Health Insurance Comparisons

A significant number of Americans are insured under group health insurance plans and the rules governing group plans in Florida are similar to those seen in most of the other states, although there are several differences that could apply in particular to public employees.

In order to join a group health insurance scheme you need to first be eligible for the scheme. For instance, despite the fact that an employer may operate a group health insurance scheme, it does not have to be open to everyone, possibly being aimed at only full-time workers. Also, the scheme may be run by an HMO and you could discover that you are living outside of the service area for the HMO.

Should you be eligible for membership of the scheme then you have to be allowed to join regardless of your state of health. In this case your state of health refers to your present health, taking into account any disability that you may be suffering from, as well as your previous medical history. It should also be noted that you cannot be excluded from the plan as a result of genetic information.

It must be understood here that, while your employer is allowed to exclude you from a scheme because you do not for instance work enough hours, he cannot exclude you based solely on your present or past medical history.

Nearly all plans has an enrollment period during which you need to elect to join the scheme which may typically be within 30 days or joining the company. However, if you decide not to join at this stage then an employer has to give you the opportunity to join during what is often called a special enrollment period when particular changes arise within your family. These changes may include such things as marriage, the birth of a child and the loss of alternative medical insurance coverage because of such things as the cessation of coverage provided through another family member because of death, reduction in working hours, legal separation, divorce, termination, retirement and similar things.

Vitually all plans will also generally have a waiting period for membership that will typically be anywhere from 30 days to 3 months. An employer has to apply this waiting period consistently for all employees and during this time an employee is not covered by the group scheme.

If the group scheme that you are joining is being run by an HMO then that HMO can also apply a waiting period (usually called an affiliation period) where once again you will not be covered. HMO affiliation periods cannot generally be greater than 2 months and when such a waiting period is required the HMO cannot then impose any pre-existing condition exclusion periods.

Under Florida law any group health plan that provides cover for dependents must also provide cover automatically for newborn babies, newly adopted children and children who are placed for adoption for a period of 31 days from birth, adoption or placement. There may also be a requirement for parents to register such children during this 31 day period if cover is to continue beyond this point.

In the case of parents taking care of disabled children who are covered under a group plan cover will normally continue beyond the age when a child would no longer be considered as a dependent, as long as the parents can show that the individual concerned is incapable of supporting himself because of mental or physical disability and that they are chiefly dependent upon the scheme member for support.

If you are employed by an employer with more than 50 employees then you will be allowed to take a leave of absence without loss of health insurance for a period of up to 12 weeks in certain circumstances. Such protection is guaranteed under the Family and Medical Leave Act (FMLA) which is designed to cover such things as the birth of a child, sickness or the need to care for a seriously ill member of your family.

Federal law allows states, county and local governments to exempt government employees from specific areas of coverage in self-insured group plans and many public employers in Florida make use of this to a degree. Because exemptions vary widely from one employer to the next it is prudent to ascertain the exact nature of yourcoverage provided if you have a public employer. These details may also be found by contacting The Center for Medicare and Medicaid Services (CMS) which keeps a list of exemptions for individual employers.

Though according to Florida law you cannot be excluded from membership of a group health insurance plan for reasons of health, there are various circumstances where exclusion periods are allowed to be imposed for pre-existing conditions. However, this is a complex area and one that is thus the subject of a further article.