| 1 | Representative Bean offered the following: |
| 2 |
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| 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 | If the form is signed by a named insured, applicant, or |
| 167 | subscriber, it shall be presumed that there was an informed, |
| 168 | knowing acceptance of such limitations." |
| 169 | 10. Plans offered through a qualified employer meet the |
| 170 | requirements of s. 125 of the Internal Revenue Code. |
| 171 | (b) Guidelines shall be developed to ensure that Cover |
| 172 | Florida plans meet minimum standards for quality of care and |
| 173 | access to care. The agency shall ensure that the Cover Florida |
| 174 | plans follow standardized grievance procedures. |
| 175 | (c) Changes in Cover Florida plan benefits, premiums, and |
| 176 | policy forms are subject to regulatory oversight by the office |
| 177 | and the agency as provided under rules adopted by the Financial |
| 178 | Services Commission and the agency. |
| 179 | (d) The agency, the office, and the Executive Office of |
| 180 | the Governor shall develop a public awareness program to be |
| 181 | implemented throughout the state for the promotion of the Cover |
| 182 | Florida Health Care Access Program. |
| 183 | (e) Public or private entities may design programs to |
| 184 | encourage Floridians to participate in the Cover Florida Health |
| 185 | Care Access Program or to encourage employers to cosponsor some |
| 186 | share of Cover Florida plan premiums for employees. |
| 187 | (5) PLAN PROPOSALS.--The agency and the office shall |
| 188 | announce, no later than July 1, 2008, an invitation to negotiate |
| 189 | for Cover Florida plan entities to design a Cover Florida plan |
| 190 | proposal in which benefits and premiums are specified. |
| 191 | (a) The invitation to negotiate shall include guidelines |
| 192 | for the review of Cover Florida plan applications, policy forms, |
| 193 | and all associated forms and provide regulatory oversight of |
| 194 | Cover Florida plan advertisement and marketing procedures. A |
| 195 | plan shall be disapproved or withdrawn if the plan: |
| 196 | 1. Contains any ambiguous, inconsistent, or misleading |
| 197 | provisions or any exceptions or conditions that deceptively |
| 198 | affect or limit the benefits purported to be assumed in the |
| 199 | general coverage provided by the plan; |
| 200 | 2. Provides benefits that are unreasonable in relation to |
| 201 | the premium charged or contains provisions that are unfair or |
| 202 | inequitable, that are contrary to the public policy of this |
| 203 | state, that encourage misrepresentation, or that result in |
| 204 | unfair discrimination in sales practices; |
| 205 | 3. Cannot demonstrate that the plan is financially sound |
| 206 | and that the applicant is able to underwrite or finance the |
| 207 | health care coverage provided; |
| 208 | 4. Cannot demonstrate that the applicant and its |
| 209 | management are in compliance with the standards required under |
| 210 | s. 624.404(3); or |
| 211 | 5. Does not guarantee that enrollees may participate in |
| 212 | the Cover Florida plan entity's comprehensive network of |
| 213 | providers, as determined by the office, the agency, and the |
| 214 | contract. |
| 215 | (b) The agency and the office may announce an invitation |
| 216 | to negotiate for the design of Cover Florida Plus products to |
| 217 | companies that offer supplemental insurance, discount medical |
| 218 | plan organizations licensed under part II of chapter 636, or |
| 219 | prepaid health clinics licensed under part II of chapter 641. |
| 220 | (c) The agency and office shall approve at least one Cover |
| 221 | Florida plan entity having an existing statewide network of |
| 222 | providers and may approve at least one regional network plan in |
| 223 | each existing Medicaid area. |
| 224 | (6) LICENSE NOT REQUIRED.-- |
| 225 | (a) The licensing requirements of the Florida Insurance |
| 226 | Code and chapter 641 relating to health maintenance |
| 227 | organizations do not apply to a Cover Florida plan approved |
| 228 | under this section unless expressly made applicable. However, |
| 229 | for the purpose of prohibiting unfair trade practices, Cover |
| 230 | Florida plans are considered to be insurance subject to the |
| 231 | applicable provisions of part IX of chapter 626 except as |
| 232 | otherwise provided in this section. |
| 233 | (b) Cover Florida plans are not covered by the Florida |
| 234 | Life and Health Insurance Guaranty Association under part III of |
| 235 | chapter 631 or by the Health Maintenance Organization Consumer |
| 236 | Assistance Plan under part IV of chapter 631. |
| 237 | (7) ELIGIBILITY.--Eligibility to enroll in a Cover Florida |
| 238 | plan is limited to residents of this state who meet all of the |
| 239 | following requirements: |
| 240 | (a) Are between 19 and 64 years of age, inclusive. |
| 241 | (b) Are not covered by a private insurance policy and are |
| 242 | not eligible for coverage through a public health insurance |
| 243 | program, such as Medicare, Medicaid, or Kidcare, unless |
| 244 | eligibility for coverage lapses due to no longer meeting income |
| 245 | or categorical requirements. |
| 246 | (c) Have not been covered by any health insurance program |
| 247 | at any time during the past 6 months, unless coverage under a |
| 248 | health insurance program was terminated within the previous 6 |
| 249 | months due to: |
| 250 | 1. Loss of a job that provided an employer-sponsored |
| 251 | health benefit plan; |
| 252 | 2. Exhaustion of coverage that was continued under COBRA |
| 253 | or continuation-of-coverage requirements under s. 627.6692; |
| 254 | 3. Reaching the limiting age under the policy; or |
| 255 | 4. Death of, or divorce from, a spouse who was provided an |
| 256 | employer-sponsored health benefit plan. |
| 257 | (d) Have applied for health care coverage through a Cover |
| 258 | Florida plan and have agreed to make any payments required for |
| 259 | participation, including periodic payments or payments due at |
| 260 | the time health care services are provided. |
| 261 | (8) RECORDS.--Each Cover Florida plan must maintain |
| 262 | enrollment data and provide network data and reasonable records |
| 263 | to enable the office and the agency to monitor plans and to |
