Small Employer Health Carrier Reinsurance Program

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A bill to be entitled 1
An act relating to a small employer health carrier 2
reinsurance program; amending s. 627.6699, F.S.; 3
removing and revising definitions; removing provisions 4
relating to the creation of the Florida Small Employer 5
Carrier Reinsurance Program; amending s. 627.642, 6
F.S.; conforming a cross-reference; amending s. 7
627.6475, F.S.; conforming provisions to changes made 8
by the act; conforming cross-references; amending ss. 9
627.657 and 627.66997, F.S.; conforming a cross-10
reference; providing an effective date. 11
12
Be It Enacted by the Legislature of the State of Florida: 13
14
Section 1. Paragraphs (c) through (o) and (r) through (w) 15
of subsection (3) of section 627.6699, Florida Statutes, are 16
redesignated as paragraphs (b) through (n) and (o) through (t), 17
respectively, subsections (12) through (17) are renumbered as 18
subsections (11) through (16), respectively, and subsection (2), 19
present paragraphs (b), (p), (q), and (s) of subsection (3), 20
paragraph (d) of subsection (9), paragraphs (b) and (c) of 21
subsection (10), and present subsection (11) of that section are 22
amended, to read: 23
627.6699 Employee Health Care Access Act.— 24
(2) PURPOSE AND INTENT.—The purpose and intent of this 25

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section is to promote the availability of health insurance 26
coverage to small employers regardless of their claims 27
experience or their employees' health status, to establish rules 28
regarding renewability of that coverage, to establish 29
limitations on the use of exclusions for preexisting conditions, 30
to provide for establishment of a reinsurance program for 31
coverage of small employers, and to improve the overall fairness 32
and efficiency of the small group health insurance market. 33
(3) DEFINITIONS.—As used in this section, the term: 34
(b) "Board" means the board of directors of the program. 35
(p) "Plan of operation" means the plan of operation of the 36
program, including articles, bylaws, and operating rules, 37
adopted by the board under subsection (11). 38
(q) "Program" means the Florida Small Employer Carrier 39
Reinsurance Program created under subsection (11). 40
(p)(s) "Reinsuring carrier" means a small employer carrier 41
that elects to comply with reinsurance the requirements set 42
forth in subsection (11). 43
(9) SMALL EMPLOYER CARRIER'S ELECTION TO BECOME A RISK-44
ASSUMING CARRIER OR A REINSURING CARRIER.— 45
(d) A small employer carrier that elects to cease 46
participating as a reinsuring carrier and to become a risk-47
assuming carrier is prohibited from reinsuring or continuing to 48
reinsure any small employer health benefits plan under 49
subsection (11) as soon as the carrier becomes a risk-assuming 50

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carrier and must pay a prorated assessment based upon business 51
issued as a reinsuring carrier for any portion of the year that 52
the business was reinsured. A small employer carrier that elects 53
to cease participating as a risk-assuming carrier and to become 54
a reinsuring carrier is permitted to reinsure small employer 55
health benefit plans under the terms set forth in subsection 56
(11) and must pay a prorated assessment based upon business 57
issued as a reinsuring carrier for any portion of the year that 58
the business was reinsured. 59
(10) ELECTION PROCESS TO BECOME A RISK-ASSUMING CARRIER.— 60
(b) In determining whether to approve an application by a 61
small employer carrier to become a risk-assuming carrier, the 62
office shall consider: 63
1. The carrier's financial ability to support the 64
assumption of the risk of small employer groups. 65
2. The carrier's history of rating and underwriting small 66
employer groups. 67
3. The carrier's commitment to market fairly to all small 68
employers in the state or its service area, as applicable. 69
4. The carrier's ability to assume and manage the risk of 70
enrolling small employer groups without the protection of the 71
reinsurance program provided in subsection (11). 72
(c) A small employer carrier that becomes a risk-assuming 73
carrier pursuant to this subsection is not subject to 74
reinsurance the assessment provisions of subsection (11). 75

