CS/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35disapproved or withdrawn; authorizing the agency and the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 coordinate with
81the Department of Revenue to develop a plan by January 1,
822009, for creating tax exemptions or refunds for
83participating in the program; requiring the corporation to
84submit an annual report to the Governor and Legislature;
85authorizing the corporation to establish and enforce
86certain program integrity measures; amending s. 409.811,
87F.S.; revising the definition of the term "premium
88assistance payment"; creating s. 624.1265, F.S.; exempting
89certain nonprofit religious organizations from
90requirements of the Florida Insurance Code; preserving
91certain authority of such organizations; requiring such
92organizations to provide certain notice to prospective
93participants; providing notice requirements; amending s.
94627.602, F.S.; requiring an insurance policy that includes
95coverage for dependent children to comply with specified
96provisions relating to dependent coverage; amending s.
97627.653, F.S.; requiring participation of employees in
98group insurance policies or group health benefit plans
99issued or renewed after a specified date; providing
100conditions for employers and employees to opt out of such
101coverage; amending s. 627.6562, F.S.; specifying the types
102of insurance policies that must provide for dependent
103coverage; extending the qualifying age for dependent
104coverage from 25 to 30 years; revising eligibility
105requirements for dependents to receive continued coverage;
106providing clarifications and limitations of dependent
107coverage; providing mechanisms for reinstatement of
108dependent coverage; providing for payment of premium;
109requiring approval of premium payment requirements by the
110office; providing notice requirements for reinstated
111coverage of dependents; providing applicability; amending
112s. 627.6699, F.S.; requiring participation of employees in
113health maintenance contracts or policies issued or renewed
114after a specified date; providing conditions for employers
115and employees to opt out of such coverage; amending s.
116641.31, F.S.; requiring participation of employees in
117policies or health maintenance contracts issued or renewed
118after a specified date; providing conditions for employers
119and employees to opt out of such coverage; requiring all
120heath maintenance contracts that provide coverage for
121family members to comply with certain statutory
122provisions; amending s. 641.402, F.S.; revising the
123definition of the term "basic services" to include certain
124hospital inpatient services; revising the definitions of
125the terms "prepaid health clinic" and "provider";
126providing an effective date.
128Be It Enacted by the Legislature of the State of Florida:
130     Section 1.  Paragraph (d) of subsection (2) of section
131112.363, Florida Statutes, is amended to read:
132     112.363  Retiree health insurance subsidy.--
134     (d)  Payment of the retiree health insurance subsidy shall
135be made only after coverage for health insurance for the retiree
136or beneficiary has been certified in writing to the Department
137of Management Services. Participation in a former employer's
138group health insurance program is not a requirement for
139eligibility under this section. Coverage issued pursuant to s.
140408.9091 is considered health insurance for the purposes of this
142     Section 2.  Paragraph (e) of subsection (2) and subsections
143(3), (5), and (10) of section 408.909, Florida Statutes, are
144amended 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
148subsection (3) which guarantees payment for specified health
149care coverage provided to the enrollee who purchases coverage as
150an individual, directly from the plan as a small business, or
151through a small business purchasing arrangement sponsored by a
152local government.
153     (3)  PROGRAM.--The agency and the office shall each approve
154or disapprove health flex plans that provide health care
155coverage for eligible participants. A health flex plan may limit
156or exclude benefits or provider network requirements otherwise
157required by law for insurers offering coverage in this state,
158may cap the total amount of claims paid per year per enrollee,
159may limit the number of enrollees, or may take any combination
160of those actions. A health flex plan offering may include the
161option of a catastrophic plan or a catastrophic plan
162supplementing the health flex plan.
163     (a)  The agency shall develop guidelines for the review of
164applications for health flex plans and shall disapprove or
165withdraw approval of plans that do not meet or no longer meet
166minimum standards for quality of care and access to care. The
167agency shall ensure that the health flex plans follow
168standardized grievance procedures similar to those required of
169health maintenance organizations.
170     (b)  The office shall develop guidelines for the review of
171health flex plan applications and provide regulatory oversight
172of health flex plan advertisement and marketing procedures. The
173office shall disapprove or shall withdraw approval of plans
175     1.  Contain any ambiguous, inconsistent, or misleading
176provisions or any exceptions or conditions that deceptively
177affect or limit the benefits purported to be assumed in the
178general coverage provided by the health flex plan;
179     2.  Provide benefits that are unreasonable in relation to
180the premium charged or contain provisions that are unfair or
181inequitable or contrary to the public policy of this state, that
182encourage misrepresentation, or that result in unfair
183discrimination in sales practices;
184     3.  Cannot demonstrate that the health flex plan is
185financially sound and that the applicant is able to underwrite
186or finance the health care coverage provided; or
187     4.  Cannot demonstrate that the applicant and its
188management are in compliance with the standards required under
189s. 624.404(3).
190     (c)  The agency and the Financial Services Commission may
191adopt rules as needed to administer this section.
