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THE BILL ITSELF

SB 1460

Florida Health Choices Program

VERSION S 1460 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.

Florida Senate - 2026 SB 1460 By Senator Martin 33-00690-26 20261460__
1 A bill to be entitled
2 An act relating to the Florida Health Choices Program;
3 amending s. 408.910, F.S.; renaming the “Florida
4 Health Choices Program” as the “Florida Employee
5 Health Choices Program”; revising legislative findings
6 and intent; revising definitions; revising the purpose
7 and components of the program; revising eligibility
8 and participation requirements for vendors under the
9 program; revising the types of health insurance
10 products that are available for purchase through the
11 program; deleting certain pricing transparency
12 requirements to conform to changes made by the act;
13 revising the structure of the insurance marketplace
14 process under the program; deleting the option for
15 risk pooling under the program; deleting exemptions
16 from certain requirements of the Florida Insurance
17 Code under the program; renaming the corporation
18 administering the program as “Florida Employee Health
19 Choices, Inc.”; revising membership of the board of
20 directors; authorizing the corporation to exercise
21 certain powers; revising duties of the board and the
22 corporation; revising the fiscal year in which the
23 corporation’s annual report is due; amending ss.
24 409.821, 409.9122, and 409.977, F.S.; conforming
25 provisions to changes made by the act; providing an
26 effective date.
28 Be It Enacted by the Legislature of the State of Florida:
30 Section 1. Section 408.910, Florida Statutes, is amended to
31 read:
32 408.910 Florida Employee Health Choices Program.—
33 (1) LEGISLATIVE INTENT.—The Legislature finds that a
34 significant number of employers and employees in the residents
35 of this state do not have adequate access to affordable, quality
36 health insurance that meets their needs care . The Legislature
37 further finds that individual coverage health reimbursement
38 arrangements offer a novel way for employers of any size to give
39 health care contributions directly to employees to empower them
40 to choose their own health plan in a broad marketplace based on
41 individual financial needs and health factors. The Legislature
42 further finds that increasing access to affordable, quality
43 health care through individual coverage health reimbursement
44 arrangements can be best accomplished by establishing a
45 competitive marketplace market for employees who receive
46 employer premium contributions through individual coverage
47 health reimbursement arrangements purchasing health insurance
48 and health services . It is therefore the intent of the
49 Legislature to create the Florida Employee Health Choices
50 Program to do the following :
51 (a) Expand opportunities for employers and employees
52 Floridians to access purchase affordable health insurance in
53 this state and health services .
54 (b) Create a platform that streamlines the purchase of
55 individual coverage for employees enrolled in individual
56 coverage health reimbursement arrangements Preserve the benefits
57 of employment-sponsored insurance while easing the
58 administrative burden for employers who offer these benefits .
59 (c) Enable individual choice in both the manner and amount
60 of health care purchased.
61 (d) Provide for the purchase of individual, portable health
62 care coverage.
63 (e) Disseminate information to employers and employees
64 about individual coverage health reimbursement arrangements
65 consumers on the price and quality of health services .
66 (f) Sponsor a competitive marketplace market that
67 stimulates product innovation, quality improvement, and
68 efficiency in the production and delivery of individual health
69 insurance plans to employees enrolled in individual coverage
70 health reimbursement arrangements health services .
71 (2) DEFINITIONS.—As used in this section, the term:
72 (a) “Corporation” means the Florida Employee Health
73 Choices, Inc., established under this section.
74 (b) “Corporation’s marketplace” means the single,
75 centralized market established by the program which that
76 facilitates the purchase of products made available in the
77 marketplace.
78 (c) “Health insurance agent” means an agent licensed under
79 part IV of chapter 626.
80 (d) “Insurer” means an entity licensed under chapter 624
81 which offers an individual health insurance policy or a group
82 health insurance policy , a preferred provider organization as
83 defined in s. 627.6471, an exclusive provider organization as
84 defined in s. 627.6472, or a health maintenance organization
85 licensed under part I of chapter 641 , or a prepaid limited
86 health service organization or discount plan organization
87 licensed under chapter 636 .
