1 | Representative Bean offered the following: |
2 |
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3 | Substitute Amendment for Amendment (830641) (with title |
4 | amendment) |
5 | Remove line(s) 5-464 and insert: |
6 | Section 1. Paragraph (d) of subsection (2) of section |
7 | 112.363, Florida Statutes, is amended to read: |
8 | 112.363 Retiree health insurance subsidy.-- |
9 | (2) ELIGIBILITY FOR RETIREE HEALTH INSURANCE SUBSIDY.-- |
10 | (d) Payment of the retiree health insurance subsidy shall |
11 | be made only after coverage for health insurance for the retiree |
12 | or beneficiary has been certified in writing to the Department |
13 | of Management Services. Participation in a former employer's |
14 | group health insurance program is not a requirement for |
15 | eligibility under this section. Coverage issued pursuant to s. |
16 | 408.9091 is considered health insurance for the purposes of this |
17 | section. |
18 | Section 2. Subsections (5) and (10) of section 408.909, |
19 | Florida Statutes, are amended to read: |
20 | 408.909 Health flex plans.-- |
21 | (5) ELIGIBILITY.--Eligibility to enroll in an approved |
22 | health flex plan is limited to residents of this state who: |
23 | (a)1. Are 64 years of age or younger; |
24 | 2.(b) Have a family income equal to or less than 300200 |
25 | percent of the federal poverty level; |
26 | (c) Are eligible under a federally approved Medicaid |
27 | demonstration waiver and reside in Palm Beach County or Miami- |
28 | Dade County; |
29 | 3. (d) Are not covered by a private insurance policy and |
30 | are not eligible for coverage through a public health insurance |
31 | program, such as Medicare or Medicaid, unless specifically |
32 | authorized under paragraph (c), or another public health care |
33 | program, such as Kidcare, and have not been covered at any time |
34 | during the past 6 months, except that: |
35 | a. A person who was covered under an individual health |
36 | maintenance contract issued by a health maintenance organization |
37 | licensed under part I of chapter 641 that also was an approved |
38 | health flex plan on October 1, 2008, may apply for coverage in |
39 | the same health maintenance organization's health flex plan |
40 | without a lapse in coverage if all other eligibility |
41 | requirements are met; or |
42 | b. A person who was covered under Medicaid or Kidcare and |
43 | lost eligibility for the Medicaid or Kidcare subsidy due to |
44 | income restrictions within 90 days prior to applying for health |
45 | care coverage through an approved health flex plan may apply for |
46 | coverage in a health flex plan without a lapse in coverage if |
47 | all other eligibility requirements are met; and |
48 | 4.(e) Have applied for health care coverage as an |
49 | individual through an approved health flex plan and have agreed |
50 | to make any payments required for participation, including |
51 | periodic payments or payments due at the time health care |
52 | services are provided; or |
53 | (b) Are part of an employer group at least 75 percent of |
54 | the employees of which have a family income equal to or less |
55 | than 300 percent of the federal poverty level and which employee |
56 | group is not covered by a private health insurance policy and |
57 | has not been covered at any time during the past 6 months. If |
58 | the health flex plan entity is a health insurer, health plan, or |
59 | health maintenance organization licensed under Florida law, only |
60 | 50 percent of the employees must meet the income requirements |
61 | for the purpose of this paragraph. |
62 | (10) EXPIRATION.--This section expires July 1, 2013 2008. |
63 | Section 3. Section 408.9091, Florida Statutes, is created |
64 | to read: |
65 | 408.9091 Cover Florida Health Care Access Program.-- |
66 | (1) SHORT TITLE.--This section may be cited as the "Cover |
67 | Florida Health Care Access Program Act." |
68 | (2) LEGISLATIVE INTENT.--The Legislature finds that a |
69 | significant number of state residents are unable to obtain |
70 | affordable health insurance coverage. The Legislature also finds |
71 | that existing health flex plan coverage has had limited |
72 | participation due in part to narrow eligibility restrictions as |
73 | well as minimal benefit options for catastrophic and emergency |
74 | care coverage. Therefore, it is the intent of the Legislature to |
75 | expand the availability of health care options for uninsured |
76 | residents by developing an affordable health care product that |
77 | emphasizes coverage for basic and preventive health care |
78 | services; provides inpatient hospital, urgent, and emergency |
79 | care services; and is offered statewide by approved health |
80 | insurers, health maintenance organizations, health-care- |
81 | provider-sponsored organizations, or health care districts. |
82 | (3) DEFINITIONS.--As used in this section, the term: |
83 | (a) "Agency" means the Agency for Health Care |
84 | Administration. |
85 | (b) "Cover Florida plan" means a consumer choice benefit |
86 | plan approved under this section that guarantees payment or |
87 | coverage for specified benefits provided to an enrollee. |
88 | (c) "Cover Florida plan coverage" means health care |
89 | services that are covered as benefits under a Cover Florida |
90 | plan. |
91 | (d) "Cover Florida plan entity" means a health insurer, |
92 | health maintenance organization, health-care-provider-sponsored |
93 | organization, or health care district that develops and |
94 | implements a Cover Florida plan and is responsible for |
95 | administering the plan and paying all claims for Cover Florida |
96 | plan coverage by enrollees. |
97 | (e) "Cover Florida Plus" means a supplemental insurance |
98 | product, such as for additional catastrophic coverage or dental, |
99 | vision, or cancer coverage, approved under this section and |
100 | offered to all enrollees. |
101 | (f) "Enrollee" means an individual who has been determined |
102 | to be eligible for and is receiving health insurance coverage |
103 | under a Cover Florida plan. |
104 | (g) "Office" means the Office of Insurance Regulation of |
105 | the Financial Services Commission. |
106 | (4) PROGRAM.--The agency and the office shall jointly |
107 | establish and administer the Cover Florida Health Care Access |
108 | Program. |
109 | (a) General Cover Florida plan components must require |
110 | that: |
111 | 1. Plans are offered on a guaranteed-issue basis to |
112 | enrollees, subject to exclusions for preexisting conditions |
113 | approved by the office and the agency. |
114 | 2. Plans are portable such that the enrollee remains |
115 | covered regardless of employment status or the cost-sharing of |
116 | premiums. |
117 | 3. Plans provide for cost containment through limits on |
118 | the number of services, caps on benefit payments, and copayments |
119 | for services. |
120 | 4. A Cover Florida plan entity makes all benefit plan and |
121 | marketing materials available in English and Spanish. |
122 | 5. In order to provide for consumer choice, Cover Florida |
123 | plan entities develop two alternative benefit option plans |
124 | having different cost and benefit levels, including at least one |
125 | plan that provides catastrophic coverage. |
126 | 6. Plans without catastrophic coverage provide coverage |
127 | options for services including, but not limited to: |
128 | a. Preventive health services, including immunizations, |
129 | annual health assessments, well-woman and well-care services, |
130 | and preventive screenings such as mammograms, cervical cancer |
