HB 811

1
A bill to be entitled
2An act relating to health insurance; amending s. 408.05,
3F.S.; changing the due date for a report from the Agency
4for Health Care Administration regarding the State Center
5for Health Statistics; amending s. 408.909, F.S.;
6providing an additional criterion for the Office of
7Insurance Regulation to disapprove or withdraw approval of
8health flex plans; amending s. 627.413, F.S.; authorizing
9insurers and health maintenance organizations to offer
10policies or contracts providing for a high-deductible plan
11meeting federal requirements and in conjunction with a
12health savings account; amending s. 627.638, F.S.;
13revising direct payment provisions for insurers; amending
14s. 627.6402, F.S.; revising the requirements for the
15healthy lifestyle premium rebate; amending s. 627.65626,
16F.S.; providing insurance rebates for healthy lifestyles;
17amending s. 627.6692, F.S.; extending a time period within
18which eligible employees may apply for continuation of
19coverage; amending s. 627.6699, F.S.; revising standards
20for determining applicability of the Employee Health Care
21Access Act; prescribing acts that may be performed by an
22employer without being considered contributing to premiums
23or facilitating administration of a policy; authorizing
24certain carriers to offer coverage to certain employees
25without being subject to the act under certain
26circumstances; requiring a carrier who offers such
27coverage to provide notice to the primary insured prior to
28cancellation for nonpayment of premium; revising an
29availability of coverage provision of the Employee Health
30Care Access Act; including high-deductible plans meeting
31federal health savings account plan requirements; revising
32membership of the board of the small employer health
33reinsurance program; revising certain reporting dates
34relating to program losses and assessments; requiring the
35board to advise executive and legislative entities on
36health insurance issues; providing requirements; amending
37s. 641.27, F.S.; increasing the interval at which the
38office examines health maintenance organizations; deleting
39authorization for the office to accept an audit report
40from a certified public accountant in lieu of conducting
41its own examination; increasing an expense limitation;
42amending s. 641.31, F.S.; providing for an insurance
43rebate for members in a health wellness program; providing
44for the rebate to cease under certain conditions;
45providing effective dates.
46
47Be It Enacted by the Legislature of the State of Florida:
48
49     Section 1.  Paragraph (l) of subsection (3) of section
50408.05, Florida Statutes, is amended to read:
51     408.05  State Center for Health Statistics.--
52     (3)  COMPREHENSIVE HEALTH INFORMATION SYSTEM.--In order to
53produce comparable and uniform health information and
54statistics, the agency shall perform the following functions:
55     (l)  Develop, in conjunction with the State Comprehensive
56Health Information System Advisory Council, and implement a
57long-range plan for making available performance outcome and
58financial data that will allow consumers to compare health care
59services. The performance outcomes and financial data the agency
60must make available shall include, but is not limited to,
61pharmaceuticals, physicians, health care facilities, and health
62plans and managed care entities. The agency shall submit the
63initial plan to the Governor, the President of the Senate, and
64the Speaker of the House of Representatives by January March 1,
652006 2005, and shall update the plan and report on the status of
66its implementation annually thereafter. The agency shall also
67make the plan and status report available to the public on its
68Internet website. As part of the plan, the agency shall identify
69the process and timeframes for implementation, any barriers to
70implementation, and recommendations of changes in the law that
71may be enacted by the Legislature to eliminate the barriers. As
72preliminary elements of the plan, the agency shall:
73     1.  Make available performance outcome and patient charge
74data collected from health care facilities pursuant to s.
75408.061(1)(a) and (2). The agency shall determine which
76conditions and procedures, performance outcomes, and patient
77charge data to disclose based upon input from the council. When
78determining which conditions and procedures are to be disclosed,
79the council and the agency shall consider variation in costs,
80variation in outcomes, and magnitude of variations and other
81relevant information. When determining which performance
82outcomes to disclose, the agency:
83     a.  Shall consider such factors as volume of cases; average
84patient charges; average length of stay; complication rates;
85mortality rates; and infection rates, among others, which shall
86be adjusted for case mix and severity, if applicable.
87     b.  May consider such additional measures that are adopted
88by the Centers for Medicare and Medicaid Studies, National
89Quality Forum, the Joint Commission on Accreditation of
90Healthcare Organizations, the Agency for Healthcare Research and
91Quality, or a similar national entity that establishes standards
92to measure the performance of health care providers, or by other
93states.
