HB 7081

1	A bill to be entitled
2	An act relating to affordable health coverage; amending s.
3	112.363, F.S.; specifying that coverage provided through
4	the Cover Florida Health Care Access Program is considered
5	health insurance coverage for the purposes of determining
6	eligibility for the state retiree health insurance
7	subsidy; amending s. 408.909, F.S.; revising the
8	definition of the term "health flex plan"; revising
9	program requirements for approval of plans by the Agency
10	for Health Care Administration; revising eligibility
11	requirements; providing certain exemptions from the 6-
12	month lapse in coverage requirement; eliminating the
13	expiration date of the health flex plan program; creating
14	s. 408.9091, F.S.; creating the Cover Florida Health Care
15	Access Program; providing a short title; providing
16	legislative intent; providing definitions; requiring the
17	agency and the Office of Insurance Regulation of the
18	Financial Services Commission within the Department of
19	Financial Services to jointly administer the program;
20	providing program requirements; requiring the development
21	of guidelines to meet minimum standards for quality of
22	care and access to care; requiring the agency to ensure
23	that the Cover Florida plans follow standardized grievance
24	procedures; requiring the office and the agency to oversee
25	changes to plan benefits; requiring the Executive Office
26	of the Governor, the agency, and the office to develop a
27	public awareness program; authorizing public and private
28	entities to design programs to encourage or extend
29	incentives for participation in the Cover Florida Health
30	Care Access Program; requiring the agency and the office
31	to announce an invitation to negotiate for Cover Florida
32	plan entities to design a coverage proposal; requiring the
33	invitation to negotiate to include certain guidelines;
34	providing certain conditions under which plans are
35	disapproved or withdrawn; authorizing the agency and the
36	office to announce an invitation to negotiate for
37	companies that offer supplemental insurance or discount
38	medical plans; requiring the agency and the office to
39	approve at least one plan entity; authorizing the agency
40	and the office to approve one regional network plan in
41	each existing Medicaid area; providing that certain
42	licensing requirements are not applicable to a Cover
43	Florida plan; providing that Cover Florida plans are
44	considered insurance under certain conditions; excluding
45	Cover Florida plans from the Florida Life and Health
46	Insurance Guaranty Association and the Health Maintenance
47	Organization Consumer Assistance Plan; providing
48	requirements for eligibility for a Cover Florida plan;
49	requiring each Cover Florida plan to maintain and provide
50	certain records; providing that coverage under a Cover
51	Florida plan is not an entitlement and does not give rise
52	to a cause of action; requiring the agency and the office
53	to evaluate the program and submit an annual report to the
54	Governor and the Legislature; authorizing the agency and
55	the Financial Services Commission to adopt rules; creating
56	s. 408.910, F.S.; establishing the Florida Health Choices
57	Program; providing legislative intent; providing
58	definitions; providing program purpose and components;
59	providing employer eligibility criteria; providing
60	individual eligibility criteria; providing employer
61	enrollment criteria; providing vendor, product, and
62	service eligibility criteria; providing for individual
63	participation regardless of subsequent job status or
64	Medicaid eligibility; providing individual enrollment
65	criteria; providing vendor enrollment criteria; providing
66	for participation by health insurance agents; providing
67	criteria for products available for purchase; providing
68	criteria for product pricing; providing for an
69	administrative surcharge; providing for an exchange
70	process; providing for enrollment periods and changes in
71	selected products; providing methods for the pooling of
72	risk; providing for exemptions from certain statutory
73	provisions, mandated offerings and coverages, and
74	licensing requirements; creating the Florida Health
75	Choices, Inc.; requiring the department to supervise any
76	liquidation or dissolution of the corporation; providing
77	for corporate governance and board membership and terms;
78	providing for reimbursement for per diem and travel
79	expenses; providing for powers and duties of the
80	corporation; requiring the corporation to submit an annual
81	report to the Governor and Legislature; authorizing the
82	corporation to establish and enforce certain program
83	integrity measures; amending s. 409.811, F.S.; revising
84	the definition of the term "premium assistance payment";
85	creating s. 624.1265, F.S.; exempting certain nonprofit
86	religious organizations from requirements of the Florida
87	Insurance Code; preserving certain authority of such
88	organizations; requiring such organizations to provide
89	certain notice to prospective participants; providing
90	notice requirements; amending s. 627.602, F.S.; requiring
91	an insurance policy that includes coverage for dependent
92	children to comply with specified provisions relating to
93	dependent coverage; amending s. 627.653, F.S.; requiring
94	participation of employees in group insurance policies or
95	group health benefit plans issued or renewed after a
96	specified date; providing conditions for employers and
97	employees to opt out of such coverage; amending s.
98	627.6562, F.S.; specifying the types of insurance policies
99	that must provide for dependent coverage; extending the
100	qualifying age for dependent coverage from 25 to 30 years;
101	revising eligibility requirements for dependents to
102	receive continued coverage; providing clarifications and
103	limitations of dependent coverage; providing mechanisms
104	for reinstatement of dependent coverage; providing for
105	payment of premium; requiring approval of premium payment
106	requirements by the office; providing notice requirements
107	for reinstated coverage of dependents; providing
108	applicability; amending s. 627.6699, F.S.; requiring
109	participation of employees in health maintenance contracts
110	or policies issued or renewed after a specified date;
111	providing conditions for employers and employees to opt
112	out of such coverage; amending s. 641.31, F.S.; requiring
113	participation of employees in policies or health
114	maintenance contracts issued or renewed after a specified
115	date; providing conditions for employers and employees to
116	opt out of such coverage; requiring all heath maintenance
117	contracts that provide coverage for family members to
118	comply with certain statutory provisions; amending s.
119	641.402, F.S.; revising the definition of the term "basic
120	services" to include certain hospital inpatient services;
121	revising the definitions of the terms "prepaid health
122	clinic" and "provider"; providing an effective date.
123
124	Be It Enacted by the Legislature of the State of Florida:
125
126	Section 1.  Paragraph (d) of subsection (2) of section
127	112.363, Florida Statutes, is amended to read:
128	112.363  Retiree health insurance subsidy.--
129	(2)  ELIGIBILITY FOR RETIREE HEALTH INSURANCE SUBSIDY.--
130	(d)  Payment of the retiree health insurance subsidy shall
131	be made only after coverage for health insurance for the retiree
132	or beneficiary has been certified in writing to the Department
133	of Management Services. Participation in a former employer's
134	group health insurance program is not a requirement for
135	eligibility under this section. Coverage issued pursuant to s.
136	408.9091 is considered health insurance for the purposes of this
137	section.
