HB 0327

1	A bill to be entitled
2	An act relating to the treatment of congenital
3	craniofacial anomalies; creating ss. 627.64194 and
4	627.6614, F.S.; requiring an individual health insurance
5	policy or a group health insurance policy to cover
6	services needed to treat congenital craniofacial anomalies
7	as authorized by a physician; amending s. 627.6515, F.S.;
8	including within an exclusion from provisions applying to
9	out-of-state groups group policies providing health
10	coverage for congenital craniofacial anomalies; amending
11	s. 641.31, F.S.; requiring a contract by a health
12	maintenance organization to cover services needed to treat
13	congenital craniofacial anomalies as authorized by a
14	physician; providing an effective date.
15
16	WHEREAS, craniofacial anomalies are a group of deformities
17	involving the growth of the head and facial bones, and these
18	anomalies are present at birth and vary in type and severity,
19	and
20	WHEREAS, experts agree that many factors contribute to the
21	development of craniofacial anomalies, that some craniofacial
22	anomalies are a result of genetic mutations, and that other
23	craniofacial anomalies may be a result of environmental factors
24	that scientists do not completely understand, and
25	WHEREAS, the most common types of craniofacial anomalies
26	include, but are not limited to, cleft lip, cleft palate,
27	craniosynostosis, hemifacial microsomia, vascular malformation,
28	hemangioma, and deformational or positional plagiocephaly, and
29	WHEREAS, insurance companies often do not fully cover the
30	costs associated with treating congenital craniofacial
31	anomalies, NOW, THEREFORE,
32
33	Be It Enacted by the Legislature of the State of Florida:
34
35	Section 1.  Section 627.64194, Florida Statutes, is created
36	to read:
37	627.64194  Services for the treatment of congenital
38	craniofacial anomalies.--A health insurance policy sold in this
39	state must provide coverage for all medically appropriate and
40	necessary equipment, supplies, supplements, and patient self-
41	management training and educational services used to treat a
42	congenital craniofacial anomaly if the patient's treating
43	physician or a physician who specializes in the treatment of
44	craniofacial anomalies certifies that such services are
45	necessary.
46	Section 2.  Subsection (2) of section 627.6515, Florida
47	Statutes, is amended to read:
48	627.6515  Out-of-state groups.--
49	(2)  Except as otherwise provided in this part, this part
50	does not apply to a group health insurance policy issued or
51	delivered outside this state under which a resident of this
52	state is provided coverage if:
53	(a)  The policy is issued to an employee group the
54	composition of which is substantially as described in s.
55	627.653; a labor union group or association group the
56	composition of which is substantially as described in s.
57	627.654; an additional group the composition of which is
58	substantially as described in s. 627.656; a group insured under
59	a blanket health policy when the composition of the group is
60	substantially in compliance with s. 627.659; a group insured
61	under a franchise health policy when the composition of the
62	group is substantially in compliance with s. 627.663; an
63	association group to cover persons associated in any other
64	common group, which common group is formed primarily for
65	purposes other than providing insurance; a group that is
66	established primarily for the purpose of providing group
67	insurance, provided the benefits are reasonable in relation to
68	the premiums charged thereunder and the issuance of the group
69	policy has resulted, or will result, in economies of
70	administration; or a group of insurance agents of an insurer,
71	which insurer is the policyholder.;
72	(b)  Certificates evidencing coverage under the policy are
73	issued to residents of this state and contain in contrasting
74	color and not less than 10-point type the following statement:
75	"The benefits of the policy providing your coverage are governed
76	primarily by the law of a state other than Florida".; and
77	(c)  The policy provides the benefits specified in ss.
78	627.419, 627.6574, 627.6575, 627.6579, 627.6612, 627.66121,
79	627.66122, 627.6613, 627.6614, 627.667, 627.6675, 627.6691, and
80	627.66911.
81	(d)  Applications for certificates of coverage offered to
82	residents of this state must contain, in contrasting color and
83	not less than 12-point type, the following statement on the same
84	page as the applicant's signature:
85
86	"This policy is primarily governed by the laws of
87	...insert state where the master policy if filed....
88	As a result, all of the rating laws applicable to
89	policies filed in this state do not apply to this
90	coverage, which may result in increases in your
91	premium at renewal that would not be permissible under
92	a Florida-approved policy. Any purchase of individual
93	health insurance should be considered carefully, as
94	future medical conditions may make it impossible to
95	qualify for another individual health policy. For
96	information concerning individual health coverage
97	under a Florida-approved policy, consult your agent or
98	the Florida Department of Financial Services."
99
100	This paragraph applies only to group certificates providing
101	health insurance coverage which require individualized
102	underwriting to determine coverage eligibility for an individual
103	or premium rates to be charged to an individual except for the
104	following:
105	1.  Policies issued to provide coverage to groups of
106	persons all of whom are in the same or functionally related
107	licensed professions, and providing coverage only to such
108	licensed professionals, their employees, or their dependents;
109	2.  Policies providing coverage to small employers as
110	defined by s. 627.6699. Such policies shall be subject to, and
111	governed by, the provisions of s. 627.6699;
112	3.  Policies issued to a bona fide association, as defined
113	by s. 627.6571(5), provided that there is a person or board
114	acting as a fiduciary for the benefit of the members, and such
115	association is not owned, controlled by, or otherwise associated
116	with the insurance company; or
117	4.  Any accidental death, accidental death and
118	dismemberment, accident-only, vision-only, dental-only, hospital
119	indemnity-only, hospital accident-only, cancer, specified
120	disease, Medicare supplement, products that supplement Medicare,
121	long-term care, or disability income insurance, or similar
122	supplemental plans provided under a separate policy,
123	certificate, or contract of insurance, which cannot duplicate
124	coverage under an underlying health plan, coinsurance, or
125	deductibles or coverage issued as a supplement to workers'
126	compensation or similar insurance, or automobile medical-payment
127	insurance.
128	Section 3.  Section 627.6614, Florida Statutes, is created
129	to read:
130	627.6614  Services for the treatment of congenital
131	craniofacial anomalies.--A group health insurance policy sold in
132	this state must provide coverage for all medically appropriate
133	and necessary equipment, supplies, supplements, and patient
134	self-management training and educational services used to treat
135	a congenital craniofacial anomaly if the patient's treating
136	physician or a physician who specializes in the treatment of
137	craniofacial anomalies certifies that such services are
138	necessary.
139	Section 4.  Present subsections (36), (37), (38), (39), and
140	(40) of section 641.31, Florida Statutes, are renumbered as
141	subsections (37), (38), (39), (40), and (41), respectively, and
142	a new subsection (36) is added to said section to read:
143	641.31  Health maintenance contracts.--
144	(36)  A health maintenance contract sold in this state must
145	provide coverage for all medically appropriate and necessary
146	equipment, supplies, supplements, and patient self-management
147	training and educational services used to treat a congenital
148	craniofacial anomaly if the patient's treating physician or a
149	physician who specializes in the treatment of craniofacial
150	anomalies certifies that such services are necessary.
151	Section 5.  This act shall take effect October 1, 2005.

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