192     (5)  ELIGIBILITY.--Eligibility to enroll in an approved
193health 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
196percent of the federal poverty level;
197     (c)  Are eligible under a federally approved Medicaid
198demonstration waiver and reside in Palm Beach County or Miami-
199Dade County;
200     3. (d)  Are not covered by a private insurance policy and
201are not eligible for coverage through a public health insurance
202program, such as Medicare or Medicaid, unless specifically
203authorized under paragraph (c), or another public health care
204program, such as Kidcare, and have not been covered at any time
205during the past 6 months, except that:
206     a.  A person who was covered under an individual health
207maintenance contract issued by a health maintenance organization
208licensed under part I of chapter 641 that also was an approved
209health flex plan on October 1, 2008, may apply for coverage in
210the same health maintenance organization's health flex plan
211without a lapse in coverage if all other eligibility
212requirements are met; or
213     b.  A person who was covered under Medicaid or Kidcare and
214lost eligibility for the Medicaid or Kidcare subsidy due to
215income restrictions within 90 days prior to applying for health
216care coverage through an approved health flex plan may apply for
217coverage in a health flex plan without a lapse in coverage if
218all other eligibility requirements are met; and
219     4.(e)  Have applied for health care coverage as an
220individual through an approved health flex plan and have agreed
221to make any payments required for participation, including
222periodic payments or payments due at the time health care
223services are provided; or
224     (b)  Are part of an employer group at least 75 percent of
225the employees of which have a family income equal to or less
226than 300 percent of the federal poverty level and which employee
227group is not covered by a private health insurance policy and
228has not been covered at any time during the past 6 months. If
229the health flex plan entity is a health insurer, health plan, or
230health maintenance organization licensed under Florida law, only
23150 percent of the employees must meet the income requirements
232for the purpose of this paragraph.
233     (10)  EXPIRATION.--This section expires July 1, 2008.
234     Section 3.  Section 408.9091, Florida Statutes, is created
235to read:
236     408.9091  Cover Florida Health Care Access Program.--
237     (1)  SHORT TITLE.--This section may be cited as the "Cover
238Florida Health Care Access Program Act."
239     (2)  LEGISLATIVE INTENT.--The Legislature finds that a
240significant number of state residents are unable to obtain
241affordable health insurance coverage. The Legislature also finds
242that existing health flex plan coverage has had limited
243participation due in part to narrow eligibility restrictions as
244well as minimal benefit options for catastrophic and emergency
245care coverage. Therefore, it is the intent of the Legislature to
246expand the availability of health care options for uninsured
247residents by developing an affordable health care product that
248emphasizes coverage for basic and preventive health care
249services; provides inpatient hospital, urgent, and emergency
250care services; and is offered statewide by approved health
251insurers, health maintenance organizations, health-care-
252provider-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
256     (b)  "Cover Florida plan" means a consumer choice benefit
257plan approved under this section that guarantees payment or
258coverage for specified benefits provided to an enrollee.
259     (c)  "Cover Florida plan coverage" means health care
260services that are covered as benefits under a Cover Florida
262     (d)  "Cover Florida plan entity" means a health insurer,
263health maintenance organization, health-care-provider-sponsored
264organization, or health care district that develops and
265implements a Cover Florida plan and is responsible for
266administering the plan and paying all claims for Cover Florida
267plan coverage by enrollees.
268     (e)  "Cover Florida Plus" means a supplemental insurance
269product, such as for additional catastrophic coverage or dental,
270vision, or cancer coverage, approved under this section and
271offered to all enrollees.
272     (f)  "Enrollee" means an individual who has been determined
273to be eligible for and is receiving health insurance coverage
274under a Cover Florida plan.
275     (g)  "Office" means the Office of Insurance Regulation of
276the Financial Services Commission.
277     (4)  PROGRAM.--The agency and the office shall jointly
278establish and administer the Cover Florida Health Care Access
280     (a)  General Cover Florida plan components must require
282     1.  Plans are offered on a guaranteed-issue basis to
283enrollees, subject to exclusions for preexisting conditions
284approved by the office and the agency.
285     2.  Plans are portable such that the enrollee remains
286covered regardless of employment status or the cost-sharing of
288     3.  Plans provide for cost containment through limits on
289the number of services, caps on benefit payments, and copayments
290for services.
291     4.  A Cover Florida plan entity makes all benefit plan and
292marketing materials available in English and Spanish.
293     5.  In order to provide for consumer choice, Cover Florida
294plan entities develop two alternative benefit option plans
295having different cost and benefit levels, including at least one
296plan that provides catastrophic coverage.
297     6.  Plans without catastrophic coverage provide coverage
298options for services including, but not limited to:
299     a.  Preventive health services, including immunizations,
300annual health assessments, well-woman and well-care services,
301and preventive screenings such as mammograms, cervical cancer
302screenings, and noninvasive colorectal or prostate screenings.
303     b.  Incentives for routine preventive care.
304     c.  Office visits for the diagnosis and treatment of
305illness 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,
311provide coverage options for all of the services listed under
312subparagraph 6.; however, such plans may include, but are not
313limited 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
318outpatient diagnostic services.
319     8.  All plans offer prescription drug benefit coverage or
320use a prescription drug manager such as the Florida Discount
321Drug Card Program.
322     9.  Plan enrollment materials provide information in plain
323language on policy benefit coverage, benefit limits, cost-
324sharing requirements, and exclusions and a clear representation
325of what is not covered in the plan. The Cover Florida Health
326Care Access Program shall require the following disclosure to be
327reviewed and executed by all consumers purchasing program
328options or insurance coverage through the program: "In
329connection with the Cover Florida Health Care Access Program
330authorized by s. 408.9091, Florida Statutes, agents and entities
331offering products and services under the program shall inform
332the named insured, applicant, or subscriber, on a form approved
333by the Office of Insurance Regulation of the Financial Services
334Commission, that the program is not an insurance program or, if
335it is an insurance program, that benefits under the coverage are
336limited under s. 408.9091, Florida Statutes, and that such
337coverage is an alternative to coverage without such limitations.
338If the form is signed by a named insured, applicant, or
339subscriber, it shall be presumed that there was an informed,
340knowing acceptance of such limitations."
341     10.  Plans offered through a qualified employer meet the
342requirements of s. 125 of the Internal Revenue Code.
343     (b)  Guidelines shall be developed to ensure that Cover
344Florida plans meet minimum standards for quality of care and
345access to care. The agency shall ensure that the Cover Florida
346plans follow standardized grievance procedures.
347     (c)  Changes in Cover Florida plan benefits, premiums, and
348policy forms are subject to regulatory oversight by the office
349and the agency as provided under rules adopted by the Financial
350Services Commission and the agency.
