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The Committee on Banking and Insurance (Gaetz) recommended the

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following amendment:

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     Senate Amendment (with directory and title amendments)

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     Delete line(s) 29-80

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and insert:

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     Section 1.  Section 627.638, Florida Statutes, is amended

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to read:

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     627.638  Direct payment for hospital, medical services.--

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     (1) A Any health insurance policy insuring against loss or

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expense due to hospital confinement or to medical and related

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services may provide for payment of benefits directly to any

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recognized hospital, licensed ambulance provider, physician

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doctor, or other person who provided the services, in accordance

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with the provisions of the policy. To comply with this section,

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the words "or to the hospital, licensed ambulance provider,

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physician doctor, or person rendering services covered by this

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policy," or similar words appropriate to the terms of the

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policy, must shall be added to applicable provisions of the

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policy.

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     (2) If Whenever, in any health insurance claim form, an

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insured specifically authorizes payment of benefits directly to

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any recognized hospital, licensed ambulance provider, physician,

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or dentist, the insurer shall make such payment to the

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designated provider of such services, unless otherwise provided

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in the insurance contract. The insurance contract may not

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prohibit, and claims forms must provide an option for, the

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payment of benefits directly to a licensed hospital, licensed

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ambulance provider, physician, or dentist for care provided

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pursuant to s. 395.1041. The insurer may require written

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attestation of assignment of benefits. The attestation of

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assignment of benefits must be in written or electronic form.

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Payment to the provider from the insurer may not be more than

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the amount that the insurer would otherwise have paid without

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the assignment.

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     Section 2.  Section 627.64731, Florida Statutes, is created

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to read:

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     627.64731 Leasing, renting, or granting access to a

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preferred provider or exclusive provider.--

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     (1) An insurer or administrator may not lease, rent, or

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otherwise grant access to the health care services of a

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preferred provider or an exclusive provider under a health care

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contract unless expressly authorized by the health care

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contract. At the time a health care contract is entered into

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with a preferred provider or exclusive provider, the insurer

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shall, to the extent possible, identify in the contract any

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third party to which the insurer or administrator that has

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granted access to the health care services of the preferred

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provider or exclusive provider. A third party that is granted

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access must comply with all the applicable terms of the health

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care contract.

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(2) An insurer or administrator must notify a preferred

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provider or exclusive provider, in writing, within 5 business

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days of the identity of any third party that has been granted

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access to the health care services of the provider by the

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insurer or administrator.

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(3) An insurer or administrator that leases, rents, or

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otherwise grants access to the health care services of a

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preferred provider or exclusive provider must maintain an

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Internet website or a toll-free telephone number through which

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the provider may obtain a listing, updated at least biannually,

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of the third parties that have been granted access to the

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provider's health care services.

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(4) An insurer or administrator that leases, rents, or

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otherwise grants access to a provider's health care services

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must ensure that an explanation of benefits or remittance advice

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furnished to the preferred provider or exclusive provider that

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delivers health care services under the health care contract

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identifies the contractual source of any applicable discount.

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(5) The right of a third party to excise the rights and

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responsibilities of an insurer or administrator under a health

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care contract terminates on the date that the preferred

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provider's or exclusive provider's contract with the insurer or

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administrator is terminated.

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(6) The provisions of this section do not apply if the

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third party that is granted access to a preferred provider's or

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exclusive provider's health care services under a health care

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contract is:

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(a) An employer or other entity providing coverage for

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health care services to the employer's employees or the entity's

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members and the employer or entity has a contract with the

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insurer or administrator or the insurer's or administrator's

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affiliate for the administration or processing of claims for

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payment or services provided under the health care contract;

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(b) An affiliate or a subsidiary of the insurer or

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administrator; or

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(c) An entity providing administrative services to, or

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receiving administrative services from, the insurer or

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administrator or the insurer's or administrators' affiliate or

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subsidiary.

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     (7) A health care contract may provide for arbitration of

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disputes arising under this section.

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     Section 3.  Present subsections (11), (12), and (13) of

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section 627.662, Florida Statutes, are renumbered as subsections

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(12), (13), and (14), respectively, and new subsection (11) is

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added to that section, to read:

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     627.662     Other provisions applicable.--The following

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provisions apply to group health insurance, blanket health

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insurance, and franchise health insurance:

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     (11) Section 627.64731, relating to leasing, renting, or

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granting access to a preferred provider or exclusive provider.

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Section 4.  Subsection (41) is added to section 641.31,

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Florida Statutes, to read:

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     641.31  Health maintenance contracts.--

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     (41) If, in a health maintenance organization claim form,

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a subscriber specifically authorizes the payment of benefits

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directly to a hospital, ambulance provider, physician, or

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dentist, the health maintenance organization must make payment

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to the designated provider of the services if the benefits are

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due to the subscriber under the terms of the agreement between

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the subscriber and the health maintenance organization. The

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health maintenance organization contract may not prohibit, and

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claims forms must provide an option for, the payment of benefits

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directly to a licensed hospital, ambulance provider, physician,

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or dentist for covered services provided, for services provided

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pursuant to s. 395.1041, and for ambulance transport and

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treatment provided pursuant to part III of chapter 401. The

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attestation of assignment of benefits must be in written or

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electronic form. Payment to the provider may not be more than

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the amount the health maintenance organization would have paid

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without the assignment. This subsection does not affect the

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requirements of ss. 641.513 and 641.3154 with respect to

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services and payment for such services provided pursuant to this

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subsection.

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================ T I T L E  A M E N D M E N T ================

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And the title is amended as follows:

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     Delete line(s) 3-19

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and insert:

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amending s. 627.638, F.S.; authorizing the payment of

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health insurance policy benefits directly to a licensed

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ambulance provider; requiring health insurance contracts

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to allow insureds to assign plan benefits to specified

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medical providers; requiring the attestation of an

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assignment of benefits to be in written or electronic

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form; creating s. 627.64731, F.S.; providing requirements

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for the rent, lease, or granting of access to the health

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care services of a preferred provider or exclusive

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provider under a health care contract; amending s.

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627.662, F.S.; applying the requirements of s. 627.64731,

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relating to the rent, lease, or granting or access to the

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health care services of a preferred provider or exclusive

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provider, to group health insurance, blanket health

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insurance, and franchise health insurance policies;

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amending s. 641.31; requiring a health maintenance

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organization to make direct payment to specified providers

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if a subscriber specifically authorizes direct payment of

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benefits to the provider; requiring the attestation of

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assignment of benefits to be in either written or

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electronic form; providing that payment to a provider may

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not exceed the amount a health maintenance organization

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would have paid without the assignment; amending s.

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641.315, F.S.;

2/18/2008  12:23:00 PM     597-04129A-08