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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
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; amending s. 8
110.12303, F.S.; requiring cost savings to an enrollee 9
to include a specified waiver, unless prohibited under 10
certain tax laws; revising what may be included in 11
cost savings; creating s. 110.12306, F.S.; defining 12
the term "designated anti -fraud unit"; requiring the 13
Division of State Group Insurance to establish and 14
maintain, or contract with other entities to establish 15
and maintain, a designated anti -fraud unit for certain 16
purposes, to adopt an anti -fraud plan, and to 17
designate staff with certain responsibilities by a 18
specified date; creating s. 110.12313, F.S.; 19
specifying that eligible former employees may obtain 20
certain health insurance coverage within a specified 21
time after their separation from employment; providing 22
requirements for certain health insurance coverage 23
options; amending s. 110.1239, F.S.; removin g language 24
that certain additional appropriations are considered 25
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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 state contribution, which result in an increase in 26
the state premium; ratifying specified rules of the 27
Florida Administrative Code relating to health 28
maintenance organization plan regions; providing 29
construction; providing effective dates. 30
31
Be It Enacted by the Legislature of the State of Florida: 32
33
Section 1. Paragraph (b) and paragraphs (c) through (p) of 34
subsection (2) of section 110.123, Florida Statutes, are 35
redesignated as parag raph (c) and paragraphs (e) through (r), 36
respectively, present paragraphs (b), (k), (m), and (o) of 37
subsection (2), paragraphs (d), (g), and (j) of subsection (3), 38
paragraph (e) of subsection (4), and paragraphs (c) and (d) of 39
subsection (13) are amended, and new paragraphs (b) and (d) are 40
added to subsection (2) of that section, to read: 41
110.123 State group insurance program. — 42
(2) DEFINITIONS.—As used in ss. 110.123 -110.1239, the 43
term: 44
(b) "Eligible former employee" means a former state 45
officer or employee who was enrolled in the state group 46
insurance program for at least 6 cumulative years with an 47
employer or employers participating in the state group insurance 48
program, and who was enrolled in the state group insurance 49
program at the time of his or h er separation from employment and 50
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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
whose separation from employment occurred on or after July 1, 51
2022. 52
(c)(b) "Enrollee" means all state officers and employees, 53
retired state officers and employees, surviving spouses of 54
deceased state officers and employe es, eligible former 55
employees, and terminated employees or individuals with 56
continuation coverage who are enrolled in an insurance plan 57
offered by the state group insurance program. The term 58
"enrollee" includes all state university officers and employees, 59
retired state university officers and employees, surviving 60
spouses of deceased state university officers and employees, and 61
terminated state university employees or individuals with 62
continuation coverage who are enrolled in an insurance plan 63
offered by the state group insurance program. 64
(d) "Enrollee cost-sharing liability" means the amount an 65
enrollee or beneficiary is responsible for paying for a covered 66
item or service under the terms of the state group insurance 67
program. The term "enrollee cost -sharing liability" includes 68
deductibles, coinsurance, and copayments, but does not include 69
premiums. 70
(m)(k) "State group health insurance plan or plans" or 71
"state plan or plans" means the state self -insured health 72
insurance plan or plans offered to state offic ers and employees, 73
retired state officers and employees, eligible former employees, 74
and surviving spouses of deceased state officers , and employees, 75
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and eligible former employees under pursuant to this section. 76
(o)(m) "State group insurance program" or " programs" means 77
the package of insurance plans offered to state officers and 78
employees, retired state officers and employees, eligible former 79
employees, and surviving spouses of deceased state officers , and 80
employees, and eligible former employees under pursuant to this 81
section, including the state group health insurance plan or 82
plans, health maintenance organization plans, TRICARE 83
supplemental insurance plans, and other plans required or 84
authorized by law. 85
(q)(o) "Surviving spouse" means the widow or wid ower of a 86
deceased state officer, full -time state employee, part -time 87
state employee, eligible former employee, or retiree if such 88
widow or widower was covered as a dependent under the state 89
group health insurance plan, TRICARE supplemental insurance 90
plan, or a health maintenance organization plan established 91
under pursuant to this section at the time of the death of the 92
deceased officer, employee, eligible former employee, or 93
retiree. The term "surviving spouse" also means any widow or 94
widower who is recei ving or eligible to receive a monthly state 95
warrant from a state retirement system as the beneficiary of a 96
state officer, full-time state employee, or retiree who died 97
prior to July 1, 1979. For the purposes of this section, any 98
such widow or widower shall cease to be a surviving spouse upon 99
his or her remarriage. 100
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(3) STATE GROUP INSURANCE PROGRAM. — 101
(d)1. Notwithstanding chapter 287 and the authority of the 102
department, for the purpose of protecting the health of, and 103
