Bill Text: FL S1724 | 2020 | Regular Session | Introduced


Bill Title: Health Care Regulations

Spectrum: Partisan Bill (Democrat 3-0)

Status: (Introduced) 2020-01-22 - Introduced [S1724 Detail]

Download: Florida-2020-S1724-Introduced.html
       Florida Senate - 2020                                    SB 1724
       
       
        
       By Senator Cruz
       
       
       
       
       
       18-00789A-20                                          20201724__
    1                        A bill to be entitled                      
    2         An act relating to health care regulations; creating
    3         s. 381.02033, F.S.; establishing the Prescription Drug
    4         Affordability Commission within the Agency for Health
    5         Care Administration; providing a purpose; providing
    6         definitions; providing requirements for membership,
    7         terms of service, and meetings; requiring
    8         manufacturers to notify the commission of proposed
    9         price increases and introductory prices of
   10         prescription drugs under certain circumstances;
   11         providing notice requirements; requiring the
   12         commission to inform the public about manufacturer
   13         notices; providing requirements for reviews of
   14         prescription drug costs and determination of excess
   15         prescription drug costs; providing for determination
   16         of prescription drug rates under certain
   17         circumstances; providing penalties for noncompliance
   18         with specified requirements; providing exceptions;
   19         requiring the Office of the Attorney General to
   20         provide guidance to stakeholders concerning certain
   21         activities and transactions; authorizing certain
   22         persons to appeal the decision of the commission;
   23         authorizing public access to certain information;
   24         establishing an advisory council; providing
   25         requirements for membership and terms of service;
   26         requiring the agency to provide the commission with
   27         staff; requiring commission and advisory council
   28         members and certain agency staff to recuse themselves
   29         if there are conflicts of interest; requiring
   30         disclosures of conflicts of interest; prohibiting
   31         acceptance of gifts, bequests, and donations;
   32         providing for reimbursement for per diem and travel
   33         expenses; requiring the commission to annually report
   34         specified information relating to prescription drug
   35         prices to the Governor and the Legislature; requiring
   36         the report to be posted on specified websites;
   37         providing rulemaking authority; amending s. 627.6487,
   38         F.S.; revising provisions relating to individual
   39         health insurance coverage for preexisting conditions;
   40         revising the definition of the term “preexisting
   41         condition”; deleting provisions authorizing insurers
   42         and health maintenance organizations to elect to limit
   43         specified coverage under certain circumstances;
   44         revising the conditions under which such insurers and
   45         health maintenance organizations may limit enrollment
   46         or deny coverage; revising construction; deleting
   47         obsolete language; creating s. 627.64875, F.S.;
   48         providing legislative intent; providing definitions;
   49         prohibiting specified health insurers from engaging in
   50         certain practices; requiring premium rates for
   51         individual health insurance policies to be based on
   52         certain factors; prohibiting rate modifications within
   53         a specified timeframe; providing exceptions; providing
   54         applicability; providing rulemaking authority to the
   55         Financial Services Commission; creating s. 627.65613,
   56         F.S.; providing definitions; prohibiting specified
   57         insurers from declining to offer coverage under group,
   58         blanket, or franchise health insurance policies to
   59         certain groups, employers, and individuals;
   60         prohibiting such insurers from imposing preexisting
   61         condition exclusions; providing applicability;
   62         providing rulemaking authority; creating s. 627.65614,
   63         F.S.; providing definitions; prohibiting specified
   64         insurers from establishing, in their franchise health
   65         insurance policies, differentials in premium rates
   66         based on preexisting conditions; requiring premium
   67         rates for franchise health insurance policies to be
   68         based on certain factors; prohibiting rate
   69         modifications within a specified timeframe; providing
   70         exceptions; providing applicability; providing
   71         rulemaking authority; amending s. 627.6699, F.S.;
   72         revising legislative purpose and intent with respect
   73         to the Employee Health Care Access Act; revising the
   74         definition of the term “modified community rating”;
   75         defining the term “preexisting condition”; deleting
   76         provisions relating to preexisting condition
   77         exclusions and limits; revising the geographic rating
   78         factors used by small employer carriers; prohibiting
   79         small employer carriers from varying premium rates
   80         based on preexisting conditions; revising the rating
   81         factors that small employer carriers must use to
   82         determine and vary premiums; providing requirements
   83         for the premium rates; revising the circumstances
   84         under which small employer carriers may modify premium
   85         rates within a specified period; prohibiting certain
   86         premium credits from being based on preexisting
   87         conditions; revising prohibited activities by small
   88         employer carriers; deleting obsolete language;
   89         deleting specified information that small employer
   90         carriers must disclose under certain circumstances;
   91         creating s. 641.1855, F.S.; providing definitions;
   92         prohibiting certain health maintenance organizations
   93         from establishing, in individual and small employer
   94         health maintenance contracts, differentials in premium
   95         rates based on preexisting conditions; requiring
   96         premium rates for such contracts to be based on
   97         certain factors; prohibiting rate modifications within
   98         a specified timeframe; providing exceptions; providing
   99         applicability; creating s. 641.31077, F.S.; providing
  100         legislative intent; providing definitions; prohibiting
  101         certain health maintenance organizations from
  102         declining to offer coverage to specified groups,
  103         employers, and individuals and from imposing
  104         preexisting condition exclusions under a contract;
  105         providing applicability; amending ss. 408.9091,
  106         409.814, 627.429, 627.607, 627.6415, 627.642,
  107         627.6425, 627.6426, 627.6512, 627.6525, 627.65625,
  108         627.6571, 627.6578, 627.6675, 627.6692, 627.6741,
  109         631.818, 641.185, 641.3007, 641.31, 641.3102,
  110         641.31073, 641.31074, 641.3903, and 641.3922, F.S.;
  111         conforming provisions to changes made by the act;
  112         amending ss. 409.816, 627.6475, and 627.66997, F.S.;
  113         conforming cross-references; repealing ss. 627.6045,
  114         627.6046, 627.6561, 627.65612, and 641.31071, F.S.,
  115         relating to preexisting conditions and limits on
  116         preexisting conditions; providing an effective date.
  117          
  118  Be It Enacted by the Legislature of the State of Florida:
  119  
  120         Section 1. Section 381.02033, Florida Statutes, is created
  121  to read:
  122         381.02033Prescription Drug Affordability Commission.—There
  123  is established the Prescription Drug Affordability Commission, a
  124  commission as defined in s. 20.03. The commission shall review
  125  manufacturers’ prices, price increases, and introductory prices
  126  of prescription drugs and shall determine the reasonableness of
  127  these prices, price increases, and introductory prices to ensure
  128  prescription drug affordability for the state health care
  129  system. The commission shall comply with the requirements of s.
  130  20.052, except as otherwise provided in this section, and shall
  131  be administratively housed within the Agency for Health Care
  132  Administration.
  133         (1)DEFINITIONS.—As used in this section, the term:
  134         (a)“Agency” means the Agency for Health Care
  135  Administration.
  136         (b)“Commission” means the Prescription Drug Affordability
  137  Commission.
  138         (c)“Conflict of interest” means:
  139         1.An association, including a financial or personal
  140  association, that has the potential to bias or has the
  141  appearance of biasing an individual’s decisions in matters
  142  related to the commission or the conduct of the commission’s
  143  activities; or
  144         2.Any instance in which an individual has received or
  145  could receive either of the following:
  146         a.A direct financial benefit of any amount deriving from
  147  the results or findings of a study or determination by or for
  148  the commission; or
  149         b.A financial benefit that, in the aggregate, exceeds
  150  $5,000 per year and that derives from a company or another
  151  individual who owns or manufactures prescription drugs,
  152  services, or items to be studied by the commission. As used in
  153  this sub-subparagraph, the term “financial benefit” includes,
  154  but is not limited to, an honorarium, a fee, a stock, or an
  155  increase in the value of an individual’s existing stockholdings.
  156         (d)“Excess cost” means the cost of appropriate use of a
  157  prescription drug that:
  158         1.Exceeds the therapeutic benefit relative to other
  159  therapeutic options or alternative treatments;
  160         2.Exceeds the cost of the same prescription drug in
  161  another country or another state by 25 percent; or
  162         3.Is not sustainable to public and private health care
  163  systems over a 10-year timeframe.
  164         (e)“Office” means the Office of the Attorney General,
  165  unless the context clearly indicates otherwise.
  166         (f)“Trade secret” has the same meaning as defined in s.
  167  688.002.
  168         (2)MEMBERSHIP OF THE COMMISSION; APPOINTMENT; TERMS OF
  169  SERVICE.—
  170         (a)The commission shall consist of five members with
  171  expertise in health economics or clinical medicine, who shall be
  172  appointed as follows:
  173         1.Two members appointed by the President of the Senate.
  174  The President of the Senate shall also appoint one alternate
  175  commission member, who shall participate in deliberations of the
  176  commission if a member appointed by the President of the Senate
  177  recuses himself or herself under subsection (12).
  178         2.Two members appointed by the Speaker of the House of
  179  Representatives. The Speaker of the House of Representatives
  180  shall also appoint one alternate commission member, who shall
  181  participate in deliberations of the commission if a member
  182  appointed by the Speaker of the House of Representatives recuses
  183  himself or herself under subsection (12).
  184         3.One member appointed by the Governor. The Governor shall
  185  also appoint one alternate commission member, who shall
  186  participate in deliberations of the commission if the member
  187  appointed by the Governor recuses himself or herself under
  188  subsection (12).
  189  
  190  Each member and alternate member of the commission is subject to
  191  confirmation by the Senate and to the dual-office-holding
  192  prohibition of s. 5(a), Art. II of the State Constitution.
  193         (b)Members shall serve 4-year terms, except that the
  194  initial terms shall be staggered as follows:
  195         1.The initial member appointed by the Governor shall serve
  196  4 years.
  197         2.Of the initial two members appointed by the President of
  198  the Senate, one shall serve 3 years, and one shall serve 2
  199  years.
  200         3.Of the initial two members appointed by the Speaker of
  201  the House of Representatives, one shall serve 3 years, and one
  202  shall serve 2 years.
  203         (c)The Governor shall designate the chair, and the chair
  204  shall designate a co-chair from among the other members of the
  205  commission.
  206         (d)A vacancy shall be filled for the remainder of the
  207  unexpired term in the same manner as the original appointment.
  208         (e)When appointing a member or alternate member to the
  209  commission or a member to the advisory council established in
  210  subsection (10), the appointing authority must consider any
  211  conflict of interest disclosed by the prospective member or
  212  alternate member.
  213         (3)MEETINGS OF THE COMMISSION.—The commission shall meet
  214  in a location readily accessible to the public at least every 6
  215  weeks to review prescription drug price notices submitted under
  216  subsection (4). A meeting may be canceled or postponed at the
  217  discretion of the chair if there is no pending decision.
  218         (a)The commission must post on its website and the
  219  agency’s website:
  220         1.A public meeting announcement at least 2 weeks before a
  221  meeting.
  222         2.Meeting materials at least 1 week before a meeting.
  223         (b)The commission shall provide an opportunity for the
  224  public to:
  225         1.Comment at a public meeting.
  226         2.Submit written comments on a pending decision.
  227         (c)The commission may allow expert testimony at a public
  228  meeting. Any decision that the commission makes must be done in
  229  a public meeting, including, but not limited to, the following
  230  decisions:
  231         1.Reviewing a prescription drug cost analysis.
  232         2.Voting on whether to impose a cost or payment limit on
  233  payors for a prescription drug.
  234         (d)A majority of commission members present constitutes a
  235  quorum.
  236         (4)REQUIRED MANUFACTURER NOTICES.—
  237         (a)A prescription drug manufacturer shall notify the
  238  commission if the manufacturer intends to:
  239         1.a.Increase the wholesale acquisition cost of a patent
  240  protected, brand name prescription drug by more than 10 percent,
  241  or by more than $3,000 per course of treatment, during any 12
  242  month period; or
  243         b.Introduce to the market a brand name prescription drug
  244  that has a wholesale acquisition cost of $30,000 per year or per
  245  course of treatment;
  246         2.Introduce to the market a biosimilar drug with a
  247  wholesale acquisition cost that is not at least 15 percent lower
  248  than the cost of the referenced brand name biologic drug at the
  249  time the biosimilar drug is introduced to the market; or
  250         3.a.Increase the wholesale acquisition cost of a generic
  251  or off-patent, sole-source brand name prescription drug by more
  252  than 25 percent, or by more than $300 per course of treatment,
  253  during any 12-month period; or
  254         b.Introduce to the market a generic prescription drug that
  255  has a wholesale acquisition cost of $1,200 or more per year.
  256  
  257  The prescription drug manufacturer must provide the notice in
  258  writing at least 30 days before the planned effective date of
  259  the increase or introduction and must include a price
  260  justification pursuant to paragraph (c).
  261         (b)The commission may, after consultation with the
  262  advisory council, require any prescription drug manufacturer to
  263  provide notice to the commission and to include a price
  264  justification pursuant to paragraph (c) for any prescription
  265  drug that creates a challenge to prescription drug affordability
  266  for the state health care system.
  267         (c)The prescription drug manufacturer must justify a
  268  proposed price increase or introductory price of a prescription
  269  drug as specified in paragraph (a) or an actual or proposed
  270  price, price increase, or introductory price of a prescription
  271  drug described in paragraph (b) by providing all documents and
  272  research related to the manufacturer’s selection of the price,
  273  price increase, or introductory price, including life cycle
  274  management; net average price in the state, which is calculated
  275  by the net average of all price concessions, excluding in-kind
  276  concessions; market competition and context; projected revenue;
  277  and, if available, estimated value and cost-effectiveness of the
  278  prescription drug.
