Bill Text: FL H0005 | 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Status: (Introduced - Dead) 2011-05-07 - Indefinitely postponed and withdrawn from consideration [H0005 Detail]

Download: Florida-2011-H0005-Introduced.html
HB 5

1
A bill to be entitled
2An act relating to health insurance; creating s.
3627.64195, F.S.; requiring individual accident or health
4insurance policies to provide certain coverage for
5orthoses and prostheses and orthotics and prosthetics;
6providing requirements and limitations; specifying
7deductible and copayment requirements; authorizing
8insurers to specify certain benefits limitations;
9providing for nonapplication to certain policy coverages;
10creating s. 627.66915, F.S.; requiring group, blanket, or
11franchise accident or health insurance policies to provide
12coverage for orthoses and prostheses and orthotics and
13prosthetics; providing requirements and limitations;
14specifying deductible and copayment requirements;
15authorizing insurers to specify certain benefits
16limitations; providing for nonapplication to certain
17policy coverages; amending s. 641.31, F.S.; requiring
18health maintenance contracts to provide coverage for
19orthoses and prostheses and orthotics and prosthetics;
20providing requirements and limitations; specifying
21deductible and copayment requirements; authorizing health
22maintenance organizations to specify certain benefits
23limitations; providing for nonapplication to certain
24contract coverages; providing an effective date.
25
26Be It Enacted by the Legislature of the State of Florida:
27
28     Section 1.  Section 627.64195, Florida Statutes, is created
29to read:
30     627.64195  Coverage for orthoses and prostheses and
31orthotics and prosthetics.-
32     (1)(a)  Each accident or health insurance policy issued,
33amended, delivered, or renewed in this state on or after January
341, 2012, that provides medical coverage that includes coverage
35for physician services in a physician's office and each accident
36or health insurance policy that provides major medical or
37similar comprehensive type coverage must provide coverage for
38benefits for orthoses and prostheses as defined in s. 468.80 and
39orthotics and prosthetics as defined in s. 468.80 that equal
40those benefits provided for under federal laws for health
41insurance for the aged and disabled pursuant to 42 U.S.C. ss.
421395k, 1395l, and 1395m and 42 C.F.R. ss. 414.202, 414.210,
43414.228, and 410.100 as applicable to this section.
44     (b)1.  The coverage is subject to the deductible and
45coinsurance provisions applicable to outpatient visits and is
46also subject to all other terms and conditions applicable to
47other benefits.
48     2.  Every insurer subject to the requirements of this
49section shall make available to the policyholder as part of the
50application, for an appropriate additional premium, the coverage
51required in this section without such coverage being subject to
52the deductible or coinsurance provisions of the policy.
53     (2)  An accident or health insurance policy may require
54prior authorization for orthoses and prostheses and orthotics
55and prosthetics in the same manner that prior authorization is
56required for any other covered benefit.
57     (3)(a)  Covered benefits for orthoses or prostheses shall
58be limited to the most appropriate model that adequately meets
59the medical needs of the patient as determined by the insured's
60treating physician.
61     (b)  The repair and replacement of orthoses or prostheses
62also shall be covered subject to copayments and deductibles,
63unless necessitated by misuse or loss.
64     (4)  An insurer may require, if coverage is provided
65through a managed care plan, that benefits mandated pursuant to
66this section be covered benefits only if the orthoses or
67prostheses are provided by a vendor and orthotics or prosthetics
68are rendered by an orthotist or prosthetist as defined in s.
69468.80.
70     (5)  This section does not apply to insurance coverage
71providing benefits for hospital confinement indemnity,
72disability income, accident only, long-term care, Medicare
73supplement, limited benefit health, specified disease indemnity,
74sickness or bodily injury or death by accident or both, and
75other limited benefit policies.
76     Section 2.  Section 627.66915, Florida Statutes, is created
77to read:
78     627.66915  Coverage for orthoses and prostheses and
79orthotics and prosthetics.-
80     (1)(a)  Each group, blanket, or franchise accident or
81health insurance policy issued, amended, delivered, or renewed
82in this state on or after January 1, 2012, that provides medical
83coverage that includes coverage for physician services in a
84physician's office and each such policy that provides major
85medical or similar comprehensive type coverage must provide
86coverage for benefits for orthoses and prostheses as defined in
87s. 468.80 and orthotics and prosthetics as defined in s. 468.80
