FL
Florida House Bill H0905

Florida 2025 Regular Session

Florida House Bill H0905 Compare Versions

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1010 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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1414 A bill to be entitled 1
1515 An act relating to the Florida Health Choices Program; 2
16-amending s. 408.910, F.S.; renaming the "Florida 3
17-Health Choices Program" as the "Florida Employee 4
18-Health Choices Program"; revising legislative intent; 5
19-revising definitions; revising program purpose and 6
20-components to provide for the sale and purchase of 7
16+amending s. 408.910, F.S.; revising the name of the 3
17+"Florida Health Choices Program" to the "Florida 4
18+Employee Health Choices Program"; revising legislative 5
19+intent; revising definitions; revising program purpose 6
20+and components to provide for the sale and purchase of 7
2121 individual health insurance plans to employees 8
2222 enrolled in individual coverage health reimb ursement 9
2323 arrangements; removing provisions relating to certain 10
2424 health care service providers, organizations, 11
2525 entities, and vendors, vendor procedures, products 12
2626 available for purchase through the program, pricing, 13
2727 risk pooling, and exemptions; revising the marketplace 14
28-process; requiring the Department of Management 15
29-Services to facilitate the formation of Florida 16
30-Employee Health Choices, Inc., and provide 17
31-administrative support; revising membership of the 18
32-board of directors; authorizing the corporation to 19
33-exercise certain powers; providing requirements for 20
34-the board and the corporation; revising the fiscal 21
35-year in which the corporation's annual report is due; 22
36-amending ss. 409.821, 409.9122, and 409.977, F.S.; 23
37-conforming provisions to changes made by the act; 24
38-providing an effective date. 25
28+process; revising corporation responsibilities; 15
29+revising the fiscal year in which the corporation's 16
30+annual report is due; amending ss. 409.821, 409.9122, 17
31+and 409.977, F.S.; conforming provisions to changes 18
32+made by the act; providing an effectiv e date. 19
33+ 20
34+Be It Enacted by the Legislature of the State of Florida: 21
35+ 22
36+ Section 1. Section 408.910, Florida Statutes, is amended 23
37+to read: 24
38+ 408.910 Florida Employee Health Choices Program. — 25
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4747 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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51- 26
52-Be It Enacted by the Legislature of the State of Florida: 27
53- 28
54- Section 1. Section 408.910, Florida Statutes, is amended 29
55-to read: 30
56- 408.910 Florida Employee Health Choices Program. — 31
57- (1) LEGISLATIVE INTENT. —The Legislature finds that a 32
58-significant number of employers and employees in the residents 33
59-of this state do not have adequate access to affordable, quality 34
60-health insurance that meets their needs care. The Legislature 35
61-further finds that individual coverage health reimbursement 36
62-arrangements offer a novel way for employers of any size to give 37
63-health care contributions directly to employees and empower them 38
64-to choose their own health plan in a broad marketplace based on 39
65-individual financial needs and health factors. The Legislature 40
66-further finds that increasing access to affordable, quality 41
67-health care through individual coverage health reimbursement 42
68-arrangements can be best accomplished by establishing a 43
69-competitive marketplace market for employees that receive 44
70-employer premium contribution s through individual coverage 45
71-health reimbursement arrangements purchasing health insurance 46
72-and health services. It is therefore the intent of the 47
73-Legislature to create the Florida Employee Health Choices 48
74-Program to: 49
75- (a) Expand opportunities for employers and employees 50
51+ (1) LEGISLATIVE INTENT. —The Legislature finds that a 26
52+significant number of employers and employees in the residents 27
53+of this state do not have adequate access to affordable, quality 28
54+health insurance that meets their needs care. The Legislature 29
55+further finds that individual coverage health reimbursement 30
56+arrangements offer a novel way for employers of any size to give 31
57+health care contributions directly to employees and empower them 32
58+to choose their own health plan in a broad marketplace based on 33
59+individual financial needs and health factors. The Legislature 34
60+further finds that increasing access to affordable, quality 35
61+health care through individual coverage health reimbursement 36
62+arrangements can be best accomplished by establishing a 37
63+competitive marketplace market for employees that receive 38
64+employer premium contributions th rough individual coverage 39
65+health reimbursement arrangements purchasing health insurance 40
66+and health services. It is therefore the intent of the 41
67+Legislature to create the Florida Employee Health Choices 42
68+Program to: 43
69+ (a) Expand opportunities for employers and employees 44
70+Floridians to access purchase affordable health insurance in 45
71+this state and health services. 46
72+ (b) Create a platform that streamlines the purchase of 47
73+individual coverage for employees enrolled in individual 48
74+coverage health reimbursement arrange ments Preserve the benefits 49
75+of employment-sponsored insurance while easing the 50
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8484 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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88-Floridians to access purchase affordable health insurance in 51
89-this state and health services. 52
90- (b) Create a platform that streamlines the purchase of 53
91-individual coverage for employees enrolled in individual 54
92-coverage health reimbursement arr angements Preserve the benefits 55
93-of employment-sponsored insurance while easing the 56
94-administrative burden for employers who offer these benefits . 57
95- (c) Enable individual choice in both the manner and amount 58
96-of health care purchased. 59
97- (d) Provide for the pu rchase of individual, portable 60
98-health care coverage. 61
99- (e) Disseminate information to employers and employees 62
100-about individual coverage health reimbursement arrangements 63
101-consumers on the price and quality of health services . 64
102- (f) Sponsor a competitive mar ket that stimulates product 65
103-innovation, quality improvement, and efficiency in the 66
104-production and delivery of individual health insurance plans to 67
105-employees enrolled in individual coverage health reimbursement 68
106-arrangements health services. 69
107- (2) DEFINITIONS.—As used in this section, the term: 70
108- (a) "Corporation" means the Florida Employee Health 71
109-Choices, Inc., established under this section. 72
110- (b) "Corporation's marketplace" means the single, 73
111-centralized market established by the program that facilitates 74
112-the purchase of products made available in the marketplace. 75
88+administrative burden for employers who offer these benefits . 51
89+ (c) Enable individual choice in both the manner and amount 52
90+of health care purchased. 53
91+ (d) Provide for the purcha se of individual, portable 54
92+health care coverage. 55
93+ (e) Disseminate information to employers and employees 56
94+about individual coverage health reimbursement arrangements 57
95+consumers on the price and quality of health services . 58
96+ (f) Sponsor a competitive market that stimulates product 59
97+innovation, quality improvement, and efficiency in the 60
98+production and delivery of individual health insurance plans to 61
99+employees enrolled in individual coverage health reimbursement 62
100+arrangements health services. 63
101+ (2) DEFINITIONS.—As used in this section, the term: 64
102+ (a) "Corporation" means the Florida Employee Health 65
103+Choices, Inc., established under this section. 66
104+ (b) "Corporation's marketplace" means the single, 67
105+centralized market established by the program that facilitates 68
106+the purchase of products made available in the marketplace. 69
107+ (c) "Health insurance agent" means an agent licensed under 70
108+part IV of chapter 626. 71
109+ (d) "Insurer" means an entity licensed under chapter 624 72
110+which offers an individual health insurance policy or a group 73
111+health insurance policy , a preferred provider organization as 74
112+defined in s. 627.6471, an exclusive provider organization as 75
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121121 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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125- (c) "Health insurance agent" means an agent licensed under 76
126-part IV of chapter 626. 77
127- (d) "Insurer" means an entity licensed under chapter 624 78
128-which offers an individual health insurance policy or a group 79
129-health insurance policy , a preferred provider organization as 80
130-defined in s. 627.6471, an exclusive provider organization as 81
131-defined in s. 627.6472, or a health maintenance organization 82
132-licensed under part I of chapter 641 , or a prepaid limited 83
133-health service organization or discount plan organization 84
134-licensed under chapter 636 . 85
135- (e) "Program" means the Florida Employee Health Choices 86
136-Program established by this section. 87
137- (3) PROGRAM PURPOSE AND COMPONENTS. —The Florida Employee 88
138-Health Choices Progr am is created as a single, centralized 89
139-market for the sale and purchase of individual health insurance 90
140-plans to employees enrolled in individual coverage health 91
141-reimbursement arrangements various products that enable 92
