| 1 | Representative(s) Mahon offered the following: |
| 2 |
|
| 3 | Amendment (with directory and title amendments) |
| 4 | Between lines 14 and 15, insert: |
| 5 | Section 1. Subsections (2) and (5) of section 408.909, |
| 6 | Florida Statutes, are amended to read: |
| 7 | 408.909 Health flex plans.-- |
| 8 | (2) DEFINITIONS.--As used in this section, the term: |
| 9 | (a) "Agency" means the Agency for Health Care |
| 10 | Administration. |
| 11 | (b) "Business" means any business registered and operating |
| 12 | in this state. |
| 13 | (c)(b) "Office" means the Office of Insurance Regulation |
| 14 | of the Financial Services Commission. |
| 15 | (d)(c) "Enrollee" means an individual who has been |
| 16 | determined to be eligible for and is receiving health care |
| 17 | coverage under a health flex plan approved under this section. |
| 18 | (e)(d) "Health care coverage" or "health flex plan |
| 19 | coverage" means health care services that are covered as |
| 20 | benefits under an approved health flex plan or that are |
| 21 | otherwise provided, either directly or through arrangements with |
| 22 | other persons, via a health flex plan on a prepaid per capita |
| 23 | basis or on a prepaid aggregate fixed-sum basis. |
| 24 | (f)(e) "Health flex plan" means a health plan approved |
| 25 | under subsection (3) which guarantees payment for specified |
| 26 | health care coverage provided to the enrollee who purchases |
| 27 | coverage directly from the plan or through a small business |
| 28 | purchasing arrangement sponsored by a local government. |
| 29 | (g)(f) "Health flex plan entity" means a health insurer, |
| 30 | health maintenance organization, health-care-provider-sponsored |
| 31 | organization, local government, health care district, other |
| 32 | public or private community-based organization, or public- |
| 33 | private partnership that develops and implements an approved |
| 34 | health flex plan and is responsible for administering the health |
| 35 | flex plan and paying all claims for health flex plan coverage by |
| 36 | enrollees of the health flex plan. |
| 37 | (5) ELIGIBILITY.--Eligibility to enroll in an approved |
| 38 | health flex plan is limited to residents of this state who: |
| 39 | (a)1. Are 64 years of age or younger; |
| 40 | 2.(b) Have a family income equal to or less than 200 |
| 41 | percent of the federal poverty level; |
| 42 | 3.(c) Are eligible under a federally approved Medicaid |
| 43 | demonstration waiver and reside in Palm Beach County or Miami- |
| 44 | Dade County; |
| 45 | 4.(d) Are not covered by a private insurance policy and |
| 46 | are not eligible for coverage through a public health insurance |
| 47 | program, such as Medicare or Medicaid, unless specifically |
| 48 | authorized under subparagraph 3. paragraph (c), or another |
| 49 | public health care program, such as KidCare, and have not been |
| 50 | covered at any time during the past 6 months; and |
| 51 | 5.(e) Have applied for health care coverage through an |
| 52 | approved health flex plan and have agreed to make any payments |
| 53 | required for participation, including periodic payments or |
| 54 | payments due at the time health care services are provided; or |
| 55 | (b) Are employees of a business that: |
| 56 | 1. Employs a workforce of 100 or fewer employees, 75 |
| 57 | percent of which meets all of the eligibility criteria specified |
| 58 | in paragraph (a); |
| 59 | 2. Offers a group health flex plan to its employees; |
| 60 | 3. Pays a portion of the premium for the health flex plan |
| 61 | on behalf of its employees; and |
| 62 | 4. Has not otherwise offered health insurance benefits in |
| 63 | the previous 12 months. |
| 64 |
|
| 65 | ================ T I T L E A M E N D M E N T ============= |
| 66 | Remove lines 6-8 and insert: |
| 67 | An act relating to employee health care; amending s. 408.909, |
| 68 | F.S.; defining the term "business" for purposes of health flex |
| 69 | plans; providing additional eligibility criteria for enrolling |
| 70 | in health flex plans; amending s. 627.6699, F.S.; revising |
| 71 | application of the Employee Health Care Access Act; providing |
| 72 | construction; authorizing carriers to offer |