  279         (5)REVIEW OF PRESCRIPTION DRUG COSTS.—
  280         (a)The commission shall inform the public about all the
  281  notices that prescription drug manufacturers are required to
  282  provide under subsection (4). The commission must post such
  283  notices on its website and the agency’s website at least 1 week
  284  before a public meeting on the noticed prescription drugs is
  285  held.
  286         (b)The commission shall undertake a cost review of all
  287  prescription drugs that are the subject of a notice under
  288  subsection (4) and shall review all the public’s comments,
  289  including written comments, provided under subsection (3) in a
  290  public meeting.
  291         (6)EXCESS COSTS TO PAYORS AND CONSUMERS.—
  292         (a)In undertaking a cost review of a prescription drug,
  293  the commission must determine if appropriate use of the
  294  prescription drug which is consistent with the United States
  295  Food and Drug Administration label or with standard medical
  296  practice has led or will lead to excess costs for the state
  297  health care system.
  298         (b)The commission may consider the following factors in
  299  determining costs and excess costs:
  300         1.The price at which the prescription drug has been or
  301  will be sold in the state.
  302         2.The average monetary price concession, discount, or
  303  rebate the prescription drug manufacturer provides to payors in
  304  the state or is expected to provide to payors in the state for
  305  the prescription drug as reported by manufacturers.
  306         3.The price at which therapeutic alternatives have been or
  307  will be sold in the state.
  308         4.The average monetary price concession, discount, or
  309  rebate the prescription drug manufacturer provides to payors in
  310  the state or is expected to provide to payors in the state for
  311  therapeutic alternatives.
  312         5.The cost of the prescription drug to payors based on
  313  patient access consistent with the United States Food and Drug
  314  Administration labeled indications or with standard medical
  315  practice.
  316         6.The effect on patient access resulting from the cost of
  317  the prescription drug relative to the health benefit.
  318         7.The current or expected value of manufacturer-supported,
  319  drug-specific patient access programs.
  320         8.The relative financial effects on health, medical, and
  321  other social services costs as may be quantified and compared to
  322  baseline effects of existing therapeutic alternatives.
  323         9.The difference between the price or proposed price of
  324  the prescription drug and the price of the same prescription
  325  drug in another country or state.
  326         10.Other such factors determined relevant by the
  327  commission.
  328         (c)After considering the factors in paragraph (b), if the
  329  commission cannot determine whether a prescription drug will
  330  produce or has produced excess costs, the commission may
  331  consider the following:
  332         1.Manufacturer research and development costs, as shown on
  333  the manufacturer’s federal tax filing for the most recent tax
  334  year, multiplied by the ratio of total manufacturer sales in the
  335  state to total manufacturer national sales for the prescription
  336  drug under review.
  337         2.That portion of direct-to-consumer marketing costs
  338  eligible for favorable federal tax treatment in the most recent
  339  tax year that are specific to the prescription drug under review
  340  and that are multiplied by the ratio of total manufacturer sales
  341  in the state to total manufacturer national sales for the
  342  prescription drug under review.
  343         3.Gross and net manufacturer revenues for the most recent
  344  tax year for the prescription drug under review.
  345         4.Any additional factors proposed by the manufacturer that
  346  the commission determines to be relevant to the circumstances
  347  for the prescription drug under review.
  348         (7)COMMISSION DETERMINATIONS; COMPLIANCE; REMEDIES.—
  349         (a)If the commission finds that the cost of the
  350  prescription drug under review creates excess costs for payors
  351  and consumers, the commission shall establish the rate that must
  352  be billed to, and paid by, payors, pharmacies, health care
  353  providers, wholesalers, distributors, and uninsured and insured
  354  consumers.
  355         (b)An affirmative vote of a majority of the commission
  356  members present at a meeting is required for any action or
  357  recommendation by the commission, including, but not limited to,
  358  an imposition of a cost or payment limit on payors for a
  359  prescription drug or an establishment of a prescription drug
  360  rate.
  361         (c)The failure to bill, or pay for, a prescription drug at
  362  the rate established by the commission under paragraph (a)
  363  constitutes a violation of this section and must be referred to
  364  the office for enforcement. Upon a finding of noncompliance with
  365  the commission requirements for a prescription drug rate, the
  366  office may pursue any remedy available under civil and criminal
  367  law. However, the office may not consider that a person is in
  368  noncompliance with this section if:
  369         1.A payor obtains a price concession from a manufacturer
  370  that results in a payor’s net cost being lower than the rate
  371  established by the commission; or
  372         2.The person is a consumer, whether insured or uninsured.
  373  
  374  The office shall provide guidance to stakeholders concerning
  375  activities that may be considered noncompliant and payment
  376  transactions in which prescription drug costs exceed the limit
  377  established by the commission.
  378         (d)The failure of a prescription drug manufacturer to
  379  submit a notice as required under subsection (4) constitutes a
  380  violation of this section and must be referred to the office for
  381  enforcement. Upon a finding of a manufacturer’s noncompliance
  382  with the commission requirements for notification, the office
  383  may pursue any remedy available under civil law.
  384         (8)APPEALS.—A person affected by a decision of the
  385  commission may appeal the decision within 30 days. The full
  386  commission shall consider the appeal and render a decision
  387  within 60 days after receipt of the appeal. The decision of the
  388  commission after appeal is subject to judicial review.
  389         (9)PUBLIC ACCESS TO INFORMATION.—Information relating to a
  390  prescription drug price notice submitted by a prescription drug
  391  manufacturer to the commission or relating to a prescription
  392  drug cost review is available to the public.
  393         (10)ADVISORY COUNCIL.—There is established an advisory
  394  council, as defined in s. 20.03, to advise the commission on
  395  prescription drug cost issues and to represent stakeholder
  396  views. The advisory council shall comply with the requirements
  397  of s. 20.052, except as otherwise provided in this section, and
  398  shall be administratively housed within the agency.
  399         (a)The advisory council shall consist of 11 members, who
  400  must be selected based on their knowledge of one or more of the
  401  following:
  402         1.The pharmaceutical business model.
  403         2.Practice of medicine or clinical knowledge and training.
  404         3.Patients’ perspectives.
  405         4.Health care cost trends and drivers.
  406         5.Clinical and health services research.
  407         6.The state health care marketplace in general.
  408         (b)Members of the advisory council shall be appointed as
  409  follows:
  410         1.Six members appointed by the Secretary of Health Care
  411  Administration, each member representing a different group as
  412  follows:
  413         a.Physicians.
  414         b.Nurses.
  415         c.Hospitals.
  416         d.Health insurers.
  417         e.A statewide health care advocacy coalition.
  418         f.A statewide senior advocacy coalition.
  419         2.Five members appointed by the Governor, each member
  420  representing a different group as follows:
  421         a.Pharmaceutical manufacturers.
  422         b.Pharmaceutical employers.
  423         c.Pharmacists.
  424         d.Prescription drug research specialists.
  425         e.The public.
  426         (c)Members of the advisory council shall serve 4-year
  427  terms, except that the initial terms shall be staggered as
  428  follows:
  429         1.Of the initial six members appointed by the Secretary of
  430  Health Care Administration, two shall serve for 4 years, two
  431  shall serve for 3 years, and two shall serve for 2 years.
  432         2.Of the initial five members appointed by the Governor,
  433  two shall serve for 4 years, two shall serve for 3 years, and
  434  one shall serve for 1 year.
  435         (d)The Governor shall designate the chair, and the chair
  436  shall designate a co-chair from among the other members of the
  437  advisory council. A vacancy shall be filled for the remainder of
  438  the unexpired term in the same manner as the original
  439  appointment.
  440         (11)COMMISSION STAFF.—The agency shall provide staff and
  441  other administrative assistance necessary to assist the
  442  commission in carrying out its responsibilities.
  443         (12)CONFLICTS OF INTEREST.—The following provisions govern
  444  any conflict of interest for a commission or advisory council
  445  member or for an agency staff member who assists the commission:
  446         (a)1.If a commission or advisory council member, or an
  447  immediate family member thereof, has a conflict of interest as
  448  defined in subparagraph (1)(c)1. or subparagraph (1)(c)2. that
  449  is related to a prescription drug under review, the commission
  450  or advisory council member, as applicable, shall recuse himself
  451  or herself from any board activity involving such prescription
  452  drug, including the review of the prescription drug.
  453         2.If an agency staff member who assists the commission has
  454  a conflict of interest as defined in subparagraph (1)(c)2. that
  455  is related to a prescription drug under review, the staff member
  456  shall recuse himself or herself from the review of the
  457  prescription drug.
  458         (b)1.A conflict of interest must be disclosed by:
  459         a.The Governor, the President of the Senate, or the
  460  Speaker of the House of Representatives, as applicable, when
  461  appointing members to the commission.
  462         b.The Governor or the Secretary of Health Care
  463  Administration, as applicable, when appointing members to the
  464  advisory council.
  465         c.The commission when:
  466         (I)Being assisted by senior agency staff; or
  467         (II)Describing any recusal as part of a final decision
  468  resulting from a review of a prescription drug.
  469         2.The commission must post a conflict of interest on its
  470  website and the agency’s website within 5 days after a conflict
  471  of interest is identified. If a public meeting of the commission
  472  occurs within that 5-day period, the commission must post the
  473  conflict of interest on both websites within 12 hours after the
  474  conflict of interest is identified or in advance of the public
  475  meeting, whichever is earlier.
  476         3.The information disclosed on the conflict of interest
  477  must include the type, nature, and magnitude of the conflict of
  478  interest of the individual involved, except to the extent that
  479  the individual recuses himself or herself from participation in
  480  any activity in which the potential conflict of interest exists.
  481         (c)A commission or advisory council member or an agency
  482  staff member assisting the commission may not accept a gift, a
  483  bequest, or a donation of services or property that suggests a
  484  conflict of interest or has the appearance of creating bias in
  485  the work of the commission or advisory council.
  486         (13)COMPENSATION.—A commission or advisory council member
  487  shall serve without compensation but shall be reimbursed for per
  488  diem and travel expenses in accordance with s. 112.061.
  489         (14)ANNUAL REPORTS.—Beginning January 1, 2021, and
  490  annually thereafter, the commission shall report to the
  491  Governor, the President of the Senate, and the Speaker of the
  492  House of Representatives on general prescription drug price
  493  trends, the number of prescription drug manufacturers required
  494  to provide notice under this section, and the number of
  495  prescription drugs that were subject to commission review and
  496  analysis, including the results of such analysis, as well as the
  497  number and disposition of appeals and judicial reviews. The
  498  commission shall post the report on its website and the agency’s
  499  website in a manner that is readily accessible to the public.
  500         (15)RULEMAKING.—The agency may adopt rules to implement
  501  and administer this section.
  502         Section 2. Section 627.6487, Florida Statutes, is reordered
  503  and amended to read:
  504         627.6487 Guaranteed availability of individual health
  505  insurance coverage to eligible individuals.—
  506         (2)(1) Subject to the requirements of this section, each
  507  health insurance issuer that offers individual health insurance
  508  coverage in this state may not, with respect to an eligible
  509  individual who desires to enroll in individual health insurance
  510  coverage:
  511         (a) Decline to offer such coverage to, or deny enrollment
  512  of, such individual; or
  513         (b) Impose any preexisting condition exclusion with respect
  514  to such coverage; or
  515         (c)Establish differentials in premium rates for such
  516  coverage based on a preexisting condition. For purposes of this
  517  section, the term “preexisting condition” means, with respect to
  518  coverage, a limitation of benefits relating to a condition based
  519  on the fact that the condition was present before the date of
  520  enrollment for such coverage, whether or not any medical advice,
  521  diagnosis, care, or treatment was recommended or received before
  522  such date.
  523         (1)(2)As used in For the purposes of this section, the
  524  term:
  525         (b)(a) “Health insurance issuer” and “issuer” mean an
  526  authorized insurer or a health maintenance organization.
  527         (c)(b) “Individual health insurance” means health
  528  insurance, as defined in s. 624.603, which is offered to an
  529  individual, including certificates of coverage offered to
  530  individuals in this state as part of a group policy issued to an
  531  association outside this state, but the term does not include
  532  short-term limited duration insurance or excepted benefits
  533  specified in s. 627.6513(1)-(14).
  534         (a)(3)For the purposes of this section, the term “Eligible
  535  individual” means an individual:
  536         1.a.(a)1. For whom, as of the date on which the individual
  537  seeks coverage under this section, the aggregate of the periods
  538  of creditable coverage, as defined in s. 627.6562(3), is 18 or
  539  more months; and
  540         b.(I)2.a. Whose most recent prior creditable coverage was
  541  under a group health plan, governmental plan, or church plan, or
  542  health insurance coverage offered in connection with any such
  543  plan; or
  544         (II)b. Whose most recent prior creditable coverage was
  545  under an individual plan issued in this state by a health
  546  insurer or health maintenance organization, which coverage is
  547  terminated due to the insurer or health maintenance organization
  548  becoming insolvent or discontinuing the offering of all
  549  individual coverage in the State of Florida, or due to the
  550  insured no longer living in the service area in the State of
  551  Florida of the insurer or health maintenance organization that
  552  provides coverage through a network plan in the State of
  553  Florida;
  554         2.(b) Who is not eligible for coverage under:
  555         a.1. A group health plan, as defined in s. 2791 of the
  556  Public Health Service Act;
  557         b.2. A conversion policy or contract issued by an
  558  authorized insurer or health maintenance organization under s.