138	Section 2.  Paragraph (e) of subsection (2) and subsections
139	(3), (5), and (10) of section 408.909, Florida Statutes, are
140	amended to read:
141	408.909  Health flex plans.--
142	(2)  DEFINITIONS.--As used in this section, the term:
143	(e)  "Health flex plan" means a health plan approved under
144	subsection (3) which guarantees payment for specified health
145	care coverage provided to the enrollee who purchases coverage as
146	an individual, directly from the plan as a small business, or
147	through a small business purchasing arrangement sponsored by a
148	local government.
149	(3)  PROGRAM.--The agency and the office shall each approve
150	or disapprove health flex plans that provide health care
151	coverage for eligible participants. A health flex plan may limit
152	or exclude benefits or provider network requirements otherwise
153	required by law for insurers offering coverage in this state,
154	may cap the total amount of claims paid per year per enrollee,
155	may limit the number of enrollees, or may take any combination
156	of those actions. A health flex plan offering may include the
157	option of a catastrophic plan or a catastrophic plan
158	supplementing the health flex plan.
159	(a)  The agency shall develop guidelines for the review of
160	applications for health flex plans and shall disapprove or
161	withdraw approval of plans that do not meet or no longer meet
162	minimum standards for quality of care and access to care. The
163	agency shall ensure that the health flex plans follow
164	standardized grievance procedures similar to those required of
165	health maintenance organizations.
166	(b)  The office shall develop guidelines for the review of
167	health flex plan applications and provide regulatory oversight
168	of health flex plan advertisement and marketing procedures. The
169	office shall disapprove or shall withdraw approval of plans
170	that:
171	1.  Contain any ambiguous, inconsistent, or misleading
172	provisions or any exceptions or conditions that deceptively
173	affect or limit the benefits purported to be assumed in the
174	general coverage provided by the health flex plan;
175	2.  Provide benefits that are unreasonable in relation to
176	the premium charged or contain provisions that are unfair or
177	inequitable or contrary to the public policy of this state, that
178	encourage misrepresentation, or that result in unfair
179	discrimination in sales practices;
180	3.  Cannot demonstrate that the health flex plan is
181	financially sound and that the applicant is able to underwrite
182	or finance the health care coverage provided; or
183	4.  Cannot demonstrate that the applicant and its
184	management are in compliance with the standards required under
185	s. 624.404(3).
186	(c)  The agency and the Financial Services Commission may
187	adopt rules as needed to administer this section.
188	(5)  ELIGIBILITY.--Eligibility to enroll in an approved
189	health flex plan is limited to residents of this state who:
190	(a)1.  Are 64 years of age or younger;
191	2.(b)  Have a family income equal to or less than 200
192	percent of the federal poverty level;
193	(c)  Are eligible under a federally approved Medicaid
194	demonstration waiver and reside in Palm Beach County or Miami-
195	Dade County;
196	3. (d)  Are not covered by a private insurance policy and
197	are not eligible for coverage through a public health insurance
198	program, such as Medicare or Medicaid, unless specifically
199	authorized under paragraph (c), or another public health care
200	program, such as Kidcare, and have not been covered at any time
201	during the past 6 months, except that:
202	a.  A person who was covered under an individual health
203	maintenance contract issued by a health maintenance organization
204	licensed under part I of chapter 641 that also was an approved
205	health flex plan on October 1, 2008, may apply for coverage in
206	the same health maintenance organization's health flex plan
207	without a lapse in coverage if all other eligibility
208	requirements are met; or
209	b.  A person who was covered under Medicaid or Kidcare and
210	lost eligibility for the Medicaid or Kidcare subsidy due to
211	income restrictions within 90 days prior to applying for health
212	care coverage through an approved health flex plan may apply for
213	coverage in a health flex plan without a lapse in coverage if
214	all other eligibility requirements are met; and
215	4.(e)  Have applied for health care coverage as an
216	individual through an approved health flex plan and have agreed
217	to make any payments required for participation, including
218	periodic payments or payments due at the time health care
219	services are provided; or
220	(b)  Are part of an employer group at least 75 percent of
221	the employees of which have a family income equal to or less
222	than 300 percent of the federal poverty level and which employee
223	group is not covered by a private health insurance policy and
224	has not been covered at any time during the past 6 months. If
225	the health flex plan entity is a health insurer, health plan, or
226	health maintenance organization licensed under Florida law, only
227	50 percent of the employees must meet the income requirements
228	for the purpose of this paragraph.
229	(10)  EXPIRATION.--This section expires July 1, 2008.
230	Section 3.  Section 408.9091, Florida Statutes, is created
231	to read:
232	408.9091  Cover Florida Health Care Access Program.--
233	(1)  SHORT TITLE.--This section may be cited as the "Cover
234	Florida Health Care Access Program Act."
235	(2)  LEGISLATIVE INTENT.--The Legislature finds that a
236	significant number of state residents are unable to obtain
237	affordable health insurance coverage. The Legislature also finds
238	that existing health flex plan coverage has had limited
239	participation due in part to narrow eligibility restrictions as
240	well as minimal benefit options for catastrophic and emergency
241	care coverage. Therefore, it is the intent of the Legislature to
242	expand the availability of health care options for uninsured
243	residents by developing an affordable health care product that
244	emphasizes coverage for basic and preventive health care
245	services; provides inpatient hospital, urgent, and emergency
246	care services; and is offered statewide by approved health
247	insurers, health maintenance organizations, health-care-
248	provider-sponsored organizations, or health care districts.
249	(3)  DEFINITIONS.--As used in this section, the term:
250	(a)  "Agency" means the Agency for Health Care
251	Administration.
252	(b)  "Cover Florida plan" means a consumer choice benefit
253	plan approved under this section that guarantees payment or
254	coverage for specified benefits provided to an enrollee.
255	(c)  "Cover Florida plan coverage" means health care
256	services that are covered as benefits under a Cover Florida
257	plan.
258	(d)  "Cover Florida plan entity" means a health insurer,
259	health maintenance organization, health-care-provider-sponsored
260	organization, or health care district that develops and
261	implements a Cover Florida plan and is responsible for
262	administering the plan and paying all claims for Cover Florida
263	plan coverage by enrollees.
264	(e)  "Cover Florida Plus" means a supplemental insurance
265	product, such as for additional catastrophic coverage or dental,
266	vision, or cancer coverage, approved under this section and
267	offered to all enrollees.
268	(f)  "Enrollee" means an individual who has been determined
269	to be eligible for and is receiving health insurance coverage
270	under a Cover Florida plan.
271	(g)  "Office" means the Office of Insurance Regulation of
272	the Financial Services Commission.
273	(4)  PROGRAM.--The agency and the office shall jointly
274	establish and administer the Cover Florida Health Care Access
275	Program.
276	(a)  General Cover Florida plan components must require
277	that:
278	1.  Plans are offered on a guaranteed-issue basis to
279	enrollees, subject to exclusions for preexisting conditions
280	approved by the office and the agency.
281	2.  Plans are portable such that the enrollee remains
282	covered regardless of employment status or the cost-sharing of
283	premiums.
