Small Employer Health Insurance

Florida Senate
-
2026

SB 1354

By
Senator Garcia

36-01414A-26 20261354__
1 A bill to be entitled
2 An act relating to small employer health insurance;
3 amending s. 627.6699, F.S.; deleting and revising
4 definitions; deleting provisions relating to the
5 creation of the Florida Small Employer Health
6 Reinsurance Program; amending ss. 627.642, 627.6475,
7 627.657, and 627.66997, F.S.; conforming cross
8 references; providing an effective date.
9
10 Be It Enacted by the Legislature of the State of Florida:
11
12 Section 1. Paragraphs (b), (p), (q), and (s) of subsection
13 (3), paragraph (d) of subsection (9), paragraphs (b) and (c) of
14 subsection (10), and subsection (11) of section 627.6699,
15 Florida Statutes, are amended to read:
16 627.6699 Employee Health Care Access Act.—
17 (3) DEFINITIONS.—As used in this section, the term:
18
(b) “Board” means the board of directors of the program.

19
(p) “Plan of operation” means the plan of operation of the

20
program, including articles, bylaws, and operating rules,

21
adopted by the board under subsection (11).

22
(q) “Program” means the Florida Small Employer Carrier

23
Reinsurance Program created under subsection (11)
.

24
(p)
(s)
“Reinsuring carrier” means a small employer carrier
25 that elects to comply with
reinsurance

the
requirements
set

26
forth in subsection (11)
.
27 (9) SMALL EMPLOYER CARRIER’S ELECTION TO BECOME A RISK
28 ASSUMING CARRIER OR A REINSURING CARRIER.—
29 (d) A small employer carrier that elects to cease
30 participating as a reinsuring carrier and to become a risk
31 assuming carrier is prohibited from reinsuring or continuing to
32 reinsure any small employer health benefits plan
under

33
subsection (11)
as soon as the carrier becomes a risk-assuming
34 carrier and must pay a prorated assessment based upon business
35 issued as a reinsuring carrier for any portion of the year that
36 the business was reinsured. A small employer carrier that elects
37 to cease participating as a risk-assuming carrier and to become
38 a reinsuring carrier is permitted to reinsure small employer
39 health benefit plans
under the terms set forth in subsection

40
(11)
and must pay a prorated assessment based upon business
41 issued as a reinsuring carrier for any portion of the year that
42 the business was reinsured.
43 (10) ELECTION PROCESS TO BECOME A RISK-ASSUMING CARRIER.—
44 (b) In determining whether to approve an application by a
45 small employer carrier to become a risk-assuming carrier, the
46 office shall consider:
47 1. The carrier’s financial ability to support the
48 assumption of the risk of small employer groups.
49 2. The carrier’s history of rating and underwriting small
50 employer groups.
51 3. The carrier’s commitment to market fairly to all small
52 employers in the state or its service area, as applicable.
53 4. The carrier’s ability to assume and manage the risk of
54 enrolling small employer groups
without the protection of the

55
reinsurance program provided in subsection (11)
.
56 (c) A small employer carrier that becomes a risk-assuming
57 carrier pursuant to this subsection is not subject to
58
reinsurance

the
assessment
provisions of subsection (11)
.
59
(11) SMALL EMPLOYER HEALTH REINSURANCE PROGRAM.—

60
(a) There is created a nonprofit entity to be known as the

61
“Florida Small Employer Health Reinsurance Program.”

62
(b)1. The program shall operate subject to the supervision

63
and control of the board.

64
2. Effective upon this act becoming a law, the board shall

65
consist of the director of the office or his or her designee,

66
who shall serve as the chairperson, and 13 additional members

67
who are representatives of carriers and insurance agents and are

68
appointed by the director of the office and serve as follows:

69
a. Five members shall be representatives of health insurers

70
licensed under chapter 624 or chapter 641. Two members shall be

71
agents who are actively engaged in the sale of health insurance.

72
Four members shall be employers or representatives of employers.

73
One member shall be a person covered under an individual health

74
insurance policy issued by a licensed insurer in this state. One

75
member shall represent the Agency for Health Care Administration

76
and shall be recommended by the Secretary of Health Care

77
Administration.

78
b. A member appointed under this subparagraph shall serve a

79
term of 4 years and shall continue in office until the member’s

80
successor takes office, except that, in order to provide for

81
staggered terms, the director of the office shall designate two

82
of the initial appointees under this subparagraph to serve terms

83
of 2 years and shall designate three of the initial appointees

84
under this subparagraph to serve terms of 3 years.

