Florida Senate - 2015 SB 1498
By Senator Soto
14-01193B-15 20151498__
1 A bill to be entitled
2 An act relating to health insurance exchanges;
3 providing a short title; creating s. 641.81, F.S.;
4 providing legislative findings and intent; defining
5 terms; requiring the Agency for Health Care
6 Administration to establish the Florida Health Access
7 Marketplace; requiring the agency to establish the
8 Small Business Health Options Program (SHOP);
9 providing contracting and rulemaking authority;
10 authorizing the marketplace to contract with certain
11 entities; defining “eligible entity”; authorizing the
12 agency to adopt rules; providing for information
13 sharing and confidentiality; providing for insurance
14 coverage availability; providing for the
15 responsibilities and duties of the marketplace;
16 providing for health benefit plan certification;
17 requiring the marketplace to certify certain health
18 benefit plans; providing a contingent effective date.
19
20 Be It Enacted by the Legislature of the State of Florida:
21
22 Section 1. This act may be cited as the “Florida Health
23 Access Marketplace Act”.
24 Section 2. Section 641.81, Florida Statutes, is created to
25 read:
26 641.81 Florida Health Access Marketplace.—
27 (1) INTENT.—The Legislature finds that a historically
28 significant proportion of the residents of this state have been
29 unable to obtain affordable health insurance coverage. The
30 Legislature also finds that increasing access to affordable,
31 quality health care is beneficial to the health and well-being
32 of all of the state’s residents, is necessary for the state’s
33 economic vitality, and provides a substantial boost to the
34 business activity of the state. The Legislature recognizes that
35 more than 1.6 million hardworking residents of this state
36 purchased health insurance for 2015 on the Affordable Care Act
37 federal health insurance exchange. The Legislature also
38 recognizes that 93 percent, or nearly all, of those residents
39 received tax credits that averaged $297 per person each month.
40 The Legislature finds that the United States Supreme Court is
41 scheduled to render a decision that may affect the availability
42 of those tax credits to residents of this state after the end of
43 Florida’s 2015 Regular Session. The Legislature also finds that
44 the Court may decide that only those individuals who buy health
45 insurance policies on state-based exchanges are eligible for the
46 federal tax credits. The Legislature recognizes that should the
47 Court issue such a ruling, more than 1 million residents of this
48 state could be at substantial risk of losing their access to
49 affordable health care and the economy of this state may lose an
50 estimated $4.75 billion in subsidy spending, when the loss of
51 both premium tax credits and cost-sharing assistance are
52 considered. Therefore, in order to preserve the ability of
53 residents of this state to qualify for the federal tax credits
54 and in order to keep those tax credits operative in the state’s
55 economy and available to residents of this state in need of
56 affordable health insurance, it is the intent of the
57 Legislature, contingent upon a ruling by the United States
58 Supreme Court that only state-based exchange policy purchasers
59 are eligible for federal tax credits and subsidies, to establish
60 a state-based health insurance exchange, pursuant to s. 1311 of
61 the Affordable Care Act.
62 (2) DEFINITIONS.—As used in this section, the term:
63 (a) “Affordable Care Act” means the federal Patient
64 Protection and Affordable Care Act, Pub. L. No. 111-148.
65 (b) “Agency” means the Agency for Health Care
66 Administration.
67 (c) “Health benefit plan” means a policy, contract,
68 certificate, or agreement offered or issued by a health carrier
69 to provide, deliver, arrange for, pay for, or reimburse any of
70 the costs of health care services. The term “health benefit
71 plan” does not include:
72 1. Coverage only for accident or disability income
73 insurance or any combination of accident or disability income
74 insurance.
75 2. Coverage issued as a supplement to liability insurance.
76 3. Liability insurance, including general liability
77 insurance and automobile liability insurance.
78 4. Workers’ compensation or similar insurance.
79 5. Automobile medical payment insurance.
80 6. Credit-only insurance.
