Florida Senate - 2019                          SENATOR AMENDMENT
       Bill No. CS for CS for CS for SB 1180
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
               Floor: 2a/AD/2R         .                                
             04/25/2019 05:12 PM       .                                

       Senator Mayfield moved the following:
    1         Senate Amendment to Substitute Amendment (636826) 
    3         Delete lines 14 - 126
    4  and insert:
    5  in its formulary during a calendar year. By March 1 annually, a
    6  health insurer shall submit a report to the office delineating
    7  such changes made in the previous calendar year. The annual
    8  report must include, at a minimum:
    9         (a)A list of all drugs that were removed from a formulary
   10  and the reasons for the removal;
   11         (b)A list of all drugs that were moved to a tier that
   12  resulted in additional out-of-pocket costs to insureds;
   13         (c)The number of insureds notified by the insurer of a
   14  change in formulary; and
   15         (d)The increased cost, by dollar amount, incurred by
   16  insureds because of such change in the formulary.
   17         (3)By May 1 annually, the office shall:
   18         (a)Compile the data in such annual reports submitted by
   19  health insurers and prepare a report summarizing the data
   20  submitted;
   21         (b)Make the report publicly accessible on its website; and
   22         (c)Submit the report to the Governor, the President of the
   23  Senate, and the Speaker of the House of Representatives.
   24         Section 2. Paragraph (e) of subsection (5) of section
   25  627.6699, Florida Statutes, is amended to read:
   26         627.6699 Employee Health Care Access Act.—
   27         (5) AVAILABILITY OF COVERAGE.—
   28         (e) All health benefit plans issued under this section must
   29  comply with the following conditions:
   30         1. For employers who have fewer than two employees, a late
   31  enrollee may be excluded from coverage for no longer than 24
   32  months if he or she was not covered by creditable coverage
   33  continually to a date not more than 63 days before the effective
   34  date of his or her new coverage.
   35         2. Any requirement used by a small employer carrier in
   36  determining whether to provide coverage to a small employer
   37  group, including requirements for minimum participation of
   38  eligible employees and minimum employer contributions, must be
   39  applied uniformly among all small employer groups having the
   40  same number of eligible employees applying for coverage or
   41  receiving coverage from the small employer carrier, except that
   42  a small employer carrier that participates in, administers, or
   43  issues health benefits pursuant to s. 381.0406 which do not
   44  include a preexisting condition exclusion may require as a
   45  condition of offering such benefits that the employer has had no
   46  health insurance coverage for its employees for a period of at
   47  least 6 months. A small employer carrier may vary application of
   48  minimum participation requirements and minimum employer
   49  contribution requirements only by the size of the small employer
   50  group.
   51         3. In applying minimum participation requirements with
   52  respect to a small employer, a small employer carrier shall not
   53  consider as an eligible employee employees or dependents who
   54  have qualifying existing coverage in an employer-based group
   55  insurance plan or an ERISA qualified self-insurance plan in
   56  determining whether the applicable percentage of participation
   57  is met. However, a small employer carrier may count eligible
   58  employees and dependents who have coverage under another health
   59  plan that is sponsored by that employer.
   60         4. A small employer carrier shall not increase any
   61  requirement for minimum employee participation or any
   62  requirement for minimum employer contribution applicable to a
   63  small employer at any time after the small employer has been
   64  accepted for coverage, unless the employer size has changed, in
   65  which case the small employer carrier may apply the requirements
   66  that are applicable to the new group size.
   67         5. If a small employer carrier offers coverage to a small
   68  employer, it must offer coverage to all the small employer’s
   69  eligible employees and their dependents. A small employer
   70  carrier may not offer coverage limited to certain persons in a
   71  group or to part of a group, except with respect to late
   72  enrollees.
   73         6. A small employer carrier may not modify any health
   74  benefit plan issued to a small employer with respect to a small
   75  employer or any eligible employee or dependent through riders,
   76  endorsements, or otherwise to restrict or exclude coverage for
   77  certain diseases or medical conditions otherwise covered by the
   78  health benefit plan.
   79         7. An initial enrollment period of at least 30 days must be
   80  provided. An annual 30-day open enrollment period must be
   81  offered to each small employer’s eligible employees and their
   82  dependents. A small employer carrier must provide special
   83  enrollment periods as required by s. 627.65615.
   84         8. A small employer carrier shall comply with s. 627.42393
   85  for any change to a prescription drug formulary.
   86         Section 3. Subsection (36) of section 641.31, Florida
   87  Statutes, is amended to read:
   88         641.31 Health maintenance contracts.—
   89         (36) Except as provided in paragraph (a), a health
   90  maintenance organization may increase the copayment for any
   91  benefit, or delete, amend, or limit any of the benefits to which
   92  a subscriber is entitled under the group contract only, upon
   93  written notice to the contract holder at least 45 days in
   94  advance of the time of coverage renewal. The health maintenance
   95  organization may amend the contract with the contract holder,
   96  with such amendment to be effective immediately at the time of
   97  coverage renewal. The written notice to the contract holder must
   98  shall specifically identify any deletions, amendments, or
   99  limitations to any of the benefits provided in the group
  100  contract during the current contract period which will be
  101  included in the group contract upon renewal. This subsection
  102  does not apply to any increases in benefits. The 45-day notice
  103  requirement does shall not apply if benefits are amended,
  104  deleted, or limited at the request of the contract holder.
  105         (a) At least 60 days before the effective date of any
  106  change to a prescription drug formulary during a contract year,
  107  the health maintenance organization shall provide general
  108  notification of the change in the formulary to current and
  109  prospective subscribers in a readily accessible format on the
  110  health maintenance organization’s website and notify,
  111  electronically or by first-class mail, any subscriber currently
  112  receiving coverage for a prescription drug for which the
  113  formulary change modifies coverage and the subscriber’s treating
  114  physician, including information on the specific drugs involved.
  115         (b)A health maintenance organization shall maintain a
  116  record of any change in its formulary during a calendar year. By
  117  March 1 annually, a health maintenance organization shall submit
  118  a report to the office delineating such changes made in the
  119  previous calendar year. The annual report must include, at a