85
3. The director of the office may remove a member for

86
cause.

87
4. Vacancies on the board shall be filled in the same

88
manner as the original appointment for the unexpired portion of

89
the term.

90
(c)1. The board shall submit to the office a plan of

91
operation to assure the fair, reasonable, and equitable

92
administration of the program. The board may at any time submit

93
to the office any amendments to the plan that the board finds to

94
be necessary or suitable.

95
2. The office shall, after notice and hearing, approve the

96
plan of operation if it determines that the plan submitted by

97
the board is suitable to assure the fair, reasonable, and

98
equitable administration of the program and provides for the

99
sharing of program gains and losses equitably and

100
proportionately in accordance with paragraph (j).

101
3. The plan of operation, or any amendment thereto, becomes

102
effective upon written approval of the office.

103
(d) The plan of operation must, among other things:

104
1. Establish procedures for handling and accounting for

105
program assets and moneys and for an annual fiscal reporting to

106
the office.

107
2. Establish procedures for selecting an administering

108
carrier and set forth the powers and duties of the administering

109
carrier.

110
3. Establish procedures for reinsuring risks.

111
4. Establish procedures for collecting assessments from

112
participating carriers to provide for claims reinsured by the

113
program and for administrative expenses, other than amounts

114
payable to the administrative carrier, incurred or estimated to

115
be incurred during the period for which the assessment is made.

116
5. Provide for any additional matters at the discretion of

117
the board.

118
(e) The board shall recommend to the office market conduct

119
requirements and other requirements for carriers and agents,

120
including requirements relating to:

121
1. Registration by each carrier with the office of its

122
intention to be a small employer carrier under this section;

123
2. Publication by the office of a list of all small

124
employer carriers, including a requirement applicable to agents

125
and carriers that a health benefit plan may not be sold by a

126
carrier that is not identified as a small employer carrier;

127
3. The availability of a broadly publicized, toll-free

128
telephone number for access by small employers to information

129
concerning this section;

130
4. Periodic reports by carriers and agents concerning

131
health benefit plans issued; and

132
5. Methods concerning periodic demonstration by small

133
employer carriers and agents that they are marketing or issuing

134
health benefit plans to small employers.

135
(f) The program has the general powers and authority

136
granted under the laws of this state to insurance companies and

137
health maintenance organizations licensed to transact business,

138
except the power to issue health benefit plans directly to

139
groups or individuals. In addition thereto, the program has

140
specific authority to:

141
1. Enter into contracts as necessary or proper to carry out

142
the provisions and purposes of this act, including the authority

143
to enter into contracts with similar programs of other states

144
for the joint performance of common functions or with persons or

145
other organizations for the performance of administrative

146
functions.

147
2. Sue or be sued, including taking any legal action

148
necessary or proper for recovering any assessments and penalties

149
for, on behalf of, or against the program or any carrier.

150
3. Take any legal action necessary to avoid the payment of

151
improper claims against the program.

152
4. Issue reinsurance policies, in accordance with the

153
requirements of this act.

154
5. Establish rules, conditions, and procedures for

155
reinsurance risks under the program participation.

156
6. Establish actuarial functions as appropriate for the

157
operation of the program.

158
7. Assess participating carriers in accordance with

159
paragraph (j), and make advance interim assessments as may be

160
reasonable and necessary for organizational and interim

161
operating expenses. Interim assessments shall be credited as

162
offsets against any regular assessments due following the close

163
of the calendar year.

164
8. Appoint appropriate legal, actuarial, and other

165
committees as necessary to provide technical assistance in the

166
operation of the program, and in any other function within the

167
authority of the program.

168
9. Borrow money to effect the purposes of the program. Any

169
notes or other evidences of indebtedness of the program which

170
are not in default constitute legal investments for carriers and

171
may be carried as admitted assets.

172
10. To the extent necessary, increase the $5,000 deductible

173
reinsurance requirement to adjust for the effects of inflation.

