Florida Senate - 2006 COMMITTEE AMENDMENT
Bill No. SB 482
Barcode 412394
CHAMBER ACTION
Senate House
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11 The Committee on Banking and Insurance (Campbell) recommended
12 the following amendment:
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14 Senate Amendment (with title amendment)
15 Delete everything after the enacting clause
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17 and insert:
18 Section 1. Section 627.64194, Florida Statutes, is
19 created to read:
20 627.64194 Services for the treatment of congenital
21 craniofacial anomalies.--A health insurance policy sold in
22 this state must provide coverage for all medically appropriate
23 and necessary equipment, supplies, supplements, and patient
24 self-management training and educational services used to
25 treat a congenital craniofacial anomaly if the patient's
26 treating physician or a physician who specializes in the
27 treatment of craniofacial anomalies certifies that such
28 services are necessary.
29 Section 2. Section 627.6614, Florida Statutes, is
30 created to read:
31 627.6614 Services for the treatment of congenital
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Florida Senate - 2006 COMMITTEE AMENDMENT
Bill No. SB 482
Barcode 412394
1 craniofacial anomalies.--A group health insurance policy sold
2 in this state must provide coverage for all medically
3 appropriate and necessary equipment, supplies, supplements,
4 and patient self-management training and educational services
5 used to treat a congenital craniofacial anomaly if the
6 patient's treating physician or a physician who specializes in
7 the treatment of craniofacial anomalies certifies that such
8 services are necessary.
9 Section 3. Present subsections (36), (37), (38), (39),
10 and (40) of section 641.31, Florida Statutes, are redesignated
11 as subsections (37), (38), (39), (40), and (41), respectively,
12 and a new subsection (36) is added to that section to read:
13 641.31 Health maintenance contracts.--
14 (36) A health maintenance contract sold in this state
15 must provide coverage for all medically appropriate and
16 necessary equipment, supplies, supplements, and patient
17 self-management training and educational services used to
18 treat a congenital craniofacial anomaly if the patient's
19 treating physician or a physician who specializes in the
20 treatment of craniofacial anomalies certifies that such
21 services are necessary.
22 Section 4. Subsection (2) of section 627.6515, Florida
23 Statutes, is amended to read:
24 627.6515 Out-of-state groups.--
25 (2) Except as otherwise provided in this part, this
26 part does not apply to a group health insurance policy issued
27 or delivered outside this state under which a resident of this
28 state is provided coverage if:
29 (a) The policy is issued to an employee group the
30 composition of which is substantially as described in s.
31 627.653; a labor union group or association group the
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Florida Senate - 2006 COMMITTEE AMENDMENT
Bill No. SB 482
Barcode 412394
1 composition of which is substantially as described in s.
2 627.654; an additional group the composition of which is
3 substantially as described in s. 627.656; a group insured
4 under a blanket health policy when the composition of the
5 group is substantially in compliance with s. 627.659; a group
6 insured under a franchise health policy when the composition
7 of the group is substantially in compliance with s. 627.663;
8 an association group to cover persons associated in any other
9 common group, which common group is formed primarily for
10 purposes other than providing insurance; a group that is
11 established primarily for the purpose of providing group
12 insurance, provided the benefits are reasonable in relation to
13 the premiums charged thereunder and the issuance of the group
14 policy has resulted, or will result, in economies of
15 administration; or a group of insurance agents of an insurer,
16 which insurer is the policyholder;
17 (b) Certificates evidencing coverage under the policy
18 are issued to residents of this state and contain in
19 contrasting color and not less than 10-point type the
20 following statement: "The benefits of the policy providing
21 your coverage are governed primarily by the law of a state
22 other than Florida"; and
23 (c) The policy provides the benefits specified in ss.
24 627.419, 627.6574, 627.6575, 627.6579, 627.6612, 627.66121,
25 627.66122, 627.6613, 627.6614, 627.667, 627.6675, 627.6691,
26 and 627.66911.
