Amendment
Bill No. CS/CS/SB 2534

Amendment No. 364545

CHAMBER ACTION
Senate		House
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1	Representative Bean offered the following:
2
3	Amendment (with title amendment)
4	Remove everything after the enacting clause and insert:
5	Section 1.  Paragraph (d) of subsection (2) of section
6	112.363, Florida Statutes, is amended to read:
7	112.363  Retiree health insurance subsidy.--
8	(2)  ELIGIBILITY FOR RETIREE HEALTH INSURANCE SUBSIDY.--
9	(d)  Payment of the retiree health insurance subsidy shall
10	be made only after coverage for health insurance for the retiree
11	or beneficiary has been certified in writing to the Department
12	of Management Services. Participation in a former employer's
13	group health insurance program is not a requirement for
14	eligibility under this section. Coverage issued pursuant to s.
15	408.9091 is considered health insurance for the purposes of this
16	section.
17	Section 2.  Subsections (5) and (10) of section 408.909,
18	Florida Statutes, are amended to read:
19	408.909  Health flex plans.--
20	(5)  ELIGIBILITY.--Eligibility to enroll in an approved
21	health flex plan is limited to residents of this state who:
22	(a)1.  Are 64 years of age or younger;
23	2.(b)  Have a family income equal to or less than 300200
24	percent of the federal poverty level;
25	(c)  Are eligible under a federally approved Medicaid
26	demonstration waiver and reside in Palm Beach County or Miami-
27	Dade County;
28	3. (d)  Are not covered by a private insurance policy and
29	are not eligible for coverage through a public health insurance
30	program, such as Medicare or Medicaid, unless specifically
31	authorized under paragraph (c), or another public health care
32	program, such as Kidcare, and have not been covered at any time
33	during the past 6 months, except that:
34	a.  A person who was covered under an individual health
35	maintenance contract issued by a health maintenance organization
36	licensed under part I of chapter 641 that also was an approved
37	health flex plan on October 1, 2008, may apply for coverage in
38	the same health maintenance organization's health flex plan
39	without a lapse in coverage if all other eligibility
40	requirements are met; or
41	b.  A person who was covered under Medicaid or Kidcare and
42	lost eligibility for the Medicaid or Kidcare subsidy due to
43	income restrictions within 90 days prior to applying for health
44	care coverage through an approved health flex plan may apply for
45	coverage in a health flex plan without a lapse in coverage if
46	all other eligibility requirements are met; and
47	4.(e)  Have applied for health care coverage as an
48	individual through an approved health flex plan and have agreed
49	to make any payments required for participation, including
50	periodic payments or payments due at the time health care
51	services are provided; or
52	(b)  Are part of an employer group at least 75 percent of
53	the employees of which have a family income equal to or less
54	than 300 percent of the federal poverty level and which employee
55	group is not covered by a private health insurance policy and
56	has not been covered at any time during the past 6 months. If
57	the health flex plan entity is a health insurer, health plan, or
58	health maintenance organization licensed under Florida law, only
59	50 percent of the employees must meet the income requirements
60	for the purpose of this paragraph.
61	(10)  EXPIRATION.--This section expires July 1, 2013 2008.
62	Section 3.  Section 408.9091, Florida Statutes, is created
63	to read:
64	408.9091  Cover Florida Health Care Access Program.--
65	(1)  SHORT TITLE.--This section may be cited as the "Cover
66	Florida Health Care Access Program Act."
67	(2)  LEGISLATIVE INTENT.--The Legislature finds that a
68	significant number of state residents are unable to obtain
69	affordable health insurance coverage. The Legislature also finds
70	that existing health flex plan coverage has had limited
71	participation due in part to narrow eligibility restrictions as
72	well as minimal benefit options for catastrophic and emergency
73	care coverage. Therefore, it is the intent of the Legislature to
74	expand the availability of health care options for uninsured
75	residents by developing an affordable health care product that
76	emphasizes coverage for basic and preventive health care
77	services; provides inpatient hospital, urgent, and emergency
78	care services; and is offered statewide by approved health
79	insurers, health maintenance organizations, health-care-
80	provider-sponsored organizations, or health care districts.
81	(3)  DEFINITIONS.--As used in this section, the term:
82	(a)  "Agency" means the Agency for Health Care
83	Administration.
84	(b)  "Cover Florida plan" means a consumer choice benefit
85	plan approved under this section that guarantees payment or
86	coverage for specified benefits provided to an enrollee.
87	(c)  "Cover Florida plan coverage" means health care
88	services that are covered as benefits under a Cover Florida
89	plan.
90	(d)  "Cover Florida plan entity" means a health insurer,
91	health maintenance organization, health-care-provider-sponsored
92	organization, or health care district that develops and
93	implements a Cover Florida plan and is responsible for
94	administering the plan and paying all claims for Cover Florida
95	plan coverage by enrollees.
96	(e)  "Cover Florida Plus" means a supplemental insurance
97	product, such as for additional catastrophic coverage or dental,
98	vision, or cancer coverage, approved under this section and
99	offered to all enrollees.
100	(f)  "Enrollee" means an individual who has been determined
101	to be eligible for and is receiving health insurance coverage
102	under a Cover Florida plan.
103	(g)  "Office" means the Office of Insurance Regulation of
104	the Financial Services Commission.
105	(4)  PROGRAM.--The agency and the office shall jointly
106	establish and administer the Cover Florida Health Care Access
107	Program.
108	(a)  General Cover Florida plan components must require
109	that:
110	1.  Plans are offered on a guaranteed-issue basis to
111	enrollees, subject to exclusions for preexisting conditions
112	approved by the office and the agency.
113	2.  Plans are portable such that the enrollee remains
114	covered regardless of employment status or the cost-sharing of
115	premiums.