| 264 | determine the financial viability of the Cover Florida plan, as |
| 265 | necessary. |
| 266 | (9) NONENTITLEMENT.--Coverage under a Cover Florida plan |
| 267 | is not an entitlement, and a cause of action does not arise |
| 268 | against the state, a local government entity, any other |
| 269 | political subdivision of the state, or the agency or the office |
| 270 | for failure to make coverage available to eligible persons under |
| 271 | this section. |
| 272 | (10) PROGRAM EVALUATION.--The agency and the office shall: |
| 273 | (a) Evaluate the Cover Florida Health Care Access Program |
| 274 | and its effect on the entities that seek approval as Cover |
| 275 | Florida plans, on the number of enrollees, and on the scope of |
| 276 | the health care coverage offered under a Cover Florida plan. |
| 277 | (b) Provide an assessment of the Cover Florida plans and |
| 278 | their potential applicability in other settings. |
| 279 | (c) Use Cover Florida plans to gather more information to |
| 280 | evaluate low-income, consumer-driven benefit packages. |
| 281 | (d) Jointly submit by March 1, 2009, and annually |
| 282 | thereafter, a report to the Governor, the President of the |
| 283 | Senate, and the Speaker of the House of Representatives that |
| 284 | provides the information specified in paragraphs (a)-(c) and |
| 285 | recommendations relating to the successful implementation and |
| 286 | administration of the program. |
| 287 | (11) RULEMAKING AUTHORITY.--The agency and the Financial |
| 288 | Services Commission may adopt rules pursuant to ss. 120.536(1) |
| 289 | and 120.54 as needed to administer this section. |
| 290 | Section 4. Section 408.910, Florida Statutes, is created |
| 291 | to read: |
| 292 | 408.910 Florida Health Choices Program.-- |
| 293 | (1) LEGISLATIVE INTENT.--The Legislature finds that a |
| 294 | significant number of the residents of this state do not have |
| 295 | adequate access to affordable, quality health care. The |
| 296 | Legislature further finds that increasing access to affordable, |
| 297 | quality health care will be best accomplished by establishing a |
| 298 | competitive market for purchasing health insurance and health |
| 299 | services. It is therefore the intent of the Legislature to |
| 300 | create the Florida Health Choices Program to: |
| 301 | (a) Expand opportunities for Floridians to purchase |
| 302 | affordable health insurance and health services. |
| 303 | (b) Preserve the benefits of employment-sponsored |
| 304 | insurance while easing the administrative burden for employers |
| 305 | who offer these benefits. |
| 306 | (c) Enable individual choice in both the manner and amount |
| 307 | of health care purchased. |
| 308 | (d) Provide for the purchase of individual, portable |
| 309 | health care coverage. |
| 310 | (e) Disseminate information to consumers on the price and |
| 311 | quality of health services. |
| 312 | (f) Sponsor a competitive market that stimulates product |
| 313 | innovation, quality improvement, and efficiency in the |
| 314 | production and delivery of health services. |
| 315 | (2) DEFINITIONS.--As used in this section: |
| 316 | (a) "Corporation" means the Florida Health Choices, Inc., |
| 317 | established under this section. |
| 318 | (b) "Health insurance agent" means an agent licensed under |
| 319 | part IV of chapter 626. |
| 320 | (c) "Insurer" means an entity licensed under chapter 624 |
| 321 | that offers an individual health insurance policy or a group |
| 322 | health insurance policy, a preferred provider organization as |
| 323 | defined in s. 627.6471, or an exclusive provider organization as |
| 324 | defined in s. 627.6472. |
| 325 | (d) "Program" means the Florida Health Choices Program |
| 326 | established by this section. |
| 327 | (3) PROGRAM PURPOSE AND COMPONENTS.--The Florida Health |
| 328 | Choices Program is created as a single, centralized market for |
| 329 | the sale and purchase of various products that enable |
| 330 | individuals to pay for health care. These products include, but |
| 331 | are not limited to, health insurance plans, health maintenance |
| 332 | organization plans, prepaid services, service contracts, and |
| 333 | flexible spending accounts. The components of the program |
| 334 | include: |
| 335 | (a) Enrollment of employers. |
| 336 | (b) Administrative services for participating employers, |
| 337 | including: |
| 338 | 1. Assistance in seeking federal approval of cafeteria |
| 339 | plans. |
| 340 | 2. Collection of premiums and other payments. |
| 341 | 3. Management of individual benefit accounts. |
| 342 | 4. Distribution of premiums to insurers and payments to |
| 343 | other eligible vendors. |
| 344 | 5. Assistance for participants in complying with reporting |
| 345 | requirements. |
| 346 | (c) Services to individual participants, including: |
| 347 | 1. Information about available products and participating |
| 348 | vendors. |
| 349 | 2. Assistance to participating individuals for assessing |
| 350 | the benefits and limits of each product, including information |
| 351 | necessary to distinguish between policies offering creditable |
| 352 | coverage and other products available through the program. |
| 353 | 3. Account information to assist individual participants |
| 354 | to manage available resources. |
| 355 | 4. Services that promote healthy behaviors. |
| 356 | (d) Recruitment of vendors, including insurers, health |
| 357 | maintenance organizations, prepaid clinic service providers, |
| 358 | provider service networks, and other providers. |
| 359 | (e) Certification of vendors to ensure capability, |
| 360 | reliability, and validity of offerings. |
| 361 | (f) Collection of data, monitoring, assessment, and |
| 362 | reporting of vendor performance. |
| 363 | (g) Information services for individuals and employers. |
| 364 | (h) Program evaluation. |
| 365 | (4) ELIGIBILITY AND PARTICIPATION.--Participation in the |
| 366 | program is voluntary and shall be available to employers, |
| 367 | individuals, vendors, and health insurance agents as specified |
| 368 | in this subsection. |
| 369 | (a) Employers eligible to enroll in the program include: |
| 370 | 1. Employers with 1 to 50 employees. |
| 371 | 2. Fiscally constrained counties described in s. 218.67. |
| 372 | 3. Municipalities with populations of fewer than 50,000 |