131 | screenings, and noninvasive colorectal or prostate screenings. |
132 | b. Incentives for routine preventive care. |
133 | c. Office visits for the diagnosis and treatment of |
134 | illness or injury. |
135 | d. Office surgery, including anesthesia. |
136 | e. Behavioral health services. |
137 | f. Durable medical equipment and prosthetics. |
138 | g. Diabetic supplies. |
139 | 7. Plans providing catastrophic coverage, at a minimum, |
140 | provide coverage options for all of the services listed under |
141 | subparagraph 6.; however, such plans may include, but are not |
142 | limited to, coverage options for: |
143 | a. Inpatient hospital stays. |
144 | b. Hospital emergency care services. |
145 | c. Urgent care services. |
146 | d. Outpatient facility services, outpatient surgery, and |
147 | outpatient diagnostic services. |
148 | 8. All plans offer prescription drug benefit coverage or |
149 | use a prescription drug manager such as the Florida Discount |
150 | Drug Card Program. |
151 | 9. Plan enrollment materials provide information in plain |
152 | language on policy benefit coverage, benefit limits, cost- |
153 | sharing requirements, and exclusions and a clear representation |
154 | of what is not covered in the plan. The Cover Florida Health |
155 | Care Access Program shall require the following disclosure to be |
156 | reviewed and executed by all consumers purchasing program |
157 | options or insurance coverage through the program: "In |
158 | connection with the Cover Florida Health Care Access Program |
159 | authorized by s. 408.9091, Florida Statutes, agents and entities |
160 | offering products and services under the program shall inform |
161 | the named insured, applicant, or subscriber, on a form approved |
162 | by the Office of Insurance Regulation of the Financial Services |
163 | Commission, that the program is not an insurance program or, if |
164 | it is an insurance program, that benefits under the coverage are |
165 | limited under s. 408.9091, Florida Statutes, and that such |
166 | coverage is an alternative to coverage without such limitations. |
167 | If the form is signed by a named insured, applicant, or |
168 | subscriber, it shall be presumed that there was an informed, |
169 | knowing acceptance of such limitations." |
170 | 10. Plans offered through a qualified employer meet the |
171 | requirements of s. 125 of the Internal Revenue Code. |
172 | (b) Guidelines shall be developed to ensure that Cover |
173 | Florida plans meet minimum standards for quality of care and |
174 | access to care. The agency shall ensure that the Cover Florida |
175 | plans follow standardized grievance procedures. |
176 | (c) Changes in Cover Florida plan benefits, premiums, and |
177 | policy forms are subject to regulatory oversight by the office |
178 | and the agency as provided under rules adopted by the Financial |
179 | Services Commission and the agency. |
180 | (d) The agency, the office, and the Executive Office of |
181 | the Governor shall develop a public awareness program to be |
182 | implemented throughout the state for the promotion of the Cover |
183 | Florida Health Care Access Program. |
184 | (e) Public or private entities may design programs to |
185 | encourage Floridians to participate in the Cover Florida Health |
186 | Care Access Program or to encourage employers to cosponsor some |
187 | share of Cover Florida plan premiums for employees. |
188 | (5) PLAN PROPOSALS.--The agency and the office shall |
189 | announce, no later than July 1, 2008, an invitation to negotiate |
190 | for Cover Florida plan entities to design a Cover Florida plan |
191 | proposal in which benefits and premiums are specified. |
192 | (a) The invitation to negotiate shall include guidelines |
193 | for the review of Cover Florida plan applications, policy forms, |
194 | and all associated forms and provide regulatory oversight of |
195 | Cover Florida plan advertisement and marketing procedures. A |
196 | plan shall be disapproved or withdrawn if the plan: |
197 | 1. Contains any ambiguous, inconsistent, or misleading |
198 | provisions or any exceptions or conditions that deceptively |
199 | affect or limit the benefits purported to be assumed in the |
200 | general coverage provided by the plan; |
201 | 2. Provides benefits that are unreasonable in relation to |
202 | the premium charged or contains provisions that are unfair or |
203 | inequitable, that are contrary to the public policy of this |
204 | state, that encourage misrepresentation, or that result in |
205 | unfair discrimination in sales practices; |
206 | 3. Cannot demonstrate that the plan is financially sound |
207 | and that the applicant is able to underwrite or finance the |
208 | health care coverage provided; |
209 | 4. Cannot demonstrate that the applicant and its |
210 | management are in compliance with the standards required under |
211 | s. 624.404(3); or |
212 | 5. Does not guarantee that enrollees may participate in |
213 | the Cover Florida plan entity's comprehensive network of |
214 | providers, as determined by the office, the agency, and the |
215 | contract. |
216 | (b) The agency and the office may announce an invitation |
217 | to negotiate for the design of Cover Florida Plus products to |
218 | companies that offer supplemental insurance, discount medical |
219 | plan organizations licensed under part II of chapter 636, or |
220 | prepaid health clinics licensed under part II of chapter 641. |
221 | (c) The agency and office shall approve at least one Cover |
222 | Florida plan entity having an existing statewide network of |
223 | providers and may approve at least one regional network plan in |
224 | each existing Medicaid area. |
225 | (6) LICENSE NOT REQUIRED.-- |
226 | (a) The licensing requirements of the Florida Insurance |
227 | Code and chapter 641 relating to health maintenance |
228 | organizations do not apply to a Cover Florida plan approved |
229 | under this section unless expressly made applicable. However, |
230 | for the purpose of prohibiting unfair trade practices, Cover |
231 | Florida plans are considered to be insurance subject to the |
232 | applicable provisions of part IX of chapter 626 except as |
233 | otherwise provided in this section. |
234 | (b) Cover Florida plans are not covered by the Florida |
235 | Life and Health Insurance Guaranty Association under part III of |
236 | chapter 631 or by the Health Maintenance Organization Consumer |
237 | Assistance Plan under part IV of chapter 631. |
238 | (7) ELIGIBILITY.--Eligibility to enroll in a Cover Florida |
239 | plan is limited to residents of this state who meet all of the |
240 | following requirements: |
241 | (a) Are between 19 and 64 years of age, inclusive. |
242 | (b) Are not covered by a private insurance policy and are |
243 | not eligible for coverage through a public health insurance |
244 | program, such as Medicare, Medicaid, or Kidcare, unless |
245 | eligibility for coverage lapses due to no longer meeting income |
246 | or categorical requirements. |
247 | (c) Have not been covered by any health insurance program |
248 | at any time during the past 6 months, unless coverage under a |
249 | health insurance program was terminated within the previous 6 |
250 | months due to: |
251 | 1. Loss of a job that provided an employer-sponsored |
252 | health benefit plan; |
253 | 2. Exhaustion of coverage that was continued under COBRA |
254 | or continuation-of-coverage requirements under s. 627.6692; |
255 | 3. Reaching the limiting age under the policy; or |
256 | 4. Death of, or divorce from, a spouse who was provided an |
