| 1 | Representative Patronis offered the following: |
| 2 |
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| 3 | Amendment (with title amendment) |
| 4 | Between lines 4184-4185 and insert: |
| 5 | Section 74. Paragraph (c) of subsection (1) of section |
| 6 | 627.602, Florida Statutes, is amended to read: |
| 7 | 627.602 Scope, format of policy.-- |
| 8 | (1) Each health insurance policy delivered or issued for |
| 9 | delivery to any person in this state must comply with all |
| 10 | applicable provisions of this code and all of the following |
| 11 | requirements: |
| 12 | (c) The policy may purport to insure only one person, |
| 13 | except that upon the application of an adult member of a family, |
| 14 | who is deemed to be the policyholder, a policy may insure, |
| 15 | either originally or by subsequent amendment, any eligible |
| 16 | members of that family, including husband, wife, any children or |
| 17 | any person dependent upon the policyholder. If an insurer offers |
| 18 | coverage for dependent children of the policyholder, such policy |
| 19 | must comply with the provisions of s. 627.6562. |
| 20 | Section 75. Section 627.6562, Florida Statutes, is |
| 21 | amended to read: |
| 22 | 627.6562 Dependent coverage.-- |
| 23 | (1) If an insurer offers coverage under a group, blanket, |
| 24 | or franchise health insurance policy that insures dependent |
| 25 | children of the policyholder or certificateholder, the policy |
| 26 | must insure a dependent child of the policyholder or |
| 27 | certificateholder at least until the end of the calendar year in |
| 28 | which the child reaches the age of 25, if the child meets all of |
| 29 | the following: |
| 30 | (a) The child is dependent upon the policyholder or |
| 31 | certificateholder for support. |
| 32 | (b) The child is living in the household of the |
| 33 | policyholder or certificateholder, or the child is a full-time |
| 34 | or part-time student. |
| 35 | (2) At the option of the group policyholder, all |
| 36 | certificateholders within a group policy shall be offered A |
| 37 | policy that is subject to the requirements of subsection (1) |
| 38 | must also offer the policyholder or certificateholder the option |
| 39 | to insure a child of the policyholder or certificateholder at |
| 40 | least until the end of the calendar year in which the child |
| 41 | reaches the age of 30, if the child: |
| 42 | (a) Is unmarried and does not have a dependent of his or |
| 43 | her own; |
| 44 | (b) Is a resident of this state or a full-time or part- |
| 45 | time student; and |
| 46 | (c) Is not eligible for provided coverage as a named |
| 47 | subscriber, insured, enrollee, or covered person under any other |
| 48 | group, blanket, or franchise health insurance policy, health |
| 49 | maintenance organization contract, or individual health benefits |
| 50 | plan, including, but not limited to, coverage offered pursuant |
| 51 | to the Consolidated Omnibus Budget Reconciliation Act of 1985 or |
| 52 | s. 627.6692, or is not entitled to benefits under Title XVIII of |
| 53 | the Social Security Act. |
| 54 | (d) The terms of the policy may include a provision that |
| 55 | the child's eligibility for coverage ceases when he or she is no |
| 56 | longer eligible as provided in this subsection. In such case, |
| 57 | coverage shall continue through the end of the calendar month in |
| 58 | which the child loses eligibility. If loss of eligibility occurs |
| 59 | because of the birth of a child, the newborn child is not |
| 60 | eligible for coverage under s. 627.6575 or s. 641.31(9). |
| 61 | (3) If, pursuant to subsection (2), a child is provided |
| 62 | coverage under the parent's policy after the end of the calendar |
| 63 | year in which the child reaches age 25 and coverage for the |
| 64 | child is subsequently terminated, the child is not eligible to |
| 65 | be covered under the parent's policy unless the child was |
| 66 | continuously covered by other creditable coverage without a gap |
| 67 | in coverage of more than 63 days. For the purposes of this |
