Bill No. CS/HB 7081
Amendment No. 001225
Senate House

1Representative Bean offered the following:
3     Substitute Amendment for Amendment (830641) (with title
5     Remove line(s) 5-464 and insert:
6     Section 1.  Paragraph (d) of subsection (2) of section
7112.363, Florida Statutes, is amended to read:
8     112.363  Retiree health insurance subsidy.--
10     (d)  Payment of the retiree health insurance subsidy shall
11be made only after coverage for health insurance for the retiree
12or beneficiary has been certified in writing to the Department
13of Management Services. Participation in a former employer's
14group health insurance program is not a requirement for
15eligibility under this section. Coverage issued pursuant to s.
16408.9091 is considered health insurance for the purposes of this
18     Section 2.  Subsections (5) and (10) of section 408.909,
19Florida Statutes, are amended to read:
20     408.909  Health flex plans.--
21     (5)  ELIGIBILITY.--Eligibility to enroll in an approved
22health 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
25percent of the federal poverty level;
26     (c)  Are eligible under a federally approved Medicaid
27demonstration waiver and reside in Palm Beach County or Miami-
28Dade County;
29     3. (d)  Are not covered by a private insurance policy and
30are not eligible for coverage through a public health insurance
31program, such as Medicare or Medicaid, unless specifically
32authorized under paragraph (c), or another public health care
33program, such as Kidcare, and have not been covered at any time
34during the past 6 months, except that:
35     a.  A person who was covered under an individual health
36maintenance contract issued by a health maintenance organization
37licensed under part I of chapter 641 that also was an approved
38health flex plan on October 1, 2008, may apply for coverage in
39the same health maintenance organization's health flex plan
40without a lapse in coverage if all other eligibility
41requirements are met; or
42     b.  A person who was covered under Medicaid or Kidcare and
43lost eligibility for the Medicaid or Kidcare subsidy due to
44income restrictions within 90 days prior to applying for health
45care coverage through an approved health flex plan may apply for
46coverage in a health flex plan without a lapse in coverage if
47all other eligibility requirements are met; and
48     4.(e)  Have applied for health care coverage as an
49individual through an approved health flex plan and have agreed
50to make any payments required for participation, including
51periodic payments or payments due at the time health care
52services are provided; or
53     (b)  Are part of an employer group at least 75 percent of
54the employees of which have a family income equal to or less
55than 300 percent of the federal poverty level and which employee
56group is not covered by a private health insurance policy and
57has not been covered at any time during the past 6 months. If
58the health flex plan entity is a health insurer, health plan, or
59health maintenance organization licensed under Florida law, only
6050 percent of the employees must meet the income requirements
61for 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
64to read:
65     408.9091  Cover Florida Health Care Access Program.--
66     (1)  SHORT TITLE.--This section may be cited as the "Cover
67Florida Health Care Access Program Act."
68     (2)  LEGISLATIVE INTENT.--The Legislature finds that a
69significant number of state residents are unable to obtain
70affordable health insurance coverage. The Legislature also finds
71that existing health flex plan coverage has had limited
72participation due in part to narrow eligibility restrictions as
73well as minimal benefit options for catastrophic and emergency
74care coverage. Therefore, it is the intent of the Legislature to
75expand the availability of health care options for uninsured
76residents by developing an affordable health care product that
77emphasizes coverage for basic and preventive health care
78services; provides inpatient hospital, urgent, and emergency
79care services; and is offered statewide by approved health
80insurers, health maintenance organizations, health-care-
81provider-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
85     (b)  "Cover Florida plan" means a consumer choice benefit
86plan approved under this section that guarantees payment or
87coverage for specified benefits provided to an enrollee.
88     (c)  "Cover Florida plan coverage" means health care
89services that are covered as benefits under a Cover Florida
91     (d)  "Cover Florida plan entity" means a health insurer,
92health maintenance organization, health-care-provider-sponsored
93organization, or health care district that develops and
94implements a Cover Florida plan and is responsible for
95administering the plan and paying all claims for Cover Florida
96plan coverage by enrollees.
97     (e)  "Cover Florida Plus" means a supplemental insurance
98product, such as for additional catastrophic coverage or dental,
99vision, or cancer coverage, approved under this section and
100offered to all enrollees.
101     (f)  "Enrollee" means an individual who has been determined
102to be eligible for and is receiving health insurance coverage
103under a Cover Florida plan.
104     (g)  "Office" means the Office of Insurance Regulation of
105the Financial Services Commission.
106     (4)  PROGRAM.--The agency and the office shall jointly
107establish and administer the Cover Florida Health Care Access
109     (a)  General Cover Florida plan components must require
111     1.  Plans are offered on a guaranteed-issue basis to
112enrollees, subject to exclusions for preexisting conditions
113approved by the office and the agency.
114     2.  Plans are portable such that the enrollee remains
115covered regardless of employment status or the cost-sharing of
117     3.  Plans provide for cost containment through limits on
118the number of services, caps on benefit payments, and copayments
119for services.
120     4.  A Cover Florida plan entity makes all benefit plan and
121marketing materials available in English and Spanish.
122     5.  In order to provide for consumer choice, Cover Florida
123plan entities develop two alternative benefit option plans
124having different cost and benefit levels, including at least one
125plan that provides catastrophic coverage.
