Florida Senate - 2016                        COMMITTEE AMENDMENT
       Bill No. CS for SB 1170
       
       
       
       
       
       
                                Ì180490#Î180490                         
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: RCS            .                                
                  02/15/2016           .                                
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       Appropriations Subcommittee on Health and Human Services
       (Richter) recommended the following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Delete lines 275 - 779
    4  and insert:
    5  policies.—Sections 627.6561, 627.65615, 627.65625, and 627.6571
    6  do not apply to:
    7         (1) any group insurance policy in relation to its provision
    8  of excepted benefits described in s. 627.6513(1)-(14)
    9  627.6561(5)(b).
   10         (2)Any group health insurance policy in relation to its
   11  provision of excepted benefits described in s. 627.6561(5)(c),
   12  if the benefits:
   13         (a)Are provided under a separate policy, certificate, or
   14  contract of insurance; or
   15         (b)Are otherwise not an integral part of the policy.
   16         (3)Any group health insurance policy in relation to its
   17  provision of excepted benefits described in s. 627.6561(5)(d),
   18  if all of the following conditions are met:
   19         (a)The benefits are provided under a separate policy,
   20  certificate, or contract of insurance;
   21         (b)There is no coordination between the provision of such
   22  benefits and any exclusion of benefits under any group policy
   23  maintained by the same policyholder; and
   24         (c)Such benefits are paid with respect to an event without
   25  regard to whether benefits are provided with respect to such an
   26  event under any group health policy maintained by the same
   27  policyholder.
   28         (4)Any group health policy in relation to its provision of
   29  excepted benefits described in s. 627.6561(5)(e), if the
   30  benefits are provided under a separate policy, certificate, or
   31  contract of insurance.
   32         Section 13. Section 627.6513, Florida Statutes, is amended
   33  to read:
   34         627.6513 Scope.—Section 641.312 and the provisions of the
   35  Employee Retirement Income Security Act of 1974, as implemented
   36  by 29 C.F.R. s. 2560.503-1, relating to internal grievances,
   37  apply to all group health insurance policies issued under this
   38  part. This section does not apply to a group health insurance
   39  policy that is subject to the Subscriber Assistance Program in
   40  s. 408.7056 or to: the types of benefits or coverages provided
   41  under s. 627.6561(5)(b)-(e) issued in any market.
   42         (1)Coverage only for accident insurance, or disability
   43  income insurance, or any combination thereof.
   44         (2)Coverage issued as a supplement to liability insurance.
   45         (3)Liability insurance, including general liability
   46  insurance and automobile liability insurance.
   47         (4)Workers’ compensation or similar insurance.
   48         (5)Automobile medical payment insurance.
   49         (6)Credit-only insurance.
   50         (7)Coverage for onsite medical clinics, including prepaid
   51  health clinics under part II of chapter 641.
   52         (8)Other similar insurance coverage, specified in rules
   53  adopted by the commission, under which benefits for medical care
   54  are secondary or incidental to other insurance benefits. To the
   55  extent possible, such rules must be consistent with regulations
   56  adopted by the United States Department of Health and Human
   57  Services.
   58         (9)Limited scope dental or vision benefits, if offered
   59  separately.
   60         (10)Benefits for long-term care, nursing home care, home
   61  health care, or community-based care, or any combination
   62  thereof, if offered separately.
   63         (11)Other similar, limited benefits, if offered
   64  separately, as specified in rules adopted by the commission.
   65         (12)Coverage only for a specified disease or illness, if
   66  offered as independent, noncoordinated benefits.
   67         (13)Hospital indemnity or other fixed indemnity insurance,
   68  if offered as independent, noncoordinated benefits.
   69         (14)Benefits provided through a Medicare supplemental
   70  health insurance policy, as defined under s. 1882(g)(1) of the
   71  Social Security Act, coverage supplemental to the coverage
   72  provided under 10 U.S.C. chapter 55, and similar supplemental
   73  coverage provided to coverage under a group health plan, which
   74  are offered as a separate insurance policy and as independent,
   75  noncoordinated benefits.
   76         Section 14. Section 627.6561, Florida Statutes, is amended
   77  to read:
   78         627.6561 Preexisting conditions.—
   79         (1) As used in this section, the term:
   80         (a) “Enrollment date” means, with respect to an individual
   81  covered under a group health policy, the date of enrollment of
   82  the individual in the plan or coverage or, if earlier, the first
   83  day of the waiting period of such enrollment.
   84         (b) “Late enrollee” means, with respect to coverage under a
   85  group health policy, a participant or beneficiary who enrolls
   86  under the policy other than during:
   87         1. The first period in which the individual is eligible to
   88  enroll under the policy.
   89         2. A special enrollment period, as provided under s.
   90  627.65615.
   91         (c) “Waiting period” means, with respect to a group health
   92  policy and an individual who is a potential participant or
   93  beneficiary of the policy, the period that must pass with
   94  respect to the individual before the individual is eligible to
   95  be covered for benefits under the terms of the policy.
   96         (2) Subject to the exceptions specified in subsection (4),
   97  an insurer that offers group health insurance coverage may, with
   98  respect to a participant or beneficiary, impose a preexisting
   99  condition exclusion only if:
  100         (a) Such exclusion relates to a physical or mental
  101  condition, regardless of the cause of the condition, for which
  102  medical advice, diagnosis, care, or treatment was recommended or
  103  received within the 6-month period ending on the enrollment
  104  date;
  105         (b) Such exclusion extends for a period of not more than 12
  106  months, or 18 months in the case of a late enrollee, after the
  107  enrollment date; and
  108         (c) The period of any such preexisting condition exclusion
  109  is reduced by the aggregate of the periods of creditable
  110  coverage, as defined in s. 627.6562(3) subsection (5),
  111  applicable to the participant or beneficiary as of the
  112  enrollment date.
  113         (3) Genetic information may not be treated as a condition
  114  described in paragraph (2)(a) in the absence of a diagnosis of
  115  the condition related to such information.
