Text of FL H 1233 (2024)

HB 1233 2024 CODING: Words stricken are deletions; words underlined are additions. hb1233-00 Page 1 of 30 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S A bill to be entitled 1 An act relating to biological sex; amending s. 1.01, 2 F.S.; defining terms relating to the sex of an 3 individual in the context of the construction of the 4 Florida Statutes; amending s. 103.091, F.S.; providing 5 that a certain birth certificate statement determines 6 whether a person is male or female and may serve as a 7 committeeman or committeewoman, respectively; amending 8 ss. 322.051, 322.08, and 322.14, F.S.; revising 9 provisions related to applications for disability 10 identification cards, application requirements for 11 driver licenses and identification cards, and 12 requirements for issued driver licenses, respectively, 13 to replace references to the term "gender" with the 14 term "sex"; creating s. 322.195, F.S.; prohibiting the 15 department from issuing original or replacement driver 16 licenses or identification cards that contain 17 specified information; requiring the department to 18 require applicants to sign an affidavit certifying 19 specified information submitted on the application for 20 a new or replacement driver license or identification 21 card; requiring the department to revoke a driver 22 license or identification card if it determines that 23 an applicant made a false attestation; creating s. 24 627.6411, F.S., and amending ss. 627.657, 627.6699, 25 HB 1233 2024 CODING: Words stricken are deletions; words underlined are additions. hb1233-00 Page 2 of 30 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S and 641.31, F.S.; requiring that individual health 26 insurance policies, group health insurance policies, 27 health benefit plans, and health maintenance 28 contracts, respectively, providing coverage for sex- 29 reassignment prescriptions or procedures must also 30 provide coverage for treatment to detransition from 31 such sex-reassignment prescriptions or procedures; 32 defining the term "detransition"; requiring health 33 insurers, insurance carriers, and health maintenance 34 organizations providing coverage of sex-reassignment 35 prescriptions or procedures to also offer policies, 36 plans, and contracts, as applicable, that do not 37 provide such coverage; providing that policies, plans, 38 and contracts may not prohibit coverage of certain 39 mental health and therapeutic services; amending s. 40 760.02, F.S.; defining the term "sex" for purposes of 41 the Florida Civil Rights Act of 1992; amending s. 42 760.07, F.S.; revising provisions related to remedies 43 for unlawful discrimination to include protection on 44 the basis of sex, rather than gender; creating s. 45 760.09, F.S.; defining terms and providing 46 construction for the application of specified 47 provisions; specifying the standard of scrutiny for 48 specified provisions; providing construction; 49 requiring certain governmental entities to identify 50 HB 1233 2024 CODING: Words stricken are deletions; words underlined are additions. hb1233-00 Page 3 of 30 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S specified information for data-gathering purposes; 51 amending ss. 760.60 and 760.80, F.S.; revising 52 provisions related to discriminatory practices of 53 certain clubs and minority representation on boards, 54 commissions, councils, and committees, respectively, 55 to replace references to the term "gender" with the 56 term "sex"; amending s. 627.6475, F.S.; conforming 57 cross-references; providing severability; providing an 58 effective date. 59 60 Be It Enacted by the Legislature of the State of Florida: 61 62 Section 1. Subsection (20) is added to section 1.01, 63 Florida Statutes, to read: 64 1.01 Definitions.—In construing these statutes and each 65 and every word, phrase, or part hereof, where the context will 66 permit: 67 (20) Notwithstanding any state law to the contrary, with 68 respect to the identification of a person's sex in the 69 application of any state law or rules or regulations, the 70 following terms have the following meanings: 71 (a) "Sex" means the classification of a human person as 72 either male or female based on the organization of the body of 73 such person for a specific reproductive role, as indicated by 74 the person's sex chromosomes, naturally occurring sex hormones, 75 HB 1233 2024 CODING: Words stricken are deletions; words underlined are additions. hb1233-00 Page 4 of 30 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S and internal and external genitalia present at birth. All 76 references to the term "gender" in these statutes must be deemed 77 to refer solely to sex as defined in this section, unless a 78 different meaning is plainly required by context to qualify, 79 limit, or define a specific word or phrase. 80 (b) "Female" means a person belonging, at birth, to the 81 biological sex that has the specific reproductive role of 82 producing ova. 83 (c) "Male" means a person belonging, at birth, to the 84 biological sex that has the specific reproductive role of 85 producing sperm. 86 (d) "Woman" and "girl" refer to human females, and the 87 terms "man" and "boy" refer to human males. 88 (e) "Mother" means a female parent, and the term "father" 89 means a male parent. 90 (f) "Equal," with respect to sex, does not mean "same" or 91 "identical." 92 Section 2. Subsection (9) is added to section 103.091, 93 Florida Statutes, to read: 94 103.091 Political parties.— 95 (9) For purposes of this section, the statement of 96 biological sex on a person's official birth certificate filed at 97 or near the time of the person's birth determines whether the 98 person is male or female and may serve as a committeeman or 99 committeewoman, respectively. 100 HB 1233 2024 CODING: Words stricken are deletions; words underlined are additions. hb1233-00 Page 5 of 30 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S Section 3. Paragraph (a) of subsection (1) of section 101 322.051, Florida Statutes, is amended to read: 102 322.051 Identification cards.