351     (d)  The agency, the office, and the Executive Office of
352the Governor shall develop a public awareness program to be
353implemented throughout the state for the promotion of the Cover
354Florida Health Care Access Program.
355     (e)  Public or private entities may design programs to
356encourage Floridians to participate in the Cover Florida Health
357Care Access Program or to encourage employers to cosponsor some
358share of Cover Florida plan premiums for employees.
359     (5)  PLAN PROPOSALS.--The agency and the office shall
360announce, no later than July 1, 2008, an invitation to negotiate
361for Cover Florida plan entities to design a Cover Florida plan
362proposal in which benefits and premiums are specified.
363     (a)  The invitation to negotiate shall include guidelines
364for the review of Cover Florida plan applications, policy forms,
365and all associated forms and provide regulatory oversight of
366Cover Florida plan advertisement and marketing procedures. A
367plan shall be disapproved or withdrawn if the plan:
368     1.  Contains any ambiguous, inconsistent, or misleading
369provisions or any exceptions or conditions that deceptively
370affect or limit the benefits purported to be assumed in the
371general coverage provided by the plan;
372     2.  Provides benefits that are unreasonable in relation to
373the premium charged or contains provisions that are unfair or
374inequitable, that are contrary to the public policy of this
375state, that encourage misrepresentation, or that result in
376unfair discrimination in sales practices;
377     3.  Cannot demonstrate that the plan is financially sound
378and that the applicant is able to underwrite or finance the
379health care coverage provided;
380     4.  Cannot demonstrate that the applicant and its
381management are in compliance with the standards required under
382s. 624.404(3); or
383     5.  Does not guarantee that enrollees may participate in
384the Cover Florida plan entity's comprehensive network of
385providers, as determined by the office, the agency, and the
387     (b)  The agency and the office may announce an invitation
388to negotiate for companies that offer supplemental insurance or
389discount medical plans that are licensed under part II of
390chapter 636 to design Cover Florida Plus products.
391     (c)  The agency and office shall approve at least one Cover
392Florida plan entity having an existing statewide network of
393providers and may approve at least one regional network plan in
394each existing Medicaid area.
395     (6)  LICENSE NOT REQUIRED.--
396     (a)  The licensing requirements of the Florida Insurance
397Code and chapter 641 relating to health maintenance
398organizations do not apply to a Cover Florida plan approved
399under this section unless expressly made applicable. However,
400for the purpose of prohibiting unfair trade practices, Cover
401Florida plans are considered to be insurance subject to the
402applicable provisions of part IX of chapter 626 except as
403otherwise provided in this section.
404     (b)  Cover Florida plans are not covered by the Florida
405Life and Health Insurance Guaranty Association under part III of
406chapter 631 or by the Health Maintenance Organization Consumer
407Assistance Plan under part IV of chapter 631.
408     (7)  ELIGIBILITY.--Eligibility to enroll in a Cover Florida
409plan is limited to residents of this state who meet all of the
410following requirements:
411     (a)  Are between 19 and 64 years of age, inclusive.
412     (b)  Are not covered by a private insurance policy and are
413not eligible for coverage through a public health insurance
414program, such as Medicare, Medicaid, or Kidcare, unless
415eligibility for coverage lapses due to no longer meeting income
416or categorical requirements.
417     (c)  Have not been covered by any health insurance program
418at any time during the past 6 months, unless coverage under a
419health insurance program was terminated within the previous 6
420months due to:
421     1.  Loss of a job that provided an employer-sponsored
422health benefit plan;
423     2.  Exhaustion of coverage that was continued under COBRA
424or 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
427employer-sponsored health benefit plan.
428     (d)  Have applied for health care coverage through a Cover
429Florida plan and have agreed to make any payments required for
430participation, including periodic payments or payments due at
431the time health care services are provided.
432     (8)  RECORDS.--Each Cover Florida plan must maintain
433enrollment data and provide network data and reasonable records
434to enable the office and the agency to monitor plans and to
435determine the financial viability of the Cover Florida plan, as
437     (9)  NONENTITLEMENT.--Coverage under a Cover Florida plan
438is not an entitlement, and a cause of action does not arise
439against the state, a local government entity, any other
440political subdivision of the state, or the agency or the office
441for failure to make coverage available to eligible persons under
442this section.
443     (10)  PROGRAM EVALUATION.--The agency and the office shall:
444     (a)  Evaluate the Cover Florida Health Care Access Program
445and its effect on the entities that seek approval as Cover
446Florida plans, on the number of enrollees, and on the scope of
447the health care coverage offered under a Cover Florida plan.
448     (b)  Provide an assessment of the Cover Florida plans and
449their potential applicability in other settings.
450     (c)  Use Cover Florida plans to gather more information to
451evaluate low-income, consumer-driven benefit packages.
452     (d)  Jointly submit by March 1, 2009, and annually
453thereafter, a report to the Governor, the President of the
454Senate, and the Speaker of the House of Representatives that
455provides the information specified in paragraphs (a)-(c) and
456recommendations relating to the successful implementation and
457administration of the program.
458     (11)  RULEMAKING AUTHORITY.--The agency and the Financial
459Services Commission may adopt rules pursuant to ss. 120.536(1)
460and 120.54 as needed to administer this section.
461     Section 4.  Section 408.910, Florida Statutes, is created
462to read:
463     408.910  Florida Health Choices Program.--
464     (1)  LEGISLATIVE INTENT.--The Legislature finds that a
465significant number of the residents of this state do not have
466adequate access to affordable, quality health care. The
467Legislature further finds that increasing access to affordable,
468quality health care will be best accomplished by establishing a
469competitive market for purchasing health insurance and health
470services. It is therefore the intent of the Legislature to
471create the Florida Health Choices Program to:
472     (a)  Expand opportunities for Floridians to purchase
473affordable health insurance and health services.
