Florida Senate - 2015 SB 1250
By Senator Montford
3-00627A-15 20151250__
1 A bill to be entitled
2 An act relating to motor vehicle insurance; amending
3 s. 627.727, F.S.; authorizing insurers to
4 electronically provide a form to reject, or select
5 lower coverage amounts of, uninsured motorist vehicle
6 coverage to an insurance applicant; authorizing the
7 applicant to sign the form electronically; amending s.
8 627.736, F.S.; revising the period during which the
9 applicable fee schedule or payment limitation under
10 Medicare applies with respect to certain personal
11 injury protection insurance coverage; deleting an
12 obsolete date; amending s. 627.744, F.S.; revising the
13 exemption from the preinsurance inspection
14 requirements for private passenger motor vehicles to
15 include certain leased vehicles; revising the list of
16 documents that an insurer may require for purposes of
17 the exemption; prohibiting the physical damage
18 coverage on a motor vehicle from being suspended
19 during the term of a policy due to the insurer’s
20 option not to require certain documents; authorizing a
21 payment of a claim to be conditioned if the insurer
22 requires a document under certain circumstances;
23 providing an effective date.
24
25 Be It Enacted by the Legislature of the State of Florida:
26
27 Section 1. Subsection (1) of section 627.727, Florida
28 Statutes, is amended to read:
29 627.727 Motor vehicle insurance; uninsured and underinsured
30 vehicle coverage; insolvent insurer protection.—
31 (1) A No motor vehicle liability insurance policy that
32 which provides bodily injury liability coverage may not shall be
33 delivered or issued for delivery in this state with respect to a
34 any specifically insured or identified motor vehicle registered
35 or principally garaged in this state unless uninsured motor
36 vehicle coverage is provided therein or supplemental thereto for
37 the protection of persons insured by the policy thereunder who
38 are legally entitled to recover damages from owners or operators
39 of uninsured motor vehicles because of bodily injury, sickness,
40 or disease, including death, resulting therefrom. However, the
41 coverage required under this section is not applicable if when,
42 or to the extent that, an insured named in the policy makes a
43 written rejection of the coverage on behalf of all insureds
44 under the policy. If When a motor vehicle is leased for a period
45 of 1 year or longer and the lessor of the such vehicle, by the
46 terms of the lease contract, provides liability coverage on the
47 leased vehicle, the lessee of the such vehicle has shall have
48 the sole privilege to reject uninsured motorist coverage or to
49 select lower limits than the bodily injury liability limits,
50 regardless of whether the lessor is qualified as a self-insurer
51 pursuant to s. 324.171. Unless an insured, or lessee having the
52 privilege of rejecting uninsured motorist coverage, requests
53 such coverage or requests higher uninsured motorist limits in
54 writing, the coverage or the such higher uninsured motorist
55 limits are need not required to be provided in or supplemental
56 to any other policy that which renews, extends, changes,
57 supersedes, or replaces an existing policy with the same bodily
58 injury liability limits when an insured or lessee had rejected
59 the coverage. If When an insured or lessee has initially
60 selected limits of uninsured motorist coverage lower than her or
61 his bodily injury liability limits, higher limits of uninsured
62 motorist coverage are need not required to be provided in or
63 supplemental to any other policy that which renews, extends,
64 changes, supersedes, or replaces an existing policy with the
65 same bodily injury liability limits unless an insured requests
66 higher uninsured motorist coverage in writing. The rejection or
67 selection of lower limits must shall be made on a form approved
68 by the office. The form must shall fully advise the applicant of
69 the nature of the coverage and must shall state that the
70 coverage is equal to bodily injury liability limits unless lower
71 limits are requested or the coverage is rejected. The heading of
72 the form shall be in 12-point bold type and shall state: “You
73 are electing not to purchase certain valuable coverage which
74 protects you and your family or you are purchasing uninsured
75 motorist limits less than your bodily injury liability limits
76 when you sign this form. Please read carefully.” If this form is
77 signed by a named insured, it will be conclusively presumed that
78 there was an informed, knowing rejection of coverage or election
79 of lower limits on behalf of all insureds. The form may be
80 provided electronically to and may be signed electronically by
81 the applicant. The requirement for 12-point bold type does not
82 apply to a form that is provided electronically; however, the
83 type for the heading of the form must be larger than the type
84 used for the surrounding text. The insurer must shall notify the
