Wednesday, May 21, 2008

Florida Plan to Be Enacted

By Merrill Matthews, Jr.

Categories: Florida

In Florida, Gov. Charlie Crist's health care access proposal was combined with an equally sweeping rival plan sponsored by the chairman of the House Health Care Appropriations Committee in a bill (S.B. 2534) that passed the legislature in the final hours of its 2008 session. The governor's "Cover Florida Health Access Program" includes an eligibility expansion for the fledgling Health Flex Access Program from 200 to 300 percent of the federal poverty level, plus a new access initiative with the following features:

* Eligible uninsured residents and small group employers would have access to basic and catastrophic major medical plans to be jointly administered by the Office of Insurance Regulation and the Agency for Healthcare Administration, subject to preexisting condition exclusions approved by the two agencies;
* A July 1, 2008, invitation for carriers to participate on a guaranteed access basis. Plans shall be disapproved if they offer benefits that are deemed unreasonable in relation the premiums charged;
* The plans are portable between the small group and the individual markets. Participating employers must establish a section 125 premium-only cafeteria plan.

Representative Aaron Bean's "Florida Health Choices Program" is described as a quasi-public "farmer's market" where small group employers and their employees have guaranteed access to participating health plans, subject to certain preexisting condition exclusions. Rates can be adjusted based on age, gender and geography, but not health status or previous claims experience. The program would provide comparative information on available plans and collect and distribute risk-adjusted premium payments to carriers. Like the governor's plan, participating employers must set up a section 125 plan. Participating insurers, HMOs and prepaid health services providers may offer a range of major medical plans and/or limited benefit policies. The program is to be administered by a 15-member board made up of appointees chosen by the governor, the Senate president and the speaker.