126     6.  Plans without catastrophic coverage provide coverage
127options for services including, but not limited to:
128     a.  Preventive health services, including immunizations,
129annual health assessments, well-woman and well-care services,
130and preventive screenings such as mammograms, cervical cancer
131screenings, and noninvasive colorectal or prostate screenings.
132     b.  Incentives for routine preventive care.
133     c.  Office visits for the diagnosis and treatment of
134illness 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,
140provide coverage options for all of the services listed under
141subparagraph 6.; however, such plans may include, but are not
142limited 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
147outpatient diagnostic services.
148     8.  All plans offer prescription drug benefit coverage or
149use a prescription drug manager such as the Florida Discount
150Drug Card Program.
151     9.  Plan enrollment materials provide information in plain
152language on policy benefit coverage, benefit limits, cost-
153sharing requirements, and exclusions and a clear representation
154of what is not covered in the plan. The Cover Florida Health
155Care Access Program shall require the following disclosure to be
156reviewed and executed by all consumers purchasing program
157options or insurance coverage through the program: "In
158connection with the Cover Florida Health Care Access Program
159authorized by s. 408.9091, Florida Statutes, agents and entities
160offering products and services under the program shall inform
161the named insured, applicant, or subscriber, on a form approved
162by the Office of Insurance Regulation of the Financial Services
163Commission, that the program is not an insurance program or, if
164it is an insurance program, that benefits under the coverage are
165limited under s. 408.9091, Florida Statutes, and that such
166coverage is an alternative to coverage without such limitations.
167If the form is signed by a named insured, applicant, or
168subscriber, it shall be presumed that there was an informed,
169knowing acceptance of such limitations."
170     10.  Plans offered through a qualified employer meet the
171requirements of s. 125 of the Internal Revenue Code.
172     (b)  Guidelines shall be developed to ensure that Cover
173Florida plans meet minimum standards for quality of care and
174access to care. The agency shall ensure that the Cover Florida
175plans follow standardized grievance procedures.
176     (c)  Changes in Cover Florida plan benefits, premiums, and
177policy forms are subject to regulatory oversight by the office
178and the agency as provided under rules adopted by the Financial
179Services Commission and the agency.
180     (d)  The agency, the office, and the Executive Office of
181the Governor shall develop a public awareness program to be
182implemented throughout the state for the promotion of the Cover
183Florida Health Care Access Program.
184     (e)  Public or private entities may design programs to
185encourage Floridians to participate in the Cover Florida Health
186Care Access Program or to encourage employers to cosponsor some
187share of Cover Florida plan premiums for employees.
188     (5)  PLAN PROPOSALS.--The agency and the office shall
189announce, no later than July 1, 2008, an invitation to negotiate
190for Cover Florida plan entities to design a Cover Florida plan
191proposal in which benefits and premiums are specified.
192     (a)  The invitation to negotiate shall include guidelines
193for the review of Cover Florida plan applications, policy forms,
194and all associated forms and provide regulatory oversight of
195Cover Florida plan advertisement and marketing procedures. A
196plan shall be disapproved or withdrawn if the plan:
197     1.  Contains any ambiguous, inconsistent, or misleading
198provisions or any exceptions or conditions that deceptively
199affect or limit the benefits purported to be assumed in the
200general coverage provided by the plan;
201     2.  Provides benefits that are unreasonable in relation to
202the premium charged or contains provisions that are unfair or
203inequitable, that are contrary to the public policy of this
204state, that encourage misrepresentation, or that result in
205unfair discrimination in sales practices;
206     3.  Cannot demonstrate that the plan is financially sound
207and that the applicant is able to underwrite or finance the
208health care coverage provided;
209     4.  Cannot demonstrate that the applicant and its
210management are in compliance with the standards required under
211s. 624.404(3); or
212     5.  Does not guarantee that enrollees may participate in
213the Cover Florida plan entity's comprehensive network of
214providers, as determined by the office, the agency, and the
216     (b)  The agency and the office may announce an invitation
217to negotiate for the design of Cover Florida Plus products to
218companies that offer supplemental insurance, discount medical
219plan organizations licensed under part II of chapter 636, or
220prepaid health clinics licensed under part II of chapter 641.
221     (c)  The agency and office shall approve at least one Cover
222Florida plan entity having an existing statewide network of
223providers and may approve at least one regional network plan in
224each existing Medicaid area.
225     (6)  LICENSE NOT REQUIRED.--
226     (a)  The licensing requirements of the Florida Insurance
227Code and chapter 641 relating to health maintenance
228organizations do not apply to a Cover Florida plan approved
229under this section unless expressly made applicable. However,
230for the purpose of prohibiting unfair trade practices, Cover
231Florida plans are considered to be insurance subject to the
232applicable provisions of part IX of chapter 626 except as
233otherwise provided in this section.
234     (b)  Cover Florida plans are not covered by the Florida
235Life and Health Insurance Guaranty Association under part III of
236chapter 631 or by the Health Maintenance Organization Consumer
237Assistance Plan under part IV of chapter 631.
238     (7)  ELIGIBILITY.--Eligibility to enroll in a Cover Florida
239plan is limited to residents of this state who meet all of the
240following requirements:
241     (a)  Are between 19 and 64 years of age, inclusive.
242     (b)  Are not covered by a private insurance policy and are
243not eligible for coverage through a public health insurance
244program, such as Medicare, Medicaid, or Kidcare, unless
245eligibility for coverage lapses due to no longer meeting income
246or categorical requirements.
