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A bill to be entitled

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An act relating to optional coverage for health-related

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disorders; amending s. 627.42395, F.S.; including certain

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amino-acid-based formulas within requirements concerning

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optional coverage for enteral formulas; amending s.

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627.668, F.S.; revising requirements for optional coverage

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for mental and nervous disorders; revising certain

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benefits limitations; providing an options application

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requirement; providing applicability; providing an

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effective date.

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

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     Section 1.  Section 627.42395, Florida Statutes, is amended

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to read:

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     627.42395  Coverage for certain prescription and

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nonprescription enteral or amino acid formulas.--

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     (1) Notwithstanding any other provision of law, any health

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insurance policy delivered or issued for delivery, to any person

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in this state or any group, blanket, or franchise health

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insurance policy delivered or issued for delivery in this state

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shall make available to the policyholder as part of the

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application, for an appropriate additional premium, coverage for:

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     (a) Prescription and nonprescription enteral formulas for

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home use which are physician prescribed as medically necessary

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for the treatment of inherited diseases of amino acid, organic

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acid, carbohydrate, or fat metabolism as well as malabsorption

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originating from congenital defects present at birth or acquired

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during the neonatal period. Such coverage for inherited diseases

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of amino acids and organic acids shall include food products

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modified to be low protein, in an amount not to exceed $2,500

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annually for any insured individual, through the age of 24.

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     (b) Amino-acid-based elemental formulas, regardless of the

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method of intake, for the medically necessary treatment of

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medically diagnosed conditions such as severe multiple allergies,

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gastroesophageal reflux, and eosinophilic disorders when ordered

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by a licensed physician.

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     (2) This section applies to any person or family

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notwithstanding the existence of any preexisting condition.

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     Section 2.  Section 627.668, Florida Statutes, is amended to

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read:

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     627.668  Optional coverage for mental and nervous disorders

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required; exception.--

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     (1)  Every insurer, health maintenance organization, and

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nonprofit hospital and medical service plan corporation

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transacting group health insurance or providing prepaid health

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care in this state shall make available to the policyholder as

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part of the application, for an appropriate additional premium

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under a group hospital and medical expense-incurred insurance

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policy, under a group prepaid health care contract, and under a

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group hospital and medical service plan contract, the benefits or

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level of benefits specified in subsection (2) for medically

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necessary treatment and care for all diagnostic categories of

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mental health conditions listed in the most recent edition of the

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Diagnostic and Statistical Manual of Mental Disorders, published

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by the American Psychiatric Association, and as listed in the

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mental and behavioral disorders section of the current

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International Classification of Diseases, which shall include,

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but not be limited to, schizophrenia, schizophrenia-form

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disorders, schizo-affective disorders, paranoid and other

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psychotic disorders, bipolar disorders, panic disorders,

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obsessive-compulsive disorders, major depressive disorders,

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anxiety disorders, mood disorders, pervasive development

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disorders or autism, depression in childhood and adolescence,

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personality disorders, paraphilias, attention deficit and

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disruptive behavior disorders, tic disorders, eating disorders

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including bulimia and anorexia, Asperger's disorder, intermittent

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explosive disorder, posttraumatic stress disorder, psychosis not

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otherwise specified (NOS) when diagnosed in a child under 17

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years of age, Rett's disorder, Tourette's disorder, delirium, and

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dementia the necessary care and treatment of mental and nervous

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disorders, as defined in the standard nomenclature of the

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American Psychiatric Association, subject to the right of the

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applicant for a group policy or contract to select any

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alternative benefits or level of benefits as may be offered by

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the insurer, health maintenance organization, or service plan

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corporation provided that, if alternate inpatient, outpatient, or

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partial hospitalization benefits are selected, such benefits

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shall not be less than the level of benefits required under

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subsection paragraph (2)(a), paragraph (2)(b), or paragraph

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(2)(c), respectively.

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     (2)  Under group policies or contracts, inpatient hospital

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benefits, partial hospitalization benefits, and outpatient

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benefits consisting of durational limits, dollar amounts,

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deductibles, and coinsurance factors may not be more restrictive

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than the treatment limitations and cost-sharing requirements

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under the plan which are applicable to other disease, illnesses,

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and medical conditions. shall not be less favorable than for

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physical illness generally, except that:

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     (a) Inpatient benefits may be limited to not less than 30

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days per benefit year as defined in the policy or contract. If

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inpatient hospital benefits are provided beyond 30 days per

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benefit year, the durational limits, dollar amounts, and

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coinsurance factors thereto need not be the same as applicable to

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physical illness generally.

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     (b) Outpatient benefits may be limited to $1,000 for

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consultations with a licensed physician, a psychologist licensed

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pursuant to chapter 490, a mental health counselor licensed

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pursuant to chapter 491, a marriage and family therapist licensed

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pursuant to chapter 491, and a clinical social worker licensed

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pursuant to chapter 491. If benefits are provided beyond the

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$1,000 per benefit year, the durational limits, dollar amounts,

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and coinsurance factors thereof need not be the same as

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applicable to physical illness generally.

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     (c) Partial hospitalization benefits shall be provided

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under the direction of a licensed physician. For purposes of this

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part, the term "partial hospitalization services" is defined as

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those services offered by a program accredited by the Joint

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Commission on Accreditation of Hospitals (JCAH) or in compliance

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with equivalent standards. Alcohol rehabilitation programs

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accredited by the Joint Commission on Accreditation of Hospitals

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or approved by the state and licensed drug abuse rehabilitation

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programs shall also be qualified providers under this section. In

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any benefit year, if partial hospitalization services or a

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combination of inpatient and partial hospitalization are

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utilized, the total benefits paid for all such services shall not

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exceed the cost of 30 days of inpatient hospitalization for

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psychiatric services, including physician fees, which prevail in

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the community in which the partial hospitalization services are

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rendered. If partial hospitalization services benefits are

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provided beyond the limits set forth in this paragraph, the

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durational limits, dollar amounts, and coinsurance factors

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thereof need not be the same as those applicable to physical

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illness generally.

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     (3) In the case of a group health plan that offers a

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participant or beneficiary two or more benefit package options

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under the plan, the requirements of this section shall be applied

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separately with respect to each such option.

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     (4)(3) Insurers must maintain strict confidentiality

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regarding psychiatric and psychotherapeutic records submitted to

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an insurer for the purpose of reviewing a claim for benefits

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payable under this section. These records submitted to an insurer

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are subject to the limitations of s. 456.057, relating to the

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furnishing of patient records.

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     Section 3.  This act shall take effect January 1, 2009, and

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applies to policies and contracts issued or renewed on or after

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that date.