Florida Health Insurance Advisory Board Meeting Report: March 27

The Florida Health Insurance Advisory Board (“Board”) met via teleconference on Friday, March 27, 2009.

 

Chairman’s Report

Board Chairman and Florida Insurance Commissioner Kevin McCarty opened with a brief discussion of the Cover Florida Health Care Access Program (“Program”), which was recently unveiled by Governor Charlie Crist for the purpose of offering affordable health coverage to approximately 3.8 million uninsured Floridians. 

To illustrate the Program target audience, Commissioner McCarty noted a recent study by the Robert Wood Johnson Foundation showing that an average of one in five Americans do not have health insurance.

Board members agreed on the importance of tracking enrollees throughout this year to determine whether the Program will prove to be a temporary bridge for participants, or a more permanent solution.

On another topic, Commissioner McCarty said that the Board is in the process of searching for a permanent executive director, and suggested a Search and Selection Committee be created to interview potential candidates.  Three Committee members agreed to serve as the Search and Selection Committee.

 

Financial Report

The Program ended 2008 at 92 percent of its budget.  A 2009 budget is expected to be ready for presentation soon.

An audit of the Program, which is anticipated to proceed more rapidly than last year, will begin on April 6, 2009.  Progress will be reported as the audit proceeds.

 

2009 Legislative Session Related to Health Insurance

Florida Deputy Insurance Commissioner Mary Beth Senkewicz discussed bills relating to health insurance that have been filed in the current 2009 Florida Legislative Session.

Ms. Senkewicz said that, unlike 2008, there are no major health bills pending, but noted several bills that were pertinent:

• House Bill 855 relating to Direct Payment of Benefits by State Representative Marcelo Llorente (R-Miami) would revise provisions for direct payment by insurers to designated providers of services authorized by insureds.

Senate Bill 1122, an identical bill relating to Health Insurance/Payment of Benefits/Claims Forms by Senator Don Gaetz (R-Fort Walton Beach), has not yet been heard by any of its committees of reference.

• SB 2478 relating to Children with Disabilities by Senator Andy Gardiner (R-Orlando) would require continuing education on developmental disabilities for certain licensees and certificate-holders, and require the Florida Department of Health to develop and implement a plan to promote awareness of developmental disabilities;

An identical House bill, HB 1385, by State Representative Steve Precourt (R-Orlando) has not yet been heard by any of its committees of reference.

• SB 1022, relating to Medicare/Insurance/End-stage Renal Disease, by Senator Thad Altman (R-Viera), would require that insurers issuing Medicare supplement policies in Florida offer the opportunity to enroll to individuals with a disability or end-stage renal disease and permit insurers offering Medicare supplement policies to effect a one-time rate schedule change.  It also would authorize insurers to propose a rate adjustment for persons younger than 65.

 

2009 Legislative Recommendations

Board Members discussed the issue of the Program’s six-month waiting period for coverage after enrollment, and whether it was possible to shorten that period.

Ms. Senkewicz noted that the Governor’s office was trying to limit enrollees to uninsured Florida residents and prevent employer-subsidized insureds from switching to the more affordable Program.  Governor Crist’s office is tracking the Program this year and will reconsider rules as warranted.

Blue Cross and Blue Shield of Florida, which is marketing the Program, said the company does not favor continuing to impose a waiting period.  Blue Cross has received many calls from people who cannot get needed coverage because of the waiting period.

Commissioner McCarty said that, if members agreed, the Board would explore the possibility of creating exceptions to the waiting period rule.

Board Members discussed how prepaid healthcare plans now are required to maintain a surplus of $150,000, and that the surplus should be raised to $300,000. Commissioner McCarty agreed that it would be fiscally prudent to pursue raising the surplus amount, but with a phase-in over three years to allow companies to meet the capital requirements. Board Members agreed new insurance plans should have to begin immediately with $300,000 in surplus.

 

Report on Federal Health Insurance Proposals

Ms. Senkewicz reported on an informal round table discussion on health care reform that was held in Washington D.C. on Tuesday, March 17 and sponsored by the United States Senate Health, Education, Labor and Pensions Committee.  The informal setting allowed for broad discussion, with topics including the implementation of “exchanges” for small employers.  Exchanges, which are a type of insurance marketplace, could be implemented on a state, regional or national level.

Debate also took place on:

• whether a federal health plan would allow for public plans to compete with private plans;
• expansion of the State Children’s Health Insurance Program and Medicaid;
• how to change the focus from care to prevention; and
• chronic care disease management.

Blue Cross and other major insurers said they would agree to lower premiums for insureds with preexisting conditions if a federal health plan had a mandate requiring all Americans to participate in the program.

Ms. Senkewicz noted that, because of the urgent need to solve economic issues, the time frame for introducing federal legislation on health care reform is uncertain.

 

Recommendations for Future Board Presentations

A Board Member expressed concern over Senate Bill 558 relating to Insurance Coverage for Prescription Drugs, as well as House Bill 263, a similar bill relating to Prescription Drug Coverage.  Although neither bill has been scheduled for a vote, the language of both as it relates to substituting generic drugs for name brands has raised issues.  The Board Member requested that a discussion of these bills be included in the next Board meeting agenda.  Other Board members concurred.

Another Board member noted that insurance and Medicare fraud has become a major issue, particularly in South Florida.  Commissioner McCarty added that the prevalence of fraud is also growing in Central and North Florida to equal that of South Florida.  He added that South Florida investigators are meeting the problem effectively, and that the region is number one in the nation for prosecution of insurance fraud. 

It was suggested that an entire session of the Board be devoted to discussing the burgeoning fraud problem and the most effective approach to fighting it.  It was agreed that, although the Board’s June 2009 meeting would be too soon for that discussion, it would be an appropriate time to put forth an agenda presentation on how to proceed.

