| 1 | Representative(s) Benson offered the following: |
| 2 |
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| 3 | Amendment (with title amendment) |
| 4 | On page 5, between lines 20 and 21, insert: |
| 5 | Section 7. Paragraph (i) of subsection (2) of section |
| 6 | 636.204, Florida Statutes, is amended to read: |
| 7 | 636.204 License required.-- |
| 8 | (2) An application for a license to operate as a discount |
| 9 | medical plan organization must be filed with the office on a |
| 10 | form prescribed by the commission. Such application must be |
| 11 | sworn to by an officer or authorized representative of the |
| 12 | applicant and be accompanied by the following, if applicable: |
| 13 | (i) A copy of the applicant's most recent financial |
| 14 | statements audited by an independent certified public |
| 15 | accountant. An applicant that is a subsidiary of a parent entity |
| 16 | that is publicly traded and that prepares audited financial |
| 17 | statements reflecting the consolidated operations of the parent |
| 18 | entity and the subsidiary may submit petition the office to |
| 19 | accept, in lieu of the audited financial statement of the |
| 20 | applicant, the audited financial statement of the parent entity |
| 21 | and a written guaranty by the parent entity that the minimum |
| 22 | capital requirements of the applicant required by this part will |
| 23 | be met by the parent entity. |
| 24 | Section 8. Subsection (1) of section 636.206, Florida |
| 25 | Statutes, is amended to read: |
| 26 | 636.206 Examinations and investigations.-- |
| 27 | (1) The office may examine or investigate the business and |
| 28 | affairs of any discount medical plan organization if the |
| 29 | commissioner has reason to believe that the discount medical |
| 30 | plan organization is not complying with the requirements of this |
| 31 | part. The office may order any discount medical plan |
| 32 | organization or applicant to produce any records, books, files, |
| 33 | advertising and solicitation materials, or other information and |
| 34 | may take statements under oath to determine whether the discount |
| 35 | medical plan organization or applicant is in violation of the |
| 36 | law or is acting contrary to the public interest. The expenses |
| 37 | incurred in conducting any examination or investigation must be |
| 38 | paid by the discount medical plan organization or applicant. |
| 39 | Examinations and investigations must be conducted as provided in |
| 40 | chapter 624. |
| 41 | Section 9. Subsection (1) of section 636.210, Florida |
| 42 | Statutes, is amended to read: |
| 43 | 636.210 Prohibited activities of a discount medical plan |
| 44 | organization.-- |
| 45 | (1) A discount medical plan organization may not: |
| 46 | (a) Use in its advertisements, marketing material, |
| 47 | brochures, and discount cards the term "insurance" except as |
| 48 | otherwise provided in this part or as a disclaimer of any |
| 49 | relationship between discount medical plan organization benefits |
| 50 | and insurance; |
| 51 | (b) Use in its advertisements, marketing material, |
| 52 | brochures, and discount cards the terms "health plan," |
| 53 | "coverage," "copay," "copayments," "preexisting conditions," |
| 54 | "guaranteed issue," "premium," "PPO," "preferred provider |
| 55 | organization," or other terms in a manner that could reasonably |
| 56 | mislead a person into believing the discount medical plan was |
| 57 | health insurance; |
| 58 | (c) Have restrictions on free access to plan providers, |
| 59 | except for hospital services, including, but not limited to, |
| 60 | waiting periods and notification periods; or |
| 61 | (d) Pay providers any fees for medical services. |
| 62 | Section 10. Subsection (1) of section 636.216, Florida |
| 63 | Statutes, is amended to read: |
| 64 | 636.216 Charge or form filings.-- |
| 65 | (1) All charges to members must be filed with the office. |
| 66 | and Any charge to members greater than $30 per month or $360 per |
| 67 | year for access to health care services other than those |
| 68 | provided by physicians licensed under chapter 458 or chapter |
| 69 | 459, or by hospitals licensed under chapter 395, must be |
| 70 | approved by the office before the charges can be used. Any |
| 71 | charge to members greater than $60 per month or $720 per year |
| 72 | for health care services that include services provided by |
| 73 | physicians licensed under chapter 458 or chapter 459, or by |
| 74 | hospitals licensed under chapter 395, must be approved by the |
| 75 | office before the charges may be used. The discount medical plan |
| 76 | organization has the burden of proof that the charges bear a |
