| 1 | Representative Ausley offered the following: |
| 2 |
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| 3 | Amendment (with title amendment) |
| 4 | Remove everything after the enacting clause and insert: |
| 5 | Section 1. Paragraph (d) of subsection (2) of section |
| 6 | 112.363, Florida Statutes, is amended to read: |
| 7 | 112.363 Retiree health insurance subsidy.-- |
| 8 | (2) ELIGIBILITY FOR RETIREE HEALTH INSURANCE SUBSIDY.-- |
| 9 | (d) Payment of the retiree health insurance subsidy shall |
| 10 | be made only after coverage for health insurance for the retiree |
| 11 | or beneficiary has been certified in writing to the Department |
| 12 | of Management Services. Participation in a former employer's |
| 13 | group health insurance program is not a requirement for |
| 14 | eligibility under this section. Coverage issued pursuant to s. |
| 15 | 408.9091 is considered health insurance for the purposes of this |
| 16 | section. |
| 17 | Section 2. Subsections (5) and (10) of section 408.909, |
| 18 | Florida Statutes, are amended to read: |
| 19 | 408.909 Health flex plans.-- |
| 20 | (5) ELIGIBILITY.--Eligibility to enroll in an approved |
| 21 | health flex plan is limited to residents of this state who: |
| 22 | (a) Are 64 years of age or younger; |
| 23 | (b) Have a family income equal to or less than 300 200 |
| 24 | percent of the federal poverty level; |
| 25 | (c) Are eligible under a federally approved Medicaid |
| 26 | demonstration waiver and reside in Palm Beach County or Miami- |
| 27 | Dade County; |
| 28 | (c)(d) Are not covered by a private insurance policy and |
| 29 | are not eligible for coverage through a public health insurance |
| 30 | program, such as Medicare or Medicaid, unless specifically |
| 31 | authorized under paragraph (c), or another public health care |
| 32 | program, such as Kidcare, and have not been covered at any time |
| 33 | during the past 6 months; who are covered under an individual |
| 34 | contract issued by a health maintenance organization that is an |
| 35 | approved health flex plan on October 1, 2008, and are applying |
| 36 | for coverage in the same health flex plan without a lapse in |
| 37 | coverage and all other eligibility requirements under this |
| 38 | subsection are met; or who were covered under Medicaid or |
| 39 | Kidcare and lost eligibility for Medicaid or a Kidcare subsidy |
| 40 | due to income restrictions within 90 days before applying for |
| 41 | health care coverage through an approved health flex plan; and |
| 42 | (d)(e) Have applied for health care coverage through an |
| 43 | approved health flex plan and have agreed to make any payments |
| 44 | required for participation, including periodic payments or |
| 45 | payments due at the time health care services are provided. |
| 46 | (10) EXPIRATION.--This section expires July 1, 2013 2008. |
| 47 | Section 3. Section 408.9091, Florida Statutes, is created |
| 48 | to read: |
| 49 | 408.9091 Cover Florida Health Care Access Act.-- |
| 50 | (1) SHORT TITLE.--This section may be cited as the "Cover |
| 51 | Florida Health Access Program Act." |
| 52 | (2) INTENT.--The Legislature finds that a significant |
| 53 | proportion of state residents are unable to obtain affordable |
| 54 | health insurance coverage. The Legislature also finds that |
| 55 | existing "health flex" plan coverage has had limited |
| 56 | participation due in part to narrow eligibility restrictions as |
| 57 | well as minimal benefit options for catastrophic and emergency |
| 58 | care coverage. Therefore, it is the Legislature's intent to |
| 59 | expand the availability of health care options for uninsured |
| 60 | residents by developing an affordable health care product that |
| 61 | emphasizes coverage for basic and preventive health care |
| 62 | services; provides inpatient hospital, urgent, and emergency |
| 63 | care services; and is offered statewide by approved health |
| 64 | insurers, health maintenance organizations, health-care- |
| 65 | provider-sponsored organizations, or health care districts. |
| 66 | (3) DEFINITIONS.--As used in this section, the term: |
