Florida Senate - 2016                                    SB 1434
       
       
        
       By Senator Brandes
       
       22-01105-16                                           20161434__
    1                        A bill to be entitled                      
    2         An act relating to the state group insurance program;
    3         amending s. 110.123, F.S.; revising applicability of
    4         certain definitions; defining the term “plan year”;
    5         authorizing the program to include additional
    6         benefits; authorizing employees to use a certain
    7         portion of the state’s contribution to purchase
    8         additional program benefits and supplemental benefits
    9         under specified circumstances; requiring the program
   10         to offer health plans with specified benefit levels;
   11         requiring the Department of Management Services to
   12         develop a plan for implementation of the benefit
   13         levels; requiring the department to submit the plan to
   14         the Governor and the Legislature; creating s.
   15         110.12303, F.S.; authorizing additional benefits to be
   16         included in the program beginning with the 2017 plan
   17         year; requiring the department to contract with at
   18         least one entity that provides comprehensive pricing
   19         and inclusive services for surgery and other medical
   20         procedures; providing contract requirements; requiring
   21         the department to report to the Governor and the
   22         Legislature regarding the contract; requiring the
   23         department to establish a price transparency pilot
   24         project in certain areas of the state; prescribing
   25         pilot project requirements; requiring the department
   26         to annually report to the Governor and the Legislature
   27         regarding the pilot project; creating s. 110.12304,
   28         F.S.; requiring the department to competitively
   29         procure an independent benefits consultant; specifying
   30         prohibitions, qualifications, and duties of the
   31         consultant; requiring the consultant to assist the
   32         department in preparing recommendations to be
   33         submitted to the Governor and the Legislature by a
   34         specified date; requiring the General Appropriations
   35         Act to establish premiums for enrollees for the 2017
   36         plan year which reflect the differences in benefit
   37         design and value among health maintenance organization
   38         plan options and preferred provider organization plan
   39         options; establishing the share of the health
   40         insurance premium for employees, early retirees, and
   41         COBRA and Medicare participants participating in the
   42         State Group Insurance Plan for specified health care
   43         plans and coverage periods; providing appropriations
   44         and authorizing positions; providing an effective
   45         date.
   46          
   47  Be It Enacted by the Legislature of the State of Florida:
   48  
   49         Section 1. Subsection (2) and paragraphs (b), (f), (h), and
   50  (j) of subsection (3) of section 110.123, Florida Statutes, are
   51  amended to read:
   52         110.123 State group insurance program.—
   53         (2) DEFINITIONS.—As used in ss. 110.123-110.1239 this
   54  section, the term:
   55         (a) “Department” means the Department of Management
   56  Services.
   57         (b) “Enrollee” means all state officers and employees,
   58  retired state officers and employees, surviving spouses of
   59  deceased state officers and employees, and terminated employees
   60  or individuals with continuation coverage who are enrolled in an
   61  insurance plan offered by the state group insurance program.
   62  “Enrollee” includes all state university officers and employees,
   63  retired state university officers and employees, surviving
   64  spouses of deceased state university officers and employees, and
   65  terminated state university employees or individuals with
   66  continuation coverage who are enrolled in an insurance plan
   67  offered by the state group insurance program.
   68         (c) “Full-time state employees” means employees of all
   69  branches or agencies of state government holding salaried
   70  positions who are paid by state warrant or from agency funds and
   71  who work or are expected to work an average of at least 30 or
   72  more hours per week; employees paid from regular salary
   73  appropriations for 8 months’ employment, including university
   74  personnel on academic contracts; and employees paid from other
   75  personal-services (OPS) funds as described in subparagraphs 1.
   76  and 2. The term includes all full-time employees of the state
   77  universities. The term does not include seasonal workers who are
   78  paid from OPS funds.
   79         1. For persons hired before April 1, 2013, the term
   80  includes any person paid from OPS funds who:
   81         a. Has worked an average of at least 30 hours or more per
   82  week during the initial measurement period from April 1, 2013,
   83  through September 30, 2013; or
   84         b. Has worked an average of at least 30 hours or more per
   85  week during a subsequent measurement period.
   86         2. For persons hired after April 1, 2013, the term includes
   87  any person paid from OPS funds who:
   88         a. Is reasonably expected to work an average of at least 30
   89  hours or more per week; or
   90         b. Has worked an average of at least 30 hours or more per
   91  week during the person’s measurement period.