284	3.  Plans provide for cost containment through limits on
285	the number of services, caps on benefit payments, and copayments
286	for services.
287	4.  A Cover Florida plan entity makes all benefit plan and
288	marketing materials available in English and Spanish.
289	5.  In order to provide for consumer choice, Cover Florida
290	plan entities develop two alternative benefit option plans
291	having different cost and benefit levels, including at least one
292	plan that provides catastrophic coverage.
293	6.  Plans without catastrophic coverage provide coverage
294	options for services including, but not limited to:
295	a.  Preventive health services, including immunizations,
296	annual health assessments, well-woman and well-care services,
297	and preventive screenings such as mammograms, cervical cancer
298	screenings, and noninvasive colorectal or prostate screenings.
299	b.  Incentives for routine preventive care.
300	c.  Office visits for the diagnosis and treatment of
301	illness or injury.
302	d.  Office surgery, including anesthesia.
303	e.  Behavioral health services.
304	f.  Durable medical equipment and prosthetics.
305	g.  Diabetic supplies.
306	7.  Plans providing catastrophic coverage, at a minimum,
307	provide coverage options for all of the services listed under
308	subparagraph 6.; however, such plans may include, but are not
309	limited to, coverage options for:
310	a.  Inpatient hospital stays.
311	b.  Hospital emergency care services.
312	c.  Urgent care services.
313	d.  Outpatient facility services, outpatient surgery, and
314	outpatient diagnostic services.
315	8.  All plans offer prescription drug benefit coverage or
316	use a prescription drug manager such as the Florida Discount
317	Drug Card Program.
318	9.  Plan enrollment materials provide information in plain
319	language on policy benefit coverage, benefit limits, cost-
320	sharing requirements, and exclusions and a clear representation
321	of what is not covered in the plan. The Cover Florida Health
322	Care Access Program shall require the following disclosure to be
323	reviewed and executed by all consumers purchasing program
324	options or insurance coverage through the program: "In
325	connection with the Cover Florida Health Care Access Program
326	authorized by s. 408.9091, Florida Statutes, agents and entities
327	offering products and services under the program shall inform
328	the named insured, applicant, or subscriber, on a form approved
329	by the Office of Insurance Regulation of the Financial Services
330	Commission, that the program is not an insurance program or, if
331	it is an insurance program, that benefits under the coverage are
332	limited under s. 408.9091, Florida Statutes, and that such
333	coverage is an alternative to coverage without such limitations.
334	If the form is signed by a named insured, applicant, or
335	subscriber, it shall be presumed that there was an informed,
336	knowing acceptance of such limitations."
337	10.  Plans offered through a qualified employer meet the
338	requirements of s. 125 of the Internal Revenue Code.
339	(b)  Guidelines shall be developed to ensure that Cover
340	Florida plans meet minimum standards for quality of care and
341	access to care. The agency shall ensure that the Cover Florida
342	plans follow standardized grievance procedures.
343	(c)  Changes in Cover Florida plan benefits, premiums, and
344	policy forms are subject to regulatory oversight by the office
345	and the agency as provided under rules adopted by the Financial
346	Services Commission and the agency.
347	(d)  The agency, the office, and the Executive Office of
348	the Governor shall develop a public awareness program to be
349	implemented throughout the state for the promotion of the Cover
350	Florida Health Care Access Program.
351	(e)  Public or private entities may design programs to
352	encourage Floridians to participate in the Cover Florida Health
353	Care Access Program or to encourage employers to cosponsor some
354	share of Cover Florida plan premiums for employees.
355	(5)  PLAN PROPOSALS.--The agency and the office shall
356	announce, no later than July 1, 2008, an invitation to negotiate
357	for Cover Florida plan entities to design a Cover Florida plan
358	proposal in which benefits and premiums are specified.
359	(a)  The invitation to negotiate shall include guidelines
360	for the review of Cover Florida plan applications, policy forms,
361	and all associated forms and provide regulatory oversight of
362	Cover Florida plan advertisement and marketing procedures. A
363	plan shall be disapproved or withdrawn if the plan:
364	1.  Contains any ambiguous, inconsistent, or misleading
365	provisions or any exceptions or conditions that deceptively
366	affect or limit the benefits purported to be assumed in the
367	general coverage provided by the plan;
368	2.  Provides benefits that are unreasonable in relation to
369	the premium charged or contains provisions that are unfair or
370	inequitable, that are contrary to the public policy of this
371	state, that encourage misrepresentation, or that result in
372	unfair discrimination in sales practices;
373	3.  Cannot demonstrate that the plan is financially sound
374	and that the applicant is able to underwrite or finance the
375	health care coverage provided;
376	4.  Cannot demonstrate that the applicant and its
377	management are in compliance with the standards required under
378	s. 624.404(3); or
379	5.  Does not guarantee that enrollees may participate in
380	the Cover Florida plan entity's comprehensive network of
381	providers, as determined by the office, the agency, and the
382	contract.
383	(b)  The agency and the office may announce an invitation
384	to negotiate for companies that offer supplemental insurance or
385	discount medical plans that are licensed under part II of
386	chapter 636 to design Cover Florida Plus products.
387	(c)  The agency and office shall approve at least one Cover
388	Florida plan entity having an existing statewide network of
389	providers and may approve at least one regional network plan in
390	each existing Medicaid area.
391	(6)  LICENSE NOT REQUIRED.--
392	(a)  The licensing requirements of the Florida Insurance
393	Code and chapter 641 relating to health maintenance
394	organizations do not apply to a Cover Florida plan approved
395	under this section unless expressly made applicable. However,
396	for the purpose of prohibiting unfair trade practices, Cover
397	Florida plans are considered to be insurance subject to the
398	applicable provisions of part IX of chapter 626 except as
399	otherwise provided in this section.
400	(b)  Cover Florida plans are not covered by the Florida
401	Life and Health Insurance Guaranty Association under part III of
402	chapter 631 or by the Health Maintenance Organization Consumer
403	Assistance Plan under part IV of chapter 631.
404	(7)  ELIGIBILITY.--Eligibility to enroll in a Cover Florida
405	plan is limited to residents of this state who meet all of the
406	following requirements:
407	(a)  Are between 19 and 64 years of age, inclusive.
408	(b)  Are not covered by a private insurance policy and are
409	not eligible for coverage through a public health insurance
410	program, such as Medicare, Medicaid, or Kidcare, unless
411	eligibility for coverage lapses due to no longer meeting income
412	or categorical requirements.
413	(c)  Have not been covered by any health insurance program
414	at any time during the past 6 months, unless coverage under a
415	health insurance program was terminated within the previous 6
416	months due to:
417	1.  Loss of a job that provided an employer-sponsored
418	health benefit plan;
419	2.  Exhaustion of coverage that was continued under COBRA
420	or continuation-of-coverage requirements under s. 627.6692;
421	3.  Reaching the limiting age under the policy; or
422	4.  Death of, or divorce from, a spouse who was provided an
423	employer-sponsored health benefit plan.