257 | employer-sponsored health benefit plan. |
258 | (d) Have applied for health care coverage through a Cover |
259 | Florida plan and have agreed to make any payments required for |
260 | participation, including periodic payments or payments due at |
261 | the time health care services are provided. |
262 | (8) RECORDS.--Each Cover Florida plan must maintain |
263 | enrollment data and provide network data and reasonable records |
264 | to enable the office and the agency to monitor plans and to |
265 | determine the financial viability of the Cover Florida plan, as |
266 | necessary. |
267 | (9) NONENTITLEMENT.--Coverage under a Cover Florida plan |
268 | is not an entitlement, and a cause of action does not arise |
269 | against the state, a local government entity, any other |
270 | political subdivision of the state, or the agency or the office |
271 | for failure to make coverage available to eligible persons under |
272 | this section. |
273 | (10) PROGRAM EVALUATION.--The agency and the office shall: |
274 | (a) Evaluate the Cover Florida Health Care Access Program |
275 | and its effect on the entities that seek approval as Cover |
276 | Florida plans, on the number of enrollees, and on the scope of |
277 | the health care coverage offered under a Cover Florida plan. |
278 | (b) Provide an assessment of the Cover Florida plans and |
279 | their potential applicability in other settings. |
280 | (c) Use Cover Florida plans to gather more information to |
281 | evaluate low-income, consumer-driven benefit packages. |
282 | (d) Jointly submit by March 1, 2009, and annually |
283 | thereafter, a report to the Governor, the President of the |
284 | Senate, and the Speaker of the House of Representatives that |
285 | provides the information specified in paragraphs (a)-(c) and |
286 | recommendations relating to the successful implementation and |
287 | administration of the program. |
288 | (11) RULEMAKING AUTHORITY.--The agency and the Financial |
289 | Services Commission may adopt rules pursuant to ss. 120.536(1) |
290 | and 120.54 as needed to administer this section. |
291 | Section 4. Section 408.910, Florida Statutes, is created |
292 | to read: |
293 | 408.910 Florida Health Choices Program.-- |
294 | (1) LEGISLATIVE INTENT.--The Legislature finds that a |
295 | significant number of the residents of this state do not have |
296 | adequate access to affordable, quality health care. The |
297 | Legislature further finds that increasing access to affordable, |
298 | quality health care will be best accomplished by establishing a |
299 | competitive market for purchasing health insurance and health |
300 | services. It is therefore the intent of the Legislature to |
301 | create the Florida Health Choices Program to: |
302 | (a) Expand opportunities for Floridians to purchase |
303 | affordable health insurance and health services. |
304 | (b) Preserve the benefits of employment-sponsored |
305 | insurance while easing the administrative burden for employers |
306 | who offer these benefits. |
307 | (c) Enable individual choice in both the manner and amount |
308 | of health care purchased. |
309 | (d) Provide for the purchase of individual, portable |
310 | health care coverage. |
311 | (e) Disseminate information to consumers on the price and |
312 | quality of health services. |
313 | (f) Sponsor a competitive market that stimulates product |
314 | innovation, quality improvement, and efficiency in the |
315 | production and delivery of health services. |
316 | (2) DEFINITIONS.--As used in this section: |
317 | (a) "Corporation" means the Florida Health Choices, Inc., |
318 | established under this section. |
319 | (b) "Health insurance agent" means an agent licensed under |
320 | part IV of chapter 626. |
321 | (c) "Insurer" means an entity licensed under chapter 624 |
322 | that offers an individual health insurance policy or a group |
323 | health insurance policy, a preferred provider organization as |
324 | defined in s. 627.6471, or an exclusive provider organization as |
325 | defined in s. 627.6472. |
326 | (d) "Program" means the Florida Health Choices Program |
327 | established by this section. |
328 | (3) PROGRAM PURPOSE AND COMPONENTS.--The Florida Health |
329 | Choices Program is created as a single, centralized market for |
330 | the sale and purchase of various products that enable |
331 | individuals to pay for health care. These products include, but |
332 | are not limited to, health insurance plans, health maintenance |
333 | organization plans, prepaid services, service contracts, and |
334 | flexible spending accounts. The components of the program |
335 | include: |
336 | (a) Enrollment of employers. |
337 | (b) Administrative services for participating employers, |
338 | including: |
339 | 1. Assistance in seeking federal approval of cafeteria |
340 | plans. |
341 | 2. Collection of premiums and other payments. |
342 | 3. Management of individual benefit accounts. |
343 | 4. Distribution of premiums to insurers and payments to |
344 | other eligible vendors. |
345 | 5. Assistance for participants in complying with reporting |
346 | requirements. |
347 | (c) Services to individual participants, including: |
348 | 1. Information about available products and participating |
349 | vendors. |
350 | 2. Assistance to participating individuals for assessing |
351 | the benefits and limits of each product, including information |
352 | necessary to distinguish between policies offering creditable |
353 | coverage and other products available through the program. |
354 | 3. Account information to assist individual participants |
355 | to manage available resources. |
356 | 4. Services that promote healthy behaviors. |
357 | (d) Recruitment of vendors, including insurers, health |
358 | maintenance organizations, prepaid clinic service providers, |
359 | provider service networks, and other providers. |
360 | (e) Certification of vendors to ensure capability, |
361 | reliability, and validity of offerings. |
362 | (f) Collection of data, monitoring, assessment, and |
363 | reporting of vendor performance. |
364 | (g) Information services for individuals and employers. |
365 | (h) Program evaluation. |
366 | (4) ELIGIBILITY AND PARTICIPATION.--Participation in the |
367 | program is voluntary and shall be available to employers, |
368 | individuals, vendors, and health insurance agents as specified |
369 | in this subsection. |
370 | (a) Employers eligible to enroll in the program include: |
371 | 1. Employers with 1 to 50 employees. |
372 | 2. Fiscally constrained counties described in s. 218.67. |
373 | 3. Municipalities with populations of fewer than 50,000 |
374 | residents. |
375 | 4. School districts in fiscally constrained counties. |
376 | (b) Individuals eligible to participate in the program |
377 | include: |
378 | 1. Individual employees of enrolled employers. |
379 | 2. State employees not eligible for state employee health |
380 | benefits. |
381 | 3. State retirees. |
382 | 4. Medicaid reform participants who select the opt-out |
383 | provision of reform. |
384 | 5. Statutory rural hospitals. |
385 | (c) Employers who choose to participate in the program may |
386 | enroll by complying with the procedures established by the |
387 | corporation. These procedures shall include, but not be limited |
388 | to, the following: |
389 | 1. Submission of required information. |
390 | 2. Compliance with federal tax requirements for the |
391 | establishment of a cafeteria plan, pursuant to s. 125 of the |
392 | Internal Revenue Code, including designation of the employer's |