   92         (d) “Health maintenance organization” or “HMO” means an
   93  entity certified under part I of chapter 641.
   94         (e) “Health plan member” means any person participating in
   95  a state group health insurance plan, a TRICARE supplemental
   96  insurance plan, or a health maintenance organization plan under
   97  the state group insurance program, including enrollees and
   98  covered dependents thereof.
   99         (f) “Part-time state employee” means an employee of any
  100  branch or agency of state government who is paid by state
  101  warrant from salary appropriations or from agency funds, and who
  102  is employed for less than an average of 30 hours per week or, if
  103  on academic contract or seasonal or other type of employment
  104  which is less than year-round, who is employed for less than 8
  105  months during any 12-month period. The term, but does not
  106  include a person paid from other-personal-services (OPS) funds,
  107  but. The term includes all part-time employees of the state
  108  universities.
  109         (g) “Plan year” means a calendar year.
  110         (h)(g) “Retired state officer or employee” or “retiree”
  111  means any state or state university officer or employee who
  112  retires under a state retirement system or a state optional
  113  annuity or retirement program or is placed on disability
  114  retirement, and who was insured under the state group insurance
  115  program at the time of retirement, and who begins receiving
  116  retirement benefits immediately after retirement from state or
  117  state university office or employment. The term also includes
  118  any state officer or state employee who retires under the
  119  Florida Retirement System Investment Plan established under part
  120  II of chapter 121 if he or she:
  121         1. Meets the age and service requirements to qualify for
  122  normal retirement as set forth in s. 121.021(29); or
  123         2. Has attained the age specified by s. 72(t)(2)(A)(i) of
  124  the Internal Revenue Code and has 6 years of creditable service.
  125         (i)(h) “State agency” or “agency” means any branch,
  126  department, or agency of state government. “State agency” or
  127  “agency” includes any state university for purposes of this
  128  section only.
  129         (j)(i) “Seasonal workers” has the same meaning as provided
  130  under 29 C.F.R. s. 500.20(s)(1).
  131         (k)(j) “State group health insurance plan or plans” or
  132  “state plan or plans” means mean the state self-insured health
  133  insurance plan or plans offered to state officers and employees,
  134  retired state officers and employees, and surviving spouses of
  135  deceased state officers and employees pursuant to this section.
  136         (l)(k) “State-contracted HMO” means any health maintenance
  137  organization under contract with the department to participate
  138  in the state group insurance program.
  139         (m)(l) “State group insurance program” or “programs” means
  140  the package of insurance plans offered to state officers and
  141  employees, retired state officers and employees, and surviving
  142  spouses of deceased state officers and employees pursuant to
  143  this section, including the state group health insurance plan or
  144  plans, health maintenance organization plans, TRICARE
  145  supplemental insurance plans, and other plans required or
  146  authorized by law.
  147         (n)(m) “State officer” means any constitutional state
  148  officer, any elected state officer paid by state warrant, or any
  149  appointed state officer who is commissioned by the Governor and
  150  who is paid by state warrant.
  151         (o)(n) “Surviving spouse” means the widow or widower of a
  152  deceased state officer, full-time state employee, part-time
  153  state employee, or retiree if such widow or widower was covered
  154  as a dependent under the state group health insurance plan, a
  155  TRICARE supplemental insurance plan, or a health maintenance
  156  organization plan established pursuant to this section at the
  157  time of the death of the deceased officer, employee, or retiree.
  158  The term “Surviving spouse” also means any widow or widower who
  159  is receiving or eligible to receive a monthly state warrant from
  160  a state retirement system as the beneficiary of a state officer,
  161  full-time state employee, or retiree who died prior to July 1,
  162  1979. For the purposes of this section, any such widow or
  163  widower shall cease to be a surviving spouse upon his or her
  164  remarriage.
  165         (p)(o) “TRICARE supplemental insurance plan” means the
  166  Department of Defense Health Insurance Program for eligible
  167  members of the uniformed services authorized by 10 U.S.C. s.
  168  1097.
  169         (3) STATE GROUP INSURANCE PROGRAM.—
  170         (b) It is the intent of the Legislature to offer a
  171  comprehensive package of health insurance and retirement
  172  benefits and a personnel system for state employees which are
  173  provided in a cost-efficient and prudent manner, and to allow
  174  state employees the option to choose benefit plans which best
  175  suit their individual needs. Therefore, The state group
  176  insurance program is established which may include the state
  177  group health insurance plan or plans, health maintenance
  178  organization plans, group life insurance plans, TRICARE
  179  supplemental insurance plans, group accidental death and
  180  dismemberment plans, and group disability insurance plans,.