94
95When determining which patient charge data to disclose, the
96agency shall consider such measures as average charge, average
97net revenue per adjusted patient day, average cost per adjusted
98patient day, and average cost per admission, among others.
99     2.  Make available performance measures, benefit design,
100and premium cost data from health plans licensed pursuant to
101chapter 627 or chapter 641. The agency shall determine which
102performance outcome and member and subscriber cost data to
103disclose, based upon input from the council. When determining
104which data to disclose, the agency shall consider information
105that may be required by either individual or group purchasers to
106assess the value of the product, which may include membership
107satisfaction, quality of care, current enrollment or membership,
108coverage areas, accreditation status, premium costs, plan costs,
109premium increases, range of benefits, copayments and
110deductibles, accuracy and speed of claims payment, credentials
111of physicians, number of providers, names of network providers,
112and hospitals in the network. Health plans shall make available
113to the agency any such data or information that is not currently
114reported to the agency or the office.
115     3.  Determine the method and format for public disclosure
116of data reported pursuant to this paragraph. The agency shall
117make its determination based upon input from the Comprehensive
118Health Information System Advisory Council. At a minimum, the
119data shall be made available on the agency's Internet website in
120a manner that allows consumers to conduct an interactive search
121that allows them to view and compare the information for
122specific providers. The website must include such additional
123information as is determined necessary to ensure that the
124website enhances informed decisionmaking among consumers and
125health care purchasers, which shall include, at a minimum,
126appropriate guidance on how to use the data and an explanation
127of why the data may vary from provider to provider. The data
128specified in subparagraph 1. shall be released no later than
129January 1, 2006, for the reporting of infection rates, and no
130later than October 1, 2005, for mortality rates and complication
131rates March 1, 2005. The data specified in subparagraph 2. shall
132be released no later than October March 1, 2006.
133     Section 2.  Paragraph (b) of subsection (3) of section
134408.909, Florida Statutes, is amended to read:
135     408.909  Health flex plans.--
136     (3)  PROGRAM.--The agency and the office shall each approve
137or disapprove health flex plans that provide health care
138coverage for eligible participants. A health flex plan may limit
139or exclude benefits otherwise required by law for insurers
140offering coverage in this state, may cap the total amount of
141claims paid per year per enrollee, may limit the number of
142enrollees, or may take any combination of those actions. A
143health flex plan offering may include the option of a
144catastrophic plan supplementing the health flex plan.
145     (b)  The office shall develop guidelines for the review of
146health flex plan applications and provide regulatory oversight
147of health flex plan advertisement and marketing procedures. The
148office shall disapprove or shall withdraw approval of plans
149that:
150     1.  Contain any ambiguous, inconsistent, or misleading
151provisions or any exceptions or conditions that deceptively
152affect or limit the benefits purported to be assumed in the
153general coverage provided by the health flex plan;
154     2.  Provide benefits that are unreasonable in relation to
155the premium charged or contain provisions that are unfair or
156inequitable or contrary to the public policy of this state, that
157encourage misrepresentation, or that result in unfair
158discrimination in sales practices; or
159     3.  Cannot demonstrate that the health flex plan is
160financially sound and that the applicant is able to underwrite
161or finance the health care coverage provided; or
162     4.  Cannot demonstrate that the applicant and its
163management are in compliance with the standards required under
164s. 624.404(3).
165     Section 3.  Subsection (6) is added to section 627.413,
166Florida Statutes, to read:
167     627.413  Contents of policies, in general; identification.-
168-
169     (6)  Notwithstanding any other provision of the Florida
170Insurance Code that is in conflict with federal requirements for
171a health savings account qualified high-deductible health plan,
172an insurer, or a health maintenance organization subject to part
173I of chapter 641, which is authorized to issue health insurance
174in this state may offer for sale an individual or group policy
175or contract that provides for a high-deductible plan that meets
176the federal requirements of a health savings account plan and
177which is offered in conjunction with a health savings account.
