Florida Senate - 2019                          SENATOR AMENDMENT
       Bill No. CS for CS for CS for SB 1180
       
       
       
       
       
       
                                Ì494528EÎ494528                         
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
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                Floor: 1/RS/2R         .                                
             04/25/2019 05:12 PM       .                                
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       Senator Mayfield moved the following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Delete lines 65 - 293
    4  and insert:
    5  this state shall provide general notification of the change in
    6  the formulary to current and prospective insureds in a readily
    7  accessible format on the insurer’s website and notify,
    8  electronically or by first-class mail, any insured currently
    9  receiving coverage for a prescription drug for which the
   10  formulary change modifies coverage and the insured’s treating
   11  physician, including information on the specific drugs involved.
   12         (2)A health insurer shall maintain a record of any change
   13  in its formulary during the policy year and, within 90 days
   14  after the end of the policy year, submit an annual report to the
   15  office delineating such changes. The annual report must include,
   16  at a minimum:
   17         (a)A list of all drugs that were removed from a formulary
   18  and the reasons for the removal;
   19         (b)A list of all drugs that were moved to a tier that
   20  resulted in additional out-of-pocket costs to insureds;
   21         (c)The number of insureds notified by the insurer of a
   22  change in formulary; and
   23         (d)The increased cost, by dollar amount, incurred by
   24  insureds because of such change in the formulary.
   25         Section 2. Paragraph (e) of subsection (5) of section
   26  627.6699, Florida Statutes, is amended to read:
   27         627.6699 Employee Health Care Access Act.—
   28         (5) AVAILABILITY OF COVERAGE.—
   29         (e) All health benefit plans issued under this section must
   30  comply with the following conditions:
   31         1. For employers who have fewer than two employees, a late
   32  enrollee may be excluded from coverage for no longer than 24
   33  months if he or she was not covered by creditable coverage
   34  continually to a date not more than 63 days before the effective
   35  date of his or her new coverage.
   36         2. Any requirement used by a small employer carrier in
   37  determining whether to provide coverage to a small employer
   38  group, including requirements for minimum participation of
   39  eligible employees and minimum employer contributions, must be
   40  applied uniformly among all small employer groups having the
   41  same number of eligible employees applying for coverage or
   42  receiving coverage from the small employer carrier, except that
   43  a small employer carrier that participates in, administers, or
   44  issues health benefits pursuant to s. 381.0406 which do not
   45  include a preexisting condition exclusion may require as a
   46  condition of offering such benefits that the employer has had no
   47  health insurance coverage for its employees for a period of at
   48  least 6 months. A small employer carrier may vary application of
   49  minimum participation requirements and minimum employer
   50  contribution requirements only by the size of the small employer
   51  group.
   52         3. In applying minimum participation requirements with
   53  respect to a small employer, a small employer carrier shall not
   54  consider as an eligible employee employees or dependents who
   55  have qualifying existing coverage in an employer-based group
   56  insurance plan or an ERISA qualified self-insurance plan in
   57  determining whether the applicable percentage of participation
   58  is met. However, a small employer carrier may count eligible
   59  employees and dependents who have coverage under another health
   60  plan that is sponsored by that employer.
   61         4. A small employer carrier shall not increase any
   62  requirement for minimum employee participation or any
   63  requirement for minimum employer contribution applicable to a
   64  small employer at any time after the small employer has been
   65  accepted for coverage, unless the employer size has changed, in
   66  which case the small employer carrier may apply the requirements
   67  that are applicable to the new group size.
   68         5. If a small employer carrier offers coverage to a small
   69  employer, it must offer coverage to all the small employer’s
   70  eligible employees and their dependents. A small employer
   71  carrier may not offer coverage limited to certain persons in a
   72  group or to part of a group, except with respect to late
   73  enrollees.
   74         6. A small employer carrier may not modify any health
