Florida Senate - 2015 CS for SB 1250
By the Committee on Banking and Insurance; and Senator Montford
597-03197-15 20151250c1
1 A bill to be entitled
2 An act relating to motor vehicle insurance; amending
3 s. 627.311, F.S.; authorizing a joint underwriting
4 plan and the Florida Automobile Joint Underwriting
5 Association to cancel certain insurance policies
6 within a specified period under certain circumstances;
7 prohibiting an insured from canceling certain
8 insurance policies within a specified period;
9 providing exceptions; amending s. 627.727. F.S.;
10 authorizing insurers to electronically provide a form
11 to reject, or to select lower coverage amounts of,
12 uninsured motorist vehicle coverage to a named
13 insured; authorizing the named insured to sign the
14 form electronically; amending s. 627.736, F.S.;
15 revising the period during which the applicable fee
16 schedule or payment limitation under Medicare applies
17 with respect to certain personal injury protection
18 insurance coverage; defining the term “service year”;
19 deleting an obsolete date; amending s. 627.744, F.S.;
20 revising the exemption from the preinsurance
21 inspection requirements for private passenger motor
22 vehicles to include certain leased vehicles; revising
23 the list of documents that an insurer may require for
24 purposes of the exemption; prohibiting the physical
25 damage coverage on a motor vehicle from being
26 suspended during the term of a policy due to the
27 insurer’s option not to require certain documents;
28 authorizing a payment of a claim to be conditioned if
29 the insurer requires a document under certain
30 circumstances; providing an effective date.
31
32 Be It Enacted by the Legislature of the State of Florida:
33
34 Section 1. Paragraph (m) is added to subsection (3) of
35 section 627.311, Florida Statutes, to read:
36 627.311 Joint underwriters and joint reinsurers; public
37 records and public meetings exemptions.—
38 (3) The office may, after consultation with insurers
39 licensed to write automobile insurance in this state, approve a
40 joint underwriting plan for purposes of equitable apportionment
41 or sharing among insurers of automobile liability insurance and
42 other motor vehicle insurance, as an alternate to the plan
43 required in s. 627.351(1). All insurers authorized to write
44 automobile insurance in this state shall subscribe to the plan
45 and participate therein. The plan shall be subject to continuous
46 review by the office which may at any time disapprove the entire
47 plan or any part thereof if it determines that conditions have
48 changed since prior approval and that in view of the purposes of
49 the plan changes are warranted. Any disapproval by the office
50 shall be subject to the provisions of chapter 120. The Florida
51 Automobile Joint Underwriting Association is created under the
52 plan. The plan and the association:
53 (m) May cancel personal lines or commercial policies issued
54 by the plan within the first 60 days after the effective date of
55 the policy or binder for nonpayment of premium if the reason for
56 cancellation is the issuance of a check for the premium which is
57 dishonored for any reason or any other type of premium payment
58 which is rejected or deemed invalid. An insured may not cancel a
59 policy or binder within the first 90 days, or within a lesser
60 period as required by the plan, after the effective date of the
61 policy or binder, except:
62 1. Upon total destruction of the insured motor vehicle;
63 2. Upon transfer of ownership of the insured motor vehicle;
64 or
65 3. After purchase of another policy or binder covering the
66 motor vehicle that was covered under the policy being canceled.
67 Section 2. Subsection (1) of section 627.727, Florida
68 Statutes, is amended to read:
69 627.727 Motor vehicle insurance; uninsured and underinsured
70 vehicle coverage; insolvent insurer protection.—
71 (1) A No motor vehicle liability insurance policy that
72 which provides bodily injury liability coverage may not shall be
73 delivered or issued for delivery in this state with respect to a
74 any specifically insured or identified motor vehicle registered
75 or principally garaged in this state unless uninsured motor
76 vehicle coverage is provided therein or supplemental thereto for
77 the protection of persons insured by the policy thereunder who
78 are legally entitled to recover damages from owners or operators
79 of uninsured motor vehicles because of bodily injury, sickness,
80 or disease, including death, resulting therefrom. However, the
81 coverage required under this section is not applicable if when,
82 or to the extent that, an insured named in the policy makes a
83 written rejection of the coverage on behalf of all insureds
84 under the policy. If When a motor vehicle is leased for a period
85 of 1 year or longer and the lessor of the such vehicle, by the
86 terms of the lease contract, provides liability coverage on the
87 leased vehicle, the lessee of the such vehicle has shall have
88 the sole privilege to reject uninsured motorist coverage or to
89 select lower limits than the bodily injury liability limits,
90 regardless of whether the lessor is qualified as a self-insurer
91 pursuant to s. 324.171. Unless an insured, or lessee having the
92 privilege of rejecting uninsured motorist coverage, requests
93 such coverage or requests higher uninsured motorist limits in
94 writing, the coverage or the such higher uninsured motorist
95 limits are need not required to be provided in or supplemental
96 to any other policy that which renews, extends, changes,
97 supersedes, or replaces an existing policy with the same bodily
98 injury liability limits when an insured or lessee had rejected
99 the coverage. If When an insured or lessee has initially
100 selected limits of uninsured motorist coverage lower than her or
101 his bodily injury liability limits, higher limits of uninsured
102 motorist coverage are need not required to be provided in or
103 supplemental to any other policy that which renews, extends,
104 changes, supersedes, or replaces an existing policy with the
105 same bodily injury liability limits unless an insured requests
106 higher uninsured motorist coverage in writing. The rejection or
107 selection of lower limits must shall be made on a form approved
108 by the office. The form must shall fully advise the named
109 insured applicant of the nature of the coverage and must shall
110 state that the coverage is equal to bodily injury liability
111 limits unless lower limits are requested or the coverage is
112 rejected. The heading of the form shall be in 12-point bold type
113 and shall state: “You are electing not to purchase certain
114 valuable coverage which protects you and your family or you are
115 purchasing uninsured motorist limits less than your bodily
116 injury liability limits when you sign this form. Please read
117 carefully.” If this form is signed by a named insured, it will
118 be conclusively presumed that there was an informed, knowing
119 rejection of coverage or election of lower limits on behalf of
120 all insureds. The form may be provided electronically to and may
121 be signed electronically by the named insured. The requirement
122 for 12-point bold type does not apply to a form that is provided
123 electronically; however, the type for the heading of the form
124 must be larger than the type used for the surrounding text. The
125 insurer must shall notify the named insured at least annually of
126 her or his options as to the coverage required by this section.