116	3.  Plans provide for cost containment through limits on
117	the number of services, caps on benefit payments, and copayments
118	for services.
119	4.  A Cover Florida plan entity makes all benefit plan and
120	marketing materials available in English and Spanish.
121	5.  In order to provide for consumer choice, Cover Florida
122	plan entities develop two alternative benefit option plans
123	having different cost and benefit levels, including at least one
124	plan that provides catastrophic coverage.
125	6.  Plans without catastrophic coverage provide coverage
126	options for services including, but not limited to:
127	a.  Preventive health services, including immunizations,
128	annual health assessments, well-woman and well-care services,
129	and preventive screenings such as mammograms, cervical cancer
130	screenings, and noninvasive colorectal or prostate screenings.
131	b.  Incentives for routine preventive care.
132	c.  Office visits for the diagnosis and treatment of
133	illness or injury.
134	d.  Office surgery, including anesthesia.
135	e.  Behavioral health services.
136	f.  Durable medical equipment and prosthetics.
137	g.  Diabetic supplies.
138	7.  Plans providing catastrophic coverage, at a minimum,
139	provide coverage options for all of the services listed under
140	subparagraph 6.; however, such plans may include, but are not
141	limited to, coverage options for:
142	a.  Inpatient hospital stays.
143	b.  Hospital emergency care services.
144	c.  Urgent care services.
145	d.  Outpatient facility services, outpatient surgery, and
146	outpatient diagnostic services.
147	8.  All plans offer prescription drug benefit coverage or
148	use a prescription drug manager such as the Florida Discount
149	Drug Card Program.
150	9.  Plan enrollment materials provide information in plain
151	language on policy benefit coverage, benefit limits, cost-
152	sharing requirements, and exclusions and a clear representation
153	of what is not covered in the plan. The Cover Florida Health
154	Care Access Program shall require the following disclosure to be
155	reviewed and executed by all consumers purchasing program
156	options or insurance coverage through the program: "In
157	connection with the Cover Florida Health Care Access Program
158	authorized by s. 408.9091, Florida Statutes, agents and entities
159	offering products and services under the program shall inform
160	the named insured, applicant, or subscriber, on a form approved
161	by the Office of Insurance Regulation of the Financial Services
162	Commission, that the program is not an insurance program or, if
163	it is an insurance program, that benefits under the coverage are
164	limited under s. 408.9091, Florida Statutes, and that such
165	coverage is an alternative to coverage without such limitations.
166	10.  Plans offered through a qualified employer meet the
167	requirements of s. 125 of the Internal Revenue Code.
168	(b)  Guidelines shall be developed to ensure that Cover
169	Florida plans meet minimum standards for quality of care and
170	access to care. The agency shall ensure that the Cover Florida
171	plans follow standardized grievance procedures.
172	(c)  Changes in Cover Florida plan benefits, premiums, and
173	policy forms are subject to regulatory oversight by the office
174	and the agency as provided under rules adopted by the Financial
175	Services Commission and the agency.
176	(d)  The agency, the office, and the Executive Office of
177	the Governor shall develop a public awareness program to be
178	implemented throughout the state for the promotion of the Cover
179	Florida Health Care Access Program.
180	(e)  Public or private entities may design programs to
181	encourage Floridians to participate in the Cover Florida Health
182	Care Access Program or to encourage employers to cosponsor some
183	share of Cover Florida plan premiums for employees.
184	(5)  PLAN PROPOSALS.--The agency and the office shall
185	announce, no later than July 1, 2008, an invitation to negotiate
186	for Cover Florida plan entities to design a Cover Florida plan
187	proposal in which benefits and premiums are specified.
188	(a)  The invitation to negotiate shall include guidelines
189	for the review of Cover Florida plan applications, policy forms,
190	and all associated forms and provide regulatory oversight of
191	Cover Florida plan advertisement and marketing procedures. A
192	plan shall be disapproved or withdrawn if the plan:
193	1.  Contains any ambiguous, inconsistent, or misleading
194	provisions or any exceptions or conditions that deceptively
195	affect or limit the benefits purported to be assumed in the
196	general coverage provided by the plan;
197	2.  Provides benefits that are unreasonable in relation to
198	the premium charged or contains provisions that are unfair or
199	inequitable, that are contrary to the public policy of this
200	state, that encourage misrepresentation, or that result in
201	unfair discrimination in sales practices;
202	3.  Cannot demonstrate that the plan is financially sound
203	and that the applicant is able to underwrite or finance the
204	health care coverage provided;
205	4.  Cannot demonstrate that the applicant and its
206	management are in compliance with the standards required under
207	s. 624.404(3); or
208	5.  Does not guarantee that enrollees may participate in
209	the Cover Florida plan entity's comprehensive network of
210	providers, as determined by the office, the agency, and the
211	contract.
212	(b)  The agency and the office may announce an invitation
213	to negotiate for the design of Cover Florida Plus products to
214	companies that offer supplemental insurance, discount medical
215	plan organizations licensed under part II of chapter 636, or
216	prepaid health clinics licensed under part II of chapter 641.
217	(c)  The agency and office shall approve at least one Cover
218	Florida plan entity having an existing statewide network of
219	providers and may approve at least one regional network plan in
220	each existing Medicaid area.
221	(6)  LICENSE NOT REQUIRED.--
222	(a)  The licensing requirements of the Florida Insurance
223	Code and chapter 641 relating to health maintenance
224	organizations do not apply to a Cover Florida plan approved
225	under this section unless expressly made applicable. However,
226	for the purpose of prohibiting unfair trade practices, Cover
227	Florida plans are considered to be insurance subject to the
228	applicable provisions of part IX of chapter 626 except as
229	otherwise provided in this section.
