HB 5009 2022
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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
A bill to be entitled 1
An act relating to the state group insurance program; 2
amending s. 110.123, F.S.; providing and revising 3
definitions; authorizing eligible former employees to 4
participate in the state group insurance program; 5
removing certain benefit levels for certain health 6
plans; conforming provisions to changes made by the 7
act; conforming cross -references; creating s. 8
110.12306, F.S.; defining the term "designated anti -9
fraud unit"; requiring the Division of State Group 10
Insurance to establish and maintain, or contract with 11
other entities to establish and maintain, a designated 12
anti-fraud unit for certain purposes, to adopt an 13
anti-fraud plan, and to designate staff with certai n 14
responsibilities by a specified date; creating s. 15
110.12313, F.S.; requiring the Department of 16
Management Services to provide an open enrollment 17
period for eligible former employees for a certain 18
plan year for certain purposes; providing requirements 19
for certain health insurance coverage options; 20
requiring that eligible former employees enroll in the 21
state group insurance program within a specified time; 22
ratifying specified rules of the Florida 23
Administrative Code; providing construction; providing 24
effective dates. 25
HB 5009 2022
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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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Be It Enacted by the Legislature of the State of Florida: 27
28
Section 1. Paragraphs (b) through (p) of subsection (2) of 29
section 110.123, Florida Statutes, are redesignated as 30
paragraphs (c) through (q), respectively, present paragraphs 31
(b), (k), (m), and (o) of subsection (2), paragraphs (d), (g), 32
and (j) of subsection (3), paragraph (e) of subsection (4), and 33
paragraphs (c) and (d) of subsection (13) are amended, and a new 34
paragraph (b) is added to subsection (2) of that section, to 35
read: 36
110.123 State group insurance program. — 37
(2) DEFINITIONS.—As used in ss. 110.123 -110.1239, the 38
term: 39
(b) "Eligible former employee" means a former full -time 40
state employee who worked at least 6 cumulative years with a 41
branch or agency of state govern ment, was enrolled in the state 42
group insurance program at the time of his or her separation 43
from employment, and whose separation from employment occurred 44
on or after July 1, 2022. The term "eligible former employee" 45
does not include seasonal workers who were paid from OPS funds 46
during their employment, state university employees, or other 47
benefits-only employees. 48
(c)(b) "Enrollee" means all state officers and employees, 49
retired state officers and employees, surviving spouses of 50
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deceased state officers a nd employees, eligible former 51
employees, and terminated employees or individuals with 52
continuation coverage who are enrolled in an insurance plan 53
offered by the state group insurance program. The term 54
"enrollee" includes all state university officers and e mployees, 55
retired state university officers and employees, surviving 56
spouses of deceased state university officers and employees, and 57
terminated state university employees or individuals with 58
continuation coverage who are enrolled in an insurance plan 59
offered by the state group insurance program. 60
(l)(k) "State group health insurance plan or plans" or 61
"state plan or plans" means the state self -insured health 62
insurance plan or plans offered to state officers and employees, 63
retired state officers and employe es, eligible former employees, 64
and surviving spouses of deceased state officers , and employees, 65
and eligible former employees under pursuant to this section. 66
(n)(m) "State group insurance program" or "programs" means 67
the package of insurance plans offere d to state officers and 68
employees, retired state officers and employees, eligible former 69
employees, and surviving spouses of deceased state officers , and 70
employees, and eligible former employees under pursuant to this 71
section, including the state group hea lth insurance plan or 72
plans, health maintenance organization plans, TRICARE 73
supplemental insurance plans, and other plans required or 74
authorized by law. 75
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(p)(o) "Surviving spouse" means the widow or widower of a 76
deceased state officer, full -time state employee, part-time 77
state employee, eligible former employee, or retiree if such 78
widow or widower was covered as a dependent under the state 79
group health insurance plan, TRICARE supplemental insurance 80
plan, or a health maintenance organization plan establishe d 81
under pursuant to this section at the time of the death of the 82
deceased officer, employee, eligible former employee, or 83
