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A bill to be entitled

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An act relating to affordable health coverage; amending s.

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408.909; redefining the term "health flex plan"; revising

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requirements for the Agency for Health Care Administration

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and the Office of Insurance Regulation in approving plans;

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revising eligibility requirements; extending the

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expiration date of the health flex plan program; amending

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s. 409.811, F.S.; redefining the term "premium assistance

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payment"; amending s. 627.602, F.S.; revising policy

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requirements pertaining to dependent children; providing a

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cross-reference; amending s. 627.653, F.S.; requiring

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participation of employees in group insurance policies or

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group health benefit plans issued or renewed after October

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1, 2008; providing opt-out provisions for employers and

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employees related to such coverage; amending s. 627.6562,

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F.S.; expanding types of insurance policies providing for

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dependent coverage; extending the qualifying age for

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dependent coverage; revising eligibility requirements for

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dependents to receive continued coverage; providing

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clarifications and limitations on dependent coverage;

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providing mechanisms for reinstatement of dependent

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coverage; providing for payment of premium; requiring

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approval of premium payment requirements by the Office of

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Insurance Regulation; providing notice requirements for

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reinstated coverage of dependents; excluding certain types

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of health coverage policies; specifying the types of

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health coverage policies governed by the act; amending ss.

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627.6699 and 641.31, F.S.; requiring participation of

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employees in health maintenance contracts or policies

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issued or renewed after October 1, 2008; providing opt-out

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provisions for employers and employees related to such

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coverage; requiring compliance with s. 627.6562, F.S., for

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all heath maintenance contracts that provide coverage for

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family members; amending s. 641.402; redefining the terms

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"basic services," "prepaid health clinic," and "provider";

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providing an effective date.

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

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     Section 1.  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, as an

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individual, directly from the plan 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 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 as an

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individual through an approved health flex plan and have agreed

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to make any payments required for participation, including

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periodic payments or payments due at the time health care

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services are provided; or.

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

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of the employees have a family income equal to or less than 300

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percent of the federal poverty level and the employee group is

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not covered by a private health insurance policy and has not been

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covered at any time during the past 6 months. If the health flex

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

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maintenance organization licensed under state law, only 50

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percent of the employees must meet the income requirements for

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the purpose of this paragraph.

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     (10) EXPIRATION.--This section expires July 1, 2013 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 if such payment does not exceed the payment required for an

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enrollee in the Florida Kidcare program.

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     Section 3.  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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that insures dependent children of the policyholder, the policy

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must comply with the provisions of s. 627.6562.

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

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Florida Statutes, is redesignated 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 other reasons for declining coverage. This notice shall

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

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or 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 5.  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, under a group, blanket, or

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franchise health insurance policy, coverage that insures

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dependent children of the policyholder or certificateholder, the

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policy 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 The child is living in the

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household of the policyholder or certificateholder, or the child

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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, Pub. L. No. 89-97

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(42 U.S.C. s. 1395 et seq.).

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     (2) Nothing in This section does not:

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     (a) Affect Affects or preempt preempts an insurer's right

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to medically underwrite or charge the appropriate premium.

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     (b) Require coverage for services provided before October

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1, 2008, to a dependent.

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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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in 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 covered person's plan terminated under

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

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election to reinstate coverage, without proof of insurability,

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

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All other dependent children who qualify for coverage under

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subsection (1) shall be automatically covered at least until the

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end of the calendar year in which the child reaches the age of

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30, unless the covered person provides the group policyholder

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with written evidence that the dependent child is married, is not

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a state resident, or is covered under a separate comprehensive

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health insurance policy or a health benefit plan or is entitled

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to benefits under Title XVIII of the Social Security Act, Pub. L.

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No. 89-97 (42 U.S.C. s. 1935, et seq.).

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

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premium by the covered person or dependent child, as appropriate

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and subject to the approval of the Office of Insurance

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Regulation, for any period of coverage relating to a dependent's

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written election for coverage pursuant to subsection (3).

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     (5) Notice regarding the reinstatement of coverage for a

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dependent child as provided under this section must be provided

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to a covered person:

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     (a) In the certificate of coverage prepared for covered

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persons by the insurer; or

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     (b) By the covered person's employer.

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The notice regarding the opportunity for reinstatement of

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coverage for a dependent child shall be given as soon as

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practicable after October 1, 2008, and such notice may be given

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through the group policyholder.

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

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

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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 6.  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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or health maintenance contracts issued or renewed after October

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1, 2008, all eligible employees and their dependents shall be

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enrolled for coverage at the time of issuance or during the next

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open or special enrollment period, unless the employee provides

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written notice to the employer declining coverage, which notice

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must include evidence of coverage under an existing group

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insurance policy or group health benefit plan, or other reasons

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for declining coverage. Such notice shall be retained by the

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employer as part of the employee's employment or insurance file.

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An employer may require its employees to participate in its group

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health plan as a condition of 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 7.  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) Unless the employer chooses otherwise, for all

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policies or health maintenance contracts issued or renewed after

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October 1, 2008, all eligible employees and their dependents

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shall be enrolled for coverage at the time of issuance or during

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the next open or special enrollment period, unless the employee

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provides written notice to the employer declining coverage, which

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notice must include evidence of coverage under an existing group

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insurance policy or group health benefit plan, or other reasons

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for declining coverage. Such notice shall be retained by the

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employer as part of the employee's employment or insurance file.

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An employer may require its employees to participate in its group

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health plan as a condition of employment.

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     (42) All health maintenance contracts that provide coverage

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for a member of the family of the subscriber shall comply with

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the provisions of s. 627.6562.

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     Section 8.  Subsections (1), (4), and (6) of section

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641.402, Florida Statutes, are amended to read:

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     641.402  Definitions.--As used in this part, the term:

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     (1) "Basic services" includes any of the following: limited

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hospital inpatient services, which may include hospital inpatient

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physician services, up to a maximum coverage benefit of five days

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and a maximum dollar amount of coverage of $15,000 per calendar

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year; emergency care, physician care other than hospital

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inpatient physician services, ambulatory diagnostic treatment,

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and preventive health care services.

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     (4)  "Prepaid health clinic" means any organization

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authorized under this part which provides, either directly or

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through arrangements with other persons, basic services to

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persons enrolled with such organization, on a prepaid per capita

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or prepaid aggregate fixed-sum basis, including those basic

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services described in this part which subscribers might

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reasonably require to maintain good health. However, no clinic

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that provides or contracts for, either directly or indirectly,

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inpatient hospital services, hospital inpatient physician

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services, or indemnity against the cost of such services shall be

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a prepaid health clinic.

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     (6) "Provider" means any physician or person other than a

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hospital that furnishes health care services under this part and

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is licensed or authorized to practice in this state.

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     Section 9.  This act shall take effect upon becoming a law,

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except that sections 3, 4, 5, and 7 of this act shall take effect

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October 1, 2008, and apply to all individual, group, blanket,

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franchise health insurance policies, and health maintenance

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contracts issued, renewed, or amended on or after that date.