1 | Representative Nelson offered the following: |
2 |
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3 | Amendment (with title amendment) |
4 | Remove line 82 and insert: |
5 | Section 2. Section 627.6562, Florida Statutes, is amended |
6 | to read: |
7 | 627.6562 Dependent coverage.-- |
8 | (1) If an insurer offers coverage under a group, blanket, |
9 | or franchise health insurance policy that insures dependent |
10 | children of the policyholder or certificateholder, unless the |
11 | group policyholder chooses otherwise, the policy must insure a |
12 | dependent child of the policyholder or certificateholder at |
13 | least until the end of the calendar year in which the child |
14 | reaches the age of 25, if the child meets all of the following: |
15 | (a) Is unmarried, a dependent as defined in the Internal |
16 | Revenue Code of 1986, as amended, and the child is dependent |
17 | upon the policyholder or certificateholder for support. |
18 | (b) Is a resident of the state The child is living in the |
19 | household of the policyholder or certificateholder, or the child |
20 | is a full-time or part-time student. |
21 | (2) A policy that is subject to the requirements of |
22 | subsection (1) must also offer the policyholder or |
23 | certificateholder the option to insure a child of the |
24 | policyholder or certificateholder at least until the end of the |
25 | calendar year in which the child reaches the age of 30, if the |
26 | child: |
27 | (a) Is unmarried and does not have a dependent of his or |
28 | her own; |
29 | (b) Is a resident of this state or a full-time or part- |
30 | time student; and |
31 | (c) Is not provided coverage as a named subscriber, |
32 | insured, enrollee, or covered person under any other group, |
33 | blanket, or franchise health insurance policy or individual |
34 | health benefits plan, or is eligible for coverage as an employee |
35 | under an employer sponsored health plan, or is not entitled to |
36 | benefits under Title XVIII of the Social Security Act. |
37 | (2)(3) If, pursuant to subsection (1) (2), a child is |
38 | provided coverage under the parent's policy after the end of the |
39 | calendar year in which the child reaches age 30 25 and coverage |
40 | for the child is subsequently terminated, the child is not |
41 | eligible to be covered under the parent's policy unless the |
42 | child was continuously covered by other creditable coverage |
43 | without a gap in coverage of more than 63 days. For the purposes |
44 | of this subsection, the term "creditable coverage" has the same |
45 | meaning as provided in s. 627.6561(5). |
46 | (3)(4) This section does not: |
47 | (a) Affect or preempt an insurer's right to medically |
48 | underwrite or charge the appropriate premium; |
49 | (b) Require coverage for services provided to a dependent |
50 | before October 1, 2090 2008; |
51 | (c) Require an employer to pay all or part of the cost of |
52 | coverage provided for a dependent under this section; or |
53 | (d) Prohibit an insurer or health maintenance organization |
54 | from increasing the limiting age for dependent coverage to age |
55 | 30 in policies or contracts issued or renewed prior to the |
56 | effective date of this act. |
57 | (4)(5)(a) Until April 1, 2009, the parent of a child who |
58 | qualifies for coverage under subsection (1) (2) but whose |
59 | coverage as a dependent child under the parent's plan terminated |
60 | under the terms of the plan before October 1, 2008, may make a |
61 | written election to reinstate coverage, without proof of |
62 | insurability, under that plan as a dependent child pursuant to |
63 | this section. All other dependent children who qualify for |
64 | coverage under subsection (1) shall be automatically covered at |
65 | least until the end of the calendar year in which the child |
66 | reaches age 30, unless the insured provides the group |
67 | policyholder with written evidence that the dependent child is |
68 | married, is not a resident of this state, is covered under a |
69 | separate comprehensive health insurance policy, is covered under |
70 | a health benefit plan, or is entitled to benefits under Title |
71 | XVIII of the Social Security Act. |
72 | (b) The covered person's plan may require the payment of a |
73 | premium by the covered person or dependent child, as |
74 | appropriate, subject to the approval of the Office of Insurance |
75 | Regulation, for any period of coverage relating to a dependent's |
76 | written election for coverage pursuant to paragraph (a). |
77 | (c) Notice regarding the reinstatement of coverage for a |
