CS/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35	disapproved or withdrawn; authorizing the agency and the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 coordinate with
81	the Department of Revenue to develop a plan by January 1,
82	2009, for creating tax exemptions or refunds for
83	participating in the program; requiring the corporation to
84	submit an annual report to the Governor and Legislature;
85	authorizing the corporation to establish and enforce
86	certain program integrity measures; amending s. 409.811,
87	F.S.; revising the definition of the term "premium
88	assistance payment"; creating s. 624.1265, F.S.; exempting
89	certain nonprofit religious organizations from
90	requirements of the Florida Insurance Code; preserving
91	certain authority of such organizations; requiring such
92	organizations to provide certain notice to prospective
93	participants; providing notice requirements; amending s.
94	627.602, F.S.; requiring an insurance policy that includes
95	coverage for dependent children to comply with specified
96	provisions relating to dependent coverage; amending s.
97	627.653, F.S.; requiring participation of employees in
98	group insurance policies or group health benefit plans
99	issued or renewed after a specified date; providing
100	conditions for employers and employees to opt out of such
101	coverage; amending s. 627.6562, F.S.; specifying the types
102	of insurance policies that must provide for dependent
103	coverage; extending the qualifying age for dependent
104	coverage from 25 to 30 years; revising eligibility
105	requirements for dependents to receive continued coverage;
106	providing clarifications and limitations of dependent
107	coverage; providing mechanisms for reinstatement of
108	dependent coverage; providing for payment of premium;
109	requiring approval of premium payment requirements by the
110	office; providing notice requirements for reinstated
111	coverage of dependents; providing applicability; amending
112	s. 627.6699, F.S.; requiring participation of employees in
113	health maintenance contracts or policies issued or renewed
114	after a specified date; providing conditions for employers
115	and employees to opt out of such coverage; amending s.
116	641.31, F.S.; requiring participation of employees in
117	policies or health maintenance contracts issued or renewed
118	after a specified date; providing conditions for employers
119	and employees to opt out of such coverage; requiring all
120	heath maintenance contracts that provide coverage for
121	family members to comply with certain statutory
122	provisions; amending s. 641.402, F.S.; revising the
123	definition of the term "basic services" to include certain
124	hospital inpatient services; revising the definitions of
125	the terms "prepaid health clinic" and "provider";
126	providing an effective date.
127
128	Be It Enacted by the Legislature of the State of Florida:
129
130	Section 1.  Paragraph (d) of subsection (2) of section
131	112.363, Florida Statutes, is amended to read:
132	112.363  Retiree health insurance subsidy.--
133	(2)  ELIGIBILITY FOR RETIREE HEALTH INSURANCE SUBSIDY.--
134	(d)  Payment of the retiree health insurance subsidy shall
135	be made only after coverage for health insurance for the retiree
136	or beneficiary has been certified in writing to the Department
137	of Management Services. Participation in a former employer's
138	group health insurance program is not a requirement for
139	eligibility under this section. Coverage issued pursuant to s.
140	408.9091 is considered health insurance for the purposes of this
141	section.
142	Section 2.  Paragraph (e) of subsection (2) and subsections
143	(3), (5), and (10) of section 408.909, Florida Statutes, are
144	amended to read:
145	408.909  Health flex plans.--
146	(2)  DEFINITIONS.--As used in this section, the term:
147	(e)  "Health flex plan" means a health plan approved under
148	subsection (3) which guarantees payment for specified health
149	care coverage provided to the enrollee who purchases coverage as
150	an individual, directly from the plan as a small business, or
151	through a small business purchasing arrangement sponsored by a
152	local government.
153	(3)  PROGRAM.--The agency and the office shall each approve
154	or disapprove health flex plans that provide health care
155	coverage for eligible participants. A health flex plan may limit
156	or exclude benefits or provider network requirements otherwise
157	required by law for insurers offering coverage in this state,
158	may cap the total amount of claims paid per year per enrollee,
159	may limit the number of enrollees, or may take any combination
160	of those actions. A health flex plan offering may include the
161	option of a catastrophic plan or a catastrophic plan
162	supplementing the health flex plan.
163	(a)  The agency shall develop guidelines for the review of
164	applications for health flex plans and shall disapprove or
165	withdraw approval of plans that do not meet or no longer meet
166	minimum standards for quality of care and access to care. The
167	agency shall ensure that the health flex plans follow
168	standardized grievance procedures similar to those required of
169	health maintenance organizations.
170	(b)  The office shall develop guidelines for the review of
171	health flex plan applications and provide regulatory oversight
172	of health flex plan advertisement and marketing procedures. The
173	office shall disapprove or shall withdraw approval of plans
174	that:
175	1.  Contain any ambiguous, inconsistent, or misleading
176	provisions or any exceptions or conditions that deceptively
177	affect or limit the benefits purported to be assumed in the
178	general coverage provided by the health flex plan;
179	2.  Provide benefits that are unreasonable in relation to
180	the premium charged or contain provisions that are unfair or
181	inequitable or contrary to the public policy of this state, that
182	encourage misrepresentation, or that result in unfair
183	discrimination in sales practices;
184	3.  Cannot demonstrate that the health flex plan is
185	financially sound and that the applicant is able to underwrite
186	or finance the health care coverage provided; or
187	4.  Cannot demonstrate that the applicant and its
188	management are in compliance with the standards required under
189	s. 624.404(3).
190	(c)  The agency and the Financial Services Commission may
191	adopt rules as needed to administer this section.
