HB 7081

A bill to be entitled
2An act relating to affordable health coverage; amending s.
3112.363, F.S.; specifying that coverage provided through
4the Cover Florida Health Care Access Program is considered
5health insurance coverage for the purposes of determining
6eligibility for the state retiree health insurance
7subsidy; amending s. 408.909, F.S.; revising the
8definition of the term "health flex plan"; revising
9program requirements for approval of plans by the Agency
10for Health Care Administration; revising eligibility
11requirements; providing certain exemptions from the 6-
12month lapse in coverage requirement; eliminating the
13expiration date of the health flex plan program; creating
14s. 408.9091, F.S.; creating the Cover Florida Health Care
15Access Program; providing a short title; providing
16legislative intent; providing definitions; requiring the
17agency and the Office of Insurance Regulation of the
18Financial Services Commission within the Department of
19Financial Services to jointly administer the program;
20providing program requirements; requiring the development
21of guidelines to meet minimum standards for quality of
22care and access to care; requiring the agency to ensure
23that the Cover Florida plans follow standardized grievance
24procedures; requiring the office and the agency to oversee
25changes to plan benefits; requiring the Executive Office
26of the Governor, the agency, and the office to develop a
27public awareness program; authorizing public and private
28entities to design programs to encourage or extend
29incentives for participation in the Cover Florida Health
30Care Access Program; requiring the agency and the office
31to announce an invitation to negotiate for Cover Florida
32plan entities to design a coverage proposal; requiring the
33invitation to negotiate to include certain guidelines;
34providing certain conditions under which plans are
35disapproved or withdrawn; authorizing the agency and the
36office to announce an invitation to negotiate for
37companies that offer supplemental insurance or discount
38medical plans; requiring the agency and the office to
39approve at least one plan entity; authorizing the agency
40and the office to approve one regional network plan in
41each existing Medicaid area; providing that certain
42licensing requirements are not applicable to a Cover
43Florida plan; providing that Cover Florida plans are
44considered insurance under certain conditions; excluding
45Cover Florida plans from the Florida Life and Health
46Insurance Guaranty Association and the Health Maintenance
47Organization Consumer Assistance Plan; providing
48requirements for eligibility for a Cover Florida plan;
49requiring each Cover Florida plan to maintain and provide
50certain records; providing that coverage under a Cover
51Florida plan is not an entitlement and does not give rise
52to a cause of action; requiring the agency and the office
53to evaluate the program and submit an annual report to the
54Governor and the Legislature; authorizing the agency and
55the Financial Services Commission to adopt rules; creating
56s. 408.910, F.S.; establishing the Florida Health Choices
57Program; providing legislative intent; providing
58definitions; providing program purpose and components;
59providing employer eligibility criteria; providing
60individual eligibility criteria; providing employer
61enrollment criteria; providing vendor, product, and
62service eligibility criteria; providing for individual
63participation regardless of subsequent job status or
64Medicaid eligibility; providing individual enrollment
65criteria; providing vendor enrollment criteria; providing
66for participation by health insurance agents; providing
67criteria for products available for purchase; providing
68criteria for product pricing; providing for an
69administrative surcharge; providing for an exchange
70process; providing for enrollment periods and changes in
71selected products; providing methods for the pooling of
72risk; providing for exemptions from certain statutory
73provisions, mandated offerings and coverages, and
74licensing requirements; creating the Florida Health
75Choices, Inc.; requiring the department to supervise any
76liquidation or dissolution of the corporation; providing
77for corporate governance and board membership and terms;
78providing for reimbursement for per diem and travel
79expenses; providing for powers and duties of the
80corporation; requiring the corporation to submit an annual
81report to the Governor and Legislature; authorizing the
82corporation to establish and enforce certain program
83integrity measures; amending s. 409.811, F.S.; revising
84the definition of the term "premium assistance payment";
85creating s. 624.1265, F.S.; exempting certain nonprofit
86religious organizations from requirements of the Florida
87Insurance Code; preserving certain authority of such
88organizations; requiring such organizations to provide
89certain notice to prospective participants; providing
90notice requirements; amending s. 627.602, F.S.; requiring
91an insurance policy that includes coverage for dependent
92children to comply with specified provisions relating to
93dependent coverage; amending s. 627.653, F.S.; requiring
94participation of employees in group insurance policies or
95group health benefit plans issued or renewed after a
96specified date; providing conditions for employers and
97employees to opt out of such coverage; amending s.
98627.6562, F.S.; specifying the types of insurance policies
99that must provide for dependent coverage; extending the
100qualifying age for dependent coverage from 25 to 30 years;
101revising eligibility requirements for dependents to
102receive continued coverage; providing clarifications and
103limitations of dependent coverage; providing mechanisms
104for reinstatement of dependent coverage; providing for
105payment of premium; requiring approval of premium payment
106requirements by the office; providing notice requirements
107for reinstated coverage of dependents; providing
108applicability; amending s. 627.6699, F.S.; requiring
109participation of employees in health maintenance contracts
110or policies issued or renewed after a specified date;
111providing conditions for employers and employees to opt
112out of such coverage; amending s. 641.31, F.S.; requiring
113participation of employees in policies or health
114maintenance contracts issued or renewed after a specified
115date; providing conditions for employers and employees to
116opt out of such coverage; requiring all heath maintenance
117contracts that provide coverage for family members to
118comply with certain statutory provisions; amending s.
119641.402, F.S.; revising the definition of the term "basic
120services" to include certain hospital inpatient services;
121revising the definitions of the terms "prepaid health
122clinic" and "provider"; providing an effective date.
124Be It Enacted by the Legislature of the State of Florida:
126     Section 1.  Paragraph (d) of subsection (2) of section
127112.363, Florida Statutes, is amended to read:
128     112.363  Retiree health insurance subsidy.--
130     (d)  Payment of the retiree health insurance subsidy shall
131be made only after coverage for health insurance for the retiree
132or beneficiary has been certified in writing to the Department
133of Management Services. Participation in a former employer's
134group health insurance program is not a requirement for
135eligibility under this section. Coverage issued pursuant to s.