— 103 (1) Any person who is 5 years of age or older, or any 104 person who has a disability, regardless of age, who applies for 105 a disabled parking permit under s. 320.0848, may be issued an 106 identification card by the department upon completion of an 107 application and payment of an application fee. 108 (a) The application must include the following information 109 regarding the applicant: 110 1. Full name (first, middle or maiden, and last), sex 111 gender, proof of social security card number satisfactory to the 112 department, which may include a military identification card, 113 county of residence, mailing address, proof of residential 114 address satisfactory to the department, country of birth, and a 115 brief description. 116 2. Proof of birth date satisfactory to the department. 117 3. Proof of identity satisfactory to the department. Such 118 proof must include one of the following documents issued to the 119 applicant: 120 a. A driver license record or identification card record 121 from another jurisdiction that required the applicant to submit 122 a document for identification which is substantially similar to 123 a document required under sub-subparagraph b., sub-subparagraph 124 c., sub-subparagraph d., sub-subparagraph e., sub-subparagraph 125 HB 1233 2024 CODING: Words stricken are deletions; words underlined are additions. hb1233-00 Page 6 of 30 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S f., sub-subparagraph g., or sub-subparagraph h.; 126 b. A certified copy of a United States birth certificate; 127 c. A valid, unexpired United States passport; 128 d. A naturalization certificate issued by the United 129 States Department of Homeland Security; 130 e. A valid, unexpired alien registration receipt card 131 (green card); 132 f. A Consular Report of Birth Abroad provided by the 133 United States Department of State; 134 g. An unexpired employment authorization card issued by 135 the United States Department of Homeland Security; or 136 h. Proof of nonimmigrant classification provided by the 137 United States Department of Homeland Security, for an original 138 identification card. In order to prove nonimmigrant 139 classification, an applicant must provide at least one of the 140 following documents. In addition, the department may require 141 applicants to produce United States Department of Homeland 142 Security documents for the sole purpose of establishing the 143 maintenance of, or efforts to maintain, continuous lawful 144 presence: 145 (I) A notice of hearing from an immigration court 146 scheduling a hearing on any proceeding. 147 (II) A notice from the Board of Immigration Appeals 148 acknowledging pendency of an appeal. 149 (III) A notice of the approval of an application for 150 HB 1233 2024 CODING: Words stricken are deletions; words underlined are additions. hb1233-00 Page 7 of 30 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S adjustment of status issued by the United States Citizenship and 151 Immigration Services. 152 (IV) An official documentation confirming the filing of a 153 petition for asylum or refugee status or any other relief issued 154 by the United States Citizenship and Immigration Services. 155 (V) A notice of action transferring any pending matter 156 from another jurisdiction to Florida, issued by the United 157 States Citizenship and Immigration Services. 158 (VI) An order of an immigration judge or immigration 159 officer granting relief that authorizes the alien to live and 160 work in the United States, including, but not limited to, 161 asylum. 162 (VII) Evidence that an application is pending for 163 adjustment of status to that of an alien lawfully admitted for 164 permanent residence in the United States or conditional 165 permanent resident status in the United States, if a visa number 166 is available having a current priority date for processing by 167 the United States Citizenship and Immigration Services. 168 (VIII) On or after January 1, 2010, an unexpired foreign 169 passport with an unexpired United States Visa affixed, 170 accompanied by an approved I-94, documenting the most recent 171 admittance into the United States. 172 173 An identification card issued based on documents required in 174 sub-subparagraph g. or sub-subparagraph h. is valid for a period 175 HB 1233 2024 CODING: Words stricken are deletions; words underlined are additions. hb1233-00 Page 8 of 30 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S not to exceed the expiration date of the document presented or 1 176 year, whichever occurs first. 177 Section 4. Paragraph (a) of subsection (2) of section 178 322.08, Florida Statutes, is amended to read: 179 322.08 Application for license; requirements for license 180 and identification card forms.— 181 (2) Each such application shall include the following 182 information regarding the applicant: 183 (a) Full name (first, middle or maiden, and last), sex 184 gender, proof of social security card number satisfactory to the 185 department, which may include a military identification card, 186 county of residence, mailing address, proof of residential 187 address satisfactory to the department, country of birth, and a 188 brief description. 189 Section 5. Paragraph (a) of subsection (1) of section 190 322.14, Florida Statutes, is amended to read: 191 322.14 Licenses issued to drivers.