192	(5)  ELIGIBILITY.--Eligibility to enroll in an approved
193	health flex plan is limited to residents of this state who:
194	(a)1.  Are 64 years of age or younger;
195	2.(b)  Have a family income equal to or less than 200
196	percent of the federal poverty level;
197	(c)  Are eligible under a federally approved Medicaid
198	demonstration waiver and reside in Palm Beach County or Miami-
199	Dade County;
200	3. (d)  Are not covered by a private insurance policy and
201	are not eligible for coverage through a public health insurance
202	program, such as Medicare or Medicaid, unless specifically
203	authorized under paragraph (c), or another public health care
204	program, such as Kidcare, and have not been covered at any time
205	during the past 6 months, except that:
206	a.  A person who was covered under an individual health
207	maintenance contract issued by a health maintenance organization
208	licensed under part I of chapter 641 that also was an approved
209	health flex plan on October 1, 2008, may apply for coverage in
210	the same health maintenance organization's health flex plan
211	without a lapse in coverage if all other eligibility
212	requirements are met; or
213	b.  A person who was covered under Medicaid or Kidcare and
214	lost eligibility for the Medicaid or Kidcare subsidy due to
215	income restrictions within 90 days prior to applying for health
216	care coverage through an approved health flex plan may apply for
217	coverage in a health flex plan without a lapse in coverage if
218	all other eligibility requirements are met; and
219	4.(e)  Have applied for health care coverage as an
220	individual through an approved health flex plan and have agreed
221	to make any payments required for participation, including
222	periodic payments or payments due at the time health care
223	services are provided; or
224	(b)  Are part of an employer group at least 75 percent of
225	the employees of which have a family income equal to or less
226	than 300 percent of the federal poverty level and which employee
227	group is not covered by a private health insurance policy and
228	has not been covered at any time during the past 6 months. If
229	the health flex plan entity is a health insurer, health plan, or
230	health maintenance organization licensed under Florida law, only
231	50 percent of the employees must meet the income requirements
232	for the purpose of this paragraph.
233	(10)  EXPIRATION.--This section expires July 1, 2008.
234	Section 3.  Section 408.9091, Florida Statutes, is created
235	to read:
236	408.9091  Cover Florida Health Care Access Program.--
237	(1)  SHORT TITLE.--This section may be cited as the "Cover
238	Florida Health Care Access Program Act."
239	(2)  LEGISLATIVE INTENT.--The Legislature finds that a
240	significant number of state residents are unable to obtain
241	affordable health insurance coverage. The Legislature also finds
242	that existing health flex plan coverage has had limited
243	participation due in part to narrow eligibility restrictions as
244	well as minimal benefit options for catastrophic and emergency
245	care coverage. Therefore, it is the intent of the Legislature to
246	expand the availability of health care options for uninsured
247	residents by developing an affordable health care product that
248	emphasizes coverage for basic and preventive health care
249	services; provides inpatient hospital, urgent, and emergency
250	care services; and is offered statewide by approved health
251	insurers, health maintenance organizations, health-care-
252	provider-sponsored organizations, or health care districts.
253	(3)  DEFINITIONS.--As used in this section, the term:
254	(a)  "Agency" means the Agency for Health Care
255	Administration.
256	(b)  "Cover Florida plan" means a consumer choice benefit
257	plan approved under this section that guarantees payment or
258	coverage for specified benefits provided to an enrollee.
259	(c)  "Cover Florida plan coverage" means health care
260	services that are covered as benefits under a Cover Florida
261	plan.
262	(d)  "Cover Florida plan entity" means a health insurer,
263	health maintenance organization, health-care-provider-sponsored
264	organization, or health care district that develops and
265	implements a Cover Florida plan and is responsible for
266	administering the plan and paying all claims for Cover Florida
267	plan coverage by enrollees.
268	(e)  "Cover Florida Plus" means a supplemental insurance
269	product, such as for additional catastrophic coverage or dental,
270	vision, or cancer coverage, approved under this section and
271	offered to all enrollees.
272	(f)  "Enrollee" means an individual who has been determined
273	to be eligible for and is receiving health insurance coverage
274	under a Cover Florida plan.
275	(g)  "Office" means the Office of Insurance Regulation of
276	the Financial Services Commission.
277	(4)  PROGRAM.--The agency and the office shall jointly
278	establish and administer the Cover Florida Health Care Access
279	Program.
280	(a)  General Cover Florida plan components must require
281	that:
282	1.  Plans are offered on a guaranteed-issue basis to
283	enrollees, subject to exclusions for preexisting conditions
284	approved by the office and the agency.
285	2.  Plans are portable such that the enrollee remains
286	covered regardless of employment status or the cost-sharing of
287	premiums.
288	3.  Plans provide for cost containment through limits on
289	the number of services, caps on benefit payments, and copayments
290	for services.
291	4.  A Cover Florida plan entity makes all benefit plan and
292	marketing materials available in English and Spanish.
293	5.  In order to provide for consumer choice, Cover Florida
294	plan entities develop two alternative benefit option plans
295	having different cost and benefit levels, including at least one
296	plan that provides catastrophic coverage.
297	6.  Plans without catastrophic coverage provide coverage
298	options for services including, but not limited to:
299	a.  Preventive health services, including immunizations,
300	annual health assessments, well-woman and well-care services,
301	and preventive screenings such as mammograms, cervical cancer
302	screenings, and noninvasive colorectal or prostate screenings.
303	b.  Incentives for routine preventive care.
304	c.  Office visits for the diagnosis and treatment of
305	illness or injury.
306	d.  Office surgery, including anesthesia.
307	e.  Behavioral health services.
308	f.  Durable medical equipment and prosthetics.
309	g.  Diabetic supplies.
310	7.  Plans providing catastrophic coverage, at a minimum,
311	provide coverage options for all of the services listed under
312	subparagraph 6.; however, such plans may include, but are not
313	limited to, coverage options for:
314	a.  Inpatient hospital stays.
315	b.  Hospital emergency care services.
316	c.  Urgent care services.
317	d.  Outpatient facility services, outpatient surgery, and
318	outpatient diagnostic services.
319	8.  All plans offer prescription drug benefit coverage or
320	use a prescription drug manager such as the Florida Discount
321	Drug Card Program.
322	9.  Plan enrollment materials provide information in plain
323	language on policy benefit coverage, benefit limits, cost-
324	sharing requirements, and exclusions and a clear representation
325	of what is not covered in the plan. The Cover Florida Health
326	Care Access Program shall require the following disclosure to be
327	reviewed and executed by all consumers purchasing program
328	options or insurance coverage through the program: "In
329	connection with the Cover Florida Health Care Access Program
330	authorized by s. 408.9091, Florida Statutes, agents and entities
331	offering products and services under the program shall inform
332	the named insured, applicant, or subscriber, on a form approved
333	by the Office of Insurance Regulation of the Financial Services
334	Commission, that the program is not an insurance program or, if
335	it is an insurance program, that benefits under the coverage are
336	limited under s. 408.9091, Florida Statutes, and that such
337	coverage is an alternative to coverage without such limitations.
338	If the form is signed by a named insured, applicant, or
339	subscriber, it shall be presumed that there was an informed,
340	knowing acceptance of such limitations."
341	10.  Plans offered through a qualified employer meet the
342	requirements of s. 125 of the Internal Revenue Code.
