The Florida Health Insurance Advisory Board (FHIAB), which provides counsel to the Office of Insurance Regulation, the Agency for Health Care Administration, the legislature, and other entities, heard 8 legislative recommendations centered around increasing policyholder protections at a meeting on Thursday.
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Louisa McQueeney, Communications Director for Florida Voices for Health and who represents individual policyholders on the board, presented each of the recommendations.
- Deductible health credit transfer
This recommendation proposes a Deductible Health Credit Transfer when an individual changes insurance policies, which would ensure their new deductible is equal to that of the prior insurer. According to McQueeney, consumers undergo financial hardship when they have to change their insurance policies outside of the Open Enrollment (OE) period and begin paying a new deductible.
Changes outside of OE can occur because of changes in life circumstances, such as a change or loss of employee coverage, or moving to another geographical location. Deductibles could reach as high as $9,100 (individual) and $18,200 (family) in 2023, according to McQueeney.
- Provide health care consumers with 1 free copy of their own medical records
This would require health care providers to supply consumers with 1 free copy of their medical records electronically or through mail. McQueeney said the recommendations would help consumers avoid financial hardships when disputing claims with insurers, which can be exacerbated when records are not available in a timely fashion.
- Protect consumers from prescription drug formulary changes during a policy year
Insurers would be prohibited from changing or removing covered prescription drugs during a policy year, but would be allowed to expand formularies that would lower prices for consumers. McQueeney notes that the consumer perspective is excluded from drug price negotiations between insurers and pharmaceutical companies, and are only informed of changes after the fact, as well as being expected to cover extra costs.
- Cap the cost of insulin at $35 per month
The recently-passed Inflation Reduction Act will cap monthly insulin costs at $35 for Medicare beneficiaries starting in 2023. This recommendation would extend the cap to individual and group policyholders, as well as require health maintenance contracts to cap cost-sharing for insulin at $35 a month starting in 2023.
“The cost of insulin, which has been around for 101 years, is 10 times higher in the US than any other developed country,” McQueeney told board members at the meeting. “It creates an enormous financial burden on Floridians who cannot survive without it.”
- Prohibit balance billing for ground emergency medical transportation
This recommendation would add ground emergency medical transportation as one of the medical services protected from balance—or “surprise”—billing for consumers. House Bill 221, signed by Gov. Rick Scott in 2016, also known as the No Surprises Act, prohibited balance billing for a range of emergency and non-emergency services.
- Include Applied Behavioral Analysis as a covered benefit in all insurance plans
Medicaid is required to cover Applied Behavioral Analysis (ABA) services, which correct or ameliorate physical or mental illness for recipients under 21. If a beneficiary loses Medicaid eligibility, which experts say is likely for many with the upcoming unwinding of the federal public health emergency, no individual or small market insurers provide coverage for ABA. This recommendation would require carriers to include at least 1 plan in each service area to cover ABA.
- Add Fetal Alcohol Spectrum Disorder (FASD) to include to the definition of the term developmental disabilities
This recommendation would add FASD to the definition of “developmental disabilities” listed in Florida Statutes 627.6686, for which Florida insurers must cover treatment. The addition is meant to reduce the number of Florididians with FASD who remain undiagnosed and increase early intervention, McQueeney said.
- Apply payments by, or on behalf of, a beneficiary to count toward the out-of-pocket cost sharing calculations
The final recommendation targets copay accumulator programs. These programs, according to McQueeney, prevent co-payments made on a consumer’s behalf from being counted towards their deductible and total out-of-pocket costs. Families most impacted by copay accumulator programs are those who rely on expensive drugs that treat HIV, cancer, and other rare and chronic diseases, often without generic or lower-cost alternatives. If passed, Florida would join 14 other states that have already passed legislation prohibiting accumulator programs.
Upon further consideration of the recommendations by board members, a follow up meeting will be scheduled in the next couple of months, where they will vote for approval. Recommendations with unanimous approval will be sent to the legislature for the 2023 session.