230	(b)  Cover Florida plans are not covered by the Florida
231	Life and Health Insurance Guaranty Association under part III of
232	chapter 631 or by the Health Maintenance Organization Consumer
233	Assistance Plan under part IV of chapter 631.
234	(7)  ELIGIBILITY.--Eligibility to enroll in a Cover Florida
235	plan is limited to residents of this state who meet all of the
236	following requirements:
237	(a)  Are between 19 and 64 years of age, inclusive.
238	(b)  Are not covered by a private insurance policy and are
239	not eligible for coverage through a public health insurance
240	program, such as Medicare, Medicaid, or Kidcare, unless
241	eligibility for coverage lapses due to no longer meeting income
242	or categorical requirements.
243	(c)  Have not been covered by any health insurance program
244	at any time during the past 6 months, unless coverage under a
245	health insurance program was terminated within the previous 6
246	months due to:
247	1.  Loss of a job that provided an employer-sponsored
248	health benefit plan;
249	2.  Exhaustion of coverage that was continued under COBRA
250	or continuation-of-coverage requirements under s. 627.6692;
251	3.  Reaching the limiting age under the policy; or
252	4.  Death of, or divorce from, a spouse who was provided an
253	employer-sponsored health benefit plan.
254	(d)  Have applied for health care coverage through a Cover
255	Florida plan and have agreed to make any payments required for
256	participation, including periodic payments or payments due at
257	the time health care services are provided.
258	(8)  RECORDS.--Each Cover Florida plan must maintain
259	enrollment data and provide network data and reasonable records
260	to enable the office and the agency to monitor plans and to
261	determine the financial viability of the Cover Florida plan, as
262	necessary.
263	(9)  NONENTITLEMENT.--Coverage under a Cover Florida plan
264	is not an entitlement, and a cause of action does not arise
265	against the state, a local government entity, any other
266	political subdivision of the state, or the agency or the office
267	for failure to make coverage available to eligible persons under
268	this section.
269	(10)  PROGRAM EVALUATION.--The agency and the office shall:
270	(a)  Evaluate the Cover Florida Health Care Access Program
271	and its effect on the entities that seek approval as Cover
272	Florida plans, on the number of enrollees, and on the scope of
273	the health care coverage offered under a Cover Florida plan.
274	(b)  Provide an assessment of the Cover Florida plans and
275	their potential applicability in other settings.
276	(c)  Use Cover Florida plans to gather more information to
277	evaluate low-income, consumer-driven benefit packages.
278	(d)  Jointly submit by March 1, 2009, and annually
279	thereafter, a report to the Governor, the President of the
280	Senate, and the Speaker of the House of Representatives that
281	provides the information specified in paragraphs (a)-(c) and
282	recommendations relating to the successful implementation and
283	administration of the program.
284	(11)  RULEMAKING AUTHORITY.--The agency and the Financial
285	Services Commission may adopt rules pursuant to ss. 120.536(1)
286	and 120.54 as needed to administer this section.
287	Section 4.  Section 408.910, Florida Statutes, is created
288	to read:
289	408.910  Florida Health Choices Program.--
290	(1)  LEGISLATIVE INTENT.--The Legislature finds that a
291	significant number of the residents of this state do not have
292	adequate access to affordable, quality health care. The
293	Legislature further finds that increasing access to affordable,
294	quality health care will be best accomplished by establishing a
295	competitive market for purchasing health insurance and health
296	services. It is therefore the intent of the Legislature to
297	create the Florida Health Choices Program to:
298	(a)  Expand opportunities for Floridians to purchase
299	affordable health insurance and health services.
300	(b)  Preserve the benefits of employment-sponsored
301	insurance while easing the administrative burden for employers
302	who offer these benefits.
303	(c)  Enable individual choice in both the manner and amount
304	of health care purchased.
305	(d)  Provide for the purchase of individual, portable
306	health care coverage.
307	(e)  Disseminate information to consumers on the price and
308	quality of health services.
309	(f)  Sponsor a competitive market that stimulates product
310	innovation, quality improvement, and efficiency in the
311	production and delivery of health services.
312	(2)  DEFINITIONS.--As used in this section:
313	(a)  "Corporation" means the Florida Health Choices, Inc.,
314	established under this section.
315	(b)  "Health insurance agent" means an agent licensed under
316	part IV of chapter 626.
317	(c)  "Insurer" means an entity licensed under chapter 624
318	that offers an individual health insurance policy or a group
319	health insurance policy, a preferred provider organization as
320	defined in s. 627.6471, or an exclusive provider organization as
321	defined in s. 627.6472.
322	(d)  "Program" means the Florida Health Choices Program
323	established by this section.
324	(3)  PROGRAM PURPOSE AND COMPONENTS.--The Florida Health
325	Choices Program is created as a single, centralized market for
326	the sale and purchase of various products that enable
327	individuals to pay for health care. These products include, but
328	are not limited to, health insurance plans, health maintenance
329	organization plans, prepaid services, service contracts, and
330	flexible spending accounts. The components of the program
331	include:
332	(a)  Enrollment of employers.
333	(b)  Administrative services for participating employers,
334	including:
335	1.  Assistance in seeking federal approval of cafeteria
336	plans.
337	2.  Collection of premiums and other payments.
338	3.  Management of individual benefit accounts.
339	4.  Distribution of premiums to insurers and payments to
340	other eligible vendors.
341	5.  Assistance for participants in complying with reporting
342	requirements.
343	(c)  Services to individual participants, including:
344	1.  Information about available products and participating
345	vendors.
346	2.  Assistance to participating individuals for assessing
347	the benefits and limits of each product, including information
348	necessary to distinguish between policies offering creditable
349	coverage and other products available through the program.
350	3.  Account information to assist individual participants
351	to manage available resources.
352	4.  Services that promote healthy behaviors.
353	(d)  Recruitment of vendors, including insurers, health
354	maintenance organizations, prepaid clinic service providers,
355	provider service networks, and other providers.
