Florida Senate - 2015                              CS for SB 856
       
       
        
       By the Committee on Banking and Insurance; and Senator Latvala
       
       
       
       
       
       597-02407-15                                           2015856c1
    1                        A bill to be entitled                      
    2         An act relating to health provider contracts; amending
    3         ss. 627.6474, 636.035, and 641.315, F.S.; providing
    4         that a contract between a health insurer, a prepaid
    5         limited health service organization, or a health
    6         maintenance organization, respectively, or a third
    7         party administrator thereof, and a licensed
    8         ophthalmologist or optometrist may not require the
    9         licensee to provide vision care services as a
   10         condition of providing any other service or to
   11         purchase certain materials or services from specified
   12         entities; providing that a contract between a health
   13         insurer, a prepaid limited health service
   14         organization, or a health maintenance organization,
   15         respectively, or a third-party administrator thereof,
   16         and a licensed optician may not require the licensee
   17         to purchase certain materials from specified entities;
   18         providing that a violation of the act’s prohibitions
   19         constitutes a specified unfair insurance trade
   20         practice; providing an effective date.
   21          
   22  Be It Enacted by the Legislature of the State of Florida:
   23  
   24         Section 1. Subsection (3) is added to section 627.6474,
   25  Florida Statutes, to read:
   26         627.6474 Provider contracts.—
   27         (3)(a) A contract between a health insurer or the insurer’s
   28  third-party administrator and:
   29         1. An ophthalmologist licensed pursuant to chapter 458 or
   30  chapter 459 or an optometrist licensed pursuant to chapter 463
   31  may not require such licensee to:
   32         a. Provide vision care services as a condition of
   33  participating as a provider of any other type of service to an
   34  insured; or
   35         b. Purchase a material or service used by the licensee from
   36  an entity in which the insurer or the insurer’s third-party
   37  administrator has a direct or indirect ownership, financial, or
   38  controlling interest.
   39         2. An optician licensed pursuant to part I of chapter 484
   40  may not require such licensee to purchase a material used by the
   41  licensee from an entity in which the insurer or the insurer’s
   42  third-party administrator has a direct or indirect ownership,
   43  financial, or controlling interest.
   44         (b) A violation of this subsection constitutes an unfair
   45  insurance trade practice under s. 626.9541(1)(d).
   46         Section 2. Subsection (14) is added to section 636.035,
   47  Florida Statutes, to read:
   48         636.035 Provider arrangements.—
   49         (14)(a) A contract between a prepaid limited health service
   50  organization or the organization’s third party administrator
   51  and:
   52         1. An ophthalmologist licensed pursuant to chapter 458 or
   53  chapter 459 or an optometrist licensed pursuant to chapter 463
   54  may not require such licensee to:
   55         a. Provide vision care services as a condition of
   56  participating as a provider of any other type of service to a
   57  subscriber; or
   58         b. Purchase a material or service used by the licensee from
   59  an entity in which the organization or organization’s third
   60  party administrator has a direct or indirect ownership,
   61  financial, or controlling interest.
   62         2. An optician licensed pursuant to part I of chapter 484
   63  may not require such licensee to purchase a material used by the
   64  licensee from an entity in which the organization or
   65  organization’s third-party administrator has a direct or
   66  indirect ownership, financial, or controlling interest.
   67         (b) A violation of this subsection constitutes an unfair
   68  insurance trade practice under s. 626.9541(1)(d).
   69         Section 3. Subsection (12) is added to section 641.315,
   70  Florida Statutes, to read:
   71         641.315 Provider contracts.—
   72         (12)(a) A contract between a health maintenance
   73  organization or the organization’s third-party administrator
   74  and:
   75         1. An ophthalmologist licensed pursuant to chapter 458 or
   76  chapter 459 or an optometrist licensed pursuant to chapter 463
   77  may not require such licensee to:
   78         a. Provide vision care services as a condition of
   79  participating as a provider of any other type of service to a
   80  subscriber; or
   81         b. Purchase a material or service used by the licensee from
   82  an entity in which the organization or organization’s third
   83  party administrator has a direct or indirect ownership,
   84  financial, or controlling interest.
   85         2. An optician licensed pursuant to part I of chapter 484
   86  may not require such licensee to purchase a material used by the
   87  licensee from an entity in which the organization or
   88  organization’s third-party administrator has a direct or
   89  indirect ownership, financial, or controlling interest.
   90         (b) A violation of this subsection constitutes an unfair
   91  insurance trade practice under s. 626.9541(1)(d).
   92         Section 4. This act shall take effect July 1, 2015.