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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 Florida Health Choices Program; 2
amending s. 408.910, F.S.; renaming the "Florida 3
Health Choices Program" as the "Florida Employee 4
Health Choices Program"; revising legislative intent; 5
revising definitions; revising program purpose and 6
components to provide for the sale and purchase of 7
individual health insurance plans to employees 8
enrolled in individual coverage health reimbursement 9
arrangements; removing provisions relating to certain 10
health care service providers, organizations, 11
entities, and vendors, vendor procedures, products 12
available for purchase through the program, pricing, 13
risk pooling, and exemptions; revising the marketplace 14
process; requiring the Department of Management 15
Services to facilitate the formation of Florida 16
Employee Health Choices, Inc., and provide 17
administrative support; revising membership of the 18
board of directors; authorizing the corporation to 19
exercise certain powers; providing requirements for 20
the board and the corporation; revising the fiscal 21
year in which the corporation's annual report is due; 22
amending ss. 409.821, 409.9122, and 409.977, F.S.; 23
conforming provisions to changes made by the act; 24
providing an effective date. 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
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Be It Enacted by the Legislature of the State of Florida: 27
28
Section 1. Section 408.910, Florida Statutes, is amended 29
to read: 30
408.910 Florida Employee Health Choices Program. — 31
(1) LEGISLATIVE INTENT. —The Legislature finds that a 32
significant number of employers and employees in the residents 33
of this state do not have adequate access to affordable, quality 34
health insurance that meets their needs care. The Legislature 35
further finds that individual coverage health reimbursement 36
arrangements offer a novel way for employers of any size to give 37
health care contributions directly to employees and empower them 38
to choose their own health plan in a broad marketplace based on 39
individual financial needs and health factors. The Legislature 40
further finds that increasing access to affordable, quality 41
health care through individual coverage health reimbursement 42
arrangements can be best accomplished by establishing a 43
competitive marketplace market for employees that receive 44
employer premium contribution s through individual coverage 45
health reimbursement arrangements purchasing health insurance 46
and health services. It is therefore the intent of the 47
Legislature to create the Florida Employee Health Choices 48
Program to: 49
(a) Expand opportunities for employers and employees 50
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Floridians to access purchase affordable health insurance in 51
this state and health services. 52
(b) Create a platform that streamlines the purchase of 53
individual coverage for employees enrolled in individual 54
coverage health reimbursement arr angements Preserve the benefits 55
of employment-sponsored insurance while easing the 56
administrative burden for employers who offer these benefits . 57
(c) Enable individual choice in both the manner and amount 58
of health care purchased. 59
(d) Provide for the pu rchase of individual, portable 60
health care coverage. 61
(e) Disseminate information to employers and employees 62
about individual coverage health reimbursement arrangements 63
consumers on the price and quality of health services . 64
(f) Sponsor a competitive mar ket that stimulates product 65
innovation, quality improvement, and efficiency in the 66
production and delivery of individual health insurance plans to 67
employees enrolled in individual coverage health reimbursement 68
arrangements health services. 69
(2) DEFINITIONS.—As used in this section, the term: 70
(a) "Corporation" means the Florida Employee Health 71
Choices, Inc., established under this section. 72
(b) "Corporation's marketplace" means the single, 73
centralized market established by the program that facilitates 74
the purchase of products made available in the marketplace. 75
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(c) "Health insurance agent" means an agent licensed under 76
part IV of chapter 626. 77
(d) "Insurer" means an entity licensed under chapter 624 78
which offers an individual health insurance policy or a group 79
health insurance policy , a preferred provider organization as 80
defined in s. 627.6471, an exclusive provider organization as 81
defined in s. 627.6472, or a health maintenance organization 82
licensed under part I of chapter 641 , or a prepaid limited 83
health service organization or discount plan organization 84
licensed under chapter 636 . 85
(e) "Program" means the Florida Employee Health Choices 86
Program established by this section. 87
(3) PROGRAM PURPOSE AND COMPONENTS. —The Florida Employee 88
