Florida Senate - 2019                              CS for SB 322
       
       
        
       By the Committee on Banking and Insurance; and Senator Simpson
       
       
       
       
       
       597-02479-19                                           2019322c1
    1                        A bill to be entitled                      
    2         An act relating to preexisting conditions; creating s.
    3         627.6046, F.S.; defining the terms “operative date”
    4         and “preexisting medical condition” with respect to
    5         individual health insurance policies; requiring
    6         insurers, contingent upon the occurrence of either of
    7         two specified events, to make at least one
    8         comprehensive major medical health insurance policy
    9         available to all residents of this state within a
   10         specified timeframe; prohibiting such insurers from
   11         excluding, limiting, denying, or delaying coverage
   12         under such policies due to preexisting medical
   13         conditions; requiring such policies to have been
   14         actively marketed on a specified date and during a
   15         certain timeframe before that date; providing
   16         applicability; creating s. 627.65612, F.S.; defining
   17         the terms “operative date” and “preexisting medical
   18         condition” with respect to group health insurance
   19         policies; requiring insurers, contingent upon the
   20         occurrence of either of two specified events, to make
   21         at least one comprehensive major medical health
   22         insurance policy available to all residents of this
   23         state within a specified timeframe; prohibiting such
   24         insurers from excluding, limiting, denying, or
   25         delaying coverage under such policies due to
   26         preexisting medical conditions; providing
   27         applicability; amending s. 641.31, F.S.; defining the
   28         terms “operative date” and “preexisting medical
   29         condition” with respect to health maintenance
   30         contracts; requiring health maintenance organizations,
   31         contingent upon the occurrence of either of two
   32         specified events, to make at least one comprehensive
   33         major medical health maintenance contract available to
   34         all residents of this state within a specified
   35         timeframe; prohibiting such health maintenance
   36         organizations from excluding, limiting, denying, or
   37         delaying coverage under such contracts due to
   38         preexisting medical conditions; requiring such
   39         contracts to have been actively marketed on a
   40         specified date and during a certain timeframe before
   41         that date; providing an effective date.
   42          
   43  Be It Enacted by the Legislature of the State of Florida:
   44  
   45         Section 1. Section 627.6046, Florida Statutes, is created
   46  to read:
   47         627.6046 Limit on preexisting conditions.—
   48         (1)As used in this section, the term:
   49         (a) “Operative date” means the date on which either of the
   50  following occurs with respect to the Patient Protection and
   51  Affordable Care Act, Pub. L. No. 111-148, as amended by the
   52  Health Care and Education Reconciliation Act of 2010, Pub. L.
   53  No. 111-152 (PPACA):
   54         1. A federal law is enacted which expressly repeals PPACA;
   55  or
   56         2. PPACA is invalidated by the United States Supreme Court.
   57         (b) “Preexisting medical condition” means a condition that
   58  was present before the effective date of coverage under a
   59  policy, whether or not any medical advice, diagnosis, care, or
   60  treatment was recommended or received before the effective date
   61  of coverage. The term includes a condition identified as a
   62  result of a preenrollment questionnaire or physical examination
   63  given to the individual, or review of medical records relating
   64  to the preenrollment period.
   65         (2)(a)Not later than 30 days after the operative date, and
   66  notwithstanding s. 627.6045 or any other law to the contrary,
   67  every insurer issuing, delivering, or issuing for delivery
   68  individual health insurance policies in this state shall make at
   69  least one comprehensive major medical health insurance policy
   70  available to all residents of this state, and such insurer may
   71  not exclude, limit, deny, or delay coverage under such policy
   72  due to one or more preexisting medical conditions.
   73         (b)An insurer may not limit or exclude benefits under such
   74  policy, including a denial of coverage applicable to an
   75  individual as a result of information relating to an
   76  individual’s health status before the individual’s effective
   77  date of coverage, or if coverage is denied, the date of the
   78  denial.
   79         (3)The comprehensive major medical health insurance policy
   80  that the insurer is required to offer under this section must be
   81  a policy that had been actively marketed in this state by the
   82  insurer as of the operative date and that was also actively
   83  marketed in this state during the year immediately preceding the
   84  operative date.
   85         (4) This section does not apply to an insurer that issues
   86  only limited benefit, disability income, specified disease,
   87  Medicare supplement, or hospital indemnity policies in this
   88  state.
   89         Section 2. Section 627.65612, Florida Statutes, is created
   90  to read:
   91         627.65612Limit on preexisting conditions.—
   92         (1) As used in this section, the terms “operative date” and
   93  “preexisting medical condition” have the same meanings as
   94  provided in s. 627.6046.
   95         (2)(a) Not later than 30 days after the operative date, and
   96  notwithstanding s. 627.6561 or any other law to the contrary,
   97  every insurer issuing, delivering, or issuing for delivery group
   98  health insurance policies in this state shall make at least one
   99  comprehensive major medical health insurance policy available to
  100  all residents of this state, and such insurer may not exclude,
  101  limit, deny, or delay coverage under such policy due to one or
  102  more preexisting medical conditions.
  103         (b)An insurer may not limit or exclude benefits under such
  104  policy, including a denial of coverage applicable to an
  105  individual as a result of information relating to an
  106  individual’s health status before the individual’s effective
  107  date of coverage, or if coverage is denied, the date of the
  108  denial.
  109         (3) This section does not apply to an insurer issuing only
  110  limited benefit, disability income, specified disease, Medicare
  111  supplement, or hospital indemnity policies in this state.
  112         Section 3. Subsection (45) is added to section 641.31,
  113  Florida Statutes, to read:
  114         641.31 Health maintenance contracts.—
  115         (45)(a) As used in this subsection, the terms “operative
  116  date” and “preexisting medical condition” have the same meanings
  117  as provided in s. 627.6046.
  118         (b)Not later than 30 days after the operative date, and
  119  notwithstanding s. 641.31071 or any other law to the contrary,
  120  every health maintenance organization issuing, delivering, or
  121  issuing for delivery individual or group contracts in this state
  122  shall make at least one comprehensive major medical health
  123  maintenance contract available to all residents of this state,
  124  and such health maintenance organization may not exclude, limit,
  125  deny, or delay coverage under such contract due to one or more
  126  preexisting medical conditions. A health maintenance
  127  organization may not limit or exclude benefits under such
  128  contract, including a denial of coverage applicable to an
  129  individual as a result of information relating to an
  130  individual’s health status before the individual’s effective
  131  date of coverage, or if coverage is denied, the date of the
  132  denial.
  133         (c)The comprehensive major medical health maintenance
  134  contract the health maintenance organization is required to
  135  offer under this section must be a contract that had been
  136  actively marketed in this state by the health maintenance
  137  organization as of the operative date and that was also actively
  138  marketed in this state during the year immediately preceding the
  139  operative date.
  140         Section 4. This act shall take effect July 1, 2019.