  116         (4)(a) Subject to paragraph (b), an insurer that offers
  117  group health insurance coverage may not impose any preexisting
  118  condition exclusion in the case of:
  119         1. An individual who, as of the last day of the 30-day
  120  period beginning with the date of birth, is covered under
  121  creditable coverage.
  122         2. A child who is adopted or placed for adoption before
  123  attaining 18 years of age and who, as of the last day of the 30
  124  day period beginning on the date of the adoption or placement
  125  for adoption, is covered under creditable coverage. This
  126  provision does not apply to coverage before the date of such
  127  adoption or placement for adoption.
  128         3. Pregnancy.
  129         (b) Subparagraphs 1. and 2. do not apply to an individual
  130  after the end of the first 63-day period during all of which the
  131  individual was not covered under any creditable coverage.
  132         (5)(a)The term, “creditable coverage,” means, with respect
  133  to an individual, coverage of the individual under any of the
  134  following:
  135         1.A group health plan, as defined in s. 2791 of the Public
  136  Health Service Act.
  137         2.Health insurance coverage consisting of medical care,
  138  provided directly, through insurance or reimbursement, or
  139  otherwise and including terms and services paid for as medical
  140  care, under any hospital or medical service policy or
  141  certificate, hospital or medical service plan contract, or
  142  health maintenance contract offered by a health insurance
  143  issuer.
  144         3.Part A or part B of Title XVIII of the Social Security
  145  Act.
  146         4.Title XIX of the Social Security Act, other than
  147  coverage consisting solely of benefits under s. 1928.
  148         5.Chapter 55 of Title 10, United States Code.
  149         6.A medical care program of the Indian Health Service or
  150  of a tribal organization.
  151         7.The Florida Comprehensive Health Association or another
  152  state health benefit risk pool.
  153         8.A health plan offered under chapter 89 of Title 5,
  154  United States Code.
  155         9.A public health plan as defined by rules adopted by the
  156  commission. To the greatest extent possible, such rules must be
  157  consistent with regulations adopted by the United States
  158  Department of Health and Human Services.
  159         10.A health benefit plan under s. 5(e) of the Peace Corps
  160  Act (22 U.S.C. s. 2504(e)).
  161         (b)Creditable coverage does not include coverage that
  162  consists solely of one or more or any combination thereof of the
  163  following excepted benefits:
  164         1.Coverage only for accident, or disability income
  165  insurance, or any combination thereof.
  166         2.Coverage issued as a supplement to liability insurance.
  167         3.Liability insurance, including general liability
  168  insurance and automobile liability insurance.
  169         4.Workers’ compensation or similar insurance.
  170         5.Automobile medical payment insurance.
  171         6.Credit-only insurance.
  172         7.Coverage for onsite medical clinics, including prepaid
  173  health clinics under part II of chapter 641.
  174         8.Other similar insurance coverage, specified in rules
  175  adopted by the commission, under which benefits for medical care
  176  are secondary or incidental to other insurance benefits. To the
  177  extent possible, such rules must be consistent with regulations
  178  adopted by the United States Department of Health and Human
  179  Services.
  180         (c)The following benefits are not subject to the
  181  creditable coverage requirements, if offered separately:
  182         1.Limited scope dental or vision benefits.
  183         2.Benefits for long-term care, nursing home care, home
  184  health care, community-based care, or any combination thereof.
  185         3.Such other similar, limited benefits as are specified in
  186  rules adopted by the commission.
  187         (d)The following benefits are not subject to creditable
  188  coverage requirements if offered as independent, noncoordinated
  189  benefits:
  190         1.Coverage only for a specified disease or illness.
  191         2.Hospital indemnity or other fixed indemnity insurance.
  192         (e)Benefits provided through a Medicare supplemental
  193  health insurance, as defined under s. 1882(g)(1) of the Social
  194  Security Act, coverage supplemental to the coverage provided
  195  under chapter 55 of Title 10, United States Code, and similar
  196  supplemental coverage provided to coverage under a group health
  197  plan are not considered creditable coverage if offered as a
  198  separate insurance policy.
  199         (6)(a)A period of creditable coverage may not be counted,
  200  with respect to enrollment of an individual under a group health
  201  plan, if, after such period and before the enrollment date,
  202  there was a 63-day period during all of which the individual was
  203  not covered under any creditable coverage.
  204         (b)Any period during which an individual is in a waiting
  205  period for any coverage under a group health plan or for group
  206  health insurance coverage may not be taken into account in
  207  determining the 63-day period under paragraph (a) or paragraph
  208  (4)(b).
  209         (7)(a)Except as otherwise provided under paragraph (b), an
  210  insurer shall count a period of creditable coverage without
  211  regard to the specific benefits covered under the period.
  212         (b)An insurer may elect to count, as creditable coverage,
  213  coverage of benefits within each of several classes or
  214  categories of benefits specified in rules adopted by the
  215  commission rather than as provided under paragraph (a). To the
  216  extent possible, such rules must be consistent with regulations
  217  adopted by the United States Department of Health and Human
  218  Services. Such election shall be made on a uniform basis for all
  219  participants and beneficiaries. Under such election, an insurer
  220  shall count a period of creditable coverage with respect to any
  221  class or category of benefits if any level of benefits is
  222  covered within such class or category.
  223         (c)In the case of an election with respect to an insurer
  224  under paragraph (b), the insurer shall:
  225         1.Prominently state in 10-point type or larger in any
  226  disclosure statements concerning the policy, and state to each
  227  certificateholder at the time of enrollment under the policy,
  228  that the insurer has made such election; and
  229         2.Include in such statements a description of the effect
  230  of this election.
  231         (8)(a)Periods of creditable coverage with respect to an
  232  individual shall be established through presentation of
  233  certifications described in this subsection or in such other
  234  manner as is specified in rules adopted by the commission. To
  235  the extent possible, such rules must be consistent with
  236  regulations adopted by the United States Department of Health
  237  and Human Services.