| 373 | residents. |
| 374 | 4. School districts in fiscally constrained counties. |
| 375 | (b) Individuals eligible to participate in the program |
| 376 | include: |
| 377 | 1. Individual employees of enrolled employers. |
| 378 | 2. State employees not eligible for state employee health |
| 379 | benefits. |
| 380 | 3. State retirees. |
| 381 | 4. Medicaid reform participants who select the opt-out |
| 382 | provision of reform. |
| 383 | 5. Statutory rural hospitals. |
| 384 | (c) Employers who choose to participate in the program may |
| 385 | enroll by complying with the procedures established by the |
| 386 | corporation. These procedures shall include, but not be limited |
| 387 | to, the following: |
| 388 | 1. Submission of required information. |
| 389 | 2. Compliance with federal tax requirements for the |
| 390 | establishment of a cafeteria plan, pursuant to s. 125 of the |
| 391 | Internal Revenue Code, including designation of the employer's |
| 392 | plan as a premium payment plan, a salary reduction plan with |
| 393 | flexible spending arrangements, or a salary reduction plan with |
| 394 | a premium payment and flexible spending arrangements. |
| 395 | 3. Determination of the employer's contribution, if any, |
| 396 | per employee, provided that such contribution is equal for each |
| 397 | eligible employee. |
| 398 | 4. Establishment of payroll deduction procedures, subject |
| 399 | to the agreement of each individual employee who voluntarily |
| 400 | participates in the program. |
| 401 | 5. Designation of the corporation as the third-party |
| 402 | administrator for the employer's health benefit plan. |
| 403 | 6. Identification of eligible employees. |
| 404 | 7. Arrangement for periodic payments. |
| 405 | (d) Eligible vendors and the products and services that |
| 406 | they are permitted to sell are as follows: |
| 407 | 1. Insurers licensed under chapter 624 may sell health |
| 408 | insurance policies, limited benefit policies, other risk-bearing |
| 409 | coverage, and other products or services. |
| 410 | 2. Health maintenance organizations licensed under part I |
| 411 | of chapter 641 may sell health insurance policies, limited |
| 412 | benefit policies, other risk-bearing products, and other |
| 413 | products or services. |
| 414 | 3. Prepaid health clinic service providers licensed under |
| 415 | part II of chapter 641 may sell prepaid service contracts and |
| 416 | other arrangements for a specified amount and type of health |
| 417 | services or treatments. |
| 418 | 4. Health care providers, including hospitals and other |
| 419 | licensed health facilities, health care clinics, licensed health |
| 420 | professionals, pharmacies, and other licensed health care |
| 421 | providers, may sell service contracts and arrangements for a |
| 422 | specified amount and type of health services or treatments. |
| 423 | 5. Provider organizations, including service networks, |
| 424 | group practices, professional associations, and other |
| 425 | incorporated organizations of providers, may sell service |
| 426 | contracts and arrangements for a specified amount and type of |
| 427 | health services or treatments. |
| 428 | 6. Corporate entities providing specific health services |
| 429 | in accordance with applicable state law may sell service |
| 430 | contracts and arrangements for a specified amount and type of |
| 431 | health services or treatments. |
| 432 | |
| 433 | A vendor described in subparagraphs 3.-6. may not sell products |
| 434 | that provide risk-bearing coverage unless that vendor is |
| 435 | authorized under a certificate of authority issued by the Office |
| 436 | of Insurance Regulation under the provisions of the Florida |
| 437 | Insurance Code. Otherwise eligible vendors may be excluded from |
| 438 | participating in the program for deceptive or predatory |
| 439 | practices, financial insolvency, or failure to comply with the |
| 440 | terms of the participation agreement or other standards set by |
| 441 | the corporation. |
| 442 | (e) Eligible individuals may voluntarily continue |
| 443 | participation in the program regardless of subsequent changes in |
| 444 | job status or Medicaid eligibility. Individuals who join the |
| 445 | program may participate by complying with the procedures |
| 446 | established by the corporation. These procedures shall include, |
| 447 | but are not limited to: |
| 448 | 1. Submission of required information. |
| 449 | 2. Authorization for payroll deduction. |
| 450 | 3. Compliance with federal tax requirements. |
| 451 | 4. Arrangements for payment in the event of job changes. |
| 452 | 5. Selection of products and services. |
| 453 | (f) Vendors who choose to participate in the program may |
| 454 | enroll by complying with the procedures established by the |
| 455 | corporation. These procedures shall include, but are not limited |
| 456 | to: |
| 457 | 1. Submission of required information, including a |
| 458 | complete description of the coverage, services, provider |
| 459 | network, payment restrictions, and other requirements of each |
| 460 | product offered through the program. |
| 461 | 2. Execution of an agreement to make all products offered |
| 462 | through the program available to all individual participants. |
| 463 | 3. Establishment of product prices based on age, gender, |
| 464 | and location of the individual participant. |
| 465 | 4. Arrangements for receiving payment for enrolled |
| 466 | participants. |
| 467 | 5. Participation in ongoing reporting processes |
| 468 | established by the corporation. |
| 469 | 6. Compliance with grievance procedures established by the |
| 470 | corporation. |
| 471 | (g) Health insurance agents licensed under part IV of |
| 472 | chapter 626 are eligible to voluntarily participate as buyers' |
| 473 | representatives. A buyer's representative acts on behalf of an |
| 474 | individual purchasing health insurance and health services |
| 475 | through the program by providing information about products and |
| 476 | services available through the program and assisting the |
| 477 | individual with both the decision and the procedure of selecting |
| 478 | specific products. Serving as a buyer's representative does not |
| 479 | constitute a conflict of interest with continuing |
| 480 | responsibilities as a health insurance agent provided the |