136408.9091 is considered health insurance for the purposes of this
138     Section 2.  Paragraph (e) of subsection (2) and subsections
139(3), (5), and (10) of section 408.909, Florida Statutes, are
140amended 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
144subsection (3) which guarantees payment for specified health
145care coverage provided to the enrollee who purchases coverage as
146an individual, directly from the plan as a small business, or
147through a small business purchasing arrangement sponsored by a
148local government.
149     (3)  PROGRAM.--The agency and the office shall each approve
150or disapprove health flex plans that provide health care
151coverage for eligible participants. A health flex plan may limit
152or exclude benefits or provider network requirements otherwise
153required by law for insurers offering coverage in this state,
154may cap the total amount of claims paid per year per enrollee,
155may limit the number of enrollees, or may take any combination
156of those actions. A health flex plan offering may include the
157option of a catastrophic plan or a catastrophic plan
158supplementing the health flex plan.
159     (a)  The agency shall develop guidelines for the review of
160applications for health flex plans and shall disapprove or
161withdraw approval of plans that do not meet or no longer meet
162minimum standards for quality of care and access to care. The
163agency shall ensure that the health flex plans follow
164standardized grievance procedures similar to those required of
165health maintenance organizations.
166     (b)  The office shall develop guidelines for the review of
167health flex plan applications and provide regulatory oversight
168of health flex plan advertisement and marketing procedures. The
169office shall disapprove or shall withdraw approval of plans
171     1.  Contain any ambiguous, inconsistent, or misleading
172provisions or any exceptions or conditions that deceptively
173affect or limit the benefits purported to be assumed in the
174general coverage provided by the health flex plan;
175     2.  Provide benefits that are unreasonable in relation to
176the premium charged or contain provisions that are unfair or
177inequitable or contrary to the public policy of this state, that
178encourage misrepresentation, or that result in unfair
179discrimination in sales practices;
180     3.  Cannot demonstrate that the health flex plan is
181financially sound and that the applicant is able to underwrite
182or finance the health care coverage provided; or
183     4.  Cannot demonstrate that the applicant and its
184management are in compliance with the standards required under
185s. 624.404(3).
186     (c)  The agency and the Financial Services Commission may
187adopt rules as needed to administer this section.
188     (5)  ELIGIBILITY.--Eligibility to enroll in an approved
189health 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
192percent of the federal poverty level;
193     (c)  Are eligible under a federally approved Medicaid
194demonstration waiver and reside in Palm Beach County or Miami-
195Dade County;
196     3. (d)  Are not covered by a private insurance policy and
197are not eligible for coverage through a public health insurance
198program, such as Medicare or Medicaid, unless specifically
199authorized under paragraph (c), or another public health care
200program, such as Kidcare, and have not been covered at any time
201during the past 6 months, except that:
202     a.  A person who was covered under an individual health
203maintenance contract issued by a health maintenance organization
204licensed under part I of chapter 641 that also was an approved
205health flex plan on October 1, 2008, may apply for coverage in
206the same health maintenance organization's health flex plan
207without a lapse in coverage if all other eligibility
208requirements are met; or
209     b.  A person who was covered under Medicaid or Kidcare and
210lost eligibility for the Medicaid or Kidcare subsidy due to
211income restrictions within 90 days prior to applying for health
212care coverage through an approved health flex plan may apply for
213coverage in a health flex plan without a lapse in coverage if
214all other eligibility requirements are met; and
215     4.(e)  Have applied for health care coverage as an
216individual through an approved health flex plan and have agreed
217to make any payments required for participation, including
218periodic payments or payments due at the time health care
219services are provided; or
220     (b)  Are part of an employer group at least 75 percent of
221the employees of which have a family income equal to or less
222than 300 percent of the federal poverty level and which employee
223group is not covered by a private health insurance policy and
224has not been covered at any time during the past 6 months. If
225the health flex plan entity is a health insurer, health plan, or
226health maintenance organization licensed under Florida law, only
22750 percent of the employees must meet the income requirements
228for the purpose of this paragraph.
229     (10)  EXPIRATION.--This section expires July 1, 2008.
230     Section 3.  Section 408.9091, Florida Statutes, is created
231to read:
232     408.9091  Cover Florida Health Care Access Program.--
233     (1)  SHORT TITLE.--This section may be cited as the "Cover
234Florida Health Care Access Program Act."
235     (2)  LEGISLATIVE INTENT.--The Legislature finds that a
236significant number of state residents are unable to obtain
237affordable health insurance coverage. The Legislature also finds
238that existing health flex plan coverage has had limited
239participation due in part to narrow eligibility restrictions as
240well as minimal benefit options for catastrophic and emergency
241care coverage. Therefore, it is the intent of the Legislature to
242expand the availability of health care options for uninsured
243residents by developing an affordable health care product that
244emphasizes coverage for basic and preventive health care
245services; provides inpatient hospital, urgent, and emergency
246care services; and is offered statewide by approved health
247insurers, health maintenance organizations, health-care-
248provider-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
252     (b)  "Cover Florida plan" means a consumer choice benefit
253plan approved under this section that guarantees payment or
254coverage for specified benefits provided to an enrollee.
255     (c)  "Cover Florida plan coverage" means health care
256services that are covered as benefits under a Cover Florida
258     (d)  "Cover Florida plan entity" means a health insurer,
259health maintenance organization, health-care-provider-sponsored
260organization, or health care district that develops and
261implements a Cover Florida plan and is responsible for
262administering the plan and paying all claims for Cover Florida
263plan coverage by enrollees.
264     (e)  "Cover Florida Plus" means a supplemental insurance
265product, such as for additional catastrophic coverage or dental,
266vision, or cancer coverage, approved under this section and
267offered to all enrollees.
268     (f)  "Enrollee" means an individual who has been determined
269to be eligible for and is receiving health insurance coverage
270under a Cover Florida plan.
271     (g)  "Office" means the Office of Insurance Regulation of
272the Financial Services Commission.
273     (4)  PROGRAM.--The agency and the office shall jointly
274establish and administer the Cover Florida Health Care Access
276     (a)  General Cover Florida plan components must require
278     1.  Plans are offered on a guaranteed-issue basis to
279enrollees, subject to exclusions for preexisting conditions
280approved by the office and the agency.