424	(d)  Have applied for health care coverage through a Cover
425	Florida plan and have agreed to make any payments required for
426	participation, including periodic payments or payments due at
427	the time health care services are provided.
428	(8)  RECORDS.--Each Cover Florida plan must maintain
429	enrollment data and provide network data and reasonable records
430	to enable the office and the agency to monitor plans and to
431	determine the financial viability of the Cover Florida plan, as
432	necessary.
433	(9)  NONENTITLEMENT.--Coverage under a Cover Florida plan
434	is not an entitlement, and a cause of action does not arise
435	against the state, a local government entity, any other
436	political subdivision of the state, or the agency or the office
437	for failure to make coverage available to eligible persons under
438	this section.
439	(10)  PROGRAM EVALUATION.--The agency and the office shall:
440	(a)  Evaluate the Cover Florida Health Care Access Program
441	and its effect on the entities that seek approval as Cover
442	Florida plans, on the number of enrollees, and on the scope of
443	the health care coverage offered under a Cover Florida plan.
444	(b)  Provide an assessment of the Cover Florida plans and
445	their potential applicability in other settings.
446	(c)  Use Cover Florida plans to gather more information to
447	evaluate low-income, consumer-driven benefit packages.
448	(d)  Jointly submit by March 1, 2009, and annually
449	thereafter, a report to the Governor, the President of the
450	Senate, and the Speaker of the House of Representatives that
451	provides the information specified in paragraphs (a)-(c) and
452	recommendations relating to the successful implementation and
453	administration of the program.
454	(11)  RULEMAKING AUTHORITY.--The agency and the Financial
455	Services Commission may adopt rules pursuant to ss. 120.536(1)
456	and 120.54 as needed to administer this section.
457	Section 4.  Section 408.910, Florida Statutes, is created
458	to read:
459	408.910  Florida Health Choices Program.--
460	(1)  LEGISLATIVE INTENT.--The Legislature finds that a
461	significant number of the residents of this state do not have
462	adequate access to affordable, quality health care. The
463	Legislature further finds that increasing access to affordable,
464	quality health care will be best accomplished by establishing a
465	competitive market for purchasing health insurance and health
466	services. It is therefore the intent of the Legislature to
467	create the Florida Health Choices Program to:
468	(a)  Expand opportunities for Floridians to purchase
469	affordable health insurance and health services.
470	(b)  Preserve the benefits of employment-sponsored
471	insurance while easing the administrative burden for employers
472	who offer these benefits.
473	(c)  Enable individual choice in both the manner and amount
474	of health care purchased.
475	(d)  Provide for the purchase of individual, portable
476	health care coverage.
477	(e)  Disseminate information to consumers on the price and
478	quality of health services.
479	(f)  Sponsor a competitive market that stimulates product
480	innovation, quality improvement, and efficiency in the
481	production and delivery of health services.
482	(2)  DEFINITIONS.--As used in this section:
483	(a)  "Corporation" means the Florida Health Choices, Inc.,
484	established under this section.
485	(b)  "Health insurance agent" means an agent licensed under
486	part IV of chapter 626.
487	(c)  "Insurer" means an individual health insurance policy
488	subject to this chapter, an insurer issuing a group health
489	insurance policy or certificate pursuant to s. 627.651, a plan
490	of self-insurance providing health coverage benefits to
491	residents of this state pursuant to s. 627.651, an insurer
492	delivering a group health policy issued or delivered outside
493	this state under which a resident of this state is provided
494	coverage pursuant to s. 627.6515, a preferred provider
495	organization as defined in s. 627.6471, or an exclusive provider
496	organization as defined in s. 627.6472.
497	(d)  "Program" means the Florida Health Choices Program
498	established by this section.
499	(3)  PROGRAM PURPOSE AND COMPONENTS.--The Florida Health
500	Choices Program is created as a single, centralized market for
501	the sale and purchase of various products that enable
502	individuals to pay for health care. These products include, but
503	are not limited to, health insurance plans, health maintenance
504	organization plans, prepaid services, service contracts, and
505	flexible spending accounts. The components of the program
506	include:
507	(a)  Enrollment of employers.
508	(b)  Administrative services for participating employers,
509	including:
510	1.  Assistance in seeking federal approval of cafeteria
511	plans.
512	2.  Collection of premiums and other payments.
513	3.  Management of individual benefit accounts.
514	4.  Distribution of premiums to insurers and payments to
515	other eligible vendors.
516	5.  Assistance for participants in complying with reporting
517	requirements.
518	(c)  Services to individual participants, including:
519	1.  Information about available products and participating
520	vendors.
521	2.  Assistance to participating individuals for assessing
522	the benefits and limits of each product, including information
523	necessary to distinguish between policies offering creditable
524	coverage and other products available through the program.
525	3.  Account information to assist individual participants
526	to manage available resources.
527	4.  Services that promote healthy behaviors.
528	(d)  Recruitment of vendors, including insurers, health
529	maintenance organizations, prepaid clinic service providers,
530	provider service networks, and other providers.
531	(e)  Certification of vendors to ensure capability,
532	reliability, and validity of offerings.
533	(f)  Collection of data, monitoring, assessment, and
534	reporting of vendor performance.
535	(g)  Information services for individuals and employers.
536	(h)  Program evaluation.
537	(4)  ELIGIBILITY AND PARTICIPATION.--Participation in the
538	program is voluntary and shall be available to employers,
539	individuals, vendors, and health insurance agents as specified
540	in this subsection.
541	(a)  Employers eligible to enroll in the program include:
542	1.  Employers with 1 to 50 employees.
543	2.  Fiscally constrained counties described in s. 218.67.
544	3.  Municipalities with populations of fewer than 50,000
545	residents.
546	4.  School districts in fiscally constrained counties.
547	(b)  Individuals eligible to participate in the program
548	include:
549	1.  Individual employees of enrolled employers.
550	2.  State employees not eligible for state employee health
551	benefits.
552	3.  State retirees.
553	4.  Medicaid reform participants who select the opt-out
554	provision of reform.
555	5.  Statutory rural hospitals.
556	(c)  Employers who choose to participate in the program may
557	enroll by complying with the procedures established by the
558	corporation. These procedures shall include, but not be limited
559	to, the following:
560	1.  Submission of required information.
561	2.  Compliance with federal tax requirements for the
562	establishment of a cafeteria plan, pursuant to s. 125 of the
563	Internal Revenue Code, including designation of the employer's
564	plan as a premium payment plan, a salary reduction plan with
565	flexible spending arrangements, or a salary reduction plan with
566	a premium payment and flexible spending arrangements.