85 named insured at least annually of her or his options as to the
86 coverage required by this section. Such notice must shall be
87 part of, and attached to, the notice of premium, must shall
88 provide for a means to allow the insured to request such
89 coverage, and must shall be given in a manner approved by the
90 office. Receipt of this notice does not constitute an
91 affirmative waiver of the insured’s right to uninsured motorist
92 coverage where the insured has not signed a selection or
93 rejection form. The coverage described under this section must
94 shall be over and above, but may shall not duplicate, the
95 benefits available to an insured under any workers’ compensation
96 law, personal injury protection benefits, disability benefits
97 law, or similar law; under any automobile medical expense
98 coverage; under any motor vehicle liability insurance coverage;
99 or from the owner or operator of the uninsured motor vehicle or
100 any other person or organization jointly or severally liable
101 together with such owner or operator for the accident; and such
102 coverage must shall cover the difference, if any, between the
103 sum of such benefits and the damages sustained, up to the
104 maximum amount of such coverage provided under this section. The
105 amount of coverage available under this section may shall not be
106 reduced by a setoff against any coverage, including liability
107 insurance. Such coverage may shall not inure directly or
108 indirectly to the benefit of a any workers’ compensation or
109 disability benefits carrier or a any person or organization
110 qualifying as a self-insurer under a any workers’ compensation
111 or disability benefits law or similar law.
112 Section 2. Paragraph (a) of subsection (5) of section
113 627.736, Florida Statutes, is amended to read:
114 627.736 Required personal injury protection benefits;
115 exclusions; priority; claims.—
116 (5) CHARGES FOR TREATMENT OF INJURED PERSONS.—
117 (a) A physician, hospital, clinic, or other person or
118 institution lawfully rendering treatment to an injured person
119 for a bodily injury covered by personal injury protection
120 insurance may charge the insurer and injured party only a
121 reasonable amount pursuant to this section for the services and
122 supplies rendered, and the insurer providing such coverage may
123 pay for such charges directly to such person or institution
124 lawfully rendering such treatment if the insured receiving such
125 treatment or his or her guardian has countersigned the properly
126 completed invoice, bill, or claim form approved by the office
127 upon which such charges are to be paid for as having actually
128 been rendered, to the best knowledge of the insured or his or
129 her guardian. However, such a charge may not exceed the amount
130 the person or institution customarily charges for like services
131 or supplies. In determining whether a charge for a particular
132 service, treatment, or otherwise is reasonable, consideration
133 may be given to evidence of usual and customary charges and
134 payments accepted by the provider involved in the dispute,
135 reimbursement levels in the community and various federal and
136 state medical fee schedules applicable to motor vehicle and
137 other insurance coverages, and other information relevant to the
138 reasonableness of the reimbursement for the service, treatment,
139 or supply.
140 1. The insurer may limit reimbursement to 80 percent of the
141 following schedule of maximum charges:
142 a. For emergency transport and treatment by providers
143 licensed under chapter 401, 200 percent of Medicare.
144 b. For emergency services and care provided by a hospital
145 licensed under chapter 395, 75 percent of the hospital’s usual
146 and customary charges.
147 c. For emergency services and care as defined by s. 395.002
148 provided in a facility licensed under chapter 395 rendered by a
149 physician or dentist, and related hospital inpatient services
150 rendered by a physician or dentist, the usual and customary
151 charges in the community.
152 d. For hospital inpatient services, other than emergency
153 services and care, 200 percent of the Medicare Part A
154 prospective payment applicable to the specific hospital
155 providing the inpatient services.
156 e. For hospital outpatient services, other than emergency
157 services and care, 200 percent of the Medicare Part A Ambulatory
158 Payment Classification for the specific hospital providing the
159 outpatient services.
160 f. For all other medical services, supplies, and care, 200
161 percent of the allowable amount under:
162 (I) The participating physicians fee schedule of Medicare
163 Part B, except as provided in sub-sub-subparagraphs (II) and
164 (III).
165 (II) Medicare Part B, in the case of services, supplies,
166 and care provided by ambulatory surgical centers and clinical
167 laboratories.
168 (III) The Durable Medical Equipment Prosthetics/Orthotics
169 and Supplies fee schedule of Medicare Part B, in the case of
170 durable medical equipment.
