Florida Senate - 2018 SB 534
By Senator Grimsley
26-00674-18 2018534__
1 A bill to be entitled
2 An act relating to the regulation of pharmacy benefits
3 managers; amending s. 465.1862, F.S.; deleting an
4 obsolete cross-reference; defining the term “health
5 insurance plan”; amending s. 626.88, F.S.; redefining
6 the term “administrator” to include pharmacy benefits
7 managers; making technical changes; providing an
8 effective date.
9
10 Be It Enacted by the Legislature of the State of Florida:
11
12 Section 1. Paragraph (b) of subsection (1) of section
13 465.1862, Florida Statutes, is amended to read:
14 465.1862 Pharmacy benefits manager contracts.—
15 (1) As used in this section, the term:
16 (b) “Pharmacy benefits manager” means a person or entity
17 doing business in this state which contracts to administer or
18 manage prescription drug benefits on behalf of a health
19 insurance plan, as defined in former s. 627.6482, to residents
20 of this state. For purposes of this paragraph, the term “health
21 insurance plan” means any hospital and medical expense incurred
22 policy, minimum premium plan, stop-loss coverage, health
23 maintenance organization contract, prepaid health clinic
24 contract, multiple-employer welfare arrangement contract, or
25 fraternal benefit society health benefits contract, whether sold
26 as an individual or group policy or contract; but the term does
27 not include any policy covering medical payments coverage or
28 personal injury protection coverage in a motor vehicle policy,
29 coverage issued as a supplement to liability insurance, or
30 workers’ compensation.
31 Section 2. Subsection (1) of section 626.88, Florida
32 Statutes, is amended to read:
33 626.88 Definitions.—For the purposes of this part, the
34 term:
35 (1) “Administrator” means is any person who directly or
36 indirectly solicits or effects coverage of, collects charges or
37 premiums from, or adjusts or settles claims on residents of this
38 state in connection with authorized commercial self-insurance
39 funds or with insured or self-insured programs which provide
40 life or health insurance coverage or coverage of any other
41 expenses described in s. 624.33(1); or any person who, through a
42 health care risk contract as defined in s. 641.234 with an
43 insurer or health maintenance organization, provides billing and
44 collection services to health insurers and health maintenance
45 organizations on behalf of health care providers; or a pharmacy
46 benefits manager as defined in s. 465.1862(1). The term does not
47 include, other than any of the following persons:
48 (a) An employer or wholly owned direct or indirect
49 subsidiary of an employer, on behalf of such employer’s
50 employees or the employees of one or more subsidiary or
51 affiliated corporations of such employer.
52 (b) A union on behalf of its members.
53 (c) An insurance company which is either authorized to
54 transact insurance in this state or is acting as an insurer with
55 respect to a policy lawfully issued and delivered by such
56 company in and pursuant to the laws of a state in which the
57 insurer was authorized to transact an insurance business.
58 (d) A health care services plan, health maintenance
59 organization, professional service plan corporation, or person
60 in the business of providing continuing care, possessing a valid
61 certificate of authority issued by the office, and the sales
62 representatives thereof, if the activities of such entity are
63 limited to the activities permitted under the certificate of
64 authority.
65 (e) An entity that is affiliated with an insurer and that
66 only performs the contractual duties, between the administrator
67 and the insurer, of an administrator for the direct and assumed
68 insurance business of the affiliated insurer. The insurer is
69 responsible for the acts of the administrator and is responsible
70 for providing all of the administrator’s books and records to
71 the insurance commissioner, upon a request from the insurance
72 commissioner. For purposes of this paragraph, the term “insurer”
73 means a licensed insurance company, health maintenance
74 organization, prepaid limited health service organization, or
75 prepaid health clinic.
76 (f) A nonresident entity licensed in its state of domicile
77 as an administrator if its duties in this state are limited to
78 the administration of a group policy or plan of insurance and no
79 more than a total of 100 lives for all plans reside in this
80 state.
81 (g) An insurance agent licensed in this state whose
82 activities are limited exclusively to the sale of insurance.
83 (h) A person licensed as a managing general agent in this
84 state, whose activities are limited exclusively to the scope of
85 activities conveyed under such license.
86 (i) An adjuster licensed in this state whose activities are
87 limited to the adjustment of claims.
88 (j) A creditor on behalf of such creditor’s debtors with
89 respect to insurance covering a debt between the creditor and
90 its debtors.
91 (k) A trust and its trustees, agents, and employees acting
92 pursuant to such trust established in conformity with 29 U.S.C.
93 s. 186.
94 (l) A trust exempt from taxation under s. 501(a) of the
95 Internal Revenue Code, a trust satisfying the requirements of
96 ss. 624.438 and 624.439, or any governmental trust as defined in
97 s. 624.33(3), and the trustees and employees acting pursuant to
98 such trust, or a custodian and its agents and employees,
99 including individuals representing the trustees in overseeing
100 the activities of a service company or administrator, acting
101 pursuant to a custodial account which meets the requirements of
102 s. 401(f) of the Internal Revenue Code.
103 (m) A financial institution which is subject to supervision
104 or examination by federal or state authorities or a mortgage
105 lender licensed under chapter 494 who collects and remits
106 premiums to licensed insurance agents or authorized insurers
107 concurrently or in connection with mortgage loan payments.
108 (n) A credit card issuing company which advances for and
109 collects premiums or charges from its credit card holders who
110 have authorized such collection if such company does not adjust
111 or settle claims.
112 (o) A person who adjusts or settles claims in the normal
113 course of such person’s practice or employment as an attorney at
114 law and who does not collect charges or premiums in connection
115 with life or health insurance coverage.
116 (p) A person approved by the department who administers
117 only self-insured workers’ compensation plans.
118 (q) A service company or service agent and its employees,
119 authorized in accordance with ss. 626.895-626.899, serving only
120 a single employer plan, multiple-employer welfare arrangements,
121 or a combination thereof.
122 (r) Any provider or group practice, as defined in s.
123 456.053, providing services under the scope of the license of
124 the provider or the member of the group practice.
125 (s) Any hospital providing billing, claims, and collection
126 services solely on its own and its physicians’ behalf and
127 providing services under the scope of its license.
128 (t) A corporation not for profit whose membership consists
129 entirely of local governmental units authorized to enter into
130 risk management consortiums under s. 112.08.
131
132 A person who provides billing and collection services to health
133 insurers and health maintenance organizations on behalf of
134 health care providers shall comply with the provisions of ss.
135 627.6131, 641.3155, and 641.51(4).
136 Section 3. This act shall take effect July 1, 2018.