SB3,25
6Section 25
. 633.01 (3) of the statutes is amended to read:
SB3,18,87
633.01
(3) “Insured
employee" means an employee who is a resident of this
8state and who is covered under
a an employee benefit plan.
SB3,26
9Section 26
. 633.01 (4) of the statutes is renumbered 633.01 (2g) and amended
10to read:
SB3,18,1611
633.01
(2g) “
Plan Employee benefit plan" means an insured or wholly or
12partially self-insured employee benefit plan which by means of direct payment,
13reimbursement or other arrangement provides to one or more employees who are
14residents of this state benefits or services that include, but are not limited to, benefits
15for medical, surgical or hospital care, benefits in the event of sickness, accident,
16disability or death, or benefits in the event of unemployment or retirement.
SB3,27
17Section 27
. 633.01 (4g) of the statutes is created to read:
SB3,18,1918
633.01
(4g) “Pharmacy benefit manager” has the meaning given in s. 632.865
19(1) (c).
SB3,28
20Section 28
. 633.01 (4r) of the statutes is created to read:
SB3,18,2221
633.01
(4r) “Prescription drug benefit” has the meaning given in s. 632.865 (1)
22(e).
SB3,29
23Section 29
. 633.01 (5) of the statutes is amended to read:
SB3,18,2524
633.01
(5) “Principal" means a person, including an insurer, that uses the
25services of an administrator to provide
a an employee benefit plan.
SB3,30
1Section
30. 633.01 (6) of the statutes is created to read:
SB3,19,22
633.01
(6) “Self-insured health plan" has the meaning given in s. 632.85 (1) (c).
SB3,31
3Section 31
. 633.04 (intro.) of the statutes is amended to read:
SB3,19,8
4633.04 Written agreement required. (intro.) An administrator may not
5administer
a an employee benefit plan in the absence of a written agreement
6between the administrator and a principal. The administrator and principal shall
7each retain a copy of the written agreement for the duration of the agreement and
8for 5 years thereafter. The written agreement shall contain the following terms:
SB3,32
9Section 32
. 633.05 of the statutes is amended to read:
SB3,19,16
10633.05 Payment to administrator. If a principal is an insurer, payment to
11the administrator of a premium or charge by or on behalf of an insured
employee is
12payment to the insurer, but payment of a return premium or claim by the insurer to
13the administrator is not payment to an insured
employee until the payment is
14received by the insured
employee. This section does not limit any right of the insurer
15against the administrator for failure to make payments to the insurer or an insured
16employee.
SB3,33
17Section 33
. 633.06 of the statutes is amended to read:
SB3,19,22
18633.06 Examination and inspection of books and records. (1) The
19commissioner may examine, audit or accept an audit of the books and records of an
20administrator
or pharmacy benefit manager as provided for examination of licensees
21under s. 601.43 (1), (3), (4) and (5), to be conducted as provided in s. 601.44, and with
22costs to be paid as provided in s. 601.45.
SB3,20,2
23(2) A principal that uses an administrator may inspect the books and records
24of the administrator, subject to any restrictions set forth in ss. 146.81 to 146.835 and
1in the written agreement required under s. 633.04, for the purpose of enabling the
2principal to fulfill its contractual obligations to
insureds insured employees.
SB3,34
3Section 34
. 633.07 of the statutes is amended to read:
SB3,20,6
4633.07 Approval of advertising. An administrator may not use any
5advertising for
a an employee benefit plan underwritten by an insurer unless the
6insurer approves the advertising in advance.
SB3,35
7Section 35
. 633.09 (4) (b) 2. and 3. of the statutes are amended to read:
SB3,20,98
633.09
(4) (b) 2. To
a an employee benefit plan policyholder for payment to a
9principal, the funds belonging to the principal.
SB3,20,1010
3. To an insured
employee, the funds belonging to the insured
employee.
SB3,36
11Section 36
. 633.11 of the statutes is amended to read:
SB3,20,17
12633.11 Claim adjustment compensation. If an administrator adjusts or
13settles claims under
a an employee benefit plan, the commission, fees or charges
14that the principal pays the administrator may not be based on the
employee benefit 15plan's loss experience. This section does not prohibit compensation based on the
16number or amount of premiums or charges collected, or the number or amount of
17claims paid or processed by the administrator.
SB3,37
18Section 37
. 633.12 (1) (intro.), (b) and (c) of the statutes are amended to read:
SB3,20,2319
633.12
(1) (intro.) An administrator shall prepare sufficient copies of a written
20notice approved in advance by the principal for distribution to all
insureds insured
21employees of the principal and either shall distribute the copies to the
insureds 22insured employees or shall provide the copies to the principal for distribution to the
23insureds insured employees. The written notice shall contain all of the following:
SB3,20,2524
(b) An explanation of the respective rights and responsibilities of the
25administrator, the principal and the
insureds
insured employees.