356	(e)  Certification of vendors to ensure capability,
357	reliability, and validity of offerings.
358	(f)  Collection of data, monitoring, assessment, and
359	reporting of vendor performance.
360	(g)  Information services for individuals and employers.
361	(h)  Program evaluation.
362	(4)  ELIGIBILITY AND PARTICIPATION.--Participation in the
363	program is voluntary and shall be available to employers,
364	individuals, vendors, and health insurance agents as specified
365	in this subsection.
366	(a)  Employers eligible to enroll in the program include:
367	1.  Employers with 1 to 50 employees.
368	2.  Fiscally constrained counties described in s. 218.67.
369	3.  Municipalities with populations of fewer than 50,000
370	residents.
371	4.  School districts in fiscally constrained counties.
372	(b)  Individuals eligible to participate in the program
373	include:
374	1.  Individual employees of enrolled employers.
375	2.  State employees not eligible for state employee health
376	benefits.
377	3.  State retirees.
378	4.  Medicaid reform participants who select the opt-out
379	provision of reform.
380	5.  Statutory rural hospitals.
381	(c)  Employers who choose to participate in the program may
382	enroll by complying with the procedures established by the
383	corporation. These procedures shall include, but not be limited
384	to, the following:
385	1.  Submission of required information.
386	2.  Compliance with federal tax requirements for the
387	establishment of a cafeteria plan, pursuant to s. 125 of the
388	Internal Revenue Code, including designation of the employer's
389	plan as a premium payment plan, a salary reduction plan with
390	flexible spending arrangements, or a salary reduction plan with
391	a premium payment and flexible spending arrangements.
392	3.  Determination of the employer's contribution, if any,
393	per employee, provided that such contribution is equal for each
394	eligible employee.
395	4.  Establishment of payroll deduction procedures, subject
396	to the agreement of each individual employee who voluntarily
397	participates in the program.
398	5.  Designation of the corporation as the third-party
399	administrator for the employer's health benefit plan.
400	6.  Identification of eligible employees.
401	7.  Arrangement for periodic payments.
402	(d)  Eligible vendors and the products and services that
403	they are permitted to sell are as follows:
404	1.  Insurers licensed under chapter 624 may sell health
405	insurance policies, limited benefit policies, other risk-bearing
406	coverage, and other products or services.
407	2.  Health maintenance organizations licensed under part I
408	of chapter 641 may sell health insurance policies, limited
409	benefit policies, other risk-bearing products, and other
410	products or services.
411	3.  Prepaid health clinic service providers licensed under
412	part II of chapter 641 may sell prepaid service contracts and
413	other arrangements for a specified amount and type of health
414	services or treatments.
415	4.  Health care providers, including hospitals and other
416	licensed health facilities, health care clinics, licensed health
417	professionals, pharmacies, and other licensed health care
418	providers, may sell service contracts and arrangements for a
419	specified amount and type of health services or treatments.
420	5.  Provider organizations, including service networks,
421	group practices, professional associations, and other
422	incorporated organizations of providers, may sell service
423	contracts and arrangements for a specified amount and type of
424	health services or treatments.
425	6.  Corporate entities providing specific health services
426	in accordance with applicable state law may sell service
427	contracts and arrangements for a specified amount and type of
428	health services or treatments.
429
430	A vendor described in subparagraphs 3.-6. may not sell products
431	that provide risk-bearing coverage unless that vendor is
432	authorized under a certificate of authority issued by the Office
433	of Insurance Regulation under the provisions of the Florida
434	Insurance Code. Otherwise eligible vendors may be excluded from
435	participating in the program for deceptive or predatory
436	practices, financial insolvency, or failure to comply with the
437	terms of the participation agreement or other standards set by
438	the corporation.
439	(e)  Eligible individuals may voluntarily continue
440	participation in the program regardless of subsequent changes in
441	job status or Medicaid eligibility. Individuals who join the
442	program may participate by complying with the procedures
443	established by the corporation. These procedures shall include,
444	but are not limited to:
445	1.  Submission of required information.
446	2.  Authorization for payroll deduction.
447	3.  Compliance with federal tax requirements.
448	4.  Arrangements for payment in the event of job changes.
449	5.  Selection of products and services.
450	(f)  Vendors who choose to participate in the program may
451	enroll by complying with the procedures established by the
452	corporation. These procedures shall include, but are not limited
453	to:
454	1.  Submission of required information, including a
455	complete description of the coverage, services, provider
456	network, payment restrictions, and other requirements of each
457	product offered through the program.
458	2.  Execution of an agreement to make all products offered
459	through the program available to all individual participants.
460	3.  Establishment of product prices based on age, gender,
461	and location of the individual participant.
462	4.  Arrangements for receiving payment for enrolled
463	participants.
464	5.  Participation in ongoing reporting processes
465	established by the corporation.
466	6.  Compliance with grievance procedures established by the
467	corporation.
468	(g)  Health insurance agents licensed under part IV of
469	chapter 626 are eligible to voluntarily participate as buyers'
470	representatives. A buyer's representative acts on behalf of an
471	individual purchasing health insurance and health services
472	through the program by providing information about products and
473	services available through the program and assisting the
474	individual with both the decision and the procedure of selecting
475	specific products. Serving as a buyer's representative does not
476	constitute a conflict of interest with continuing
477	responsibilities as a health insurance agent provided the
478	relationship between each agent and any participating vendor is
479	disclosed prior to advising an individual participant about the
480	products and services available through the program. In order to
481	participate, a health insurance agent shall comply with the
482	procedures established by the corporation, including:
483	1.  Completion of training requirements.
484	2.  Execution of a participation agreement specifying the
485	terms and conditions of participation.
486	3.  Disclosure of any appointments to solicit insurance or
487	procure applications for vendors participating in the program.
488	4.  Arrangements to receive payment from the corporation
489	for services as a buyer's representative.