343	(b)  Guidelines shall be developed to ensure that Cover
344	Florida plans meet minimum standards for quality of care and
345	access to care. The agency shall ensure that the Cover Florida
346	plans follow standardized grievance procedures.
347	(c)  Changes in Cover Florida plan benefits, premiums, and
348	policy forms are subject to regulatory oversight by the office
349	and the agency as provided under rules adopted by the Financial
350	Services Commission and the agency.
351	(d)  The agency, the office, and the Executive Office of
352	the Governor shall develop a public awareness program to be
353	implemented throughout the state for the promotion of the Cover
354	Florida Health Care Access Program.
355	(e)  Public or private entities may design programs to
356	encourage Floridians to participate in the Cover Florida Health
357	Care Access Program or to encourage employers to cosponsor some
358	share of Cover Florida plan premiums for employees.
359	(5)  PLAN PROPOSALS.--The agency and the office shall
360	announce, no later than July 1, 2008, an invitation to negotiate
361	for Cover Florida plan entities to design a Cover Florida plan
362	proposal in which benefits and premiums are specified.
363	(a)  The invitation to negotiate shall include guidelines
364	for the review of Cover Florida plan applications, policy forms,
365	and all associated forms and provide regulatory oversight of
366	Cover Florida plan advertisement and marketing procedures. A
367	plan shall be disapproved or withdrawn if the plan:
368	1.  Contains any ambiguous, inconsistent, or misleading
369	provisions or any exceptions or conditions that deceptively
370	affect or limit the benefits purported to be assumed in the
371	general coverage provided by the plan;
372	2.  Provides benefits that are unreasonable in relation to
373	the premium charged or contains provisions that are unfair or
374	inequitable, that are contrary to the public policy of this
375	state, that encourage misrepresentation, or that result in
376	unfair discrimination in sales practices;
377	3.  Cannot demonstrate that the plan is financially sound
378	and that the applicant is able to underwrite or finance the
379	health care coverage provided;
380	4.  Cannot demonstrate that the applicant and its
381	management are in compliance with the standards required under
382	s. 624.404(3); or
383	5.  Does not guarantee that enrollees may participate in
384	the Cover Florida plan entity's comprehensive network of
385	providers, as determined by the office, the agency, and the
386	contract.
387	(b)  The agency and the office may announce an invitation
388	to negotiate for companies that offer supplemental insurance or
389	discount medical plans that are licensed under part II of
390	chapter 636 to design Cover Florida Plus products.
391	(c)  The agency and office shall approve at least one Cover
392	Florida plan entity having an existing statewide network of
393	providers and may approve at least one regional network plan in
394	each existing Medicaid area.
395	(6)  LICENSE NOT REQUIRED.--
396	(a)  The licensing requirements of the Florida Insurance
397	Code and chapter 641 relating to health maintenance
398	organizations do not apply to a Cover Florida plan approved
399	under this section unless expressly made applicable. However,
400	for the purpose of prohibiting unfair trade practices, Cover
401	Florida plans are considered to be insurance subject to the
402	applicable provisions of part IX of chapter 626 except as
403	otherwise provided in this section.
404	(b)  Cover Florida plans are not covered by the Florida
405	Life and Health Insurance Guaranty Association under part III of
406	chapter 631 or by the Health Maintenance Organization Consumer
407	Assistance Plan under part IV of chapter 631.
408	(7)  ELIGIBILITY.--Eligibility to enroll in a Cover Florida
409	plan is limited to residents of this state who meet all of the
410	following requirements:
411	(a)  Are between 19 and 64 years of age, inclusive.
412	(b)  Are not covered by a private insurance policy and are
413	not eligible for coverage through a public health insurance
414	program, such as Medicare, Medicaid, or Kidcare, unless
415	eligibility for coverage lapses due to no longer meeting income
416	or categorical requirements.
417	(c)  Have not been covered by any health insurance program
418	at any time during the past 6 months, unless coverage under a
419	health insurance program was terminated within the previous 6
420	months due to:
421	1.  Loss of a job that provided an employer-sponsored
422	health benefit plan;
423	2.  Exhaustion of coverage that was continued under COBRA
424	or continuation-of-coverage requirements under s. 627.6692;
425	3.  Reaching the limiting age under the policy; or
426	4.  Death of, or divorce from, a spouse who was provided an
427	employer-sponsored health benefit plan.
428	(d)  Have applied for health care coverage through a Cover
429	Florida plan and have agreed to make any payments required for
430	participation, including periodic payments or payments due at
431	the time health care services are provided.
432	(8)  RECORDS.--Each Cover Florida plan must maintain
433	enrollment data and provide network data and reasonable records
434	to enable the office and the agency to monitor plans and to
435	determine the financial viability of the Cover Florida plan, as
436	necessary.
437	(9)  NONENTITLEMENT.--Coverage under a Cover Florida plan
438	is not an entitlement, and a cause of action does not arise
439	against the state, a local government entity, any other
440	political subdivision of the state, or the agency or the office
441	for failure to make coverage available to eligible persons under
442	this section.
443	(10)  PROGRAM EVALUATION.--The agency and the office shall:
444	(a)  Evaluate the Cover Florida Health Care Access Program
445	and its effect on the entities that seek approval as Cover
446	Florida plans, on the number of enrollees, and on the scope of
447	the health care coverage offered under a Cover Florida plan.
448	(b)  Provide an assessment of the Cover Florida plans and
449	their potential applicability in other settings.
450	(c)  Use Cover Florida plans to gather more information to
451	evaluate low-income, consumer-driven benefit packages.
452	(d)  Jointly submit by March 1, 2009, and annually
453	thereafter, a report to the Governor, the President of the
454	Senate, and the Speaker of the House of Representatives that
455	provides the information specified in paragraphs (a)-(c) and
456	recommendations relating to the successful implementation and
457	administration of the program.
458	(11)  RULEMAKING AUTHORITY.--The agency and the Financial
459	Services Commission may adopt rules pursuant to ss. 120.536(1)
460	and 120.54 as needed to administer this section.
461	Section 4.  Section 408.910, Florida Statutes, is created
462	to read:
463	408.910  Florida Health Choices Program.--
464	(1)  LEGISLATIVE INTENT.--The Legislature finds that a
465	significant number of the residents of this state do not have
466	adequate access to affordable, quality health care. The
467	Legislature further finds that increasing access to affordable,
468	quality health care will be best accomplished by establishing a
469	competitive market for purchasing health insurance and health
470	services. It is therefore the intent of the Legislature to
471	create the Florida Health Choices Program to:
472	(a)  Expand opportunities for Floridians to purchase
473	affordable health insurance and health services.