88 (e) “Program” means the Florida Employee Health Choices
89 Program established by this section.
90 (3) PROGRAM PURPOSE AND COMPONENTS.—The Florida Employee
91 Health Choices Program is created as a single, centralized
92 marketplace market for the sale and purchase of individual
93 health insurance plans by employees enrolled in an individual
94 coverage health reimbursement arrangement various products that
95 enable individuals to pay for health care. These products
96 include, but are not limited to, health insurance plans, health
97 maintenance organization plans, prepaid services, service
98 contracts, and flexible spending accounts . The components of the
99 program include:
100 (a) Enrollment of employers.
101 (b) Administrative services for participating employers,
102 including:
103 1. Assistance in seeking federal approval of cafeteria
104 plans.
105 2. Collection of premiums and other payments.
106 3. Management of individual benefit accounts.
107 4. Distribution of premiums to insurers and payments to
108 other eligible vendors.
109 5. Assistance for participants in complying with reporting
110 requirements.
111 (c) Services to individual participants, including:
112 1. Information about available products and participating
113 vendors.
114 2. Assistance with assessing the benefits and limits of
115 each product , including information necessary to distinguish
116 between policies offering creditable coverage and other products
117 available through the program .
118 3. Account information to assist individual participants
119 with managing available resources.
120 4. Services that promote healthy behaviors.
121 (d) Recruitment of vendors, including insurers and , health
122 maintenance organizations , prepaid clinic service providers,
123 provider service networks, and other providers .
124 (e) Certification of vendors to ensure capability,
125 reliability, and validity of offerings.
126 (f) Collection of data, monitoring, assessment, and
127 reporting of vendor performance.
128 (g) Information services for individuals and employers.
129 (h) Program evaluation.
130 (4) ELIGIBILITY AND PARTICIPATION.—Participation in the
131 program is voluntary and shall be available to employers,
132 individuals, vendors, and health insurance agents as specified
133 in this subsection.
134 (a) Employers eligible to enroll in the program include
135 those employers that meet criteria established by the
136 corporation and elect to make their employees eligible through
137 the program.
138 (b) Individuals eligible to participate in the program
139 include:
140 1. Individual employees of enrolled employers.
141 2. Other individuals that meet criteria established by the
142 corporation.
143 (c) Employers who choose to participate in the program may
144 enroll by complying with the procedures established by the
145 corporation. The procedures must include, but are not limited
146 to:
147 1. Submission of required information.
148 2. Compliance with federal tax requirements for the
149 establishment of a cafeteria plan, pursuant to s. 125 of the
150 Internal Revenue Code, including designation of the employer’s
151 plan as a premium payment plan, a salary reduction plan that has
152 flexible spending arrangements, or a salary reduction plan that
153 has a premium payment and flexible spending arrangements.
154 3. Determination of the employer’s contribution, if any,
155 per employee, provided that such contribution is equal for each
156 eligible employee.
157 4. Establishment of payroll deduction procedures, subject
158 to the agreement of each individual employee who voluntarily
159 participates in the program.
160 5. Designation of the corporation as the third-party
161 administrator for the employer’s health benefit plan.
162 6. Identification of eligible employees.
163 7. Arrangement for periodic payments.
164 8. Employer notification to employees of the intent to
165 transfer from an existing employee health plan to the program at
166 least 90 days before the transition.
167 (d) All eligible vendors who choose to participate and the
168 products and services that the vendors are permitted to sell are
169 as follows:
170 1. Insurers licensed under chapter 624 may sell health
171 insurance policies , limited benefit policies, other risk-bearing
172 coverage, and other products or services .
173 2. Health maintenance organizations licensed under part I
174 of chapter 641 may sell health maintenance contracts , limited
175 benefit policies, other risk-bearing products, and other
176 products or services .
177 3. Prepaid limited health service organizations may sell
178 products and services as authorized under part I of chapter 636,
179 and discount plan organizations may sell products and services
180 as authorized under part II of chapter 636.