| 67 | (a) "Agency" means the Agency for Health Care |
| 68 | Administration. |
| 69 | (b) "Office" means the Office of Insurance Regulation of |
| 70 | the Financial Services Commission. |
| 71 | (c) "Enrollee" means an individual who has been determined |
| 72 | to be eligible for and is receiving health insurance coverage |
| 73 | under a Cover Florida plan. |
| 74 | (d) "Cover Florida plan" means a consumer choice benefit |
| 75 | plan approved under this section which guarantees payment or |
| 76 | coverage for specified benefits provided to an enrollee. |
| 77 | (e) "Cover Florida plan coverage" means health care |
| 78 | services that are covered as benefits under a Cover Florida |
| 79 | plan. |
| 80 | (f) "Cover Florida plan entity" means a health insurer, |
| 81 | health maintenance organization, health-care-provider-sponsored |
| 82 | organization, or health care district that develops and |
| 83 | implements a Cover Florida plan and is responsible for |
| 84 | administering the plan and paying all claims for Cover Florida |
| 85 | plan coverage by enrollees. |
| 86 | (g) "Cover Florida Plus" plan means a supplemental |
| 87 | insurance product, such as for additional catastrophic coverage |
| 88 | or dental, vision, or cancer coverage, approved under this |
| 89 | section and offered to all enrollees. |
| 90 | (4) PROGRAM.--The agency and the office shall jointly |
| 91 | establish and administer the Cover Florida Health Care Access |
| 92 | Program. |
| 93 | (a) General Cover Florida plan components must require |
| 94 | that: |
| 95 | 1. Plans are offered as guaranteed issue to enrollees, |
| 96 | subject to exclusions for preexisting conditions approved by the |
| 97 | office and the agency. |
| 98 | 2. Plans are portable, such that the enrollee remains |
| 99 | covered regardless of employment status or the cost-sharing of |
| 100 | premiums. |
| 101 | 3. Plans may provide for cost containment through limits |
| 102 | on the number of services, caps on benefit payments, and |
| 103 | copayments for services. |
| 104 | 4. A Cover Florida health plan entity makes all benefit |
| 105 | plan and marketing materials available in English and Spanish. |
| 106 | 5. In order to provide for consumer choice, Cover Florida |
| 107 | health plan entities develop two alternative benefit option |
| 108 | plans having different cost and benefit levels, including at |
| 109 | least one plan that provides catastrophic coverage. |
| 110 | 6. Plans without catastrophic coverage provide coverage |
| 111 | options for the following services, including, but not limited |
| 112 | to: |
| 113 | a. Preventive health services, including preventive |
| 114 | screenings, annual health assessments, and well-care and well- |
| 115 | woman services, including mammograms, screenings for cervical |
| 116 | cancer, noninvasive colorectal or prostate screenings, and |
| 117 | immunizations. |
| 118 | b. Incentives for routine, preventive care. |
| 119 | c. Office visits for the diagnosis and treatment of |
| 120 | illness or injury. |
| 121 | d. Office surgery, including anesthesia. |
| 122 | e. Services related to behavioral health services. |
| 123 | f. Durable medical equipment and prosthetics. |
| 124 | g. Diabetic supplies. |
| 125 | 7. Plans providing catastrophic coverage, at a minimum, |
| 126 | provide coverage options for all of the services listed under |
| 127 | subparagraph 6., and in addition include, but are not limited |
| 128 | to, coverage options for: |
| 129 | a. Inpatient hospital stays. |
| 130 | b. Hospital emergency care services. |
| 131 | c. Urgent care services. |
| 132 | d. Outpatient facility services, outpatient surgery, and |
| 133 | outpatient diagnostic services. |
| 134 | 8. Plans offer prescription drug benefit coverage on all |
| 135 | plans, or use a prescription drug manager, such as the Florida |
| 136 | Discount Drug Card Program. |
| 137 | 9. Plans provide, in enrollment materials, plain-language |
| 138 | information on policy benefit coverage, benefit limits, cost- |
| 139 | sharing requirements, and exclusions and a clear representation |
