SESSION WATCH
THE BILL ITSELF

HB 1079

Small Employer Health Carrier Reinsurance Program

VERSION H 1079 Filed · BACK TO THE SUMMARY · OFFICIAL RECORD

underlined language is being added; struck language is being deleted. Line numbers are the Legislature's own — the same ones amendments cite.

1 A bill to be entitled
2 An act relating to a small employer health carrier
3 reinsurance program; amending s. 627.6699, F.S.;
4 removing and revising definitions; removing provisions
5 relating to the creation of the Florida Small Employer
6 Carrier Reinsurance Program; amending s. 627.642,
7 F.S.; conforming a cross-reference; amending s.
8 627.6475, F.S.; conforming provisions to changes made
9 by the act; conforming cross-references; amending ss.
10 627.657 and 627.66997, F.S.; conforming a cross-
11 reference; providing an effective date.
13 Be It Enacted by the Legislature of the State of Florida: Section 1. Paragraphs (c) through (o) and (r) through (w)
16 of subsection (3) of section 627.6699, Florida Statutes, are
17 redesignated as paragraphs (b) through (n) and (o) through (t),
18 respectively, subsections (12) through (17) are renumbered as
19 subsections (11) through (16), respectively, and subsection (2),
20 present paragraphs (b), (p), (q), and (s) of subsection (3),
21 paragraph (d) of subsection (9), paragraphs (b) and (c) of
22 subsection (10), and present subsection (11) of that section are
23 amended, to read:
24 627.6699 Employee Health Care Access Act.—
25 (2) PURPOSE AND INTENT.—The purpose and intent of this
26 section is to promote the availability of health insurance
27 coverage to small employers regardless of their claims
28 experience or their employees' health status, to establish rules
29 regarding renewability of that coverage, to establish
30 limitations on the use of exclusions for preexisting conditions,
31 to provide for establishment of a reinsurance program for
32 coverage of small employers, and to improve the overall fairness
33 and efficiency of the small group health insurance market.
34 (3) DEFINITIONS.—As used in this section, the term:
35 (b) "Board" means the board of directors of the program.
36 (p) "Plan of operation" means the plan of operation of the
37 program, including articles, bylaws, and operating rules,
38 adopted by the board under subsection (11).
39 (q) "Program" means the Florida Small Employer Carrier
40 Reinsurance Program created under subsection (11).
41 (p)(s) "Reinsuring carrier" means a small employer carrier
42 that elects to comply with reinsurance the requirements set
43 forth in subsection (11).
44 (9) SMALL EMPLOYER CARRIER'S ELECTION TO BECOME A RISK-
45 ASSUMING CARRIER OR A REINSURING CARRIER.—
46 (d) A small employer carrier that elects to cease
47 participating as a reinsuring carrier and to become a risk-
48 assuming carrier is prohibited from reinsuring or continuing to
49 reinsure any small employer health benefits plan under
50 subsection (11) as soon as the carrier becomes a risk-assuming
51 carrier and must pay a prorated assessment based upon business
52 issued as a reinsuring carrier for any portion of the year that
53 the business was reinsured. A small employer carrier that elects
54 to cease participating as a risk-assuming carrier and to become
55 a reinsuring carrier is permitted to reinsure small employer
56 health benefit plans under the terms set forth in subsection
57 (11) and must pay a prorated assessment based upon business
58 issued as a reinsuring carrier for any portion of the year that
59 the business was reinsured.
60 (10) ELECTION PROCESS TO BECOME A RISK-ASSUMING CARRIER.—
61 (b) In determining whether to approve an application by a
62 small employer carrier to become a risk-assuming carrier, the
63 office shall consider:
64 1. The carrier's financial ability to support the
65 assumption of the risk of small employer groups.
66 2. The carrier's history of rating and underwriting small
67 employer groups.
68 3. The carrier's commitment to market fairly to all small
69 employers in the state or its service area, as applicable.
70 4. The carrier's ability to assume and manage the risk of
71 enrolling small employer groups without the protection of the
72 reinsurance program provided in subsection (11).
73 (c) A small employer carrier that becomes a risk-assuming
74 carrier pursuant to this subsection is not subject to
75 reinsurance the assessment provisions of subsection (11).
76 (11) SMALL EMPLOYER HEALTH REINSURANCE PROGRAM.—
77 (a) There is created a nonprofit entity to be known as the
78 "Florida Small Employer Health Reinsurance Program."