  238         (b)An insurer that offers group health insurance coverage
  239  shall provide the certification described in paragraph (a):
  240         1.At the time an individual ceases to be covered under the
  241  plan or otherwise becomes covered under a COBRA continuation
  242  provision or continuation pursuant to s. 627.6692.
  243         2.In the case of an individual becoming covered under a
  244  COBRA continuation provision or pursuant to s. 627.6692, at the
  245  time the individual ceases to be covered under such a provision.
  246         3.Upon the request on behalf of an individual made not
  247  later than 24 months after the date of cessation of the coverage
  248  described in this paragraph.
  249  
  250  The certification under subparagraph 1. may be provided, to the
  251  extent practicable, at a time consistent with notices required
  252  under any applicable COBRA continuation provision or
  253  continuation pursuant to s. 627.6692.
  254         (c)The certification described in this section is a
  255  written certification that must include:
  256         1.The period of creditable coverage of the individual
  257  under the policy and the coverage, if any, under such COBRA
  258  continuation provision or continuation pursuant to s. 627.6692;
  259  and
  260         2.The waiting period, if any, imposed with respect to the
  261  individual for any coverage under such policy.
  262         (d)In the case of an election described in subsection (7)
  263  by an insurer, if the insurer enrolls an individual for coverage
  264  under the plan and the individual provides a certification of
  265  coverage of the individual, as provided in this subsection:
  266         1.Upon request of such insurer, the insurer that issued
  267  the certification provided by the individual shall promptly
  268  disclose to such requesting plan or insurer information on
  269  coverage of classes and categories of health benefits available
  270  under such insurer’s plan or coverage.
  271         2.Such insurer may charge the requesting insurer for the
  272  reasonable cost of disclosing such information.
  273         (e)The commission shall adopt rules to prevent an
  274  insurer’s failure to provide information under this subsection
  275  with respect to previous coverage of an individual from
  276  adversely affecting any subsequent coverage of the individual
  277  under another group health plan or health insurance coverage. To
  278  the greatest extent possible, such rules must be consistent with
  279  regulations adopted by the United States Department of Health
  280  and Human Services.
  281         (9)(a)Except as provided in paragraph (b), no period
  282  before July 1, 1996, shall be taken into account in determining
  283  creditable coverage.
  284         (b)The commission shall adopt rules that provide a process
  285  whereby individuals who need to establish creditable coverage
  286  for periods before July 1, 1996, and who would have such
  287  coverage credited but for paragraph (a), may be given credit for
  288  creditable coverage for such periods through the presentation of
  289  documents or other means. To the greatest extent possible, such
  290  rules must be consistent with regulations adopted by the United
  291  States Department of Health and Human Services.
  292         (10)Except as otherwise provided in this subsection,
  293  paragraph (8)(b) applies to events that occur on or after July
  294  1, 1996.
  295         (a)In no case is a certification required to be provided
  296  under paragraph (8)(b) prior to June 1, 1997.
  297         (b)In the case of an event that occurred on or after July
  298  1, 1996, and before October 1, 1996, a certification is not
  299  required to be provided under paragraph (8)(b), unless an
  300  individual, with respect to whom the certification is required
  301  to be made, requests such certification in writing.
  302         (11)In the case of an individual who seeks to establish
  303  creditable coverage for any period for which certification is
  304  not required because it relates to an event that occurred before
  305  July 1, 1996:
  306         (a)The individual may present other creditable coverage in
  307  order to establish the period of creditable coverage.
  308         (b)An insurer is not subject to any penalty or enforcement
  309  action with respect to the insurer’s crediting, or not
  310  crediting, such coverage if the insurer has sought to comply in
  311  good faith with applicable provisions of this section.
  312         (12)For purposes of subsection (9), any plan amendment
  313  made pursuant to a collective bargaining agreement relating to
  314  the plan which amends the plan solely to conform to any
  315  requirement of this section may not be treated as a termination
  316  of such collective bargaining agreement.
  317         (13)This section does not apply to any health insurance
  318  coverage in relation to its provision of excepted benefits
  319  described in paragraph (5)(b).
  320         (14)This section does not apply to any health insurance
  321  coverage in relation to its provision of excepted benefits
  322  described in paragraphs (5)(c), (d), or (e), if the benefits are
  323  provided under a separate policy, certificate, or contract of
  324  insurance.
  325         (15)This section applies to health insurance coverage
  326  offered, sold, issued, renewed, or in effect on or after July 1,
  327  1997.
  328         Section 15. Subsection (3) of section 627.6562, Florida
  329  Statutes, is amended to read:
  330         627.6562 Dependent coverage.—
  331         (3) If, pursuant to subsection (2), a child is provided
  332  coverage under the parent’s policy after the end of the calendar
  333  year in which the child reaches age 25 and coverage for the
  334  child is subsequently terminated, the child is not eligible to
  335  be covered under the parent’s policy unless the child was
  336  continuously covered by other creditable coverage without a gap
  337  in coverage of more than 63 days.
  338         (a) For the purposes of this subsection, the term
  339  “creditable coverage” means, with respect to an individual,
  340  coverage of the individual under any of the following: has the
  341  same meaning as provided in s. 627.6561(5).
  342         1.A group health plan, as defined in s. 2791 of the Public
  343  Health Service Act.
  344         2.Health insurance coverage consisting of medical care
  345  provided directly through insurance or reimbursement or
  346  otherwise, and including terms and services paid for as medical
  347  care, under any hospital or medical service policy or
  348  certificate, hospital or medical service plan contract, or
  349  health maintenance contract offered by a health insurance
  350  issuer.
  351         3.Part A or part B of Title XVIII of the Social Security
  352  Act.
  353         4.Title XIX of the Social Security Act, other than
  354  coverage consisting solely of benefits under s. 1928.
  355         5.Title 10 U.S.C. chapter 55.
  356         6.A medical care program of the Indian Health Service or
  357  of a tribal organization.
  358         7.The Florida Comprehensive Health Association or another
  359  state health benefit risk pool.
  360         8.A health plan offered under 5 U.S.C. chapter 89.