81 7. Coverage for on-site medical clinics.
82 8. Insurance coverage as specified in federal regulations
83 issued pursuant to the federal Health Insurance Portability and
84 Accountability Act of 1996, Pub. L. No. 104-191 (HIPAA of 1996),
85 under which benefits for health care services are secondary or
86 incidental to other insurance benefits.
87 9. The following benefits, if they are provided under a
88 separate policy, certificate, or contract of insurance or are
89 otherwise not an integral part of the plan:
90 a. Limited scope dental or vision benefits.
91 b. Benefits for long-term care, nursing home care, home
92 health care, community-based care or any combination of those
93 benefits.
94 c. Limited benefits as specified in federal regulations
95 issued pursuant to the federal HIPAA of 1996.
96 d. Coverage only for a specified disease or illness.
97 e. Hospital indemnity or other fixed indemnity insurance.
98 f. Medicare supplemental health insurance policies as
99 defined under the Social Security Act, 42 U.S.C. s. 1882(g)(1),
100 whether provided individually or under a group health plan.
101 g. Coverage supplemental to the coverage provided under 10
102 U.S.C. ch. 55, whether provided individually or under a group
103 health plan.
104 (d) “Health carrier” or “carrier” means:
105 1. An insurance company licensed in accordance with the
106 Florida Insurance Code to provide health insurance.
107 2. A health maintenance organization licensed pursuant to
108 the Florida Insurance Code.
109 3. A preferred provider administrator registered under the
110 Florida Insurance Code.
111 4. A nonprofit hospital or medical service organization or
112 health benefit plan licensed pursuant to Title XXIX or the
113 Florida Insurance Code.
114 (e) “Marketplace” means the Florida Health Access
115 Marketplace established in this section pursuant to s. 1311 of
116 the Affordable Care Act.
117 (f) “Qualified employer” means a small employer that elects
118 to make its full-time employees and, at the option of the
119 employer, some or all of its part-time employees eligible for
120 one or more qualified health plans or qualified stand-alone
121 dental benefit plans offered through the SHOP exchange and that:
122 1. Has its principal place of business in this state and
123 elects to provide coverage through the SHOP exchange to all of
124 its eligible employees, wherever employed; or
125 2. Elects to provide coverage through the SHOP exchange to
126 all of its eligible employees who are principally employed in
127 this state.
128 (g) “Qualified health plan” means a health benefit plan
129 that has in effect a certification that the plan meets the
130 criteria for certification described in this section and s.
131 1311(c) of the Affordable Care Act.
132 (h) “Qualified individual” means an individual, including a
133 minor, who:
134 1. Is seeking to enroll in a qualified health plan or
135 qualified stand-alone dental benefit plan offered to individuals
136 through the marketplace;
137 2. Resides in this state within the meaning of the
138 Affordable Care Act;
139 3. At the time of enrollment, is not incarcerated, other
140 than incarceration pending the disposition of charges; and
141 4. Is, and is reasonably expected to be, for the entire
142 period for which enrollment is sought, a citizen or national of
143 the United States or an alien lawfully present in the United
144 States.
145 (i) “Qualified stand-alone dental benefit plan” means a
146 stand-alone dental benefit plan that has been certified in
147 accordance with subsection (8).
148 (j) “SHOP exchange” means the Small Business Health Options
149 Program established pursuant to subsection (3).
150 (k) “Small employer” means an employer that employed an
151 average of not more than 100 employees during the preceding
152 calendar year. For purposes of this paragraph:
153 1. All persons treated as a single employer under the
154 Internal Revenue Code, 26 U.S.C. s. 414(b), (c), (m) or (o),
155 must be treated as a single employer.
156 2. A successor employer and a predecessor employer, under
157 the Internal Revenue Code, 26 U.S.C. s. 414, must be treated as
158 a single employer.
159 3. All employees must be counted, including part-time
160 employees and employees who are not eligible for coverage
161 through the employer.