142-individuals to pay for health care. The se products include, but 93
143-are not limited to, health insurance plans, health maintenance 94
144-organization plans, prepaid services, service contracts, and 95
145-flexible spending accounts . The components of the program 96
146-include: 97
147- (a) Enrollment of employers. 98
148- (b) Administrative services for participating employers, 99
149-including: 100
125+defined in s. 627.6472, or a health maintenance organization 76
126+licensed under part I of chapter 641 , or a prepaid limited 77
127+health service organization or discount plan organization 78
128+licensed under chapter 636 . 79
129+ (e) "Program" means the Florida Employee Health Choices 80
130+Program established by this section. 81
131+ (3) PROGRAM PURPOSE AND COMPONENTS. —The Florida Employee 82
132+Health Choices Program is created as a single, centralized 83
133+market for the sale and purchase of individual health insurance 84
134+plans to employees enrolled in individual coverage health 85
135+reimbursement arrangements various products that enable 86
136+individuals to pay for health care. These products include, but 87
137+are not limited to, health insurance plans, health maintenance 88
138+organization plans, prepaid services, service contracts, and 89
139+flexible spending accounts . The components of the program 90
140+include: 91
141+ (a) Enrollment of employers. 92
142+ (b) Administrative services for participating employers, 93
143+including: 94
144+ 1. Assistance in seeking federal approval of cafeteria 95
145+plans. 96
146+ 2. Collection of premiums and other payments. 97
147+ 3. Management of individual benefit accounts. 98
148+ 4. Distribution of premiums to insu rers and payments to 99
149+other eligible vendors. 100
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158158 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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162- 1. Assistance in seeking federal approval of cafeteria 101
163-plans. 102
164- 2. Collection of premiums and other payments. 103
165- 3. Management of individual benefit accounts. 104
166- 4. Distribution of premiums to in surers and payments to 105
167-other eligible vendors. 106
168- 5. Assistance for participants in complying with reporting 107
169-requirements. 108
170- (c) Services to individual participants, including: 109
171- 1. Information about available products and participating 110
172-vendors. 111
173- 2. Assistance with assessing the benefits and limits of 112
174-each product, including information necessary to distinguish 113
175-between policies offering creditable coverage and other products 114
176-available through the program . 115
177- 3. Account information to assist individual partic ipants 116
178-with managing available resources. 117
179- 4. Services that promote healthy behaviors. 118
180- (d) Recruitment of vendors, including insurers and, health 119
181-maintenance organizations , prepaid clinic service providers, 120
182-provider service networks, and other providers . 121
183- (e) Certification of vendors to ensure capability, 122
184-reliability, and validity of offerings. 123
185- (f) Collection of data, monitoring, assessment, and 124
186-reporting of vendor performance. 125
162+ 5. Assistance for participants in complying with reporting 101
163+requirements. 102
164+ (c) Services to individual participants, including: 103
165+ 1. Information about available products and participating 104
166+vendors. 105
167+ 2. Assistance with assessing the benefits and limits of 106
168+each product, including information necessary to distinguish 107
169+between policies offering creditable coverage and other products 108
170+available through the program . 109
171+ 3. Account information to assist individual particip ants 110
172+with managing available resources. 111
173+ 4. Services that promote healthy behaviors. 112
174+ (d) Recruitment of vendors, including insurers and, health 113
175+maintenance organizations , prepaid clinic service providers, 114
176+provider service networks, and other providers . 115
177+ (e) Certification of vendors to ensure capability, 116
178+reliability, and validity of offerings. 117
179+ (f) Collection of data, monitoring, assessment, and 118
180+reporting of vendor performance. 119
181+ (g) Information services for individuals and employers. 120
182+ (h) Program evaluation. 121
183+ (4) ELIGIBILITY AND PARTICIPATION. —Participation in the 122
184+program is voluntary and shall be available to employers, 123
185+individuals, vendors, and health insurance agents as specified 124
186+in this subsection. 125
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195195 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- (g) Information services for individuals and employers. 126
200- (h) Program evaluation. 127
201- (4) ELIGIBILITY AND PARTICIPATION. —Participation in the 128
202-program is voluntary and shall be available to employers, 129
203-individuals, vendors, and health insurance agents as specified 130
204-in this subsection. 131
205- (a) Employers eligible to enroll in the progr am include 132
206-those employers that meet criteria established by the 133
207-corporation and elect to make their employees eligible through 134
208-the program. 135
209- (b) Individuals eligible to participate in the program 136
210-include: 137
211- 1. Individual employees of enrolled employers. 138
212- 2. Other individuals that meet criteria established by the 139
213-corporation. 140
214- (c) Employers who choose to participate in the program may 141
215-enroll by complying with the procedures established by the 142
216-corporation. The procedures must include, but are not limited 143
217-to: 144
218- 1. Submission of required information. 145
219- 2. Compliance with federal tax requirements for the 146
220-establishment of a cafeteria plan, pursuant to s. 125 of the 147
221-Internal Revenue Code, including designation of the employer's 148
222-plan as a premium payment plan, a salary reduction plan that has 149
223-flexible spending arrangements, or a salary reduction plan that 150
199+ (a) Employers eligible to enroll in the program include 126
200+those employers that meet criteria established by the 127
201+corporation and elect to make their employees eligible through 128
202+the program. 129
203+ (b) Individuals eligible to participate in the program 130
204+include: 131
205+ 1. Individual employees of enrolled employers. 132
206+ 2. Other individuals that meet criteria established by the 133
207+corporation. 134
208+ (c) Employers who choose to participate in the program may 135
209+enroll by complying with the procedures established by the 136
210+corporation. The procedures must include, but are not limited 137
211+to: 138
212+ 1. Submission of required information. 139
213+ 2. Compliance with federal tax requirements for the 140
214+establishment of a cafeteria plan, pursuant to s. 125 of the 141
215+Internal Revenue Code, including designation of the employer's 142
216+plan as a premium payment plan, a s alary reduction plan that has 143
217+flexible spending arrangements, or a salary reduction plan that 144
218+has a premium payment and flexible spending arrangements. 145
219+ 3. Determination of the employer's contribution, if any, 146
220+per employee, provided that such contribution is equal for each 147
221+eligible employee. 148
222+ 4. Establishment of payroll deduction procedures, subject 149
223+to the agreement of each individual employee who voluntarily 150
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232232 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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236-has a premium payment and flexible spending arrangements. 151
237- 3. Determination of the employer's contribution, if any, 152
238-per employee, provided that such contributi on is equal for each 153
239-eligible employee. 154
240- 4. Establishment of payroll deduction procedures, subject 155
241-to the agreement of each individual employee who voluntarily 156
242-participates in the program. 157
243- 5. Designation of the corporation as the third -party 158
244-administrator for the employer's health benefit plan. 159
245- 6. Identification of eligible employees. 160
246- 7. Arrangement for periodic payments. 161
247- 8. Employer notification to employees of the intent to 162
248-transfer from an existing employee health plan to the program at 163
249-least 90 days before the transition. 164
250- (d) All eligible vendors who choose to participate and the 165
251-products and services that the vendors are permitted to sell are 166
252-as follows: 167
253- 1. Insurers licensed under chapter 624 may sell health 168
254-insurance policies, limited benefit policies, other risk -bearing 169
255-coverage, and other products or services . 170
256- 2. Health maintenance organizations licensed under part I 171
257-of chapter 641 may sell health maintenance contracts , limited 172
258-benefit policies, other risk -bearing products, and other 173
259-products or services . 174
260- 3. Prepaid limited health service organizations may sell 175
236+participates in the program. 151
237+ 5. Designation of the corporation as the third -party 152
238+administrator for the employer's health benefit plan. 153
239+ 6. Identification of eligible employees. 154
240+ 7. Arrangement for periodic payments. 155
241+ 8. Employer notification to employees of the intent to 156
242+transfer from an existing employee health plan to the program at 157
243+least 90 days before the transition. 158
244+ (d) All eligible vendors who choose to participate and the 159
245+products and services that the vendors are permitted to sell are 160
246+as follows: 161
247+ 1. Insurers licensed under chapter 624 may sell health 162
248+insurance policies, limited benefit policies, other risk -bearing 163
249+coverage, and other products or services . 164