474     (b)  Preserve the benefits of employment-sponsored
475insurance while easing the administrative burden for employers
476who offer these benefits.
477     (c)  Enable individual choice in both the manner and amount
478of health care purchased.
479     (d)  Provide for the purchase of individual, portable
480health care coverage.
481     (e)  Disseminate information to consumers on the price and
482quality of health services.
483     (f)  Sponsor a competitive market that stimulates product
484innovation, quality improvement, and efficiency in the
485production and delivery of health services.
486     (2)  DEFINITIONS.--As used in this section:
487     (a)  "Corporation" means the Florida Health Choices, Inc.,
488established under this section.
489     (b)  "Health insurance agent" means an agent licensed under
490part IV of chapter 626.
491     (c)  "Insurer" means an individual health insurance policy
492subject to this chapter, an insurer issuing a group health
493insurance policy or certificate pursuant to s. 627.651, a plan
494of self-insurance providing health coverage benefits to
495residents of this state pursuant to s. 627.651, an insurer
496delivering a group health policy issued or delivered outside
497this state under which a resident of this state is provided
498coverage pursuant to s. 627.6515, a preferred provider
499organization as defined in s. 627.6471, or an exclusive provider
500organization as defined in s. 627.6472.
501     (d)  "Program" means the Florida Health Choices Program
502established by this section.
503     (3)  PROGRAM PURPOSE AND COMPONENTS.--The Florida Health
504Choices Program is created as a single, centralized market for
505the sale and purchase of various products that enable
506individuals to pay for health care. These products include, but
507are not limited to, health insurance plans, health maintenance
508organization plans, prepaid services, service contracts, and
509flexible spending accounts. The components of the program
511     (a)  Enrollment of employers.
512     (b)  Administrative services for participating employers,
514     1.  Assistance in seeking federal approval of cafeteria
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
519other eligible vendors.
520     5.  Assistance for participants in complying with reporting
522     (c)  Services to individual participants, including:
523     1.  Information about available products and participating
525     2.  Assistance to participating individuals for assessing
526the benefits and limits of each product, including information
527necessary to distinguish between policies offering creditable
528coverage and other products available through the program.
529     3.  Account information to assist individual participants
530to manage available resources.
531     4.  Services that promote healthy behaviors.
532     (d)  Recruitment of vendors, including insurers, health
533maintenance organizations, prepaid clinic service providers,
534provider service networks, and other providers.
535     (e)  Certification of vendors to ensure capability,
536reliability, and validity of offerings.
537     (f)  Collection of data, monitoring, assessment, and
538reporting of vendor performance.
539     (g)  Information services for individuals and employers.
540     (h)  Program evaluation.
541     (4)  ELIGIBILITY AND PARTICIPATION.--Participation in the
542program is voluntary and shall be available to employers,
543individuals, vendors, and health insurance agents as specified
544in 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
550     4.  School districts in fiscally constrained counties.
551     (b)  Individuals eligible to participate in the program
553     1.  Individual employees of enrolled employers.
554     2.  State employees not eligible for state employee health
556     3.  State retirees.
557     4.  Medicaid reform participants who select the opt-out
558provision of reform.
559     5.  Statutory rural hospitals.
560     (c)  Employers who choose to participate in the program may
561enroll by complying with the procedures established by the
562corporation. These procedures shall include, but not be limited
563to, the following:
564     1.  Submission of required information.
565     2.  Compliance with federal tax requirements for the
566establishment of a cafeteria plan, pursuant to s. 125 of the
567Internal Revenue Code, including designation of the employer's
568plan as a premium payment plan, a salary reduction plan with
569flexible spending arrangements, or a salary reduction plan with
570a premium payment and flexible spending arrangements.
571     3.  Determination of the employer's contribution, if any,
572per employee, provided that such contribution is equal for each
573eligible employee.
574     4.  Establishment of payroll deduction procedures, subject
575to the agreement of each individual employee who voluntarily
576participates in the program.
577     5.  Designation of the corporation as the third-party
578administrator 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
582they are permitted to sell are as follows:
583     1.  Insurers licensed under chapter 627 may sell health
584insurance policies, limited benefit policies, other risk-bearing
585coverage, and other products or services.
586     2.  Health maintenance organizations licensed under part I
587of chapter 641 may sell health insurance policies, limited
588benefit policies, other risk-bearing products, and other
589products or services.
590     3.  Prepaid health clinic service providers licensed under
591part II of chapter 641 may sell prepaid service contracts and
592other arrangements for a specified amount and type of health
593services or treatments.
594     4.  Out-of-state insurers may sell health insurance
595policies, limited benefit policies, other risk-bearing products,
596and other products or services.
597     5.  Health care providers, including hospitals and other
598licensed health facilities, health care clinics, licensed health
599professionals, pharmacies, and other licensed health care
600providers, may sell service contracts and arrangements for a
601specified amount and type of health services or treatments.
602     6.  Provider organizations, including service networks,
603group practices, professional associations, and other
604incorporated organizations of providers, may sell service
605contracts and arrangements for a specified amount and type of
606health services or treatments.
607     7.  Corporate entities providing specific health services
608in accordance with applicable state law may sell service
609contracts and arrangements for a specified amount and type of
610health services or treatments.
612Otherwise eligible vendors may be excluded from participating in
613the program for deceptive or predatory practices, financial
614insolvency, or failure to comply with the terms of the
615participation agreement or other standards set by the
617     (e)  Eligible individuals may voluntarily continue
618participation in the program regardless of subsequent changes in
619job status or Medicaid eligibility. Individuals who join the
620program may participate by complying with the procedures
621established by the corporation. These procedures shall include,
622but 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
629enroll by complying with the procedures established by the
630corporation. These procedures shall include, but are not limited
632     1.  Submission of required information, including a
633complete description of the coverage, services, provider
634network, payment restrictions, and other requirements of each
635product offered through the program.
