| 1 | Representative(s) Garcia offered the following: |
| 2 |
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| 3 | Amendment (with title amendment) |
| 4 | Between lines 116 and 117, insert: |
| 5 | Section 4. 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 5. 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 | act. The office may order any discount medical plan organization |
| 32 | or applicant to produce any records, books, files, advertising |
| 33 | and solicitation materials, or other information and may take |
| 34 | statements under oath to determine whether the discount medical |
| 35 | plan organization or applicant is in violation of the law or is |
| 36 | acting contrary to the public interest. The expenses incurred in |
| 37 | conducting any examination or investigation must be paid by the |
| 38 | discount medical plan organization or applicant. Examinations |
| 39 | and investigations must be conducted as provided in chapter 624. |
| 40 | Section 6. Subsection (1) of section 636.210, Florida |
| 41 | Statutes, is amended to read: |
| 42 | 636.210 Prohibited activities of a discount medical plan |
| 43 | organization.-- |
| 44 | (1) A discount medical plan organization may not: |
| 45 | (a) Use in its advertisements, marketing material, |
| 46 | brochures, and discount cards the term "insurance" except as |
| 47 | otherwise provided in this part or as a disclaimer of any |
| 48 | relationship between discount medical plan organization benefits |
| 49 | and insurance; |
| 50 | (b) Use in its advertisements, marketing material, |
| 51 | brochures, and discount cards the terms "health plan," |
| 52 | "coverage," "copay," "copayments," "preexisting conditions," |
| 53 | "guaranteed issue," "premium," "PPO," "preferred provider |
| 54 | organization," or other terms in a manner that could reasonably |
| 55 | mislead a person into believing the discount medical plan was |
| 56 | health insurance; |
| 57 | (c) Have restrictions on free access to plan providers, |
| 58 | except for hospital services, including, but not limited to, |
| 59 | waiting periods and notification periods; or |
| 60 | (d) Pay providers any fees for medical services. |
| 61 | Section 7. Subsections (1), (3), and (4) of section |
| 62 | 636.216, Florida Statutes, are amended to read: |
| 63 | 636.216 Charge or form filings.-- |
| 64 | (1) All charges to members must be filed with the office. |
| 65 | and Any charge to members greater than $30 per month or $360 per |
| 66 | year for access to healthcare services, other than those |
| 67 | provided by physicians licensed under chapter 458 or chapter 459 |
| 68 | or by hospitals licensed under chapter 395, must be approved by |
| 69 | the office before the charges can be used. Any charge to members |
| 70 | greater than $60 dollars per month or $720 per year for |
| 71 | healthcare services that include services provided by physicians |
| 72 | licensed under chapters 458 and 459 or by hospitals licensed |
| 73 | under chapter 395 must be approved by the office before the |
| 74 | charges can be used. The discount medical plan organization has |
| 75 | the burden of proof that the charges bear a reasonable relation |
| 76 | to the benefits received by the member. |
| 77 | (3) All forms used, including the written agreement |
| 78 | pursuant to subsection (2), must first be filed with and |
| 79 | approved by the office. Every form filed shall be identified by |
| 80 | a unique form number placed in the lower left corner of each |
| 81 | form. |
| 82 | (4) A charge or form is considered approved on the 60th |
| 83 | day after its date of filing unless it has been previously |
| 84 | disapproved by the office. The office shall disapprove any form |
| 85 | that does not meet the requirements of this part or that is |
| 86 | unreasonable, discriminatory, misleading, or unfair. If such |
| 87 | filing is filings are disapproved, the office shall notify the |
| 88 | discount medical plan organization and shall specify in the |
| 89 | notice the reasons for disapproval. |
| 90 | Section 8. Subsection (2) of section 636.218, Florida |
| 91 | Statutes, is amended to read: |
| 92 | 636.218 Annual reports.-- |
| 93 | (2) Such reports must be on forms prescribed by the |
| 94 | commission and must include: |
| 95 | (a) Audited financial statements prepared in accordance |
| 96 | with generally accepted accounting principles certified by an |
| 97 | independent certified public accountant, including the |
| 98 | organization's balance sheet, income statement, and statement of |
| 99 | changes in cash flow for the preceding year. An organization |
| 100 | that is a subsidiary of a parent entity that is publicly traded |
| 101 | and that prepares audited financial statements reflecting the |
| 102 | consolidated operations of the parent entity and the |
| 103 | organization may petition the office to accept, in lieu of the |
| 104 | audited financial statement of the organization, the audited |
| 105 | financial statement of the parent entity and a written guaranty |
| 106 | by the parent entity that the minimum capital requirements of |
| 107 | the organization required by this part will be met by the parent |
| 108 | entity. |
| 109 | (a)(b) If different from the initial application or the |
| 110 | last annual report, a list of the names and residence addresses |
| 111 | of all persons responsible for the conduct of the organization's |
| 112 | affairs, together with a disclosure of the extent and nature of |
| 113 | any contracts or arrangements between such persons and the |
| 114 | discount medical plan organization, including any possible |
| 115 | conflicts of interest. |
| 116 | (b)(c) The number of discount medical plan members in the |
| 117 | state. |
| 118 | (c)(d) Such other information relating to the performance |
| 119 | of the discount medical plan organization as is reasonably |
| 120 | required by the commission or office. |
| 121 | Section 9. Subsection (1) of section 636.220, Florida |
| 122 | Statutes, is amended to read: |
| 123 | 636.220 Minimum capital requirements.-- |
| 124 | (1) Each discount medical plan organization must at all |
| 125 | times maintain a net worth of at least $150,000 and each |
| 126 | discount medical plan organization shall certify in writing |
| 127 | under oath at licensure and annually that the minimum |
| 128 | capitalization requirements of this part are satisfied. |
| 129 | Section 10. Section 636.232, Florida Statutes, is amended |
| 130 | to read: |
| 131 | 636.232 Rules.--The commission may adopt rules to |
| 132 | administer this part, including rules for the licensing of |
| 133 | discount medical plan organizations; establishing standards for |
| 134 | evaluating forms, advertisements, marketing materials, |
| 135 | brochures, and discount cards; providing for the collection of |
| 136 | data; relating to disclosures to plan members; and defining |
| 137 | terms used in this part. |
| 138 | Section 11. Section 636.230, Florida Statutes, is |
| 139 | repealed. |
| 140 |
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| 141 | ======= T I T L E A M E N D M E N T ======= |
| 142 | Remove line(s) 15 and insert: |
| 143 | under group health insurance policies; amending s. 636.204, |
| 144 | F.S.; revising a license application provision for discount |
| 145 | medical plan organizations; amending s. 636.206, F.S.; revising |
| 146 | examination and investigative authority; amending s. 636.210, |
| 147 | F.S.; providing an exception to prohibited activities; amending |
| 148 | s. 636.216, F.S.; providing exception to review of certain |
| 149 | charges to members of the plan; amending s. 636.218, F.S.; |
| 150 | removing certain information from the annual report; amending s. |
| 151 | 636.220, F.S.; revising certain minimum capital requirements of |
| 152 | discount medical plan organizations; amending s. 636.232, F.S.; |
| 153 | revising commission rulemaking authority; repealing s. 636.230, |
| 154 | F.S., relating to the bundling of discount medical plans with |
| 155 | other products; amending s. 641.31, |