Florida 2022 Regular Session

Florida House Bill H1063 Compare Versions

Only one version of the bill is available at this time.

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3	3	HB 1063 2022
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7	7	CODING: Words stricken are deletions; words underlined are additions.
8	8	hb1063-00
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10	10	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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12	12
13	13
14	14	A bill to be entitled 1
15	15	An act relating to health insurance cost sharing; 2
16	16	creating s. 627.6383, F.S.; defining the term "cost -3
17	17	sharing requirement"; requiring specified individual 4
18	18	health insurers and their pharmacy benefit managers to 5
19	19	apply payments by or on behalf of insureds toward the 6
20	20	total contributions of the insureds' cost -sharing 7
21	21	requirements; providing applicability; amending s. 8
22	22	627.6385, F.S.; requiring specified individual health 9
23	23	insurers to disclose on their websites and in their 10
24	24	policies their applications of payments by or on 11
25	25	behalf of policyholders toward the policyholders' 12
26	26	total contributions to cost -sharing requirements; 13
27	27	providing applicability; amending ss. 627.64741 , 14
28	28	627.6572, and 641.314, F.S.; requiring pharmacy 15
29	29	benefit managers to apply payments by or on behalf of 16
30	30	insureds and subscribers toward the insureds' and 17
31	31	subscribers' total contributions to cost -sharing 18
32	32	requirements; providing applicability; providing 19
33	33	disclosure requirements; creating s. 627.65715, F.S., 20
34	34	and amending s. 641.31, F.S.; defining the term "cost -21
35	35	sharing requirement"; requiring specified group health 22
36	36	insurers and health maintenance organizations and 23
37	37	their pharmacy benefit managers to apply paymen ts by 24
38	38	or on behalf of insureds and subscribers toward the 25
39	39
40	40	HB 1063 2022
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45	45	hb1063-00
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47	47	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
48	48
49	49
50	50
51	51	total contributions of the insureds' and subscribers' 26
52	52	cost-sharing requirements, respectively; providing 27
53	53	disclosure requirements; providing applicability; 28
54	54	amending s. 627.6699, F.S.; providing requi rements for 29
55	55	small employer carriers; amending s. 409.967, F.S.; 30
56	56	conforming a cross-reference; amending s. 641.185, 31
57	57	F.S.; conforming a provision to changes made by the 32
58	58	act; providing a declaration of important state 33
59	59	interest; providing an effective date. 34
60	60	35
61	61	Be It Enacted by the Legislature of the State of Florida: 36
62	62	37
63	63	Section 1. Section 627.6383, Florida Statutes, is created 38
64	64	to read: 39
65	65	627.6383 Cost-sharing requirements. — 40
66	66	(1) As used in this section, the term "cost -sharing 41
67	67	requirement" means a dollar li mit, deductible, copayment, 42
68	68	coinsurance, or any other out -of-pocket expense imposed on an 43
69	69	insured, including, but not limited to, the annual limitation on 44
70	70	cost sharing subject to 42 U.S.C. s. 18022. 45
71	71	(2)(a) Each health insurer issuing, delivering, or 46
72	72	renewing a policy in this state which provides prescription drug 47
73	73	coverage or each pharmacy benefit manager on behalf of such 48
74	74	health insurer must apply any amount paid by an insured or by 49
75	75	another person on behalf of the insured toward the insured's 50
76	76
77	77	HB 1063 2022
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79	79
80	80
81	81	CODING: Words stricken are deletions; words underlined are additions.