250+ 2. Health maintenance organizations licensed under part I 165
251+of chapter 641 may sell health maintenance contracts , limited 166
252+benefit policies, other risk -bearing products, and other 167
253+products or services. 168
254+ 3. Prepaid limited health service organizations may sell 169
255+products and services as authorized under part I of chapter 636, 170
256+and discount plan organizations may sell products and services 171
257+as authorized under part II of chapter 636. 172
258+ 4. Prepaid health clinic service providers licensed under 173
259+part II of chapter 641 may sell prepaid service contracts and 174
260+other arrangements for a specified amount and type of health 175
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269269 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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273-products and services as authorized under part I of chapter 636, 176
274-and discount plan organizations may sell products and services 177
275-as authorized under part II of chapter 636. 178
276- 4. Prepaid health clinic service providers licensed under 179
277-part II of chapter 641 may sell prepaid service contracts and 180
278-other arrangements for a specified amount and type of health 181
279-services or treatments. 182
280- 5. Health care providers, including hospi tals and other 183
281-licensed health facilities, health care clinics, licensed health 184
282-professionals, pharmacies, and other licensed health care 185
283-providers, may sell service contracts and arrangements for a 186
284-specified amount and type of health services or treatment s. 187
285- 6. Provider organizations, including service networks, 188
286-group practices, professional associations, and other 189
287-incorporated organizations of providers, may sell service 190
288-contracts and arrangements for a specified amount and type of 191
289-health services or tre atments. 192
290- 7. Corporate entities providing specific health services 193
291-in accordance with applicable state law may sell service 194
292-contracts and arrangements for a specified amount and type of 195
293-health services or treatments. 196
294- 197
295-A vendor described in subparagraphs 3 .-7. may not sell products 198
296-that provide risk-bearing coverage unless that vendor is 199
297-authorized under a certificate of authority issued by the Office 200
273+services or treatments. 176
274+ 5. Health care providers, including hospitals and othe r 177
275+licensed health facilities, health care clinics, licensed health 178
276+professionals, pharmacies, and other licensed health care 179
277+providers, may sell service contracts and arrangements for a 180
278+specified amount and type of health services or treatments. 181
279+ 6. Provider organizations, including service networks, 182
280+group practices, professional associations, and other 183
281+incorporated organizations of providers, may sell service 184
282+contracts and arrangements for a specified amount and type of 185
283+health services or treatments. 186
284+ 7. Corporate entities providing specific health services 187
285+in accordance with applicable state law may sell service 188
286+contracts and arrangements for a specified amount and type of 189
287+health services or treatments. 190
288+ 191
289+A vendor described in subparagraphs 3. -7. may not sell products 192
290+that provide risk-bearing coverage unless that vendor is 193
291+authorized under a certificate of authority issued by the Office 194
292+of Insurance Regulation and is authorized to provide coverage in 195
293+the relevant geographic area. Otherwise Eligible vendors may be 196
294+excluded from participating in the program for deceptive or 197
295+predatory practices, financial insolvency, or failure to comply 198
296+with the terms of the participation agreement or other standards 199
297+set by the corporation. 200
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306306 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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310-of Insurance Regulation and is authorized to provide coverage in 201
311-the relevant geographic area. Otherwise Eligible vendors may be 202
312-excluded from participating in the program for deceptive or 203
313-predatory practices, financial insolvency, or failure to comply 204
314-with the terms of the participation agreement or other standards 205
315-set by the corporation. 206
316- (e) Eligible indivi duals may participate in the program 207
317-voluntarily. Individuals who join the program may participate by 208
318-complying with the procedures established by the corporation. 209
319-These procedures must include, but are not limited to: 210
320- 1. Submission of required informati on. 211
321- 2. Authorization for payroll deduction. 212
322- 3. Compliance with federal tax requirements. 213
323- 4. Arrangements for payment. 214
324- 5. Selection of products and services. 215
325- (f) Vendors who choose to participate in the program may 216
326-enroll by complying with the pro cedures established by the 217
327-corporation. These procedures may include, but are not limited 218
328-to: 219
329- 1. Submission of required information, including a 220
330-complete description of the coverage, services, provider 221
331-network, payment restrictions, and other requirement s of each 222
332-product offered through the program. 223
333- 2. Execution of an agreement to comply with requirements 224
334-established by the corporation. 225
310+ (e) Eligible individuals may par ticipate in the program 201
311+voluntarily. Individuals who join the program may participate by 202
312+complying with the procedures established by the corporation. 203
313+These procedures must include, but are not limited to: 204
314+ 1. Submission of required information. 205
315+ 2. Authorization for payroll deduction. 206
316+ 3. Compliance with federal tax requirements. 207
317+ 4. Arrangements for payment. 208
318+ 5. Selection of products and services. 209
319+ (f) Vendors who choose to participate in the program may 210
320+enroll by complying with the procedures estab lished by the 211
321+corporation. These procedures may include, but are not limited 212
322+to: 213
323+ 1. Submission of required information, including a 214
324+complete description of the coverage, services, provider 215
325+network, payment restrictions, and other requirements of each 216
326+product offered through the program. 217
327+ 2. Execution of an agreement to comply with requirements 218
328+established by the corporation. 219
329+ 3. Execution of an agreement that prohibits refusal to 220
330+sell any offered product or service to a participant who elects 221
331+to buy it. 222
332+ 4. Establishment of product prices based on applicable 223
333+criteria. 224
334+ 4.5. Arrangements for receiving payment for enrolled 225
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343343 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- 3. Execution of an agreement that prohibits refusal to 226
348-sell any offered product or service to a participant who elec ts 227
349-to buy it. 228
350- 4. Establishment of product prices based on applicable 229
351-criteria. 230
352- 4.5. Arrangements for receiving payment for enrolled 231
353-participants. 232
354- 5.6. Participation in ongoing reporting processes 233
355-established by the corporation. 234
356- 6.7. Compliance with grievance procedures established by 235
357-the corporation. 236
358- (g) Health insurance agents licensed under part IV of 237
359-chapter 626 are eligible to voluntarily participate as buyers' 238
360-representatives. A buyer's representative acts on behalf of an 239
361-individual purchasing health insurance and health services 240
362-through the program by providing information about products and 241
363-services available through the program and assisting the 242
364-individual with both the decision and the procedure of selecting 243
365-specific products. Serving as a buyer's representative does not 244
366-constitute a conflict of interest with continuing 245
367-responsibilities as a health insurance agent if the relationship 246
368-between each agent and any participating vendor is disclosed 247
369-before advising an individual participant about the products and 248
370-services available through the progra m. In order to participate, 249
371-a health insurance agent shall comply with the procedures 250
347+participants. 226
348+ 5.6. Participation in ongoing reporting processes 227
349+established by the corporation. 228
350+ 6.7. Compliance with grievance procedures established by 229
351+the corporation. 230
352+ (g) Health insurance agents licensed under part IV of 231
353+chapter 626 are eligible to voluntarily participate as buyers' 232
354+representatives. A buyer's representative acts on behalf of an 233
355+individual purchasing health insurance and health services 234
356+through the program by providing information about products and 235
357+services available through the program and assisting the 236
358+individual with both the decision and the procedure of selecting 237
359+specific products. Serving as a buyer's representative does not 238
360+constitute a conflict of interest with continuing 239
361+responsibilities as a health insurance agent if the relationship 240
362+between each agent and any participating vendor is disclosed 241
363+before advising an individual participant about the products and 242
364+services available through the program. In order to participate, 243
365+a health insurance agent shall comply with the procedures 244
366+established by the corporation, including: 245
367+ 1. Completion of training requirements. 246
368+ 2. Execution of a participation agreement specifying the 247
369+terms and conditions of participation. 248
370+ 3. Disclosure of any appointments to solicit insurance or 249