| 481 | relationship between each agent and any participating vendor is |
| 482 | disclosed prior to advising an individual participant about the |
| 483 | products and services available through the program. In order to |
| 484 | participate, a health insurance agent shall comply with the |
| 485 | procedures established by the corporation, including: |
| 486 | 1. Completion of training requirements. |
| 487 | 2. Execution of a participation agreement specifying the |
| 488 | terms and conditions of participation. |
| 489 | 3. Disclosure of any appointments to solicit insurance or |
| 490 | procure applications for vendors participating in the program. |
| 491 | 4. Arrangements to receive payment from the corporation |
| 492 | for services as a buyer's representative. |
| 493 | (5) PRODUCTS.-- |
| 494 | (a) The products that may be made available for purchase |
| 495 | through the program include, but are not limited to: |
| 496 | 1. Health insurance policies. |
| 497 | 2. Limited benefit plans. |
| 498 | 3. Prepaid clinic services. |
| 499 | 4. Service contracts. |
| 500 | 5. Arrangements for purchase of specific amounts and types |
| 501 | of health services and treatments. |
| 502 | 6. Flexible spending accounts. |
| 503 | (b) Health insurance policies, limited benefit plans, |
| 504 | prepaid service contracts, and other contracts for services must |
| 505 | ensure the availability of covered services and benefits to |
| 506 | participating individuals for at least 1 full enrollment year. |
| 507 | (c) Products may be offered for multiyear periods provided |
| 508 | the price of the product is specified for the entire period or |
| 509 | for each separately priced segment of the policy or contract. |
| 510 | (d) The corporation shall require the following disclosure |
| 511 | to be reviewed and executed by all consumers purchasing program |
| 512 | options or insurance coverage through the corporation: "In |
| 513 | connection with the Florida Health Choices Program authorized by |
| 514 | s. 408.910, Florida Statutes, agents and entities offering |
| 515 | products and services under the program shall inform the named |
| 516 | insured, applicant, or subscriber, on a form approved by the |
| 517 | Office of Insurance Regulation of the Financial Services |
| 518 | Commission, that the products and services are not insurance or, |
| 519 | if they are insurance, that benefits under the coverage are |
| 520 | limited under s. 408.910, Florida Statutes, and that such |
| 521 | coverage is an alternative to coverage without such limitations. |
| 522 | If the form is signed by a named insured, applicant, or |
| 523 | subscriber, it shall be presumed that there was an informed, |
| 524 | knowing acceptance of such limitations." |
| 525 | (6) PRICING.--Prices for the products sold through the |
| 526 | program shall be transparent to participants and established by |
| 527 | the vendors based on age, gender, and location of participants. |
| 528 | The corporation shall develop a methodology to evaluate the |
| 529 | actuarial soundness of products offered through the program. The |
| 530 | methodology shall be reviewed by the Office of Insurance |
| 531 | Regulation prior to use by the corporation. Prior to making the |
| 532 | product available to individual participants, the corporation |
| 533 | shall use the methodology to compare the expected health care |
| 534 | costs for the covered services and benefits to the vendor's |
| 535 | price for that coverage. The results shall be reported to |
| 536 | individuals participating in the program. Once established, the |
| 537 | price set by the vendor must remain in force for at least 1 year |
| 538 | and may only be redetermined by the vendor at the next annual |
| 539 | enrollment period. The corporation shall annually assess a |
| 540 | surcharge for each premium or price set by a participating |
| 541 | vendor. This surcharge may not be more than 2.5 percent of the |
| 542 | price and shall be used to generate funding for administrative |
| 543 | services provided by the corporation and payments to buyers' |
| 544 | representatives. |
| 545 | (7) EXCHANGE PROCESS.--The program shall provide a single, |
| 546 | centralized market for purchase of health insurance and health |
| 547 | services. Purchases may be made by participating individuals |
| 548 | over the Internet or through the services of a participating |
| 549 | health insurance agent. Information about each product and |
| 550 | service available through the program shall be made available |
| 551 | through printed material and an interactive Internet website. A |
| 552 | participant needing personal assistance to select products and |
| 553 | services shall be referred to a participating agent in his or |
| 554 | her area. |
| 555 | (a) Participation in the program may begin at any time |
| 556 | during a year when the employer completes enrollment and meets |
| 557 | the requirements specified by the corporation pursuant to |
| 558 | paragraph (4)(c). |
| 559 | (b) Initial selection of products and services must be |
| 560 | made by an individual participant within 60 days after the date |
| 561 | on which the individual's employer qualified for participation. |
| 562 | An individual who fails to enroll in products and services by |
| 563 | the end of this period shall be limited to participation in |
| 564 | flexible spending account services until the next annual |
| 565 | enrollment period. |
| 566 | (c) Initial enrollment periods for each product selected |
| 567 | by an individual participant must last a minimum of 12 months, |
| 568 | unless the individual participant specifically agrees to a |
| 569 | different enrollment period. |
| 570 | (d) When an individual has selected one or more products |
| 571 | and enrolled in those products for at least 12 months or any |
| 572 | other period specifically agreed to by the individual |
| 573 | participant, changes in selected products and services may only |
| 574 | be made during the annual enrollment period established by the |
| 575 | corporation. |
| 576 | (e) The limits established in paragraphs (b)-(d) apply to |
| 577 | any risk-bearing product that promises future payment or |
| 578 | coverage for a variable amount of benefits or services. The |
| 579 | limits do not apply to initiation of flexible spending plans |