281     2.  Plans are portable such that the enrollee remains
282covered regardless of employment status or the cost-sharing of
284     3.  Plans provide for cost containment through limits on
285the number of services, caps on benefit payments, and copayments
286for services.
287     4.  A Cover Florida plan entity makes all benefit plan and
288marketing materials available in English and Spanish.
289     5.  In order to provide for consumer choice, Cover Florida
290plan entities develop two alternative benefit option plans
291having different cost and benefit levels, including at least one
292plan that provides catastrophic coverage.
293     6.  Plans without catastrophic coverage provide coverage
294options for services including, but not limited to:
295     a.  Preventive health services, including immunizations,
296annual health assessments, well-woman and well-care services,
297and preventive screenings such as mammograms, cervical cancer
298screenings, and noninvasive colorectal or prostate screenings.
299     b.  Incentives for routine preventive care.
300     c.  Office visits for the diagnosis and treatment of
301illness 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,
307provide coverage options for all of the services listed under
308subparagraph 6.; however, such plans may include, but are not
309limited 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
314outpatient diagnostic services.
315     8.  All plans offer prescription drug benefit coverage or
316use a prescription drug manager such as the Florida Discount
317Drug Card Program.
318     9.  Plan enrollment materials provide information in plain
319language on policy benefit coverage, benefit limits, cost-
320sharing requirements, and exclusions and a clear representation
321of what is not covered in the plan. The Cover Florida Health
322Care Access Program shall require the following disclosure to be
323reviewed and executed by all consumers purchasing program
324options or insurance coverage through the program: "In
325connection with the Cover Florida Health Care Access Program
326authorized by s. 408.9091, Florida Statutes, agents and entities
327offering products and services under the program shall inform
328the named insured, applicant, or subscriber, on a form approved
329by the Office of Insurance Regulation of the Financial Services
330Commission, that the program is not an insurance program or, if
331it is an insurance program, that benefits under the coverage are
332limited under s. 408.9091, Florida Statutes, and that such
333coverage is an alternative to coverage without such limitations.
334If the form is signed by a named insured, applicant, or
335subscriber, it shall be presumed that there was an informed,
336knowing acceptance of such limitations."
337     10.  Plans offered through a qualified employer meet the
338requirements of s. 125 of the Internal Revenue Code.
339     (b)  Guidelines shall be developed to ensure that Cover
340Florida plans meet minimum standards for quality of care and
341access to care. The agency shall ensure that the Cover Florida
342plans follow standardized grievance procedures.
343     (c)  Changes in Cover Florida plan benefits, premiums, and
344policy forms are subject to regulatory oversight by the office
345and the agency as provided under rules adopted by the Financial
346Services Commission and the agency.
347     (d)  The agency, the office, and the Executive Office of
348the Governor shall develop a public awareness program to be
349implemented throughout the state for the promotion of the Cover
350Florida Health Care Access Program.
351     (e)  Public or private entities may design programs to
352encourage Floridians to participate in the Cover Florida Health
353Care Access Program or to encourage employers to cosponsor some
354share of Cover Florida plan premiums for employees.
355     (5)  PLAN PROPOSALS.--The agency and the office shall
356announce, no later than July 1, 2008, an invitation to negotiate
357for Cover Florida plan entities to design a Cover Florida plan
358proposal in which benefits and premiums are specified.
359     (a)  The invitation to negotiate shall include guidelines
360for the review of Cover Florida plan applications, policy forms,
361and all associated forms and provide regulatory oversight of
362Cover Florida plan advertisement and marketing procedures. A
363plan shall be disapproved or withdrawn if the plan:
364     1.  Contains any ambiguous, inconsistent, or misleading
365provisions or any exceptions or conditions that deceptively
366affect or limit the benefits purported to be assumed in the
367general coverage provided by the plan;
368     2.  Provides benefits that are unreasonable in relation to
369the premium charged or contains provisions that are unfair or
370inequitable, that are contrary to the public policy of this
371state, that encourage misrepresentation, or that result in
372unfair discrimination in sales practices;
373     3.  Cannot demonstrate that the plan is financially sound
374and that the applicant is able to underwrite or finance the
375health care coverage provided;
376     4.  Cannot demonstrate that the applicant and its
377management are in compliance with the standards required under
378s. 624.404(3); or
379     5.  Does not guarantee that enrollees may participate in
380the Cover Florida plan entity's comprehensive network of
381providers, as determined by the office, the agency, and the
383     (b)  The agency and the office may announce an invitation
384to negotiate for companies that offer supplemental insurance or
385discount medical plans that are licensed under part II of
386chapter 636 to design Cover Florida Plus products.
387     (c)  The agency and office shall approve at least one Cover
388Florida plan entity having an existing statewide network of
389providers and may approve at least one regional network plan in
390each existing Medicaid area.
391     (6)  LICENSE NOT REQUIRED.--
392     (a)  The licensing requirements of the Florida Insurance
393Code and chapter 641 relating to health maintenance
394organizations do not apply to a Cover Florida plan approved
395under this section unless expressly made applicable. However,
396for the purpose of prohibiting unfair trade practices, Cover
397Florida plans are considered to be insurance subject to the
398applicable provisions of part IX of chapter 626 except as
399otherwise provided in this section.
400     (b)  Cover Florida plans are not covered by the Florida
401Life and Health Insurance Guaranty Association under part III of
402chapter 631 or by the Health Maintenance Organization Consumer
403Assistance Plan under part IV of chapter 631.
404     (7)  ELIGIBILITY.--Eligibility to enroll in a Cover Florida
405plan is limited to residents of this state who meet all of the
406following requirements:
407     (a)  Are between 19 and 64 years of age, inclusive.
408     (b)  Are not covered by a private insurance policy and are
409not eligible for coverage through a public health insurance
410program, such as Medicare, Medicaid, or Kidcare, unless
411eligibility for coverage lapses due to no longer meeting income
412or categorical requirements.
413     (c)  Have not been covered by any health insurance program
414at any time during the past 6 months, unless coverage under a
415health insurance program was terminated within the previous 6
416months due to:
417     1.  Loss of a job that provided an employer-sponsored
418health benefit plan;
419     2.  Exhaustion of coverage that was continued under COBRA
420or 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
423employer-sponsored health benefit plan.