567	3.  Determination of the employer's contribution, if any,
568	per employee, provided that such contribution is equal for each
569	eligible employee.
570	4.  Establishment of payroll deduction procedures, subject
571	to the agreement of each individual employee who voluntarily
572	participates in the program.
573	5.  Designation of the corporation as the third-party
574	administrator for the employer's health benefit plan.
575	6.  Identification of eligible employees.
576	7.  Arrangement for periodic payments.
577	(d)  Eligible vendors and the products and services that
578	they are permitted to sell are as follows:
579	1.  Insurers licensed under chapter 627 may sell health
580	insurance policies, limited benefit policies, other risk-bearing
581	coverage, and other products or services.
582	2.  Health maintenance organizations licensed under part I
583	of chapter 641 may sell health insurance policies, limited
584	benefit policies, other risk-bearing products, and other
585	products or services.
586	3.  Prepaid health clinic service providers licensed under
587	part II of chapter 641 may sell prepaid service contracts and
588	other arrangements for a specified amount and type of health
589	services or treatments.
590	4.  Out-of-state insurers may sell health insurance
591	policies, limited benefit policies, other risk-bearing products,
592	and other products or services.
593	5.  Health care providers, including hospitals and other
594	licensed health facilities, health care clinics, licensed health
595	professionals, pharmacies, and other licensed health care
596	providers, may sell service contracts and arrangements for a
597	specified amount and type of health services or treatments.
598	6.  Provider organizations, including service networks,
599	group practices, professional associations, and other
600	incorporated organizations of providers, may sell service
601	contracts and arrangements for a specified amount and type of
602	health services or treatments.
603	7.  Corporate entities providing specific health services
604	in accordance with applicable state law may sell service
605	contracts and arrangements for a specified amount and type of
606	health services or treatments.
607
608	Otherwise eligible vendors may be excluded from participating in
609	the program for deceptive or predatory practices, financial
610	insolvency, or failure to comply with the terms of the
611	participation agreement or other standards set by the
612	corporation.
613	(e)  Eligible individuals may voluntarily continue
614	participation in the program regardless of subsequent changes in
615	job status or Medicaid eligibility. Individuals who join the
616	program may participate by complying with the procedures
617	established by the corporation. These procedures shall include,
618	but are not limited to:
619	1.  Submission of required information.
620	2.  Authorization for payroll deduction.
621	3.  Compliance with federal tax requirements.
622	4.  Arrangements for payment in the event of job changes.
623	5.  Selection of products and services.
624	(f)  Vendors who choose to participate in the program may
625	enroll by complying with the procedures established by the
626	corporation. These procedures shall include, but are not limited
627	to:
628	1.  Submission of required information, including a
629	complete description of the coverage, services, provider
630	network, payment restrictions, and other requirements of each
631	product offered through the program.
632	2.  Execution of an agreement to make all products offered
633	through the program available to all individual participants.
634	3.  Establishment of product prices based on age, gender,
635	and location of the individual participant.
636	4.  Arrangements for receiving payment for enrolled
637	participants.
638	5.  Participation in ongoing reporting processes
639	established by the corporation.
640	6.  Compliance with grievance procedures established by the
641	corporation.
642	(g)  Health insurance agents licensed under part IV of
643	chapter 626 are eligible to voluntarily participate as buyers'
644	representatives. A buyer's representative acts on behalf of an
645	individual purchasing health insurance and health services
646	through the program by providing information about products and
647	services available through the program and assisting the
648	individual with both the decision and the procedure of selecting
649	specific products. Serving as a buyer's representative does not
650	constitute a conflict of interest with continuing
651	responsibilities as a health insurance agent provided the
652	relationship between each agent and any participating vendor is
653	disclosed prior to advising an individual participant about the
654	products and services available through the program. In order to
655	participate, a health insurance agent shall comply with the
656	procedures established by the corporation, including:
657	1.  Completion of training requirements.
658	2.  Execution of a participation agreement specifying the
659	terms and conditions of participation.
660	3.  Disclosure of any appointments to solicit insurance or
661	procure applications for vendors participating in the program.
662	4.  Arrangements to receive payment from the corporation
663	for services as a buyer's representative.
664	(5)  PRODUCTS.--
665	(a)  The products that may be made available for purchase
666	through the program include, but are not limited to:
667	1.  Health insurance policies.
668	2.  Limited benefit plans.
669	3.  Prepaid clinic services.
670	4.  Service contracts.
671	5.  Arrangements for purchase of specific amounts and types
672	of health services and treatments.
673	6.  Flexible spending accounts.
674	(b)  Health insurance policies, limited benefit plans,
675	prepaid service contracts, and other contracts for services must
676	ensure the availability of covered services and benefits to
677	participating individuals for at least 1 full enrollment year.
678	(c)  Products may be offered for multiyear periods provided
679	the price of the product is specified for the entire period or
680	for each separately priced segment of the policy or contract.
681	(d)  The corporation shall require the following disclosure
682	to be reviewed and executed by all consumers purchasing program
683	options or insurance coverage through the corporation: "In
684	connection with the Florida Health Choices Program authorized by
685	s. 408.910, Florida Statutes, agents and entities offering
686	products and services under the program shall inform the named
687	insured, applicant, or subscriber, on a form approved by the
688	Office of Insurance Regulation of the Financial Services
689	Commission, that the products and services are not insurance or,
690	if they are insurance, that benefits under the coverage are
691	limited under s. 408.910, Florida Statutes, and that such
692	coverage is an alternative to coverage without such limitations.
693	If the form is signed by a named insured, applicant, or
694	subscriber, it shall be presumed that there was an informed,
695	knowing acceptance of such limitations."
696	(6)  PRICING.--Prices for the products sold through the
697	program shall be transparent to participants and established by
698	the vendors based on age, gender, and location of participants.
699	Prior to making the product available to individual
700	participants, the corporation shall ensure that the prices are
701	analyzed to compare the expected health care costs for the
702	covered services and benefits to the vendor's price for that
703	coverage. The results shall be reported to individuals
704	participating in the program. Once established, the price set by
705	the vendor must remain in force for at least 1 year and may only
706	be redetermined by the vendor at the next annual enrollment
707	period. The corporation shall annually set a load factor to each
708	premium or price set by a participating vendor. This surcharge
709	may not be more than 2.5 percent of the price and shall be used
710	to generate funding for administrative services provided by the
711	corporation and payments to buyers' representatives.
712	(7)  EXCHANGE PROCESS.--The program shall provide a single,
713	centralized market for purchase of health insurance and health
714	services. Purchases may be made by participating individuals
715	over the Internet or through the services of a participating
716	health insurance agent. Information about each product and
717	service available through the program shall be made available
718	through printed material and an interactive Internet website. A
719	participant needing personal assistance to select products and
720	services shall be referred to a participating agent in his or
721	her area.