162 4. If an employer was not in existence throughout the
163 preceding calendar year, the determination of whether that
164 employer is a small employer must be based on the average number
165 of employees reasonably expected to be employed by that employer
166 on business days in the current calendar year.
167 5. An employer that makes enrollment in qualified health
168 plans or qualified stand-alone dental benefit plans available to
169 its employees through the SHOP exchange, and, in a subsequent
170 calendar year, would cease to be a small employer by reason of
171 an increase in the number of its employees, must continue to be
172 treated as a small employer for purposes of this section as long
173 as the employer continuously makes enrollment through the SHOP
174 exchange available to its employees.
175 (l) “Stand-alone dental benefit plan” means a policy,
176 contract, certificate, or agreement offered or issued by a
177 carrier to provide, deliver, arrange for, pay for, or reimburse
178 any of the costs of limited scope dental benefits meeting the
179 requirements of s. 9832(c)(2)(A) of the Internal Revenue Code of
180 1986.
181 (3) MARKETPLACE ESTABLISHED; PURPOSES.—The agency shall
182 establish the Florida Health Access Marketplace to function as a
183 health insurance exchange, pursuant to the Affordable Care Act,
184 to facilitate the purchase and sale of qualified health plans
185 and qualified stand-alone dental benefit plans in the individual
186 market in this state and to provide for the establishment of a
187 Small Business Health Options Program to assist qualified
188 employers in this state in facilitating the enrollment of their
189 employees in qualified health plans and qualified stand-alone
190 dental benefit plans offered in the small group market. The
191 purpose of the marketplace is to reduce the number of uninsured
192 individuals, provide a transparent marketplace and consumer
193 education, and assist individuals with access to programs,
194 premium tax credits, and cost-sharing reductions. It is also the
195 purpose of the marketplace to maximize the receipt of federal
196 funds, including those available pursuant to the Affordable Care
197 Act.
198 (4) CONTRACTING AND RULEMAKING AUTHORITY.—The marketplace
199 may contract with an eligible entity for any of its functions as
200 described in this section. For the purposes of this subsection,
201 “eligible entity” includes, but is not limited to, any program
202 or entity, public or private, that has experience in individual
203 and small group health insurance or benefit administration or
204 other experience relevant to the services needed to carry out
205 the purposes of this section, except that a health carrier or
206 the affiliate of a health carrier is not an eligible entity. The
207 agency may adopt rules as necessary for the proper
208 administration and enforcement of this section under the Florida
209 Administrative Procedure Act.
210 (5) INFORMATION SHARING; CONFIDENTIALITY.—The marketplace
211 may enter into information-sharing agreements with federal and
212 state agencies and other states’ exchanges to carry out its
213 responsibilities under this section. Such agreements must
214 include adequate protections with respect to the confidentiality
215 of the information to be shared and comply with all state and
216 federal laws, rules and regulations.
217 (6) AVAILABILITY OF COVERAGE.—
218 (a) The marketplace shall make qualified health plans and
219 qualified stand-alone dental benefit plans available to
220 qualified individuals and qualified employers no later than
221 January 1, 2017. The marketplace may enroll qualified
222 individuals and qualified employers beginning on or after
223 September 1, 2016.
224 (b) The marketplace may not make available any health
225 benefit plan that is not a qualified health plan or any stand
226 alone dental benefit plan that is not a qualified stand-alone
227 dental benefit plan.
228 (c) The marketplace shall allow a health carrier to offer a
229 qualified stand-alone dental benefit plan through the
230 marketplace, either separately or in conjunction with a
231 qualified health plan, if the plan provides pediatric dental
232 benefits meeting the requirements of s. 1302(b)(1)(J) of the
233 Affordable Care Act. This paragraph does not prohibit a carrier
234 from offering other dental benefit plans consistent with the
235 requirements of subsection (8) of this section.