Health Choices Progr am is created as a single, centralized 89
market for the sale and purchase of individual health insurance 90
plans to employees enrolled in individual coverage health 91
reimbursement arrangements various products that enable 92
individuals to pay for health care. The se products include, but 93
are not limited to, health insurance plans, health maintenance 94
organization plans, prepaid services, service contracts, and 95
flexible spending accounts . The components of the program 96
include: 97
(a) Enrollment of employers. 98
(b) Administrative services for participating employers, 99
including: 100
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1. Assistance in seeking federal approval of cafeteria 101
plans. 102
2. Collection of premiums and other payments. 103
3. Management of individual benefit accounts. 104
4. Distribution of premiums to in surers and payments to 105
other eligible vendors. 106
5. Assistance for participants in complying with reporting 107
requirements. 108
(c) Services to individual participants, including: 109
1. Information about available products and participating 110
vendors. 111
2. Assistance with assessing the benefits and limits of 112
each product, including information necessary to distinguish 113
between policies offering creditable coverage and other products 114
available through the program . 115
3. Account information to assist individual partic ipants 116
with managing available resources. 117
4. Services that promote healthy behaviors. 118
(d) Recruitment of vendors, including insurers and, health 119
maintenance organizations , prepaid clinic service providers, 120
provider service networks, and other providers . 121
(e) Certification of vendors to ensure capability, 122
reliability, and validity of offerings. 123
(f) Collection of data, monitoring, assessment, and 124
reporting of vendor performance. 125
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(g) Information services for individuals and employers. 126
(h) Program evaluation. 127
(4) ELIGIBILITY AND PARTICIPATION. —Participation in the 128
program is voluntary and shall be available to employers, 129
individuals, vendors, and health insurance agents as specified 130
in this subsection. 131
(a) Employers eligible to enroll in the progr am include 132
those employers that meet criteria established by the 133
corporation and elect to make their employees eligible through 134
the program. 135
(b) Individuals eligible to participate in the program 136
include: 137
1. Individual employees of enrolled employers. 138
2. Other individuals that meet criteria established by the 139
corporation. 140
(c) Employers who choose to participate in the program may 141
enroll by complying with the procedures established by the 142
corporation. The procedures must include, but are not limited 143
to: 144
1. Submission of required information. 145
2. Compliance with federal tax requirements for the 146
establishment of a cafeteria plan, pursuant to s. 125 of the 147
Internal Revenue Code, including designation of the employer's 148
plan as a premium payment plan, a salary reduction plan that has 149
flexible spending arrangements, or a salary reduction plan that 150
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has a premium payment and flexible spending arrangements. 151
3. Determination of the employer's contribution, if any, 152
per employee, provided that such contributi on is equal for each 153
eligible employee. 154
4. Establishment of payroll deduction procedures, subject 155
to the agreement of each individual employee who voluntarily 156
participates in the program. 157
5. Designation of the corporation as the third -party 158
administrator for the employer's health benefit plan. 159
6. Identification of eligible employees. 160
7. Arrangement for periodic payments. 161
8. Employer notification to employees of the intent to 162
transfer from an existing employee health plan to the program at 163
least 90 days before the transition. 164
(d) All eligible vendors who choose to participate and the 165
products and services that the vendors are permitted to sell are 166
as follows: 167
1. Insurers licensed under chapter 624 may sell health 168
insurance policies, limited benefit policies, other risk -bearing 169
coverage, and other products or services . 170
2. Health maintenance organizations licensed under part I 171
of chapter 641 may sell health maintenance contracts , limited 172
benefit policies, other risk -bearing products, and other 173
products or services . 174
3. Prepaid limited health service organizations may sell 175
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products and services as authorized under part I of chapter 636, 176
and discount plan organizations may sell products and services 177
as authorized under part II of chapter 636. 178
4. Prepaid health clinic service providers licensed under 179
part II of chapter 641 may sell prepaid service contracts and 180