79 (b)1. The program shall operate subject to the supervision
80 and control of the board.
81 2. Effective upon this act becoming a law, the board shall
82 consist of the director of the office or his or her designee,
83 who shall serve as the chairperson, and 13 additional members
84 who are representatives of carriers and insurance agents and are
85 appointed by the director of the office and serve as follows:
86 a. Five members shall be representatives of health
87 insurers licensed under chapter 624 or chapter 641. Two members
88 shall be agents who are actively engaged in the sale of health
89 insurance. Four members shall be employers or representatives of
90 employers. One member shall be a person covered under an
91 individual health insurance policy issued by a licensed insurer
92 in this state. One member shall represent the Agency for Health
93 Care Administration and shall be recommended by the Secretary of
94 Health Care Administration.
95 b. A member appointed under this subparagraph shall serve
96 a term of 4 years and shall continue in office until the
97 member's successor takes office, except that, in order to
98 provide for staggered terms, the director of the office shall
99 designate two of the initial appointees under this subparagraph
100 to serve terms of 2 years and shall designate three of the
101 initial appointees under this subparagraph to serve terms of 3
102 years.
103 3. The director of the office may remove a member for
104 cause.
105 4. Vacancies on the board shall be filled in the same
106 manner as the original appointment for the unexpired portion of
107 the term.
108 (c)1. The board shall submit to the office a plan of
109 operation to assure the fair, reasonable, and equitable
110 administration of the program. The board may at any time submit
111 to the office any amendments to the plan that the board finds to
112 be necessary or suitable.
113 2. The office shall, after notice and hearing, approve the
114 plan of operation if it determines that the plan submitted by
115 the board is suitable to assure the fair, reasonable, and
116 equitable administration of the program and provides for the
117 sharing of program gains and losses equitably and
118 proportionately in accordance with paragraph (j).
119 3. The plan of operation, or any amendment thereto,
120 becomes effective upon written approval of the office.
121 (d) The plan of operation must, among other things:
122 1. Establish procedures for handling and accounting for
123 program assets and moneys and for an annual fiscal reporting to
124 the office.
125 2. Establish procedures for selecting an administering
126 carrier and set forth the powers and duties of the administering
127 carrier.
128 3. Establish procedures for reinsuring risks.
129 4. Establish procedures for collecting assessments from
130 participating carriers to provide for claims reinsured by the
131 program and for administrative expenses, other than amounts
132 payable to the administrative carrier, incurred or estimated to
133 be incurred during the period for which the assessment is made.
134 5. Provide for any additional matters at the discretion of
135 the board.
136 (e) The board shall recommend to the office market conduct
137 requirements and other requirements for carriers and agents,
138 including requirements relating to:
139 1. Registration by each carrier with the office of its
140 intention to be a small employer carrier under this section;
141 2. Publication by the office of a list of all small
142 employer carriers, including a requirement applicable to agents
143 and carriers that a health benefit plan may not be sold by a
144 carrier that is not identified as a small employer carrier;
145 3. The availability of a broadly publicized, toll-free
146 telephone number for access by small employers to information
147 concerning this section;
148 4. Periodic reports by carriers and agents concerning
149 health benefit plans issued; and
150 5. Methods concerning periodic demonstration by small
151 employer carriers and agents that they are marketing or issuing
152 health benefit plans to small employers.
153 (f) The program has the general powers and authority
154 granted under the laws of this state to insurance companies and
155 health maintenance organizations licensed to transact business,
156 except the power to issue health benefit plans directly to
157 groups or individuals. In addition thereto, the program has
158 specific authority to:
159 1. Enter into contracts as necessary or proper to carry
160 out the provisions and purposes of this act, including the
161 authority to enter into contracts with similar programs of other
162 states for the joint performance of common functions or with
163 persons or other organizations for the performance of
164 administrative functions.
165 2. Sue or be sued, including taking any legal action
166 necessary or proper for recovering any assessments and penalties
167 for, on behalf of, or against the program or any carrier.
168 3. Take any legal action necessary to avoid the payment of
169 improper claims against the program.
170 4. Issue reinsurance policies, in accordance with the
171 requirements of this act.
172 5. Establish rules, conditions, and procedures for
173 reinsurance risks under the program participation.
174 6. Establish actuarial functions as appropriate for the
175 operation of the program.
