| 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. Subsection (2) of section 636.204, Florida |
| 6 | 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 | (a) A copy of the applicant's articles of incorporation or |
| 14 | other organizing documents, including all amendments. |
| 15 | (b) A copy of the applicant's bylaws. |
| 16 | (c) A list of the names, addresses, official positions, |
| 17 | and biographical information of the individuals who are |
| 18 | responsible for conducting the applicant's affairs, including, |
| 19 | but not limited to, all members of the board of directors, board |
| 20 | of trustees, executive committee, or other governing board or |
| 21 | committee, the officers, contracted management company |
| 22 | personnel, and any person or entity owning or having the right |
| 23 | to acquire 10 percent or more of the voting securities of the |
| 24 | applicant. Such listing must fully disclose the extent and |
| 25 | nature of any contracts or arrangements between any individual |
| 26 | who is responsible for conducting the applicant's affairs and |
| 27 | the discount medical plan organization, including any possible |
| 28 | conflicts of interest. |
| 29 | (d) A complete biographical statement, on forms prescribed |
| 30 | by the commission, an independent investigation report, and a |
| 31 | set of fingerprints, as provided in chapter 624, with respect to |
| 32 | each individual identified under paragraph (c). |
| 33 | (e) A statement generally describing the applicant, its |
| 34 | facilities and personnel, and the medical services to be |
| 35 | offered. |
| 36 | (f) A copy of the form of all contracts made or to be made |
| 37 | between the applicant and any providers or provider networks |
| 38 | regarding the provision of medical services to members. |
| 39 | (g) A copy of the form of any contract made or arrangement |
| 40 | to be made between the applicant and any person listed in |
| 41 | paragraph (c). |
| 42 | (h) A copy of the form of any contract made or to be made |
| 43 | between the applicant and any person, corporation, partnership, |
| 44 | or other entity for the performance on the applicant's behalf of |
| 45 | any function, including, but not limited to, marketing, |
| 46 | administration, enrollment, investment management, and |
| 47 | subcontracting for the provision of health services to members. |
| 48 | (i) A copy of the applicant's most recent financial |
| 49 | statements audited by an independent certified public |
| 50 | accountant. An applicant that is a subsidiary of a parent entity |
| 51 | that is publicly traded and that prepares audited financial |
| 52 | statements reflecting the consolidated operations of the parent |
| 53 | entity and the subsidiary may petition the office to accept, in |
| 54 | lieu of the audited financial statement of the applicant, the |
| 55 | audited financial statement of the parent entity and a written |
| 56 | guaranty by the parent entity that the minimum capital |
| 57 | requirements of the applicant required by this part will be met |
| 58 | by the parent entity. |
| 59 | (i)(j) A description of the proposed method of marketing. |
| 60 | (j)(k) A description of the subscriber complaint |
| 61 | procedures to be established and maintained. |
| 62 | (k)(l) The fee for issuance of a license. |
| 63 | (l)(m) Such other information as the commission or office |
| 64 | may reasonably require to make the determinations required by |
| 65 | this part. |
| 66 | Section 5. Subsection (1) of section 636.206, Florida |
| 67 | Statutes, is amended to read: |
| 68 | 636.206 Examinations and investigations.-- |
| 69 | (1) The office may examine or investigate the business and |
| 70 | affairs of any discount medical plan organization if the |
| 71 | commissioner has reason to believe that the discount medical |
| 72 | plan organization is not complying with the requirements of this |
| 73 | act. The office may order any discount medical plan organization |
| 74 | or applicant to produce any records, books, files, advertising |
| 75 | and solicitation materials, or other information and may take |
| 76 | statements under oath to determine whether the discount medical |
| 77 | plan organization or applicant is in violation of the law or is |
| 78 | acting contrary to the public interest. The expenses incurred in |
| 79 | conducting any examination or investigation must be paid by the |
| 80 | discount medical plan organization or applicant. Examinations |
| 81 | and investigations must be conducted as provided in chapter 624. |
| 82 | Section 6. Subsection (1) of section 636.210, Florida |
| 83 | Statutes, is amended to read: |
| 84 | 636.210 Prohibited activities of a discount medical plan |
| 85 | organization.-- |
| 86 | (1) A discount medical plan organization may not: |
| 87 | (a) Use in its advertisements, marketing material, |
| 88 | brochures, and discount cards the term "insurance" except as |
| 89 | otherwise provided in this part or as a disclaimer of any |
| 90 | relationship between discount medical plan organization benefits |
| 91 | and insurance; |
| 92 | (b) Use in its advertisements, marketing material, |
| 93 | brochures, and discount cards the terms "health plan," |
| 94 | "coverage," "copay," "copayments," "preexisting conditions," |
| 95 | "guaranteed issue," "premium," "PPO," "preferred provider |
| 96 | organization," or other terms in a manner that could reasonably |
| 97 | mislead a person into believing the discount medical plan was |
| 98 | health insurance; |