other arrangements for a specified amount and type of health 181
services or treatments. 182
5. Health care providers, including hospi tals and other 183
licensed health facilities, health care clinics, licensed health 184
professionals, pharmacies, and other licensed health care 185
providers, may sell service contracts and arrangements for a 186
specified amount and type of health services or treatment s. 187
6. Provider organizations, including service networks, 188
group practices, professional associations, and other 189
incorporated organizations of providers, may sell service 190
contracts and arrangements for a specified amount and type of 191
health services or tre atments. 192
7. Corporate entities providing specific health services 193
in accordance with applicable state law may sell service 194
contracts and arrangements for a specified amount and type of 195
health services or treatments. 196
197
A vendor described in subparagraphs 3 .-7. may not sell products 198
that provide risk-bearing coverage unless that vendor is 199
authorized under a certificate of authority issued by the Office 200
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of Insurance Regulation and is authorized to provide coverage in 201
the relevant geographic area. Otherwise Eligible vendors may be 202
excluded from participating in the program for deceptive or 203
predatory practices, financial insolvency, or failure to comply 204
with the terms of the participation agreement or other standards 205
set by the corporation. 206
(e) Eligible indivi duals may participate in the program 207
voluntarily. Individuals who join the program may participate by 208
complying with the procedures established by the corporation. 209
These procedures must include, but are not limited to: 210
1. Submission of required informati on. 211
2. Authorization for payroll deduction. 212
3. Compliance with federal tax requirements. 213
4. Arrangements for payment. 214
5. Selection of products and services. 215
(f) Vendors who choose to participate in the program may 216
enroll by complying with the pro cedures established by the 217
corporation. These procedures may include, but are not limited 218
to: 219
1. Submission of required information, including a 220
complete description of the coverage, services, provider 221
network, payment restrictions, and other requirement s of each 222
product offered through the program. 223
2. Execution of an agreement to comply with requirements 224
established by the corporation. 225
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3. Execution of an agreement that prohibits refusal to 226
sell any offered product or service to a participant who elec ts 227
to buy it. 228
4. Establishment of product prices based on applicable 229
criteria. 230
4.5. Arrangements for receiving payment for enrolled 231
participants. 232
5.6. Participation in ongoing reporting processes 233
established by the corporation. 234
6.7. Compliance with grievance procedures established by 235
the corporation. 236
(g) Health insurance agents licensed under part IV of 237
chapter 626 are eligible to voluntarily participate as buyers' 238
representatives. A buyer's representative acts on behalf of an 239
individual purchasing health insurance and health services 240
through the program by providing information about products and 241
services available through the program and assisting the 242
individual with both the decision and the procedure of selecting 243
specific products. Serving as a buyer's representative does not 244
constitute a conflict of interest with continuing 245
responsibilities as a health insurance agent if the relationship 246
between each agent and any participating vendor is disclosed 247
before advising an individual participant about the products and 248
services available through the progra m. In order to participate, 249
a health insurance agent shall comply with the procedures 250
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established by the corporation, including: 251
1. Completion of training requirements. 252
2. Execution of a participation agreement specifying the 253
terms and conditions of pa rticipation. 254
3. Disclosure of any appointments to solicit insurance or 255
procure applications for vendors participating in the program. 256
4. Arrangements to receive payment from the corporation 257
for services as a buyer's representative. 258
(5) PRODUCTS.— 259
(a) The products that may be made available for purchase 260
through the program include , but are not limited to : 261
(a)1. Health insurance policies. 262
(b)2. Health maintenance contracts. 263
3. Limited benefit plans. 264
4. Prepaid clinic services. 265
5. Service contracts. 266
6. Arrangements for purchase of specific amounts and types 267
of health services and treatments. 268
7. Flexible spending accounts. 269
(b) Health insurance policies, health maintenance 270
contracts, limited benefit plans, prepaid service contracts, and 271
