Senate Bill sb0274

CODING: Words stricken are deletions; words underlined are additions.
    Florida Senate - 2007                                   SB 274

    By Senator Margolis





    35-185-07

  1                      A bill to be entitled

  2         An act relating to cystic fibrosis treatment;

  3         creating s. 627.6614, F.S.; requiring a group

  4         health insurance policy to cover services

  5         needed to treat cystic fibrosis authorized by a

  6         physician; amending s. 641.31, F.S.; requiring

  7         a contract by a health maintenance organization

  8         to cover services needed to treat cystic

  9         fibrosis as authorized by a physician; amending

10         s. 627.6515, F.S., relating to out-of-state

11         groups; conforming a cross-reference to changes

12         made by the act; providing that the act

13         fulfills an important state interest; providing

14         an effective date.

15  

16         WHEREAS, cystic fibrosis is a genetic disease that

17  adversely affects the respiratory system and the digestive

18  system, and

19         WHEREAS, only half of those suffering with cystic

20  fibrosis live to the age of 32, and

21         WHEREAS, the treatments for individuals with cystic

22  fibrosis include ingesting pancreatic enzymes or a wide

23  assortment of nutritional supplements, frequent postural

24  draining to clear the respiratory system, or using a feeding

25  tube to provide sustenance, and

26         WHEREAS, insurance companies oftentimes do not fully

27  cover the costs associated with treating cystic fibrosis, a

28  fatal disease, NOW, THEREFORE,

29  

30  Be It Enacted by the Legislature of the State of Florida:

31  

                                  1

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






    Florida Senate - 2007                                   SB 274
    35-185-07




 1         Section 1.  Section 627.6614, Florida Statutes, is

 2  created to read:

 3         627.6614  Cystic fibrosis treatment services.--A group

 4  health insurance policy sold in this state must provide

 5  coverage for all medically necessary chest physiotherapy

 6  provided by a respiratory therapist licensed under part V of

 7  chapter 468, home health care, equipment, supplies, and

 8  enteral formulas described in s. 627.42395 which are used to

 9  treat cystic fibrosis if the patient's treating physician or a

10  physician authorized by the insurer who specializes in the

11  treatment of cystic fibrosis certifies that such services are

12  medically necessary. The insurer may require the policyholder

13  to be responsible for any deductible or copayment that

14  generally applies under the policy.

15         Section 2.  Present subsections (36), (37), (38), (39),

16  and (40) of section 641.31, Florida Statutes, are redesignated

17  as subsections (37), (38), (39), (40), and (41), respectively,

18  and a new subsection (36) is added to that section, to read:

19         641.31  Health maintenance contracts.--

20         (36)  A group health maintenance contract sold in this

21  state must provide coverage for all medically necessary chest

22  physiotherapy provided by a respiratory therapist licensed

23  under part V of chapter 468, home health care, equipment,

24  supplies, and enteral formulas described in s. 627.42395 which

25  are used to treat cystic fibrosis if the patient's treating

26  physician or a physician authorized by the health maintenance

27  organization who specializes in the treatment of cystic

28  fibrosis certifies that such services are medically necessary.

29  The health maintenance organization may require the subscriber

30  to be responsible for any deductible or copayment that

31  generally applies under the contract.

                                  2

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






    Florida Senate - 2007                                   SB 274
    35-185-07




 1         Section 3.  Subsection (2) of section 627.6515, Florida

 2  Statutes, is amended to read:

 3         627.6515  Out-of-state groups.--

 4         (2)  Except as otherwise provided in this part, this

 5  part does not apply to a group health insurance policy issued

 6  or delivered outside this state under which a resident of this

 7  state is provided coverage if:

 8         (a)  The policy is issued to an employee group the

 9  composition of which is substantially as described in s.

10  627.653; a labor union group or association group the

11  composition of which is substantially as described in s.

