CS for CS for SB 2534 Third Engrossed

20082534e3

A bill to be entitled

An act relating to health insurance; amending s. 112.363,

F.S.; specifying that coverage provided through the Cover

Florida Health Care Access Program is considered health

insurance coverage for the purposes of determining

eligibility for the state retiree health insurance

subsidy; amending s. 408.909, F.S.; revising eligibility

for enrollment in a health flex plan; revising the

expiration date of the health flex plan program; creating

s. 408.9091, F.S.; creating the Cover Florida Health Care

Access Program; providing a short title; providing

legislative intent; providing definitions; requiring the

Agency for Health Care Administration and the Office of

Insurance Regulation of the Financial Services Commission

within the Department of Financial Services to jointly

administer the program; providing program requirements;

requiring the development of guidelines to meet minimum

standards for quality of care and access to care;

requiring the agency to ensure that the Cover Florida

plans follow standardized grievance procedures; requiring

the Executive Office of the Governor, the agency, and the

office to develop a public awareness program; authorizing

public and private entities to design or extend incentives

for participation in the Cover Florida Access Program;

requiring the agency and the office to announce an

invitation to negotiate for Cover Florida plan entities to

design a coverage proposal; requiring the agency and the

office to approve one plan entity; authorizing the agency

and the office to approve one regional network plan in

each existing Medicaid area; requiring the invitation to

negotiate to include certain guidelines; providing certain

conditions in which plans are disapproved or withdrawn;

authorizing the agency and the office to announce an

invitation to negotiate for companies that offer

supplemental insurance or discount medical plans;

providing that certain licensing requirements or ch. 641,

F.S., are not applicable to a Cover Florida plan;

providing that Cover Florida plans are considered

insurance under certain conditions; excluding Cover

Florida plans from the Florida Life and Health Insurance

Guaranty Association and the Health Maintenance

Organization Consumer Assistance Plan; providing

requirements for eligibility in a Cover Florida plan;

requiring each Cover Florida plan to maintain and provide

certain records; providing that coverage under a Cover

Florida plan is not an entitlement and does not give rise

to a cause of action; requiring the agency and the office

to evaluate the Cover Florida program and submit an annual

report to the Governor and the Legislature; requiring the

agency and the Financial Services Commission to adopt

rules; creating s. 408.910, F.S.; establishing the Florida

Health Choices Program; providing legislative intent;

providing definitions; providing program purpose and

components; providing employer eligibility criteria;

providing individual eligibility criteria; providing

employer enrollment criteria; providing vendor, product,

and service eligibility criteria; providing for individual

participation regardless of subsequent job status or

Medicaid eligibility; providing vendor enrollment

criteria; providing for participation by health insurance

agents; providing criteria for products available for

purchase; providing criteria for product pricing;

providing for an administrative surcharge; providing for

an exchange process; providing for enrollment periods and

changes in selected products; requiring the corporation to

establish a website to provide information about products

and services; providing methods for the pooling of risk;

providing for exemptions from certain statutory

provisions, mandated offerings and coverages, and

licensing requirements; providing for administrators;

creating the Florida Health Choices, Inc.; requiring the

department to supervise any liquidation or dissolution of

the corporation; providing for corporate governance and

board membership and terms; providing for reimbursement

for per diem and travel expenses; providing for powers and

duties of the corporation; requiring the corporation to

coordinate with the Department of Revenue to develop a

plan by January 1, 2009, for creating tax exemptions or

refunds for participating in the program; requiring the

corporation to submit an annual report to the Governor and

Legislature; authorizing the corporation to establish and

enforce certain program integrity measures; amending s.

409.814, F.S.; revising the eligibility requirements for

participation in the Medikids program or the Florida

Healthy Kids program; deleting certain limitations;

creating s. 624.1265, F.S.; exempting certain nonprofit

religious organizations from requirements of the Florida

Insurance Code; preserving certain authority of such

organizations; requiring such organizations to provide

certain notice to prospective participants; providing

notice requirements; amending s. 624.91, F.S.; revising

the duties of the Florida Healthy Kids Corporation;

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

health insurance policies insuring dependent children of a

policyholder comply with certain provisions of state law;

amending s. 627.6562, F.S.; requiring group health

insurance policies that provide dependent coverage to

provide the policyholder with the option of insuring a

child until the age of 30 under certain circumstances;

100

amending s. 641.31, F.S.; requiring that health

101

maintenance organization contracts providing coverage for

102

a member of the subscriber's family to comply with certain

103

provisions of state law; providing an appropriation;

104

providing an effective date.

105

106

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

107

108

Section 1. Paragraph (d) of subsection (2) of section

109

112.363, Florida Statutes, is amended to read:

110

112.363 Retiree health insurance subsidy.--

111

(2) ELIGIBILITY FOR RETIREE HEALTH INSURANCE SUBSIDY.--

112

(d) Payment of the retiree health insurance subsidy shall

113

be made only after coverage for health insurance for the retiree

114

or beneficiary has been certified in writing to the Department of

115

Management Services. Participation in a former employer's group

116

health insurance program is not a requirement for eligibility

117

under this section. Coverage issued pursuant to s. 408.9091 is

118

considered health insurance for the purposes of this section.

119

Section 2. Subsections (5) and (10) of section 408.909,

120

Florida Statutes, are amended to read:

121

408.909 Health flex plans.--

122

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

123

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

124

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

125

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

126

percent of the federal poverty level;

127

128

demonstration waiver and reside in Palm Beach County or Miami-

129

Dade County;

130

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

131

not eligible for coverage through a public health insurance

132

program, such as Medicare or Medicaid, unless specifically

133

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

134

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

135

during the past 6 months, except that:

136

a. A person who was covered under an individual health

137

maintenance contract issued by a health maintenance organization

138

licensed under part I of chapter 641 which was also an approved

139

health flex plan on October 1, 2008, may apply for coverage in

140

the same health maintenance organization's health flex plan

141

without a lapse in coverage if all other eligibility requirements

142

are met; or

143

b. A person who was covered under Medicaid or Kidcare and

144

lost eligibility for the Medicaid or Kidcare subsidy due to

145

income restrictions within 90 days prior to applying for health

146

care coverage through an approved health flex plan may apply for

147

coverage in a health flex plan without a lapse in coverage if all

148

other eligibility requirements are met; and

149

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

150

individual through an approved health flex plan and have agreed

151

to make any payments required for participation, including

152

periodic payments or payments due at the time health care

153

services are provided; or

154

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

155

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

156

than 300 percent of the federal poverty level and the employer

157

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

158

not been covered at any time during the past 6 months. If the

159

health flex plan entity is a health insurer, health plan, or

160

health maintenance organization licensed under Florida law, only

161

50 percent of the employees must meet the income requirements for

162

the purpose of this paragraph.