247     (c)  Have not been covered by any health insurance program
248at any time during the past 6 months, unless coverage under a
249health insurance program was terminated within the previous 6
250months due to:
251     1.  Loss of a job that provided an employer-sponsored
252health benefit plan;
253     2.  Exhaustion of coverage that was continued under COBRA
254or 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
257employer-sponsored health benefit plan.
258     (d)  Have applied for health care coverage through a Cover
259Florida plan and have agreed to make any payments required for
260participation, including periodic payments or payments due at
261the time health care services are provided.
262     (8)  RECORDS.--Each Cover Florida plan must maintain
263enrollment data and provide network data and reasonable records
264to enable the office and the agency to monitor plans and to
265determine the financial viability of the Cover Florida plan, as
267     (9)  NONENTITLEMENT.--Coverage under a Cover Florida plan
268is not an entitlement, and a cause of action does not arise
269against the state, a local government entity, any other
270political subdivision of the state, or the agency or the office
271for failure to make coverage available to eligible persons under
272this section.
273     (10)  PROGRAM EVALUATION.--The agency and the office shall:
274     (a)  Evaluate the Cover Florida Health Care Access Program
275and its effect on the entities that seek approval as Cover
276Florida plans, on the number of enrollees, and on the scope of
277the health care coverage offered under a Cover Florida plan.
278     (b)  Provide an assessment of the Cover Florida plans and
279their potential applicability in other settings.
280     (c)  Use Cover Florida plans to gather more information to
281evaluate low-income, consumer-driven benefit packages.
282     (d)  Jointly submit by March 1, 2009, and annually
283thereafter, a report to the Governor, the President of the
284Senate, and the Speaker of the House of Representatives that
285provides the information specified in paragraphs (a)-(c) and
286recommendations relating to the successful implementation and
287administration of the program.
288     (11)  RULEMAKING AUTHORITY.--The agency and the Financial
289Services Commission may adopt rules pursuant to ss. 120.536(1)
290and 120.54 as needed to administer this section.
291     Section 4.  Section 408.910, Florida Statutes, is created
292to read:
293     408.910  Florida Health Choices Program.--
294     (1)  LEGISLATIVE INTENT.--The Legislature finds that a
295significant number of the residents of this state do not have
296adequate access to affordable, quality health care. The
297Legislature further finds that increasing access to affordable,
298quality health care will be best accomplished by establishing a
299competitive market for purchasing health insurance and health
300services. It is therefore the intent of the Legislature to
301create the Florida Health Choices Program to:
302     (a)  Expand opportunities for Floridians to purchase
303affordable health insurance and health services.
304     (b)  Preserve the benefits of employment-sponsored
305insurance while easing the administrative burden for employers
306who offer these benefits.
307     (c)  Enable individual choice in both the manner and amount
308of health care purchased.
309     (d)  Provide for the purchase of individual, portable
310health care coverage.
311     (e)  Disseminate information to consumers on the price and
312quality of health services.
313     (f)  Sponsor a competitive market that stimulates product
314innovation, quality improvement, and efficiency in the
315production and delivery of health services.
316     (2)  DEFINITIONS.--As used in this section:
317     (a)  "Corporation" means the Florida Health Choices, Inc.,
318established under this section.
319     (b)  "Health insurance agent" means an agent licensed under
320part IV of chapter 626.
321     (c)  "Insurer" means an entity licensed under chapter 624
322that offers an individual health insurance policy or a group
323health insurance policy, a preferred provider organization as
324defined in s. 627.6471, or an exclusive provider organization as
325defined in s. 627.6472.
326     (d)  "Program" means the Florida Health Choices Program
327established by this section.
328     (3)  PROGRAM PURPOSE AND COMPONENTS.--The Florida Health
329Choices Program is created as a single, centralized market for
330the sale and purchase of various products that enable
331individuals to pay for health care. These products include, but
332are not limited to, health insurance plans, health maintenance
333organization plans, prepaid services, service contracts, and
334flexible spending accounts. The components of the program
336     (a)  Enrollment of employers.
337     (b)  Administrative services for participating employers,
339     1.  Assistance in seeking federal approval of cafeteria
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
344other eligible vendors.
345     5.  Assistance for participants in complying with reporting
347     (c)  Services to individual participants, including:
348     1.  Information about available products and participating
350     2.  Assistance to participating individuals for assessing
351the benefits and limits of each product, including information
352necessary to distinguish between policies offering creditable
353coverage and other products available through the program.
354     3.  Account information to assist individual participants
355to manage available resources.
356     4.  Services that promote healthy behaviors.
357     (d)  Recruitment of vendors, including insurers, health
358maintenance organizations, prepaid clinic service providers,
359provider service networks, and other providers.
360     (e)  Certification of vendors to ensure capability,
361reliability, and validity of offerings.
362     (f)  Collection of data, monitoring, assessment, and
363reporting of vendor performance.
364     (g)  Information services for individuals and employers.
365     (h)  Program evaluation.
366     (4)  ELIGIBILITY AND PARTICIPATION.--Participation in the
367program is voluntary and shall be available to employers,
368individuals, vendors, and health insurance agents as specified
369in 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
375     4.  School districts in fiscally constrained counties.
376     (b)  Individuals eligible to participate in the program
378     1.  Individual employees of enrolled employers.
379     2.  State employees not eligible for state employee health
381     3.  State retirees.
382     4.  Medicaid reform participants who select the opt-out
383provision of reform.
384     5.  Statutory rural hospitals.
