Florida Senate - 2013 SENATOR AMENDMENT
Bill No. CS for SB 422
Barcode 364504
LEGISLATIVE ACTION
Senate . House
.
.
.
Floor: WD .
03/27/2013 12:41 PM .
—————————————————————————————————————————————————————————————————
—————————————————————————————————————————————————————————————————
Senator Benacquisto moved the following:
1 Senate Substitute for Amendment (353984) (with title
2 amendment)
3
4 Delete everything after the enacting clause
5 and insert:
6 Section 1. This act may be cited as the “Cancer Treatment
7 Fairness Act.”
8 Section 2. Section 627.42391, Florida Statutes, is created
9 to read:
10 627.42391 Cancer treatment parity; orally administered
11 cancer treatment medications.—
12 (1) As used in this section, the term:
13 (a) “Cancer treatment medication” means medication
14 prescribed by a treating physician who determines that the
15 medication is medically necessary to kill or slow the growth of
16 cancerous cells in a manner consistent with nationally accepted
17 standards of practice.
18 (b) “Cost sharing” includes copayments, coinsurance, dollar
19 limits, and deductibles imposed on the covered person.
20 (2) Beginning January 2, 2014, an individual or group
21 insurance policy, including a policy issued to a small employer
22 as defined in s. 627.6699, delivered, issued for delivery,
23 renewed, amended, or continued in this state which provides
24 medical, major medical, or similar comprehensive coverage and
25 includes coverage for cancer treatment medications, must also
26 cover prescribed, orally administered cancer treatment
27 medications and may not apply cost-sharing requirements for
28 prescribed, orally administered cancer treatment medications
29 which are less favorable to the covered person than cost-sharing
30 requirements for intravenous or injected cancer treatment
31 medications covered under the policy.
32 (3) An insurer that provides a policy described in
33 subsection (2), and any participating entity through which the
34 insurer offers health services, may not:
35 (a) Vary the terms of a policy in effect on July 1, 2013,
36 in order to avoid compliance with this section.
37 (b) Provide any incentive, including, but not limited to, a
38 monetary incentive, or impose treatment limitations to encourage
39 a covered person to accept less than the minimum protections
40 available under this section.
41 (c) Penalize a health care practitioner or reduce or limit
42 the compensation of a health care practitioner for recommending
43 or providing services or care to a covered person as required
44 under this section.
45 (d) Provide any incentive, including, but not limited to, a
46 monetary incentive, to induce a health care practitioner to
47 provide care or services that do not comply with this section.
48 (e) Change the classification of any intravenous or
49 injected cancer treatment medication or increase the amount of
50 cost sharing applicable to any intravenous or injected cancer
51 treatment medication in effect on July 1, 2013, in order to
52 comply with this section.
53 Section 3. Section 641.313, Florida Statutes, is created to
54 read:
55 641.313 Cancer treatment parity; orally administered cancer
56 treatment medications.—
57 (1) As used in this section, the term:
58 (a) “Cancer treatment medication” means medication
59 prescribed by a treating physician who determines that the
60 medication is medically necessary to kill or slow the growth of
61 cancerous cells in a manner consistent with nationally accepted
62 standards of practice.
63 (b) “Cost sharing” includes copayments, coinsurance, dollar
64 limits, and deductibles imposed on the covered person.
65 (2) Beginning January 2, 2014, a health maintenance
66 contract, including a contract issued to a small employer as
67 defined in s. 627.6699, delivered, issued for delivery, renewed,
68 amended, or continued in this state which provides medical,
69 major medical, or similar comprehensive coverage and includes
70 coverage for cancer treatment medications, must also cover
71 prescribed, orally administered cancer treatment medications and
72 may not apply cost-sharing requirements for prescribed, orally
73 administered cancer treatment medications which are less
74 favorable to the covered person than cost-sharing requirements
75 for intravenous or injected cancer treatment medications covered
76 under the contract.
77 (3) A health maintenance organization that provides a
78 contract described in subsection (2), and any participating
79 entity through which the health maintenance organization offers
80 health services, may not:
81 (a) Vary the terms of a contract in effect on July 1, 2013,
82 in order to avoid compliance with this section.
83 (b) Provide any incentive, including, but not limited to, a
84 monetary incentive, or impose treatment limitations to encourage
85 a covered person to accept less than the minimum protections
86 available under this section.
87 (c) Penalize a health care practitioner or reduce or limit
88 the compensation of a health care practitioner for recommending
89 or providing services or care to a covered person as required
90 under this section.
91 (d) Provide any incentive, including, but not limited to, a
92 monetary incentive, to induce a health care practitioner to
93 provide care or services that do not comply with this section.
94 (e) Change the classification of any intravenous or
95 injected cancer treatment medication or increase the amount of
96 cost sharing applicable to any intravenous or injected cancer
97 treatment medication in effect on July 1, 2013, in order to
98 comply with this section.