| 140 | of what is not covered in the plan. |
| 141 | 10. Plans offered through a qualified employer meet the |
| 142 | requirements of s. 125 of the Internal Revenue Code. |
| 143 | (b) Guidelines shall be developed to ensure that Cover |
| 144 | Florida plans meet minimum standards for quality of care and |
| 145 | access to care. The agency shall ensure that the Cover Florida |
| 146 | plans follow standardized grievance procedures. |
| 147 | (c) Changes in Cover Florida plan benefits, premiums, and |
| 148 | policy forms are subject to regulatory oversight by the office |
| 149 | and agency as provided by rules adopted by the Financial |
| 150 | Services Commission and the agency. |
| 151 | (d) The agency, the office, and the Executive Office of |
| 152 | the Governor shall develop a public awareness program to be |
| 153 | implemented throughout the state for the promotion of the Cover |
| 154 | Florida Health Access Program. |
| 155 | (e) Public or private entities may design programs to |
| 156 | encourage Floridians to participate in the Cover Florida Health |
| 157 | Access Program, or to encourage employers to cosponsor some |
| 158 | share of Cover Florida plan premiums for employees. |
| 159 | (5) PLAN PROPOSALS.--The agency and the office shall |
| 160 | announce, no later than July 1, 2008, an invitation to negotiate |
| 161 | for Cover Florida plan entities to design a Cover Florida plan |
| 162 | proposal in which benefits and premiums are specified. |
| 163 | (a) The invitation to negotiate shall include guidelines |
| 164 | for the review of Cover Florida plan applications, policy forms, |
| 165 | and all associated forms, and provide regulatory oversight of |
| 166 | Cover Florida plan advertisement and marketing procedures. A |
| 167 | plan shall be disapproved or withdrawn if the plan: |
| 168 | 1. Contains any ambiguous, inconsistent, or misleading |
| 169 | provisions or any exceptions or conditions that deceptively |
| 170 | affect or limit the benefits purported to be assumed in the |
| 171 | general coverage provided by the plan; |
| 172 | 2. Provides benefits that are unreasonable in relation to |
| 173 | the premium charged or contains provisions that are unfair or |
| 174 | inequitable, that are contrary to the public policy of this |
| 175 | state, that encourage misrepresentation, or that result in |
| 176 | unfair discrimination in sales practices; |
| 177 | 3. Cannot demonstrate that the plan is financially sound |
| 178 | and that the applicant is able to underwrite or finance the |
| 179 | health care coverage provided; |
| 180 | 4. Cannot demonstrate that the applicant and its |
| 181 | management are in compliance with the standards required under |
| 182 | s. 624.404(3); or |
| 183 | 5. Does not guarantee that enrollees may participate in |
| 184 | the Cover Florida plan entity's comprehensive network of |
| 185 | providers, as determined by the office, the agency, and the |
| 186 | contract. |
| 187 | (b) The agency and the office may announce an invitation |
| 188 | to negotiate for the design of Cover Florida Plus products to |
| 189 | companies that offer supplemental insurance, discount medical |
| 190 | plan organizations licensed under part II of chapter 636, or |
| 191 | prepaid health clinics licensed under part II of chapter 641. |
| 192 | (c) The agency and office shall approve at least one Cover |
| 193 | Florida plan entity having an existing statewide network of |
| 194 | providers, and may approve at least one regional network plan in |
| 195 | each existing Medicaid area. |
| 196 | (6) LICENSE NOT REQUIRED.-- |
| 197 | (a) The licensing requirements of the Florida Insurance |
| 198 | Code and chapter 641, relating to health maintenance |
| 199 | organizations, do not apply to a Cover Florida plan approved |
| 200 | under this section unless expressly made applicable. However, |
| 201 | for the purpose of prohibiting unfair trade practices, Cover |
| 202 | Florida plans are considered to be insurance subject to the |
| 203 | applicable provisions of part IX of chapter 626, except as |
| 204 | otherwise provided in this section. |
