| 1 | Representative Ausley offered the following: |
| 2 |
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| 3 | Amendment to Amendment (830641) |
| 4 | Remove lines 95-140 and insert: |
| 5 | 1. Plans are offered as guaranteed issue to enrollees, |
| 6 | subject to exclusions for preexisting conditions approved by the |
| 7 | office and the agency, such exclusions for preexisting |
| 8 | conditions to be limited to no more than 12 months. |
| 9 | 2. Plans are portable, such that the enrollee remains |
| 10 | covered regardless of employment status or the cost-sharing of |
| 11 | premiums. |
| 12 | 3. Plans may provide for cost containment through limits |
| 13 | on the number of services, caps on benefit payments, and |
| 14 | copayments for services. |
| 15 | 4. A Cover Florida health plan entity makes all benefit |
| 16 | plan and marketing materials available in English and Spanish. |
| 17 | 5. In order to provide for consumer choice, Cover Florida |
| 18 | health plan entities develop two alternative benefit option |
| 19 | plans having different cost and benefit levels, including at |
| 20 | least one plan that provides catastrophic coverage. |
| 21 | 6. Plans without catastrophic coverage provide coverage |
| 22 | options for the following services, including, but not limited |
| 23 | to: |
| 24 | a. Preventive health services, including preventive |
| 25 | screenings, annual health assessments, and well-care and well- |
| 26 | woman services, including mammograms, screenings for cervical |
| 27 | cancer, noninvasive colorectal or prostate screenings, |
| 28 | immunizations, prenatal care, and labor and delivery. |
| 29 | b. Incentives for routine, preventive care. |
| 30 | c. Office visits for the diagnosis and treatment of |
| 31 | illness or injury. |
| 32 | d. Office surgery, including anesthesia. |
| 33 | e. Services related to behavioral health services. |
| 34 | f. Durable medical equipment and prosthetics. |
| 35 | g. Diabetic supplies. |
| 36 | 7. Plans providing catastrophic coverage, at a minimum, |
| 37 | provide coverage options for all of the services listed under |
| 38 | subparagraph 6., and in addition include, but are not limited |
| 39 | to, coverage options for: |
| 40 | a. Inpatient hospital stays. |
| 41 | b. Hospital emergency care services. |
| 42 | c. Urgent care services. |
| 43 | d. Outpatient facility services, outpatient surgery, and |
| 44 | outpatient diagnostic services. |
| 45 | 8. Plans offer prescription drug benefit coverage on all |
| 46 | plans, or use a prescription drug manager, such as the Florida |
| 47 | Discount Drug Card Program. |
| 48 | 9. Plans provide, in enrollment materials, plain-language |
| 49 | information on policy benefit coverage, benefit limits, cost- |
| 50 | sharing requirements, and exclusions and a clear representation |
| 51 | of what is not covered in the plan, including how choosing a |
| 52 | plan could affect current rights under federal and state laws. |