Bill Text: FL S1078 | 2021 | Regular Session | Introduced
Bill Title: Health Insurance Cost Sharing
Spectrum: Slight Partisan Bill (Democrat 2-1)
Status: (Failed) 2021-04-30 - Died in Banking and Insurance [S1078 Detail]
Download: Florida-2021-S1078-Introduced.html
Florida Senate - 2021 SB 1078 By Senator Brodeur 9-00583A-21 20211078__ 1 A bill to be entitled 2 An act relating to health insurance cost sharing; 3 creating s. 627.6383, F.S.; defining the term “cost 4 sharing requirement”; requiring specified individual 5 health insurers and their pharmacy benefits managers 6 to apply payments by or on behalf of insureds toward 7 the total contributions of the insureds’ cost-sharing 8 requirements; providing applicability; amending s. 9 627.6385, F.S.; requiring specified individual health 10 insurers to disclose on their websites and in their 11 policies their applications of payments by or on 12 behalf of policyholders toward the policyholders’ 13 total contributions to cost-sharing requirements; 14 providing applicability; amending ss. 627.64741, 15 627.6572, and 641.314, F.S.; requiring pharmacy 16 benefits managers to apply payments by or on behalf of 17 insureds and subscribers toward the insureds’ and 18 subscribers’ total contributions to cost-sharing 19 requirements; providing applicability; providing 20 disclosure requirements; creating s. 627.65715, F.S., 21 and amending s. 641.31, F.S.; defining the term “cost 22 sharing requirement”; requiring specified group health 23 insurers and health maintenance organizations and 24 their pharmacy benefits managers to apply payments by 25 or on behalf of insureds and subscribers toward the 26 total contributions of the insureds’ and subscribers’ 27 cost-sharing requirements, respectively; providing 28 disclosure requirements; providing applicability; 29 amending s. 627.6699, F.S.; providing requirements for 30 small employer carriers; amending s. 409.967, F.S.; 31 conforming a cross-reference; amending s. 641.185, 32 F.S.; conforming a provision to changes made by the 33 act; providing a declaration of important state 34 interest; providing an effective date. 35 36 Be It Enacted by the Legislature of the State of Florida: 37 38 Section 1. Section 627.6383, Florida Statutes, is created 39 to read: 40 627.6383 Cost-sharing requirements.— 41 (1) As used in this section, the term “cost-sharing 42 requirement” means a dollar limit, deductible, copayment, 43 coinsurance, or any other out-of-pocket expense imposed on an 44 insured, including, but not limited to, the annual limitation on 45 cost sharing subject to 42 U.S.C. s. 18022. 46 (2)(a) Each health insurer issuing, delivering, or renewing 47 a policy in this state which provides prescription drug coverage 48 or each pharmacy benefits manager on behalf of such health 49 insurer must apply any amount paid by an insured or by another 50 person on behalf of the insured toward the insured’s total 51 contribution to any cost-sharing requirement. 52 (b) The amount paid by or on behalf of the insured which is 53 applied toward the insured’s total contribution to any cost 54 sharing requirement under paragraph (a) includes, but is not 55 limited to, any payment with, or any discount through, financial 56 assistance, a manufacturer copay card, a product voucher, or any 57 other reduction in out-of-pocket expenses made by or on behalf 58 of the insured for a prescription drug. 59 (3) This section applies to any health insurance policy 60 issued, delivered, or renewed in this state on or after January 61 1, 2022. 62 Section 2. Present subsections (2) and (3) of section 63 627.6385, Florida Statutes, are redesignated as subsections (3) 64 and (4), respectively, a new subsection (2) is added to that 65 section, and present subsection (2) of that section is amended, 66 to read: 67 627.6385 Disclosures to policyholders; calculations of cost 68 sharing.— 69 (2) Each health insurer issuing, delivering, or renewing a 70 policy in this state which provides prescription drug coverage, 71 regardless of whether the prescription drug benefits are 72 administered or managed by the health insurer or by a pharmacy 73 benefits manager on behalf of the health insurer, shall disclose 74 on its website that any amount paid by a policyholder or by 75 another person on behalf of the policyholder shall be applied 76 toward the policyholder’s total contribution to any cost-sharing 77 requirement pursuant to s. 627.6383. This subsection applies to 78 any policy issued, delivered, or renewed in this state on or 79 after January 1, 2022. 