Senate Bill sb2708
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Florida Senate - 2007 SB 2708
By Senator Storms
10-1474-07
1 A bill to be entitled
2 An act relating to small employer health
3 insurance; amending s. 627.6699, F.S.; revising
4 a definition; creating the Healthy Florida
5 Small Employer Program for the purpose of
6 making health insurance available to small
7 employers; providing eligibility requirements;
8 requiring the employer to pay a certain portion
9 of the employee premiums; providing for the
10 reimbursement of claims paid by small employee
11 carriers from the Healthy Florida Small
12 Employer Stop-Loss Trust Fund and for the
13 management and disbursement of moneys from the
14 trust fund; requiring small employee carriers
15 to submit plans and claims data to the Office
16 of Insurance Regulation; authorizing the office
17 to contract for the management and marketing of
18 the program; requiring an annual report;
19 requiring the office to adopt rules; providing
20 an appropriation; providing an effective date.
21
22 Be It Enacted by the Legislature of the State of Florida:
23
24 Section 1. Present paragraphs (o) through (w) of
25 subsection (3) of section 617.6699, Florida Statutes, are
26 redesignated as paragraphs (p) through (x), respectively, and
27 a new paragraph (o) is added to that subsection, paragraph (c)
28 of subsection (15) of that section is amended, present
29 subsections (16) and (17) are redesignated as subsections (17)
30 and (18), respectively, and a new subsection (16) is added to
31 that section, to read:
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Florida Senate - 2007 SB 2708
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1 627.6699 Employee Health Care Access Act.--
2 (3) DEFINITIONS.--As used in this section, the term:
3 (o) "Office" means the Office of Insurance Regulation
4 of the Department of Financial Services.
5 (15) SMALL EMPLOYERS ACCESS PROGRAM.--
6 (c) Definitions.--For purposes of this subsection:
7 1. "Fair commission" means a commission structure
8 determined by the insurers and reflected in the insurers' rate
9 filings made pursuant to this subsection.
10 2. "Insurer" means any entity that provides health
11 insurance in this state. For purposes of this subsection,
12 insurer includes an insurance company holding a certificate of
13 authority pursuant to chapter 624 or a health maintenance
14 organization holding a certificate of authority pursuant to
15 chapter 641, which qualifies to provide coverage to small
16 employer groups pursuant to this section.
17 3. "Mutually supported benefit plan" means an optional
18 alternative coverage plan developed within a defined
19 geographic region which may include, but is not limited to, a
20 minimum level of primary care coverage in which the percentage
21 of the premium is distributed among the employer, the
22 employee, and community-generated revenue either alone or in
23 conjunction with federal matching funds.
24 4. "Office" means the Office of Insurance Regulation
25 of the Department of Financial Services.
26 4.5. "Participating insurer" means any insurer
27 providing health insurance to small employers that has been
28 selected by the office in accordance with this subsection for
29 its designated region.
30 5.6. "Program" means the Small Employer Access Program
31 as created by this subsection.
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1 (16) HEALTHY FLORIDA SMALL EMPLOYER PROGRAM.--The
2 Healthy Florida Small Employer Program is established for the
3 purpose of making affordable health insurance available to
4 qualifying small employers and to encourage small employers to
5 offer health insurance coverage to their employees. All small
6 employer carriers shall offer the standard, basic,
7 high-deductible, and limited health benefit plans described in
8 subsection (12) to all qualified small employers at rates that
9 incorporate the reduction in claims costs available to
10 carriers under this program.
11 (a) A qualifying small employer is a small employer
12 that has:
13 1. No health benefit plan covering employees in effect
14 during the previous 12-month period prior to application; and
15 2. At least 30 percent of its eligible employees
16 receiving annual wages from the employer at a maximum level
17 less than or equal to $33,000 for the 2007-2008 fiscal year.
18 The maximum wage shall be adjusted annually beginning July 1,
19 2008. For each fiscal year, the adjustment shall be a
20 percentage of the annual wage figure that took effect on July
21 1 of the prior fiscal year. The percentage adjustment shall
22 correspond to the percentage change in the federal poverty
23 guideline for a family unit of two persons, as annually
24 defined and updated by the federal Department of Health and
25 Human Services.
26 (b) A qualifying small employer must pay at least 50
27 percent of the premium for employees covered under the basic
28 plan, and must offer coverage to all employees receiving
29 annual wages at the maximum level described in subparagraph
30 (a)2. and at least one such employee must accept such
31 coverage. The amount of the premium contributed by the
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1 employer must be the same percentage for all covered
2 employees.
3 (c) The small employer shall provide the small
4 employer carrier with written certification that the employer
5 is a qualifying small employer at the time of initial
6 application and annually at the time of contract renewal. The
7 carrier may require the submission of appropriate
8 documentation in support of the employer's certification.
9 (d) The Insurance Commissioner, by order, may require
10 small employer carriers to give preference to qualifying small
11 employers whose eligible employees have the lowest average
12 salaries.
13 (e) Moneys in the Healthy Florida Small Employer
14 Stop-Loss Trust Fund established under s. 17.45 shall be used
15 to reimburse small employer carriers for claims paid in
16 accordance with this program.
17 1. The trust fund shall be administered by the office
18 and the costs of administering the fund shall be paid from the
19 fund. The Chief Financial Officer shall invest the fund's
20 assets in the same manner that other state moneys may be
21 invested, and any investment earnings of the fund shall be
22 retained to the credit of the fund.
