Florida 2023 Regular Session

Florida House Bill H0897 Compare Versions

Version 1 (Old)

Version 2 (New)

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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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14		-	1
	14	+	A bill to be entitled 1
15	15		An act relating to group health plans; amending s. 2
16	16		624.438, F.S.; making technical changes; revising the 3
17	17		definition of and providing requirements for bona fide 4
18	18		groups for purposes of issuance of certificates of 5
19	19		authority and multiple -employer welfare arrangements; 6
20	20		amending s. 624.441, F.S.; making a technical change; 7
21	21		amending s. 627.654, F.S.; conforming a provision to 8
22	22		changes made by the act; providing an effect ive date. 9
23	23		10
24	24		Be It Enacted by the Legislature of the State of Florida: 11
25	25		12
26	26		Section 1. Paragraph (b) of subsection (1) of section 13
27	27		624.438, Florida Statutes, is amended to read: 14
28	28		624.438 General eligibility. — 15
29	29		(1) To meet the requirements for issuance o f a certificate 16
30	30		of authority and to maintain a multiple -employer welfare 17
31	31		arrangement, an arrangement: 18
32	32		(b) Must be established by a trade association, industry 19
33	33		association, professional association of employers or 20
34	34		professionals, or a bona fide group that as defined in 29 C.F.R. 21
35	35		part 2510.3-5 which has a constitution or bylaws specifically 22
36	36		stating its purpose and that which has been organized for 23
37	37		purposes in addition to obtaining or providing insurance. 24
38	38		1. A trade association consists of employer members member 25
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51	51		employers who are in the same trade as recognized by the 26
52	52		appropriate licensing agency. 27
53	53		2. An industry association consists of employer members 28
54	54		member employers who are in the same major group code, as 29
55	55		defined by the Standard Industrial Classificat ion Manual issued 30
56	56		by the federal Office of Management and Budget, unless 31
57	57		restricted by subparagraph 1. or subparagraph 3. 32
58	58		3. A professional association consists of employer members 33
59	59		member employers who are of the same profession as recognized by 34
60	60		the appropriate licensing agency. 35
61	61		4. A bona fide group is a group or association of 36
62	62		employers which meets the following requirements: 37
63	63		a. The primary purpose of the group or association may be 38
64	64		to offer and provide health coverage to its employer members and 39
65	65		their employees. However, the group or association must also 40
66	66		have at least one substantial business purpose unrelated to such 41
67	67		primary purpose. For purposes of this sub -subparagraph, a 42
68	68		substantial business purpose is deemed to exist if the group or 43
69	69		association would be a viable entity in the absence of 44
70	70		sponsoring an employee benefit plan. A substantial business 45
71	71		purpose includes promoting common business interests in a given 46
72	72		trade or employer community and is not required to be a for -47
73	73		profit activity. 48
74	74		b. Each employer member of the group or association which 49
75	75		participates in the group health plan is a person acting 50
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88	88		directly as an employer of at least one employee who is a 51
89	89		participant covered under the plan. 52
90	90		c. The group or association has a formal organizationa l 53
91	91		structure with a governing body and has bylaws or other similar 54
92	92		indications of formality. 55
93	93		d. The functions and activities of the group or 56
94	94		association are controlled by its employer members, and the 57
95	95		group's or association's employer members that partici pate in 58
96	96		the group health plan control the plan. Control must be present 59
97	97		both in form and in substance. 60
98	98		e. The employer members have a principal place of business 61
99	99		in the same region that does not exceed the boundaries of a 62
100	100		single state or metropolitan are a, even if the metropolitan area 63
101	101		includes more than one state. 64
102	102		f. The group or association does not make health coverage 65
103	103		through the group's or association's group health plan available 66
104	104		to any person other than: 67
105	105		(I) An employee of a current employer member of the group 68
106	106		or association; 69
107	107		(II) A former employee of a current employer member of the 70
108	108		group or association who became eligible for coverage under the 71
109	109		group health plan when the former employee was an employee of 72
110	110		the employer; or 73
111	111		(III) A beneficiary, such as a spouse or dependent child, 74
112	112		of an individual described in sub -sub-subparagraph (I) or sub -75
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125	125		sub-subparagraph (II). 76
126	126		g. The group or association and the health coverage 77
127	127		offered by the group or association comply with the 78
128	128		nondiscrimination pro visions of s. 627.6699. 79
129	129		h. The group or association is not a health insurance 80
130	130		issuer as defined in s. 733(b)(2) of the Employee Retirement 81
131	131		Income Security Act of 1974, 29 U.S.C. s. 1191b(b)(2), or owned 82
132	132		or controlled by such a health insurance issuer or by a 83
133	133		subsidiary or affiliate of such a health insurance issuer, other 84
134	134		than to the extent such entities participate in the group or 85
135	135		association in their capacity as employer members of the group 86
136	136		or association. 87
137	137		88
138	138		The requirements of this paragraph do not app ly to an 89
139	139		arrangement licensed before April 1, 1995, regardless of the 90
140	140		nature of its business. However, an arrangement exempt from the 91
141	141		requirements of this paragraph may not expand the nature of its 92
142	142		business beyond that set forth in the articles of incorpor ation 93
143	143		of its sponsoring association as of April 1, 1995, except as 94
144	144		authorized in this paragraph. 95
145	145		Section 2. Subsection (1) of section 624.441, Florida 96
146	146		Statutes, is amended to read: 97
147	147		624.441 Insolvency protection. — 98
148	148		(1) To assure the faithful performa nce of its obligations 99
149	149		to its employer members member employers and covered employees 100
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162	162		and their dependents, every arrangement shall deposit with the 101
163	163		department cash, securities of the type eligible for deposit by 102
164	164		insurers under s. 625.52, or any combinatio n of these, in an 103
165	165		amount equal to 25 percent of the preceding 12 months' health 104
166	166		care claims expenditures or 5 percent of gross annual premiums 105
167	167		for the succeeding year, whichever is greater, which deposit 106
168	168		shall be made within 30 days after the close of each fiscal 107
169	169		year; however, in no case shall the amount of the deposit exceed 108
170	170		$500,000. 109
171	171		Section 3. Paragraph (a) of subsection (1) of section 110
172	172		627.654, Florida Statutes, is amended to read: 111
173	173		627.654 Labor union, association, and small employer health 112
174	174		alliance groups.— 113
175	175		(1)(a) A bona fide group as defined in s. 624.438(1)(b)4., 114
176	176		an or association of employers, as defined in 29 C.F.R. part 115
177	177		2510.3-5, or a group of individuals may be insured under a 116
178	178		policy issued to an association, including a labor union, which 117
179	179		association has a constitution and bylaws and which has been 118
180	180		organized for purposes in addition to that of obtaining 119
181	181		insurance, or to the trustees of a fund established by such an 120
182	182		association, which association or trustees shall be deemed the 121
183	183		policyholder, insuring at least 15 individual members of the 122
184	184		association for the benefit of persons other than the officers 123
185	185		of the association, the association, or trustees. 124
186	186		Section 4. This act shall take effect upon becoming a law. 125