Florida Senate - 2016 SB 340 By Senator Latvala 20-00036A-16 2016340__ 1 A bill to be entitled 2 An act relating to vision care plans; amending ss. 3 627.6474, 636.035, and 641.315, F.S.; providing that a 4 health insurer, a prepaid limited health service 5 organization, and a health maintenance organization, 6 respectively, may not require a licensed 7 ophthalmologist or optometrist to join a network 8 solely for the purpose of credentialing the licensee 9 for another vision network; providing that such 10 insurers and organizations are not prevented by the 11 act from entering into a contract with another vision 12 care plan; providing that such insurers and 13 organizations may not restrict a licensed 14 ophthalmologist, optometrist, or optician to specific 15 suppliers of materials or optical laboratories; 16 providing that such insurers and organizations are not 17 restricted by the act in determining certain amounts 18 of coverage or reimbursement; requiring such insurers’ 19 and organizations’ online vision care network provider 20 directories to be updated monthly; providing that a 21 violation of certain prohibitions in the act 22 constitutes a specified unfair insurance trade 23 practice; providing an effective date. 24 25 Be It Enacted by the Legislature of the State of Florida: 26 27 Section 1. Subsection (3) is added to section 627.6474, 28 Florida Statutes, to read: 29 627.6474 Provider contracts.— 30 (3)(a) A health insurer may not require an ophthalmologist 31 licensed pursuant to chapter 458 or chapter 459 or an 32 optometrist licensed pursuant to chapter 463 to join a network 33 solely for the purpose of credentialing the licensee for another 34 insurer’s vision network. This paragraph does not prevent a 35 health insurer from entering into a contract with another 36 insurer’s vision care plan to use the vision network. 37 (b) A health insurer may not restrict an ophthalmologist 38 licensed pursuant to chapter 458 or chapter 459, an optometrist 39 licensed pursuant to chapter 463, or an optician licensed 40 pursuant to part I of chapter 484 to specific suppliers of 41 materials or optical laboratories. This paragraph does not 42 restrict a health insurer in determining specific amounts of 43 coverage or reimbursement for the use of network or out-of 44 network suppliers or laboratories. 45 (c) A health insurer’s online vision care network provider 46 directory must be updated monthly to reflect the vision care 47 providers currently participating in the health insurer’s 48 network. 49 (d) A knowing violation of paragraph (a) or paragraph (b) 50 constitutes an unfair insurance trade practice under s. 51 626.9541(1)(d). 52 Section 2. Subsection (14) is added to section 636.035, 53 Florida Statutes, to read: 54 636.035 Provider arrangements.— 55 (14)(a) A prepaid limited health service organization may 56 not require an ophthalmologist licensed pursuant to chapter 458 57 or chapter 459 or an optometrist licensed pursuant to chapter 58 463 to join a network solely for the purpose of credentialing 59 the licensee for another organization’s vision network. This 60 paragraph does not prevent such organization from entering into 61 a contract with another organization’s vision care plan to use 62 the vision network. 63 (b) A prepaid limited health service organization may not 64 restrict an ophthalmologist licensed pursuant to chapter 458 or 65 chapter 459, an optometrist licensed pursuant to chapter 463, or 66 an optician licensed pursuant to part I of chapter 484 to 67 specific suppliers of materials or optical laboratories. This 68 paragraph does not restrict such organization in determining 69 specific amounts of coverage or reimbursement for the use of 70 network or out-of-network suppliers or laboratories. 71 (c) A prepaid limited health service organization’s online 72 vision care network provider directory must be updated monthly 73 to reflect the vision care providers currently participating in 74 the organization’s network. 75 (d) A knowing violation of paragraph (a) or paragraph (b) 76 constitutes an unfair insurance trade practice under s. 77 626.9541(1)(d). 78 Section 3. Subsection (12) is added to section 641.315, 79 Florida Statutes, to read: 80 641.315 Provider contracts.— 81 (12)(a) A health maintenance organization may not require 82 an ophthalmologist licensed pursuant to chapter 458 or chapter 83 459 or an optometrist licensed pursuant to chapter 463 to join a 84 network solely for the purpose of credentialing the licensee for 85 another organization’s vision network. This paragraph does not 86 prevent such organization from entering into a contract with 87 another organization’s vision care plan to use the vision 88 network. 89 (b) A health maintenance organization may not restrict an 90 ophthalmologist licensed pursuant to chapter 458 or chapter 459, 91 an optometrist licensed pursuant to chapter 463, or an optician 92 licensed pursuant to part I of chapter 484 to specific suppliers 93 of materials or optical laboratories. This paragraph does not 94 restrict such organization in determining specific amounts of 95 coverage or reimbursement for the use of network or out-of 96 network suppliers or laboratories. 97 (c) A health maintenance organization’s online vision care 98 network provider directory must be updated monthly to reflect 99 the vision care providers currently participating in the 100 organization’s network. 101 (d) A knowing violation of paragraph (a) or paragraph (b) 102 constitutes an unfair insurance trade practice under s. 103 626.9541(1)(d). 104 Section 4. This act shall take effect July 1, 2016.