  181  Furthermore, the department is additionally authorized to
  182  establish and provide as part of the state group insurance
  183  program any other group insurance plans or coverage choices, and
  184  other benefits authorized by law that are consistent with the
  185  provisions of this section.
  186         (f) Except as provided for in subparagraph (h)2., the state
  187  contribution toward the cost of any plan in the state group
  188  insurance program must shall be uniform with respect to all
  189  state employees in a state collective bargaining unit
  190  participating in the same coverage tier in the same plan. This
  191  section does not prohibit the development of separate benefit
  192  plans for officers and employees exempt from the career service
  193  or the development of separate benefit plans for each collective
  194  bargaining unit. For the 2019 plan year and thereafter, if the
  195  state’s contribution is more than the premium cost of the health
  196  plan selected by the employee, subject to federal limitation,
  197  the employee may elect to have the balance:
  198         1. Credited to the employee’s flexible spending account;
  199         2. Credited to the employee’s health savings account;
  200         3. Used to purchase additional benefits offered through the
  201  state group insurance program; or
  202         4. Used to increase the employee’s salary.
  203         (h)1. A person eligible to participate in the state group
  204  insurance program may be authorized by rules adopted by the
  205  department, in lieu of participating in the state group health
  206  insurance plan, to exercise an option to elect membership in a
  207  health maintenance organization plan that which is under
  208  contract with the state in accordance with criteria established
  209  by this section and such by said rules. The offer of optional
  210  membership in a health maintenance organization plan permitted
  211  by this paragraph may be limited or conditioned by rule as may
  212  be necessary to meet the requirements of state and federal laws.
  213         2. The department shall contract with health maintenance
  214  organizations seeking to participate in the state group
  215  insurance program through a request for proposal or other
  216  procurement process, as developed by the Department of
  217  Management Services and determined to be appropriate.
  218         a. The department shall establish a schedule of minimum
  219  benefits for health maintenance organization coverage, which
  220  must include and that schedule shall include: physician
  221  services; inpatient and outpatient hospital services; emergency
  222  medical services, including out-of-area emergency coverage;
  223  diagnostic laboratory and diagnostic and therapeutic radiologic
  224  services; mental health, alcohol, and chemical dependency
  225  treatment services meeting the minimum requirements of state and
  226  federal law; skilled nursing facilities and services;
  227  prescription drugs; age-based and gender-based wellness
  228  benefits; and other benefits as may be required by the
  229  department. Additional services may be provided subject to the
  230  contract between the department and the HMO. As used in this
  231  paragraph, the term “age-based and gender-based wellness
  232  benefits” includes aerobic exercise, education in alcohol and
  233  substance abuse prevention, blood cholesterol screening, health
  234  risk appraisals, blood pressure screening and education,
  235  nutrition education, program planning, safety belt education,
  236  smoking cessation, stress management, weight management, and
  237  women’s health education.
  238         b. The department may establish uniform deductibles,
  239  copayments, coverage tiers, or coinsurance schedules for all
  240  participating HMO plans.
  241         c. The department may require detailed information from
  242  each health maintenance organization participating in the
  243  procurement process, including information pertaining to
  244  organizational status, experience in providing prepaid health
  245  benefits, accessibility of services, financial stability of the
  246  plan, quality of management services, accreditation status,
  247  quality of medical services, network access and adequacy,
  248  performance measurement, ability to meet the department’s
  249  reporting requirements, and the actuarial basis of the proposed
  250  rates and other data determined by the director to be necessary
  251  for the evaluation and selection of health maintenance
  252  organization plans and negotiation of appropriate rates for
  253  these plans. Upon receipt of proposals by health maintenance
  254  organization plans and the evaluation of those proposals, the
  255  department may enter into negotiations with all of the plans or
  256  a subset of the plans, as the department determines appropriate.
  257  Nothing shall preclude the department from negotiating regional
  258  or statewide contracts with health maintenance organization
  259  plans when this is cost-effective and when the department
  260  determines that the plan offers high value to enrollees.
