| 1 | A bill to be entitled |
| 2 | An act relating to small employer health insurance; |
| 3 | amending s. 627.6699, F.S.; establishing the Healthy |
| 4 | Florida Small Employer Health Insurance Program for |
| 5 | certain purposes; providing requirements for small |
| 6 | employer carriers; describing qualifying small employers; |
| 7 | providing requirements for small employers; providing wage |
| 8 | level criteria for small employers; providing for |
| 9 | reimbursement of small employer carriers for portions of |
| 10 | claims paid from the Healthy Florida Small Employer Stop |
| 11 | Loss Fund; providing procedures, requirements, and |
| 12 | limitations on reimbursements from the fund; requiring the |
| 13 | Financial Services Commission to adopt rules; providing |
| 14 | duties of the Office of Insurance Regulation in |
| 15 | administering and making reimbursement payments; providing |
| 16 | for eligibility and criteria for reimbursement; |
| 17 | authorizing the office to hire an organization to |
| 18 | administer the fund; providing for a proposal submittal |
| 19 | process for organizations to administer the fund; |
| 20 | providing fund administration requirements; authorizing |
| 21 | the administration organization to purchase insurance for |
| 22 | certain purposes; providing for payment from the fund for |
| 23 | such insurance; authorizing the office to use fund moneys |
| 24 | for certain purposes; providing a limitation; authorizing |
| 25 | the office to contract with marketing organizations to |
| 26 | assist in such purposes; requiring the office to report on |
| 27 | the program to the Governor and Legislature; providing for |
| 28 | future repeal of the program; providing an effective date. |
| 29 |
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| 30 | Be It Enacted by the Legislature of the State of Florida: |
| 31 |
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| 32 | Section 1. Subsection (17) of section 627.6699, Florida |
| 33 | Statutes, is renumbered as subsection (18) and a new subsection |
| 34 | (17) is added to that section to read: |
| 35 | 627.6699 Employee Health Care Access Act.-- |
| 36 | (17) HEALTHY FLORIDA SMALL EMPLOYER HEALTH INSURANCE |
| 37 | PROGRAM.--The Healthy Florida Small Employer Health Insurance |
| 38 | Program is established for the purpose of making small employer |
| 39 | health insurance available to qualifying small employers as |
| 40 | defined in this subsection. The program is designed to encourage |
| 41 | small employers to offer health insurance coverage to their |
| 42 | employees. All small employer carriers shall offer high |
| 43 | deductible plans as referenced in subsection (12) to all |
| 44 | qualified small employers, at rates which incorporate the |
| 45 | savings provided by the stop loss fund established in s. |
| 46 | 627.66991, and the provisions of this subsection. |
| 47 | (a)1. A qualifying small employer is a small employer |
| 48 | with: |
| 49 | a. No health benefit plan covering employees in effect |
| 50 | during the previous 12-month period prior to application. |
| 51 | b. At least 30 percent of its eligible employees receiving |
| 52 | annual wages from the employer at a level equal to or less than |
| 53 | $33,000. The $33,000 figure shall be adjusted annually pursuant |
| 54 | to paragraph (b). |
| 55 | 2. A qualifying small employer must pay at least 50 |
| 56 | percent of the premium for covered employees under the basic |
| 57 | plan and must offer coverage to all employees receiving annual |
| 58 | wages at a level of $33,000 or less, and at least one such |
| 59 | employee shall accept such coverage. The employer premium |
| 60 | contribution must be the same percentage for all covered |
| 61 | employees. |
| 62 | (b) The wage levels used in paragraph (a) shall be |
| 63 | adjusted annually, beginning in 2008. The adjustment shall take |
| 64 | effect on July 1 of each year. For July 1, 2008, the adjustment |
| 65 | shall be a percentage of the annual wage figure specified in |
| 66 | paragraph (a). For subsequent years, the adjustment shall be a |
| 67 | percentage of the annual wage figure which took effect on July 1 |
| 68 | of the immediately preceding year. The percentage adjustment |
| 69 | shall be the same percentage by which the current year's nonfarm |
| 70 | federal poverty level, as defined and updated by the United |
| 71 | States Department of Health and Human Services, for a family |
| 72 | unit of two persons for the 48 contiguous states and Washington, |
| 73 | D.C., changed from the same level established for the prior |
| 74 | year. |
| 75 | (c) A small employer carrier shall obtain from the |
| 76 | employer written certification at the time of initial |
| 77 | application and annually thereafter in conjunction with the |
