Florida Senate - 2019                        COMMITTEE AMENDMENT
       Bill No. SB 1180
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: RCS            .                                
                  03/18/2019           .                                

       The Committee on Banking and Insurance (Mayfield) recommended
       the following:
    1         Senate Amendment 
    3         Delete lines 30 - 140
    4  and insert:
    5  drug that the insured’s treating physician determines is
    6  medically necessary:
    7         (a)Remove the prescription drug from its list of covered
    8  drugs during the policy year unless the United States Food and
    9  Drug Administration has issued a statement about the drug which
   10  calls into question the clinical safety of the drug or the
   11  manufacturer of the drug has notified the United States Food and
   12  Drug Administration of a manufacturing discontinuance or
   13  potential discontinuance of the drug as required by s. 506C of
   14  the Federal Food, Drug, and Cosmetic Act, 21 U.S.C. s. 356c.
   15         (b)Reclassify the drug to a more restrictive drug tier or
   16  increase the amount that an insured must pay for a copayment,
   17  coinsurance, or deductible for prescription drug benefits or
   18  reclassify the drug to a higher cost-sharing tier during the
   19  policy year.
   20         (2)This section does not:
   21         (a) Prohibit the addition of prescription drugs to the list
   22  of drugs covered under the policy during the policy year.
   23         (b)Apply to a grandfathered health plan as defined in s.
   24  627.402 or to benefits set forth in s. 627.6513(1)-(14).
   25         (c)Alter or amend s. 465.025, which provides conditions
   26  under which a pharmacist may substitute a generically equivalent
   27  drug product for a brand name drug product.
   28         (d)Alter or amend s. 465.0252, which provides conditions
   29  under which a pharmacist may dispense a substitute biological
   30  product for the prescribed biological product.
   31         (e) Apply to a Medicaid managed care plan under part IV of
   32  chapter 409.
   33         Section 2. Paragraph (e) of subsection (5) of section
   34  627.6699, Florida Statutes, is amended to read:
   35         627.6699 Employee Health Care Access Act.—
   36         (5) AVAILABILITY OF COVERAGE.—
   37         (e) All health benefit plans issued under this section must
   38  comply with the following conditions:
   39         1. For employers who have fewer than two employees, a late
   40  enrollee may be excluded from coverage for no longer than 24
   41  months if he or she was not covered by creditable coverage
   42  continually to a date not more than 63 days before the effective
   43  date of his or her new coverage.
   44         2. Any requirement used by a small employer carrier in
   45  determining whether to provide coverage to a small employer
   46  group, including requirements for minimum participation of
   47  eligible employees and minimum employer contributions, must be
   48  applied uniformly among all small employer groups having the
   49  same number of eligible employees applying for coverage or
   50  receiving coverage from the small employer carrier, except that
   51  a small employer carrier that participates in, administers, or
   52  issues health benefits pursuant to s. 381.0406 which do not
   53  include a preexisting condition exclusion may require as a
   54  condition of offering such benefits that the employer has had no
   55  health insurance coverage for its employees for a period of at
   56  least 6 months. A small employer carrier may vary application of
   57  minimum participation requirements and minimum employer
   58  contribution requirements only by the size of the small employer
   59  group.
   60         3. In applying minimum participation requirements with
   61  respect to a small employer, a small employer carrier shall not
   62  consider as an eligible employee employees or dependents who
   63  have qualifying existing coverage in an employer-based group
   64  insurance plan or an ERISA qualified self-insurance plan in
   65  determining whether the applicable percentage of participation
   66  is met. However, a small employer carrier may count eligible
   67  employees and dependents who have coverage under another health
   68  plan that is sponsored by that employer.
   69         4. A small employer carrier shall not increase any
   70  requirement for minimum employee participation or any
   71  requirement for minimum employer contribution applicable to a
   72  small employer at any time after the small employer has been
   73  accepted for coverage, unless the employer size has changed, in
   74  which case the small employer carrier may apply the requirements
   75  that are applicable to the new group size.
   76         5. If a small employer carrier offers coverage to a small
   77  employer, it must offer coverage to all the small employer’s
   78  eligible employees and their dependents. A small employer
   79  carrier may not offer coverage limited to certain persons in a
   80  group or to part of a group, except with respect to late
   81  enrollees.
   82         6. A small employer carrier may not modify any health
   83  benefit plan issued to a small employer with respect to a small
   84  employer or any eligible employee or dependent through riders,
   85  endorsements, or otherwise to restrict or exclude coverage for
   86  certain diseases or medical conditions otherwise covered by the
   87  health benefit plan.
   88         7. An initial enrollment period of at least 30 days must be
   89  provided. An annual 30-day open enrollment period must be
   90  offered to each small employer’s eligible employees and their
   91  dependents. A small employer carrier must provide special
   92  enrollment periods as required by s. 627.65615.
   93         8. A small employer carrier must limit changes to
   94  prescription drug formularies as required by s. 627.42393.
   95         Section 3. Subsection (36) of section 641.31, Florida
   96  Statutes, is amended to read:
   97         641.31 Health maintenance contracts.—
   98         (36) A health maintenance organization may increase the
   99  copayment for any benefit, or delete, amend, or limit any of the
  100  benefits to which a subscriber is entitled under the group
  101  contract only, upon written notice to the contract holder at
  102  least 45 days in advance of the time of coverage renewal. The
  103  health maintenance organization may amend the contract with the
  104  contract holder, with such amendment to be effective immediately
  105  at the time of coverage renewal. The written notice to the
  106  contract holder must shall specifically identify any deletions,
  107  amendments, or limitations to any of the benefits provided in
  108  the group contract during the current contract period which will
  109  be included in the group contract upon renewal. This subsection
  110  does not apply to any increases in benefits. The 45-day notice
  111  requirement does shall not apply if benefits are amended,
  112  deleted, or limited at the request of the contract holder.
  113         (a) Other than at the time of coverage renewal, a health
  114  maintenance contract that provides medical, major medical, or
  115  similar comprehensive coverage may not, while the subscriber is
  116  taking a prescription drug that the subscriber’s treating
  117  physician determines is medically necessary: