HB 1353

1	A bill to be entitled
2	An act relating to cystic fibrosis treatment; amending s.
3	627.6515, F.S; including within an exclusion from
4	provisions applying to out-of-state groups group policies
5	providing health coverage for cystic fibrosis; creating s.
6	627.6614, F.S.; requiring a group health insurance policy
7	to cover services needed to treat cystic fibrosis as
8	authorized by a physician; amending s. 641.31, F.S.;
9	requiring a contract by a health maintenance organization
10	to cover services needed to treat cystic fibrosis as
11	authorized by a physician; providing a legislative finding
12	of fulfillment of an important state interest; providing
13	application; providing an effective date.
14
15	WHEREAS, cystic fibrosis is a genetic disease that
16	adversely affects the respiratory system and the digestive
17	system, and
18	WHEREAS, only half of those suffering with cystic fibrosis
19	live to the age of 32, and
20	WHEREAS, the treatments for individuals with cystic
21	fibrosis include ingesting pancreatic enzymes or a wide
22	assortment of nutritional supplements, frequent postural
23	draining to clear the respiratory system, or using a feeding
24	tube to provide sustenance, and
25	WHEREAS, insurance companies oftentimes do not fully cover
26	the costs associated with treating cystic fibrosis, a fatal
27	disease, NOW, THEREFORE,
28
29	Be It Enacted by the Legislature of the State of Florida:
30
31	Section 1.  Subsection (2) of section 627.6515, Florida
32	Statutes, is amended to read:
33	627.6515  Out-of-state groups.--
34	(2)  Except as otherwise provided in this part, this part
35	does not apply to a group health insurance policy issued or
36	delivered outside this state under which a resident of this
37	state is provided coverage if:
38	(a)  The policy is issued to an employee group the
39	composition of which is substantially as described in s.
40	627.653; a labor union group or association group the
41	composition of which is substantially as described in s.
42	627.654; an additional group the composition of which is
43	substantially as described in s. 627.656; a group insured under
44	a blanket health policy when the composition of the group is
45	substantially in compliance with s. 627.659; a group insured
46	under a franchise health policy when the composition of the
47	group is substantially in compliance with s. 627.663; an
48	association group to cover persons associated in any other
49	common group, which common group is formed primarily for
50	purposes other than providing insurance; a group that is
51	established primarily for the purpose of providing group
52	insurance, provided the benefits are reasonable in relation to
53	the premiums charged thereunder and the issuance of the group
54	policy has resulted, or will result, in economies of
55	administration; or a group of insurance agents of an insurer,
56	which insurer is the policyholder.;
57	(b)  Certificates evidencing coverage under the policy are
58	issued to residents of this state and contain in contrasting
59	color and not less than 10-point type the following statement:
60	"The benefits of the policy providing your coverage are governed
61	primarily by the law of a state other than Florida".; and
62	(c)  The policy provides the benefits specified in ss.
63	627.419, 627.6574, 627.6575, 627.6579, 627.6612, 627.66121,
64	627.66122, 627.6613, 627.6614, 627.667, 627.6675, 627.6691, and
65	627.66911.
66	(d)  Applications for certificates of coverage offered to
67	residents of this state must contain, in contrasting color and
68	not less than 12-point type, the following statement on the same
69	page as the applicant's signature:
70
71	"This policy is primarily governed by the laws of   insert state
72	where the master policy is if filed  . As a result, all of the
73	rating laws applicable to policies filed in this state do not
74	apply to this coverage, which may result in increases in your
75	premium at renewal that would not be permissible under a
76	Florida-approved policy. Any purchase of individual health
77	insurance should be considered carefully, as future medical
78	conditions may make it impossible to qualify for another
79	individual health policy. For information concerning individual
80	health coverage under a Florida-approved policy, consult your
81	agent or the Florida Department of Financial Services."
82
83	This paragraph applies only to group certificates providing
84	health insurance coverage which require individualized
85	underwriting to determine coverage eligibility for an individual
86	or premium rates to be charged to an individual except for the
87	following:
88	1.  Policies issued to provide coverage to groups of
89	persons all of whom are in the same or functionally related
90	licensed professions, and providing coverage only to such
91	licensed professionals, their employees, or their dependents;
92	2.  Policies providing coverage to small employers as
93	defined by s. 627.6699. Such policies shall be subject to, and
94	governed by, the provisions of s. 627.6699;
95	3.  Policies issued to a bona fide association, as defined
96	by s. 627.6571(5), provided that there is a person or board
97	acting as a fiduciary for the benefit of the members, and such
98	association is not owned, controlled by, or otherwise associated
99	with the insurance company; or
100	4.  Any accidental death, accidental death and
101	dismemberment, accident-only, vision-only, dental-only, hospital
102	indemnity-only, hospital accident-only, cancer, specified
103	disease, Medicare supplement, products that supplement Medicare,
104	long-term care, or disability income insurance, or similar
105	supplemental plans provided under a separate policy,
106	certificate, or contract of insurance, which cannot duplicate
107	coverage under an underlying health plan, coinsurance, or
108	deductibles or coverage issued as a supplement to workers'
109	compensation or similar insurance, or automobile medical-payment
110	insurance.
111	Section 2.  Section 627.6614, Florida Statutes, is created
112	to read:
113	627.6614  Cystic fibrosis treatment services.--A group
114	health insurance policy sold in this state must provide coverage
115	for all medically necessary chest physiotherapy provided by a
116	respiratory therapist licensed under part V of chapter 468 and
117	home health care, equipment, supplies, and enteral formulas
118	described in s. 627.42395 used to treat cystic fibrosis if the
119	patient's treating physician or a physician authorized by the
120	insurer who specializes in the treatment of cystic fibrosis
121	certifies that such services are medically necessary. The
122	insurer may require the policyholder to be responsible for any
123	deductible or copayment that generally applies under the policy.
124	Section 3.  Present subsections (36), (37), (38), (39), and
125	(40) of section 641.31, Florida Statutes, are renumbered as
126	subsections (37), (38), (39), (40), and (41), respectively, and
127	new subsection (36) is added to that section to read:
128	641.31  Health maintenance contracts.--
129	(36)  A group health maintenance contract sold in this
130	state must provide coverage for all medically necessary chest
131	physiotherapy provided by a respiratory therapist licensed under
132	part V of chapter 468 and home health care, equipment, supplies,
133	and enteral formulas described in s. 627.42395 used to treat
134	cystic fibrosis if the patient's treating physician or a
135	physician authorized by the health maintenance organization who
136	specializes in the treatment of cystic fibrosis certifies that
137	such services are medically necessary. The health maintenance
138	organization may require the subscriber to be responsible for
139	any deductible or copayment that generally applies under the
140	contract.
141	Section 4.  The Legislature finds that this act fulfills an
142	important state interest.
143	Section 5.  This act shall take effect October 1, 2006, and
144	applies to all policies and contracts issued or renewed on or
145	after that date.

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