Florida Senate - 2026 SB 1354 By Senator Garcia 36-01414A-26 20261354__ Page 1 of 21 CODING: Words stricken are deletions; words underlined are additions. A bill to be entitled 1

An act relating to small employer health insurance; 2 amending s. 627.6699, F.S.; deleting and revising 3

definitions; deleting provisions relating to the 4 creation of the Florida Small Employer Health 5 Reinsurance Program; amending ss. 627.642, 627.6475, 6 627.657, and 627.66997, F.S.; conforming cross-7 references; providing an effective date. 8 9 Be It Enacted by the Legislature of the State of Florida: 10 11

Section 1. Paragraphs (b), (p), (q), and (

s) of subsection 12 (3), paragraph (

d) of subsection (9), paragraphs (

b) and (

c) of 13 subsection (10), and subsection (11) of

section 627.6699, 14 Florida Statutes, are amended to read: 15 627.6699 Employee Health Care Access Act.— 16

(3) DEFINITIONS.—As used in this section, the term: 17 (b) “Board” means the board of directors of the program. 18 (p) “Plan of operation” means the plan of operation of the 19 program, including articles, bylaws, and operating rules, 20 adopted by the board under subsection (11). 21 (q) “Program” means the Florida Small Employer Carrier 22 Reinsurance Program created under subsection (11). 23 (p)(s) “Reinsuring carrier” means a small employer carrier 24 that elects to comply with reinsurance the requirements set 25 forth in subsection (11). 26

(9) SMALL EMPLOYER CARRIER’S ELECTION TO BECOME A RISK-27 ASSUMING CARRIER OR A REINSURING CARRIER.— 28 (

d) A small employer carrier that elects to cease 29

Florida Senate - 2026 SB 1354 36-01414A-26 20261354__ Page 2 of 21 CODING: Words stricken are deletions; words underlined are additions. participating as a reinsuring carrier and to become a risk-30 assuming carrier is prohibited from reinsuring or continuing to 31 reinsure any small employer health benefits plan under 32 subsection (11) as soon as the carrier becomes a risk-assuming 33 carrier and must pay a prorated assessment based upon business 34 issued as a reinsuring carrier for any portion of the year that 35 the business was reinsured.

A small employer carrier that elects 36 to cease participating as a risk-assuming carrier and to become 37 a reinsuring carrier is permitted to reinsure small employer 38 health benefit plans under the terms set forth in subsection 39 (11) and must pay a prorated assessment based upon business 40 issued as a reinsuring carrier for any portion of the year that 41 the business was reinsured. 42

(10) ELECTION PROCESS TO BECOME A RISK-ASSUMING CARRIER.— 43 (

b) In determining whether to approve an application by a 44 small employer carrier to become a risk-assuming carrier, the 45 office shall consider: 46 1. The carrier’s financial ability to support the 47 assumption of the risk of small employer groups. 48 2. The carrier’s history of rating and underwriting small 49 employer groups. 50 3. The carrier’s commitment to market fairly to all small 51 employers in the state or its service area, as applicable. 52 4. The carrier’s ability to assume and manage the risk of 53 enrolling small employer groups without the protection of the 54 reinsurance program provided in subsection (11). 55 (

c) A small employer carrier that becomes a risk-assuming 56 carrier pursuant to this subsection is not subject to 57 reinsurance the assessment provisions of subsection (11). 58

Florida Senate - 2026 SB 1354 36-01414A-26 20261354__ Page 3 of 21 CODING: Words stricken are deletions; words underlined are additions.