474	(b)  Preserve the benefits of employment-sponsored
475	insurance while easing the administrative burden for employers
476	who offer these benefits.
477	(c)  Enable individual choice in both the manner and amount
478	of health care purchased.
479	(d)  Provide for the purchase of individual, portable
480	health care coverage.
481	(e)  Disseminate information to consumers on the price and
482	quality of health services.
483	(f)  Sponsor a competitive market that stimulates product
484	innovation, quality improvement, and efficiency in the
485	production and delivery of health services.
486	(2)  DEFINITIONS.--As used in this section:
487	(a)  "Corporation" means the Florida Health Choices, Inc.,
488	established under this section.
489	(b)  "Health insurance agent" means an agent licensed under
490	part IV of chapter 626.
491	(c)  "Insurer" means an individual health insurance policy
492	subject to this chapter, an insurer issuing a group health
493	insurance policy or certificate pursuant to s. 627.651, a plan
494	of self-insurance providing health coverage benefits to
495	residents of this state pursuant to s. 627.651, an insurer
496	delivering a group health policy issued or delivered outside
497	this state under which a resident of this state is provided
498	coverage pursuant to s. 627.6515, a preferred provider
499	organization as defined in s. 627.6471, or an exclusive provider
500	organization as defined in s. 627.6472.
501	(d)  "Program" means the Florida Health Choices Program
502	established by this section.
503	(3)  PROGRAM PURPOSE AND COMPONENTS.--The Florida Health
504	Choices Program is created as a single, centralized market for
505	the sale and purchase of various products that enable
506	individuals to pay for health care. These products include, but
507	are not limited to, health insurance plans, health maintenance
508	organization plans, prepaid services, service contracts, and
509	flexible spending accounts. The components of the program
510	include:
511	(a)  Enrollment of employers.
512	(b)  Administrative services for participating employers,
513	including:
514	1.  Assistance in seeking federal approval of cafeteria
515	plans.
516	2.  Collection of premiums and other payments.
517	3.  Management of individual benefit accounts.
518	4.  Distribution of premiums to insurers and payments to
519	other eligible vendors.
520	5.  Assistance for participants in complying with reporting
521	requirements.
522	(c)  Services to individual participants, including:
523	1.  Information about available products and participating
524	vendors.
525	2.  Assistance to participating individuals for assessing
526	the benefits and limits of each product, including information
527	necessary to distinguish between policies offering creditable
528	coverage and other products available through the program.
529	3.  Account information to assist individual participants
530	to manage available resources.
531	4.  Services that promote healthy behaviors.
532	(d)  Recruitment of vendors, including insurers, health
533	maintenance organizations, prepaid clinic service providers,
534	provider service networks, and other providers.
535	(e)  Certification of vendors to ensure capability,
536	reliability, and validity of offerings.
537	(f)  Collection of data, monitoring, assessment, and
538	reporting of vendor performance.
539	(g)  Information services for individuals and employers.
540	(h)  Program evaluation.
541	(4)  ELIGIBILITY AND PARTICIPATION.--Participation in the
542	program is voluntary and shall be available to employers,
543	individuals, vendors, and health insurance agents as specified
544	in this subsection.
545	(a)  Employers eligible to enroll in the program include:
546	1.  Employers with 1 to 50 employees.
547	2.  Fiscally constrained counties described in s. 218.67.
548	3.  Municipalities with populations of fewer than 50,000
549	residents.
550	4.  School districts in fiscally constrained counties.
551	(b)  Individuals eligible to participate in the program
552	include:
553	1.  Individual employees of enrolled employers.
554	2.  State employees not eligible for state employee health
555	benefits.
556	3.  State retirees.
557	4.  Medicaid reform participants who select the opt-out
558	provision of reform.
559	5.  Statutory rural hospitals.
560	(c)  Employers who choose to participate in the program may
561	enroll by complying with the procedures established by the
562	corporation. These procedures shall include, but not be limited
563	to, the following:
564	1.  Submission of required information.
565	2.  Compliance with federal tax requirements for the
566	establishment of a cafeteria plan, pursuant to s. 125 of the
567	Internal Revenue Code, including designation of the employer's
568	plan as a premium payment plan, a salary reduction plan with
569	flexible spending arrangements, or a salary reduction plan with
570	a premium payment and flexible spending arrangements.
571	3.  Determination of the employer's contribution, if any,
572	per employee, provided that such contribution is equal for each
573	eligible employee.
574	4.  Establishment of payroll deduction procedures, subject
575	to the agreement of each individual employee who voluntarily
576	participates in the program.
577	5.  Designation of the corporation as the third-party
578	administrator for the employer's health benefit plan.
579	6.  Identification of eligible employees.
580	7.  Arrangement for periodic payments.
581	(d)  Eligible vendors and the products and services that
582	they are permitted to sell are as follows:
583	1.  Insurers licensed under chapter 627 may sell health
584	insurance policies, limited benefit policies, other risk-bearing
585	coverage, and other products or services.
586	2.  Health maintenance organizations licensed under part I
587	of chapter 641 may sell health insurance policies, limited
588	benefit policies, other risk-bearing products, and other
589	products or services.
590	3.  Prepaid health clinic service providers licensed under
591	part II of chapter 641 may sell prepaid service contracts and
592	other arrangements for a specified amount and type of health
593	services or treatments.
594	4.  Out-of-state insurers may sell health insurance
595	policies, limited benefit policies, other risk-bearing products,
596	and other products or services.
597	5.  Health care providers, including hospitals and other
598	licensed health facilities, health care clinics, licensed health
599	professionals, pharmacies, and other licensed health care
600	providers, may sell service contracts and arrangements for a
601	specified amount and type of health services or treatments.
602	6.  Provider organizations, including service networks,
603	group practices, professional associations, and other
604	incorporated organizations of providers, may sell service
605	contracts and arrangements for a specified amount and type of
606	health services or treatments.
607	7.  Corporate entities providing specific health services
608	in accordance with applicable state law may sell service
609	contracts and arrangements for a specified amount and type of
610	health services or treatments.
611
612	Otherwise eligible vendors may be excluded from participating in
613	the program for deceptive or predatory practices, financial
614	insolvency, or failure to comply with the terms of the
615	participation agreement or other standards set by the
616	corporation.