163

(10) EXPIRATION.--This section expires July 1, 2013 2008.

164

Section 3. Section 408.9091, Florida Statutes, is created

165

to read:

166

408.9091 Cover Florida Health Care Access Program.--

167

(1) SHORT TITLE.--This section may be cited as the "Cover

168

Florida Health Care Access Program Act."

169

(2) LEGISLATIVE INTENT.--The Legislature finds that a

170

significant number of state residents are unable to obtain

171

affordable health insurance coverage. The Legislature also finds

172

that existing health flex plan coverage has had limited

173

participation due in part to narrow eligibility restrictions as

174

well as minimal benefit options for catastrophic and emergency

175

care coverage. Therefore, it is the intent of the Legislature to

176

expand the availability of health care options for uninsured

177

residents by developing an affordable health care product that

178

emphasizes coverage for basic and preventive health care

179

services; provides inpatient hospital, urgent, and emergency care

180

services; and is offered statewide by approved health insurers,

181

health maintenance organizations, health-care-provider-sponsored

182

organizations, or health care districts.

183

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

184

(a) "Agency" means the Agency for Health Care

185

Administration.

186

(b) "Cover Florida plan" means a consumer choice benefit

187

plan approved under this section which guarantees payment or

188

coverage for specified benefits provided to an enrollee.

189

190

services that are covered as benefits under a Cover Florida plan.

191

(d) "Cover Florida plan entity" means a health insurer,

192

health maintenance organization, health-care-provider-sponsored

193

organization, or health care district that develops and

194

implements a Cover Florida plan and is responsible for

195

administering the plan and paying all claims for Cover Florida

196

plan coverage by enrollees.

197

(e) "Cover Florida Plus" means a supplemental insurance

198

product, such as for additional catastrophic coverage or dental,

199

vision, or cancer coverage, approved under this section and

200

offered to all enrollees.

201

(f) "Enrollee" means an individual who has been determined

202

to be eligible for and is receiving health insurance coverage

203

under a Cover Florida plan.

204

(g) "Office" means the Office of Insurance Regulation of

205

the Financial Services Commission.

206

(4) PROGRAM.--The agency and the office shall jointly

207

establish and administer the Cover Florida Health Care Access

208

Program.

209

(a) General Cover Florida plan components must require

210

that:

211

1. Plans are offered on a guaranteed-issue basis to

212

enrollees, subject to exclusions for preexisting conditions

213

approved by the office and the agency.

214

2. Plans are portable such that the enrollee remains

215

covered regardless of employment status or the cost-sharing of

216

premiums.

217

3. Plans provide for cost containment through limits on the

218

number of services, caps on benefit payments, and copayments for

219

services.

220

4. A Cover Florida plan entity makes all benefit plan and

221

marketing materials available in English and Spanish.

222

5. In order to provide for consumer choice, Cover Florida

223

plan entities develop two alternative benefit option plans having

224

different cost and benefit levels, including at least one plan

225

that provides catastrophic coverage.

226

6. Plans without catastrophic coverage provide coverage

227

options for services including, but not limited to:

228

a. Preventive health services, including immunizations,

229

annual health assessments, well-woman and well-care services, and

230

preventive screenings such as mammograms, cervical cancer

231

screenings, and noninvasive colorectal or prostate screenings.

232

b. Incentives for routine preventive care.

233

c. Office visits for the diagnosis and treatment of illness

234

or injury.

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d. Office surgery, including anesthesia.

236

e. Behavioral health services.

237

f. Durable medical equipment and prosthetics.

238

g. Diabetic supplies.

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7. Plans providing catastrophic coverage, at a minimum,

240

provide coverage options for all of the services listed under

241

subparagraph 6.; however, such plans may include, but are not

242

limited to, coverage options for:

243

a. Inpatient hospital stays.

244

b. Hospital emergency care services.

245

c. Urgent care services.

246

d. Outpatient facility services, outpatient surgery, and

247

outpatient diagnostic services.

248

8. All plans offer prescription drug benefit coverage, use

249

a prescription drug manager, or offer a discount drug card.

250

9. Plan enrollment materials provide information in plain

251

language on policy benefit coverage, benefit limits, cost-sharing

252

requirements, and exclusions and a clear representation of what

253

is not covered in the plan. Such enrollment materials must

254

include a standard disclosure form adopted by rule by the

255

Financial Services Commission, to be reviewed and executed by all

256

consumers purchasing Cover Florida plan coverage.

257

10. Plans offered through a qualified employer meet the

258

requirements of s. 125 of the Internal Revenue Code.

259

(b) Guidelines shall be developed to ensure that Cover

260

Florida plans meet minimum standards for quality of care and

261

access to care. The agency shall ensure that the Cover Florida

262

plans follow standardized grievance procedures.

263

264

policy forms are subject to regulatory oversight by the office

265

and the agency as provided under rules adopted by the Financial

266

Services Commission and the agency.

267

(d) The agency, the office, and the Executive Office of the

268

Governor shall develop a public awareness program to be

269

implemented throughout the state for the promotion of the Cover

270

Florida Health Care Access Program.

271

(e) Public or private entities may design programs to

272

encourage Floridians to participate in the Cover Florida Health

273

Care Access Program or to encourage employers to cosponsor some

274

share of Cover Florida plan premiums for employees.

275

(5) PLAN PROPOSALS.--The agency and the office shall

276

announce, no later than July 1, 2008, an invitation to negotiate

277

for Cover Florida plan entities to design a Cover Florida plan

278

proposal in which benefits and premiums are specified.