722	(a)  Participation in the program may begin at any time
723	during a year when the employer completes enrollment and meets
724	the requirements specified by the corporation pursuant to
725	paragraph (4)(c).
726	(b)  Initial selection of products and services must be
727	made by an individual participant within 60 days after the date
728	on which the individual's employer qualified for participation.
729	An individual who fails to enroll in products and services by
730	the end of this period shall be limited to participation in
731	flexible spending account services until the next annual
732	enrollment period.
733	(c)  Initial enrollment periods for each product selected
734	by an individual participant must last a minimum of 12 months,
735	unless the individual participant specifically agrees to a
736	different enrollment period.
737	(d)  When an individual has selected one or more products
738	and enrolled in those products for at least 12 months or any
739	other period specifically agreed to by the individual
740	participant, changes in selected products and services may only
741	be made during the annual enrollment period established by the
742	corporation.
743	(e)  The limits established in paragraphs (b)-(d) apply to
744	any risk-bearing product that promises future payment or
745	coverage for a variable amount of benefits or services. The
746	limits do not apply to initiation of flexible spending plans
747	when those plans are not associated with specific high-
748	deductible insurance policies or to the use of spending accounts
749	for any products offering individual participants specific
750	amounts and types of health services and treatments at a
751	contracted price.
752	(8)  RISK POOLING.--The program shall utilize methods for
753	pooling the risk of individual participants and preventing
754	selection bias. These methods shall include, but not be limited
755	to, a postenrollment risk adjustment of the premium payments to
756	the vendors. The corporation shall establish a methodology for
757	assessing the risk of enrolled individual participants based on
758	data reported by the vendors about their enrollees. Monthly
759	distributions of payments to the vendors shall be adjusted based
760	on the assessed relative risk profile of the enrollees in each
761	risk-bearing product for the most recent period for which data
762	is available.
763	(9)  EXEMPTIONS.--
764	(a)  Policies sold as part of the program are not subject
765	to the licensing requirements of the Florida Insurance Code,
766	chapter 641, or the mandated offerings or coverages established
767	in part VI of chapter 627 and chapter 641.
768	(b)  The corporation is authorized to act as an
769	administrator as defined in s. 626.88. However, the corporation
770	is not subject to the licensing requirements of part VII of
771	chapter 626.
772	(10)  LIQUIDATION OR DISSOLUTION.--The Department of
773	Financial Services shall supervise any liquidation or
774	dissolution of the corporation and shall have, with respect to
775	such liquidation or dissolution, all power granted to it
776	pursuant to the Florida Insurance Code.
777	(11)  CORPORATION.--There is created the Florida Health
778	Choices, Inc., which shall be registered, incorporated,
779	organized, and operated in compliance with chapter 617. The
780	purpose of the corporation is to administer the program created
781	in this section and to conduct such other business as may
782	further the administration of the program.
783	(a)  The corporation shall be governed by a board of
784	directors consisting of 15 individuals appointed in the
785	following manner:
786	1.  Five members appointed by and serving at the pleasure
787	of the Governor, consisting of:
788	a.  The Secretary of Health Care Administration or a
789	designee with expertise in health care services.
790	b.  The Secretary of Management Services or a designee with
791	expertise in state employee benefits.
792	c.  Three representatives of eligible public employers.
793	2.  Five members appointed by and serving at the pleasure
794	of the President of the Senate, consisting of representatives of
795	employers, insurers, health care providers, health insurance
796	agents, and individual participants.
797	3.  Five members appointed by and serving at the pleasure
798	of the Speaker of the House of Representatives, consisting of
799	representatives of employers, insurers, health care providers,
800	health insurance agents, and individual participants.
801	(b)  Members shall be appointed for terms of up to 3 years.
802	Any member is eligible for reappointment. A vacancy on the board
803	shall be filled for the unexpired portion of the term in the
804	same manner as the original appointment.
805	(c)  The board shall select a chief executive officer for
806	the corporation who shall be responsible for the selection of
807	such other staff as may be authorized by the corporation's
808	operating budget as adopted by the board.
809	(d)  Board members are entitled to receive, from funds of
810	the corporation, reimbursement for per diem and travel expenses
811	as provided by s. 112.061. No other compensation is authorized.
812	(e)  There shall be no liability on the part of, and no
813	cause of action shall arise against, any member of the board or
814	its employees or agents for any action taken by them in the
815	performance of their powers and duties under this section.
816	(f)  The board shall develop and adopt bylaws and other
817	corporate procedures as necessary for the operation of the
818	corporation and carrying out the purposes of this section. The
819	bylaws shall specify procedures for selection of officers and
820	qualifications for reappointment, provided that no board member
821	shall serve more than 8 consecutive years. The bylaws shall also
822	require an annual membership meeting that provides an
823	opportunity for input and interaction with individual
824	participants in the program.
825	(g)  The corporation may exercise all powers granted to it
826	under chapter 617 necessary to carry out the purposes of this
827	section, including, but not limited to, the power to receive and
828	accept grants, loans, or advances of funds from any public or
829	private agency and to receive and accept from any source
830	contributions of money, property, labor, or any other thing of
831	value to be held, used, and applied for the purposes of this
832	section.
833	(h)  The corporation shall:
834	1.  Determine eligibility of employers, vendors,
835	individuals, and agents in accordance with subsection (4).
836	2.  Establish procedures necessary for the operation of the
837	program, including, but not limited to, procedures for
838	application, enrollment, risk assessment, risk adjustment, plan
839	administration, performance monitoring, and consumer education.
840	3.  Arrange for collection of contributions from
841	participating employers and individuals.
842	4.  Arrange for payment of premiums and other appropriate
843	disbursements based on the selections of products and services
844	by the individual participants.
845	5.  Establish criteria for disenrollment of participating
846	individuals based on failure to pay the individual's share of
847	any contribution required to maintain enrollment in selected
848	products.
849	6.  Establish criteria for exclusion of vendors pursuant to
850	paragraph (4)(d).
851	7.  Develop and implement a plan for promoting public
852	awareness of and participation in the program.
853	8.  Secure staff and consultant services necessary to the
854	operation of the program.
855	9.  Establish policies and procedures regarding
856	participation in the program for individuals, vendors, health
857	insurance agents, and employers.
858	10.  Beginning in fiscal year 2009-2010, submit by February
859	1 an annual report to the Governor, the President of the Senate,
860	and the Speaker of the House of Representatives documenting the
861	corporation's activities in compliance with the duties
862	delineated in this section.
863	(i)  To ensure program integrity and to safeguard the
864	financial transactions made under the auspices of the program,
865	the corporation is authorized to establish qualifying criteria
866	and certification procedures for vendors, require performance
867	bonds or other guarantees of ability to complete contractual
868	obligations, monitor the performance of vendors, and enforce the
869	agreements of the program through financial penalty or
870	disqualification from the program.