   75  benefit plan issued to a small employer with respect to a small
   76  employer or any eligible employee or dependent through riders,
   77  endorsements, or otherwise to restrict or exclude coverage for
   78  certain diseases or medical conditions otherwise covered by the
   79  health benefit plan.
   80         7. An initial enrollment period of at least 30 days must be
   81  provided. An annual 30-day open enrollment period must be
   82  offered to each small employer’s eligible employees and their
   83  dependents. A small employer carrier must provide special
   84  enrollment periods as required by s. 627.65615.
   85         8. A small employer carrier shall comply with s. 627.42393
   86  for any change to a prescription drug formulary.
   87         Section 3. Subsection (36) of section 641.31, Florida
   88  Statutes, is amended to read:
   89         641.31 Health maintenance contracts.—
   90         (36) Except as provided in paragraph (a), a health
   91  maintenance organization may increase the copayment for any
   92  benefit, or delete, amend, or limit any of the benefits to which
   93  a subscriber is entitled under the group contract only, upon
   94  written notice to the contract holder at least 45 days in
   95  advance of the time of coverage renewal. The health maintenance
   96  organization may amend the contract with the contract holder,
   97  with such amendment to be effective immediately at the time of
   98  coverage renewal. The written notice to the contract holder must
   99  shall specifically identify any deletions, amendments, or
  100  limitations to any of the benefits provided in the group
  101  contract during the current contract period which will be
  102  included in the group contract upon renewal. This subsection
  103  does not apply to any increases in benefits. The 45-day notice
  104  requirement does shall not apply if benefits are amended,
  105  deleted, or limited at the request of the contract holder.
  106         (a) At least 60 days before the effective date of any
  107  change to a prescription drug formulary during a contract year,
  108  the health maintenance organization shall provide general
  109  notification of the change in the formulary to current and
  110  prospective subscribers in a readily accessible format on the
  111  health maintenance organization’s website and notify,
  112  electronically or by first-class mail, any subscriber currently
  113  receiving coverage for a prescription drug for which the
  114  formulary change modifies coverage and the subscriber’s treating
  115  physician, including information on the specific drugs involved.
  116         (b)A health maintenance organization shall maintain a
  117  record of any change in its formulary during the policy year
  118  and, within 90 days after the end of the policy year, submit an
  119  annual report to the office delineating such changes. The annual
  120  report must include, at a minimum:
  121         1.A list of all drugs that were removed from a formulary
  122  and the reasons for the removal;
  123         2.A list of all drugs that were moved to a tier that
  124  resulted in additional out-of-pocket costs to subscribers;
  125         3.The number of subscribers notified by the health
  126  maintenance organization of a change in formulary; and
  127         4.The increased cost, by dollar amount, incurred by
  128  subscribers because of such change in the formulary.
  129  
  130  ================= T I T L E  A M E N D M E N T ================
  131  And the title is amended as follows:
  132         Delete lines 6 - 53
  133  and insert:
  134         current and prospective insureds, and the insureds’
  135         treating physicians, within a certain timeframe before
  136         the effective date of any change to a prescription
  137         drug formulary during a policy year; requiring such
  138         insurers to maintain a record of formulary changes and
  139         submit a certain annual report to the Office of
  140         Insurance Regulation within a certain timeframe;
  141         specifying requirements for the annual report;
  142         amending s. 627.6699, F.S.; requiring small employer
  143         carriers to comply with certain requirements for any
  144         change to a prescription drug formulary under the
  145         health benefit plan; amending s. 641.31, F.S.;
  146         requiring health maintenance organizations to provide
  147         certain notices to current and prospective
  148         subscribers, and the subscribers’ treating physicians,
  149         within a certain timeframe before the effective date
  150         of any change to a prescription drug formulary during
  151         a contract year; requiring such health maintenance
  152         organizations to maintain a record of formulary
  153         changes and submit a certain annual report to the
  154         office within a certain timeframe; specifying
  155         requirements for the annual report; providing a
  156         declaration of important state