  559  627.6675 or s. 641.3921, respectively, offered to an individual
  560  who is no longer eligible for coverage under either an insured
  561  or self-insured employer plan;
  562         c.3. Part A or part B of Title XVIII of the Social Security
  563  Act; or
  564         d.4. A state plan under Title XIX of such act, or any
  565  successor program, and does not have other health insurance
  566  coverage;
  567         3.(c) With respect to whom the most recent coverage within
  568  the coverage period described in subparagraph 1. paragraph (a)
  569  was not terminated based on a factor described in s.
  570  627.6571(2)(a) or (b), relating to nonpayment of premiums or
  571  fraud, unless such nonpayment of premiums or fraud was due to
  572  acts of an employer or person other than the individual;
  573         4.(d) Who, having been offered the option of continuation
  574  coverage under a COBRA continuation provision or under s.
  575  627.6692, elected such coverage; and
  576         5.(e) Who, if the individual elected such continuation
  577  provision, has exhausted such continuation coverage under such
  578  provision or program.
  579         (d)“Preexisting condition” means a condition that was
  580  present before the effective date of coverage under a health
  581  insurance policy or the date of the coverage denial, regardless
  582  of whether any medical advice, diagnosis, care, or treatment was
  583  recommended or received for such condition before that date.
  584         (4)(a)The health insurance issuer may elect to limit the
  585  coverage offered under subsection (1) if the issuer offers at
  586  least two different policy forms of health insurance coverage,
  587  both of which:
  588         1.Are designed for, made generally available to, actively
  589  marketed to, and enroll both eligible and other individuals by
  590  the issuer; and
  591         2.Meet the requirement of paragraph (b).
  592  
  593  For purposes of this subsection, policy forms that have
  594  different cost-sharing arrangements or different riders are
  595  considered to be different policy forms.
  596         (b)The requirement of this subsection is met for health
  597  insurance coverage policy forms offered by an issuer in the
  598  individual market if the issuer offers the policy forms for
  599  individual health insurance coverage with the largest, and next
  600  to largest, premium volume of all such policy forms offered by
  601  the issuer in this state or applicable marketing or service
  602  area, as prescribed in rules adopted by the commission, in the
  603  individual market in the period involved. To the greatest extent
  604  possible, such rules must be consistent with regulations adopted
  605  by the United States Department of Health and Human Services.
  606         (3)(a)(5)(a) In the case of a health insurance issuer that
  607  offers individual health insurance coverage through a network
  608  plan, the issuer may:
  609         1. Limit the individuals who may be enrolled under such
  610  coverage to those who live, reside, or work within the service
  611  area for such network plan; and
  612         2. Within the service area of such plan, deny such coverage
  613  to such individuals if the issuer has demonstrated to the office
  614  that:
  615         a. It will not have the capacity to deliver services
  616  adequately to additional individual enrollees because of its
  617  obligations to existing group contract holders and enrollees and
  618  individual enrollees; and
  619         b. It is applying this paragraph uniformly to individuals
  620  without regard to any health-status-related or preexisting
  621  condition-related factor of such individuals and without regard
  622  to whether the individuals are eligible individuals.
  623         (b) An issuer, upon denying individual health insurance
  624  coverage in any service area in accordance with subparagraph
  625  (a)2., may not offer coverage in the individual market within
  626  such service area for a period of 180 days after such coverage
  627  is denied.
  628         (4)(a)(6)(a) A health insurance issuer may deny individual
  629  health insurance coverage to an eligible individual if the
  630  issuer has demonstrated to the office that:
  631         1. It does not have the financial reserves necessary to
  632  underwrite additional coverage; and
  633         2. It is applying this paragraph uniformly to all
  634  individuals in the individual market in this state consistent
  635  with the laws of this state and without regard to any health
  636  status-related or preexisting-condition-related factor of such
  637  individuals and without regard to whether the individuals are
  638  eligible individuals.
  639         (b) An issuer, upon denying individual health insurance
  640  coverage in any service area in accordance with paragraph (a),
  641  may not offer such coverage in the individual market within such
  642  service area for a period of 180 days after the date such
  643  coverage is denied or until the issuer has demonstrated to the
  644  office that the issuer has sufficient financial reserves to
  645  underwrite additional coverage, whichever occurs later.
  646         (5)(a)(7)(a) Subsection (2)(1) does not require that a
  647  health insurance issuer that offers health insurance coverage
  648  only in connection with group health plans or through one or
  649  more bona fide associations, as defined in s. 627.6571(5), or
  650  both, offer such health insurance coverage in the individual
  651  market.
  652         (b) A health insurance issuer that offers health insurance
  653  coverage in connection with group health plans is not deemed to
  654  be a health insurance issuer offering individual health
  655  insurance coverage solely because such issuer offers a
  656  conversion policy.
  657         (6)(a)(8) This section does not:
  658         (a) restrict the amount of the premium rates that an issuer
  659  may charge an individual for individual health insurance
  660  coverage, except that the issuer:
  661         1.May not establish, under the same individual health
  662  insurance coverage, differentials in premium rates that are
  663  based on a preexisting condition.
  664         2.Shall develop and vary premium rates based only on the
  665  factors specified in s. 627.64875.; or
  666         (b) This section does not prevent a health insurance issuer
  667  that offers individual health insurance coverage from
  668  establishing premium discounts or rebates or modifying otherwise
  669  applicable copayments or deductibles in return for adherence to
  670  programs of health promotion and disease prevention.
  671         (7)(9) Each health insurance issuer that offers individual
  672  health insurance coverage to an eligible individual shall elect
  673  to become a risk-assuming carrier or a reinsuring carrier, as
  674  provided by s. 627.6475.
  675         (8)(10) This section applies to individual health insurance
  676  coverage offered on or after January 1, 2021 1998. An individual
  677  who would have been eligible for coverage on July 1, 1997, shall
  678  be eligible for coverage on January 1, 1998, and shall remain
  679  eligible for the same period of time after January 1, 1998, that
  680  the individual would have remained eligible for coverage after
  681  July 1, 1997.
  682         Section 3. Section 627.64875, Florida Statutes, is created
  683  to read:
  684         627.64875Preexisting conditions; premium rates.—
  685         (1)This section establishes protections for those with
  686  preexisting conditions who seek to obtain insurance coverage.
  687         (2)As used in this section, the term:
  688         (a)“Eligible individual” has the same meaning as defined
  689  in s. 627.6487.
  690         (b)“Health insurance issuer” or “issuer” has the same
  691  meaning as defined in s. 627.6487.
  692         (c)“Individual health insurance” means health insurance,
  693  as defined in s. 624.603, that is offered to an individual,
  694  including certificates of coverage offered to individuals in
  695  this state as part of a group policy issued to an association
  696  outside this state, but the term does not include excepted
  697  benefits specified in s. 627.6513(1)-(14).
  698         (d)“Preexisting condition” has the same meaning as defined
  699  in s. 627.6487.
  700         (e)“Short-term health insurance” has the same meaning as
  701  defined in s. 627.6426.
  702         (3)A health insurance issuer that offers an individual
  703  health insurance policy in this state may not, with respect to
  704  an eligible individual who desires to enroll in individual
  705  health insurance coverage:
  706         (a)Decline to offer such coverage to, or deny enrollment
  707  of, such individual;
  708         (b)Impose any preexisting condition exclusion with respect
  709  to such coverage; or
  710         (c)Establish differentials in premium rates for such
  711  coverage based on a preexisting condition.
  712         (4)A health insurance issuer that offers an individual
  713  health insurance policy shall develop premium rates under the
  714  policy based on, and shall vary the rates by, only the following
  715  factors:
  716         (a)Whether the policy coverage is individual or family
  717  coverage.
  718         (b)The geographic rating area that is established in
  719  accordance with federal law.
  720         (c)Age, except that the health insurance issuer may not
  721  charge an adult in the oldest age band more than 3 times the
  722  rate the issuer charges an adult in the youngest age band for
  723  the same coverage.
  724         (d)Tobacco use, except that the health insurance issuer
  725  may not charge a tobacco user more than 1 1/15 times the rate
  726  the issuer charges a non-tobacco user for the same coverage.
  727  
  728  With respect to family coverage under the individual health
  729  insurance policy, an issuer shall apply the rating variations
  730  authorized under this subsection based on the premium
  731  attributable to each family member under such policy in
  732  accordance with commission rules.
  733         (5)A health insurance issuer that offers an individual
  734  health insurance policy in this state may not modify the premium
  735  rates for coverages under the policy within 12 months after the
  736  initial issue date or renewal date, unless there is a change:
  737         (a)In the geographic rating area that is established in
  738  accordance with federal law;
  739         (b)In tobacco use;
  740         (c)In family composition if the coverage is family
  741  coverage;
  742         (d)In the coverage benefits requested by the eligible
  743  individual; or
  744         (e)Due to a requirement by federal law or regulation or
  745  due to an express authorization by state law or rule.
  746         (6)This section applies to any health insurance, as
  747  defined in s. 624.603, including short-term health insurance,
  748  that is offered under an individual health insurance policy.
  749  This section does not apply to disability income insurance or
  750  income replacement insurance coverage.
  751         (7)The commission may adopt rules to administer this
  752  section and to ensure that rating practices used by health
  753  insurance issuers for individual health insurance policies are
  754  consistent with the purposes of this section.
  755         Section 4. Section 627.65613, Florida Statutes, is created
  756  to read:
  757         627.65613Preexisting conditions.—
  758         (1)This act establishes protections for those with
  759  preexisting conditions who seek to obtain insurance coverage.
  760         (2)As used in this section, the term:
  761         (a)“Preexisting condition” has the same meaning as defined
  762  in s. 627.6487.
  763         (b)“Short-term health insurance” has the same meaning as
  764  defined in s. 627.6525.
  765         (3)An insurer authorized to issue, deliver, issue for
  766  delivery, or renew a group, blanket, or franchise health
  767  insurance policy in this state may not, with respect to a group,
  768  employer, or individual that is eligible to enroll in such
  769  policy and that applies for coverage under such policy:
  770         (a)Decline to offer such coverage to, or deny enrollment
  771  of, such group, employer, or individual; or
  772         (b)Impose any preexisting condition exclusion with respect
  773  to such coverage.
  774         (4)This section applies to any health insurance, as
  775  defined in s. 624.603, including short-term health insurance,
  776  that is offered under a group, blanket, or franchise health
  777  insurance policy. This section does not apply to disability
  778  income insurance or income replacement insurance coverage.
  779         (5)The commission may adopt rules to administer this
  780  section.
  781         Section 5. Section 627.65614, Florida Statutes, is created
  782  to read:
  783         627.65614Premium rates for franchise health insurance
  784  policies.—
  785         (1)As used in this section, the term:
  786         (a)“Preexisting condition” has the same meaning as defined
  787  in s. 627.6487.
  788         (b)“Short-term health insurance” has the same meaning as
  789  defined in s. 627.6525.
  790         (2)An insurer authorized to issue, deliver, issue for
  791  delivery, or renew a franchise health insurance policy in this
  792  state may not establish, under such policy, differentials in
  793  premium rates that are based on a preexisting condition. The
  794  insurer shall develop premium rates under the policy based on,
  795  and shall vary the rates by, only the following factors:
  796         (a)Whether the policy coverage is individual or family
  797  coverage.
  798         (b)The geographic rating area that is established in
  799  accordance with federal law.
  800         (c)Age, except that the insurer may not charge an adult in
  801  the oldest age band more than 3 times the rate the insurer
  802  charges an adult in the youngest age band for the same coverage.
  803         (d)Tobacco use, except that the insurer may not charge a
  804  tobacco user more than 1 1/15 times the rate the insurer charges
  805  a non-tobacco user for the same coverage.
  806  
  807  With respect to family coverage under the franchise health
  808  insurance policy, an insurer shall apply the rating variations
  809  authorized under this subsection based on the premium
  810  attributable to each family member in accordance with commission
  811  rules.
  812         (3)An insurer authorized to issue, deliver, issue for
  813  delivery, or renew a franchise health insurance policy in this
  814  state may not modify the premium rates for coverages under the
  815  policy within 12 months after the initial issue date or renewal
  816  date, unless there is a change:
  817         (a)In the size, composition, or geographic rating area of
  818  the group insured under the franchise health insurance policy;
  819         (b)In tobacco use;
  820         (c)In family composition if the coverage is family
  821  coverage;
  822         (d)In the coverage benefits requested by the policyholder
  823  or by the group; or
  824         (e)Due to a requirement by federal law or regulation or
  825  due to an express authorization by state law or rule.
  826         (4)This section applies to any health insurance, as
  827  defined in s. 624.603, including short-term health insurance,
  828  that is offered under a franchise health insurance policy. This
  829  section does not apply to disability income insurance or income
  830  replacement insurance coverage.
  831         (5)The commission may adopt rules to administer this
  832  section and to ensure that the rating practices used by insurers
  833  for franchise health insurance policies are consistent with the
  834  purposes of this section.