| 205 | (b) Cover Florida plans are not covered by the Florida |
| 206 | Life and Health Insurance Guaranty Association under part III of |
| 207 | chapter 631 or by the Health Maintenance Organization Consumer |
| 208 | Assistance Plan under part IV of chapter 631. |
| 209 | (7) ELIGIBILITY.--Eligibility to enroll in a Cover Florida |
| 210 | plan is limited to residents of this state who meet all of the |
| 211 | following: |
| 212 | (a) Are 19 to 64 years of age. |
| 213 | (b) Are not covered by a private health insurance policy |
| 214 | and are not eligible for coverage through a public health |
| 215 | insurance program, such as Medicare, Medicaid, or Kidcare, |
| 216 | unless eligibility for coverage lapses due to no longer meeting |
| 217 | income or categorical requirements. |
| 218 | (c) Have not been covered by any health insurance program |
| 219 | at any time during the past 6 months, unless coverage under a |
| 220 | health insurance program was terminated within the previous 6 |
| 221 | months due to: |
| 222 | 1. Loss of a job that provided an employer-sponsored |
| 223 | health benefit plan; |
| 224 | 2. Exhaustion of coverage that was continued under COBRA |
| 225 | or continuation-of-coverage requirements under s. 627.6692; |
| 226 | 3. Reaching the limiting age under the policy; or |
| 227 | 4. Death of, or divorce from, a spouse who was provided |
| 228 | employer-sponsored health benefit plan. |
| 229 | (d) Have applied for health care coverage through a Cover |
| 230 | Florida plan and have agreed to make any payments required for |
| 231 | participation, including periodic payments or payments due at |
| 232 | the time health care services are provided. |
| 233 | (8) RECORDS.--Each Cover Florida plan must maintain |
| 234 | enrollment data and provide network data and reasonable records |
| 235 | to enable the office and agency to monitor plans and to |
| 236 | determine the financial viability of the Cover Florida plan, as |
| 237 | necessary. |
| 238 | (9) NONENTITLEMENT.--Coverage under a Cover Florida plan |
| 239 | is not an entitlement, and a cause of action does not arise |
| 240 | against the state, a local government entity, any other |
| 241 | political subdivision of this state, or the agency or office for |
| 242 | failure to make coverage available to eligible persons under |
| 243 | this section. |
| 244 | (10) PROGRAM EVALUATION.--The agency and the office shall: |
| 245 | (a) Evaluate the Cover Florida program and its effect on |
| 246 | the entities that seek approval as Cover Florida plans, on the |
| 247 | number of enrollees, and on the scope of the health care |
| 248 | coverage offered under a Cover Florida plan; |
| 249 | (b) Provide an assessment of the Cover Florida plans and |
| 250 | their potential applicability in other settings; |
| 251 | (c) Use Cover Florida plans to gather more information to |
| 252 | evaluate low-income, consumer-driven benefit packages; and |
| 253 | (d) Jointly submit by March 1, 2009, and annually |
| 254 | thereafter, a report to the Governor, the President of the |
| 255 | Senate, and the Speaker of the House of Representatives |
| 256 | providing the information specified in paragraphs (a)-(c) and |
| 257 | recommendations relating to the successful implementation and |
| 258 | administration of the program. |
| 259 | (11) RULEMAKING AUTHORITY.--The agency and the Financial |
| 260 | Services Commission may adopt rules as needed to administer this |
| 261 | section. |
| 262 | Section 4. Paragraph (b) of subsection (5) of section |
| 263 | 624.91, Florida Statutes, is amended to read: |
| 264 | 624.91 The Florida Healthy Kids Corporation Act.-- |
| 265 | (5) CORPORATION AUTHORIZATION, DUTIES, POWERS.-- |
| 266 | (b) The Florida Healthy Kids Corporation shall: |
| 267 | 1. Arrange for the collection of any family, local |
| 268 | contributions, or employer payment or premium, in an amount to |
| 269 | be determined by the board of directors, to provide for payment |
| 270 | of premiums for comprehensive insurance coverage and for the |
| 271 | actual or estimated administrative expenses. |