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(11) SMALL EMPLOYER HEALTH REINSURANCE PROGRAM.— 76
(a) There is created a nonprofit entity to be known as the 77
"Florida Small Employer Health Reinsurance Program." 78
(b)1. The program shall operate subject to the supervision 79
and control of the board. 80
2. Effective upon this act becoming a law, the board shall 81
consist of the director of the office or his or her designee, 82
who shall serve as the chairperson, and 13 additional members 83
who are representatives of carriers and insurance agents and are 84
appointed by the director of the office and serve as follows: 85
a. Five members shall be representatives of health 86
insurers licensed under chapter 624 or chapter 641. Two members 87
shall be agents who are actively engaged in the sale of health 88
insurance. Four members shall be employers or representatives of 89
employers. One member shall be a person covered under an 90
individual health insurance policy issued by a licensed insurer 91
in this state. One member shall represent the Agency for Health 92
Care Administration and shall be recommended by the Secretary of 93
Health Care Administration. 94
b. A member appointed under this subparagraph shall serve 95
a term of 4 years and shall continue in office until the 96
member's successor takes office, except that, in order to 97
provide for staggered terms, the director of the office shall 98
designate two of the initial appointees under this subparagraph 99
to serve terms of 2 years and shall designate three of the 100

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initial appointees under this subparagraph to serve terms of 3 101
years. 102
3. The director of the office may remove a member for 103
cause. 104
4. Vacancies on the board shall be filled in the same 105
manner as the original appointment for the unexpired portion of 106
the term. 107
(c)1. The board shall submit to the office a plan of 108
operation to assure the fair, reasonable, and equitable 109
administration of the program. The board may at any time submit 110
to the office any amendments to the plan that the board finds to 111
be necessary or suitable. 112
2. The office shall, after notice and hearing, approve the 113
plan of operation if it determines that the plan submitted by 114
the board is suitable to assure the fair, reasonable, and 115
equitable administration of the program and provides for the 116
sharing of program gains and losses equitably and 117
proportionately in accordance with paragraph (j). 118
3. The plan of operation, or any amendment thereto, 119
becomes effective upon written approval of the office. 120
(d) The plan of operation must, among other things: 121
1. Establish procedures for handling and accounting for 122
program assets and moneys and for an annual fiscal reporting to 123
the office. 124
2. Establish procedures for selecting an administering 125

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carrier and set forth the powers and duties of the administering 126
carrier. 127
3. Establish procedures for reinsuring risks. 128
4. Establish procedures for collecting assessments from 129
participating carriers to provide for claims reinsured by the 130
program and for administrative expenses, other than amounts 131
payable to the administrative carrier, incurred or estimated to 132
be incurred during the period for which the assessment is made. 133
5. Provide for any additional matters at the discretion of 134
the board. 135
(e) The board shall recommend to the office market conduct 136
requirements and other requirements for carriers and agents, 137
including requirements relating to: 138
1. Registration by each carrier with the office of its 139
intention to be a small employer carrier under this section; 140
2. Publication by the office of a list of all small 141
employer carriers, including a requirement applicable to agents 142
and carriers that a health benefit plan may not be sold by a 143
carrier that is not identified as a small employer carrier; 144
3. The availability of a broadly publicized, toll-free 145
telephone number for access by small employers to information 146
concerning this section; 147
4. Periodic reports by carriers and agents concerning 148
health benefit plans issued; and 149
5. Methods concerning periodic demonstration by small 150

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employer carriers and agents that they are marketing or issuing 151
health benefit plans to small employers. 152
(f) The program has the general powers and authority 153
granted under the laws of this state to insurance companies and 154
health maintenance organizations licensed to transact business, 155
except the power to issue health benefit plans directly to 156
groups or individuals. In addition thereto, the program has 157
specific authority to: 158
1. Enter into contracts as necessary or proper to carry 159
out the provisions and purposes of this act, including the 160
authority to enter into contracts with similar programs of other 161
states for the joint performance of common functions or with 162
persons or other organizations for the performance of 163
administrative functions. 164
2. Sue or be sued, including taking any legal action 165
necessary or proper for recovering any assessments and penalties 166
for, on behalf of, or against the program or any carrier. 167
3. Take any legal action necessary to avoid the payment of 168
improper claims against the program. 169
4. Issue reinsurance policies, in accordance with the 170
requirements of this act. 171
5. Establish rules, conditions, and procedures for 172
reinsurance risks under the program participation. 173
6. Establish actuarial functions as appropriate for the 174
operation of the program. 175