490	(5)  PRODUCTS.--
491	(a)  The products that may be made available for purchase
492	through the program include, but are not limited to:
493	1.  Health insurance policies.
494	2.  Limited benefit plans.
495	3.  Prepaid clinic services.
496	4.  Service contracts.
497	5.  Arrangements for purchase of specific amounts and types
498	of health services and treatments.
499	6.  Flexible spending accounts.
500	(b)  Health insurance policies, limited benefit plans,
501	prepaid service contracts, and other contracts for services must
502	ensure the availability of covered services and benefits to
503	participating individuals for at least 1 full enrollment year.
504	(c)  Products may be offered for multiyear periods provided
505	the price of the product is specified for the entire period or
506	for each separately priced segment of the policy or contract.
507	(d)  The corporation shall require the following disclosure
508	to be reviewed and executed by all consumers purchasing program
509	options or insurance coverage through the corporation: "In
510	connection with the Florida Health Choices Program authorized by
511	s. 408.910, Florida Statutes, agents and entities offering
512	products and services under the program shall inform the named
513	insured, applicant, or subscriber, on a form approved by the
514	Office of Insurance Regulation of the Financial Services
515	Commission, that the products and services are not insurance or,
516	if they are insurance, that benefits under the coverage are
517	limited under s. 408.910, Florida Statutes, and that such
518	coverage is an alternative to coverage without such limitations.
519	If the form is signed by a named insured, applicant, or
520	subscriber, it shall be presumed that there was an informed,
521	knowing acceptance of such limitations."
522	(6)  PRICING.--Prices for the products sold through the
523	program shall be transparent to participants and established by
524	the vendors based on age, gender, and location of participants.
525	The corporation shall develop a methodology to evaluate the
526	actuarial soundness of products offered through the program. The
527	methodology shall be reviewed by the Office of Insurance
528	Regulation prior to use by the corporation. Prior to making the
529	product available to individual participants, the corporation
530	shall use the methodology to compare the expected health care
531	costs for the covered services and benefits to the vendor's
532	price for that coverage. The results shall be reported to
533	individuals participating in the program. Once established, the
534	price set by the vendor must remain in force for at least 1 year
535	and may only be redetermined by the vendor at the next annual
536	enrollment period. The corporation shall annually assess a
537	surcharge for each premium or price set by a participating
538	vendor. This surcharge may not be more than 2.5 percent of the
539	price and shall be used to generate funding for administrative
540	services provided by the corporation and payments to buyers'
541	representatives.
542	(7)  EXCHANGE PROCESS.--The program shall provide a single,
543	centralized market for purchase of health insurance and health
544	services. Purchases may be made by participating individuals
545	over the Internet or through the services of a participating
546	health insurance agent. Information about each product and
547	service available through the program shall be made available
548	through printed material and an interactive Internet website. A
549	participant needing personal assistance to select products and
550	services shall be referred to a participating agent in his or
551	her area.
552	(a)  Participation in the program may begin at any time
553	during a year when the employer completes enrollment and meets
554	the requirements specified by the corporation pursuant to
555	paragraph (4)(c).
556	(b)  Initial selection of products and services must be
557	made by an individual participant within 60 days after the date
558	on which the individual's employer qualified for participation.
559	An individual who fails to enroll in products and services by
560	the end of this period shall be limited to participation in
561	flexible spending account services until the next annual
562	enrollment period.
563	(c)  Initial enrollment periods for each product selected
564	by an individual participant must last a minimum of 12 months,
565	unless the individual participant specifically agrees to a
566	different enrollment period.
567	(d)  When an individual has selected one or more products
568	and enrolled in those products for at least 12 months or any
569	other period specifically agreed to by the individual
570	participant, changes in selected products and services may only
571	be made during the annual enrollment period established by the
572	corporation.
573	(e)  The limits established in paragraphs (b)-(d) apply to
574	any risk-bearing product that promises future payment or
575	coverage for a variable amount of benefits or services. The
576	limits do not apply to initiation of flexible spending plans
577	when those plans are not associated with specific high-
578	deductible insurance policies or to the use of spending accounts
579	for any products offering individual participants specific
580	amounts and types of health services and treatments at a
581	contracted price.
582	(8)  RISK POOLING.--The program shall utilize methods for
583	pooling the risk of individual participants and preventing
584	selection bias. These methods shall include, but not be limited
585	to, a postenrollment risk adjustment of the premium payments to
586	the vendors. The corporation shall establish a methodology for
587	assessing the risk of enrolled individual participants based on
588	data reported by the vendors about their enrollees. Monthly
589	distributions of payments to the vendors shall be adjusted based
590	on the assessed relative risk profile of the enrollees in each
591	risk-bearing product for the most recent period for which data
592	is available.
593	(9)  EXEMPTIONS.--
594	(a)  Policies sold as part of the program are not subject
595	to the licensing requirements of the Florida Insurance Code,
596	chapter 641, or the mandated offerings or coverages established
597	in part VI of chapter 627 and chapter 641.
598	(b)  The corporation is authorized to act as an
599	administrator as defined in s. 626.88. However, the corporation
600	is not subject to the licensing requirements of part VII of
601	chapter 626.
602	(10)  LIQUIDATION OR DISSOLUTION.--The Department of
603	Financial Services shall supervise any liquidation or
604	dissolution of the corporation and shall have, with respect to
605	such liquidation or dissolution, all power granted to it
606	pursuant to the Florida Insurance Code.
607	(11)  CORPORATION.--There is created the Florida Health
608	Choices, Inc., which shall be registered, incorporated,
609	organized, and operated in compliance with chapter 617. The
610	purpose of the corporation is to administer the program created
611	in this section and to conduct such other business as may
612	further the administration of the program.
