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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 coverage for colorectal cancer 2
screening and diagnosis; amending s. 408.9091, F.S.; 3
revising the colorectal screening requirements for 4
specified plans under the Cover Florida Health Care 5
Access Program; creating s. 627.64192, F.S.; defin ing 6
the term "cost sharing"; requiring specified 7
individual health insurance policies to provide 8
coverage for specified colorectal cancer screening 9
tests, procedures, and examinations under certain 10
circumstances; prohibiting individual health insurers 11
from imposing any cost sharing for such coverage; 12
providing applicability; creating s. 627.6614, F.S.; 13
defining the term "cost sharing"; requiring specified 14
group, blanket, and franchise health insurance 15
policies to provide coverage for specified colorectal 16
cancer screening tests, procedures, and examinations 17
under certain circumstances; prohibiting group, 18
blanket, and franchise health insurers from imposing 19
any cost sharing for such coverage; creating s. 20
641.31093, F.S.; defining the term "cost sharing"; 21
requiring specified health maintenance contracts to 22
provide coverage for specified colorectal cancer 23
screening tests, procedures, and examinations under 24
certain circumstances; prohibiting health maintenance 25
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organizations from imposing any cost sharing for such 26
coverage; providing applicability; providing an 27
effective date. 28
29
Be It Enacted by the Legislature of the State of Florida: 30
31
Section 1. Paragraph (a) of subsection (4) of section 32
408.9091, Florida Statutes, is amended to read: 33
408.9091 Cover Flori da Health Care Access Program. — 34
(4) PROGRAM.—The agency and the office shall jointly 35
establish and administer the Cover Florida Health Care Access 36
Program. 37
(a) General Cover Florida plan components must require 38
that: 39
1. Plans are offered on a guarant eed-issue basis to 40
enrollees, subject to exclusions for preexisting conditions 41
approved by the office and the agency. 42
2. Plans are portable such that the enrollee remains 43
covered regardless of employment status or the cost sharing of 44
premiums. 45
3. Plans provide for cost containment through limits on 46
the number of services, caps on benefit payments, and copayments 47
for services. 48
4. A Cover Florida plan entity makes all benefit plan and 49
marketing materials available in English and Spanish. 50
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5. In order to provide for consumer choice, Cover Florida 51
plan entities develop two alternative benefit option plans 52
having different cost and benefit levels, including at least one 53
plan that provides catastrophic coverage. 54
6. Plans without catastrophic coverage prov ide coverage 55
options for services including, but not limited to: 56
a. Preventive health services, including immunizations, 57
annual health assessments, well -woman and well-care services, 58
and preventive screenings such as mammograms, cervical cancer 59
screenings, and noninvasive colorectal or prostate screenings, 60
and colorectal cancer screenings in accordance with s. 61
627.64192, s. 627.6614, or s. 641.31093 . 62
b. Incentives for routine preventive care. 63
c. Office visits for the diagnosis and treatment of 64
illness or injury. 65
d. Office surgery, including anesthesia. 66
e. Behavioral health services. 67
f. Durable medical equipment and prosthetics. 68
g. Diabetic supplies. 69
7. Plans providing catastrophic coverage, at a minimum, 70
provide coverage options for all of the services listed under 71
subparagraph 6.; however, such plans may include, but are not 72
limited to, coverage options for: 73
a. Inpatient hospital stays. 74
b. Hospital emergency care services. 75
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c. Urgent care services. 76
d. Outpatient facility services, ou tpatient surgery, and 77
outpatient diagnostic services. 78
8. All plans offer prescription drug benefit coverage, use 79
a prescription drug manager, or offer a discount drug card. 80
9. Plan enrollment materials provide information in plain 81
language on policy be nefit coverage, benefit limits, cost -82
sharing requirements, and exclusions and a clear representation 83
of what is not covered in the plan. Such enrollment materials 84
must include a standard disclosure form adopted by rule by the 85
Financial Services Commission, to be reviewed and executed by 86
all consumers purchasing Cover Florida plan coverage. 87
10. Plans offered through a qualified employer meet the 88
requirements of s. 125 of the Internal Revenue Code. 89
Section 2. Section 627.64192, Florida Statutes, is crea ted 90
to read: 91
627.64192 Coverage for colorectal cancer screening and 92
diagnosis.— 93