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7. Assess participating carriers in accordance with 176
paragraph (j), and make advance interim assessments as may be 177
reasonable and necessary for organizational and interim 178
operating expenses. Interim assessments shall be credited as 179
offsets against any regular assessments due following the close 180
of the calendar year. 181
8. Appoint appropriate legal, actuarial, and other 182
committees as necessary to provide technical assistance in the 183
operation of the program, and in any other function within the 184
authority of the program. 185
9. Borrow money to effect the purposes of the program. Any 186
notes or other evidences of indebtedness of the program which 187
are not in default constitute legal investments for carriers and 188
may be carried as admitted assets. 189
10. To the extent necessary, increase the $5,000 190
deductible reinsurance requirement to adjust for the effects of 191
inflation. 192
(g) A reinsuring carrier may reinsure with the program 193
coverage of an eligible employee of a small employer, or any 194
dependent of such an employee, subject to each of the following 195
provisions: 196
1. Except in the case of a late enrollee, a reinsuring 197
carrier may reinsure an eligible employee or dependent within 60 198
days after the commencement of the coverage of the small 199
employer. A newly employed eligible employee or dependent of a 200

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small employer may be reinsured within 60 days after the 201
commencement of his or her coverage. 202
2. A small employer carrier may reinsure an entire 203
employer group within 60 days after the commencement of the 204
group's coverage under the plan. 205
3. The program may not reimburse a participating carrier 206
with respect to the claims of a reinsured employee or dependent 207
until the carrier has paid incurred claims of at least $5,000 in 208
a calendar year for benefits covered by the program. In 209
addition, the reinsuring carrier shall be responsible for 10 210
percent of the next $50,000 and 5 percent of the next $100,000 211
of incurred claims during a calendar year and the program shall 212
reinsure the remainder. 213
4. The board annually shall adjust the initial level of 214
claims and the maximum limit to be retained by the carrier to 215
reflect increases in costs and utilization within the standard 216
market for health benefit plans within the state. The adjustment 217
shall not be less than the annual change in the medical 218
component of the "Consumer Price Index for All Urban Consumers" 219
of the Bureau of Labor Statistics of the Department of Labor, 220
unless the board proposes and the office approves a lower 221
adjustment factor. 222
5. A small employer carrier may terminate reinsurance for 223
all reinsured employees or dependents on any plan anniversary. 224
6. The premium rate charged for reinsurance by the program 225

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to a health maintenance organization that is approved by the 226
Secretary of Health and Human Services as a federally qualified 227
health maintenance organization pursuant to 42 U.S.C. s. 228
300e(c)(2)(A) and that, as such, is subject to requirements that 229
limit the amount of risk that may be ceded to the program, which 230
requirements are more restrictive than subparagraph 3., shall be 231
reduced by an amount equal to that portion of the risk, if any, 232
which exceeds the amount set forth in subparagraph 3. which may 233
not be ceded to the program. 234
7. The board may consider adjustments to the premium rates 235
charged for reinsurance by the program for carriers that use 236
effective cost containment measures, including high-cost case 237
management, as defined by the board. 238
8. A reinsuring carrier shall apply its case-management 239
and claims-handling techniques, including, but not limited to, 240
utilization review, individual case management, preferred 241
provider provisions, other managed care provisions or methods of 242
operation, consistently with both reinsured business and 243
nonreinsured business. 244
(h)1. The board, as part of the plan of operation, shall 245
establish a methodology for determining premium rates to be 246
charged by the program for reinsuring small employers and 247
individuals pursuant to this section. The methodology shall 248
include a system for classification of small employers that 249
reflects the types of case characteristics commonly used by 250

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small employer carriers in the state. The methodology shall 251
provide for the development of basic reinsurance premium rates, 252
which shall be multiplied by the factors set for them in this 253
paragraph to determine the premium rates for the program. The 254
basic reinsurance premium rates shall be established by the 255
board, subject to the approval of the office. The premium rates 256
set by the board may vary by geographical area, as determined 257
under this section, to reflect differences in cost. The 258
multiplying factors must be established as follows: 259
a. The entire group may be reinsured for a rate that is 260
1.5 times the rate established by the board. 261
b. An eligible employee or dependent may be reinsured for 262
a rate that is 5 times the rate established by the board. 263
2. The board periodically shall review the methodology 264
established, including the system of classification and any 265
rating factors, to assure that it reasonably reflects the claims 266
experience of the program. The board may propose changes to the 267
rates which shall be subject to the approval of the office. 268
(i) If a health benefit plan for a small employer issued 269
in accordance with this subsection is entirely or partially 270
reinsured with the program, the premium charged to the small 271
employer for any rating period for the coverage issued must be 272
consistent with the requirements relating to premium rates set 273
forth in this section. 274
(j)1. Before July 1 of each calendar year, the board shall 275

