Bill Text: FL S1522 | 2011 | Regular Session | Comm Sub

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Wellness or Health Improvement Programs

Spectrum: Slight Partisan Bill (? 2-1)

Status: (Introduced - Dead) 2011-05-03 - Read 2nd time -SJ 754 [S1522 Detail]

Download: Florida-2011-S1522-Comm_Sub.html

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       Florida Senate - 2011                             CS for SB 1522
       
       
       
       By the Committee on Health Regulation; and Senator Gaetz
       
       
       
       
       588-02833-11                                          20111522c1
    1                        A bill to be entitled                      
    2         An act relating to wellness or health improvement
    3         programs; amending s. 626.9541, F.S.; authorizing
    4         insurers to offer a voluntary wellness or health
    5         improvement program and to encourage or reward
    6         participation in the program by offering rewards or
    7         incentives to health benefit plan members; authorizing
    8         insurers to require plan members not participating in
    9         the wellness or health improvement programs to provide
   10         verification that their medical condition warrants
   11         nonparticipation in order for the nonparticipants to
   12         receive rewards or incentives; requiring that the
   13         reward or incentive be disclosed in the policy or
   14         certificate; amending s. 627.6402, F.S.; authorizing
   15         insurers to offer rewards or incentives to health
   16         benefit plan members to encourage or reward
   17         participation in wellness or health improvement
   18         programs; authorizing insurers to require plan members
   19         not participating in programs to provide verification
   20         that their medical condition warrants
   21         nonparticipation; amending s. 627.65626, F.S.;
   22         authorizing group health insurers to offer rewards or
   23         incentives to health benefit plan members to encourage
   24         or reward participation in wellness or health
   25         improvement programs; authorizing insurers to require
   26         plan members not participating in programs to provide
   27         verification that their medical condition warrants
   28         nonparticipation; amending s. 641.31, F.S.; deleting
   29         provisions authorizing health maintenance
   30         organizations to offer rebates of premiums for
   31         participation in a wellness program; authorizing
   32         health maintenance organizations to offer rewards or
   33         incentives to members to encourage or reward
   34         participation in wellness or health improvement
   35         programs; authorizing the health maintenance
   36         organization to require plan members not participating
   37         in programs to provide verification that their medical
   38         condition warrants nonparticipation; amending s.
   39         641.3903, F.S.; providing for a wellness or health
   40         improvement program; providing authorization to offer
   41         certain rewards or incentives for participation;
   42         authorizing verification of a nonparticipant’s medical
   43         condition; providing an effective date.
   44  
   45  Be It Enacted by the Legislature of the State of Florida:
   46  
   47         Section 1. Subsection (4) is added to section 626.9541,
   48  Florida Statutes, to read:
   49         626.9541 Unfair methods of competition and unfair or
   50  deceptive acts or practices defined.—
   51         (4) WELLNESS OR HEALTH IMPROVEMENT PROGRAMS.—
   52         (a) Authorization to offer rewards or incentives for
   53  participation.—An insurer issuing a group or individual health
   54  benefit plan may offer a voluntary wellness or health
   55  improvement program and may encourage or reward participation in
   56  the program by authorizing rewards or incentives, including, but
   57  not limited to, merchandise, gift cards, debit cards, premium
   58  discounts or rebates, contributions to a member’s health savings
   59  account, or modifications to copayment, deductible, or
   60  coinsurance amounts. Any advertisement of the program is not
   61  subject to the limitations set forth in paragraph (1)(m).
   62         (b) Verification of medical condition by nonparticipants
   63  due to medical condition.—An insurer may require a health
   64  benefit plan member to provide verification, such as an
   65  affirming statement from the member’s physician, that the
   66  member’s medical condition makes it unreasonably difficult or
   67  inadvisable to participate in the wellness or health improvement
   68  program in order for that nonparticipant to receive the reward
   69  or incentive.
   70         (c) Disclosure requirement.—A reward or incentive offered
   71  under this subsection shall be disclosed in the policy or
   72  certificate.
   73         (d) Other incentives.—This subsection does not prohibit
   74  insurers from offering other incentives or rewards for adherence
   75  to a wellness or health improvement program if otherwise
   76  authorized by state or federal law.
   77         Section 2. Section 627.6402, Florida Statutes, is amended
   78  to read:
   79         627.6402 Insurance rebates or rewards for healthy
   80  lifestyles.—
   81         (1) Any rate, rating schedule, or rating manual for an
   82  individual health insurance policy filed with the office may
   83  provide for an appropriate rebate of premiums paid in the last
   84  year when the individual covered by such plan is enrolled in and
   85  maintains participation in any health wellness, maintenance, or
   86  improvement program approved by the health plan. The rebate may
   87  be based on premiums paid in the last calendar year or the last
   88  policy year. The individual must provide evidence of
   89  demonstrative maintenance or improvement of the individual’s
   90  health status as determined by assessments of agreed-upon health
   91  status indicators between the individual and the health insurer,
   92  including, but not limited to, reduction in weight, body mass
   93  index, and smoking cessation. Any rebate provided by the health
   94  insurer is presumed to be appropriate unless credible data
   95  demonstrates otherwise, or unless such rebate program requires
   96  the insured to incur costs to qualify for the rebate which equal
   97  or exceed the value of the rebate, but in no event shall the
