Amendment
Bill No. 0947

Amendment No. 538987

CHAMBER ACTION
Senate		House
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1	Representative Farkas offered the following:
2
3	Amendment (with title amendment)
4	Between lines 116 and 117, insert:
5	Section 6.  Section 627.94076, Florida Statutes, is created
6	to read:
7	627.94076  Time limit on certain defenses.--Notwithstanding
8	the provisions of s. 627.607, each long-term care insurance
9	policy shall provide that the policy shall be incontestable
10	after it has been in force during the lifetime of the insured
11	for a period of 2 years after its date of issue except for
12	nonpayment of premiums.
13	Section 7.  Section 627.9403, Florida Statutes, is amended
14	to read:
15	627.9403  Scope.--The provisions of this part shall apply
16	to long-term care insurance policies delivered or issued for
17	delivery in this state, and to policies delivered or issued for
18	delivery outside this state to the extent provided in s.
19	627.9406, by an insurer, a fraternal benefit society as defined
20	in s. 632.601, a health maintenance organization as defined in
21	s. 641.19, a prepaid health clinic as defined in s. 641.402, or
22	a multiple-employer welfare arrangement as defined in s.
23	624.437. A policy which is advertised, marketed, or offered as a
24	long-term care policy and as a Medicare supplement policy shall
25	meet the requirements of this part and the requirements of ss.
26	627.671-627.675 and, to the extent of a conflict, be subject to
27	the requirement that is more favorable to the policyholder or
28	certificateholder. The provisions of this part shall not apply
29	to a continuing care contract issued pursuant to chapter 651 and
30	shall not apply to guaranteed renewable policies issued prior to
31	October 1, 1988. Any limited benefit policy that limits coverage
32	to care in a nursing home or to one or more lower levels of care
33	required or authorized to be provided by this part or by
34	commission rule is a type of long-term care insurance policy
35	that must meet all requirements of this part that apply to long-
36	term care insurance policies, except ss. 627.9407(3)(c), (9),
37	(10)(f), and (12) and 627.94073(2). If the limited benefit
38	policy does not provide coverage for care in a nursing home, but
39	does provide coverage for one or more lower levels of care, the
40	policy shall also be exempt from the requirements of s.
41	627.9407(3)(d).
42	Section 8.  Subsections (1) and (7) of section 627.9404,
43	Florida Statutes, are amended to read:
44	627.9404  Definitions.--For the purposes of this part:
45	(1)  "Long-term care insurance policy" means any insurance
46	policy or rider advertised, marketed, offered, or designed to
47	provide coverage on an expense-incurred, indemnity, prepaid, or
48	other basis for one or more necessary or medically necessary
49	diagnostic, preventive, therapeutic, curing, treating,
50	mitigating, rehabilitative, maintenance, or personal care
51	services provided in a setting other than an acute care unit of
52	a hospital. Long-term care insurance shall not include any
53	insurance policy which is offered primarily to provide basic
54	Medicare supplement coverage, basic hospital expense coverage,
55	basic medical-surgical expense coverage, hospital confinement
56	indemnity coverage, major medical expense coverage, disability
57	income protection coverage, accident only coverage, specified
58	disease or specified accident coverage, or limited benefit
59	health insurance coverage not otherwise defined as long-term
60	care insurance.
61	(7)  "Limited benefit policy" means any long-term care
62	insurance policy that limits coverage to care in a nursing home
63	or to one or more lower levels of care required or authorized to
64	be provided by this part or by commission rule.
65	Section 9.  Subsections (3) and (7) of section 627.9407,
66	Florida Statutes, are amended to read:
67	627.9407  Disclosure, advertising, and performance
68	standards for long-term care insurance.--
69	(3)  RESTRICTIONS.--A long-term care insurance policy may
70	not:
71	(a)  Be canceled, nonrenewed, or otherwise terminated on
72	the grounds of the age or the deterioration of the mental or
73	physical health of the insured individual or certificateholder;
74	however, the office may authorize nonrenewal for an insurer on a
75	statewide basis on terms and conditions determined to be
