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A bill to be entitled

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An act relating to health insurance; amending ss.

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627.42395 and 641.31, F.S.; requiring health insurance

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policies and health maintenance contracts in this state to

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provide additional premium coverage for amino-acid-based

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elemental formulas for the treatment of certain medical

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conditions; amending s. 627.6741, F.S.; requiring an

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insurer issuing Medicare supplement policies to offer a

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Medicare supplement policy without conditioning the

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issuance or discriminating in the price based on health

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status to individuals who are eligible for Medicare due to

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having end-stage renal disease and who meet other

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conditions; providing an 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 of severe multiple food protein

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allergies, gastroesophageal reflux, eosinophilic disorders, and

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short bowel syndrome when ordered by a licensed physician.

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Treatments using amino-acid-based elemental formulas must be

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medically necessary and appropriate treatment that is consistent

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with the person's symptoms, diagnosis, and condition, and may not

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be furnished primarily for the convenience of the person or

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provider. Conditions for which these formulas are used in

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experimental or investigational services do not meet the

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criterion of medical necessity.

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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.  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) A health maintenance contract must make available

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coverage of amino-acid-based elemental formulas, regardless of

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the method of intake, for the medically necessary treatment of

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medically diagnosed conditions such as severe multiple food

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protein allergies, gastroesophageal reflux, eosinophilic

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disorders, and short bowel syndrome when ordered by a licensed

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physician. Treatments using amino-acid-based elemental formulas

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must be medically necessary and appropriate treatment that is

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consistent with the person's symptoms, diagnosis, and condition,

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and may not be furnished primarily for the convenience of the

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person or provider. Conditions for which these formulas are used

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in experimental or investigational services do not meet the

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criterion of medical necessity.

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     Section 3.  Subsection (1) of section 627.6741, Florida

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Statutes, is amended to read:

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     627.6741  Issuance, cancellation, nonrenewal, and

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replacement.--

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     (1)  An insurer issuing Medicare supplement policies in this

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state shall offer the opportunity of enrolling in a Medicare

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supplement policy, without conditioning the issuance or

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effectiveness of the policy on, and without discriminating in the

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price of the policy based on, the medical or health status or

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receipt of health care by the individual:

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     (a)  To any individual who is 65 years of age or older and

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who resides in this state, upon the request of the individual

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during the 6-month period beginning with the first month in which

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the individual has attained 65 years of age and is enrolled in

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Medicare part B; or

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     (b)  To any individual who is 65 years of age or older and

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is enrolled in Medicare part B, who resides in this state, upon

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the request of the individual during the 2-month period following

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termination of coverage under a group health insurance policy;

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or.

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     (c) To any individual who resides in this state, who is

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eligible for Medicare due to having end-stage renal disease, and

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who is enrolled in Medicare part B, upon the request of the

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individual within 6 months after becoming eligible for Medicare,

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or by January 1, 2009, whichever is later.

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A Medicare supplement policy issued to an individual under

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paragraph (a) or paragraph (b) may not exclude benefits based on

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a preexisting condition if the individual has a continuous period

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of creditable coverage, as defined in s. 627.6561(5), of at least

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6 months as of the date of application for coverage.

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     Section 4.  This act shall take effect October 1, 2008.