  361         9.A public health plan as defined by rules adopted by the
  362  commission. To the greatest extent possible, such rules must be
  363  consistent with regulations adopted by the United States
  364  Department of Health and Human Services.
  365         10.A health benefit plan under s. 5(e) of the Peace Corps
  366  Act, 22 U.S.C. s. 2504(e).
  367         (b)Creditable coverage does not include coverage that
  368  consists of one or more, or any combination thereof, of the
  369  following excepted benefits:
  370         1.Coverage only for accident insurance, or disability
  371  income insurance, or any combination thereof.
  372         2.Coverage issued as a supplement to liability insurance.
  373         3.Liability insurance, including general liability
  374  insurance and automobile liability insurance.
  375         4.Workers’ compensation or similar insurance.
  376         5.Automobile medical payment insurance.
  377         6.Credit-only insurance.
  378         7.Coverage for onsite medical clinics, including prepaid
  379  health clinics under part II of chapter 641.
  380         8.Other similar insurance coverage specified in rules
  381  adopted by the commission under which benefits for medical care
  382  are secondary or incidental to other insurance benefits. To the
  383  extent possible, such rules must be consistent with regulations
  384  adopted by the United States Department of Health and Human
  385  Services.
  386         (c)The following benefits are not subject to the
  387  creditable coverage requirements, if offered separately:
  388         1.Limited scope dental or vision benefits.
  389         2.Benefits for long-term care, nursing home care, home
  390  health care, community-based care, or any combination thereof.
  391         3.Other similar, limited benefits specified in rules
  392  adopted by the commission.
  393         (d)The following benefits are not subject to creditable
  394  coverage requirements if offered as independent, noncoordinated
  395  benefits:
  396         1.Coverage only for a specified disease or illness.
  397         2.Hospital indemnity or other fixed indemnity insurance.
  398         (e)Benefits provided through a Medicare supplemental
  399  health insurance policy, as defined under s. 1882(g)(1) of the
  400  Social Security Act, coverage supplemental to the coverage
  401  provided under 10 U.S.C. chapter 55, and similar supplemental
  402  coverage provided to coverage under a group health plan are not
  403  considered creditable coverage if offered as a separate
  404  insurance policy.
  405         Section 16. Subsection (1) of section 627.65626, Florida
  406  Statutes, is amended to read:
  407         627.65626 Insurance rebates for healthy lifestyles.—
  408         (1) Any rate, rating schedule, or rating manual for a
  409  health insurance policy that provides creditable coverage as
  410  defined in s. 627.6562(3) 627.6561(5) filed with the office
  411  shall provide for an appropriate rebate of premiums paid in the
  412  last policy year, contract year, or calendar year when the
  413  majority of members of a health plan have enrolled and
  414  maintained participation in any health wellness, maintenance, or
  415  improvement program offered by the group policyholder and health
  416  plan. The rebate may be based upon premiums paid in the last
  417  calendar year or policy year. The group must provide evidence of
  418  demonstrative maintenance or improvement of the enrollees’
  419  health status as determined by assessments of agreed-upon health
  420  status indicators between the policyholder and the health
  421  insurer, including, but not limited to, reduction in weight,
  422  body mass index, and smoking cessation. The group or health
  423  insurer may contract with a third-party administrator to
  424  assemble and report the health status required in this
  425  subsection between the policyholder and the health insurer. Any
  426  rebate provided by the health insurer is presumed to be
  427  appropriate unless credible data demonstrates otherwise, or
  428  unless the rebate program requires the insured to incur costs to
  429  qualify for the rebate which equal or exceed the value of the
  430  rebate, but the rebate may not exceed 10 percent of paid
  431  premiums.
  432         Section 17. Paragraphs (e) and (l) of subsection (3) and
  433  paragraph (d) of subsection (5) of section 627.6699, Florida
  434  Statutes, are amended to read:
  435         627.6699 Employee Health Care Access Act.—
  436         (3) DEFINITIONS.—As used in this section, the term:
  437         (e) “Creditable coverage” has the same meaning as provided
  438  ascribed in s. 627.6562(3) 627.6561.
  439         (l) “Late enrollee” means an eligible employee or dependent
  440  who, with respect to coverage under a group health policy, is a
  441  participant or beneficiary who enrolls under the policy other
  442  than during:
  443         1.The first period in which the individual is eligible to
  444  enroll under the policy.
  445         2.A special enrollment period, as provided under s.
  446  627.65615 as defined under s. 627.6561(1)(b).
  447         (5) AVAILABILITY OF COVERAGE.—
  448         (d) A health benefit plan covering small employers, issued
  449  or renewed on or after January 1, 1994, must comply with the
  450  following conditions:
  451         1. All health benefit plans must be offered and issued on a
  452  guaranteed-issue basis. Additional or increased benefits may
  453  only be offered by riders.
  454         2.Paragraph (c) applies to health benefit plans issued to
  455  a small employer who has two or more eligible employees and to
  456  health benefit plans that are issued to a small employer who has
  457  fewer than two eligible employees and that cover an employee who
  458  has had creditable coverage continually to a date not more than
  459  63 days before the effective date of the new coverage.
  460         2.3. For health benefit plans that are issued to a small
  461  employer who has fewer than two employees and that cover an
  462  employee who has not been continually covered by creditable
  463  coverage within 63 days before the effective date of the new
  464  coverage, preexisting condition provisions must not exclude
  465  coverage for a period beyond 24 months following the employee’s
  466  effective date of coverage and may relate only to:
  467         a. Conditions that, during the 24-month period immediately
  468  preceding the effective date of coverage, had manifested
  469  themselves in such a manner as would cause an ordinarily prudent
  470  person to seek medical advice, diagnosis, care, or treatment or
  471  for which medical advice, diagnosis, care, or treatment was
  472  recommended or received; or
  473         b. A pregnancy existing on the effective date of coverage.