279

(a) The invitation to negotiate shall include guidelines

280

for the review of Cover Florida plan applications, policy forms,

281

and all associated forms and provide regulatory oversight of

282

Cover Florida plan advertisement and marketing procedures. A plan

283

shall be disapproved or withdrawn if the plan:

284

1. Contains any ambiguous, inconsistent, or misleading

285

provisions or any exceptions or conditions that deceptively

286

affect or limit the benefits purported to be assumed in the

287

general coverage provided by the plan;

288

2. Provides benefits that are unreasonable in relation to

289

the premium charged or contains provisions that are unfair or

290

inequitable, that are contrary to the public policy of this

291

state, that encourage misrepresentation, or that result in unfair

292

discrimination in sales practices;

293

3. Cannot demonstrate that the plan is financially sound

294

and that the applicant is able to underwrite or finance the

295

health care coverage provided;

296

4. Cannot demonstrate that the applicant and its management

297

are in compliance with the standards required under s.

298

624.404(3); or

299

5. Does not guarantee that enrollees may participate in the

300

Cover Florida plan entity's comprehensive network of providers,

301

as determined by the office, the agency, and the contract.

302

(b) The agency and the office may announce an invitation to

303

negotiate for the design of Cover Florida Plus products to

304

companies that offer supplemental insurance, discount medical

305

plan organizations licensed under part II of chapter 636, or

306

prepaid health clinics licensed under part II of chapter 641.

307

308

Florida plan entity having an existing statewide network of

309

providers and may approve at least one regional network plan in

310

each existing Medicaid area.

311

(6) LICENSE NOT REQUIRED.--

312

(a) The licensing requirements of the Florida Insurance

313

Code and chapter 641 relating to health maintenance organizations

314

do not apply to a Cover Florida plan approved under this section

315

unless expressly made applicable. However, for the purpose of

316

prohibiting unfair trade practices, Cover Florida plans are

317

considered to be insurance subject to the applicable provisions

318

of part IX of chapter 626 except as otherwise provided in this

319

section.

320

(b) Cover Florida plans are not covered by the Florida Life

321

and Health Insurance Guaranty Association under part III of

322

chapter 631 or by the Health Maintenance Organization Consumer

323

Assistance Plan under part IV of chapter 631.

324

(7) ELIGIBILITY.--Eligibility to enroll in a Cover Florida

325

plan is limited to residents of this state who meet all of the

326

following requirements:

327

(a) Are between 19 and 64 years of age, inclusive.

328

(b) Are not covered by a private insurance policy and are

329

not eligible for coverage through a public health insurance

330

program, such as Medicare, Medicaid, or Kidcare, unless

331

eligibility for coverage lapses due to no longer meeting income

332

or categorical requirements.

333

334

at any time during the past 6 months, unless coverage under a

335

health insurance program was terminated within the previous 6

336

months due to:

337

1. Loss of a job that provided an employer-sponsored health

338

benefit plan;

339

2. Exhaustion of coverage that was continued under COBRA or

340

continuation-of-coverage requirements under s. 627.6692;

341

3. Reaching the limiting age under the policy; or

342

4. Death of, or divorce from, a spouse who was provided an

343

employer-sponsored health benefit plan.

344

(d) Have applied for health care coverage through a Cover

345

Florida plan and have agreed to make any payments required for

346

participation, including periodic payments or payments due at the

347

time health care services are provided.

348

(8) RECORDS.--Each Cover Florida plan must maintain

349

enrollment data and provide network data and reasonable records

350

to enable the office and the agency to monitor plans and to

351

determine the financial viability of the Cover Florida plan, as

352

necessary.

353

(9) NONENTITLEMENT.--Coverage under a Cover Florida plan is

354

not an entitlement, and a cause of action does not arise against

355

the state, a local government entity, any other political

356

subdivision of the state, or the agency or the office for failure

357

to make coverage available to eligible persons under this

358

section.

359

(10) PROGRAM EVALUATION.--The agency and the office shall:

360

(a) Evaluate the Cover Florida Health Care Access Program

361

and its effect on the entities that seek approval as Cover

362

Florida plans, on the number of enrollees, and on the scope of

363

the health care coverage offered under a Cover Florida plan.

364

(b) Provide an assessment of the Cover Florida plans and

365

their potential applicability in other settings.

366

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evaluate low-income, consumer-driven benefit packages.

368

(d) Jointly submit by March 1, 2009, and annually

369

thereafter, a report to the Governor, the President of the

370

Senate, and the Speaker of the House of Representatives which

371

provides the information specified in paragraphs (a)-(c) and

372

recommendations relating to the successful implementation and

373

administration of the program.

374

(11) RULEMAKING AUTHORITY.--The agency and the Financial

375

Services Commission may adopt rules pursuant to ss. 120.536(1)

376

and 120.54 as needed to administer this section.

377

Section 4. Section 408.910, Florida Statutes, is created to

378

read:

379

408.910 Florida Health Choices Program.--

380

(1) LEGISLATIVE INTENT.--The Legislature finds that a

381

significant number of the residents of this state do not have

382

adequate access to affordable, quality health care. The

383

Legislature further finds that increasing access to affordable,

384

quality health care can be best accomplished by establishing a

385

competitive market for purchasing health insurance and health

386

services. It is therefore the intent of the Legislature to create

387

the Florida Health Choices Program to:

388

(a) Expand opportunities for Floridians to purchase

389

affordable health insurance and health services.

390

(b) Preserve the benefits of employment-sponsored insurance

391

while easing the administrative burden for employers who offer

392

these benefits.

393

394

of health care purchased.

395

(d) Provide for the purchase of individual, portable health

396

care coverage.

397

(e) Disseminate information to consumers on the price and

398

quality of health services.

399

(f) Sponsor a competitive market that stimulates product

400

innovation, quality improvement, and efficiency in the production

401

and delivery of health services.

402

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

403

(a) "Corporation" means the Florida Health Choices, Inc.,

404

established under this section.

405

(b) "Health insurance agent" means an agent licensed under

406

part IV of chapter 626.

407

408

which offers an individual health insurance policy or a group

409

health insurance policy, a preferred provider organization as

410

defined in s. 627.6471, or an exclusive provider organization as

411

defined in s. 627.6472.

412

(d) "Program" means the Florida Health Choices Program

413

established by this section.

