CS/HB 177

1	A bill to be entitled
2	An act relating to health insurance; amending s. 627.4236,
3	F.S.; revising the definition of the term "bone marrow
4	transplant"; amending ss. 627.642, 627.657, and 641.31,
5	F.S.; requiring an identification card containing
6	specified information to be given to insureds under health
7	benefit plans and group health insurance policies and
8	persons having health care services through health
9	maintenance contracts; creating s. 627.4108, F.S.;
10	authorizing life or health insurers or health maintenance
11	organizations to offer to groups a credit reflecting
12	demonstrable administrative savings resulting from
13	efficiencies under specified conditions; providing
14	applicability; authorizing the Financial Services
15	Commission to establish certain rules; amending s.
16	408.909, F.S.; clarifying licensure provisions for health
17	flex plans; revising criteria for eligibility for
18	enrollment in a health flex plan; creating s. 445.015,
19	F.S.; establishing a small business health insurance plan
20	grant program; providing purposes of the grant program;
21	providing conditions for use of grant funds; providing
22	duties of the Agency for Workforce Innovation and the
23	Office of Insurance Regulation; requiring a report to the
24	Governor and Legislature; providing an appropriation;
25	providing applicability; providing effective dates.
26
27	Be It Enacted by the Legislature of the State of Florida:
28
29	Section 1.  Subsection (1) of section 627.4236, Florida
30	Statutes, is amended to read:
31	627.4236  Coverage for bone marrow transplant procedures.--
32	(1)  As used in this section, the term "bone marrow
33	transplant" means human blood precursor cells administered to a
34	patient to restore normal hematological and immunological
35	functions following ablative or nonablative therapy with
36	curative or life-prolonging intent. Human blood precursor cells
37	may be obtained from the patient in an autologous transplant or
38	from a medically acceptable related or unrelated donor, and may
39	be derived from bone marrow, circulating blood, or a combination
40	of bone marrow and circulating blood. If chemotherapy is an
41	integral part of the treatment involving bone marrow
42	transplantation, the term "bone marrow transplant" includes both
43	the transplantation and the chemotherapy.
44	Section 2.  Subsection (3) is added to section 627.642,
45	Florida Statutes, to read:
46	627.642  Outline of coverage.--
47	(3)  In addition to the outline of coverage, a policy as
48	specified in s. 627.6699(3)(k) must be accompanied by an
49	identification card that contains, at a minimum:
50	(a)  The name of the organization issuing the policy or the
51	name of the organization administering the policy, whichever
52	applies.
53	(b)  The name of the contract holder.
54	(c)  The type of plan only if the plan is filed in the
55	state, an indication that the plan is self-funded, or the name
56	of the network.
57	(d)  The member identification number, contract number, and
58	policy or group number, if applicable.
59	(e)  A contact phone number or electronic address for
60	authorizations.
61	(f)  A phone number or electronic address whereby the
62	covered person or hospital, physician, or other person rendering
63	services covered by the policy may determine if the plan is
64	insured and may obtain a benefits verification in order to
65	estimate patient financial responsibility, in compliance with
66	privacy rules under the Health Insurance Portability and
67	Accountability Act.
68	(g)  The national plan identifier, in accordance with the
69	compliance date set forth by the federal Department of Health
70	and Human Services.
71
72	The identification card must present the information in a
73	readily identifiable manner or, alternatively, the information
74	may be embedded on the card and available through magnetic
75	stripe or smart card. The information may also be provided
76	through other electronic technology.
77	Section 3.  Present subsection (2) of section 627.657,
78	Florida Statutes, is renumbered as subsection (3), and a new
79	subsection (2) is added to that section to read:
80	627.657  Provisions of group health insurance policies.--
81	(2)  The medical policy as specified in s. 627.6699(3)(k)
82	must be accompanied by an identification card that contains, at
83	a minimum:
84	(a)  The name of the organization issuing the policy or
85	name of the organization administering the policy, whichever
86	applies.
87	(b)  The name of the certificateholder.
88	(c)  The type of plan only if the plan is filed in the
89	state, an indication that the plan is self-funded, or the name
90	of the network.
91	(d)  The member identification number, contract number, and
92	policy or group number, if applicable.