| 272 | 2. Arrange for the collection of any voluntary |
| 273 | contributions to provide for payment of premiums for children |
| 274 | who are not eligible for medical assistance under Title XXI of |
| 275 | the Social Security Act. |
| 276 | 3. Subject to the provisions of s. 409.8134, accept |
| 277 | voluntary supplemental local match contributions that comply |
| 278 | with the requirements of Title XXI of the Social Security Act |
| 279 | for the purpose of providing additional coverage in contributing |
| 280 | counties under Title XXI. |
| 281 | 4. Establish the administrative and accounting procedures |
| 282 | for the operation of the corporation. |
| 283 | 5. Establish, with consultation from appropriate |
| 284 | professional organizations, standards for preventive health |
| 285 | services and providers and comprehensive insurance benefits |
| 286 | appropriate to children, provided that such standards for rural |
| 287 | areas shall not limit primary care providers to board-certified |
| 288 | pediatricians. |
| 289 | 6. Determine eligibility for children seeking to |
| 290 | participate in the Title XXI-funded components of the Florida |
| 291 | Kidcare program consistent with the requirements specified in s. |
| 292 | 409.814, as well as the non-Title-XXI-eligible children as |
| 293 | provided in subsection (3). |
| 294 | 7. Establish procedures under which providers of local |
| 295 | match to, applicants to and participants in the program may have |
| 296 | grievances reviewed by an impartial body and reported to the |
| 297 | board of directors of the corporation. |
| 298 | 8. Establish participation criteria and, if appropriate, |
| 299 | contract with an authorized insurer, health maintenance |
| 300 | organization, or third-party administrator to provide |
| 301 | administrative services to the corporation. |
| 302 | 9. Establish enrollment criteria which shall include |
| 303 | penalties or waiting periods of not fewer than 60 days for |
| 304 | reinstatement of coverage upon voluntary cancellation for |
| 305 | nonpayment of family premiums. |
| 306 | 10. Contract with authorized insurers or any provider of |
| 307 | health care services, meeting standards established by the |
| 308 | corporation, for the provision of comprehensive insurance |
| 309 | coverage to participants. Such standards shall include criteria |
| 310 | under which the corporation may contract with more than one |
| 311 | provider of health care services in program sites. Health plans |
| 312 | shall be selected through a competitive bid process. The Florida |
| 313 | Healthy Kids Corporation shall purchase goods and services in |
| 314 | the most cost-effective manner consistent with the delivery of |
| 315 | quality medical care. The maximum administrative cost for a |
| 316 | Florida Healthy Kids Corporation contract shall be 15 percent. |
| 317 | For health care contracts, the minimum medical loss ratio for a |
| 318 | Florida Healthy Kids Corporation contract shall be 85 percent. |
| 319 | For dental contracts, the remaining compensation to be paid to |
| 320 | the authorized insurer or provider under a Florida Healthy Kids |
| 321 | Corporation contract shall be no less than an amount which is 85 |
| 322 | percent of premium; to the extent any contract provision does |
| 323 | not provide for this minimum compensation, this section shall |
| 324 | prevail. The health plan selection criteria and scoring system, |
| 325 | and the scoring results, shall be available upon request for |
| 326 | inspection after the bids have been awarded. |
| 327 | 11. Establish disenrollment criteria in the event local |
| 328 | matching funds are insufficient to cover enrollments. |
| 329 | 12. Develop and implement a plan to publicize the Florida |
| 330 | Healthy Kids Corporation, the eligibility requirements of the |
| 331 | program, and the procedures for enrollment in the program and to |
| 332 | maintain public awareness of the corporation and the program. |
| 333 | 13. Secure staff necessary to properly administer the |
| 334 | corporation. Staff costs shall be funded from state and local |