371+procure applications for vendors participating in the program. 250
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380380 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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384-established by the corporation, including: 251
385- 1. Completion of training requirements. 252
386- 2. Execution of a participation agreement specifying the 253
387-terms and conditions of pa rticipation. 254
388- 3. Disclosure of any appointments to solicit insurance or 255
389-procure applications for vendors participating in the program. 256
390- 4. Arrangements to receive payment from the corporation 257
391-for services as a buyer's representative. 258
392- (5) PRODUCTS.— 259
393- (a) The products that may be made available for purchase 260
394-through the program include , but are not limited to : 261
395- (a)1. Health insurance policies. 262
396- (b)2. Health maintenance contracts. 263
397- 3. Limited benefit plans. 264
398- 4. Prepaid clinic services. 265
399- 5. Service contracts. 266
400- 6. Arrangements for purchase of specific amounts and types 267
401-of health services and treatments. 268
402- 7. Flexible spending accounts. 269
403- (b) Health insurance policies, health maintenance 270
404-contracts, limited benefit plans, prepaid service contracts, and 271
405-other contracts for services must ensure the availability of 272
406-covered services. 273
407- (c) Products may be offered for multiyear periods provided 274
408-the price of the product is specified for the entire period or 275
384+ 4. Arrangements to receive payment from the co rporation 251
385+for services as a buyer's representative. 252
386+ (5) PRODUCTS.— 253
387+ (a) The products that may be made available for purchase 254
388+through the program include , but are not limited to : 255
389+ (a)1. Health insurance policies. 256
390+ (b)2. Health maintenance contracts. 257
391+ 3. Limited benefit plans. 258
392+ 4. Prepaid clinic services. 259
393+ 5. Service contracts. 260
394+ 6. Arrangements for purchase of specific amounts and types 261
395+of health services and treatments. 262
396+ 7. Flexible spending accounts. 263
397+ (b) Health insurance policies, health mainten ance 264
398+contracts, limited benefit plans, prepaid service contracts, and 265
399+other contracts for services must ensure the availability of 266
400+covered services. 267
401+ (c) Products may be offered for multiyear periods provided 268
402+the price of the product is specified for the entire period or 269
403+for each separately priced segment of the policy or contract. 270
404+ (d) The corporation shall provide a disclosure form for 271
405+consumers to acknowledge their understanding of the nature of, 272
406+and any limitations to, the benefits provided by the pro ducts 273
407+and services being purchased by the consumer. 274
408+ (e) The corporation must determine that making the plan 275
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417417 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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421-for each separately priced segment of the policy or con tract. 276
422- (d) The corporation shall provide a disclosure form for 277
423-consumers to acknowledge their understanding of the nature of, 278
424-and any limitations to, the benefits provided by the products 279
425-and services being purchased by the consumer. 280
426- (e) The corporation must determine that making the plan 281
427-available through the program is in the interest of eligible 282
428-individuals and eligible employers in the state. 283
429- (6) SURCHARGE PRICING.—Prices for the products and 284
430-services sold through the program must be transparent t o 285
431-participants and established by the vendors. The corporation 286
432-shall annually assess a surcharge for each premium or price set 287
433-by a participating vendor. The surcharge may not be more than 288
434-2.5 percent of the price and shall be used to generate funding 289
435-for administrative services provided by the corporation and 290
436-payments to buyers' representatives. 291
437- (7) THE MARKETPLACE PROCESS. —The program shall provide a 292
438-single, centralized market for access to purchase of health 293
439-insurance and, health maintenance contracts by an employee 294
440-enrolled in an individual coverage health reimbursement 295
441-arrangement, and other health products and services . Purchases 296
442-may be made by participating individuals over the Internet or 297
443-through the services of a participating health insurance age nt. 298
444-Information about each product and service available through the 299
445-program shall be made available through printed material and an 300
421+available through the program is in the interest of eligible 276
422+individuals and eligible employers in the state. 277
423+ (6) SURCHARGE PRICING.—Prices for the products and 278
424+services sold through the program must be transparent to 279
425+participants and established by the vendors. The corporation 280
426+shall annually assess a surcharge for each premium or price set 281
427+by a participating vendor. The surcharge may not be more than 282
428+2.5 percent of the price and shall be used to generate funding 283
429+for administrative services provided by the corporation and 284
430+payments to buyers' representatives. 285
431+ (7) THE MARKETPLACE PROCESS. —The program shall provide a 286
432+single, centralized market for access to purchase of health 287
433+insurance and, health maintenance contracts by an employee 288
434+enrolled in an individual coverage health reimbursement 289
435+arrangement, and other health products and services . Purchases 290
436+may be made by participating individuals over the Internet or 291
437+through the services of a participating health insurance agent. 292
438+Information about each product and service available through the 293
439+program shall be made available through printed material and an 294
440+interactive Internet website. A participant needing personal 295
441+assistance to select products and services shall be referred to 296
442+a participating agent in his or her area. 297
443+ (a) Participation in the program may begin at any time 298
444+during a year after the employer completes enrollment and meets 299
445+the requirements specified by the corporation pursuant to 300
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454454 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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456456
457457
458-interactive Internet website. A participant needing personal 301
459-assistance to select products and services shall be referred t o 302
460-a participating agent in his or her area. 303
461- (a) Participation in the program may begin at any time 304
462-during a year after the employer completes enrollment and meets 305
463-the requirements specified by the corporation pursuant to 306
464-paragraph (4)(c). 307
465- (b) Initial selection of products and services must be 308
466-made by an individual participant within the applicable open 309
467-enrollment period. 310
468- (c) Initial enrollment periods for each product selected 311
469-by an individual participant must last at least 12 months, 312
470-unless the individual participant specifically agrees to a 313
471-different enrollment period. 314
472- (d) If an individual has selected one or more products and 315
473-enrolled in those products for at least 12 months or any other 316
474-period specifically agreed to by the individual participant, 317
475-changes in selected products and services may only be made 318
476-during the annual enrollment period established by the 319
477-corporation. 320
478- (e) The limits established in paragraphs (b) -(d) apply to 321
479-any risk-bearing product that promises future payment or 322
480-coverage for a variable amount of benefits or services. The 323
481-limits do not apply to initiation of flexible spending plans if 324
482-those plans are not associated with specific high -deductible 325
458+paragraph (4)(c). 301
459+ (b) Initial selection of products and services must be 302
460+made by an individual participant within the applicable open 303
461+enrollment period. 304
462+ (c) Initial enrollment periods for each product selected 305
463+by an individual participant must last at least 12 months, 306
464+unless the individual participant specifically agrees to a 307
465+different enrollment period. 308
466+ (d) If an individual has selected one or more products and 309
467+enrolled in those products for at least 12 months o r any other 310
468+period specifically agreed to by the individual participant, 311
469+changes in selected products and services may only be made 312
470+during the annual enrollment period established by the 313
471+corporation. 314
472+ (e) The limits established in paragraphs (b) -(d) apply to 315
473+any risk-bearing product that promises future payment or 316
474+coverage for a variable amount of benefits or services. The 317
475+limits do not apply to initiation of flexible spending plans if 318
476+those plans are not associated with specific high -deductible 319
477+insurance policies or the use of spending accounts for any 320
478+products offering individual participants specific amounts and 321
479+types of health services and treatments at a contracted price. 322
480+ (8) CONSUMER INFORMATION. —The corporation shall: 323
481+ (a) Establish a secure websi te to facilitate the purchase 324
482+of products and services by participating individuals. The 325
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491491 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
492492
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495-insurance policies or the use of spending accounts for any 326
496-products offering indiv idual participants specific amounts and 327
