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A bill to be entitled

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An act relating to health insurance; amending s. 408.909,

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F.S.; expanding the definition of "health flex plan" to

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include those who purchase coverage as an individual;

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authorizing a health flex plan to limit or exclude certain

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provider network requirements; providing that a health

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flex plan offering may include the option of a

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catastrophic plan supplementing the health flex plan;

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revising requirements for eligibility to enroll in a

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health flex plan; extending the date of expiration of

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certain provisions of state law regarding health flex

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plans; amending s. 409.811, F.S.; expanding the definition

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of "premium assistance payment" to include the direct

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payment of the premium for a qualifying child to be

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covered as a dependent under an employer-sponsored group

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family plan when such payment does not exceed the payment

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required for an enrollee in the Florida Kidcare program;

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amending s. 627.6562, F.S.; requiring that certain health

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insurance policies insure a dependent child of the

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policyholder or certificateholder for a specified period

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under certain conditions; limiting certain coverage

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requirements; preserving certain rights of insurers,

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employers, and health maintenance organizations; providing

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that dependent children meeting certain criteria may,

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within a specified period, make a written election to

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reinstate coverage, without proof of insurability, under

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that plan as a dependent child; providing for coverage for

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certain other dependent children; providing that a plan

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may require the payment of a premium by the insured or

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dependent child, subject to the approval of the Office of

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Insurance Regulation, for any period of coverage relating

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to a dependent's written election of coverage; requiring

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that notice be sent to an insured regarding the

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reinstatement of coverage for a dependent child; providing

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requirements for such notice; limiting the application of

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certain provisions of state law to certain insurance

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policies; amending s. 627.602, F.S.; requiring that

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policies insuring dependent children of a policyholder

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comply with certain provisions of state law; amending ss.

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641.31, 627.653, and 627.6699, F.S.; requiring that all

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health maintenance contracts providing coverage for a

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member of the subscriber's family comply with certain

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provisions of state law; requiring that, for all policies

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issued or renewed after a specified date, all eligible

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employees and their dependents be enrolled for coverage at

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the time of issuance of a policy or during the next open

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or special enrollment period, unless the employer chooses

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otherwise or the employee provides written notice to the

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employer declining coverage; requiring that such notice

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contain certain information; requiring that such notice be

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retained by the employer as part of the employee's

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employment or insurance file; authorizing an employer to

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require its employees to participate in its group health

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plan as a condition of employment; providing effective

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dates.

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Be It Enacted by the Legislature of the State of Florida:

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     Section 1.  Paragraph (e) of subsection (2) and subsections

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(3), (5), and (10) of section 408.909, Florida Statutes, are

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amended to read:

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     408.909  Health flex plans.--

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     (2)  DEFINITIONS.--As used in this section, the term:

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     (e)  "Health flex plan" means a health plan approved under

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subsection (3) which guarantees payment for specified health care

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coverage provided to the enrollee who purchases coverage directly

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from the plan as an individual or as a small business, or through

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a small business purchasing arrangement sponsored by a local

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government.

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     (3)  PROGRAM.--The agency and the office shall each approve

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or disapprove health flex plans that provide health care coverage

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for eligible participants. A health flex plan may limit or

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exclude benefits or provider network requirements otherwise

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required by law for insurers offering coverage in this state, may

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cap the total amount of claims paid per year per enrollee, may

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limit the number of enrollees, or may take any combination of

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those actions. A health flex plan offering may include the option

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of a catastrophic plan or a catastrophic plan supplementing the

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health flex plan.

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     (a)  The agency shall develop guidelines for the review of

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applications for health flex plans and shall disapprove or

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withdraw approval of plans that do not meet or no longer meet

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minimum standards for quality of care and access to care. The

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agency shall ensure that the health flex plans follow

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standardized grievance procedures similar to those required of

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health maintenance organizations.