providing medical services to, state employees and eligible 104
former employees participating in the state group insurance 105
program, the department may contract to retain the services of 106
professional administrators for the state group insurance 107
program. The agency shall follow good purchasing pr actices of 108
state procurement to the extent practicable under the 109
circumstances. 110
2. Each vendor in a major procurement, and any other 111
vendor if the department deems it necessary to protect the 112
state's financial interests, shall, at the time of executing a ny 113
contract with the department, post an appropriate bond with the 114
department in an amount determined by the department to be 115
adequate to protect the state's interests but not higher than 116
the full amount estimated to be paid annually to the vendor 117
under the contract. 118
3. Each major contract entered into by the department 119
under pursuant to this section must shall contain a provision 120
for payment of liquidated damages to the department for material 121
noncompliance by a vendor with a contract provision. The 122
department may require a liquidated damages provision in any 123
contract if the department deems it necessary to protect the 124
state's financial interests. 125
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4. Section 120.57(3) applies to the department's 126
contracting process, except: 127
a. A formal written pro test of any decision, intended 128
decision, or other action subject to protest must shall be filed 129
within 72 hours after receipt of notice of the decision, 130
intended decision, or other action. 131
b. As an alternative to any provision of s. 120.57(3), the 132
department may proceed with the bid selection or contract award 133
process if the director of the department sets forth, in 134
writing, particular facts and circumstances that demonstrate the 135
necessity of continuing the procurement process or the contract 136
award process in order to avoid a substantial disruption to the 137
provision of any scheduled insurance services. 138
5. The department shall make arrangements as necessary to 139
contribute claims data of the state group health insurance plan 140
to the contracted vendor selected by the Agency for Health Care 141
Administration under pursuant to s. 408.05(3)(c). 142
6. Each contracted vendor for the state group health 143
insurance plan shall contribute Florida claims data to the 144
contracted vendor selected by the Agency for Health Care 145
Administration under pursuant to s. 408.05(3)(c). 146
(g) Participation by individuals in the program is 147
available to all state officers, full -time state employees, and 148
part-time state employees , and eligible former employees and is 149
voluntary. Participation in the program is also available to 150
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retired state officers and employees who elect at the time of 151
retirement to continue coverage under the program, but may elect 152
to continue all or only part of the coverage they had at the 153
time of retirement. A surviving spouse may elect to continue 154
coverage only under a state group health insurance plan, a 155
TRICARE supplemental insurance plan, or a health maintenance 156
organization plan. 157
(j) For the 2020 plan year and each plan year thereafter, 158
health plans shall be offere d in the following benefit levels: 159
1. Platinum level, which shall have an actuarial value of 160
at least 90 percent. 161
2. Gold level, which shall have an actuarial value of at 162
least 80 percent. 163
3. Silver level, which shall have an actuarial value of at 164
least 70 percent. 165
4. Bronze level, which shall have an actuarial value of at 166
least 60 percent. 167
(4) PAYMENT OF PREMIUMS; CONTRIBUTION BY STATE; LIMITATION 168
ON ACTIONS TO PAY AND COLLECT PREMIUMS. — 169
(e) No state contribution for the cost of any part of the 170
premium shall be made for retirees , or surviving spouses, or 171
eligible former employees for any type of coverage under the 172
state group insurance program. However, any state agency that 173
employs a full-time law enforcement officer, correctional 174
officer, or correctional probation officer who is killed or 175
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suffers catastrophic injury in the line of duty as provided in 176
s. 112.19, or a full -time firefighter who is killed or suffers 177
catastrophic injury in the line of duty as provided in s. 178
112.191, shall pay the en tire premium of the state group health 179
insurance plan selected for the employee's surviving spouse 180
until remarried, and for each dependent child of the employee, 181
subject to the conditions and limitations set forth in s. 112.19 182
or s. 112.191, as applicable. 183
(13) OTHER-PERSONAL-SERVICES EMPLOYEES (OPS). — 184
(c) The initial measurement period used to determine 185
whether an employee hired before April 1, 2013, and paid from 186
OPS funds is a full-time employee described in subparagraph 187
(2)(e)1. subparagraph (2)(c)1 . is the 6-month period from April 188
1, 2013, through September 30, 2013. 189
(d) All other measurement periods used to determine 190
whether an employee paid from OPS funds is a full -time employee 191
described in paragraph (2)(e) paragraph (2)(c) must be for 12 192
consecutive months. 193
Section 2. Paragraph (a) of subsection (2) of section 194
110.12303, Florida Statutes, is amended to read: 195
110.12303 State group insurance program; additional 196
benefits; price transparency program; reporting. — 197
(2)(a) The department shall contract with at least one 198
entity that provides comprehensive pricing and inclusive 199
services for surgery and other medical procedures which may be 200
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accessed at the option of the enrollee. The contract shall 201
require the entity to: 202