393 | plan as a premium payment plan, a salary reduction plan with |
394 | flexible spending arrangements, or a salary reduction plan with |
395 | a premium payment and flexible spending arrangements. |
396 | 3. Determination of the employer's contribution, if any, |
397 | per employee, provided that such contribution is equal for each |
398 | eligible employee. |
399 | 4. Establishment of payroll deduction procedures, subject |
400 | to the agreement of each individual employee who voluntarily |
401 | participates in the program. |
402 | 5. Designation of the corporation as the third-party |
403 | administrator for the employer's health benefit plan. |
404 | 6. Identification of eligible employees. |
405 | 7. Arrangement for periodic payments. |
406 | (d) Eligible vendors and the products and services that |
407 | they are permitted to sell are as follows: |
408 | 1. Insurers licensed under chapter 624 may sell health |
409 | insurance policies, limited benefit policies, other risk-bearing |
410 | coverage, and other products or services. |
411 | 2. Health maintenance organizations licensed under part I |
412 | of chapter 641 may sell health insurance policies, limited |
413 | benefit policies, other risk-bearing products, and other |
414 | products or services. |
415 | 3. Prepaid health clinic service providers licensed under |
416 | part II of chapter 641 may sell prepaid service contracts and |
417 | other arrangements for a specified amount and type of health |
418 | services or treatments. |
419 | 4. Health care providers, including hospitals and other |
420 | licensed health facilities, health care clinics, licensed health |
421 | professionals, pharmacies, and other licensed health care |
422 | providers, may sell service contracts and arrangements for a |
423 | specified amount and type of health services or treatments. |
424 | 5. Provider organizations, including service networks, |
425 | group practices, professional associations, and other |
426 | incorporated organizations of providers, may sell service |
427 | contracts and arrangements for a specified amount and type of |
428 | health services or treatments. |
429 | 6. Corporate entities providing specific health services |
430 | in accordance with applicable state law may sell service |
431 | contracts and arrangements for a specified amount and type of |
432 | health services or treatments. |
433 | |
434 | A vendor described in subparagraphs 3.-6. may not sell products |
435 | that provide risk-bearing coverage unless that vendor is |
436 | authorized under a certificate of authority issued by the Office |
437 | of Insurance Regulation under the provisions of the Florida |
438 | Insurance Code. Otherwise eligible vendors may be excluded from |
439 | participating in the program for deceptive or predatory |
440 | practices, financial insolvency, or failure to comply with the |
441 | terms of the participation agreement or other standards set by |
442 | the corporation. |
443 | (e) Eligible individuals may voluntarily continue |
444 | participation in the program regardless of subsequent changes in |
445 | job status or Medicaid eligibility. Individuals who join the |
446 | program may participate by complying with the procedures |
447 | established by the corporation. These procedures shall include, |
448 | but are not limited to: |
449 | 1. Submission of required information. |
450 | 2. Authorization for payroll deduction. |
451 | 3. Compliance with federal tax requirements. |
452 | 4. Arrangements for payment in the event of job changes. |
453 | 5. Selection of products and services. |
454 | (f) Vendors who choose to participate in the program may |
455 | enroll by complying with the procedures established by the |
456 | corporation. These procedures shall include, but are not limited |
457 | to: |
458 | 1. Submission of required information, including a |
459 | complete description of the coverage, services, provider |
460 | network, payment restrictions, and other requirements of each |
461 | product offered through the program. |
462 | 2. Execution of an agreement to make all products offered |
463 | through the program available to all individual participants. |
464 | 3. Establishment of product prices based on age, gender, |
465 | and location of the individual participant. |
466 | 4. Arrangements for receiving payment for enrolled |
467 | participants. |
468 | 5. Participation in ongoing reporting processes |
469 | established by the corporation. |
470 | 6. Compliance with grievance procedures established by the |
471 | corporation. |
472 | (g) Health insurance agents licensed under part IV of |
473 | chapter 626 are eligible to voluntarily participate as buyers' |
474 | representatives. A buyer's representative acts on behalf of an |
475 | individual purchasing health insurance and health services |
476 | through the program by providing information about products and |
477 | services available through the program and assisting the |
478 | individual with both the decision and the procedure of selecting |
479 | specific products. Serving as a buyer's representative does not |
480 | constitute a conflict of interest with continuing |
481 | responsibilities as a health insurance agent provided the |
482 | relationship between each agent and any participating vendor is |
483 | disclosed prior to advising an individual participant about the |
484 | products and services available through the program. In order to |
485 | participate, a health insurance agent shall comply with the |
486 | procedures established by the corporation, including: |
487 | 1. Completion of training requirements. |
488 | 2. Execution of a participation agreement specifying the |
489 | terms and conditions of participation. |
490 | 3. Disclosure of any appointments to solicit insurance or |
491 | procure applications for vendors participating in the program. |
492 | 4. Arrangements to receive payment from the corporation |
493 | for services as a buyer's representative. |
494 | (5) PRODUCTS.-- |
495 | (a) The products that may be made available for purchase |
496 | through the program include, but are not limited to: |
497 | 1. Health insurance policies. |
498 | 2. Limited benefit plans. |
499 | 3. Prepaid clinic services. |
500 | 4. Service contracts. |
501 | 5. Arrangements for purchase of specific amounts and types |
502 | of health services and treatments. |
503 | 6. Flexible spending accounts. |
504 | (b) Health insurance policies, limited benefit plans, |
505 | prepaid service contracts, and other contracts for services must |
506 | ensure the availability of covered services and benefits to |
507 | participating individuals for at least 1 full enrollment year. |
508 | (c) Products may be offered for multiyear periods provided |
509 | the price of the product is specified for the entire period or |
510 | for each separately priced segment of the policy or contract. |
511 | (d) The corporation shall require the following disclosure |
512 | to be reviewed and executed by all consumers purchasing program |
513 | options or insurance coverage through the corporation: "In |
514 | connection with the Florida Health Choices Program authorized by |
515 | s. 408.910, Florida Statutes, agents and entities offering |
516 | products and services under the program shall inform the named |
517 | insured, applicant, or subscriber, on a form approved by the |
518 | Office of Insurance Regulation of the Financial Services |
519 | Commission, that the products and services are not insurance or, |
520 | if they are insurance, that benefits under the coverage are |
521 | limited under s. 408.910, Florida Statutes, and that such |