  261         d. The department may limit the number of HMOs that it
  262  contracts with in each service area based on the nature of the
  263  bids the department receives, the number of state employees in
  264  the service area, or any unique geographical characteristics of
  265  the service area. The department shall establish by rule service
  266  areas throughout the state.
  267         e. All persons participating in the state group insurance
  268  program may be required to contribute towards a total state
  269  group health premium that may vary depending upon the plan,
  270  coverage level, and coverage tier selected by the enrollee and
  271  the level of state contribution authorized by the Legislature.
  272         3. The department is authorized to negotiate and to
  273  contract with specialty psychiatric hospitals for mental health
  274  benefits, on a regional basis, for alcohol, drug abuse, and
  275  mental and nervous disorders. The department may establish,
  276  subject to the approval of the Legislature pursuant to
  277  subsection (5), any such regional plan upon completion of an
  278  actuarial study to determine any impact on plan benefits and
  279  premiums.
  280         4. In addition to contracting pursuant to subparagraph 2.,
  281  the department may enter into contract with any HMO to
  282  participate in the state group insurance program with any HMO
  283  that which:
  284         a. Serves more greater than 5,000 recipients on a prepaid
  285  basis under the Medicaid program;
  286         b. Does not currently meet the 25-percent non-Medicare/non
  287  Medicaid enrollment composition requirement established by the
  288  Department of Health excluding participants enrolled in the
  289  state group insurance program;
  290         c. Meets the minimum benefit package and copayments and
  291  deductibles contained in sub-subparagraphs 2.a. and b.;
  292         d. Is willing to participate in the state group insurance
  293  program at a cost of premiums that is not more greater than 95
  294  percent of the cost of HMO premiums accepted by the department
  295  in each service area; and
  296         e. Meets the minimum surplus requirements of s. 641.225.
  297  
  298  The department is authorized to contract with HMOs that meet the
  299  requirements of sub-subparagraphs a.-d. prior to the open
  300  enrollment period for state employees. The department is not
  301  required to renew the contract with the HMOs as set forth in
  302  this paragraph more than twice. Thereafter, the HMOs shall be
  303  eligible to participate in the state group insurance program
  304  only through the request for proposal or invitation to negotiate
  305  process described in subparagraph 2.
  306         5. All enrollees in a state group health insurance plan, a
  307  TRICARE supplemental insurance plan, or any health maintenance
  308  organization plan have the option of changing to any other
  309  health plan that is offered by the state within any open
  310  enrollment period designated by the department. Open enrollment
  311  shall be held at least once each calendar year.
  312         6. When a contract between a treating provider and the
  313  state-contracted health maintenance organization is terminated
  314  for any reason other than for cause, each party shall allow any
  315  enrollee for whom treatment was active to continue coverage and
  316  care when medically necessary, through completion of treatment
  317  of a condition for which the enrollee was receiving care at the
  318  time of the termination, until the enrollee selects another
  319  treating provider, or until the next open enrollment period
  320  offered, whichever is longer, but no longer than 6 months after
  321  termination of the contract. Each party to the terminated
  322  contract shall allow an enrollee who has initiated a course of
  323  prenatal care, regardless of the trimester in which care was
  324  initiated, to continue care and coverage until completion of
  325  postpartum care. This does not prevent a provider from refusing
  326  to continue to provide care to an enrollee who is abusive,
  327  noncompliant, or in arrears in payments for services provided.
  328  For care continued under this subparagraph, the program and the
  329  provider shall continue to be bound by the terms of the
  330  terminated contract. Changes made within 30 days before
  331  termination of a contract are effective only if agreed to by
  332  both parties.
  333         7. Any HMO participating in the state group insurance
  334  program shall submit health care utilization and cost data to
  335  the department, in such form and in such manner as the
  336  department shall require, as a condition of participating in the
  337  program. The department shall enter into negotiations with its
  338  contracting HMOs to determine the nature and scope of the data
  339  submission and the final requirements, format, penalties
  340  associated with noncompliance, and timetables for submission.
  341  These determinations shall be adopted by rule.
  342         8. The department may establish and direct, with respect to
  343  collective bargaining issues, a comprehensive package of
  344  insurance benefits that may include supplemental health and life
  345  coverage, dental care, long-term care, vision care, and other
  346  benefits it determines necessary to enable state employees to
  347  select from among benefit options that best suit their
  348  individual and family needs. Beginning with the 2017 plan year,
  349  the package of benefits may also include products and services
  350  described in s. 110.12303.
