HB 773 — Coverage for Diagnostic and Supplemental Breast Examinations

F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB773CS/HB773 2024 A bill to be entitled An act relating to coverage for diagnostic and supplemental breast examinations;

prohibitingproviding thedefinitions; state group insurance program from imposing any enrollee cost-sharing liability with respect to coverage for diagnostic breast examinations and supplemental breast examinations;

definingamending thes. terms "diagnostic breast examination" and "supplemental breast examination";

creating110.12303, ss.F.S.;

627.64181,prohibiting 627.66131,the state group insurance program from imposing on an enrollee any cost-sharing requirement with respect to coverage for diagnostic breast examinations and 641.31093,supplemental F.S.;breast examinations;

defining terms;

prohibiting the imposition of cost-sharing requirements for diagnostic and supplemental breast examinations by individual accident and health insurance policies;

group, blanket, and franchise accident and health insurance policies;

and health maintenance contracts, respectively, which provide such coverage;

authorizing the Financial Services Commission to adopt rules;

Paragraph (c)(a), paragraphs (b) through (p), and paragraphs (q) and (r) of subsection (3)(2) of section 110.123, Florida Statutes, isare amendedredesignated as paragraph (b), paragraphs (d) through (r), and paragraphs (t) and (u), respectively, paragraphs (c) and (d) of subsection (14) are amended, and new paragraphs (a), (c), and (s) are added to subsection (2) of that section, to read:

110.123 State group insurance program.— Page(2) 1ofDEFINITIONS.—As 7used CODING:in ss.

110.123-110.1239, the term:

(a) "Cost-sharing requirement" means an insured's deductible, coinsurance, copayment, or similar out-of-pocket Page 1of 3 CODING:

hb0773-00hb0773-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB773CS/HB773 2024 (3)expense. STATE GROUP INSURANCE PROGRAM.— (c)1.

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Prior to the negotiation of contracts for health care services, the Legislature intends that the department shall develop, with respect to state collective bargaining issues, the health benefits and terms to be included in the state group health insurance program.

The department shall adopt rules necessary to perform its responsibilities pursuant to this section.

The department is responsible for the contract management and day- to-day management of the state employee health insurance program, including, but not limited to, employee enrollment, premium collection, payment to health care providers, and other administrative functions related to the program.

2.

In any contract or plan for state employee health benefits which provides coverages for diagnostic breast Page 2of 7 CODING:

Words strickenare deletions;

words underlined are additions.

hb0773-00 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB773 2024 examinations or supplemental breast examinations, as those terms are defined in s.

627.64181(1), the state group insurance program may not impose any enrollee cost-sharing liability.

Section 2.

Section 627.64181, Florida Statutes, is created to read:

627.64181 Coverage for diagnostic and supplemental breast examinations;

cost-sharing requirements prohibited.— (1) As used in this section, the term:

(a) "Cost-sharing requirement" means an insured's deductible, coinsurance, copayment, or similar out-of-pocket expense.

(b) "Diagnostic breast examination" means a medically necessary and appropriate examination of the breast, including, but not limited to, an examination using diagnostic mammography, breast magnetic resonance imaging, or breast ultrasound, which is used to evaluate an abnormality that is seen or suspected from a screening examination for breast cancer.

(c) "Supplemental breast examination" means a medically necessary and appropriate examination of the breast, including, but not limited to, an examination using breast magnetic resonance imaging or breast ultrasound, which is:

Based on personal or family medical history or additional factors that may increase the person's risk of breast Pagecancer. 3of 7 CODING:

(14) OTHER-PERSONAL-SERVICES EMPLOYEES (OPS).— (c) The initial measurement period used to determine whether an employee hired before April 1, 2013, and paid from OPS funds is a full-time employee described in subparagraph (2)(g)1.

(2)(e)1.

is the 6-month period from April 1, 2013, through September 30, 2013.

(d) All other measurement periods used to determine whether an employee paid from OPS funds is a full-time employee described in paragraph (2)(g) (2)(e) must be for 12 consecutive Page 2of 3 CODING:

hb0773-00hb0773-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB773CS/HB773 2024 cancer.months.

(2)Section An2. accident or health insurance policy issued, amended, delivered, or renewed on or after January 1, 2025, which provides coverage for diagnostic breast examinations and supplemental breast examinations may not impose any cost-sharing requirement with respect to such coverage.