HB 0597

1	A bill to be entitled
2	An act relating to cystic fibrosis treatment; creating ss.
3	627.64194 and 627.6614, F.S.; requiring an individual
4	health insurance policy or a group health insurance policy
5	to cover services needed to treat cystic fibrosis as
6	authorized by a physician; amending s. 627.6515, F.S;
7	including within an exclusion from provisions applying to
8	out-of-state groups group policies providing health
9	coverage for cystic fibrosis; amending s. 641.31, F.S.;
10	requiring a contract by a health maintenance organization
11	to cover services needed to treat cystic fibrosis as
12	authorized by a physician; providing an effective date.
13
14	WHEREAS, cystic fibrosis is a genetic disease that
15	adversely affects the respiratory system and the digestive
16	system, and
17	WHEREAS, there are 1,006 children and adults in Florida
18	today suffering from cystic fibrosis, and
19	WHEREAS, only half of those suffering with cystic fibrosis
20	live to the age of 32, and
21	WHEREAS, the treatments for individuals with cystic
22	fibrosis include ingesting pancreatic enzymes or a wide
23	assortment of nutritional supplements, frequent postural
24	draining to clear the respiratory system, or using a feeding
25	tube to provide sustenance, and
26	WHEREAS, insurance companies oftentimes do not fully cover
27	the costs associated with treating cystic fibrosis, a fatal
28	disease, NOW, THEREFORE,
29
30	Be It Enacted by the Legislature of the State of Florida:
31
32	Section 1.  Section 627.64194, Florida Statutes, is created
33	to read:
34	627.64194  Cystic fibrosis treatment services.--A health
35	insurance policy sold in this state must provide coverage for
36	all medically appropriate and necessary equipment, supplies,
37	supplements, and patient self-management training and
38	educational services used to treat cystic fibrosis if the
39	patient's treating physician or a physician who specializes in
40	the treatment of cystic fibrosis certifies that such services
41	are necessary.
42	Section 2.  Subsection (2) of section 627.6515, Florida
43	Statutes, is amended to read:
44	627.6515  Out-of-state groups.--
45	(2)  Except as otherwise provided in this part, this part
46	does not apply to a group health insurance policy issued or
47	delivered outside this state under which a resident of this
48	state is provided coverage if:
49	(a)  The policy is issued to an employee group the
50	composition of which is substantially as described in s.
51	627.653; a labor union group or association group the
52	composition of which is substantially as described in s.
53	627.654; an additional group the composition of which is
54	substantially as described in s. 627.656; a group insured under
55	a blanket health policy when the composition of the group is
56	substantially in compliance with s. 627.659; a group insured
57	under a franchise health policy when the composition of the
58	group is substantially in compliance with s. 627.663; an
59	association group to cover persons associated in any other
60	common group, which common group is formed primarily for
61	purposes other than providing insurance; a group that is
62	established primarily for the purpose of providing group
63	insurance, provided the benefits are reasonable in relation to
64	the premiums charged thereunder and the issuance of the group
65	policy has resulted, or will result, in economies of
66	administration; or a group of insurance agents of an insurer,
67	which insurer is the policyholder.;
68	(b)  Certificates evidencing coverage under the policy are
69	issued to residents of this state and contain in contrasting
70	color and not less than 10-point type the following statement:
71	"The benefits of the policy providing your coverage are governed
72	primarily by the law of a state other than Florida".; and
73	(c)  The policy provides the benefits specified in ss.
74	627.419, 627.6574, 627.6575, 627.6579, 627.6612, 627.66121,
75	627.66122, 627.6613, 627.6614, 627.667, 627.6675, 627.6691, and
76	627.66911.
77	(d)  Applications for certificates of coverage offered to
78	residents of this state must contain, in contrasting color and
79	not less than 12-point type, the following statement on the same
80	page as the applicant's signature:
81
82	"This policy is primarily governed by the laws of
83	...insert state where the master policy if filed....
84	As a result, all of the rating laws applicable to
85	policies filed in this state do not apply to this
86	coverage, which may result in increases in your
87	premium at renewal that would not be permissible under
88	a Florida-approved policy. Any purchase of individual
89	health insurance should be considered carefully, as
90	future medical conditions may make it impossible to
91	qualify for another individual health policy. For
92	information concerning individual health coverage
93	under a Florida-approved policy, consult your agent or
94	the Florida Department of Financial Services."
95
96	This paragraph applies only to group certificates providing
97	health insurance coverage which require individualized
98	underwriting to determine coverage eligibility for an individual
99	or premium rates to be charged to an individual except for the
100	following:
101	1.  Policies issued to provide coverage to groups of
102	persons all of whom are in the same or functionally related
103	licensed professions, and providing coverage only to such
104	licensed professionals, their employees, or their dependents;
105	2.  Policies providing coverage to small employers as
106	defined by s. 627.6699. Such policies shall be subject to, and
107	governed by, the provisions of s. 627.6699;
108	3.  Policies issued to a bona fide association, as defined
109	by s. 627.6571(5), provided that there is a person or board
110	acting as a fiduciary for the benefit of the members, and such
111	association is not owned, controlled by, or otherwise associated
112	with the insurance company; or
113	4.  Any accidental death, accidental death and
114	dismemberment, accident-only, vision-only, dental-only, hospital
115	indemnity-only, hospital accident-only, cancer, specified
116	disease, Medicare supplement, products that supplement Medicare,
117	long-term care, or disability income insurance, or similar
118	supplemental plans provided under a separate policy,
119	certificate, or contract of insurance, which cannot duplicate
120	coverage under an underlying health plan, coinsurance, or
121	deductibles or coverage issued as a supplement to workers'
122	compensation or similar insurance, or automobile medical-payment
123	insurance.
124	Section 3.  Section 627.6614, Florida Statutes, is created
125	to read:
126	627.6614  Cystic fibrosis treatment services.--A group
127	health insurance policy sold in this state must provide coverage
128	for all medically appropriate and necessary equipment, supplies,
129	supplements, and patient self-management training and
130	educational services used to treat cystic fibrosis if the
131	patient's treating physician or a physician who specializes in
132	the treatment of cystic fibrosis certifies that such services
133	are necessary.
134	Section 4.  Present subsections (36), (37), (38), (39), and
135	(40) of section 641.31, Florida Statutes, are renumbered as
136	subsections (37), (38), (39), (40), and (41), respectively, and
137	new subsection (36) is added to said section to read:
138	641.31  Health maintenance contracts.--
139	(36)  A health maintenance contract sold in this state must
140	provide coverage for all medically appropriate and necessary
141	equipment, supplies, supplements, and patient self-management
142	training and educational services used to treat cystic fibrosis
143	if the patient's treating physician or a physician who
144	specializes in the treatment of cystic fibrosis certifies that
145	such services are necessary.
146	Section 5.  This act shall take effect July 1, 2005.

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