1. The entity to have procedures and evidence -based 203
standards to ensure the inclusion of only high -quality health 204
care providers. 205
2. The entity to provide assistance to the enrollee in 206
accessing and coordinating care. 207
3. The entity to provide cost savings to the state group 208
insurance program to be shared with both the state and the 209
enrollee. Cost savings payable to an enrollee must, unless 210
prohibited by first-dollar coverage rules under applicable tax 211
law, include a waiver of enrollee cost -sharing liability for 212
surgery and other medical procedures. Cost savings may 213
additionally include amounts payable to an enrollee or 214
beneficiary as follows may be: 215
a. Credited to the enrollee's flexible spending account; 216
b. Credited to the enrollee's health savings account; 217
c. Credited to the enrollee's health reimbursement 218
account; or 219
d. Paid as additional health plan reimbursements not 220
exceeding the amount of the enrollee's out -of-pocket medical 221
expenses. 222
4. The entity, in conjunction with the department, to 223
provide an educational c ampaign for enrollees to learn about the 224
services offered by the entity. 225
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Section 3. Section 110.12306, Florida Statutes, is created 226
to read: 227
110.12306 Anti-fraud investigative units. — 228
(1) As used in this section, the term "designated anti -229
fraud unit" means a distinct unit within the Division of State 230
Group Insurance which is made up of employees whose principal 231
responsibilities are the investigation and disposition of claims 232
and who are also assigned to investigate fraud. 233
(2) By December 31, 2022, the division: 234
(a)1. Shall establish and maintain a designated anti -fraud 235
unit to investigate and report possible fraudulent insurance 236
acts by insureds, persons making claims for services against the 237
State Employees Health Insurance Trust Fund, or vendors under 238
contract with the division. 239
2. May contract with other entities to investigate and 240
report possible fraudulent insurance acts by insureds, persons 241
making claims for services against the State Employees Health 242
Insurance Trust Fund, or vend ors under contract with the 243
division. 244
(b) Shall adopt an anti -fraud plan. 245
(c) Shall designate staff with the primary responsibility 246
of implementing the requirements of this section. 247
Section 4. Section 110.12313, Florida Statutes, is created 248
to read: 249
110.12313 Enrollment for eligible former employees. —An 250
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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
eligible former employee may obtain health insurance coverage 251
under s. 110.123, and enroll in the state group insurance 252
program at any time within 24 months after his or her separation 253
from employment. The options provided to an eligible former 254
employee must be the same health insurance coverage and premium 255
payment conditions provided to covered retirees, except for life 256
insurance and flexible spending account plans. 257
Section 5. Subsection (3) of section 110.1239, Florida 258
Statutes, is amended to read: 259
110.1239 State group health insurance program funding. —It 260
is the intent of the Legislature that the state group health 261
insurance program be managed, administered, operated, and funded 262
in such a manner as to maximize the protection of state employee 263
health insurance benefits. Inherent in this intent is the 264
recognition that the health insurance liabilities attributable 265
to the benefits offered state employees should be fairly, 266
orderly, and equitably fu nded. Accordingly: 267
(3) For purposes of funding, any additional appropriation 268
amounts allocated to the state group health insurance program by 269
the Legislature shall be considered as a state contribution and 270
thus an increase in the state premiums. 271
Section 6. (1) The following rules are ratified for the 272
sole and exclusive purpose of satisfying any condition on 273
effectiveness imposed under s. 110.123(3)(h)2.d., Florida 274
Statutes: Rules 60P-1.003, 60P-2.002, and 60P-2.003, Florida 275
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Administrative Code, title d "Definitions," "Eligibility and 276
Enrollment," and "Changes in Coverage," respectively, as filed 277
for adoption with the Department of State pursuant to the 278
certification packages dated October 1, 2019, and November 4, 279
2021. 280
(2) This act may not be codifie d in the Florida Statutes. 281
After this act becomes law, its enactment and effective dates 282
shall be noted in the Florida Administrative Code or the Florida 283
Administrative Register, or both, as appropriate. This act does 284
not alter rulemaking authority delegat ed by prior law; provided 285
any amendment to a rule ratified pursuant to this act which 286
would modify the designated geographical areas for use in 287
procurements of Health Maintenance Organization services before 288
January 1, 2024, would require ratification by t he Legislature 289
before taking effect. This act does not constitute legislative 290
preemption of or exception to any provision of law governing 291
adoption or enforcement of the rules cited, and is intended to 292
preserve the status of any cited rule as a rule under chapter 293
120, Florida Statutes. This act does not cure any rulemaking 294
defect or preempt any challenge based on lack of authority or a 295
violation of the legal requirements governing the adoption of 296
any rule cited. 297
(3) This section shall take effect upon becoming a law. 298
Section 7. Except as otherwise expressly provided in this 299
act and except for this section, which shall take effect upon 300
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this act becoming a law, this act shall take effect July 1, 301
2022. 302