617	(e)  Eligible individuals may voluntarily continue
618	participation in the program regardless of subsequent changes in
619	job status or Medicaid eligibility. Individuals who join the
620	program may participate by complying with the procedures
621	established by the corporation. These procedures shall include,
622	but are not limited to:
623	1.  Submission of required information.
624	2.  Authorization for payroll deduction.
625	3.  Compliance with federal tax requirements.
626	4.  Arrangements for payment in the event of job changes.
627	5.  Selection of products and services.
628	(f)  Vendors who choose to participate in the program may
629	enroll by complying with the procedures established by the
630	corporation. These procedures shall include, but are not limited
631	to:
632	1.  Submission of required information, including a
633	complete description of the coverage, services, provider
634	network, payment restrictions, and other requirements of each
635	product offered through the program.
636	2.  Execution of an agreement to make all products offered
637	through the program available to all individual participants.
638	3.  Establishment of product prices based on age, gender,
639	and location of the individual participant.
640	4.  Arrangements for receiving payment for enrolled
641	participants.
642	5.  Participation in ongoing reporting processes
643	established by the corporation.
644	6.  Compliance with grievance procedures established by the
645	corporation.
646	(g)  Health insurance agents licensed under part IV of
647	chapter 626 are eligible to voluntarily participate as buyers'
648	representatives. A buyer's representative acts on behalf of an
649	individual purchasing health insurance and health services
650	through the program by providing information about products and
651	services available through the program and assisting the
652	individual with both the decision and the procedure of selecting
653	specific products. Serving as a buyer's representative does not
654	constitute a conflict of interest with continuing
655	responsibilities as a health insurance agent provided the
656	relationship between each agent and any participating vendor is
657	disclosed prior to advising an individual participant about the
658	products and services available through the program. In order to
659	participate, a health insurance agent shall comply with the
660	procedures established by the corporation, including:
661	1.  Completion of training requirements.
662	2.  Execution of a participation agreement specifying the
663	terms and conditions of participation.
664	3.  Disclosure of any appointments to solicit insurance or
665	procure applications for vendors participating in the program.
666	4.  Arrangements to receive payment from the corporation
667	for services as a buyer's representative.
668	(5)  PRODUCTS.--
669	(a)  The products that may be made available for purchase
670	through the program include, but are not limited to:
671	1.  Health insurance policies.
672	2.  Limited benefit plans.
673	3.  Prepaid clinic services.
674	4.  Service contracts.
675	5.  Arrangements for purchase of specific amounts and types
676	of health services and treatments.
677	6.  Flexible spending accounts.
678	(b)  Health insurance policies, limited benefit plans,
679	prepaid service contracts, and other contracts for services must
680	ensure the availability of covered services and benefits to
681	participating individuals for at least 1 full enrollment year.
682	(c)  Products may be offered for multiyear periods provided
683	the price of the product is specified for the entire period or
684	for each separately priced segment of the policy or contract.
685	(d)  The corporation shall require the following disclosure
686	to be reviewed and executed by all consumers purchasing program
687	options or insurance coverage through the corporation: "In
688	connection with the Florida Health Choices Program authorized by
689	s. 408.910, Florida Statutes, agents and entities offering
690	products and services under the program shall inform the named
691	insured, applicant, or subscriber, on a form approved by the
692	Office of Insurance Regulation of the Financial Services
693	Commission, that the products and services are not insurance or,
694	if they are insurance, that benefits under the coverage are
695	limited under s. 408.910, Florida Statutes, and that such
696	coverage is an alternative to coverage without such limitations.
697	If the form is signed by a named insured, applicant, or
698	subscriber, it shall be presumed that there was an informed,
699	knowing acceptance of such limitations."
700	(6)  PRICING.--Prices for the products sold through the
701	program shall be transparent to participants and established by
702	the vendors based on age, gender, and location of participants.
703	Prior to making the product available to individual
704	participants, the corporation shall ensure that the prices are
705	analyzed to compare the expected health care costs for the
706	covered services and benefits to the vendor's price for that
707	coverage. The results shall be reported to individuals
708	participating in the program. Once established, the price set by
709	the vendor must remain in force for at least 1 year and may only
710	be redetermined by the vendor at the next annual enrollment
711	period. The corporation shall annually set a load factor to each
712	premium or price set by a participating vendor. This surcharge
713	may not be more than 2.5 percent of the price and shall be used
714	to generate funding for administrative services provided by the
715	corporation and payments to buyers' representatives.
716	(7)  EXCHANGE PROCESS.--The program shall provide a single,
717	centralized market for purchase of health insurance and health
718	services. Purchases may be made by participating individuals
719	over the Internet or through the services of a participating
720	health insurance agent. Information about each product and
721	service available through the program shall be made available
722	through printed material and an interactive Internet website. A
723	participant needing personal assistance to select products and
724	services shall be referred to a participating agent in his or
725	her area.
726	(a)  Participation in the program may begin at any time
727	during a year when the employer completes enrollment and meets
728	the requirements specified by the corporation pursuant to
729	paragraph (4)(c).
730	(b)  Initial selection of products and services must be
731	made by an individual participant within 60 days after the date
732	on which the individual's employer qualified for participation.
733	An individual who fails to enroll in products and services by
734	the end of this period shall be limited to participation in
735	flexible spending account services until the next annual
736	enrollment period.
737	(c)  Initial enrollment periods for each product selected
738	by an individual participant must last a minimum of 12 months,
739	unless the individual participant specifically agrees to a
740	different enrollment period.
741	(d)  When an individual has selected one or more products
742	and enrolled in those products for at least 12 months or any
743	other period specifically agreed to by the individual
744	participant, changes in selected products and services may only
745	be made during the annual enrollment period established by the
746	corporation.
747	(e)  The limits established in paragraphs (b)-(d) apply to
748	any risk-bearing product that promises future payment or
749	coverage for a variable amount of benefits or services. The
750	limits do not apply to initiation of flexible spending plans
751	when those plans are not associated with specific high-
752	deductible insurance policies or to the use of spending accounts
753	for any products offering individual participants specific
754	amounts and types of health services and treatments at a
755	contracted price.