other contracts for services must ensure the availability of 272
covered services. 273
(c) Products may be offered for multiyear periods provided 274
the price of the product is specified for the entire period or 275
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for each separately priced segment of the policy or con tract. 276
(d) The corporation shall provide a disclosure form for 277
consumers to acknowledge their understanding of the nature of, 278
and any limitations to, the benefits provided by the products 279
and services being purchased by the consumer. 280
(e) The corporation must determine that making the plan 281
available through the program is in the interest of eligible 282
individuals and eligible employers in the state. 283
(6) SURCHARGE PRICING.—Prices for the products and 284
services sold through the program must be transparent t o 285
participants and established by the vendors. The corporation 286
shall annually assess a surcharge for each premium or price set 287
by a participating vendor. The surcharge may not be more than 288
2.5 percent of the price and shall be used to generate funding 289
for administrative services provided by the corporation and 290
payments to buyers' representatives. 291
(7) THE MARKETPLACE PROCESS. —The program shall provide a 292
single, centralized market for access to purchase of health 293
insurance and, health maintenance contracts by an employee 294
enrolled in an individual coverage health reimbursement 295
arrangement, and other health products and services . Purchases 296
may be made by participating individuals over the Internet or 297
through the services of a participating health insurance age nt. 298
Information about each product and service available through the 299
program shall be made available through printed material and an 300
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interactive Internet website. A participant needing personal 301
assistance to select products and services shall be referred t o 302
a participating agent in his or her area. 303
(a) Participation in the program may begin at any time 304
during a year after the employer completes enrollment and meets 305
the requirements specified by the corporation pursuant to 306
paragraph (4)(c). 307
(b) Initial selection of products and services must be 308
made by an individual participant within the applicable open 309
enrollment period. 310
(c) Initial enrollment periods for each product selected 311
by an individual participant must last at least 12 months, 312
unless the individual participant specifically agrees to a 313
different enrollment period. 314
(d) If an individual has selected one or more products and 315
enrolled in those products for at least 12 months or any other 316
period specifically agreed to by the individual participant, 317
changes in selected products and services may only be made 318
during the annual enrollment period established by the 319
corporation. 320
(e) The limits established in paragraphs (b) -(d) apply to 321
any risk-bearing product that promises future payment or 322
coverage for a variable amount of benefits or services. The 323
limits do not apply to initiation of flexible spending plans if 324
those plans are not associated with specific high -deductible 325
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insurance policies or the use of spending accounts for any 326
products offering indiv idual participants specific amounts and 327
types of health services and treatments at a contracted price. 328
(8) CONSUMER INFORMATION. —The corporation shall: 329
(a) Establish a secure website to facilitate the purchase 330
of products and services by participating individuals. The 331
website must provide information about each product or service 332
available through the program. 333
(b) Inform individuals about other public health care 334
programs. 335
(9) RISK POOLING.—The program may use methods for pooling 336
the risk of individual participants and preventing selection 337
bias. These methods may include, but are not limited to, a 338
postenrollment risk adjustment of the premium payments to the 339
vendors. The corporation may establish a methodology for 340
assessing the risk of enrolled indiv idual participants based on 341
data reported annually by the vendors about their enrollees. 342
Distribution of payments to the vendors may be adjusted based on 343
the assessed relative risk profile of the enrollees in each 344
risk-bearing product for the most recent p eriod for which data 345
is available. 346
(9)(10) EXEMPTIONS.— 347
(a) Products, other than the products set forth in 348
subparagraphs (4)(d)1. -4., sold as part of the program are not 349
subject to the licensing requirements of the Florida Insurance 350
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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
Code, as defined in s. 624.01 or the mandated offerings or 351
coverages established in part VI of chapter 627 and chapter 641. 352