(1) As used in this section, the term "cost sharing" 94
includes copayments, coinsurance, dollar limits, and deductibles 95
imposed on the covered person. The term does not inclu de 96
premiums. 97
(2)(a) A health insurance policy issued, amended, 98
delivered, or renewed on or after January 1, 2026, must provide 99
coverage for a colorectal cancer screening test, procedure, or 100
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examination conducted by a health care provider which is: 101
1.a. Approved by the United States Food and Drug 102
Administration and meets the requirements of the National 103
Coverage Determination 210.3 made by the Centers for Medicare 104
and Medicaid Services; or 105
b. In accordance with the most recent or most recently 106
published guidelines and recommendations established by the 107
American Cancer Society for the ages, family histories, and 108
frequencies referenced in such guidelines and recommendations; 109
and 110
2. Deemed appropriate by the attending physician after 111
conferring with the patient. 112
(b) The health insurer may not impose any cost sharing on 113
the insured for the coverage of a colorectal cancer screening 114
test, procedure, or examination described in paragraph (a), 115
regardless of whether the test, procedure, or examination is 116
conducted by an in-network or out-of-network health care 117
provider. 118
(3) This section does not apply to a nonrenewable health 119
insurance policy written for a period of less than 6 months. 120
Section 3. Section 627.6614, Florida Statutes, is created 121
to read: 122
627.6614 Coverage for colorectal cancer screening and 123
diagnosis.— 124
(1) As used in this section, the term "cost sharing" 125
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includes copayments, coinsurance, dollar limits, and deductibles 126
imposed on the covered person. The term does not include 127
premiums. 128
(2)(a) A health insurance policy issued, amended, 129
delivered, or renewed on or after January 1, 2026, must provide 130
coverage for a colorectal cancer screening test, procedure, or 131
examination conducted by a health care provider which is: 132
1.a. Approved by the United States Food and Drug 133
Administration and meets the requirements of the National 134
Coverage Determination 210.3 made by the Centers for Medicare 135
and Medicaid Services; or 136
b. In accordance with the most recent or most recently 137
published guidelines and recommendations established by the 138
American Cancer Society for the ages, family histories, and 139
frequencies referenced in such guidelines and recommendations; 140
and 141
2. Deemed appropriate by the attending physician after 142
conferring with the patient. 143
(b) The health insurer may not impose any cost sharing on 144
the insured for the coverage of a colorectal cancer screening 145
test, procedure, or examination described in paragraph (a), 146
regardless of whether the test, procedure, or examination is 147
conducted by an in-network or out-of-network health care 148
provider. 149
Section 4. Section 641.31093, Florida Statutes, is created 150
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to read: 151
641.31093 Coverage for colorectal cancer screening and 152
diagnosis.— 153
(1) As used in this section, the term "cost sharing" 154
includes copayments, coinsurance, dollar limits, and deductibles 155
imposed on the covered person. The term does not include 156
premiums. 157
(2)(a) A health maintenance contract issued, amended, 158
delivered, or renewed on or after January 1, 2026, must provide 159
coverage for a colorectal cancer screening test, procedure, or 160
examination conducted by a health care provider which is: 161
1.a. Approved by the United States Food and Drug 162
Administration and meets the requirements of the National 163
Coverage Determination 210.3 made by th e Centers for Medicare 164
and Medicaid Services; or 165
b. In accordance with the most recent or most recently 166
published guidelines and recommendations established by the 167
American Cancer Society for the ages, family histories, and 168
frequencies referenced in such guidelines and recommendations; 169
and 170
2. Deemed appropriate by the attending physician after 171
conferring with the patient. 172
(b) The health maintenance organization may not impose any 173
cost sharing on the subscriber for the coverage of a colorectal 174
cancer screening test, procedure, or examination described in 175
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paragraph (a), regardless of whether the test, procedure, or 176
examination is conducted by an in -network or out-of-network 177
health care provider. 178
(3) This section does not apply to a nonrenewable 179
individual health maintenance contract written for a period of 180
less than 6 months. 181
Section 5. This act shall take effect July 1, 2025. 182