  351         a. Based upon a desired benefit package, the department
  352  shall issue a request for proposal or invitation to negotiate
  353  for health insurance providers interested in participating in
  354  the state group insurance program or, and the department shall
  355  issue a request for proposal or invitation to negotiate for
  356  insurance providers interested in participating in the non
  357  health-related components of the state group insurance program.
  358  Upon receipt of all proposals, the department may enter into
  359  contract negotiations with insurance providers submitting bids
  360  or negotiate a specially designed benefit package. Insurance
  361  Providers offering or providing supplemental coverage as of May
  362  30, 1991, which qualify for pretax benefit treatment pursuant to
  363  s. 125 of the Internal Revenue Code of 1986, with 5,500 or more
  364  state employees currently enrolled may be included by the
  365  department in the supplemental insurance benefit plan
  366  established by the department without participating in a request
  367  for proposal, submitting bids, negotiating contracts, or
  368  negotiating a specially designed benefit package. These
  369  contracts must shall provide state employees with the most cost
  370  effective and comprehensive coverage available; however, except
  371  as provided in subparagraph (f)3., no state or agency funds may
  372  not shall be contributed toward the cost of any part of the
  373  premium of such supplemental benefit plans. With respect to
  374  dental coverage, the division shall include in any solicitation
  375  or contract for any state group dental program made after July
  376  1, 2001, a comprehensive indemnity dental plan option which
  377  offers enrollees a completely unrestricted choice of dentists.
  378  If a dental plan is endorsed, or in some manner recognized as
  379  the preferred product, such plan must shall include a
  380  comprehensive indemnity dental plan option that which provides
  381  enrollees with a completely unrestricted choice of dentists.
  382         b. Pursuant to the applicable provisions of s. 110.161, and
  383  s. 125 of the Internal Revenue Code of 1986, the department
  384  shall enroll in the pretax benefit program those state employees
  385  who voluntarily elect coverage in any of the supplemental
  386  insurance benefit plans as provided by sub-subparagraph a.
  387         c. Nothing herein contained shall be construed to prohibit
  388  insurance providers from continuing to provide or offer
  389  supplemental benefit coverage to state employees as provided
  390  under existing agency plans.
  391         (j) For the 2019 plan year and thereafter, health plans
  392  shall be offered in the following benefit levels:
  393         1. Platinum level, which shall have an actuarial value of
  394  at least 90 percent.
  395         2. Gold level, which shall have an actuarial value of at
  396  least 80 percent.
  397         3. Silver level, which shall have an actuarial value of at
  398  least 70 percent.
  399         4. Bronze level, which shall have an actuarial value of at
  400  least 60 percent Notwithstanding paragraph (f) requiring uniform
  401  contributions, and for the 2011-2012 fiscal year only, the state
  402  contribution toward the cost of any plan in the state group
  403  insurance plan is the difference between the overall premium and
  404  the employee contribution. This subsection expires June 30,
  405  2012.
  406         Section 2. In consultation with the independent benefits
  407  consultant described in s. 110.12304, Florida Statutes, as
  408  created by this act, the Department of Management Services shall
  409  develop a plan for the implementation of the benefit levels
  410  described in s. 110.123(3)(j), Florida Statutes. The department
  411  shall submit the plan to the Governor, the President of the
  412  Senate, and the Speaker of the House of Representatives no later
  413  than January 1, 2018, and include recommendations for:
  414         (a) Employer and employee contribution policies.
  415         (b) Steps necessary for maintaining or improving total
  416  employee compensation levels when the transition is initiated.
  417         (c) An education strategy to inform employees of the
  418  additional choices available in the state group insurance
  419  program.
  420         Section 3. Section 110.12303, Florida Statutes, is created
  421  to read:
  422         110.12303 State group insurance program; additional
  423  benefits; price transparency pilot program; reporting.—Beginning
  424  with the 2017 plan year:
  425         (1) In addition to the comprehensive package of health
  426  insurance and other benefits required or authorized to be
  427  included in the state group insurance program, the package of
  428  benefits may also include products and services offered by:
  429         (a) Prepaid limited health service organizations as
  430  authorized by part I of chapter 636.
  431         (b) Discount medical plan organizations as authorized by
  432  part II of chapter 636.
  433         (c) Prepaid health clinics licensed under part II of
  434  chapter 641.
