HB 0295

1
A bill to be entitled
2An act relating to the state group insurance program;
3amending s. 110.123, F.S.; revising definitions; including
4the TRICARE supplemental insurance plan within the state
5group insurance program; requiring the Department of
6Management Services to purchase health care for employees
7under the TRICARE supplemental insurance plan; authorizing
8a surviving spouse to elect to continue coverage under the
9TRICARE supplemental insurance plan; providing that an
10enrollee in the TRICARE supplemental insurance plan may
11change to any other state health plan during open
12enrollment; providing an effective date.
13
14Be It Enacted by the Legislature of the State of Florida:
15
16     Section 1.  Subsections (2) and (3) of section 110.123,
17Florida Statutes, are amended to read:
18     110.123  State group insurance program.--
19     (2)  DEFINITIONS.--As used in this section, the term:
20     (a)  "Department" means the Department of Management
21Services.
22     (b)  "Enrollee" means all state officers and employees,
23retired state officers and employees, surviving spouses of
24deceased state officers and employees, and terminated employees
25or individuals with continuation coverage who are enrolled in an
26insurance plan offered by the state group insurance program.
27"Enrollee" includes all state university officers and employees,
28retired state university officers and employees, surviving
29spouses of deceased state university officers and employees, and
30terminated state university employees or individuals with
31continuation coverage who are enrolled in an insurance plan
32offered by the state group insurance program.
33     (c)  "Full-time state employees" includes all full-time
34employees of all branches or agencies of state government
35holding salaried positions and paid by state warrant or from
36agency funds, and employees paid from regular salary
37appropriations for 8 months' employment, including university
38personnel on academic contracts, but in no case shall "state
39employee" or "salaried position" include persons paid from
40other-personal-services (OPS) funds. "Full-time employees"
41includes all full-time employees of the state universities.
42     (d)  "Health maintenance organization" or "HMO" means an
43entity certified under part I of chapter 641.
44     (e)  "Health plan member" means any person participating in
45a state group health insurance plan, a TRICARE supplemental
46insurance plan, or in a health maintenance organization plan
47under the state group insurance program, including enrollees and
48covered dependents thereof.
49     (f)  "Part-time state employee" means any employee of any
50branch or agency of state government paid by state warrant from
51salary appropriations or from agency funds, and who is employed
52for less than the normal full-time workweek established by the
53department or, if on academic contract or seasonal or other type
54of employment which is less than year-round, is employed for
55less than 8 months during any 12-month period, but in no case
56shall "part-time" employee include a person paid from other-
57personal-services (OPS) funds. "Part-time state employee"
58includes any part-time employee of the state universities.
59     (g)  "Retired state officer or employee" or "retiree" means
60any state or state university officer or employee who retires
61under a state retirement system or a state optional annuity or
62retirement program or is placed on disability retirement, and
63who was insured under the state group insurance program at the
64time of retirement, and who begins receiving retirement benefits
65immediately after retirement from state or state university
66office or employment. In addition to these requirements, any
67state officer or state employee who retires under the Public
68Employee Optional Retirement Program established under part II
69of chapter 121 shall be considered a "retired state officer or
70employee" or "retiree" as used in this section if he or she:
71     1.  Meets the age and service requirements to qualify for
72normal retirement as set forth in s. 121.021(29); or
73     2.  Has attained the age specified by s. 72(t)(2)(A)(i) of
74the Internal Revenue Code and has 6 years of creditable service.
75     (h)  "State agency" or "agency" means any branch,
76department, or agency of state government. "State agency" or
77"agency" includes any state university for purposes of this
78section only.
79     (i)  "State group health insurance plan or plans" or "state
80plan or plans" mean the state self-insured health insurance plan
81or plans offered to state officers and employees, retired state
82officers and employees, and surviving spouses of deceased state
83officers and employees pursuant to this section.
84     (j)  "State-contracted HMO" means any health maintenance
85organization under contract with the department to participate
86in the state group insurance program.
87     (k)  "State group insurance program" or "programs" means
88the package of insurance plans offered to state officers and
89employees, retired state officers and employees, and surviving
90spouses of deceased state officers and employees pursuant to
91this section, including the state group health insurance plan or
92plans, health maintenance organization plans, TRICARE
93supplemental insurance plans, and other plans required or
94authorized by law.
95     (l)  "State officer" means any constitutional state
96officer, any elected state officer paid by state warrant, or any
97appointed state officer who is commissioned by the Governor and
98who is paid by state warrant.