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     (b)  The office shall develop guidelines for the review of

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health flex plan applications and provide regulatory oversight of

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health flex plan advertisement and marketing procedures. The

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office shall disapprove or shall withdraw approval of plans that:

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     1.  Contain any ambiguous, inconsistent, or misleading

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provisions or any exceptions or conditions that deceptively

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affect or limit the benefits purported to be assumed in the

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general coverage provided by the health flex plan;

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     2.  Provide benefits that are unreasonable in relation to

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the premium charged or contain provisions that are unfair or

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inequitable or contrary to the public policy of this state, that

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encourage misrepresentation, or that result in unfair

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discrimination in sales practices;

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     3.  Cannot demonstrate that the health flex plan is

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financially sound and that the applicant is able to underwrite or

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finance the health care coverage provided; or

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     4.  Cannot demonstrate that the applicant and its management

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are in compliance with the standards required under s.

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624.404(3).

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     (c)  The agency and the Financial Services Commission may

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adopt rules as needed to administer this section.

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     (5)  ELIGIBILITY.--Eligibility to enroll in an approved

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health flex plan is limited to residents of this state who:

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     (a)1. Are 64 years of age or younger;

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     2.(b) Have a family income equal to or less than 300 200

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percent of the federal poverty level;

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     (c) Are eligible under a federally approved Medicaid

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demonstration waiver and reside in Palm Beach County or Miami-

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Dade County;

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     3.(d) Are not covered by a private insurance policy and are

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not eligible for coverage through a public health insurance

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program, such as Medicare or Medicaid, unless specifically

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authorized under paragraph (c), or another public health care

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program, such as Kidcare, and have not been covered at any time

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during the past 6 months; and

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     4.(e) Have applied for health care coverage through an

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approved health flex plan and have agreed to make any payments

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required for participation, including periodic payments or

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payments due at the time health care services are provided.

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     (b) Are part of an employer group in which at least 75

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percent of the employees have a family income equal to or less

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than 300 percent of the federal poverty level, and the employee

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group is not covered by a private health insurance policy and has

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not been covered at any time during the immediately preceding 6

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months. If the health flex plan entity is a health insurer,

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health plan, or health maintenance organization properly licensed

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under Florida law, only 50 percent of the employees must meet the

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income requirements of this paragraph.

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     (10) EXPIRATION.--This section expires July 1, 2014 2008.

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     Section 2.  Subsection (22) of section 409.811, Florida

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Statutes, is amended to read:

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     409.811  Definitions relating to Florida Kidcare Act.--As

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used in ss. 409.810-409.820, the term:

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     (22)  "Premium assistance payment" means the monthly

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consideration paid by the agency per enrollee in the Florida

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Kidcare program towards health insurance premiums and may include

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the direct payment of the premium for a qualifying child to be

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covered as a dependent under an employer-sponsored group family

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plan, when such payment does not exceed the payment required for

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an enrollee in the program.

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     Section 3.  Section 627.6562, Florida Statutes, is amended

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to read:

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     627.6562  Dependent coverage.--

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     (1) If an insurer offers coverage under a group, blanket,

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or franchise health insurance policy that insures dependent

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children of the policyholder or certificateholder, the policy

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must insure a dependent child of the policyholder or

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certificateholder at least until the end of the calendar year in

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which the child reaches the age of 30 25, if the child meets all

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of the following:

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     (a) Is unmarried and does not have a dependent of his or

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her own; The child is dependent upon the policyholder or

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certificateholder for support.

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     (b) Is a resident of this state; and The child is living in

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the household of the policyholder or certificateholder, or the

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child is a full-time or part-time student.

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     (c) Is not actually provided coverage as a named

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subscriber, insured, enrollee, or covered person under any other

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group, blanket, or franchise health insurance policy or

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individual health benefits plan, or is not entitled to benefits

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under Title XVIII of the Social Security Act.

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     (2) Nothing in This section does not:

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     (a) Affect or preempt affects or preempts an insurer's

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right to medically underwrite or charge the appropriate premium.