78 | dependent child as provided under this subsection must be |
79 | provided to a covered person in the certificate of coverage |
80 | prepared for covered persons by the insurer or by the covered |
81 | person's employer. Such notice may be given through the group |
82 | policyholder. |
83 | (5)(6) This section and any cross-references to this |
84 | section are only intended to apply to group major medical |
85 | policies and are not intended to apply to conversion policies, |
86 | policies offered pursuant to the Consolidated Omnibus Budget |
87 | Reconciliation Act of 1985 or s. 627.6692, individual policies, |
88 | out-of-state group policies written pursuant to s. 627.6515, or |
89 | limited benefit or supplemental policies, including but not |
90 | limited to, dental, vision, does not apply to accident only, |
91 | specified disease, disability income, Medicare supplement, or |
92 | long-term care insurance policies. |
93 | Section 3. Paragraph (b) of subsection (12) of section |
94 | 627.6699, Florida Statutes, is amended, and paragraph (l) is |
95 | added to subsection (13) of that section, to read: |
96 | 627.6699 Employee Health Care Access Act.-- |
97 | (12) STANDARD, BASIC, HIGH DEDUCTIBLE, AND LIMITED HEALTH |
98 | BENEFIT PLANS.-- |
99 | (b)1. Each small employer carrier issuing new health |
100 | benefit plans shall offer to any small employer, upon request, a |
101 | standard health benefit plan, a basic health benefit plan, and a |
102 | high deductible plan that meets the requirements of a health |
103 | savings account plan as defined by federal law or a health |
104 | reimbursement arrangement as authorized by the Internal Revenue |
105 | Service, that meet the criteria set forth in this section. |
106 | 2. For purposes of this subsection, the terms "standard |
107 | health benefit plan," "basic health benefit plan," and "high |
108 | deductible plan" mean policies or contracts that a small |
109 | employer carrier offers to eligible small employers that |
110 | contain: |
111 | a. An exclusion for services that are not medically |
112 | necessary or that are not covered preventive health services; |
113 | and |
114 | b. A procedure for preauthorization by the small employer |
115 | carrier, or its designees. |
116 | 3. A small employer carrier may include the following |
117 | managed care provisions in the policy or contract to control |
118 | costs: |
119 | a. A preferred provider arrangement or exclusive provider |
120 | organization or any combination thereof, in which a small |
121 | employer carrier enters into a written agreement with the |
122 | provider to provide services at specified levels of |
123 | reimbursement or to provide reimbursement to specified |
124 | providers. Any such written agreement between a provider and a |
125 | small employer carrier must contain a provision under which the |
126 | parties agree that the insured individual or covered member has |
127 | no obligation to make payment for any medical service rendered |
128 | by the provider which is determined not to be medically |
129 | necessary. A carrier may use preferred provider arrangements or |
130 | exclusive provider arrangements to the same extent as allowed in |
131 | group products that are not issued to small employers. |
132 | b. A procedure for utilization review by the small |
133 | employer carrier or its designees. |
134 |
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135 | This subparagraph does not prohibit a small employer carrier |
136 | from including in its policy or contract additional managed care |
137 | and cost containment provisions, subject to the approval of the |
138 | office, which have potential for controlling costs in a manner |
139 | that does not result in inequitable treatment of insureds or |
140 | subscribers. The carrier may use such provisions to the same |
141 | extent as authorized for group products that are not issued to |
142 | small employers. |
143 | 4. The standard health benefit plan shall include: |
144 | a. Coverage for inpatient hospitalization; |
145 | b. Coverage for outpatient services; |
146 | c. Coverage for newborn children pursuant to s. 627.6575; |
147 | d. Coverage for child care supervision services pursuant |
148 | to s. 627.6579; |
149 | e. Coverage for adopted children upon placement in the |
150 | residence pursuant to s. 627.6578; |
151 | f. Coverage for mammograms pursuant to s. 627.6613; |
152 | g. Coverage for handicapped children pursuant to s. |
153 | 627.6615; |
154 | h. Emergency or urgent care out of the geographic service |
155 | area; and |