178     Section 4.  Subsection (2) of section 627.638, Florida
179Statutes, is amended to read:
180     627.638  Direct payment for hospital, medical services.--
181     (2)  Whenever, in any health insurance claim form, an
182insured specifically authorizes payment of benefits directly to
183any recognized hospital, or physician, or dentist, the insurer
184shall make such payment to the designated provider of such
185services, unless otherwise provided in the insurance contract.
186The insurance contract may not prohibit, and claims forms must
187provide an option for, the payment of benefits directly to a
188licensed hospital, physician, or dentist for care provided
189pursuant to s. 395.1041. The insurer may require written
190attestation of assignment of benefits. Payment to the provider
191from the insurer may not be more than the amount that the
192insurer would otherwise have paid without the assignment.
193     Section 5.  Section 627.6402, Florida Statutes, is amended
194to read:
195     627.6402  Insurance rebates for healthy lifestyles.--
196     (1)  Any rate, rating schedule, or rating manual for an
197individual health insurance policy filed with the office may
198shall provide for an appropriate rebate of premiums paid in the
199last calendar year when the individual covered by such plan is
200enrolled in and maintains participation in any health wellness,
201maintenance, or improvement program approved by the health plan.
202The rebate may be based on premiums paid in the last calendar
203year or the last policy year. The individual must provide
204evidence of demonstrative maintenance or improvement of the
205individual's health status as determined by assessments of
206agreed-upon health status indicators between the individual and
207the health insurer, including, but not limited to, reduction in
208weight, body mass index, and smoking cessation. Any rebate
209provided by the health insurer is presumed to be appropriate
210unless credible data demonstrates otherwise, or unless such
211rebate program requires the insured to incur costs to qualify
212for the rebate which equal or exceed the value of the rebate,
213but in no event shall the rebate not exceed 10 percent of paid
214premiums.
215     (2)  The premium rebate authorized by this section shall be
216effective for an insured on an annual basis, unless the
217individual fails to maintain or improve his or her health status
218while participating in an approved wellness program, or credible
219evidence demonstrates that the individual is not participating
220in the approved wellness program.
221     Section 6.  Section 627.65626, Florida Statutes, is amended
222to read:
223     627.65626  Insurance rebates for healthy lifestyles.--
224     (1)  Any rate, rating schedule, or rating manual for a
225health insurance policy that provides creditable coverage as
226defined in s. 627.6561(5) filed with the office shall provide
227for an appropriate rebate of premiums paid in the last policy
228year, contract year, or calendar year when the majority of
229members of a health plan have enrolled and maintained
230participation in any health wellness, maintenance, or
231improvement program offered by the group policyholder and health
232plan employer. The rebate may be based upon premiums paid in the
233last calendar year or policy year. The group employer must
234provide evidence of demonstrative maintenance or improvement of
235the enrollees' health status as determined by assessments of
236agreed-upon health status indicators between the policyholder
237employer and the health insurer, including, but not limited to,
238reduction in weight, body mass index, and smoking cessation. The
239group or health insurer may contract with a third-party
240administrator to assemble and report the health status required
241in this subsection between the policyholder and the health
242insurer. Any rebate provided by the health insurer is presumed
243to be appropriate unless credible data demonstrates otherwise,
244or unless the rebate program requires the insured to incur costs
245to qualify for the rebate which equal or exceeds the value of
246the rebate, but the rebate may shall not exceed 10 percent of
247paid premiums.
248     (2)  The premium rebate authorized by this section shall be
249effective for an insured on an annual basis unless the number of
250participating members on the policy renewal anniversary
251employees becomes less than the majority of the members
252employees eligible for participation in the wellness program.
253     Section 7.  Paragraphs (d) and (j) of subsection (5) of
254section 627.6692, Florida Statutes, are amended to read:
255     627.6692  Florida Health Insurance Coverage Continuation
256Act.--
257     (5)  CONTINUATION OF COVERAGE UNDER GROUP HEALTH PLANS.--
258     (d)1.  A qualified beneficiary must give written notice to
259the insurance carrier within 63 30 days after the occurrence of
260a qualifying event. Unless otherwise specified in the notice, a
261notice by any qualified beneficiary constitutes notice on behalf
262of all qualified beneficiaries. The written notice must inform
263the insurance carrier of the occurrence and type of the
264qualifying event giving rise to the potential election by a
265qualified beneficiary of continuation of coverage under the
266group health plan issued by that insurance carrier, except that
267in cases where the covered employee has been involuntarily
268discharged, the nature of such discharge need not be disclosed.
