Florida Senate - 2013 COMMITTEE AMENDMENT
Bill No. SB 1842
Barcode 786768
LEGISLATIVE ACTION
Senate . House
Comm: RCS .
04/18/2013 .
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The Committee on Appropriations (Benacquisto) recommended the
following:
1 Senate Amendment (with title amendment)
2
3 Between lines 861 and 862
4 insert:
5 Section 18. Subsection (6) and paragraph (b) of subsection
6 (7) of section 627.6675, Florida Statutes, are amended to read:
7 627.6675 Conversion on termination of eligibility.—Subject
8 to all of the provisions of this section, a group policy
9 delivered or issued for delivery in this state by an insurer or
10 nonprofit health care services plan that provides, on an
11 expense-incurred basis, hospital, surgical, or major medical
12 expense insurance, or any combination of these coverages, shall
13 provide that an employee or member whose insurance under the
14 group policy has been terminated for any reason, including
15 discontinuance of the group policy in its entirety or with
16 respect to an insured class, and who has been continuously
17 insured under the group policy, and under any group policy
18 providing similar benefits that the terminated group policy
19 replaced, for at least 3 months immediately prior to
20 termination, shall be entitled to have issued to him or her by
21 the insurer a policy or certificate of health insurance,
22 referred to in this section as a “converted policy.” A group
23 insurer may meet the requirements of this section by contracting
24 with another insurer, authorized in this state, to issue an
25 individual converted policy, which policy has been approved by
26 the office under s. 627.410. An employee or member shall not be
27 entitled to a converted policy if termination of his or her
28 insurance under the group policy occurred because he or she
29 failed to pay any required contribution, or because any
30 discontinued group coverage was replaced by similar group
31 coverage within 31 days after discontinuance.
32 (6) OPTIONAL COVERAGE.—The insurer is shall not be required
33 to issue a converted policy covering any person who is or could
34 be covered by Medicare. The insurer is shall not be required to
35 issue or renew a converted policy covering a person if
36 paragraphs (a) and (b) apply to the person:
37 (a) If any of the following apply to the person:
38 1. The person is covered for similar benefits by another
39 hospital, surgical, medical, or major medical expense insurance
40 policy or hospital or medical service subscriber contract or
41 medical practice or other prepayment plan, or by any other plan
42 or program.
43 2. The person is eligible for similar benefits, whether or
44 not actually provided coverage, under any arrangement of
45 coverage for individuals in a group, whether on an insured or
46 uninsured basis.
47 3. Similar benefits are provided for or are available to
48 the person under any state or federal law.
49 (b) If the benefits provided under the sources referred to
50 in subparagraph (a)1. or the benefits provided or available
51 under the sources referred to in subparagraphs (a)2. and 3.,
52 together with the benefits provided by the converted policy,
53 would result in overinsurance according to the insurer’s
54 standards. The insurer’s standards must bear some reasonable
55 relationship to actual health care costs in the area in which
56 the insured lives at the time of conversion and must be filed
57 with the office before prior to their use in denying coverage.
58 (7) INFORMATION REQUESTED BY INSURER.—
59 (b) The converted policy may provide that the insurer may
60 refuse to renew the policy or the coverage of any person only
61 for one or more of the following reasons:
62 1. Either The benefits provided under the sources referred
63 to in subparagraphs (a)1. and 2. for the person or the benefits
64 provided or available under the sources referred to in
65 subparagraph (a)3. for the person, together with the benefits
66 provided by the converted policy, would result in overinsurance
67 according to the insurer’s standards on file with the office.
68 The reason for nonrenewal authorized by this subparagraph is not
69 required to be contained in the converted policy but must be
70 provided in writing to the policyholder at least 90 days before
71 the policy renewal date.
72 2. The converted policyholder fails to provide the
73 information requested pursuant to paragraph (a).
74 3. Fraud or intentional misrepresentation in applying for
75 any benefits under the converted policy.
76 4. Other reasons approved by the office.
77 Section 19. Subsection (6) of section 641.3922, Florida
78 Statutes, is amended and paragraph (h) is added to subsection
79 (7) of that section, to read:
80 641.3922 Conversion contracts; conditions.—Issuance of a
81 converted contract shall be subject to the following conditions:
82 (6) OPTIONAL COVERAGE.—The health maintenance organization
83 may shall not be required to issue a converted contract covering
84 any person if such person is or could be covered by Medicare,
85 Title XVIII of the Social Security Act, as added by the Social
86 Security Amendments of 1965, or as later amended or superseded.
87 Furthermore, the health maintenance organization is shall not be
88 required to issue or renew a converted health maintenance
89 contract covering any person if:
90 (a)1. The person is covered for similar benefits by another
91 hospital, surgical, medical, or major medical expense insurance
92 policy or hospital or medical service subscriber contract or
93 medical practice or other prepayment plan or by any other plan
94 or program;
95 2. The person is eligible for similar benefits, whether
96 actually or not covered therefor, under any arrangement of
97 coverage for individuals in a group, whether on an insured or
98 uninsured basis; or
99 3. Similar benefits are provided for or are available to
100 the person pursuant to or in accordance with the requirements of
101 any state or federal law; and
102 (b) A converted health maintenance contract may include a
103 provision whereby the health maintenance organization may
104 request information, in advance of any premium due date of a
105 health maintenance contract, of any person covered thereunder as
106 to whether:
107 1. She or he is covered for similar benefits by another
108 hospital, surgical, medical, or major medical expense insurance
109 policy or hospital or medical service subscriber contract or
110 medical practice or other prepayment plan or by another any
111 other plan or program;
112 2. She or he is covered for similar benefits under an any
113 arrangement of coverage for individuals in a group, whether on
114 an insured or uninsured basis; or
115 3. Similar benefits are provided for or are available to
116 the person pursuant to or in accordance with the requirements of
117 any state or federal law.
118 (7) REASONS FOR CANCELLATION; TERMINATION.—The converted
119 health maintenance contract must contain a cancellation or
120 nonrenewability clause providing that the health maintenance
121 organization may refuse to renew the contract of any person
122 covered thereunder, but cancellation or nonrenewal must be
123 limited to one or more of the following reasons:
124 (h) The subscriber is covered for similar benefits or
125 eligible for similar benefits, or similar benefits are provided
126 for or are available to the subscriber as described in paragraph
127 (6)(a). The reason for nonrenewal authorized by this paragraph
128 is not required to be contained in the converted health
129 maintenance contract but must be provided in writing to the
130 subscriber at least 90 days before the contract renewal date.
131
132 ================= T I T L E A M E N D M E N T ================
133 And the title is amended as follows:
134 Delete line 93
135 and insert:
136 repeal of this provision; amending s. 627.6675, F.S.;
137 specifying conditions for nonrenewal of a conversion
138 policy; amending s. 641.3922, F.S.; specifying
139 conditions for nonrenewal of a health maintenance
140 organization conversion contract; providing effective
141 dates.