Florida Senate - 2019                          SENATOR AMENDMENT
       Bill No. CS for CS for SB 322
       
       
       
       
       
       
                                Ì1309468Î130946                         
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
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                Floor: 2/F/2R          .                                
             04/24/2019 11:42 AM       .                                
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       Senator Rodriguez moved the following:
       
    1         Senate Substitute for Amendment (220604) (with title
    2  amendment)
    3  
    4         Delete everything after the enacting clause
    5  and insert:
    6         Section 1. Effective July 1, 2019, paragraph (b) of
    7  subsection (1) of section 624.438, Florida Statutes, is amended
    8  to read:
    9         624.438 General eligibility.—
   10         (1) To meet the requirements for issuance of a certificate
   11  of authority and to maintain a multiple-employer welfare
   12  arrangement, an arrangement:
   13         (b)1. Must be established by a bona fide group trade
   14  association, industry association, or professional association
   15  of employers as defined in 29 C.F.R. s. 2510.3-5 or
   16  professionals which has a constitution or bylaws specifically
   17  stating its purpose and which has been organized and maintained
   18  in good faith for a continuous period of 1 year for purposes in
   19  addition to other than that of obtaining or providing insurance.
   20         2.Must not combine member employers from disparate trades,
   21  industries, or professions as defined by the appropriate
   22  licensing agencies, and must not combine member employers from
   23  more than one of the employer categories defined in sub
   24  subparagraphs a.-c.
   25         a.A trade association consists of member employers who are
   26  in the same trade as recognized by the appropriate licensing
   27  agency.
   28         b.An industry association consists of member employers who
   29  are in the same major group code, as defined by the Standard
   30  Industrial Classification Manual issued by the federal Office of
   31  Management and Budget, unless restricted by sub-subparagraph a.
   32  or sub-subparagraph c.
   33         c.A professional association consists of member employers
   34  who are of the same profession as recognized by the appropriate
   35  licensing agency.
   36  
   37  The requirements of this paragraph subparagraph do not apply to
   38  an arrangement licensed before prior to April 1, 1995,
   39  regardless of the nature of its business. However, an
   40  arrangement exempt from the requirements of this paragraph
   41  subparagraph may not expand the nature of its business beyond
   42  that set forth in the articles of incorporation of its
   43  sponsoring association as of April 1, 1995, except as authorized
   44  in this paragraph subparagraph.
   45         Section 2. Section 627.443, Florida Statutes, is created to
   46  read:
   47         627.443 Essential health benefits.—
   48         (1) As used in this section, the term:
   49         (a)“EHB-benchmark plan” has the same meaning as provided
   50  in 45 C.F.R. s. 156.20.
   51         (b)“PPACA” has the same meaning as in s. 627.402.
   52         (2) A health insurer or health maintenance organization
   53  issuing or delivering an individual or a group health insurance
   54  policy or health maintenance contract in this state may create a
   55  new health insurance policy or health maintenance contract that:
   56         (a) Must include at least one service or coverage under
   57  each of the 10 essential health benefits categories under 42
   58  U.S.C. s. 18022(b) which are required under PPACA;
   59         (b) May fulfill the requirement in paragraph (a) by
   60  selecting one or more services or coverages for each of the
   61  required categories from the list of essential health benefits
   62  required by any single state or multiple states; and
   63         (c) May comply with paragraphs (a) and (b) by selecting one
   64  or more services or coverages from any one or more of the
   65  required categories of essential health benefits from one state
   66  or multiple states.
   67         (3) This section specifically authorizes an insurer or
   68  health maintenance organization to include any combination of
   69  services or coverages required by any one or a combination of
   70  states to provide the 10 categories of essential health benefits
   71  required under PPACA in a policy or contract issued in this
   72  state.
   73         (4)Health insurance policies and health maintenance
   74  contracts created by health insurers and health maintenance
   75  organizations under this section:
   76         (a) May be submitted to the office for consideration as
   77  part of the office’s study of this state’s essential health
   78  benefits benchmark plan; and
   79         (b) May also be submitted to the office for evaluation as
   80  equivalent to the current state EHB-benchmark plan or to any
   81  EHB-benchmark plan created in the future.
   82         Section 3. Section 627.6045, Florida Statutes, is repealed.
   83         Section 4. Section 627.6046, Florida Statutes, is created
   84  to read:
   85         627.6046 Preexisting conditions coverage.—
   86         (1)As used in this section, the term “preexisting
   87  condition” means a condition that was present before the
   88  effective date of coverage under an individual health insurance
   89  policy, whether or not any medical advice, diagnosis, care, or
   90  treatment was recommended or received before the effective date
   91  of coverage. The term includes a condition identified as a
   92  result of a preenrollment questionnaire or physical examination
   93  given to the individual, or review of medical records relating
   94  to the preenrollment period.