269The written notice must, at a minimum, identify the employer,
270the group health plan number, the name and address of all
271qualified beneficiaries, and such other information required by
272the insurance carrier under the terms of the group health plan
273or the commission by rule, to the extent that such information
274is known by the qualified beneficiary.
275     2.  Within 14 days after the receipt of written notice
276under subparagraph 1., the insurance carrier shall send each
277qualified beneficiary by certified mail an election and premium
278notice form, approved by the office, which form must provide for
279the qualified beneficiary's election or nonelection of
280continuation of coverage under the group health plan and the
281applicable premium amount due after the election to continue
282coverage. This subparagraph does not require separate mailing of
283notices to qualified beneficiaries residing in the same
284household, but requires a separate mailing for each separate
285household.
286     (j)  Notwithstanding paragraph (b), if a qualified
287beneficiary in the military reserve or National Guard has
288elected to continue coverage and is thereafter called to active
289duty and the coverage under the group plan is terminated by the
290beneficiary or the carrier due to the qualified beneficiary
291becoming eligible for TRICARE (the health care program provided
292by the United States Defense Department), the 18-month period or
293such other applicable maximum time period for which the
294qualified beneficiary would otherwise be entitled to continue
295coverage is tolled during the time that he or she is covered
296under the TRICARE program. Within 63 30 days after the federal
297TRICARE coverage terminates, the qualified beneficiary may elect
298to continue coverage under the group health plan, retroactively
299to the date coverage terminated under TRICARE, for the remainder
300of the 18-month period or such other applicable time period,
301subject to termination of coverage at the earliest of the
302conditions specified in paragraph (b).
303     Section 8.  Paragraph (a) of subsection (4), paragraph (c)
304of subsection (5), and paragraphs (b) and (j) of subsection (11)
305of section 627.6699, Florida Statutes, are amended, and
306paragraph (o) is added to subsection (11) of that section, to
307read:
308     627.6699  Employee Health Care Access Act.--
309     (4)  APPLICABILITY AND SCOPE.--
310     (a)1.  This section applies to a health benefit plan that
311provides coverage to employees of a small employer in this
312state, unless the coverage policy is marketed directly to the
313individual employee, and the employer does not contribute
314directly or indirectly to participate in the collection or
315distribution of premiums or facilitate the administration of the
316coverage policy in any manner. For the purposes of this
317subparagraph, an employer is not deemed to be contributing to
318the premiums or facilitating the administration of coverage if
319the employer does not contribute to the premium and merely
320collects the premiums for coverage from an employee's wages or
321salary through payroll deduction and submits payment for the
322premiums of one or more employees in a lump sum to a carrier.
323     2.  A carrier authorized to issue group or individual
324health benefit plans under this chapter or chapter 641 may offer
325coverage as described in this paragraph to individual employees
326without being subject to this section if the employer has not
327had a group health benefit plan in place in the prior 6 months.
328A carrier authorized to issue group or individual health benefit
329plans under this chapter or chapter 641 may offer coverage as
330described in this subparagraph to employees that are not
331eligible employees as defined in this section, whether or not
332the small employer has a group health benefit plan in place. A
333carrier that offers coverage as described in this subparagraph
334must provide a cancellation notice to the primary insured at
335least 10 days prior to canceling the coverage for nonpayment of
336premium.
337     (5)  AVAILABILITY OF COVERAGE.--
338     (c)  Every small employer carrier must, as a condition of
339transacting business in this state:
340     1.  Offer and issue all small employer health benefit plans
341on a guaranteed-issue basis to every eligible small employer,
342with 2 to 50 eligible employees, that elects to be covered under
343such plan, agrees to make the required premium payments, and
344satisfies the other provisions of the plan. A rider for
345additional or increased benefits may be medically underwritten
346and may only be added to the standard health benefit plan. The
347increased rate charged for the additional or increased benefit
348must be rated in accordance with this section.
