Florida Senate - 2008 CS for SB 164
By the Committee on Health Policy; and Senators Crist and Saunders
587-05447-08 2008164c1
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A bill to be entitled
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An act relating to health insurance policies; amending s.
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627.668, F.S.; revising the requirements for optional
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coverage for mental and nervous disorders; prohibiting the
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durational limits, dollar amounts, deductibles, or
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coinsurance factors for certain specified illnesses or
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conditions from being less favorable than those for
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physical illness; repealing s. 627.669, F.S., relating to
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optional coverage for substance abuse impaired persons;
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amending s. 627.6675, F.S., relating to required benefits;
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conforming provisions to changes made by the act;
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providing for application; 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 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 subsections (2) and (3) subsection
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(2) for the necessary care and treatment of mental and nervous
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disorders, as defined in the most recent edition of the
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Diagnostic and Statistical Manual of Mental Disorders published
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by standard nomenclature of the American Psychiatric Association,
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subject to the right of the applicant for a group policy or
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contract to select any alternative benefits or level of benefits
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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 subsections (2) and (3)
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paragraph (2)(a), paragraph (2)(b), or paragraph (2)(c),
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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 shall not be less favorable
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than for physical illness generally for the necessary care and
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treatment of schizophrenia, schizo-affective disorders, major
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depression, bipolar disorders, panic disorders, generalized
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anxiety disorders, postraumatic stress disorders, substance abuse
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disorders, eating disorders, delirium, dementia, childhood
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ADD/ADHD, developmental disorders, borderline personality
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disorder, and mental disorder due to a medical condition.
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(3)(2) Under group policies or contracts, inpatient
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hospital benefits, partial hospitalization benefits, and
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outpatient benefits for mental health disorders not listed in
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subsection (2) consisting of durational limits, dollar amounts,
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deductibles, and coinsurance factors shall not be less favorable
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than for 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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(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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benefits were provided in the group plan.
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Section 4. 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.
CODING: Words stricken are deletions; words underlined are additions.