156 | i. Coverage for services provided by a hospice licensed |
157 | under s. 400.602 in cases where such coverage would be the most |
158 | appropriate and the most cost-effective method for treating a |
159 | covered illness. |
160 | 5. The standard health benefit plan and the basic health |
161 | benefit plan may include a schedule of benefit limitations for |
162 | specified services and procedures. If the committee develops |
163 | such a schedule of benefits limitation for the standard health |
164 | benefit plan or the basic health benefit plan, a small employer |
165 | carrier offering the plan must offer the employer an option for |
166 | increasing the benefit schedule amounts by 4 percent annually. |
167 | 6. The basic health benefit plan shall include all of the |
168 | benefits specified in subparagraph 4.; however, the basic health |
169 | benefit plan shall place additional restrictions on the benefits |
170 | and utilization and may also impose additional cost containment |
171 | measures. |
172 | 7. Sections 627.419(2), (3), and (4), 627.6562, 627.6574, |
173 | 627.6612, 627.66121, 627.66122, 627.6616, 627.6618, 627.668, and |
174 | 627.66911 apply to the standard health benefit plan and to the |
175 | basic health benefit plan. However, notwithstanding said |
176 | provisions, the plans may specify limits on the number of |
177 | authorized treatments, if such limits are reasonable and do not |
178 | discriminate against any type of provider. |
179 | 8. The high deductible plan associated with a health |
180 | savings account or a health reimbursement arrangement shall |
181 | include all the benefits specified in subparagraph 4. |
182 | 9. Each small employer carrier that provides for inpatient |
183 | and outpatient services by allopathic hospitals may provide as |
184 | an option of the insured similar inpatient and outpatient |
185 | services by hospitals accredited by the American Osteopathic |
186 | Association when such services are available and the osteopathic |
187 | hospital agrees to provide the service. |
188 | (13) STANDARDS TO ASSURE FAIR MARKETING.-- |
189 | (l)1. In order to improve the ability of small employers |
190 | to obtain information including premium rates for small employer |
191 | health benefit plans and to facilitate the application process, |
192 | all small employer carriers shall use a uniform employee health |
193 | status form. The office, in consultation with small employer |
194 | carriers, shall develop such a form and the commission shall |
195 | adopt such a form by rule. The form shall be designed to permit |
196 | its use both as a written document and through electronic or |
197 | other alternative delivery formats. The form shall include the |
198 | following health data elements for all persons to be covered |
199 | under the policy that occurred in the 2 years prior to the date |
200 | of completion of the form: |
201 | a. Any treatment by any licensed medical practitioner. |
202 | b. Any procedure or treatment in a hospital, |
203 | rehabilitation program, or surgical center. |
204 | c. All current medications prescribed by a licensed |
205 | practitioner. |
206 | d. Current diagnosis of pregnancy. |
207 | e. Current use of any tobacco products. |
208 | f. Pending test results. |
209 | g. Workers compensation injury or illness. |
210 | h. Tests or treatments recommended but not completed. |
211 | 2. The form shall require the signature of the employee |
212 | completing the form. Use of a standardized form shall not |
213 | prevent a small employer carrier from obtaining information from |
214 | other sources in order to determine the appropriate premium rate |
215 | for a small employer. |
216 | Section 4. This act shall take effect October 1. 2009, and |
217 | shall apply to all policies issued or renewed on or after that |
218 | date. |
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223 | ----------------------------------------------------- |
224 | T I T L E A M E N D M E N T |
225 | Remove line 12 and insert: |
226 | credibility criteria for the rate adjustment; amending s. |
227 | 627.6562, F.S.; revising criteria, requirements, and limitations |
228 | for dependent coverage for group, blanket, or franchise health |
229 | insurance policies; amending s. 627.6699, F.S.; expanding |
230 | application of certain requirements to standard health and basic |
231 | health benefit plans; requiring small employer carriers to use a |
232 | uniform employee health status form; specifying form |
233 | requirements; providing application; providing an |
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