349     2.  In the absence of enrollment availability in the
350Florida Health Insurance Plan, offer and issue basic and
351standard small employer health benefit plans and a high-
352deductible plan that meets the requirements of a health savings
353account plan or health reimbursement account as defined by
354federal law, on a guaranteed-issue basis, during a 31-day open
355enrollment period of August 1 through August 31 of each year, to
356every eligible small employer, with fewer than two eligible
357employees, which small employer is not formed primarily for the
358purpose of buying health insurance and which elects to be
359covered under such plan, agrees to make the required premium
360payments, and satisfies the other provisions of the plan.
361Coverage provided under this subparagraph shall begin on October
3621 of the same year as the date of enrollment, unless the small
363employer carrier and the small employer agree to a different
364date. A rider for additional or increased benefits may be
365medically underwritten and may only be added to the standard
366health benefit plan. The increased rate charged for the
367additional or increased benefit must be rated in accordance with
368this section. For purposes of this subparagraph, a person, his
369or her spouse, and his or her dependent children constitute a
370single eligible employee if that person and spouse are employed
371by the same small employer and either that person or his or her
372spouse has a normal work week of less than 25 hours. Any right
373to an open enrollment of health benefit coverage for groups of
374fewer than two employees, pursuant to this section, shall remain
375in full force and effect in the absence of the availability of
376new enrollment into the Florida Health Insurance Plan.
377     3.  This paragraph does not limit a carrier's ability to
378offer other health benefit plans to small employers if the
379standard and basic health benefit plans are offered and
380rejected.
381     (11)  SMALL EMPLOYER HEALTH REINSURANCE PROGRAM.--
382     (b)1.  The program shall operate subject to the supervision
383and control of the board.
384     2.  Effective upon this act becoming a law, the board shall
385consist of the director of the office or his or her designee,
386who shall serve as the chairperson, and 13 additional members
387who are representatives of carriers and insurance agents and are
388appointed by the director of the office and serve as follows:
389     a.  Five members shall be representatives of health
390insurers licensed under chapter 624 or chapter 641. Two members
391shall be agents who are actively engaged in the sale of health
392insurance. Four members shall be employers or representatives of
393employers. One member shall be a person covered under an
394individual health insurance policy issued by a licensed insurer
395in this state. One member shall represent the Agency for Health
396Care Administration and shall be recommended by the Secretary of
397Health Care Administration. The director of the office shall
398include representatives of small employer carriers subject to
399assessment under this subsection. If two or more carriers elect
400to be risk-assuming carriers, the membership must include at
401least two representatives of risk-assuming carriers; if one
402carrier is risk-assuming, one member must be a representative of
403such carrier. At least one member must be a carrier who is
404subject to the assessments, but is not a small employer carrier.
405Subject to such restrictions, at least five members shall be
406selected from individuals recommended by small employer carriers
407pursuant to procedures provided by rule of the commission. Three
408members shall be selected from a list of health insurance
409carriers that issue individual health insurance policies. At
410least two of the three members selected must be reinsuring
411carriers. Two members shall be selected from a list of insurance
412agents who are actively engaged in the sale of health insurance.
413     b.  A member appointed under this subparagraph shall serve
414a term of 4 years and shall continue in office until the
415member's successor takes office, except that, in order to
416provide for staggered terms, the director of the office shall
417designate two of the initial appointees under this subparagraph
418to serve terms of 2 years and shall designate three of the
419initial appointees under this subparagraph to serve terms of 3
420years.
421     3.  The director of the office may remove a member for
422cause.
423     4.  Vacancies on the board shall be filled in the same
424manner as the original appointment for the unexpired portion of
425the term.
426     5.  The director of the office may require an entity that
427recommends persons for appointment to submit additional lists of
428recommended appointees.
429     (j)1.  Before July March 1 of each calendar year, the board
430shall determine and report to the office the program net loss
431for the previous year, including administrative expenses for
432that year, and the incurred losses for the year, taking into
433account investment income and other appropriate gains and
434losses.
435     2.  Any net loss for the year shall be recouped by
436assessment of the carriers, as follows:
437     a.  The operating losses of the program shall be assessed
438in the following order subject to the specified limitations. The
439first tier of assessments shall be made against reinsuring
440carriers in an amount which shall not exceed 5 percent of each
441reinsuring carrier's premiums from health benefit plans covering
442small employers. If such assessments have been collected and
443additional moneys are needed, the board shall make a second tier
444of assessments in an amount which shall not exceed 0.5 percent
445of each carrier's health benefit plan premiums. Except as
446provided in paragraph (n), risk-assuming carriers are exempt
447from all assessments authorized pursuant to this section. The
448amount paid by a reinsuring carrier for the first tier of
449assessments shall be credited against any additional assessments
450made.