82	82	hb1063-00
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84	84	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
85	85
86	86
87	87
88	88	total contribution to any cost-sharing requirement. 51
89	89	(b) The amount paid by or on behalf of the insured which 52
90	90	is applied toward the insured's total contribution to any cost -53
91	91	sharing requirement under paragraph (a) includes, but is not 54
92	92	limited to, any payment with, or any discount through, financial 55
93	93	assistance, a manufacturer copay card, a product voucher, or any 56
94	94	other reduction in out -of-pocket expenses made by or on behalf 57
95	95	of the insured for a prescription drug. 58
96	96	(3) This section applies to any health insurance polic y 59
97	97	issued, delivered, or renewed in this state on or after January 60
98	98	1, 2023. 61
99	99	Section 2. Subsections (2) and (3) of section 627.6385, 62
100	100	Florida Statutes, are renumbered as subsections (3) and (4), 63
101	101	respectively, present subsection (2) is amended, and a new 64
102	102	subsection (2) is added to that section, to read: 65
103	103	627.6385 Disclosures to policyholders; calculations of 66
104	104	cost sharing.— 67
105	105	(2) Each health insurer issuing, delivering, or renewing a 68
106	106	policy in this state which provides prescription drug coverage, 69
107	107	regardless of whether the prescription drug benefits are 70
108	108	administered or managed by the health insurer or by a pharmacy 71
109	109	benefit manager on behalf of the health insurer, shall disclose 72
110	110	on its website that any amount paid by a policyholder or by 73
111	111	another person on beha lf of the policyholder shall be applied 74
112	112	toward the policyholder's total contribution to any cost -sharing 75
113	113
114	114	HB 1063 2022
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121	121	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
122	122
123	123
124	124
125	125	requirement pursuant to s. 627.6383. This subsection applies to 76
126	126	any policy issued, delivered, or renewed in this state on or 77
127	127	after January 1, 2023. 78
128	128	(3)(2) Each health insurer shall include in every policy 79
129	129	delivered or issued for delivery to any person in the state or 80
130	130	in materials provided as required by s. 627.64725 notice that 81
131	131	the information required by this section is available 82
132	132	electronically and th e address of the website where the 83
133	133	information can be accessed. In addition, each health insurer 84
134	134	issuing, delivering, or renewing a policy in this state which 85
135	135	provides prescription drug coverage, regardless of whether the 86
136	136	prescription drug benefits are adm inistered or managed by the 87
137	137	health insurer or by a pharmacy benefit manager on behalf of the 88
138	138	health insurer, shall include in every policy that is issued, 89
139	139	delivered, or renewed to any person in this state on or after 90
140	140	January 1, 2023, the disclosure that an y amount paid by a 91
141	141	policyholder or by another person on behalf of the policyholder 92
142	142	shall be applied toward the policyholder's total contribution to 93
143	143	any cost-sharing requirement pursuant to s. 627.6383. 94
144	144	Section 3. Paragraph (c) is added to subsection (2 ) of 95
145	145	section 627.64741, Florida Statutes, to read: 96
146	146	627.64741 Pharmacy benefit manager contracts. — 97
147	147	(2) A contract between a health insurer and a pharmacy 98
148	148	benefit manager must require that the pharmacy benefit manager: 99
149	149	(c)1. Apply any amount paid by an insured or by another 100
150	150
151	151	HB 1063 2022
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156	156	hb1063-00
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158	158	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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160	160
161	161
162	162	person on behalf of the insured toward the insured's total 101
163	163	contribution to any cost -sharing requirement pursuant to s. 102
164	164	627.6383. This subparagraph applies to any insured whose 103
165	165	insurance policy is iss ued, delivered, or renewed in this state 104
166	166	on or after January 1, 2023. 105
167	167	2. Disclose to every insured whose insurance policy is 106
168	168	issued, delivered, or renewed in this state on or after January 107
169	169	1, 2023, that the pharmacy benefit manager shall apply any 108
170	170	amount paid by the insured or by another person on behalf of the 109
171	171	insured toward the insured's total contribution to any cost -110
172	172	sharing requirement pursuant to s. 627.6383. 111
173	173	Section 4. Section 627.65715, Florida Statutes, is created 112
174	174	to read: 113
175	175	627.65715 Cost-sharing requirements.— 114
176	176	(1) As used in this section, the term "cost -sharing 115