— 192 (1)(a) The department shall, upon successful completion of 193 all required examinations and payment of the required fee, issue 194 to every qualified applicant a printed driver license that must 195 bear a color photograph or digital image of the licensee; the 196 name of the state; a distinguishing number assigned to the 197 licensee, which, beginning November 1, 2023, must have a minimum 198 of four randomly generated digits on each original, renewal, or 199 replacement driver license; and the licensee's full name, date 200 HB 1233 2024 CODING: Words stricken are deletions; words underlined are additions. hb1233-00 Page 9 of 30 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S of birth, and residence address; a brief description of the 201 licensee, including, but not limited to, the licensee's sex 202 gender and height; and the dates of issuance and expiration of 203 the license. A space must shall be provided upon which the 204 licensee must shall affix his or her usual signature. A license 205 is invalid until it has been signed by the licensee except that 206 the signature of the licensee is not required if it appears 207 thereon in facsimile or if the licensee is not present within 208 this the state at the time of issuance. 209 Section 6. Section 322.195, Florida Statutes, is created 210 to read: 211 322.195 Specification of a person's sex on driver licenses 212 and identification cards.—The department may not issue an 213 original or replacement driver license or identification card 214 that specifies a person's sex as different from that specified 215 on the person's original certificate of live birth. The 216 department must require an applicant to sign an affidavit 217 certifying that the sex specified on the application submitted 218 for a new or replacement driver license or identification card 219 is identical to that specified on the applicant's original 220 certificate of live birth. If the department determines that the 221 applicant made a false attestation, the department must revoke 222 his or her driver license or identification card. 223 Section 7. Section 627.6411, Florida Statutes, is created 224 to read: 225 HB 1233 2024 CODING: Words stricken are deletions; words underlined are additions. hb1233-00 Page 10 of 30 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S 627.6411 Coverage of certain treatment.— 226 (1) Any health insurance policy delivered or issued in 227 this state on or after July 1, 2024, which provides, for an 228 appropriate additional premium, coverage for sex-reassignment 229 prescriptions or procedures as defined in s. 456.001 must also 230 provide coverage for treatment to detransition from such sex- 231 reassignment prescriptions or procedures. As used in this 232 subsection, the term "detransition" means to reverse or attempt 233 to reverse the effects of sex-reassignment prescriptions or 234 procedures as defined in s. 456.001. 235 (2) A health insurer that delivers or issues a health 236 insurance policy in this state providing coverage described 237 under subsection (1) must also offer a health insurance policy 238 that does not provide such coverage. 239 (3) Any health insurance policy delivered or issued in 240 this state on or after July 1, 2024, may not prohibit the 241 coverage of mental health or therapeutic services to treat a 242 person's perception that his or her sex is inconsistent with the 243 person's sex at birth by affirming the insured's sex as defined 244 in s. 456.001. 245 Section 8. Subsections (4), (5), and (6) are added to 246 section 627.657, Florida Statutes, to read: 247 627.657 Provisions of group health insurance policies.— 248 (4) Any group health insurance policy delivered or issued 249 in this state on or after July 1, 2024, which provides, for an 250 HB 1233 2024 CODING: Words stricken are deletions; words underlined are additions. hb1233-00 Page 11 of 30 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S appropriate additional premium, coverage for sex-reassignment 251 prescriptions or procedures as defined in s. 456.001 must also 252 provide coverage for treatment to detransition from such sex- 253 reassignment prescriptions or procedures. As used in this 254 subsection, the term "detransition" means to reverse or attempt 255 to reverse the effects of sex-reassignment prescriptions or 256 procedures as defined in s. 456.001. 257 (5) A group health insurer that delivers or issues a group 258 health insurance policy in this state providing coverage 259 described under subsection (4) must also offer a group health 260 insurance policy that does not provide such coverage. 261 (6) Any group health insurance policy delivered or issued 262 in this state on or after July 1, 2024, may not prohibit the 263 coverage of mental health or therapeutic services to treat a 264 person's perception that his or her sex is inconsistent with the 265 person's sex at birth by affirming the insured's sex as defined 266 in s. 456.001. 267 Section 9. Present subsections (5) through (17) of section 268 627.6699, Florida Statutes, are redesignated as subsections (6) 269 through (18), respectively, a new subsection (5) is added to 270 that section, and paragraphs (a), (n), (p), (q), (s), and (t) of 271 subsection (3), paragraph (b) of present subsection (6), 272 paragraphs (c) and (d) of present subsection (9), and paragraphs 273 (a) through (d) of present subsection (10) are amended, to read: 274 627.6699 Employee Health Care Access Act.— 275 HB 1233 2024 CODING: Words stricken are deletions; words underlined are additions. hb1233-00 Page 12 of 30 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S (3) DEFINITIONS.—As used in this section, the term: 276 (a) "Actuarial certification" means a written statement, 277 by a member of the American Academy of Actuaries or another 278 person acceptable to the office, that a small employer carrier 279 is in compliance with subsection (7) (6), based upon the 280 person's examination, including a review of the appropriate 281 records and of the actuarial assumptions and methods used by the 282 carrier in establishing premium rates for applicable health 283 benefit plans. 284 (n) "Modified community rating" means a method used to 285 develop carrier premiums which spreads financial risk across a 286 large population; allows the use of separate rating factors for 287 age, gender, family composition, tobacco usage, and geographic 288 area as determined under paragraph (6)(f) (5)(f); and allows 289 adjustments for: claims experience, health status, or duration 290 of coverage as permitted under subparagraph (7)(b)5. (6)(b)5.; 291 and administrative and acquisition expenses as permitted under 292 subparagraph (7)(b)5. (6)(b)5. 