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     (b) Require coverage for services provided to a dependent

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before October 1, 2008.

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     (c) Require that an employer pay all or part of the cost of

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coverage provided for a dependent under this section.

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     (d) Prohibit an insurer or health maintenance organization

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from increasing the limiting age for dependent coverage to age 30

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for policies or contracts issued or renewed before October 1,

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2008.

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     (3) Until April 1, 2009, a dependent child who qualifies

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for coverage under subsection (1) but whose coverage as a

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dependent child under a insured's plan terminated under the terms

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of the plan before October 1, 2008, may make a written election

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to reinstate coverage, without proof of insurability, under that

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plan as a dependent child. All other dependent children who

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qualify for coverage under subsection (1) shall be automatically

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covered at least until the end of the calendar year in which the

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child reaches age 30, unless the insured provides the group

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policyholder with written evidence that the dependent child is

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married, is not a resident of Florida, is covered under a

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separate comprehensive health insurance policy, is covered under

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a health benefit plan, or is entitled to benefits under Title

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XVIII of the Social Security Act.

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     (4) The insured's plan may require the payment of a premium

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by the insured or dependent child, as appropriate, subject to the

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approval of the Office of Insurance Regulation, for any period of

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coverage relating to a dependent's written election of coverage

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pursuant to paragraph (3).

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     (5) Notice regarding the reinstatement of coverage for a

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dependent child as provided in this section must be provided to

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an insured in the certificate of coverage prepared for such

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insureds by the insurer or by the insured's employer. The notice

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regarding the opportunity for reinstatement of coverage for a

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dependent child shall be given as soon as practicable after July

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1, 2008, and such notice may be given through the group

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policyholder.

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     (6) This section does not apply to accident only,

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specified-disease, disability income, Medicare supplement, or

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long-term-care insurance policies.

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     (7) This section applies to all group, blanket, or

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franchise health insurance policies covering residents of this

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state, including, but not limited to, policies in which the

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carrier has reserved the right to change the premium.

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     Section 4.  Paragraph (c) of subsection (1) of section

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627.602, Florida Statutes, is amended to read:

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     627.602  Scope, format of policy.--

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     (1)  Each health insurance policy delivered or issued for

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delivery to any person in this state must comply with all

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applicable provisions of this code and all of the following

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requirements:

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     (c)  The policy may purport to insure only one person,

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except that upon the application of an adult member of a family,

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who is deemed to be the policyholder, a policy may insure, either

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originally or by subsequent amendment, any eligible members of

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that family, including husband, wife, any children or any person

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dependent upon the policyholder. If an insurer offers coverage

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for dependent children of the policyholder, such policy must

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comply with the provisions of s. 627.6562.

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     Section 5.  Subsections (41) and (42) are added to section

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641.31, Florida Statutes, to read:

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     641.31  Health maintenance contracts.--

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     (41) All health maintenance contracts providing coverage

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for a member of the subscriber's family must comply with the

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provisions of s. 627.6562.

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     (42) Unless the employer chooses otherwise, for all

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policies issued or renewed after October 1, 2008, all eligible

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employees and their dependents shall be enrolled for coverage at

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the time of issuance or during the next open or special

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enrollment period, unless the employee provides written notice to

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the employer declining coverage. Such notice must include

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evidence of coverage under an existing group insurance policy or

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group health benefit plan, or reasons for declining coverage.

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Such notice shall be retained by the employer as part of the

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employee's employment or insurance file. An employer may require

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its employees to participate in its group health plan as a

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condition of employment.