88that equal those benefits provided for under federal laws for
89health insurance for the aged and disabled pursuant to 42 U.S.C.
90ss. 1395k, 1395l, and 1395m and 42 C.F.R. ss. 414.202, 414.210,
91414.228, and 410.100 as applicable to this section.
92     (b)1.  The coverage is subject to the deductible and
93coinsurance provisions applicable to outpatient visits and is
94also subject to all other terms and conditions applicable to
95other benefits.
96     2.  Every insurer subject to the requirements of this
97section shall make available to the policyholder as part of the
98application, for an appropriate additional premium, the coverage
99required in this section without such coverage being subject to
100the deductible or coinsurance provisions of the policy.
101     (2)  A group, blanket, or franchise accident or health
102insurance policy may require prior authorization for orthoses
103and prostheses and orthotics and prosthetics in the same manner
104that prior authorization is required for any other covered
105benefit.
106     (3)(a)  Covered benefits for orthoses or prostheses shall
107be limited to the most appropriate model that adequately meets
108the medical needs of the patient as determined by the insured's
109treating physician.
110     (b)  The repair and replacement of orthoses or prostheses
111also shall be covered subject to copayments and deductibles,
112unless necessitated by misuse or loss.
113     (4)  An insurer may require, if coverage is provided
114through a managed care plan, that benefits mandated pursuant to
115this section be covered benefits only if the orthoses or
116prostheses are provided by a vendor and orthotics or prosthetics
117are rendered by an orthotist or prosthetist as defined in s.
118468.80.
119     (5)  This section does not apply to insurance coverage
120providing benefits for hospital confinement indemnity,
121disability income, accident only, long-term care, Medicare
122supplement, limited benefit health, specified disease indemnity,
123sickness or bodily injury or death by accident or both, and
124other limited benefit policies.
125     Section 3.  Subsection (44) is added to section 641.31,
126Florida Statutes, to read:
127     641.31  Health maintenance contracts.-
128     (44)(a)  Each health maintenance contract issued, amended,
129delivered, or renewed in this state on or after January 1, 2012,
130that provides medical coverage that includes coverage for
131physician services in a physician's office and each contract,
132plan, or policy that provides major medical or similar
133comprehensive type coverage must provide coverage for benefits
134for orthoses and prostheses as defined in s. 468.80 and
135orthotics and prosthetics as defined in s. 468.80 that equal
136those benefits provided for under federal laws for health
137insurance for the aged and disabled pursuant to 42 U.S.C. ss.
1381395k, 1395l, and 1395m and 42 C.F.R. ss. 414.202, 414.210,
139414.228, and 410.100 as applicable to this subsection.
140     (b)1.  The coverage is subject to the deductible and
141coinsurance provisions applicable to outpatient visits and is
142also subject to all other terms and conditions applicable to
143other benefits.
144     2.  Every health maintenance organization subject to the
145requirements of this subsection shall make available to the
146subscriber as part of the application, for an appropriate
147additional premium, the coverage required in this subsection
148without such coverage being subject to the deductible or
149coinsurance provisions of the contract.
150     (c)  A health maintenance contract may require prior
151authorization for orthoses and prostheses and orthotics and
152prosthetics in the same manner that prior authorization is
153required for any other covered benefit.
154     (d)1.  Covered benefits for orthoses or prostheses shall be
155limited to the most appropriate model that adequately meets the
156medical needs of the patient as determined by the insured's
157treating physician.
158     2.  The repair and replacement of orthoses or prostheses
159also shall be covered subject to copayments and deductibles,
160unless necessitated by misuse or loss.
161     (e)  A health maintenance contract may require that
162benefits mandated pursuant to this subsection be covered
163benefits only if the orthoses or prostheses are provided by a
164vendor and orthotics or prosthetics are rendered by a orthotist
165or prosthetist as defined in s. 468.80.
166     (f)  This subsection does not apply to insurance coverage
167providing benefits for hospital confinement indemnity,
168disability income, accident only, long-term care, Medicare
169supplement, limited benefit health, specified disease indemnity,
170sickness or bodily injury or death by accident or both, and
171other limited benefit policies.
172     Section 4.  This act shall take effect July 1, 2011.


CODING: Words stricken are deletions; words underlined are additions.
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