c) If assessments and other receipts by the plan,
11 board, or plan administrator exceed the actual losses and
12 administrative expenses of the plan, the excess shall be held
13 in interest and used by the board to offset future losses. As
14 used in this subsection, the term "future losses" includes
15 reserves for claims incurred but not reported.
16 (d) Each insurer's assessment shall be determined
17 annually by the board or plan administrator based on annual
18 statements and other reports deemed necessary by the board or
19 plan administrator and filed with the board or plan
20 administrator by the insurer. Any deficit incurred under the
21 plan by persons previously enrolled in the Florida
22 Comprehensive Health Association shall be recouped by the
23 assessments against insurers by the board or plan
24 administrator in the manner provided in paragraph (b), and the
25 insurers may recover the assessment in the normal course of
26 their respective businesses without time limitation.
27 (e) If a person actively enrolled in the Florida
28 Comprehensive Health Association after implementation of the
29 plan loses eligibility for participation in the Florida
30 Comprehensive Health Association, such person shall not be
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1 included in the calculation of the assessment if the person
2 later regains eligibility for participation in the plan.
3 (f) When all persons actively enrolled in the Florida
4 Comprehensive Health Association as of the date of
5 implementation of the plan are no longer eligible for
6 participation in the Florida Comprehensive Health Association,
7 the board of directors and plan administrator shall no longer
8 be allowed to assess insurers in this state for incurred
9 losses in the Florida Comprehensive Health Association.
10 Section 3. This act shall take effect July 1, 2005.
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13 SENATE SUMMARY
14 Revises various provisions relating to health insurance
and the Florida Health Insurance Plan, including
15 definitions, eligibility requirements, revenue sources,
and provider reimbursement. (See bill for details.)
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