Eight policy recommendations on health insurance affordability could go before the Florida Legislature during the 2022 session, which convenes Jan. 11. The Florida Health Insurance Advisory Board (FHIAB), consisting of various health plan carriers, agents, and employer representatives and chaired by Insurance Commissioner David Altmaier, discussed these recommendations at Tuesday’s board meeting.
Stay one step ahead. Join our email list for the latest news.Subscribe
Board member Louisa McQueeney, communications director of Florida Voices for Health, presented the following recommendations:
1) Allow small group plans to offer employee/dependent coverage
McQueeney pointed out that coverage for an employee’s spouse/dependents(s) under small employer-sponsored health plans is covered entirely by the employee. Under the Affordable Care Act (ACA) spouses not covered by employee-sponsored plans can qualify for Premium Tax Credits (PTC). The recommendation is to allow small group plans to provide a dependents-only coverage option, so the employee’s spouse can qualify for PTC.
2) Deductible credit transfers between plans
McQueeney noted that some insurance policies require consumers to pay full deductibles before the plan pays. This can cause financial stress on consumers that change plans in the middle of the plan year due to a change in employment, moving, or other causes. The recommendation is to provide individual consumers with Deductible Health Credit Transfers that will cover the entire deductible amount paid 90 days prior to a plan switch.
3) Provide consumers with one free copy of medical records
McQueeney advocated for patients to have better access to health records. Availability of medical records during a consumer’s negotiations with an insurance company may reduce claim denials and lessen the consumer’s financial burden, she said.
4) Prohibit insurance carriers from changing prescriptions drug formularies during a policy year
Consumers who need prescription drugs, especially less accessible drugs without a generic market brand, are expected to cover cost increases during a policy year, decided by the insurer, pharmaceutical company, and Office of Insurance Regulation, according to McQueeney. This recommendation would prohibit amending or removing coverage of a prescription drug, but carriers may still expand drug formularies and lower prices.
5) Prohibit balance billing for emergency medical transportation
Consumers in need of emergency transportation to health services by road, water, or air, cannot “make an informed decision” about the cost of transport, said McQueeney. Transportation may be covered by health plans, but some coverage gaps lead to balance bills, which can be a costly, unexpected expense for consumers.
Board members noted that a 2020 bill already prohibits balance bills for air emergency transport. Going forward, the recommendation will only apply to road or water transport.
6) Require carriers to include Applied Behavior Analysis (ABA) as a covered benefit
Currently, only Florida Medicaid covers ABA services, which greatly benefit recipients with developmental disabilities, according to McQueeney. Coverage under other plans would benefit those who are ineligible or may become ineligible for Medicaid. Each carrier would include a minimum of one plan in each service area that would provide coverage for these services.
7) Include services addressing Fetal Alcohol Spectrum Disorder (FASD) as an optional covered benefit
A 2018 NIH study found that up to 1 in 20 first-graders have FASD as a result of prenatal alcohol exposure (PAE). McQueeney added that children with FASD are commonly undiagnosed or misdiagnosed as having autism spectrum disorder, and do not receive the proper health services. The recommendation will include FASD under the definition of the term “developmental disabilities,” which may be an optional benefit under Florida statute.
8) Prohibit copay accumulator programs that benefit
McQueeney noted that copay accumulator programs, between insurers and pharmacy benefit managers (PBM) allow costs covered by a copay to be reduced from the insurer’s baseline share, instead of the consumer. Other states, such as Georgia and West Virginia, already have legislation prohibiting copay accumulator programs.
The board will vote on the policy recommendations at its next meeting, which has not been specified. Recommendations require a unanimous vote from the board to proceed to the legislature.