99     (m)  "Surviving spouse" means the widow or widower of a
100deceased state officer, full-time state employee, part-time
101state employee, or retiree if such widow or widower was covered
102as a dependent under the state group health insurance plan, a
103TRICARE supplemental insurance plan, or a health maintenance
104organization plan established pursuant to this section at the
105time of the death of the deceased officer, employee, or retiree.
106"Surviving spouse" also means any widow or widower who is
107receiving or eligible to receive a monthly state warrant from a
108state retirement system as the beneficiary of a state officer,
109full-time state employee, or retiree who died prior to July 1,
1101979.  For the purposes of this section, any such widow or
111widower shall cease to be a surviving spouse upon his or her
112remarriage.
113     (3)  STATE GROUP INSURANCE PROGRAM.--
114     (a)  The Division of State Group Insurance is created
115within the Department of Management Services.
116     (b)  It is the intent of the Legislature to offer a
117comprehensive package of health insurance and retirement
118benefits and a personnel system for state employees which are
119provided in a cost-efficient and prudent manner, and to allow
120state employees the option to choose benefit plans which best
121suit their individual needs. Therefore, the state group
122insurance program is established which may include the state
123group health insurance plan or plans, health maintenance
124organization plans, group life insurance plans, TRICARE
125supplemental insurance plans, group accidental death and
126dismemberment plans, and group disability insurance plans.
127Furthermore, the department is additionally authorized to
128establish and provide as part of the state group insurance
129program any other group insurance plans or coverage choices that
130are consistent with the provisions of this section.
131     (c)  Notwithstanding any provision in this section to the
132contrary, it is the intent of the Legislature that the
133department shall be responsible for all aspects of the purchase
134of health care for state employees under the state group health
135insurance plan or plans, TRICARE supplemental insurance plans,
136and the health maintenance organization plans. Responsibilities
137shall include, but not be limited to, the development of
138requests for proposals or invitations to negotiate for state
139employee health services, the determination of health care
140benefits to be provided, and the negotiation of contracts for
141health care and health care administrative services.  Prior to
142the negotiation of contracts for health care services, the
143Legislature intends that the department shall develop, with
144respect to state collective bargaining issues, the health
145benefits and terms to be included in the state group health
146insurance program. The department shall adopt rules necessary to
147perform its responsibilities pursuant to this section.  It is
148the intent of the Legislature that the department shall be
149responsible for the contract management and day-to-day
150management of the state employee health insurance program,
151including, but not limited to, employee enrollment, premium
152collection, payment to health care providers, and other
153administrative functions related to the program.
154     (d)1.  Notwithstanding the provisions of chapter 287 and
155the authority of the department, for the purpose of protecting
156the health of, and providing medical services to, state
157employees participating in the state group insurance program,
158the department may contract to retain the services of
159professional administrators for the state group insurance
160program.  The agency shall follow good purchasing practices of
161state procurement to the extent practicable under the
162circumstances.
163     2.  Each vendor in a major procurement, and any other
164vendor if the department deems it necessary to protect the
165state's financial interests, shall, at the time of executing any
166contract with the department, post an appropriate bond with the
167department in an amount determined by the department to be
168adequate to protect the state's interests but not higher than
169the full amount estimated to be paid annually to the vendor
170under the contract.
171     3.  Each major contract entered into by the department
172pursuant to this section shall contain a provision for payment
173of liquidated damages to the department for material
174noncompliance by a vendor with a contract provision. The
175department may require a liquidated damages provision in any
176contract if the department deems it necessary to protect the
177state's financial interests.
178     4.  The provisions of s. 120.57(3) apply to the
179department's contracting process, except:
180     a.  A formal written protest of any decision, intended
181decision, or other action subject to protest shall be filed
182within 72 hours after receipt of notice of the decision,
183intended decision, or other action.
184     b.  As an alternative to any provision of s. 120.57(3), the
185department may proceed with the bid selection or contract award
186process if the director of the department sets forth, in
187writing, particular facts and circumstances which demonstrate
188the necessity of continuing the procurement process or the
189contract award process in order to avoid a substantial
190disruption to the provision of any scheduled insurance services.
191     (e)  The Department of Management Services and the Division
192of State Group Insurance may shall not prohibit or limit any
193properly licensed insurer, health maintenance organization,
194prepaid limited health services organization, or insurance agent
195from competing for any insurance product or plan purchased,
196provided, or endorsed by the department or the division on the
197basis of the compensation arrangement used by the insurer or
198organization for its agents.
199     (f)  Except as provided for in subparagraph (h)2., the
200state contribution toward the cost of any plan in the state
201group insurance program shall be uniform with respect to all
202state employees in a state collective bargaining unit
203participating in the same coverage tier in the same plan.