613	(a)  The corporation shall be governed by a board of
614	directors consisting of 15 individuals appointed in the
615	following manner:
616	1.  Five members appointed by and serving at the pleasure
617	of the Governor, consisting of:
618	a.  The Secretary of Health Care Administration or a
619	designee with expertise in health care services.
620	b.  The Secretary of Management Services or a designee with
621	expertise in state employee benefits.
622	c.  The Commissioner of the Office of Insurance Regulation
623	or a designee with expertise in insurance regulation.
624	d.  Two representatives of eligible public employers.
625	2.  Five members appointed by and serving at the pleasure
626	of the President of the Senate, consisting of representatives of
627	employers, insurers, health care providers, health insurance
628	agents, and individual participants.
629	3.  Five members appointed by and serving at the pleasure
630	of the Speaker of the House of Representatives, consisting of
631	representatives of employers, insurers, health care providers,
632	health insurance agents, and individual participants.
633	(b)  Members shall be appointed for terms of up to 3 years.
634	Any member is eligible for reappointment. A vacancy on the board
635	shall be filled for the unexpired portion of the term in the
636	same manner as the original appointment.
637	(c)  The board shall select a chief executive officer for
638	the corporation who shall be responsible for the selection of
639	such other staff as may be authorized by the corporation's
640	operating budget as adopted by the board.
641	(d)  Board members are entitled to receive, from funds of
642	the corporation, reimbursement for per diem and travel expenses
643	as provided by s. 112.061. No other compensation is authorized.
644	(e)  There shall be no liability on the part of, and no
645	cause of action shall arise against, any member of the board or
646	its employees or agents for any action taken by them in the
647	performance of their powers and duties under this section.
648	(f)  The board shall develop and adopt bylaws and other
649	corporate procedures as necessary for the operation of the
650	corporation and carrying out the purposes of this section. The
651	bylaws shall:
652	1.  Specify procedures for selection of officers and
653	qualifications for reappointment, provided that no board member
654	shall serve more than 9 consecutive years.
655	2.  Require an annual membership meeting that provides an
656	opportunity for input and interaction with individual
657	participants in the program.
658	3.  Specify policies and procedures regarding conflicts of
659	interest, including prohibiting a member from participating in
660	any decision that would inure to the benefit of the member or
661	the organization that employs the member. The policies and
662	procedures shall also require public disclosure of the interest
663	that prevents the member from participating in a decision on a
664	particular matter.
665	(g)  The corporation may exercise all powers granted to it
666	under chapter 617 necessary to carry out the purposes of this
667	section, including, but not limited to, the power to receive and
668	accept grants, loans, or advances of funds from any public or
669	private agency and to receive and accept from any source
670	contributions of money, property, labor, or any other thing of
671	value to be held, used, and applied for the purposes of this
672	section.
673	(h)  The corporation shall:
674	1.  Determine eligibility of employers, vendors,
675	individuals, and agents in accordance with subsection (4).
676	2.  Establish procedures necessary for the operation of the
677	program, including, but not limited to, procedures for
678	application, enrollment, risk assessment, risk adjustment, plan
679	administration, performance monitoring, and consumer education.
680	3.  Arrange for collection of contributions from
681	participating employers and individuals.
682	4.  Arrange for payment of premiums and other appropriate
683	disbursements based on the selections of products and services
684	by the individual participants.
685	5.  Establish criteria for disenrollment of participating
686	individuals based on failure to pay the individual's share of
687	any contribution required to maintain enrollment in selected
688	products.
689	6.  Establish criteria for exclusion of vendors pursuant to
690	paragraph (4)(d).
691	7.  Develop and implement a plan for promoting public
692	awareness of and participation in the program.
693	8.  Secure staff and consultant services necessary to the
694	operation of the program.
695	9.  Establish policies and procedures regarding
696	participation in the program for individuals, vendors, health
697	insurance agents, and employers.
698	10.  Develop a plan, in coordination with the Department of
699	Revenue, to establish tax credits or refunds for employers that
700	participate in the program. The corporation shall submit the
701	plan to the Governor, the President of the Senate, and the
702	Speaker of the House of Representatives no later than January 1,
703	2009.
704	11.  Beginning in fiscal year 2009-2010, submit by February
705	1 an annual report to the Governor, the President of the Senate,
706	and the Speaker of the House of Representatives documenting the
707	corporation's activities in compliance with the duties
708	delineated in this section.
709	(i)  To ensure program integrity and to safeguard the
710	financial transactions made under the auspices of the program,
711	the corporation is authorized to establish qualifying criteria
712	and certification procedures for vendors, require performance
713	bonds or other guarantees of ability to complete contractual
714	obligations, monitor the performance of vendors, and enforce the
715	agreements of the program through financial penalty or
716	disqualification from the program.
717	Section 5.  Subsection (22) of section 409.811, Florida
718	Statutes, is amended to read:
719	409.811  Definitions relating to Florida Kidcare Act.--As
720	used in ss. 409.810-409.820, the term:
721	(22)  "Premium assistance payment" means the monthly
722	consideration paid by the agency per enrollee in the Florida
723	Kidcare program towards health insurance premiums and may
724	include the direct payment of the premium for a qualifying child
725	to be covered as a dependent under an employer-sponsored group
726	family plan when such payment does not exceed the payment
727	required for an enrollee in the Florida Kidcare program.