636     2.  Execution of an agreement to make all products offered
637through the program available to all individual participants.
638     3.  Establishment of product prices based on age, gender,
639and location of the individual participant.
640     4.  Arrangements for receiving payment for enrolled
642     5.  Participation in ongoing reporting processes
643established by the corporation.
644     6.  Compliance with grievance procedures established by the
646     (g)  Health insurance agents licensed under part IV of
647chapter 626 are eligible to voluntarily participate as buyers'
648representatives. A buyer's representative acts on behalf of an
649individual purchasing health insurance and health services
650through the program by providing information about products and
651services available through the program and assisting the
652individual with both the decision and the procedure of selecting
653specific products. Serving as a buyer's representative does not
654constitute a conflict of interest with continuing
655responsibilities as a health insurance agent provided the
656relationship between each agent and any participating vendor is
657disclosed prior to advising an individual participant about the
658products and services available through the program. In order to
659participate, a health insurance agent shall comply with the
660procedures established by the corporation, including:
661     1.  Completion of training requirements.
662     2.  Execution of a participation agreement specifying the
663terms and conditions of participation.
664     3.  Disclosure of any appointments to solicit insurance or
665procure applications for vendors participating in the program.
666     4.  Arrangements to receive payment from the corporation
667for services as a buyer's representative.
668     (5)  PRODUCTS.--
669     (a)  The products that may be made available for purchase
670through 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
676of health services and treatments.
677     6.  Flexible spending accounts.
678     (b)  Health insurance policies, limited benefit plans,
679prepaid service contracts, and other contracts for services must
680ensure the availability of covered services and benefits to
681participating individuals for at least 1 full enrollment year.
682     (c)  Products may be offered for multiyear periods provided
683the price of the product is specified for the entire period or
684for each separately priced segment of the policy or contract.
685     (d)  The corporation shall require the following disclosure
686to be reviewed and executed by all consumers purchasing program
687options or insurance coverage through the corporation: "In
688connection with the Florida Health Choices Program authorized by
689s. 408.910, Florida Statutes, agents and entities offering
690products and services under the program shall inform the named
691insured, applicant, or subscriber, on a form approved by the
692Office of Insurance Regulation of the Financial Services
693Commission, that the products and services are not insurance or,
694if they are insurance, that benefits under the coverage are
695limited under s. 408.910, Florida Statutes, and that such
696coverage is an alternative to coverage without such limitations.
697If the form is signed by a named insured, applicant, or
698subscriber, it shall be presumed that there was an informed,
699knowing acceptance of such limitations."
700     (6)  PRICING.--Prices for the products sold through the
701program shall be transparent to participants and established by
702the vendors based on age, gender, and location of participants.
703Prior to making the product available to individual
704participants, the corporation shall ensure that the prices are
705analyzed to compare the expected health care costs for the
706covered services and benefits to the vendor's price for that
707coverage. The results shall be reported to individuals
708participating in the program. Once established, the price set by
709the vendor must remain in force for at least 1 year and may only
710be redetermined by the vendor at the next annual enrollment
711period. The corporation shall annually set a load factor to each
712premium or price set by a participating vendor. This surcharge
713may not be more than 2.5 percent of the price and shall be used
714to generate funding for administrative services provided by the
715corporation and payments to buyers' representatives.
716     (7)  EXCHANGE PROCESS.--The program shall provide a single,
717centralized market for purchase of health insurance and health
718services. Purchases may be made by participating individuals
719over the Internet or through the services of a participating
720health insurance agent. Information about each product and
721service available through the program shall be made available
722through printed material and an interactive Internet website. A
723participant needing personal assistance to select products and
724services shall be referred to a participating agent in his or
725her area.
726     (a)  Participation in the program may begin at any time
727during a year when the employer completes enrollment and meets
728the requirements specified by the corporation pursuant to
729paragraph (4)(c).
730     (b)  Initial selection of products and services must be
731made by an individual participant within 60 days after the date
732on which the individual's employer qualified for participation.
733An individual who fails to enroll in products and services by
734the end of this period shall be limited to participation in
735flexible spending account services until the next annual
736enrollment period.
737     (c)  Initial enrollment periods for each product selected
738by an individual participant must last a minimum of 12 months,
739unless the individual participant specifically agrees to a
740different enrollment period.
741     (d)  When an individual has selected one or more products
742and enrolled in those products for at least 12 months or any
743other period specifically agreed to by the individual
744participant, changes in selected products and services may only
745be made during the annual enrollment period established by the
747     (e)  The limits established in paragraphs (b)-(d) apply to
748any risk-bearing product that promises future payment or
749coverage for a variable amount of benefits or services. The
750limits do not apply to initiation of flexible spending plans
751when those plans are not associated with specific high-
752deductible insurance policies or to the use of spending accounts
753for any products offering individual participants specific
754amounts and types of health services and treatments at a
755contracted price.
756     (8)  RISK POOLING.--The program shall utilize methods for
757pooling the risk of individual participants and preventing
758selection bias. These methods shall include, but not be limited
759to, a postenrollment risk adjustment of the premium payments to
760the vendors. The corporation shall establish a methodology for
761assessing the risk of enrolled individual participants based on
762data reported by the vendors about their enrollees. Monthly
763distributions of payments to the vendors shall be adjusted based
764on the assessed relative risk profile of the enrollees in each
765risk-bearing product for the most recent period for which data
766is available.
767     (9)  EXEMPTIONS.--
768     (a)  Policies sold as part of the program are not subject
769to the licensing requirements of the Florida Insurance Code,
770chapter 641, or the mandated offerings or coverages established
771in part VI of chapter 627 and chapter 641.