177	177	requirement" means a dollar limit, deductible, copayment, 116
178	178	coinsurance, or any other out -of-pocket expense imposed on an 117
179	179	insured, including, but not limited to, the annual limitation on 118
180	180	cost sharing subject to 42 U.S.C. s. 18022. 119
181	181	(2)(a) Each insurer issuing, delivering, or renewing a 120
182	182	policy in this state which provides prescription drug coverage 121
183	183	or each pharmacy benefit manager on behalf of such insurer must 122
184	184	apply any amount paid by an insured or by another person on 123
185	185	behalf of the insured toward the insured's total contribution to 124
186	186	any cost-sharing requirement. 125
187	187
188	188	HB 1063 2022
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191	191
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193	193	hb1063-00
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195	195	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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199	199	(b) The amount paid by or on behalf of the insured which 126
200	200	is applied toward the insured's total contribution to any cost -127
201	201	sharing requirement under paragraph (a) includes, but is not 128
202	202	limited to, any payment with, or any discount through, financial 129
203	203	assistance, a manufacturer copay card, a product voucher, or any 130
204	204	other reduction in out -of-pocket expenses made by or on behalf 131
205	205	of the insured for a prescription drug. 132
206	206	(3) Each insurer issuing, delivering, or renewing a policy 133
207	207	in this state which provides prescription drug coverage, 134
208	208	regardless of whether the prescription drug benefits are 135
209	209	administered or managed by the insurer or by a pharmacy benefit 136
210	210	manager on behalf of the insurer, shall disclose, on its website 137
211	211	and in every policy issued, delivered, or renewed in this state 138
212	212	on or after January 1, 2023, that any amount paid by an insured 139
213	213	or by another person on behalf of the insured shall be applied 140
214	214	toward the insured's total contribution to any cost -sharing 141
215	215	requirement. 142
216	216	(4) This section applies to any group health insurance 143
217	217	policy issued, delivered, or renewed in this state on or after 144
218	218	January 1, 2023. 145
219	219	Section 5. Paragraph (c) is added to subsection (2) of 146
220	220	section 627.6572, Florida Statutes, to read: 147
221	221	627.6572 Pharmacy benefit manager contracts. — 148
222	222	(2) A contract between a health insurer and a pharmacy 149
223	223	benefit manager must require that the pharmacy benefit manager: 150
224	224
225	225	HB 1063 2022
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229	229	CODING: Words stricken are deletions; words underlined are additions.
230	230	hb1063-00
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232	232	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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234	234
235	235
236	236	(c)1. Apply any amount paid by an insured or by another 151
237	237	person on behalf of the insured toward the insured's total 152
238	238	contribution to any cost -sharing requirement pursuant to s. 153
239	239	627.65715. This subparagraph applies to any insured whose 154
240	240	insurance policy is issued, deliv ered, or renewed in this state 155
241	241	on or after January 1, 2023. 156
242	242	2. Disclose to every insured whose insurance policy is 157
243	243	issued, delivered, or renewed in this state on or after January 158
244	244	1, 2023, that the pharmacy benefit manager shall apply any 159
245	245	amount paid by the insured or by another person on behalf of the 160
246	246	insured toward the insured's total contribution to any cost -161
247	247	sharing requirement pursuant to s. 627.65715. 162
248	248	Section 6. Paragraph (e) of subsection (5) of section 163
249	249	627.6699, Florida Statutes, is amended to r ead: 164
250	250	627.6699 Employee Health Care Access Act. — 165
251	251	(5) AVAILABILITY OF COVERAGE. — 166
252	252	(e) All health benefit plans issued under this section 167
253	253	must comply with the following conditions: 168
254	254	1. For employers who have fewer than two employees, a late 169
255	255	enrollee may be excluded from coverage for no longer than 24 170
256	256	months if he or she was not covered by creditable coverage 171
257	257	continually to a date not more than 63 days before the effective 172
258	258	date of his or her new coverage. 173
259	259	2. Any requirement used by a small employer carr ier in 174
260	260	determining whether to provide coverage to a small employer 175
261	261
262	262	HB 1063 2022
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266	266	CODING: Words stricken are deletions; words underlined are additions.