   95         (2)A nongrandfathered individual health insurance policy
   96  issued or delivered in this state may not exclude, limit, deny,
   97  or delay coverage due to a preexisting condition.
   98         Section 5. Effective July 1, 2019, subsection (1) of
   99  section 627.6425, Florida Statutes, is amended to read:
  100         627.6425 Renewability of individual coverage.—
  101         (1) Except as otherwise provided in this section, an
  102  insurer that provides individual health insurance coverage to an
  103  individual shall renew or continue in force such coverage at the
  104  option of the individual. For the purpose of this section, the
  105  term “individual health insurance” means health insurance
  106  coverage, as described in s. 624.603, offered to an individual
  107  in this state, including certificates of coverage offered to
  108  individuals in this state as part of a group policy issued to an
  109  association outside this state, but the term does not include
  110  short-term limited duration insurance or excepted benefits
  111  specified in s. 627.6513(1)-(14).
  112         Section 6. Effective July 1, 2019, section 627.6426,
  113  Florida Statutes, is created to read:
  114         627.6426Short-term health insurance.—
  115         (1)For purposes of this part, the term “short-term health
  116  insurance” means health insurance coverage provided by an issuer
  117  with an expiration date specified in the contract which is less
  118  than 12 months after the original effective date of the contract
  119  and, taking into account renewals or extensions, has a duration
  120  not to exceed 36 months in total.
  121         (2)All contracts for short-term health insurance entered
  122  into by an issuer and an individual seeking coverage:
  123         (a)Must include the following disclosure:
  124  
  125  “This coverage is not required to comply with certain federal
  126  market requirements for health insurance, including some
  127  requirements contained in the Patient Protection and Affordable
  128  Care Act. Your policy might also have lifetime and/or annual
  129  dollar limits on health benefits. If this coverage expires or
  130  you lose eligibility for this coverage, you might have to wait
  131  until an open enrollment period to get other health insurance
  132  coverage.”
  133         (b)May not exclude, limit, deny, or delay coverage due to
  134  a preexisting condition. As used in this paragraph, the term
  135  “preexisting condition” means a condition that was present
  136  before the effective date of coverage under a contract, whether
  137  or not any medical advice, diagnosis, care, or treatment was
  138  recommended or received before the effective date of coverage.
  139  The term includes a condition identified as a result of a
  140  preenrollment questionnaire or physical examination given to the
  141  individual, or review of medical records relating to the
  142  preenrollment period.
  143         Section 7. Section 627.6525, Florida Statutes, is created
  144  to read:
  145         627.6525Short-term health insurance.—
  146         (1)For purposes of this part, the term “short-term health
  147  insurance” means a group, blanket, or franchise policy of health
  148  insurance coverage provided by an issuer with an expiration date
  149  specified in the contract which is less than 12 months after the
  150  original effective date of the contract and, taking into account
  151  renewals or extensions, has a duration not to exceed 36 months
  152  in total.
  153         (2)All contracts for short-term health insurance entered
  154  into by an issuer and a party seeking coverage:
  155         (a)Must include the following disclosure:
  156  
  157  “This coverage is not required to comply with certain federal
  158  market requirements for health insurance, including some
  159  requirements contained in the Patient Protection and Affordable
  160  Care Act. Your policy might also have lifetime and/or annual
  161  dollar limits on health benefits. If this coverage expires or
  162  you lose eligibility for this coverage, you might have to wait
  163  until an open enrollment period to get other health insurance
  164  coverage.”
  165         (b)May not exclude, limit, deny, or delay coverage due to
  166  a preexisting condition. As used in this paragraph, the term
  167  “preexisting condition” means a condition that was present
  168  before the effective date of coverage under a contract, whether
  169  or not any medical advice, diagnosis, care, or treatment was
  170  recommended or received before the effective date of coverage.
