Florida Individual Health Insurance
Health insurance has become a bare necessity of life when it comes to guarding your family against health hazards and the medical expenses associated with them. Although health insurance is little more costly than group coverage, Florida individual health insurance is a perfect solution for those who lack any other coverage. There are laws and regulations in Florida surrounding these individual health insurance policies that you should be aware of, in order to make a more informed decision.
Eligibility: How Am I Evaluated?
Generally, a health insurer has the flexibility to decide how applications are handled and who gets accepted for a policy. Many insurers use factors such as health status, age, gender, and lifestyle habits to decide who they will cover. There are no real regulations on why an applicant can be turned down and an insurer can deny you for almost any reason. However, you cannot be denied coverage if:
- You were diagnosed with breast cancer and completed treatment more than two years prior
- You were fully covered by a group health plan for at least 3 months
- You are HIPAA-eligible
- You move out of an insurance company s service area and are looking for a new plan
Florida does not have a high risk pool for the medically-uninsurable individuals. In response to HIPPA Group-to-Individual Portability Coverage regulations, Florida does require private insurers to guarantee issue of health insurance to HIPPA eligible customers through a conversion policy.
Florida Guaranteed Benefits & Pre-Existing Conditions
For the most part, insurers are not required to include specific policies in their selection of plans. There are no laws in Florida that mandate standardized policies for individual health insurance. That being said, there are a few benefits that all insurers are required to cover under all plans, such as childhood immunizations, mammograms, post delivery hospital care for mothers and diabetes treatment. Florida health insurance plans must also set the same coverage limits and maximums for mental health conditions as they do for physical health conditions; which is known as mental health parity.
When it comes to pre-existing conditions, HIPPA eligible consumers cannot have exclusion periods and elimination riders imposed on their policy. Pre-existing conditions can be included in an elimination rider attached to your policy, which will exclude them from coverage under the policy forever. The only exception is breast cancer, which cannot be included on an elimination rider if you completed treatment at least 2 years prior. Pre-existing conditions can also be included in an exclusionary period of up to 2 years. To determine what is a pre-existing condition, insurers can look back in your medical files up to 2 years prior to your application. Any condition that you did or should have sought medical advice or treatment for can be considered a pre-existing condition. If, within the first 2 years of your policy, you make a claim regarding a condition that was not listed as pre-existing, your insurer can check back 2 years prior to your application to see if it is something that should have been listed as pre-existing. If so, then your claim can be denied.
Florida Individual Health Insurance Premiums
Premiums are determined at the discretion of the insurer and are usually based on individual factors, such as age, gender, health coverage plan, health status, and family size. There are no regulations that state what you can or cannot be charged for a policy. Essentially, an insurer can charge you what they want to and if you are older or have a medical condition, you will likely pay more for your insurance coverage. Your insurer is also allowed to raise your insurance premiums anytime. However, your insurer cannot cancel your policy because of an illness and they can t deny you the chance to renew your policy, unless they have discontinued the policy type for all customers or have withdrawn from the individual market altogether.
It is true that insurance protection can save you from huge medical bills, so it is advisable to consult with a Floridian qualified broker or agent to help you choose from the variety of health plans.
* Please refer to our legal terms and conditions for disclaimers pertaining to the content on this page.