HB 901

1	A bill to be entitled
2	An act relating to health insurance; creating s.
3	627.64194, F.S.; requiring individual accident or
4	health insurance policies to provide certain coverage
5	for orthoses and prostheses and orthotics and
6	prosthetics; providing requirements and limitations;
7	specifying deductible and copayment requirements;
8	authorizing insurers to specify certain benefits
9	limitations; providing for nonapplication to certain
10	policy coverages; creating s. 627.66915, F.S.;
11	requiring group, blanket, or franchise accident or
12	health insurance policies to provide coverage for
13	orthoses and prostheses and orthotics and prosthetics;
14	providing requirements and limitations; specifying
15	deductible and copayment requirements; authorizing
16	insurers to specify certain benefits limitations;
17	providing for nonapplication to certain policy
18	coverages; amending s. 641.31, F.S.; requiring health
19	maintenance contracts to provide coverage for orthoses
20	and prostheses and orthotics and prosthetics;
21	providing requirements and limitations; specifying
22	deductible and copayment requirements; authorizing
23	health maintenance organizations to specify certain
24	benefits limitations; providing for nonapplication to
25	certain contract coverages; providing an effective
26	date.
27
28	Be It Enacted by the Legislature of the State of Florida:
29
30	Section 1.  Section 627.64194, Florida Statutes, is created
31	to read:
32	627.64194  Coverage for orthoses and prostheses and
33	orthotics and prosthetics.-
34	(1)(a)  Each accident or health insurance policy issued,
35	amended, delivered, or renewed in this state on or after January
36	1, 2013, that provides medical coverage that includes coverage
37	for physician services in a physician's office and each accident
38	or health insurance policy that provides major medical or
39	similar comprehensive type coverage must provide coverage for
40	benefits for orthoses and prostheses as defined in s. 468.80 and
41	orthotics and prosthetics as defined in s. 468.80 that equal
42	those benefits provided for under federal laws for health
43	insurance for the aged and disabled pursuant to 42 U.S.C. ss.
44	1395k, 1395l, and 1395m and 42 C.F.R. ss. 414.202, 414.210,
45	414.228, and 410.100 as applicable to this section.
46	(b)1.  The coverage is subject to the deductible and
47	coinsurance provisions applicable to outpatient visits and is
48	also subject to all other terms and conditions applicable to
49	other benefits.
50	2.  Every insurer subject to the requirements of this
51	section shall make available to the policyholder as part of the
52	application, for an appropriate additional premium, the coverage
53	required in this section without such coverage being subject to
54	the deductible or coinsurance provisions of the policy.
55	(2)  An accident or health insurance policy may require
56	prior authorization for orthoses and prostheses and orthotics
57	and prosthetics in the same manner that prior authorization is
58	required for any other covered benefit.
59	(3)(a)  Covered benefits for orthoses or prostheses shall
60	be limited to the most appropriate model that adequately meets
61	the medical needs of the patient as determined by the insured's
62	treating physician.
63	(b)  The repair and replacement of orthoses or prostheses
64	shall also be covered subject to copayments and deductibles,
65	unless necessitated by misuse or loss.
66	(4)  An insurer may require, if coverage is provided
67	through a managed care plan, that benefits mandated pursuant to
68	this section be covered benefits only if the orthoses or
69	prostheses are provided by a vendor and orthotics or prosthetics
70	are rendered by an orthotist or prosthetist as defined in s.
71	468.80.
72	(5)  This section does not apply to insurance coverage
73	providing benefits for hospital confinement indemnity,
74	disability income, accident only, long-term care, Medicare
75	supplement, limited benefit health, specified disease indemnity,
76	sickness or bodily injury or death by accident or both, and
77	other limited benefit policies.
78	Section 2.  Section 627.66915, Florida Statutes, is created
79	to read:
80	627.66915  Coverage for orthoses and prostheses and
81	orthotics and prosthetics.-
82	(1)(a)  Each group, blanket, or franchise accident or
83	health insurance policy issued, amended, delivered, or renewed
84	in this state on or after January 1, 2013, that provides medical
85	coverage that includes coverage for physician services in a
86	physician's office and each such policy that provides major
87	medical or similar comprehensive type coverage must provide
88	coverage for benefits for orthoses and prostheses as defined in
89	s. 468.80 and orthotics and prosthetics as defined in s. 468.80
90	that equal those benefits provided for under federal laws for
91	health insurance for the aged and disabled pursuant to 42 U.S.C.