176 7. Assess participating carriers in accordance with
177 paragraph (j), and make advance interim assessments as may be
178 reasonable and necessary for organizational and interim
179 operating expenses. Interim assessments shall be credited as
180 offsets against any regular assessments due following the close
181 of the calendar year.
182 8. Appoint appropriate legal, actuarial, and other
183 committees as necessary to provide technical assistance in the
184 operation of the program, and in any other function within the
185 authority of the program.
186 9. Borrow money to effect the purposes of the program. Any
187 notes or other evidences of indebtedness of the program which
188 are not in default constitute legal investments for carriers and
189 may be carried as admitted assets.
190 10. To the extent necessary, increase the $5,000
191 deductible reinsurance requirement to adjust for the effects of
192 inflation.
193 (g) A reinsuring carrier may reinsure with the program
194 coverage of an eligible employee of a small employer, or any
195 dependent of such an employee, subject to each of the following
196 provisions:
197 1. Except in the case of a late enrollee, a reinsuring
198 carrier may reinsure an eligible employee or dependent within 60
199 days after the commencement of the coverage of the small
200 employer. A newly employed eligible employee or dependent of a
201 small employer may be reinsured within 60 days after the
202 commencement of his or her coverage.
203 2. A small employer carrier may reinsure an entire
204 employer group within 60 days after the commencement of the
205 group's coverage under the plan.
206 3. The program may not reimburse a participating carrier
207 with respect to the claims of a reinsured employee or dependent
208 until the carrier has paid incurred claims of at least $5,000 in
209 a calendar year for benefits covered by the program. In
210 addition, the reinsuring carrier shall be responsible for 10
211 percent of the next $50,000 and 5 percent of the next $100,000
212 of incurred claims during a calendar year and the program shall
213 reinsure the remainder.
214 4. The board annually shall adjust the initial level of
215 claims and the maximum limit to be retained by the carrier to
216 reflect increases in costs and utilization within the standard
217 market for health benefit plans within the state. The adjustment
218 shall not be less than the annual change in the medical
219 component of the "Consumer Price Index for All Urban Consumers"
220 of the Bureau of Labor Statistics of the Department of Labor,
221 unless the board proposes and the office approves a lower
222 adjustment factor.
223 5. A small employer carrier may terminate reinsurance for
224 all reinsured employees or dependents on any plan anniversary.
225 6. The premium rate charged for reinsurance by the program
226 to a health maintenance organization that is approved by the
227 Secretary of Health and Human Services as a federally qualified
228 health maintenance organization pursuant to 42 U.S.C. s.
229 300e(c)(2)(A) and that, as such, is subject to requirements that
230 limit the amount of risk that may be ceded to the program, which
231 requirements are more restrictive than subparagraph 3., shall be
232 reduced by an amount equal to that portion of the risk, if any,
233 which exceeds the amount set forth in subparagraph 3. which may
234 not be ceded to the program.
235 7. The board may consider adjustments to the premium rates
236 charged for reinsurance by the program for carriers that use
237 effective cost containment measures, including high-cost case
238 management, as defined by the board.
239 8. A reinsuring carrier shall apply its case-management
240 and claims-handling techniques, including, but not limited to,
241 utilization review, individual case management, preferred
242 provider provisions, other managed care provisions or methods of
243 operation, consistently with both reinsured business and
244 nonreinsured business.
245 (h)1. The board, as part of the plan of operation, shall
246 establish a methodology for determining premium rates to be
247 charged by the program for reinsuring small employers and
248 individuals pursuant to this section. The methodology shall
249 include a system for classification of small employers that
250 reflects the types of case characteristics commonly used by
251 small employer carriers in the state. The methodology shall
252 provide for the development of basic reinsurance premium rates,
253 which shall be multiplied by the factors set for them in this
254 paragraph to determine the premium rates for the program. The
255 basic reinsurance premium rates shall be established by the
256 board, subject to the approval of the office. The premium rates
257 set by the board may vary by geographical area, as determined
258 under this section, to reflect differences in cost. The
259 multiplying factors must be established as follows:
260 a. The entire group may be reinsured for a rate that is
261 1.5 times the rate established by the board.
262 b. An eligible employee or dependent may be reinsured for
263 a rate that is 5 times the rate established by the board.