| 78 | contract renewal that such employer meets the requirements of a |
| 79 | qualifying small employer. A small employer carrier may require |
| 80 | the submission of appropriate documentation in support of the |
| 81 | certification. |
| 82 | (d) The commissioner, by order, may require small employer |
| 83 | carriers to give preference to qualifying small employers whose |
| 84 | eligible employees have the lowest average salaries. |
| 85 | (e) A small employer carrier shall submit reports to the |
| 86 | office in a format and at times as may be reasonably required in |
| 87 | order to evaluate the operations and results of the program |
| 88 | established by this subsection. |
| 89 | (f)1. Commencing on January 1, 2007, small employer |
| 90 | carriers shall be eligible to receive reimbursement for 90 |
| 91 | percent of aggregate claims paid, under the plans issued |
| 92 | pursuant to this subsection, between $5,000 and $75,000 in a |
| 93 | calendar year for any covered lives under a qualified small |
| 94 | employer contract issued pursuant to this subsection. Claims |
| 95 | paid for covered lives under qualifying small employer contracts |
| 96 | issued pursuant to this subsection shall be reimbursable from |
| 97 | the Healthy Florida Small Employer Stop Loss Fund created in s. |
| 98 | 627.66991. |
| 99 | 2. The premiums for qualifying small employer contracts |
| 100 | must factor in the availability of reimbursement from the fund. |
| 101 | 3. The commission shall adopt rules pursuant to ss. |
| 102 | 120.536(1) and 120.54 that set forth procedures for the |
| 103 | operation of the fund and distribution of moneys from the fund. |
| 104 | 4. Claims shall be reported and funds shall be distributed |
| 105 | from the fund on a calendar-year basis. Claims shall be eligible |
| 106 | for reimbursement only for the calendar year in which the claims |
| 107 | are paid. |
| 108 | 5. Each small employer carrier shall submit a request for |
| 109 | reimbursement from the fund on forms prescribed by the |
| 110 | commission. The request for reimbursement shall be submitted no |
| 111 | later than April 1, following the end of the calendar year for |
| 112 | which the reimbursement request is made. The office may require |
| 113 | small employer carriers to submit such claims data in connection |
| 114 | with reimbursement requests as the office deems necessary to |
| 115 | enable the office to distribute moneys and oversee the operation |
| 116 | of the fund. The office may require that such data be submitted |
| 117 | on a per member, aggregate, or categorical basis. Data shall be |
| 118 | reported separately for each qualifying small employer plan |
| 119 | issued under this subsection. |
| 120 | 6. The office shall calculate the total claims |
| 121 | reimbursement amount for all small employer carriers for the |
| 122 | calendar year for which claims are being reported. |
| 123 | a. If the total amount requested for reimbursement for a |
| 124 | calendar year exceeds funds available for distribution from the |
| 125 | fund for claims paid during that same calendar year, the |
| 126 | commissioner shall provide for a pro rata distribution of the |
| 127 | available funds. Each small employer carrier shall be eligible |
| 128 | to receive only such proportionate amount of the available funds |
| 129 | as the small employer carrier's total eligible claims paid bears |
| 130 | to the total eligible claims paid by all small employer |
| 131 | carriers. Any claims for reimbursement that cannot be made due |
| 132 | to a deficit for a particular calendar year may be carried over |
| 133 | to a subsequent calendar year. |
| 134 | b. If funds available for distribution for claims paid by |
| 135 | all small employer carriers during a calendar year exceeds the |
| 136 | total amount requested for reimbursement by all small employer |
| 137 | carriers during that same calendar year, any excess funds shall |
| 138 | be carried forward in the fund and made available for |
| 139 | distribution from the fund in the next calendar year. Such |
| 140 | excess funds shall be in addition to the moneys appropriated for |
| 141 | the fund in the subsequent calendar year. |
| 142 | 7.a. Upon the request of the office, each small employer |
| 143 | carrier shall be required to furnish such data in a format and |
| 144 | at times as the office deems necessary to oversee the operation |
| 145 | of the fund. Each small employer carrier shall provide the |
| 146 | office with monthly reports of the total enrollment under the |
| 147 | qualifying small employer contracts issued pursuant to this |
| 148 | subsection. |
| 149 | b. The office shall estimate the per member annual cost of |
| 150 | total claims reimbursement from the fund for qualifying small |