385     (c)  Employers who choose to participate in the program may
386enroll by complying with the procedures established by the
387corporation. These procedures shall include, but not be limited
388to, the following:
389     1.  Submission of required information.
390     2.  Compliance with federal tax requirements for the
391establishment of a cafeteria plan, pursuant to s. 125 of the
392Internal Revenue Code, including designation of the employer's
393plan as a premium payment plan, a salary reduction plan with
394flexible spending arrangements, or a salary reduction plan with
395a premium payment and flexible spending arrangements.
396     3.  Determination of the employer's contribution, if any,
397per employee, provided that such contribution is equal for each
398eligible employee.
399     4.  Establishment of payroll deduction procedures, subject
400to the agreement of each individual employee who voluntarily
401participates in the program.
402     5.  Designation of the corporation as the third-party
403administrator 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
407they are permitted to sell are as follows:
4081.  Insurers licensed under chapter 624 may sell health
409insurance policies, limited benefit policies, other risk-bearing
410coverage, and other products or services.
411     2.  Health maintenance organizations licensed under part I
412of chapter 641 may sell health insurance policies, limited
413benefit policies, other risk-bearing products, and other
414products or services.
415     3.  Prepaid health clinic service providers licensed under
416part II of chapter 641 may sell prepaid service contracts and
417other arrangements for a specified amount and type of health
418services or treatments.
419     4.  Health care providers, including hospitals and other
420licensed health facilities, health care clinics, licensed health
421professionals, pharmacies, and other licensed health care
422providers, may sell service contracts and arrangements for a
423specified amount and type of health services or treatments.
424     5.  Provider organizations, including service networks,
425group practices, professional associations, and other
426incorporated organizations of providers, may sell service
427contracts and arrangements for a specified amount and type of
428health services or treatments.
429     6.  Corporate entities providing specific health services
430in accordance with applicable state law may sell service
431contracts and arrangements for a specified amount and type of
432health services or treatments.
434A vendor described in subparagraphs 3.-6. may not sell products
435that provide risk-bearing coverage unless that vendor is
436authorized under a certificate of authority issued by the Office
437of Insurance Regulation under the provisions of the Florida
438Insurance Code. Otherwise eligible vendors may be excluded from
439participating in the program for deceptive or predatory
440practices, financial insolvency, or failure to comply with the
441terms of the participation agreement or other standards set by
442the corporation.
443     (e)  Eligible individuals may voluntarily continue
444participation in the program regardless of subsequent changes in
445job status or Medicaid eligibility. Individuals who join the
446program may participate by complying with the procedures
447established by the corporation. These procedures shall include,
448but 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
455enroll by complying with the procedures established by the
456corporation. These procedures shall include, but are not limited
458     1.  Submission of required information, including a
459complete description of the coverage, services, provider
460network, payment restrictions, and other requirements of each
461product offered through the program.
462     2.  Execution of an agreement to make all products offered
463through the program available to all individual participants.
464     3.  Establishment of product prices based on age, gender,
465and location of the individual participant.
466     4.  Arrangements for receiving payment for enrolled
468     5.  Participation in ongoing reporting processes
469established by the corporation.
470     6.  Compliance with grievance procedures established by the
472     (g)  Health insurance agents licensed under part IV of
473chapter 626 are eligible to voluntarily participate as buyers'
474representatives. A buyer's representative acts on behalf of an
475individual purchasing health insurance and health services
476through the program by providing information about products and
477services available through the program and assisting the
478individual with both the decision and the procedure of selecting
479specific products. Serving as a buyer's representative does not
480constitute a conflict of interest with continuing
481responsibilities as a health insurance agent provided the
482relationship between each agent and any participating vendor is
483disclosed prior to advising an individual participant about the
484products and services available through the program. In order to
485participate, a health insurance agent shall comply with the
486procedures established by the corporation, including:
487     1.  Completion of training requirements.
488     2.  Execution of a participation agreement specifying the
489terms and conditions of participation.
490     3.  Disclosure of any appointments to solicit insurance or
491procure applications for vendors participating in the program.
492     4.  Arrangements to receive payment from the corporation
493for services as a buyer's representative.
494     (5)  PRODUCTS.--
495     (a)  The products that may be made available for purchase
496through 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
502of health services and treatments.
503     6.  Flexible spending accounts.
504     (b)  Health insurance policies, limited benefit plans,
505prepaid service contracts, and other contracts for services must
506ensure the availability of covered services and benefits to
507participating individuals for at least 1 full enrollment year.
508     (c)  Products may be offered for multiyear periods provided
509the price of the product is specified for the entire period or
510for each separately priced segment of the policy or contract.
511     (d)  The corporation shall require the following disclosure
512to be reviewed and executed by all consumers purchasing program
513options or insurance coverage through the corporation: "In
514connection with the Florida Health Choices Program authorized by
515s. 408.910, Florida Statutes, agents and entities offering
516products and services under the program shall inform the named
517insured, applicant, or subscriber, on a form approved by the
518Office of Insurance Regulation of the Financial Services
519Commission, that the products and services are not insurance or,
520if they are insurance, that benefits under the coverage are
521limited under s. 408.910, Florida Statutes, and that such
522coverage is an alternative to coverage without such limitations.
523If the form is signed by a named insured, applicant, or
524subscriber, it shall be presumed that there was an informed,
525knowing acceptance of such limitations."