  435         (d) Licensed health care providers, including hospitals and
  436  other health facilities, health care clinics, and health
  437  professionals, who sell service contracts and arrangements for a
  438  specified amount and type of health services.
  439         (e) Provider organizations, including service networks,
  440  group practices, professional associations, and other
  441  incorporated organizations of providers, who sell service
  442  contracts and arrangements for a specified amount and type of
  443  health services.
  444         (f) Entities that provide specific health services in
  445  accordance with applicable state law and sell service contracts
  446  and arrangements for a specified amount and type of health
  447  services.
  448         (g) Entities that provide health services or treatments
  449  through a bidding process.
  450         (h) Entities that provide health services or treatments
  451  through the bundling or aggregating of health services or
  452  treatments.
  453         (i) Entities that provide other innovative and cost
  454  effective health service delivery methods.
  455         (2) The department shall:
  456         (a) Contract with at least one entity that provides
  457  comprehensive pricing and inclusive services for surgery and
  458  other medical procedures that may be accessed at the option of
  459  the enrollee. The contract shall require the entity to:
  460         1. Have procedures and evidence-based standards to ensure
  461  the inclusion of only high-quality health care providers.
  462         2. Provide assistance to the enrollee in accessing and
  463  coordinating care.
  464         3. Provide cost savings to the state group insurance
  465  program to be shared with both the state and the enrollee. Cost
  466  savings payable to an enrollee may be:
  467         a. Credited to the enrollee’s flexible spending account;
  468         b. Credited to the enrollee’s health savings account;
  469         c. Credited to the enrollee’s health reimbursement account;
  470  or
  471         d. Paid as additional health plan reimbursements not
  472  exceeding the amount of the employee’s out-of-pocket medical
  473  expenses.
  474         4. Provide an educational campaign for enrollees to learn
  475  about the services offered by the entity.
  476         (b) Report to the Governor, the President of the Senate,
  477  and the Speaker of the House of Representatives, on or before
  478  January 15 of each year, on the participation level and cost
  479  savings to both the enrollee and the state resulting from any
  480  contract described in this subsection.
  481         (3) The department shall establish a 3-year price
  482  transparency pilot project in at least one area, but in not more
  483  than three areas, of the state where a substantial percentage of
  484  the state group insurance program enrollees live. The purpose of
  485  the project is to reward value-based pricing by publishing the
  486  prices of certain diagnostic and elective surgical procedures
  487  and sharing with the enrollee and the state any savings
  488  generated by the enrollee’s choice of providers.
  489         (a) Participation in the project shall be voluntary for
  490  enrollees.
  491         (b) The department shall designate between 20 and 50
  492  diagnostic procedures and elective surgical procedures that are
  493  commonly used by enrollees.
  494         (c) Health plans shall provide the department with the
  495  contracted price by provider for each designated procedure. The
  496  department shall post the prices on its website and shall
  497  designate one price per procedure as the benchmark price, using
  498  a mean, an average, or other method of comparing the prices.
  499         (d) If an enrollee participating in the project selects a
  500  provider that performs the designated procedure at a price below
  501  the benchmark price for that procedure, the enrollee shall
  502  receive from the state 50 percent of the difference between the
  503  price of the procedure by the selected provider and the
  504  benchmark price. The amount payable to the enrollee may be:
  505         1. Credited to the enrollee’s flexible spending account;
  506         2. Credited to the enrollee’s health savings account;
  507         3. Credited to the enrollee’s health reimbursement account;
  508  or
  509         4. Paid as additional health plan reimbursements not
  510  exceeding the amount of the enrollee’s out-of-pocket medical
  511  expenses.
  512         (e) On or before January 1 of 2018, 2019, and 2020, the
  513  department shall report to the Governor, the President of the
  514  Senate, and the Speaker of the House of Representatives on the
  515  participation level, amount paid to enrollees, and cost savings
  516  to both the enrollees and the state resulting from the price
  517  transparency pilot project.
  518         Section 4. Section 110.12304, Florida Statutes, is created
  519  to read:
  520         110.12304 Independent benefits consultant.—
  521         (1) The department shall competitively procure an
  522  independent benefits consultant.
  523         (2) The independent benefits consultant may not:
  524         (a) Be owned or controlled by a health maintenance
  525  organization or an insurer.
  526         (b) Have an ownership interest in a health maintenance
  527  organization or an insurer.
  528         (c) Have a direct or an indirect financial interest in a
  529  health maintenance organization or an insurer.