181 4. Prepaid health clinic service providers licensed under
182 part II of chapter 641 may sell prepaid service contracts and
183 other arrangements for a specified amount and type of health
184 services or treatments.
185 5. Health care providers, including hospitals and other
186 licensed health facilities, health care clinics, licensed health
187 professionals, pharmacies, and other licensed health care
188 providers, may sell service contracts and arrangements for a
189 specified amount and type of health services or treatments.
190 6. Provider organizations, including service networks,
191 group practices, professional associations, and other
192 incorporated organizations of providers, may sell service
193 contracts and arrangements for a specified amount and type of
194 health services or treatments.
195 7. Corporate entities providing specific health services in
196 accordance with applicable state law may sell service contracts
197 and arrangements for a specified amount and type of health
198 services or treatments.
200 A vendor described in subparagraphs 3.-7. may not sell products
201 that provide risk-bearing coverage unless that vendor is
202 authorized under a certificate of authority issued by the Office
203 of Insurance Regulation and is authorized to provide coverage in
204 the relevant geographic area. Otherwise Eligible vendors may be
205 excluded from participating in the program for deceptive or
206 predatory practices, financial insolvency, or failure to comply
207 with the terms of the participation agreement or other standards
208 set by the corporation.
209 (e) Eligible individuals may participate in the program
210 voluntarily. Individuals who join the program may participate by
211 complying with the procedures established by the corporation.
212 These procedures must include, but are not limited to:
213 1. Submission of required information.
214 2. Authorization for payroll deduction.
215 3. Compliance with federal tax requirements.
216 4. Arrangements for payment.
217 5. Selection of products and services.
218 (f) Vendors who choose to participate in the program may
219 enroll by complying with the procedures established by the
220 corporation. These procedures may include, but are not limited
221 to:
222 1. Submission of required information, including a complete
223 description of the coverage, services, provider network, payment
224 restrictions, and other requirements of each product offered
225 through the program.
226 2. Execution of an agreement to comply with requirements
227 established by the corporation.
228 3. Execution of an agreement that prohibits refusal to sell
229 any offered product or service to a participant who elects to
230 buy it.
231 4. Establishment of product prices based on applicable
232 criteria.
233 5. Arrangements for receiving payment for enrolled
234 participants.
235 5. 6. Participation in ongoing reporting processes
236 established by the corporation.
237 6. 7. Compliance with grievance procedures established by
238 the corporation.
239 (g) Health insurance agents licensed under part IV of
240 chapter 626 are eligible to voluntarily participate as buyers’
241 representatives. A buyer’s representative acts on behalf of an
242 individual purchasing health insurance and health services
243 through the program by providing information about products and
244 services available through the program and assisting the
245 individual with both the decision and the procedure of selecting
246 specific products. Serving as a buyer’s representative does not
247 constitute a conflict of interest with continuing
248 responsibilities as a health insurance agent if the relationship
249 between each agent and any participating vendor is disclosed
250 before advising an individual participant about the products and
251 services available through the program. In order to participate,
252 a health insurance agent shall comply with the procedures
253 established by the corporation, including:
254 1. Completion of training requirements.
255 2. Execution of a participation agreement specifying the
256 terms and conditions of participation.
257 3. Disclosure of any appointments to solicit insurance or
258 procure applications for vendors participating in the program.
259 4. Arrangements to receive payment from the corporation for
260 services as a buyer’s representative.
261 (5) PRODUCTS.—
262 (a) The products that may be made available for purchase
263 through the program include , but are not limited to:
264 1. health insurance policies and .
265 2. health maintenance contracts.
266 3. Limited benefit plans.
267 4. Prepaid clinic services.
268 5. Service contracts.
269 6. Arrangements for purchase of specific amounts and types
270 of health services and treatments.
271 7. Flexible spending accounts.
272 (b) Health insurance policies, health maintenance
273 contracts, limited benefit plans, prepaid service contracts, and
274 other contracts for services must ensure the availability of
275 covered services.