497-types of health services and treatments at a contracted price. 328
498- (8) CONSUMER INFORMATION. —The corporation shall: 329
499- (a) Establish a secure website to facilitate the purchase 330
500-of products and services by participating individuals. The 331
501-website must provide information about each product or service 332
502-available through the program. 333
503- (b) Inform individuals about other public health care 334
504-programs. 335
505- (9) RISK POOLING.—The program may use methods for pooling 336
506-the risk of individual participants and preventing selection 337
507-bias. These methods may include, but are not limited to, a 338
508-postenrollment risk adjustment of the premium payments to the 339
509-vendors. The corporation may establish a methodology for 340
510-assessing the risk of enrolled indiv idual participants based on 341
511-data reported annually by the vendors about their enrollees. 342
512-Distribution of payments to the vendors may be adjusted based on 343
513-the assessed relative risk profile of the enrollees in each 344
514-risk-bearing product for the most recent p eriod for which data 345
515-is available. 346
516- (9)(10) EXEMPTIONS.— 347
517- (a) Products, other than the products set forth in 348
518-subparagraphs (4)(d)1. -4., sold as part of the program are not 349
519-subject to the licensing requirements of the Florida Insurance 350
495+website must provide information about each product or service 326
496+available through the program. 327
497+ (b) Inform individuals about other public health care 328
498+programs. 329
499+ (9) RISK POOLING.—The program may use methods for pooling 330
500+the risk of individual participants and preventing selection 331
501+bias. These methods may include, but are not limited to, a 332
502+postenrollment risk adjustment of the premium payments to the 333
503+vendors. The corpora tion may establish a methodology for 334
504+assessing the risk of enrolled individual participants based on 335
505+data reported annually by the vendors about their enrollees. 336
506+Distribution of payments to the vendors may be adjusted based on 337
507+the assessed relative risk pr ofile of the enrollees in each 338
508+risk-bearing product for the most recent period for which data 339
509+is available. 340
510+ (9)(10) EXEMPTIONS.— 341
511+ (a) Products, other than the products set forth in 342
512+subparagraphs (4)(d)1. -4., sold as part of the program are not 343
513+subject to the licensing requirements of the Florida Insurance 344
514+Code, as defined in s. 624.01 or the mandated offerings or 345
515+coverages established in part VI of chapter 627 and chapter 641. 346
516+ (b) The corporation may act as an administrator as defined 347
517+in s. 626.88 but is not required to be certified pursuant to 348
518+part VII of chapter 626. However, a third party administrator 349
519+used by the corporation must be certified under part VII of 350
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528528 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
529529
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532-Code, as defined in s. 624.01 or the mandated offerings or 351
533-coverages established in part VI of chapter 627 and chapter 641. 352
534- (b) The corporation may act as an administrator as defined 353
535-in s. 626.88 but is not required to be certified pursuant to 354
536-part VII of chapter 626. Howe ver, a third party administrator 355
537-used by the corporation must be certified under part VII of 356
538-chapter 626. 357
539- (c) Any standard forms, website design, or marketing 358
540-communication developed by the corporation and used by the 359
541-corporation, or any vendor that meets the requirements of 360
542-paragraph (4)(f) is not subject to the Florida Insurance Code, 361
543-as established in s. 624.01. 362
544- (10) CORPORATION.—There is created the Florida Employee 363
545-Health Choices, Inc., which shall be registered, incorporated, 364
546-organized, and operated in compliance with part III of chapter 365
547-112 and chapters 119, 286, and 617. The purpose of the 366
548-corporation is to administer the program created in this section 367
549-and to conduct such other business as may further the 368
550-administration of the program. The D epartment of Management 369
551-Services shall facilitate the formation of the corporation and 370
552-provide administrative support for the corporation until January 371
553-1, 2028. The corporation must be self -sustaining and no longer 372
554-require administrative assistance from th e Department of 373
555-Management Services by January 1, 2028. 374
556- (a) The corporation shall be governed by an eight -member 375
532+chapter 626. 351
533+ (c) Any standard forms, website design, or marketing 352
534+communication develope d by the corporation and used by the 353
535+corporation, or any vendor that meets the requirements of 354
536+paragraph (4)(f) is not subject to the Florida Insurance Code, 355
537+as established in s. 624.01. 356
538+ (10)(11) CORPORATION.—There is created the Florida 357
539+Employee Health Choices, Inc., which shall be registered, 358
540+incorporated, organized, and operated in compliance with part 359
541+III of chapter 112 and chapters 119, 286, and 617. The purpose 360
542+of the corporation is to administer the program created in this 361
543+section and to conduct such other business as may further the 362
544+administration of the program. 363
545+ (a) The corporation shall be governed by a 15 -member board 364
546+of directors consisting of: 365
547+ 1. Three ex officio, nonvoting members to include: 366
548+ a. The Secretary of Health Care Admi nistration or a 367
549+designee with expertise in health care services. 368
550+ b. The Secretary of Management Services or a designee with 369
551+expertise in state employee benefits. 370
552+ c. The commissioner of the Office of Insurance Regulation 371
553+or a designee with expertise in insurance regulation. 372
554+ 2. Four members appointed by and serving at the pleasure 373
555+of the Governor. 374
556+ 3. Four members appointed by and serving at the pleasure 375
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565565 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
566566
567567
568568
569-board of directors. Board members shall be appointed for terms 376
570-of up to 3 years and shall be eligible for reappointment. A 377
571-vacancy on the board shall be filled for the unexpired portion 378
572-of the term in the same manner as the original appointment. 379
573-Board members may not include an affiliate or subsidiary of an 380
574-eligible vendor. Board members shall serve without compensation, 381
575-but are entitled to rec eive, from funds of the corporation, 382
576-reimbursement for per diem and travel expenses as provided in s. 383
577-112.061. The membership of the board shall consist of: 384
578- 1. Three members appointed by the Governor. 385
579- 2. Two members appointed by the President of the Se nate. 386
580- 3. Two members appointed by the Speaker of the House of 387
581-Representatives. 388
582- 4. The Secretary of Management Services or a designee with 389
583-expertise in state employee benefits and procurement as an ex 390
584-officio, nonvoting member. 391
585- (b) The corporation may exercise all powers granted to it 392
586-under chapter 617 necessary to carry out the purposes of this 393
587-section, including, but not limited to, the power to receive and 394
588-accept grants, loans, or advances of funds from any public or 395
589-private agency and to receive an d accept from any source 396
590-contributions of money, property, labor, or any other thing of 397
591-value to be held, used, and applied for the purposes of this 398
592-section. 399
593- (c) There is no liability on the part of, and no cause of 400
569+of the President of the Senate. 376
570+ 4. Four members appointed by and serving at the pleasure 377
571+of the Speaker of the House of Representatives. 378
572+ 5. Board members may not include insurers, health 379
573+insurance agents or brokers, health care providers, health 380
574+maintenance organizations, prepaid service providers, or any 381
575+other entity, affiliate , or subsidiary of eligible vendors. 382
576+ (b) Members shall be appointed for terms of up to 3 years. 383
577+Any member is eligible for reappointment. A vacancy on the board 384
578+shall be filled for the unexpired portion of the term in the 385
579+same manner as the original appointment. 386
580+ (c) The board shall select a chief executive officer for 387
581+the corporation who shall be responsible for the selection of 388
582+such other staff as may be authorized by the corporation's 389
583+operating budget as adopted by the board. 390
584+ (d) Board members are entitled to receive, f rom funds of 391
585+the corporation, reimbursement for per diem and travel expenses 392
586+as provided by s. 112.061. No other compensation is authorized. 393
587+ (e) There is no liability on the part of, and no cause of 394
588+action shall arise against, any member of the board or its 395
589+employees or agents for any action taken by them in the 396
590+performance of their powers and duties under this section. 397
591+ (f) The board shall develop and adopt bylaws and other 398
592+corporate procedures as necessary for the operation of the 399
593+corporation and carry ing out the purposes of this section. The 400
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602602 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
603603
604604
605605
606-action shall arise against, any member of the board or its 401
607-employees or agents for any action taken by them in the 402
608-performance of their powers and duties under this section. 403
609- (d) The board shall develop and adopt bylaws and other 404