264 2. The board periodically shall review the methodology
265 established, including the system of classification and any
266 rating factors, to assure that it reasonably reflects the claims
267 experience of the program. The board may propose changes to the
268 rates which shall be subject to the approval of the office.
269 (i) If a health benefit plan for a small employer issued
270 in accordance with this subsection is entirely or partially
271 reinsured with the program, the premium charged to the small
272 employer for any rating period for the coverage issued must be
273 consistent with the requirements relating to premium rates set
274 forth in this section.
275 (j)1. Before July 1 of each calendar year, the board shall
276 determine and report to the office the program net loss for the
277 previous year, including administrative expenses for that year,
278 and the incurred losses for the year, taking into account
279 investment income and other appropriate gains and losses.
280 2. Any net loss for the year shall be recouped by
281 assessment of the carriers, as follows:
282 a. The operating losses of the program shall be assessed
283 in the following order subject to the specified limitations. The
284 first tier of assessments shall be made against reinsuring
285 carriers in an amount which shall not exceed 5 percent of each
286 reinsuring carrier's premiums from health benefit plans covering
287 small employers. If such assessments have been collected and
288 additional moneys are needed, the board shall make a second tier
289 of assessments in an amount which shall not exceed 0.5 percent
290 of each carrier's health benefit plan premiums. Except as
291 provided in paragraph (m), risk-assuming carriers are exempt
292 from all assessments authorized pursuant to this section. The
293 amount paid by a reinsuring carrier for the first tier of
294 assessments shall be credited against any additional assessments
295 made.
296 b. The board shall equitably assess carriers for operating
297 losses of the plan based on market share. The board shall
298 annually assess each carrier a portion of the operating losses
299 of the plan. The first tier of assessments shall be determined
300 by multiplying the operating losses by a fraction, the numerator
301 of which equals the reinsuring carrier's earned premium
302 pertaining to direct writings of small employer health benefit
303 plans in the state during the calendar year for which the
304 assessment is levied, and the denominator of which equals the
305 total of all such premiums earned by reinsuring carriers in the
306 state during that calendar year. The second tier of assessments
307 shall be based on the premiums that all carriers, except risk-
308 assuming carriers, earned on all health benefit plans written in
309 this state. The board may levy interim assessments against
310 carriers to ensure the financial ability of the plan to cover
311 claims expenses and administrative expenses paid or estimated to
312 be paid in the operation of the plan for the calendar year prior
313 to the association's anticipated receipt of annual assessments
314 for that calendar year. Any interim assessment is due and
315 payable within 30 days after receipt by a carrier of the interim
316 assessment notice. Interim assessment payments shall be credited
317 against the carrier's annual assessment. Health benefit plan
318 premiums and benefits paid by a carrier that are less than an
319 amount determined by the board to justify the cost of collection
320 may not be considered for purposes of determining assessments.
321 c. Subject to the approval of the office, the board shall
322 make an adjustment to the assessment formula for reinsuring
323 carriers that are approved as federally qualified health
324 maintenance organizations by the Secretary of Health and Human
325 Services pursuant to 42 U.S.C. s. 300e(c)(2)(A) to the extent,
326 if any, that restrictions are placed on them that are not
327 imposed on other small employer carriers.
328 3. Before July 1 of each year, the board shall determine
329 and file with the office an estimate of the assessments needed
330 to fund the losses incurred by the program in the previous
331 calendar year.
332 4. If the board determines that the assessments needed to
333 fund the losses incurred by the program in the previous calendar
334 year will exceed the amount specified in subparagraph 2., the
335 board shall evaluate the operation of the program and report its
336 findings, including any recommendations for changes to the plan
337 of operation, to the office within 180 days following the end of
338 the calendar year in which the losses were incurred. The
339 evaluation shall include an estimate of future assessments, the
340 administrative costs of the program, the appropriateness of the
341 premiums charged and the level of carrier retention under the
342 program, and the costs of coverage for small employers. If the
343 board fails to file a report with the office within 180 days
344 following the end of the applicable calendar year, the office
345 may evaluate the operations of the program and implement such
346 amendments to the plan of operation the office deems necessary
347 to reduce future losses and assessments.
348 5. If assessments exceed the amount of the actual losses
349 and administrative expenses of the program, the excess shall be
350 held as interest and used by the board to offset future losses
351 or to reduce program premiums. As used in this paragraph, the
352 term "future losses" includes reserves for incurred but not
353 reported claims.
