Florida Senate - 2014 SB 1570
By Senator Sachs
34-00735-14 20141570__
1 A bill to be entitled
2 An act relating to health insurance; amending ss.
3 627.410, 627.411, and 641.31, F.S.; deleting
4 provisions that exempt certain nongrandfathered health
5 plans from rate review or approval by the Office of
6 Insurance Regulation for a specified period; providing
7 an effective date.
8
9 Be It Enacted by the Legislature of the State of Florida:
10
11 Section 1. Subsection (9) of section 627.410, Florida
12 Statutes, is amended to read:
13 627.410 Filing, approval of forms.—
14 (9) For plan years 2014 and 2015, nongrandfathered health
15 plans for the individual or small group market are not subject
16 to rate review or approval by the office. An insurer or health
17 maintenance organization issuing or renewing such health plans
18 shall file rates and any change in rates with the office as
19 required by paragraph (6)(a), but the filing and rates are not
20 subject to subsection (2); paragraph (6)(b), paragraph (6)(c),
21 or paragraph (6)(d); or subsection (7).
22 (a) For each individual and small group nongrandfathered
23 health plan, an insurer or health maintenance organization shall
24 include a notice describing or illustrating the estimated impact
25 of PPACA on monthly premiums with the delivery of the policy or
26 contract or, upon renewal, the premium renewal notice. The
27 notice must be in a format established by rule of the
28 commission. The format must specify how the information required
29 under paragraph (b) is to be described or illustrated, and may
30 allow for specified variations from such requirements in order
31 to provide a more accurate and meaningful disclosure of the
32 estimated impact of PPACA on monthly premiums, as determined by
33 the commission. All notices shall be submitted to the office for
34 informational purposes by September 1, 2013. The notice is
35 required only for the first issuance or renewal of the policy or
36 contract on or after January 1, 2014.
37 (b) The information provided in the notice shall be based
38 on the statewide average premium for the policy or contract for
39 the bronze, silver, gold, or platinum level plan, whichever is
40 applicable to the policy or contract, and provide an estimate of
41 the following effects of PPACA requirements:
42 1. The dollar amount of the premium which is attributable
43 to the impact of guaranteed issuance of coverage. This estimate
44 must include, but is not required to itemize, the impact of the
45 requirement that rates be based on factors unrelated to health
46 status, how the individual coverage mandate and subsidies
47 provided in the health insurance exchange established in this
48 state pursuant to PPACA affect the impact of guaranteed issuance
49 of coverage, and estimated reinsurance credits.
50 2. The dollar amount of the premium which is attributable
51 to fees, taxes, and assessments.
52 3. For individual policies or contracts, the dollar amount
53 of the premium increase or decrease from the premium that would
54 have otherwise been due which is attributable to the combined
55 impact of the requirement that rates for age be limited to a 3
56 to-1 ratio and the prohibition against using gender as a rating
57 factor. This estimate must be displayed for the average rates
58 for male and female insureds, respectively, for the following
59 three age categories: age 21 years to 29 years, age 30 years to
60 54 years, and age 55 years to 64 years.
61 4. The dollar amount which is attributable to the
62 requirement that essential health benefits be provided and to
63 meet the required actuarial value for the product, as compared
64 to the statewide average premium for the policy or contract for
65 the plan issued by that insurer or organization that has the
66 highest enrollment in the individual or small group market on
67 July 1, 2013, whichever is applicable. The statewide average
68 premiums for the plan that has the highest enrollment must
69 include all policyholders, including those that have health
70 conditions that increase the standard premium.
71 (c) The office, in consultation with the department, shall
72 develop a summary of the estimated impact of PPACA on monthly
73 premiums as contained in the notices submitted by insurers and
74 health maintenance organizations, which must be available on the
75 respective websites of the office and department by October 1,
76 2013.
77 (d) This subsection is repealed on March 1, 2015.
78 Section 2. Subsection (4) of section 627.411, Florida
79 Statutes, is amended to read:
80 627.411 Grounds for disapproval.—
81 (4) The provisions of this section which apply to rates,
82 rating practices, or the relationship of benefits to the premium
83 charged do not apply to nongrandfathered health plans described
84 in s. 627.410(9). This subsection is repealed on March 1, 2015.
85 Section 3. Paragraph (f) of subsection (3) of section
86 641.31, Florida Statutes, is amended to read:
87 641.31 Health maintenance contracts.—
88 (3)
89 (f)1. For plan years 2014 and 2015, nongrandfathered health
90 plans for the individual or small group market are not subject
91 to rate review or approval by the office. A health maintenance
92 organization that issues or renews a nongrandfathered health
93 plan is subject to s. 627.410(9). As used in this paragraph, the
94 terms “PPACA” and “nongrandfathered health plan” have the same
95 meanings as those terms are defined in s. 627.402.
96 2. This paragraph is repealed effective March 1, 2015.
97 Section 4. This act shall take effect upon becoming a law.