772     (b)  The corporation is authorized to act as an
773administrator as defined in s. 626.88. However, the corporation
774is not subject to the licensing requirements of part VII of
775chapter 626.
776     (10)  LIQUIDATION OR DISSOLUTION.--The Department of
777Financial Services shall supervise any liquidation or
778dissolution of the corporation and shall have, with respect to
779such liquidation or dissolution, all power granted to it
780pursuant to the Florida Insurance Code.
781     (11)  CORPORATION.--There is created the Florida Health
782Choices, Inc., which shall be registered, incorporated,
783organized, and operated in compliance with chapter 617. The
784purpose of the corporation is to administer the program created
785in this section and to conduct such other business as may
786further the administration of the program.
787     (a)  The corporation shall be governed by a board of
788directors consisting of 15 individuals appointed in the
789following manner:
790     1.  Five members appointed by and serving at the pleasure
791of the Governor, consisting of:
792     a.  The Secretary of Health Care Administration or a
793designee with expertise in health care services.
794     b.  The Secretary of Management Services or a designee with
795expertise in state employee benefits.
796     c.  Three representatives of eligible public employers.
797     2.  Five members appointed by and serving at the pleasure
798of the President of the Senate, consisting of representatives of
799employers, insurers, health care providers, health insurance
800agents, and individual participants.
801     3.  Five members appointed by and serving at the pleasure
802of the Speaker of the House of Representatives, consisting of
803representatives of employers, insurers, health care providers,
804health insurance agents, and individual participants.
805     (b)  Members shall be appointed for terms of up to 3 years.
806Any member is eligible for reappointment. A vacancy on the board
807shall be filled for the unexpired portion of the term in the
808same manner as the original appointment.
809     (c)  The board shall select a chief executive officer for
810the corporation who shall be responsible for the selection of
811such other staff as may be authorized by the corporation's
812operating budget as adopted by the board.
813     (d)  Board members are entitled to receive, from funds of
814the corporation, reimbursement for per diem and travel expenses
815as provided by s. 112.061. No other compensation is authorized.
816     (e)  There shall be no liability on the part of, and no
817cause of action shall arise against, any member of the board or
818its employees or agents for any action taken by them in the
819performance of their powers and duties under this section.
820     (f)  The board shall develop and adopt bylaws and other
821corporate procedures as necessary for the operation of the
822corporation and carrying out the purposes of this section. The
823bylaws shall specify procedures for selection of officers and
824qualifications for reappointment, provided that no board member
825shall serve more than 8 consecutive years. The bylaws shall also
826require an annual membership meeting that provides an
827opportunity for input and interaction with individual
828participants in the program.
829     (g)  The corporation may exercise all powers granted to it
830under chapter 617 necessary to carry out the purposes of this
831section, including, but not limited to, the power to receive and
832accept grants, loans, or advances of funds from any public or
833private agency and to receive and accept from any source
834contributions of money, property, labor, or any other thing of
835value to be held, used, and applied for the purposes of this
837     (h)  The corporation shall:
838     1.  Determine eligibility of employers, vendors,
839individuals, and agents in accordance with subsection (4).
840     2.  Establish procedures necessary for the operation of the
841program, including, but not limited to, procedures for
842application, enrollment, risk assessment, risk adjustment, plan
843administration, performance monitoring, and consumer education.
844     3.  Arrange for collection of contributions from
845participating employers and individuals.
846     4.  Arrange for payment of premiums and other appropriate
847disbursements based on the selections of products and services
848by the individual participants.
849     5.  Establish criteria for disenrollment of participating
850individuals based on failure to pay the individual's share of
851any contribution required to maintain enrollment in selected
853     6.  Establish criteria for exclusion of vendors pursuant to
854paragraph (4)(d).
855     7.  Develop and implement a plan for promoting public
856awareness of and participation in the program.
857     8.  Secure staff and consultant services necessary to the
858operation of the program.
859     9.  Establish policies and procedures regarding
860participation in the program for individuals, vendors, health
861insurance agents, and employers.
862     10.  Develop a plan, in coordination with the Department of
863Revenue, to establish tax credits or refunds for employers that
864participate in the program. The corporation shall submit the
865plan to the Governor, the President of the Senate, and the
866Speaker of the House of Representatives no later than January 1,
868     11.  Beginning in fiscal year 2009-2010, submit by February
8691 an annual report to the Governor, the President of the Senate,
870and the Speaker of the House of Representatives documenting the
871corporation's activities in compliance with the duties
872delineated in this section.
873     (i)  To ensure program integrity and to safeguard the
874financial transactions made under the auspices of the program,
875the corporation is authorized to establish qualifying criteria
876and certification procedures for vendors, require performance
877bonds or other guarantees of ability to complete contractual
878obligations, monitor the performance of vendors, and enforce the
879agreements of the program through financial penalty or
880disqualification from the program.
881     Section 5.  Subsection (22) of section 409.811, Florida
882Statutes, is amended to read:
883     409.811  Definitions relating to Florida Kidcare Act.--As
884used in ss. 409.810-409.820, the term:
885     (22)  "Premium assistance payment" means the monthly
886consideration paid by the agency per enrollee in the Florida
887Kidcare program towards health insurance premiums and may
888include the direct payment of the premium for a qualifying child
889to be covered as a dependent under an employer-sponsored group
890family plan when such payment does not exceed the payment
891required for an enrollee in the Florida Kidcare program.
892     Section 6.  Section 624.1265, Florida Statutes, is created
893to read:
894     624.1265  Nonprofit religious organization exemption;
895authority; notice.--
896     (1)  Any nonprofit religious organization that qualifies
897under Title 26, s. 501 of the Internal Revenue Code of 1986, as
898amended; that limits its participants to members of the same
899religion; that acts as an organizational clearinghouse for
900information between participants who have financial, physical,
901or medical needs and participants with the ability to pay for
902the benefit of those participants with financial, physical, or
903medical needs; that provides for the financial or medical needs
904of a participant through payments directly from one participant
905to another; and that suggests amounts that participants may
906voluntarily give with no assumption of risk or promise to pay
907either among the participants or between the participants and
908the organization are not subject to any requirements of the
909Florida Insurance Code.