414

(3) PROGRAM PURPOSE AND COMPONENTS.--The Florida Health

415

Choices Program is created as a single, centralized market for

416

the sale and purchase of various products that enable individuals

417

to pay for health care. These products include, but are not

418

limited to, health insurance plans, health maintenance

419

organization plans, prepaid services, service contracts, and

420

flexible spending accounts. The components of the program

421

include:

422

(a) Enrollment of employers.

423

(b) Administrative services for participating employers,

424

including:

425

1. Assistance in seeking federal approval of cafeteria

426

plans.

427

2. Collection of premiums and other payments.

428

3. Management of individual benefit accounts.

429

4. Distribution of premiums to insurers and payments to

430

other eligible vendors.

431

5. Assistance for participants in complying with reporting

432

requirements.

433

434

1. Information about available products and participating

435

vendors.

436

2. Assistance with assessing the benefits and limits of

437

each product, including information necessary to distinguish

438

between policies offering creditable coverage and other products

439

available through the program.

440

3. Account information to assist individual participants

441

with managing available resources.

442

4. Services that promote healthy behaviors.

443

(d) Recruitment of vendors, including insurers, health

444

maintenance organizations, prepaid clinic service providers,

445

provider service networks, and other providers.

446

(e) Certification of vendors to ensure capability,

447

reliability, and validity of offerings.

448

(f) Collection of data, monitoring, assessment, and

449

reporting of vendor performance.

450

(g) Information services for individuals and employers.

451

(h) Program evaluation.

452

(4) ELIGIBILITY AND PARTICIPATION.--Participation in the

453

program is voluntary and shall be available to employers,

454

individuals, vendors, and health insurance agents as specified in

455

this subsection.

456

(a) Employers eligible to enroll in the program include:

457

1. Employers that have 1 to 50 employees.

458

2. Fiscally constrained counties described in s. 218.67.

459

3. Municipalities having populations of fewer than 50,000

460

residents.

461

4. School districts in fiscally constrained counties.

462

(b) Individuals eligible to participate in the program

463

include:

464

1. Individual employees of enrolled employers.

465

2. State employees not eligible for state employee health

466

benefits.

467

3. State retirees.

468

4. Medicaid reform participants who select the opt-out

469

provision of reform.

470

5. Statutory rural hospitals.

471

472

enroll by complying with the procedures established by the

473

corporation. The procedures must include, but are not limited to:

474

1. Submission of required information.

475

2. Compliance with federal tax requirements for the

476

establishment of a cafeteria plan, pursuant to s. 125 of the

477

Internal Revenue Code, including designation of the employer's

478

plan as a premium payment plan, a salary reduction plan that has

479

flexible spending arrangements, or a salary reduction plan that

480

has a premium payment and flexible spending arrangements.

481

3. Determination of the employer's contribution, if any,

482

per employee, provided that such contribution is equal for each

483

eligible employee.

484

4. Establishment of payroll deduction procedures, subject

485

to the agreement of each individual employee who voluntarily

486

participates in the program.

487

5. Designation of the corporation as the third-party

488

administrator for the employer's health benefit plan.

489

6. Identification of eligible employees.

490

7. Arrangement for periodic payments.

491

8. Employer notification to employees of the intent to

492

transfer from an existing employee health plan to the program at

493

least 90 days before the transition.

494

(d) Eligible vendors and the products and services that the

495

vendors are permitted to sell are as follows:

496

1. Insurers licensed under chapter 624 may sell health

497

insurance policies, limited benefit policies, other risk-bearing

498

coverage, and other products or services.

499

2. Health maintenance organizations licensed under part I

500

of chapter 641 may sell health insurance policies, limited

501

benefit policies, other risk-bearing products, and other products

502

or services.

503

3. Prepaid health clinic service providers licensed under

504

part II of chapter 641 may sell prepaid service contracts and

505

other arrangements for a specified amount and type of health

506

services or treatments.

507

4. Health care providers, including hospitals and other

508

licensed health facilities, health care clinics, licensed health

509

professionals, pharmacies, and other licensed health care

510

providers, may sell service contracts and arrangements for a

511

specified amount and type of health services or treatments.

512

5. Provider organizations, including service networks,

513

group practices, professional associations, and other

514

incorporated organizations of providers, may sell service

515

contracts and arrangements for a specified amount and type of

516

health services or treatments.

517

6. Corporate entities providing specific health services in

518

accordance with applicable state law may sell service contracts

519

and arrangements for a specified amount and type of health

520

services or treatments.

521

522

A vendor described in subparagraphs 3.-6. may not sell products

523

that provide risk-bearing coverage unless that vendor is

524

authorized under a certificate of authority issued by the Office

525

of Insurance Regulation under the provisions of the Florida

526

Insurance Code. Otherwise eligible vendors may be excluded from

527

participating in the program for deceptive or predatory

528

practices, financial insolvency, or failure to comply with the

529

terms of the participation agreement or other standards set by

530

the corporation.

531

(e) Eligible individuals may voluntarily continue

532

participation in the program regardless of subsequent changes in

533

job status or Medicaid eligibility. Individuals who join the

534

program may participate by complying with the procedures

535

established by the corporation. These procedures must include,

536

but are not limited to:

537

1. Submission of required information.

538

2. Authorization for payroll deduction.

539

3. Compliance with federal tax requirements.

540

4. Arrangements for payment in the event of job changes.

541

5. Selection of products and services.

542

(f) Vendors who choose to participate in the program may

543

enroll by complying with the procedures established by the

544

corporation. These procedures must include, but are not limited

545

to:

546

1. Submission of required information, including a complete

547

description of the coverage, services, provider network, payment

548

restrictions, and other requirements of each product offered

549

through the program.

550

2. Execution of an agreement to make all risk-bearing

551

products offered through the program guaranteed-issue policies,

552

subject to preexisting-condition exclusions established by the

553

corporation.

554

3. Execution of an agreement that prohibits refusal to sell

555

any offered non-risk-bearing product to a participant who elects

556

to buy it.

557

4. Establishment of product prices based on age, gender,

558

and location of the individual participant.

559

5. Arrangements for receiving payment for enrolled

560

participants.

561

6. Participation in ongoing reporting processes established

562

by the corporation.

563

7. Compliance with grievance procedures established by the

564

corporation.