127 Such notice must shall be part of, and attached to, the notice
128 of premium, must shall provide for a means to allow the insured
129 to request such coverage, and must shall be given in a manner
130 approved by the office. Receipt of this notice does not
131 constitute an affirmative waiver of the insured’s right to
132 uninsured motorist coverage where the insured has not signed a
133 selection or rejection form. The coverage described under this
134 section must shall be over and above, but may shall not
135 duplicate, the benefits available to an insured under any
136 workers’ compensation law, personal injury protection benefits,
137 disability benefits law, or similar law; under any automobile
138 medical expense coverage; under any motor vehicle liability
139 insurance coverage; or from the owner or operator of the
140 uninsured motor vehicle or any other person or organization
141 jointly or severally liable together with such owner or operator
142 for the accident; and such coverage must shall cover the
143 difference, if any, between the sum of such benefits and the
144 damages sustained, up to the maximum amount of such coverage
145 provided under this section. The amount of coverage available
146 under this section may shall not be reduced by a setoff against
147 any coverage, including liability insurance. Such coverage may
148 shall not inure directly or indirectly to the benefit of a any
149 workers’ compensation or disability benefits carrier or a any
150 person or organization qualifying as a self-insurer under a any
151 workers’ compensation or disability benefits law or similar law.
152 Section 3. Paragraph (a) of subsection (5) of section
153 627.736, Florida Statutes, is amended to read:
154 627.736 Required personal injury protection benefits;
155 exclusions; priority; claims.—
156 (5) CHARGES FOR TREATMENT OF INJURED PERSONS.—
157 (a) A physician, hospital, clinic, or other person or
158 institution lawfully rendering treatment to an injured person
159 for a bodily injury covered by personal injury protection
160 insurance may charge the insurer and injured party only a
161 reasonable amount pursuant to this section for the services and
162 supplies rendered, and the insurer providing such coverage may
163 pay for such charges directly to such person or institution
164 lawfully rendering such treatment if the insured receiving such
165 treatment or his or her guardian has countersigned the properly
166 completed invoice, bill, or claim form approved by the office
167 upon which such charges are to be paid for as having actually
168 been rendered, to the best knowledge of the insured or his or
169 her guardian. However, such a charge may not exceed the amount
170 the person or institution customarily charges for like services
171 or supplies. In determining whether a charge for a particular
172 service, treatment, or otherwise is reasonable, consideration
173 may be given to evidence of usual and customary charges and
174 payments accepted by the provider involved in the dispute,
175 reimbursement levels in the community and various federal and
176 state medical fee schedules applicable to motor vehicle and
177 other insurance coverages, and other information relevant to the
178 reasonableness of the reimbursement for the service, treatment,
179 or supply.
180 1. The insurer may limit reimbursement to 80 percent of the
181 following schedule of maximum charges:
182 a. For emergency transport and treatment by providers
183 licensed under chapter 401, 200 percent of Medicare.
184 b. For emergency services and care provided by a hospital
185 licensed under chapter 395, 75 percent of the hospital’s usual
186 and customary charges.
187 c. For emergency services and care as defined by s. 395.002
188 provided in a facility licensed under chapter 395 rendered by a
189 physician or dentist, and related hospital inpatient services
190 rendered by a physician or dentist, the usual and customary
191 charges in the community.
192 d. For hospital inpatient services, other than emergency
193 services and care, 200 percent of the Medicare Part A
194 prospective payment applicable to the specific hospital
195 providing the inpatient services.
196 e. For hospital outpatient services, other than emergency
197 services and care, 200 percent of the Medicare Part A Ambulatory
198 Payment Classification for the specific hospital providing the
199 outpatient services.