910     (2)  Nothing in this section prevents the organization
911described in subsection (1) from establishing qualifications of
912participation relating to the health of a prospective
913participant, prevents a participant from limiting the financial
914or medical needs that may be eligible for payment, or prevents
915the organization from canceling the membership of a participant
916when such participant indicates his or her unwillingness to
917participate by failing to make a payment to another participant
918for a period in excess of 60 days.
919     (3)  The organization described in subsection (1) shall
920provide each prospective participant in the organizational
921clearinghouse written notice that the organization is not an
922insurance company, that membership is not offered through an
923insurance company, and that the organization is not subject to
924the regulatory requirements or consumer protections of the
925Florida Insurance Code.
926     Section 7.  Paragraph (c) of subsection (1) of section
927627.602, Florida Statutes, is amended to read:
928     627.602  Scope, format of policy.--
929     (1)  Each health insurance policy delivered or issued for
930delivery to any person in this state must comply with all
931applicable provisions of this code and all of the following
933     (c)  The policy may purport to insure only one person,
934except that upon the application of an adult member of a family,
935who is deemed to be the policyholder, a policy may insure,
936either originally or by subsequent amendment, any eligible
937members of that family, including husband, wife, any children or
938any person dependent upon the policyholder. If an insurer offers
939coverage that insures dependent children of the policyholder,
940the policy must comply with s. 627.6562.
941     Section 8.  Subsection (4) of section 627.653, Florida
942Statutes, 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
946policies issued or renewed after October 1, 2008, all eligible
947employees and their dependents shall be enrolled for coverage at
948the time of issuance or during the next open or special
949enrollment period, unless the employee provides written notice
950to the employer declining coverage, which notice shall include
951evidence of coverage under an existing group insurance policy or
952group health benefit plan or other reasons for declining
953coverage. Such notice shall be retained by the employer as part
954of the employee's employment or insurance file. An employer may
955require its employees to participate in its group health plan as
956a condition of employment. This subsection shall apply to all
957individual, group, blanket, and franchise health insurance
958policies and health maintenance contracts issued, renewed, or
959amended after October 1, 2008.
960     Section 9.  Section 627.6562, Florida Statutes, is amended
961to read:
962     627.6562  Dependent coverage.--
963     (1)  If an insurer offers, under a group, blanket, or
964franchise health insurance policy, coverage that insures
965dependent children of the policyholder or certificateholder, the
966policy must insure a dependent child of the policyholder or
967certificateholder at least until the end of the calendar year in
968which the child reaches the age of 30 25, if the child meets all
969of the following:
970     (a)  Is unmarried and is a dependent as defined in the
971Federal Tax Code The child is dependent upon the policyholder or
972certificateholder for support.
973     (b)  Is a resident of this state The child is living in the
974household of the policyholder or certificateholder, or the child
975is a full-time or part-time student.
976     (c)  Is not provided coverage as a named subscriber,
977insured, enrollee, or covered person under any other group,
978blanket, or franchise health insurance policy or individual
979health benefit plan or entitled to benefits under Title XVIII of
980the Social Security Act, Pub. L. No. 89-97, 42 U.S.C. ss. 1395
981et seq.
982     (d)  Is not eligible for coverage as an employee under an
983employer sponsored health plan.
984     (2)  Nothing in This section does not:
985     (a)  Affect or preempt affects or preempts an insurer's
986right to medically underwrite or charge the appropriate premium.
987     (b)  Require coverage for services provided to a dependent
988before October 1, 2008.
989     (c)  Require an employer to pay all or part of the cost of
990coverage provided for a dependent under this section.
991     (d)  Prohibit an insurer or health maintenance organization
992from increasing the limiting age for dependent coverage to age
99330 in policies or contracts issued or renewed prior to the
994effective date of this act.
995     (3)  Until April 1, 2009, a dependent child who qualifies
996for coverage under subsection (1) but whose coverage as a
997dependent child under a covered person's plan terminated under
998the terms of the plan before October 1, 2008, may make a written
999election to reinstate coverage, without proof of insurability,
1000under that plan as a dependent child pursuant to this section.
1001All other dependent children who qualify for coverage under
1002subsection (1) shall be automatically covered at least until the
1003end of the calendar year in which the child reaches the age of
100430, unless the covered person provides the group policyholder
1005with written evidence the dependent child is married, is not a
1006resident of the state, is covered under a separate comprehensive
1007health insurance policy or a health benefit plan, is entitled to
1008benefits under Title XVIII of the Social Security Act, Pub. L.
1009No. 89-97, 42 U.S.C. ss. 1935 et seq., or is eligible for
1010coverage as an employee under an employer-sponsored health plan.
1011     (4)  The covered person's plan may require the payment of a
1012premium by the covered person or dependent child, as
1013appropriate, subject to the approval of the Office of Insurance
1014Regulation, for any period of coverage relating to a dependent's
1015written election for coverage pursuant to subsection (3).
1016     (5)  Notice regarding the reinstatement of coverage for a
1017dependent child as provided under this section must be provided
1018to a covered person in the certificate of coverage prepared for
1019covered persons by the insurer or by the covered person's
1020employer. The notice shall be given as soon as practicable after
1021July 1, 2008, and such notice may be given through the group
1023     (6)  This section does not apply to accident only,
1024specified disease, disability income, Medicare supplement, or
1025long-term care insurance policies.
1026     (7)  This section applies to all group, blanket, and
1027franchise health insurance policies covering residents of this
1028state, including, but not limited to, policies in which the
1029carrier has reserved the right to change the premium. This
1030section applies to all individual, group, blanket, and franchise
1031health insurance policies and health maintenance contracts
1032issued, renewed, or amended after October 1, 2008.
