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1
2 An act relating to the state group insurance program;
3 amending s. 110.123, F.S.; providing and revising
4 definitions; authorizing eligible former employees to
5 participate in the state group insurance program;
6 removing certain benefit levels for certain health
7 plans; conforming provisions to changes made by the
8 act; conforming cross-references; amending s.
9 110.12303, F.S.; requiring cost savings to an enrollee
10 to include a specified waiver, unless prohibited under
11 certain tax laws; revising what may be included in
12 cost savings; creating s. 110.12306, F.S.; defining
13 the term "designated anti-fraud unit"; requiring the
14 Division of State Group Insurance to establish and
15 maintain, or contract with other entities to establish
16 and maintain, a designated anti-fraud unit for certain
17 purposes, to adopt an anti-fraud plan, and to
18 designate staff with certain responsibilities by a
19 specified date; creating s. 110.12313, F.S.;
20 specifying that eligible former employees may obtain
21 certain health insurance coverage within a specified
22 time after their separation from employment; providing
23 requirements for certain health insurance coverage
24 options; amending s. 110.1239, F.S.; removing language
25 that certain additional appropriations are considered
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26 a state contribution, which result in an increase in
27 the state premium; ratifying specified rules of the
28 Florida Administrative Code relating to health
29 maintenance organization plan regions; providing
30 construction; providing effective dates.
31
32 Be It Enacted by the Legislature of the State of Florida:
33
34 Section 1. Paragraph (b) and paragraphs (c) through (p) of
35 subsection (2) of section 110.123, Florida Statutes, are
36 redesignated as paragraph (c) and paragraphs (e) through (r),
37 respectively, present paragraphs (b), (k), (m), and (o) of
38 subsection (2), paragraphs (d), (g), and (j) of subsection (3),
39 paragraph (e) of subsection (4), and paragraphs (c) and (d) of
40 subsection (13) are amended, and new paragraphs (b) and (d) are
41 added to subsection (2) of that section, to read:
42 110.123 State group insurance program.—
43 (2) DEFINITIONS.—As used in ss. 110.123-110.1239, the
44 term:
45 (b) "Eligible former employee" means a former state
46 officer or employee who was enrolled in the state group
47 insurance program for at least 6 cumulative years with an
48 employer or employers participating in the state group insurance
49 program, and who was enrolled in the state group insurance
50 program at the time of his or her separation from employment and
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51 whose separation from employment occurred on or after July 1,
52 2022.
53 (c)(b) "Enrollee" means all state officers and employees,
54 retired state officers and employees, surviving spouses of
55 deceased state officers and employees, eligible former
56 employees, and terminated employees or individuals with
57 continuation coverage who are enrolled in an insurance plan
58 offered by the state group insurance program. The term
59 "enrollee" includes all state university officers and employees,
60 retired state university officers and employees, surviving
61 spouses of deceased state university officers and employees, and
62 terminated state university employees or individuals with
63 continuation coverage who are enrolled in an insurance plan
64 offered by the state group insurance program.
65 (d) "Enrollee cost-sharing liability" means the amount an
66 enrollee or beneficiary is responsible for paying for a covered
67 item or service under the terms of the state group insurance
68 program. The term "enrollee cost-sharing liability" includes
69 deductibles, coinsurance, and copayments, but does not include
70 premiums.
71 (m)(k) "State group health insurance plan or plans" or
72 "state plan or plans" means the state self-insured health
73 insurance plan or plans offered to state officers and employees,
74 retired state officers and employees, eligible former employees,
75 and surviving spouses of deceased state officers, and employees,
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76 and eligible former employees under pursuant to this section.
77 (o)(m) "State group insurance program" or "programs" means
78 the package of insurance plans offered to state officers and
79 employees, retired state officers and employees, eligible former
80 employees, and surviving spouses of deceased state officers, and
81 employees, and eligible former employees under pursuant to this
82 section, including the state group health insurance plan or
83 plans, health maintenance organization plans, TRICARE
84 supplemental insurance plans, and other plans required or
85 authorized by law.
86 (q)(o) "Surviving spouse" means the widow or widower of a
87 deceased state officer, full-time state employee, part-time
88 state employee, eligible former employee, or retiree if such
89 widow or widower was covered as a dependent under the state
90 group health insurance plan, TRICARE supplemental insurance
91 plan, or a health maintenance organization plan established
92 under pursuant to this section at the time of the death of the
93 deceased officer, employee, eligible former employee, or
94 retiree. The term "surviving spouse" also means any widow or
95 widower who is receiving or eligible to receive a monthly state
96 warrant from a state retirement system as the beneficiary of a
97 state officer, full-time state employee, or retiree who died
98 prior to July 1, 1979. For the purposes of this section, any
99 such widow or widower shall cease to be a surviving spouse upon
100 his or her remarriage.
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101 (3) STATE GROUP INSURANCE PROGRAM.—
102 (d)1. Notwithstanding chapter 287 and the authority of the
103 department, for the purpose of protecting the health of, and
104 providing medical services to, state employees and eligible
105 former employees participating in the state group insurance
106 program, the department may contract to retain the services of
107 professional administrators for the state group insurance
108 program. The agency shall follow good purchasing pr actices of
109 state procurement to the extent practicable under the
110 circumstances.
