Florida Senate - 2010 SB 182
By Senator Crist
12-00103A-10 2010182__
1 A bill to be entitled
2 An act relating to coverage for mental and nervous
3 disorders; amending s. 627.668, F.S.; revising
4 requirements and limitations for optional coverage for
5 mental and nervous disorders; specifying
6 nonapplication under certain circumstances; amending
7 s. 627.6675, F.S.; conforming a cross-reference;
8 repealing s. 627.669, F.S., relating to optional
9 coverage required for substance abuse impaired
10 persons; providing for application; providing an
11 effective date.
12
13 Be It Enacted by the Legislature of the State of Florida:
14
15 Section 1. Section 627.668, Florida Statutes, is amended to
16 read:
17 627.668 Optional coverage for mental and nervous disorders
18 required; exception.—
19 (1) Every insurer, health maintenance organization, and
20 nonprofit hospital and medical service plan corporation
21 transacting group health insurance or providing prepaid health
22 care in this state under a group hospital and medical expense
23 incurred insurance policy, a group prepaid health care contract,
24 or a group hospital and medical service plan contract shall make
25 available to the policyholder as part of the application, for an
26 appropriate additional premium under a group hospital and
27 medical expense-incurred insurance policy, under a group prepaid
28 health care contract, and under a group hospital and medical
29 service plan contract, the benefits or level of benefits
30 specified in subsections subsection (2) and (3) for the
31 necessary care and treatment of mental and nervous disorders, as
32 defined in the most recent edition of the Diagnostic and
33 Statistical Manual of Mental Disorders published by standard
34 nomenclature of the American Psychiatric Association. This
35 requirement is, subject to the right of the applicant for a
36 group policy or contract to select any alternative benefits or
37 level of benefits as may be offered by the insurer, health
38 maintenance organization, or service plan corporation. provided
39 that, If alternate inpatient, outpatient, or partial
40 hospitalization benefits are selected, such benefits shall not
41 be less than the level of benefits required under subsections
42 (2) and (3) paragraph (2)(a), paragraph (2)(b), or paragraph
43 (2)(c), respectively. With respect to the state group insurance
44 program, the term “policyholder” means the State of Florida.
45 (2) Under group policies or contracts, inpatient hospital
46 benefits, partial hospitalization benefits, and outpatient
47 benefits consisting of durational limits, dollar amounts,
48 deductibles, and coinsurance factors shall not be less favorable
49 for the necessary care and treatment of schizophrenia and
50 psychotic disorders, mood disorders, anxiety disorders,
51 substance abuse disorders, eating disorders, and childhood
52 ADD/ADHD than for physical illness generally.
53 (3)(2) Under group policies or contracts, Inpatient
54 hospital benefits, partial hospitalization benefits, and
55 outpatient benefits for mental health disorders not listed in
56 subsection (2) consisting of durational limits, dollar amounts,
57 deductibles, and coinsurance factors shall not be less favorable
58 than for physical illness generally, except that:
59 (a) Inpatient benefits may be limited to not less than 45
60 30 days per benefit year as defined in the policy or contract.
61 If inpatient hospital benefits are provided beyond 45 30 days
62 per benefit year, the durational limits, dollar amounts, and
63 coinsurance factors thereto need not be the same as applicable
64 to physical illness generally.
65 (b) Outpatient benefits may be limited to 60 visits per
66 benefit year $1,000 for consultations with a licensed physician,
67 a psychologist licensed pursuant to chapter 490, a mental health
68 counselor licensed pursuant to chapter 491, a marriage and
69 family therapist licensed pursuant to chapter 491, and a
70 clinical social worker licensed pursuant to chapter 491. If
71 benefits are provided beyond the 60 visits $1,000 per benefit
72 year, the durational limits, dollar amounts, and coinsurance
73 factors thereof need not be the same as applicable to physical
74 illness generally.
75 (c) Partial hospitalization benefits shall be provided
76 under the direction of a licensed physician. For purposes of
77 this part, the term “partial hospitalization services” is
78 defined as those services offered by a program accredited by the
79 Joint Commission on Accreditation of Hospitals (JCAH) or in
80 compliance with equivalent standards. Alcohol rehabilitation
81 programs accredited by the Joint Commission on Accreditation of
82 Hospitals or approved by the state and licensed drug abuse
83 rehabilitation programs are shall also be qualified providers
84 under this section. In any benefit year, if partial
85 hospitalization services or a combination of inpatient and
86 partial hospitalization are utilized, the total benefits paid
87 for all such services shall not exceed the cost of 45 30 days of
88 inpatient hospitalization for psychiatric services, including
89 physician fees, which prevail in the community in which the
90 partial hospitalization services are rendered. If partial
91 hospitalization services benefits are provided beyond the limits
92 set forth in this paragraph, the durational limits, dollar
93 amounts, and coinsurance factors thereof need not be the same as
94 those applicable to physical illness generally.
95 (4) In order to reduce service costs and utilization
96 without compromising quality of care, the insurer or health
97 maintenance organization that provides benefits under this
98 section may impose appropriate financial incentives, peer
99 review, utilization requirements, and other methods used for the
100 management of benefits provided for other medical conditions.
101 (5)(3) Insurers must maintain strict confidentiality
102 regarding psychiatric and psychotherapeutic records submitted to
103 an insurer for the purpose of reviewing a claim for benefits
104 payable under this section. These records submitted to an
105 insurer are subject to the limitations of s. 456.057, relating
106 to the furnishing of patient records.
107 (6) This section does not apply with respect to a group
108 health plan, or health insurance coverage offered in connection
109 with a group health plan, if the application of this section to
110 such plan or coverage results in an increase of more than 2
111 percent in the cost of such coverage, as determined and
112 certified by an independent actuary to the Office of Insurance
113 Regulation.
114 Section 2. Paragraph (b) of subsection (8) of section
115 627.6675, Florida Statutes, is amended to read:
116 627.6675 Conversion on termination of eligibility.—Subject
117 to all of the provisions of this section, a group policy
118 delivered or issued for delivery in this state by an insurer or
119 nonprofit health care services plan that provides, on an
120 expense-incurred basis, hospital, surgical, or major medical
121 expense insurance, or any combination of these coverages, shall
122 provide that an employee or member whose insurance under the
123 group policy has been terminated for any reason, including
124 discontinuance of the group policy in its entirety or with
125 respect to an insured class, and who has been continuously
126 insured under the group policy, and under any group policy
127 providing similar benefits that the terminated group policy
128 replaced, for at least 3 months immediately prior to
129 termination, shall be entitled to have issued to him or her by
130 the insurer a policy or certificate of health insurance,
131 referred to in this section as a “converted policy.” A group
132 insurer may meet the requirements of this section by contracting
133 with another insurer, authorized in this state, to issue an
134 individual converted policy, which policy has been approved by
135 the office under s. 627.410. An employee or member shall not be
136 entitled to a converted policy if termination of his or her
137 insurance under the group policy occurred because he or she
138 failed to pay any required contribution, or because any
139 discontinued group coverage was replaced by similar group
140 coverage within 31 days after discontinuance.
141 (8) BENEFITS OFFERED.—
142 (b) An insurer shall offer the benefits specified in s.
143 627.668 and the benefits specified in s. 627.669 if those
144 benefits were provided in the group plan.
145 Section 3. Section 627.669, Florida Statutes, is repealed.
146 Section 4. This act shall take effect January 1, 2011, and
147 applies to policies and contracts issued or renewed on or after
148 that date.