| 77 | reasonable relation to the benefits received by the member. |
| 78 | Section 11. Subsection (2) of section 636.218, Florida |
| 79 | Statutes, is amended to read: |
| 80 | 636.218 Annual reports.-- |
| 81 | (2) Such reports must be on forms prescribed by the |
| 82 | commission and must include: |
| 83 | (a) Audited financial statements prepared in accordance |
| 84 | with generally accepted accounting principles certified by an |
| 85 | independent certified public accountant, including the |
| 86 | organization's balance sheet, income statement, and statement of |
| 87 | changes in cash flow for the preceding year. An organization |
| 88 | that is a subsidiary of a parent entity that is publicly traded |
| 89 | and that prepares audited financial statements reflecting the |
| 90 | consolidated operations of the parent entity and the |
| 91 | organization may petition the office to accept, in lieu of the |
| 92 | audited financial statement of the organization, the audited |
| 93 | financial statement of the parent entity and a written guaranty |
| 94 | by the parent entity that the minimum capital requirements of |
| 95 | the organization required by this part will be met by the parent |
| 96 | entity. |
| 97 | (a)(b) If different from the initial application or the |
| 98 | last annual report, a list of the names and residence addresses |
| 99 | of all persons responsible for the conduct of the organization's |
| 100 | affairs, together with a disclosure of the extent and nature of |
| 101 | any contracts or arrangements between such persons and the |
| 102 | discount medical plan organization, including any possible |
| 103 | conflicts of interest. |
| 104 | (b)(c) The number of discount medical plan members in the |
| 105 | state. |
| 106 | (c)(d) Such other information relating to the performance |
| 107 | of the discount medical plan organization as is reasonably |
| 108 | required by the commission or office. |
| 109 | Section 12. Subsection (1) of section 636.220, Florida |
| 110 | Statutes, is amended to read: |
| 111 | 636.220 Minimum capital requirements.-- |
| 112 | (1) Each discount medical plan organization must at all |
| 113 | times maintain a net worth of at least $150,000 and shall |
| 114 | certify in writing and under oath at the time of licensure and |
| 115 | annually thereafter that the minimum capitalization requirements |
| 116 | of this part are satisfied. |
| 117 | Section 13. Section 636.230, Florida Statutes, is amended |
| 118 | to read: |
| 119 | 636.230 Bundling discount medical plans with insurance |
| 120 | other products.--When a marketer or discount medical plan |
| 121 | organization sells a discount medical plan together with any |
| 122 | insurance other product, the fees for the discount medical plan |
| 123 | must be provided in writing to the member if the fees exceed $30 |
| 124 | per month for access to healthcare services other than those |
| 125 | provided by physicians licensed under chapter 458 or chapter |
| 126 | 459, or by hospitals licensed under chapter 395, or $60 dollars |
| 127 | per month for healthcare services which include services |
| 128 | provided by physicians licensed under chapter 458 or chapter |
| 129 | 459, or by hospitals licensed under chapter 395. |
| 130 |
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| 131 |
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| 132 | ========= T I T L E A M E N D M E N T ========= |
| 133 | On page 1, line 13, after the semicolon, insert: |
| 134 | amending s. 636.204, F.S.; authorizing submittal of alternative |
| 135 | audited financial statements; amending s. 636.206, F.S.; |
| 136 | authorizing the Office of Insurance Regulation to examine or |
| 137 | investigate the business of a discount medical plan organization |
| 138 | under certain circumstances; amending s. 636.210, F.S.; |
| 139 | providing an exception to the prohibited restrictions on free |
| 140 | access to plan providers for hospital services; amending s. |
| 141 | 636.216, F.S.; revising the charges and filing requirements for |
| 142 | access to certain health care services; amending s. 636.218, |
| 143 | F.S.; deleting a requirement that audited financial statements |
| 144 | be included in the annual report filed by a discount medical |
| 145 | plan organization; amending s. 636.220, F.S.; requiring a |
| 146 | discount medical plan organization to certify in writing and |
| 147 | under oath that certain requirements are satisfied; amending s. |
| 148 | 636.230, F.S.; revising provisions relating to bundling discount |
| 149 | medical plans with insurance products; providing notification |
| 150 | requirement for fees in excess of certain amounts; |