610-corporate procedures necessary for the operation of the 405
611-corporation and carrying out the purposes of this section. At a 406
612-minimum, the bylaws shall: 407
613- 1. Specify procedures for selection of officers and 408
614-qualifications for reappointment, provided that a board member 409
615-may not serve more than 9 consecutive years. 410
616- 2. Require an annual membership meeting that provides an 411
617-opportunity for input and interaction with individual 412
618-participants in the program. 413
619- 3. Specify policies and procedures regarding conflicts of 414
620-interest, including part III of chapter 112, which prohibit a 415
621-member from participating in any decision that would inure to 416
622-the benefit of the member or the organization that employs the 417
623-member. The policies and procedures shall also require public 418
624-disclosure of the interest that prevents the member from 419
625-participating in a decision on a particular matter. 420
626- 4. Specify procedures for adopting an annual budget. 421
627- 5. Specify procedures for selecting a chief executive 422
628-officer for the corporation who shall be responsible for 423
629-securing staff and consultant services necessary f or the 424
630-operation of the program as may be authorized by the 425
606+bylaws shall: 401
607+ 1. Specify procedures for selection of officers and 402
608+qualifications for reappointment, provided that no board member 403
609+shall serve more than 9 consecutive years. 404
610+ 2. Require an annual membership meeti ng that provides an 405
611+opportunity for input and interaction with individual 406
612+participants in the program. 407
613+ 3. Specify policies and procedures regarding conflicts of 408
614+interest, including the provisions of part III of chapter 112, 409
615+which prohibit a member from p articipating in any decision that 410
616+would inure to the benefit of the member or the organization 411
617+that employs the member. The policies and procedures shall also 412
618+require public disclosure of the interest that prevents the 413
619+member from participating in a decisi on on a particular matter. 414
620+ (g) The corporation may exercise all powers granted to it 415
621+under chapter 617 necessary to carry out the purposes of this 416
622+section, including, but not limited to, the power to receive and 417
623+accept grants, loans, or advances of funds from any public or 418
624+private agency and to receive and accept from any source 419
625+contributions of money, property, labor, or any other thing of 420
626+value to be held, used, and applied for the purposes of this 421
627+section. 422
628+ (h) The corporation shall: 423
629+ 1. Determine eligibility of employers, vendors, 424
630+individuals, and agents in accordance with subsection (4). 425
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639639 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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643-corporation's operating budget. 426
644- (e) The corporation must establish policies and procedures 427
645-for application, enrollment, plan administration, performance 428
646-monitoring, and consumer education, and o ther policies and 429
647-procedures necessary for the operation of the program, 430
648-including, but not limited to: 431
649- 1. Criteria for participation in the program, and 432
650-procedures for determining the eligibility of employers, 433
651-vendors, individuals, and health insurance agents and employers 434
652-to participate in the program. 435
653- 2. Exclusion of vendors pursuant to paragraph (4)(d). 436
654- 3. Collection of contributions from participating 437
655-employers and individuals. 438
656- 4. Payment of premiums and other appropriate disbursements 439
657-based on the selections of products and services by the 440
658-individual participants. 441
659- 5. Disenrollment of participating individuals based on 442
660-failure to pay the individual's share of any contribution 443
661-required to maintain enrollment in selected products. 444
662- (f) The corporation shall procure a vendor to facilitate a 445
663-platform that streamlines the purchase of individual coverage 446
664-for employees enrolled in individual health coverage 447
665-reimbursement arrangements. 448
666- 1. Within 90 days after the formation of the corporation, 449
667-the department shall, as directed by the board, issue an 450
643+ 2. Establish procedures necessary for the operation of the 426
644+program, including, but not limited to, procedures for 427
645+application, enrollment, risk assessment, risk a djustment, plan 428
646+administration, performance monitoring, and consumer education. 429
647+ 3. Arrange for collection of contributions from 430
648+participating employers and individuals. 431
649+ 4. Arrange for payment of premiums and other appropriate 432
650+disbursements based on the selections of products and services 433
651+by the individual participants. 434
652+ 5. Establish criteria for disenrollment of participating 435
653+individuals based on failure to pay the individual's share of 436
654+any contribution required to maintain enrollment in selected 437
655+products. 438
656+ 6. Establish criteria for exclusion of vendors pursuant to 439
657+paragraph (4)(d). 440
658+ 7. Develop and implement a plan for promoting public 441
659+awareness of and participation in the program. 442
660+ 8. Secure staff and consultant services necessary to the 443
661+operation of the program. 444
662+ 9. Establish policies and procedures regarding 445
663+participation in the program for individuals, vendors, health 446
664+insurance agents, and employers. 447
665+ 10. Provide for the operation of a toll -free hotline to 448
666+respond to requests for assistance . 449
667+ 11. Provide for initial, open, and special enrollment 450
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676676 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
677677
678678
679679
680-invitation to negotiate to procure the vendor. Responsive 451
681-bidders shall demonstrate the ability to establish a platform 452
682-fully operational for open enrollment by January 1, 2027, and 453
683-provide for initial, o pen, and special enrollment periods. 454
684- 2. The department shall evaluate and score the procurement 455
685-bids, enter into negotiations at the direction of the board, and 456
686-make recommendations to the board related to the contract award. 457
687-The corporation shall select the vendor and execute the contract 458
688-within 180 days after the issuance of the invitation to 459
689-negotiate. 460
690- (g) The corporation must develop and implement a plan for 461
691-promoting public awareness of and participation in the program, 462
692-and must establish a toll -free hotline to respond to requests 463
693-for assistance from employers and plan enrollees. 464
694- (h) The corporation may evaluate and implement additional 465
695-options for employer participation which conform with common 466
696-insurance practices. 467
697- (11) CORPORATION.—There is created the Florida Health 468
698-Choices, Inc., which shall be registered, incorporated, 469
699-organized, and operated in compliance with part III of chapter 470
700-112 and chapters 119, 286, and 617. The purpose of the 471
701-corporation is to administer the program created in thi s section 472
702-and to conduct such other business as may further the 473
703-administration of the program. 474
704- (a) The corporation shall be governed by a 15 -member board 475
680+periods. 451
681+ 12. Evaluate options for employer participation which may 452
682+conform with common insurance practices. 453
683+ (11)(12) REPORT.—Beginning in the 2026-2027 2009-2010 454
684+fiscal year, submit by February 1 an annual report to the 455
685+Governor, the President of the Senate, and the Speaker of the 456
686+House of Representatives documenting the corporation's 457
687+activities in compliance with the duties delineated in this 458
688+section. 459
689+ (12)(13) PROGRAM INTEGRITY.—To ensure program integrity 460
690+and to safeguard the financial transactions made under the 461
691+auspices of the program, the corporation is authorized to 462
692+establish qualifying criteria and certification procedures for 463
693+vendors, require performance bonds or other guarantees of 464
694+ability to complete contractual obligations, monitor the 465
695+performance of vendors, and enforce the agreements of the 466
696+program through financial penalty or disqualification from the 467
697+program. 468
698+ (13)(14) EXEMPTION FROM PUBLIC RECORDS REQUIREMENTS. — 469
699+ (a) Definitions.—For purposes of this subsection, the 470
700+term: 471
701+ 1. "Buyer's representative" means a participating 472
702+insurance agent as described in paragraph (4)(g). 473
703+ 2. "Enrollee" means an employer who is eligible to enroll 474
704+in the program pursuant to paragraph (4)(a). 475
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713713 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
714714
715715
716716
717-of directors consisting of: 476
718- 1. Three ex officio, nonvoting members to include: 477
719- a. The Secretary of Health Care Administration or a 478
720-designee with expertise in health care services. 479
721- b. The Secretary of Management Services or a designee with 480
722-expertise in state employee benefits. 481
723- c. The commissioner of the Office of Insurance Regulation 482
724-or a designee with expertise in insurance regulation. 483
725- 2. Four members appointed by and serving at the pleasure 484
726-of the Governor. 485
727- 3. Four members appointed by and serving at the pleasure 486
728-of the President of the Senate. 487
729- 4. Four members appointed by and serving at th e pleasure 488
730-of the Speaker of the House of Representatives. 489