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determine and report to the office the program net loss for the 276
previous year, including administrative expenses for that year, 277
and the incurred losses for the year, taking into account 278
investment income and other appropriate gains and losses. 279
2. Any net loss for the year shall be recouped by 280
assessment of the carriers, as follows: 281
a. The operating losses of the program shall be assessed 282
in the following order subject to the specified limitations. The 283
first tier of assessments shall be made against reinsuring 284
carriers in an amount which shall not exceed 5 percent of each 285
reinsuring carrier's premiums from health benefit plans covering 286
small employers. If such assessments have been collected and 287
additional moneys are needed, the board shall make a second tier 288
of assessments in an amount which shall not exceed 0.5 percent 289
of each carrier's health benefit plan premiums. Except as 290
provided in paragraph (m), risk-assuming carriers are exempt 291
from all assessments authorized pursuant to this section. The 292
amount paid by a reinsuring carrier for the first tier of 293
assessments shall be credited against any additional assessments 294
made. 295
b. The board shall equitably assess carriers for operating 296
losses of the plan based on market share. The board shall 297
annually assess each carrier a portion of the operating losses 298
of the plan. The first tier of assessments shall be determined 299
by multiplying the operating losses by a fraction, the numerator 300

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of which equals the reinsuring carrier's earned premium 301
pertaining to direct writings of small employer health benefit 302
plans in the state during the calendar year for which the 303
assessment is levied, and the denominator of which equals the 304
total of all such premiums earned by reinsuring carriers in the 305
state during that calendar year. The second tier of assessments 306
shall be based on the premiums that all carriers, except risk-307
assuming carriers, earned on all health benefit plans written in 308
this state. The board may levy interim assessments against 309
carriers to ensure the financial ability of the plan to cover 310
claims expenses and administrative expenses paid or estimated to 311
be paid in the operation of the plan for the calendar year prior 312
to the association's anticipated receipt of annual assessments 313
for that calendar year. Any interim assessment is due and 314
payable within 30 days after receipt by a carrier of the interim 315
assessment notice. Interim assessment payments shall be credited 316
against the carrier's annual assessment. Health benefit plan 317
premiums and benefits paid by a carrier that are less than an 318
amount determined by the board to justify the cost of collection 319
may not be considered for purposes of determining assessments. 320
c. Subject to the approval of the office, the board shall 321
make an adjustment to the assessment formula for reinsuring 322
carriers that are approved as federally qualified health 323
maintenance organizations by the Secretary of Health and Human 324
Services pursuant to 42 U.S.C. s. 300e(c)(2)(A) to the extent, 325

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if any, that restrictions are placed on them that are not 326
imposed on other small employer carriers. 327
3. Before July 1 of each year, the board shall determine 328
and file with the office an estimate of the assessments needed 329
to fund the losses incurred by the program in the previous 330
calendar year. 331
4. If the board determines that the assessments needed to 332
fund the losses incurred by the program in the previous calendar 333
year will exceed the amount specified in subparagraph 2., the 334
board shall evaluate the operation of the program and report its 335
findings, including any recommendations for changes to the plan 336
of operation, to the office within 180 days following the end of 337
the calendar year in which the losses were incurred. The 338
evaluation shall include an estimate of future assessments, the 339
administrative costs of the program, the appropriateness of the 340
premiums charged and the level of carrier retention under the 341
program, and the costs of coverage for small employers. If the 342
board fails to file a report with the office within 180 days 343
following the end of the applicable calendar year, the office 344
may evaluate the operations of the program and implement such 345
amendments to the plan of operation the office deems necessary 346
to reduce future losses and assessments. 347
5. If assessments exceed the amount of the actual losses 348
and administrative expenses of the program, the excess shall be 349
held as interest and used by the board to offset future losses 350