451     b.  The board shall equitably assess carriers for operating
452losses of the plan based on market share. The board shall
453annually assess each carrier a portion of the operating losses
454of the plan. The first tier of assessments shall be determined
455by multiplying the operating losses by a fraction, the numerator
456of which equals the reinsuring carrier's earned premium
457pertaining to direct writings of small employer health benefit
458plans in the state during the calendar year for which the
459assessment is levied, and the denominator of which equals the
460total of all such premiums earned by reinsuring carriers in the
461state during that calendar year. The second tier of assessments
462shall be based on the premiums that all carriers, except risk-
463assuming carriers, earned on all health benefit plans written in
464this state. The board may levy interim assessments against
465carriers to ensure the financial ability of the plan to cover
466claims expenses and administrative expenses paid or estimated to
467be paid in the operation of the plan for the calendar year prior
468to the association's anticipated receipt of annual assessments
469for that calendar year. Any interim assessment is due and
470payable within 30 days after receipt by a carrier of the interim
471assessment notice. Interim assessment payments shall be credited
472against the carrier's annual assessment. Health benefit plan
473premiums and benefits paid by a carrier that are less than an
474amount determined by the board to justify the cost of collection
475may not be considered for purposes of determining assessments.
476     c.  Subject to the approval of the office, the board shall
477make an adjustment to the assessment formula for reinsuring
478carriers that are approved as federally qualified health
479maintenance organizations by the Secretary of Health and Human
480Services pursuant to 42 U.S.C. s. 300e(c)(2)(A) to the extent,
481if any, that restrictions are placed on them that are not
482imposed on other small employer carriers.
483     3.  Before July March 1 of each year, the board shall
484determine and file with the office an estimate of the
485assessments needed to fund the losses incurred by the program in
486the previous calendar year.
487     4.  If the board determines that the assessments needed to
488fund the losses incurred by the program in the previous calendar
489year will exceed the amount specified in subparagraph 2., the
490board shall evaluate the operation of the program and report its
491findings, including any recommendations for changes to the plan
492of operation, to the office within 180 90 days following the end
493of the calendar year in which the losses were incurred. The
494evaluation shall include an estimate of future assessments, the
495administrative costs of the program, the appropriateness of the
496premiums charged and the level of carrier retention under the
497program, and the costs of coverage for small employers. If the
498board fails to file a report with the office within 180 90 days
499following the end of the applicable calendar year, the office
500may evaluate the operations of the program and implement such
501amendments to the plan of operation the office deems necessary
502to reduce future losses and assessments.
503     5.  If assessments exceed the amount of the actual losses
504and administrative expenses of the program, the excess shall be
505held as interest and used by the board to offset future losses
506or to reduce program premiums. As used in this paragraph, the
507term "future losses" includes reserves for incurred but not
508reported claims.
509     6.  Each carrier's proportion of the assessment shall be
510determined annually by the board, based on annual statements and
511other reports considered necessary by the board and filed by the
512carriers with the board.
513     7.  Provision shall be made in the plan of operation for
514the imposition of an interest penalty for late payment of an
515assessment.
516     8.  A carrier may seek, from the office, a deferment, in
517whole or in part, from any assessment made by the board. The
518office may defer, in whole or in part, the assessment of a
519carrier if, in the opinion of the office, the payment of the
520assessment would place the carrier in a financially impaired
521condition. If an assessment against a carrier is deferred, in
522whole or in part, the amount by which the assessment is deferred
523may be assessed against the other carriers in a manner
524consistent with the basis for assessment set forth in this
525section. The carrier receiving such deferment remains liable to
526the program for the amount deferred and is prohibited from
527reinsuring any individuals or groups in the program if it fails
528to pay assessments.
529     (o)  The board shall advise the office, the Agency for
530Health Care Administration, the department, other executive
531departments, and the Legislature on health insurance issues.