293 (p) "Plan of operation" means the plan of operation of the 294 program, including articles, bylaws, and operating rules, 295 adopted by the board under subsection (12) (11). 296 (q) "Program" means the Florida Small Employer Carrier 297 Reinsurance Program created under subsection (12) (11). 298 (s) "Reinsuring carrier" means a small employer carrier 299 that elects to comply with the requirements set forth in 300 HB 1233 2024 CODING: Words stricken are deletions; words underlined are additions. hb1233-00 Page 13 of 30 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S subsection (12) (11). 301 (t) "Risk-assuming carrier" means a small employer carrier 302 that elects to comply with the requirements set forth in 303 subsection (11) (10). 304 (5) REQUIREMENTS FOR CERTAIN COVERAGE.— 305 (a) Any health benefit plan delivered or issued in this 306 state on or after July 1, 2024, which provides, for an 307 appropriate additional premium, coverage for sex-reassignment 308 prescriptions or procedures as defined in s. 456.001 must also 309 provide coverage for treatment to detransition from such sex- 310 reassignment prescriptions or procedures. As used in this 311 subsection, the term "detransition" means to reverse or attempt 312 to reverse the effects of sex-reassignment prescriptions or 313 procedures as defined in s. 456.001. 314 (b) A carrier that delivers or issues a health benefit 315 plan in this state providing coverage described under paragraph 316 (a) must also offer a health benefit plan that does not provide 317 such coverage. 318 (c) Any health benefit plan delivered or issued in this 319 state on or after July 1, 2024, may not prohibit the coverage of 320 mental health or therapeutic services to treat a person's 321 perception that his or her sex is inconsistent with the person's 322 sex at birth by affirming the insured's sex as defined in s. 323 456.001. 324 (7)(6) RESTRICTIONS RELATING TO PREMIUM RATES.— 325 HB 1233 2024 CODING: Words stricken are deletions; words underlined are additions. hb1233-00 Page 14 of 30 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S (b) For all small employer health benefit plans that are 326 subject to this section and issued by small employer carriers on 327 or after January 1, 1994, premium rates for health benefit plans 328 are subject to the following: 329 1. Small employer carriers must use a modified community 330 rating methodology in which the premium for each small employer 331 is determined solely on the basis of the eligible employee's and 332 eligible dependent's gender, age, family composition, tobacco 333 use, or geographic area as determined under paragraph (6)(f) 334 (5)(f) and in which the premium may be adjusted as permitted by 335 this paragraph. A small employer carrier is not required to use 336 gender as a rating factor for a nongrandfathered health plan. 337 2. Rating factors related to age, gender, family 338 composition, tobacco use, or geographic location may be 339 developed by each carrier to reflect the carrier's experience. 340 The factors used by carriers are subject to office review and 341 approval. 342 3. Small employer carriers may not modify the rate for a 343 small employer for 12 months from the initial issue date or 344 renewal date, unless the composition of the group changes or 345 benefits are changed. However, a small employer carrier may 346 modify the rate one time within the 12 months after the initial 347 issue date for a small employer who enrolls under a previously 348 issued group policy that has a common anniversary date for all 349 employers covered under the policy if: 350 HB 1233 2024 CODING: Words stricken are deletions; words underlined are additions. hb1233-00 Page 15 of 30 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S a. The carrier discloses to the employer in a clear and 351 conspicuous manner the date of the first renewal and the fact 352 that the premium may increase on or after that date. 353 b. The insurer demonstrates to the office that 354 efficiencies in administration are achieved and reflected in the 355 rates charged to small employers covered under the policy. 356 4. A carrier may issue a group health insurance policy to 357 a small employer health alliance or other group association with 358 rates that reflect a premium credit for expense savings 359 attributable to administrative activities being performed by the 360 alliance or group association if such expense savings are 361 specifically documented in the insurer's rate filing and are 362 approved by the office. Any such credit may not be based on 363 different morbidity assumptions or on any other factor related 364 to the health status or claims experience of any person covered 365 under the policy. This subparagraph does not exempt an alliance 366 or group association from licensure for activities that require 367 licensure under the insurance code. A carrier issuing a group 368 health insurance policy to a small employer health alliance or 369 other group association shall allow any properly licensed and 370 appointed agent of that carrier to market and sell the small 371 employer health alliance or other group association policy. Such 372 agent shall be paid the usual and customary commission paid to 373 any agent selling the policy. 374 5. Any adjustments in rates for claims experience, health 375 HB 1233 2024 CODING: Words stricken are deletions; words underlined are additions. hb1233-00 Page 16 of 30 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S status, or duration of coverage may not be charged to individual 376 employees or dependents. For a small employer's policy, such 377 adjustments may not result in a rate for the small employer 378 which deviates more than 15 percent from the carrier's approved 379 rate. Any such adjustment must be applied uniformly to the rates 380 charged for all employees and dependents of the small employer. 