99 Section 4. Subsection (2) of section 627.6515, Florida
100 Statutes, is amended to read:
101 627.6515 Out-of-state groups.—
102 (2) Except as otherwise provided in this part, this part
103 does not apply to a group health insurance policy issued or
104 delivered outside this state under which a resident of this
105 state is provided coverage if:
106 (a) The policy is issued to an employee group the
107 composition of which is substantially as described in s.
108 627.653; a labor union group or association group the
109 composition of which is substantially as described in s.
110 627.654; an additional group the composition of which is
111 substantially as described in s. 627.656; a group insured under
112 a blanket health policy when the composition of the group is
113 substantially in compliance with s. 627.659; a group insured
114 under a franchise health policy when the composition of the
115 group is substantially in compliance with s. 627.663; an
116 association group to cover persons associated in any other
117 common group, which common group is formed primarily for
118 purposes other than providing insurance; a group that is
119 established primarily for the purpose of providing group
120 insurance, provided the benefits are reasonable in relation to
121 the premiums charged thereunder and the issuance of the group
122 policy has resulted, or will result, in economies of
123 administration; or a group of insurance agents of an insurer,
124 which insurer is the policyholder;
125 (b) Certificates evidencing coverage under the policy are
126 issued to residents of this state and contain in contrasting
127 color and not less than 10-point type the following statement:
128 “The benefits of the policy providing your coverage are governed
129 primarily by the law of a state other than Florida”; and
130 (c) The policy provides the benefits specified in ss.
131 627.419, 627.42391, 627.6574, 627.6575, 627.6579, 627.6612,
132 627.66121, 627.66122, 627.6613, 627.667, 627.6675, 627.6691, and
133 627.66911, and complies with the requirements of s. 627.66996.
134 (d) Applications for certificates of coverage offered to
135 residents of this state must contain, in contrasting color and
136 not less than 12-point type, the following statement on the same
137 page as the applicant’s signature:
138
139 “This policy is primarily governed by the laws of
140 ...insert state where the master policy if filed....
141 As a result, all of the rating laws applicable to
142 policies filed in this state do not apply to this
143 coverage, which may result in increases in your
144 premium at renewal that would not be permissible under
145 a Florida-approved policy. Any purchase of individual
146 health insurance should be considered carefully, as
147 future medical conditions may make it impossible to
148 qualify for another individual health policy. For
149 information concerning individual health coverage
150 under a Florida-approved policy, consult your agent or
151 the Florida Department of Financial Services.”
152
153 This paragraph applies only to group certificates providing
154 health insurance coverage which require individualized
155 underwriting to determine coverage eligibility for an individual
156 or premium rates to be charged to an individual except for the
157 following:
158 1. Policies issued to provide coverage to groups of persons
159 all of whom are in the same or functionally related licensed
160 professions, and providing coverage only to such licensed
161 professionals, their employees, or their dependents;
162 2. Policies providing coverage to small employers as
163 defined by s. 627.6699. Such policies shall be subject to, and
164 governed by, the provisions of s. 627.6699;
165 3. Policies issued to a bona fide association, as defined
166 by s. 627.6571(5), provided that there is a person or board
167 acting as a fiduciary for the benefit of the members, and such
168 association is not owned, controlled by, or otherwise associated
169 with the insurance company; or
170 4. Any accidental death, accidental death and
171 dismemberment, accident-only, vision-only, dental-only, hospital
172 indemnity-only, hospital accident-only, cancer, specified
173 disease, Medicare supplement, products that supplement Medicare,
174 long-term care, or disability income insurance, or similar
175 supplemental plans provided under a separate policy,
176 certificate, or contract of insurance, which cannot duplicate
177 coverage under an underlying health plan, coinsurance, or
178 deductibles or coverage issued as a supplement to workers’
179 compensation or similar insurance, or automobile medical-payment
180 insurance.
181 Section 5. This act shall take effect July 1, 2013, and
182 applies to policies and contracts issued or renewed on or after
183 that date.
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 everything before the enacting clause
188 and insert:
189 A bill to be entitled
190 An act relating to cancer treatment; providing a short
191 title; creating ss. 627.42391 and 641.313, F.S.;
192 providing definitions; requiring that an individual or
193 group insurance policy or a health maintenance
194 contract that provides coverage for cancer treatment
195 medications provide coverage for orally administered
196 cancer treatment medications on a basis no less
197 favorable than that required by the policy or contract
198 for intravenously administered or injected cancer
199 treatment medications; prohibiting insurers, health
200 maintenance organizations, and certain other entities
201 from engaging in specified actions to avoid compliance
202 with this act; amending s. 627.6515, F.S.; adding a
203 cross-reference to conform to changes made by the act;
204 providing an effective date.