276 (c) Products may be offered for multiyear periods provided
277 the price of the product is specified for the entire period or
278 for each separately priced segment of the policy or contract.
279 (d) The corporation shall provide a disclosure form for
280 consumers to acknowledge their understanding of the nature of,
281 and any limitations to, the benefits provided by the products
282 and services being purchased by the consumer.
283 (e) The corporation must determine that making the plan
284 available through the program is in the interest of eligible
285 individuals and eligible employers in the state.
286 (6) SURCHARGE PRICING .— Prices for the products and services
287 sold through the program must be transparent to participants and
288 established by the vendors. The corporation shall annually
289 assess a surcharge for each premium or price set by a
290 participating vendor. The surcharge may not be more than 2.5
291 percent of the price and must shall be used to generate funding
292 for administrative services provided by the corporation and
293 payments to buyers’ representatives.
294 (7) THE MARKETPLACE PROCESS.—The program shall provide a
295 single, centralized marketplace market for access to purchase of
296 health insurance and , health maintenance contracts by an
297 employee enrolled in an individual coverage health reimbursement
298 arrangement , and other health products and services . Purchases
299 may be made by participating individuals over the Internet or
300 through the services of a participating health insurance agent.
301 Information about each product and service available through the
302 program must shall be made available through printed material
303 and an interactive Internet website. A participant needing
304 personal assistance to select products and services must shall
305 be referred to a participating agent in his or her area.
306 (a) Participation in the program may begin at any time
307 during a year after the employer completes enrollment and meets
308 the requirements specified by the corporation pursuant to
309 paragraph (4)(c).
310 (b) Initial selection of products and services must be made
311 by an individual participant within the applicable open
312 enrollment period.
313 (c) Initial enrollment periods for each product selected by
314 an individual participant must last at least 12 months, unless
315 the individual participant specifically agrees to a different
316 enrollment period.
317 (d) If an individual has selected one or more products and
318 enrolled in those products for at least 12 months or any other
319 period specifically agreed to by the individual participant,
320 changes in selected products and services may only be made
321 during the annual enrollment period established by the
322 corporation.
323 (e) The limits established in paragraphs (b)-(d) apply to
324 any risk-bearing product that promises future payment or
325 coverage for a variable amount of benefits or services. The
326 limits do not apply to initiation of flexible spending plans if
327 those plans are not associated with specific high-deductible
328 insurance policies or the use of spending accounts for any
329 products offering individual participants specific amounts and
330 types of health services and treatments at a contracted price.
331 (8) CONSUMER INFORMATION.—The corporation shall:
332 (a) Establish a secure website to facilitate the purchase
333 of products and services by participating individuals. The
334 website must provide information about each product or service
335 available through the program.
336 (b) Inform individuals about other public health care
337 programs.
338 (9) RISK POOLING.—The program may use methods for pooling
339 the risk of individual participants and preventing selection
340 bias. These methods may include, but are not limited to, a
341 postenrollment risk adjustment of the premium payments to the
342 vendors. The corporation may establish a methodology for
343 assessing the risk of enrolled individual participants based on
344 data reported annually by the vendors about their enrollees.
345 Distribution of payments to the vendors may be adjusted based on
346 the assessed relative risk profile of the enrollees in each
347 risk-bearing product for the most recent period for which data
348 is available.
349 (10) EXEMPTION EXEMPTIONS .—
350 (a) Products, other than the products set forth in
351 subparagraphs (4)(d)1.-4., sold as part of the program are not
352 subject to the licensing requirements of the Florida Insurance
353 Code, as defined in s. 624.01 or the mandated offerings or
354 coverages established in part VI of chapter 627 and chapter 641.
355 (b) The corporation may act as an administrator as defined
356 in s. 626.88 but is not required to be certified pursuant to
357 part VII of chapter 626. However, a third party administrator
358 used by the corporation must be certified under part VII of
359 chapter 626.
360 (c) Any standard forms, website design, or marketing
361 communication developed by the corporation and used by the
362 corporation, or any vendor that meets the requirements of
363 paragraph (4)(f) is not subject to the Florida Insurance Code,
364 as established in s. 624.01.