   98  rebate exceed 10 percent of paid premiums.
   99         (2) The premium rebate authorized by this section shall be
  100  effective for an insured on an annual basis, unless the
  101  individual fails to maintain or improve his or her health status
  102  while participating in an approved wellness program, or credible
  103  evidence demonstrates that the individual is not participating
  104  in the approved wellness program.
  105         (3) Rebates or rewards are permitted pursuant to s.
  106  626.9541(4).
  107         Section 3. Section 627.65626, Florida Statutes, is amended
  108  to read:
  109         627.65626 Insurance rebates or rewards for healthy
  110  lifestyles.—
  111         (1) Any rate, rating schedule, or rating manual for a
  112  health insurance policy that provides creditable coverage as
  113  defined in s. 627.6561(5) filed with the office shall provide
  114  for an appropriate rebate of premiums paid in the last policy
  115  year, contract year, or calendar year when the majority of
  116  members of a health plan have enrolled and maintained
  117  participation in any health wellness, maintenance, or
  118  improvement program offered by the group policyholder and health
  119  plan. The rebate may be based upon premiums paid in the last
  120  calendar year or policy year. The group must provide evidence of
  121  demonstrative maintenance or improvement of the enrollees’
  122  health status as determined by assessments of agreed-upon health
  123  status indicators between the policyholder and the health
  124  insurer, including, but not limited to, reduction in weight,
  125  body mass index, and smoking cessation. The group or health
  126  insurer may contract with a third-party administrator to
  127  assemble and report the health status required in this
  128  subsection between the policyholder and the health insurer. Any
  129  rebate provided by the health insurer is presumed to be
  130  appropriate unless credible data demonstrates otherwise, or
  131  unless the rebate program requires the insured to incur costs to
  132  qualify for the rebate which equal or exceed the value of the
  133  rebate, but the rebate may not exceed 10 percent of paid
  134  premiums.
  135         (2) The premium rebate authorized by this section shall be
  136  effective for an insured on an annual basis unless the number of
  137  participating members on the policy renewal anniversary becomes
  138  less than the majority of the members eligible for participation
  139  in the wellness program.
  140         (3) Rebates or rewards are permitted pursuant to s.
  141  626.9541(4).
  142         Section 4. Subsection (40) of section 641.31, Florida
  143  Statutes, is amended to read:
  144         641.31 Health maintenance contracts.—
  145         (40) A health maintenance organization that issues
  146  individual or group contracts may offer a reward or premium
  147  rebate pursuant to s. 626.9541(4) for a healthy lifestyle
  148  program.
  149         (a) Any group rate, rating schedule, or rating manual for a
  150  health maintenance organization policy, which provides
  151  creditable coverage as defined in s. 627.6561(5), filed with the
  152  office shall provide for an appropriate rebate of premiums paid
  153  in the last policy year, contract year, or calendar year when
  154  the majority of members of a health plan are enrolled in and
  155  have maintained participation in any health wellness,
  156  maintenance, or improvement program offered by the group
  157  contract holder. The group must provide evidence of
  158  demonstrative maintenance or improvement of his or her health
  159  status as determined by assessments of agreed-upon health status
  160  indicators between the group and the health insurer, including,
  161  but not limited to, reduction in weight, body mass index, and
  162  smoking cessation. Any rebate provided by the health maintenance
  163  organization is presumed to be appropriate unless credible data
  164  demonstrates otherwise, or unless the rebate program requires
  165  the insured to incur costs to qualify for the rebate which
  166  equals or exceeds the value of the rebate but the rebate may not
  167  exceed 10 percent of paid premiums.
  168         (b) The premium rebate authorized by this section shall be
  169  effective for a subscriber on an annual basis, unless the number
  170  of participating members on the contract renewal anniversary
  171  becomes fewer than the majority of the members eligible for
  172  participation in the wellness program.
  173         (c) A health maintenance organization that issues
  174  individual contracts may offer a premium rebate, as provided
  175  under this section, for a healthy lifestyle program.
  176         Section 5. Subsection (15) is added to section 641.3903,
  177  Florida Statutes, to read:
  178         641.3903 Unfair methods of competition and unfair or
  179  deceptive acts or practices defined.—The following are defined
  180  as unfair methods of competition and unfair or deceptive acts or
  181  practices:
  182         (15) EXCEPTION FOR WELLNESS OR HEALTH IMPROVEMENT
  183  PROGRAMS.—
  184         (a) Authorization to offer rewards or incentives for
  185  participation.—An organization issuing a group or individual
  186  health benefit plan may offer a voluntary wellness or health
  187  improvement program and may encourage or reward participation in
  188  the program by authorizing rewards or incentives, including, but
  189  not limited to, merchandise, gift cards, debit cards, premium
  190  discounts or rebates, contributions to a member’s health savings
  191  account, or modifications to copayment, deductible, or
  192  coinsurance amounts.
  193         (b) Verification of medical condition by nonparticipants.
  194  An organization may require a health benefit plan member to
  195  provide verification, such as an affirming statement from the
  196  member’s physician, that the member’s medical condition makes it
  197  unreasonably difficult or inadvisable to participate in the
  198  wellness or health improvement program. A reward or incentive
  199  offered under this subsection is not a violation of this section
  200  if the program is disclosed in the contract or certificate. This
  201  subsection does not prohibit an organization from offering other
  202  incentives or rewards for adherence to a wellness or health
  203  improvement program if otherwise authorized by state or federal
  204  law.
  205         Section 6. This act shall take effect July 1, 2011.