SB45,1396,1716(i) Apply different medical necessity criteria based on financial interests
17rather than patient needs.
SB45,1396,1918(j) Disregard a treating health care providers medical assessment without a
19valid clinical reason.
SB45,1396,2120(k) Mandate prior approval for routine or urgent procedures in a manner that
21causes harmful delays.
SB45,1396,2422(L) For a disability insurance policy that provides coverage of emergency
23medical services, refuse to cover emergency medical services provided by out-of-
24network providers.
SB45,1397,2
1(m) List a health care provider as in-network on a provider directory and then
2deny a claim by stating the health care provider is out-of-network.
SB45,1397,43(n) Deny coverage based on age, gender, disability, or a chronic condition
4rather than medical necessity.
SB45,1397,65(o) Apply stricter standards in reviewing claims related to mental health
6conditions than claims related to physical health conditions.
SB45,1397,87(p) Perform a blanket denial of claims for high-cost conditions without an
8individualized review of each claim.
SB45,1397,99(r) Reclassify a claim to a lower-cost treatment to reduce insurer payout.
SB45,1397,1110(s) Require an insured to fail a cheaper treatment before approving coverage
11for necessary care.
SB45,1397,1212(t) Manipulate cost-sharing rules to shift higher costs to insureds.
SB45,1397,1713(5) Transparency and reporting. (a) Beginning on January 1, 2027, an
14insurer shall annually publish a report detailing the insurers claim denial rates,
15reasons for claim denials, and the outcome of any appeal of a claim denial for the
16previous year for all disability insurance policies under which the insurer provides
17coverage.
SB45,1397,1918(b) The commissioner shall maintain a public database of insurers claim
19denial rates and the outcomes of independent reviews under s. 632.835.
SB45,1397,2320(c) Beginning on January 1, 2027, an insurer that uses artificial intelligence
21or algorithmic decision-making in claims processing shall annually publish a report
22detailing all of the following for the previous year for all disability insurance policies
23under which the insurer provides coverage:
SB45,1398,2
11. The percentage of claims submitted to the insurer that were reviewed by
2artificial intelligence or algorithmic decision-making.
SB45,1398,532. The claim denial rate of claims reviewed by artificial intelligence or
4algorithmic decision-making compared to the claim denial rate of claims reviewed
5by humans.
SB45,1398,763. The steps the insurer takes to ensure fairness and accuracy in decisions
7made by artificial intelligence or algorithmic decision-making.
SB45,1398,118(6) Claim denial rate audits. (a) The commissioner may conduct an audit
9of an insurer if the insurers claim denials are of such frequency as to indicate a
10general business practice. This paragraph is supplemental to and does not limit
11any other powers or duties of the commissioner.
SB45,1398,1312(b) The commissioner may collect any relevant information from an insurer
13that is necessary to conduct an audit under par. (a).
SB45,1398,1514(c) The commissioner may contract with a 3rd party to conduct an audit under
15par. (a).
SB45,1398,2016(d) The commissioner may, based on the findings of an audit under par. (a),
17order the insurer who is the subject of the audit to comply with a corrective action
18plan approved by the commissioner. The commissioner shall specify in any
19corrective action plan under this paragraph the deadline by which an insurer must
20be in compliance with the corrective action plan.
SB45,1398,2221(e) An insurer who is the subject of an audit under par. (a) shall provide a
22written response to any adverse findings of the audit.
SB45,1399,223(f) If an insurer fails to comply with a corrective action plan under par. (d) by

1the deadline specified by the commissioner, the commissioner may order the
2insurer to pay a forfeiture pursuant to s. 601.64 (3).
SB45,1399,63(7) Forfeitures. A violation of this section that results in a harmful delay in
4an insureds care or an adverse health outcome for an insured shall be subject to a
5civil forfeiture of $10,000 per occurrence, in addition to any other penalties provided
6in s. 601.64 (3) or other law.
SB45,28887Section 2888. 601.575 of the statutes is created to read:
SB45,1399,138601.575 Prescription drug importation program. (1) Importation
9program requirements. The commissioner, in consultation with persons
10interested in the sale and pricing of prescription drugs and appropriate officials
11and agencies of the federal government, shall design and implement a prescription
12drug importation program for the benefit of residents of this state, that generates
13savings for residents, and that satisfies all of the following:
SB45,1399,1614(a) The commissioner shall designate a state agency to become a licensed
15wholesale distributor or to contract with a licensed wholesale distributor and shall
16seek federal certification and approval to import prescription drugs.
SB45,1399,1817(b) The program shall comply with relevant requirements of 21 USC 384,
18including safety and cost savings requirements.
SB45,1399,2019(c) The program shall import prescription drugs from Canadian suppliers
20regulated under any appropriate Canadian or provincial laws.