111 2. Each vendor in a major procurement, and any other
112 vendor if the department deems it necessary to protect the
113 state's financial interests, shall, at the time of executing any
114 contract with the department, post an appropriate bond with the
115 department in an amount determined by the department to be
116 adequate to protect the state's interests but not higher than
117 the full amount estimated to be paid annually to the vendor
118 under the contract.
119 3. Each major contract entered into by the department
120 under pursuant to this section must shall contain a provision
121 for payment of liquidated damages to the department for material
122 noncompliance by a vendor with a contract provision. The
123 department may require a liquidated damages provision in any
124 contract if the department deems it necessary to protect the
125 state's financial interests.
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126 4. Section 120.57(3) applies to the department's
127 contracting process, except:
128 a. A formal written protest of any decision, intended
129 decision, or other action subject to protest must shall be filed
130 within 72 hours after receipt of notice of the decision,
131 intended decision, or other action.
132 b. As an alternative to any provision of s. 120.57(3), the
133 department may proceed with the bid selection or contract award
134 process if the director of the department sets forth, in
135 writing, particular facts and circumstances that demonstrate the
136 necessity of continuing the procurement process or the contract
137 award process in order to avoid a substantial disruption to the
138 provision of any scheduled insurance services.
139 5. The department shall make arrangements as necessary to
140 contribute claims data of the state group health insurance plan
141 to the contracted vendor selected by the Agency for Health Care
142 Administration under pursuant to s. 408.05(3)(c).
143 6. Each contracted vendor for the state group health
144 insurance plan shall contribute Florida claims data to the
145 contracted vendor selected by the Agency for Health Care
146 Administration under pursuant to s. 408.05(3)(c).
147 (g) Participation by individuals in the program is
148 available to all state officers, full-time state employees, and
149 part-time state employees, and eligible former employees and is
150 voluntary. Participation in the program is also available to
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151 retired state officers and employees who elect at the time of
152 retirement to continue coverage under the program, but may elect
153 to continue all or only part of the coverage they had at the
154 time of retirement. A surviving spouse may elect to continue
155 coverage only under a state group health insurance plan, a
156 TRICARE supplemental insurance plan, or a health maintenance
157 organization plan.
158 (j) For the 2020 plan year and each plan year thereafter,
159 health plans shall be offered in the following benefit levels:
160 1. Platinum level, which shall have an actuarial value of
161 at least 90 percent.
162 2. Gold level, which shall have an actuarial value of at
163 least 80 percent.
164 3. Silver level, which shall have an actuarial value of at
165 least 70 percent.
166 4. Bronze level, which shall have an actuarial value of at
167 least 60 percent.
168 (4) PAYMENT OF PREMIUMS; CONTRIBUTION BY STATE; LIMITATION
169 ON ACTIONS TO PAY AND COLLECT PREMIUMS.—
170 (e) No state contribution for the cost of any part of the
171 premium shall be made for retirees, or surviving spouses, or
172 eligible former employees for any type of coverage under the
173 state group insurance program. However, any state agency that
174 employs a full-time law enforcement officer, correctional
175 officer, or correctional probation officer who is killed or
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176 suffers catastrophic injury in the line of duty as provided in
177 s. 112.19, or a full-time firefighter who is killed or suffers
178 catastrophic injury in the line of duty as provided in s.
179 112.191, shall pay the entire premium of the state group health
180 insurance plan selected for the employee's surviving spouse
181 until remarried, and for each dependent child of the employee,
182 subject to the conditions and limitations set forth in s. 112.19
183 or s. 112.191, as applicable.
184 (13) OTHER-PERSONAL-SERVICES EMPLOYEES (OPS).—
185 (c) The initial measurement period used to determine
186 whether an employee hired before April 1, 2013, and paid from
187 OPS funds is a full-time employee described in subparagraph
188 (2)(e)1. subparagraph (2)(c)1. is the 6-month period from April
189 1, 2013, through September 30, 2013.
190 (d) All other measurement periods used to determine
191 whether an employee paid from OPS funds is a full-time employee
192 described in paragraph (2)(e) paragraph (2)(c) must be for 12
193 consecutive months.
194 Section 2. Paragraph (a) of subsection (2) of section
195 110.12303, Florida Statutes, is amended to read:
196 110.12303 State group insurance program; additional
197 benefits; price transparency program; reporting.—
198 (2)(a) The department shall contract with at least one
199 entity that provides comprehensive pricing and inclusive
200 services for surgery and other medical procedures which may be
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201 accessed at the option of the enrollee. The contract shall
202 require the entity to:
203 1. The entity to have procedures and evidence-based
204 standards to ensure the inclusion of only high-quality health
205 care providers.
206 2. The entity to provide assistance to the enrollee in
207 accessing and coordinating care.
208 3. The entity to provide cost savings to the state group
209 insurance program to be shared with both the state and the
210 enrollee. Cost savings payable to an enrollee must, unless
211 prohibited by first-dollar coverage rules under applicable tax
212 law, include a waiver of enrollee cost-sharing liability for
213 surgery and other medical pro