(11) SMALL EMPLOYER HEALTH REINSURANCE PROGRAM.— 59 (

a) There is created a nonprofit entity to be known as the 60 “Florida Small Employer Health Reinsurance Program.” 61 (b)1. The program shall operate subject to the supervision 62 and control of the board. 63 2. Effective upon this act becoming a law, the board shall 64 consist of the director of the office or his or her designee, 65 who shall serve as the chairperson, and 13 additional members 66 who are representatives of carriers and insurance agents and are 67 appointed by the director of the office and serve as follows: 68 a. Five members shall be representatives of health insurers 69 licensed under

chapter 624 or

chapter 641. Two members shall be 70 agents who are actively engaged in the sale of health insurance. 71 Four members shall be employers or representatives of employers. 72 One member shall be a person covered under an individual health 73 insurance policy issued by a licensed insurer in this state. One 74 member shall represent the Agency for Health Care Administration 75 and shall be recommended by the Secretary of Health Care 76 Administration. 77 b.

A member appointed under this subparagraph shall serve a 78 term of 4 years and shall continue in office until the member’s 79 successor takes office, except that, in order to provide for 80 staggered terms, the director of the office shall designate two 81 of the initial appointees under this subparagraph to serve terms 82 of 2 years and shall designate three of the initial appointees 83 under this subparagraph to serve terms of 3 years. 84 3. The director of the office may remove a member for 85 cause. 86 4. Vacancies on the board shall be filled in the same 87

Florida Senate - 2026 SB 1354 36-01414A-26 20261354__ Page 4 of 21 CODING: Words stricken are deletions; words underlined are additions. manner as the original appointment for the unexpired portion of 88 the term. 89 (c)1. The board shall submit to the office a plan of 90 operation to assure the fair, reasonable, and equitable 91 administration of the program. The board may at any time submit 92 to the office any amendments to the plan that the board finds to 93 be necessary or suitable. 94 2.

The office shall, after notice and hearing, approve the 95 plan of operation if it determines that the plan submitted by 96 the board is suitable to assure the fair, reasonable, and 97 equitable administration of the program and provides for the 98 sharing of program gains and losses equitably and 99 proportionately in accordance with paragraph (j). 100 3. The plan of operation, or any amendment thereto, becomes 101 effective upon written approval of the office. 102 (

d) The plan of operation must, among other things: 103 1. Establish procedures for handling and accounting for 104 program assets and moneys and for an annual fiscal reporting to 105 the office. 106 2. Establish procedures for selecting an administering 107 carrier and set forth the powers and duties of the administering 108 carrier. 109 3. Establish procedures for reinsuring risks. 110 4.

Establish procedures for collecting assessments from 111 participating carriers to provide for claims reinsured by the 112 program and for administrative expenses, other than amounts 113 payable to the administrative carrier, incurred or estimated to 114 be incurred during the period for which the assessment is made. 115 5. Provide for any additional matters at the discretion of 116

Florida Senate - 2026 SB 1354 36-01414A-26 20261354__ Page 5 of 21 CODING: Words stricken are deletions; words underlined are additions. the board. 117 (

e) The board shall recommend to the office market conduct 118 requirements and other requirements for carriers and agents, 119 including requirements relating to: 120 1. Registration by each carrier with the office of its 121 intention to be a small employer carrier under this section; 122 2. Publication by the office of a list of all small 123 employer carriers, including a requirement applicable to agents 124 and carriers that a health benefit plan may not be sold by a 125 carrier that is not identified as a small employer carrier; 126 3.

The availability of a broadly publicized, toll-free 127 telephone number for access by small employers to information 128 concerning this section; 129 4. Periodic reports by carriers and agents concerning 130 health benefit plans issued; and 131 5. Methods concerning periodic demonstration by small 132 employer carriers and agents that they are marketing or issuing 133 health benefit plans to small employers. 134 (

f) The program has the general powers and authority 135 granted under the laws of this state to insurance companies and 136 health maintenance organizations licensed to transact business, 137 except the power to issue health benefit plans directly to 138 groups or individuals. In addition thereto, the program has 139 specific authority to: 140 1. Enter into contracts as necessary or proper to carry out 141 the provisions and purposes of this act, including the authority 142 to enter into contracts with similar programs of other states 143 for the joint performance of common functions or with persons or 144 other organizations for the performance of administrative 145

Florida Senate - 2026 SB 1354 36-01414A-26 20261354__ Page 7 of 21 CODING: Words stricken are deletions; words underlined are additions. coverage of an eligible employee of a small employer, or any 175 dependent of such an employee, subject to each of the following 176 provisions: 177 1. Except in the case of a late enrollee, a reinsuring 178 carrier may reinsure an eligible employee or dependent within 60 179 days after the commencement of the coverage of the small 180 employer.