365 (10) CORPORATION.—There is created Florida Employee Health
366 Choices, Inc., which shall be registered, incorporated,
367 organized, and operated in compliance with part III of chapter
368 112 and chapters 119, 286, and 617. The purpose of the
369 corporation is to administer the program created in this section
370 and to conduct such other business as may further the
371 administration of the program. The Department of Management
372 Services shall facilitate the formation of the corporation and
373 provide administrative support for the corporation until January
374 1, 2029. The corporation must be self-sustaining and no longer
375 require administrative assistance from the Department of
376 Management Services by January 1, 2029.
377 (a) The corporation shall be governed by an eight-member
378 board of directors. Board members shall be appointed for terms
379 of up to 3 years and shall be eligible for reappointment. A
380 vacancy on the board shall be filled for the unexpired portion
381 of the term in the same manner as the original appointment.
382 Board members may not include an individual who is affiliated
383 with or employed by an eligible vendor or a subsidiary of an
384 eligible vendor. Board members shall serve without compensation,
385 but are entitled to receive, from funds of the corporation,
386 reimbursement for per diem and travel expenses as provided in s.
387 112.061. The membership of the board shall consist of:
388 1. Three members appointed by the Governor.
389 2. Two members appointed by the President of the Senate.
390 3. Two members appointed by the Speaker of the House of
391 Representatives.
392 4. The Secretary of Management Services or a designee with
393 expertise in state employee benefits and procurement, as an ex
394 officio nonvoting member.
395 (b) The corporation may exercise all powers granted to it
396 under chapter 617 necessary to carry out the purposes of this
397 section, including, but not limited to, the power to receive and
398 accept grants, loans, or advances of funds from any public or
399 private agency and to receive and accept from any source
400 contributions of money, property, labor, or any other thing of
401 value to be held, used, and applied for the purposes of this
402 section.
403 (c) There is no liability on the part of, and a cause of
404 action may not arise against, any member of the board or its
405 employees or agents for any action taken by them in exercising
406 their powers and performing their duties under this section.
407 (d) The board shall develop and adopt bylaws and other
408 corporate procedures necessary for the operation of the
409 corporation and carrying out the purposes of this section. At a
410 minimum, the bylaws must:
411 1. Specify procedures for selection of officers and
412 qualifications for reappointment, provided that a board member
413 may not serve more than 9 consecutive years.
414 2. Require an annual membership meeting that provides an
415 opportunity for input and interaction with individual
416 participants in the program.
417 3. Specify policies and procedures regarding conflicts of
418 interest, including part III of chapter 112, which prohibit a
419 member from participating in any decision that would inure to
420 the benefit of the member or the organization that employs the
421 member. The policies and procedures must also require public
422 disclosure of the interest that prevents the member from
423 participating in a decision on a particular matter.
424 4. Specify procedures for adopting an annual budget.
425 5. Specify procedures for selecting a chief executive
426 officer for the corporation who shall be responsible for
427 securing staff and consultant services necessary for the
428 operation of the program as may be authorized by the
429 corporation’s operating budget.
430 (e) The corporation shall establish policies and procedures
431 for application, enrollment, plan administration, performance
432 monitoring, and consumer education, and other policies and
433 procedures necessary for the operation of the program,
434 including, but not limited to:
435 1. Criteria for participation in the program and procedures
436 for determining the eligibility of employers, vendors,
437 individuals, and health insurance agents and their employers to
438 participate in the program.
439 2. Exclusion of vendors pursuant to paragraph (4)(d).
440 3. Collection of contributions from participating employers
441 and individuals.
442 4. Payment of premiums and other appropriate disbursements
443 based on the selections of products and services by
444 participating individuals.
445 5. Disenrollment of participating individuals based on
446 failure to pay the individual’s share of any contribution
447 required to maintain enrollment in selected products.
448 (f) The corporation shall procure a vendor to facilitate a
449 platform that streamlines the purchase of individual coverage
450 for employees enrolled in individual coverage health
451 reimbursement arrangements.