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or to reduce program premiums. As used in this paragraph, the 351
term "future losses" includes reserves for incurred but not 352
reported claims. 353
6. Each carrier's proportion of the assessment shall be 354
determined annually by the board, based on annual statements and 355
other reports considered necessary by the board and filed by the 356
carriers with the board. 357
7. Provision shall be made in the plan of operation for 358
the imposition of an interest penalty for late payment of an 359
assessment. 360
8. A carrier may seek, from the office, a deferment, in 361
whole or in part, from any assessment made by the board. The 362
office may defer, in whole or in part, the assessment of a 363
carrier if, in the opinion of the office, the payment of the 364
assessment would place the carrier in a financially impaired 365
condition. If an assessment against a carrier is deferred, in 366
whole or in part, the amount by which the assessment is deferred 367
may be assessed against the other carriers in a manner 368
consistent with the basis for assessment set forth in this 369
section. The carrier receiving such deferment remains liable to 370
the program for the amount deferred and is prohibited from 371
reinsuring any individuals or groups in the program if it fails 372
to pay assessments. 373
(k) Neither the participation in the program as reinsuring 374
carriers, the establishment of rates, forms, or procedures, nor 375

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any other joint or collective action required by this act, may 376
be the basis of any legal action, criminal or civil liability, 377
or penalty against the program or any of its carriers either 378
jointly or separately. 379
(l) The board shall monitor compliance with this section, 380
including the market conduct of small employer carriers, and 381
shall report to the office any unfair trade practices and 382
misleading or unfair conduct by a small employer carrier that 383
has been reported to the board by agents, consumers, or any 384
other person. The office shall investigate all reports and, upon 385
a finding of noncompliance with this section or of unfair or 386
misleading practices, shall take action against the small 387
employer carrier as permitted under the insurance code or 388
chapter 641. The board is not given investigatory or regulatory 389
powers, but must forward all reports of cases or abuse or 390
misrepresentation to the office. 391
(m) Notwithstanding paragraph (j), the administrative 392
expenses of the program shall be recouped by assessment of risk-393
assuming carriers and reinsuring carriers and such amounts shall 394
not be considered part of the operating losses of the plan for 395
the purposes of this paragraph. Each carrier's portion of such 396
administrative expenses shall be determined by multiplying the 397
total of such administrative expenses by a fraction, the 398
numerator of which equals the carrier's earned premium 399
pertaining to direct writing of small employer health benefit 400

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plans in the state during the calendar year for which the 401
assessment is levied, and the denominator of which equals the 402
total of such premiums earned by all carriers in the state 403
during such calendar year. 404
(n) The board shall advise the office, the Agency for 405
Health Care Administration, the department, other executive 406
departments, and the Legislature on health insurance issues. 407
Specifically, the board shall: 408
1. Provide a forum for stakeholders, consisting of 409
insurers, employers, agents, consumers, and regulators, in the 410
private health insurance market in this state. 411
2. Review and recommend strategies to improve the 412
functioning of the health insurance markets in this state with a 413
specific focus on market stability, access, and pricing. 414
3. Make recommendations to the office for legislation 415
addressing health insurance market issues and provide comments 416
on health insurance legislation proposed by the office. 417
4. Meet at least three times each year. One meeting shall 418
be held to hear reports and to secure public comment on the 419
health insurance market, to develop any legislation needed to 420
address health insurance market issues, and to provide comments 421
on health insurance legislation proposed by the office. 422
5. Issue a report to the office on the state of the health 423
insurance market by September 1 each year. The report shall 424
include recommendations for changes in the health insurance 425

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market, results from implementation of previous recommendations, 426
and information on health insurance markets. 427
Section 2. Subsection (3) of section 627.642, Florida 428
Statutes, is amended to read: 429
627.642 Outline of coverage.— 430
(3) In addition to the outline of coverage, a policy as 431
specified in s. 627.6699(3)(j) s. 627.6699(3)(k) must be 432
accompanied by an identification card that contains, at a 433
minimum: 434
(a) The name of the organization issuing the policy or the 435
name of the organization administering the policy, whichever 436
applies. 437
(b) The name of the contract holder. 438
(c) The type of plan only if the plan is filed in the 439
state, an indication that the plan is self-funded, or the name 440
of the network. 441
(d) The member identification number, contract number, and 442
policy or group number, if applicable. 443
(e) A contact phone number or electronic address for 444
authorizations and admission certifications. 445
(f) A phone number or electronic address whereby the 446
covered person or hospital, physician, or other person rendering 447
services covered by the policy may obtain benefits verification 448
and information in order to estimate patient financial 449
responsibility, in compliance with privacy rules under the 450