236 (d) The marketplace or a carrier offering qualified health
237 plans or qualified stand-alone dental benefit plans through the
238 marketplace may not charge an individual a fee or penalty for
239 termination of coverage if the individual enrolls in another
240 type of minimum essential coverage because the individual has
241 become newly eligible for that coverage or because the
242 individual’s employer-sponsored coverage has become affordable
243 under the standards of s. 1401 of the Affordable Care Act.
244 (e) The agency may standardize qualified health plans to be
245 offered through the marketplace.
246 (7) DUTIES AND RESPONSIBILITIES OF THE MARKETPLACE.—The
247 marketplace shall:
248 (a) Implement procedures, consistent with guidelines
249 developed under this section and s. 1311(c) of the Affordable
250 Care Act, for the certification, recertification, and
251 decertification of health benefit plans as qualified health
252 plans and of stand-alone dental benefit plans as qualified
253 stand-alone dental benefit plans.
254 (b) Provide for the operation of a toll-free telephone
255 hotline to respond to requests for assistance, which includes
256 the opportunity for live customer service.
257 (c) Make available enrollment periods as provided under s.
258 1311(c)(6) of the Affordable Care Act.
259 (d) Maintain a publicly accessible website through which
260 enrollees and prospective enrollees of qualified health plans
261 and qualified stand-alone dental benefit plans may obtain
262 standardized comparative information on such plans.
263 (e) Assign a rating to each qualified health plan offered
264 through the marketplace in accordance with the rating system
265 developed under s. 1311(c)(3) of the Affordable Care Act and
266 determine each qualified health plan’s level of coverage in
267 accordance with regulations issued under s. 1302(d)(2)(A) of the
268 Affordable Care Act.
269 (f) Use a standardized format for presenting health and
270 dental benefit options in the marketplace, including the use of
271 the uniform outline of coverage established under the Public
272 Health Service Act, 42 U.S.C. s. 300gg-15 (2010).
273 (g) In accordance with s. 1413 of the Affordable Care Act,
274 inform individuals of eligibility requirements for the Medicaid
275 program under Title XIX of the United States Social Security
276 Act, the State Children’s Health Insurance Program under Title
277 XXI of the United States Social Security Act, or under any
278 applicable state or local public program and if, through
279 screening of an application by the marketplace, the marketplace
280 determines that an individual is eligible for any such program,
281 enroll the individual in that program.
282 (h) Determine the criteria and process for eligibility,
283 enrollment, and disenrollment of enrollees and potential
284 enrollees in the marketplace and coordinate that process with
285 the state and local government entities administering other
286 health care coverage programs, in order to ensure consistent
287 eligibility and enrollment processes and seamless transitions
288 between coverages. To the extent possible, the agency shall
289 encourage the use of existing infrastructure and capacity from
290 other state agencies.
291 (i) Determine the minimum requirements a carrier must meet
292 to be considered for participation in the marketplace and the
293 standards and criteria for selecting qualified health plans to
294 be offered through the marketplace which are in the best
295 interests of qualified individuals and qualified employers. The
296 agency shall consistently and uniformly apply these
297 requirements, standards, and criteria to all carriers offering
298 qualified health plans through the marketplace and, if relevant,
299 shall apply those requirements, standards, and criteria to
300 carriers offering qualified stand-alone dental benefit plans or
301 other dental benefit plans through the marketplace. In the
302 course of selectively contracting for health care coverage
303 offered to qualified individuals and qualified employers through
304 the marketplace, the agency shall seek to contract with carriers
305 so as to provide health care coverage choices that offer the
306 optimal combination of choice, value, quality and service. In
307 its evaluation of the quality of health care coverage offered by
308 a carrier, the agency shall consider comparative health care
309 quality information and assessments.
310 (j) Provide, in each region of the state, a choice of
311 qualified health plans at each of the levels of coverage
312 contained in s. 1302(d) and (e) of the Affordable Care Act.