A newly employed eligible employee or dependent of a 181 small employer may be reinsured within 60 days after the 182 commencement of his or her coverage. 183 2. A small employer carrier may reinsure an entire employer 184 group within 60 days after the commencement of the group’s 185 coverage under the plan. 186 3. The program may not reimburse a participating carrier 187 with respect to the claims of a reinsured employee or dependent 188 until the carrier has paid incurred claims of at least $5,000 in 189 a calendar year for benefits covered by the program.

In 190 addition, the reinsuring carrier shall be responsible for 10 191 percent of the next $50,000 and 5 percent of the next $100,000 192 of incurred claims during a calendar year and the program shall 193 reinsure the remainder. 194 4. The board annually shall adjust the initial level of 195 claims and the maximum limit to be retained by the carrier to 196 reflect increases in costs and utilization within the standard 197 market for health benefit plans within the state.

The adjustment 198 shall not be less than the annual change in the medical 199 component of the “Consumer Price Index for All Urban Consumers” 200 of the Bureau of Labor Statistics of the Department of Labor, 201 unless the board proposes and the office approves a lower 202 adjustment factor. 203

Florida Senate - 2026 SB 1354 36-01414A-26 20261354__ Page 8 of 21 CODING: Words stricken are deletions; words underlined are additions. 5. A small employer carrier may terminate reinsurance for 204 all reinsured employees or dependents on any plan anniversary. 205 6. The premium rate charged for reinsurance by the program 206 to a health maintenance organization that is approved by the 207 Secretary of Health and Human Services as a federally qualified 208 health maintenance organization pursuant to 42 U.S.C. s. 209 300e(c)(2)(

A) and that, as such, is subject to requirements that 210 limit the amount of risk that may be ceded to the program, which 211 requirements are more restrictive than subparagraph 3., shall be 212 reduced by an amount equal to that portion of the risk, if any, 213 which exceeds the amount set forth in subparagraph 3. which may 214 not be ceded to the program. 215 7. The board may consider adjustments to the premium rates 216 charged for reinsurance by the program for carriers that use 217 effective cost containment measures, including high-cost case 218 management, as defined by the board. 219 8.

A reinsuring carrier shall apply its case-management and 220 claims-handling techniques, including, but not limited to, 221 utilization review, individual case management, preferred 222 provider provisions, other managed care provisions or methods of 223 operation, consistently with both reinsured business and 224 nonreinsured business. 225 (h)1. The board, as part of the plan of operation, shall 226 establish a methodology for determining premium rates to be 227 charged by the program for reinsuring small employers and 228 individuals pursuant to this section.

The methodology shall 229 include a system for classification of small employers that 230 reflects the types of case characteristics commonly used by 231 small employer carriers in the state. The methodology shall 232

Florida Senate - 2026 SB 1354 36-01414A-26 20261354__ Page 9 of 21 CODING: Words stricken are deletions; words underlined are additions. provide for the development of basic reinsurance premium rates, 233 which shall be multiplied by the factors set for them in this 234 paragraph to determine the premium rates for the program. The 235 basic reinsurance premium rates shall be established by the 236 board, subject to the approval of the office. The premium rates 237 set by the board may vary by geographical area, as determined 238 under this section, to reflect differences in cost.

The 239 multiplying factors must be established as follows: 240 a. The entire group may be reinsured for a rate that is 1.5 241 times the rate established by the board. 242 b. An eligible employee or dependent may be reinsured for a 243 rate that is 5 times the rate established by the board. 244 2. The board periodically shall review the methodology 245 established, including the system of classification and any 246 rating factors, to assure that it reasonably reflects the claims 247 experience of the program.