354 6. Each carrier's proportion of the assessment shall be
355 determined annually by the board, based on annual statements and
356 other reports considered necessary by the board and filed by the
357 carriers with the board.
358 7. Provision shall be made in the plan of operation for
359 the imposition of an interest penalty for late payment of an
360 assessment.
361 8. A carrier may seek, from the office, a deferment, in
362 whole or in part, from any assessment made by the board. The
363 office may defer, in whole or in part, the assessment of a
364 carrier if, in the opinion of the office, the payment of the
365 assessment would place the carrier in a financially impaired
366 condition. If an assessment against a carrier is deferred, in
367 whole or in part, the amount by which the assessment is deferred
368 may be assessed against the other carriers in a manner
369 consistent with the basis for assessment set forth in this
370 section. The carrier receiving such deferment remains liable to
371 the program for the amount deferred and is prohibited from
372 reinsuring any individuals or groups in the program if it fails
373 to pay assessments.
374 (k) Neither the participation in the program as reinsuring
375 carriers, the establishment of rates, forms, or procedures, nor
376 any other joint or collective action required by this act, may
377 be the basis of any legal action, criminal or civil liability,
378 or penalty against the program or any of its carriers either
379 jointly or separately.
380 (l) The board shall monitor compliance with this section,
381 including the market conduct of small employer carriers, and
382 shall report to the office any unfair trade practices and
383 misleading or unfair conduct by a small employer carrier that
384 has been reported to the board by agents, consumers, or any
385 other person. The office shall investigate all reports and, upon
386 a finding of noncompliance with this section or of unfair or
387 misleading practices, shall take action against the small
388 employer carrier as permitted under the insurance code or
389 chapter 641. The board is not given investigatory or regulatory
390 powers, but must forward all reports of cases or abuse or
391 misrepresentation to the office.
392 (m) Notwithstanding paragraph (j), the administrative
393 expenses of the program shall be recouped by assessment of risk-
394 assuming carriers and reinsuring carriers and such amounts shall
395 not be considered part of the operating losses of the plan for
396 the purposes of this paragraph. Each carrier's portion of such
397 administrative expenses shall be determined by multiplying the
398 total of such administrative expenses by a fraction, the
399 numerator of which equals the carrier's earned premium
400 pertaining to direct writing of small employer health benefit
401 plans in the state during the calendar year for which the
402 assessment is levied, and the denominator of which equals the
403 total of such premiums earned by all carriers in the state
404 during such calendar year.
405 (n) The board shall advise the office, the Agency for
406 Health Care Administration, the department, other executive
407 departments, and the Legislature on health insurance issues.
408 Specifically, the board shall:
409 1. Provide a forum for stakeholders, consisting of
410 insurers, employers, agents, consumers, and regulators, in the
411 private health insurance market in this state.
412 2. Review and recommend strategies to improve the
413 functioning of the health insurance markets in this state with a
414 specific focus on market stability, access, and pricing.
415 3. Make recommendations to the office for legislation
416 addressing health insurance market issues and provide comments
417 on health insurance legislation proposed by the office.
418 4. Meet at least three times each year. One meeting shall
419 be held to hear reports and to secure public comment on the
420 health insurance market, to develop any legislation needed to
421 address health insurance market issues, and to provide comments
422 on health insurance legislation proposed by the office.
423 5. Issue a report to the office on the state of the health
424 insurance market by September 1 each year. The report shall
425 include recommendations for changes in the health insurance
426 market, results from implementation of previous recommendations,
427 and information on health insurance markets.
428 Section 2. Subsection (3) of section 627.642, Florida
429 Statutes, is amended to read:
430 627.642 Outline of coverage.—
431 (3) In addition to the outline of coverage, a policy as
432 specified in s. 627.6699(3)(j) s. 627.6699(3)(k) must be
433 accompanied by an identification card that contains, at a
434 minimum:
435 (a) The name of the organization issuing the policy or the
436 name of the organization administering the policy, whichever
437 applies.
438 (b) The name of the contract holder.
439 (c) The type of plan only if the plan is filed in the
440 state, an indication that the plan is self-funded, or the name
441 of the network.
442 (d) The member identification number, contract number, and
443 policy or group number, if applicable.
444 (e) A contact phone number or electronic address for
445 authorizations and admission certifications.