| 99 | (c) Have restrictions on free access to plan providers, |
| 100 | except for hospital services, including, but not limited to, |
| 101 | waiting periods and notification periods; or |
| 102 | (d) Pay providers any fees for medical services. |
| 103 | Section 7. Subsections (1), (3), and (4) of section |
| 104 | 636.216, Florida Statutes, are amended to read: |
| 105 | 636.216 Charge or form filings.-- |
| 106 | (1) All charges to members must be filed with the office. |
| 107 | and Any charge to members greater than $30 per month or $360 per |
| 108 | year for access to healthcare services, other than those |
| 109 | provided by physicians licensed under chapters 458 and 459 or by |
| 110 | hospitals licensed under chapter 395, must be approved by the |
| 111 | office before the charges can be used. Any charge to members |
| 112 | greater than $60 dollars per month or $720 per year for |
| 113 | healthcare services that include services provided by physicians |
| 114 | licensed under chapter 458 and 459 or by hospitals licensed |
| 115 | under chapter 395 must be approved by the office before the |
| 116 | charges can be used. The discount medical plan organization has |
| 117 | the burden of proof that the charges bear a reasonable relation |
| 118 | to the benefits received by the member. |
| 119 | (3) All forms used, including the written agreement |
| 120 | pursuant to subsection (2), must first be filed with and |
| 121 | approved by the office. Every form filed shall be identified by |
| 122 | a unique form number placed in the lower left corner of each |
| 123 | form. |
| 124 | (4) A charge or form is considered approved on the 60th |
| 125 | day after its date of filing unless it has been previously |
| 126 | disapproved by the office. The office shall disapprove any form |
| 127 | that does not meet the requirements of this part or that is |
| 128 | unreasonable, discriminatory, misleading, or unfair. If such |
| 129 | filing is filings are disapproved, the office shall notify the |
| 130 | discount medical plan organization and shall specify in the |
| 131 | notice the reasons for disapproval. |
| 132 | Section 8. Subsection (2) of section 636.218, Florida |
| 133 | Statutes, is amended to read: |
| 134 | 636.218 Annual reports.-- |
| 135 | (2) Such reports must be on forms prescribed by the |
| 136 | commission and must include: |
| 137 | (a) Audited financial statements prepared in accordance |
| 138 | with generally accepted accounting principles certified by an |
| 139 | independent certified public accountant, including the |
| 140 | organization's balance sheet, income statement, and statement of |
| 141 | changes in cash flow for the preceding year. An organization |
| 142 | that is a subsidiary of a parent entity that is publicly traded |
| 143 | and that prepares audited financial statements reflecting the |
| 144 | consolidated operations of the parent entity and the |
| 145 | organization may petition the office to accept, in lieu of the |
| 146 | audited financial statement of the organization, the audited |
| 147 | financial statement of the parent entity and a written guaranty |
| 148 | by the parent entity that the minimum capital requirements of |
| 149 | the organization required by this part will be met by the parent |
| 150 | entity. |
| 151 | (a)(b) If different from the initial application or the |
| 152 | last annual report, a list of the names and residence addresses |
| 153 | of all persons responsible for the conduct of the organization's |
| 154 | affairs, together with a disclosure of the extent and nature of |
| 155 | any contracts or arrangements between such persons and the |
| 156 | discount medical plan organization, including any possible |
| 157 | conflicts of interest. |
| 158 | (b)(c) The number of discount medical plan members in the |
| 159 | state. |
| 160 | (c)(d) Such other information relating to the performance |
| 161 | of the discount medical plan organization as is reasonably |
| 162 | required by the commission or office. |
| 163 | Section 9. Subsection (1) of section 636.220, Florida |
| 164 | Statutes, is amended to read: |
| 165 | 636.220 Minimum capital requirements.-- |
| 166 | (1) Each discount medical plan organization must at all |
| 167 | times maintain a net worth of at least $150,000 and each |
| 168 | discount medical plan organization shall certify in writing |
| 169 | under oath at licensure and annually that the minimum |
| 170 | capitalization requirements of this part are satisfied. |
| 171 | Section 10. Section 636.230, Florida Statutes, is |
| 172 | repealed. |
| 173 |
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| 174 | ======= T I T L E A M E N D M E N T ======= |
| 175 | Remove line(s) 15 and insert: |
| 176 | under group health insurance policies; amending s. 636.204, |
| 177 | F.S.; revising license application provisions for discount |
| 178 | medical plan organizations; amending s. 636.206, F.S.; revising |
| 179 | examination and investigative authority; amending s. 636.210, |
| 180 | F.S.; providing an exception to prohibited activities; amending |
| 181 | s. 636.216, F.S.; providing exception to review of certain |
| 182 | charges to members of the plan; amending s. 636.218, F.S.; |
| 183 | removing certain information from the annual report; amending s. |
| 184 | 636.220, F.S.; revising certain minimum capital requirements of |
| 185 | discount medical plan organizations; repealing s. 636.230, F.S., |
| 186 | relating to the bundling of discount medical plans with other |
| 187 | products; amending s. 641.31, |