Under Florida law, you are entitled to a “free look” period of 10 days when you purchase an individual health insurance policy. Medical underwriting is allowed without restriction in Florida. Medical underwriting is the process that an insurance company uses to decide, based on your medical history, whether or not to take your application for insurance, whether or not to add a waiting period for pre-existing conditions (if your state allows it), and how much to charge you for that insurance. There is a 24 month exclusionary period for preexisting conditions for those without prior credible coverage under HIPAA.
High Risk Pool
For medically uninsurable individuals, those utilizing their HIPAA rights are guaranteed health insurance coverage through a Florida insurance carrier. The high risk pool is currently closed to new enrollees. Florida is working on starting a new high risk pool entitled the Florida Health Insurance Plan. |
With the rising cost in health insurance, the percentage of employers offering health insurance has decreased in the small business sector. In 2006, 37 percent of small business employers offered health insurance to their employees (a five percent decrease from 2005, according to AHIP). Florida’s state ranking was 28th in 2006 for percent of employers offering health insurance.
- All small groups in Florida:
- Average Monthly Premium Single $345, Average Monthly Premium Family $904
- Groups with 26 to 50 employees:
- Average Monthly Premium Single $310, Average Monthly Premium Family $813
- Groups with 11 to 25 employees:
- Average Monthly Premium Single $309, Average Monthly Premium Family $811
- Groups with 10 or fewer employees:
- Average Monthly Premium Single $381, Average Monthly Premium Family $999
(Family premiums estimated for a family of four)
In Florida, medical underwriting is allowed with rate restrictions at plus or minus 15% of the indexed rate depending on the health of the group. For preexisting condition requirements the company may look back in a consumer’s medical history 6 months and impose a 12 month exclusionary period for those that did not have prior medical coverage. |
Florida offers COBRA, the Consolidate Omnibus Budget Reconciliation Act of 1985. Many companies with 20 or more employees that offer health insurance are required to offer employees and their dependents continuation coverage for benefits that were lost due, for example, to job loss, reduction in hours worked, death, or divorce. If you qualify for COBRA benefits, your health plan administrator must give you a notice stating your right to choose to continue benefits provided by the plan. You then have 60 days to accept coverage or lose the rights to the benefit.
Florida Mini-COBRA law provides similar continuation of coverage protection for employees who will work for employers with fewer than 20 employees. Note: Under Florida’s Mini-COBRA law, the employee must notify the insurer within 63 days of losing group eligibility that he or she is eligible to continue coverage.
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Medicaid is a state/federal program that pays for medical and long-term care services for low-income pregnant women, children, certain people on Medicare, disabled individuals and nursing home residents. These individuals must meet certain income and other requirements determined by either the Department of Children and Families or the Social Security Administration.
Income requirements:
Covered Services
Advanced Registered Nurse Practitioners, Ambulatory Surgical Center, birth center services, child health check up, chiropractic care, dental, durable medical equipment and supplies, Federally Qualified Health Centers, home health, hospice, hospital, inpatient/outpatient care, laboratory, licensed midwifes, mental health, optometry, physician, physician assistant, podiatry, prescriptions, Rural Health Clinics, therapy, transportation, and X-rays, and other health care services.
Co-Payments
Co-pays range between $1-3 dollars and up to $300 for emergency room services. There are no co-payments if you are under 18, pregnant, living in a nursing home, or receiving family planning services.
Medicaid Cards
Medicaid cards are issued for each individual who is eligible for Medicaid and should be presented to medical providers when medical care is being requested. The providers verify current eligibility and bill Medicaid directly for the cost of the care.
You may learn more about Florida Medicaid at http://www.fdhc.state.fl.us/Medicaid/index.shtml |
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