313 (k) Require, as a condition of participation in the
314 marketplace, carriers to fairly and affirmatively offer, market,
315 and sell in the marketplace at least one product within each of
316 the levels of coverage contained in s. 1302(d) and (e) of the
317 Affordable Care Act. The agency may require carriers to offer
318 additional products within each of the levels of coverage. This
319 paragraph does not apply to a carrier that solely offers
320 supplemental coverage in the marketplace or that solely offers a
321 qualified stand-alone dental benefit plan.
322 (l) Require, as a condition of participation in the
323 marketplace, carriers selling products outside the marketplace
324 to fairly and affirmatively offer, market, and sell all products
325 made available to individuals and small employers in the
326 marketplace to individuals and small employers, respectively,
327 purchasing coverage outside the marketplace.
328 (m) Establish and make available by electronic means and by
329 a toll-free telephone number a calculator to determine the
330 actual cost of coverage after application of any premium tax
331 credit under s. 1401 of the Affordable Care Act or any cost
332 sharing reduction under s. 1402 of the Affordable Care Act.
333 (n) Establish a SHOP exchange through which qualified
334 employers may access coverage for their employees, enabling any
335 qualified employer to specify a level of coverage or amount of
336 contribution toward coverage so that any of its employees may
337 enroll in any qualified health plan or qualified stand-alone
338 dental benefit plan offered through the SHOP exchange at the
339 specified level of coverage.
340 (o) Perform duties related to determining eligibility for
341 premium tax credits, reduced cost sharing, and individual
342 responsibility requirement exemptions.
343 (p) Review the rate of premium growth within the
344 marketplace and outside the marketplace and consider the
345 information in developing recommendations on whether to continue
346 limiting qualified employer status to small employers.
347 (q) Credit the amount of any free choice voucher to the
348 monthly premium of the health benefit plan in which an employee
349 is enrolled, in accordance with s. 10108 of the Affordable Care
350 Act, and collect the amount credited from the offering qualified
351 employer.
352 (r) Report on the operation of the marketplace, beginning
353 January 1, 2018, and annually thereafter, to the Governor, the
354 Chief Financial Officer, the President of the Senate, the
355 Speaker of the House of Representatives, and the standing
356 committees of the Senate and the House of Representatives having
357 jurisdiction over appropriations and financial affairs,
358 insurance and financial services matters, and health and human
359 services matters. The report must include an accurate accounting
360 of all activities, receipts and expenditures of the marketplace.
361 (8) HEALTH BENEFIT PLAN CERTIFICATION.—
362 (a) The marketplace shall certify a health benefit plan as
363 a qualified health plan if:
364 1. The health benefit plan provides the essential health
365 benefits package described in s. 1302(a) of the Affordable Care
366 Act, except that the plan is not required to provide essential
367 benefits that duplicate the minimum benefits of qualified stand
368 alone dental benefit plans, as provided in paragraph (e), if:
369 a. The marketplace has determined that at least one
370 qualified stand-alone dental benefit plan is available to
371 supplement the plan’s coverage; and
372 b. The carrier makes prominent disclosure at the time it
373 offers the plan, in a form approved by the marketplace, that the
374 plan does not provide the full range of essential pediatric
375 dental benefits and that qualified stand-alone dental benefit
376 plans providing those benefits and other dental benefits not
377 covered by the plan are offered through the marketplace;
378 2. The premium rates and contract language have been
379 approved by the agency;
380 3. The health benefit plan provides at least a bronze level
381 of coverage, as determined pursuant to s. 1302(d)(1)(A) of the
382 Affordable Care Act for catastrophic plans, and will be offered
383 only to individuals eligible for catastrophic coverage;
384 4. The health benefit plan’s cost-sharing requirements do
385 not exceed the limits established under s. 1302(c)(1) of the
386 Affordable Care Act and, if the plan is offered through the SHOP
387 exchange, the plan’s deductible does not exceed the limits
388 established under s. 1302(c)(2) of the Affordable Care Act;
389 5. The health carrier offering the health benefit plan:
390 a. Is licensed and in good standing to offer health
391 insurance coverage in this state;
392 b. Offers at least one qualified health plan in the silver
393 level and at least one plan in the gold level as described in s.