The board may propose changes to the 248 rates which shall be subject to the approval of the office. 249 (

i) If a health benefit plan for a small employer issued in 250 accordance with this subsection is entirely or partially 251 reinsured with the program, the premium charged to the small 252 employer for any rating period for the coverage issued must be 253 consistent with the requirements relating to premium rates set 254 forth in this section. 255 (j)1.

Before July 1 of each calendar year, the board shall 256 determine and report to the office the program net loss for the 257 previous year, including administrative expenses for that year, 258 and the incurred losses for the year, taking into account 259 investment income and other appropriate gains and losses. 260 2. Any net loss for the year shall be recouped by 261

Florida Senate - 2026 SB 1354 36-01414A-26 20261354__ Page 10 of 21 CODING: Words stricken are deletions; words underlined are additions. assessment of the carriers, as follows: 262 a. The operating losses of the program shall be assessed in 263 the following order subject to the specified limitations. The 264 first tier of assessments shall be made against reinsuring 265 carriers in an amount which shall not exceed 5 percent of each 266 reinsuring carrier’s premiums from health benefit plans covering 267 small employers.

If such assessments have been collected and 268 additional moneys are needed, the board shall make a second tier 269 of assessments in an amount which shall not exceed 0.5 percent 270 of each carrier’s health benefit plan premiums. Except as 271 provided in paragraph (m), risk-assuming carriers are exempt 272 from all assessments authorized pursuant to this section. The 273 amount paid by a reinsuring carrier for the first tier of 274 assessments shall be credited against any additional assessments 275 made. 276 b.

The board shall equitably assess carriers for operating 277 losses of the plan based on market share. The board shall 278 annually assess each carrier a portion of the operating losses 279 of the plan.

The first tier of assessments shall be determined 280 by multiplying the operating losses by a fraction, the numerator 281 of which equals the reinsuring carrier’s earned premium 282 pertaining to direct writings of small employer health benefit 283 plans in the state during the calendar year for which the 284 assessment is levied, and the denominator of which equals the 285 total of all such premiums earned by reinsuring carriers in the 286 state during that calendar year.

The second tier of assessments 287 shall be based on the premiums that all carriers, except risk-288 assuming carriers, earned on all health benefit plans written in 289 this state. The board may levy interim assessments against 290

Florida Senate - 2026 SB 1354 36-01414A-26 20261354__ Page 11 of 21 CODING: Words stricken are deletions; words underlined are additions. carriers to ensure the financial ability of the plan to cover 291 claims expenses and administrative expenses paid or estimated to 292 be paid in the operation of the plan for the calendar year prior 293 to the association’s anticipated receipt of annual assessments 294 for that calendar year. Any interim assessment is due and 295 payable within 30 days after receipt by a carrier of the interim 296 assessment notice.

Interim assessment payments shall be credited 297 against the carrier’s annual assessment. Health benefit plan 298 premiums and benefits paid by a carrier that are less than an 299 amount determined by the board to justify the cost of collection 300 may not be considered for purposes of determining assessments. 301 c. Subject to the approval of the office, the board shall 302 make an adjustment to the assessment formula for reinsuring 303 carriers that are approved as federally qualified health 304 maintenance organizations by the Secretary of Health and Human 305 Services pursuant to 42 U.S.C. s. 300e(c)(2)(

A) to the extent, 306 if any, that restrictions are placed on them that are not 307 imposed on other small employer carriers. 308 3. Before July 1 of each year, the board shall determine 309 and file with the office an estimate of the assessments needed 310 to fund the losses incurred by the program in the previous 311 calendar year. 312 4.