12  627.654; an additional group the composition of which is

13  substantially as described in s. 627.656; a group insured

14  under a blanket health policy when the composition of the

15  group is substantially in compliance with s. 627.659; a group

16  insured under a franchise health policy when the composition

17  of the group is substantially in compliance with s. 627.663;

18  an association group to cover persons associated in any other

19  common group, which common group is formed primarily for

20  purposes other than providing insurance; a group that is

21  established primarily for the purpose of providing group

22  insurance, provided the benefits are reasonable in relation to

23  the premiums charged thereunder and the issuance of the group

24  policy has resulted, or will result, in economies of

25  administration; or a group of insurance agents of an insurer,

26  which insurer is the policyholder;

27         (b)  Certificates evidencing coverage under the policy

28  are issued to residents of this state and contain in

29  contrasting color and not less than 10-point type the

30  following statement:  "The benefits of the policy providing

31  

                                  3

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






    Florida Senate - 2007                                   SB 274
    35-185-07




 1  your coverage are governed primarily by the law of a state

 2  other than Florida"; and

 3         (c)  The policy provides the benefits specified in ss.

 4  627.419, 627.6574, 627.6575, 627.6579, 627.6612, 627.66121,

 5  627.66122, 627.6613, 627.6614, 627.667, 627.6675, 627.6691,

 6  and 627.66911.

 7         (d)  Applications for certificates of coverage offered

 8  to residents of this state must contain, in contrasting color

 9  and not less than 12-point type, the following statement on

10  the same page as the applicant's signature:

11  

12         "This policy is primarily governed by the laws

13         of ...insert state where the master policy if

14         filed.... As a result, all of the rating laws

15         applicable to policies filed in this state do

16         not apply to this coverage, which may result in

17         increases in your premium at renewal that would

18         not be permissible under a Florida-approved

19         policy. Any purchase of individual health

20         insurance should be considered carefully, as

21         future medical conditions may make it

22         impossible to qualify for another individual

23         health policy. For information concerning

24         individual health coverage under a

25         Florida-approved policy, consult your agent or

26         the Florida Department of Financial Services."

27  

28  This paragraph applies only to group certificates providing

29  health insurance coverage which require individualized

30  underwriting to determine coverage eligibility for an

31  

                                  4

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






    Florida Senate - 2007                                   SB 274
    35-185-07




 1  individual or premium rates to be charged to an individual

 2  except for the following:

 3         1.  Policies issued to provide coverage to groups of

 4  persons all of whom are in the same or functionally related

 5  licensed professions, and providing coverage only to such

 6  licensed professionals, their employees, or their dependents;

 7         2.  Policies providing coverage to small employers as

 8  defined by s. 627.6699. Such policies shall be subject to, and

 9  governed by, the provisions of s. 627.6699;

10         3.  Policies issued to a bona fide association, as

11  defined by s. 627.6571(5), provided that there is a person or

12  board acting as a fiduciary for the benefit of the members,

13  and such association is not owned, controlled by, or otherwise

14  associated with the insurance company; or

15         4.  Any accidental death, accidental death and

16  dismemberment, accident-only, vision-only, dental-only,

17  hospital indemnity-only, hospital accident-only, cancer,

18  specified disease, Medicare supplement, products that

19  supplement Medicare, long-term care, or disability income

20  insurance, or similar supplemental plans provided under a

21  separate policy, certificate, or contract of insurance, which

22  cannot duplicate coverage under an underlying health plan,

23  coinsurance, or deductibles or coverage issued as a supplement

24  to workers' compensation or similar insurance, or automobile

25  medical-payment insurance.

26         Section 4.  The Legislature finds that this act

27  fulfills an important state interest.

28         Section 5.  This act shall take effect October 1, 2007,

29  and applies to policies and contracts issued or renewed on or

30  after that date.

31  

                                  5

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






    Florida Senate - 2007                                   SB 274
    35-185-07




 1            *****************************************

 2                          SENATE SUMMARY

 3    Requires an individual health insurance policy, a group
      health insurance policy, or a contract by a health
 4    maintenance organization to cover services needed to
      treat cystic fibrosis as authorized by a physician.
 5  

 6  

 7  

 8  

 9  

10  

11  

12  

13  

14  

15  

16  

17  

18  

19  

20  

21  

22  

23  

24  

25  

26  

27  

28  

29  

30  

31  

                                  6

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