| 580 | when those plans are not associated with specific high- |
| 581 | deductible insurance policies or to the use of spending accounts |
| 582 | for any products offering individual participants specific |
| 583 | amounts and types of health services and treatments at a |
| 584 | contracted price. |
| 585 | (8) RISK POOLING.--The program shall utilize methods for |
| 586 | pooling the risk of individual participants and preventing |
| 587 | selection bias. These methods shall include, but not be limited |
| 588 | to, a postenrollment risk adjustment of the premium payments to |
| 589 | the vendors. The corporation shall establish a methodology for |
| 590 | assessing the risk of enrolled individual participants based on |
| 591 | data reported by the vendors about their enrollees. Monthly |
| 592 | distributions of payments to the vendors shall be adjusted based |
| 593 | on the assessed relative risk profile of the enrollees in each |
| 594 | risk-bearing product for the most recent period for which data |
| 595 | is available. |
| 596 | (9) EXEMPTIONS.-- |
| 597 | (a) Policies sold as part of the program are not subject |
| 598 | to the licensing requirements of the Florida Insurance Code, |
| 599 | chapter 641, or the mandated offerings or coverages established |
| 600 | in part VI of chapter 627 and chapter 641. |
| 601 | (b) The corporation is authorized to act as an |
| 602 | administrator as defined in s. 626.88. However, the corporation |
| 603 | is not subject to the licensing requirements of part VII of |
| 604 | chapter 626. |
| 605 | (10) LIQUIDATION OR DISSOLUTION.--The Department of |
| 606 | Financial Services shall supervise any liquidation or |
| 607 | dissolution of the corporation and shall have, with respect to |
| 608 | such liquidation or dissolution, all power granted to it |
| 609 | pursuant to the Florida Insurance Code. |
| 610 | (11) CORPORATION.--There is created the Florida Health |
| 611 | Choices, Inc., which shall be registered, incorporated, |
| 612 | organized, and operated in compliance with chapter 617. The |
| 613 | purpose of the corporation is to administer the program created |
| 614 | in this section and to conduct such other business as may |
| 615 | further the administration of the program. |
| 616 | (a) The corporation shall be governed by a board of |
| 617 | directors consisting of 15 individuals appointed in the |
| 618 | following manner: |
| 619 | 1. Five members appointed by and serving at the pleasure |
| 620 | of the Governor, consisting of: |
| 621 | a. The Secretary of Health Care Administration or a |
| 622 | designee with expertise in health care services. |
| 623 | b. The Secretary of Management Services or a designee with |
| 624 | expertise in state employee benefits. |
| 625 | c. The Commissioner of the Office of Insurance Regulation |
| 626 | or a designee with expertise in insurance regulation. |
| 627 | d. Two representatives of eligible public employers. |
| 628 | 2. Five members appointed by and serving at the pleasure |
| 629 | of the President of the Senate, consisting of representatives of |
| 630 | employers, insurers, health care providers, health insurance |
| 631 | agents, and individual participants. |
| 632 | 3. Five members appointed by and serving at the pleasure |
| 633 | of the Speaker of the House of Representatives, consisting of |
| 634 | representatives of employers, insurers, health care providers, |
| 635 | health insurance agents, and individual participants. |
| 636 | (b) Members shall be appointed for terms of up to 3 years. |
| 637 | Any member is eligible for reappointment. A vacancy on the board |
| 638 | shall be filled for the unexpired portion of the term in the |
| 639 | same manner as the original appointment. |
| 640 | (c) The board shall select a chief executive officer for |
| 641 | the corporation who shall be responsible for the selection of |
| 642 | such other staff as may be authorized by the corporation's |
| 643 | operating budget as adopted by the board. |
| 644 | (d) Board members are entitled to receive, from funds of |
| 645 | the corporation, reimbursement for per diem and travel expenses |
| 646 | as provided by s. 112.061. No other compensation is authorized. |
| 647 | (e) There shall be no liability on the part of, and no |
| 648 | cause of action shall arise against, any member of the board or |
| 649 | its employees or agents for any action taken by them in the |
| 650 | performance of their powers and duties under this section. |
| 651 | (f) The board shall develop and adopt bylaws and other |
| 652 | corporate procedures as necessary for the operation of the |
| 653 | corporation and carrying out the purposes of this section. The |
| 654 | bylaws shall: |
| 655 | 1. Specify procedures for selection of officers and |
| 656 | qualifications for reappointment, provided that no board member |
| 657 | shall serve more than 9 consecutive years. |
| 658 | 2. Require an annual membership meeting that provides an |
| 659 | opportunity for input and interaction with individual |
| 660 | participants in the program. |
| 661 | 3. Specify policies and procedures regarding conflicts of |
| 662 | interest, including prohibiting a member from participating in |
| 663 | any decision that would inure to the benefit of the member or |
| 664 | the organization that employs the member. The policies and |
| 665 | procedures shall also require public disclosure of the interest |
| 666 | that prevents the member from participating in a decision on a |
| 667 | particular matter. |
| 668 | (g) The corporation may exercise all powers granted to it |
| 669 | under chapter 617 necessary to carry out the purposes of this |
| 670 | section, including, but not limited to, the power to receive and |
| 671 | accept grants, loans, or advances of funds from any public or |
| 672 | private agency and to receive and accept from any source |
| 673 | contributions of money, property, labor, or any other thing of |
| 674 | value to be held, used, and applied for the purposes of this |
| 675 | section. |
| 676 | (h) The corporation shall: |
| 677 | 1. Determine eligibility of employers, vendors, |
| 678 | individuals, and agents in accordance with subsection (4). |
| 679 | 2. Establish procedures necessary for the operation of the |
| 680 | program, including, but not limited to, procedures for |
| 681 | application, enrollment, risk assessment, risk adjustment, plan |