728	Section 6.  Section 624.1265, Florida Statutes, is created
729	to read:
730	624.1265  Nonprofit religious organization exemption;
731	authority; notice.--
732	(1)  Any nonprofit religious organization that qualifies
733	under Title 26, s. 501 of the Internal Revenue Code of 1986, as
734	amended; that limits its participants to members of the same
735	religion; that acts as an organizational clearinghouse for
736	information between participants who have financial, physical,
737	or medical needs and participants with the ability to pay for
738	the benefit of those participants with financial, physical, or
739	medical needs; that provides for the financial or medical needs
740	of a participant through payments directly from one participant
741	to another; and that suggests amounts that participants may
742	voluntarily give with no assumption of risk or promise to pay
743	either among the participants or between the participants and
744	the organization are not subject to any requirements of the
745	Florida Insurance Code.
746	(2)  Nothing in this section prevents the organization
747	described in subsection (1) from establishing qualifications of
748	participation relating to the health of a prospective
749	participant, prevents a participant from limiting the financial
750	or medical needs that may be eligible for payment, or prevents
751	the organization from canceling the membership of a participant
752	when such participant indicates his or her unwillingness to
753	participate by failing to make a payment to another participant
754	for a period in excess of 60 days.
755	(3)  The organization described in subsection (1) shall
756	provide each prospective participant in the organizational
757	clearinghouse written notice that the organization is not an
758	insurance company, that membership is not offered through an
759	insurance company, and that the organization is not subject to
760	the regulatory requirements or consumer protections of the
761	Florida Insurance Code.
762	Section 7.  Section 627.6562, Florida Statutes, is amended
763	to read:
764	627.6562  Dependent coverage.--
765	(1)  If an insurer offers coverage that insures dependent
766	children of the policyholder or certificateholder, the policy
767	must insure a dependent child of the policyholder or
768	certificateholder at least until the end of the calendar year in
769	which the child reaches the age of 25, if the child meets all of
770	the following:
771	(a)  The child is dependent upon the policyholder or
772	certificateholder for support.
773	(b)  The child is living in the household of the
774	policyholder or certificateholder, or the child is a full-time
775	or part-time student.
776	(2)  A policy that is subject to the requirements of
777	subsection (1) must also offer the policyholder or
778	certificateholder the option to insure a child of the
779	policyholder or certificateholder at least until the end of the
780	calendar year in which the child reaches the age of 30, if the
781	child:
782	(a)  Is unmarried and does not have a dependent of his or
783	her own;
784	(b)  Is a resident of this state or a full-time or part-
785	time student; and
786	(c)  Is not provided coverage as a named subscriber,
787	insured, enrollee, or covered person under any other group,
788	blanket, or franchise health insurance policy or individual
789	health benefits plan, or entitled to benefits under Title XVIII
790	of the Social Security Act.
791	(3)  If, pursuant to subsection (2), a child is provided
792	coverage under the parent's policy after the end of the calendar
793	year in which the child reaches age 25, and coverage for the
794	child is subsequently terminated, the child is not eligible to
795	be covered under the parent's policy unless the child was
796	continuously covered by other creditable coverage without a gap
797	in coverage of more than 63 days. For the purposes of this
798	subsection, the term "creditable coverage" has the same meaning
799	as defined in s. 627.6561(5).
800	(4)(2)  Nothing in This section does not affect or preempt
801	affects or preempts an insurer's right to medically underwrite
802	or charge the appropriate premium.      (b)  Require coverage
803	for services provided to a dependent before October 1, 2008.
804	(c)  Require an employer to pay all or part of the cost of
805	coverage provided for a dependent under this section.
806	(d)  Prohibit an insurer or health maintenance organization
807	from increasing the limiting age for dependent coverage to age
808	30 in policies or contracts issued or renewed prior to the
809	effective date of this act.
810	(5)  Until April 1, 2009, a dependent child who qualifies
811	for coverage under subsection (1) but whose coverage as a
812	dependent child under a covered person's plan terminated under
813	the terms of the plan before October 1, 2008, may make a written
814	election to reinstate coverage, without proof of insurability,
815	under that plan as a dependent child pursuant to this section.
816	All other dependent children who qualify for coverage under
817	subsection (1) shall be automatically covered at least until the
818	end of the calendar year in which the child reaches the age of
819	30, unless the covered person provides the group policyholder
820	with written evidence the dependent child is married, is not a
821	resident of the state, is covered under a separate comprehensive
822	health insurance policy or a health benefit plan, is entitled to
823	benefits under Title XVIII of the Social Security Act, Pub. L.
824	No. 89-97, 42 U.S.C. ss. 1935 et seq., or is eligible for
825	coverage as an employee under an employer-sponsored health plan.
826	(6)  The covered person's plan may require the payment of a
827	premium by the covered person or dependent child, as
828	appropriate, subject to the approval of the Office of Insurance
829	Regulation, for any period of coverage relating to a dependent's
830	written election for coverage pursuant to subsection (3).
831	(7)  Notice regarding the reinstatement of coverage for a
832	dependent child as provided under this section must be provided
833	to a covered person in the certificate of coverage prepared for
834	covered persons by the insurer or by the covered person's
835	employer. The notice shall be given as soon as practicable after
836	July 1, 2008, and such notice may be given through the group
837	policyholder.
838	(8)  This section does not apply to accident only,
839	specified disease, disability income, Medicare supplement, or
840	long-term care insurance policies.
841	(9)  This section applies to all group, blanket, and
842	franchise health insurance policies covering residents of this
843	state, including, but not limited to, policies in which the
844	carrier has reserved the right to change the premium. This
845	section applies to all individual, group, blanket, and franchise
846	health insurance policies and health maintenance contracts
847	issued, renewed, or amended after October 1, 2008.
848	Section 8.  Subsections (1), (4), and (6) of section
849	641.402, Florida Statutes, are amended to read:
850	641.402  Definitions.--As used in this part, the term:
851	(1)  "Basic services" includes any of the following:
852	limited hospital inpatient services, which may include hospital
853	inpatient physician services, up to a maximum of coverage
854	benefit of 5 days and a maximum dollar amount of coverage of
855	$15,000 per calendar year; emergency care;, physician care other
856	than hospital inpatient physician services;, ambulatory
857	diagnostic treatment;, and preventive health care services.