80 (3)(2)Each health insurer shall include in every policy 81 delivered or issued for delivery to any person in the state or 82 in materials provided as required by s. 627.64725 notice that 83 the information required by this section is available 84 electronically and the address of the website where the 85 information can be accessed. In addition, each health insurer 86 issuing, delivering, or renewing a policy in this state which 87 provides prescription drug coverage, regardless of whether the 88 prescription drug benefits are administered or managed by the 89 health insurer or by a pharmacy benefits manager on behalf of 90 the health insurer, shall include in every policy that is 91 issued, delivered, or renewed to any person in this state on or 92 after January 1, 2022, the disclosure that any amount paid by a 93 policyholder or by another person on behalf of the policyholder 94 shall be applied toward the policyholder’s total contribution to 95 any cost-sharing requirement pursuant to s. 627.6383. 96 Section 3. Paragraph (c) is added to subsection (2) of 97 section 627.64741, Florida Statutes, to read: 98 627.64741 Pharmacy benefit manager contracts.— 99 (2) A contract between a health insurer and a pharmacy 100 benefit manager must require that the pharmacy benefit manager: 101 (c)1. Apply any amount paid by an insured or by another 102 person on behalf of the insured toward the insured’s total 103 contribution to any cost-sharing requirement pursuant to s. 104 627.6383. This subparagraph applies to any insured whose 105 insurance policy is issued, delivered, or renewed in this state 106 on or after January 1, 2022. 107 2. Disclose to every insured whose insurance policy is 108 issued, delivered, or renewed in this state on or after January 109 1, 2022, that the pharmacy benefits manager shall apply any 110 amount paid by the insured or by another person on behalf of the 111 insured toward the insured’s total contribution to any cost 112 sharing requirement pursuant to s. 627.6383. 113 Section 4. Section 627.65715, Florida Statutes, is created 114 to read: 115 627.65715 Cost-sharing requirements.— 116 (1) As used in this section, the term “cost-sharing 117 requirement” means a dollar limit, deductible, copayment, 118 coinsurance, or any other out-of-pocket expense imposed on an 119 insured, including, but not limited to, the annual limitation on 120 cost sharing subject to 42 U.S.C. s. 18022. 121 (2)(a) Each insurer issuing, delivering, or renewing a 122 policy in this state which provides prescription drug coverage 123 or each pharmacy benefits manager on behalf of such insurer must 124 apply any amount paid by an insured or by another person on 125 behalf of the insured toward the insured’s total contribution to 126 any cost-sharing requirement. 127 (b) The amount paid by or on behalf of the insured which is 128 applied toward the insured’s total contribution to any cost 129 sharing requirement under paragraph (a) includes, but is not 130 limited to, any payment with, or any discount through, financial 131 assistance, a manufacturer copay card, a product voucher, or any 132 other reduction in out-of-pocket expenses made by or on behalf 133 of the insured for a prescription drug. 134 (3) Each insurer issuing, delivering, or renewing a policy 135 in this state which provides prescription drug coverage, 136 regardless of whether the prescription drug benefits are 137 administered or managed by the insurer or by a pharmacy benefits 138 manager on behalf of the insurer, shall disclose, on its website 139 and in every policy issued, delivered, or renewed in this state 140 on or after January 1, 2022, that any amount paid by an insured 141 or by another person on behalf of the insured shall be applied 142 toward the insured’s total contribution to any cost-sharing 143 requirement. 144 (4) This section applies to any group health insurance 145 policy issued, delivered, or renewed in this state on or after 146 January 1, 2022. 147 Section 5. Paragraph (c) is added to subsection (2) of 148 section 627.6572, Florida Statutes, to read: 149 627.6572 Pharmacy benefit manager contracts.— 150 (2) A contract between a health insurer and a pharmacy 151 benefit manager must require that the pharmacy benefit manager: 152 (c)1. Apply any amount paid by an insured or by another 153 person on behalf of the insured toward the insured’s total 154 contribution to any cost-sharing requirement pursuant to s. 155 627.65715. This subparagraph applies to any insured whose 156 insurance policy is issued, delivered, or renewed in this state 157 on or after January 1, 2022. 