1033     Section 10.  Paragraph (h) of subsection (5) of section
1034627.6699, Florida Statutes, is amended to read:
1035     627.6699  Employee Health Care Access Act.--
1037     (h)  All health benefit plans issued under this section
1038must comply with the following conditions:
1039     1.  For employers who have fewer than two employees, a late
1040enrollee may be excluded from coverage for no longer than 24
1041months if he or she was not covered by creditable coverage
1042continually to a date not more than 63 days before the effective
1043date of his or her new coverage.
1044     2.  Any requirement used by a small employer carrier in
1045determining whether to provide coverage to a small employer
1046group, including requirements for minimum participation of
1047eligible employees and minimum employer contributions, must be
1048applied uniformly among all small employer groups having the
1049same number of eligible employees applying for coverage or
1050receiving coverage from the small employer carrier, except that
1051a small employer carrier that participates in, administers, or
1052issues health benefits pursuant to s. 381.0406 which do not
1053include a preexisting condition exclusion may require as a
1054condition of offering such benefits that the employer has had no
1055health insurance coverage for its employees for a period of at
1056least 6 months. A small employer carrier may vary application of
1057minimum participation requirements and minimum employer
1058contribution requirements only by the size of the small employer
1060     3.  Unless the employer chooses otherwise, for all policies
1061or health maintenance contracts issued or renewed after October
10621, 2008, all eligible employees and their dependents shall be
1063enrolled for coverage at the time of issuance or during the next
1064open or special enrollment period, unless the employee provides
1065written notice to the employer declining coverage, which notice
1066shall include evidence of coverage under an existing group
1067insurance policy or group health benefit plan or other reasons
1068for declining coverage. Such notice shall be retained by the
1069employer as part of the employee's employment or insurance file.
1070An employer may require its employees to participate in its
1071group health plan as a condition of employment.
1072     4.3.  In applying minimum participation requirements with
1073respect to a small employer, a small employer carrier shall not
1074consider as an eligible employee employees or dependents who
1075have qualifying existing coverage in an employer-based group
1076insurance plan or an ERISA qualified self-insurance plan in
1077determining whether the applicable percentage of participation
1078is met. However, a small employer carrier may count eligible
1079employees and dependents who have coverage under another health
1080plan that is sponsored by that employer.
1081     5.4.  A small employer carrier shall not increase any
1082requirement for minimum employee participation or any
1083requirement for minimum employer contribution applicable to a
1084small employer at any time after the small employer has been
1085accepted for coverage, unless the employer size has changed, in
1086which case the small employer carrier may apply the requirements
1087that are applicable to the new group size.
1088     6.5.  If a small employer carrier offers coverage to a
1089small employer, it must offer coverage to all the small
1090employer's eligible employees and their dependents. A small
1091employer carrier may not offer coverage limited to certain
1092persons in a group or to part of a group, except with respect to
1093late enrollees.
1094     7.6.  A small employer carrier may not modify any health
1095benefit plan issued to a small employer with respect to a small
1096employer or any eligible employee or dependent through riders,
1097endorsements, or otherwise to restrict or exclude coverage for
1098certain diseases or medical conditions otherwise covered by the
1099health benefit plan.
1100     8.7.  An initial enrollment period of at least 30 days must
1101be provided. An annual 30-day open enrollment period must be
1102offered to each small employer's eligible employees and their
1103dependents. A small employer carrier must provide special
1104enrollment periods as required by s. 627.65615.
1105     Section 11.  Subsections (41) and (42) are added to section
1106641.31, Florida Statutes, to read:
1107     641.31  Health maintenance contracts.--
1108     (41)  Unless the employer chooses otherwise, for all
1109policies or health maintenance contracts issued or renewed after
1110October 1, 2008, all eligible employees and their dependents
1111shall be enrolled for coverage at the time of issuance or during
1112the next open or special enrollment period, unless the employee
1113provides written notice to the employer declining coverage,
1114which notice shall include evidence of coverage under an
1115existing group insurance policy or group health benefit plan or
1116other reasons for declining coverage. Such notice shall be
1117retained by the employer as part of the employee's employment or
1118insurance file. An employer may require its employees to
1119participate in its group health plan as a condition of
1120employment. This subsection shall apply to all individual,
1121group, blanket, and franchise health insurance policies and
1122health maintenance contracts issued, renewed, or amended after
1123October 1, 2008.
1124     (42)  All health maintenance contracts that provide
1125coverage for a member of the family of the subscriber shall
1126comply with s. 627.6562.
1127     Section 12.  Subsections (1), (4), and (6) of section
1128641.402, 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:
1131limited hospital inpatient services, which may include hospital
1132inpatient physician services, up to a maximum of coverage
1133benefit of 5 days and a maximum dollar amount of coverage of
1134$15,000 per calendar year; emergency care;, physician care other
1135than hospital inpatient physician services;, ambulatory
1136diagnostic treatment;, and preventive health care services.
1137     (4)  "Prepaid health clinic" means any organization
1138authorized under this part which provides, either directly or
1139through arrangements with other persons, basic services to
1140persons enrolled with such organization, on a prepaid per capita
1141or prepaid aggregate fixed-sum basis, including those basic
1142services described in this part which subscribers might
1143reasonably require to maintain good health. However, no clinic
1144that provides or contracts for, either directly or indirectly,
1145inpatient hospital services, hospital inpatient physician
1146services, or indemnity against the cost of such services shall
1147be a prepaid health clinic.
1148     (6)  "Provider" means any physician or person other than a
1149hospital that furnishes health care services under this part and
1150is licensed or authorized to practice in this state.
1151     Section 13.  This act shall take effect upon becoming a

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