HB 1105

1	A bill to be entitled
2	An act relating to cystic fibrosis treatment; creating s.
3	627.6614, F.S.; requiring a group health insurance policy
4	to cover services needed to treat cystic fibrosis
5	authorized by a physician; amending s. 641.31, F.S.;
6	requiring a contract by a health maintenance organization
7	to cover services needed to treat cystic fibrosis as
8	authorized by a physician; amending s. 627.6515, F.S.,
9	relating to out-of-state groups; conforming a cross-
10	reference to changes made by the act; providing that the
11	act fulfills an important state interest; providing an
12	effective date.
13
14	WHEREAS, cystic fibrosis is a genetic disease that
15	adversely affects the respiratory system and the digestive
16	system, and
17	WHEREAS, only half of those suffering with cystic fibrosis
18	live to the age of 32, and
19	WHEREAS, the treatments for individuals with cystic
20	fibrosis include ingesting pancreatic enzymes or a wide
21	assortment of nutritional supplements, frequent postural
22	draining to clear the respiratory system, or using a feeding
23	tube to provide sustenance, and
24	WHEREAS, insurance companies oftentimes do not fully cover
25	the costs associated with treating cystic fibrosis, a fatal
26	disease, NOW, THEREFORE,
27
28	Be It Enacted by the Legislature of the State of Florida:
29
30	Section 1.  Section 627.6614, Florida Statutes, is created
31	to read:
32	627.6614  Cystic fibrosis treatment services.--A group
33	health insurance policy sold in this state must provide coverage
34	for all medically necessary chest physiotherapy provided by a
35	respiratory therapist licensed under part V of chapter 468, home
36	health care, equipment, supplies, and enteral formulas described
37	in s. 627.42395 which are used to treat cystic fibrosis if the
38	patient's treating physician or a physician authorized by the
39	insurer who specializes in the treatment of cystic fibrosis
40	certifies that such services are medically necessary. The
41	insurer may require the policyholder to be responsible for any
42	deductible or copayment that generally applies under the policy.
43	Section 2.  Present subsections (36), (37), (38), (39), and
44	(40) of section 641.31, Florida Statutes, are redesignated as
45	subsections (37), (38), (39), (40), and (41), respectively, and
46	a new subsection (36) is added to that section, to read:
47	641.31  Health maintenance contracts.--
48	(36)  A group health maintenance contract sold in this
49	state must provide coverage for all medically necessary chest
50	physiotherapy provided by a respiratory therapist licensed under
51	part V of chapter 468, home health care, equipment, supplies,
52	and enteral formulas described in s. 627.42395 which are used to
53	treat cystic fibrosis if the patient's treating physician or a
54	physician authorized by the health maintenance organization who
55	specializes in the treatment of cystic fibrosis certifies that
56	such services are medically necessary. The health maintenance
57	organization may require the subscriber to be responsible for
58	any deductible or copayment that generally applies under the
59	contract.
60	Section 3.  Subsection (2) of section 627.6515, Florida
61	Statutes, is amended to read:
62	627.6515  Out-of-state groups.--
63	(2)  Except as otherwise provided in this part, this part
64	does not apply to a group health insurance policy issued or
65	delivered outside this state under which a resident of this
66	state is provided coverage if:
67	(a)  The policy is issued to an employee group the
68	composition of which is substantially as described in s.
69	627.653; a labor union group or association group the
70	composition of which is substantially as described in s.
71	627.654; an additional group the composition of which is
72	substantially as described in s. 627.656; a group insured under
73	a blanket health policy when the composition of the group is
74	substantially in compliance with s. 627.659; a group insured
75	under a franchise health policy when the composition of the
76	group is substantially in compliance with s. 627.663; an
77	association group to cover persons associated in any other
78	common group, which common group is formed primarily for
79	purposes other than providing insurance; a group that is
80	established primarily for the purpose of providing group
81	insurance, provided the benefits are reasonable in relation to
82	the premiums charged thereunder and the issuance of the group
83	policy has resulted, or will result, in economies of
84	administration; or a group of insurance agents of an insurer,
85	which insurer is the policyholder;
86	(b)  Certificates evidencing coverage under the policy are
87	issued to residents of this state and contain in contrasting
88	color and not less than 10-point type the following statement:
89	"The benefits of the policy providing your coverage are governed
90	primarily by the law of a state other than Florida"; and
91	(c)  The policy provides the benefits specified in ss.
92	627.419, 627.6574, 627.6575, 627.6579, 627.6612, 627.66121,
93	627.66122, 627.6613, 627.6614, 627.667, 627.6675, 627.6691, and
94	627.66911.
95	(d)  Applications for certificates of coverage offered to
96	residents of this state must contain, in contrasting color and
97	not less than 12-point type, the following statement on the same
98	page as the applicant's signature:
99
100	"This policy is primarily governed by the laws of   insert state
101	where the master policy is if filed  . As a result, all of the
102	rating laws applicable to policies filed in this state do not
103	apply to this coverage, which may result in increases in your
104	premium at renewal that would not be permissible under a
105	Florida-approved policy. Any purchase of individual health
106	insurance should be considered carefully, as future medical
107	conditions may make it impossible to qualify for another
108	individual health policy. For information concerning individual
109	health coverage under a Florida-approved policy, consult your
110	agent or the Florida Department of Financial Services."
111
112	This paragraph applies only to group certificates providing
113	health insurance coverage which require individualized
114	underwriting to determine coverage eligibility for an individual
115	or premium rates to be charged to an individual except for the
116	following:
117	1.  Policies issued to provide coverage to groups of
118	persons all of whom are in the same or functionally related
119	licensed professions, and providing coverage only to such
120	licensed professionals, their employees, or their dependents;
121	2.  Policies providing coverage to small employers as
122	defined by s. 627.6699. Such policies shall be subject to, and
123	governed by, the provisions of s. 627.6699;
124	3.  Policies issued to a bona fide association, as defined
125	by s. 627.6571(5), provided that there is a person or board
126	acting as a fiduciary for the benefit of the members, and such
127	association is not owned, controlled by, or otherwise associated
128	with the insurance company; or
129	4.  Any accidental death, accidental death and
130	dismemberment, accident-only, vision-only, dental-only, hospital
131	indemnity-only, hospital accident-only, cancer, specified
132	disease, Medicare supplement, products that supplement Medicare,
133	long-term care, or disability income insurance, or similar
134	supplemental plans provided under a separate policy,
135	certificate, or contract of insurance, which cannot duplicate
136	coverage under an underlying health plan, coinsurance, or
137	deductibles or coverage issued as a supplement to workers'
138	compensation or similar insurance, or automobile medical-payment
139	insurance.
140	Section 4.  The Legislature finds that this act fulfills an
141	important state interest.
142	Section 5.  This act shall take effect October 1, 2007, and
143	applies to policies and contracts issued or renewed on or after
144	that date.

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