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An Examination Of Group Health Insurance Plans In Florida

Many Americans are insured under group health insurance plans and the rules governing such plans in the state of Florida are similar to those in most other states, although there are various differences that can apply particularly to public employees.

In order to join a group health insurance plan you must first be eligible for memberships of the plan. For example, although an employer may have a group health insurance plan, it may not be open to everyone, possibly being meant for only full-time workers. In addition, the plan may be operated by a Health Management Organization (HMO) and you may find that you live outside of the service area for the HMO.

Assuming that you are eligible for the plan then you must be allowed to join regardless of your state of health. Here your state of health means your current health, including any disability that you may be suffering from, as well as your prior medical history. It is also interesting to note that you may not be excluded from the plan on the basis of genetic information.

It is also important to note here that, while an employer is permitted to refuse you membership because you do not for example work enough hours, he may not refuse you membership solely on your present or prior medical history.

Almost every plan will have an enrollment period during which you must join the scheme which could typically be within about 30 days or starting work. However, if you choose not to join at that stage then an employer has to give you the opportunity to join during what is frequently called a special enrollment period if particular changes arise within your family. These changes could include such things as marriage, the adoption of a child and the loss of alternative health insurance coverage because of such things as the cessation of coverage provided through another family member as a result of death, reduction in working hours, termination, divorce, legal separation, retirement and similar circumstances.

Almost all plans will also normally include a waiting period for membership that will typically be anything from 30 days to about 3 months. This waiting period must be applied consistently across all employees and during this period an employee is not covered by the group plan.

Where the group plan that you are joining is run by an HMO then the HMO may also require a waiting period (often referred to as an affiliation period) during which you will again not be covered. HMO affiliation periods may not normally be greater than 2 months and if such a waiting period is applied the HMO cannot then impose any pre-existing condition exclusion periods.

Under the provisions of Florida law any group plan that provides cover for dependents also has to provide cover automatically for newborns, newly adopted children and children placed for adoption for 31 days from birth, adoption or placement. There may also be a requirement for parents to register these children with the plan during this 31 day period for cover to continue beyond this point.

In the case of parents with disabled children who are covered under a group health plan cover will normally continue beyond the age at which a child would no longer be considered as a dependent, as long as the parents can demonstrate that the individual concerned cannot support himself because of physical or mental disability and that they are principally dependent upon the plan member for support.

If you work for an employer with more than 50 employees then you can take a leave of absence without loss of health insurance for up to 12 weeks in certain circumstances. This protection is guaranteed under the Family and Medical Leave Act (FMLA) which is intended to cover such things as childbirth, illness or the need to take care of a seriously ill family member.

Federal law allows states down to local government level to exempt government employees from certain coverage in self-insured group health plans and a lot of public employers in Florida make use of this to some extent. As exemptions vary widely between employers it is a good idea to establish the precise nature of yourcoverage provided if you have a public employer. These details may also be found by getting in touch with The Center for Medicare and Medicaid Services (CMS) which maintains a list of employer exemptions.

In spite of the fact that according to Florida law you may not be refused membership of a group health insurance plan on the basis of health, there are various circumstances where schemes are allowed to impose exclusion periods for pre-existing conditions. This is however a complicated topic and one that is therefore the subject of a further article.

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