retiree. The term "surviving spouse" also means any widow or 84
widower who is receiving or eligible to receive a monthly state 85
warrant from a state retirement system as the beneficiary of a 86
state officer, full-time state employee, or retiree who died 87
prior to July 1, 1979. For the purposes of this section, any 88
such widow or widower shall cease to be a surviving spouse upon 89
his or her remarriage. 90
(3) STATE GROUP INSURANCE PROGRAM. — 91
(d)1. Notwithstanding chapter 287 and the authority of the 92
department, for the purpose of protecting the health of, and 93
providing medical services to, state employees and eligible 94
former employees participating in the state group insurance 95
program, the department may contract to retain the services of 96
professional administrators for the state group insurance 97
program. The agency shall follow good purchasing practices of 98
state procurement to the extent practicabl e under the 99
circumstances. 100
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2. Each vendor in a major procurement, and any other 101
vendor if the department deems it necessary to protect the 102
state's financial interests, shall, at the time of executing any 103
contract with the department, post an appropriate bond with the 104
department in an amount determined by the department to be 105
adequate to protect the state's interests but not higher than 106
the full amount estimated to be paid annually to the vendor 107
under the contract. 108
3. Each major contract entered into by the department 109
under pursuant to this section must shall contain a provision 110
for payment of liquidated damages to the department for material 111
noncompliance by a vendor with a contract provision. The 112
department may require a liquidated damages provision in any 113
contract if the department deems it necessary to protect the 114
state's financial interests. 115
4. Section 120.57(3) applies to the department's 116
contracting process, except: 117
a. A formal written protest of any decision, intended 118
decision, or other action subject to protest must shall be filed 119
within 72 hours after receipt of notice of the decision, 120
intended decision, or other action. 121
b. As an alternative to any provision of s. 120.57(3), the 122
department may proceed with the bid s election or contract award 123
process if the director of the department sets forth, in 124
writing, particular facts and circumstances that demonstrate the 125
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necessity of continuing the procurement process or the contract 126
award process in order to avoid a substanti al disruption to the 127
provision of any scheduled insurance services. 128
5. The department shall make arrangements as necessary to 129
contribute claims data of the state group health insurance plan 130
to the contracted vendor selected by the Agency for Health Care 131
Administration under pursuant to s. 408.05(3)(c). 132
6. Each contracted vendor for the state group health 133
insurance plan shall contribute Florida claims data to the 134
contracted vendor selected by the Agency for Health Care 135
Administration under pursuant to s. 408.05(3)(c). 136
(g) Participation by individuals in the program is 137
available to all state officers, full -time state employees, and 138
part-time state employees , and eligible former employees and is 139
voluntary. Participation in the program is also available to 140
retired state officers and employees who elect at the time of 141
retirement to continue coverage under the program, but may elect 142
to continue all or only part of the coverage they had at the 143
time of retirement. A surviving spouse may elect to continue 144
coverage only under a state group health insurance plan, a 145
TRICARE supplemental insurance plan, or a health maintenance 146
organization plan. 147
(j) For the 2020 plan year and each plan year thereafter, 148
health plans shall be offered in the following benefit levels: 149
1. Platinum level, which shall have an actuarial value of 150
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at least 90 percent. 151
2. Gold level, which shall have an actuarial value of at 152
least 80 percent. 153
3. Silver level, which shall have an actuarial value of at 154
least 70 percent. 155
4. Bronze level, which shall have an actuarial value of at 156
least 60 percent. 157
(4) PAYMENT OF PREMIUMS; CONTRIBUTION BY STATE; LIMITATION 158
ON ACTIONS TO PAY AND COLLECT PREMIUMS. — 159
(e) A No state contribution for the cost of any part of 160
the premium may not shall be made for retirees , or surviving 161
spouses, or eligible former employees for any type of coverage 162
under the state group insurance program. However, any state 163
agency that employs a full -time law enforcement officer, 164
correctional officer, or correcti onal probation officer who is 165
killed or suffers catastrophic injury in the line of duty as 166
provided in s. 112.19, or a full -time firefighter who is killed 167
