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A bill to be entitled

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An act relating to coverage for mental, nervous, and

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substance-related disorders; amending s. 627.668, F.S.;

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revising requirements for optional coverage for mental,

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nervous, and substance-related disorders; revising certain

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benefits limitations; providing an options application

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requirement; repealing s. 627.669, F.S., relating to

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optional coverage required for substance abuse impaired

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persons; amending s. 627.6675, F.S.; conforming a cross-

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reference; 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 627.668, Florida Statutes, is amended to

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read:

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     627.668 Optional coverage for mental, and nervous, and

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substance-related disorders 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 all diagnostic

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categories of mental health and substance-related disorders

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listed in the most recent edition of the Diagnostic and

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Statistical Manual of Mental Disorders, published by the American

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Psychiatric Association, and as listed in the mental and

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behavioral disorders section of the current International

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Classification of Diseases, to include schizophrenia,

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schizophreniform disorders, schizo-affective disorders, paranoid

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and other psychotic disorders, bipolar disorders, panic

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disorders, obsessive-compulsive disorders, major depressive

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disorders, anxiety disorders, mood disorders, pervasive

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development disorders or autism, depression in childhood and

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adolescence, personality disorders, paraphilias, attention

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deficit and disruptive behavior disorders, tic disorders, eating

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disorders including bulimia and anorexia, substance-related

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disorders, Asperger's disorder, intermittent explosive disorder,

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posttraumatic stress disorder, psychosis not otherwise specified

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(NOS) when diagnosed in a child under 17 years of age, Rett's

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disorder, Tourette's disorder, delirium, and dementia the

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necessary care and treatment of mental and nervous disorders, as

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defined in the standard nomenclature of the American Psychiatric

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Association, subject to the right of the applicant for a group

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policy or contract to select any alternative benefits or level of

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benefits as may be offered by the insurer, health maintenance

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organization, or service plan corporation provided that, if

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alternate inpatient, outpatient, or partial hospitalization

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benefits are selected, such benefits shall not be less than the

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level of benefits required under subsection paragraph (2)(a),

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paragraph (2)(b), or paragraph (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 that 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 2. Section 627.669, Florida Statutes, is repealed.

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     Section 3.  Paragraph (b) of subsection (8) of section

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627.6675, Florida Statutes, is amended to read:

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     627.6675  Conversion on termination of eligibility.--Subject

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to all of the provisions of this section, a group policy

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delivered or issued for delivery in this state by an insurer or

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nonprofit health care services plan that provides, on an expense-

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incurred basis, hospital, surgical, or major medical expense

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insurance, or any combination of these coverages, shall provide

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that an employee or member whose insurance under the group policy

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has been terminated for any reason, including discontinuance of

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the group policy in its entirety or with respect to an insured

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class, and who has been continuously insured under the group

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policy, and under any group policy providing similar benefits

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that the terminated group policy replaced, for at least 3 months

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immediately prior to termination, shall be entitled to have

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issued to him or her by the insurer a policy or certificate of

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health insurance, referred to in this section as a "converted

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policy." A group insurer may meet the requirements of this

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section by contracting with another insurer, authorized in this

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state, to issue an individual converted policy, which policy has

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been approved by the office under s. 627.410. An employee or

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member shall not be entitled to a converted policy if termination

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of his or her insurance under the group policy occurred because

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he or she failed to pay any required contribution, or because any

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discontinued group coverage was replaced by similar group

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coverage within 31 days after discontinuance.

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     (8)  BENEFITS OFFERED.--

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     (b)  An insurer shall offer the benefits specified in s.

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627.668 and the benefits specified in s. 627.669 if those

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benefits were provided in the group plan.

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     Section 4.  This act shall take effect January 1, 2009.