452 1. Within 90 days after the formation of the corporation,
453 the department shall, as directed by the board, issue an
454 invitation to negotiate to procure the vendor. Responsive
455 bidders must demonstrate the ability to establish a platform
456 fully operational for open enrollment by January 1, 2028, and
457 provide for initial, open, and special enrollment periods.
458 2. The department shall evaluate and score the procurement
459 bids, enter into negotiations at the direction of the board, and
460 make recommendations to the board related to the contract award.
461 The corporation shall select the vendor and execute the contract
462 within 180 days after the issuance of the invitation to
463 negotiate.
464 (g) The corporation shall develop and implement a plan for
465 promoting public awareness of and participation in the program
466 and shall establish a toll-free hotline to respond to requests
467 for assistance from employers and plan enrollees.
468 (h) The corporation may evaluate and implement additional
469 options for employer participation which conform with common
470 insurance practices.
471 (11) CORPORATION.—There is created the Florida Health
472 Choices, Inc., which shall be registered, incorporated,
473 organized, and operated in compliance with part III of chapter
474 112 and chapters 119, 286, and 617. The purpose of the
475 corporation is to administer the program created in this section
476 and to conduct such other business as may further the
477 administration of the program.
478 (a) The corporation shall be governed by a 15-member board
479 of directors consisting of:
480 1. Three ex officio, nonvoting members to include:
481 a. The Secretary of Health Care Administration or a
482 designee with expertise in health care services.
483 b. The Secretary of Management Services or a designee with
484 expertise in state employee benefits.
485 c. The commissioner of the Office of Insurance Regulation
486 or a designee with expertise in insurance regulation.
487 2. Four members appointed by and serving at the pleasure of
488 the Governor.
489 3. Four members appointed by and serving at the pleasure of
490 the President of the Senate.
491 4. Four members appointed by and serving at the pleasure of
492 the Speaker of the House of Representatives.
493 5. Board members may not include insurers, health insurance
494 agents or brokers, health care providers, health maintenance
495 organizations, prepaid service providers, or any other entity,
496 affiliate or subsidiary of eligible vendors.
497 (b) Members shall be appointed for terms of up to 3 years.
498 Any member is eligible for reappointment. A vacancy on the board
499 shall be filled for the unexpired portion of the term in the
500 same manner as the original appointment.
501 (c) The board shall select a chief executive officer for
502 the corporation who shall be responsible for the selection of
503 such other staff as may be authorized by the corporation’s
504 operating budget as adopted by the board.
505 (d) Board members are entitled to receive, from funds of
506 the corporation, reimbursement for per diem and travel expenses
507 as provided by s. 112.061. No other compensation is authorized.
508 (e) There is no liability on the part of, and no cause of
509 action shall arise against, any member of the board or its
510 employees or agents for any action taken by them in the
511 performance of their powers and duties under this section.
512 (f) The board shall develop and adopt bylaws and other
513 corporate procedures as necessary for the operation of the
514 corporation and carrying out the purposes of this section. The
515 bylaws shall:
516 1. Specify procedures for selection of officers and
517 qualifications for reappointment, provided that no board member
518 shall serve more than 9 consecutive years.
519 2. Require an annual membership meeting that provides an
520 opportunity for input and interaction with individual
521 participants in the program.
522 3. Specify policies and procedures regarding conflicts of
523 interest, including the provisions of part III of chapter 112,
524 which prohibit a member from participating in any decision that
525 would inure to the benefit of the member or the organization
526 that employs the member. The policies and procedures shall also
527 require public disclosure of the interest that prevents the
528 member from participating in a decision on a particular matter.
529 (g) The corporation may exercise all powers granted to it
530 under chapter 617 necessary to carry out the purposes of this
531 section, including, but not limited to, the power to receive and
532 accept grants, loans, or advances of funds from any public or
533 private agency and to receive and accept from any source
534 contributions of money, property, labor, or any other thing of
535 value to be held, used, and applied for the purposes of this
536 section.