  474         Section 18. Subsection (1) and paragraph (c) of subsection
  475  (2) of section 627.6741, Florida Statutes, are amended to read:
  476         627.6741 Issuance, cancellation, nonrenewal, and
  477  replacement.—
  478         (1)(a) An insurer issuing Medicare supplement policies in
  479  this state shall offer the opportunity of enrolling in a
  480  Medicare supplement policy, without conditioning the issuance or
  481  effectiveness of the policy on, and without discriminating in
  482  the price of the policy based on, the medical or health status
  483  or receipt of health care by the individual:
  484         1. To any individual who is 65 years of age or older, or
  485  under 65 years of age and eligible for Medicare by reason of
  486  disability or end-stage renal disease, and who resides in this
  487  state, upon the request of the individual during the 6-month
  488  period beginning with the first month in which the individual
  489  has attained 65 years of age and is enrolled in Medicare Part B,
  490  or is eligible for Medicare by reason of a disability or end
  491  stage renal disease, and is enrolled in Medicare Part B; or
  492         2. To any individual who is 65 years of age or older, or
  493  under 65 years of age and eligible for Medicare by reason of a
  494  disability or end-stage renal disease, who is enrolled in
  495  Medicare Part B, and who resides in this state, upon the request
  496  of the individual during the 2-month period following
  497  termination of coverage under a group health insurance policy.
  498         (b) The 6-month period to enroll in a Medicare supplement
  499  policy for an individual who is under 65 years of age and is
  500  eligible for Medicare by reason of disability or end-stage renal
  501  disease and otherwise eligible under subparagraph (a)1. or
  502  subparagraph (a)2. and first enrolled in Medicare Part B before
  503  October 1, 2009, begins on October 1, 2009.
  504         (c) A company that has offered Medicare supplement policies
  505  to individuals under 65 years of age who are eligible for
  506  Medicare by reason of disability or end-stage renal disease
  507  before October 1, 2009, may, for one time only, effect a rate
  508  schedule change that redefines the age bands of the premium
  509  classes without activating the period of discontinuance required
  510  by s. 627.410(6)(e)2.
  511         (d) As a part of an insurer’s rate filings, before and
  512  including the insurer’s first rate filing for a block of policy
  513  forms in 2015, notwithstanding the provisions of s.
  514  627.410(6)(e)3., an insurer shall consider the experience of the
  515  policies or certificates for the premium classes including
  516  individuals under 65 years of age and eligible for Medicare by
  517  reason of disability or end-stage renal disease separately from
  518  the balance of the block so as not to affect the other premium
  519  classes. For filings in such time period only, credibility of
  520  that experience shall be as follows: if a block of policy forms
  521  has 1,250 or more policies or certificates in force in the age
  522  band including ages under 65 years of age, full or 100-percent
  523  credibility shall be given to the experience; and if fewer than
  524  250 policies or certificates are in force, no or zero-percent
  525  credibility shall be given. Linear interpolation shall be used
  526  for in-force amounts between the low and high values. Florida
  527  only experience shall be used if it is 100-percent credible. If
  528  Florida-only experience is not 100-percent credible, a
  529  combination of Florida-only and nationwide experience shall be
  530  used. If Florida-only experience is zero-percent credible,
  531  nationwide experience shall be used. The insurer may file its
  532  initial rates and any rate adjustment based upon the experience
  533  of these policies or certificates or based upon expected claim
  534  experience using experience data of the same company, other
  535  companies in the same or other states, or using data publicly
  536  available from the Centers for Medicaid and Medicare Services if
  537  the insurer’s combined Florida and nationwide experience is not
  538  100-percent credible, separate from the balance of all other
  539  Medicare supplement policies.
  540  
  541  A Medicare supplement policy issued to an individual under
  542  subparagraph (a)1. or subparagraph (a)2. may not exclude
  543  benefits based on a preexisting condition if the individual has
  544  a continuous period of creditable coverage, as defined in s.
  545  627.6562(3) 627.6561(5), of at least 6 months as of the date of
  546  application for coverage.
  547         (2) For both individual and group Medicare supplement
  548  policies:
  549         (c) If a Medicare supplement policy or certificate replaces
  550  another Medicare supplement policy or certificate or creditable
  551  coverage as defined in s. 627.6562(3) 627.6561(5), the replacing
  552  insurer shall waive any time periods applicable to preexisting
  553  conditions, waiting periods, elimination periods, and
  554  probationary periods in the new Medicare supplement policy for
  555  similar benefits to the extent such time was spent under the
  556  original policy, subject to the requirements of s. 627.6561(6)
  557  (11).
  558         Section 19. Subsection (2) and paragraph (a) of subsection
  559  (40) of section 641.31, Florida Statutes, are amended to read:
  560         641.31 Health maintenance contracts.—
  561         (2) The rates charged by any health maintenance
  562  organization to its subscribers shall not be excessive,
  563  inadequate, or unfairly discriminatory or follow a rating
  564  methodology that is inconsistent, indeterminate, or ambiguous or
  565  encourages misrepresentation or misunderstanding. A law
  566  restricting or limiting deductibles, coinsurance, copayments, or
  567  annual or lifetime maximum payments shall not apply to any
  568  health maintenance organization contract that provides coverage
  569  as described in s. 641.31071(5)(a)2., offered or delivered to an
  570  individual or a group of 51 or more persons. The commission, in
  571  accordance with generally accepted actuarial practice as applied
  572  to health maintenance organizations, may define by rule what
  573  constitutes excessive, inadequate, or unfairly discriminatory
  574  rates and may require whatever information it deems necessary to
  575  determine that a rate or proposed rate meets the requirements of
  576  this subsection.