424     (d)  Have applied for health care coverage through a Cover
425Florida plan and have agreed to make any payments required for
426participation, including periodic payments or payments due at
427the time health care services are provided.
428     (8)  RECORDS.--Each Cover Florida plan must maintain
429enrollment data and provide network data and reasonable records
430to enable the office and the agency to monitor plans and to
431determine the financial viability of the Cover Florida plan, as
433     (9)  NONENTITLEMENT.--Coverage under a Cover Florida plan
434is not an entitlement, and a cause of action does not arise
435against the state, a local government entity, any other
436political subdivision of the state, or the agency or the office
437for failure to make coverage available to eligible persons under
438this section.
439     (10)  PROGRAM EVALUATION.--The agency and the office shall:
440     (a)  Evaluate the Cover Florida Health Care Access Program
441and its effect on the entities that seek approval as Cover
442Florida plans, on the number of enrollees, and on the scope of
443the health care coverage offered under a Cover Florida plan.
444     (b)  Provide an assessment of the Cover Florida plans and
445their potential applicability in other settings.
446     (c)  Use Cover Florida plans to gather more information to
447evaluate low-income, consumer-driven benefit packages.
448     (d)  Jointly submit by March 1, 2009, and annually
449thereafter, a report to the Governor, the President of the
450Senate, and the Speaker of the House of Representatives that
451provides the information specified in paragraphs (a)-(c) and
452recommendations relating to the successful implementation and
453administration of the program.
454     (11)  RULEMAKING AUTHORITY.--The agency and the Financial
455Services Commission may adopt rules pursuant to ss. 120.536(1)
456and 120.54 as needed to administer this section.
457     Section 4.  Section 408.910, Florida Statutes, is created
458to read:
459     408.910  Florida Health Choices Program.--
460     (1)  LEGISLATIVE INTENT.--The Legislature finds that a
461significant number of the residents of this state do not have
462adequate access to affordable, quality health care. The
463Legislature further finds that increasing access to affordable,
464quality health care will be best accomplished by establishing a
465competitive market for purchasing health insurance and health
466services. It is therefore the intent of the Legislature to
467create the Florida Health Choices Program to:
468     (a)  Expand opportunities for Floridians to purchase
469affordable health insurance and health services.
470     (b)  Preserve the benefits of employment-sponsored
471insurance while easing the administrative burden for employers
472who offer these benefits.
473     (c)  Enable individual choice in both the manner and amount
474of health care purchased.
475     (d)  Provide for the purchase of individual, portable
476health care coverage.
477     (e)  Disseminate information to consumers on the price and
478quality of health services.
479     (f)  Sponsor a competitive market that stimulates product
480innovation, quality improvement, and efficiency in the
481production and delivery of health services.
482     (2)  DEFINITIONS.--As used in this section:
483     (a)  "Corporation" means the Florida Health Choices, Inc.,
484established under this section.
485     (b)  "Health insurance agent" means an agent licensed under
486part IV of chapter 626.
487     (c)  "Insurer" means an individual health insurance policy
488subject to this chapter, an insurer issuing a group health
489insurance policy or certificate pursuant to s. 627.651, a plan
490of self-insurance providing health coverage benefits to
491residents of this state pursuant to s. 627.651, an insurer
492delivering a group health policy issued or delivered outside
493this state under which a resident of this state is provided
494coverage pursuant to s. 627.6515, a preferred provider
495organization as defined in s. 627.6471, or an exclusive provider
496organization as defined in s. 627.6472.
497     (d)  "Program" means the Florida Health Choices Program
498established by this section.
499     (3)  PROGRAM PURPOSE AND COMPONENTS.--The Florida Health
500Choices Program is created as a single, centralized market for
501the sale and purchase of various products that enable
502individuals to pay for health care. These products include, but
503are not limited to, health insurance plans, health maintenance
504organization plans, prepaid services, service contracts, and
505flexible spending accounts. The components of the program
507     (a)  Enrollment of employers.
508     (b)  Administrative services for participating employers,
510     1.  Assistance in seeking federal approval of cafeteria
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
515other eligible vendors.
516     5.  Assistance for participants in complying with reporting
518     (c)  Services to individual participants, including:
519     1.  Information about available products and participating
521     2.  Assistance to participating individuals for assessing
522the benefits and limits of each product, including information
523necessary to distinguish between policies offering creditable
524coverage and other products available through the program.
525     3.  Account information to assist individual participants
526to manage available resources.
527     4.  Services that promote healthy behaviors.
528     (d)  Recruitment of vendors, including insurers, health
529maintenance organizations, prepaid clinic service providers,
530provider service networks, and other providers.
531     (e)  Certification of vendors to ensure capability,
532reliability, and validity of offerings.
533     (f)  Collection of data, monitoring, assessment, and
534reporting of vendor performance.
535     (g)  Information services for individuals and employers.
536     (h)  Program evaluation.
537     (4)  ELIGIBILITY AND PARTICIPATION.--Participation in the
538program is voluntary and shall be available to employers,
539individuals, vendors, and health insurance agents as specified
540in 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
546     4.  School districts in fiscally constrained counties.
547     (b)  Individuals eligible to participate in the program
549     1.  Individual employees of enrolled employers.
550     2.  State employees not eligible for state employee health
552     3.  State retirees.
553     4.  Medicaid reform participants who select the opt-out
554provision of reform.
555     5.  Statutory rural hospitals.
556     (c)  Employers who choose to participate in the program may
557enroll by complying with the procedures established by the
558corporation. These procedures shall include, but not be limited
559to, the following:
560     1.  Submission of required information.
561     2.  Compliance with federal tax requirements for the
562establishment of a cafeteria plan, pursuant to s. 125 of the
563Internal Revenue Code, including designation of the employer's
564plan as a premium payment plan, a salary reduction plan with
565flexible spending arrangements, or a salary reduction plan with
566a premium payment and flexible spending arrangements.
567     3.  Determination of the employer's contribution, if any,
568per employee, provided that such contribution is equal for each
569eligible employee.
570     4.  Establishment of payroll deduction procedures, subject
571to the agreement of each individual employee who voluntarily
572participates in the program.