| 682 | administration, performance monitoring, and consumer education. |
| 683 | 3. Arrange for collection of contributions from |
| 684 | participating employers and individuals. |
| 685 | 4. Arrange for payment of premiums and other appropriate |
| 686 | disbursements based on the selections of products and services |
| 687 | by the individual participants. |
| 688 | 5. Establish criteria for disenrollment of participating |
| 689 | individuals based on failure to pay the individual's share of |
| 690 | any contribution required to maintain enrollment in selected |
| 691 | products. |
| 692 | 6. Establish criteria for exclusion of vendors pursuant to |
| 693 | paragraph (4)(d). |
| 694 | 7. Develop and implement a plan for promoting public |
| 695 | awareness of and participation in the program. |
| 696 | 8. Secure staff and consultant services necessary to the |
| 697 | operation of the program. |
| 698 | 9. Establish policies and procedures regarding |
| 699 | participation in the program for individuals, vendors, health |
| 700 | insurance agents, and employers. |
| 701 | 10. Develop a plan, in coordination with the Department of |
| 702 | Revenue, to establish tax credits or refunds for employers that |
| 703 | participate in the program. The corporation shall submit the |
| 704 | plan to the Governor, the President of the Senate, and the |
| 705 | Speaker of the House of Representatives no later than January 1, |
| 706 | 2009. |
| 707 | 11. Beginning in fiscal year 2009-2010, submit by February |
| 708 | 1 an annual report to the Governor, the President of the Senate, |
| 709 | and the Speaker of the House of Representatives documenting the |
| 710 | corporation's activities in compliance with the duties |
| 711 | delineated in this section. |
| 712 | (i) To ensure program integrity and to safeguard the |
| 713 | financial transactions made under the auspices of the program, |
| 714 | the corporation is authorized to establish qualifying criteria |
| 715 | and certification procedures for vendors, require performance |
| 716 | bonds or other guarantees of ability to complete contractual |
| 717 | obligations, monitor the performance of vendors, and enforce the |
| 718 | agreements of the program through financial penalty or |
| 719 | disqualification from the program. |
| 720 | Section 5. Subsection (22) of section 409.811, Florida |
| 721 | Statutes, is amended to read: |
| 722 | 409.811 Definitions relating to Florida Kidcare Act.--As |
| 723 | used in ss. 409.810-409.820, the term: |
| 724 | (22) "Premium assistance payment" means the monthly |
| 725 | consideration paid by the agency per enrollee in the Florida |
| 726 | Kidcare program towards health insurance premiums and may |
| 727 | include the direct payment of the premium for a qualifying child |
| 728 | to be covered as a dependent under an employer-sponsored group |
| 729 | family plan when such payment does not exceed the payment |
| 730 | required for an enrollee in the Florida Kidcare program. |
| 731 | Section 6. Section 624.1265, Florida Statutes, is created |
| 732 | to read: |
| 733 | 624.1265 Nonprofit religious organization exemption; |
| 734 | authority; notice.-- |
| 735 | (1) Any nonprofit religious organization that qualifies |
| 736 | under Title 26, s. 501 of the Internal Revenue Code of 1986, as |
| 737 | amended; that limits its participants to members of the same |
| 738 | religion; that acts as an organizational clearinghouse for |
| 739 | information between participants who have financial, physical, |
| 740 | or medical needs and participants with the ability to pay for |
| 741 | the benefit of those participants with financial, physical, or |
| 742 | medical needs; that provides for the financial or medical needs |
| 743 | of a participant through payments directly from one participant |
| 744 | to another; and that suggests amounts that participants may |
| 745 | voluntarily give with no assumption of risk or promise to pay |
| 746 | either among the participants or between the participants and |
| 747 | the organization are not subject to any requirements of the |
| 748 | Florida Insurance Code. |
| 749 | (2) Nothing in this section prevents the organization |
| 750 | described in subsection (1) from establishing qualifications of |
| 751 | participation relating to the health of a prospective |
| 752 | participant, prevents a participant from limiting the financial |
| 753 | or medical needs that may be eligible for payment, or prevents |
| 754 | the organization from canceling the membership of a participant |
| 755 | when such participant indicates his or her unwillingness to |
| 756 | participate by failing to make a payment to another participant |
| 757 | for a period in excess of 60 days. |
| 758 | (3) The organization described in subsection (1) shall |
| 759 | provide each prospective participant in the organizational |
| 760 | clearinghouse written notice that the organization is not an |
| 761 | insurance company, that membership is not offered through an |
| 762 | insurance company, and that the organization is not subject to |
| 763 | the regulatory requirements or consumer protections of the |
| 764 | Florida Insurance Code. |
| 765 | Section 7. Section 627.6562, Florida Statutes, is amended |
| 766 | to read: |
| 767 | 627.6562 Dependent coverage.-- |
| 768 | (1) If an insurer offers coverage that insures dependent |
| 769 | children of the policyholder or certificateholder, the policy |
| 770 | must insure a dependent child of the policyholder or |
| 771 | certificateholder at least until the end of the calendar year in |
| 772 | which the child reaches the age of 25, if the child meets all of |
| 773 | the following: |
| 774 | (a) The child is dependent upon the policyholder or |
| 775 | certificateholder for support. |
| 776 | (b) The child is living in the household of the |
| 777 | policyholder or certificateholder, or the child is a full-time |
| 778 | or part-time student. |
| 779 | (2) A policy that is subject to the requirements of |
| 780 | subsection (1) must also offer the policyholder or |
| 781 | certificateholder the option to insure a child of the |
| 782 | policyholder or certificateholder at least until the end of the |
| 783 | calendar year in which the child reaches the age of 30, if the |
| 784 | child: |
| 785 | (a) Is unmarried and does not have a dependent of his or |