526     (6)  PRICING.--Prices for the products sold through the
527program shall be transparent to participants and established by
528the vendors based on age, gender, and location of participants.
529The corporation shall develop a methodology to evaluate the
530actuarial soundness of products offered through the program. The
531methodology shall be reviewed by the Office of Insurance
532Regulation prior to use by the corporation. Prior to making the
533product available to individual participants, the corporation
534shall use the methodology to compare the expected health care
535costs for the covered services and benefits to the vendor's
536price for that coverage. The results shall be reported to
537individuals participating in the program. Once established, the
538price set by the vendor must remain in force for at least 1 year
539and may only be redetermined by the vendor at the next annual
540enrollment period. The corporation shall annually assess a
541surcharge for each premium or price set by a participating
542vendor. This surcharge may not be more than 2.5 percent of the
543price and shall be used to generate funding for administrative
544services provided by the corporation and payments to buyers'
546     (7)  EXCHANGE PROCESS.--The program shall provide a single,
547centralized market for purchase of health insurance and health
548services. Purchases may be made by participating individuals
549over the Internet or through the services of a participating
550health insurance agent. Information about each product and
551service available through the program shall be made available
552through printed material and an interactive Internet website. A
553participant needing personal assistance to select products and
554services shall be referred to a participating agent in his or
555her area.
556     (a)  Participation in the program may begin at any time
557during a year when the employer completes enrollment and meets
558the requirements specified by the corporation pursuant to
559paragraph (4)(c).
560     (b)  Initial selection of products and services must be
561made by an individual participant within 60 days after the date
562on which the individual's employer qualified for participation.
563An individual who fails to enroll in products and services by
564the end of this period shall be limited to participation in
565flexible spending account services until the next annual
566enrollment period.
567     (c)  Initial enrollment periods for each product selected
568by an individual participant must last a minimum of 12 months,
569unless the individual participant specifically agrees to a
570different enrollment period.
571     (d)  When an individual has selected one or more products
572and enrolled in those products for at least 12 months or any
573other period specifically agreed to by the individual
574participant, changes in selected products and services may only
575be made during the annual enrollment period established by the
577     (e)  The limits established in paragraphs (b)-(d) apply to
578any risk-bearing product that promises future payment or
579coverage for a variable amount of benefits or services. The
580limits do not apply to initiation of flexible spending plans
581when those plans are not associated with specific high-
582deductible insurance policies or to the use of spending accounts
583for any products offering individual participants specific
584amounts and types of health services and treatments at a
585contracted price.
586     (8)  RISK POOLING.--The program shall utilize methods for
587pooling the risk of individual participants and preventing
588selection bias. These methods shall include, but not be limited
589to, a postenrollment risk adjustment of the premium payments to
590the vendors. The corporation shall establish a methodology for
591assessing the risk of enrolled individual participants based on
592data reported by the vendors about their enrollees. Monthly
593distributions of payments to the vendors shall be adjusted based
594on the assessed relative risk profile of the enrollees in each
595risk-bearing product for the most recent period for which data
596is available.
597     (9)  EXEMPTIONS.--
598     (a)  Policies sold as part of the program are not subject
599to the licensing requirements of the Florida Insurance Code,
600chapter 641, or the mandated offerings or coverages established
601in part VI of chapter 627 and chapter 641.
602     (b)  The corporation is authorized to act as an
603administrator as defined in s. 626.88. However, the corporation
604is not subject to the licensing requirements of part VII of
605chapter 626.
606     (10)  LIQUIDATION OR DISSOLUTION.--The Department of
607Financial Services shall supervise any liquidation or
608dissolution of the corporation and shall have, with respect to
609such liquidation or dissolution, all power granted to it
610pursuant to the Florida Insurance Code.
611     (11)  CORPORATION.--There is created the Florida Health
612Choices, Inc., which shall be registered, incorporated,
613organized, and operated in compliance with chapter 617. The
614purpose of the corporation is to administer the program created
615in this section and to conduct such other business as may
616further the administration of the program.
617     (a)  The corporation shall be governed by a board of
618directors consisting of 15 individuals appointed in the
619following manner:
620     1.  Five members appointed by and serving at the pleasure
621of the Governor, consisting of:
622     a.  The Secretary of Health Care Administration or a
623designee with expertise in health care services.
624     b.  The Secretary of Management Services or a designee with
625expertise in state employee benefits.
626     c.  The Commissioner of the Office of Insurance Regulation
627or a designee with expertise in insurance regulation.
628d.  Two representatives of eligible public employers.
629     2.  Five members appointed by and serving at the pleasure
630of the President of the Senate, consisting of representatives of
631employers, insurers, health care providers, health insurance
632agents, and individual participants.
633     3.  Five members appointed by and serving at the pleasure
634of the Speaker of the House of Representatives, consisting of
635representatives of employers, insurers, health care providers,
636health insurance agents, and individual participants.
637     (b)  Members shall be appointed for terms of up to 3 years.
638Any member is eligible for reappointment. A vacancy on the board
639shall be filled for the unexpired portion of the term in the
640same manner as the original appointment.
641     (c)  The board shall select a chief executive officer for
642the corporation who shall be responsible for the selection of
643such other staff as may be authorized by the corporation's
644operating budget as adopted by the board.
645     (d)  Board members are entitled to receive, from funds of
646the corporation, reimbursement for per diem and travel expenses
647as provided by s. 112.061. No other compensation is authorized.