522 | coverage is an alternative to coverage without such limitations. |
523 | If the form is signed by a named insured, applicant, or |
524 | subscriber, it shall be presumed that there was an informed, |
525 | knowing acceptance of such limitations." |
526 | (6) PRICING.--Prices for the products sold through the |
527 | program shall be transparent to participants and established by |
528 | the vendors based on age, gender, and location of participants. |
529 | The corporation shall develop a methodology to evaluate the |
530 | actuarial soundness of products offered through the program. The |
531 | methodology shall be reviewed by the Office of Insurance |
532 | Regulation prior to use by the corporation. Prior to making the |
533 | product available to individual participants, the corporation |
534 | shall use the methodology to compare the expected health care |
535 | costs for the covered services and benefits to the vendor's |
536 | price for that coverage. The results shall be reported to |
537 | individuals participating in the program. Once established, the |
538 | price set by the vendor must remain in force for at least 1 year |
539 | and may only be redetermined by the vendor at the next annual |
540 | enrollment period. The corporation shall annually assess a |
541 | surcharge for each premium or price set by a participating |
542 | vendor. This surcharge may not be more than 2.5 percent of the |
543 | price and shall be used to generate funding for administrative |
544 | services provided by the corporation and payments to buyers' |
545 | representatives. |
546 | (7) EXCHANGE PROCESS.--The program shall provide a single, |
547 | centralized market for purchase of health insurance and health |
548 | services. Purchases may be made by participating individuals |
549 | over the Internet or through the services of a participating |
550 | health insurance agent. Information about each product and |
551 | service available through the program shall be made available |
552 | through printed material and an interactive Internet website. A |
553 | participant needing personal assistance to select products and |
554 | services shall be referred to a participating agent in his or |
555 | her area. |
556 | (a) Participation in the program may begin at any time |
557 | during a year when the employer completes enrollment and meets |
558 | the requirements specified by the corporation pursuant to |
559 | paragraph (4)(c). |
560 | (b) Initial selection of products and services must be |
561 | made by an individual participant within 60 days after the date |
562 | on which the individual's employer qualified for participation. |
563 | An individual who fails to enroll in products and services by |
564 | the end of this period shall be limited to participation in |
565 | flexible spending account services until the next annual |
566 | enrollment period. |
567 | (c) Initial enrollment periods for each product selected |
568 | by an individual participant must last a minimum of 12 months, |
569 | unless the individual participant specifically agrees to a |
570 | different enrollment period. |
571 | (d) When an individual has selected one or more products |
572 | and enrolled in those products for at least 12 months or any |
573 | other period specifically agreed to by the individual |
574 | participant, changes in selected products and services may only |
575 | be made during the annual enrollment period established by the |
576 | corporation. |
577 | (e) The limits established in paragraphs (b)-(d) apply to |
578 | any risk-bearing product that promises future payment or |
579 | coverage for a variable amount of benefits or services. The |
580 | limits do not apply to initiation of flexible spending plans |
581 | when those plans are not associated with specific high- |
582 | deductible insurance policies or to the use of spending accounts |
583 | for any products offering individual participants specific |
584 | amounts and types of health services and treatments at a |
585 | contracted price. |
586 | (8) RISK POOLING.--The program shall utilize methods for |
587 | pooling the risk of individual participants and preventing |
588 | selection bias. These methods shall include, but not be limited |
589 | to, a postenrollment risk adjustment of the premium payments to |
590 | the vendors. The corporation shall establish a methodology for |
591 | assessing the risk of enrolled individual participants based on |
592 | data reported by the vendors about their enrollees. Monthly |
593 | distributions of payments to the vendors shall be adjusted based |
594 | on the assessed relative risk profile of the enrollees in each |
595 | risk-bearing product for the most recent period for which data |
596 | is available. |
597 | (9) EXEMPTIONS.-- |
598 | (a) Policies sold as part of the program are not subject |
599 | to the licensing requirements of the Florida Insurance Code, |
600 | chapter 641, or the mandated offerings or coverages established |
601 | in part VI of chapter 627 and chapter 641. |
602 | (b) The corporation is authorized to act as an |
603 | administrator as defined in s. 626.88. However, the corporation |
604 | is not subject to the licensing requirements of part VII of |
605 | chapter 626. |
606 | (10) LIQUIDATION OR DISSOLUTION.--The Department of |
607 | Financial Services shall supervise any liquidation or |
608 | dissolution of the corporation and shall have, with respect to |
609 | such liquidation or dissolution, all power granted to it |
610 | pursuant to the Florida Insurance Code. |
611 | (11) CORPORATION.--There is created the Florida Health |
612 | Choices, Inc., which shall be registered, incorporated, |
613 | organized, and operated in compliance with chapter 617. The |
614 | purpose of the corporation is to administer the program created |
615 | in this section and to conduct such other business as may |
616 | further the administration of the program. |
617 | (a) The corporation shall be governed by a board of |
618 | directors consisting of 15 individuals appointed in the |
619 | following manner: |
620 | 1. Five members appointed by and serving at the pleasure |
621 | of the Governor, consisting of: |
622 | a. The Secretary of Health Care Administration or a |
623 | designee with expertise in health care services. |
624 | b. The Secretary of Management Services or a designee with |
625 | expertise in state employee benefits. |
626 | c. The Commissioner of the Office of Insurance Regulation |
627 | or a designee with expertise in insurance regulation. |
628 | d. Two representatives of eligible public employers. |
629 | 2. Five members appointed by and serving at the pleasure |
630 | of the President of the Senate, consisting of representatives of |
631 | employers, insurers, health care providers, health insurance |
632 | agents, and individual participants. |
633 | 3. Five members appointed by and serving at the pleasure |
634 | of the Speaker of the House of Representatives, consisting of |
635 | representatives of employers, insurers, health care providers, |
636 | health insurance agents, and individual participants. |
637 | (b) Members shall be appointed for terms of up to 3 years. |
638 | Any member is eligible for reappointment. A vacancy on the board |
639 | shall be filled for the unexpired portion of the term in the |
640 | same manner as the original appointment. |
641 | (c) The board shall select a chief executive officer for |
642 | the corporation who shall be responsible for the selection of |
643 | such other staff as may be authorized by the corporation's |