381 A small employer carrier may make an adjustment to a small 382 employer's renewal premium, up to 10 percent annually, due to 383 the claims experience, health status, or duration of coverage of 384 the employees or dependents of the small employer. If the 385 aggregate resulting from the application of such adjustment 386 exceeds the premium that would have been charged by application 387 of the approved modified community rate by 4 percent for the 388 current policy term, the carrier shall limit the application of 389 such adjustments only to minus adjustments. For any subsequent 390 policy term, if the total aggregate adjusted premium actually 391 charged does not exceed the premium that would have been charged 392 by application of the approved modified community rate by 4 393 percent, the carrier may apply both plus and minus adjustments. 394 A small employer carrier may provide a credit to a small 395 employer's premium based on administrative and acquisition 396 expense differences resulting from the size of the group. Group 397 size administrative and acquisition expense factors may be 398 developed by each carrier to reflect the carrier's experience 399 and are subject to office review and approval. 400 HB 1233 2024 CODING: Words stricken are deletions; words underlined are additions. hb1233-00 Page 17 of 30 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S 6. A small employer carrier rating methodology may include 401 separate rating categories for one dependent child, for two 402 dependent children, and for three or more dependent children for 403 family coverage of employees having a spouse and dependent 404 children or employees having dependent children only. A small 405 employer carrier may have fewer, but not greater, numbers of 406 categories for dependent children than those specified in this 407 subparagraph. 408 7. Small employer carriers may not use a composite rating 409 methodology to rate a small employer with fewer than 10 410 employees. For the purposes of this subparagraph, the term 411 "composite rating methodology" means a rating methodology that 412 averages the impact of the rating factors for age and gender in 413 the premiums charged to all of the employees of a small 414 employer. 415 8. A carrier may separate the experience of small employer 416 groups with fewer than 2 eligible employees from the experience 417 of small employer groups with 2-50 eligible employees for 418 purposes of determining an alternative modified community 419 rating. 420 a. If a carrier separates the experience of small employer 421 groups, the rate to be charged to small employer groups of fewer 422 than 2 eligible employees may not exceed 150 percent of the rate 423 determined for small employer groups of 2-50 eligible employees. 424 However, the carrier may charge excess losses of the experience 425 HB 1233 2024 CODING: Words stricken are deletions; words underlined are additions. hb1233-00 Page 18 of 30 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S pool consisting of small employer groups with less than 2 426 eligible employees to the experience pool consisting of small 427 employer groups with 2-50 eligible employees so that all losses 428 are allocated and the 150-percent rate limit on the experience 429 pool consisting of small employer groups with less than 2 430 eligible employees is maintained. 431 b. Notwithstanding s. 627.411(1), the rate to be charged 432 to a small employer group of fewer than 2 eligible employees, 433 insured as of July 1, 2002, may be up to 125 percent of the rate 434 determined for small employer groups of 2-50 eligible employees 435 for the first annual renewal and 150 percent for subsequent 436 annual renewals. 437 9. A carrier shall separate the experience of 438 grandfathered health plans from nongrandfathered health plans 439 for determining rates. 440 (10)(9) SMALL EMPLOYER CARRIER'S ELECTION TO BECOME A 441 RISK-ASSUMING CARRIER OR A REINSURING CARRIER.— 442 (c) An election to become a risk-assuming carrier is 443 subject to approval under subsection (11) (10). 444 (d) A small employer carrier that elects to cease 445 participating as a reinsuring carrier and to become a risk- 446 assuming carrier is prohibited from reinsuring or continuing to 447 reinsure any small employer health benefits plan under 448 subsection (12) (11) as soon as the carrier becomes a risk- 449 assuming carrier and must pay a prorated assessment based upon 450 HB 1233 2024 CODING: Words stricken are deletions; words underlined are additions. hb1233-00 Page 19 of 30 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S business issued as a reinsuring carrier for any portion of the 451 year that the business was reinsured. A small employer carrier 452 that elects to cease participating as a risk-assuming carrier 453 and to become a reinsuring carrier is permitted to reinsure 454 small employer health benefit plans under the terms set forth in 455 subsection (12) (11) and must pay a prorated assessment based 456 upon business issued as a reinsuring carrier for any portion of 457 the year that the business was reinsured. 458 (11)(10) ELECTION PROCESS TO BECOME A RISK-ASSUMING 459 CARRIER.— 460 (a)1. A small employer carrier may become a risk-assuming 461 carrier by filing with the office a designation of election 462 under subsection (10) (9) in a format and manner prescribed by 463 the commission. The office shall approve the election of a small 464 employer carrier to become a risk-assuming carrier if the office 465 finds that the carrier is capable of assuming that status 466 pursuant to the criteria set forth in paragraph (b). 467 2. The office must approve or disapprove any designation 468 as a risk-assuming carrier within 60 days after filing. 469 (b) In determining whether to approve an application by a 470 small employer carrier to become a risk-assuming carrier, the 471 office shall consider: 472 1. The carrier's financial ability to support the 473 assumption of the risk of small employer groups. 