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Health Insurance Portability and Accountability Act. 451
(g) The national plan identifier, in accordance with the 452
compliance date set forth by the federal Department of Health 453
and Human Services. 454
455
The identification card must present the information in a 456
readily identifiable manner or, alternatively, the information 457
may be embedded on the card and available through magnetic 458
stripe or smart card. The information may also be provided 459
through other electronic technology. 460
Section 3. Paragraph (a) of subsection (2), paragraphs 461
(a), (e), and (g) of subsection (7), and paragraph (a) of 462
subsection (8) of section 627.6475, Florida Statutes, is amended 463
to read: 464
627.6475 Individual reinsurance pool.— 465
(2) DEFINITIONS.—As used in this section: 466
(a) "Board," "Carrier," and "health benefit plan" have the 467
same meaning ascribed in s. 627.6699(3). 468
(7) INDIVIDUAL HEALTH REINSURANCE PROGRAM.— 469
(a) The individual health reinsurance program shall 470
operate subject to the supervision and control of the board of 471
the small employer health reinsurance program established 472
pursuant to s. 627.6699(11). The board shall establish a 473
separate, segregated account for eligible individuals reinsured 474
pursuant to this section, which account may not be commingled 475

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with the small employer health reinsurance account. 476
(e)1. Before March 1 of each calendar year, the board 477
shall determine and report to the office the program net loss in 478
the individual account for the previous year, including 479
administrative expenses for that year and the incurred losses 480
for that year, taking into account investment income and other 481
appropriate gains and losses. 482
2. Any net loss in the individual account for the year 483
shall be recouped by assessing the carriers as follows: 484
a. The operating losses of the program shall be assessed 485
in the following order subject to the specified limitations. The 486
first tier of assessments shall be made against reinsuring 487
carriers in an amount that may not exceed 5 percent of each 488
reinsuring carrier's premiums for individual health insurance. 489
If such assessments have been collected and additional moneys 490
are needed, the board shall make a second tier of assessments in 491
an amount that may not exceed 0.5 percent of each carrier's 492
health benefit plan premiums. 493
b. Except as provided in paragraph (f), risk-assuming 494
carriers are exempt from all assessments authorized pursuant to 495
this section. The amount paid by a reinsuring carrier for the 496
first tier of assessments shall be credited against any 497
additional assessments made. 498
c. The board shall equitably assess reinsuring carriers 499
for operating losses of the individual account based on market 500

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share. The board shall annually assess each carrier a portion of 501
the operating losses of the individual account. The first tier 502
of assessments shall be determined by multiplying the operating 503
losses by a fraction, the numerator of which equals the 504
reinsuring carrier's earned premium pertaining to direct 505
writings of individual health insurance in the state during the 506
calendar year for which the assessment is levied, and the 507
denominator of which equals the total of all such premiums 508
earned by reinsuring carriers in the state during that calendar 509
year. The second tier of assessments shall be based on the 510
premiums that all carriers, except risk-assuming carriers, 511
earned on all health benefit plans written in this state. The 512
board may levy interim assessments against reinsuring carriers 513
to ensure the financial ability of the plan to cover claims 514
expenses and administrative expenses paid or estimated to be 515
paid in the operation of the plan for the calendar year prior to 516
the association's anticipated receipt of annual assessments for 517
that calendar year. Any interim assessment is due and payable 518
within 30 days after receipt by a carrier of the interim 519
assessment notice. Interim assessment payments shall be credited 520
against the carrier's annual assessment. Health benefit plan 521
premiums and benefits paid by a carrier that are less than an 522
amount determined by the board to justify the cost of collection 523
may not be considered for purposes of determining assessments. 524
d. Subject to the approval of the office, the board shall 525