171
172 However, if such services, supplies, or care is not reimbursable
173 under Medicare Part B, as provided in this sub-subparagraph, the
174 insurer may limit reimbursement to 80 percent of the maximum
175 reimbursable allowance under workers’ compensation, as
176 determined under s. 440.13 and rules adopted thereunder which
177 are in effect at the time such services, supplies, or care is
178 provided. Services, supplies, or care that is not reimbursable
179 under Medicare or workers’ compensation is not required to be
180 reimbursed by the insurer.
181 2. For purposes of subparagraph 1., the applicable fee
182 schedule or payment limitation under Medicare is the fee
183 schedule or payment limitation in effect on March 1 of the year
184 in which the services, supplies, or care is rendered and for the
185 area in which such services, supplies, or care is rendered, and
186 the applicable fee schedule or payment limitation applies from
187 March 1 until the last day of February throughout the remainder
188 of the following that year, notwithstanding any subsequent
189 change made to the fee schedule or payment limitation, except
190 that it may not be less than the allowable amount under the
191 applicable schedule of Medicare Part B for 2007 for medical
192 services, supplies, and care subject to Medicare Part B.
193 3. Subparagraph 1. does not allow the insurer to apply any
194 limitation on the number of treatments or other utilization
195 limits that apply under Medicare or workers’ compensation. An
196 insurer that applies the allowable payment limitations of
197 subparagraph 1. must reimburse a provider who lawfully provided
198 care or treatment under the scope of his or her license,
199 regardless of whether such provider is entitled to reimbursement
200 under Medicare due to restrictions or limitations on the types
201 or discipline of health care providers who may be reimbursed for
202 particular procedures or procedure codes. However, subparagraph
203 1. does not prohibit an insurer from using the Medicare coding
204 policies and payment methodologies of the federal Centers for
205 Medicare and Medicaid Services, including applicable modifiers,
206 to determine the appropriate amount of reimbursement for medical
207 services, supplies, or care if the coding policy or payment
208 methodology does not constitute a utilization limit.
209 4. If an insurer limits payment as authorized by
210 subparagraph 1., the person providing such services, supplies,
211 or care may not bill or attempt to collect from the insured any
212 amount in excess of such limits, except for amounts that are not
213 covered by the insured’s personal injury protection coverage due
214 to the coinsurance amount or maximum policy limits.
215 5. Effective July 1, 2012, An insurer may limit payment as
216 authorized by this paragraph only if the insurance policy
217 includes a notice at the time of issuance or renewal that the
218 insurer may limit payment pursuant to the schedule of charges
219 specified in this paragraph. A policy form approved by the
220 office satisfies this requirement. If a provider submits a
221 charge for an amount less than the amount allowed under
222 subparagraph 1., the insurer may pay the amount of the charge
223 submitted.
224 Section 3. Paragraphs (a) and (b) of subsection (2) of
225 section 627.744, Florida Statutes, are amended to read:
226 627.744 Required preinsurance inspection of private
227 passenger motor vehicles.—
228 (2) This section does not apply:
229 (a) To a policy for a policyholder who has been insured for
230 2 years or longer, without interruption, under a private
231 passenger motor vehicle policy that which provides physical
232 damage coverage for any vehicle, if the agent of the insurer
233 verifies the previous coverage.
234 (b) To a new, unused motor vehicle purchased or leased from
235 a licensed motor vehicle dealer or leasing company., if The
236 insurer may require is provided with:
237 1. A bill of sale, or buyer’s order, or lease agreement
238 that which contains a full description of the motor vehicle,
239 including all options and accessories; or
240 2. A copy of the title or registration that which
241 establishes transfer of ownership from the dealer or leasing
242 company to the customer and a copy of the window sticker or the
243 dealer invoice showing the itemized options and equipment and
244 the total retail price of the vehicle.
245
246 For the purposes of this paragraph, the physical damage coverage
247 on the motor vehicle may not be suspended during the term of the
248 policy due to the applicant’s failure to provide or the
249 insurer’s option not to require the required documents. However,
250 if the insurer requires a document under this paragraph at the
251 time the policy is issued, payment of a claim may be is
252 conditioned upon the receipt by the insurer of the required
253 documents, and no physical damage loss occurring after the
254 effective date of the coverage is payable until the documents
255 are provided to the insurer.
256 Section 4. This act shall take effect July 1, 2015.