446 (f) A phone number or electronic address whereby the
447 covered person or hospital, physician, or other person rendering
448 services covered by the policy may obtain benefits verification
449 and information in order to estimate patient financial
450 responsibility, in compliance with privacy rules under the
451 Health Insurance Portability and Accountability Act.
452 (g) The national plan identifier, in accordance with the
453 compliance date set forth by the federal Department of Health
454 and Human Services.
456 The identification card must present the information in a
457 readily identifiable manner or, alternatively, the information
458 may be embedded on the card and available through magnetic
459 stripe or smart card. The information may also be provided
460 through other electronic technology.
461 Section 3. Paragraph (a) of subsection (2), paragraphs
462 (a), (e), and (g) of subsection (7), and paragraph (a) of
463 subsection (8) of section 627.6475, Florida Statutes, is amended
464 to read:
465 627.6475 Individual reinsurance pool.—
466 (2) DEFINITIONS.—As used in this section:
467 (a) "Board," "Carrier," and "health benefit plan" have the
468 same meaning ascribed in s. 627.6699(3).
469 (7) INDIVIDUAL HEALTH REINSURANCE PROGRAM.—
470 (a) The individual health reinsurance program shall
471 operate subject to the supervision and control of the board of
472 the small employer health reinsurance program established
473 pursuant to s. 627.6699(11). The board shall establish a
474 separate, segregated account for eligible individuals reinsured
475 pursuant to this section, which account may not be commingled
476 with the small employer health reinsurance account.
477 (e)1. Before March 1 of each calendar year, the board
478 shall determine and report to the office the program net loss in
479 the individual account for the previous year, including
480 administrative expenses for that year and the incurred losses
481 for that year, taking into account investment income and other
482 appropriate gains and losses.
483 2. Any net loss in the individual account for the year
484 shall be recouped by assessing the carriers as follows:
485 a. The operating losses of the program shall be assessed
486 in the following order subject to the specified limitations. The
487 first tier of assessments shall be made against reinsuring
488 carriers in an amount that may not exceed 5 percent of each
489 reinsuring carrier's premiums for individual health insurance.
490 If such assessments have been collected and additional moneys
491 are needed, the board shall make a second tier of assessments in
492 an amount that may not exceed 0.5 percent of each carrier's
493 health benefit plan premiums.
494 b. Except as provided in paragraph (f), risk-assuming
495 carriers are exempt from all assessments authorized pursuant to
496 this section. The amount paid by a reinsuring carrier for the
497 first tier of assessments shall be credited against any
498 additional assessments made.
499 c. The board shall equitably assess reinsuring carriers
500 for operating losses of the individual account based on market
501 share. The board shall annually assess each carrier a portion of
502 the operating losses of the individual account. The first tier
503 of assessments shall be determined by multiplying the operating
504 losses by a fraction, the numerator of which equals the
505 reinsuring carrier's earned premium pertaining to direct
506 writings of individual health insurance in the state during the
507 calendar year for which the assessment is levied, and the
508 denominator of which equals the total of all such premiums
509 earned by reinsuring carriers in the state during that calendar
510 year. The second tier of assessments shall be based on the
511 premiums that all carriers, except risk-assuming carriers,
512 earned on all health benefit plans written in this state. The
513 board may levy interim assessments against reinsuring carriers
514 to ensure the financial ability of the plan to cover claims
515 expenses and administrative expenses paid or estimated to be
516 paid in the operation of the plan for the calendar year prior to
517 the association's anticipated receipt of annual assessments for
518 that calendar year. Any interim assessment is due and payable
519 within 30 days after receipt by a carrier of the interim
520 assessment notice. Interim assessment payments shall be credited
521 against the carrier's annual assessment. Health benefit plan
522 premiums and benefits paid by a carrier that are less than an
523 amount determined by the board to justify the cost of collection
524 may not be considered for purposes of determining assessments.
525 d. Subject to the approval of the office, the board shall
526 adjust the assessment formula for reinsuring carriers that are
527 approved as federally qualified health maintenance organizations
528 by the Secretary of Health and Human Services pursuant to 42
529 U.S.C. s. 300e(c)(2)(A) to the extent, if any, that restrictions
530 are placed on them which are not imposed on other carriers.
531 3. Before March 1 of each year, the board shall determine
532 and file with the office an estimate of the assessments needed
533 to fund the losses incurred by the program in the individual
534 account for the previous calendar year.
