Florida Senate - 2019 CS for CS for SB 418 By the Committees on Rules; and Banking and Insurance; and Senator Simpson 595-04132-19 2019418c2 1 A bill to be entitled 2 An act relating to essential health benefits under 3 health plans; defining the terms “EHB-benchmark plan” 4 and “office”; requiring the Office of Insurance 5 Regulation to conduct a study evaluating this state’s 6 current benchmark plan for essential health benefits 7 under the federal Patient Protection and Affordable 8 Care Act (PPACA) and options for changing the 9 benchmark plan for future plan years; requiring the 10 office, in conducting the study, to consider plans and 11 certain benefits used by other states and to compare 12 costs with those of this state; requiring the office 13 to solicit and consider proposed health plans from 14 health insurers and health maintenance organizations 15 in developing recommendations; requiring the office, 16 by a certain date, to provide a report with certain 17 recommendations and a certain analysis to the Governor 18 and the Legislature; creating s. 627.443, F.S.; 19 defining the terms “EHB-benchmark plan” and “PPACA”; 20 authorizing health insurers and health maintenance 21 organizations to create new health insurance policies 22 and health maintenance contracts meeting certain 23 criteria for essential health benefits under PPACA; 24 providing that such criteria may be met by certain 25 means; providing construction; providing that such 26 policies and contracts created by health insurers and 27 health maintenance organizations may be submitted to 28 the office for certain purposes; providing an 29 effective date. 30 31 Be It Enacted by the Legislature of the State of Florida: 32 33 Section 1. Study of state essential health benefits 34 benchmark plan; report.— 35 (1) As used in this section, the term: 36 (a) “EHB-benchmark plan” has the same meaning as provided 37 in 45 C.F.R. s. 156.20. 38 (b) “Office” means the Office of Insurance Regulation. 39 (2) The office shall conduct a study to evaluate this 40 state’s current EHB-benchmark plan for nongrandfathered 41 individual and group health plans and options for changing the 42 EHB-benchmark plan pursuant to 45 C.F.R. s. 156.111 for future 43 plan years. In conducting the study, the office shall: 44 (a) Consider EHB-benchmark plans and benefits under the 10 45 essential health benefits categories established under 45 C.F.R. 46 s. 156.110(a) which are used by the other 49 states; 47 (b) Compare the costs of benefits within such categories 48 and overall costs of EHB-benchmark plans used by other states 49 with the costs of benefits within the categories and overall 50 costs of the current EHB-benchmark plan of this state; and 51 (c) Solicit and consider proposed individual and group 52 health plans from health insurers and health maintenance 53 organizations in developing recommendations for changes to the 54 current EHB-benchmark plan. 55 (3) By October 30, 2019, the office shall submit a report 56 to the Governor, the President of the Senate, and the Speaker of 57 the House of Representatives which must include recommendations 58 for changing the current EHB-benchmark plan to provide 59 comprehensive care at a lower cost than this state’s current 60 EHB-benchmark plan. In its report, the office shall provide an 61 analysis as to whether proposed health plans it receives under 62 paragraph (2)(c) meet the requirements for an EHB-benchmark plan 63 under 45 C.F.R. s. 156.111(b). 64 Section 2. Section 627.443, Florida Statutes, is created to 65 read: 66 627.443 Essential health benefits.— 67 (1) As used in this section, the term: 68 (a) “EHB-benchmark plan” has the same meaning as provided 69 in 45 C.F.R. s. 156.20. 70 (b) “PPACA” has the same meaning as in s. 627.402. 71 (2) A health insurer or health maintenance organization 72 issuing or delivering an individual or a group health insurance 73 policy or health maintenance contract in this state may create a 74 new health insurance policy or health maintenance contract that: 75 (a) Must include at least one service or coverage under 76 each of the 10 essential health benefits categories under 42 77 U.S.C. s. 18022(b) which are required under PPACA; 78 (b) May fulfill the requirement in paragraph (a) by 79 selecting one or more services or coverages for each of the 80 required categories from the list of essential health benefits 81 required by any single state or multiple states; and 82 (c) May comply with paragraphs (a) and (b) by selecting one 83 or more services or coverages from any one or more of the 84 required categories of essential health benefits from one state 85 or multiple states. 86 (3) This section specifically authorizes an insurer or 87 health maintenance organization to include any combination of 88 services or coverages required by any one or a combination of 89 states to provide the 10 categories of essential health benefits 90 required under PPACA in a policy or contract issued in this 91 state. 92 (4) Health insurance policies and health maintenance 93 contracts created by health insurers and health maintenance 94 organizations under this section: 95 (a) May be submitted to the office for consideration as 96 part of the office’s study of this state’s essential health 97 benefits benchmark plan; and 98 (b) May also be submitted to the office for evaluation as 99 equivalent to the current state EHB-benchmark plan or to any 100 EHB-benchmark plan created in the future. 101 Section 3. This act shall take effect upon becoming a law.