  835         Section 6. Present paragraphs (q) through (w) of subsection
  836  (3) of section 627.6699, Florida Statutes, are redesignated as
  837  paragraphs (r) through (x), respectively, a new paragraph (q) is
  838  added to that subsection, and subsection (2), paragraph (n) of
  839  subsection (3), paragraphs (b) through (f) of subsection (5),
  840  paragraphs (a) and (b) of subsection (6), paragraphs (b), (d),
  841  and (e) of subsection (12), and paragraph (b) of subsection (13)
  842  of that section are amended, to read:
  843         627.6699 Employee Health Care Access Act.—
  844         (2) PURPOSE AND INTENT.—The purpose and intent of this
  845  section is to promote the availability of health insurance
  846  coverage to small employers regardless of their claims
  847  experience or their employees’ health status or preexisting
  848  conditions, to establish rules regarding renewability of that
  849  coverage, to establish limitations on the use of exclusions for
  850  preexisting conditions, to provide for establishment of a
  851  reinsurance program for coverage of small employers, and to
  852  improve the overall fairness and efficiency of the small group
  853  health insurance market.
  854         (3) DEFINITIONS.—As used in this section, the term:
  855         (n) “Modified community rating” means a method used to
  856  develop carrier premiums which spreads financial risk across a
  857  large population; allows the use of separate rating factors for
  858  age, gender, family composition, tobacco usage, and geographic
  859  area as determined under paragraph (5)(f); and allows
  860  adjustments for: claims experience, health status, or duration
  861  of coverage as permitted under subparagraph (6)(b)6. (6)(b)5.;
  862  and administrative and acquisition expenses as permitted under
  863  subparagraph (6)(b)6. (6)(b)5.
  864         (q)“Preexisting condition” has the same meaning as defined
  865  in s. 627.6487.
  866         (5) AVAILABILITY OF COVERAGE.—
  867         (b) Every small employer carrier must, as a condition of
  868  transacting business in this state, offer and issue all small
  869  employer health benefit plans on a guaranteed-issue basis to
  870  every eligible small employer, with 2 to 50 eligible employees,
  871  that elects to be covered under such plan, agrees to make the
  872  required premium payments, and satisfies the other provisions of
  873  the plan. A rider for additional or increased benefits may be
  874  medically underwritten and may only be added to the standard
  875  health benefit plan. The increased rate charged for the
  876  additional or increased benefit must be rated in accordance with
  877  this section.
  878         (c) Except as provided in paragraph (d), A health benefit
  879  plan covering small employers must comply with preexisting
  880  condition provisions specified in s. 627.65613 s. 627.6561 or,
  881  for health maintenance contracts, in ss. 641.1855 and 641.31077
  882  s. 641.31071.
  883         (d) A health benefit plan covering small employers, issued
  884  or renewed on or after January 1, 2021 1994, must comply with
  885  the following conditions:
  886         1.All health benefit plans must be offered and issued on a
  887  guaranteed-issue basis. Additional or increased benefits may
  888  only be offered by riders.
  889         2.For health benefit plans that are issued to a small
  890  employer who has fewer than two employees and that cover an
  891  employee who has not been continually covered by creditable
  892  coverage within 63 days before the effective date of the new
  893  coverage, preexisting condition provisions must not exclude
  894  coverage for a period beyond 24 months following the employee’s
  895  effective date of coverage and may relate only to:
  896         a.Conditions that, during the 24-month period immediately
  897  preceding the effective date of coverage, had manifested
  898  themselves in such a manner as would cause an ordinarily prudent
  899  person to seek medical advice, diagnosis, care, or treatment or
  900  for which medical advice, diagnosis, care, or treatment was
  901  recommended or received; or
  902         b.A pregnancy existing on the effective date of coverage.
  903         (e) All health benefit plans issued under this section must
  904  comply with the following conditions:
  905         1. For employers who have fewer than two employees, a late
  906  enrollee may be excluded from coverage for no longer than 24
  907  months if he or she was not covered by creditable coverage
  908  continually to a date not more than 63 days before the effective
  909  date of his or her new coverage.
  910         2. Any requirement used by a small employer carrier in
  911  determining whether to provide coverage to a small employer
  912  group, including requirements for minimum participation of
  913  eligible employees and minimum employer contributions, must be
  914  applied uniformly among all small employer groups having the
  915  same number of eligible employees applying for coverage or
  916  receiving coverage from the small employer carrier, except that
  917  a small employer carrier that participates in, administers, or
  918  issues health benefits pursuant to s. 381.0406 which do not
  919  include a preexisting condition exclusion may require as a
  920  condition of offering such benefits that the employer has had no
  921  health insurance coverage for its employees for a period of at
  922  least 6 months. A small employer carrier may vary application of
  923  minimum participation requirements and minimum employer
  924  contribution requirements only by the size of the small employer
  925  group.
  926         3. In applying minimum participation requirements with
  927  respect to a small employer, a small employer carrier shall not
  928  consider as an eligible employee employees or dependents who
  929  have qualifying existing coverage in an employer-based group
  930  insurance plan or an ERISA qualified self-insurance plan in
  931  determining whether the applicable percentage of participation
  932  is met. However, a small employer carrier may count eligible
  933  employees and dependents who have coverage under another health
  934  plan that is sponsored by that employer.
  935         4. A small employer carrier shall not increase any
  936  requirement for minimum employee participation or any
  937  requirement for minimum employer contribution applicable to a
  938  small employer at any time after the small employer has been
  939  accepted for coverage, unless the employer size has changed, in
  940  which case the small employer carrier may apply the requirements
  941  that are applicable to the new group size.
  942         5. If a small employer carrier offers coverage to a small
  943  employer, it must offer coverage to all the small employer’s
  944  eligible employees and their dependents. A small employer
  945  carrier may not offer coverage limited to certain persons in a
  946  group or to part of a group, except with respect to late
  947  enrollees.
  948         6. A small employer carrier may not modify any health
  949  benefit plan issued to a small employer with respect to a small
  950  employer or any eligible employee or dependent through riders,
  951  endorsements, or otherwise to restrict or exclude coverage for
  952  certain diseases or medical conditions otherwise covered by the
  953  health benefit plan.
  954         7. An initial enrollment period of at least 30 days must be
  955  provided. An annual 30-day open enrollment period must be
  956  offered to each small employer’s eligible employees and their
  957  dependents. A small employer carrier must provide special
  958  enrollment periods as required by s. 627.65615.
  959         (f) The boundaries of geographic areas used by a small
  960  employer carrier must coincide with county lines. A carrier may
  961  not apply different geographic rating factors to the rates of
  962  small employers located within the same county or within the
  963  same geographic rating area that is established in accordance
  964  with federal law.
  965         (6) RESTRICTIONS RELATING TO PREMIUM RATES.—
  966         (a) The commission may, by rule, establish regulations to
  967  administer this section and to ensure assure that rating
  968  practices used by small employer carriers are consistent with
  969  the purpose of this section, including ensuring assuring that
  970  differences in rates charged for health benefit plans by small
  971  employer carriers are reasonable and reflect objective
  972  differences in plan design, not including differences due to the
  973  nature of the groups assumed to select particular health benefit
  974  plans.
  975         (b) For all small employer health benefit plans that are
  976  subject to this section and issued by small employer carriers on
  977  or after January 1, 2021 1994, premium rates for health benefit
  978  plans are subject to the following:
  979         1. A small employer carrier may not vary premium rates
  980  based on one or more preexisting conditions. A small employer
  981  carrier carriers must use a modified community rating
  982  methodology in which the premium for each small employer is
  983  determined solely on the basis of the eligible employee’s and
  984  eligible dependent’s gender, age, family composition, tobacco
  985  use, or geographic area as determined under paragraph (5)(f) and
  986  in which the premium may be adjusted as permitted by this
  987  paragraph. A small employer carrier:
  988         a.May not charge an adult in the oldest age band more than
  989  3 times the rate the small employer carrier charges an adult in
  990  the youngest age band under the same health benefit plan.
  991         b.May not charge a tobacco user more than 1 1/15 times the
  992  rate the small employer carrier charges a non-tobacco user under
  993  the same health benefit plan.
  994         c.Must, with respect to family coverage, apply the rating
  995  variations authorized under this subparagraph based on the
  996  premium attributable to each family member under the health
  997  benefit plan in accordance with commission rules is not required
  998  to use gender as a rating factor for a nongrandfathered health
  999  plan.
 1000         2. Rating factors related to age, gender, family
 1001  composition, tobacco use, or geographic location may be
 1002  developed by each carrier to reflect the carrier’s experience.
 1003  The factors used by carriers are subject to office review and
 1004  approval.
 1005         3. Except as provided in subparagraph 4., a small employer
 1006  carrier carriers may not modify the rate for a small employer or
 1007  an eligible employee within for 12 months after from the initial
 1008  issue date or renewal date, unless there is a change:
 1009         a.In the group’s size, composition, or geographic rating
 1010  area as established in accordance with federal law; of the group
 1011         b.In tobacco use;
 1012         c.In family composition if the eligible employee’s
 1013  coverage is family coverage;
 1014         d.In the coverage benefits requested by the eligible
 1015  employee or the small employer; or
 1016         e.Due to a requirement by federal law or regulation or due
 1017  to an express authorization by state law or rule changes or
 1018  benefits are changed.
 1019         4.However, A small employer carrier may modify the rate
 1020  one time within the 12 months after the initial issue date for a
 1021  small employer who enrolls under a previously issued group
 1022  policy that has a common anniversary date for all employers
 1023  covered under the policy if:
 1024         a. The carrier discloses to the employer in a clear and
 1025  conspicuous manner the date of the first renewal and the fact
 1026  that the premium may increase on or after that date.
 1027         b. The insurer demonstrates to the office that efficiencies
 1028  in administration are achieved and reflected in the rates
 1029  charged to small employers covered under the policy.
 1030         5.4. A carrier may issue a group health insurance policy to
 1031  a small employer health alliance or other group association with
 1032  rates that reflect a premium credit for expense savings
 1033  attributable to administrative activities being performed by the
 1034  alliance or group association if such expense savings are
 1035  specifically documented in the insurer’s rate filing and are
 1036  approved by the office. Any such credit may not be based on
 1037  different morbidity assumptions or on any other factor related
 1038  to the health status, preexisting conditions, or claims
 1039  experience of any person covered under the policy. This
 1040  subparagraph does not exempt an alliance or group association
 1041  from licensure for activities that require licensure under the
 1042  insurance code. A carrier issuing a group health insurance
 1043  policy to a small employer health alliance or other group
 1044  association shall allow any properly licensed and appointed
 1045  agent of that carrier to market and sell the small employer
 1046  health alliance or other group association policy. Such agent
 1047  shall be paid the usual and customary commission paid to any
 1048  agent selling the policy.
 1049         6.5. Any adjustments in rates for claims experience, health
 1050  status, or duration of coverage may not be charged to individual
 1051  employees or dependents. For a small employer’s policy, such
 1052  adjustments may not result in a rate for the small employer
 1053  which deviates more than 15 percent from the carrier’s approved
 1054  rate. Any such adjustment must be applied uniformly to the rates
 1055  charged for all employees and dependents of the small employer.
 1056  A small employer carrier may make an adjustment to a small
 1057  employer’s renewal premium, up to 10 percent annually, due to
 1058  the claims experience, health status, or duration of coverage of
 1059  the employees or dependents of the small employer. If the
 1060  aggregate resulting from the application of such adjustment
 1061  exceeds the premium that would have been charged by application
 1062  of the approved modified community rate by 4 percent for the
 1063  current policy term, the carrier shall limit the application of
 1064  such adjustments only to minus adjustments. For any subsequent
 1065  policy term, if the total aggregate adjusted premium actually
 1066  charged does not exceed the premium that would have been charged
 1067  by application of the approved modified community rate by 4
 1068  percent, the carrier may apply both plus and minus adjustments.
 1069  A small employer carrier may provide a credit to a small
 1070  employer’s premium based on administrative and acquisition
 1071  expense differences resulting from the size of the group. Group
 1072  size administrative and acquisition expense factors may be
 1073  developed by each carrier to reflect the carrier’s experience
 1074  and are subject to office review and approval.
 1075         7.6. A small employer carrier rating methodology may
 1076  include separate rating categories for one dependent child, for
 1077  two dependent children, and for three or more dependent children
 1078  for family coverage of employees having a spouse and dependent
 1079  children or employees having dependent children only. A small
 1080  employer carrier may have fewer, but not greater, numbers of
 1081  categories for dependent children than those specified in this
 1082  subparagraph.
 1083         8.7. Small employer carriers may not use a composite rating
 1084  methodology to rate a small employer with fewer than 10
 1085  employees. For the purposes of this subparagraph, the term
 1086  “composite rating methodology” means a rating methodology that
 1087  averages the impact of the rating factors for age and gender in
 1088  the premiums charged to all of the employees of a small
 1089  employer.
 1090         9.8. A carrier may separate the experience of small
 1091  employer groups with fewer than 2 eligible employees from the
 1092  experience of small employer groups with 2-50 eligible employees
 1093  for purposes of determining an alternative modified community
 1094  rating.
 1095         a. If a carrier separates the experience of small employer
 1096  groups, the rate to be charged to small employer groups of fewer
 1097  than 2 eligible employees may not exceed 150 percent of the rate
 1098  determined for small employer groups of 2-50 eligible employees.
 1099  However, the carrier may charge excess losses of the experience
 1100  pool consisting of small employer groups with fewer less than 2
 1101  eligible employees to the experience pool consisting of small
 1102  employer groups with 2-50 eligible employees so that all losses
 1103  are allocated and the 150-percent rate limit on the experience
 1104  pool consisting of small employer groups with fewer less than 2
 1105  eligible employees is maintained.