| 786 | her own; |
| 787 | (b) Is a resident of this state or a full-time or part- |
| 788 | time student; and |
| 789 | (c) Is not provided coverage as a named subscriber, |
| 790 | insured, enrollee, or covered person under any other group, |
| 791 | blanket, or franchise health insurance policy or individual |
| 792 | health benefits plan, or entitled to benefits under Title XVIII |
| 793 | of the Social Security Act. |
| 794 | (3) If, pursuant to subsection (2), a child is provided |
| 795 | coverage under the parent's policy after the end of the calendar |
| 796 | year in which the child reaches age 25, and coverage for the |
| 797 | child is subsequently terminated, the child is not eligible to |
| 798 | be covered under the parent's policy unless the child was |
| 799 | continuously covered by other creditable coverage without a gap |
| 800 | in coverage of more than 63 days. For the purposes of this |
| 801 | subsection, the term "creditable coverage" has the same meaning |
| 802 | as defined in s. 627.6561(5). |
| 803 | (4)(2) Nothing in This section does not affect or preempt |
| 804 | affects or preempts an insurer's right to medically underwrite |
| 805 | or charge the appropriate premium. (b) Require coverage |
| 806 | for services provided to a dependent before October 1, 2008. |
| 807 | (c) Require an employer to pay all or part of the cost of |
| 808 | coverage provided for a dependent under this section. |
| 809 | (d) Prohibit an insurer or health maintenance organization |
| 810 | from increasing the limiting age for dependent coverage to age |
| 811 | 30 in policies or contracts issued or renewed prior to the |
| 812 | effective date of this act. |
| 813 | (5) Until April 1, 2009, a dependent child who qualifies |
| 814 | for coverage under subsection (1) but whose coverage as a |
| 815 | dependent child under a covered person's plan terminated under |
| 816 | the terms of the plan before October 1, 2008, may make a written |
| 817 | election to reinstate coverage, without proof of insurability, |
| 818 | under that plan as a dependent child pursuant to this section. |
| 819 | All other dependent children who qualify for coverage under |
| 820 | subsection (1) shall be automatically covered at least until the |
| 821 | end of the calendar year in which the child reaches the age of |
| 822 | 30, unless the covered person provides the group policyholder |
| 823 | with written evidence the dependent child is married, is not a |
| 824 | resident of the state, is covered under a separate comprehensive |
| 825 | health insurance policy or a health benefit plan, is entitled to |
| 826 | benefits under Title XVIII of the Social Security Act, Pub. L. |
| 827 | No. 89-97, 42 U.S.C. ss. 1935 et seq., or is eligible for |
| 828 | coverage as an employee under an employer-sponsored health plan. |
| 829 | (6) The covered person's plan may require the payment of a |
| 830 | premium by the covered person or dependent child, as |
| 831 | appropriate, subject to the approval of the Office of Insurance |
| 832 | Regulation, for any period of coverage relating to a dependent's |
| 833 | written election for coverage pursuant to subsection (3). |
| 834 | (7) Notice regarding the reinstatement of coverage for a |
| 835 | dependent child as provided under this section must be provided |
| 836 | to a covered person in the certificate of coverage prepared for |
| 837 | covered persons by the insurer or by the covered person's |
| 838 | employer. The notice shall be given as soon as practicable after |
| 839 | July 1, 2008, and such notice may be given through the group |
| 840 | policyholder. |
| 841 | (8) This section does not apply to accident only, |
| 842 | specified disease, disability income, Medicare supplement, or |
| 843 | long-term care insurance policies. |
| 844 | (9) This section applies to all group, blanket, and |
| 845 | franchise health insurance policies covering residents of this |
| 846 | state, including, but not limited to, policies in which the |
| 847 | carrier has reserved the right to change the premium. This |
| 848 | section applies to all individual, group, blanket, and franchise |
| 849 | health insurance policies and health maintenance contracts |
| 850 | issued, renewed, or amended after October 1, 2008. |
| 851 | Section 8. Subsections (1), (4), and (6) of section |
| 852 | 641.402, Florida Statutes, are amended to read: |
| 853 | 641.402 Definitions.--As used in this part, the term: |
| 854 | (1) "Basic services" includes any of the following: |
| 855 | limited hospital inpatient services, which may include hospital |
| 856 | inpatient physician services, up to a maximum of coverage |
| 857 | benefit of 5 days and a maximum dollar amount of coverage of |
| 858 | $15,000 per calendar year; emergency care;, physician care other |
| 859 | than hospital inpatient physician services;, ambulatory |
| 860 | diagnostic treatment;, and preventive health care services. |
| 861 | (4) "Prepaid health clinic" means any organization |
| 862 | authorized under this part which provides, either directly or |
| 863 | through arrangements with other persons, basic services to |
| 864 | persons enrolled with such organization, on a prepaid per capita |
| 865 | or prepaid aggregate fixed-sum basis, including those basic |
| 866 | services described in this part which subscribers might |
| 867 | reasonably require to maintain good health. However, no clinic |
| 868 | that provides or contracts for, either directly or indirectly, |
| 869 | inpatient hospital services, hospital inpatient physician |
| 870 | services, or indemnity against the cost of such services shall |
| 871 | be a prepaid health clinic. |
| 872 | (6) "Provider" means any physician or person other than a |
| 873 | hospital that furnishes health care services under this part and |
| 874 | is licensed or authorized to practice in this state. |
| 875 | Section 9. This act shall take effect upon becoming a law. |
| 876 |
|
| 877 |
|
| 878 |
|
| 879 | ----------------------------------------------------- |
| 880 | T I T L E A M E N D M E N T |
| 881 | Remove the entire title and insert: |
| 882 | Remove the entire title and insert: |
| 883 | A bill to be entitled |
| 884 | An act relating to affordable health coverage; amending s. |
| 885 | 112.363, F.S.; specifying that coverage provided through |
