HB 21

1	A bill to be entitled
2	An act relating to health insurance; creating ss.
3	627.6404, 627.6572, and 641.31093, F.S.; requiring all
4	antiretroviral agents to be included on health plan
5	formularies; prohibiting access-limiting procedures used
6	to restrict antiretroviral agents prescribed to treat a
7	person with HIV; amending s. 627.6515, F.S.; including
8	reference to such requirements on policies issued by out-
9	of-state groups; providing an effective date.
10
11	Be It Enacted by the Legislature of the State of Florida:
12
13	Section 1.  Section 627.6404, Florida Statutes, is created
14	to read:
15	627.6404  HIV treatment.-Antiretroviral agents prescribed
16	to treat a person with HIV must be included on a health plan
17	formulary and may not be restricted through a requirement for
18	prior authorization, step therapy, or other limitation that
19	limits access to any antiretroviral agent.
20	Section 2.  Section 627.6572, Florida Statutes, is created
21	to read:
22	627.6572  HIV treatment.-Antiretroviral agents prescribed
23	to treat a person with HIV must be included on a health plan
24	formulary and may not be restricted through a requirement for
25	prior authorization, step therapy, or other limitation that
26	limits access to any antiretroviral agent.
27	Section 3.  Section 641.31093, Florida Statutes, is created
28	to read:
29	641.31093  HIV treatment.-Antiretroviral agents prescribed
30	to treat a person with HIV must be included on a health plan
31	formulary and may not be restricted through a requirement for
32	prior authorization, step therapy, or other limitation that
33	limits access to any antiretroviral agent.
34	Section 4.  Subsection (2) of section 627.6515, Florida
35	Statutes, is amended to read:
36	627.6515  Out-of-state groups.-
37	(2)  Except as otherwise provided in this part, this part
38	does not apply to a group health insurance policy issued or
39	delivered outside this state under which a resident of this
40	state is provided coverage if:
41	(a)  The policy is issued to an employee group the
42	composition of which is substantially as described in s.
43	627.653; a labor union group or association group the
44	composition of which is substantially as described in s.
45	627.654; an additional group the composition of which is
46	substantially as described in s. 627.656; a group insured under
47	a blanket health policy when the composition of the group is
48	substantially in compliance with s. 627.659; a group insured
49	under a franchise health policy when the composition of the
50	group is substantially in compliance with s. 627.663; an
51	association group to cover persons associated in any other
52	common group, which common group is formed primarily for
53	purposes other than providing insurance; a group that is
54	established primarily for the purpose of providing group
55	insurance, provided the benefits are reasonable in relation to
56	the premiums charged thereunder and the issuance of the group
57	policy has resulted, or will result, in economies of
58	administration; or a group of insurance agents of an insurer,
59	which insurer is the policyholder.;
60	(b)  Certificates evidencing coverage under the policy are
61	issued to residents of this state and contain in contrasting
62	color and not less than 10-point type the following statement:
63	"The benefits of the policy providing your coverage are governed
64	primarily by the law of a state other than Florida".; and
65	(c)  The policy provides the benefits specified in ss.
66	627.419, 627.6572, 627.6574, 627.6575, 627.6579, 627.6612,
67	627.66121, 627.66122, 627.6613, 627.667, 627.6675, 627.6691, and
68	627.66911.
69	(d)  Applications for certificates of coverage offered to
70	residents of this state must contain, in contrasting color and
71	not less than 12-point type, the following statement on the same
72	page as the applicant's signature:
73
74	"This policy is primarily governed by the laws of ...insert
75	state where the master policy if filed.... As a result, all of
76	the rating laws applicable to policies filed in this state do
77	not apply to this coverage, which may result in increases in
78	your premium at renewal that would not be permissible under a
79	Florida-approved policy. Any purchase of individual health
80	insurance should be considered carefully, as future medical
81	conditions may make it impossible to qualify for another
82	individual health policy. For information concerning individual
83	health coverage under a Florida-approved policy, consult your
84	agent or the Florida Department of Financial Services."
85
86	This paragraph applies only to group certificates providing
87	health insurance coverage which require individualized
88	underwriting to determine coverage eligibility for an individual
89	or premium rates to be charged to an individual except for the
90	following:
91	1.  Policies issued to provide coverage to groups of
92	persons all of whom are in the same or functionally related
93	licensed professions, and providing coverage only to such
94	licensed professionals, their employees, or their dependents;
95	2.  Policies providing coverage to small employers as
96	defined by s. 627.6699. Such policies shall be subject to, and
97	governed by, the provisions of s. 627.6699;
98	3.  Policies issued to a bona fide association, as defined
99	by s. 627.6571(5), provided that there is a person or board
100	acting as a fiduciary for the benefit of the members, and such
101	association is not owned, controlled by, or otherwise associated
102	with the insurance company; or
103	4.  Any accidental death, accidental death and
104	dismemberment, accident-only, vision-only, dental-only, hospital
105	indemnity-only, hospital accident-only, cancer, specified
106	disease, Medicare supplement, products that supplement Medicare,
107	long-term care, or disability income insurance, or similar
108	supplemental plans provided under a separate policy,
109	certificate, or contract of insurance, which cannot duplicate
110	coverage under an underlying health plan, coinsurance, or
111	deductibles or coverage issued as a supplement to workers'
112	compensation or similar insurance, or automobile medical-payment
113	insurance.
114	Section 5.  This act shall take effect July 1, 2011.

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