648     (e)  There shall be no liability on the part of, and no
649cause of action shall arise against, any member of the board or
650its employees or agents for any action taken by them in the
651performance of their powers and duties under this section.
652     (f)  The board shall develop and adopt bylaws and other
653corporate procedures as necessary for the operation of the
654corporation and carrying out the purposes of this section. The
655bylaws shall:
656     1.  Specify procedures for selection of officers and
657qualifications for reappointment, provided that no board member
658shall serve more than 9 consecutive years.
659     2.  Require an annual membership meeting that provides an
660opportunity for input and interaction with individual
661participants in the program.
662     3.  Specify policies and procedures regarding conflicts of
663interest, including prohibiting a member from participating in
664any decision that would inure to the benefit of the member or
665the organization that employs the member. The policies and
666procedures shall also require public disclosure of the interest
667that prevents the member from participating in a decision on a
668particular matter.
669     (g)  The corporation may exercise all powers granted to it
670under chapter 617 necessary to carry out the purposes of this
671section, including, but not limited to, the power to receive and
672accept grants, loans, or advances of funds from any public or
673private agency and to receive and accept from any source
674contributions of money, property, labor, or any other thing of
675value to be held, used, and applied for the purposes of this
677     (h)  The corporation shall:
678     1.  Determine eligibility of employers, vendors,
679individuals, and agents in accordance with subsection (4).
680     2.  Establish procedures necessary for the operation of the
681program, including, but not limited to, procedures for
682application, enrollment, risk assessment, risk adjustment, plan
683administration, performance monitoring, and consumer education.
684     3.  Arrange for collection of contributions from
685participating employers and individuals.
686     4.  Arrange for payment of premiums and other appropriate
687disbursements based on the selections of products and services
688by the individual participants.
689     5.  Establish criteria for disenrollment of participating
690individuals based on failure to pay the individual's share of
691any contribution required to maintain enrollment in selected
693     6.  Establish criteria for exclusion of vendors pursuant to
694paragraph (4)(d).
695     7.  Develop and implement a plan for promoting public
696awareness of and participation in the program.
697     8.  Secure staff and consultant services necessary to the
698operation of the program.
699     9.  Establish policies and procedures regarding
700participation in the program for individuals, vendors, health
701insurance agents, and employers.
702     10.  Develop a plan, in coordination with the Department of
703Revenue, to establish tax credits or refunds for employers that
704participate in the program. The corporation shall submit the
705plan to the Governor, the President of the Senate, and the
706Speaker of the House of Representatives no later than January 1,
708     11.  Beginning in fiscal year 2009-2010, submit by February
7091 an annual report to the Governor, the President of the Senate,
710and the Speaker of the House of Representatives documenting the
711corporation's activities in compliance with the duties
712delineated in this section.
713     (i)  To ensure program integrity and to safeguard the
714financial transactions made under the auspices of the program,
715the corporation is authorized to establish qualifying criteria
716and certification procedures for vendors, require performance
717bonds or other guarantees of ability to complete contractual
718obligations, monitor the performance of vendors, and enforce the
719agreements of the program through financial penalty or
720disqualification from the program.
721     Section 5.  Subsection (22) of section 409.811, Florida
722Statutes, is amended to read:
723     409.811  Definitions relating to Florida Kidcare Act.--As
724used in ss. 409.810-409.820, the term:
725     (22)  "Premium assistance payment" means the monthly
726consideration paid by the agency per enrollee in the Florida
727Kidcare program towards health insurance premiums and may
728include the direct payment of the premium for a qualifying child
729to be covered as a dependent under an employer-sponsored group
730family plan when such payment does not exceed the payment
731required for an enrollee in the Florida Kidcare program.
732     Section 6.  Section 624.1265, Florida Statutes, is created
733to read:
734     624.1265  Nonprofit religious organization exemption;
735authority; notice.--
736     (1)  Any nonprofit religious organization that qualifies
737under Title 26, s. 501 of the Internal Revenue Code of 1986, as
738amended; that limits its participants to members of the same
739religion; that acts as an organizational clearinghouse for
740information between participants who have financial, physical,
741or medical needs and participants with the ability to pay for
742the benefit of those participants with financial, physical, or
743medical needs; that provides for the financial or medical needs
744of a participant through payments directly from one participant
745to another; and that suggests amounts that participants may
746voluntarily give with no assumption of risk or promise to pay
747either among the participants or between the participants and
748the organization are not subject to any requirements of the
749Florida Insurance Code.
750     (2)  Nothing in this section prevents the organization
751described in subsection (1) from establishing qualifications of
752participation relating to the health of a prospective
753participant, prevents a participant from limiting the financial
754or medical needs that may be eligible for payment, or prevents
755the organization from canceling the membership of a participant
756when such participant indicates his or her unwillingness to
757participate by failing to make a payment to another participant
758for a period in excess of 60 days.
759     (3)  The organization described in subsection (1) shall
760provide each prospective participant in the organizational
761clearinghouse written notice that the organization is not an
762insurance company, that membership is not offered through an
763insurance company, and that the organization is not subject to
764the regulatory requirements or consumer protections of the
765Florida Insurance Code.
766     Section 7.  Section 627.6562, Florida Statutes, is amended
767to read:
768     627.6562  Dependent coverage.--
769     (1)  If an insurer offers coverage that insures dependent
770children of the policyholder or certificateholder, the policy
771must insure a dependent child of the policyholder or
772certificateholder at least until the end of the calendar year in
773which the child reaches the age of 25, if the child meets all of
774the following:
775     (a)  The child is dependent upon the policyholder or
776certificateholder for support.
