Bill Amendment: FL S0322 | 2019 | Regular Session
NOTE: For additional amemendments please see the Bill Drafting List
Bill Title: Health Plans
Status: 2019-06-26 - Chapter No. 2019-129 [S0322 Detail]
Download: Florida-2019-S0322-Senate_Floor_Substitue_Amendment_130946_to_Amendment_Delete_All_220604_.html
Bill Title: Health Plans
Status: 2019-06-26 - Chapter No. 2019-129 [S0322 Detail]
Download: Florida-2019-S0322-Senate_Floor_Substitue_Amendment_130946_to_Amendment_Delete_All_220604_.html
Florida Senate - 2019 SENATOR AMENDMENT Bill No. CS for CS for SB 322 Ì1309468Î130946 LEGISLATIVE ACTION Senate . House . . . Floor: 2/F/2R . 04/24/2019 11:42 AM . ————————————————————————————————————————————————————————————————— ————————————————————————————————————————————————————————————————— 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 grouptrade14association, industry association,orprofessionalassociation 15 of employers as defined in 29 C.F.R. s. 2510.3-5or16professionalswhich has a constitution or bylaws specifically 17 stating its purpose and which has been organizedand maintained18in good faith for a continuous period of 1 yearfor purposes in 19 addition toother than that ofobtaining or providing insurance. 202.Must not combine member employers from disparate trades,21industries, or professions as defined by the appropriate22licensing agencies, and must not combine member employers from23more than one of the employer categories defined in sub24subparagraphs a.-c.25a.A trade association consists of member employers who are26in the same trade as recognized by the appropriate licensing27agency.28b.An industry association consists of member employers who29are in the same major group code, as defined by the Standard30Industrial Classification Manual issued by the federal Office of31Management and Budget, unless restricted by sub-subparagraph a.32or sub-subparagraph c.33c.A professional association consists of member employers34who are of the same profession as recognized by the appropriate35licensing agency.36 37 The requirements of this paragraphsubparagraphdo not apply to 38 an arrangement licensed beforeprior toApril 1, 1995, 39 regardless of the nature of its business. However, an 40 arrangement exempt from the requirements of this paragraph 41subparagraphmay 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 paragraphsubparagraph. 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 110short-term limited duration insurance orexcepted 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: 114 627.6426 Short-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: 145 627.6525 Short-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 bylawsand183not less than 25 individual membersand which has been organized 184and has been maintained in good faith for a period of 1 yearfor 185 purposes in addition toother thanthat ofobtaining 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 be196organized as a not-for-profit corporation under chapter 617.197Notwithstanding any other law, if a small employer member of an198alliance loses eligibility to purchase health care through the199alliance solely because the business of the small employer200member expands to more than 50 and fewer than 75 eligible201employees, the small employer member may, at its next renewal202date, purchase coverage through the alliance for not more than 1203additional year. A small employer health alliance shall204establish conditions of participation in the alliance by a small205employer, including, but not limited to:2061.Assurance that the small employer is not formed for the207purpose of securing health benefit coverage.2082.Assurance that the employees of a small employer have209not been added for the purpose of securing health benefit210coverage.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.