565

(g) Health insurance agents licensed under part IV of

566

chapter 626 are eligible to voluntarily participate as buyers'

567

representatives. A buyer's representative acts on behalf of an

568

individual purchasing health insurance and health services

569

through the program by providing information about products and

570

services available through the program and assisting the

571

individual with both the decision and the procedure of selecting

572

specific products. Serving as a buyer's representative does not

573

constitute a conflict of interest with continuing

574

responsibilities as a health insurance agent if the relationship

575

between each agent and any participating vendor is disclosed

576

before advising an individual participant about the products and

577

services available through the program. In order to participate,

578

a health insurance agent shall comply with the procedures

579

established by the corporation, including:

580

1. Completion of training requirements.

581

2. Execution of a participation agreement specifying the

582

terms and conditions of participation.

583

3. Disclosure of any appointments to solicit insurance or

584

procure applications for vendors participating in the program.

585

4. Arrangements to receive payment from the corporation for

586

services as a buyer's representative.

587

(5) PRODUCTS.--

588

(a) The products that may be made available for purchase

589

through the program include, but are not limited to:

590

1. Health insurance policies.

591

2. Limited benefit plans.

592

3. Prepaid clinic services.

593

4. Service contracts.

594

5. Arrangements for purchase of specific amounts and types

595

of health services and treatments.

596

6. Flexible spending accounts.

597

(b) Health insurance policies, limited benefit plans,

598

prepaid service contracts, and other contracts for services must

599

ensure the availability of covered services and benefits to

600

participating individuals for at least 1 full enrollment year.

601

602

the price of the product is specified for the entire period or

603

for each separately priced segment of the policy or contract.

604

(d) The corporation shall provide a disclosure form for

605

consumers to acknowledge their understanding of the nature of,

606

and any limitations to, the benefits provided by the products and

607

services being purchased by the consumer.

608

(6) PRICING.--Prices for the products sold through the

609

program must be transparent to participants and established by

610

the vendors based on age, gender, and location of participants.

611

The corporation shall develop a methodology for evaluating the

612

actuarial soundness of products offered through the program. The

613

methodology shall be reviewed by the Office of Insurance

614

Regulation prior to use by the corporation. Before making the

615

product available to individual participants, the corporation

616

shall use the methodology to compare the expected health care

617

costs for the covered services and benefits to the vendor's price

618

for that coverage. The results shall be reported to individuals

619

participating in the program. Once established, the price set by

620

the vendor must remain in force for at least 1 year and may only

621

be redetermined by the vendor at the next annual enrollment

622

period. The corporation shall annually assess a surcharge for

623

each premium or price set by a participating vendor. The

624

surcharge may not be more than 2.5 percent of the price and shall

625

be used to generate funding for administrative services provided

626

by the corporation and payments to buyers' representatives.

627

(7) EXCHANGE PROCESS.--The program shall provide a single,

628

centralized market for purchase of health insurance and health

629

services. Purchases may be made by participating individuals over

630

the Internet or through the services of a participating health

631

insurance agent. Information about each product and service

632

available through the program shall be made available through

633

printed material and an interactive Internet website. A

634

participant needing personal assistance to select products and

635

services shall be referred to a participating agent in his or her

636

area.

637

(a) Participation in the program may begin at any time

638

during a year after the employer completes enrollment and meets

639

the requirements specified by the corporation pursuant to

640

paragraph (4)(c).

641

(b) Initial selection of products and services must be made

642

by an individual participant within 60 days after the date the

643

individual's employer qualified for participation. An individual

644

who fails to enroll in products and services by the end of this

645

period is limited to participation in flexible spending account

646

services until the next annual enrollment period.

647

648

an individual participant must last at least 12 months, unless

649

the individual participant specifically agrees to a different

650

enrollment period.

651

(d) If an individual has selected one or more products and

652

enrolled in those products for at least 12 months or any other

653

period specifically agreed to by the individual participant,

654

changes in selected products and services may only be made during

655

the annual enrollment period established by the corporation.

656

(e) The limits established in paragraphs (b)-(d) apply to

657

any risk-bearing product that promises future payment or coverage

658

for a variable amount of benefits or services. The limits do not

659

apply to initiation of flexible spending plans if those plans are

660

not associated with specific high-deductible insurance policies

661

or the use of spending accounts for any products offering

662

individual participants specific amounts and types of health

663

services and treatments at a contracted price.

664

(8) CONSUMER INFORMATION.--The corporation shall establish

665

a secure website to facilitate the purchase of products and

666

services by participating individuals. The website must provide

667

information about each product or service available through the

668

program.

669

(a) Prior to making a risk-bearing product available

670

through the program, the corporation shall provide information

671

regarding the product to the Office of Insurance Regulation. The

672

office shall review the product information and provide consumer

673

information and a recommendation on the risk-bearing product to

674

the corporation within 30 days after receiving the product

675

information.

676

1. Upon receiving a recommendation that a risk-bearing

677

product should be made available in the marketplace, the

678

corporation may include the product on its website. If the

679

consumer information and recommendation is not received within 30

680

days, the corporation may make the risk-bearing product available

681

on the website without consumer information from the office.

682

2. Upon receiving a recommendation that a risk-bearing

683

product should not be made available in the marketplace, the

684

risk-bearing product may be included as an eligible product in

685

the marketplace and on its website only if a majority of the

686

board of directors vote to include the product.

687

(b) If a risk-bearing product is made available on the

688

website, the corporation shall make the consumer information and

689

office recommendation available on the website and in print

690

format. The corporation shall make late-submitted and ongoing

691

updates to consumer information available on the website and in

692

print format.

693

(9) RISK POOLING.--The program shall utilize methods for

694

pooling the risk of individual participants and preventing

695

selection bias. These methods shall include, but are not limited

696

to, a postenrollment risk adjustment of the premium payments to

697

the vendors. The corporation shall establish a methodology for

698

assessing the risk of enrolled individual participants based on

699

data reported by the vendors about their enrollees. Monthly

700

distributions of payments to the vendors shall be adjusted based

701

on the assessed relative risk profile of the enrollees in each

702

risk-bearing product for the most recent period for which data is

703

available.

704

(10) EXEMPTIONS.--

705

(a) Policies sold as part of the program are not subject to

706

the licensing requirements of the Florida Insurance Code, chapter

707

641, or the mandated offerings or coverages established in part

708

VI of chapter 627 and chapter 641.