731- 5. Board members may not include insurers, health 490
732-insurance agents or brokers, health care providers, health 491
733-maintenance organizations, prepaid service providers, or any 492
734-other entity, affiliate o r subsidiary of eligible vendors. 493
735- (b) Members shall be appointed for terms of up to 3 years. 494
736-Any member is eligible for reappointment. A vacancy on the board 495
737-shall be filled for the unexpired portion of the term in the 496
738-same manner as the original appoint ment. 497
739- (c) The board shall select a chief executive officer for 498
740-the corporation who shall be responsible for the selection of 499
741-such other staff as may be authorized by the corporation's 500
717+ 3. "Participant" means an individual who is eligible to 476
718+participate in the program pursuant to paragraph (4)(b). 477
719+ 4. "Proprietary confidential business information" means 478
720+information, regardless of form or characteristics, that is 479
721+owned or controlled by a v endor requesting confidentiality under 480
722+this section; that is intended to be and is treated by the 481
723+vendor as private in that the disclosure of the information 482
724+would cause harm to the business operations of the vendor; that 483
725+has not been disclosed unless disc losed pursuant to a statutory 484
726+provision, an order of a court or administrative body, or a 485
727+private agreement providing that the information may be released 486
728+to the public; and that is information concerning: 487
729+ a. Business plans. 488
730+ b. Internal auditing contro ls and reports of internal 489
731+auditors. 490
732+ c. Reports of external auditors for privately held 491
733+companies. 492
734+ d. Client and customer lists. 493
735+ e. Potentially patentable material. 494
736+ f. A trade secret as defined in s. 688.002. 495
737+ 5. "Vendor" means a participating ins urer or health 496
738+maintenance organization or other provider of services as 497
739+described in paragraph (4)(d) . 498
740+ (b) Public record exemptions. — 499
741+ 1. Personal identifying information of an enrollee or 500
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750750 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
751751
752752
753753
754-operating budget as adopted by the board. 501
755- (d) Board members are enti tled to receive, from funds of 502
756-the corporation, reimbursement for per diem and travel expenses 503
757-as provided by s. 112.061. No other compensation is authorized. 504
758- (e) There is no liability on the part of, and no cause of 505
759-action shall arise against, any membe r of the board or its 506
760-employees or agents for any action taken by them in the 507
761-performance of their powers and duties under this section. 508
762- (f) The board shall develop and adopt bylaws and other 509
763-corporate procedures as necessary for the operation of the 510
764-corporation and carrying out the purposes of this section. The 511
765-bylaws shall: 512
766- 1. Specify procedures for selection of officers and 513
767-qualifications for reappointment, provided that no board member 514
768-shall serve more than 9 consecutive years. 515
769- 2. Require an annua l membership meeting that provides an 516
770-opportunity for input and interaction with individual 517
771-participants in the program. 518
772- 3. Specify policies and procedures regarding conflicts of 519
773-interest, including the provisions of part III of chapter 112, 520
774-which prohibit a member from participating in any decision that 521
775-would inure to the benefit of the member or the organization 522
776-that employs the member. The policies and procedures shall also 523
777-require public disclosure of the interest that prevents the 524
778-member from participating in a decision on a particular matter. 525
754+participant who has applied for or participates in the Florida 501
755+Employee Health Choices Program is confidential and exempt from 502
756+s. 119.07(1) and s. 24(a), Art. I of the State Constitution. 503
757+ 2. Client and customer lists of a buyer's representative 504
758+held by the corporation are confidential and exempt from s. 505
759+119.07(1) and s. 24(a), Art. I of the State Constitution. 506
760+ 3. Proprietary confidential business information held by 507
761+the corporation is confidential and exempt from s. 119.07(1) and 508
762+s. 24(a), Art. I of the State Constitution. 509
763+ (c) Retroactive application. —The public record exemptions 510
764+provided for in paragraph (b) apply to information held by the 511
765+corporation before, on, or after the effective date of this 512
766+exemption. 513
767+ (d) Authorized release. — 514
768+ 1. Upon request, information made confidential and exempt 515
769+pursuant to this subsection shall be disclosed to: 516
770+ a. Another governmental entity in the performance of its 517
771+official duties and responsibilities. 518
772+ b. Any person who has the written consent of the program 519
773+applicant. 520
774+ c. The Florida Kidcare program for the purpose of 521
775+administering the program authorized in ss. 409.810 -409.821. 522
776+ 2. Paragraph (b) does not prohibit a participant's legal 523
777+guardian from obtaining confirmation of coverage, dates of 524
778+coverage, the name of the participant's health plan, and the 525
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787787 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
788788
789789
790790
791- (g) The corporation may exercise all powers granted to it 526
792-under chapter 617 necessary to carry out the purposes of this 527
793-section, including, but not limited to, the power to receive and 528
794-accept grants, loans, or advances of funds from any public or 529
795-private agency and to receive and accept from any source 530
796-contributions of money, property, labor, or any other thing of 531
797-value to be held, used, and applied for the purposes of this 532
798-section. 533
799- (h) The corporation shall: 534
800- 1. Determine eligibility of employers, vendors, 535
801-individuals, and agents in accordance with subsection (4). 536
802- 2. Establish procedures necessary for the operation of the 537
803-program, including, but not limited to, procedures for 538
804-application, enrollment, risk assessment, risk adjustment, plan 539
805-administration, performance monitoring, and consumer education. 540
806- 3. Arrange for collection of contributions from 541
807-participating employers and individuals. 542
808- 4. Arrange for payment of premiums and other appropriate 543
809-disbursements based on the selections of products and services 544
810-by the individual participants. 545
811- 5. Establish criteria for disenrollment of participating 546
812-individuals based on failure to pay the individual's share of 547
813-any contribution required to maintain enrollment in selected 548
814-products. 549
815- 6. Establish criteria for exclusion of vendors pursuant to 550
791+amount of premium being paid. 526
792+ (e) Penalty.—A person who knowingly and willfully violates 527
793+this subsection commits a misdemeanor of the second degree, 528
794+punishable as provided in s. 775.082 or s. 775.083. 529
795+ Section 2. Paragraph (a) of subsection (2) of section 530
796+409.821, Florida Statutes, is amended to read: 531
797+ 409.821 Florida Kidcare program public records exemption. — 532
798+ (2)(a) Upon request, such information shall be disclosed 533
799+to: 534
800+ 1. Another governmental entity in the performance of its 535
801+official duties and responsibilities; 536
802+ 2. The Department of Revenue for purposes of administering 537
803+the state Title IV-D program; 538
804+ 3. The Florida Employee Health Choices, Inc., for the 539
805+purpose of administering the program authorized pursuant to s. 540
806+408.910; or 541
807+ 4. Any person who has the written consent of the program 542
808+applicant. 543
809+ Section 3. Subsection (3) of section 409.9122, Florida 544
810+Statutes, is amended to read: 545
811+ 409.9122 Medicaid managed care enrollment; HIV/AIDS 546
812+patients; procedures; data collection; accounting; information 547
813+system; medical loss ratio.— 548
814+ (3) The agency shall develop a process to enable any 549
815+recipient with access to employer -sponsored health care coverage 550
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824824 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
825825
826826
827827
828-paragraph (4)(d). 551
829- 7. Develop and implement a plan for promoting public 552
830-awareness of and participation in the program. 553
831- 8. Secure staff and consultant services necessary to the 554
832-operation of the program. 555
833- 9. Establish policies and procedures regarding 556
834-participation in the program for individuals, vendors, health 557
835-insurance agents, and employers. 558
836- 10. Provide for the operation of a toll -free hotline to 559
837-respond to requests for assistance. 560
838- 11. Provide for initial, open, and special enrollment 561
839-periods. 562
840- 12. Evaluate options for employer participation which may 563
841-conform with common insurance practices. 564
842- (11)(12) REPORT.—Beginning in the 2026-2027 2009-2010 565
843-fiscal year, submit by February 1 an annual report to the 566
844-Governor, the President of the Senate, and the Speaker of the 567
845-House of Representatives documenting the corporation's 568
846-activities in compliance with the duties delineated in this 569
847-section. 570
848- (12)(13) PROGRAM INTEGRITY.—To ensure program integrity 571
849-and to safeguard the financial transactions made under the 572
850-auspices of the program, the corporation is authorized to 573
851-establish qualifying criteria and certification procedures for 574
852-vendors, require performance bonds or other guar antees of 575
828+to opt out of all eligible plans in the Medicaid program and to 551
