Bill Text: FL S0180 | 2011 | Regular Session | Introduced
Bill Title: Health Insurance
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2011-05-07 - Indefinitely postponed and withdrawn from consideration [S0180 Detail]
Download: Florida-2011-S0180-Introduced.html
Florida Senate - 2011 SB 180
By Senator Sobel
31-00278-11 2011180__
1 A bill to be entitled
2 An act relating to health insurance; creating ss.
3 627.6404, 627.6572, and 641.31093, F.S.; requiring all
4 antiretroviral agents to be included on health plan
5 formularies; prohibiting access-limiting procedures
6 used to restrict antiretroviral agents prescribed to
7 treat a person with HIV; amending s. 627.6515, F.S.;
8 including reference to such requirements on policies
9 issued by out-of-state groups; providing an effective
10 date.
11
12 Be It Enacted by the Legislature of the State of Florida:
13
14 Section 1. Section 627.6404, Florida Statutes, is created
15 to read:
16 627.6404 HIV treatment.—Antiretroviral agents prescribed to
17 treat a person with HIV must be included on a health plan
18 formulary and may not be restricted through a requirement for
19 prior authorization, step therapy, or other limitation that
20 limits access to any antiretroviral agent.
21 Section 2. Section 627.6572, Florida Statutes, is created
22 to read:
23 627.6572 HIV treatment.—Antiretroviral agents prescribed to
24 treat a person with HIV must be included on a health plan
25 formulary and may not be restricted through a requirement for
26 prior authorization, step therapy, or other limitation that
27 limits access to any antiretroviral agent.
28 Section 3. Section 641.31093, Florida Statutes, is created
29 to read:
30 641.31093 HIV treatment.—Antiretroviral agents prescribed
31 to treat a person with HIV must be included on a health plan
32 formulary and may not be restricted through a requirement for
33 prior authorization, step therapy, or other limitation that
34 limits access to any antiretroviral agent.
35 Section 4. Subsection (2) of section 627.6515, Florida
36 Statutes, is amended to read:
37 627.6515 Out-of-state groups.—
38 (2) Except as otherwise provided in this part, this part
39 does not apply to a group health insurance policy issued or
40 delivered outside this state under which a resident of this
41 state is provided coverage if:
42 (a) The policy is issued to an employee group the
43 composition of which is substantially as described in s.
44 627.653; a labor union group or association group the
45 composition of which is substantially as described in s.
46 627.654; an additional group the composition of which is
47 substantially as described in s. 627.656; a group insured under
48 a blanket health policy when the composition of the group is
49 substantially in compliance with s. 627.659; a group insured
50 under a franchise health policy when the composition of the
51 group is substantially in compliance with s. 627.663; an
52 association group to cover persons associated in any other
53 common group, which common group is formed primarily for
54 purposes other than providing insurance; a group that is
55 established primarily for the purpose of providing group
56 insurance, provided the benefits are reasonable in relation to
57 the premiums charged thereunder and the issuance of the group
58 policy has resulted, or will result, in economies of
59 administration; or a group of insurance agents of an insurer,
60 which insurer is the policyholder.;
61 (b) Certificates evidencing coverage under the policy are
62 issued to residents of this state and contain in contrasting
63 color and not less than 10-point type the following statement:
64 “The benefits of the policy providing your coverage are governed
65 primarily by the law of a state other than Florida”.; and
66 (c) The policy provides the benefits specified in ss.
67 627.419, 627.6572, 627.6574, 627.6575, 627.6579, 627.6612,
68 627.66121, 627.66122, 627.6613, 627.667, 627.6675, 627.6691, and
69 627.66911.
70 (d) Applications for certificates of coverage offered to
71 residents of this state must contain, in contrasting color and
72 not less than 12-point type, the following statement on the same
73 page as the applicant’s signature:
74
75 “This policy is primarily governed by the laws of ...insert
76 state where the master policy if filed.... As a result, all of
77 the rating laws applicable to policies filed in this state do
78 not apply to this coverage, which may result in increases in
79 your premium at renewal that would not be permissible under a
80 Florida-approved policy. Any purchase of individual health
81 insurance should be considered carefully, as future medical
82 conditions may make it impossible to qualify for another
83 individual health policy. For information concerning individual
84 health coverage under a Florida-approved policy, consult your
85 agent or the Florida Department of Financial Services.”
86
87 This paragraph applies only to group certificates providing
88 health insurance coverage which require individualized
89 underwriting to determine coverage eligibility for an individual
90 or premium rates to be charged to an individual except for the
91 following:
92 1. Policies issued to provide coverage to groups of persons
93 all of whom are in the same or functionally related licensed
94 professions, and providing coverage only to such licensed
95 professionals, their employees, or their dependents;
96 2. Policies providing coverage to small employers as
97 defined by s. 627.6699. Such policies shall be subject to, and
98 governed by, the provisions of s. 627.6699;
99 3. Policies issued to a bona fide association, as defined
100 by s. 627.6571(5), provided that there is a person or board
101 acting as a fiduciary for the benefit of the members, and such
102 association is not owned, controlled by, or otherwise associated
103 with the insurance company; or
104 4. Any accidental death, accidental death and
105 dismemberment, accident-only, vision-only, dental-only, hospital
106 indemnity-only, hospital accident-only, cancer, specified
107 disease, Medicare supplement, products that supplement Medicare,
108 long-term care, or disability income insurance, or similar
109 supplemental plans provided under a separate policy,
110 certificate, or contract of insurance, which cannot duplicate
111 coverage under an underlying health plan, coinsurance, or
112 deductibles or coverage issued as a supplement to workers’
113 compensation or similar insurance, or automobile medical-payment
114 insurance.
115 Section 5. This act shall take effect July 1, 2011.