709

(b) The corporation may act as an administrator as defined

710

in s. 626.88 but is not required to be certified pursuant to part

711

VII of chapter 626. However, a third party administrator used by

712

the corporation must be certified under part VII of chapter 626.

713

(11) CORPORATION.--There is created the Florida Health

714

Choices, Inc., which shall be registered, incorporated,

715

organized, and operated in compliance with part III of chapter

716

112, chapter 119, chapter 286 and chapter 617. The purpose of the

717

corporation is to administer the program created in this section

718

and to conduct such other business as may further the

719

administration of the program.

720

(a) The corporation shall be governed by a 15-member board

721

of directors consisting of:

722

1. Three ex officio, nonvoting members to include:

723

a. The Secretary of Health Care Administration or a

724

designee with expertise in health care services.

725

b. The Secretary of Management Services or a designee with

726

expertise in state employee benefits.

727

c. The Commissioner of the Office of Insurance Regulation

728

or a designee with expertise in insurance regulation.

729

2. Four members appointed by and serving at the pleasure of

730

the Governor.

731

3. Four members appointed by and serving at the pleasure of

732

the President of the Senate.

733

4. Four members appointed by and serving at the pleasure of

734

the Speaker of the House of Representatives.

735

5. Board members may not include insurers, health insurance

736

agents or brokers, health care providers, health maintenance

737

organizations, prepaid service providers, or any other entity,

738

affiliate or subsidiary of eligible vendors.

739

(b) Members shall be appointed for terms of up to 3 years.

740

Any member is eligible for reappointment. A vacancy on the board

741

shall be filled for the unexpired portion of the term in the same

742

manner as the original appointment.

743

744

the corporation who shall be responsible for the selection of

745

such other staff as may be authorized by the corporation's

746

operating budget as adopted by the board.

747

(d) Board members are entitled to receive, from funds of

748

the corporation, reimbursement for per diem and travel expenses

749

as provided by s. 112.061. No other compensation is authorized.

750

(e) There is no liability on the part of, and no cause of

751

action shall arise against, any member of the board or its

752

employees or agents for any action taken by them in the

753

performance of their powers and duties under this section.

754

(f) The board shall develop and adopt bylaws and other

755

corporate procedures as necessary for the operation of the

756

corporation and carrying out the purposes of this section. The

757

bylaws shall:

758

1. Specify procedures for selection of officers and

759

qualifications for reappointment, provided that no board member

760

shall serve more than 9 consecutive years.

761

2. Require an annual membership meeting that provides an

762

opportunity for input and interaction with individual

763

participants in the program.

764

3. Specify policies and procedures regarding conflicts of

765

interest, including the provisions of part III of chapter 112,

766

which prohibit a member from participating in any decision that

767

would inure to the benefit of the member or the organization that

768

employs the member. The policies and procedures shall also

769

require public disclosure of the interest that prevents the

770

member from participating in a decision on a particular matter.

771

(g) The corporation may exercise all powers granted to it

772

under chapter 617 necessary to carry out the purposes of this

773

section, including, but not limited to, the power to receive and

774

accept grants, loans, or advances of funds from any public or

775

private agency and to receive and accept from any source

776

contributions of money, property, labor, or any other thing of

777

value to be held, used, and applied for the purposes of this

778

section.

779

(h) The corporation may establish technical advisory panels

780

consisting of interested parties, including consumers, health

781

care providers, individuals with expertise in insurance

782

regulation, and insurers.

783

(i) The corporation shall:

784

1. Determine eligibility of employers, vendors,

785

individuals, and agents in accordance with subsection (4).

786

2. Establish procedures necessary for the operation of the

787

program, including, but not limited to, procedures for

788

application, enrollment, risk assessment, risk adjustment, plan

789

administration, performance monitoring, and consumer education.

790

3. Arrange for collection of contributions from

791

participating employers and individuals.

792

4. Arrange for payment of premiums and other appropriate

793

disbursements based on the selections of products and services by

794

the individual participants.

795

5. Establish criteria for disenrollment of participating

796

individuals based on failure to pay the individual's share of any

797

contribution required to maintain enrollment in selected

798

products.

799

6. Establish criteria for exclusion of vendors pursuant to

800

paragraph (4)(d).

801

7. Develop and implement a plan for promoting public

802

awareness of and participation in the program.

803

8. Secure staff and consultant services necessary to the

804

operation of the program.

805

9. Establish policies and procedures regarding

806

participation in the program for individuals, vendors, health

807

insurance agents, and employers.

808

10. Develop a plan, in coordination with the Department of

809

Revenue, to establish tax credits or refunds for employers that

810

participate in the program. The corporation shall submit the plan

811

to the Governor, the President of the Senate, and the Speaker of

812

the House of Representatives by January 1, 2009.

813

(12) REPORT.--Beginning in the 2009-2010 fiscal year,

814

submit by February 1 an annual report to the Governor, the

815

President of the Senate, and the Speaker of the House of

816

Representatives documenting the corporation's activities in

817

compliance with the duties delineated in this section.

818

(13) PROGRAM INTEGRITY.--To ensure program integrity and to

819

safeguard the financial transactions made under the auspices of

820

the program, the corporation is authorized to establish

821

qualifying criteria and certification procedures for vendors,

822

require performance bonds or other guarantees of ability to

823

complete contractual obligations, monitor the performance of

824

vendors, and enforce the agreements of the program through

825

financial penalty or disqualification from the program.

826

Section 5. Subsection (5) of section 409.814, Florida

827

Statutes, is amended to read:

828

409.814 Eligibility.--A child who has not reached 19 years

829

of age whose family income is equal to or below 200 percent of

830

the federal poverty level is eligible for the Florida Kidcare

831

program as provided in this section. For enrollment in the

832

Children's Medical Services Network, a complete application

833

includes the medical or behavioral health screening. If,

834

subsequently, an individual is determined to be ineligible for

835

coverage, he or she must immediately be disenrolled from the

836

respective Florida Kidcare program component.