537 (h) The corporation shall:
538 1. Determine eligibility of employers, vendors,
539 individuals, and agents in accordance with subsection (4).
540 2. Establish procedures necessary for the operation of the
541 program, including, but not limited to, procedures for
542 application, enrollment, risk assessment, risk adjustment, plan
543 administration, performance monitoring, and consumer education.
544 3. Arrange for collection of contributions from
545 participating employers and individuals.
546 4. Arrange for payment of premiums and other appropriate
547 disbursements based on the selections of products and services
548 by the individual participants.
549 5. Establish criteria for disenrollment of participating
550 individuals based on failure to pay the individual’s share of
551 any contribution required to maintain enrollment in selected
552 products.
553 6. Establish criteria for exclusion of vendors pursuant to
554 paragraph (4)(d).
555 7. Develop and implement a plan for promoting public
556 awareness of and participation in the program.
557 8. Secure staff and consultant services necessary to the
558 operation of the program.
559 9. Establish policies and procedures regarding
560 participation in the program for individuals, vendors, health
561 insurance agents, and employers.
562 10. Provide for the operation of a toll-free hotline to
563 respond to requests for assistance.
564 11. Provide for initial, open, and special enrollment
565 periods.
566 12. Evaluate options for employer participation which may
567 conform with common insurance practices.
568 (11) (12) REPORT.—Beginning in the 2027-2028 2009-2010
569 fiscal year, the corporation shall submit by February 1 an
570 annual report to the Governor, the President of the Senate, and
571 the Speaker of the House of Representatives documenting the
572 corporation’s activities in compliance with the duties
573 delineated in this section.
574 (12) (13) PROGRAM INTEGRITY.—To ensure program integrity and
575 to safeguard the financial transactions made under the auspices
576 of the program, the corporation is authorized to establish
577 qualifying criteria and certification procedures for vendors,
578 require performance bonds or other guarantees of ability to
579 complete contractual obligations, monitor the performance of
580 vendors, and enforce the agreements of the program through
581 financial penalty or disqualification from the program.
582 (13) (14) EXEMPTION FROM PUBLIC RECORDS REQUIREMENTS.—
583 (a) Definitions.—For purposes of this subsection, the term:
584 1. “Buyer’s representative” means a participating insurance
585 agent as described in paragraph (4)(g).
586 2. “Enrollee” means an employer who is eligible to enroll
587 in the program pursuant to paragraph (4)(a).
588 3. “Participant” means an individual who is eligible to
589 participate in the program pursuant to paragraph (4)(b).
590 4. “Proprietary confidential business information” means
591 information, regardless of form or characteristics, that is
592 owned or controlled by a vendor requesting confidentiality under
593 this section; that is intended to be and is treated by the
594 vendor as private in that the disclosure of the information
595 would cause harm to the business operations of the vendor; that
596 has not been disclosed unless disclosed pursuant to a statutory
597 provision, an order of a court or administrative body, or a
598 private agreement providing that the information may be released
599 to the public; and that is information concerning:
600 a. Business plans.
601 b. Internal auditing controls and reports of internal
602 auditors.
603 c. Reports of external auditors for privately held
604 companies.
605 d. Client and customer lists.
606 e. Potentially patentable material.
607 f. A trade secret as defined in s. 688.002.
608 5. “Vendor” means a participating insurer or other provider
609 of services as described in paragraph (4)(d).
610 (b) Public record exemptions.—
611 1. Personal identifying information of an enrollee or
612 participant who has applied for or participates in the Florida
613 Employee Health Choices Program is confidential and exempt from
614 s. 119.07(1) and s. 24(a), Art. I of the State Constitution.
615 2. Client and customer lists of a buyer’s representative
616 held by the corporation are confidential and exempt from s.
617 119.07(1) and s. 24(a), Art. I of the State Constitution.
618 3. Proprietary confidential business information held by
619 the corporation is confidential and exempt from s. 119.07(1) and
620 s. 24(a), Art. I of the State Constitution.