474 2. The carrier's history of rating and underwriting small 475 HB 1233 2024 CODING: Words stricken are deletions; words underlined are additions. hb1233-00 Page 20 of 30 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S employer groups. 476 3. The carrier's commitment to market fairly to all small 477 employers in the state or its service area, as applicable. 478 4. The carrier's ability to assume and manage the risk of 479 enrolling small employer groups without the protection of the 480 reinsurance program provided in subsection (12) (11). 481 (c) A small employer carrier that becomes a risk-assuming 482 carrier pursuant to this subsection is not subject to the 483 assessment provisions of subsection (12) (11). 484 (d) The office shall provide public notice of a small 485 employer carrier's designation of election under subsection (10) 486 (9) to become a risk-assuming carrier and shall provide at least 487 a 21-day period for public comment prior to making a decision on 488 the election. The office shall hold a hearing on the election at 489 the request of the carrier. 490 Section 10. Subsections (48), (49), and (50) are added to 491 section 641.31, Florida Statutes, to read: 492 641.31 Health maintenance contracts.— 493 (48) Any health maintenance contract delivered or issued 494 in this state on or after July 1, 2024, which provides, for an 495 appropriate additional premium, coverage for sex-reassignment 496 prescriptions or procedures as defined in s. 456.001 must also 497 provide coverage for treatment to detransition from such sex- 498 reassignment prescriptions or procedures. As used in this 499 subsection, the term "detransition" means to reverse or attempt 500 HB 1233 2024 CODING: Words stricken are deletions; words underlined are additions. hb1233-00 Page 21 of 30 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S to reverse the effects of sex-reassignment prescriptions or 501 procedures as defined in s. 456.001. 502 (49) A health maintenance organization that delivers or 503 issues a health maintenance contract providing coverage 504 described under subsection (48) must also offer a health 505 maintenance contract that does not provide such coverage. 506 (50) Any health maintenance contract delivered or issued 507 in this state on or after July 1, 2024, may not prohibit the 508 coverage of mental health or therapeutic services to treat a 509 person's perception that his or her sex is inconsistent with the 510 person's sex at birth by affirming the subscriber's sex as 511 defined in s. 456.001. 512 Section 11. Subsection (12) is added to section 760.02, 513 Florida Statutes, to read: 514 760.02 Definitions.—For the purposes of ss. 760.01-760.11 515 and 509.092, the term: 516 (12) "Sex" means the classification of a human person as 517 either male or female based on the organization of the body of 518 such person for a specific reproductive role, as indicated by 519 the person's sex chromosomes, naturally occurring sex hormones, 520 and internal and external genitalia present at birth. 521 Section 12. Section 760.07, Florida Statutes, is amended 522 to read: 523 760.07 Remedies for unlawful discrimination.—Any violation 524 of any Florida statute that makes unlawful discrimination 525 HB 1233 2024 CODING: Words stricken are deletions; words underlined are additions. hb1233-00 Page 22 of 30 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S because of race, color, religion, sex gender, pregnancy, 526 national origin, age, handicap, or marital status in the areas 527 of education, employment, or public accommodations gives rise to 528 a cause of action for all relief and damages described in s. 529 760.11(5), unless greater damages are expressly provided for. If 530 the statute prohibiting unlawful discrimination provides an 531 administrative remedy, the action for equitable relief and 532 damages provided for in this section may be initiated only after 533 the plaintiff has exhausted his or her administrative remedy. 534 The term "public accommodations" does not include lodge halls or 535 other similar facilities of private organizations which are made 536 available for public use occasionally or periodically. The right 537 to trial by jury is preserved in any case in which the plaintiff 538 is seeking actual or punitive damages. 539 Section 13. Section 760.09, Florida Statutes, is created 540 to read: 541 760.09 Construction.— 542 (1) Notwithstanding any state law to the contrary, with 543 respect to the identification of an individual's sex in the 544 application of this chapter, the following construction applies 545 and the following terms have the following meanings: 546 (a) "Sex" means an individual's biological sex, either 547 male or female, at birth. 548 (b) "Female" means an individual whose biological 549 reproductive system is developed to produce ova, and the term 550 HB 1233 2024 CODING: Words stricken are deletions; words underlined are additions. hb1233-00 Page 23 of 30 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S "male" means an individual whose biological reproductive system 551 is developed to fertilize the ova of a female. 552 (c) "Woman" and "girl" refer to human females, and the 553 terms "man" and "boy" refer to human males. 554 (d) "Mother" means a female parent, and the term "father" 555 means a male parent. 556 (e) "Equal," with respect to biological sex, does not mean 557 "same" or "identical." 558 (f) With respect to biological sex, separate 559 accommodations are not inherently unequal. 560 (g) An individual born with a medically verifiable 561 diagnosis of a disorder in sex development must be provided 562 legal protections and accommodations afforded under the 563 Americans with Disabilities Act and applicable state law. 564 (2) Laws and rules that distinguish between the sexes are 565 subject to intermediate constitutional scrutiny. Intermediate 566 constitutional scrutiny forbids unfair discrimination against 567 similarly situated male and female individuals but allows the 568 law to distinguish between the sexes where such distinctions are 569 substantially related to important state interests. 