871	Section 5.  Subsection (22) of section 409.811, Florida
872	Statutes, is amended to read:
873	409.811  Definitions relating to Florida Kidcare Act.--As
874	used in ss. 409.810-409.820, the term:
875	(22)  "Premium assistance payment" means the monthly
876	consideration paid by the agency per enrollee in the Florida
877	Kidcare program towards health insurance premiums and may
878	include the direct payment of the premium for a qualifying child
879	to be covered as a dependent under an employer-sponsored group
880	family plan when such payment does not exceed the payment
881	required for an enrollee in the Florida Kidcare program.
882	Section 6.  Section 624.1265, Florida Statutes, is created
883	to read:
884	624.1265  Nonprofit religious organization exemption;
885	authority; notice.--
886	(1)  Any nonprofit religious organization that qualifies
887	under Title 26, s. 501 of the Internal Revenue Code of 1986, as
888	amended; that limits its participants to members of the same
889	religion; that acts as an organizational clearinghouse for
890	information between participants who have financial, physical,
891	or medical needs and participants with the ability to pay for
892	the benefit of those participants with financial, physical, or
893	medical needs; that provides for the financial or medical needs
894	of a participant through payments directly from one participant
895	to another; and that suggests amounts that participants may
896	voluntarily give with no assumption of risk or promise to pay
897	either among the participants or between the participants and
898	the organization are not subject to any requirements of the
899	Florida Insurance Code.
900	(2)  Nothing in this section prevents the organization
901	described in subsection (1) from establishing qualifications of
902	participation relating to the health of a prospective
903	participant, prevents a participant from limiting the financial
904	or medical needs that may be eligible for payment, or prevents
905	the organization from canceling the membership of a participant
906	when such participant indicates his or her unwillingness to
907	participate by failing to make a payment to another participant
908	for a period in excess of 60 days.
909	(3)  The organization described in subsection (1) shall
910	provide each prospective participant in the organizational
911	clearinghouse written notice that the organization is not an
912	insurance company, that membership is not offered through an
913	insurance company, and that the organization is not subject to
914	the regulatory requirements or consumer protections of the
915	Florida Insurance Code.
916	Section 7.  Paragraph (c) of subsection (1) of section
917	627.602, Florida Statutes, is amended to read:
918	627.602  Scope, format of policy.--
919	(1)  Each health insurance policy delivered or issued for
920	delivery to any person in this state must comply with all
921	applicable provisions of this code and all of the following
922	requirements:
923	(c)  The policy may purport to insure only one person,
924	except that upon the application of an adult member of a family,
925	who is deemed to be the policyholder, a policy may insure,
926	either originally or by subsequent amendment, any eligible
927	members of that family, including husband, wife, any children or
928	any person dependent upon the policyholder. If an insurer offers
929	coverage that insures dependent children of the policyholder,
930	the policy must comply with s. 627.6562.
931	Section 8.  Subsection (4) of section 627.653, Florida
932	Statutes, is renumbered as subsection (5), and a new subsection
933	(4) is added to that section to read:
934	627.653  Employee groups.--
935	(4)  Unless the employer chooses otherwise, for all
936	policies issued or renewed after October 1, 2008, all eligible
937	employees and their dependents shall be enrolled for coverage at
938	the time of issuance or during the next open or special
939	enrollment period, unless the employee provides written notice
940	to the employer declining coverage, which notice shall include
941	evidence of coverage under an existing group insurance policy or
942	group health benefit plan or other reasons for declining
943	coverage. Such notice shall be retained by the employer as part
944	of the employee's employment or insurance file. An employer may
945	require its employees to participate in its group health plan as
946	a condition of employment. This subsection shall apply to all
947	individual, group, blanket, and franchise health insurance
948	policies and health maintenance contracts issued, renewed, or
949	amended after October 1, 2008.
950	Section 9.  Section 627.6562, Florida Statutes, is amended
951	to read:
952	627.6562  Dependent coverage.--
953	(1)  If an insurer offers, under a group, blanket, or
954	franchise health insurance policy, coverage that insures
955	dependent children of the policyholder or certificateholder, the
956	policy must insure a dependent child of the policyholder or
957	certificateholder at least until the end of the calendar year in
958	which the child reaches the age of 30 25, if the child meets all
959	of the following:
960	(a)  Is unmarried and is a dependent as defined in the
961	Federal Tax Code The child is dependent upon the policyholder or
962	certificateholder for support.
963	(b)  Is a resident of this state The child is living in the
964	household of the policyholder or certificateholder, or the child
965	is a full-time or part-time student.
966	(c)  Is not provided coverage as a named subscriber,
967	insured, enrollee, or covered person under any other group,
968	blanket, or franchise health insurance policy or individual
969	health benefit plan or entitled to benefits under Title XVIII of
970	the Social Security Act, Pub. L. No. 89-97, 42 U.S.C. ss. 1395
971	et seq.
972	(d)  Is not eligible for coverage as an employee under an
973	employer sponsored health plan.
974	(2)  Nothing in This section does not:
975	(a)  Affect or preempt affects or preempts an insurer's
976	right to medically underwrite or charge the appropriate premium.
977	(b)  Require coverage for services provided to a dependent
978	before October 1, 2008.
979	(c)  Require an employer to pay all or part of the cost of
980	coverage provided for a dependent under this section.
981	(d)  Prohibit an insurer or health maintenance organization
982	from increasing the limiting age for dependent coverage to age
983	30 in policies or contracts issued or renewed prior to the
984	effective date of this act.
985	(3)  Until April 1, 2009, a dependent child who qualifies
986	for coverage under subsection (1) but whose coverage as a
987	dependent child under a covered person's plan terminated under
988	the terms of the plan before October 1, 2008, may make a written
989	election to reinstate coverage, without proof of insurability,
990	under that plan as a dependent child pursuant to this section.
991	All other dependent children who qualify for coverage under
992	subsection (1) shall be automatically covered at least until the
993	end of the calendar year in which the child reaches the age of
994	30, unless the covered person provides the group policyholder
995	with written evidence the dependent child is married, is not a
996	resident of the state, is covered under a separate comprehensive
997	health insurance policy or a health benefit plan, is entitled to
998	benefits under Title XVIII of the Social Security Act, Pub. L.
999	No. 89-97, 42 U.S.C. ss. 1935 et seq., or is eligible for
1000	coverage as an employee under an employer-sponsored health plan.
1001	(4)  The covered person's plan may require the payment of a
1002	premium by the covered person or dependent child, as
1003	appropriate, subject to the approval of the Office of Insurance
1004	Regulation, for any period of coverage relating to a dependent's
1005	written election for coverage pursuant to subsection (3).