(b) The corporation may act as an administrator as defined 353
in s. 626.88 but is not required to be certified pursuant to 354
part VII of chapter 626. Howe ver, a third party administrator 355
used by the corporation must be certified under part VII of 356
chapter 626. 357
(c) Any standard forms, website design, or marketing 358
communication developed by the corporation and used by the 359
corporation, or any vendor that meets the requirements of 360
paragraph (4)(f) is not subject to the Florida Insurance Code, 361
as established in s. 624.01. 362
(10) CORPORATION.—There is created the Florida Employee 363
Health Choices, Inc., which shall be registered, incorporated, 364
organized, and operated in compliance with part III of chapter 365
112 and chapters 119, 286, and 617. The purpose of the 366
corporation is to administer the program created in this section 367
and to conduct such other business as may further the 368
administration of the program. The D epartment of Management 369
Services shall facilitate the formation of the corporation and 370
provide administrative support for the corporation until January 371
1, 2028. The corporation must be self -sustaining and no longer 372
require administrative assistance from th e Department of 373
Management Services by January 1, 2028. 374
(a) The corporation shall be governed by an eight -member 375
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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
board of directors. Board members shall be appointed for terms 376
of up to 3 years and shall be eligible for reappointment. A 377
vacancy on the board shall be filled for the unexpired portion 378
of the term in the same manner as the original appointment. 379
Board members may not include an affiliate or subsidiary of an 380
eligible vendor. Board members shall serve without compensation, 381
but are entitled to rec eive, from funds of the corporation, 382
reimbursement for per diem and travel expenses as provided in s. 383
112.061. The membership of the board shall consist of: 384
1. Three members appointed by the Governor. 385
2. Two members appointed by the President of the Se nate. 386
3. Two members appointed by the Speaker of the House of 387
Representatives. 388
4. The Secretary of Management Services or a designee with 389
expertise in state employee benefits and procurement as an ex 390
officio, nonvoting member. 391
(b) The corporation may exercise all powers granted to it 392
under chapter 617 necessary to carry out the purposes of this 393
section, including, but not limited to, the power to receive and 394
accept grants, loans, or advances of funds from any public or 395
private agency and to receive an d accept from any source 396
contributions of money, property, labor, or any other thing of 397
value to be held, used, and applied for the purposes of this 398
section. 399
(c) There is no liability on the part of, and no cause of 400
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action shall arise against, any member of the board or its 401
employees or agents for any action taken by them in the 402
performance of their powers and duties under this section. 403
(d) The board shall develop and adopt bylaws and other 404
corporate procedures necessary for the operation of the 405
corporation and carrying out the purposes of this section. At a 406
minimum, the bylaws shall: 407
1. Specify procedures for selection of officers and 408
qualifications for reappointment, provided that a board member 409
may not serve more than 9 consecutive years. 410
2. Require an annual membership meeting that provides an 411
opportunity for input and interaction with individual 412
participants in the program. 413
3. Specify policies and procedures regarding conflicts of 414
interest, including part III of chapter 112, which prohibit a 415
member from participating in any decision that would inure to 416
the benefit of the member or the organization that employs the 417
member. The policies and procedures shall also require public 418
disclosure of the interest that prevents the member from 419
participating in a decision on a particular matter. 420
4. Specify procedures for adopting an annual budget. 421
5. Specify procedures for selecting a chief executive 422
officer for the corporation who shall be responsible for 423
securing staff and consultant services necessary f or the 424
operation of the program as may be authorized by the 425
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corporation's operating budget. 426
(e) The corporation must establish policies and procedures 427
for application, enrollment, plan administration, performance 428
monitoring, and consumer education, and o ther policies and 429
procedures necessary for the operation of the program, 430
including, but not limited to: 431
1. Criteria for participation in the program, and 432
procedures for determining the eligibility of employers, 433
vendors, individuals, and health insurance agents and employers 434