756	(8)  RISK POOLING.--The program shall utilize methods for
757	pooling the risk of individual participants and preventing
758	selection bias. These methods shall include, but not be limited
759	to, a postenrollment risk adjustment of the premium payments to
760	the vendors. The corporation shall establish a methodology for
761	assessing the risk of enrolled individual participants based on
762	data reported by the vendors about their enrollees. Monthly
763	distributions of payments to the vendors shall be adjusted based
764	on the assessed relative risk profile of the enrollees in each
765	risk-bearing product for the most recent period for which data
766	is available.
767	(9)  EXEMPTIONS.--
768	(a)  Policies sold as part of the program are not subject
769	to the licensing requirements of the Florida Insurance Code,
770	chapter 641, or the mandated offerings or coverages established
771	in part VI of chapter 627 and chapter 641.
772	(b)  The corporation is authorized to act as an
773	administrator as defined in s. 626.88. However, the corporation
774	is not subject to the licensing requirements of part VII of
775	chapter 626.
776	(10)  LIQUIDATION OR DISSOLUTION.--The Department of
777	Financial Services shall supervise any liquidation or
778	dissolution of the corporation and shall have, with respect to
779	such liquidation or dissolution, all power granted to it
780	pursuant to the Florida Insurance Code.
781	(11)  CORPORATION.--There is created the Florida Health
782	Choices, Inc., which shall be registered, incorporated,
783	organized, and operated in compliance with chapter 617. The
784	purpose of the corporation is to administer the program created
785	in this section and to conduct such other business as may
786	further the administration of the program.
787	(a)  The corporation shall be governed by a board of
788	directors consisting of 15 individuals appointed in the
789	following manner:
790	1.  Five members appointed by and serving at the pleasure
791	of the Governor, consisting of:
792	a.  The Secretary of Health Care Administration or a
793	designee with expertise in health care services.
794	b.  The Secretary of Management Services or a designee with
795	expertise in state employee benefits.
796	c.  Three representatives of eligible public employers.
797	2.  Five members appointed by and serving at the pleasure
798	of the President of the Senate, consisting of representatives of
799	employers, insurers, health care providers, health insurance
800	agents, and individual participants.
801	3.  Five members appointed by and serving at the pleasure
802	of the Speaker of the House of Representatives, consisting of
803	representatives of employers, insurers, health care providers,
804	health insurance agents, and individual participants.
805	(b)  Members shall be appointed for terms of up to 3 years.
806	Any member is eligible for reappointment. A vacancy on the board
807	shall be filled for the unexpired portion of the term in the
808	same manner as the original appointment.
809	(c)  The board shall select a chief executive officer for
810	the corporation who shall be responsible for the selection of
811	such other staff as may be authorized by the corporation's
812	operating budget as adopted by the board.
813	(d)  Board members are entitled to receive, from funds of
814	the corporation, reimbursement for per diem and travel expenses
815	as provided by s. 112.061. No other compensation is authorized.
816	(e)  There shall be no liability on the part of, and no
817	cause of action shall arise against, any member of the board or
818	its employees or agents for any action taken by them in the
819	performance of their powers and duties under this section.
820	(f)  The board shall develop and adopt bylaws and other
821	corporate procedures as necessary for the operation of the
822	corporation and carrying out the purposes of this section. The
823	bylaws shall specify procedures for selection of officers and
824	qualifications for reappointment, provided that no board member
825	shall serve more than 8 consecutive years. The bylaws shall also
826	require an annual membership meeting that provides an
827	opportunity for input and interaction with individual
828	participants in the program.
829	(g)  The corporation may exercise all powers granted to it
830	under chapter 617 necessary to carry out the purposes of this
831	section, including, but not limited to, the power to receive and
832	accept grants, loans, or advances of funds from any public or
833	private agency and to receive and accept from any source
834	contributions of money, property, labor, or any other thing of
835	value to be held, used, and applied for the purposes of this
836	section.
837	(h)  The corporation shall:
838	1.  Determine eligibility of employers, vendors,
839	individuals, and agents in accordance with subsection (4).
840	2.  Establish procedures necessary for the operation of the
841	program, including, but not limited to, procedures for
842	application, enrollment, risk assessment, risk adjustment, plan
843	administration, performance monitoring, and consumer education.
844	3.  Arrange for collection of contributions from
845	participating employers and individuals.
846	4.  Arrange for payment of premiums and other appropriate
847	disbursements based on the selections of products and services
848	by the individual participants.
849	5.  Establish criteria for disenrollment of participating
850	individuals based on failure to pay the individual's share of
851	any contribution required to maintain enrollment in selected
852	products.
853	6.  Establish criteria for exclusion of vendors pursuant to
854	paragraph (4)(d).
855	7.  Develop and implement a plan for promoting public
856	awareness of and participation in the program.
857	8.  Secure staff and consultant services necessary to the
858	operation of the program.
859	9.  Establish policies and procedures regarding
860	participation in the program for individuals, vendors, health
861	insurance agents, and employers.
862	10.  Develop a plan, in coordination with the Department of
863	Revenue, to establish tax credits or refunds for employers that
864	participate in the program. The corporation shall submit the
865	plan to the Governor, the President of the Senate, and the
866	Speaker of the House of Representatives no later than January 1,
867	2009.
868	11.  Beginning in fiscal year 2009-2010, submit by February
869	1 an annual report to the Governor, the President of the Senate,
870	and the Speaker of the House of Representatives documenting the
871	corporation's activities in compliance with the duties
872	delineated in this section.
873	(i)  To ensure program integrity and to safeguard the
874	financial transactions made under the auspices of the program,
875	the corporation is authorized to establish qualifying criteria
876	and certification procedures for vendors, require performance
877	bonds or other guarantees of ability to complete contractual
878	obligations, monitor the performance of vendors, and enforce the
879	agreements of the program through financial penalty or
880	disqualification from the program.
881	Section 5.  Subsection (22) of section 409.811, Florida
882	Statutes, is amended to read:
883	409.811  Definitions relating to Florida Kidcare Act.--As
884	used in ss. 409.810-409.820, the term:
885	(22)  "Premium assistance payment" means the monthly
886	consideration paid by the agency per enrollee in the Florida
887	Kidcare program towards health insurance premiums and may
888	include the direct payment of the premium for a qualifying child
889	to be covered as a dependent under an employer-sponsored group
890	family plan when such payment does not exceed the payment
891	required for an enrollee in the Florida Kidcare program.