837

(5) A child whose family income is above 200 percent of the

838

federal poverty level or a child who is excluded under the

839

provisions of subsection (4) may participate in the Medikids

840

program as provided in s. 409.8132 or, if the child is ineligible

841

for Medikids by reason of age, in the Florida Healthy Kids

842

program, subject to the following provisions:

843

(a) The family is not eligible for premium assistance

844

payments and must pay the full cost of the premium, including any

845

administrative costs.

846

(b) The agency is authorized to place limits on enrollment

847

in Medikids by these children in order to avoid adverse

848

selection. The number of children participating in Medikids whose

849

family income exceeds 200 percent of the federal poverty level

850

must not exceed 10 percent of total enrollees in the Medikids

851

program.

852

(b)(c) The board of directors of the Florida Healthy Kids

853

Corporation may is authorized to place limits on enrollment of

854

these children in order to avoid adverse selection. In addition,

855

the board is authorized to offer a reduced benefit package to

856

these children in order to limit program costs for such families.

857

The number of children participating in the Florida Healthy Kids

858

program whose family income exceeds 200 percent of the federal

859

poverty level must not exceed 10 percent of total enrollees in

860

the Florida Healthy Kids program.

861

Section 6. Section 624.1265, Florida Statutes, is created

862

to read:

863

624.1265 Nonprofit religious organization exemption;

864

authority; notice.--

865

(1) A nonprofit religious organization is not subject to

866

the requirements of the Florida Insurance Code if the nonprofit

867

religious organization qualifies under Title 26, s. 501 of the

868

Internal Revenue Code of 1986, as amended; limits its

869

participants to members of the same religion; acts as an

870

organizational clearinghouse for information between participants

871

who have financial, physical, or medical needs and participants

872

who have the ability to pay for the benefit of those participants

873

who have financial, physical, or medical needs; provides for the

874

financial or medical needs of a participant through payments

875

directly from one participant to another participant; and

876

suggests amounts that participants may voluntarily give with no

877

assumption of risk or promise to pay among the participants or

878

between the participants.

879

(2) This section does not prevent the organization

880

described in subsection (1) from establishing qualifications of

881

participation relating to the health of a prospective

882

participant, does not prevent a participant from limiting the

883

financial or medical needs that may be eligible for payment, and

884

does not prevent the organization from canceling the membership

885

of a participant when such participant indicates his or her

886

unwillingness to participate by failing to make a payment to

887

another participant for a period in excess of 60 days.

888

(3) The religious organization described in subsection (1)

889

shall provide each prospective participant in the organizational

890

clearinghouse written notice that the organization is not an

891

insurance company, that membership is not offered through an

892

insurance company, and that the organization is not subject to

893

the regulatory requirements or consumer protections of the

894

Florida Insurance Code.

895

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

896

624.91, Florida Statutes, is amended to read:

897

624.91 The Florida Healthy Kids Corporation Act.--

898

(5) CORPORATION AUTHORIZATION, DUTIES, POWERS.--

899

(b) The Florida Healthy Kids Corporation shall:

900

1. Arrange for the collection of any family, local

901

contributions, or employer payment or premium, in an amount to be

902

determined by the board of directors, to provide for payment of

903

premiums for comprehensive insurance coverage and for the actual

904

or estimated administrative expenses.

905

2. Arrange for the collection of any voluntary

906

contributions to provide for payment of premiums for children who

907

are not eligible for medical assistance under Title XXI of the

908

Social Security Act.

909

3. Subject to the provisions of s. 409.8134, accept

910

voluntary supplemental local match contributions that comply with

911

the requirements of Title XXI of the Social Security Act for the

912

purpose of providing additional coverage in contributing counties

913

under Title XXI.

914

4. Establish the administrative and accounting procedures

915

for the operation of the corporation.

916

5. Establish, with consultation from appropriate

917

professional organizations, standards for preventive health

918

services and providers and comprehensive insurance benefits

919

appropriate to children, provided that such standards for rural

920

areas shall not limit primary care providers to board-certified

921

pediatricians.

922

6. Determine eligibility for children seeking to

923

participate in the Title XXI-funded components of the Florida

924

Kidcare program consistent with the requirements specified in s.

925

409.814, as well as the non-Title-XXI-eligible children as

926

provided in subsection (3).

927

7. Establish procedures under which providers of local

928

match to, applicants to and participants in the program may have

929

grievances reviewed by an impartial body and reported to the

930

board of directors of the corporation.

931

8. Establish participation criteria and, if appropriate,

932

contract with an authorized insurer, health maintenance

933

organization, or third-party administrator to provide

934

administrative services to the corporation.

935

9. Establish enrollment criteria which shall include

936

penalties or waiting periods of not fewer than 60 days for

937

reinstatement of coverage upon voluntary cancellation for

938

nonpayment of family premiums.

939

10. Contract with authorized insurers or any provider of

940

health care services, meeting standards established by the

941

corporation, for the provision of comprehensive insurance

942

coverage to participants. Such standards shall include criteria

943

under which the corporation may contract with more than one

944

provider of health care services in program sites. Health plans

945

shall be selected through a competitive bid process. The Florida

946

Healthy Kids Corporation shall purchase goods and services in the

947

most cost-effective manner consistent with the delivery of

948

quality medical care. The maximum administrative cost for a

949

Florida Healthy Kids Corporation contract shall be 15 percent.

950

For health care contracts, the minimum medical loss ratio for a

951

Florida Healthy Kids Corporation contract shall be 85 percent.

952

For dental contracts, the remaining compensation to be paid to

953

the authorized insurer or provider under a Florida Healthy Kids

954

Corporation contract shall be no less than an amount which is 85

955

percent of premium; to the extent any contract provision does not

956

provide for this minimum compensation, this section shall

957

prevail. The health plan selection criteria and scoring system,

958

and the scoring results, shall be available upon request for

959

inspection after the bids have been awarded.

960

11. Establish disenrollment criteria in the event local

961

matching funds are insufficient to cover enrollments.

962

12. Develop and implement a plan to publicize the Florida

963

Healthy Kids Corporation, the eligibility requirements of the

964

program, and the procedures for enrollment in the program and to

965

maintain public awareness of the corporation and the program.

966

13. Secure staff necessary to properly administer the

967

corporation. Staff costs shall be funded from state and local

968

matching funds and such other private or public funds as become

969

available. The board of directors shall determine the number of

970

staff members necessary to administer the corporation.