to participate in the program. 435
2. Exclusion of vendors pursuant to paragraph (4)(d). 436
3. Collection of contributions from participating 437
employers and individuals. 438
4. Payment of premiums and other appropriate disbursements 439
based on the selections of products and services by the 440
individual participants. 441
5. Disenrollment of participating individuals based on 442
failure to pay the individual's share of any contribution 443
required to maintain enrollment in selected products. 444
(f) The corporation shall procure a vendor to facilitate a 445
platform that streamlines the purchase of individual coverage 446
for employees enrolled in individual health coverage 447
reimbursement arrangements. 448
1. Within 90 days after the formation of the corporation, 449
the department shall, as directed by the board, issue an 450
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invitation to negotiate to procure the vendor. Responsive 451
bidders shall demonstrate the ability to establish a platform 452
fully operational for open enrollment by January 1, 2027, and 453
provide for initial, o pen, and special enrollment periods. 454
2. The department shall evaluate and score the procurement 455
bids, enter into negotiations at the direction of the board, and 456
make recommendations to the board related to the contract award. 457
The corporation shall select the vendor and execute the contract 458
within 180 days after the issuance of the invitation to 459
negotiate. 460
(g) The corporation must develop and implement a plan for 461
promoting public awareness of and participation in the program, 462
and must establish a toll -free hotline to respond to requests 463
for assistance from employers and plan enrollees. 464
(h) The corporation may evaluate and implement additional 465
options for employer participation which conform with common 466
insurance practices. 467
(11) CORPORATION.—There is created the Florida Health 468
Choices, Inc., which shall be registered, incorporated, 469
organized, and operated in compliance with part III of chapter 470
112 and chapters 119, 286, and 617. The purpose of the 471
corporation is to administer the program created in thi s section 472
and to conduct such other business as may further the 473
administration of the program. 474
(a) The corporation shall be governed by a 15 -member board 475
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of directors consisting of: 476
1. Three ex officio, nonvoting members to include: 477
a. The Secretary of Health Care Administration or a 478
designee with expertise in health care services. 479
b. The Secretary of Management Services or a designee with 480
expertise in state employee benefits. 481
c. The commissioner of the Office of Insurance Regulation 482
or a designee with expertise in insurance regulation. 483
2. Four members appointed by and serving at the pleasure 484
of the Governor. 485
3. Four members appointed by and serving at the pleasure 486
of the President of the Senate. 487
4. Four members appointed by and serving at th e pleasure 488
of the Speaker of the House of Representatives. 489
5. Board members may not include insurers, health 490
insurance agents or brokers, health care providers, health 491
maintenance organizations, prepaid service providers, or any 492
other entity, affiliate o r subsidiary of eligible vendors. 493
(b) Members shall be appointed for terms of up to 3 years. 494
Any member is eligible for reappointment. A vacancy on the board 495
shall be filled for the unexpired portion of the term in the 496
same manner as the original appoint ment. 497
(c) The board shall select a chief executive officer for 498
the corporation who shall be responsible for the selection of 499
such other staff as may be authorized by the corporation's 500
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operating budget as adopted by the board. 501
(d) Board members are enti tled to receive, from funds of 502
the corporation, reimbursement for per diem and travel expenses 503
as provided by s. 112.061. No other compensation is authorized. 504
(e) There is no liability on the part of, and no cause of 505
action shall arise against, any membe r of the board or its 506
employees or agents for any action taken by them in the 507
performance of their powers and duties under this section. 508
(f) The board shall develop and adopt bylaws and other 509
corporate procedures as necessary for the operation of the 510
corporation and carrying out the purposes of this section. The 511
bylaws shall: 512
1. Specify procedures for selection of officers and 513
qualifications for reappointment, provided that no board member 514
shall serve more than 9 consecutive years. 515
2. Require an annua l membership meeting that provides an 516
opportunity for input and interaction with individual 517
participants in the program. 518
3. Specify policies and procedures regarding conflicts of 519
interest, including the provisions of part III of chapter 112, 520