892	Section 6.  Section 624.1265, Florida Statutes, is created
893	to read:
894	624.1265  Nonprofit religious organization exemption;
895	authority; notice.--
896	(1)  Any nonprofit religious organization that qualifies
897	under Title 26, s. 501 of the Internal Revenue Code of 1986, as
898	amended; that limits its participants to members of the same
899	religion; that acts as an organizational clearinghouse for
900	information between participants who have financial, physical,
901	or medical needs and participants with the ability to pay for
902	the benefit of those participants with financial, physical, or
903	medical needs; that provides for the financial or medical needs
904	of a participant through payments directly from one participant
905	to another; and that suggests amounts that participants may
906	voluntarily give with no assumption of risk or promise to pay
907	either among the participants or between the participants and
908	the organization are not subject to any requirements of the
909	Florida Insurance Code.
910	(2)  Nothing in this section prevents the organization
911	described in subsection (1) from establishing qualifications of
912	participation relating to the health of a prospective
913	participant, prevents a participant from limiting the financial
914	or medical needs that may be eligible for payment, or prevents
915	the organization from canceling the membership of a participant
916	when such participant indicates his or her unwillingness to
917	participate by failing to make a payment to another participant
918	for a period in excess of 60 days.
919	(3)  The organization described in subsection (1) shall
920	provide each prospective participant in the organizational
921	clearinghouse written notice that the organization is not an
922	insurance company, that membership is not offered through an
923	insurance company, and that the organization is not subject to
924	the regulatory requirements or consumer protections of the
925	Florida Insurance Code.
926	Section 7.  Paragraph (c) of subsection (1) of section
927	627.602, Florida Statutes, is amended to read:
928	627.602  Scope, format of policy.--
929	(1)  Each health insurance policy delivered or issued for
930	delivery to any person in this state must comply with all
931	applicable provisions of this code and all of the following
932	requirements:
933	(c)  The policy may purport to insure only one person,
934	except that upon the application of an adult member of a family,
935	who is deemed to be the policyholder, a policy may insure,
936	either originally or by subsequent amendment, any eligible
937	members of that family, including husband, wife, any children or
938	any person dependent upon the policyholder. If an insurer offers
939	coverage that insures dependent children of the policyholder,
940	the policy must comply with s. 627.6562.
941	Section 8.  Subsection (4) of section 627.653, Florida
942	Statutes, is renumbered as subsection (5), and a new subsection
943	(4) is added to that section to read:
944	627.653  Employee groups.--
945	(4)  Unless the employer chooses otherwise, for all
946	policies issued or renewed after October 1, 2008, all eligible
947	employees and their dependents shall be enrolled for coverage at
948	the time of issuance or during the next open or special
949	enrollment period, unless the employee provides written notice
950	to the employer declining coverage, which notice shall include
951	evidence of coverage under an existing group insurance policy or
952	group health benefit plan or other reasons for declining
953	coverage. Such notice shall be retained by the employer as part
954	of the employee's employment or insurance file. An employer may
955	require its employees to participate in its group health plan as
956	a condition of employment. This subsection shall apply to all
957	individual, group, blanket, and franchise health insurance
958	policies and health maintenance contracts issued, renewed, or
959	amended after October 1, 2008.
960	Section 9.  Section 627.6562, Florida Statutes, is amended
961	to read:
962	627.6562  Dependent coverage.--
963	(1)  If an insurer offers, under a group, blanket, or
964	franchise health insurance policy, coverage that insures
965	dependent children of the policyholder or certificateholder, the
966	policy must insure a dependent child of the policyholder or
967	certificateholder at least until the end of the calendar year in
968	which the child reaches the age of 30 25, if the child meets all
969	of the following:
970	(a)  Is unmarried and is a dependent as defined in the
971	Federal Tax Code The child is dependent upon the policyholder or
972	certificateholder for support.
973	(b)  Is a resident of this state The child is living in the
974	household of the policyholder or certificateholder, or the child
975	is a full-time or part-time student.
976	(c)  Is not provided coverage as a named subscriber,
977	insured, enrollee, or covered person under any other group,
978	blanket, or franchise health insurance policy or individual
979	health benefit plan or entitled to benefits under Title XVIII of
980	the Social Security Act, Pub. L. No. 89-97, 42 U.S.C. ss. 1395
981	et seq.
982	(d)  Is not eligible for coverage as an employee under an
983	employer sponsored health plan.
984	(2)  Nothing in This section does not:
985	(a)  Affect or preempt affects or preempts an insurer's
986	right to medically underwrite or charge the appropriate premium.
987	(b)  Require coverage for services provided to a dependent
988	before October 1, 2008.
989	(c)  Require an employer to pay all or part of the cost of
990	coverage provided for a dependent under this section.
991	(d)  Prohibit an insurer or health maintenance organization
992	from increasing the limiting age for dependent coverage to age
993	30 in policies or contracts issued or renewed prior to the
994	effective date of this act.
995	(3)  Until April 1, 2009, a dependent child who qualifies
996	for coverage under subsection (1) but whose coverage as a
997	dependent child under a covered person's plan terminated under
998	the terms of the plan before October 1, 2008, may make a written
999	election to reinstate coverage, without proof of insurability,
1000	under that plan as a dependent child pursuant to this section.
1001	All other dependent children who qualify for coverage under
1002	subsection (1) shall be automatically covered at least until the
1003	end of the calendar year in which the child reaches the age of
1004	30, unless the covered person provides the group policyholder
1005	with written evidence the dependent child is married, is not a
1006	resident of the state, is covered under a separate comprehensive
1007	health insurance policy or a health benefit plan, is entitled to
1008	benefits under Title XVIII of the Social Security Act, Pub. L.
1009	No. 89-97, 42 U.S.C. ss. 1935 et seq., or is eligible for
1010	coverage as an employee under an employer-sponsored health plan.
1011	(4)  The covered person's plan may require the payment of a
1012	premium by the covered person or dependent child, as
1013	appropriate, subject to the approval of the Office of Insurance
1014	Regulation, for any period of coverage relating to a dependent's
1015	written election for coverage pursuant to subsection (3).
1016	(5)  Notice regarding the reinstatement of coverage for a
1017	dependent child as provided under this section must be provided
1018	to a covered person in the certificate of coverage prepared for
1019	covered persons by the insurer or by the covered person's
1020	employer. The notice shall be given as soon as practicable after
1021	July 1, 2008, and such notice may be given through the group
1022	policyholder.
1023	(6)  This section does not apply to accident only,
1024	specified disease, disability income, Medicare supplement, or
1025	long-term care insurance policies.