174
(g) A reinsuring carrier may reinsure with the program

175
coverage of an eligible employee of a small employer, or any

176
dependent of such an employee, subject to each of the following

177
provisions:

178
1. Except in the case of a late enrollee, a reinsuring

179
carrier may reinsure an eligible employee or dependent within 60

180
days after the commencement of the coverage of the small

181
employer. A newly employed eligible employee or dependent of a

182
small employer may be reinsured within 60 days after the

183
commencement of his or her coverage.

184
2. A small employer carrier may reinsure an entire employer

185
group within 60 days after the commencement of the group’s

186
coverage under the plan.

187
3. The program may not reimburse a participating carrier

188
with respect to the claims of a reinsured employee or dependent

189
until the carrier has paid incurred claims of at least $5,000 in

190
a calendar year for benefits covered by the program. In

191
addition, the reinsuring carrier shall be responsible for 10

192
percent of the next $50,000 and 5 percent of the next $100,000

193
of incurred claims during a calendar year and the program shall

194
reinsure the remainder.

195
4. The board annually shall adjust the initial level of

196
claims and the maximum limit to be retained by the carrier to

197
reflect increases in costs and utilization within the standard

198
market for health benefit plans within the state. The adjustment

199
shall not be less than the annual change in the medical

200
component of the “Consumer Price Index for All Urban Consumers”

201
of the Bureau of Labor Statistics of the Department of Labor,

202
unless the board proposes and the office approves a lower

203
adjustment factor.

204
5. A small employer carrier may terminate reinsurance for

205
all reinsured employees or dependents on any plan anniversary.

206
6. The premium rate charged for reinsurance by the program

207
to a health maintenance organization that is approved by the

208
Secretary of Health and Human Services as a federally qualified

209
health maintenance organization pursuant to 42 U.S.C. s.

210
300e(c)(2)(A) and that, as such, is subject to requirements that

211
limit the amount of risk that may be ceded to the program, which

212
requirements are more restrictive than subparagraph 3., shall be

213
reduced by an amount equal to that portion of the risk, if any,

214
which exceeds the amount set forth in subparagraph 3. which may

215
not be ceded to the program.

216
7. The board may consider adjustments to the premium rates

217
charged for reinsurance by the program for carriers that use

218
effective cost containment measures, including high-cost case

219
management, as defined by the board.

220
8. A reinsuring carrier shall apply its case-management and

221
claims-handling techniques, including, but not limited to,

222
utilization review, individual case management, preferred

223
provider provisions, other managed care provisions or methods of

224
operation, consistently with both reinsured business and

225
nonreinsured business.

226
(h)1. The board, as part of the plan of operation, shall

227
establish a methodology for determining premium rates to be

228
charged by the program for reinsuring small employers and

229
individuals pursuant to this section. The methodology shall

230
include a system for classification of small employers that

231
reflects the types of case characteristics commonly used by

232
small employer carriers in the state. The methodology shall

233
provide for the development of basic reinsurance premium rates,

234
which shall be multiplied by the factors set for them in this

235
paragraph to determine the premium rates for the program. The

236
basic reinsurance premium rates shall be established by the

237
board, subject to the approval of the office. The premium rates

238
set by the board may vary by geographical area, as determined

239
under this section, to reflect differences in cost. The

240
multiplying factors must be established as follows:

241
a. The entire group may be reinsured for a rate that is 1.5

242
times the rate established by the board.

243
b. An eligible employee or dependent may be reinsured for a

244
rate that is 5 times the rate established by the board.

245
2. The board periodically shall review the methodology

246
established, including the system of classification and any

247
rating factors, to assure that it reasonably reflects the claims

248
experience of the program. The board may propose changes to the

249
rates which shall be subject to the approval of the office.

250
(i) If a health benefit plan for a small employer issued in

251
accordance with this subsection is entirely or partially

252
reinsured with the program, the premium charged to the small

253
employer for any rating period for the coverage issued must be

254
consistent with the requirements relating to premium rates set

255
forth in this section.

256
(j)1. Before July 1 of each calendar year, the board shall

257
determine and report to the office the program net loss for the

258
previous year, including administrative expenses for that year,

259
and the incurred losses for the year, taking into account

260
investment income and other appropriate gains and losses.