570 Notwithstanding any state law to the contrary, distinctions 571 between the sexes with respect to athletics, prisons or other 572 detention facilities, domestic violence shelters, rape crisis 573 centers, locker rooms, restrooms, and other areas where biology, 574 safety, or privacy are implicated which result in separate 575 HB 1233 2024 CODING: Words stricken are deletions; words underlined are additions. hb1233-00 Page 24 of 30 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S accommodations are substantially related to the important state 576 interest of protecting the health, safety, and privacy of 577 individuals in such circumstances. 578 (3) Any school district, or public school therein, and any 579 state agency, department, or office or political subdivision 580 thereof that collects vital statistics for the purpose of 581 complying with antidiscrimination laws or for the purpose of 582 gathering accurate public health, crime, economic, or other data 583 must identify the sex, as defined in s. 1.01(20), of each 584 individual who is part of the collected data identify set. 585 Section 14. Subsection (1) of section 760.60, Florida 586 Statutes, is amended to read: 587 760.60 Discriminatory practices of certain clubs 588 prohibited; remedies.— 589 (1) It is unlawful for A person to discriminate against 590 any individual because of race, color, religion, sex gender, 591 national origin, handicap, age above the age of 21, or marital 592 status in evaluating an application for membership in a club 593 that has more than 400 members, that provides regular meal 594 service, and that regularly receives payment for dues, fees, use 595 of space, facilities, services, meals, or beverages directly or 596 indirectly from nonmembers for business purposes. It is unlawful 597 for A person, on behalf of such a club, to publish, circulate, 598 issue, display, post, or mail any advertisement, notice, or 599 solicitation that contains a statement to the effect that the 600 HB 1233 2024 CODING: Words stricken are deletions; words underlined are additions. hb1233-00 Page 25 of 30 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S accommodations, advantages, facilities, membership, or 601 privileges of the club are denied to any individual because of 602 race, color, religion, sex gender, national origin, handicap, 603 age above the age of 21, or marital status. This subsection does 604 not apply to fraternal or benevolent organizations, ethnic 605 clubs, or religious organizations where business activity is not 606 prevalent. 607 Section 15. Subsection (4) of section 760.80, Florida 608 Statutes, is amended to read: 609 760.80 Minority representation on boards, commissions, 610 councils, and committees.— 611 (4) Each appointing authority described in subsection (3) 612 shall submit a report to the Secretary of State annually by 613 December 1 which discloses the number of appointments made 614 during the preceding year from each minority group and the 615 number of nonminority appointments made, expressed both in 616 numerical terms and as a percentage of the total membership of 617 the board, commission, council, or committee. In addition, 618 information must shall be included in the report detailing the 619 number of physically disabled persons appointed to boards, 620 commissions, councils, and committees in the previous calendar 621 year. A copy of the report must shall be submitted to the 622 Governor, the Speaker of the House of Representatives, and the 623 President of the Senate. In addition, each appointing authority 624 shall designate a person responsible for retaining all 625 HB 1233 2024 CODING: Words stricken are deletions; words underlined are additions. hb1233-00 Page 26 of 30 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S applications for appointment, who shall ensure that information 626 describing each applicant's race, ethnicity, sex gender, 627 physical disability, if applicable, and qualifications is 628 available for public inspection during reasonable hours. Nothing 629 in this section requires disclosure of an applicant's identity 630 or of any other information made confidential by law. 631 Section 16. Subsection (4), paragraphs (a), (e), and (g) 632 of subsection (7), and paragraph (a) of subsection (8) of 633 section 627.6475, Florida Statutes, are amended to read: 634 627.6475 Individual reinsurance pool.— 635 (4) MAINTENANCE OF RECORDS.—Each health insurance issuer 636 that offers individual health insurance must maintain at its 637 principal place of business a complete and detailed description 638 of its rating practices and renewal practices, as required for 639 small employer carriers pursuant to s. 627.6699(9) s. 640 627.6699(8). 641 (7) INDIVIDUAL HEALTH REINSURANCE PROGRAM.— 642 (a) The individual health reinsurance program shall 643 operate subject to the supervision and control of the board of 644 the small employer health reinsurance program established 645 pursuant to s. 627.6699(12) s. 627.6699(11). The board shall 646 establish a separate, segregated account for eligible 647 individuals reinsured pursuant to this section, which account 648 may not be commingled with the small employer health reinsurance 649 account. 650 HB 1233 2024 CODING: Words stricken are deletions; words underlined are additions. hb1233-00 Page 27 of 30 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S (e)1. Before March 1 of each calendar year, the board 651 shall determine and report to the office the program net loss in 652 the individual account for the previous year, including 653 administrative expenses for that year and the incurred losses 654 for that year, taking into account investment income and other 655 appropriate gains and losses. 