 1106         b. Notwithstanding s. 627.411(1), the rate to be charged to
 1107  a small employer group of fewer than 2 eligible employees,
 1108  insured as of July 1, 2002, may be up to 125 percent of the rate
 1109  determined for small employer groups of 2-50 eligible employees
 1110  for the first annual renewal and 150 percent for subsequent
 1111  annual renewals.
 1112         10.9. A carrier shall separate the experience of
 1113  grandfathered health plans from nongrandfathered health plans
 1114  for determining rates.
 1115         (12) STANDARDS TO ENSURE ASSURE FAIR MARKETING.—
 1116         (b) A small employer carrier or agent shall not, directly
 1117  or indirectly, engage in the following activities:
 1118         1. Encouraging or directing small employers to refrain from
 1119  filing an application for coverage with the small employer
 1120  carrier because of the health status, preexisting condition,
 1121  claims experience, industry, occupation, or geographic location
 1122  of the small employer.
 1123         2. Encouraging or directing small employers to seek
 1124  coverage from another carrier because of the health status,
 1125  preexisting condition, claims experience, industry, occupation,
 1126  or geographic location of the small employer.
 1127         (d) A small employer carrier shall not, directly or
 1128  indirectly, enter into any contract, agreement, or arrangement
 1129  with an agent that provides for or results in the compensation
 1130  paid to an agent for the sale of a health benefit plan to be
 1131  varied because of the health status, preexisting condition,
 1132  claims experience, industry, occupation, or geographic location
 1133  of the small employer except if the compensation arrangement
 1134  provides compensation to an agent on the basis of percentage of
 1135  premium, provided that the percentage shall not vary because of
 1136  the health status, preexisting condition, claims experience,
 1137  industry, occupation, or geographic area of the small employer.
 1138         (e) A small employer carrier shall not terminate, fail to
 1139  renew, or limit its contract or agreement of representation with
 1140  an agent for any reason related to the health status,
 1141  preexisting condition, claims experience, occupation, or
 1142  geographic location of the small employers placed by the agent
 1143  with the small employer carrier unless the agent consistently
 1144  engages in practices that violate this section or s. 626.9541.
 1145         (13) DISCLOSURE OF INFORMATION.—
 1146         (b)1. Subject to subparagraph 3., with respect to a small
 1147  employer carrier that offers a health benefit plan to a small
 1148  employer, information described in this paragraph is information
 1149  that concerns:
 1150         a. The provisions of such coverage concerning an insurer’s
 1151  right to change premium rates and the factors that may affect
 1152  changes in premium rates;
 1153         b. The provisions of such coverage that relate to
 1154  renewability of coverage;
 1155         c.The provisions of such coverage that relate to any
 1156  preexisting condition exclusions; and
 1157         c.d. The benefits and premiums available under all health
 1158  insurance coverage for which the employer is qualified.
 1159         2. Information required under this subsection shall be
 1160  provided to small employers in a manner determined to be
 1161  understandable by the average small employer, and shall be
 1162  sufficient to reasonably inform small employers of their rights
 1163  and obligations under the health insurance coverage.
 1164         3. An insurer is not required under this subsection to
 1165  disclose any information that is proprietary or a trade secret
 1166  under state law.
 1167         Section 7. Section 641.1855, Florida Statutes, is created
 1168  to read:
 1169         641.1855Premium rates for individual and small employer
 1170  health maintenance contracts.—
 1171         (1)As used in this section, the term:
 1172         (a)“Health maintenance contract” means a health
 1173  maintenance contract offered in the individual market, a health
 1174  maintenance contract that is individually underwritten, or a
 1175  health maintenance contract provided to a small employer.
 1176         (b)“Preexisting condition” has the same meaning as defined
 1177  in s. 641.31077.
 1178         (c)“Short-term health insurance” has the same meaning as
 1179  defined in s. 641.31077.
 1180         (2)A health maintenance organization that offers a health
 1181  maintenance contract in this state may not establish, under such
 1182  contract, differentials in premium rates that are based on a
 1183  preexisting condition. The health maintenance organization shall
 1184  develop premium rates under the contract based on, and shall
 1185  vary the rates by, only the following factors:
 1186         (a)Whether the contract coverage is individual or family
 1187  coverage.
 1188         (b)The geographic rating area that is established in
 1189  accordance with federal law.
 1190         (c)Age, except that the health maintenance organization
 1191  may not charge an adult in the oldest age band more than 3 times
 1192  the rate the health maintenance organization charges an adult in
 1193  the youngest age band for the same coverage.
 1194         (d)Tobacco use, except that the health maintenance
 1195  organization may not charge a tobacco user more than 1 1/15
 1196  times the rate the health maintenance organization charges a
 1197  non-tobacco user for the same coverage.
 1198  
 1199  With respect to family coverage under the health maintenance
 1200  contract, a health maintenance organization shall apply the
 1201  rating variations authorized under this subsection based on the
 1202  premium attributable to each family member in accordance with
 1203  commission rules.
 1204         (3)A health maintenance organization that offers a health
 1205  maintenance contract in this state may not modify the premium
 1206  rates for coverages under the health maintenance contract within
 1207  12 months after the initial issue date or renewal date, unless
 1208  there is a change:
 1209         (a)In the individual contract holder’s geographic rating
 1210  area if the contract is an individual health maintenance
 1211  contract, or in the small employer’s size, composition, or
 1212  geographic rating area established in accordance with federal
 1213  law if the contract is a small employer health maintenance
 1214  contract;
 1215         (b)In tobacco use;
 1216         (c)In family composition if the coverage is family
 1217  coverage;
 1218         (d)In the coverage benefits requested by the contract
 1219  holder or by the small employer; or
 1220         (e)Due to a requirement by federal law or regulation or
 1221  due to an express authorization by state law or rule.
 1222         (4)This section applies to any health insurance, as
 1223  defined in s. 624.603, including short-term health insurance,
 1224  that is offered under a health maintenance contract. This
 1225  section does not apply to disability income insurance or income
 1226  replacement insurance coverage.
 1227         Section 8. Section 641.31077, Florida Statutes, is created
 1228  to read:
 1229         641.31077Preexisting conditions.—
 1230         (1)This act establishes protections for those with
 1231  preexisting conditions who seek to obtain insurance coverage.
 1232         (2)As used in this section, the term:
 1233         (a)“Preexisting condition” means a condition that existed
 1234  before the effective date of health maintenance coverage or the
 1235  date of the coverage denial, regardless of whether any medical
 1236  advice, diagnosis, care, or treatment was recommended or
 1237  received for such condition before that date.
 1238         (b)“Short-term health insurance” means a health
 1239  maintenance contract with an expiration date specified in the
 1240  contract that is less than 12 months after the original
 1241  effective date of the contract and, taking into account renewals
 1242  or extensions, has a duration not to exceed 36 months in total.
 1243         (3)A health maintenance organization issuing or delivering
 1244  an individual or group health maintenance contract in this state
 1245  may not, with respect to a group, an employer, or an individual
 1246  that is eligible to enroll for coverage under such contract and
 1247  that applies for coverage under such contract:
 1248         (a)Decline to offer such coverage to, or deny enrollment
 1249  of, such group, employer, or individual; or
 1250         (b)Impose any preexisting condition exclusion with respect
 1251  to such coverage.
 1252         (4)This section applies to any health insurance, as
 1253  defined in s. 624.603, including short-term health insurance,
 1254  that is offered under an individual or group health maintenance
 1255  contract. This section does not apply to disability income
 1256  insurance or income replacement insurance coverage.
 1257         Section 9. Paragraph (a) of subsection (4) of section
 1258  408.9091, Florida Statutes, is amended to read:
 1259         408.9091 Cover Florida Health Care Access Program.—
 1260         (4) PROGRAM.—The agency and the office shall jointly
 1261  establish and administer the Cover Florida Health Care Access
 1262  Program.
 1263         (a) General Cover Florida plan components must require
 1264  that:
 1265         1. Plans are offered on a guaranteed-issue basis to
 1266  enrollees, subject to exclusions for preexisting conditions
 1267  approved by the office and the agency.
 1268         2. Plans are portable such that the enrollee remains
 1269  covered regardless of employment status or the cost sharing of
 1270  premiums.
 1271         3. Plans provide for cost containment through limits on the
 1272  number of services, caps on benefit payments, and copayments for
 1273  services.
 1274         4. A Cover Florida plan entity makes all benefit plan and
 1275  marketing materials available in English and Spanish.
 1276         5. In order to provide for consumer choice, Cover Florida
 1277  plan entities develop two alternative benefit option plans
 1278  having different cost and benefit levels, including at least one
 1279  plan that provides catastrophic coverage.
 1280         6. Plans without catastrophic coverage provide coverage
 1281  options for services including, but not limited to:
 1282         a. Preventive health services, including immunizations,
 1283  annual health assessments, well-woman and well-care services,
 1284  and preventive screenings such as mammograms, cervical cancer
 1285  screenings, and noninvasive colorectal or prostate screenings.
 1286         b. Incentives for routine preventive care.
 1287         c. Office visits for the diagnosis and treatment of illness
 1288  or injury.
 1289         d. Office surgery, including anesthesia.
 1290         e. Behavioral health services.
 1291         f. Durable medical equipment and prosthetics.
 1292         g. Diabetic supplies.
 1293         7. Plans providing catastrophic coverage, at a minimum,
 1294  provide coverage options for all of the services listed under
 1295  subparagraph 6.; however, such plans may include, but are not
 1296  limited to, coverage options for:
 1297         a. Inpatient hospital stays.
 1298         b. Hospital emergency care services.
 1299         c. Urgent care services.
 1300         d. Outpatient facility services, outpatient surgery, and
 1301  outpatient diagnostic services.
 1302         8. All plans offer prescription drug benefit coverage, use
 1303  a prescription drug manager, or offer a discount drug card.
 1304         9. Plan enrollment materials provide information in plain
 1305  language on policy benefit coverage, benefit limits, cost
 1306  sharing requirements, and exclusions and a clear representation
 1307  of what is not covered in the plan. Such enrollment materials
 1308  must include a standard disclosure form adopted by rule by the
 1309  Financial Services Commission, to be reviewed and executed by
 1310  all consumers purchasing Cover Florida plan coverage.
 1311         10. Plans offered through a qualified employer meet the
 1312  requirements of s. 125 of the Internal Revenue Code.
 1313         Section 10. Subsection (5) of section 409.814, Florida
 1314  Statutes, is amended to read:
 1315         409.814 Eligibility.—A child who has not reached 19 years
 1316  of age whose family income is equal to or below 200 percent of
 1317  the federal poverty level is eligible for the Florida Kidcare
 1318  program as provided in this section. If an enrolled individual
 1319  is determined to be ineligible for coverage, he or she must be
 1320  immediately disenrolled from the respective Florida Kidcare
 1321  program component.
 1322         (5)A child who is otherwise eligible for the Florida
 1323  Kidcare program and who has a preexisting condition that
 1324  prevents coverage under another insurance plan as described in
 1325  paragraph (4)(a) which would have disqualified the child for the
 1326  Florida Kidcare program if the child were able to enroll in the
 1327  plan is eligible for Florida Kidcare coverage when enrollment is
 1328  possible.
 1329         Section 11. Subsection (3) of section 409.816, Florida
 1330  Statutes, is amended to read:
 1331         409.816 Limitations on premiums and cost sharing.—The
 1332  following limitations on premiums and cost sharing are
 1333  established for the program.
 1334         (3) Enrollees in families with a family income above 150
 1335  percent of the federal poverty level who are not receiving
 1336  coverage under the Medicaid program or who are not eligible
 1337  under s. 409.814(5) s. 409.814(6) may be required to pay
 1338  enrollment fees, premiums, copayments, deductibles, coinsurance,
 1339  or similar charges on a sliding scale related to income, except
 1340  that the total annual aggregate cost sharing with respect to all
 1341  children in a family may not exceed 5 percent of the family’s
 1342  income. However, copayments, deductibles, coinsurance, or
 1343  similar charges may not be imposed for preventive services,
 1344  including well-baby and well-child care, age-appropriate
 1345  immunizations, and routine hearing and vision screenings.
 1346         Section 12. Paragraph (b) of subsection (5) of section
 1347  627.429, Florida Statutes, is amended to read:
 1348         627.429 Medical tests for HIV infection and AIDS for
 1349  insurance purposes.—
 1350         (5) RESTRICTIONS ON COVERAGE EXCLUSIONS AND LIMITATIONS.—
 1351         (b) Subject to the total benefits limits in a health
 1352  insurance policy, no health insurance policy shall contain an
 1353  exclusion or limitation with respect to coverage for exposure to
 1354  the HIV infection or a specific sickness or medical condition
 1355  derived from such infection, except as provided in a preexisting
 1356  condition clause. This paragraph does not prohibit the issuance
 1357  of accident-only or specified disease health policies.
 1358         Section 13. Subsection (2) of section 627.607, Florida
 1359  Statutes, is amended to read:
 1360         627.607 Time limit on certain defenses.—
 1361         (2) A policy may, in place of the provision set forth in
 1362  subsection (1), include the following provision:
 1363         “Incontestable:
 1364         (a) Misstatements in the Application: After this policy has
 1365  been in force for 2 years during the insured’s lifetime
 1366  (excluding any period during which the insured is disabled), the
 1367  insurer cannot contest the statements in the application.
 1368         (b)Preexisting Conditions: No claim for loss incurred or
 1369  disability starting after 2 years from the issue date will be
 1370  reduced or denied because a sickness or physical condition, not
 1371  excluded by name or specific description before the date of
 1372  loss, had existed before the effective date of coverage.”