  577         (40)(a) Any group rate, rating schedule, or rating manual
  578  for a health maintenance organization policy, which provides
  579  creditable coverage as defined in s. 627.6562(3) 627.6561(5),
  580  filed with the office shall provide for an appropriate rebate of
  581  premiums paid in the last policy year, contract year, or
  582  calendar year when the majority of members of a health plan are
  583  enrolled in and have maintained participation in any health
  584  wellness, maintenance, or improvement program offered by the
  585  group contract holder. The group must provide evidence of
  586  demonstrative maintenance or improvement of his or her health
  587  status as determined by assessments of agreed-upon health status
  588  indicators between the group and the health insurer, including,
  589  but not limited to, reduction in weight, body mass index, and
  590  smoking cessation. Any rebate provided by the health maintenance
  591  organization is presumed to be appropriate unless credible data
  592  demonstrates otherwise, or unless the rebate program requires
  593  the insured to incur costs to qualify for the rebate which
  594  equals or exceeds the value of the rebate but the rebate may not
  595  exceed 10 percent of paid premiums.
  596         Section 20. Section 641.31071, Florida Statutes, is amended
  597  to read:
  598         641.31071 Preexisting conditions.—
  599         (1) As used in this section, the term:
  600         (a) “Enrollment date” means, with respect to an individual
  601  covered under a group health maintenance organization contract,
  602  the date of enrollment of the individual in the plan or coverage
  603  or, if earlier, the first day of the waiting period of such
  604  enrollment.
  605         (b) “Late enrollee” means, with respect to coverage under a
  606  group health maintenance organization contract, a participant or
  607  beneficiary who enrolls under the contract other than during:
  608         1. The first period in which the individual is eligible to
  609  enroll under the plan.
  610         2. A special enrollment period, as provided under s.
  611  641.31072.
  612         (c) “Waiting period” means, with respect to a group health
  613  maintenance organization contract and an individual who is a
  614  potential participant or beneficiary under the contract, the
  615  period that must pass with respect to the individual before the
  616  individual is eligible to be covered for benefits under the
  617  terms of the contract.
  618         (2) Subject to the exceptions specified in subsection (4),
  619  a health maintenance organization that offers group coverage,
  620  may, with respect to a participant or beneficiary, impose a
  621  preexisting condition exclusion only if:
  622         (a) Such exclusion relates to a physical or mental
  623  condition, regardless of the cause of the condition, for which
  624  medical advice, diagnosis, care, or treatment was recommended or
  625  received within the 6-month period ending on the enrollment
  626  date;
  627         (b) Such exclusion extends for a period of not more than 12
  628  months, or 18 months in the case of a late enrollee, after the
  629  enrollment date; and
  630         (c) The period of any such preexisting condition exclusion
  631  is reduced by the aggregate of the periods of creditable
  632  coverage, as defined in s. 627.6562(3) subsection (5),
  633  applicable to the participant or beneficiary as of the
  634  enrollment date.
  635         (3) Genetic information shall not be treated as a condition
  636  described in paragraph (2)(a) in the absence of a diagnosis of
  637  the condition related to such information.
  638         (4)(a) Subject to paragraph (b), a health maintenance
  639  organization that offers group coverage may not impose any
  640  preexisting condition exclusion in the case of:
  641         1. An individual who, as of the last day of the 30-day
  642  period beginning with the date of birth, is covered under
  643  creditable coverage.
  644         2. A child who is adopted or placed for adoption before
  645  attaining 18 years of age and who, as of the last day of the 30
  646  day period beginning on the date of the adoption or placement
  647  for adoption, is covered under creditable coverage. This
  648  provision shall not apply to coverage before the date of such
  649  adoption or placement for adoption.
  650         3. Pregnancy.
  651         (b) Subparagraphs (a)1. and 2. do not apply to an
  652  individual after the end of the first 63-day period during all
  653  of which the individual was not covered under any creditable
  654  coverage.
  655         (5)(a)The term “creditable coverage” means, with respect
  656  to an individual, coverage of the individual under any of the
  657  following:
  658         1.A group health plan, as defined in s. 2791 of the Public
  659  Health Service Act.
  660         2.Health insurance coverage consisting of medical care,
  661  provided directly, through insurance or reimbursement or
  662  otherwise, and including terms and services paid for as medical
  663  care, under any hospital or medical service policy or
  664  certificate, hospital or medical service plan contract, or
  665  health maintenance contract offered by a health insurance
  666  issuer.
  667         3.Part A or part B of Title XVIII of the Social Security
  668  Act.
  669         4.Title XIX of the Social Security Act, other than
  670  coverage consisting solely of benefits under s. 1928.
  671         5.Chapter 55 of Title 10, United States Code.
  672         6.A medical care program of the Indian Health Service or
  673  of a tribal organization.
  674         7.The Florida Comprehensive Health Association or another
  675  state health benefit risk pool.
  676         8.A health plan offered under chapter 89 of Title 5,
  677  United States Code.
  678         9.A public health plan as defined by rule of the
  679  commission. To the greatest extent possible, such rules must be
  680  consistent with regulations adopted by the United States
  681  Department of Health and Human Services.
  682         10.A health benefit plan under s. 5(e) of the Peace Corps
  683  Act (22 U.S.C. s. 2504(e)).
  684         (b)Creditable coverage does not include coverage that
  685  consists solely of one or more or any combination thereof of the
  686  following excepted benefits:
  687         1.Coverage only for accident, or disability income
  688  insurance, or any combination thereof.
  689         2.Coverage issued as a supplement to liability insurance.
  690         3.Liability insurance, including general liability
  691  insurance and automobile liability insurance.
  692         4.Workers’ compensation or similar insurance.
  693         5.Automobile medical payment insurance.
  694         6.Credit-only insurance.
  695         7.Coverage for onsite medical clinics.
  696         8.Other similar insurance coverage, specified in rules
  697  adopted by the commission, under which benefits for medical care
  698  are secondary or incidental to other insurance benefits. To the
  699  greatest extent possible, such rules must be consistent with
  700  regulations adopted by the United States Department of Health
  701  and Human Services.
  702         (c)The following benefits are not subject to the
  703  creditable coverage requirements, if offered separately;
  704         1.Limited scope dental or vision benefits.
  705         2.Benefits or long-term care, nursing home care, home
  706  health care, community-based care, or any combination of these.
  707         3.Such other similar, limited benefits as are specified in
  708  rules adopted by the commission. To the greatest extent
  709  possible, such rules must be consistent with regulations adopted
  710  by the United States Department of Health and Human Services.
