Florida Senate - 2011 SENATOR AMENDMENT
Bill No. CS for SB 1922
Barcode 320662
LEGISLATIVE ACTION
Senate . House
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Floor: 2/AD/2R .
05/02/2011 03:34 PM .
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Senator Garcia moved the following:
1 Senate Amendment (with title amendment)
2
3 Delete lines 112 - 289
4 and insert:
5 (4) ELIGIBILITY AND PARTICIPATION.—Participation in the
6 program is voluntary and shall be available to employers,
7 individuals, vendors, and health insurance agents as specified
8 in this subsection.
9 (a) Employers eligible to enroll in the program include:
10 1. Employers that meet criteria established by the
11 corporation and elect to make their employees eligible for one
12 or more health products offered through the program have 1 to 50
13 employees.
14 2. Fiscally constrained counties described in s. 218.67.
15 3. Municipalities having populations of fewer than 50,000
16 residents.
17 4. School districts in fiscally constrained counties.
18 5. Statutory rural hospitals.
19 (b) Individuals eligible to participate in the program
20 include:
21 1. Individual employees of enrolled employers.
22 2. State employees not eligible for state employee health
23 benefits.
24 3. State retirees.
25 4. Medicaid reform participants who opt out select the opt
26 out provision of reform.
27 5. Statutory rural hospitals.
28 (c) Employers who choose to participate in the program may
29 enroll by complying with the procedures established by the
30 corporation. The procedures must include, but are not limited
31 to:
32 1. Submission of required information.
33 2. Compliance with federal tax requirements for the
34 establishment of a cafeteria plan, pursuant to s. 125 of the
35 Internal Revenue Code, including designation of the employer’s
36 plan as a premium payment plan, a salary reduction plan that has
37 flexible spending arrangements, or a salary reduction plan that
38 has a premium payment and flexible spending arrangements.
39 3. Determination of the employer’s contribution, if any,
40 per employee, provided that such contribution is equal for each
41 eligible employee.
42 4. Establishment of payroll deduction procedures, subject
43 to the agreement of each individual employee who voluntarily
44 participates in the program.
45 5. Designation of the corporation as the third-party
46 administrator for the employer’s health benefit plan.
47 6. Identification of eligible employees.
48 7. Arrangement for periodic payments.
49 8. Employer notification to employees of the intent to
50 transfer from an existing employee health plan to the program at
51 least 90 days before the transition.
52 (d) All eligible vendors who choose to participate and the
53 products and services that the vendors are permitted to sell are
54 as follows:
55 1. Insurers licensed under chapter 624 may sell health
56 insurance policies, limited benefit policies, other risk-bearing
57 coverage, and other products or services.
58 2. Health maintenance organizations licensed under part I
59 of chapter 641 may sell health maintenance contracts insurance
60 policies, limited benefit policies, other risk-bearing products,
61 and other products or services.
62 3. Prepaid limited health service organizations may sell
63 products and services as authorized under part I of chapter 636,
64 and discount medical plan organizations may sell products and
65 services as authorized under part II of chapter 636.
66 4.3. Prepaid health clinic service providers licensed under
67 part II of chapter 641 may sell prepaid service contracts and
68 other arrangements for a specified amount and type of health
69 services or treatments.
70 5.4. Health care providers, including hospitals and other
71 licensed health facilities, health care clinics, licensed health
72 professionals, pharmacies, and other licensed health care
73 providers, may sell service contracts and arrangements for a
74 specified amount and type of health services or treatments.
75 6.5. Provider organizations, including service networks,
76 group practices, professional associations, and other
77 incorporated organizations of providers, may sell service
78 contracts and arrangements for a specified amount and type of
79 health services or treatments.
80 7.6. Corporate entities providing specific health services
81 in accordance with applicable state law may sell service
82 contracts and arrangements for a specified amount and type of
83 health services or treatments.
84
85 A vendor described in subparagraphs 4.-7. 3.-6. may not sell
86 products that provide risk-bearing coverage unless that vendor
87 is authorized under a certificate of authority issued by the
88 Office of Insurance Regulation and is authorized to provide
89 coverage in the relevant geographic area under the provisions of
90 the Florida Insurance Code. Otherwise eligible vendors may be
91 excluded from participating in the program for deceptive or
92 predatory practices, financial insolvency, or failure to comply
93 with the terms of the participation agreement or other standards
94 set by the corporation.