| 335 | matching funds and such other private or public funds as become |
| 336 | available. The board of directors shall determine the number of |
| 337 | staff members necessary to administer the corporation. |
| 338 | 14. Provide a report annually to the Governor, Chief |
| 339 | Financial Officer, Commissioner of Education, Senate President, |
| 340 | Speaker of the House of Representatives, and Minority Leaders of |
| 341 | the Senate and the House of Representatives. |
| 342 | 15. Provide information on a quarterly basis to the |
| 343 | Legislature and the Governor which compares the costs and |
| 344 | utilization of the full-pay enrolled population and the Title |
| 345 | XXI-subsidized enrolled population in the KidCare program. The |
| 346 | information, at a minimum, must include: |
| 347 | a. The monthly enrollment and expenditure for full-pay |
| 348 | enrollees in the Medikids and Florida Healthy Kids programs |
| 349 | compared to the Title XXI-subsidized enrolled population; and |
| 350 | b. The costs and utilization by service of the full-pay |
| 351 | enrollees in the Medikids and Florida Healthy Kids programs and |
| 352 | the Title XXI-subsidized enrolled population. |
| 353 | |
| 354 | By February 1, 2009, the Florida Healthy Kids Corporation shall |
| 355 | provide a study to the Legislature and the Governor on premium |
| 356 | impacts to the subsidized portion of the program from the |
| 357 | inclusion of the full-pay program, which shall include |
| 358 | recommendations on how to eliminate or mitigate possible impacts |
| 359 | to the subsidized premiums. |
| 360 | 16.15. Establish benefit packages which conform to the |
| 361 | provisions of the Florida Kidcare program, as created in ss. |
| 362 | 409.810-409.820. |
| 363 | Section 5. Subsection (5) of section 409.814, Florida |
| 364 | Statutes, is amended to read: |
| 365 | 409.814 Eligibility.--A child who has not reached 19 years |
| 366 | of age whose family income is equal to or below 200 percent of |
| 367 | the federal poverty level is eligible for the Florida Kidcare |
| 368 | program as provided in this section. For enrollment in the |
| 369 | Children's Medical Services Network, a complete application |
| 370 | includes the medical or behavioral health screening. If, |
| 371 | subsequently, an individual is determined to be ineligible for |
| 372 | coverage, he or she must immediately be disenrolled from the |
| 373 | respective Florida Kidcare program component. |
| 374 | (5) A child whose family income is above 200 percent of |
| 375 | the federal poverty level or a child who is excluded under the |
| 376 | provisions of subsection (4) may participate in the Medikids |
| 377 | program as provided in s. 409.8132 or, if the child is |
| 378 | ineligible for Medikids by reason of age, in the Florida Healthy |
| 379 | Kids program, subject to the following provisions: |
| 380 | (a) The family is not eligible for premium assistance |
| 381 | payments and must pay the full cost of the premium, including |
| 382 | any administrative costs. |
| 383 | (b) The agency is authorized to place limits on enrollment |
| 384 | in Medikids by these children in order to avoid adverse |
| 385 | selection. The number of children participating in Medikids |
| 386 | whose family income exceeds 200 percent of the federal poverty |
| 387 | level must not exceed 10 percent of total enrollees in the |
| 388 | Medikids program. |
| 389 | (b)(c) The board of directors of the Florida Healthy Kids |
| 390 | Corporation may is authorized to place limits on enrollment of |
| 391 | these children in order to avoid adverse selection. In addition, |
| 392 | the board is authorized to offer a reduced benefit package to |
| 393 | these children in order to limit program costs for such |
| 394 | families. The number of children participating in the Florida |
| 395 | Healthy Kids program whose family income exceeds 200 percent of |
| 396 | the federal poverty level must not exceed 10 percent of total |
| 397 | enrollees in the Florida Healthy Kids program. |
| 398 | Section 6. Effective upon this act becoming law and |
| 399 | applicable to policies issued or renewed on or after October 1, |