  711         (d)The following benefits are not subject to creditable
  712  coverage requirements if offered as independent, noncoordinated
  713  benefits:
  714         1.Coverage only for a specified disease or illness.
  715         2.Hospital indemnity or other fixed indemnity insurance.
  716         (e)Benefits provided through Medicare supplemental health
  717  insurance, as defined under s. 1882(g)(1) of the Social Security
  718  Act, coverage supplemental to the coverage provided under
  719  chapter 55 of Title 10, United States Code, and similar
  720  supplemental coverage provided to coverage under a group health
  721  plan are not considered creditable coverage if offered as a
  722  separate insurance policy.
  723         (6)(a)A period of creditable coverage may not be counted,
  724  with respect to enrollment of an individual under a group health
  725  maintenance organization contract, if, after such period and
  726  before the enrollment date, there was a 63-day period during all
  727  of which the individual was not covered under any creditable
  728  coverage.
  729         (b)Any period during which an individual is in a waiting
  730  period, or in an affiliation period as defined in subsection
  731  (9), for any coverage under a group health maintenance
  732  organization contract may not be taken into account in
  733  determining the 63-day period under paragraph (a) or paragraph
  734  (4)(b).
  735         (7)(a)Except as otherwise provided under paragraph (b), a
  736  health maintenance organization shall count a period of
  737  creditable coverage without regard to the specific benefits
  738  covered under the period.
  739         (b)A health maintenance organization may elect to count as
  740  creditable coverage, coverage of benefits within each of several
  741  classes or categories of benefits specified in rules adopted by
  742  the commission rather than as provided under paragraph (a). Such
  743  election shall be made on a uniform basis for all participants
  744  and beneficiaries. Under such election, a health maintenance
  745  organization shall count a period of creditable coverage with
  746  respect to any class or category of benefits if any level of
  747  benefits is covered within such class or category.
  748         (c)In the case of an election with respect to a health
  749  maintenance organization under paragraph (b), the organization
  750  shall:
  751         1.Prominently state in 10-point type or larger in any
  752  disclosure statements concerning the contract, and state to each
  753  enrollee at the time of enrollment under the contract, that the
  754  organization has made such election; and
  755         2.Include in such statements a description of the effect
  756  of this election.
  757         (8)(a)Periods of creditable coverage with respect to an
  758  individual shall be established through presentation of
  759  certifications described in this subsection or in such other
  760  manner as may be specified in rules adopted by the commission.
  761         (b)A health maintenance organization that offers group
  762  coverage shall provide the certification described in paragraph
  763  (a):
  764         1.At the time an individual ceases to be covered under the
  765  plan or otherwise becomes covered under a COBRA continuation
  766  provision or continuation pursuant to s. 627.6692.
  767         2.In the case of an individual becoming covered under a
  768  COBRA continuation provision or pursuant to s. 627.6692, at the
  769  time the individual ceases to be covered under such a provision.
  770         3.Upon the request on behalf of an individual made not
  771  later than 24 months after the date of cessation of the coverage
  772  described in this paragraph.
  773  
  774  The certification under subparagraph 1. may be provided, to the
  775  extent practicable, at a time consistent with notices required
  776  under any applicable COBRA continuation provision or
  777  continuation pursuant to s. 627.6692.
  778         (c)The certification is a written certification of:
  779         1.The period of creditable coverage of the individual
  780  under the contract and the coverage, if any, under such COBRA
  781  continuation provision or continuation pursuant to s. 627.6692;
  782  and
  783         2.The waiting period, if any, imposed with respect to the
  784  individual for any coverage under such contract.
  785         (d)In the case of an election described in subsection (7)
  786  by a health maintenance organization, if the organization
  787  enrolls an individual for coverage under the plan and the
  788  individual provides a certification of coverage of the
  789  individual, as provided by this subsection:
  790         1.Upon request of such health maintenance organization,
  791  the insurer or health maintenance organization that issued the
  792  certification provided by the individual shall promptly disclose
  793  to such requesting organization information on coverage of
  794  classes and categories of health benefits available under such
  795  insurer’s or health maintenance organization’s plan or coverage.
  796         2.Such insurer or health maintenance organization may
  797  charge the requesting organization for the reasonable cost of
  798  disclosing such information.
  799         (e)The commission shall adopt rules to prevent an
  800  insurer’s or health maintenance organization’s failure to
  801  provide information under this subsection with respect to
  802  previous coverage of an individual from adversely affecting any
  803  subsequent coverage of the individual under another group health
  804  plan or health maintenance organization coverage.
  805         (9)(a)A health maintenance organization may provide for an
  806  affiliation period with respect to coverage through the
  807  organization only if:
  808         1.No preexisting condition exclusion is imposed with
  809  respect to coverage through the organization;
  810         2.The period is applied uniformly without regard to any
  811  health-status-related factors; and
  812         3.Such period does not exceed 2 months or 3 months in the
  813  case of a late enrollee.
  814         (b)For the purposes of this section, the term “affiliation
  815  period” means a period that, under the terms of the coverage
  816  offered by the health maintenance organization, must expire
  817  before the coverage becomes effective. The organization is not
  818  required to provide health care services or benefits during such
  819  period, and no premium may be charged to the participant or
  820  beneficiary for any coverage during the period. Such period
  821  begins on the enrollment date and runs concurrently with any
  822  waiting period under the plan.
  823         (c)As an alternative to the method authorized by paragraph
  824  (a), a health maintenance organization may address adverse
  825  selection in a method approved by the office.
  826         (10)(a)Except as provided in paragraph (b), no period
  827  before July 1, 1996, shall be taken into account in determining
  828  creditable coverage.
  829         (b)The commission shall adopt rules that provide a process
  830  whereby individuals who need to establish creditable coverage
  831  for periods before July 1, 1996, and who would have such
  832  coverage credited but for paragraph (a), may be given credit for
  833  creditable coverage for such periods through the presentation of
  834  documents or other means.
