ii. Members 18 years of age or older;
iii. Consent to provide personal and medical information to the
department; and
iv. Referral and supervision of a physician participating in the PPO and
HMO networks during the 2025 and 2026 plan year.
By January 15, 2026, the Department of Management Services shall report
to the Legislature the number of individuals who applied to participate
in the pilot program and the number of participants who enrolled in the
pilot program.
d. All participants must enroll in one of the third-party provider
wellness programs offered through the pilot program. By April 15, 2026,
for the quarter ending March 31, 2026, and quarterly thereafter, each
participant's active engagement with the wellness program provider must
be certified by the department. Any participant whose active engagement
cannot be certified in any quarter will be immediately disenrolled from
the pilot program.
e. Participants of the 2025 plan year pilot program whose BMI falls
below the established criteria and would be otherwise ineligible to
participate in the 2026 plan year pilot program may still access the
wellness program component of the pilot program. For these participants,
the department may also allow the use of generic versions of Federal
Drug Administration approved medications for chronic weight management
for participants as a way to transition off of glucagon-like peptide 1
agonists. These participants shall not count towards the 2,800 member
limit.
f. Compensation under the contract shall be paid from the State
Employees Health Insurance Trust Fund. The third-party provider shall be
compensated based solely on a per-enrollee fee which in the aggregate
may not exceed $6.0 million for the 2026 plan year.
g. In the event the Department of Management Services does not execute a
contract with a third-party provider by September 30, 2025, the
department shall continue the pilot program within the PPO and the HMO
plans to provide coverage for the treatment and management of obesity
and related conditions during the 2026 plan year.
9.a. Effective with the 2026 plan year, the Department of Management
Services shall continue the Diabetes Pilot Program within the PPO and
the self-insured HMO plans.
b. The pilot program will be limited to 2,000 participants. Participants
must be members of the PPO plan or a self-insured HMO plan during the
2026 plan year.
c. The department shall establish criteria for the diabetes pilot
program that includes offering participants:
i. A cellular meter that provides real time feedback for glucose
readings;
ii. Testing strips and related supplies for enrolled members;
iii. Continuous remote monitoring with emergency outreach; and
iv. Live coaching from certified diabetes educators. The pilot program
shall measure meaningful clinical outcomes for the enrollees including a
reduction in HbA1c and hypoglycemia levels.
By January 15, 2026, the department shall report to the Legislature the
number of individuals who applied to participate in the diabetes pilot
program and the number of participants who enrolled in the pilot
program.
10. Effective January 1, 2026, a participant has the option to receive
coordination of cancer care support from the entity the Department of
Management Services contracts pursuant to section 110.12303(2)(a),
Florida Statutes.
(d) State Group Health Insurance Premiums for the Period July 1, 2025,
through June 30, 2026.
Funds are provided in each state agency, state university's, and state