261
2. Any net loss for the year shall be recouped by

262
assessment of the carriers, as follows:

263
a. The operating losses of the program shall be assessed in

264
the following order subject to the specified limitations. The

265
first tier of assessments shall be made against reinsuring

266
carriers in an amount which shall not exceed 5 percent of each

267
reinsuring carrier’s premiums from health benefit plans covering

268
small employers. If such assessments have been collected and

269
additional moneys are needed, the board shall make a second tier

270
of assessments in an amount which shall not exceed 0.5 percent

271
of each carrier’s health benefit plan premiums. Except as

272
provided in paragraph (m), risk-assuming carriers are exempt

273
from all assessments authorized pursuant to this section. The

274
amount paid by a reinsuring carrier for the first tier of

275
assessments shall be credited against any additional assessments

276
made.

277
b. The board shall equitably assess carriers for operating

278
losses of the plan based on market share. The board shall

279
annually assess each carrier a portion of the operating losses

280
of the plan. The first tier of assessments shall be determined

281
by multiplying the operating losses by a fraction, the numerator

282
of which equals the reinsuring carrier’s earned premium

283
pertaining to direct writings of small employer health benefit

284
plans in the state during the calendar year for which the

285
assessment is levied, and the denominator of which equals the

286
total of all such premiums earned by reinsuring carriers in the

287
state during that calendar year. The second tier of assessments

288
shall be based on the premiums that all carriers, except risk

289
assuming carriers, earned on all health benefit plans written in

290
this state. The board may levy interim assessments against

291
carriers to ensure the financial ability of the plan to cover

292
claims expenses and administrative expenses paid or estimated to

293
be paid in the operation of the plan for the calendar year prior

294
to the association’s anticipated receipt of annual assessments

295
for that calendar year. Any interim assessment is due and

296
payable within 30 days after receipt by a carrier of the interim

297
assessment notice. Interim assessment payments shall be credited

298
against the carrier’s annual assessment. Health benefit plan

299
premiums and benefits paid by a carrier that are less than an

300
amount determined by the board to justify the cost of collection

301
may not be considered for purposes of determining assessments.

302
c. Subject to the approval of the office, the board shall

303
make an adjustment to the assessment formula for reinsuring

304
carriers that are approved as federally qualified health

305
maintenance organizations by the Secretary of Health and Human

306
Services pursuant to 42 U.S.C. s. 300e(c)(2)(A) to the extent,

307
if any, that restrictions are placed on them that are not

308
imposed on other small employer carriers.

309
3. Before July 1 of each year, the board shall determine

310
and file with the office an estimate of the assessments needed

311
to fund the losses incurred by the program in the previous

312
calendar year.

313
4. If the board determines that the assessments needed to

314
fund the losses incurred by the program in the previous calendar

315
year will exceed the amount specified in subparagraph 2., the

316
board shall evaluate the operation of the program and report its

317
findings, including any recommendations for changes to the plan

318
of operation, to the office within 180 days following the end of

319
the calendar year in which the losses were incurred. The

320
evaluation shall include an estimate of future assessments, the

321
administrative costs of the program, the appropriateness of the

322
premiums charged and the level of carrier retention under the

323
program, and the costs of coverage for small employers. If the

324
board fails to file a report with the office within 180 days

325
following the end of the applicable calendar year, the office

326
may evaluate the operations of the program and implement such

327
amendments to the plan of operation the office deems necessary

328
to reduce future losses and assessments.

329
5. If assessments exceed the amount of the actual losses

330
and administrative expenses of the program, the excess shall be

331
held as interest and used by the board to offset future losses

332
or to reduce program premiums. As used in this paragraph, the

333
term “future losses” includes reserves for incurred but not

334
reported claims.

335
6. Each carrier’s proportion of the assessment shall be

336
determined annually by the board, based on annual statements and

337
other reports considered necessary by the board and filed by the

338
carriers with the board.

339
7. Provision shall be made in the plan of operation for the

340
imposition of an interest penalty for late payment of an

341
assessment.