  835         (11)Except as otherwise provided in this subsection, the
  836  requirements of paragraph (8)(b) shall apply to events that
  837  occur on or after July 1, 1996.
  838         (a)In no case is a certification required to be provided
  839  under paragraph (8)(b) prior to June 1, 1997.
  840         (b)In the case of an event that occurs on or after July 1,
  841  1996, and before October 1, 1996, a certification is not
  842  required to be provided under paragraph (8)(b), unless an
  843  individual, with respect to whom the certification is required
  844  to be made, requests such certification in writing.
  845         (12)In the case of an individual who seeks to establish
  846  creditable coverage for any period for which certification is
  847  not required because it relates to an event occurring before
  848  July 1, 1996:
  849         (a)The individual may present other creditable coverage in
  850  order to establish the period of creditable coverage.
  851         (b)A health maintenance organization is not subject to any
  852  penalty or enforcement action with respect to the organization’s
  853  crediting, or not crediting, such coverage if the organization
  854  has sought to comply in good faith with applicable provisions of
  855  this section.
  856         (13)For purposes of subsection (10), any plan amendment
  857  made pursuant to a collective bargaining agreement relating to
  858  the plan which amends the plan solely to conform to any
  859  requirement of this section may not be treated as a termination
  860  of such collective bargaining agreement.
  861         Section 21. Subsections (1), (3), and (4) of section
  862  641.31074, Florida Statutes, are amended to read:
  863         641.31074 Guaranteed renewability of coverage.—
  864         (1) Except as otherwise provided in this section, a health
  865  maintenance organization that issues a group health insurance
  866  contract must renew or continue in force such coverage at the
  867  option of the contract holder.
  868         (3)(a) A health maintenance organization may discontinue
  869  offering a particular contract form for group coverage offered
  870  in the small group market or large group market only if:
  871         1. The health maintenance organization provides notice to
  872  each contract holder provided coverage of this form in such
  873  market, and participants and beneficiaries covered under such
  874  coverage, of such discontinuation at least 90 days prior to the
  875  date of the nonrenewal of such coverage;
  876         2. The health maintenance organization offers to each
  877  contract holder provided coverage of this form in such market
  878  the option to purchase all, or in the case of the large group
  879  market, any other health insurance coverage currently being
  880  offered by the health maintenance organization in such market;
  881  and
  882         3. In exercising the option to discontinue coverage of this
  883  form and in offering the option of coverage under subparagraph
  884  2., the health maintenance organization acts uniformly without
  885  regard to the claims experience of those contract holders or any
  886  health-status-related factor that relates to any participants or
  887  beneficiaries covered or new participants or beneficiaries who
  888  may become eligible for such coverage.
  889         (b)1. In any case in which a health maintenance
  890  organization elects to discontinue offering all coverage in the
  891  individual market, the small group market, or the large group
  892  market, or any combination thereof both, in this state, coverage
  893  may be discontinued by the insurer only if:
  894         a. The health maintenance organization provides notice to
  895  the office and to each contract holder, and participants and
  896  beneficiaries covered under such coverage, of such
  897  discontinuation at least 180 days prior to the date of the
  898  nonrenewal of such coverage; and
  899         b. All health insurance issued or delivered for issuance in
  900  this state in such market is discontinued and coverage under
  901  such health insurance coverage in such market is not renewed.
  902         2. In the case of a discontinuation under subparagraph 1.
  903  in a market, the health maintenance organization may not provide
  904  for the issuance of any health maintenance organization contract
  905  coverage in the market in this state during the 5-year period
  906  beginning on the date of the discontinuation of the last
  907  insurance contract not renewed.
  908         (4) At the time of coverage renewal, a health maintenance
  909  organization may modify the coverage for a product offered:
  910         (a) In the large group market; or
  911         (b) In the small group market if, for coverage that is
  912  available in such market other than only through one or more
  913  bona fide associations, as defined in s. 627.6571(5), such
  914  modification is consistent with s. 627.6699 and effective on a
  915  uniform basis among group health plans with that product; or
  916         (c)In the individual market if the modification is
  917  consistent with the laws of this state and effective on a
  918  uniform basis among all individuals with that policy form.
  919  
  920  ================= T I T L E  A M E N D M E N T ================
  921  And the title is amended as follows:
  922         Delete lines 29 - 55
  923  and insert:
  924         types of benefits or coverages; amending s. 627.6561,
  925         F.S.; conforming a cross-reference; revising
  926         conditions under which an insurer may impose a
  927         preexisting condition exclusion; deleting the
  928         definition of the term “creditable coverage”; removing
  929         certain requirements relating to creditable coverage
  930         to conform to changes made by the act; amending s.
  931         627.6562, F.S.; redefining the term “creditable
  932         coverage”; providing exceptions and applicability;
  933         amending s. 627.65626, F.S.; conforming a cross
  934         reference; amending s. 627.6699, F.S.; redefining
  935         terms; deleting a provision that requires a certain
  936         health benefit plan to comply with specified
  937         preexisting condition provisions; amending s.
  938         627.6741, F.S.; conforming cross-references;
  939         conforming a provision to changes made by the act;
  940         amending s. 641.31, F.S.; deleting a provision
  941         specifying that a law restricting or limiting
  942         deductibles, coinsurance, copayments, or annual or
  943         lifetime maximum payments may not apply to a certain
  944         health maintenance organization contract; conforming a
  945         cross-reference; amending s. 641.31071, F.S.;
  946         conforming a cross-reference; deleting the definition
  947         of the term “creditable coverage”; removing certain
  948         requirements relating to creditable coverage to
  949         conform to changes made by the act; amending s.
  950         641.31074; requiring a health maintenance organization
  951         that issues a health insurance contract, rather than a
  952         group health insurance contract, to renew or continue
  953         in force such coverage at the contract holder’s
  954         option; revising conditions under which a health
  955         maintenance organization may discontinue offering a
  956         particular contract form; adding to the conditions
  957         under which a health maintenance organization may, at
  958         the time of coverage renewal, modify coverage for a
  959         product offered; amending s.