829+use Medicaid financial assistance to pay for the recipient' s 552
830+share of cost in any such employer -sponsored coverage. 553
831+Contingent on federal approval, the agency shall also enable 554
832+recipients with access to other insurance or related products 555
833+that provide access to health care services created pursuant to 556
834+state law, including any plan or product available pursuant to 557
835+the Florida Employee Health Choices Program or any health 558
836+exchange, to opt out. The amount of financial assistance 559
837+provided for each recipient may not exceed the amount of the 560
838+Medicaid premium that would h ave been paid to a plan for that 561
839+recipient. 562
840+ Section 4. Subsection (4) of section 409.977, Florida 563
841+Statutes, is amended to read: 564
842+ 409.977 Enrollment. — 565
843+ (4) The agency shall develop a process to enable a 566
844+recipient with access to employer -sponsored health care coverage 567
845+to opt out of all managed care plans and to use Medicaid 568
846+financial assistance to pay for the recipient's share of the 569
847+cost in such employer -sponsored coverage. The agency shall also 570
848+enable recipients with access to other insurance or relat ed 571
849+products providing access to health care services created 572
850+pursuant to state law, including any product available under the 573
851+Florida Employee Health Choices Program, or any health exchange, 574
852+to opt out. The amount of financial assistance provided for each 575
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861861 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
862862
863863
864864
865-ability to complete contractual obligations, monitor the 576
866-performance of vendors, and enforce the agreements of the 577
867-program through financial penalty or disqualification from the 578
868-program. 579
869- (13)(14) EXEMPTION FROM PUBLIC RECORDS REQUIREMENTS. — 580
870- (a) Definitions.—For purposes of this subsection, the 581
871-term: 582
872- 1. "Buyer's representative" means a participating 583
873-insurance agent as described in paragraph (4)(g). 584
874- 2. "Enrollee" means an employer who is eligible to enroll 585
875-in the program pursuant to paragrap h (4)(a). 586
876- 3. "Participant" means an individual who is eligible to 587
877-participate in the program pursuant to paragraph (4)(b). 588
878- 4. "Proprietary confidential business information" means 589
879-information, regardless of form or characteristics, that is 590
880-owned or controlled by a vendor requesting confidentiality under 591
881-this section; that is intended to be and is treated by the 592
882-vendor as private in that the disclosure of the information 593
883-would cause harm to the business operations of the vendor; that 594
884-has not been disclos ed unless disclosed pursuant to a statutory 595
885-provision, an order of a court or administrative body, or a 596
886-private agreement providing that the information may be released 597
887-to the public; and that is information concerning: 598
888- a. Business plans. 599
889- b. Internal auditing controls and reports of internal 600
890-
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898-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
899-
900-
901-
902-auditors. 601
903- c. Reports of external auditors for privately held 602
904-companies. 603
905- d. Client and customer lists. 604
906- e. Potentially patentable material. 605
907- f. A trade secret as defined in s. 688.002. 606
908- 5. "Vendor" means a par ticipating insurer or other 607
909-provider of services as described in paragraph (4)(d). 608
910- (b) Public record exemptions. — 609
911- 1. Personal identifying information of an enrollee or 610
912-participant who has applied for or participates in the Florida 611
913-Employee Health Choices Program is confidential and exempt from 612
914-s. 119.07(1) and s. 24(a), Art. I of the State Constitution. 613
915- 2. Client and customer lists of a buyer's representative 614
916-held by the corporation are confidential and exempt from s. 615
917-119.07(1) and s. 24(a), Art. I of the State Constitution. 616
918- 3. Proprietary confidential business information held by 617
919-the corporation is confidential and exempt from s. 119.07(1) and 618
920-s. 24(a), Art. I of the State Constitution. 619
921- (c) Retroactive application. —The public record exemptions 620
922-provided for in paragraph (b) apply to information held by the 621
923-corporation before, on, or after the effective date of this 622
924-exemption. 623
925- (d) Authorized release. — 624
926- 1. Upon request, information made confidential and exempt 625
927-
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935-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
936-
937-
938-
939-pursuant to this subsection shall be d isclosed to: 626
940- a. Another governmental entity in the performance of its 627
941-official duties and responsibilities. 628
942- b. Any person who has the written consent of the program 629
943-applicant. 630
944- c. The Florida Kidcare program for the purpose of 631
945-administering the progra m authorized in ss. 409.810 -409.821. 632
946- 2. Paragraph (b) does not prohibit a participant's legal 633
947-guardian from obtaining confirmation of coverage, dates of 634
948-coverage, the name of the participant's health plan, and the 635
949-amount of premium being paid. 636
950- (e) Penalty.—A person who knowingly and willfully violates 637
951-this subsection commits a misdemeanor of the second degree, 638
952-punishable as provided in s. 775.082 or s. 775.083. 639
953- Section 2. Paragraph (a) of subsection (2) of section 640
954-409.821, Florida Statutes, is a mended to read: 641
955- 409.821 Florida Kidcare program public records exemption. — 642
956- (2)(a) Upon request, such information shall be disclosed 643
957-to: 644
958- 1. Another governmental entity in the performance of its 645
959-official duties and responsibilities; 646
960- 2. The Department of Revenue for purposes of administering 647
961-the state Title IV-D program; 648
962- 3. The Florida Employee Health Choices, Inc., for the 649
963-purpose of administering the program authorized pursuant to s. 650
964-
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972-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
973-
974-
975-
976-408.910; or 651
977- 4. Any person who has the written consent of the pr ogram 652
978-applicant. 653
979- Section 3. Subsection (3) of section 409.9122, Florida 654
980-Statutes, is amended to read: 655
981- 409.9122 Medicaid managed care enrollment; HIV/AIDS 656
982-patients; procedures; data collection; accounting; information 657
983-system; medical loss ratio. — 658
984- (3) The agency shall develop a process to enable any 659
985-recipient with access to employer -sponsored health care coverage 660
986-to opt out of all eligible plans in the Medicaid program and to 661
987-use Medicaid financial assistance to pay for the recipient's 662
988-share of cost in any such employer-sponsored coverage. 663
989-Contingent on federal approval, the agency shall also enable 664
990-recipients with access to other insurance or related products 665
991-that provide access to health care services created pursuant to 666
992-state law, including any plan or product available pursuant to 667
993-the Florida Employee Health Choices Program or any health 668
994-exchange, to opt out. The amount of financial assistance 669
995-provided for each recipient may not exceed the amount of the 670
996-Medicaid premium that would have been paid to a plan for that 671
997-recipient. 672
998- Section 4. Subsection (4) of section 409.977, Florida 673
999-Statutes, is amended to read: 674
1000- 409.977 Enrollment. — 675
1001-
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1010-
1011-
1012-
1013- (4) The agency shall develop a process to enable a 676
1014-recipient with access to employer -sponsored health care coverage 677
1015-to opt out of all managed care plans and to use Medicaid 678
1016-financial assistance to pay for the recipient's share of the 679
1017-cost in such employer -sponsored coverage. The agency shall also 680
1018-enable recipients with access to other insurance or related 681
1019-products providing access to health care services created 682
1020-pursuant to state law, including any product available under the 683
1021-Florida Employee Health Choices Program, or any health exchange, 684
1022-to opt out. The amount of financial assistance provided for each 685
1023-recipient may not exceed the amount of the Medicaid premium that 686
1024-would have been paid to a managed care plan for that recipient. 687
1025-The agency shall require Medicaid recipients with access to 688
1026-employer-sponsored health care coverage to enroll in that 689
1027-coverage and use Medicaid financial assistance to pay for the 690
1028-recipient's share of the cost for such coverage. The amount of 691
1029-financial assistance provided for each recipient may not exceed 692
1030-the amount of the Medicaid premium that would have been paid to 693
1031-a managed care plan for that recipient. 694
1032- Section 5. This act shall take effect July 1, 2025. 695
865+recipient may not exceed the amount of the Medicaid premium that 576
866+would have been paid to a managed care plan for that recipient. 577
867+The agency shall require Medicaid recipients with access to 578
868+employer-sponsored health care coverage to enroll in that 579
869+coverage and use Medicaid financial assistance to pay for the 580
870+recipient's share of the cost for such coverage. The amount of 581
871+financial assistance provided for each recipient may not exceed 582
872+the amount of the Medicaid premium that would have been paid to 583
873+a managed care plan for that recipient. 584
874+ Section 5. This act shall take effect July 1, 2025. 585