656 2. Any net loss in the individual account for the year 657 shall be recouped by assessing the carriers as follows: 658 a. The operating losses of the program shall be assessed 659 in the following order subject to the specified limitations. The 660 first tier of assessments shall be made against reinsuring 661 carriers in an amount that may not exceed 5 percent of each 662 reinsuring carrier's premiums for individual health insurance. 663 If such assessments have been collected and additional moneys 664 are needed, the board shall make a second tier of assessments in 665 an amount that may not exceed 0.5 percent of each carrier's 666 health benefit plan premiums. 667 b. Except as provided in paragraph (f), risk-assuming 668 carriers are exempt from all assessments authorized pursuant to 669 this section. The amount paid by a reinsuring carrier for the 670 first tier of assessments shall be credited against any 671 additional assessments made. 672 c. The board shall equitably assess reinsuring carriers 673 for operating losses of the individual account based on market 674 share. The board shall annually assess each carrier a portion of 675 HB 1233 2024 CODING: Words stricken are deletions; words underlined are additions. hb1233-00 Page 28 of 30 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S the operating losses of the individual account. The first tier 676 of assessments shall be determined by multiplying the operating 677 losses by a fraction, the numerator of which equals the 678 reinsuring carrier's earned premium pertaining to direct 679 writings of individual health insurance in the state during the 680 calendar year for which the assessment is levied, and the 681 denominator of which equals the total of all such premiums 682 earned by reinsuring carriers in the state during that calendar 683 year. The second tier of assessments shall be based on the 684 premiums that all carriers, except risk-assuming carriers, 685 earned on all health benefit plans written in this state. The 686 board may levy interim assessments against reinsuring carriers 687 to ensure the financial ability of the plan to cover claims 688 expenses and administrative expenses paid or estimated to be 689 paid in the operation of the plan for the calendar year prior to 690 the association's anticipated receipt of annual assessments for 691 that calendar year. Any interim assessment is due and payable 692 within 30 days after receipt by a carrier of the interim 693 assessment notice. Interim assessment payments shall be credited 694 against the carrier's annual assessment. Health benefit plan 695 premiums and benefits paid by a carrier that are less than an 696 amount determined by the board to justify the cost of collection 697 may not be considered for purposes of determining assessments. 698 d. Subject to the approval of the office, the board shall 699 adjust the assessment formula for reinsuring carriers that are 700 HB 1233 2024 CODING: Words stricken are deletions; words underlined are additions. hb1233-00 Page 29 of 30 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S approved as federally qualified health maintenance organizations 701 by the Secretary of Health and Human Services pursuant to 42 702 U.S.C. s. 300e(c)(2)(A) to the extent, if any, that restrictions 703 are placed on them which are not imposed on other carriers. 704 3. Before March 1 of each year, the board shall determine 705 and file with the office an estimate of the assessments needed 706 to fund the losses incurred by the program in the individual 707 account for the previous calendar year. 708 4. If the board determines that the assessments needed to 709 fund the losses incurred by the program in the individual 710 account for the previous calendar year will exceed the amount 711 specified in subparagraph 2., the board shall evaluate the 712 operation of the program and report its findings and 713 recommendations to the office in the format established in s. 714 627.6699(12) s. 627.6699(11) for the comparable report for the 715 small employer reinsurance program. 716 (g) Except as otherwise provided in this section, the 717 board and the office shall have all powers, duties, and 718 responsibilities with respect to carriers that issue and 719 reinsure individual health insurance, as specified for the board 720 and the office in s. 627.6699(12) s. 627.6699(11) with respect 721 to small employer carriers, including, but not limited to, the 722 provisions of s. 627.6699(12) s. 627.6699(11) relating to: 723 1. Use of assessments that exceed the amount of actual 724 losses and expenses. 725 HB 1233 2024 CODING: Words stricken are deletions; words underlined are additions. hb1233-00 Page 30 of 30 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S 2. The annual determination of each carrier's proportion 726 of the assessment. 727 3. Interest for late payment of assessments. 728 4. Authority for the office to approve deferment of an 729 assessment against a carrier. 730 5. Limited immunity from legal actions or carriers. 731 6. Development of standards for compensation to be paid to 732 agents. Such standards shall be limited to those specifically 733 enumerated in s. 627.6699(13)(d) s. 627.6699(12)(d). 734 7. Monitoring compliance by carriers with this section. 735 (8) STANDARDS TO ASSURE FAIR MARKETING.— 736 (a) Each health insurance issuer that offers individual 737 health insurance shall actively market coverage to eligible 738 individuals in the state. The provisions of s. 627.6699(13) s. 739 627.6699(12) that apply to small employer carriers that market 740 policies to small employers shall also apply to health insurance 741 issuers that offer individual health insurance with respect to 742 marketing policies to individuals. 743 Section 17. If any provision of this act or the 744 application thereof to any person or circumstance is held 745 invalid, the invalidity does not affect other provisions or 746 applications of the act which can be given effect without the 747 invalid provision or application, and to this end the provisions 748 of this act are declared severable. 749 Section 18. This act shall take effect July 1, 2024. 750