394 1302(d)(1)(B) and (d)(1)(C) of the Affordable Care Act,
395 respectively, through each component of the marketplace in which
396 the carrier participates. As used in this sub-subparagraph,
397 “component” means the SHOP exchange and the marketplace;
398 c. Offers at least one qualified health plan that provides
399 the essential health benefits package described in s. 1302(a) of
400 the Affordable Care Act without benefits that duplicate the
401 minimum dental benefits of stand-alone dental benefit plans, if
402 the marketplace has determined that at least one qualified
403 stand-alone dental benefit plan is available through the
404 marketplace to supplement the qualified health plan’s coverage;
405 d. Charges the same premium rate for each qualified health
406 plan without regard to whether the plan is offered through the
407 marketplace and without regard to whether the plan is offered
408 directly from the carrier or through an insurance producer;
409 e. As required by subsection (6), does not charge any fees
410 or penalties for termination of coverage; and
411 f. Complies with the regulations developed under s. 1311(c)
412 of the Affordable Care Act and such other requirements as the
413 marketplace may establish;
414 6. The health benefit plan meets the requirements of
415 certification as adopted by agency rules and by regulations
416 adopted under s. 1311(c) of the Affordable Care Act, which
417 include, but are not limited to, minimum standards in the areas
418 of marketing practices, network adequacy, essential community
419 providers in underserved areas, accreditation, quality
420 improvement, uniform enrollment forms, and descriptions of
421 coverage and information on quality measures for health benefit
422 plan performance; and
423 7. The agency determines that making the health benefit
424 plan available through the marketplace is in the interest of
425 qualified individuals and qualified employers.
426 (b) The marketplace may not exclude a health benefit plan:
427 1. On the basis that the health benefit plan is a fee-for
428 service plan;
429 2. Through the imposition of premium price controls by the
430 marketplace; or
431 3. On the basis that the health benefit plan provides
432 treatments necessary to prevent patients’ deaths in
433 circumstances in which the marketplace determines the treatments
434 are inappropriate or too costly.
435 (c) The marketplace shall require each health carrier
436 seeking certification of a health benefit plan as a qualified
437 health plan to:
438 1. Submit a justification for any premium rate increase
439 before implementation of that increase. The carrier shall
440 prominently post the information concerning the justification on
441 its publicly accessible website. The marketplace shall take this
442 information, along with the information and the recommendations
443 provided to the marketplace under the Public Health Service Act,
444 42 U.S.C. s. 300gg-94 (2010), into consideration when
445 determining whether to allow the carrier to make health benefit
446 plans available through the marketplace.
447 2. Make available to the public and submit to the
448 marketplace accurate, transparent, and timely disclosure of the
449 following:
450 a. Claims payment policies and practices.
451 b. Periodic financial disclosures.
452 c. Data on enrollment.
453 d. Data on disenrollment.
454 e. Data on the number of claims that are denied.
455 f. Data on rating practices.
456 g. Information on cost sharing and payments with respect to
457 any out-of-network coverage.
458 h. Information on enrollee and participant rights under
459 Title I of the Affordable Care Act.
460
461 The information required in this subparagraph must be provided
462 in plain language, as that term is defined in s. 1311(e)(3)(B)
463 of the Affordable Care Act.
464 3. Make available to an individual, in a timely manner upon
465 the request of the individual, the amount of cost sharing,
466 including deductibles, copayments, and coinsurance, under the
467 individual’s plan or coverage that the individual would be
468 responsible for paying with respect to the furnishing of a
469 specific item or service by a participating provider. At a
470 minimum, this information must be made available to the
471 individual through a publicly accessible website and through
472 other means for an individual without access to the Internet.