204Nothing contained within This section does not prohibit
205prohibits the development of separate benefit plans for officers
206and employees exempt from the career service or the development
207of separate benefit plans for each collective bargaining unit.
208     (g)  Participation by individuals in the program is shall
209be available to all state officers, full-time state employees,
210and part-time state employees; and such participation in the
211program or any plan is thereof shall be voluntary. Participation
212in the program is shall also be available to retired state
213officers and employees, as defined in paragraph (2)(g), who
214elect at the time of retirement to continue coverage under the
215program, but they may elect to continue all or only part of the
216coverage they had at the time of retirement. A surviving spouse
217may elect to continue coverage only under a state group health
218insurance plan, a TRICARE supplemental insurance plan, or a
219health maintenance organization plan.
220     (h)1.  A person eligible to participate in the state group
221insurance program may be authorized by rules adopted by the
222department, in lieu of participating in the state group health
223insurance plan, to exercise an option to elect membership in a
224health maintenance organization plan which is under contract
225with the state in accordance with criteria established by this
226section and by said rules.  The offer of optional membership in
227a health maintenance organization plan permitted by this
228paragraph may be limited or conditioned by rule as may be
229necessary to meet the requirements of state and federal laws.
230     2.  The department shall contract with health maintenance
231organizations seeking to participate in the state group
232insurance program through a request for proposal or other
233procurement process, as developed by the Department of
234Management Services and determined to be appropriate.
235     a.  The department shall establish a schedule of minimum
236benefits for health maintenance organization coverage, and that
237schedule shall include: physician services; inpatient and
238outpatient hospital services; emergency medical services,
239including out-of-area emergency coverage; diagnostic laboratory
240and diagnostic and therapeutic radiologic services; mental
241health, alcohol, and chemical dependency treatment services
242meeting the minimum requirements of state and federal law;
243skilled nursing facilities and services; prescription drugs;
244age-based and gender-based wellness benefits; and other benefits
245as may be required by the department. Additional services may be
246provided subject to the contract between the department and the
247HMO.
248     b.  The department may establish uniform deductibles,
249copayments, coverage tiers, or coinsurance schedules for all
250participating HMO plans.
251     c.  The department may require detailed information from
252each health maintenance organization participating in the
253procurement process, including information pertaining to
254organizational status, experience in providing prepaid health
255benefits, accessibility of services, financial stability of the
256plan, quality of management services, accreditation status,
257quality of medical services, network access and adequacy,
258performance measurement, ability to meet the department's
259reporting requirements, and the actuarial basis of the proposed
260rates and other data determined by the director to be necessary
261for the evaluation and selection of health maintenance
262organization plans and negotiation of appropriate rates for
263these plans.  Upon receipt of proposals by health maintenance
264organization plans and the evaluation of those proposals, the
265department may enter into negotiations with all of the plans or
266a subset of the plans, as the department determines appropriate.
267Nothing shall preclude the department from negotiating regional
268or statewide contracts with health maintenance organization
269plans when this is cost-effective and when the department
270determines that the plan offers high value to enrollees.
271     d.  The department may limit the number of HMOs that it
272contracts with in each service area based on the nature of the
273bids the department receives, the number of state employees in
274the service area, or any unique geographical characteristics of
275the service area. The department shall establish by rule service
276areas throughout the state.
277     e.  All persons participating in the state group insurance
278program may be required to contribute towards a total state
279group health premium that may vary depending upon the plan and
280coverage tier selected by the enrollee and the level of state
281contribution authorized by the Legislature.
282     3.  The department is authorized to negotiate and to
283contract with specialty psychiatric hospitals for mental health
284benefits, on a regional basis, for alcohol, drug abuse, and
285mental and nervous disorders. The department may establish,
286subject to the approval of the Legislature pursuant to
287subsection (5), any such regional plan upon completion of an
288actuarial study to determine any impact on plan benefits and
289premiums.
290     4.  In addition to contracting pursuant to subparagraph 2.,
291the department may enter into contract with any HMO to
292participate in the state group insurance program which:
293     a.  Serves greater than 5,000 recipients on a prepaid basis
294under the Medicaid program;
295     b.  Does not currently meet the 25-percent non-
296Medicare/non-Medicaid enrollment composition requirement
297established by the Department of Health excluding participants
298enrolled in the state group insurance program;
299     c.  Meets the minimum benefit package and copayments and
300deductibles contained in sub-subparagraphs 2.a. and b.;
301     d.  Is willing to participate in the state group insurance
302program at a cost of premiums that is not greater than 95
303percent of the cost of HMO premiums accepted by the department
304in each service area; and
305     e.  Meets the minimum surplus requirements of s. 641.225.