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     Section 6.  Present subsection (4) of section 627.653,

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Florida Statutes, is renumbered as subsection (5), and a new

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subsection (4) is added to that section, to read:

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     627.653  Employee groups.--

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     (4) Unless the employer chooses otherwise, for all policies

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issued or renewed after October 1, 2008, all eligible employees

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and their dependents shall be enrolled for coverage at the time

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of issuance or during the next open or special enrollment period,

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unless the employee provides written notice to the employer

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declining coverage. Such notice must include evidence of coverage

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under an existing group insurance policy or group health benefit

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plan, or reasons for declining coverage. Such notice shall be

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retained by the employer as part of the employee's employment or

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insurance file. An employer may require its employees to

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participate in its group health plan as a condition of

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employment.

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     Section 7.  Paragraph (h) of subsection (5) of section

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627.6699, Florida Statutes, is amended to read:

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     627.6699  Employee Health Care Access Act.--

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     (5)  AVAILABILITY OF COVERAGE.--

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     (h)  All health benefit plans issued under this section must

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comply with the following conditions:

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     1.  For employers who have fewer than two employees, a late

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enrollee may be excluded from coverage for no longer than 24

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months if he or she was not covered by creditable coverage

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continually to a date not more than 63 days before the effective

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date of his or her new coverage.

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     2.  Any requirement used by a small employer carrier in

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determining whether to provide coverage to a small employer

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group, including requirements for minimum participation of

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eligible employees and minimum employer contributions, must be

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applied uniformly among all small employer groups having the same

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number of eligible employees applying for coverage or receiving

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coverage from the small employer carrier, except that a small

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employer carrier that participates in, administers, or issues

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health benefits pursuant to s. 381.0406 which do not include a

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preexisting condition exclusion may require as a condition of

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offering such benefits that the employer has had no health

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insurance coverage for its employees for a period of at least 6

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months. A small employer carrier may vary application of minimum

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participation requirements and minimum employer contribution

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requirements only by the size of the small employer group.

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     3. Unless the employer chooses otherwise, for all policies

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issued or renewed after October 1, 2008, all eligible employees

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and their dependents shall be enrolled for coverage at the time

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of issuance or during the next open or special enrollment period,

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unless the employee provides written notice to the employer

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declining coverage. Such notice must include evidence of coverage

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under an existing group insurance policy or group health benefit

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plan, or reasons for declining coverage. Such notice shall be

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retained by the employer as part of the employee's employment or

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insurance file. An employer may require its employees to

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participate in its group health plan as a condition of

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employment.

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     4.3. In applying minimum participation requirements with

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respect to a small employer, a small employer carrier shall not

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consider as an eligible employee employees or dependents who have

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qualifying existing coverage in an employer-based group insurance

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plan or an ERISA qualified self-insurance plan in determining

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whether the applicable percentage of participation is met.

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However, a small employer carrier may count eligible employees

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and dependents who have coverage under another health plan that

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is sponsored by that employer.

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     5.4. A small employer carrier shall not increase any

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requirement for minimum employee participation or any requirement

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for minimum employer contribution applicable to a small employer

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at any time after the small employer has been accepted for

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coverage, unless the employer size has changed, in which case the

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small employer carrier may apply the requirements that are

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applicable to the new group size.

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     6.5. If a small employer carrier offers coverage to a small

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employer, it must offer coverage to all the small employer's

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eligible employees and their dependents. A small employer carrier

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may not offer coverage limited to certain persons in a group or

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to part of a group, except with respect to late enrollees.

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     7.6. A small employer carrier may not modify any health

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benefit plan issued to a small employer with respect to a small

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employer or any eligible employee or dependent through riders,

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endorsements, or otherwise to restrict or exclude coverage for

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certain diseases or medical conditions otherwise covered by the

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health benefit plan.

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     8.7. An initial enrollment period of at least 30 days must

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be provided. An annual 30-day open enrollment period must be

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offered to each small employer's eligible employees and their

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dependents. A small employer carrier must provide special

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enrollment periods as required by s. 627.65615.

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     Section 8.  This act shall take effect upon becoming a law,

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except that sections 2, 3, and 4 shall take effect October 1,

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2008, and shall apply to all individual, group, blanket, and

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franchise health insurance policies issued or amended on or after

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that date.