777     (b)  The child is living in the household of the
778policyholder or certificateholder, or the child is a full-time
779or part-time student.
780     (2)  A policy that is subject to the requirements of
781subsection (1) must also offer the policyholder or
782certificateholder the option to insure a child of the
783policyholder or certificateholder at least until the end of the
784calendar year in which the child reaches the age of 30, if the
786     (a)  Is unmarried and does not have a dependent of his or
787her own;
788     (b)  Is a resident of this state or a full-time or part-
789time student; and
790     (c)  Is not provided coverage as a named subscriber,
791insured, enrollee, or covered person under any other group,
792blanket, or franchise health insurance policy or individual
793health benefits plan, or entitled to benefits under Title XVIII
794of the Social Security Act.
795     (3)  If, pursuant to subsection (2), a child is provided
796coverage under the parent's policy after the end of the calendar
797year in which the child reaches age 25, and coverage for the
798child is subsequently terminated, the child is not eligible to
799be covered under the parent's policy unless the child was
800continuously covered by other creditable coverage without a gap
801in coverage of more than 63 days. For the purposes of this
802subsection, the term "creditable coverage" has the same meaning
803as defined in s. 627.6561(5).
804     (4)(2)  Nothing in This section does not affect or preempt
805affects or preempts an insurer's right to medically underwrite
806or charge the appropriate premium.      (b)  Require coverage
807for services provided to a dependent before October 1, 2008.
808     (c)  Require an employer to pay all or part of the cost of
809coverage provided for a dependent under this section.
810     (d)  Prohibit an insurer or health maintenance organization
811from increasing the limiting age for dependent coverage to age
81230 in policies or contracts issued or renewed prior to the
813effective date of this act.
814     (5)  Until April 1, 2009, a dependent child who qualifies
815for coverage under subsection (1) but whose coverage as a
816dependent child under a covered person's plan terminated under
817the terms of the plan before October 1, 2008, may make a written
818election to reinstate coverage, without proof of insurability,
819under that plan as a dependent child pursuant to this section.
820All other dependent children who qualify for coverage under
821subsection (1) shall be automatically covered at least until the
822end of the calendar year in which the child reaches the age of
82330, unless the covered person provides the group policyholder
824with written evidence the dependent child is married, is not a
825resident of the state, is covered under a separate comprehensive
826health insurance policy or a health benefit plan, is entitled to
827benefits under Title XVIII of the Social Security Act, Pub. L.
828No. 89-97, 42 U.S.C. ss. 1935 et seq., or is eligible for
829coverage as an employee under an employer-sponsored health plan.
830     (6)  The covered person's plan may require the payment of a
831premium by the covered person or dependent child, as
832appropriate, subject to the approval of the Office of Insurance
833Regulation, for any period of coverage relating to a dependent's
834written election for coverage pursuant to subsection (3).
835     (7)  Notice regarding the reinstatement of coverage for a
836dependent child as provided under this section must be provided
837to a covered person in the certificate of coverage prepared for
838covered persons by the insurer or by the covered person's
839employer. The notice shall be given as soon as practicable after
840July 1, 2008, and such notice may be given through the group
842     (8)  This section does not apply to accident only,
843specified disease, disability income, Medicare supplement, or
844long-term care insurance policies.
845     (9)  This section applies to all group, blanket, and
846franchise health insurance policies covering residents of this
847state, including, but not limited to, policies in which the
848carrier has reserved the right to change the premium. This
849section applies to all individual, group, blanket, and franchise
850health insurance policies and health maintenance contracts
851issued, renewed, or amended after October 1, 2008.
852     Section 8.  Subsections (41) and (42) are added to section
853641.31, Florida Statutes, to read:
854     641.31  Health maintenance contracts.--
855     (41)  Unless the employer chooses otherwise, for all
856policies or health maintenance contracts issued or renewed after
857October 1, 2008, all eligible employees and their dependents
858shall be enrolled for coverage at the time of issuance or during
859the next open or special enrollment period, unless the employee
860provides written notice to the employer declining coverage,
861which notice shall include evidence of coverage under an
862existing group insurance policy or group health benefit plan or
863other reasons for declining coverage. Such notice shall be
864retained by the employer as part of the employee's employment or
865insurance file. An employer may require its employees to
866participate in its group health plan as a condition of
867employment. This subsection shall apply to all individual,
868group, blanket, and franchise health insurance policies and
869health maintenance contracts issued, renewed, or amended after
870October 1, 2008.
871     (42)  All health maintenance contracts that provide
872coverage for a member of the family of the subscriber shall
873comply with s. 627.6562.
874     Section 9.  Subsections (1), (4), and (6) of section
875641.402, 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:
878limited hospital inpatient services, which may include hospital
879inpatient physician services, up to a maximum of coverage
880benefit of 5 days and a maximum dollar amount of coverage of
881$15,000 per calendar year; emergency care;, physician care other
882than hospital inpatient physician services;, ambulatory
883diagnostic treatment;, and preventive health care services.
884     (4)  "Prepaid health clinic" means any organization
885authorized under this part which provides, either directly or
886through arrangements with other persons, basic services to
887persons enrolled with such organization, on a prepaid per capita
888or prepaid aggregate fixed-sum basis, including those basic
889services described in this part which subscribers might
890reasonably require to maintain good health. However, no clinic
891that provides or contracts for, either directly or indirectly,
892inpatient hospital services, hospital inpatient physician
893services, or indemnity against the cost of such services shall
894be a prepaid health clinic.