342
8. A carrier may seek, from the office, a deferment, in

343
whole or in part, from any assessment made by the board. The

344
office may defer, in whole or in part, the assessment of a

345
carrier if, in the opinion of the office, the payment of the

346
assessment would place the carrier in a financially impaired

347
condition. If an assessment against a carrier is deferred, in

348
whole or in part, the amount by which the assessment is deferred

349
may be assessed against the other carriers in a manner

350
consistent with the basis for assessment set forth in this

351
section. The carrier receiving such deferment remains liable to

352
the program for the amount deferred and is prohibited from

353
reinsuring any individuals or groups in the program if it fails

354
to pay assessments.

355
(k) Neither the participation in the program as reinsuring

356
carriers, the establishment of rates, forms, or procedures, nor

357
any other joint or collective action required by this act, may

358
be the basis of any legal action, criminal or civil liability,

359
or penalty against the program or any of its carriers either

360
jointly or separately.

361
(l) The board shall monitor compliance with this section,

362
including the market conduct of small employer carriers, and

363
shall report to the office any unfair trade practices and

364
misleading or unfair conduct by a small employer carrier that

365
has been reported to the board by agents, consumers, or any

366
other person. The office shall investigate all reports and, upon

367
a finding of noncompliance with this section or of unfair or

368
misleading practices, shall take action against the small

369
employer carrier as permitted under the insurance code or

370
chapter 641. The board is not given investigatory or regulatory

371
powers, but must forward all reports of cases or abuse or

372
misrepresentation to the office.

373
(m) Notwithstanding paragraph (j), the administrative

374
expenses of the program shall be recouped by assessment of risk

375
assuming carriers and reinsuring carriers and such amounts shall

376
not be considered part of the operating losses of the plan for

377
the purposes of this paragraph. Each carrier’s portion of such

378
administrative expenses shall be determined by multiplying the

379
total of such administrative expenses by a fraction, the

380
numerator of which equals the carrier’s earned premium

381
pertaining to direct writing of small employer health benefit

382
plans in the state during the calendar year for which the

383
assessment is levied, and the denominator of which equals the

384
total of such premiums earned by all carriers in the state

385
during such calendar year.

386
(n) The board shall advise the office, the Agency for

387
Health Care Administration, the department, other executive

388
departments, and the Legislature on health insurance issues.

389
Specifically, the board shall:

390
1. Provide a forum for stakeholders, consisting of

391
insurers, employers, agents, consumers, and regulators, in the

392
private health insurance market in this state.

393
2. Review and recommend strategies to improve the

394
functioning of the health insurance markets in this state with a

395
specific focus on market stability, access, and pricing.

396
3. Make recommendations to the office for legislation

397
addressing health insurance market issues and provide comments

398
on health insurance legislation proposed by the office.

399
4. Meet at least three times each year. One meeting shall

400
be held to hear reports and to secure public comment on the

401
health insurance market, to develop any legislation needed to

402
address health insurance market issues, and to provide comments

403
on health insurance legislation proposed by the office.

404
5. Issue a report to the office on the state of the health

405
insurance market by September 1 each year. The report shall

406
include recommendations for changes in the health insurance

407
market, results from implementation of previous recommendations,

408
and information on health insurance markets.

409 Section 2. Subsection (3) of section 627.642, Florida
410 Statutes, is amended to read:
411 627.642 Outline of coverage.—
412 (3) In addition to the outline of coverage, a policy as
413 specified in
s. 627.6699(3)(j)

s. 627.6699(3)(k)
must be
414 accompanied by an identification card that contains, at a
415 minimum:
416 (a) The name of the organization issuing the policy or the
417 name of the organization administering the policy, whichever
418 applies.
419 (b) The name of the contract holder.
420 (c) The type of plan only if the plan is filed in the
421 state, an indication that the plan is self-funded, or the name
422 of the network.
423 (d) The member identification number, contract number, and
424 policy or group number, if applicable.
425 (e) A contact phone number or electronic address for
426 authorizations and admission certifications.
427 (f) A phone number or electronic address whereby the
428 covered person or hospital, physician, or other person rendering
429 services covered by the policy may obtain benefits verification
430 and information in order to estimate patient financial
431 responsibility, in compliance with privacy rules under the
432 Health Insurance Portability and Accountability Act.
433 (g) The national plan identifier, in accordance with the
434 compliance date set forth by the federal Department of Health
435 and Human Services.
436
437 The identification card must present the information in a
438 readily identifiable manner or, alternatively, the information
439 may be embedded on the card and available through magnetic
440 stripe or smart card. The information may also be provided
441 through other electronic technology.
442 Section 3. Paragraph (a) of subsection (2), paragraphs (a),
443 (e), and (g) of subsection (7), and paragraph (a) of subsection
444 (8) of section 627.6475, Florida Statutes, are amended to read:
445 627.6475 Individual reinsurance pool.—
446 (2) DEFINITIONS.—As used in this section:
447 (a)
“Board,”
“Carrier
,
” and “health benefit plan” have the
448 same meaning ascribed in s. 627.6699(3).
449 (7) INDIVIDUAL HEALTH REINSURANCE PROGRAM.—
450 (a) The individual health reinsurance program shall operate
451 subject to the supervision and control of the board of the small
452 employer health reinsurance program
established pursuant to s.