If the board determines that the assessments needed to 313 fund the losses incurred by the program in the previous calendar 314 year will exceed the amount specified in subparagraph 2., the 315 board shall evaluate the operation of the program and report its 316 findings, including any recommendations for changes to the plan 317 of operation, to the office within 180 days following the end of 318 the calendar year in which the losses were incurred. The 319

Florida Senate - 2026 SB 1354 36-01414A-26 20261354__ Page 12 of 21 CODING: Words stricken are deletions; words underlined are additions. evaluation shall include an estimate of future assessments, the 320 administrative costs of the program, the appropriateness of the 321 premiums charged and the level of carrier retention under the 322 program, and the costs of coverage for small employers.

If the 323 board fails to file a report with the office within 180 days 324 following the end of the applicable calendar year, the office 325 may evaluate the operations of the program and implement such 326 amendments to the plan of operation the office deems necessary 327 to reduce future losses and assessments. 328 5. If assessments exceed the amount of the actual losses 329 and administrative expenses of the program, the excess shall be 330 held as interest and used by the board to offset future losses 331 or to reduce program premiums.

As used in this paragraph, the 332 term “future losses” includes reserves for incurred but not 333 reported claims. 334 6. Each carrier’s proportion of the assessment shall be 335 determined annually by the board, based on annual statements and 336 other reports considered necessary by the board and filed by the 337 carriers with the board. 338 7. Provision shall be made in the plan of operation for the 339 imposition of an interest penalty for late payment of an 340 assessment. 341 8. A carrier may seek, from the office, a deferment, in 342 whole or in part, from any assessment made by the board.

The 343 office may defer, in whole or in part, the assessment of a 344 carrier if, in the opinion of the office, the payment of the 345 assessment would place the carrier in a financially impaired 346 condition. If an assessment against a carrier is deferred, in 347 whole or in part, the amount by which the assessment is deferred 348

Florida Senate - 2026 SB 1354 36-01414A-26 20261354__ Page 13 of 21 CODING: Words stricken are deletions; words underlined are additions. may be assessed against the other carriers in a manner 349 consistent with the basis for assessment set forth in this 350 section. The carrier receiving such deferment remains liable to 351 the program for the amount deferred and is prohibited from 352 reinsuring any individuals or groups in the program if it fails 353 to pay assessments. 354 (

k) Neither the participation in the program as reinsuring 355 carriers, the establishment of rates, forms, or procedures, nor 356 any other joint or collective action required by this act, may 357 be the basis of any legal action, criminal or civil liability, 358 or penalty against the program or any of its carriers either 359 jointly or separately. 360 (

l) The board shall monitor compliance with this section, 361 including the market conduct of small employer carriers, and 362 shall report to the office any unfair trade practices and 363 misleading or unfair conduct by a small employer carrier that 364 has been reported to the board by agents, consumers, or any 365 other person. The office shall investigate all reports and, upon 366 a finding of noncompliance with this

section or of unfair or 367 misleading practices, shall take action against the small 368 employer carrier as permitted under the insurance code or 369

chapter 641. The board is not given investigatory or regulatory 370 powers, but must forward all reports of cases or abuse or 371 misrepresentation to the office. 372 (

m) Notwithstanding paragraph (j), the administrative 373 expenses of the program shall be recouped by assessment of risk-374 assuming carriers and reinsuring carriers and such amounts shall 375 not be considered part of the operating losses of the plan for 376 the purposes of this paragraph. Each carrier’s portion of such 377

Florida Senate - 2026 SB 1354 36-01414A-26 20261354__ Page 14 of 21 CODING: Words stricken are deletions; words underlined are additions. administrative expenses shall be determined by multiplying the 378 total of such administrative expenses by a fraction, the 379 numerator of which equals the carrier’s earned premium 380 pertaining to direct writing of small employer health benefit 381 plans in the state during the calendar year for which the 382 assessment is levied, and the denominator of which equals the 383 total of such premiums earned by all carriers in the state 384 during such calendar year. 385 (

n) The board shall advise the office, the Agency for 386 Health Care Administration, the department, other executive 387 departments, and the Legislature on health insurance issues. 388 Specifically, the board shall: 389 1. Provide a forum for stakeholders, consisting of 390 insurers, employers, agents, consumers, and regulators, in the 391 private health insurance market in this state. 392 2. Review and recommend strategies to improve the 393 functioning of the health insurance markets in this state with a 394 specific focus on market stability, access, and pricing. 395 3.