644 | operating budget as adopted by the board. |
645 | (d) Board members are entitled to receive, from funds of |
646 | the corporation, reimbursement for per diem and travel expenses |
647 | as provided by s. 112.061. No other compensation is authorized. |
648 | (e) There shall be no liability on the part of, and no |
649 | cause of action shall arise against, any member of the board or |
650 | its employees or agents for any action taken by them in the |
651 | performance of their powers and duties under this section. |
652 | (f) The board shall develop and adopt bylaws and other |
653 | corporate procedures as necessary for the operation of the |
654 | corporation and carrying out the purposes of this section. The |
655 | bylaws shall: |
656 | 1. Specify procedures for selection of officers and |
657 | qualifications for reappointment, provided that no board member |
658 | shall serve more than 9 consecutive years. |
659 | 2. Require an annual membership meeting that provides an |
660 | opportunity for input and interaction with individual |
661 | participants in the program. |
662 | 3. Specify policies and procedures regarding conflicts of |
663 | interest, including prohibiting a member from participating in |
664 | any decision that would inure to the benefit of the member or |
665 | the organization that employs the member. The policies and |
666 | procedures shall also require public disclosure of the interest |
667 | that prevents the member from participating in a decision on a |
668 | particular matter. |
669 | (g) The corporation may exercise all powers granted to it |
670 | under chapter 617 necessary to carry out the purposes of this |
671 | section, including, but not limited to, the power to receive and |
672 | accept grants, loans, or advances of funds from any public or |
673 | private agency and to receive and accept from any source |
674 | contributions of money, property, labor, or any other thing of |
675 | value to be held, used, and applied for the purposes of this |
676 | section. |
677 | (h) The corporation shall: |
678 | 1. Determine eligibility of employers, vendors, |
679 | individuals, and agents in accordance with subsection (4). |
680 | 2. Establish procedures necessary for the operation of the |
681 | program, including, but not limited to, procedures for |
682 | application, enrollment, risk assessment, risk adjustment, plan |
683 | administration, performance monitoring, and consumer education. |
684 | 3. Arrange for collection of contributions from |
685 | participating employers and individuals. |
686 | 4. Arrange for payment of premiums and other appropriate |
687 | disbursements based on the selections of products and services |
688 | by the individual participants. |
689 | 5. Establish criteria for disenrollment of participating |
690 | individuals based on failure to pay the individual's share of |
691 | any contribution required to maintain enrollment in selected |
692 | products. |
693 | 6. Establish criteria for exclusion of vendors pursuant to |
694 | paragraph (4)(d). |
695 | 7. Develop and implement a plan for promoting public |
696 | awareness of and participation in the program. |
697 | 8. Secure staff and consultant services necessary to the |
698 | operation of the program. |
699 | 9. Establish policies and procedures regarding |
700 | participation in the program for individuals, vendors, health |
701 | insurance agents, and employers. |
702 | 10. Develop a plan, in coordination with the Department of |
703 | Revenue, to establish tax credits or refunds for employers that |
704 | participate in the program. The corporation shall submit the |
705 | plan to the Governor, the President of the Senate, and the |
706 | Speaker of the House of Representatives no later than January 1, |
707 | 2009. |
708 | 11. Beginning in fiscal year 2009-2010, submit by February |
709 | 1 an annual report to the Governor, the President of the Senate, |
710 | and the Speaker of the House of Representatives documenting the |
711 | corporation's activities in compliance with the duties |
712 | delineated in this section. |
713 | (i) To ensure program integrity and to safeguard the |
714 | financial transactions made under the auspices of the program, |
715 | the corporation is authorized to establish qualifying criteria |
716 | and certification procedures for vendors, require performance |
717 | bonds or other guarantees of ability to complete contractual |
718 | obligations, monitor the performance of vendors, and enforce the |
719 | agreements of the program through financial penalty or |
720 | disqualification from the program. |
721 | Section 5. Subsection (22) of section 409.811, Florida |
722 | Statutes, is amended to read: |
723 | 409.811 Definitions relating to Florida Kidcare Act.--As |
724 | used in ss. 409.810-409.820, the term: |
725 | (22) "Premium assistance payment" means the monthly |
726 | consideration paid by the agency per enrollee in the Florida |
727 | Kidcare program towards health insurance premiums and may |
728 | include the direct payment of the premium for a qualifying child |
729 | to be covered as a dependent under an employer-sponsored group |
730 | family plan when such payment does not exceed the payment |
731 | required for an enrollee in the Florida Kidcare program. |
732 | Section 6. Section 624.1265, Florida Statutes, is created |
733 | to read: |
734 | 624.1265 Nonprofit religious organization exemption; |
735 | authority; notice.-- |
736 | (1) Any nonprofit religious organization that qualifies |
737 | under Title 26, s. 501 of the Internal Revenue Code of 1986, as |
738 | amended; that limits its participants to members of the same |
739 | religion; that acts as an organizational clearinghouse for |
740 | information between participants who have financial, physical, |
741 | or medical needs and participants with the ability to pay for |
742 | the benefit of those participants with financial, physical, or |
743 | medical needs; that provides for the financial or medical needs |
744 | of a participant through payments directly from one participant |
745 | to another; and that suggests amounts that participants may |
746 | voluntarily give with no assumption of risk or promise to pay |
747 | either among the participants or between the participants and |
748 | the organization are not subject to any requirements of the |
749 | Florida Insurance Code. |
750 | (2) Nothing in this section prevents the organization |
751 | described in subsection (1) from establishing qualifications of |
752 | participation relating to the health of a prospective |
753 | participant, prevents a participant from limiting the financial |
754 | or medical needs that may be eligible for payment, or prevents |
755 | the organization from canceling the membership of a participant |
756 | when such participant indicates his or her unwillingness to |
757 | participate by failing to make a payment to another participant |
758 | for a period in excess of 60 days. |
759 | (3) The organization described in subsection (1) shall |
760 | provide each prospective participant in the organizational |
761 | clearinghouse written notice that the organization is not an |
762 | insurance company, that membership is not offered through an |
763 | insurance company, and that the organization is not subject to |
764 | the regulatory requirements or consumer protections of the |
765 | Florida Insurance Code. |
766 | Section 7. Section 627.6562, Florida Statutes, is amended |
767 | to read: |
768 | 627.6562 Dependent coverage.-- |
769 | (1) If an insurer offers coverage that insures dependent |