  171  The term includes a condition identified as a result of a
  172  preenrollment questionnaire or physical examination given to the
  173  individual, or review of medical records relating to the
  174  preenrollment period.
  175         Section 8. Effective July 1, 2019, subsection (1) of
  176  section 627.654, Florida Statutes, is amended to read:
  177         627.654 Labor union, association, and small employer health
  178  alliance groups.—
  179         (1)(a) A bona fide group or association of employers, as
  180  defined in 29 C.F.R. s. 2510.3-5, or a group of individuals may
  181  be insured under a policy issued to an association, including a
  182  labor union, which association has a constitution and bylaws and
  183  not less than 25 individual members and which has been organized
  184  and has been maintained in good faith for a period of 1 year for
  185  purposes in addition to other than that of obtaining insurance,
  186  or to the trustees of a fund established by such an association,
  187  which association or trustees shall be deemed the policyholder,
  188  insuring at least 15 individual members of the association for
  189  the benefit of persons other than the officers of the
  190  association, the association, or trustees.
  191         (b) A small employer, as defined in s. 627.6699 and
  192  including the employer’s eligible employees and the spouses and
  193  dependents of such employees, may be insured under a policy
  194  issued to a small employer health alliance by a carrier as
  195  defined in s. 627.6699. A small employer health alliance must be
  196  organized as a not-for-profit corporation under chapter 617.
  197  Notwithstanding any other law, if a small employer member of an
  198  alliance loses eligibility to purchase health care through the
  199  alliance solely because the business of the small employer
  200  member expands to more than 50 and fewer than 75 eligible
  201  employees, the small employer member may, at its next renewal
  202  date, purchase coverage through the alliance for not more than 1
  203  additional year. A small employer health alliance shall
  204  establish conditions of participation in the alliance by a small
  205  employer, including, but not limited to:
  206         1.Assurance that the small employer is not formed for the
  207  purpose of securing health benefit coverage.
  208         2.Assurance that the employees of a small employer have
  209  not been added for the purpose of securing health benefit
  210  coverage.
  211         Section 9. Section 627.65612, Florida Statutes, is created
  212  to read:
  213         627.65612 Preexisting conditions coverage.—
  214         (1)As used in this section, the term “preexisting
  215  condition” means a condition that was present before the
  216  effective date of coverage under a group health insurance
  217  policy, whether or not any medical advice, diagnosis, care, or
  218  treatment was recommended or received before the effective date
  219  of coverage. The term includes a condition identified as a
  220  result of a preenrollment questionnaire or physical examination
  221  given to the individual, or review of medical records relating
  222  to the preenrollment period.
  223         (2)A group health insurance policy issued or delivered in
  224  this state may not exclude, limit, deny, or delay coverage due
  225  to a preexisting condition.
  226         Section 10. Subsection (45) is added to section 641.31,
  227  Florida Statutes, to read:
  228         641.31 Health maintenance contracts.—
  229         (45)(a) As used in this subsection, the term “preexisting
  230  condition” means a condition that was present before the
  231  effective date of coverage under a health maintenance contract,
  232  whether or not any medical advice, diagnosis, care, or treatment
  233  was recommended or received before the effective date of
  234  coverage. The term includes a condition identified as a result
  235  of a preenrollment questionnaire or physical examination given
  236  to the individual, or review of medical records relating to the
  237  preenrollment period.
  238         (b) A health maintenance contract issued or delivered in
  239  this state may not exclude, limit, deny, or delay coverage due
  240  to a preexisting condition.
  241         Section 11. Study of state essential health benefits
  242  benchmark plan; report.—
  243         (1)As used in this section, the term:
  244         (a)“EHB-benchmark plan” has the same meaning as provided
  245  in 45 C.F.R. s. 156.20.
  246         (b)“Office” means the Office of Insurance Regulation.
  247         (2)The office shall conduct a study to evaluate this
  248  state’s current EHB-benchmark plan for nongrandfathered
  249  individual and group health plans and options for changing the
  250  EHB-benchmark plan pursuant to 45 C.F.R. s. 156.111 for future
  251  plan years. In conducting the study, the office shall:
  252         (a)Consider EHB-benchmark plans and benefits under the 10
  253  essential health benefits categories established under 45 C.F.R.