95 (e) Any risk-bearing product available under subparagraphs
96 (d)1.-4. must be approved by the Office of Insurance Regulation.
97 Any non-risk-bearing product must be approved by the
98 corporation.
99 (f)(e) Eligible individuals may voluntarily continue
100 participation in the program regardless of subsequent changes in
101 job status or Medicaid eligibility. Individuals who join the
102 program may participate by complying with the procedures
103 established by the corporation. These procedures must include,
104 but are not limited to:
105 1. Submission of required information.
106 2. Authorization for payroll deduction.
107 3. Compliance with federal tax requirements.
108 4. Arrangements for payment in the event of job changes.
109 5. Selection of products and services.
110 (g)(f) Vendors who choose to participate in the program may
111 enroll by complying with the procedures established by the
112 corporation. These procedures may must include, but are not
113 limited to:
114 1. Submission of required information, including a complete
115 description of the coverage, services, provider network, payment
116 restrictions, and other requirements of each product offered
117 through the program.
118 2. Execution of an agreement that to make all risk-bearing
119 products offered through the program are in compliance with the
120 insurance code and are guaranteed-issue policies, subject to
121 preexisting condition exclusions established by the corporation.
122 3. Execution of an agreement that prohibits refusal to sell
123 any offered non-risk-bearing product to a participant who elects
124 to buy it.
125 4. Establishment of product prices based on age, gender,
126 family composition, and location of the individual participant,
127 which may include medical underwriting.
128 5. Arrangements for receiving payment for enrolled
129 participants.
130 6. Participation in ongoing reporting processes established
131 by the corporation.
132 7. Compliance with grievance procedures established by the
133 corporation.
134 (h)(g) Health insurance agents licensed under part IV of
135 chapter 626 are eligible to voluntarily participate as buyers’
136 representatives. A buyer’s representative acts on behalf of an
137 individual purchasing health insurance and health services
138 through the program by providing information about products and
139 services available through the program and assisting the
140 individual with both the decision and the procedure of selecting
141 specific products. Serving as a buyer’s representative does not
142 constitute a conflict of interest with continuing
143 responsibilities as a health insurance agent if the relationship
144 between each agent and any participating vendor is disclosed
145 before advising an individual participant about the products and
146 services available through the program. In order to participate,
147 a health insurance agent shall comply with the procedures
148 established by the corporation, including:
149 1. Completion of training requirements.
150 2. Execution of a participation agreement specifying the
151 terms and conditions of participation.
152 3. Disclosure of any appointments to solicit insurance or
153 procure applications for vendors participating in the program.
154 4. Arrangements to receive payment from the corporation for
155 services as a buyer’s representative.
156 (5) PRODUCTS.—
157 (a) The products that may be made available for purchase
158 through the program include, but are not limited to:
159 1. Health insurance policies.
160 2. Limited benefit plans.
161 3. Prepaid clinic services.
162 4. Service contracts.
163 5. Arrangements for purchase of specific amounts and types
164 of health services and treatments.
165 6. Flexible spending accounts.
166 7. Health maintenance contracts.
167 (b) Health insurance policies, health maintenance
168 contracts, limited benefit plans, prepaid service contracts, and
169 other contracts for services must ensure the availability of
170 covered services and benefits to participating individuals for
171 at least 1 full enrollment year.
172 (c) Products may be offered for multiyear periods provided
173 the price of the product is specified for the entire period or
174 for each separately priced segment of the policy or contract.
175 (d) The corporation shall provide a disclosure form for
176 consumers to acknowledge their understanding of the nature of,
177 and any limitations to, the benefits provided by the products
178 and services being purchased by the consumer.
179 (e) The corporation must determine that making the plan
180 available through the program is in the interest of eligible
181 individuals and eligible employers in the state.
182 (6) PRICING.—Prices for the products and services sold
183 through the
184
185 ================= T I T L E A M E N D M E N T ================
186 And the title is amended as follows:
187 Delete line 9
188 and insert:
189 contracts or products and services; requiring prices
190 for the products and services sold through the program
191 to be transparent to participants and established by
192 the vendors; requiring certain