1026	(7)  This section applies to all group, blanket, and
1027	franchise health insurance policies covering residents of this
1028	state, including, but not limited to, policies in which the
1029	carrier has reserved the right to change the premium. This
1030	section applies to all individual, group, blanket, and franchise
1031	health insurance policies and health maintenance contracts
1032	issued, renewed, or amended after October 1, 2008.
1033	Section 10.  Paragraph (h) of subsection (5) of section
1034	627.6699, Florida Statutes, is amended to read:
1035	627.6699  Employee Health Care Access Act.--
1036	(5)  AVAILABILITY OF COVERAGE.--
1037	(h)  All health benefit plans issued under this section
1038	must comply with the following conditions:
1039	1.  For employers who have fewer than two employees, a late
1040	enrollee may be excluded from coverage for no longer than 24
1041	months if he or she was not covered by creditable coverage
1042	continually to a date not more than 63 days before the effective
1043	date of his or her new coverage.
1044	2.  Any requirement used by a small employer carrier in
1045	determining whether to provide coverage to a small employer
1046	group, including requirements for minimum participation of
1047	eligible employees and minimum employer contributions, must be
1048	applied uniformly among all small employer groups having the
1049	same number of eligible employees applying for coverage or
1050	receiving coverage from the small employer carrier, except that
1051	a small employer carrier that participates in, administers, or
1052	issues health benefits pursuant to s. 381.0406 which do not
1053	include a preexisting condition exclusion may require as a
1054	condition of offering such benefits that the employer has had no
1055	health insurance coverage for its employees for a period of at
1056	least 6 months. A small employer carrier may vary application of
1057	minimum participation requirements and minimum employer
1058	contribution requirements only by the size of the small employer
1059	group.
1060	3.  Unless the employer chooses otherwise, for all policies
1061	or health maintenance contracts issued or renewed after October
1062	1, 2008, all eligible employees and their dependents shall be
1063	enrolled for coverage at the time of issuance or during the next
1064	open or special enrollment period, unless the employee provides
1065	written notice to the employer declining coverage, which notice
1066	shall include evidence of coverage under an existing group
1067	insurance policy or group health benefit plan or other reasons
1068	for declining coverage. Such notice shall be retained by the
1069	employer as part of the employee's employment or insurance file.
1070	An employer may require its employees to participate in its
1071	group health plan as a condition of employment.
1072	4.3.  In applying minimum participation requirements with
1073	respect to a small employer, a small employer carrier shall not
1074	consider as an eligible employee employees or dependents who
1075	have qualifying existing coverage in an employer-based group
1076	insurance plan or an ERISA qualified self-insurance plan in
1077	determining whether the applicable percentage of participation
1078	is met. However, a small employer carrier may count eligible
1079	employees and dependents who have coverage under another health
1080	plan that is sponsored by that employer.
1081	5.4.  A small employer carrier shall not increase any
1082	requirement for minimum employee participation or any
1083	requirement for minimum employer contribution applicable to a
1084	small employer at any time after the small employer has been
1085	accepted for coverage, unless the employer size has changed, in
1086	which case the small employer carrier may apply the requirements
1087	that are applicable to the new group size.
1088	6.5.  If a small employer carrier offers coverage to a
1089	small employer, it must offer coverage to all the small
1090	employer's eligible employees and their dependents. A small
1091	employer carrier may not offer coverage limited to certain
1092	persons in a group or to part of a group, except with respect to
1093	late enrollees.
1094	7.6.  A small employer carrier may not modify any health
1095	benefit plan issued to a small employer with respect to a small
1096	employer or any eligible employee or dependent through riders,
1097	endorsements, or otherwise to restrict or exclude coverage for
1098	certain diseases or medical conditions otherwise covered by the
1099	health benefit plan.
1100	8.7.  An initial enrollment period of at least 30 days must
1101	be provided. An annual 30-day open enrollment period must be
1102	offered to each small employer's eligible employees and their
1103	dependents. A small employer carrier must provide special
1104	enrollment periods as required by s. 627.65615.
1105	Section 11.  Subsections (41) and (42) are added to section
1106	641.31, Florida Statutes, to read:
1107	641.31  Health maintenance contracts.--
1108	(41)  Unless the employer chooses otherwise, for all
1109	policies or health maintenance contracts issued or renewed after
1110	October 1, 2008, all eligible employees and their dependents
1111	shall be enrolled for coverage at the time of issuance or during
1112	the next open or special enrollment period, unless the employee
1113	provides written notice to the employer declining coverage,
1114	which notice shall include evidence of coverage under an
1115	existing group insurance policy or group health benefit plan or
1116	other reasons for declining coverage. Such notice shall be
1117	retained by the employer as part of the employee's employment or
1118	insurance file. An employer may require its employees to
1119	participate in its group health plan as a condition of
1120	employment. This subsection shall apply to all individual,
1121	group, blanket, and franchise health insurance policies and
1122	health maintenance contracts issued, renewed, or amended after
1123	October 1, 2008.
1124	(42)  All health maintenance contracts that provide
1125	coverage for a member of the family of the subscriber shall
1126	comply with s. 627.6562.
1127	Section 12.  Subsections (1), (4), and (6) of section
1128	641.402, Florida Statutes, are amended to read:
1129	641.402  Definitions.--As used in this part, the term:
1130	(1)  "Basic services" includes any of the following:
1131	limited hospital inpatient services, which may include hospital
1132	inpatient physician services, up to a maximum of coverage
1133	benefit of 5 days and a maximum dollar amount of coverage of
1134	$15,000 per calendar year; emergency care;, physician care other
1135	than hospital inpatient physician services;, ambulatory
1136	diagnostic treatment;, and preventive health care services.
1137	(4)  "Prepaid health clinic" means any organization
1138	authorized under this part which provides, either directly or
1139	through arrangements with other persons, basic services to
1140	persons enrolled with such organization, on a prepaid per capita
1141	or prepaid aggregate fixed-sum basis, including those basic
1142	services described in this part which subscribers might
1143	reasonably require to maintain good health. However, no clinic
1144	that provides or contracts for, either directly or indirectly,
1145	inpatient hospital services, hospital inpatient physician
1146	services, or indemnity against the cost of such services shall
1147	be a prepaid health clinic.
1148	(6)  "Provider" means any physician or person other than a
1149	hospital that furnishes health care services under this part and
1150	is licensed or authorized to practice in this state.
1151	Section 13.  This act shall take effect upon becoming a
1152	law.

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