Make recommendations to the office for legislation 396 addressing health insurance market issues and provide comments 397 on health insurance legislation proposed by the office. 398 4. Meet at least three times each year. One meeting shall 399 be held to hear reports and to secure public comment on the 400 health insurance market, to develop any legislation needed to 401 address health insurance market issues, and to provide comments 402 on health insurance legislation proposed by the office. 403 5. Issue a report to the office on the state of the health 404 insurance market by September 1 each year.

The report shall 405 include recommendations for changes in the health insurance 406

Florida Senate - 2026 SB 1354 36-01414A-26 20261354__ Page 15 of 21 CODING: Words stricken are deletions; words underlined are additions. market, results from implementation of previous recommendations, 407 and information on health insurance markets. 408

Section 2. Subsection (3) of

section 627.642, Florida 409 Statutes, is amended to read: 410 627.642 Outline of coverage.— 411

(3) In addition to the outline of coverage, a policy as 412 specified in s. 627.6699(3)(

j) s. 627.6699(3)(

k) must be 413 accompanied by an identification card that contains, at a 414 minimum: 415 (

a) The name of the organization issuing the policy or the 416 name of the organization administering the policy, whichever 417 applies. 418 (

b) The name of the contract holder. 419 (

c) The type of plan only if the plan is filed in the 420 state, an indication that the plan is self-funded, or the name 421 of the network. 422 (

d) The member identification number, contract number, and 423 policy or group number, if applicable. 424 (

e) A contact phone number or electronic address for 425 authorizations and admission certifications. 426 (

f) A phone number or electronic address whereby the 427 covered person or hospital, physician, or other person rendering 428 services covered by the policy may obtain benefits verification 429 and information in order to estimate patient financial 430 responsibility, in compliance with privacy rules under the 431 Health Insurance Portability and Accountability Act. 432 (

g) The national plan identifier, in accordance with the 433 compliance date set forth by the federal Department of Health 434 and Human Services. 435

Florida Senate - 2026 SB 1354 36-01414A-26 20261354__ Page 16 of 21 CODING: Words stricken are deletions; words underlined are additions. 436 The identification card must present the information in a 437 readily identifiable manner or, alternatively, the information 438 may be embedded on the card and available through magnetic 439 stripe or smart card. The information may also be provided 440 through other electronic technology. 441

Section 3. Paragraph (

a) of subsection (2), paragraphs (a), 442 (e), and (

g) of subsection (7), and paragraph (

a) of subsection 443 (8) of

section 627.6475, Florida Statutes, are amended to read: 444 627.6475 Individual reinsurance pool.— 445

(2) DEFINITIONS.—As used in this section: 446 (a) “Board,” “Carrier,” and “health benefit plan” have the 447 same meaning ascribed in s. 627.6699(3). 448

(7) INDIVIDUAL HEALTH REINSURANCE PROGRAM.— 449 (

a) The individual health reinsurance program shall operate 450 subject to the supervision and control of the board of the small 451 employer health reinsurance program established pursuant to s. 452 627.6699(11). The board shall establish a separate, segregated 453 account for eligible individuals reinsured pursuant to this 454 section, which account may not be commingled with the small 455 employer health reinsurance account. 456 (e)1.

Before March 1 of each calendar year, the board shall 457 determine and report to the office the program net loss in the 458 individual account for the previous year, including 459 administrative expenses for that year and the incurred losses 460 for that year, taking into account investment income and other 461 appropriate gains and losses. 462 2. Any net loss in the individual account for the year 463 shall be recouped by assessing the carriers as follows: 464

Florida Senate - 2026 SB 1354 36-01414A-26 20261354__ Page 17 of 21 CODING: Words stricken are deletions; words underlined are additions. a. The operating losses of the program shall be assessed in 465 the following order subject to the specified limitations.

