Senate Bill sb0560
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Florida Senate - 2005 SB 560
By Senator Bullard
39-600-05
1 A bill to be entitled
2 An act relating to the treatment of congenital
3 craniofacial anomalies; creating ss. 627.64194
4 and 627.6614, F.S.; requiring an individual
5 health insurance policy or a group health
6 insurance policy to cover services needed to
7 treat congenital craniofacial anomalies as
8 authorized by a physician; amending s. 641.31,
9 F.S.; requiring a contract by a health
10 maintenance organization to cover services
11 needed to treat congenital craniofacial
12 anomalies as authorized by a physician;
13 amending s. 627.6515, F.S., relating to
14 out-of-state groups; conforming a
15 cross-reference to changes made by the act;
16 providing an effective date.
17
18 WHEREAS, craniofacial anomalies are a group of
19 deformities involving the growth of the head and facial bones,
20 and these anomalies are present at birth and vary in type and
21 severity, and
22 WHEREAS, experts agree that many factors contribute to
23 the development of craniofacial anomalies, some craniofacial
24 anomalies are a result of genetic mutations, and other
25 craniofacial anomalies may be a result of environmental
26 factors that scientists do not completely understand, and
27 WHEREAS, the most common types of craniofacial
28 anomalies include, but are not limited to, cleft lip, cleft
29 palate, craniosynostosis, hemifacial microsomia, vascular
30 malformation, hemangioma, and deformational or positional
31 plagiocephaly, and
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Florida Senate - 2005 SB 560
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1 WHEREAS, insurance companies often do not fully cover
2 the costs associated with treating congenital craniofacial
3 anomalies, NOW, THEREFORE,
4
5 Be It Enacted by the Legislature of the State of Florida:
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7 Section 1. Section 627.64194, Florida Statutes, is
8 created to read:
9 627.64194 Services for the treatment of congenital
10 craniofacial anomalies.--A health insurance policy sold in
11 this state must provide coverage for all medically appropriate
12 and necessary equipment, supplies, supplements, and patient
13 self-management training and educational services used to
14 treat a congenital craniofacial anomaly if the patient's
15 treating physician or a physician who specializes in the
16 treatment of craniofacial anomalies certifies that such
17 services are necessary.
18 Section 2. Section 627.6614, Florida Statutes, is
19 created to read:
20 627.6614 Services for the treatment of congenital
21 craniofacial anomalies.--A group health insurance policy sold
22 in this state must provide coverage for all medically
23 appropriate and necessary equipment, supplies, supplements,
24 and patient self-management training and educational services
25 used to treat a congenital craniofacial anomaly if the
26 patient's treating physician or a physician who specializes in
27 the treatment of craniofacial anomalies certifies that such
28 services are necessary.
29 Section 3. Present subsections (36), (37), (38), (39),
30 and (40) of section 641.31, Florida Statutes, are redesignated
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Florida Senate - 2005 SB 560
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1 as subsections (37), (38), (39), (40), and (41), respectively,
2 and a new subsection (36) is added to that section to read:
3 641.31 Health maintenance contracts.--
4 (36) A health maintenance contract sold in this state
5 must provide coverage for all medically appropriate and
6 necessary equipment, supplies, supplements, and patient
7 self-management training and educational services used to
8 treat a congenital craniofacial anomaly if the patient's
9 treating physician or a physician who specializes in the
10 treatment of craniofacial anomalies certifies that such
11 services are necessary.
12 Section 4. Subsection (2) of section 627.6515, Florida
13 Statutes, is amended to read:
14 627.6515 Out-of-state groups.--
15 (2) Except as otherwise provided in this part, this
16 part does not apply to a group health insurance policy issued
17 or delivered outside this state under which a resident of this
18 state is provided coverage if:
19 (a) The policy is issued to an employee group the
20 composition of which is substantially as described in s.
21 627.653; a labor union group or association group the
22 composition of which is substantially as described in s.
23 627.654; an additional group the composition of which is
24 substantially as described in s. 627.656; a group insured
25 under a blanket health policy when the composition of the
26 group is substantially in compliance with s. 627.659; a group
27 insured under a franchise health policy when the composition
28 of the group is substantially in compliance with s. 627.663;
29 an association group to cover persons associated in any other
30 common group, which common group is formed primarily for
31 purposes other than providing insurance; a group that is
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Florida Senate - 2005 SB 560
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1 established primarily for the purpose of providing group
2 insurance, provided the benefits are reasonable in relation to
3 the premiums charged thereunder and the issuance of the group
4 policy has resulted, or will result, in economies of
5 administration; or a group of insurance agents of an insurer,
6 which insurer is the policyholder;
7 (b) Certificates evidencing coverage under the policy
8 are issued to residents of this state and contain in
9 contrasting color and not less than 10-point type the
10 following statement: "The benefits of the policy providing
11 your coverage are governed primarily by the law of a state
12 other than Florida"; and
13 (c) The policy provides the benefits specified in ss.
14 627.419, 627.6574, 627.6575, 627.6579, 627.6612, 627.66121,
15 627.66122, 627.6613, 627.6614, 627.667, 627.6675, 627.6691,
16 and 627.66911.
17 (d) Applications for certificates of coverage offered
18 to residents of this state must contain, in contrasting color
19 and not less than 12-point type, the following statement on
20 the same page as the applicant's signature:
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22 "This policy is primarily governed by the laws
23 of ...insert state where the master policy if
24 filed.... As a result, all of the rating laws
25 applicable to policies filed in this state do
26 not apply to this coverage, which may result in
27 increases in your premium at renewal that would
28 not be permissible under a Florida-approved
29 policy. Any purchase of individual health
30 insurance should be considered carefully, as
31 future medical conditions may make it
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1 impossible to qualify for another individual
2 health policy. For information concerning
3 individual health coverage under a
4 Florida-approved policy, consult your agent or
5 the Florida Department of Financial Services."
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7 This paragraph applies only to group certificates providing
8 health insurance coverage which require individualized
9 underwriting to determine coverage eligibility for an
10 individual or premium rates to be charged to an individual
11 except for the following:
12 1. Policies issued to provide coverage to groups of
13 persons all of whom are in the same or functionally related
14 licensed professions, and providing coverage only to such
15 licensed professionals, their employees, or their dependents;
16 2. Policies providing coverage to small employers as
17 defined by s. 627.6699. Such policies shall be subject to, and
18 governed by, the provisions of s. 627.6699;
19 3. Policies issued to a bona fide association, as
20 defined by s. 627.6571(5), provided that there is a person or
21 board acting as a fiduciary for the benefit of the members,
22 and such association is not owned, controlled by, or otherwise
23 associated with the insurance company; or
24 4. Any accidental death, accidental death and
25 dismemberment, accident-only, vision-only, dental-only,
26 hospital indemnity-only, hospital accident-only, cancer,
27 specified disease, Medicare supplement, products that
28 supplement Medicare, long-term care, or disability income
29 insurance, or similar supplemental plans provided under a
30 separate policy, certificate, or contract of insurance, which
31 cannot duplicate coverage under an underlying health plan,
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1 coinsurance, or deductibles or coverage issued as a supplement
2 to workers' compensation or similar insurance, or automobile
3 medical-payment insurance.
4 Section 5. This act shall take effect October 1, 2005.
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7 SENATE SUMMARY
8 Requires an individual health insurance policy, a group
health insurance policy, or a contract by a health
9 maintenance organization to cover services needed to
treat congenital craniofacial anomalies as authorized by
10 a physician.
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