971

14. Provide a report annually to the Governor, Chief

972

Financial Officer, Commissioner of Education, Senate President,

973

Speaker of the House of Representatives, and Minority Leaders of

974

the Senate and the House of Representatives.

975

15. Provide information on a quarterly basis to the

976

Legislature and the Governor which compares the costs and

977

utilization of the full-pay enrolled population and the Title

978

XXI-subsidized enrolled population in the Florida Kidcare

979

program. The information, at a minimum, must include:

980

a. The monthly enrollment and expenditure for full-pay

981

enrollees in the Medikids and Florida Healthy Kids programs

982

compared to the Title XXI-subsidized enrolled population; and

983

b. The costs and utilization by service of the full-pay

984

enrollees in the Medikids and Florida Healthy Kids programs and

985

the Title XXI-subsidized enrolled population.

986

987

By February 1, 2009, the Florida Healthy Kids Corporation shall

988

provide a study to the Legislature and the Governor on premium

989

impacts to the subsidized portion of the program from the

990

inclusion of the full-pay program, which shall include

991

recommendations on how to eliminate or mitigate possible impacts

992

to the subsidized premiums.

993

16.15. Establish benefit packages which conform to the

994

provisions of the Florida Kidcare program, as created in ss.

995

409.810-409.820.

996

Section 8. Effective upon this act becoming a law and

997

applicable to policies issued or renewed on or after October 1,

998

2008, paragraph (c) of subsection (1) of section 627.602, Florida

999

Statutes, is amended to read:

1000

627.602 Scope, format of policy.--

1001

(1) Each health insurance policy delivered or issued for

1002

delivery to any person in this state must comply with all

1003

applicable provisions of this code and all of the following

1004

requirements:

1005

1006

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

1007

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

1008

originally or by subsequent amendment, any eligible members of

1009

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

1010

dependent upon the policyholder. If an insurer offers coverage

1011

for dependent children of the policyholder, such policy must

1012

comply with the provisions of s. 627.6562.

1013

Section 9. Effective upon this act becoming a law and

1014

applicable to policies issued or renewed on or after October 1,

1015

2008, section 627.6562, Florida Statutes, is amended to read:

1016

627.6562 Dependent coverage.--

1017

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

1018

or franchise health insurance policy that insures dependent

1019

children of the policyholder or certificateholder, the policy

1020

must insure a dependent child of the policyholder or

1021

certificateholder at least until the end of the calendar year in

1022

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

1023

the following:

1024

(a) The child is dependent upon the policyholder or

1025

certificateholder for support.

1026

(b) The child is living in the household of the

1027

policyholder or certificateholder, or the child is a full-time or

1028

part-time student.

1029

(2) A policy that is subject to the requirements of

1030

subsection (1) must also offer the policyholder or

1031

certificateholder the option to insure a child of the

1032

policyholder or certificateholder at least until the end of the

1033

calendar year in which the child reaches the age of 30, if the

1034

child:

1035

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

1036

her own;

1037

(b) Is a resident of this state or a full-time or part-time

1038

student; and

1039

1040

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

1041

blanket, or franchise health insurance policy or individual

1042

health benefits plan, or is not entitled to benefits under Title

1043

XVIII of the Social Security Act.

1044

(3) If, pursuant to subsection (2), a child is provided

1045

coverage under the parent's policy after the end of the calendar

1046

year in which the child reaches age 25 and coverage for the child

1047

is subsequently terminated, the child is not eligible to be

1048

covered under the parent's policy unless the child was

1049

continuously covered by other creditable coverage without a gap

1050

in coverage of more than 63 days. For the purposes of this

1051

subsection, the term "creditable coverage" has the same meaning

1052

as provided in s. 627.6561(5).

1053

(4)(2) Nothing in This section does not:

1054

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

1055

right to medically underwrite or charge the appropriate premium;

1056

(b) Require coverage for services provided to a dependent

1057

before October 1, 2008;

1058

1059

coverage provided for a dependent under this section; or

1060

(d) Prohibit an insurer or health maintenance organization

1061

from increasing the limiting age for dependent coverage to age 30

1062

in policies or contracts issued or renewed prior to the effective

1063

date of this act.

1064

(5)(a) Until April 1, 2009, the parent of a child who

1065

qualifies for coverage under subsection (2) but whose coverage as

1066

a dependent child under the parent's plan terminated under the

1067

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

1068

election to reinstate coverage, without proof of insurability,

1069

under that plan as a dependent child pursuant to this section.

1070

(b) The covered person's plan may require the payment of a

1071

premium by the covered person or dependent child, as appropriate,

1072

subject to the approval of the Office of Insurance Regulation,

1073

for any period of coverage relating to a dependent's written

1074

election for coverage pursuant to paragraph (a).

1075

1076

dependent child as provided under this subsection must be

1077

provided to a covered person in the certificate of coverage

1078

prepared for covered persons by the insurer or by the covered

1079

person's employer. Such notice may be given through the group

1080

policyholder.

1081

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

1082

disease, disability income, Medicare supplement, or long-term

1083

care insurance policies.

1084

Section 10. Effective upon this act becoming a law and

1085

applicable to contracts issued or renewed on or after October 1,

1086

2008, subsection (41) is added to section 641.31, Florida

1087

Statutes, to read:

1088

641.31 Health maintenance contracts.--

1089

(41) All health maintenance contracts providing coverage

1090

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

1091

provisions of s. 627.6562.

1092

Section 11. For the 2008-2009 fiscal year, the following is

1093

appropriated from the General Revenue Fund to the Agency for

1094

Health Care Administration to fund the Florida Health Choices

1095

Program:

1096

(1) The sum of $325,000 in nonrecurring funds for the

1097

salaries and benefits of the chief executive office and staff of

1098

Florida Health Choices, Inc., for the 2008-2009 fiscal year.

1099

(2) The sum of $825,000 in nonrecurring funds for costs

1100

related to the general administration, marketing, consulting, and

1101

other duties of the Florida Health Choices, Inc., for the 2008-

1102

2009 fiscal year.

1103

(3) The sum of $350,000 in nonrecurring funds for the

1104

third-party administrator functions of Florida Health Choices

1105

Inc., during the 2008-2009 fiscal year.

1106

Section 12. This act shall take effect upon becoming a law.

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