| 68 | subsection, the term "creditable coverage" has the same meaning |
| 69 | as provided in s. 627.6561(5). |
| 70 | (4) This section does not: |
| 71 | (a) Affect or preempt an insurer's right to medically |
| 72 | underwrite or charge the appropriate premium and carriers, |
| 73 | including small employer carriers as defined in s. |
| 74 | 627.6699(3)(w), and are expressly authorized to charge |
| 75 | actuarially sound, distinct rates that are separate from the |
| 76 | rates for dependent coverage for coverage of children of |
| 77 | certificateholders covered pursuant to subsection (2); |
| 78 | (b) Require coverage for services provided to a dependent |
| 79 | before October 1, 2008; |
| 80 | (c) Require an employer to pay all or part of the cost of |
| 81 | coverage provided for a dependent under this section; or |
| 82 | (d) Prohibit an insurer or health maintenance organization |
| 83 | from increasing the limiting age for dependent coverage to age |
| 84 | 30 in policies or contracts issued or renewed prior to the |
| 85 | effective date of this act. |
| 86 | (5)(a) Until April 1, 2009, the parent of a child who |
| 87 | qualifies for coverage under subsection (2) but whose coverage |
| 88 | as a dependent child under the parent's plan terminated under |
| 89 | the terms of the plan before October 1, 2008, may make a written |
| 90 | election to reinstate coverage, without proof of insurability, |
| 91 | under that plan as a dependent child pursuant to this section. |
| 92 | (b) The covered person's plan may require the payment of a |
| 93 | premium by the covered person or dependent child, as |
| 94 | appropriate, subject to the approval of the Office of Insurance |
| 95 | Regulation, for any period of coverage relating to a dependent's |
| 96 | written election for coverage pursuant to paragraph (a). |
| 97 | (c) Notice regarding the reinstatement of coverage for a |
| 98 | dependent child as provided under this subsection must be |
| 99 | provided to a covered person in the certificate of coverage |
| 100 | prepared for covered persons by the insurer or by the covered |
| 101 | person's employer. Such notice may be given through the group |
| 102 | policyholder. |
| 103 | (6) This section applies only to group major medical |
| 104 | policies and does not apply to conversion policies, policies |
| 105 | offered pursuant to the Consolidated Omnibus Budget |
| 106 | Reconciliation Act of 1985 or s. 627.6692, individual policies, |
| 107 | out-of-state group policies written pursuant to s. 627.6515, or |
| 108 | limited benefit or supplemental policies, including, but not |
| 109 | limited to, accident only, specified disease, disability income, |
| 110 | Medicare supplement, or long-term care insurance, or other |
| 111 | supplemental or limited benefit policies. |
| 112 | (7) The commission may adopt rules pursuant to ss. |
| 113 | 120.536(1) and 120.54 to administer this section. |
| 114 | Section 76. Subsection (41) of section 641.31, Florida |
| 115 | Statutes, is amended to read: |
| 116 | 641.31 Health maintenance contracts.-- |
| 117 | (41) All group health maintenance contracts providing |
| 118 | coverage for a member of the subscriber's family must comply |
| 119 | with the provisions of s. 627.6562. |
| 120 |
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| 121 |
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| 122 | ----------------------------------------------------- |
| 123 | T I T L E A M E N D M E N T |
| 124 | Remove line 328 and insert: |
| 125 | agency to develop rules; amending s. 627.602, F.S.; deleting a |
| 126 | requirement that certain policies providing coverage for |
| 127 | dependent children comply with certain provisions; amending s. |
| 128 | 627.6562, F.S.; revising dependent coverage requirements; |
| 129 | specifying limited application to group major medical policies; |
| 130 | authorizing the Financial Services Commission to adopt rules; |
| 131 | amending s. 641.31, F.S.; specifying required application of |
| 132 | certain provisions to certain group health maintenance |
| 133 | contracts; providing an effective date. |