Florida group health insurance is sold to companies who in turn provide coverage for their employees.
Florida group health insurance is sold to businesses and organizations in Florida who then offer coverage to their employees and members. These groups and business health insurance plans are cheap compared to individual or family coverage because the cost of medical services can be spread among many people. Because the risk associated with small group health insurance is lower for the insurance carrier, they are also more willing to underwrite policies for those with pre-existing conditions. Actually, all small group health insurance plans are required to have guaranteed compensation according to federal law.
Your protections will differ somewhat, based on whether your plan is a fully insured group health insurance plan or a self-insured group health plan. The plan’s benefits information must specify whether the plan is self-insured. You have to be qualified for the group health plan. For instance, your employer may not give health benefits to all employees. Your employer may provide an HMO plan that you cannot join because you live outside of the plan’s service area.
You can’t be turned away or charged more due to your health status. This protection is known as nondiscrimination. Employers may refuse or restrict coverage for other reasons (like part-time employment), as long as these are unrelated to health status and applied steadily. Nevertheless, if you work for a small employer in Florida, health insurance companies must offer all eligible employees’ coverage.
When you start a new job with health insurance through an HMO, the HMO may need an affiliation period before coverage begins. During this affiliation period, you will not have a health insurance plan. An HMO affiliation period can’t exceed 2 months (3 months for late enrollees), and you cannot be charged a premium during it.
If you have to take leave from your job because of illness, the birth or adoption of a child, or care for a seriously ill family member, you can keep your group health coverage for a limited time. A federal law called a Family, and Medical Leave Act (FMLA) guarantees you up to 12 weeks of job-protected leave in these situations. The FMLA applies to you if you work at a company with 50 or more employees.
When you first enroll in a group health plan, the employer or insurance carrier may ask if you have any pre-existing conditions. If you claim during the first year of coverage, the health insurance may look back to see whether it was for such a situation. If so, it may attempt to exclude coverage for services related to that condition for a certain length of time. Nevertheless, federal and state laws protect you by limiting these pre-existing condition exclusion periods under group health plans.
A group health plan can count as pre-existing conditions only for those you received a diagnosis, treatment, or medical advice within the 6 months immediately before you joined that plan. This period is also known as the lookback period.
Florida Small Employer or Self-Employed Health Insurance
Self-employed individuals count as small scale employers in Florida but have different insurance policies.
Florida has passed reforms to expand some health insurance protections. Some of these reforms apply to groups of various sizes. Normally, small employers are those that employ 1-50 employees. Self-employed individuals count as small employers in Florida but have somewhat different protections.
With a few exceptions, small employers can’t be turned down. This is known as a guaranteed issue. If you employ no more than 50 persons, health insurance companies in Florida must sell you any small group health plan they sell to other small employers. Nevertheless, they can require that a minimum percentage of your workers participate in your group health plan. They can also necessitate you to contribute a minimum rate of your workers’ premiums.
If you are purchasing a large group health plan for 51 or more employees, your group can be turned down. Your insurance can’t be canceled because someone in your group becomes sick. This is known as guaranteed renewability, and it applies to group plans of all sizes. Insurers can impose other conditions, nevertheless. They can necessitate you to meet minimum participation and contribution rates in order to renew your coverage. Also, they can refuse to renew your coverage for nonpayment of premiums or if you commit fraud.
If you are self-employed with no other employees, you are considered to be a group of one. Insurers are required to accept your application for the standard plan or basic plan in August of every year to make coverage effective on October 1, of that year. They can refuse to sell you other plans, though. Additionally, the rules for pre-existing condition exclusion periods are somewhat different.
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