  254  s. 156.110(a) which are used by the other 49 states;
  255         (b)Compare the costs of benefits within such categories
  256  and overall costs of EHB-benchmark plans used by other states
  257  with the costs of benefits within the categories and overall
  258  costs of the current EHB-benchmark plan of this state; and
  259         (c)Solicit and consider proposed individual and group
  260  health plans from health insurers and health maintenance
  261  organizations in developing recommendations for changes to the
  262  current EHB-benchmark plan.
  263         (3)By October 30, 2019, the office shall submit a report
  264  to the Governor, the President of the Senate, and the Speaker of
  265  the House of Representatives which must include recommendations
  266  for changing the current EHB-benchmark plan to provide
  267  comprehensive care at a lower cost than this state’s current
  268  EHB-benchmark plan. In its report, the office shall provide an
  269  analysis as to whether proposed health plans it receives under
  270  paragraph (2)(c) meet the requirements for an EHB-benchmark plan
  271  under 45 C.F.R. s. 156.111(b).
  272         Section 12. If any provision of this act or its application
  273  to any person or circumstance is held invalid, the invalidity
  274  does not affect other provisions or applications of the act
  275  which can be given effect without the invalid provision or
  276  application, and to this end the provisions of this act are
  277  severable.
  278         Section 13. Except as otherwise expressly provided in this
  279  act, this act shall take effect upon becoming a law.
  280  
  281  ================= T I T L E  A M E N D M E N T ================
  282  And the title is amended as follows:
  283         Delete everything before the enacting clause
  284  and insert:
  285                        A bill to be entitled                      
  286         An act relating to health plans; amending s. 624.438,
  287         F.S.; revising eligibility requirements for multiple
  288         employer welfare arrangements; creating s. 627.443,
  289         F.S.; defining the terms “EHB-benchmark plan” and
  290         “PPACA”; authorizing health insurers and health
  291         maintenance organizations to create new health
  292         insurance policies and health maintenance contracts
  293         meeting certain criteria for essential health benefits
  294         under the federal Patient Protection and Affordable
  295         Care Act (PPACA); providing that such criteria may be
  296         met by certain means; providing construction;
  297         providing that such policies and contracts created by
  298         health insurers and health maintenance organizations
  299         may be submitted to the Office of Insurance Regulation
  300         for certain purposes; repealing s. 627.6045, F.S.,
  301         relating to preexisting conditions; creating s.
  302         627.6046, F.S.; defining the term “preexisting
  303         condition”; prohibiting nongrandfathered individual
  304         health insurance policies, from excluding, limiting,
  305         denying, or delaying coverage due to preexisting
  306         conditions; amending s. 627.6425, F.S.; revising the
  307         definition of the term “individual health insurance”
  308         relating to renewability of individual coverage;
  309         creating ss. 627.6426 and 627.6525, F.S.; defining the
  310         term “short-term health insurance”; providing
  311         disclosure requirements for short-term individual,
  312         group, blanket, and franchise health insurance
  313         policies; prohibiting such contracts from excluding,
  314         limiting, denying, or delaying coverage due to
  315         preexisting conditions; amending s. 627.654, F.S.;
  316         revising requirements for, and applicability relating
  317         to, association and small employer policies; creating
  318         s. 627.65612, F.S.; defining the term “preexisting
  319         condition”; prohibiting group health insurance
  320         policies from excluding, limiting, denying, or
  321         delaying coverage due to preexisting conditions;
  322         amending s. 641.31, F.S.; defining the term
  323         “preexisting condition”; prohibiting health
  324         maintenance contracts from excluding, limiting,
  325         denying, or delaying coverage due to preexisting
  326         conditions; defining the terms “EHB-benchmark plan”
  327         and “office”; requiring the office to conduct a study
  328         evaluating this state’s current benchmark plan for
  329         essential health benefits under PPACA and options for
  330         changing the benchmark plan for future plan years;
  331         requiring the office, in conducting the study, to
  332         consider plans and certain benefits used by other
  333         states and to compare costs with those of this state;
  334         requiring the office to solicit and consider proposed
  335         health plans from health insurers and health
  336         maintenance organizations in developing
  337         recommendations; requiring the office, by a certain
  338         date, to provide a report with certain recommendations
  339         and a certain analysis to the Governor and the
  340         Legislature; providing for severability; providing
  341         effective dates.