858	(4)  "Prepaid health clinic" means any organization
859	authorized under this part which provides, either directly or
860	through arrangements with other persons, basic services to
861	persons enrolled with such organization, on a prepaid per capita
862	or prepaid aggregate fixed-sum basis, including those basic
863	services described in this part which subscribers might
864	reasonably require to maintain good health. However, no clinic
865	that provides or contracts for, either directly or indirectly,
866	inpatient hospital services, hospital inpatient physician
867	services, or indemnity against the cost of such services shall
868	be a prepaid health clinic.
869	(6)  "Provider" means any physician or person other than a
870	hospital that furnishes health care services under this part and
871	is licensed or authorized to practice in this state.
872	Section 9.  This act shall take effect upon becoming a law.
873
874
875
876	-----------------------------------------------------
877	T I T L E  A M E N D M E N T
878	Remove the entire title and insert:
879	Remove the entire title and insert:
880	A bill to be entitled
881	An act relating to affordable health coverage; amending s.
882	112.363, F.S.; specifying that coverage provided through
883	the Cover Florida Health Care Access Program is considered
884	health insurance coverage for the purposes of determining
885	eligibility for the state retiree health insurance
886	subsidy; amending s. 408.909, F.S.; revising eligibility
887	requirements; providing cetain exemptions from the 6-month
888	lapse in coverage requirement; extending the expiration
889	date of the health flex plan; creating s. 408.9091, F.S.;
890	creating the Cover Florida Health Care Access Program;
891	providing a short title; providing legislative intent;
892	providing definitions; requiring the agency and the Office
893	of Insurance Regulation of the Financial Services
894	Commission within the Department of Financial Services to
895	jointly administer the program; providing program
896	requirements; requiring the development of guidelines to
897	meet minimum standards for quality of care and access to
898	care; requiring the agency to ensure that the Cover
899	Florida plans follow standardized grievance procedures;
900	requiring the office and the agency to oversee changes to
901	plan benefits; requiring the Executive Office of the
902	Governor, the agency, and the office to develop a public
903	awareness program; authorizing public and private entities
904	to design programs to encourage or extend incentives for
905	participation in the Cover Florida Health Care Access
906	Program; requiring the agency and the office to announce
907	an invitation to negotiate for Cover Florida plan entities
908	to design a coverage proposal; requiring the invitation to
909	negotiate to include certain guidelines; providing certain
910	conditions under which plans are disapproved or withdrawn;
911	authorizing the agency and the office to announce an
912	invitation to negotiate for companies that offer
913	supplemental insurance or discount medical plans;
914	requiring the agency and the office to approve at least
915	one plan entity; authorizing the agency and the office to
916	approve one regional network plan in each existing
917	Medicaid area; providing that certain licensing
918	requirements are not applicable to a Cover Florida plan;
919	providing that Cover Florida plans are considered
920	insurance under certain conditions; excluding Cover
921	Florida plans from the Florida Life and Health Insurance
922	Guaranty Association and the Health Maintenance
923	Organization Consumer Assistance Plan; providing
924	requirements for eligibility for a Cover Florida plan;
925	requiring each Cover Florida plan to maintain and provide
926	certain records; providing that coverage under a Cover
927	Florida plan is not an entitlement and does not give rise
928	to a cause of action; requiring the agency and the office
929	to evaluate the program and submit an annual report to the
930	Governor and the Legislature; authorizing the agency and
931	the Financial Services Commission to adopt rules; creating
932	s. 408.910, F.S.; establishing the Florida Health Choices
933	Program; providing legislative intent; providing
934	definitions; providing program purpose and components;
935	providing employer eligibility criteria; providing
936	individual eligibility criteria; providing employer
937	enrollment criteria; providing vendor, product, and
938	service eligibility criteria; providing for individual
939	participation regardless of subsequent job status or
940	Medicaid eligibility; providing individual enrollment
941	criteria; providing vendor enrollment criteria; providing
942	for participation by health insurance agents; providing
943	criteria for products available for purchase; providing
944	criteria for product pricing; providing for an
945	administrative surcharge; providing for an exchange
946	process; providing for enrollment periods and changes in
947	selected products; providing methods for the pooling of
948	risk; providing for exemptions from certain statutory
949	provisions, mandated offerings and coverages, and
950	licensing requirements; creating the Florida Health
951	Choices, Inc.; requiring the department to supervise any
952	liquidation or dissolution of the corporation; providing
953	for corporate governance and board membership and terms;
954	providing for reimbursement for per diem and travel
955	expenses; providing for powers and duties of the
956	corporation; requiring the corporation to coordinate with
957	the Department of Revenue to develop a plan by January 1,
958	2009, for creating tax exemptions or refunds for
959	participating in the program; requiring the corporation to
960	submit an annual report to the Governor and Legislature;
961	authorizing the corporation to establish and enforce
962	certain program integrity measures; amending s. 409.811,
963	F.S.; revising the definition of the term "premium
964	assistance payment"; creating s. 624.1265, F.S.; exempting
965	certain nonprofit religious organizations from
966	requirements of the Florida Insurance Code; preserving
967	certain authority of such organizations; requiring such
968	organizations to provide certain notice to prospective
969	participants; providing notice requirements; amending s.
970	627.6562, F.S.; requiring insurance policies that provide
971	dependent coverage to provide the policyholder with the
972	option of insuring a child until the age of 30 under
973	certain circumstances; amending s. 627.6699, F.S.;
974	requiring participation of employees in health maintenance
975	contracts or policies issued or renewed after a specified
976	date; providing conditions for employers and employees to
977	opt out of such coverage; amending s. 641.402, F.S.;
978	revising the definition of the term "basic services" to
979	include certain hospital inpatient services; revising the
980	definitions of the terms "prepaid health clinic" and
981	"provider"; providing an effective date.
982

CODING: Words stricken are deletions; words underlined are additions.