573     5.  Designation of the corporation as the third-party
574administrator 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
578they are permitted to sell are as follows:
579     1.  Insurers licensed under chapter 627 may sell health
580insurance policies, limited benefit policies, other risk-bearing
581coverage, and other products or services.
582     2.  Health maintenance organizations licensed under part I
583of chapter 641 may sell health insurance policies, limited
584benefit policies, other risk-bearing products, and other
585products or services.
586     3.  Prepaid health clinic service providers licensed under
587part II of chapter 641 may sell prepaid service contracts and
588other arrangements for a specified amount and type of health
589services or treatments.
590     4.  Out-of-state insurers may sell health insurance
591policies, limited benefit policies, other risk-bearing products,
592and other products or services.
593     5.  Health care providers, including hospitals and other
594licensed health facilities, health care clinics, licensed health
595professionals, pharmacies, and other licensed health care
596providers, may sell service contracts and arrangements for a
597specified amount and type of health services or treatments.
598     6.  Provider organizations, including service networks,
599group practices, professional associations, and other
600incorporated organizations of providers, may sell service
601contracts and arrangements for a specified amount and type of
602health services or treatments.
603     7.  Corporate entities providing specific health services
604in accordance with applicable state law may sell service
605contracts and arrangements for a specified amount and type of
606health services or treatments.
608Otherwise eligible vendors may be excluded from participating in
609the program for deceptive or predatory practices, financial
610insolvency, or failure to comply with the terms of the
611participation agreement or other standards set by the
613     (e)  Eligible individuals may voluntarily continue
614participation in the program regardless of subsequent changes in
615job status or Medicaid eligibility. Individuals who join the
616program may participate by complying with the procedures
617established by the corporation. These procedures shall include,
618but 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
625enroll by complying with the procedures established by the
626corporation. These procedures shall include, but are not limited
628     1.  Submission of required information, including a
629complete description of the coverage, services, provider
630network, payment restrictions, and other requirements of each
631product offered through the program.
632     2.  Execution of an agreement to make all products offered
633through the program available to all individual participants.
634     3.  Establishment of product prices based on age, gender,
635and location of the individual participant.
636     4.  Arrangements for receiving payment for enrolled
638     5.  Participation in ongoing reporting processes
639established by the corporation.
640     6.  Compliance with grievance procedures established by the
642     (g)  Health insurance agents licensed under part IV of
643chapter 626 are eligible to voluntarily participate as buyers'
644representatives. A buyer's representative acts on behalf of an
645individual purchasing health insurance and health services
646through the program by providing information about products and
647services available through the program and assisting the
648individual with both the decision and the procedure of selecting
649specific products. Serving as a buyer's representative does not
650constitute a conflict of interest with continuing
651responsibilities as a health insurance agent provided the
652relationship between each agent and any participating vendor is
653disclosed prior to advising an individual participant about the
654products and services available through the program. In order to
655participate, a health insurance agent shall comply with the
656procedures established by the corporation, including:
657     1.  Completion of training requirements.
658     2.  Execution of a participation agreement specifying the
659terms and conditions of participation.
660     3.  Disclosure of any appointments to solicit insurance or
661procure applications for vendors participating in the program.
662     4.  Arrangements to receive payment from the corporation
663for services as a buyer's representative.
664     (5)  PRODUCTS.--
665     (a)  The products that may be made available for purchase
666through 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
672of health services and treatments.
673     6.  Flexible spending accounts.
674     (b)  Health insurance policies, limited benefit plans,
675prepaid service contracts, and other contracts for services must
676ensure the availability of covered services and benefits to
677participating individuals for at least 1 full enrollment year.
678     (c)  Products may be offered for multiyear periods provided
679the price of the product is specified for the entire period or
680for each separately priced segment of the policy or contract.
681     (d)  The corporation shall require the following disclosure
682to be reviewed and executed by all consumers purchasing program
683options or insurance coverage through the corporation: "In
684connection with the Florida Health Choices Program authorized by
685s. 408.910, Florida Statutes, agents and entities offering
686products and services under the program shall inform the named
687insured, applicant, or subscriber, on a form approved by the
688Office of Insurance Regulation of the Financial Services
689Commission, that the products and services are not insurance or,
690if they are insurance, that benefits under the coverage are
691limited under s. 408.910, Florida Statutes, and that such
692coverage is an alternative to coverage without such limitations.
693If the form is signed by a named insured, applicant, or
694subscriber, it shall be presumed that there was an informed,
695knowing acceptance of such limitations."
696     (6)  PRICING.--Prices for the products sold through the
697program shall be transparent to participants and established by
698the vendors based on age, gender, and location of participants.
699Prior to making the product available to individual
700participants, the corporation shall ensure that the prices are
701analyzed to compare the expected health care costs for the
702covered services and benefits to the vendor's price for that
703coverage. The results shall be reported to individuals
704participating in the program. Once established, the price set by
705the vendor must remain in force for at least 1 year and may only
706be redetermined by the vendor at the next annual enrollment
707period. The corporation shall annually set a load factor to each
708premium or price set by a participating vendor. This surcharge
709may not be more than 2.5 percent of the price and shall be used
710to generate funding for administrative services provided by the
711corporation and payments to buyers' representatives.
712     (7)  EXCHANGE PROCESS.--The program shall provide a single,
713centralized market for purchase of health insurance and health
714services. Purchases may be made by participating individuals
715over the Internet or through the services of a participating
716health insurance agent. Information about each product and
717service available through the program shall be made available
718through printed material and an interactive Internet website. A
719participant needing personal assistance to select products and
720services shall be referred to a participating agent in his or
721her area.
722     (a)  Participation in the program may begin at any time
723during a year when the employer completes enrollment and meets
724the requirements specified by the corporation pursuant to
725paragraph (4)(c).
726     (b)  Initial selection of products and services must be
727made by an individual participant within 60 days after the date
728on which the individual's employer qualified for participation.
729An individual who fails to enroll in products and services by
730the end of this period shall be limited to participation in
731flexible spending account services until the next annual
732enrollment period.
733     (c)  Initial enrollment periods for each product selected
734by an individual participant must last a minimum of 12 months,
735unless the individual participant specifically agrees to a
736different enrollment period.