473 4. Make a separate disclosure of the price of pediatric
474 dental benefits if the plan provides a comprehensive essential
475 health benefits package described in s. 1302(a) of the
476 Affordable Care Act, as long as the carrier is not required to
477 offer the pediatric dental benefit for sale on the marketplace
478 on a stand-alone basis.
479 (d) The marketplace may not exempt any health carrier
480 seeking certification of a qualified health plan, regardless of
481 the type or size of the carrier, from state licensure or
482 solvency requirements.
483 (e) The provisions of this section that are applicable to
484 qualified health plans also apply to the extent relevant to
485 qualified stand-alone dental benefit plans except as provided in
486 this paragraph or by rules adopted by the marketplace.
487 1. The marketplace may certify a stand-alone dental benefit
488 plan as a qualified stand-alone dental benefit plan if the
489 carrier offering the plan:
490 a. Is licensed and in good standing to offer dental
491 coverage in this state. The carrier need not be licensed to
492 offer other health benefits;
493 b. Offers at least one stand-alone dental benefit plan that
494 includes only the essential pediatric dental benefit requirement
495 of s. 1302(b)(1)(J) of the Affordable Care Act, as long as this
496 requirement does not limit a carrier from providing other stand
497 alone dental benefit plans that are certified by the
498 marketplace;
499 c. Charges the same premium rate for each stand-alone
500 dental benefit plan without regard to whether the plan is
501 offered through the marketplace and without regard to whether
502 the plan is offered directly from the carrier or through an
503 insurance producer;
504 d. Submits the premium rates and contract language to the
505 agency for approval;
506 e. As required by subsection (6), does not charge any fees
507 or penalties for termination of coverage; and
508 f. Complies with any requirements adopted under s. 1311(d)
509 of the Affordable Care Act and any rules adopted by the
510 marketplace pursuant to this section.
511 2. The qualified stand-alone dental benefit plan must be
512 limited to dental and oral health benefits, without
513 substantially duplicating the benefits typically offered by
514 health benefit plans without dental coverage, and must meet the
515 requirements for essential pediatric dental benefits prescribed
516 pursuant to s. 1302(b)(1)(J) of the Affordable Care Act and such
517 other dental benefits as may be specified by rule or regulation.
518 3. Carriers may jointly offer a comprehensive plan through
519 the marketplace in which the dental benefits are provided by a
520 carrier through a qualified stand-alone dental benefit plan and
521 the other benefits are provided by a carrier through a qualified
522 health plan, if the plans are priced separately and are also
523 made available for purchase separately at the same prices.
524 4. The marketplace may not exclude a stand-alone dental
525 benefit plan on the basis that the plan is a fee-for-service
526 plan or through the imposition of premium price controls by the
527 marketplace.
528 (f) In addition to the certification of a qualified stand
529 alone dental benefit plan pursuant to this subsection, the
530 marketplace may certify other stand-alone dental benefit plans,
531 either as part of a qualified health plan or separately, in
532 accordance with this subsection and any rules adopted by the
533 marketplace.
534
535 The marketplace shall apply the criteria of this subsection in a
536 manner that ensures fairness between or among health carriers
537 participating in the marketplace.
538 Section 3. This act shall take effect October 1, 2015, if,
539 before that date, the United States Supreme Court rules in King
540 v. Burwell, Docket Number 14-114, that it is impermissible under
541 the Patient Protection and Affordable Care Act, 42 U.S.C. s.
542 1321, for individuals who purchase coverage through exchanges
543 established by the Federal Government to obtain federal tax
544 credit subsidies or benefits or that individuals who purchase
545 coverage through exchanges established by state governments are
546 the only individuals eligible for federal tax credit subsidies
547 or benefits under the Patient Protection and Affordable Care
548 Act, 42 U.S.C. s. 1321. If the Supreme Court does not enter such
549 a ruling before that date, or rules in King v. Burwell that such
550 subsidies or benefits are available to individuals who purchase
551 coverage through exchanges established by the Federal
552 Government, this act shall not take effect.