Amendment
Bill No. CS/CS/HB 675

Amendment No. 870275

CHAMBER ACTION
Senate		House
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1	Representative Nelson offered the following:
2
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
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.
219
220
221
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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
234

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