 1373         Section 14. Subsection (1) of section 627.6415, Florida
 1374  Statutes, is amended to read:
 1375         627.6415 Coverage for natural-born, adopted, and foster
 1376  children; children in insured’s custodial care.—
 1377         (1) A health insurance policy that provides coverage for a
 1378  member of the family of the insured shall, as to the family
 1379  member’s coverage, provide that the health insurance benefits
 1380  applicable to children of the insured also apply to an adopted
 1381  child or a foster child of the insured placed in compliance with
 1382  chapter 63, before prior to the child’s 18th birthday, from the
 1383  moment of placement in the residence of the insured. Except in
 1384  the case of a foster child, The policy may not exclude coverage
 1385  for any preexisting condition of the child. In the case of a
 1386  newborn child, coverage begins at the moment of birth if a
 1387  written agreement to adopt the child has been entered into by
 1388  the insured before prior to the birth of the child, whether or
 1389  not the agreement is enforceable. This section does not require
 1390  coverage for an adopted child who is not ultimately placed in
 1391  the residence of the insured in compliance with chapter 63.
 1392         Section 15. Paragraph (c) of subsection (2) of section
 1393  627.642, Florida Statutes, is amended to read:
 1394         627.642 Outline of coverage.—
 1395         (2) The outline of coverage shall contain:
 1396         (c) A summary statement of the principal exclusions and
 1397  limitations or reductions contained in the policy, including,
 1398  but not limited to, preexisting conditions, probationary
 1399  periods, elimination periods, deductibles, coinsurance, and any
 1400  age limitations or reductions.
 1401         Section 16. Paragraphs (d) and (e) of subsection (2) and
 1402  paragraph (a) of subsection (3) of section 627.6425, Florida
 1403  Statutes, are amended to read:
 1404         627.6425 Renewability of individual coverage.—
 1405         (2) An insurer may nonrenew or discontinue health insurance
 1406  coverage of an individual in the individual market based only on
 1407  one or more of the following:
 1408         (d) In the case of a health insurer that offers health
 1409  insurance coverage in the market through a network plan, the
 1410  individual no longer resides, lives, or works in the service
 1411  area, or in an area for which the insurer is authorized to do
 1412  business, but only if such coverage is terminated under this
 1413  paragraph uniformly without regard to any health-status-related
 1414  or preexisting-condition-related factor of covered individuals.
 1415  As used in this section, the term “preexisting condition” has
 1416  the same meaning as defined in s. 627.6487.
 1417         (e) In the case of health insurance coverage that is made
 1418  available in the individual market only through one or more bona
 1419  fide associations, as defined in s. 627.6571(5), the membership
 1420  of the individual in the association, on the basis of which the
 1421  coverage is provided, ceases, but only if such coverage is
 1422  terminated under this paragraph uniformly without regard to any
 1423  health-status-related or preexisting-condition-related factor of
 1424  covered individuals.
 1425         (3)(a) If an insurer decides to discontinue offering a
 1426  particular policy form for health insurance coverage offered in
 1427  the individual market, coverage under such form may be
 1428  discontinued by the insurer only if:
 1429         1. The insurer provides notice to each covered individual
 1430  provided coverage under this policy form in the individual
 1431  market of such discontinuation at least 90 days before the date
 1432  of the nonrenewal of such coverage;
 1433         2. The insurer offers to each individual in the individual
 1434  market provided coverage under this policy form the option to
 1435  purchase any other individual health insurance coverage
 1436  currently being offered by the insurer for individuals in such
 1437  market in the state; and
 1438         3. In exercising the option to discontinue coverage of a
 1439  policy form and in offering the option of coverage under
 1440  subparagraph 2., the insurer acts uniformly without regard to
 1441  any health-status-related or preexisting-condition-related
 1442  factor of enrolled individuals or individuals who may become
 1443  eligible for such coverage. If a policy form covers both
 1444  grandfathered and nongrandfathered health plans, an insurer may
 1445  nonrenew coverage only for the nongrandfathered health plans, in
 1446  which case the requirements of subparagraphs 1. and 2. apply
 1447  only to the nongrandfathered health plans. As used in this
 1448  subparagraph, the terms “grandfathered health plan” and
 1449  “nongrandfathered health plan” have the same meaning as provided
 1450  in s. 627.402.
 1451         Section 17. Subsection (2) of section 627.6426, Florida
 1452  Statutes, is amended to read:
 1453         627.6426 Short-term health insurance.—
 1454         (2) All contracts for short-term health insurance entered
 1455  into by an issuer and an individual seeking coverage shall
 1456  include the following disclosure:
 1457  
 1458  “This coverage is not required to comply with certain federal
 1459  market requirements for health insurance, principally those
 1460  contained in the Patient Protection and Affordable Care Act. Be
 1461  sure to check your policy carefully to make sure you are aware
 1462  of any exclusions or limitations regarding coverage of
 1463  preexisting conditions or health benefits (such as
 1464  hospitalization, emergency services, maternity care, preventive
 1465  care, prescription drugs, and mental health and substance use
 1466  disorder services). Your policy might also have lifetime and/or
 1467  annual dollar limits on health benefits. If this coverage
 1468  expires or you lose eligibility for this coverage, you might
 1469  have to wait until an open enrollment period to get other health
 1470  insurance coverage.”
 1471         Section 18. Paragraphs (b) and (e) of subsection (2) of
 1472  section 627.6475, Florida Statutes, are amended to read:
 1473         627.6475 Individual reinsurance pool.—
 1474         (2) DEFINITIONS.—As used in this section:
 1475         (b) “Health insurance issuer,” “issuer,” and “individual
 1476  health insurance” have the same meaning as defined in s.
 1477  627.6487 ascribed in s. 627.6487(2).
 1478         (e) “Eligible individual” has the same meaning as defined
 1479  in s. 627.6487 ascribed in s. 627.6487(3).
 1480         Section 19. Section 627.6512, Florida Statutes, is amended
 1481  to read:
 1482         627.6512 Exemption of certain group health insurance
 1483  policies.—Sections 627.6561, 627.65615, 627.65625, and 627.6571
 1484  do not apply to any group insurance policy in relation to its
 1485  provision of benefits described in s. 627.6513(1)-(14).
 1486         Section 20. Subsection (2) of section 627.6525, Florida
 1487  Statutes, is amended to read:
 1488         627.6525 Short-term health insurance.—
 1489         (2) All contracts for short-term health insurance entered
 1490  into by an issuer and a party seeking coverage shall include the
 1491  following disclosure:
 1492  “This coverage is not required to comply with certain federal
 1493  market requirements for health insurance, principally those
 1494  contained in the Patient Protection and Affordable Care Act. Be
 1495  sure to check your policy carefully to make sure you are aware
 1496  of any exclusions or limitations regarding coverage of
 1497  preexisting conditions or health benefits (such as
 1498  hospitalization, emergency services, maternity care, preventive
 1499  care, prescription drugs, and mental health and substance use
 1500  disorder services). Your policy might also have lifetime and/or
 1501  annual dollar limits on health benefits. If this coverage
 1502  expires or you lose eligibility for this coverage, you might
 1503  have to wait until an open enrollment period to get other health
 1504  insurance coverage.”
 1505         Section 21. Section 627.65625, Florida Statutes, is amended
 1506  to read:
 1507         627.65625 Prohibiting discrimination against individual
 1508  participants and beneficiaries based on health status or
 1509  preexisting conditions.—
 1510         (1) Subject to subsection (2), an insurer that offers a
 1511  group health insurance policy may not establish rules for
 1512  eligibility, including continued eligibility, of an individual
 1513  to enroll under the terms of the policy based on any of the
 1514  following health-status-related or preexisting-condition-related
 1515  factors in relation to the individual or a dependent of the
 1516  individual:
 1517         (a) Health status.
 1518         (b) Medical condition, including physical and mental
 1519  illnesses.
 1520         (c) Claims experience.
 1521         (d) Receipt of health care.
 1522         (e) Medical history.
 1523         (f) Genetic information.
 1524         (g) Evidence of insurability, including conditions arising
 1525  out of acts of domestic violence.
 1526         (h) Disability.
 1527         (i)Preexisting condition.
 1528  
 1529  As used in this section, the term “preexisting condition” has
 1530  the same meaning as defined in s. 627.6487.
 1531         (2) Subsection (1) does not:
 1532         (a) Require an insurer to provide particular benefits other
 1533  than those provided under the terms of such plan or coverage.
 1534         (b) Prevent such a plan or coverage from establishing
 1535  limitations or restrictions on the amount, level, extent, or
 1536  nature of the benefits or coverage for similarly situated
 1537  individuals enrolled in the plan or coverage.
 1538         (3) For purposes of subsection (1), rules for eligibility
 1539  to enroll under a policy include rules for defining any
 1540  applicable waiting periods of enrollment.
 1541         (4)(a) An insurer that offers health insurance coverage may
 1542  not require any individual, as a condition of enrollment or
 1543  continued enrollment under the policy, to pay a premium or
 1544  contribution that is greater than such premium or contribution
 1545  for a similarly situated individual enrolled under the policy on
 1546  the basis of any health-status-related or preexisting-condition
 1547  related factor in relation to the individual or to an individual
 1548  enrolled under the policy as a dependent of the individual.
 1549         (b) This subsection does not:
 1550         1. Restrict the amount that an employer may be charged for
 1551  coverage under a group health insurance policy; or
 1552         2. Prevent an insurer that offers group health insurance
 1553  coverage from establishing premium discounts or rebates or
 1554  modifying otherwise applicable copayments or deductibles in
 1555  return for adherence to programs of health promotion and disease
 1556  prevention.
 1557         Section 22. Paragraph (f) of subsection (2), paragraph (a)
 1558  of subsection (3), and subsection (5) of section 627.6571,
 1559  Florida Statutes, are amended to read:
 1560         627.6571 Guaranteed renewability of coverage.—
 1561         (2) An insurer may nonrenew or discontinue a group health
 1562  insurance policy based only on one or more of the following
 1563  conditions:
 1564         (f) In the case of health insurance coverage that is made
 1565  available only through one or more bona fide associations as
 1566  defined in subsection (5) or through one or more small employer
 1567  health alliances as described in s. 627.654(1)(b), the
 1568  membership of an employer in the association or in the small
 1569  employer health alliance, on the basis of which the coverage is
 1570  provided, ceases, but only if such coverage is terminated under
 1571  this paragraph uniformly without regard to any health-status
 1572  related or preexisting-condition-related factor that relates to
 1573  any covered individuals. As used in this section, the term
 1574  “preexisting condition” has the same meaning as defined in s.
 1575  627.6487.
 1576         (3)(a) An insurer may discontinue offering a particular
 1577  policy form of group health insurance coverage offered in the
 1578  small-group market or large-group market only if:
 1579         1. The insurer provides notice to each policyholder
 1580  provided coverage under this policy form, and to participants
 1581  and beneficiaries covered under such coverage, of such
 1582  discontinuation at least 90 days before the date of the
 1583  nonrenewal of such coverage;
 1584         2. The insurer offers to each policyholder provided
 1585  coverage under this policy form the option to purchase all, or
 1586  in the case of the large-group market, any other health
 1587  insurance coverage currently being offered by the insurer in
 1588  such market; and
 1589         3. In exercising the option to discontinue coverage of this
 1590  form and in offering the option of coverage under subparagraph
 1591  2., the insurer acts uniformly without regard to the claims
 1592  experience of those policyholders or any health-status-related
 1593  or preexisting-condition-related factor that relates to any
 1594  participants or beneficiaries covered or new participants or
 1595  beneficiaries who may become eligible for such coverage. If a
 1596  policy form covers both grandfathered and nongrandfathered
 1597  health plans, an insurer may nonrenew coverage only for
 1598  nongrandfathered health plans, in which case the requirements of
 1599  subparagraphs 1. and 2. apply only to the nongrandfathered
 1600  health plans. As used in this subparagraph, the terms
 1601  “grandfathered health plan” and “nongrandfathered health plan”
 1602  have the same meanings as provided in s. 627.402.
 1603         (5) As used in this section, the term “bona fide
 1604  association” means an association that:
 1605         (a) Has been actively in existence for at least 5 years;
 1606         (b) Has been formed and maintained in good faith for
 1607  purposes other than obtaining insurance;
 1608         (c) Does not condition membership in the association on any
 1609  health-status-related or preexisting-condition-related factor
 1610  that relates to an individual, including an employee of an
 1611  employer or a dependent of an employee;
 1612         (d) Makes health insurance coverage offered through the
 1613  association available to all members regardless of any health
 1614  status-related or preexisting-condition-related factor that
 1615  relates to such members or individuals eligible for coverage
 1616  through a member; and
 1617         (e) Does not make health insurance coverage offered through
 1618  the association available other than in connection with a member
 1619  of the association.
 1620         Section 23. Subsection (1) of section 627.6578, Florida
 1621  Statutes, is amended to read:
 1622         627.6578 Coverage for natural-born, adopted, and foster
 1623  children; children in insured’s custodial care.—
 1624         (1) A group, blanket, or franchise health insurance policy
 1625  that provides coverage for a family member of the
 1626  certificateholder or subscriber shall, as to such family
 1627  member’s coverage, provide that benefits applicable to children
 1628  of the certificateholder or subscriber also apply to an adopted
 1629  child or a foster child of the certificateholder or subscriber
 1630  placed in compliance with chapter 63, from the moment of
 1631  placement in the residence of the certificateholder or
 1632  subscriber. Except in the case of a foster child, The policy may
 1633  not exclude coverage for any preexisting condition of the child.