1006	(5)  Notice regarding the reinstatement of coverage for a
1007	dependent child as provided under this section must be provided
1008	to a covered person in the certificate of coverage prepared for
1009	covered persons by the insurer or by the covered person's
1010	employer. The notice shall be given as soon as practicable after
1011	July 1, 2008, and such notice may be given through the group
1012	policyholder.
1013	(6)  This section does not apply to accident only,
1014	specified disease, disability income, Medicare supplement, or
1015	long-term care insurance policies.
1016	(7)  This section applies to all group, blanket, and
1017	franchise health insurance policies covering residents of this
1018	state, including, but not limited to, policies in which the
1019	carrier has reserved the right to change the premium. This
1020	section applies to all individual, group, blanket, and franchise
1021	health insurance policies and health maintenance contracts
1022	issued, renewed, or amended after October 1, 2008.
1023	Section 10.  Paragraph (h) of subsection (5) of section
1024	627.6699, Florida Statutes, is amended to read:
1025	627.6699  Employee Health Care Access Act.--
1026	(5)  AVAILABILITY OF COVERAGE.--
1027	(h)  All health benefit plans issued under this section
1028	must comply with the following conditions:
1029	1.  For employers who have fewer than two employees, a late
1030	enrollee may be excluded from coverage for no longer than 24
1031	months if he or she was not covered by creditable coverage
1032	continually to a date not more than 63 days before the effective
1033	date of his or her new coverage.
1034	2.  Any requirement used by a small employer carrier in
1035	determining whether to provide coverage to a small employer
1036	group, including requirements for minimum participation of
1037	eligible employees and minimum employer contributions, must be
1038	applied uniformly among all small employer groups having the
1039	same number of eligible employees applying for coverage or
1040	receiving coverage from the small employer carrier, except that
1041	a small employer carrier that participates in, administers, or
1042	issues health benefits pursuant to s. 381.0406 which do not
1043	include a preexisting condition exclusion may require as a
1044	condition of offering such benefits that the employer has had no
1045	health insurance coverage for its employees for a period of at
1046	least 6 months. A small employer carrier may vary application of
1047	minimum participation requirements and minimum employer
1048	contribution requirements only by the size of the small employer
1049	group.
1050	3.  Unless the employer chooses otherwise, for all policies
1051	or health maintenance contracts issued or renewed after October
1052	1, 2008, all eligible employees and their dependents shall be
1053	enrolled for coverage at the time of issuance or during the next
1054	open or special enrollment period, unless the employee provides
1055	written notice to the employer declining coverage, which notice
1056	shall include evidence of coverage under an existing group
1057	insurance policy or group health benefit plan or other reasons
1058	for declining coverage. Such notice shall be retained by the
1059	employer as part of the employee's employment or insurance file.
1060	An employer may require its employees to participate in its
1061	group health plan as a condition of employment.
1062	4.3.  In applying minimum participation requirements with
1063	respect to a small employer, a small employer carrier shall not
1064	consider as an eligible employee employees or dependents who
1065	have qualifying existing coverage in an employer-based group
1066	insurance plan or an ERISA qualified self-insurance plan in
1067	determining whether the applicable percentage of participation
1068	is met. However, a small employer carrier may count eligible
1069	employees and dependents who have coverage under another health
1070	plan that is sponsored by that employer.
1071	5.4.  A small employer carrier shall not increase any
1072	requirement for minimum employee participation or any
1073	requirement for minimum employer contribution applicable to a
1074	small employer at any time after the small employer has been
1075	accepted for coverage, unless the employer size has changed, in
1076	which case the small employer carrier may apply the requirements
1077	that are applicable to the new group size.
1078	6.5.  If a small employer carrier offers coverage to a
1079	small employer, it must offer coverage to all the small
1080	employer's eligible employees and their dependents. A small
1081	employer carrier may not offer coverage limited to certain
1082	persons in a group or to part of a group, except with respect to
1083	late enrollees.
1084	7.6.  A small employer carrier may not modify any health
1085	benefit plan issued to a small employer with respect to a small
1086	employer or any eligible employee or dependent through riders,
1087	endorsements, or otherwise to restrict or exclude coverage for
1088	certain diseases or medical conditions otherwise covered by the
1089	health benefit plan.
1090	8.7.  An initial enrollment period of at least 30 days must
1091	be provided. An annual 30-day open enrollment period must be
1092	offered to each small employer's eligible employees and their
1093	dependents. A small employer carrier must provide special
1094	enrollment periods as required by s. 627.65615.
1095	Section 11.  Subsections (41) and (42) are added to section
1096	641.31, Florida Statutes, to read:
1097	641.31  Health maintenance contracts.--
1098	(41)  Unless the employer chooses otherwise, for all
1099	policies or health maintenance contracts issued or renewed after
1100	October 1, 2008, all eligible employees and their dependents
1101	shall be enrolled for coverage at the time of issuance or during
1102	the next open or special enrollment period, unless the employee
1103	provides written notice to the employer declining coverage,
1104	which notice shall include evidence of coverage under an
1105	existing group insurance policy or group health benefit plan or
1106	other reasons for declining coverage. Such notice shall be
1107	retained by the employer as part of the employee's employment or
1108	insurance file. An employer may require its employees to
1109	participate in its group health plan as a condition of
1110	employment. This subsection shall apply to all individual,
1111	group, blanket, and franchise health insurance policies and
1112	health maintenance contracts issued, renewed, or amended after
1113	October 1, 2008.
1114	(42)  All health maintenance contracts that provide
1115	coverage for a member of the family of the subscriber shall
1116	comply with s. 627.6562.
1117	Section 12.  Subsections (1), (4), and (6) of section
1118	641.402, Florida Statutes, are amended to read:
1119	641.402  Definitions.--As used in this part, the term:
1120	(1)  "Basic services" includes any of the following:
1121	limited hospital inpatient services, which may include hospital
1122	inpatient physician services, up to a maximum of coverage
1123	benefit of 5 days and a maximum dollar amount of coverage of
1124	$15,000 per calendar year; emergency care;, physician care other
1125	than hospital inpatient physician services;, ambulatory
1126	diagnostic treatment;, and preventive health care services.
1127	(4)  "Prepaid health clinic" means any organization
1128	authorized under this part which provides, either directly or
1129	through arrangements with other persons, basic services to
1130	persons enrolled with such organization, on a prepaid per capita
1131	or prepaid aggregate fixed-sum basis, including those basic
1132	services described in this part which subscribers might
1133	reasonably require to maintain good health. However, no clinic
1134	that provides or contracts for, either directly or indirectly,
1135	inpatient hospital services, hospital inpatient physician
1136	services, or indemnity against the cost of such services shall
1137	be a prepaid health clinic.
1138	(6)  "Provider" means any physician or person other than a
1139	hospital that furnishes health care services under this part and
1140	is licensed or authorized to practice in this state.
1141	Section 13.  This act shall take effect upon becoming a
1142	law.

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