306
307The department is authorized to contract with HMOs that meet the
308requirements of sub-subparagraphs a.-d. prior to the open
309enrollment period for state employees.  The department is not
310required to renew the contract with the HMOs as set forth in
311this paragraph more than twice. Thereafter, the HMOs shall be
312eligible to participate in the state group insurance program
313only through the request for proposal or invitation to negotiate
314process described in subparagraph 2.
315     5.  All enrollees in a state group health insurance plan, a
316TRICARE supplemental insurance plan, or any health maintenance
317organization plan shall have the option of changing to any other
318health plan that which is offered by the state within any open
319enrollment period designated by the department. Open enrollment
320shall be held at least once each calendar year.
321     6.  When a contract between a treating provider and the
322state-contracted health maintenance organization is terminated
323for any reason other than for cause, each party shall allow any
324enrollee for whom treatment was active to continue coverage and
325care when medically necessary, through completion of treatment
326of a condition for which the enrollee was receiving care at the
327time of the termination, until the enrollee selects another
328treating provider, or until the next open enrollment period
329offered, whichever is longer, but no longer than 6 months after
330termination of the contract. Each party to the terminated
331contract shall allow an enrollee who has initiated a course of
332prenatal care, regardless of the trimester in which care was
333initiated, to continue care and coverage until completion of
334postpartum care. This does not prevent a provider from refusing
335to continue to provide care to an enrollee who is abusive,
336noncompliant, or in arrears in payments for services provided.
337For care continued under this subparagraph, the program and the
338provider shall continue to be bound by the terms of the
339terminated contract. Changes made within 30 days before
340termination of a contract are effective only if agreed to by
341both parties.
342     7.  Any HMO participating in the state group insurance
343program shall submit health care utilization and cost data to
344the department, in such form and in such manner as the
345department shall require, as a condition of participating in the
346program.  The department shall enter into negotiations with its
347contracting HMOs to determine the nature and scope of the data
348submission and the final requirements, format, penalties
349associated with noncompliance, and timetables for submission.  
350These determinations shall be adopted by rule.
351     8.  The department may establish and direct, with respect
352to collective bargaining issues, a comprehensive package of
353insurance benefits that may include supplemental health and life
354coverage, dental care, long-term care, vision care, and other
355benefits it determines necessary to enable state employees to
356select from among benefit options that best suit their
357individual and family needs.
358     a.  Based upon a desired benefit package, the department
359shall issue a request for proposal or invitation to negotiate
360for health insurance providers interested in participating in
361the state group insurance program, and the department shall
362issue a request for proposal or invitation to negotiate for
363insurance providers interested in participating in the non-
364health-related components of the state group insurance program.
365Upon receipt of all proposals, the department may enter into
366contract negotiations with insurance providers submitting bids
367or negotiate a specially designed benefit package. Insurance
368providers offering or providing supplemental coverage as of May
36930, 1991, which qualify for pretax benefit treatment pursuant to
370s. 125 of the Internal Revenue Code of 1986, with 5,500 or more
371state employees currently enrolled may be included by the
372department in the supplemental insurance benefit plan
373established by the department without participating in a request
374for proposal, submitting bids, negotiating contracts, or
375negotiating a specially designed benefit package. These
376contracts shall provide state employees with the most cost-
377effective and comprehensive coverage available; however, no
378state or agency funds shall be contributed toward the cost of
379any part of the premium of such supplemental benefit plans. With
380respect to dental coverage, the division shall include in any
381solicitation or contract for any state group dental program made
382after July 1, 2001, a comprehensive indemnity dental plan option
383which offers enrollees a completely unrestricted choice of
384dentists. If a dental plan is endorsed, or in some manner
385recognized as the preferred product, such plan shall include a
386comprehensive indemnity dental plan option which provides
387enrollees with a completely unrestricted choice of dentists.
388     b.  Pursuant to the applicable provisions of s. 110.161,
389and s. 125 of the Internal Revenue Code of 1986, the department
390shall enroll in the pretax benefit program those state employees
391who voluntarily elect coverage in any of the supplemental
392insurance benefit plans as provided by sub-subparagraph a.
393     c.  Nothing herein contained shall be construed to prohibit
394insurance providers from continuing to provide or offer
395supplemental benefit coverage to state employees as provided
396under existing agency plans.
397     (i)  The benefits of the insurance authorized by this
398section shall not be in lieu of any benefits payable under
399chapter 440, the Workers' Compensation Law. The insurance
400authorized by this law shall not be deemed to constitute
401insurance to secure workers' compensation benefits as required
402by chapter 440.
403     Section 2.  This act shall take effect upon becoming a law.


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