267	267	hb1063-00
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269	269	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
270	270
271	271
272	272
273	273	group, including requirements for minimum participation of 176
274	274	eligible employees and minimum employer contributions, must be 177
275	275	applied uniformly among all small employer groups having the 178
276	276	same number of eligible employees applying for coverage or 179
277	277	receiving coverage from the small employer carrier, except that 180
278	278	a small employer carrier that participates in, administers, or 181
279	279	issues health benefits pursuant to s. 381.0406 which do not 182
280	280	include a preexisting condition exclusion may require as a 183
281	281	condition of offering such benefits that the employer has had no 184
282	282	health insurance coverage for its employees for a period of at 185
283	283	least 6 months. A small employer carrier may vary application of 186
284	284	minimum participatio n requirements and minimum employer 187
285	285	contribution requirements only by the size of the small employer 188
286	286	group. 189
287	287	3. In applying minimum participation requirements with 190
288	288	respect to a small employer, a small employer carrier shall not 191
289	289	consider as an eligible emp loyee employees or dependents who 192
290	290	have qualifying existing coverage in an employer -based group 193
291	291	insurance plan or an ERISA qualified self -insurance plan in 194
292	292	determining whether the applicable percentage of participation 195
293	293	is met. However, a small employer carr ier may count eligible 196
294	294	employees and dependents who have coverage under another health 197
295	295	plan that is sponsored by that employer. 198
296	296	4. A small employer carrier shall not increase any 199
297	297	requirement for minimum employee participation or any 200
298	298
299	299	HB 1063 2022
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306	306	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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308	308
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310	310	requirement for minim um employer contribution applicable to a 201
311	311	small employer at any time after the small employer has been 202
312	312	accepted for coverage, unless the employer size has changed, in 203
313	313	which case the small employer carrier may apply the requirements 204
314	314	that are applicable to th e new group size. 205
315	315	5. If a small employer carrier offers coverage to a small 206
316	316	employer, it must offer coverage to all the small employer's 207
317	317	eligible employees and their dependents. A small employer 208
318	318	carrier may not offer coverage limited to certain persons i n a 209
319	319	group or to part of a group, except with respect to late 210
320	320	enrollees. 211
321	321	6. A small employer carrier may not modify any health 212
322	322	benefit plan issued to a small employer with respect to a small 213
323	323	employer or any eligible employee or dependent through riders, 214
324	324	endorsements, or otherwise to restrict or exclude coverage for 215
325	325	certain diseases or medical conditions otherwise covered by the 216
326	326	health benefit plan. 217
327	327	7. An initial enrollment period of at least 30 days must 218
328	328	be provided. An annual 30 -day open enrollment peri od must be 219
329	329	offered to each small employer's eligible employees and their 220
330	330	dependents. A small employer carrier must provide special 221
331	331	enrollment periods as required by s. 627.65615. 222
332	332	8. A small employer carrier shall comply with s. 627.65715 223
333	333	with respect to contribution to cost -sharing requirements as 224
334	334	defined in subsection (1) of that section. 225
335	335
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343	343	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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347	347	Section 7. Subsection (48) is added to section 641.31, 226
348	348	Florida Statutes, to read: 227
349	349	641.31 Health maintenance contracts. — 228
350	350	(48)(a) As used in this subsection, the term "cost -sharing 229
351	351	requirement" means a dollar limit, deductible, copayment, 230
352	352	coinsurance, or any other out -of-pocket expense imposed on a 231
353	353	subscriber, including, but not limited to, the annual limitation 232
354	354	on cost sharing subject to 42 U.S.C. s. 18022. 233
355	355	(b)1. Each health maintenance organization issuing, 234
356	356	delivering, or renewing a health maintenance contract or 235
357	357	certificate in this state which provides prescription drug 236
358	358	coverage or each pharmacy benefit manager on behalf of such 237
359	359	health maintenance organization must apply any amount paid by a 238
360	360	subscriber or by another person on behalf of the subscriber 239
361	361	toward the subscriber's total contribution to any cost -sharing 240
362	362	requirement. 241
363	363	2. The amount paid by or on behalf of the sub scriber which 242
364	364	is applied toward the subscriber's total contribution to any 243
365	365	cost-sharing requirement under subparagraph 1. includes, but is 244