737     (d)  When an individual has selected one or more products
738and enrolled in those products for at least 12 months or any
739other period specifically agreed to by the individual
740participant, changes in selected products and services may only
741be made during the annual enrollment period established by the
743     (e)  The limits established in paragraphs (b)-(d) apply to
744any risk-bearing product that promises future payment or
745coverage for a variable amount of benefits or services. The
746limits do not apply to initiation of flexible spending plans
747when those plans are not associated with specific high-
748deductible insurance policies or to the use of spending accounts
749for any products offering individual participants specific
750amounts and types of health services and treatments at a
751contracted price.
752     (8)  RISK POOLING.--The program shall utilize methods for
753pooling the risk of individual participants and preventing
754selection bias. These methods shall include, but not be limited
755to, a postenrollment risk adjustment of the premium payments to
756the vendors. The corporation shall establish a methodology for
757assessing the risk of enrolled individual participants based on
758data reported by the vendors about their enrollees. Monthly
759distributions of payments to the vendors shall be adjusted based
760on the assessed relative risk profile of the enrollees in each
761risk-bearing product for the most recent period for which data
762is available.
763     (9)  EXEMPTIONS.--
764     (a)  Policies sold as part of the program are not subject
765to the licensing requirements of the Florida Insurance Code,
766chapter 641, or the mandated offerings or coverages established
767in part VI of chapter 627 and chapter 641.
768     (b)  The corporation is authorized to act as an
769administrator as defined in s. 626.88. However, the corporation
770is not subject to the licensing requirements of part VII of
771chapter 626.
772     (10)  LIQUIDATION OR DISSOLUTION.--The Department of
773Financial Services shall supervise any liquidation or
774dissolution of the corporation and shall have, with respect to
775such liquidation or dissolution, all power granted to it
776pursuant to the Florida Insurance Code.
777     (11)  CORPORATION.--There is created the Florida Health
778Choices, Inc., which shall be registered, incorporated,
779organized, and operated in compliance with chapter 617. The
780purpose of the corporation is to administer the program created
781in this section and to conduct such other business as may
782further the administration of the program.
783     (a)  The corporation shall be governed by a board of
784directors consisting of 15 individuals appointed in the
785following manner:
786     1.  Five members appointed by and serving at the pleasure
787of the Governor, consisting of:
788     a.  The Secretary of Health Care Administration or a
789designee with expertise in health care services.
790     b.  The Secretary of Management Services or a designee with
791expertise in state employee benefits.
792     c.  Three representatives of eligible public employers.
793     2.  Five members appointed by and serving at the pleasure
794of the President of the Senate, consisting of representatives of
795employers, insurers, health care providers, health insurance
796agents, and individual participants.
797     3.  Five members appointed by and serving at the pleasure
798of the Speaker of the House of Representatives, consisting of
799representatives of employers, insurers, health care providers,
800health insurance agents, and individual participants.
801     (b)  Members shall be appointed for terms of up to 3 years.
802Any member is eligible for reappointment. A vacancy on the board
803shall be filled for the unexpired portion of the term in the
804same manner as the original appointment.
805     (c)  The board shall select a chief executive officer for
806the corporation who shall be responsible for the selection of
807such other staff as may be authorized by the corporation's
808operating budget as adopted by the board.
809     (d)  Board members are entitled to receive, from funds of
810the corporation, reimbursement for per diem and travel expenses
811as provided by s. 112.061. No other compensation is authorized.
812     (e)  There shall be no liability on the part of, and no
813cause of action shall arise against, any member of the board or
814its employees or agents for any action taken by them in the
815performance of their powers and duties under this section.
816     (f)  The board shall develop and adopt bylaws and other
817corporate procedures as necessary for the operation of the
818corporation and carrying out the purposes of this section. The
819bylaws shall specify procedures for selection of officers and
820qualifications for reappointment, provided that no board member
821shall serve more than 8 consecutive years. The bylaws shall also
822require an annual membership meeting that provides an
823opportunity for input and interaction with individual
824participants in the program.
825     (g)  The corporation may exercise all powers granted to it
826under chapter 617 necessary to carry out the purposes of this
827section, including, but not limited to, the power to receive and
828accept grants, loans, or advances of funds from any public or
829private agency and to receive and accept from any source
830contributions of money, property, labor, or any other thing of
831value to be held, used, and applied for the purposes of this
833     (h)  The corporation shall:
834     1.  Determine eligibility of employers, vendors,
835individuals, and agents in accordance with subsection (4).
836     2.  Establish procedures necessary for the operation of the
837program, including, but not limited to, procedures for
838application, enrollment, risk assessment, risk adjustment, plan
839administration, performance monitoring, and consumer education.
840     3.  Arrange for collection of contributions from
841participating employers and individuals.
842     4.  Arrange for payment of premiums and other appropriate
843disbursements based on the selections of products and services
844by the individual participants.
845     5.  Establish criteria for disenrollment of participating
846individuals based on failure to pay the individual's share of
847any contribution required to maintain enrollment in selected
849     6.  Establish criteria for exclusion of vendors pursuant to
850paragraph (4)(d).
851     7.  Develop and implement a plan for promoting public
852awareness of and participation in the program.
853     8.  Secure staff and consultant services necessary to the
854operation of the program.
855     9.  Establish policies and procedures regarding
856participation in the program for individuals, vendors, health
857insurance agents, and employers.
858     10.  Beginning in fiscal year 2009-2010, submit by February
8591 an annual report to the Governor, the President of the Senate,
860and the Speaker of the House of Representatives documenting the
861corporation's activities in compliance with the duties
862delineated in this section.
863     (i)  To ensure program integrity and to safeguard the
864financial transactions made under the auspices of the program,
865the corporation is authorized to establish qualifying criteria
866and certification procedures for vendors, require performance
867bonds or other guarantees of ability to complete contractual
868obligations, monitor the performance of vendors, and enforce the
869agreements of the program through financial penalty or
870disqualification from the program.
