| 1 | A bill to be entitled |
| 2 | An act relating to access to health care; amending s. |
| 3 | 408.909, F.S.; clarifying licensure provisions for health |
| 4 | flex plans; revising criteria for eligibility for |
| 5 | enrollment in a health flex plan; creating s. 445.015, |
| 6 | F.S.; establishing a small business health insurance plan |
| 7 | grant program; providing purposes of the grant program; |
| 8 | providing conditions for use of grant funds; providing |
| 9 | duties of the Agency for Workforce Innovation and the |
| 10 | Office of Insurance Regulation; requiring a report to the |
| 11 | Governor and Legislature; providing an appropriation; |
| 12 | providing an effective date. |
| 13 |
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| 14 | Be It Enacted by the Legislature of the State of Florida: |
| 15 |
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| 16 | Section 1. Subsection (5) of section 408.909, Florida |
| 17 | Statutes, is amended, and paragraph (d) is added to subsection |
| 18 | (3) of that section, to read: |
| 19 | 408.909 Health flex plans.-- |
| 20 | (3) PROGRAM.--The agency and the office shall each approve |
| 21 | or disapprove health flex plans that provide health care |
| 22 | coverage for eligible participants. A health flex plan may limit |
| 23 | or exclude benefits otherwise required by law for insurers |
| 24 | offering coverage in this state, may cap the total amount of |
| 25 | claims paid per year per enrollee, may limit the number of |
| 26 | enrollees, or may take any combination of those actions. A |
| 27 | health flex plan offering may include the option of a |
| 28 | catastrophic plan supplementing the health flex plan. |
| 29 | (d) In order to expedite financial determinations and |
| 30 | immediately qualify a large base of eligible entities to offer |
| 31 | health flex plans, health insurers licensed under chapters 624 |
| 32 | and 627, fraternal benefit societies licensed under chapter 632, |
| 33 | prepaid limited health service organizations licensed under |
| 34 | chapter 636, health maintenance organizations licensed under |
| 35 | part I of chapter 641, prepaid health clinics licensed under |
| 36 | part II of chapter 641, and provider service networks authorized |
| 37 | under chapter 409 shall be deemed in compliance with the |
| 38 | financial requirements to offer a health flex plan. In addition, |
| 39 | any local government or health care district that has the |
| 40 | initial operating funds and taxing authority to fulfill its |
| 41 | obligations under the proposed health flex plan shall be deemed |
| 42 | in compliance with the financial requirements to offer a health |
| 43 | flex plan. |
| 44 | (5) ELIGIBILITY.--Eligibility to enroll in an approved |
| 45 | health flex plan is limited to residents of this state who: |
| 46 | (a) Are 64 years of age or younger; |
| 47 | (b) Have a family income equal to or less than 250 200 |
| 48 | percent of the federal poverty level; |
| 49 | (c) Are eligible under a federally approved Medicaid |
| 50 | demonstration waiver and reside in Palm Beach County or Miami- |
| 51 | Dade County; |
| 52 | (d) Are not covered by a private insurance policy and are |
| 53 | not eligible for coverage through a public health insurance |
| 54 | program, such as Medicare or Medicaid, unless specifically |
| 55 | authorized under paragraph (c), or another public health care |
| 56 | program, such as Kidcare, and have not been covered at any time |
| 57 | during the past 6 months; and |
| 58 | (d)(e) Have applied for health care coverage through an |
| 59 | approved health flex plan and have agreed to make any payments |
| 60 | required for participation, including periodic payments or |
| 61 | payments due at the time health care services are provided; and |
| 62 | (e) Are either: |
| 63 | 1. Not covered by a private insurance policy and not |
| 64 | eligible for coverage through a public health insurance program, |
| 65 | such as Medicare or Medicaid, unless specifically authorized |
| 66 | under paragraph (c), or another public health care program, such |
| 67 | as Kidcare, and have not been covered at any time during the |
| 68 | past 6 months; or |
| 69 | 2. Part of an employer group that is not covered by a |
| 70 | private health insurance policy and has not been covered at any |
| 71 | time during the past 6 months and in which at least 75 percent |
| 72 | of the employees have a family income equal to or less than 250 |
| 73 | percent of the federal poverty level. If the health flex plan |
| 74 | entity is a properly licensed health insurer, health plan, or |
| 75 | health maintenance organization, this subparagraph applies when |
| 76 | only 50 percent of the employees have a family income equal to |
| 77 | or less than 250 percent of the federal poverty level. |
| 78 | Section 2. Section 445.015, Florida Statutes, is created |
| 79 | to read: |
| 80 | 445.015 Small business health insurance plan grant |
| 81 | program.-- |
| 82 | (1) The agency shall establish a small business health |
| 83 | insurance plan grant program to award, administer, and monitor |
| 84 | grants to small employers and small businesses to develop and |
| 85 | offer cafeteria health plans that qualify under s. 125 of the |
| 86 | Internal Revenue Code and include options such as prepaid health |
| 87 | clinic services licensed under part II of chapter 641 for the |
| 88 | purpose of improving access to health insurance for uninsured |
| 89 | employees. The agency shall give priority to employer proposals |
| 90 | that would improve access for previously uninsured employees or |
| 91 | include long-term commitments to insure employees. Grant funds |
| 92 | shall not be used for ongoing maintenance of the plans or for |
| 93 | employer contributions. Health plans may identify and assist |
| 94 | eligible small employers and small businesses in obtaining |
| 95 | grants. The agency, in consultation with the Office of Insurance |
| 96 | Regulation, shall evaluate each project funded by a grant to |
| 97 | measure any increases in access to insurance and the long-term |
| 98 | viability of such increases. The agency shall design materials |
| 99 | and interactive programs to inform small employers and small |
| 100 | businesses about such cafeteria health plans and shall provide |
| 101 | training to assist small employers and small businesses in |
| 102 | developing such plans. Training shall include technical |
| 103 | assistance in establishing relationships with health plans and |
| 104 | individualized guidance on operational methods and |
| 105 | infrastructure that will best support and ensure the long-term |
| 106 | success of using these plans. |
| 107 | (2) The agency shall submit a report that documents the |
| 108 | specific activities undertaken during the fiscal year pursuant |
| 109 | to this section annually to the Governor, the President of the |
| 110 | Senate, and the Speaker of the House of Representatives no later |
| 111 | than February 1. |
| 112 | Section 3. The sum of $250,000 in nonrecurring revenue is |
| 113 | appropriated from the General Revenue Fund to the Agency for |
| 114 | Workforce Innovation for the 2007-2008 fiscal year to award |
| 115 | Small Business Health Insurance Plan Grants to eligible |
| 116 | businesses. |
| 117 | Section 4. This act shall take effect July 1, 2007. |