No. HB 1531
Filed under Insurance.
Government-facilitated Purchases and Sales of Individual and Small Employer Health and Dental Plans; Establishes Florida Health Insurance Exchange within OIR to facilitate purchase & sale of qualified health plans; provides duties of exchange; authorizes exchange to contract with eligible entity to perform exchange's functions; authorizes exchange to enter into agreements with governmental agencies & entities to carry out exchange's responsibilities; provides general requirements & prohibitions for exchange; provides certifications by exchange of health & dental benefit plans; authorizes Commissioner of Insurance Regulation & office to contract with vendor to build & manage exchange.
Plain English Summary
AI-GENERATEDEstablishes the Florida Health Insurance Exchange as a government entity inside the Office of Insurance Regulation, to facilitate buying and selling health and dental plans certified under federal PPACA standards, for individuals and, through a new Small Business Health Options Program, small employers.
The Commissioner and the Office of Insurance Regulation must hire a vendor through competitive procurement to build and run the exchange, which may also contract out its functions to an eligible entity, though a health carrier or its affiliate cannot serve as that entity.
Sets certification rules carriers must meet to sell through the exchange: covering required essential benefits, offering plans at multiple coverage tiers, disclosing pricing and claims data in plain language, and charging the same premium whether sold through the exchange or directly.
Requires the exchange to help enroll eligible people in Medicaid or the Children's Health Insurance Program, fund outreach navigators, and share certain enrollees' and employers' information with the federal government for tax-credit and individual-mandate purposes.
AICreates the Florida Health Insurance Exchange as a governmental entity inside the Office of Insurance Regulation to facilitate the purchase and sale of qualified health and dental plans for individuals and, through a SHOP Exchange, small employers.
AIThe exchange may contract out its functions to an eligible entity with relevant administrative experience, but a health carrier or any affiliate of a health carrier is barred from qualifying as that entity.
AIA carrier certified to sell through the exchange must charge the same premium rate for a qualified health plan whether it is sold through the exchange, directly by the carrier, or through an insurance producer.
AIThe exchange cannot refuse to list a health benefit plan solely because it is fee-for-service, because of exchange-imposed price controls, or because the plan covers treatments necessary to prevent patients' deaths that the exchange finds too costly or inappropriate.
AIThe Commissioner of Insurance Regulation and the Office of Insurance Regulation must contract with a vendor chosen through competitive procurement to build and manage the exchange, rather than running it entirely with state staff.
AIEven though this section is created effective July 1, 2026, the exchange is not required to make qualified health plans available to consumers and employers until January 1, 2028.
AIThe exchange must transfer to the U.S. Treasury Secretary the names and taxpayer identification numbers of people certified as exempt from the individual mandate and of employees found newly eligible for premium tax credits because an employer's coverage was inadequate.
AIThe exchange may not use funds meant for its administrative and operational expenses on staff retreats, promotional giveaways, excessive executive compensation, or promoting legislative or regulatory changes.