871     Section 5.  Subsection (22) of section 409.811, Florida
872Statutes, is amended to read:
873     409.811  Definitions relating to Florida Kidcare Act.--As
874used in ss. 409.810-409.820, the term:
875     (22)  "Premium assistance payment" means the monthly
876consideration paid by the agency per enrollee in the Florida
877Kidcare program towards health insurance premiums and may
878include the direct payment of the premium for a qualifying child
879to be covered as a dependent under an employer-sponsored group
880family plan when such payment does not exceed the payment
881required for an enrollee in the Florida Kidcare program.
882     Section 6.  Section 624.1265, Florida Statutes, is created
883to read:
884     624.1265  Nonprofit religious organization exemption;
885authority; notice.--
886     (1)  Any nonprofit religious organization that qualifies
887under Title 26, s. 501 of the Internal Revenue Code of 1986, as
888amended; that limits its participants to members of the same
889religion; that acts as an organizational clearinghouse for
890information between participants who have financial, physical,
891or medical needs and participants with the ability to pay for
892the benefit of those participants with financial, physical, or
893medical needs; that provides for the financial or medical needs
894of a participant through payments directly from one participant
895to another; and that suggests amounts that participants may
896voluntarily give with no assumption of risk or promise to pay
897either among the participants or between the participants and
898the organization are not subject to any requirements of the
899Florida Insurance Code.
900     (2)  Nothing in this section prevents the organization
901described in subsection (1) from establishing qualifications of
902participation relating to the health of a prospective
903participant, prevents a participant from limiting the financial
904or medical needs that may be eligible for payment, or prevents
905the organization from canceling the membership of a participant
906when such participant indicates his or her unwillingness to
907participate by failing to make a payment to another participant
908for a period in excess of 60 days.
909     (3)  The organization described in subsection (1) shall
910provide each prospective participant in the organizational
911clearinghouse written notice that the organization is not an
912insurance company, that membership is not offered through an
913insurance company, and that the organization is not subject to
914the regulatory requirements or consumer protections of the
915Florida Insurance Code.
916     Section 7.  Paragraph (c) of subsection (1) of section
917627.602, Florida Statutes, is amended to read:
918     627.602  Scope, format of policy.--
919     (1)  Each health insurance policy delivered or issued for
920delivery to any person in this state must comply with all
921applicable provisions of this code and all of the following
923     (c)  The policy may purport to insure only one person,
924except that upon the application of an adult member of a family,
925who is deemed to be the policyholder, a policy may insure,
926either originally or by subsequent amendment, any eligible
927members of that family, including husband, wife, any children or
928any person dependent upon the policyholder. If an insurer offers
929coverage that insures dependent children of the policyholder,
930the policy must comply with s. 627.6562.
931     Section 8.  Subsection (4) of section 627.653, Florida
932Statutes, 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
936policies issued or renewed after October 1, 2008, all eligible
937employees and their dependents shall be enrolled for coverage at
938the time of issuance or during the next open or special
939enrollment period, unless the employee provides written notice
940to the employer declining coverage, which notice shall include
941evidence of coverage under an existing group insurance policy or
942group health benefit plan or other reasons for declining
943coverage. Such notice shall be retained by the employer as part
944of the employee's employment or insurance file. An employer may
945require its employees to participate in its group health plan as
946a condition of employment. This subsection shall apply to all
947individual, group, blanket, and franchise health insurance
948policies and health maintenance contracts issued, renewed, or
949amended after October 1, 2008.
950     Section 9.  Section 627.6562, Florida Statutes, is amended
951to read:
952     627.6562  Dependent coverage.--
953     (1)  If an insurer offers, under a group, blanket, or
954franchise health insurance policy, coverage that insures
955dependent children of the policyholder or certificateholder, the
956policy must insure a dependent child of the policyholder or
957certificateholder at least until the end of the calendar year in
958which the child reaches the age of 30 25, if the child meets all
959of the following:
960     (a)  Is unmarried and is a dependent as defined in the
961Federal Tax Code The child is dependent upon the policyholder or
962certificateholder for support.
963     (b)  Is a resident of this state The child is living in the
964household of the policyholder or certificateholder, or the child
965is a full-time or part-time student.
966     (c)  Is not provided coverage as a named subscriber,
967insured, enrollee, or covered person under any other group,
968blanket, or franchise health insurance policy or individual
969health benefit plan or entitled to benefits under Title XVIII of
970the Social Security Act, Pub. L. No. 89-97, 42 U.S.C. ss. 1395
971et seq.
972     (d)  Is not eligible for coverage as an employee under an
973employer sponsored health plan.
974     (2)  Nothing in This section does not:
975     (a)  Affect or preempt affects or preempts an insurer's
976right to medically underwrite or charge the appropriate premium.
977     (b)  Require coverage for services provided to a dependent
978before October 1, 2008.
979     (c)  Require an employer to pay all or part of the cost of
980coverage provided for a dependent under this section.
981     (d)  Prohibit an insurer or health maintenance organization
982from increasing the limiting age for dependent coverage to age
98330 in policies or contracts issued or renewed prior to the
984effective date of this act.
985     (3)  Until April 1, 2009, a dependent child who qualifies
986for coverage under subsection (1) but whose coverage as a
987dependent child under a covered person's plan terminated under
988the terms of the plan before October 1, 2008, may make a written
989election to reinstate coverage, without proof of insurability,
990under that plan as a dependent child pursuant to this section.
991All other dependent children who qualify for coverage under
992subsection (1) shall be automatically covered at least until the
993end of the calendar year in which the child reaches the age of
99430, unless the covered person provides the group policyholder
995with written evidence the dependent child is married, is not a
996resident of the state, is covered under a separate comprehensive
997health insurance policy or a health benefit plan, is entitled to
998benefits under Title XVIII of the Social Security Act, Pub. L.
999No. 89-97, 42 U.S.C. ss. 1935 et seq., or is eligible for
1000coverage as an employee under an employer-sponsored health plan.
1001     (4)  The covered person's plan may require the payment of a
1002premium by the covered person or dependent child, as
1003appropriate, subject to the approval of the Office of Insurance
1004Regulation, for any period of coverage relating to a dependent's
1005written election for coverage pursuant to subsection (3).
1006     (5)  Notice regarding the reinstatement of coverage for a
1007dependent child as provided under this section must be provided
1008to a covered person in the certificate of coverage prepared for
1009covered persons by the insurer or by the covered person's
1010employer. The notice shall be given as soon as practicable after
1011July 1, 2008, and such notice may be given through the group
1013     (6)  This section does not apply to accident only,
1014specified disease, disability income, Medicare supplement, or
1015long-term care insurance policies.