93	(e)  A contact phone number or electronic address for
94	authorizations.
95	(f)  A phone number or electronic address whereby the
96	covered person or hospital, physician, or other person rendering
97	services covered by the policy may determine if the plan is
98	insured and may obtain a benefits verification in order to
99	estimate patient financial responsibility, in compliance with
100	privacy rules under the Health Insurance Portability and
101	Accountability Act.
102	(g)  The national plan identifier, in accordance with the
103	compliance date set forth by the federal Department of Health
104	and Human Services.
105
106	The identification card must present the information in a
107	readily identifiable manner or, alternatively, the information
108	may be embedded on the card and available through magnetic
109	stripe or smart card. The information may also be provided
110	through other electronic technology.
111	Section 4.  Subsection (41) is added to section 641.31,
112	Florida Statutes, to read:
113	641.31  Health maintenance contracts.--
114	(41)  The contract, certificate, or member handbook must be
115	accompanied by an identification card that contains, at a
116	minimum:
117	(a)  The name of the organization offering the contract or
118	name of the organization administering the contract, whichever
119	applies.
120	(b)  The name of the subscriber.
121	(c)  A statement that the health plan is a health
122	maintenance organization. Only a health plan with a certificate
123	of authority issued under this chapter may be identified as a
124	health maintenance organization.
125	(d)  The member identification number, contract number, and
126	group number, if applicable.
127	(e)  A contact phone number or electronic address for
128	authorizations.
129	(f)  A phone number or electronic address whereby the
130	covered person or hospital, physician, or other person rendering
131	services covered by the contract may determine if the plan is
132	insured and may obtain a benefits verification in order to
133	estimate patient financial responsibility, in compliance with
134	privacy rules under the Health Insurance Portability and
135	Accountability Act.
136	(g)  The national plan identifier, in accordance with the
137	compliance date set forth by the federal Department of Health
138	and Human Services.
139
140	The identification card must present the information in a
141	readily identifiable manner or, alternatively, the information
142	may be embedded on the card and available through magnetic
143	stripe or smart card. The information may also be provided
144	through other electronic technology.
145	Section 5.  Effective July 1, 2007, section 627.4108,
146	Florida Statutes, is created to read:
147	627.4108  Credit for administrative efficiencies.--A life
148	or health insurer or health maintenance organization may offer
149	to groups a credit reflecting demonstrable administrative
150	savings resulting from efficiencies that occur when two or more
151	life or health insurance products, or a health maintenance
152	organization contract and one or more life or health insurance
153	products, are purchased from the insurer or its affiliated
154	companies or health maintenance organization. The insurer or
155	health maintenance organization shall be required to demonstrate
156	to the office that the proposed credit is reasonable, does not
157	exceed the administrative savings, and is offered in a
158	nondiscriminatory manner. Such demonstration may be submitted
159	for approval separate from any premium rate filing. In no event
160	shall such credit, resulting in reduction of revenue, be
161	reflected in the experience used in rate filings. The commission
162	may establish by rule procedures to be used in ascertaining the
163	appropriate amount and reasonableness of the credit in relation
164	to the administrative savings and to ensure that it is offered
165	in a nondiscriminatory manner.
166	Section 6.  Effective July 1, 2007, subsection (5) of
167	section 408.909, Florida Statutes, is amended, and paragraph (d)
168	is added to subsection (3) of that section, to read:
169	408.909  Health flex plans.--
170	(3)  PROGRAM.--The agency and the office shall each approve
171	or disapprove health flex plans that provide health care
172	coverage for eligible participants. A health flex plan may limit
173	or exclude benefits otherwise required by law for insurers
174	offering coverage in this state, may cap the total amount of
175	claims paid per year per enrollee, may limit the number of
176	enrollees, or may take any combination of those actions. A
177	health flex plan offering may include the option of a
178	catastrophic plan supplementing the health flex plan.