23 2. Beginning January 1, 2008, small employer carriers
24 providing coverage under this program are eligible to receive
25 reimbursement for up to 90 percent of the aggregate claims
26 between $5,000 and $75,000 paid in a calendar year for covered
27 lives under the plans issued to eligible small employers under
28 this program. The premiums received by a small employer
29 carrier from qualifying small employer contracts shall be
30 factored into the amount of claims reimbursement the carrier
31 may receive from the trust fund.
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1 3. Claims shall be reported and moneys be distributed
2 from the trust fund on a calendar-year basis. A small employer
3 carrier's request for reimbursement must be submitted no later
4 than April 1 following the end of the calendar year in which
5 the claim was paid, and, except as provided in
6 sub-subparagraph 5.a., may be paid only from moneys in the
7 fund for the calendar year in which the claim was paid.
8 4. The office may require the carrier to submit such
9 plan and claims data as it considers necessary to ensure
10 accountability, to ensure that moneys are distributed
11 equitably and in accordance with this subsection, and to
12 permit evaluation of the program. The office may require that
13 such data be submitted on a per-member, aggregate, or
14 categorical basis. Data shall also be reported separately for
15 each qualifying small employer plan issued under this program.
16 5. The office shall calculate the total amount of
17 claims reimbursement for all small employer carriers for the
18 calendar year for which claims are reported.
19 a. If the total amount requested for reimbursement for
20 a calendar year exceeds the moneys available, the Insurance
21 Commissioner shall provide for a pro rata distribution of the
22 available funds. Each small employer carrier shall be eligible
23 to receive only such proportionate amount of the available
24 funds as the small employer carrier's total eligible claims
25 bears to the total eligible claims paid by all small employer
26 carriers. Any claims for reimbursement which cannot be made
27 due to a deficit for a particular calendar year may be carried
28 over to the next calendar year.
29 b. If moneys available for distribution during a
30 calendar year exceed the total amount requested for
31 reimbursement by all small employer carriers for that year,
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1 any excess moneys shall be carried forward and made available
2 for distribution in the next calendar year. Such excess funds
3 shall be in addition to the moneys appropriated to the trust
4 fund in the next calendar year.
5 6. The office shall periodically determine the total
6 number of eligible small employers that may be enrolled under
7 small employer carrier contracts under this program by
8 dividing the total moneys available for distribution from the
9 fund by the total of all estimated claims-reimbursement costs
10 to be paid from the fund based on the average annual cost of
11 claims from all currently enrolled eligible small employers.
12 a. The office shall suspend the enrollment of new
13 small employers if it determines that the total enrollment
14 reported by all small employer carriers exceeds the total
15 enrollment that can be supported by the fund. The office shall
16 provide the small employer carriers with notification of any
17 enrollment suspension.
18 b. If, at any point during a suspension of enrollment
19 of new qualifying employers, the office determines that funds
20 are available to provide for the addition of new enrollments,
21 the office shall reactivate new enrollments and notify all
22 small employer carriers that enrollment of eligible new
23 employers may commence.
24 c. The suspension of enrolling new qualifying small
25 employers does not preclude providing coverage to new
26 employees or their dependents of a small employer that is
27 already enrolled in the program.
28 7. The office may contract for the administration of
29 the fund in accordance with chapter 287. The contractor shall
30 maintain complete records, submit reports to the office which
31 enable the office to evaluate and ensure the orderly operation
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1 of the fund, and be subject to inspection by the office. If
2 deemed necessary, the office shall direct the contractor to
3 purchase stop-loss insurance or reinsurance from an insurer
4 licensed to write such insurance in this state from the assets
5 of the fund.
6 (f) The office may use up to 10 percent of the annual
7 funds appropriated to the program to market the program to
8 small employers, which shall include, but need not be limited
9 to, public education, outreach activities, and enrollment
10 strategies. The office may contract for such services.
11 (g) By September 2008, and annually thereafter, the
12 office shall submit to the Governor, the President of the
13 Senate, and the Speaker of the House of Representatives a
14 report summarizing the activities of the program, including,
15 but not limited to, the number of small employers enrolled,
16 the number and amount of claims paid, and an estimate of the
17 required funding for the next program year.
18 (h) The office shall adopt rules to administer this
19 subsection, including, but not limited to, rules providing
20 procedures and forms for requesting and receiving
21 reimbursement from the fund, methodologies for calculating the
22 reimbursement of small employer carriers, and forms for
23 reporting employer and claims data.
24 (i) The office may apply for available matching funds
25 from the Medicaid Low-Income Pool established under s.
26 409.911, and shall receive priority over other requests for
27 such funds.
28 Section 2. For the 2007-2008 fiscal year, the sum of
29 $10 million is appropriated from the General Revenue Fund and
30 shall be deposited into the Healthy Florida Small Employer
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1 Stop-Loss Trust Fund and used for the purposes specified in
2 this act.
3 Section 3. This act shall take effect July 1, 2007.
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6 SENATE SUMMARY
7 Creates the Healthy Florida Small Employer Program to
make affordable health insurance available to qualifying
8 small employers. Requires the employer to pay a certain
portion of the employee premiums. Provides for the
9 reimbursement of claims paid by small employee carriers
from the Healthy Florida Small Employer Stop-Loss Trust
10 Fund, and for the management and disbursement of moneys
from the trust fund. Requires small employee carriers to
11 submit plans and claims data to the Office of Insurance
Regulation. Authorizes the office to contract for the
12 management and marketing of the program. Requires an
annual report. Provides for rules.
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