Senate Bill sb0318
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Florida Senate - 2005 SB 318
By Senator Margolis
35-264A-05
1 A bill to be entitled
2 An act relating to cystic fibrosis treatment;
3 creating ss. 627.64194 and 627.6614, F.S.;
4 requiring an individual health insurance policy
5 or a group health insurance policy to cover
6 services needed to treat cystic fibrosis as
7 authorized by a physician; amending s. 641.31,
8 F.S.; requiring a contract by a health
9 maintenance organization to cover services
10 needed to treat cystic fibrosis as authorized
11 by a physician; amending s. 627.6515, F.S.,
12 relating to out-of-state groups; conforming a
13 cross-reference to changes made by the act;
14 providing an effective date.
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16 WHEREAS, cystic fibrosis is a genetic disease that
17 adversely affects the respiratory system and the digestive
18 system, and
19 WHEREAS, there are 1,006 children and adults in Florida
20 today suffering from cystic fibrosis, and
21 WHEREAS, only half of those suffering with cystic
22 fibrosis live to the age of 32, and
23 WHEREAS, the treatments for individuals with cystic
24 fibrosis include ingesting pancreatic enzymes or a wide
25 assortment of nutritional supplements, frequent postural
26 draining to clear the respiratory system, or using a feeding
27 tube to provide sustenance, and
28 WHEREAS, insurance companies oftentimes do not fully
29 cover the costs associated with treating cystic fibrosis, a
30 fatal disease, NOW, THEREFORE,
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Florida Senate - 2005 SB 318
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1 Be It Enacted by the Legislature of the State of Florida:
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3 Section 1. Section 627.64194, Florida Statutes, is
4 created to read:
5 627.64194 Cystic fibrosis treatment services.--A
6 health insurance policy sold in this state must provide
7 coverage for all medically appropriate and necessary
8 equipment, supplies, supplements, and patient self-management
9 training and educational services used to treat cystic
10 fibrosis if the patient's treating physician or a physician
11 who specializes in the treatment of cystic fibrosis certifies
12 that such services are necessary.
13 Section 2. Section 627.6614, Florida Statutes, is
14 created to read:
15 627.6614 Cystic fibrosis treatment services.--A group
16 health insurance policy sold in this state must provide
17 coverage for all medically appropriate and necessary
18 equipment, supplies, supplements, and patient self-management
19 training and educational services used to treat cystic
20 fibrosis if the patient's treating physician or a physician
21 who specializes in the treatment of cystic fibrosis certifies
22 that such services are necessary.
23 Section 3. Present subsections (36), (37), (38), (39),
24 and (40) of section 641.31, Florida Statutes, are redesignated
25 as subsections (37), (38), (39), (40), and (41), respectively,
26 and a new subsection (36) is added to that section to read:
27 641.31 Health maintenance contracts.--
28 (36) A health maintenance contract sold in this state
29 must provide coverage for all medically appropriate and
30 necessary equipment, supplies, supplements, and patient
31 self-management training and educational services used to
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Florida Senate - 2005 SB 318
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1 treat cystic fibrosis if the patient's treating physician or a
2 physician who specializes in the treatment of cystic fibrosis
3 certifies that such services are necessary.
4 Section 4. Subsection (2) of section 627.6515, Florida
5 Statutes, is amended to read:
6 627.6515 Out-of-state groups.--
7 (2) Except as otherwise provided in this part, this
8 part does not apply to a group health insurance policy issued
9 or delivered outside this state under which a resident of this
10 state is provided coverage if:
11 (a) The policy is issued to an employee group the
12 composition of which is substantially as described in s.
13 627.653; a labor union group or association group the
14 composition of which is substantially as described in s.
15 627.654; an additional group the composition of which is
16 substantially as described in s. 627.656; a group insured
17 under a blanket health policy when the composition of the
18 group is substantially in compliance with s. 627.659; a group
19 insured under a franchise health policy when the composition
20 of the group is substantially in compliance with s. 627.663;
21 an association group to cover persons associated in any other
22 common group, which common group is formed primarily for
23 purposes other than providing insurance; a group that is
24 established primarily for the purpose of providing group
25 insurance, provided the benefits are reasonable in relation to
26 the premiums charged thereunder and the issuance of the group
27 policy has resulted, or will result, in economies of
28 administration; or a group of insurance agents of an insurer,
29 which insurer is the policyholder;
30 (b) Certificates evidencing coverage under the policy
31 are issued to residents of this state and contain in
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Florida Senate - 2005 SB 318
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1 contrasting color and not less than 10-point type the
2 following statement: "The benefits of the policy providing
3 your coverage are governed primarily by the law of a state
4 other than Florida"; and
5 (c) The policy provides the benefits specified in ss.
6 627.419, 627.6574, 627.6575, 627.6579, 627.6612, 627.66121,
7 627.66122, 627.6613, 627.6614, 627.667, 627.6675, 627.6691,
8 and 627.66911.
9 (d) Applications for certificates of coverage offered
10 to residents of this state must contain, in contrasting color
11 and not less than 12-point type, the following statement on
12 the same page as the applicant's signature:
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14 "This policy is primarily governed by the laws
15 of ...insert state where the master policy if
16 filed.... As a result, all of the rating laws
17 applicable to policies filed in this state do
18 not apply to this coverage, which may result in
19 increases in your premium at renewal that would
20 not be permissible under a Florida-approved
21 policy. Any purchase of individual health
22 insurance should be considered carefully, as
23 future medical conditions may make it
24 impossible to qualify for another individual
25 health policy. For information concerning
26 individual health coverage under a
27 Florida-approved policy, consult your agent or
28 the Florida Department of Financial Services."
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30 This paragraph applies only to group certificates providing
31 health insurance coverage which require individualized
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1 underwriting to determine coverage eligibility for an
2 individual or premium rates to be charged to an individual
3 except for the following:
4 1. Policies issued to provide coverage to groups of
5 persons all of whom are in the same or functionally related
6 licensed professions, and providing coverage only to such
7 licensed professionals, their employees, or their dependents;
8 2. Policies providing coverage to small employers as
9 defined by s. 627.6699. Such policies shall be subject to, and
10 governed by, the provisions of s. 627.6699;
11 3. Policies issued to a bona fide association, as
12 defined by s. 627.6571(5), provided that there is a person or
13 board acting as a fiduciary for the benefit of the members,
14 and such association is not owned, controlled by, or otherwise
15 associated with the insurance company; or
16 4. Any accidental death, accidental death and
17 dismemberment, accident-only, vision-only, dental-only,
18 hospital indemnity-only, hospital accident-only, cancer,
19 specified disease, Medicare supplement, products that
20 supplement Medicare, long-term care, or disability income
21 insurance, or similar supplemental plans provided under a
22 separate policy, certificate, or contract of insurance, which
23 cannot duplicate coverage under an underlying health plan,
24 coinsurance, or deductibles or coverage issued as a supplement
25 to workers' compensation or similar insurance, or automobile
26 medical-payment insurance.
27 Section 5. This act shall take effect October 1, 2005.
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2 SENATE SUMMARY
3 Requires an individual health insurance policy, a group
health insurance policy, or a contract by a health
4 maintenance organization to cover services needed to
treat cystic fibrosis as authorized by a physician.
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