| 886 | the Cover Florida Health Care Access Program is considered |
| 887 | health insurance coverage for the purposes of determining |
| 888 | eligibility for the state retiree health insurance |
| 889 | subsidy; amending s. 408.909, F.S.; revising eligibility |
| 890 | requirements; providing cetain exemptions from the 6-month |
| 891 | lapse in coverage requirement; extending the expiration |
| 892 | date of the health flex plan; creating s. 408.9091, F.S.; |
| 893 | creating the Cover Florida Health Care Access Program; |
| 894 | providing a short title; providing legislative intent; |
| 895 | providing definitions; requiring the agency and the Office |
| 896 | of Insurance Regulation of the Financial Services |
| 897 | Commission within the Department of Financial Services to |
| 898 | jointly administer the program; providing program |
| 899 | requirements; requiring the development of guidelines to |
| 900 | meet minimum standards for quality of care and access to |
| 901 | care; requiring the agency to ensure that the Cover |
| 902 | Florida plans follow standardized grievance procedures; |
| 903 | requiring the office and the agency to oversee changes to |
| 904 | plan benefits; requiring the Executive Office of the |
| 905 | Governor, the agency, and the office to develop a public |
| 906 | awareness program; authorizing public and private entities |
| 907 | to design programs to encourage or extend incentives for |
| 908 | participation in the Cover Florida Health Care Access |
| 909 | Program; requiring the agency and the office to announce |
| 910 | an invitation to negotiate for Cover Florida plan entities |
| 911 | to design a coverage proposal; requiring the invitation to |
| 912 | negotiate to include certain guidelines; providing certain |
| 913 | conditions under which plans are disapproved or withdrawn; |
| 914 | authorizing the agency and the office to announce an |
| 915 | invitation to negotiate for companies that offer |
| 916 | supplemental insurance or discount medical plans; |
| 917 | requiring the agency and the office to approve at least |
| 918 | one plan entity; authorizing the agency and the office to |
| 919 | approve one regional network plan in each existing |
| 920 | Medicaid area; providing that certain licensing |
| 921 | requirements are not applicable to a Cover Florida plan; |
| 922 | providing that Cover Florida plans are considered |
| 923 | insurance under certain conditions; excluding Cover |
| 924 | Florida plans from the Florida Life and Health Insurance |
| 925 | Guaranty Association and the Health Maintenance |
| 926 | Organization Consumer Assistance Plan; providing |
| 927 | requirements for eligibility for a Cover Florida plan; |
| 928 | requiring each Cover Florida plan to maintain and provide |
| 929 | certain records; providing that coverage under a Cover |
| 930 | Florida plan is not an entitlement and does not give rise |
| 931 | to a cause of action; requiring the agency and the office |
| 932 | to evaluate the program and submit an annual report to the |
| 933 | Governor and the Legislature; authorizing the agency and |
| 934 | the Financial Services Commission to adopt rules; creating |
| 935 | s. 408.910, F.S.; establishing the Florida Health Choices |
| 936 | Program; providing legislative intent; providing |
| 937 | definitions; providing program purpose and components; |
| 938 | providing employer eligibility criteria; providing |
| 939 | individual eligibility criteria; providing employer |
| 940 | enrollment criteria; providing vendor, product, and |
| 941 | service eligibility criteria; providing for individual |
| 942 | participation regardless of subsequent job status or |
| 943 | Medicaid eligibility; providing individual enrollment |
| 944 | criteria; providing vendor enrollment criteria; providing |
| 945 | for participation by health insurance agents; providing |
| 946 | criteria for products available for purchase; providing |
| 947 | criteria for product pricing; providing for an |
| 948 | administrative surcharge; providing for an exchange |
| 949 | process; providing for enrollment periods and changes in |
| 950 | selected products; providing methods for the pooling of |
| 951 | risk; providing for exemptions from certain statutory |
| 952 | provisions, mandated offerings and coverages, and |
| 953 | licensing requirements; creating the Florida Health |
| 954 | Choices, Inc.; requiring the department to supervise any |
| 955 | liquidation or dissolution of the corporation; providing |
| 956 | for corporate governance and board membership and terms; |
| 957 | providing for reimbursement for per diem and travel |
| 958 | expenses; providing for powers and duties of the |
| 959 | corporation; requiring the corporation to coordinate with |
| 960 | the Department of Revenue to develop a plan by January 1, |
| 961 | 2009, for creating tax exemptions or refunds for |
| 962 | participating in the program; requiring the corporation to |
| 963 | submit an annual report to the Governor and Legislature; |
| 964 | authorizing the corporation to establish and enforce |
| 965 | certain program integrity measures; amending s. 409.811, |
| 966 | F.S.; revising the definition of the term "premium |
| 967 | assistance payment"; creating s. 624.1265, F.S.; exempting |
| 968 | certain nonprofit religious organizations from |
| 969 | requirements of the Florida Insurance Code; preserving |
| 970 | certain authority of such organizations; requiring such |
| 971 | organizations to provide certain notice to prospective |
| 972 | participants; providing notice requirements; amending s. |
| 973 | 627.6562, F.S.; requiring insurance policies that provide |
| 974 | dependent coverage to provide the policyholder with the |
| 975 | option of insuring a child until the age of 30 under |
| 976 | certain circumstances; amending s. 627.6699, F.S.; |
| 977 | requiring participation of employees in health maintenance |
| 978 | contracts or policies issued or renewed after a specified |
| 979 | date; providing conditions for employers and employees to |
| 980 | opt out of such coverage; amending s. 641.402, F.S.; |
| 981 | revising the definition of the term "basic services" to |
| 982 | include certain hospital inpatient services; revising the |
| 983 | definitions of the terms "prepaid health clinic" and |
| 984 | "provider"; providing an effective date. |
| 985 |
|