In conclusion, the Board officially recognized that Commissioner McCarty was selected as “2008 Regulator of the Year” by the LexisNexis Insurance Law Center’s Advisory Board.

The next meeting is scheduled for June 11, 2009 at 9:30 A.M. via teleconference.

With business concluded, the meeting adjourned.

 

The Office of Florida Governor Charlie Crist published the following press release on the Program on March 30, 2009:

 

Governor Crist Visits South Florida Cover Florida Health Insurance Provider

Policyholders save hundreds of dollars on health care insurance

HIALEAH – Governor Charlie Crist today visited Medica Health Plans Medical Center in Hialeah to discuss the benefits of Cover Florida Health Care coverage for Floridians without health insurance.  He encouraged Floridians to learn more about the affordable, quality health insurance coverage that is increasing access to health care for uninsured applicants age 19 to 64. He also discussed the plans with Cover Florida policyholders David Katzberg and Luisa Diaz.

“Without health care, people worry about getting sick and not being able to afford expensive doctor and hospital bills,” Governor Crist said. “Cover Florida Health Care is health care coverage people can afford, and the online information makes it easy for people to choose the plan right for them.”

Medica Health Plan of Florida is one of five Cover Florida insurers available in Miami-Dade County. The two statewide carriers are Blue Cross Blue Shield of Florida and United Healthcare, and two additional insurers are JMH Health Plan and Total Health Choice. Twelve of the 21 Cover Florida plans available in Miami-Dade County have monthly premiums averaging $155 or less – and all of the preventive plans average less than $155. Medica and Total Health also serve Broward County.

Each insurer offers at least two benefit options – one with catastrophic and hospital coverage, and one focusing on preventive care. Each plan has a wide-ranging set of benefit options that include coverage for preventive services, screenings, office visits, as well as office surgery, urgent care, hospital coverage, emergency care, prescription drugs, durable medical equipment, and diabetic supplies.

While at the center, Governor Crist emphasized how Cover Florida Health Care plans provide affordable access to health care for uninsured Floridians by highlighting the stories of two policyholders:

• Luisa Diaz, 63, is retired and has been without insurance for three years. During that time, she was very concerned about getting sick and not getting regular health checkups. She researched possible insurance companies, but they charged between $700 and $800 a month because of her age. She learned about Cover Florida through a television news story. She pays less than $250 a month and is very happy with this insurance coverage.
• David Katzberg was unemployed for two years until the condo where he had volunteered for years offered him a paying position.  He used the Cover Florida online comparison tools to select the plan best for him.  Through his Cover Florida Health Care plan, he was finally able to purchase new eyeglasses.

Also joining Governor Crist for the tour of Mary Saiz, vice president of Medica Healthcare Plans, and Eduardo Rubio, director of center operations.

Last week, Governor Crist announced the initial results of the first two months of enrollment in Cover Florida Health Care plans. As of February 28, 2009, the health plans reported enrolling 952 Floridians – 82 percent of whom chose catastrophic coverage, and 18 percent chose preventive coverage.  He also encouraged businesses, health care providers and other organizations to help increase awareness about the affordable, quality health insurance coverage made available to Florida’s nearly four million uninsured applicants age 19 to 64. 

Governor Crist encouraged Floridians interested in Cover Florida Health Care plans to visit the www.CoverFloridaHealthCare.com Web site and compare the sample benefits and premium information from insurers. Each company operates a Cover Florida-specific toll-free telephone line and Web page making it possible for interested individuals to discuss their health care options with each insurer directly.

 

More About Cover Florida Health Care

Six health insurance providers have been authorized by the Agency for Health Care Administration, the Office of Insurance Regulation and the Executive Office of the Governor to offer Cover Florida Health Care plans. Blue Cross Blue Shield of Florida and United Healthcare are available in all 67 Florida counties, with additional insurers available in Broward, Miami-Dade, Volusia and Flagler counties.

Consumers interested in purchasing Cover Florida benefits should contact the insurance carriers directly.  The six companies have designed 25 creative health insurance products. Cover Florida plans contain no mandates for participation and are portable from one employer to another because they are individual policies.  Voluntary for both employers and policyholders, employers also may voluntarily share in the cost of the plan with their employees or may assist employees with a payroll deduction, providing a pre-tax benefit for the employee and a payroll tax break for the employer.

The cost of plans varies, depending on the applicant’s age, gender and choice of preventive coverage or catastrophic and hospital coverage. Fourteen of the 25 Cover Florida plans have monthly premiums averaging $155 or less, with all of the preventive plans offering coverage for, on average, $155 or less.

The Cover Florida plan was unanimously approved by the 2008 Legislature, and no tax dollars are required to make the plans available to Floridians. Selected by the State of Florida through a competitive bidding process, the six private insurance carriers were chosen based on their proposed robust, innovative and affordable health insurance products.

Acting jointly on behalf of the State of Florida, the Agency for Health Care Administration and the Office of Insurance Regulation issued the competitive Invitation to Negotiate and reviewed insurers’ responses, along with representatives from the Executive Office of the Governor. Once the six providers were selected, the state agencies worked jointly with the insurance carriers to finalize the contracts. Throughout the competitive process, the state agencies worked to ensure that Cover Florida products would not only offer robust benefits but also be financially sound. Moving forward, the state agencies are monitoring the sale of the products and addressing consumer concerns.

For more information about Cover Florida benefit options, visit www.CoverFloridaHealthCare.com. To see sample benefits and costs, click on “Available Plans,” and select a county or compare all available Cover Florida Health Care plans.

 

 

Should you have any questions or comments, please contact Colodny Fass.

 

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