158 2. Disclose to every insured whose insurance policy is 159 issued, delivered, or renewed in this state on or after January 160 1, 2022, that the pharmacy benefits manager shall apply any 161 amount paid by the insured or by another person on behalf of the 162 insured toward the insured’s total contribution to any cost 163 sharing requirement pursuant to s. 627.65715. 164 Section 6. Paragraph (e) of subsection (5) of section 165 627.6699, Florida Statutes, is amended to read: 166 627.6699 Employee Health Care Access Act.— 167 (5) AVAILABILITY OF COVERAGE.— 168 (e) All health benefit plans issued under this section must 169 comply with the following conditions: 170 1. For employers who have fewer than two employees, a late 171 enrollee may be excluded from coverage for no longer than 24 172 months if he or she was not covered by creditable coverage 173 continually to a date not more than 63 days before the effective 174 date of his or her new coverage. 175 2. Any requirement used by a small employer carrier in 176 determining whether to provide coverage to a small employer 177 group, including requirements for minimum participation of 178 eligible employees and minimum employer contributions, must be 179 applied uniformly among all small employer groups having the 180 same number of eligible employees applying for coverage or 181 receiving coverage from the small employer carrier, except that 182 a small employer carrier that participates in, administers, or 183 issues health benefits pursuant to s. 381.0406 which do not 184 include a preexisting condition exclusion may require as a 185 condition of offering such benefits that the employer has had no 186 health insurance coverage for its employees for a period of at 187 least 6 months. A small employer carrier may vary application of 188 minimum participation requirements and minimum employer 189 contribution requirements only by the size of the small employer 190 group. 191 3. In applying minimum participation requirements with 192 respect to a small employer, a small employer carrier shall not 193 consider as an eligible employee employees or dependents who 194 have qualifying existing coverage in an employer-based group 195 insurance plan or an ERISA qualified self-insurance plan in 196 determining whether the applicable percentage of participation 197 is met. However, a small employer carrier may count eligible 198 employees and dependents who have coverage under another health 199 plan that is sponsored by that employer. 200 4. A small employer carrier shall not increase any 201 requirement for minimum employee participation or any 202 requirement for minimum employer contribution applicable to a 203 small employer at any time after the small employer has been 204 accepted for coverage, unless the employer size has changed, in 205 which case the small employer carrier may apply the requirements 206 that are applicable to the new group size. 207 5. If a small employer carrier offers coverage to a small 208 employer, it must offer coverage to all the small employer’s 209 eligible employees and their dependents. A small employer 210 carrier may not offer coverage limited to certain persons in a 211 group or to part of a group, except with respect to late 212 enrollees. 213 6. A small employer carrier may not modify any health 214 benefit plan issued to a small employer with respect to a small 215 employer or any eligible employee or dependent through riders, 216 endorsements, or otherwise to restrict or exclude coverage for 217 certain diseases or medical conditions otherwise covered by the 218 health benefit plan. 219 7. An initial enrollment period of at least 30 days must be 220 provided. An annual 30-day open enrollment period must be 221 offered to each small employer’s eligible employees and their 222 dependents. A small employer carrier must provide special 223 enrollment periods as required by s. 627.65615. 224 8. A small employer carrier shall comply with s. 627.65715 225 with respect to contribution to cost-sharing requirements, as 226 defined in that section. 227 Section 7. Subsection (48) is added to section 641.31, 228 Florida Statutes, to read: 229 641.31 Health maintenance contracts.— 230 (48)(a) As used in this subsection, the term “cost-sharing 231 requirement” means a dollar limit, deductible, copayment, 232 coinsurance, or any other out-of-pocket expense imposed on a 233 subscriber, including, but not limited to, the annual limitation 234 on cost sharing subject to 42 U.S.C. s. 18022. 