Florida Senate - 2006 SENATOR AMENDMENT
Bill No. CS for SB 2432
Barcode 185716
CHAMBER ACTION
Senate House
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3 Floor: 1/WD/2R .
04/26/2006 11:06 AM .
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11 Senator Peaden moved the following amendment:
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13 Senate Amendment (with title amendment)
14 On page 2, between lines 21 and 22,
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16 insert:
17 Section 2. Subsection (2) of section 636.204, Florida
18 Statutes, is amended to read:
19 636.204 License required.--
20 (2) An application for a license to operate as a
21 discount medical plan organization must be filed with the
22 office on a form prescribed by the commission. Such
23 application must be sworn to by an officer or authorized
24 representative of the applicant and be accompanied by the
25 following, if applicable:
26 (a) A copy of the applicant's articles of
27 incorporation or other organizing documents, including all
28 amendments.
29 (b) A copy of the applicant's bylaws.
30 (c) A list of the names, addresses, official
31 positions, and biographical information of the individuals who
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Florida Senate - 2006 SENATOR AMENDMENT
Bill No. CS for SB 2432
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1 are responsible for conducting the applicant's affairs,
2 including, but not limited to, all members of the board of
3 directors, board of trustees, executive committee, or other
4 governing board or committee, the officers, contracted
5 management company personnel, and any person or entity owning
6 or having the right to acquire 10 percent or more of the
7 voting securities of the applicant. Such listing must fully
8 disclose the extent and nature of any contracts or
9 arrangements between any individual who is responsible for
10 conducting the applicant's affairs and the discount medical
11 plan organization, including any possible conflicts of
12 interest.
13 (d) A complete biographical statement, on forms
14 prescribed by the commission, an independent investigation
15 report, and a set of fingerprints, as provided in chapter 624,
16 with respect to each individual identified under paragraph
17 (c).
18 (e) A statement generally describing the applicant,
19 its facilities and personnel, and the medical services to be
20 offered.
21 (f) A copy of the form of all contracts made or to be
22 made between the applicant and any providers or provider
23 networks regarding the provision of medical services to
24 members.
25 (g) A copy of the form of any contract made or
26 arrangement to be made between the applicant and any person
27 listed in paragraph (c).
28 (h) A copy of the form of any contract made or to be
29 made between the applicant and any person, corporation,
30 partnership, or other entity for the performance on the
31 applicant's behalf of any function, including, but not limited
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Florida Senate - 2006 SENATOR AMENDMENT
Bill No. CS for SB 2432
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1 to, marketing, administration, enrollment, investment
2 management, and subcontracting for the provision of health
3 services to members.
4 (i) A copy of the applicant's most recent financial
5 statements audited by an independent certified public
6 accountant. An applicant that is a subsidiary of a parent
7 entity that is publicly traded and that prepares audited
8 financial statements reflecting the consolidated operations of
9 the parent entity and the subsidiary may submit petition the
10 office to accept, in lieu of the audited financial statement
11 of the applicant, the audited financial statement of the
12 parent entity and a written guaranty by the parent entity that
13 the minimum capital requirements of the applicant required by
14 this part will be met by the parent entity.
15 (j) A description of the proposed method of marketing.
16 (k) A description of the subscriber complaint
17 procedures to be established and maintained.
18 (l) The fee for issuance of a license.
19 (m) Such other information as the commission or office
20 may reasonably require to make the determinations required by
21 this part.
22 Section 3. Subsection (1) of section 636.206, Florida
23 Statutes, is amended to read:
24 636.206 Examinations and investigations.--
25 (1) The office may examine or investigate the business
26 and affairs of any discount medical plan organization if the
27 commissioner has reason to believe that the discount medical
28 plan organization is not complying with the requirements of
29 this part. The office may order any discount medical plan
30 organization or applicant to produce any records, books,
31 files, advertising and solicitation materials, or other
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Florida Senate - 2006 SENATOR AMENDMENT
Bill No. CS for SB 2432
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1 information and may take statements under oath to determine
2 whether the discount medical plan organization or applicant is
3 in violation of the law or is acting contrary to the public
4 interest. The expenses incurred in conducting any examination
5 or investigation must be paid by the discount medical plan
6 organization or applicant. Examinations and investigations
7 must be conducted as provided in chapter 624.
8 Section 4. Subsection (1) of section 636.210, Florida
9 Statutes, is amended to read:
10 636.210 Prohibited activities of a discount medical
11 plan organization.--
12 (1) A discount medical plan organization may not:
13 (a) Use in its advertisements, marketing material,
14 brochures, and discount cards the term "insurance" except as
15 otherwise provided in this part or as a disclaimer of any
16 relationship between discount medical plan organization
17 benefits and insurance;
18 (b) Use in its advertisements, marketing material,
19 brochures, and discount cards the terms "health plan,"
20 "coverage," "copay," "copayments," "preexisting conditions,"
21 "guaranteed issue," "premium," "PPO," "preferred provider
22 organization," or other terms in a manner that could
23 reasonably mislead a person into believing the discount
24 medical plan was health insurance;
25 (c) Have restrictions on free access to plan
26 providers, except for hospital services, including, but not
27 limited to, waiting periods and notification periods; or
28 (d) Pay providers any fees for medical services.
