Your Rights under Florida Health Insurance Law
(Copyright 2005 All Rights Reserved)
Individual Health Insurance:
Individuals, families, self employed and small business owners are having an increasingly difficult time finding health insurance.
Those with pre-existing medical conditions have even more difficulty. There are a multitude of companies offering health insurance in most states and people without serious pre-existing health conditions should be able to find a health insurance plan to suit their needs and budget.
In Florida, as in many other states, your health insurance options are somewhat dependent on your health status. In general, insurers that sell individual health insurance in Florida are free to turn you down because of your health status and other factors. However, once you have health insurance, your coverage cannot be canceled because you get sick.
If you have low or moderate household income, you may be eligible for free or subsidized health coverage for yourself or members of your family.
If your children are 18 years or younger, do not have health insurance and meet other qualifications, they may be eligible to buy health insurance through the Florida KidCare Program.
If you have lost your health insurance and are receiving benefits from the Trade Adjustment Assistance (TAA) Program then you may be eligible for a federal income tax credit to help pay for new health coverage.
If you are a retiree aged 55-65 and receiving pension benefits from Pension Benefits Guarantee Corporation (PBGC), then you may also be eligible for the HCTC.
Under Florida law, newborns, newly adopted children and children placed for adoption are automatically covered under the parents’ fully insured health plan for the first 31 days if the plan covers dependents.
Medicaid is a program that provides low-income Florida residents with health coverage. Medicaid covers families with children, pregnant women, the elderly, and people with disabilities. Legal residents, who are not U.S. citizens, may be eligible for Medicaid, with proper immigration documents.
The Mary Brogan Breast and Cervical Cancer Program provides full healthcare benefits through Medicaid to qualified women who are screened through the Florida Breast and Cervical Cancer Early Detection Program and diagnosed with breast or cervical cancer. You must be between the ages of 50 and 64 in order to be eligible.
For more information on health insurance in Florida visit the Florida Department of Financial Services website at http://www.doi.state.fl.us or call toll-free at (800) 342-2762.
Florida offers a high-risk pool to provide insurance for residents of Florida with health conditions, who are unable to buy private health insurance and for people who are federally eligible. For more information on the Florida Comprehensive Health Association. The phone number is (850) 309-1200. However, it is closed to new enrollees effective 6/30/91.
Group Health Insurance:
Florida Group Health Insurance is for businesses with 2 or more employees, which can include the owner of the business.
Group health insurance is regulated by both the state and federal government. The HIPAA act of 1997 determines eligibility in some cases and provides rules for individuals leaving a group plan. The group plans usually have more benefits than an individual plan because of federal requirements established by ERISA and HIPAA laws.
As long as an employer meets the criteria required by the
Florida Health Insurance Company, they cannot be turned down for insurance nor can any of the employees be turned down.
Insurance companies can impose a pre-existing medical condition waiting period if the employee was without insurance for more than 63 days prior to enrolling or if the employee did not have insurance for an 18 month period prior to enrolling.
Under Florida law, your disabled child can remain covered as a dependent under your group health plan into adulthood.
If you have to take leave from your job due to illness, the birth or adoption of a child, or to care for a seriously ill family member, you may be able to keep your group health coverage for a limited time.
If you have had at least 3 months of coverage under a fully insured group health plan and then lose it, you are guaranteed the right to buy a conversion policy.
Coverage under your group health plan (if your employer offers one) cannot be denied or limited, nor can you be required to pay more, because of your health status.
Your insurance can not be canceled because someone in your group becomes sick.
All group health plans in Florida must limit exclusion of pre-existing conditions.
If you leave your job, you may be able to remain in your old group health plan for a certain length of time.
If you have had at least 3 months of coverage under a fully insured group health plan and then lose it, you are guaranteed the right to buy an individual health policy from the company that provided your group coverage. This is called a conversion policy.
If you are a small employer buying a group health plan, you cannot be turned down because of the health status, age, or any factor that might predict the use of health services of those in the group.
Group health plans can count as pre-existing conditions only those for which you actually received (or were recommended to receive) a diagnosis, treatment or medical advice within the 6 months immediately before you joined that plan.
Group health plans cannot apply a pre-existing condition exclusion period for pregnancy, newborns or newly adopted children, children placed for adoption, or genetic information.
In Florida, five public employers have decided that certain health insurance protections will not apply to their employees. If you have group health coverage through these employers, you should contact them for more information. These five public employers are the City of Clermont, the City of Lakeland, the County of Lee, the Florida League of Cities and the Orlando Utilities Commission.
If you are self-employed with no other workers, you are considered a group of one. In order to show that you qualify as a self-employed person or a business group of one, insurance companies are allowed to require that you provide them with your tax forms.
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