or suffers catastrophic injury in the line of duty as provided 168
in s. 112.191, shall pay the entire pr emium of the state group 169
health insurance plan selected for the employee's surviving 170
spouse until remarried, and for each dependent child of the 171
employee, subject to the conditions and limitations set forth in 172
s. 112.19 or s. 112.191, as applicable. 173
(13) OTHER-PERSONAL-SERVICES EMPLOYEES (OPS). — 174
(c) The initial measurement period used to determine 175
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whether an employee hired before April 1, 2013, and paid from 176
OPS funds is a full-time employee described in subparagraph 177
(2)(d)1. subparagraph (2)(c)1. is the 6-month period from April 178
1, 2013, through September 30, 2013. 179
(d) All other measurement periods used to determine 180
whether an employee paid from OPS funds is a full -time employee 181
described in paragraph (2)(d) paragraph (2)(c) must be for 12 182
consecutive months. 183
Section 2. Section 110.12306, Florida Statutes, is created 184
to read: 185
110.12306 Anti-fraud investigative units. — 186
(1) As used in this section, the term "designated anti -187
fraud unit" means a distinct unit within the Division of State 188
Group Insurance which is made up of employees whose principal 189
responsibilities are the investigation and disposition of claims 190
and who are also assigned to investigate fraud. 191
(2) By December 31, 2022, the division: 192
(a)1. Shall establish and maintain a designated anti-fraud 193
unit to investigate and report possible fraudulent insurance 194
acts by insureds, persons making claims for services against the 195
State Employees Health Insurance Trust Fund, or vendors under 196
contract with the division. 197
2. May contract with other entities to investigate and 198
report possible fraudulent insurance acts by insureds, persons 199
making claims for services against the State Employees Health 200
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Insurance Trust Fund, or vendors under contract with the 201
division. 202
(b) Shall adopt an anti -fraud plan. 203
(c) Shall designate staff with the primary responsibility 204
of implementing the requirements of this section. 205
Section 3. Section 110.12313, Florida Statutes, is created 206
to read: 207
110.12313 Open enrollment period for eligible former 208
employees.—On or after October 1, 2022, for the plan year 209
beginning January 1, 2023, the Department of Management Services 210
shall provide an open enrollment period for eligible former 211
employees who want to obtain health insurance coverage under s. 212
110.123. The options offe red during the open enrollment period 213
must provide the same health insurance coverage as the coverage 214
provided to active employees and under the same premium payment 215
conditions in effect for early retirees. The department shall 216
continue to provide an open enrollment period for eligible 217
former employees for each successive plan year. An eligible 218
former employee who wishes to obtain health insurance coverage 219
under s. 110.123 must enroll in the state group insurance 220
program within 24 months after his or her da te of separation 221
from employment. 222
Section 4. (1) The following rules, as filed for adoption 223
with the Department of State pursuant to the certification 224
packages dated October 1, 2019, and November 3, 2021, are 225
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ratified for the sole and exclusive purpos e of satisfying any 226
condition on their effectiveness imposed under s. 227
110.123(3)(h)2.d., Florida Statutes: 228
(a) Rule 60P-1.003, Florida Administrative Code, entitled 229
Definitions. 230
(b) Rule 60P-2.002, Florida Administrative Code, entitled 231
Eligibility and Enrollment. 232
(c) Rule 60P-2.003, Florida Administrative Code, entitled 233
Changes in Coverage. 234
(2) This section serves no other purpose and may not be 235
codified in the Florida Statutes. The enactment and effective 236
dates of this act shall be noted in the Florida Administrative 237
Code, the Florida Administrative Register, or both, as 238
appropriate after the act becomes law. This section does not 239
alter rulemaking authority delegated by prior law, does not 240
constitute legislative preemption of or exception to any law 241
governing adoption or enforcement of the rule cited, and is 242
intended to preserve the status of any cited rule as a rule 243
under chapter 120, Florida Statutes. This section does not cure 244
any rulemaking defect or pre empt any challenge based on lack of 245
authority or a violation of the legal requirements governing the 246
adoption of any rule cited. 247
(3) This section shall take effect upon becoming a law. 248
Section 5. Except as otherwise expressly provided in this 249
act and except for this section, which shall take effect upon 250
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this act becoming a law, this act shall take effect July 1, 251
2022. 252