| 151 | employer contracts based upon available data and appropriate |
| 152 | actuarial assumptions. Upon request, each small employer carrier |
| 153 | shall furnish to the office claims experience data for use in |
| 154 | such estimations. |
| 155 | c. The office shall determine total eligible enrollment |
| 156 | under qualifying small employer contracts. For qualifying small |
| 157 | employer contracts, the total eligible enrollment shall be |
| 158 | determined by dividing the total funds available for |
| 159 | distribution from the fund by the estimated per member annual |
| 160 | cost of total claims reimbursement from the fund. |
| 161 | d. The office shall suspend the enrollment of new |
| 162 | employers under qualifying small employer contracts if the |
| 163 | office determines that the total enrollment reported by all |
| 164 | small employer carriers exceeds the total eligible enrollment |
| 165 | causing anticipated annual expenditures from the fund to exceed |
| 166 | the total funds available for distribution from the fund. |
| 167 | e. The office shall provide the small employer carriers |
| 168 | with notification of any enrollment suspension. |
| 169 | f. If at any point during a suspension of enrollment of |
| 170 | new qualifying small employers the office determines that funds |
| 171 | are sufficient to provide for the addition of new enrollments, |
| 172 | the office may reactivate new enrollments and notify all small |
| 173 | employer carriers that enrollment of new employers may again |
| 174 | commence. |
| 175 | g. The suspension of issuance of qualifying small employer |
| 176 | contracts to new qualifying small employers shall not preclude |
| 177 | the addition of new employees of an employer already covered |
| 178 | under such a contract or new dependents of employees already |
| 179 | covered under such contracts. |
| 180 | 8. The office may obtain the services of an organization |
| 181 | to administer the fund. The office shall establish guidelines |
| 182 | for the submission of proposals by organizations for the |
| 183 | purposes of administering the fund and make a determination |
| 184 | whether to approve, disapprove, or recommend modification to the |
| 185 | proposal of an applicant to administer the fund. An organization |
| 186 | approved to administer the fund shall submit reports to the |
| 187 | office in such format and at times as may be required by the |
| 188 | office in order to facilitate evaluation and ensure orderly |
| 189 | operation of the fund. An organization approved to administer |
| 190 | the fund shall maintain records in a format as designated by the |
| 191 | office and which shall be available for inspection by or at the |
| 192 | request of the office. The office shall determine the amount of |
| 193 | compensation to be allocated to an approved organization as |
| 194 | payment for fund administration. Compensation of the |
| 195 | organization shall be payable from the fund. An organization |
| 196 | approved to administer the fund may be removed by the office and |
| 197 | must cooperate in the orderly transition of services to another |
| 198 | approved organization or to the office. |
| 199 | 9. If the office deems it appropriate for the proper |
| 200 | administration of the fund, the administrator of the fund, on |
| 201 | behalf of and with the prior approval of the office, shall be |
| 202 | authorized to purchase stop loss insurance or reinsurance from |
| 203 | an insurer licensed to write such type of insurance in this |
| 204 | state. Such stop loss insurance or reinsurance may be purchased |
| 205 | to the extent moneys are available in the fund. |
| 206 | 10. The office may use moneys in the fund for purposes of |
| 207 | developing and implementing public education, outreach, and |
| 208 | facilitated enrollment strategies targeted to small employers. |
| 209 | The office may contract with marketing organizations to perform |
| 210 | or provide assistance with such education, outreach, and |
| 211 | enrollment strategies. The office shall determine the amount of |
| 212 | funding available for the purposes of this subparagraph, which |
| 213 | in no event shall exceed 10 percent of the annual funding |
| 214 | amounts for the fund. |
| 215 | (g) By September 1, 2007, and annually thereafter, the |
| 216 | office shall submit to the Governor, the President of the |
| 217 | Senate, and the Speaker of the House of Representatives a report |
| 218 | summarizing the activities of the program, including enrollment |
| 219 | and claims paid and an estimate of the required funding for the |
| 220 | next program year. |
| 221 | (h) This subsection is repealed July 1, 2010. |
| 222 | Section 2. This act shall take effect July 1, 2006. |