| 1 | A bill to be entitled |
| 2 | An act relating to health insurance; amending s. 627.638, |
| 3 | F.S.; proscribing insurance contracts from prohibiting |
| 4 | payment of benefits directly to a licensed hospital, |
| 5 | physician, and dentist for certain care; providing a |
| 6 | claims form requirement; amending s. 627.6699, F.S.; |
| 7 | revising application of the act; providing construction; |
| 8 | authorizing carriers to offer coverage to certain |
| 9 | employees without being subject to the act under certain |
| 10 | circumstances; providing requirements; providing an |
| 11 | effective date. |
| 12 |
|
| 13 | Be It Enacted by the Legislature of the State of Florida: |
| 14 |
|
| 15 | Section 1. Subsection (2) of section 627.638, Florida |
| 16 | Statutes, is amended to read: |
| 17 | 627.638 Direct payment for hospital, medical services.-- |
| 18 | (2) Whenever, in any health insurance claim form, an |
| 19 | insured specifically authorizes payment of benefits directly to |
| 20 | any recognized hospital, or physician, or dentist, the insurer |
| 21 | shall make such payment to the designated provider of such |
| 22 | services, unless otherwise provided in the insurance contract. |
| 23 | The insurance contract may not prohibit, and claims forms must |
| 24 | provide option for, the payment of benefits directly to a |
| 25 | licensed hospital, physician, and dentist for care provided |
| 26 | pursuant to s. 395.1041. |
| 27 | Section 2. Paragraph (a) of subsection (4) of section |
| 28 | 627.6699, Florida Statutes, is amended to read: |
| 29 | 627.6699 Employee Health Care Access Act.-- |
| 30 | (4) APPLICABILITY AND SCOPE.-- |
| 31 | (a)1. This section applies to a health benefit plan that |
| 32 | provides coverage to employees of a small employer in this |
| 33 | state, unless the coverage policy is marketed directly to the |
| 34 | individual employee, and the employer does not contribute |
| 35 | directly or indirectly to participate in the collection or |
| 36 | distribution of premiums or facilitate the administration of the |
| 37 | coverage policy in any manner. For the purposes of this |
| 38 | subparagraph, an employer shall not be deemed to be contributing |
| 39 | to the premiums or facilitating the administration of coverage |
| 40 | if the employer does not contribute towards the premium and |
| 41 | merely collects the premiums for such coverage from an |
| 42 | employee's wages or salary through payroll deduction and submits |
| 43 | payment for the premiums of one or more employees in a lump sum |
| 44 | to a carrier. |
| 45 | 2. A carrier authorized to issue group or individual |
| 46 | health benefit plans under chapter 627 or chapter 641 may offer |
| 47 | coverage as described in this subparagraph to individual |
| 48 | employees without being subject to this section if the employer |
| 49 | has not had a group health benefit plan in place in the prior 6 |
| 50 | months. A carrier authorized to issue group or individual health |
| 51 | benefit plans under chapter 627 or chapter 641 may offer |
| 52 | coverage as described in this subparagraph to employees that are |
| 53 | not eligible employees as defined in this section, whether or |
| 54 | not the small employer has a group health benefit plan in place. |
| 55 | A carrier that offers coverage as described in this subparagraph |
| 56 | must provide a cancellation notice to the primary insured at |
| 57 | least 10 days prior to canceling the coverage for nonpayment of |
| 58 | premium. |
| 59 | Section 3. This act shall take effect July 1, 2005. |