which prohibit a member from participating in any decision that 521
would inure to the benefit of the member or the organization 522
that employs the member. The policies and procedures shall also 523
require public disclosure of the interest that prevents the 524
member from participating in a decision on a particular matter. 525
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(g) The corporation may exercise all powers granted to it 526
under chapter 617 necessary to carry out the purposes of this 527
section, including, but not limited to, the power to receive and 528
accept grants, loans, or advances of funds from any public or 529
private agency and to receive and accept from any source 530
contributions of money, property, labor, or any other thing of 531
value to be held, used, and applied for the purposes of this 532
section. 533
(h) The corporation shall: 534
1. Determine eligibility of employers, vendors, 535
individuals, and agents in accordance with subsection (4). 536
2. Establish procedures necessary for the operation of the 537
program, including, but not limited to, procedures for 538
application, enrollment, risk assessment, risk adjustment, plan 539
administration, performance monitoring, and consumer education. 540
3. Arrange for collection of contributions from 541
participating employers and individuals. 542
4. Arrange for payment of premiums and other appropriate 543
disbursements based on the selections of products and services 544
by the individual participants. 545
5. Establish criteria for disenrollment of participating 546
individuals based on failure to pay the individual's share of 547
any contribution required to maintain enrollment in selected 548
products. 549
6. Establish criteria for exclusion of vendors pursuant to 550
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paragraph (4)(d). 551
7. Develop and implement a plan for promoting public 552
awareness of and participation in the program. 553
8. Secure staff and consultant services necessary to the 554
operation of the program. 555
9. Establish policies and procedures regarding 556
participation in the program for individuals, vendors, health 557
insurance agents, and employers. 558
10. Provide for the operation of a toll -free hotline to 559
respond to requests for assistance. 560
11. Provide for initial, open, and special enrollment 561
periods. 562
12. Evaluate options for employer participation which may 563
conform with common insurance practices. 564
(11)(12) REPORT.—Beginning in the 2026-2027 2009-2010 565
fiscal year, submit by February 1 an annual report to the 566
Governor, the President of the Senate, and the Speaker of the 567
House of Representatives documenting the corporation's 568
activities in compliance with the duties delineated in this 569
section. 570
(12)(13) PROGRAM INTEGRITY.—To ensure program integrity 571
and to safeguard the financial transactions made under the 572
auspices of the program, the corporation is authorized to 573
establish qualifying criteria and certification procedures for 574
vendors, require performance bonds or other guar antees of 575
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ability to complete contractual obligations, monitor the 576
performance of vendors, and enforce the agreements of the 577
program through financial penalty or disqualification from the 578
program. 579
(13)(14) EXEMPTION FROM PUBLIC RECORDS REQUIREMENTS. — 580
(a) Definitions.—For purposes of this subsection, the 581
term: 582
1. "Buyer's representative" means a participating 583
insurance agent as described in paragraph (4)(g). 584
2. "Enrollee" means an employer who is eligible to enroll 585
in the program pursuant to paragrap h (4)(a). 586
3. "Participant" means an individual who is eligible to 587
participate in the program pursuant to paragraph (4)(b). 588
4. "Proprietary confidential business information" means 589
information, regardless of form or characteristics, that is 590
owned or controlled by a vendor requesting confidentiality under 591
this section; that is intended to be and is treated by the 592
vendor as private in that the disclosure of the information 593
would cause harm to the business operations of the vendor; that 594
has not been disclos ed unless disclosed pursuant to a statutory 595
provision, an order of a court or administrative body, or a 596
private agreement providing that the information may be released 597
to the public; and that is information concerning: 598
a. Business plans. 599
b. Internal auditing controls and reports of internal 600
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auditors. 601
c. Reports of external auditors for privately held 602
companies. 603
d. Client and customer lists. 604
e. Potentially patentable material. 605
f. A trade secret as defined in s. 688.002. 606
5. "Vendor" means a par ticipating insurer or other 607
provider of services as described in paragraph (4)(d). 608
(b) Public record exemptions. — 609