1016     (7)  This section applies to all group, blanket, and
1017franchise health insurance policies covering residents of this
1018state, including, but not limited to, policies in which the
1019carrier has reserved the right to change the premium. This
1020section applies to all individual, group, blanket, and franchise
1021health insurance policies and health maintenance contracts
1022issued, renewed, or amended after October 1, 2008.
1023     Section 10.  Paragraph (h) of subsection (5) of section
1024627.6699, Florida Statutes, is amended to read:
1025     627.6699  Employee Health Care Access Act.--
1027     (h)  All health benefit plans issued under this section
1028must comply with the following conditions:
1029     1.  For employers who have fewer than two employees, a late
1030enrollee may be excluded from coverage for no longer than 24
1031months if he or she was not covered by creditable coverage
1032continually to a date not more than 63 days before the effective
1033date of his or her new coverage.
1034     2.  Any requirement used by a small employer carrier in
1035determining whether to provide coverage to a small employer
1036group, including requirements for minimum participation of
1037eligible employees and minimum employer contributions, must be
1038applied uniformly among all small employer groups having the
1039same number of eligible employees applying for coverage or
1040receiving coverage from the small employer carrier, except that
1041a small employer carrier that participates in, administers, or
1042issues health benefits pursuant to s. 381.0406 which do not
1043include a preexisting condition exclusion may require as a
1044condition of offering such benefits that the employer has had no
1045health insurance coverage for its employees for a period of at
1046least 6 months. A small employer carrier may vary application of
1047minimum participation requirements and minimum employer
1048contribution requirements only by the size of the small employer
1050     3.  Unless the employer chooses otherwise, for all policies
1051or health maintenance contracts issued or renewed after October
10521, 2008, all eligible employees and their dependents shall be
1053enrolled for coverage at the time of issuance or during the next
1054open or special enrollment period, unless the employee provides
1055written notice to the employer declining coverage, which notice
1056shall include evidence of coverage under an existing group
1057insurance policy or group health benefit plan or other reasons
1058for declining coverage. Such notice shall be retained by the
1059employer as part of the employee's employment or insurance file.
1060An employer may require its employees to participate in its
1061group health plan as a condition of employment.
1062     4.3.  In applying minimum participation requirements with
1063respect to a small employer, a small employer carrier shall not
1064consider as an eligible employee employees or dependents who
1065have qualifying existing coverage in an employer-based group
1066insurance plan or an ERISA qualified self-insurance plan in
1067determining whether the applicable percentage of participation
1068is met. However, a small employer carrier may count eligible
1069employees and dependents who have coverage under another health
1070plan that is sponsored by that employer.
1071     5.4.  A small employer carrier shall not increase any
1072requirement for minimum employee participation or any
1073requirement for minimum employer contribution applicable to a
1074small employer at any time after the small employer has been
1075accepted for coverage, unless the employer size has changed, in
1076which case the small employer carrier may apply the requirements
1077that are applicable to the new group size.
1078     6.5.  If a small employer carrier offers coverage to a
1079small employer, it must offer coverage to all the small
1080employer's eligible employees and their dependents. A small
1081employer carrier may not offer coverage limited to certain
1082persons in a group or to part of a group, except with respect to
1083late enrollees.
1084     7.6.  A small employer carrier may not modify any health
1085benefit plan issued to a small employer with respect to a small
1086employer or any eligible employee or dependent through riders,
1087endorsements, or otherwise to restrict or exclude coverage for
1088certain diseases or medical conditions otherwise covered by the
1089health benefit plan.
1090     8.7.  An initial enrollment period of at least 30 days must
1091be provided. An annual 30-day open enrollment period must be
1092offered to each small employer's eligible employees and their
1093dependents. A small employer carrier must provide special
1094enrollment periods as required by s. 627.65615.
1095     Section 11.  Subsections (41) and (42) are added to section
1096641.31, Florida Statutes, to read:
1097     641.31  Health maintenance contracts.--
1098     (41)  Unless the employer chooses otherwise, for all
1099policies or health maintenance contracts issued or renewed after
1100October 1, 2008, all eligible employees and their dependents
1101shall be enrolled for coverage at the time of issuance or during
1102the next open or special enrollment period, unless the employee
1103provides written notice to the employer declining coverage,
1104which notice shall include evidence of coverage under an
1105existing group insurance policy or group health benefit plan or
1106other reasons for declining coverage. Such notice shall be
1107retained by the employer as part of the employee's employment or
1108insurance file. An employer may require its employees to
1109participate in its group health plan as a condition of
1110employment. This subsection shall apply to all individual,
1111group, blanket, and franchise health insurance policies and
1112health maintenance contracts issued, renewed, or amended after
1113October 1, 2008.
1114     (42)  All health maintenance contracts that provide
1115coverage for a member of the family of the subscriber shall
1116comply with s. 627.6562.
1117     Section 12.  Subsections (1), (4), and (6) of section
1118641.402, 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:
1121limited hospital inpatient services, which may include hospital
1122inpatient physician services, up to a maximum of coverage
1123benefit of 5 days and a maximum dollar amount of coverage of
1124$15,000 per calendar year; emergency care;, physician care other
1125than hospital inpatient physician services;, ambulatory
1126diagnostic treatment;, and preventive health care services.
1127     (4)  "Prepaid health clinic" means any organization
1128authorized under this part which provides, either directly or
1129through arrangements with other persons, basic services to
1130persons enrolled with such organization, on a prepaid per capita
1131or prepaid aggregate fixed-sum basis, including those basic
1132services described in this part which subscribers might
1133reasonably require to maintain good health. However, no clinic
1134that provides or contracts for, either directly or indirectly,
1135inpatient hospital services, hospital inpatient physician
1136services, or indemnity against the cost of such services shall
1137be a prepaid health clinic.
1138     (6)  "Provider" means any physician or person other than a
1139hospital that furnishes health care services under this part and
1140is licensed or authorized to practice in this state.
1141     Section 13.  This act shall take effect upon becoming a

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