The 466 first tier of assessments shall be made against reinsuring 467 carriers in an amount that may not exceed 5 percent of each 468 reinsuring carrier’s premiums for individual health insurance. 469 If such assessments have been collected and additional moneys 470 are needed, the board shall make a second tier of assessments in 471 an amount that may not exceed 0.5 percent of each carrier’s 472 health benefit plan premiums. 473 b. Except as provided in paragraph (f), risk-assuming 474 carriers are exempt from all assessments authorized pursuant to 475 this section.

The amount paid by a reinsuring carrier for the 476 first tier of assessments shall be credited against any 477 additional assessments made. 478 c. The board shall equitably assess reinsuring carriers for 479 operating losses of the individual account based on market 480 share. The board shall annually assess each carrier a portion of 481 the operating losses of the individual account.

The first tier 482 of assessments shall be determined by multiplying the operating 483 losses by a fraction, the numerator of which equals the 484 reinsuring carrier’s earned premium pertaining to direct 485 writings of individual health insurance in the state during the 486 calendar year for which the assessment is levied, and the 487 denominator of which equals the total of all such premiums 488 earned by reinsuring carriers in the state during that calendar 489 year.

The second tier of assessments shall be based on the 490 premiums that all carriers, except risk-assuming carriers, 491 earned on all health benefit plans written in this state. The 492 board may levy interim assessments against reinsuring carriers 493

Florida Senate - 2026 SB 1354 36-01414A-26 20261354__ Page 18 of 21 CODING: Words stricken are deletions; words underlined are additions. to ensure the financial ability of the plan to cover claims 494 expenses and administrative expenses paid or estimated to be 495 paid in the operation of the plan for the calendar year prior to 496 the association’s anticipated receipt of annual assessments for 497 that calendar year. Any interim assessment is due and payable 498 within 30 days after receipt by a carrier of the interim 499 assessment notice.

Interim assessment payments shall be credited 500 against the carrier’s annual assessment. Health benefit plan 501 premiums and benefits paid by a carrier that are less than an 502 amount determined by the board to justify the cost of collection 503 may not be considered for purposes of determining assessments. 504 d. Subject to the approval of the office, the board shall 505 adjust the assessment formula for reinsuring carriers that are 506 approved as federally qualified health maintenance organizations 507 by the Secretary of Health and Human Services pursuant to 42 508 U.S.C. s. 300e(c)(2)(

A) to the extent, if any, that restrictions 509 are placed on them which are not imposed on other carriers. 510 3. Before March 1 of each year, the board shall determine 511 and file with the office an estimate of the assessments needed 512 to fund the losses incurred by the program in the individual 513 account for the previous calendar year. 514 4.

If the board determines that the assessments needed to 515 fund the losses incurred by the program in the individual 516 account for the previous calendar year will exceed the amount 517 specified in subparagraph 2., the board shall evaluate the 518 operation of the program and report its findings and 519 recommendations to the office in the format established in s. 520 627.6699(11) for the comparable report for the small employer 521 reinsurance program. 522

Florida Senate - 2026 SB 1354 36-01414A-26 20261354__ Page 19 of 21 CODING: Words stricken are deletions; words underlined are additions. (

g) Except as otherwise provided in this section, the board 523 and the office shall have all powers, duties, and 524 responsibilities with respect to carriers that issue and 525 reinsure individual health insurance, as specified for the board 526 and the office in s. 627.6699(11) with respect to small employer 527 carriers, including, but not limited to, the provisions of s. 528 627.6699(11) relating to: 529 1. Use of assessments that exceed the amount of actual 530 losses and expenses. 531 2. The annual determination of each carrier’s proportion of 532 the assessment. 533 3.