29 Section 5. Subsection (1) of section 636.216, Florida
30 Statutes, is amended to read:
31 636.216 Charge or form filings.--
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Florida Senate - 2006 SENATOR AMENDMENT
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1 (1) All charges to members must be filed with the
2 office. and Any charge to members greater than $30 per month
3 or $360 per year for access to health care services other than
4 those provided by physicians licensed under chapter 458 or
5 chapter 459, or by hospitals licensed under chapter 395, must
6 be approved by the office before the charges can be used. Any
7 charge to members greater than $60 per month or $720 per year
8 for health care services that include services provided by
9 physicians licensed under chapter 458 or chapter 459, or by
10 hospitals licensed under chapter 395, must be approved by the
11 office before the charges may be used. The discount medical
12 plan organization has the burden of proof that the charges
13 bear a reasonable relation to the benefits received by the
14 member.
15 Section 6. Section 636.218, Florida Statutes, is
16 amended to read:
17 636.218 Annual reports.--
18 (1) Each discount medical plan organization must file
19 with the office, within 3 months after the end of each fiscal
20 year, an annual report.
21 (2) Such reports must be on forms prescribed by the
22 commission and must include:
23 (a) Audited financial statements prepared in
24 accordance with generally accepted accounting principles
25 certified by an independent certified public accountant,
26 including the organization's balance sheet, income statement,
27 and statement of changes in cash flow for the preceding year.
28 An organization that is a subsidiary of a parent entity that
29 is publicly traded and that prepares audited financial
30 statements reflecting the consolidated operations of the
31 parent entity and the organization may petition the office to
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Florida Senate - 2006 SENATOR AMENDMENT
Bill No. CS for SB 2432
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1 accept, in lieu of the audited financial statement of the
2 organization, the audited financial statement of the parent
3 entity and a written guaranty by the parent entity that the
4 minimum capital requirements of the organization required by
5 this part will be met by the parent entity.
6 (a)(b) If different from the initial application or
7 the last annual report, a list of the names and residence
8 addresses of all persons responsible for the conduct of the
9 organization's affairs, together with a disclosure of the
10 extent and nature of any contracts or arrangements between
11 such persons and the discount medical plan organization,
12 including any possible conflicts of interest.
13 (b)(c) The number of discount medical plan members in
14 the state.
15 (c)(d) Such other information relating to the
16 performance of the discount medical plan organization as is
17 reasonably required by the commission or office.
18 (3) Every discount medical plan organization which
19 fails to file an annual report in the form and within the time
20 required by this section shall forfeit up to $500 for each day
21 for the first 10 days during which the neglect continues and
22 shall forfeit up to $1,000 for each day after the first 10
23 days during which the neglect continues; and, upon notice by
24 the office to that effect, the organization's authority to
25 enroll new members or to do business in this state ceases
26 while such default continues. The office shall deposit all
27 sums collected by the office under this section to the credit
28 of the Insurance Regulatory Trust Fund. The office may not
29 collect more than $50,000 for each report.
30 Section 7. Section 636.220, Florida Statutes, is
31 amended to read:
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Florida Senate - 2006 SENATOR AMENDMENT
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1 636.220 Minimum capital requirements.--
2 (1) Each discount medical plan organization must at
3 all times maintain a net worth of at least $150,000 and shall
4 certify in writing and under oath at the time of licensure and
5 annually thereafter that the minimum capitalization
6 requirements of this part are satisfied.
7 (2) The office may not issue a license unless the
8 discount medical plan organization has a net worth of at least
9 $150,000.
10 Section 8. Section 636.230, Florida Statutes, is
11 amended to read:
12 636.230 Bundling discount medical plans with insurance
13 other products.--When a marketer or discount medical plan
14 organization sells a discount medical plan together with any
15 insurance other product, the fees for the discount medical
16 plan must be provided in writing to the member if the fees
17 exceed $30 per month for access to health care services other
18 than those provided by physicians licensed under chapter 458
19 or chapter 459, or by hospitals licensed under chapter 395, or
20 $60 per month for health care services that include services
21 provided by physicians licensed under chapter 458 or chapter
22 459, or by hospitals licensed under chapter 395.
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24 (Redesignate subsequent sections.)
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27 ================ T I T L E A M E N D M E N T ===============
28 And the title is amended as follows:
29 On page 1, line 8, after the semicolon,
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31 insert:
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Florida Senate - 2006 SENATOR AMENDMENT
Bill No. CS for SB 2432
Barcode 185716
1 amending s. 636.204, F.S.; providing that an
2 applicant for licensure as a discount medical
3 plan organization may submit an audited
4 financial statement of the parent entity in
5 lieu of the audited financial statement of the
6 applicant; amending s. 636.206, F.S.;
7 authorizing the Office of Insurance Regulation
8 to examine or investigate the business of a
9 discount medical plan organization under
10 certain circumstances; amending s. 636.210,
11 F.S.; providing an exception to the prohibited
12 restrictions on free access to plan providers
13 for hospital services; amending s. 636.216,
14 F.S.; revising the charges and filing
15 requirements for access to certain health care
16 services; amending s. 636.218, F.S.; deleting a
17 requirement that audited financial statements
18 be included in the annual report filed by a
19 discount medical plan organization; amending s.
20 636.220, F.S.; requiring a discount medical
21 plan organization to certify in writing and
22 under oath that certain requirements are
23 satisfied; amending s. 636.230, F.S.; requiring
24 the fees for a discount medical plan to be
25 provided in writing under certain
26 circumstances;
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