  530         (3) The independent benefits consultant must have
  531  substantial experience in consultation and design of employee
  532  benefit programs for large employers and public employers,
  533  including experience with plans that qualify as cafeteria plans
  534  pursuant to s. 125 of the Internal Revenue Code of 1986.
  535         (4) The independent benefits consultant shall:
  536         (a) Provide an ongoing assessment of trends in benefits and
  537  employer-sponsored insurance which affect the state group
  538  insurance program.
  539         (b) Conduct a comprehensive analysis of the state group
  540  insurance program, including available benefits, coverage
  541  options, and claims experience.
  542         (c) Identify and establish appropriate adjustment
  543  procedures necessary to respond to any risk segmentation that
  544  may occur when increased choices are offered to employees.
  545         (d) Assist the department in the submission of any
  546  necessary plan revisions for federal review.
  547         (e) Assist the department in ensuring compliance with
  548  applicable federal regulations and state rules.
  549         (f) Assist the department in monitoring the adequacy of
  550  funding and reserves for the state self-insured plan.
  551         (g) Assist the department in preparing recommendations for
  552  any modifications to the state group insurance program, which
  553  shall be submitted to the Governor, the President of the Senate,
  554  and the Speaker of the House of Representatives no later than
  555  January 1 of each year.
  556         Section 5. For the 2017 plan year, the General
  557  Appropriations Act must implement premiums for enrollees which
  558  reflect the differences in benefit design and value among the
  559  health maintenance organization (HMO) plan options and the
  560  preferred provider organization (PPO) plan options offered in
  561  the state group insurance program.
  562         (1) Effective July 1, 2016, for the coverage period
  563  beginning August 1, 2016, and continuing through December 31,
  564  2016, the employee’s share of the health insurance premiums for
  565  the standard plans remains $50 per month for individual coverage
  566  and $180 per month for family coverage.
  567         (2) Effective December 1, 2016, for the coverage period
  568  beginning January 1, 2017, the employee’s share of the health
  569  insurance premium for the standard HMO plan is $60 per month for
  570  individual coverage and $200 per month for family coverage. For
  571  the same coverage period, the employee’s share of the health
  572  insurance premium for the standard PPO plan is $45 per month for
  573  individual coverage and $170 per month for family coverage. For
  574  the same coverage period, the employee’s share of the health
  575  insurance premium for Capital Health Plan is $40 per month for
  576  individual coverage and $170 per month for family coverage.
  577         (3) Effective July 1, 2016, for the coverage period
  578  beginning August 1, 2016, and continuing through December 31,
  579  2016, the employee’s share of the health insurance premium for
  580  the high-deductible health plans remains $15 per month for
  581  individual coverage and $64.30 per month for family coverage.
  582         (4) Effective December 1, 2016, for the coverage period
  583  beginning January 1, 2017, the employee’s share of the health
  584  insurance premium for the high-deductible health plans is $10
  585  per month for individual coverage and $50 per month for family
  586  coverage.
  587         (5) Effective July 1, 2016, for the coverage period
  588  beginning August 1, 2016, the employee’s share of the health
  589  insurance premium for the standard PPO plan, the standard HMO
  590  plan, and Capital Health Plan remains $8.34 per month for
  591  individual coverage and $30 per month for family coverage for
  592  employees filling positions with “agency payall” benefits.
  593         (6) Effective July 1, 2016, for the coverage period
  594  beginning August 1, 2016, and continuing through December 31,
  595  2016, the employee’s share of the health insurance premium for
  596  the high-deductible health plans remains $8.34 per month for
  597  individual coverage and $30 per month for family coverage for
  598  employees filling positions with “agency payall” benefits.
  599         (7) Effective December 1, 2016, for the coverage period
  600  beginning January 1, 2017, the employee’s share of the health
  601  insurance premium for the high-deductible health plans is $8.34
  602  per month for individual coverage and $25 per month for family
  603  coverage for employees filling positions with “agency payall”
  604  benefits.
  605         (8) Effective July 1, 2016, for the coverage period
  606  beginning August 1, 2016, and continuing through December 31,
  607  2016, the employee’s share of the health insurance premium for
  608  the standard plans and the high-deductible health plans remains
  609  $30 per month for each employee participating in the Spouse
  610  Program in accordance with rules of the Department of Management
  611  Services.
  612         (9) Effective December 1, 2016, for the coverage period
  613  beginning January 1, 2017, the employee’s share of the health
  614  insurance premium for the standard plans remains $30 for each
  615  employee participating in the Spouse Program in accordance with
  616  rules of the Department of Management Services.