366	366	not limited to, any payment with, or any discount through, 245
367	367	financial assistance, a manufacturer copay card, a product 246
368	368	voucher, or any other reduction in out -of-pocket expenses made 247
369	369	by or on behalf of the subscriber for a prescription drug. 248
370	370	(c) Each health maintenance organization issuing, 249
371	371	delivering, or renewing a health maintenance contract or 250
372	372
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380	380	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
381	381
382	382
383	383
384	384	certificate in this stat e which provides prescription drug 251
385	385	coverage, regardless of whether the prescription drug benefits 252
386	386	are administered or managed by the health maintenance 253
387	387	organization or by a pharmacy benefit manager on behalf of the 254
388	388	health maintenance organization, shall di sclose, on its website 255
389	389	and in every subscriber's health maintenance contract, 256
390	390	certificate, or member handbook issued, delivered, or renewed in 257
391	391	this state on or after January 1, 2023, that any amount paid by 258
392	392	a subscriber or by another person on behalf of th e subscriber 259
393	393	shall be applied toward the subscriber's total contribution to 260
394	394	any cost-sharing requirement. 261
395	395	(d) This subsection applies to any health maintenance 262
396	396	contract or certificate issued, delivered, or renewed in this 263
397	397	state on or after January 1, 202 3. 264
398	398	Section 8. Paragraph (c) is added to subsection (2) of 265
399	399	section 641.314, Florida Statutes, to read: 266
400	400	641.314 Pharmacy benefit manager contracts. — 267
401	401	(2) A contract between a health maintenance organization 268
402	402	and a pharmacy benefit manager must require that the pharmacy 269
403	403	benefit manager: 270
404	404	(c)1. Apply any amount paid by a subscriber or by another 271
405	405	person on behalf of the subscriber toward the subscriber's total 272
406	406	contribution to any cost -sharing requirement pursuant to s. 273
407	407	641.31(48). This subparagraph applie s to any subscriber whose 274
408	408	health maintenance contract or certificate is issued, delivered, 275
409	409
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417	417	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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419	419
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421	421	or renewed in this state on or after January 1, 2023. 276
422	422	2. Disclose to every subscriber whose health maintenance 277
423	423	contract or certificate is issued, delivered, or ren ewed in this 278
424	424	state on or after January 1, 2023, that the pharmacy benefit 279
425	425	manager shall apply any amount paid by the subscriber or by 280
426	426	another person on behalf of the subscriber toward the 281
427	427	subscriber's total contribution to any cost -sharing requirement 282
428	428	pursuant to s. 641.31(48). 283
429	429	Section 9. Paragraph (o) of subsection (2) of section 284
430	430	409.967, Florida Statutes, is amended to read: 285
431	431	409.967 Managed care plan accountability. — 286
432	432	(2) The agency shall establish such contract requirements 287
433	433	as are necessary for th e operation of the statewide managed care 288
434	434	program. In addition to any other provisions the agency may deem 289
435	435	necessary, the contract must require: 290
436	436	(o) Transparency.—Managed care plans shall comply with ss. 291
437	437	627.6385(4) ss. 627.6385(3) and 641.54(7). 292
438	438	Section 10. Paragraph (k) of subsection (1) of section 293
439	439	641.185, Florida Statutes, is amended to read: 294
440	440	641.185 Health maintenance organization subscriber 295
441	441	protections.— 296
442	442	(1) With respect to the provisions of this part and part 297
443	443	III, the principles expressed i n the following statements serve 298
444	444	as standards to be followed by the commission, the office, the 299
445	445	department, and the Agency for Health Care Administration in 300
446	446
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454	454	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
455	455
456	456
457	457
458	458	exercising their powers and duties, in exercising administrative 301
459	459	discretion, in administrative inte rpretations of the law, in 302
460	460	enforcing its provisions, and in adopting rules: 303
461	461	(k) A health maintenance organization subscriber shall be 304
462	462	given a copy of the applicable health maintenance contract, 305
463	463	certificate, or member handbook specifying: all the provisio ns, 306
464	464	disclosure, and limitations required pursuant to s. 641.31(1) , 307
465	465	and (4), and (48); the covered services, including those 308
466	466	services, medical conditions, and provider types specified in 309
467	467	ss. 641.31, 641.31094, 641.31095, 641.31096, 641.51(11), and 310
468	468	641.513; and where and in what manner services may be obtained 311
469	469	pursuant to s. 641.31(4). 312
470	470	Section 11. The Legislature finds that this act fulfills 313
471	471	an important state interest. 314
472	472	Section 12. This act shall take effect July 1, 2022. 315