621 (c) Retroactive application.—The public record exemptions
622 provided for in paragraph (b) apply to information held by the
623 corporation before, on, or after the effective date of this
624 exemption.
625 (d) Authorized release.—
626 1. Upon request, information made confidential and exempt
627 pursuant to this subsection must shall be disclosed to:
628 a. Another governmental entity in the performance of its
629 official duties and responsibilities.
630 b. Any person who has the written consent of the program
631 applicant.
632 c. The Florida Kidcare program for the purpose of
633 administering the program authorized in ss. 409.810-409.821.
634 2. Paragraph (b) does not prohibit a participant’s legal
635 guardian from obtaining confirmation of coverage, dates of
636 coverage, the name of the participant’s health plan, and the
637 amount of premium being paid.
638 (e) Penalty.—A person who knowingly and willfully violates
639 this subsection commits a misdemeanor of the second degree,
640 punishable as provided in s. 775.082 or s. 775.083.
641 Section 2. Paragraph (a) of subsection (2) of section
642 409.821, Florida Statutes, is amended to read:
643 409.821 Florida Kidcare program public records exemption.—
644 (2)(a) Upon request, such information shall be disclosed
645 to:
646 1. Another governmental entity in the performance of its
647 official duties and responsibilities;
648 2. The Department of Revenue for purposes of administering
649 the state Title IV-D program;
650 3. The Florida Employee Health Choices, Inc., for the
651 purpose of administering the program authorized pursuant to s.
652 408.910; or
653 4. Any person who has the written consent of the program
654 applicant.
655 Section 3. Subsection (3) of section 409.9122, Florida
656 Statutes, is amended to read:
657 409.9122 Medicaid managed care enrollment; HIV/AIDS
658 patients; procedures; data collection; accounting; information
659 system; medical loss ratio.—
660 (3) The agency shall develop a process to enable any
661 recipient with access to employer-sponsored health care coverage
662 to opt out of all eligible plans in the Medicaid program and to
663 use Medicaid financial assistance to pay for the recipient’s
664 share of cost in any such employer-sponsored coverage.
665 Contingent on federal approval, the agency shall also enable
666 recipients with access to other insurance or related products
667 that provide access to health care services created pursuant to
668 state law, including any plan or product available pursuant to
669 the Florida Employee Health Choices Program or any health
670 exchange, to opt out. The amount of financial assistance
671 provided for each recipient may not exceed the amount of the
672 Medicaid premium that would have been paid to a plan for that
673 recipient.
674 Section 4. Subsection (4) of section 409.977, Florida
675 Statutes, is amended to read:
676 409.977 Enrollment.—
677 (4) The agency shall develop a process to enable a
678 recipient with access to employer-sponsored health care coverage
679 to opt out of all managed care plans and to use Medicaid
680 financial assistance to pay for the recipient’s share of the
681 cost in such employer-sponsored coverage. The agency shall also
682 enable recipients with access to other insurance or related
683 products providing access to health care services created
684 pursuant to state law, including any product available under the
685 Florida Employee Health Choices Program, or any health exchange,
686 to opt out. The amount of financial assistance provided for each
687 recipient may not exceed the amount of the Medicaid premium that
688 would have been paid to a managed care plan for that recipient.
689 The agency shall require Medicaid recipients with access to
690 employer-sponsored health care coverage to enroll in that
691 coverage and use Medicaid financial assistance to pay for the
692 recipient’s share of the cost for such coverage. The amount of
693 financial assistance provided for each recipient may not exceed
694 the amount of the Medicaid premium that would have been paid to
695 a managed care plan for that recipient. The agency may exceed
696 this amount for a high-cost patient if it determines it would be
697 cost effective to do so. The agency shall annually, beginning
698 June 30, 2026, submit an annual report on the program to the
699 Legislature including, but not limited to, the level of
700 participation; participant demographics, income levels, type of
701 employer-based coverage, and amount of health care utilization;
702 and a cost-effectiveness analysis both in the aggregate and on
703 an individual patient basis.
704 Section 5. This act shall take effect July 1, 2026.