| 400 | 2008, section 627.6562, Florida Statutes, is amended to read: |
| 401 | 627.6562 Dependent coverage.-- |
| 402 | (1) If an insurer offers coverage that insures dependent |
| 403 | children of the policyholder or certificateholder, the policy |
| 404 | must insure a dependent child of the policyholder or |
| 405 | certificateholder at least until the end of the calendar year in |
| 406 | which the child reaches the age of 25, if the child meets all of |
| 407 | the following: |
| 408 | (a) The child is dependent upon the policyholder or |
| 409 | certificateholder for support. |
| 410 | (b) The child is living in the household of the |
| 411 | policyholder or certificateholder, or the child is a full-time |
| 412 | or part-time student. |
| 413 | (2) A policy that is subject to the requirements of |
| 414 | subsection (1) must also offer the policyholder or |
| 415 | certificateholder the option to insure a child of the |
| 416 | policyholder or certificateholder at least until the end of the |
| 417 | calendar year in which the child reaches the age of 30, if the |
| 418 | child: |
| 419 | (a) Is unmarried and does not have a dependent of his or |
| 420 | her own; |
| 421 | (b) Is a resident of this state or a full-time or part- |
| 422 | time student; and |
| 423 | (c) Is not provided coverage as a named subscriber, |
| 424 | insured, enrollee, or covered person under any other group, |
| 425 | blanket, or franchise health insurance policy or individual |
| 426 | health benefits plan, or entitled to benefits under Title XVIII |
| 427 | of the Social Security Act. |
| 428 | (3) If, pursuant to subsection (2), a child is provided |
| 429 | coverage under the parent's policy after the end of the calendar |
| 430 | year in which the child reaches age 25, and coverage for the |
| 431 | child is subsequently terminated, the child is not eligible to |
| 432 | be covered under the parent's policy unless the child was |
| 433 | continuously covered by other creditable coverage without a gap |
| 434 | in coverage of more than 63 days. For the purposes of this |
| 435 | subsection, the term "creditable coverage" has the same meaning |
| 436 | as defined in s. 627.6561(5). |
| 437 | (4)(2) Nothing in This section does not affect or preempt |
| 438 | affects or preempts an insurer's right to medically underwrite |
| 439 | or charge the appropriate premium. |
| 440 | Section 7. Effective upon this act becoming a law and |
| 441 | applicable to policies issued or renewed on or after that date, |
| 442 | paragraph (v) of subsection (3) of section 627.6699, Florida |
| 443 | Statutes, is amended to read: |
| 444 | 627.6699 Employee Health Care Access Act.-- |
| 445 | (3) DEFINITIONS.--As used in this section, the term: |
| 446 | (v) "Small employer" means, in connection with a health |
| 447 | benefit plan with respect to a calendar year and a plan year, |
| 448 | any person, sole proprietor, self-employed individual, |
| 449 | independent contractor, firm, corporation, partnership, or |
| 450 | association that is actively engaged in business, has its |
| 451 | principal place of business in this state, employed an average |
| 452 | of at least 1 but not more than 50 eligible employees on |
| 453 | business days during the preceding calendar year, the majority |
| 454 | of whom were employed within this state, and employs at least 1 |
| 455 | employee on the first day of the plan year, and is not formed |
| 456 | primarily for the purpose of purchasing health insurance. In |
| 457 | determining the number of eligible employees, companies that are |
| 458 | an affiliated group as defined in s. 1504(a) of the Internal |
| 459 | Revenue Code shall be considered one employer. For purposes of |
| 460 | this section, a sole proprietor, an independent contractor, or a |
| 461 | self-employed individual is considered a small employer only if |
| 462 | all of the conditions and criteria established in this section |
| 463 | are met. |
| 464 | Section 8. This act shall take effect upon becoming a law. |
| 465 |