200 f. For all other medical services, supplies, and care, 200
201 percent of the allowable amount under:
202 (I) The participating physicians fee schedule of Medicare
203 Part B, except as provided in sub-sub-subparagraphs (II) and
204 (III).
205 (II) Medicare Part B, in the case of services, supplies,
206 and care provided by ambulatory surgical centers and clinical
207 laboratories.
208 (III) The Durable Medical Equipment Prosthetics/Orthotics
209 and Supplies fee schedule of Medicare Part B, in the case of
210 durable medical equipment.
211
212 However, if such services, supplies, or care is not reimbursable
213 under Medicare Part B, as provided in this sub-subparagraph, the
214 insurer may limit reimbursement to 80 percent of the maximum
215 reimbursable allowance under workers’ compensation, as
216 determined under s. 440.13 and rules adopted thereunder which
217 are in effect at the time such services, supplies, or care is
218 provided. Services, supplies, or care that is not reimbursable
219 under Medicare or workers’ compensation is not required to be
220 reimbursed by the insurer.
221 2. For purposes of subparagraph 1., the applicable fee
222 schedule or payment limitation under Medicare is the fee
223 schedule or payment limitation in effect on March 1 of the
224 service year in which the services, supplies, or care is
225 rendered and for the area in which such services, supplies, or
226 care is rendered, and the applicable fee schedule or payment
227 limitation applies to services, supplies, or care rendered
228 during throughout the remainder of that service year,
229 notwithstanding any subsequent change made to the fee schedule
230 or payment limitation, except that it may not be less than the
231 allowable amount under the applicable schedule of Medicare Part
232 B for 2007 for medical services, supplies, and care subject to
233 Medicare Part B. For purposes of this subparagraph, the term
234 “service year” means the period from March 1 through the end of
235 February of the following year.
236 3. Subparagraph 1. does not allow the insurer to apply any
237 limitation on the number of treatments or other utilization
238 limits that apply under Medicare or workers’ compensation. An
239 insurer that applies the allowable payment limitations of
240 subparagraph 1. must reimburse a provider who lawfully provided
241 care or treatment under the scope of his or her license,
242 regardless of whether such provider is entitled to reimbursement
243 under Medicare due to restrictions or limitations on the types
244 or discipline of health care providers who may be reimbursed for
245 particular procedures or procedure codes. However, subparagraph
246 1. does not prohibit an insurer from using the Medicare coding
247 policies and payment methodologies of the federal Centers for
248 Medicare and Medicaid Services, including applicable modifiers,
249 to determine the appropriate amount of reimbursement for medical
250 services, supplies, or care if the coding policy or payment
251 methodology does not constitute a utilization limit.
252 4. If an insurer limits payment as authorized by
253 subparagraph 1., the person providing such services, supplies,
254 or care may not bill or attempt to collect from the insured any
255 amount in excess of such limits, except for amounts that are not
256 covered by the insured’s personal injury protection coverage due
257 to the coinsurance amount or maximum policy limits.
258 5. Effective July 1, 2012, An insurer may limit payment as
259 authorized by this paragraph only if the insurance policy
260 includes a notice at the time of issuance or renewal that the
261 insurer may limit payment pursuant to the schedule of charges
262 specified in this paragraph. A policy form approved by the
263 office satisfies this requirement. If a provider submits a
264 charge for an amount less than the amount allowed under
265 subparagraph 1., the insurer may pay the amount of the charge
266 submitted.
267 Section 4. Paragraphs (a) and (b) of subsection (2) of
268 section 627.744, Florida Statutes, are amended to read:
269 627.744 Required preinsurance inspection of private
270 passenger motor vehicles.—
271 (2) This section does not apply:
272 (a) To a policy for a policyholder who has been insured for
273 2 years or longer, without interruption, under a private
274 passenger motor vehicle policy that which provides physical
275 damage coverage for any vehicle, if the agent of the insurer
276 verifies the previous coverage.
277 (b) To a new, unused motor vehicle purchased or leased from
278 a licensed motor vehicle dealer or leasing company., if The
279 insurer may require is provided with:
280 1. A bill of sale, or buyer’s order, or lease agreement
281 that which contains a full description of the motor vehicle,
282 including all options and accessories; or
283 2. A copy of the title or registration that which
284 establishes transfer of ownership from the dealer or leasing
285 company to the customer and a copy of the window sticker or the
286 dealer invoice showing the itemized options and equipment and
287 the total retail price of the vehicle.
288
289 For the purposes of this paragraph, the physical damage coverage
290 on the motor vehicle may not be suspended during the term of the
291 policy due to the applicant’s failure to provide or the
292 insurer’s option not to require the required documents. However,
293 if the insurer requires a document under this paragraph at the
294 time the policy is issued, payment of a claim may be is
295 conditioned upon the receipt by the insurer of the required
296 documents, and no physical damage loss occurring after the
297 effective date of the coverage is payable until the documents
298 are provided to the insurer.
299 Section 5. This act shall take effect July 1, 2015.