770 | children of the policyholder or certificateholder, the policy |
771 | must insure a dependent child of the policyholder or |
772 | certificateholder at least until the end of the calendar year in |
773 | which the child reaches the age of 25, if the child meets all of |
774 | the following: |
775 | (a) The child is dependent upon the policyholder or |
776 | certificateholder for support. |
777 | (b) The child is living in the household of the |
778 | policyholder or certificateholder, or the child is a full-time |
779 | or part-time student. |
780 | (2) A policy that is subject to the requirements of |
781 | subsection (1) must also offer the policyholder or |
782 | certificateholder the option to insure a child of the |
783 | policyholder or certificateholder at least until the end of the |
784 | calendar year in which the child reaches the age of 30, if the |
785 | child: |
786 | (a) Is unmarried and does not have a dependent of his or |
787 | her own; |
788 | (b) Is a resident of this state or a full-time or part- |
789 | time student; and |
790 | (c) Is not provided coverage as a named subscriber, |
791 | insured, enrollee, or covered person under any other group, |
792 | blanket, or franchise health insurance policy or individual |
793 | health benefits plan, or entitled to benefits under Title XVIII |
794 | of the Social Security Act. |
795 | (3) If, pursuant to subsection (2), a child is provided |
796 | coverage under the parent's policy after the end of the calendar |
797 | year in which the child reaches age 25, and coverage for the |
798 | child is subsequently terminated, the child is not eligible to |
799 | be covered under the parent's policy unless the child was |
800 | continuously covered by other creditable coverage without a gap |
801 | in coverage of more than 63 days. For the purposes of this |
802 | subsection, the term "creditable coverage" has the same meaning |
803 | as defined in s. 627.6561(5). |
804 | (4)(2) Nothing in This section does not affect or preempt |
805 | affects or preempts an insurer's right to medically underwrite |
806 | or charge the appropriate premium. (b) Require coverage |
807 | for services provided to a dependent before October 1, 2008. |
808 | (c) Require an employer to pay all or part of the cost of |
809 | coverage provided for a dependent under this section. |
810 | (d) Prohibit an insurer or health maintenance organization |
811 | from increasing the limiting age for dependent coverage to age |
812 | 30 in policies or contracts issued or renewed prior to the |
813 | effective date of this act. |
814 | (5) Until April 1, 2009, a dependent child who qualifies |
815 | for coverage under subsection (1) but whose coverage as a |
816 | dependent child under a covered person's plan terminated under |
817 | the terms of the plan before October 1, 2008, may make a written |
818 | election to reinstate coverage, without proof of insurability, |
819 | under that plan as a dependent child pursuant to this section. |
820 | All other dependent children who qualify for coverage under |
821 | subsection (1) shall be automatically covered at least until the |
822 | end of the calendar year in which the child reaches the age of |
823 | 30, unless the covered person provides the group policyholder |
824 | with written evidence the dependent child is married, is not a |
825 | resident of the state, is covered under a separate comprehensive |
826 | health insurance policy or a health benefit plan, is entitled to |
827 | benefits under Title XVIII of the Social Security Act, Pub. L. |
828 | No. 89-97, 42 U.S.C. ss. 1935 et seq., or is eligible for |
829 | coverage as an employee under an employer-sponsored health plan. |
830 | (6) The covered person's plan may require the payment of a |
831 | premium by the covered person or dependent child, as |
832 | appropriate, subject to the approval of the Office of Insurance |
833 | Regulation, for any period of coverage relating to a dependent's |
834 | written election for coverage pursuant to subsection (3). |
835 | (7) Notice regarding the reinstatement of coverage for a |
836 | dependent child as provided under this section must be provided |
837 | to a covered person in the certificate of coverage prepared for |
838 | covered persons by the insurer or by the covered person's |
839 | employer. The notice shall be given as soon as practicable after |
840 | July 1, 2008, and such notice may be given through the group |
841 | policyholder. |
842 | (8) This section does not apply to accident only, |
843 | specified disease, disability income, Medicare supplement, or |
844 | long-term care insurance policies. |
845 | (9) This section applies to all group, blanket, and |
846 | franchise health insurance policies covering residents of this |
847 | state, including, but not limited to, policies in which the |
848 | carrier has reserved the right to change the premium. This |
849 | section applies to all individual, group, blanket, and franchise |
850 | health insurance policies and health maintenance contracts |
851 | issued, renewed, or amended after October 1, 2008. |
852 | Section 8. Subsections (41) and (42) are added to section |
853 | 641.31, Florida Statutes, to read: |
854 | 641.31 Health maintenance contracts.-- |
855 | (41) Unless the employer chooses otherwise, for all |
856 | policies or health maintenance contracts issued or renewed after |
857 | October 1, 2008, all eligible employees and their dependents |
858 | shall be enrolled for coverage at the time of issuance or during |
859 | the next open or special enrollment period, unless the employee |
860 | provides written notice to the employer declining coverage, |
861 | which notice shall include evidence of coverage under an |
862 | existing group insurance policy or group health benefit plan or |
863 | other reasons for declining coverage. Such notice shall be |
864 | retained by the employer as part of the employee's employment or |
865 | insurance file. An employer may require its employees to |
866 | participate in its group health plan as a condition of |
867 | employment. This subsection shall apply to all individual, |
868 | group, blanket, and franchise health insurance policies and |
869 | health maintenance contracts issued, renewed, or amended after |
870 | October 1, 2008. |
871 | (42) All health maintenance contracts that provide |
872 | coverage for a member of the family of the subscriber shall |
873 | comply with s. 627.6562. |
874 | Section 9. Subsections (1), (4), and (6) of section |
875 | 641.402, Florida Statutes, are amended to read: |
876 | 641.402 Definitions.--As used in this part, the term: |
877 | (1) "Basic services" includes any of the following: |
878 | limited hospital inpatient services, which may include hospital |
879 | inpatient physician services, up to a maximum of coverage |
880 | benefit of 5 days and a maximum dollar amount of coverage of |
881 | $15,000 per calendar year; emergency care;, physician care other |
882 | than hospital inpatient physician services;, ambulatory |
883 | diagnostic treatment;, and preventive health care services. |
884 | (4) "Prepaid health clinic" means any organization |
885 | authorized under this part which provides, either directly or |
886 | through arrangements with other persons, basic services to |
887 | persons enrolled with such organization, on a prepaid per capita |
888 | or prepaid aggregate fixed-sum basis, including those basic |
889 | services described in this part which subscribers might |
890 | reasonably require to maintain good health. However, no clinic |
891 | that provides or contracts for, either directly or indirectly, |