453
627.6699(11)
. The board shall establish a separate, segregated
454 account for eligible individuals reinsured pursuant to this
455 section, which account may not be commingled with the small
456 employer health reinsurance account.
457 (e)1. Before March 1 of each calendar year, the board shall
458 determine and report to the office the program net loss in the
459 individual account for the previous year, including
460 administrative expenses for that year and the incurred losses
461 for that year, taking into account investment income and other
462 appropriate gains and losses.
463 2. Any net loss in the individual account for the year
464 shall be recouped by assessing the carriers as follows:
465 a. The operating losses of the program shall be assessed in
466 the following order subject to the specified limitations. The
467 first tier of assessments shall be made against reinsuring
468 carriers in an amount that may not exceed 5 percent of each
469 reinsuring carrier’s premiums for individual health insurance.
470 If such assessments have been collected and additional moneys
471 are needed, the board shall make a second tier of assessments in
472 an amount that may not exceed 0.5 percent of each carrier’s
473 health benefit plan premiums.
474 b. Except as provided in paragraph (f), risk-assuming
475 carriers are exempt from all assessments authorized pursuant to
476 this section. The amount paid by a reinsuring carrier for the
477 first tier of assessments shall be credited against any
478 additional assessments made.
479 c. The board shall equitably assess reinsuring carriers for
480 operating losses of the individual account based on market
481 share. The board shall annually assess each carrier a portion of
482 the operating losses of the individual account. The first tier
483 of assessments shall be determined by multiplying the operating
484 losses by a fraction, the numerator of which equals the
485 reinsuring carrier’s earned premium pertaining to direct
486 writings of individual health insurance in the state during the
487 calendar year for which the assessment is levied, and the
488 denominator of which equals the total of all such premiums
489 earned by reinsuring carriers in the state during that calendar
490 year. The second tier of assessments shall be based on the
491 premiums that all carriers, except risk-assuming carriers,
492 earned on all health benefit plans written in this state. The
493 board may levy interim assessments against reinsuring carriers
494 to ensure the financial ability of the plan to cover claims
495 expenses and administrative expenses paid or estimated to be
496 paid in the operation of the plan for the calendar year prior to
497 the association’s anticipated receipt of annual assessments for
498 that calendar year. Any interim assessment is due and payable
499 within 30 days after receipt by a carrier of the interim
500 assessment notice. Interim assessment payments shall be credited
501 against the carrier’s annual assessment. Health benefit plan
502 premiums and benefits paid by a carrier that are less than an
503 amount determined by the board to justify the cost of collection
504 may not be considered for purposes of determining assessments.
505 d. Subject to the approval of the office, the board shall
506 adjust the assessment formula for reinsuring carriers that are
507 approved as federally qualified health maintenance organizations
508 by the Secretary of Health and Human Services pursuant to 42
509 U.S.C. s. 300e(c)(2)(A) to the extent, if any, that restrictions
510 are placed on them which are not imposed on other carriers.
511 3. Before March 1 of each year, the board shall determine
512 and file with the office an estimate of the assessments needed
513 to fund the losses incurred by the program in the individual
514 account for the previous calendar year.
515 4. If the board determines that the assessments needed to
516 fund the losses incurred by the program in the individual
517 account for the previous calendar year will exceed the amount
518 specified in subparagraph 2., the board shall evaluate the
519 operation of the program and report its findings and
520 recommendations to the office
in the format established in s.