535 4. If the board determines that the assessments needed to
536 fund the losses incurred by the program in the individual
537 account for the previous calendar year will exceed the amount
538 specified in subparagraph 2., the board shall evaluate the
539 operation of the program and report its findings and
540 recommendations to the office in the format established in s.
541 627.6699(11) for the comparable report for the small employer
542 reinsurance program.
543 (g) Except as otherwise provided in this section, the
544 board and the office shall have all powers, duties, and
545 responsibilities with respect to carriers that issue and
546 reinsure individual health insurance, as specified for the board
547 and the office in s. 627.6699(11) with respect to small employer
548 carriers, including, but not limited to, the provisions of s.
549 627.6699(11) relating to:
550 1. Use of assessments that exceed the amount of actual
551 losses and expenses.
552 2. The annual determination of each carrier's proportion
553 of the assessment.
554 3. Interest for late payment of assessments.
555 4. Authority for the office to approve deferment of an
556 assessment against a carrier.
557 5. Limited immunity from legal actions or carriers.
558 6. Development of standards for compensation to be paid to
559 agents. Such standards shall be limited to those specifically
560 enumerated in s. 627.6699(11)(d) s. 627.6699(12)(d).
561 7. Monitoring compliance by carriers with this section.
562 (8) STANDARDS TO ASSURE FAIR MARKETING.—
563 (a) Each health insurance issuer that offers individual
564 health insurance shall actively market coverage to eligible
565 individuals in the state. The provisions of s. 627.6699(11) s.
566 627.6699(12) that apply to small employer carriers that market
567 policies to small employers shall also apply to health insurance
568 issuers that offer individual health insurance with respect to
569 marketing policies to individuals.
570 Section 4. Subsection (2) of section 627.657, Florida
571 Statutes, is amended to read:
572 627.657 Provisions of group health insurance policies.—
573 (2) The medical policy as specified in s. 627.6699(3)(j)
574 s. 627.6699(3)(k) must be accompanied by an identification card
575 that contains, at a minimum:
576 (a) The name of the organization issuing the policy or
577 name of the organization administering the policy, whichever
578 applies.
579 (b) The name of the certificateholder.
580 (c) The type of plan only if the plan is filed in the
581 state, an indication that the plan is self-funded, or the name
582 of the network.
583 (d) The member identification number, contract number, and
584 policy or group number, if applicable.
585 (e) A contact phone number or electronic address for
586 authorizations and admission certifications.
587 (f) A phone number or electronic address whereby the
588 covered person or hospital, physician, or other person rendering
589 services covered by the policy may obtain benefits verification
590 and information in order to estimate patient financial
591 responsibility, in compliance with privacy rules under the
592 Health Insurance Portability and Accountability Act.
593 (g) The national plan identifier, in accordance with the
594 compliance date set forth by the federal Department of Health
595 and Human Services.
597 The identification card must present the information in a
598 readily identifiable manner or, alternatively, the information
599 may be embedded on the card and available through magnetic
600 stripe or smart card. The information may also be provided
601 through other electronic technology.
602 Section 5. Subsection (1) of section 627.66997, Florida
603 Statutes, is amended to read:
604 627.66997 Stop-loss insurance.—
605 (1) A self-insured health benefit plan established or
606 maintained by a small employer, as defined in s. 627.6699(3)(s)
607 s. 627.6699(3)(v), is exempt from s. 627.6699 and may use a
608 stop-loss insurance policy issued to the employer. For purposes
609 of this subsection, the term "stop-loss insurance policy" means
610 an insurance policy issued to a small employer which covers the
611 small employer's obligation for the excess cost of medical care
612 on an equivalent basis per employee provided under a self-
613 insured health benefit plan.
614 (a) A small employer stop-loss insurance policy is
615 considered a health insurance policy and is subject to s.
616 627.6699 if the policy has an aggregate attachment point that is
617 lower than the greatest of:
618 1. Two thousand dollars multiplied by the number of
619 employees;
620 2. One hundred twenty percent of expected claims, as
621 determined by the stop-loss insurer in accordance with actuarial
622 standards of practice; or
623 3. Twenty thousand dollars.
624 (b) Once claims under the small employer health benefit
625 plan reach the aggregate attachment point set forth in paragraph
626 (a), the stop-loss insurance policy authorized under this
627 section must cover 100 percent of all claims that exceed the
628 aggregate attachment point.
629 Section 6. This act shall take effect July 1, 2026.