92	ss. 1395k, 1395l, and 1395m and 42 C.F.R. ss. 414.202, 414.210,
93	414.228, and 410.100 as applicable to this section.
94	(b)1.  The coverage is subject to the deductible and
95	coinsurance provisions applicable to outpatient visits and is
96	also subject to all other terms and conditions applicable to
97	other benefits.
98	2.  Every insurer subject to the requirements of this
99	section shall make available to the policyholder as part of the
100	application, for an appropriate additional premium, the coverage
101	required in this section without such coverage being subject to
102	the deductible or coinsurance provisions of the policy.
103	(2)  A group, blanket, or franchise accident or health
104	insurance policy may require prior authorization for orthoses
105	and prostheses and orthotics and prosthetics in the same manner
106	that prior authorization is required for any other covered
107	benefit.
108	(3)(a)  Covered benefits for orthoses or prostheses shall
109	be limited to the most appropriate model that adequately meets
110	the medical needs of the patient as determined by the insured's
111	treating physician.
112	(b)  The repair and replacement of orthoses or prostheses
113	shall also be covered subject to copayments and deductibles,
114	unless necessitated by misuse or loss.
115	(4)  An insurer may require, if coverage is provided
116	through a managed care plan, that benefits mandated pursuant to
117	this section be covered benefits only if the orthoses or
118	prostheses are provided by a vendor and orthotics or prosthetics
119	are rendered by an orthotist or prosthetist as defined in s.
120	468.80.
121	(5)  This section does not apply to insurance coverage
122	providing benefits for hospital confinement indemnity,
123	disability income, accident only, long-term care, Medicare
124	supplement, limited benefit health, specified disease indemnity,
125	sickness or bodily injury or death by accident or both, and
126	other limited benefit policies.
127	Section 3.  Subsection (44) is added to section 641.31,
128	Florida Statutes, to read:
129	641.31  Health maintenance contracts.-
130	(44)(a)  Each health maintenance contract issued, amended,
131	delivered, or renewed in this state on or after January 1, 2013,
132	that provides medical coverage that includes coverage for
133	physician services in a physician's office and each contract,
134	plan, or policy that provides major medical or similar
135	comprehensive type coverage must provide coverage for benefits
136	for orthoses and prostheses as defined in s. 468.80 and
137	orthotics and prosthetics as defined in s. 468.80 that equal
138	those benefits provided for under federal laws for health
139	insurance for the aged and disabled pursuant to 42 U.S.C. ss.
140	1395k, 1395l, and 1395m and 42 C.F.R. ss. 414.202, 414.210,
141	414.228, and 410.100 as applicable to this subsection.
142	(b)1.  The coverage is subject to the deductible and
143	coinsurance provisions applicable to outpatient visits and is
144	also subject to all other terms and conditions applicable to
145	other benefits.
146	2.  Every health maintenance organization subject to the
147	requirements of this subsection shall make available to the
148	subscriber as part of the application, for an appropriate
149	additional premium, the coverage required in this subsection
150	without such coverage being subject to the deductible or
151	coinsurance provisions of the contract.
152	(c)  A health maintenance contract may require prior
153	authorization for orthoses and prostheses and orthotics and
154	prosthetics in the same manner that prior authorization is
155	required for any other covered benefit.
156	(d)1.  Covered benefits for orthoses or prostheses shall be
157	limited to the most appropriate model that adequately meets the
158	medical needs of the patient as determined by the insured's
159	treating physician.
160	2.  The repair and replacement of orthoses or prostheses
161	shall also be covered subject to copayments and deductibles,
162	unless necessitated by misuse or loss.
163	(e)  A health maintenance contract may require that
164	benefits mandated pursuant to this subsection be covered
165	benefits only if the orthoses or prostheses are provided by a
166	vendor and orthotics or prosthetics are rendered by a orthotist
167	or prosthetist as defined in s. 468.80.
168	(f)  This subsection does not apply to insurance coverage
169	providing benefits for hospital confinement indemnity,
170	disability income, accident only, long-term care, Medicare
171	supplement, limited benefit health, specified disease indemnity,
172	sickness or bodily injury or death by accident or both, and
173	other limited benefit policies.
174	Section 4.  This act shall take effect July 1, 2012.

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