235 (b)1. Each health maintenance organization issuing, 236 delivering, or renewing a health maintenance contract or 237 certificate in this state which provides prescription drug 238 coverage or each pharmacy benefits manager on behalf of such 239 health maintenance organization must apply any amount paid by a 240 subscriber or by another person on behalf of the subscriber 241 toward the subscriber’s total contribution to any cost-sharing 242 requirement. 243 2. The amount paid by or on behalf of the subscriber which 244 is applied toward the subscriber’s total contribution to any 245 cost-sharing requirement under subparagraph 1. includes, but is 246 not limited to, any payment with, or any discount through, 247 financial assistance, a manufacturer copay card, a product 248 voucher, or any other reduction in out-of-pocket expenses made 249 by or on behalf of the subscriber for a prescription drug. 250 (c) Each health maintenance organization issuing, 251 delivering, or renewing a health maintenance contract or 252 certificate in this state which provides prescription drug 253 coverage, regardless of whether the prescription drug benefits 254 are administered or managed by the health maintenance 255 organization or by a pharmacy benefits manager on behalf of the 256 health maintenance organization, shall disclose, on its website 257 and in every subscriber’s health maintenance contract, 258 certificate, or member handbook issued, delivered, or renewed in 259 this state on or after January 1, 2022, that any amount paid by 260 a subscriber or by another person on behalf of the subscriber 261 shall be applied toward the subscriber’s total contribution to 262 any cost-sharing requirement. 263 (d) This subsection applies to any health maintenance 264 contract or certificate issued, delivered, or renewed in this 265 state on or after January 1, 2022. 266 Section 8. Paragraph (c) is added to subsection (2) of 267 section 641.314, Florida Statutes, to read: 268 641.314 Pharmacy benefit manager contracts.— 269 (2) A contract between a health maintenance organization 270 and a pharmacy benefit manager must require that the pharmacy 271 benefit manager: 272 (c)1. Apply any amount paid by a subscriber or by another 273 person on behalf of the subscriber toward the subscriber’s total 274 contribution to any cost-sharing requirement pursuant to s. 275 641.31(48). This subparagraph applies to any subscriber whose 276 health maintenance contract or certificate is issued, delivered, 277 or renewed in this state on or after January 1, 2022. 278 2. Disclose to every subscriber whose health maintenance 279 contract or certificate is issued, delivered, or renewed in this 280 state on or after January 1, 2022, that the pharmacy benefits 281 manager shall apply any amount paid by the subscriber or by 282 another person on behalf of the subscriber toward the 283 subscriber’s total contribution to any cost-sharing requirement 284 pursuant to s. 641.31(48). 285 Section 9. Paragraph (o) of subsection (2) of section 286 409.967, Florida Statutes, is amended to read: 287 409.967 Managed care plan accountability.— 288 (2) The agency shall establish such contract requirements 289 as are necessary for the operation of the statewide managed care 290 program. In addition to any other provisions the agency may deem 291 necessary, the contract must require: 292 (o) Transparency.—Managed care plans shall comply with ss. 293 627.6385(4)ss. 627.6385(3)and 641.54(7). 294 Section 10. Paragraph (k) of subsection (1) of section 295 641.185, Florida Statutes, is amended to read: 296 641.185 Health maintenance organization subscriber 297 protections.— 298 (1) With respect to the provisions of this part and part 299 III, the principles expressed in the following statements serve 300 as standards to be followed by the commission, the office, the 301 department, and the Agency for Health Care Administration in 302 exercising their powers and duties, in exercising administrative 303 discretion, in administrative interpretations of the law, in 304 enforcing its provisions, and in adopting rules: 305 (k) A health maintenance organization subscriber shall be 306 given a copy of the applicable health maintenance contract, 307 certificate, or member handbook specifying: all the provisions, 308 disclosure, and limitations required pursuant to s. 641.31(1), 309and(4), and (48); the covered services, including those 310 services, medical conditions, and provider types specified in 311 ss. 641.31, 641.31094, 641.31095, 641.31096, 641.51(11), and 312 641.513; and where and in what manner services may be obtained 313 pursuant to s. 641.31(4). 314 Section 11. The Legislature finds that this act fulfills an 315 important state interest. 316 Section 12. This act shall take effect July 1, 2021.