27 (d) Applications for certificates of coverage offered
28 to residents of this state must contain, in contrasting color
29 and not less than 12-point type, the following statement on
30 the same page as the applicant's signature:
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Florida Senate - 2006 COMMITTEE AMENDMENT
Bill No. SB 482
Barcode 412394
1 "This policy is primarily governed by the laws
2 of ...insert state where the master policy if
3 filed.... As a result, all of the rating laws
4 applicable to policies filed in this state do
5 not apply to this coverage, which may result in
6 increases in your premium at renewal that would
7 not be permissible under a Florida-approved
8 policy. Any purchase of individual health
9 insurance should be considered carefully, as
10 future medical conditions may make it
11 impossible to qualify for another individual
12 health policy. For information concerning
13 individual health coverage under a
14 Florida-approved policy, consult your agent or
15 the Florida Department of Financial Services."
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17 This paragraph applies only to group certificates providing
18 health insurance coverage which require individualized
19 underwriting to determine coverage eligibility for an
20 individual or premium rates to be charged to an individual
21 except for the following:
22 1. Policies issued to provide coverage to groups of
23 persons all of whom are in the same or functionally related
24 licensed professions, and providing coverage only to such
25 licensed professionals, their employees, or their dependents;
26 2. Policies providing coverage to small employers as
27 defined by s. 627.6699. Such policies shall be subject to, and
28 governed by, the provisions of s. 627.6699;
29 3. Policies issued to a bona fide association, as
30 defined by s. 627.6571(5), provided that there is a person or
31 board acting as a fiduciary for the benefit of the members,
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Florida Senate - 2006 COMMITTEE AMENDMENT
Bill No. SB 482
Barcode 412394
1 and such association is not owned, controlled by, or otherwise
2 associated with the insurance company; or
3 4. Any accidental death, accidental death and
4 dismemberment, accident-only, vision-only, dental-only,
5 hospital indemnity-only, hospital accident-only, cancer,
6 specified disease, Medicare supplement, products that
7 supplement Medicare, long-term care, or disability income
8 insurance, or similar supplemental plans provided under a
9 separate policy, certificate, or contract of insurance, which
10 cannot duplicate coverage under an underlying health plan,
11 coinsurance, or deductibles or coverage issued as a supplement
12 to workers' compensation or similar insurance, or automobile
13 medical-payment insurance.
14 Section 5. This act shall take effect October 1, 2006.
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17 ================ T I T L E A M E N D M E N T ===============
18 And the title is amended as follows:
19 Delete everything before the enacting clause
20
21 and insert:
22 A bill to be entitled
23 An act relating to the treatment of congenital
24 craniofacial anomalies; creating ss. 627.64194
25 and 627.6614, F.S.; requiring an individual
26 health insurance policy or a group health
27 insurance policy to cover services needed to
28 treat congenital craniofacial anomalies as
29 authorized by a physician; amending s. 641.31,
30 F.S.; requiring a contract by a health
31 maintenance organization to cover services
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Florida Senate - 2006 COMMITTEE AMENDMENT
Bill No. SB 482
Barcode 412394
1 needed to treat congenital craniofacial
2 anomalies as authorized by a physician;
3 amending s. 627.6515, F.S., relating to
4 out-of-state groups; conforming a
5 cross-reference to changes made by the act;
6 providing an effective date.
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8 WHEREAS, craniofacial anomalies are a group of
9 deformities involving the growth of the head and facial bones,
10 and these anomalies are present at birth and vary in type and
11 severity, and
12 WHEREAS, experts agree that many factors contribute to
13 the development of craniofacial anomalies, some craniofacial
14 anomalies are a result of genetic mutations, and other
15 craniofacial anomalies may be a result of environmental
16 factors that scientists do not completely understand, and
17 WHEREAS, the most common types of craniofacial
18 anomalies include, but are not limited to, cleft lip, cleft
19 palate, craniosynostosis, hemifacial microsomia, vascular
20 malformation, hemangioma, and deformational or positional
21 plagiocephaly, and
22 WHEREAS, insurance companies often do not fully cover
23 the costs associated with treating congenital craniofacial
24 anomalies, NOW, THEREFORE,
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