Florida Senate - 2008 (Reformatted) SB 364
By Senator Margolis
35-00230-08 2008364__
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A bill to be entitled
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An act relating to cystic fibrosis treatment; creating s.
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627.6614, F.S.; requiring a group health insurance policy
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to cover services needed to treat cystic fibrosis which
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are authorized by a physician; amending s. 641.31, F.S.;
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requiring a contract by a health maintenance organization
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to cover services needed to treat cystic fibrosis as
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authorized by a physician; amending s. 627.6515, F.S.,
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relating to out-of-state groups; conforming a cross-
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reference to changes made by the act; providing that the
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act fulfills an important state interest; providing an
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effective date.
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WHEREAS, cystic fibrosis is a genetic disease that adversely
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affects the respiratory system and the digestive system, and
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WHEREAS, only half of those suffering who have cystic
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fibrosis live to the age of 32, and
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WHEREAS, the treatments for individuals who have cystic
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fibrosis include ingesting pancreatic enzymes or a wide
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assortment of nutritional supplements, frequent postural draining
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to clear the respiratory system, or using a feeding tube to
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provide sustenance, and
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WHEREAS, insurance companies often times do not fully cover
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the costs associated with treating cystic fibrosis, a fatal
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disease, NOW, THEREFORE,
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Be It Enacted by the Legislature of the State of Florida:
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Section 1. Section 627.6614, Florida Statutes, is created
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to read:
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627.6614 Cystic fibrosis treatment services.--A group
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health insurance policy issued in this state must provide
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coverage for all medically necessary chest physiotherapy provided
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by a respiratory therapist licensed under part V of chapter 468,
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home health care, equipment, supplies, and enteral formulas
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described in s. 627.42395 which are used to treat cystic fibrosis
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if the patient's treating physician or a physician authorized by
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the insurer who specializes in the treatment of cystic fibrosis
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certifies that such services are medically necessary. The insurer
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may require the policyholder to be responsible for any deductible
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or copayment that generally applies under the policy.
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Section 2. Present subsections (36), (37), (38), (39), and
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(40) of section 641.31, Florida Statutes, are redesignated as
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subsections (37), (38), (39), (40), and (41), respectively, and a
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new subsection (36) is added to that section, to read:
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641.31 Health maintenance contracts.--
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(36) A group health maintenance contract issued in this
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state must provide coverage for all medically necessary chest
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physiotherapy provided by a respiratory therapist licensed under
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part V of chapter 468, home health care, equipment, supplies, and
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enteral formulas described in s. 627.42395 which are used to
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treat cystic fibrosis if the patient's treating physician or a
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physician authorized by the health maintenance organization who
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specializes in the treatment of cystic fibrosis certifies that
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such services are medically necessary. The health maintenance
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organization may require the subscriber to be responsible for any
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deductible or copayment that generally applies under the
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contract.
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Section 3. Subsection (2) of section 627.6515, Florida
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Statutes, is amended to read:
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627.6515 Out-of-state groups.--
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(2) Except as otherwise provided in this part, this part
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does not apply to a group health insurance policy issued or
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delivered outside this state under which a resident of this state
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is provided coverage if:
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(a) The policy is issued to an employee group the
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composition of which is substantially as described in s. 627.653;
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a labor union group or association group the composition of which
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is substantially as described in s. 627.654; an additional group
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the composition of which is substantially as described in s.
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627.656; a group insured under a blanket health policy when the
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composition of the group is substantially in compliance with s.
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627.659; a group insured under a franchise health policy when the
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composition of the group is substantially in compliance with s.
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627.663; an association group to cover persons associated in any
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other common group, which common group is formed primarily for
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purposes other than providing insurance; a group that is
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established primarily for the purpose of providing group
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insurance, provided the benefits are reasonable in relation to
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the premiums charged thereunder and the issuance of the group
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policy has resulted, or will result, in economies of
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administration; or a group of insurance agents of an insurer,
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which insurer is the policyholder;
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(b) Certificates evidencing coverage under the policy are
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issued to residents of this state and contain in contrasting
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color and not less than 10-point type the following statement:
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"The benefits of the policy providing your coverage are governed
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primarily by the law of a state other than Florida"; and
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(c) The policy provides the benefits specified in ss.
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(d) Applications for certificates of coverage offered to
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residents of this state must contain, in contrasting color and
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not less than 12-point type, the following statement on the same
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page as the applicant's signature:
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"This policy is primarily governed by the laws of
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...insert state where the master policy is if
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filed.... As a result, all of the rating laws
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applicable to policies filed in this state do not
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apply to this coverage, which may result in increases
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in your premium at renewal that would not be
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permissible under a Florida-approved policy. Any
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purchase of individual health insurance should be
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considered carefully, as future medical conditions
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may make it impossible to qualify for another
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individual health policy. For information concerning
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individual health coverage under a Florida-approved
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policy, consult your agent or the Florida Department
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of Financial Services."
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This paragraph applies only to group certificates providing
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health insurance coverage which require individualized
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underwriting to determine coverage eligibility for an
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individual or premium rates to be charged to an individual
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except for the following:
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1. Policies issued to provide coverage to groups of
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persons all of whom are in the same or functionally related
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licensed professions, and providing coverage only to such
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licensed professionals, their employees, or their dependents;
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2. Policies providing coverage to small employers as
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defined by s. 627.6699. Such policies shall be subject to, and
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governed by, the provisions of s. 627.6699;
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3. Policies issued to a bona fide association, as defined
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by s. 627.6571(5), provided that there is a person or board
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acting as a fiduciary for the benefit of the members, and such
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association is not owned, controlled by, or otherwise
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associated with the insurance company; or
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4. Any accidental death, accidental death and
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dismemberment, accident-only, vision-only, dental-only,
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hospital indemnity-only, hospital accident-only, cancer,
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specified disease, Medicare supplement, products that
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supplement Medicare, long-term care, or disability income
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insurance, or similar supplemental plans provided under a
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separate policy, certificate, or contract of insurance, which
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cannot duplicate coverage under an underlying health plan,
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coinsurance, or deductibles or coverage issued as a supplement
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to workers' compensation or similar insurance, or automobile
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medical-payment insurance.
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Section 4. The Legislature finds that this act fulfills
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an important state interest.
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Section 5. This act shall take effect January 1, 2009,
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and applies to policies and contracts issued or renewed on or
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after that date.
CODING: Words stricken are deletions; words underlined are additions.