892 | inpatient hospital services, hospital inpatient physician |
893 | services, or indemnity against the cost of such services shall |
894 | be a prepaid health clinic. |
895 | (6) "Provider" means any physician or person other than a |
896 | hospital that furnishes health care services under this part and |
897 | is licensed or authorized to practice in this state. |
898 | Section 10. This act shall take effect upon becoming a |
899 | law. |
900 |
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901 |
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902 |
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903 |
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904 |
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905 | ----------------------------------------------------- |
906 | T I T L E A M E N D M E N T |
907 | Remove line(s) 473-526 and insert: |
908 | An act relating to affordable health coverage; amending s. |
909 | 112.363, F.S.; specifying that coverage provided through |
910 | the Cover Florida Health Care Access Program is considered |
911 | health insurance coverage for the purposes of determining |
912 | eligibility for the state retiree health insurance |
913 | subsidy; amending s. 408.909, F.S.; revising eligibility |
914 | requirements; providing certain exemptions from the 6- |
915 | month lapse in coverage requirement; extending the |
916 | expiration date of the health flex plan; creating s. |
917 | 408.9091, F.S.; creating the Cover Florida Health Care |
918 | Access Program; providing a short title; providing |
919 | legislative intent; providing definitions; requiring the |
920 | agency and the Office of Insurance Regulation of the |
921 | Financial Services Commission within the Department of |
922 | Financial Services to jointly administer the program; |
923 | providing program requirements; requiring the development |
924 | of guidelines to meet minimum standards for quality of |
925 | care and access to care; requiring the agency to ensure |
926 | that the Cover Florida plans follow standardized grievance |
927 | procedures; requiring the office and the agency to oversee |
928 | changes to plan benefits; requiring the Executive Office |
929 | of the Governor, the agency, and the office to develop a |
930 | public awareness program; authorizing public and private |
931 | entities to design programs to encourage or extend |
932 | incentives for participation in the Cover Florida Health |
933 | Care Access Program; requiring the agency and the office |
934 | to announce an invitation to negotiate for Cover Florida |
935 | plan entities to design a coverage proposal; requiring the |
936 | invitation to negotiate to include certain guidelines; |
937 | providing certain conditions under which plans are |
938 | disapproved or withdrawn; authorizing the agency and the |
939 | office to announce an invitation to negotiate for |
940 | companies that offer supplemental insurance or discount |
941 | medical plans; requiring the agency and the office to |
942 | approve at least one plan entity; authorizing the agency |
943 | and the office to approve one regional network plan in |
944 | each existing Medicaid area; providing that certain |
945 | licensing requirements are not applicable to a Cover |
946 | Florida plan; providing that Cover Florida plans are |
947 | considered insurance under certain conditions; excluding |
948 | Cover Florida plans from the Florida Life and Health |
949 | Insurance Guaranty Association and the Health Maintenance |
950 | Organization Consumer Assistance Plan; providing |
951 | requirements for eligibility for a Cover Florida plan; |
952 | requiring each Cover Florida plan to maintain and provide |
953 | certain records; providing that coverage under a Cover |
954 | Florida plan is not an entitlement and does not give rise |
955 | to a cause of action; requiring the agency and the office |
956 | to evaluate the program and submit an annual report to the |
957 | Governor and the Legislature; authorizing the agency and |
958 | the Financial Services Commission to adopt rules; creating |
959 | s. 408.910, F.S.; establishing the Florida Health Choices |
960 | Program; providing legislative intent; providing |
961 | definitions; providing program purpose and components; |
962 | providing employer eligibility criteria; providing |
963 | individual eligibility criteria; providing employer |
964 | enrollment criteria; providing vendor, product, and |
965 | service eligibility criteria; providing for individual |
966 | participation regardless of subsequent job status or |
967 | Medicaid eligibility; providing individual enrollment |
968 | criteria; providing vendor enrollment criteria; providing |
969 | for participation by health insurance agents; providing |
970 | criteria for products available for purchase; providing |
971 | criteria for product pricing; providing for an |
972 | administrative surcharge; providing for an exchange |
973 | process; providing for enrollment periods and changes in |
974 | selected products; providing methods for the pooling of |
975 | risk; providing for exemptions from certain statutory |
976 | provisions, mandated offerings and coverages, and |
977 | licensing requirements; creating the Florida Health |
978 | Choices, Inc.; requiring the department to supervise any |
979 | liquidation or dissolution of the corporation; providing |
980 | for corporate governance and board membership and terms; |
981 | providing for reimbursement for per diem and travel |
982 | expenses; providing for powers and duties of the |
983 | corporation; requiring the corporation to coordinate with |
984 | the Department of Revenue to develop a plan by January 1, |
985 | 2009, for creating tax exemptions or refunds for |
986 | participating in the program; requiring the corporation to |
987 | submit an annual report to the Governor and Legislature; |
988 | authorizing the corporation to establish and enforce |
989 | certain program integrity measures; amending s. 409.811, |
990 | F.S.; revising the definition of the term "premium |
991 | assistance payment"; creating s. 624.1265, F.S.; exempting |
992 | certain nonprofit religious organizations from |
993 | requirements of the Florida Insurance Code; preserving |
994 | certain authority of such organizations; requiring such |
995 | organizations to provide certain notice to prospective |
996 | participants; providing notice requirements; amending s. |
997 | 627.6562, F.S.; requiring insurance policies that provide |
998 | dependent coverage to provide the policyholder with the |
999 | option of insuring a child until the age of 30 under |
1000 | certain circumstances; amending s. 627.6699, F.S.; |
1001 | requiring participation of employees in health maintenance |
1002 | contracts or policies issued or renewed after a specified |
1003 | date; providing conditions for employers and employees to |
1004 | opt out of such coverage; amending s. 641.31, F.S.; |
1005 | requiring participation of employees in policies or health |
1006 | maintenance contracts issued or renewed after a specified |
1007 | date; providing conditions for employers and employees to |
1008 | opt out of such coverage; requiring all heath maintenance |
1009 | contracts that provide coverage for family members to |
1010 | comply with certain statutory provisions; amending s. |
1011 | 641.402, F.S.; revising the definition of the term "basic |
1012 | services" to include certain hospital inpatient services; |
1013 | revising the definitions of the terms "prepaid health |
1014 | clinic" and "provider"; providing an effective date. |