532Specifically, the board shall:
533     1.  Provide a forum for stakeholders, consisting of
534insurers, employers, agents, consumers, and regulators, in the
535private health insurance market in this state.
536     2.  Review and recommend strategies to improve the
537functioning of the health insurance markets in this state with a
538specific focus on market stability, access, and pricing.
539     3.  Make recommendations to the office for legislation
540addressing health insurance market issues and provide comments
541on health insurance legislation proposed by the office.
542     4.  Meet at least three times each year. One meeting shall
543be held to hear reports and to secure public comment on the
544health insurance market, to develop any legislation needed to
545address health insurance market issues, and to provide comments
546on health insurance legislation proposed by the office.
547     5.  Issue a report to the office on the state of the health
548insurance market by September 1 each year. The report shall
549include recommendations for changes in the health insurance
550market, results from implementation of previous recommendations,
551and information on health insurance markets.
552     Section 9.  Subsection (1) of section 641.27, Florida
553Statutes, is amended to read:
554     641.27  Examination by the department.--
555     (1)  The office shall examine the affairs, transactions,
556accounts, business records, and assets of any health maintenance
557organization as often as it deems it expedient for the
558protection of the people of this state, but not less frequently
559than once every 5 3 years. In lieu of making its own financial
560examination, the office may accept an independent certified
561public accountant's audit report prepared on a statutory
562accounting basis consistent with this part. However, except when
563the medical records are requested and copies furnished pursuant
564to s. 456.057, medical records of individuals and records of
565physicians providing service under contract to the health
566maintenance organization shall not be subject to audit, although
567they may be subject to subpoena by court order upon a showing of
568good cause. For the purpose of examinations, the office may
569administer oaths to and examine the officers and agents of a
570health maintenance organization concerning its business and
571affairs. The examination of each health maintenance organization
572by the office shall be subject to the same terms and conditions
573as apply to insurers under chapter 624. In no event shall
574expenses of all examinations exceed a maximum of $50,000 $20,000
575for any 1-year period. Any rehabilitation, liquidation,
576conservation, or dissolution of a health maintenance
577organization shall be conducted under the supervision of the
578department, which shall have all power with respect thereto
579granted to it under the laws governing the rehabilitation,
580liquidation, reorganization, conservation, or dissolution of
581life insurance companies.
582     Section 10.  Subsection (40) of section 641.31, Florida
583Statutes, is amended to read:
584     641.31  Health maintenance contracts.--
585     (40)(a)  Any group rate, rating schedule, or rating manual
586for a health maintenance organization policy, which provides
587creditable coverage as defined in s. 627.6561(5), filed with the
588office shall provide for an appropriate rebate of premiums paid
589in the last policy year, contract year, or calendar year when
590the majority of members of a health individual covered by such
591plan are is enrolled in and maintained maintains participation
592in any health wellness, maintenance, or improvement program
593offered by the group contract holder approved by the health
594plan. The group individual must provide evidence of
595demonstrative maintenance or improvement of his or her health
596status as determined by assessments of agreed-upon health status
597indicators between the group individual and the health insurer,
598including, but not limited to, reduction in weight, body mass
599index, and smoking cessation. Any rebate provided by the health
600maintenance organization insurer is presumed to be appropriate
601unless credible data demonstrates otherwise, or unless the
602rebate program requires the insured to incur costs to qualify
603for the rebate which equals or exceeds the value of the rebate
604but the rebate may shall not exceed 10 percent of paid premiums.
605     (b)  The premium rebate authorized by this section shall be
606effective for a subscriber an insured on an annual basis, unless
607the number of participating members on the contract renewal
608anniversary becomes fewer than the majority of the members
609eligible for participation in the wellness program individual
610fails to maintain or improve his or her health status while
611participating in an approved wellness program, or credible
612evidence demonstrates that the individual is not participating
613in the approved wellness program.
614     (c)  A health maintenance organization that issues
615individual contracts may offer a premium rebate, as provided
616under this section, for a healthy lifestyle program.
617     Section 11.  Except as otherwise expressly provided in this
618act and except for this section, which shall take effect upon
619becoming a law, this act shall take effect July 1, 2005, and
620shall apply to all policies or contracts issued or renewed on or
621after July 1, 2005.


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