 1634  In the case of a newborn child, coverage begins at the moment of
 1635  birth if a written agreement to adopt such child has been
 1636  entered into by the certificateholder or subscriber before prior
 1637  to the birth of the child, whether or not the agreement is
 1638  enforceable. This section does not require coverage for an
 1639  adopted child who is not ultimately placed in the residence of
 1640  the certificateholder or subscriber in compliance with chapter
 1641  63.
 1642         Section 24. Present subsections (10) through (20) of
 1643  section 627.6675, Florida Statutes, are renumbered as
 1644  subsections (9) through (19), respectively, and subsection (9)
 1645  and present subsection (15) of that section are amended, to
 1646  read:
 1647         627.6675 Conversion on termination of eligibility.—Subject
 1648  to all of the provisions of this section, a group policy
 1649  delivered or issued for delivery in this state by an insurer or
 1650  nonprofit health care services plan that provides, on an
 1651  expense-incurred basis, hospital, surgical, or major medical
 1652  expense insurance, or any combination of these coverages, shall
 1653  provide that an employee or member whose insurance under the
 1654  group policy has been terminated for any reason, including
 1655  discontinuance of the group policy in its entirety or with
 1656  respect to an insured class, and who has been continuously
 1657  insured under the group policy, and under any group policy
 1658  providing similar benefits that the terminated group policy
 1659  replaced, for at least 3 months immediately prior to
 1660  termination, shall be entitled to have issued to him or her by
 1661  the insurer a policy or certificate of health insurance,
 1662  referred to in this section as a “converted policy.” A group
 1663  insurer may meet the requirements of this section by contracting
 1664  with another insurer, authorized in this state, to issue an
 1665  individual converted policy, which policy has been approved by
 1666  the office under s. 627.410. An employee or member shall not be
 1667  entitled to a converted policy if termination of his or her
 1668  insurance under the group policy occurred because he or she
 1669  failed to pay any required contribution, or because any
 1670  discontinued group coverage was replaced by similar group
 1671  coverage within 31 days after discontinuance.
 1672         (9)PREEXISTING CONDITION PROVISION.—The converted policy
 1673  shall not exclude a preexisting condition not excluded by the
 1674  group policy. However, the converted policy may provide that any
 1675  hospital, surgical, or medical benefits payable under the
 1676  converted policy may be reduced by the amount of any such
 1677  benefits payable under the group policy after the termination of
 1678  coverage under the group policy. The converted policy may also
 1679  provide that during the first policy year the benefits payable
 1680  under the converted policy, together with the benefits payable
 1681  under the group policy, shall not exceed those that would have
 1682  been payable had the individual’s insurance under the group
 1683  policy remained in force.
 1684         (14)(15) BENEFIT LEVELS.—If the benefit levels required in
 1685  subsection (9) (10) exceed the benefit levels provided under the
 1686  group policy, the conversion policy may offer benefits which are
 1687  substantially similar to those provided under the group policy
 1688  in lieu of those required in subsection (9) (10).
 1689         Section 25. Paragraph (b) of subsection (5) of section
 1690  627.6692, Florida Statutes, is amended to read:
 1691         627.6692 Florida Health Insurance Coverage Continuation
 1692  Act.—
 1693         (5) CONTINUATION OF COVERAGE UNDER GROUP HEALTH PLANS.—
 1694         (b) Coverage under the group health plan must, at a
 1695  minimum, extend for the period beginning on the date of the
 1696  qualifying event and ending not earlier than the earliest of the
 1697  following:
 1698         1. The date that is 18 months after the date on which the
 1699  qualified beneficiary’s benefits under the group health plan
 1700  would otherwise have ceased because of a qualifying event.
 1701         2. The date on which coverage ceases under the group health
 1702  plan by reason of a failure to make timely payment of the
 1703  applicable premium with respect to any qualified beneficiary.
 1704         3. The date a qualified beneficiary becomes covered under
 1705  any other group health plan, if the qualified beneficiary will
 1706  not be subject to any exclusion or limitation because of a
 1707  preexisting condition of that beneficiary.
 1708         4. The date a qualified beneficiary is entitled to benefits
 1709  under either part A or part B of Title XVIII of the Social
 1710  Security Act (Medicare).
 1711         5. The date on which the employer terminates coverage under
 1712  the group health plan for all employees. If the employer
 1713  terminates coverage under the group health plan for all
 1714  employees and if such group health plan is replaced by similar
 1715  coverage under another group health plan, the qualified
 1716  beneficiary shall have the right to become covered under the new
 1717  group health plan for the balance of the period that she or he
 1718  would have remained covered under the prior group health plan. A
 1719  qualified beneficiary is to be treated in the same manner as an
 1720  active beneficiary for whom a qualifying event has not taken
 1721  place.
 1722         Section 26. Subsection (1) of section 627.66997, Florida
 1723  Statutes, is amended to read:
 1724         627.66997 Stop-loss insurance.—
 1725         (1) A self-insured health benefit plan established or
 1726  maintained by a small employer, as defined in s. 627.6699(3) s.
 1727  627.6699(3)(v), is exempt from s. 627.6699 and may use a stop
 1728  loss insurance policy issued to the employer. For purposes of
 1729  this subsection, the term “stop-loss insurance policy” means an
 1730  insurance policy issued to a small employer which covers the
 1731  small employer’s obligation for the excess cost of medical care
 1732  on an equivalent basis per employee provided under a self
 1733  insured health benefit plan.
 1734         (a) A small employer stop-loss insurance policy is
 1735  considered a health insurance policy and is subject to s.
 1736  627.6699 if the policy has an aggregate attachment point that is
 1737  lower than the greatest of:
 1738         1. Two thousand dollars multiplied by the number of
 1739  employees;
 1740         2. One hundred twenty percent of expected claims, as
 1741  determined by the stop-loss insurer in accordance with actuarial
 1742  standards of practice; or
 1743         3. Twenty thousand dollars.
 1744         (b) Once claims under the small employer health benefit
 1745  plan reach the aggregate attachment point set forth in paragraph
 1746  (a), the stop-loss insurance policy authorized under this
 1747  section must cover 100 percent of all claims that exceed the
 1748  aggregate attachment point.
 1749         Section 27. Subsection (1), paragraph (b) and present
 1750  paragraph (c) of subsection (2), and paragraph (c) of subsection
 1751  (3) of section 627.6741, Florida Statutes, are amended to read:
 1752         627.6741 Issuance, cancellation, nonrenewal, and
 1753  replacement.—
 1754         (1)(a) An insurer issuing Medicare supplement policies in
 1755  this state shall offer the opportunity of enrolling in a
 1756  Medicare supplement policy, without conditioning the issuance or
 1757  effectiveness of the policy on, and without discriminating in
 1758  the price of the policy based on, the medical or health status
 1759  or preexisting conditions or receipt of health care by the
 1760  individual:
 1761         1. To any individual who is 65 years of age or older, or
 1762  under 65 years of age and eligible for Medicare by reason of
 1763  disability or end-stage renal disease, and who resides in this
 1764  state, upon the request of the individual during the 6-month
 1765  period beginning with the first month in which the individual
 1766  has attained 65 years of age and is enrolled in Medicare Part B,
 1767  or is eligible for Medicare by reason of a disability or end
 1768  stage renal disease, and is enrolled in Medicare Part B; or
 1769         2. To any individual who is 65 years of age or older, or
 1770  under 65 years of age and eligible for Medicare by reason of a
 1771  disability or end-stage renal disease, who is enrolled in
 1772  Medicare Part B, and who resides in this state, upon the request
 1773  of the individual during the 2-month period following
 1774  termination of coverage under a group health insurance policy.
 1775         (b) The 6-month period to enroll in a Medicare supplement
 1776  policy for an individual who is under 65 years of age and is
 1777  eligible for Medicare by reason of disability or end-stage renal
 1778  disease and otherwise eligible under subparagraph (a)1. or
 1779  subparagraph (a)2. and first enrolled in Medicare Part B before
 1780  October 1, 2009, begins on October 1, 2009.
 1781         (c) A company that has offered Medicare supplement policies
 1782  to individuals under 65 years of age who are eligible for
 1783  Medicare by reason of disability or end-stage renal disease
 1784  before October 1, 2009, may, for one time only, effect a rate
 1785  schedule change that redefines the age bands of the premium
 1786  classes without activating the period of discontinuance required
 1787  by s. 627.410(6)(e)2.
 1788         (d) As a part of an insurer’s rate filings, before and
 1789  including the insurer’s first rate filing for a block of policy
 1790  forms in 2015, notwithstanding the provisions of s.
 1791  627.410(6)(e)3., an insurer shall consider the experience of the
 1792  policies or certificates for the premium classes including
 1793  individuals under 65 years of age and eligible for Medicare by
 1794  reason of disability or end-stage renal disease separately from
 1795  the balance of the block so as not to affect the other premium
 1796  classes. For filings in such time period only, credibility of
 1797  that experience shall be as follows: if a block of policy forms
 1798  has 1,250 or more policies or certificates in force in the age
 1799  band including ages under 65 years of age, full or 100-percent
 1800  credibility shall be given to the experience; and if fewer than
 1801  250 policies or certificates are in force, no or zero-percent
 1802  credibility shall be given. Linear interpolation shall be used
 1803  for in-force amounts between the low and high values. Florida
 1804  only experience shall be used if it is 100-percent credible. If
 1805  Florida-only experience is not 100-percent credible, a
 1806  combination of Florida-only and nationwide experience shall be
 1807  used. If Florida-only experience is zero-percent credible,
 1808  nationwide experience shall be used. The insurer may file its
 1809  initial rates and any rate adjustment based upon the experience
 1810  of these policies or certificates or based upon expected claim
 1811  experience using experience data of the same company, other
 1812  companies in the same or other states, or using data publicly
 1813  available from the Centers for Medicaid and Medicare Services if
 1814  the insurer’s combined Florida and nationwide experience is not
 1815  100-percent credible, separate from the balance of all other
 1816  Medicare supplement policies.
 1817  
 1818  A Medicare supplement policy issued to an individual under
 1819  subparagraph (a)1. or subparagraph (a)2. may not exclude
 1820  benefits based on a preexisting condition if the individual has
 1821  a continuous period of creditable coverage, as defined in s.
 1822  627.6562(3), of at least 6 months as of the date of application
 1823  for coverage. As used in this section, the term “preexisting
 1824  condition” has the same meaning as defined in s. 627.6487.
 1825         (2) For both individual and group Medicare supplement
 1826  policies:
 1827         (b)If it is not replacing an existing policy, a Medicare
 1828  supplement policy shall not limit or preclude liability under
 1829  the policy for a period longer than 6 months because of a health
 1830  condition existing before the policy is effective. The policy
 1831  may not define a preexisting condition more restrictively than a
 1832  condition for which medical advice was given or treatment was
 1833  recommended by or received from a physician within 6 months
 1834  before the effective date of coverage.
 1835         (b)(c) If a Medicare supplement policy or certificate
 1836  replaces another Medicare supplement policy or certificate or
 1837  creditable coverage as defined in s. 627.6562(3), the replacing
 1838  insurer shall waive any time periods applicable to preexisting
 1839  conditions, waiting periods, elimination periods, and
 1840  probationary periods in the new Medicare supplement policy for
 1841  similar benefits to the extent such time was spent under the
 1842  original policy.
 1843         (3) For group Medicare supplement policies:
 1844         (c) If a group Medicare supplement policy is replaced by
 1845  another group Medicare supplement policy purchased by the same
 1846  policyholder, the succeeding insurer shall offer coverage to all
 1847  persons covered under the old group policy on its date of
 1848  termination. Coverage under the new group policy may not result
 1849  in any exclusion for preexisting conditions that would have been
 1850  covered under the group policy being replaced.
 1851         Section 28. Paragraph (d) of subsection (3) of section
 1852  631.818, Florida Statutes, is amended to read:
 1853         631.818 Powers and duties of the plan.—
 1854         (3) The plan may appoint one or more HMOs in the same
 1855  geographical area as defined in s. 641.19 to provide health care
 1856  services, subject to all of the following conditions:
 1857         (d) Such coverage may shall not exclude a preexisting
 1858  condition not excluded by the policy of the insolvent HMO.
 1859         Section 29. Paragraphs (f), (g), and (h) of subsection (1)
 1860  of section 641.185, Florida Statutes, are amended to read:
 1861         641.185 Health maintenance organization subscriber
 1862  protections.—
 1863         (1) With respect to the provisions of this part and part
 1864  III, the principles expressed in the following statements serve
 1865  as standards to be followed by the commission, the office, the
 1866  department, and the Agency for Health Care Administration in
 1867  exercising their powers and duties, in exercising administrative
 1868  discretion, in administrative interpretations of the law, in
 1869  enforcing its provisions, and in adopting rules:
 1870         (f) A health maintenance organization subscriber should
 1871  receive the flexibility to transfer to another Florida health
 1872  maintenance organization, regardless of health status or
 1873  preexisting conditions, pursuant to ss. 641.228, 641.3104,
 1874  641.3107, 641.3111, 641.3921, and 641.3922. As used in this
 1875  section, the term “preexisting condition” has the same meaning
 1876  as defined in s. 641.31077.
 1877         (g) A health maintenance organization subscriber should be
 1878  eligible for coverage without discrimination against individual
 1879  participants and beneficiaries of group plans based on health
 1880  status pursuant to s. 641.31073 or based on preexisting
 1881  conditions pursuant to s. 641.31077.