Interest for late payment of assessments. 534 4. Authority for the office to approve deferment of an 535 assessment against a carrier. 536 5. Limited immunity from legal actions or carriers. 537 6. Development of standards for compensation to be paid to 538 agents. Such standards shall be limited to those specifically 539 enumerated in s. 627.6699(11)(

d) s. 627.6699(12)(d). 540 7. Monitoring compliance by carriers with this section. 541

(8) STANDARDS TO ASSURE FAIR MARKETING.— 542 (

a) Each health insurance issuer that offers individual 543 health insurance shall actively market coverage to eligible 544 individuals in the state. The provisions of s. 627.6699(11) s. 545 627.6699(12) that apply to small employer carriers that market 546 policies to small employers shall also apply to health insurance 547 issuers that offer individual health insurance with respect to 548 marketing policies to individuals. 549

Section 4. Subsection (2) of

section 627.657, Florida 550 Statutes, is amended to read: 551

Florida Senate - 2026 SB 1354 36-01414A-26 20261354__ Page 20 of 21 CODING: Words stricken are deletions; words underlined are additions. 627.657 Provisions of group health insurance policies.— 552

(2) The medical policy as specified in s. 627.6699(3)(

j) s. 553 627.6699(3)(

k) must be accompanied by an identification card 554 that contains, at a minimum: 555 (

a) The name of the organization issuing the policy or name 556 of the organization administering the policy, whichever applies. 557 (

b) The name of the certificateholder. 558 (

c) The type of plan only if the plan is filed in the 559 state, an indication that the plan is self-funded, or the name 560 of the network. 561 (

d) The member identification number, contract number, and 562 policy or group number, if applicable. 563 (

e) A contact phone number or electronic address for 564 authorizations and admission certifications. 565 (

f) A phone number or electronic address whereby the 566 covered person or hospital, physician, or other person rendering 567 services covered by the policy may obtain benefits verification 568 and information in order to estimate patient financial 569 responsibility, in compliance with privacy rules under the 570 Health Insurance Portability and Accountability Act. 571 (

g) The national plan identifier, in accordance with the 572 compliance date set forth by the federal Department of Health 573 and Human Services. 574 575 The identification card must present the information in a 576 readily identifiable manner or, alternatively, the information 577 may be embedded on the card and available through magnetic 578 stripe or smart card. The information may also be provided 579 through other electronic technology. 580

Florida Senate - 2026 SB 1354 36-01414A-26 20261354__ Page 21 of 21 CODING: Words stricken are deletions; words underlined are additions.

Section 5. Subsection (1) of

section 627.66997, Florida 581 Statutes, is amended to read: 582 627.66997 Stop-loss insurance.— 583

(1) A self-insured health benefit plan established or 584 maintained by a small employer, as defined in s. 627.6699(3)(s) 585 s. 627.6699(3)(v), is exempt from s. 627.6699 and may use a 586 stop-loss insurance policy issued to the employer. For purposes 587 of this subsection, the term “stop-loss insurance policy” means 588 an insurance policy issued to a small employer which covers the 589 small employer’s obligation for the excess cost of medical care 590 on an equivalent basis per employee provided under a self-591 insured health benefit plan. 592 (

a) A small employer stop-loss insurance policy is 593 considered a health insurance policy and is subject to s. 594 627.6699 if the policy has an aggregate attachment point that is 595 lower than the greatest of: 596 1. Two thousand dollars multiplied by the number of 597 employees; 598 2. One hundred twenty percent of expected claims, as 599 determined by the stop-loss insurer in accordance with actuarial 600 standards of practice; or 601 3. Twenty thousand dollars. 602 (

b) Once claims under the small employer health benefit 603 plan reach the aggregate attachment point set forth in paragraph 604 (a), the stop-loss insurance policy authorized under this 605

section must cover 100 percent of all claims that exceed the 606 aggregate attachment point. 607

Section 6. This act shall take effect July 1, 2026. 608