895     (6)  "Provider" means any physician or person other than a
896hospital that furnishes health care services under this part and
897is licensed or authorized to practice in this state.
898     Section 10.  This act shall take effect upon becoming a
T I T L E  A M E N D M E N T
907     Remove line(s) 473-526 and insert:
908An act relating to affordable health coverage; amending s.
909112.363, F.S.; specifying that coverage provided through
910the Cover Florida Health Care Access Program is considered
911health insurance coverage for the purposes of determining
912eligibility for the state retiree health insurance
913subsidy; amending s. 408.909, F.S.; revising eligibility
914requirements; providing certain exemptions from the 6-
915month lapse in coverage requirement; extending the
916expiration date of the health flex plan; creating s.
917408.9091, F.S.; creating the Cover Florida Health Care
918Access Program; providing a short title; providing
919legislative intent; providing definitions; requiring the
920agency and the Office of Insurance Regulation of the
921Financial Services Commission within the Department of
922Financial Services to jointly administer the program;
923providing program requirements; requiring the development
924of guidelines to meet minimum standards for quality of
925care and access to care; requiring the agency to ensure
926that the Cover Florida plans follow standardized grievance
927procedures; requiring the office and the agency to oversee
928changes to plan benefits; requiring the Executive Office
929of the Governor, the agency, and the office to develop a
930public awareness program; authorizing public and private
931entities to design programs to encourage or extend
932incentives for participation in the Cover Florida Health
933Care Access Program; requiring the agency and the office
934to announce an invitation to negotiate for Cover Florida
935plan entities to design a coverage proposal; requiring the
936invitation to negotiate to include certain guidelines;
937providing certain conditions under which plans are
938disapproved or withdrawn; authorizing the agency and the
939office to announce an invitation to negotiate for
940companies that offer supplemental insurance or discount
941medical plans; requiring the agency and the office to
942approve at least one plan entity; authorizing the agency
943and the office to approve one regional network plan in
944each existing Medicaid area; providing that certain
945licensing requirements are not applicable to a Cover
946Florida plan; providing that Cover Florida plans are
947considered insurance under certain conditions; excluding
948Cover Florida plans from the Florida Life and Health
949Insurance Guaranty Association and the Health Maintenance
950Organization Consumer Assistance Plan; providing
951requirements for eligibility for a Cover Florida plan;
952requiring each Cover Florida plan to maintain and provide
953certain records; providing that coverage under a Cover
954Florida plan is not an entitlement and does not give rise
955to a cause of action; requiring the agency and the office
956to evaluate the program and submit an annual report to the
957Governor and the Legislature; authorizing the agency and
958the Financial Services Commission to adopt rules; creating
959s. 408.910, F.S.; establishing the Florida Health Choices
960Program; providing legislative intent; providing
961definitions; providing program purpose and components;
962providing employer eligibility criteria; providing
963individual eligibility criteria; providing employer
964enrollment criteria; providing vendor, product, and
965service eligibility criteria; providing for individual
966participation regardless of subsequent job status or
967Medicaid eligibility; providing individual enrollment
968criteria; providing vendor enrollment criteria; providing
969for participation by health insurance agents; providing
970criteria for products available for purchase; providing
971criteria for product pricing; providing for an
972administrative surcharge; providing for an exchange
973process; providing for enrollment periods and changes in
974selected products; providing methods for the pooling of
975risk; providing for exemptions from certain statutory
976provisions, mandated offerings and coverages, and
977licensing requirements; creating the Florida Health
978Choices, Inc.; requiring the department to supervise any
979liquidation or dissolution of the corporation; providing
980for corporate governance and board membership and terms;
981providing for reimbursement for per diem and travel
982expenses; providing for powers and duties of the
983corporation; requiring the corporation to coordinate with
984the Department of Revenue to develop a plan by January 1,
9852009, for creating tax exemptions or refunds for
986participating in the program; requiring the corporation to
987submit an annual report to the Governor and Legislature;
988authorizing the corporation to establish and enforce
989certain program integrity measures; amending s. 409.811,
990F.S.; revising the definition of the term "premium
991assistance payment"; creating s. 624.1265, F.S.; exempting
992certain nonprofit religious organizations from
993requirements of the Florida Insurance Code; preserving
994certain authority of such organizations; requiring such
995organizations to provide certain notice to prospective
996participants; providing notice requirements; amending s.
997627.6562, F.S.; requiring insurance policies that provide
998dependent coverage to provide the policyholder with the
999option of insuring a child until the age of 30 under
1000certain circumstances; amending s. 627.6699, F.S.;
1001requiring participation of employees in health maintenance
1002contracts or policies issued or renewed after a specified
1003date; providing conditions for employers and employees to
1004opt out of such coverage; amending s. 641.31, F.S.;
1005requiring participation of employees in policies or health
1006maintenance contracts issued or renewed after a specified
1007date; providing conditions for employers and employees to
1008opt out of such coverage; requiring all heath maintenance
1009contracts that provide coverage for family members to
1010comply with certain statutory provisions; amending s.
1011641.402, F.S.; revising the definition of the term "basic
1012services" to include certain hospital inpatient services;
1013revising the definitions of the terms "prepaid health
1014clinic" and "provider"; providing an effective date.

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