 1882         (h) A health maintenance organization that issues a group
 1883  health contract must: provide coverage for preexisting
 1884  conditions pursuant to s. 641.31071; guarantee renewability of
 1885  coverage pursuant to s. 641.31074; provide notice of
 1886  cancellation pursuant to s. 641.3108; provide extension of
 1887  benefits pursuant to s. 641.3111; provide for conversion on
 1888  termination of eligibility pursuant to s. 641.3921; and provide
 1889  for conversion contracts and conditions pursuant to s. 641.3922.
 1890         Section 30. Paragraph (b) of subsection (5) of section
 1891  641.3007, Florida Statutes, is amended to read:
 1892         641.3007 HIV infection and AIDS for contract purposes.—
 1893         (5) RESTRICTIONS ON CONTRACT EXCLUSIONS AND LIMITATIONS.—
 1894         (b) No health maintenance organization contract shall
 1895  exclude or limit coverage for exposure to the HIV infection or a
 1896  specific sickness or medical condition derived from such
 1897  infection, except as provided in a preexisting condition clause.
 1898         Section 31. Paragraph (c) of subsection (3) and subsections
 1899  (16) and (47) of section 641.31, Florida Statutes, are amended
 1900  to read:
 1901         641.31 Health maintenance contracts.—
 1902         (3)
 1903         (c) The office shall disapprove any form filed under this
 1904  subsection, or withdraw any previous approval thereof, if the
 1905  form:
 1906         1. Is in any respect in violation of, or does not comply
 1907  with, any provision of this part or rule adopted thereunder.
 1908         2. Contains or incorporates by reference, where such
 1909  incorporation is otherwise permissible, any inconsistent,
 1910  ambiguous, or misleading clauses or exceptions and conditions
 1911  which deceptively affect the risk purported to be assumed in the
 1912  general coverage of the contract.
 1913         3. Has any title, heading, or other indication of its
 1914  provisions which is misleading.
 1915         4. Is printed or otherwise reproduced in such a manner as
 1916  to render any material provision of the form substantially
 1917  illegible.
 1918         5. Contains provisions which are unfair, inequitable, or
 1919  contrary to the public policy of this state or which encourage
 1920  misrepresentation.
 1921         6. Excludes coverage for human immunodeficiency virus
 1922  infection or acquired immune deficiency syndrome or contains
 1923  limitations in the benefits payable, or in the terms or
 1924  conditions of such contract, for human immunodeficiency virus
 1925  infection or acquired immune deficiency syndrome which are
 1926  different from than those that which apply to any other sickness
 1927  or medical condition.
 1928         7.Excludes coverage for a preexisting condition or
 1929  contains limitations in the benefits payable for a preexisting
 1930  condition. As used in this section, the term “preexisting
 1931  condition” has the same meaning as defined in s. 641.31077.
 1932         (16) The contracts must clearly disclose the intent of the
 1933  health maintenance organization as to the applicability or
 1934  nonapplicability of coverage to preexisting conditions, as
 1935  defined in s. 641.31077. If coverage of the contract is not to
 1936  be applicable to preexisting conditions, the contract shall
 1937  specify, in substance, that coverage pertains solely to
 1938  accidental bodily injuries resulting from accidents occurring
 1939  after the effective date of coverage and that sicknesses are
 1940  limited to those which first manifest themselves subsequent to
 1941  the effective date of coverage.
 1942         (47)(a)As used in this subsection, the terms “operative
 1943  date” and “preexisting medical condition” have the same meanings
 1944  as provided in s. 627.6046.
 1945         (b)A Not later than 30 days after the operative date, and
 1946  notwithstanding s. 641.31071 or any other law to the contrary,
 1947  every health maintenance organization issuing, delivering, or
 1948  issuing for delivery comprehensive major medical individual or
 1949  group health maintenance contracts in this state shall make at
 1950  least one comprehensive major medical health maintenance
 1951  contract available to residents in the health maintenance
 1952  organization’s approved service areas of this state, and such
 1953  health maintenance organization may not exclude, limit, deny, or
 1954  delay coverage under such contract due to one or more
 1955  preexisting medical conditions, as defined in s. 641.31077. A
 1956  health maintenance organization may not limit or exclude
 1957  benefits under such contract, including a denial of coverage,
 1958  applicable to an individual as a result of information relating
 1959  to an individual’s health status before the individual’s
 1960  effective date of coverage, or if coverage is denied, the date
 1961  of the denial.
 1962         (c)The comprehensive major medical health maintenance
 1963  contract the health maintenance organization is required to
 1964  offer under this section must be a contract that had been
 1965  actively marketed in this state by the health maintenance
 1966  organization as of the operative date and that was also actively
 1967  marketed in this state during the year immediately preceding the
 1968  operative date.
 1969         Section 32. Subsection (2) of section 641.3102, Florida
 1970  Statutes, is amended to read:
 1971         641.3102 Restrictions upon expulsion or refusal to issue or
 1972  renew contract.—
 1973         (2) A health maintenance organization may shall not expel
 1974  or refuse to renew the coverage of, or refuse to enroll, any
 1975  individual member of a subscriber group on the basis of the
 1976  race, color, creed, marital status, sex, or national origin of
 1977  the subscriber or individual. A health maintenance organization
 1978  may shall not expel or refuse to renew the coverage of any
 1979  individual member of a subscriber group on the basis of the age,
 1980  health status, health care needs, preexisting condition as
 1981  defined in s. 641.31077, or prospective costs of health care
 1982  services of the subscriber or individual. Nothing in This
 1983  section does not shall prohibit a health maintenance
 1984  organization from requiring that, as a condition of continued
 1985  eligibility for membership, dependents of a subscriber, upon
 1986  reaching a specified age, convert to a converted contract or
 1987  that individuals entitled to have payments for health costs made
 1988  under Title XVIII of the United States Social Security Act, as
 1989  amended, be issued a health maintenance contract for Medicare
 1990  beneficiaries so long as the health maintenance organization is
 1991  authorized to issue health maintenance contracts for Medicare
 1992  beneficiaries.
 1993         Section 33. Section 641.31073, Florida Statutes, is amended
 1994  to read:
 1995         641.31073 Prohibiting discrimination against individual
 1996  participants and beneficiaries based on health status or
 1997  preexisting conditions.—
 1998         (1) Subject to subsection (2), a health maintenance
 1999  organization that offers group health insurance coverage may not
 2000  establish rules for eligibility, including continued
 2001  eligibility, of an individual to enroll under the terms of the
 2002  contract based on any of the following health-status-related or
 2003  preexisting-condition-related factors in relation to the
 2004  individual or a dependent of the individual:
 2005         (a) Health status.
 2006         (b) Medical condition, including physical and mental
 2007  illnesses.
 2008         (c) Claims experience.
 2009         (d) Receipt of health care.
 2010         (e) Medical history.
 2011         (f) Genetic information.
 2012         (g) Evidence of insurability, including conditions arising
 2013  out of acts of domestic violence.
 2014         (h) Disability.
 2015         (i)Preexisting condition.
 2016  
 2017  As used in this section, the term “preexisting condition” has
 2018  the same meaning as defined in s. 641.31077.
 2019         (2) Subsection (1) does not:
 2020         (a) Require a health maintenance organization to provide
 2021  particular benefits other than those provided under the terms of
 2022  such plan or coverage.
 2023         (b) Prevent such a plan or coverage from establishing
 2024  limitations or restrictions on the amount, level, extent, or
 2025  nature of the benefits or coverage for similarly situated
 2026  individuals enrolled in the plan or coverage.
 2027         (3) For purposes of subsection (1), rules for eligibility
 2028  to enroll under a contract include rules for defining any
 2029  applicable affiliation or waiting periods of enrollment.
 2030         (4)(a) A health maintenance organization that offers health
 2031  insurance coverage may not require any individual, as a
 2032  condition of enrollment or continued enrollment under the
 2033  contract, to pay a premium or contribution that is greater than
 2034  such premium or contribution for a similarly situated individual
 2035  enrolled under the contract on the basis of any health-status
 2036  related or preexisting-condition-related factor in relation to
 2037  the individual or to an individual enrolled under the contract
 2038  as a dependent of the individual.
 2039         (b) This subsection does not:
 2040         1. Restrict the amount that an employer may be charged for
 2041  coverage under a group health insurance contract.
 2042         2. Prevent a health maintenance organization offering group
 2043  health insurance coverage from establishing premium discounts or
 2044  rebates or modifying otherwise applicable copayments or
 2045  deductibles in return for adherence to programs of health
 2046  promotion and disease prevention.
 2047         Section 34. Paragraph (f) of subsection (2) and paragraph
 2048  (a) of subsection (3) of section 641.31074, Florida Statutes,
 2049  are amended to read:
 2050         641.31074 Guaranteed renewability of coverage.—
 2051         (2) A health maintenance organization may nonrenew or
 2052  discontinue a contract based only on one or more of the
 2053  following conditions:
 2054         (f) In the case of coverage that is made available only
 2055  through one or more bona fide associations as defined in s.
 2056  627.6571(5), the membership of an employer in the association,
 2057  on the basis of which the coverage is provided, ceases, but only
 2058  if such coverage is terminated under this paragraph uniformly
 2059  without regard to any health-status-related or preexisting
 2060  condition-related factor that relates to any covered
 2061  individuals. As used in this section, the term “preexisting
 2062  condition” has the same meaning as defined in s. 641.31077.
 2063         (3)(a) A health maintenance organization may discontinue
 2064  offering a particular contract form only if:
 2065         1. The health maintenance organization provides notice to
 2066  each contract holder provided coverage of this form in such
 2067  market, and participants and beneficiaries covered under such
 2068  coverage, of such discontinuation at least 90 days before prior
 2069  to the date of the nonrenewal of such coverage;
 2070         2. The health maintenance organization offers to each
 2071  contract holder provided coverage of this form in such market
 2072  the option to purchase all, or in the case of the large group
 2073  market, any other health insurance coverage currently being
 2074  offered by the health maintenance organization in such market;
 2075  and
 2076         3. In exercising the option to discontinue coverage of this
 2077  form and in offering the option of coverage under subparagraph
 2078  2., the health maintenance organization acts uniformly without
 2079  regard to the claims experience of those contract holders or any
 2080  health-status-related or preexisting-condition-related factor
 2081  that relates to any participants or beneficiaries covered or new
 2082  participants or beneficiaries who may become eligible for such
 2083  coverage.
 2084         Section 35. Paragraph (a) of subsection (12) of section
 2085  641.3903, Florida Statutes, is amended to read:
 2086         641.3903 Unfair methods of competition and unfair or
 2087  deceptive acts or practices defined.—The following are defined
 2088  as unfair methods of competition and unfair or deceptive acts or
 2089  practices:
 2090         (12) PROHIBITED DISCRIMINATORY PRACTICES.—A health
 2091  maintenance organization may not:
 2092         (a) Engage or attempt to engage in discriminatory practices
 2093  that discourage participation on the basis of actual or
 2094  perceived health status or actual or perceived preexisting
 2095  condition, as defined in s. 641.31077, of Medicaid recipients.
 2096         Section 36. Subsections (10) through (14) of section
 2097  641.3922, Florida Statutes, are renumbered as subsections (9)
 2098  through (13), respectively, and paragraphs (f) and (g) of
 2099  subsection (7) and present subsection (9) of that section are
 2100  amended, to read:
 2101         641.3922 Conversion contracts; conditions.—Issuance of a
 2102  converted contract shall be subject to the following conditions:
 2103         (7) REASONS FOR CANCELLATION; TERMINATION.—The converted
 2104  health maintenance contract must contain a cancellation or
 2105  nonrenewability clause providing that the health maintenance
 2106  organization may refuse to renew the contract of any person
 2107  covered thereunder, but cancellation or nonrenewal must be
 2108  limited to one or more of the following reasons:
 2109         (f) A dependent of the subscriber has reached the limiting
 2110  age under the converted contract, subject to subsection (11)
 2111  (12); but the refusal to renew coverage shall apply only to
 2112  coverage of the dependent, except in the case of handicapped
 2113  children.
 2114         (g) A change in marital status that makes a person
 2115  ineligible under the original terms of the converted contract,
 2116  subject to subsection (11) (12).
 2117         (9)PREEXISTING CONDITION PROVISION.—The converted health
 2118  maintenance contract shall not exclude a preexisting condition
 2119  not excluded by the group contract. However, the converted
 2120  health maintenance contract may provide that any coverage
 2121  benefits thereunder may be reduced by the amount of any coverage
 2122  or benefits under the group health maintenance contract after
 2123  the termination of the person’s coverage or benefits thereunder.
 2124  The converted health maintenance contract may also include
 2125  provisions so that during the first coverage year the coverage
 2126  or benefits under the converted contract, together with the
 2127  coverage or benefits under the group health maintenance
 2128  contract, shall not exceed those that would have been provided
 2129  had the individual’s coverage or benefits under the group
 2130  contract remained in force and effect.
 2131         Section 37. Section 627.6045, Florida Statutes, is
 2132  repealed.
 2133         Section 38. Section 627.6046, Florida Statutes, is
 2134  repealed.
 2135         Section 39. Section 627.6561, Florida Statutes, is
 2136  repealed.
 2137         Section 40. Section 627.65612, Florida Statutes, is
 2138  repealed.
 2139         Section 41. Section 641.31071, Florida Statutes, is
 2140  repealed.
 2141         Section 42. This act shall take effect January 1, 2021.

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