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Florida Senate Passes Health Benefits Package

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Members of the Florida Senate voted 23-14 Thursday to pass Senate Bill 322, package of three pieces of health insurance legislation.

The package could set standards for health insurance in Florida if Congress, or the courts, kill the current Affordable Care Act coverage standards.

(Related: Sudden Cost-Sharing Reduction End Could Thump Florida Blue)

The original text of S.B. 322 would let a health insurer or health maintenance organization offer major medical policies that exclude or limit coverage for preexisting medical conditions, as long as the carriers also actively marketed policies without such restrictions. That section of S.B. 322 would not set any limits on the difference between the cost of the policies with preexisting condition coverage restrictions and the cost of policies without such restrictions.

This week, senators added the text of two other state Senate health bills to S.B. 322 through amendments.

One amendment added provisions from S.B. 418. That bill would set state essential health benefits (EHB) package rules, to replace the current ACA benefits package standards.

Another amendment added provisions from S.B. 1422. Those provisions coming from S.B. 1422 would help insurers in Florida use new Trump administration regulations to offer association health plans, and to offer short-term health insurance policies that, with renewals, can stay in place for up to 36 months.

The sponsors of the provisions in the package have said that they hope to lower health insurance premiums.

For 2019, premium hikes for individual ACA-compliant plans averaged 5.2%, according to an analysis of S.B. 418, the source of the health benefits package section of S.B. 322,

Details to Come Later

The three-bill S.B. 322 package is only 17 pages long.

The EHB section, for example, gives few details about how the new EHB packages might compare with the state’s current EHB package.

The ACA has created 10 broad EHB benefits categories. The categories include emergency services; pregnancy, maternity and newborn care, mental health and substance abuse treatment; rehab services and devices; hospitalizations; and preventative and wellness care.

The U.S. Department of Health and Human Services (HHS) has completed regulations that will give states more discretion over EHBs beginning in 2020. Under new HHS rules, a state could pick an EHB package used in another state in 2017. Or, it could substitute one or more of the broad EHB categories or services ordered under a category used in another state or multiple states.

Any HMO or health insurer that reworks policies with substituted benefits must:

  • Ensure benefits are “substantially equivalent” to the EHB benchmark plan.
  • Not modify benefits so that one category has an excess of benefits while others do not.
  • Guarantee benefits and services serve all segments of the population.

The EHB section in S.B. 322 would let a health insurer or health maintenance organization to use EHB packages from other states when designing benefits packages for sale in Florida.

The Florida Office of Insurance Regulation is supposed to make recommendations by Oct. 30 on ideas for changing the state’s current EHB standard, to make it possible for insurers to provide comprehensive care at a lower cost.

The Companion Bill

The Florida House has been considering a bill that’s similar to the expanded version of S.B. 322, H.R. 997. Members of the House Health and Human Services Committee approved H.R. 997 by a 11-5 vote April 9.

The Calendar

The Florida Legislature’s regular session ends May 3.


The Florida Senate tracking page for S.B. 322 is available here

The tracking page for S.B. 418 is here.

The tracking page for S.B. 1422 is here.

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