1. Personal identifying information of an enrollee or 610
participant who has applied for or participates in the Florida 611
Employee Health Choices Program is confidential and exempt from 612
s. 119.07(1) and s. 24(a), Art. I of the State Constitution. 613
2. Client and customer lists of a buyer's representative 614
held by the corporation are confidential and exempt from s. 615
119.07(1) and s. 24(a), Art. I of the State Constitution. 616
3. Proprietary confidential business information held by 617
the corporation is confidential and exempt from s. 119.07(1) and 618
s. 24(a), Art. I of the State Constitution. 619
(c) Retroactive application. —The public record exemptions 620
provided for in paragraph (b) apply to information held by the 621
corporation before, on, or after the effective date of this 622
exemption. 623
(d) Authorized release. — 624
1. Upon request, information made confidential and exempt 625
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pursuant to this subsection shall be d isclosed to: 626
a. Another governmental entity in the performance of its 627
official duties and responsibilities. 628
b. Any person who has the written consent of the program 629
applicant. 630
c. The Florida Kidcare program for the purpose of 631
administering the progra m authorized in ss. 409.810 -409.821. 632
2. Paragraph (b) does not prohibit a participant's legal 633
guardian from obtaining confirmation of coverage, dates of 634
coverage, the name of the participant's health plan, and the 635
amount of premium being paid. 636
(e) Penalty.—A person who knowingly and willfully violates 637
this subsection commits a misdemeanor of the second degree, 638
punishable as provided in s. 775.082 or s. 775.083. 639
Section 2. Paragraph (a) of subsection (2) of section 640
409.821, Florida Statutes, is a mended to read: 641
409.821 Florida Kidcare program public records exemption. — 642
(2)(a) Upon request, such information shall be disclosed 643
to: 644
1. Another governmental entity in the performance of its 645
official duties and responsibilities; 646
2. The Department of Revenue for purposes of administering 647
the state Title IV-D program; 648
3. The Florida Employee Health Choices, Inc., for the 649
purpose of administering the program authorized pursuant to s. 650
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408.910; or 651
4. Any person who has the written consent of the pr ogram 652
applicant. 653
Section 3. Subsection (3) of section 409.9122, Florida 654
Statutes, is amended to read: 655
409.9122 Medicaid managed care enrollment; HIV/AIDS 656
patients; procedures; data collection; accounting; information 657
system; medical loss ratio. — 658
(3) The agency shall develop a process to enable any 659
recipient with access to employer -sponsored health care coverage 660
to opt out of all eligible plans in the Medicaid program and to 661
use Medicaid financial assistance to pay for the recipient's 662
share of cost in any such employer-sponsored coverage. 663
Contingent on federal approval, the agency shall also enable 664
recipients with access to other insurance or related products 665
that provide access to health care services created pursuant to 666
state law, including any plan or product available pursuant to 667
the Florida Employee Health Choices Program or any health 668
exchange, to opt out. The amount of financial assistance 669
provided for each recipient may not exceed the amount of the 670
Medicaid premium that would have been paid to a plan for that 671
recipient. 672
Section 4. Subsection (4) of section 409.977, Florida 673
Statutes, is amended to read: 674
409.977 Enrollment. — 675
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(4) The agency shall develop a process to enable a 676
recipient with access to employer -sponsored health care coverage 677
to opt out of all managed care plans and to use Medicaid 678
financial assistance to pay for the recipient's share of the 679
cost in such employer -sponsored coverage. The agency shall also 680
enable recipients with access to other insurance or related 681
products providing access to health care services created 682
pursuant to state law, including any product available under the 683
Florida Employee Health Choices Program, or any health exchange, 684
to opt out. The amount of financial assistance provided for each 685
recipient may not exceed the amount of the Medicaid premium that 686
would have been paid to a managed care plan for that recipient. 687
The agency shall require Medicaid recipients with access to 688
employer-sponsored health care coverage to enroll in that 689
coverage and use Medicaid financial assistance to pay for the 690
recipient's share of the cost for such coverage. The amount of 691
financial assistance provided for each recipient may not exceed 692
the amount of the Medicaid premium that would have been paid to 693
a managed care plan for that recipient. 694
Section 5. This act shall take effect July 1, 2025. 695