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adjust the assessment formula for reinsuring carriers that are 526
approved as federally qualified health maintenance organizations 527
by the Secretary of Health and Human Services pursuant to 42 528
U.S.C. s. 300e(c)(2)(A) to the extent, if any, that restrictions 529
are placed on them which are not imposed on other carriers. 530
3. Before March 1 of each year, the board shall determine 531
and file with the office an estimate of the assessments needed 532
to fund the losses incurred by the program in the individual 533
account for the previous calendar year. 534
4. If the board determines that the assessments needed to 535
fund the losses incurred by the program in the individual 536
account for the previous calendar year will exceed the amount 537
specified in subparagraph 2., the board shall evaluate the 538
operation of the program and report its findings and 539
recommendations to the office in the format established in s. 540
627.6699(11) for the comparable report for the small employer 541
reinsurance program. 542
(g) Except as otherwise provided in this section, the 543
board and the office shall have all powers, duties, and 544
responsibilities with respect to carriers that issue and 545
reinsure individual health insurance, as specified for the board 546
and the office in s. 627.6699(11) with respect to small employer 547
carriers, including, but not limited to, the provisions of s. 548
627.6699(11) relating to: 549
1. Use of assessments that exceed the amount of actual 550

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losses and expenses. 551
2. The annual determination of each carrier's proportion 552
of the assessment. 553
3. Interest for late payment of assessments. 554
4. Authority for the office to approve deferment of an 555
assessment against a carrier. 556
5. Limited immunity from legal actions or carriers. 557
6. Development of standards for compensation to be paid to 558
agents. Such standards shall be limited to those specifically 559
enumerated in s. 627.6699(11)(d) s. 627.6699(12)(d). 560
7. Monitoring compliance by carriers with this section. 561
(8) STANDARDS TO ASSURE FAIR MARKETING.— 562
(a) Each health insurance issuer that offers individual 563
health insurance shall actively market coverage to eligible 564
individuals in the state. The provisions of s. 627.6699(11) s. 565
627.6699(12) that apply to small employer carriers that market 566
policies to small employers shall also apply to health insurance 567
issuers that offer individual health insurance with respect to 568
marketing policies to individuals. 569
Section 4. Subsection (2) of section 627.657, Florida 570
Statutes, is amended to read: 571
627.657 Provisions of group health insurance policies.— 572
(2) The medical policy as specified in s. 627.6699(3)(j) 573
s. 627.6699(3)(k) must be accompanied by an identification card 574
that contains, at a minimum: 575

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(a) The name of the organization issuing the policy or 576
name of the organization administering the policy, whichever 577
applies. 578
(b) The name of the certificateholder. 579
(c) The type of plan only if the plan is filed in the 580
state, an indication that the plan is self-funded, or the name 581
of the network. 582
(d) The member identification number, contract number, and 583
policy or group number, if applicable. 584
(e) A contact phone number or electronic address for 585
authorizations and admission certifications. 586
(f) A phone number or electronic address whereby the 587
covered person or hospital, physician, or other person rendering 588
services covered by the policy may obtain benefits verification 589
and information in order to estimate patient financial 590
responsibility, in compliance with privacy rules under the 591
Health Insurance Portability and Accountability Act. 592
(g) The national plan identifier, in accordance with the 593
compliance date set forth by the federal Department of Health 594
and Human Services. 595
596
The identification card must present the information in a 597
readily identifiable manner or, alternatively, the information 598
may be embedded on the card and available through magnetic 599
stripe or smart card. The information may also be provided 600

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through other electronic technology. 601
Section 5. Subsection (1) of section 627.66997, Florida 602
Statutes, is amended to read: 603
627.66997 Stop-loss insurance.— 604
(1) A self-insured health benefit plan established or 605
maintained by a small employer, as defined in s. 627.6699(3)(s) 606
s. 627.6699(3)(v), is exempt from s. 627.6699 and may use a 607
stop-loss insurance policy issued to the employer. For purposes 608
of this subsection, the term "stop-loss insurance policy" means 609
an insurance policy issued to a small employer which covers the 610
small employer's obligation for the excess cost of medical care 611
on an equivalent basis per employee provided under a self-612
insured health benefit plan. 613
(a) A small employer stop-loss insurance policy is 614
considered a health insurance policy and is subject to s. 615
627.6699 if the policy has an aggregate attachment point that is 616
lower than the greatest of: 617
1. Two thousand dollars multiplied by the number of 618
employees; 619
2. One hundred twenty percent of expected claims, as 620
determined by the stop-loss insurer in accordance with actuarial 621
standards of practice; or 622
3. Twenty thousand dollars. 623
(b) Once claims under the small employer health benefit 624
plan reach the aggregate attachment point set forth in paragraph 625

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(a), the stop-loss insurance policy authorized under this 626
section must cover 100 percent of all claims that exceed the 627
aggregate attachment point. 628
Section 6. This act shall take effect July 1, 2026. 629