521
627.6699(11) for the comparable report for the small employer

522
reinsurance program
.
523 (g) Except as otherwise provided in this section, the board
524 and the office shall have all powers, duties, and
525 responsibilities with respect to carriers that issue and
526 reinsure individual health insurance,
as specified for the board

527
and the office in s. 627.6699(11) with respect to small employer

528
carriers,
including, but not limited to
, the provisions of s.

529
627.6699(11) relating to
:
530 1. Use of assessments that exceed the amount of actual
531 losses and expenses.
532 2. The annual determination of each carrier’s proportion of
533 the assessment.
534 3. Interest for late payment of assessments.
535 4. Authority for the office to approve deferment of an
536 assessment against a carrier.
537 5. Limited immunity from legal actions or carriers.
538 6. Development of standards for compensation to be paid to
539 agents. Such standards shall be limited to those specifically
540 enumerated in
s. 627.6699(11)(d)

s. 627.6699(12)(d)
.
541 7. Monitoring compliance by carriers with this section.
542 (8) STANDARDS TO ASSURE FAIR MARKETING.—
543 (a) Each health insurance issuer that offers individual
544 health insurance shall actively market coverage to eligible
545 individuals in the state. The provisions of
s. 627.6699(11)

s.

546
627.6699(12)
that apply to small employer carriers that market
547 policies to small employers shall also apply to health insurance
548 issuers that offer individual health insurance with respect to
549 marketing policies to individuals.
550 Section 4. Subsection (2) of section 627.657, Florida
551 Statutes, is amended to read:
552 627.657 Provisions of group health insurance policies.—
553 (2) The medical policy as specified in
s. 627.6699(3)(j)

s.

554
627.6699(3)(k)
must be accompanied by an identification card
555 that contains, at a minimum:
556 (a) The name of the organization issuing the policy or name
557 of the organization administering the policy, whichever applies.
558 (b) The name of the certificateholder.
559 (c) The type of plan only if the plan is filed in the
560 state, an indication that the plan is self-funded, or the name
561 of the network.
562 (d) The member identification number, contract number, and
563 policy or group number, if applicable.
564 (e) A contact phone number or electronic address for
565 authorizations and admission certifications.
566 (f) A phone number or electronic address whereby the
567 covered person or hospital, physician, or other person rendering
568 services covered by the policy may obtain benefits verification
569 and information in order to estimate patient financial
570 responsibility, in compliance with privacy rules under the
571 Health Insurance Portability and Accountability Act.
572 (g) The national plan identifier, in accordance with the
573 compliance date set forth by the federal Department of Health
574 and Human Services.
575
576 The identification card must present the information in a
577 readily identifiable manner or, alternatively, the information
578 may be embedded on the card and available through magnetic
579 stripe or smart card. The information may also be provided
580 through other electronic technology.
581 Section 5. Subsection (1) of section 627.66997, Florida
582 Statutes, is amended to read:
583 627.66997 Stop-loss insurance.—
584 (1) A self-insured health benefit plan established or
585 maintained by a small employer, as defined in
s. 627.6699(3)(s)

586
s. 627.6699(3)(v)
, is exempt from s. 627.6699 and may use a
587 stop-loss insurance policy issued to the employer. For purposes
588 of this subsection, the term “stop-loss insurance policy” means
589 an insurance policy issued to a small employer which covers the
590 small employer’s obligation for the excess cost of medical care
591 on an equivalent basis per employee provided under a self
592 insured health benefit plan.
593 (a) A small employer stop-loss insurance policy is
594 considered a health insurance policy and is subject to s.
595 627.6699 if the policy has an aggregate attachment point that is
596 lower than the greatest of:
597 1. Two thousand dollars multiplied by the number of
598 employees;
599 2. One hundred twenty percent of expected claims, as
600 determined by the stop-loss insurer in accordance with actuarial
601 standards of practice; or
602 3. Twenty thousand dollars.
603 (b) Once claims under the small employer health benefit
604 plan reach the aggregate attachment point set forth in paragraph
605 (a), the stop-loss insurance policy authorized under this
606 section must cover 100 percent of all claims that exceed the
607 aggregate attachment point.
608 Section 6. This act shall take effect July 1, 2026.