76	necessary by the office to protect the interests of the
77	insureds, if the insurer demonstrates that renewal will
78	jeopardize the insurer's solvency or that substantial and
79	unexpected loss experience cannot reasonably be mitigated or
80	remedied.
81	(b)  Contain a provision establishing a new waiting period
82	in the event existing coverage is converted to or replaced by a
83	new or other form within the same insurer or any affiliated
84	insurer, except with respect to an increase in benefits
85	voluntarily selected by the insured individual or group
86	policyholder.
87	(c)  Restrict its coverage to care only in a nursing home
88	licensed pursuant to part II of chapter 400 or provide
89	significantly more coverage for such care than coverage for
90	lower levels of care. The commission shall adopt rules defining
91	what constitutes significantly more coverage in nursing homes
92	licensed pursuant to part II of chapter 400 than for lower
93	levels of care.
94	(d)  Provide coverage for less than 24 consecutive months
95	for nursing home care for each covered person.
96	(d)(e)  Contain an elimination period in excess of 180
97	days. As used in this paragraph, the term "elimination period"
98	means the number of days at the beginning of a period of
99	confinement for which no benefits are payable.
100	(7)  RATE STRUCTURE.--
101	(a)  A long-term care insurance policy may not be issued if
102	the premiums to be charged are calculated to increase based
103	solely on the age of the insured.
104	(b)  Any long-term care insurance policy or certificate
105	issued or renewed, at the option of the policyholder or
106	certificateholder, shall make available to the insured the
107	contingent benefit upon lapse as provided in the Long-Term Care
108	Insurance Model Regulation adopted by the National Association
109	of Insurance Commissioners in the second quarter of the year
110	2000.
111	(c)  Any premium increase for existing insureds shall not
112	result in a premium charged to the insureds that would exceed
113	the premium charged on a newly issued insurance policy, except
114	to reflect benefit differences. If the insurer is not currently
115	issuing new coverage, the new business rate shall be as
116	published by the office at the rate representing the new
117	business rate of insurers representing 80 percent of the
118	carriers currently issuing policies with similar coverage as
119	determined by the prior calendar year earned premium.
120	(d)  Compliance with the pooling provisions of s.
121	627.410(6)(e)3. shall be determined by pooling the experience of
122	all affiliated insurers.
123	Section 10.  Subsection (3) of section 641.2018, Florida
124	Statutes, is amended to read:
125	641.2018  Limited coverage for home health care
126	authorized.--
127	(3)  Any contract that limits coverage to home health care
128	benefits as provided in this section must also meet all of the
129	requirements of ss. 627.9403-627.9408 of the Long-Term Care
130	Insurance Act, except s. 627.9407(3)(c), (d), and (9).
131	Section 11.  This act shall apply to long-term care
132	insurance policies issued or renewed on or after July 1, 2006.
133	For any long-term care insurance policy issued prior to July 1,
134	2006, the provisions of section 6 shall apply to such policy
135	only upon renewal of such policy on or after July 1, 2008, and
136	the policy shall so provide by endorsement to the policy.
137
138	======= T I T L E  A M E N D M E N T =======
139	Remove line 38 and insert:
140	and Legislature; creating s. 627.94076, F.S.; requiring
141	long-term care insurance policies to provide
142	incontestability after a certain time period; providing an
143	exception; amending s. 627.9403, F.S.; specifying that
144	certain limited benefit policies are a type of long-term
145	care insurance policy; deleting an exemption from a
146	minimum time period coverage requirement for certain
147	limited benefit policies; amending s. 627.9404, F.S.;
148	revising definitions; amending s. 627.9407, F.S.; revising
149	certain restrictions on long-term care insurance policies;
150	providing additional rate structure requirements for long-
151	term care insurance policies; amending s. 641.2018, F.S.;
152	correcting a cross-reference; providing application;
153	providing an effective date.

CODING: Words stricken are deletions; words underlined are additions.