179	(d)  In order to expedite financial determinations and
180	immediately qualify a large base of eligible entities to offer
181	health flex plans, health insurers licensed under chapters 624
182	and 627, fraternal benefit societies licensed under chapter 632,
183	prepaid limited health service organizations licensed under
184	chapter 636, health maintenance organizations licensed under
185	part I of chapter 641, prepaid health clinics licensed under
186	part II of chapter 641, and hospital-owned provider service
187	networks authorized under chapter 409 shall be deemed in
188	compliance with the financial requirements to offer a health
189	flex plan. In addition, any local government or health care
190	district that has the initial operating funds and taxing
191	authority to fulfill its obligations under the proposed health
192	flex plan shall be deemed in compliance with the financial
193	requirements to offer a health flex plan.
194	(5)  ELIGIBILITY.--Eligibility to enroll in an approved
195	health flex plan is limited to residents of this state who:
196	(a)  Are 64 years of age or younger;
197	(b)  Have a family income equal to or less than 250 200
198	percent of the federal poverty level;
199	(c)  Are eligible under a federally approved Medicaid
200	demonstration waiver and reside in Palm Beach County or Miami-
201	Dade County;
202	(d)  Are not covered by a private insurance policy and are
203	not eligible for coverage through a public health insurance
204	program, such as Medicare or Medicaid, unless specifically
205	authorized under paragraph (c), or another public health care
206	program, such as Kidcare, and have not been covered at any time
207	during the past 6 months; and
208	(d)(e)  Have applied for health care coverage through an
209	approved health flex plan and have agreed to make any payments
210	required for participation, including periodic payments or
211	payments due at the time health care services are provided; and
212	(e)  Are either:
213	1.  Not covered by a private insurance policy and not
214	eligible for coverage through a public health insurance program,
215	such as Medicare or Medicaid, unless specifically authorized
216	under paragraph (c), or another public health care program, such
217	as Kidcare, and have not been covered at any time during the
218	past 6 months; or
219	2.  Part of an employer group that is not covered by a
220	private health insurance policy and has not been covered at any
221	time during the past 6 months and in which at least 75 percent
222	of the employees have a family income equal to or less than 250
223	percent of the federal poverty level. If the health flex plan
224	entity is a properly licensed health insurer, health plan, or
225	health maintenance organization, this subparagraph applies when
226	only 50 percent of the employees have a family income equal to
227	or less than 250 percent of the federal poverty level.
228	Section 7.  Effective July 1, 2007, section 445.015,
229	Florida Statutes, is created to read:
230	445.015  Small business health insurance plan grant
231	program.--
232	(1)  The agency shall establish a small business health
233	insurance plan grant program to award, administer, and monitor
234	grants to small employers and small businesses to develop and
235	offer cafeteria health plans that qualify under s. 125 of the
236	Internal Revenue Code and include options such as prepaid health
237	clinic services licensed under part II of chapter 641 for the
238	purpose of improving access to health insurance for uninsured
239	employees. The agency shall give priority to employer proposals
240	that would improve access for previously uninsured employees or
241	include long-term commitments to insure employees. Grant funds
242	shall not be used for ongoing maintenance of the plans or for
243	employer contributions. Health plans may identify and assist
244	eligible small employers and small businesses in obtaining
245	grants. The agency, in consultation with the Office of Insurance
246	Regulation, shall evaluate each project funded by a grant to
247	measure any increases in access to insurance and the long-term
248	viability of such increases. The agency shall design materials
249	and interactive programs to inform small employers and small
250	businesses about such cafeteria health plans and shall provide
251	training to assist small employers and small businesses in
252	developing such plans. Training shall include technical
253	assistance in establishing relationships with health plans and
254	individualized guidance on operational methods and
255	infrastructure that will best support and ensure the long-term
256	success of using these plans.
257	(2)  The agency shall submit a report that documents the
258	specific activities undertaken during the fiscal year pursuant
259	to this section annually to the Governor, the President of the
260	Senate, and the Speaker of the House of Representatives no later
261	than February 1.
262	Section 8.  Effective July 1, 2007, the sum of $250,000 in
263	nonrecurring revenue is appropriated from the General Revenue
264	Fund to the Agency for Workforce Innovation for the 2007-2008
265	fiscal year to award Small Business Health Insurance Plan Grants
266	to eligible businesses.
267	Section 9.  Except as otherwise expressly provided in this
268	act, this act shall take effect January 1, 2008, and shall apply
269	to identification cards issued for policies or certificates
270	issued or renewed on or after that date.

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