  617         (10) Effective December 1, 2016, for the coverage period
  618  beginning January 1, 2017, the employee’s share of the health
  619  insurance premium for the high-deductible health plans is $25
  620  for each employee participating in the Spouse Program in
  621  accordance with rules of the Department of Management Services.
  622         (11) Effective July 1, 2016, for the coverage period
  623  beginning August 1, 2016, an “early retiree” participating in a
  624  standard plan shall continue to pay a monthly premium equal to
  625  100 percent of the total premium charged, including state and
  626  employee contributions, for an active employee participating in
  627  the standard plan.
  628         (12) Effective July 1, 2016, for the coverage period
  629  beginning August 1, 2016, and continuing through December 31,
  630  2016, an “early retiree” participating in a high-deductible
  631  health plan shall continue to pay $564.86 per month for
  632  individual coverage and $1,245.03 per month for family coverage.
  633         (13) Effective December 1, 2016, for the coverage period
  634  beginning January 1, 2017, an “early retiree” participating in a
  635  high-deductible health plan shall pay $559.86 per month for
  636  individual coverage and $1,230.73 per month for family coverage.
  637         (14) Effective July 1, 2016, for the coverage period
  638  beginning August 1, 2016, and continuing through December 31,
  639  2016, the monthly premium for Medicare participants in the
  640  standard plans remains $359.61 for “one eligible,” $1,036.90 for
  641  “one under/one over,” and $719.22 for “both eligible.”
  642         (15) Effective December 1, 2016, for the coverage period
  643  beginning January 1, 2017, the monthly premium for Medicare
  644  participants in the standard PPO plan is $356.49 for “one
  645  eligible,” $1,027.89 for “one under/one over,” and $712.97 for
  646  “both eligible.” For the same coverage period, the monthly
  647  premium for Medicare participants participating in the standard
  648  HMO plan is $371.32 for “one eligible,” $1,070.67 for “one
  649  under/one over,” and $742.64 for “both eligible.”
  650         (16) Effective July 1, 2016, for the coverage period
  651  beginning August 1, 2016, the monthly premium for Medicare
  652  participants in the high-deductible health plan is $271.07 for
  653  “one eligible,” $849.19 for “one under/one over,” and $542.14
  654  for “both eligible.”
  655         (17) Effective July 1, 2016, for the coverage period
  656  beginning August 1, 2016, the monthly premium for Medicare
  657  participants enrolled in a fully insured standard HMO plan or an
  658  HMO high-deductible health plan is equal to the negotiated
  659  monthly premium for the selected state-contracted health
  660  maintenance organization.
  661         (18) Effective July 1, 2016, for the coverage period
  662  beginning August 1, 2016, a COBRA participant in the State Group
  663  Health Insurance Program shall continue to pay a premium equal
  664  to 102 percent of the total premium charged, including state and
  665  employee contributions, for an active employee participating in
  666  the program.
  667         (19) Effective July 1, 2016, for the coverage period
  668  beginning August 1, 2016, the state share of State Group Health
  669  Insurance Program premiums is the same as those in effect on
  670  July 1, 2014, pursuant to chapter 2014-51, Laws of Florida.
  671         Section 6. (1) For the 2016-2017 fiscal year, the sums of
  672  $151,216 in recurring funds and $507,546 in nonrecurring funds
  673  are appropriated from the State Employees Health Insurance Trust
  674  Fund to the Department of Management Services, and two full-time
  675  equivalent positions with associated salary rate of 120,000 are
  676  authorized, for the purpose of implementing this act.
  677         (2)(a) The recurring funds appropriated in this section
  678  shall be allocated to the following specific appropriation
  679  categories within the Insurance Benefits Administration Program:
  680  $150,528 to “Salaries and Benefits” and $688 to “Special
  681  Categories-Transfer to Department of Management Services-Human
  682  Resources Purchased per Statewide Contract.”
  683         (b) The nonrecurring funds appropriated in this section
  684  shall be allocated to the following specific appropriation
  685  categories: $500,000 to “Special Categories Contracted Services”
  686  and $7,546 to “Expenses.”
  687         Section 7. This act shall take effect July 1, 2016.