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| 469 | ----------------------------------------------------- |
| 470 | T I T L E A M E N D M E N T |
| 471 | Remove the entire title and insert: |
| 472 | A bill to be entitled |
| 473 | An act relating to health insurance; amending s. 112.363, F.S.; |
| 474 | specifying that coverage provided through the Cover Florida |
| 475 | Health Care Access Program is considered health insurance |
| 476 | coverage for the purposes of determining eligibility for the |
| 477 | state retiree health insurance subsidy; amending s. 408.909, |
| 478 | F.S.; revising eligibility for enrollment in a health flex plan; |
| 479 | revising the expiration date of the health flex plan program; |
| 480 | creating s. 408.9091, F.S.; creating the Cover Florida Health |
| 481 | Care Access Program; providing a short title; providing |
| 482 | legislative intent; providing definitions; requiring the Agency |
| 483 | for Health Care Administration and the Office of Insurance |
| 484 | Regulation of the Financial Services Commission within the |
| 485 | Department of Financial Services to jointly administer the |
| 486 | program; providing program requirements; requiring the |
| 487 | development of guidelines to meet minimum standards for quality |
| 488 | care and access to care; requiring the agency to ensure that the |
| 489 | Cover Florida plans follow standardized grievance procedures; |
| 490 | requiring the Executive Office of the Governor, the agency, and |
| 491 | the office to develop a public awareness program; authorizing |
| 492 | public and private entities to design or extend incentives for |
| 493 | participation in the Cover Florida Access Program; requiring the |
| 494 | agency and the office to announce an invitation to negotiate for |
| 495 | Cover Florida plan entities to design a coverage proposal; |
| 496 | requiring the agency and the office to approve one plan entity; |
| 497 | authorizing the agency and the office to approve one regional |
| 498 | network plan in each existing Medicaid area; requiring the |
| 499 | invitation to negotiate to include certain guidelines; providing |
| 500 | certain conditions in which plans are disapproved or withdrawn; |
| 501 | authorizing the agency and the office to announce an invitation |
| 502 | to negotiate for companies that offer supplemental insurance or |
| 503 | discount medical plans; providing that certain licensing |
| 504 | requirements or ch. 641, F.S., are not applicable to a Cover |
| 505 | Florida plan; providing that Cover Florida plans are considered |
| 506 | insurance under certain conditions; excluding Cover Florida |
| 507 | plans from the Florida Life and Health Insurance Guaranty |
| 508 | Association and the Health Maintenance Organization Consumer |
| 509 | Assistance Plan; providing requirements for eligibility in a |
| 510 | Cover Florida plan; requiring each Cover Florida plan to |
| 511 | maintain and provide certain records; providing that coverage |
| 512 | under a Cover Florida plan is not an entitlement and does not |
| 513 | give rise to a cause of action; requiring the agency and the |
| 514 | office to evaluate the Cover Florida program and submit an |
| 515 | annual report to the Governor and the Legislature; requiring the |
| 516 | agency and the Financial Services Commission to adopt rules; |
| 517 | amending s. 624.91, F.S.; revising the duties of the Florida |
| 518 | Healthy Kids Corporation; amending s. 409.814, F.S.; revising |
| 519 | the eligibility requirements for participation in the Medikids |
| 520 | program or the Florida Healthy Kids program; deleting certain |
| 521 | limitations; amending s. 627.6562, F.S.; requiring insurance |
| 522 | policies that provide dependent coverage to provide the |
| 523 | policyholder with the option of insuring a child until the age |
| 524 | of 30 under certain circumstances; amending s. 627.6699, F.S.; |
| 525 | redefining the term "small employer" for purposes of the |
| 526 | Employee Health Care Access Act; providing an effective date. |
| 527 |
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| 528 |
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