Florida Health Insurance
FL State Resident's Guide to Healthcare Coverage
If you live in Florida, you have access to a variety of types of health insurance. You may receive
Florida
health insurance through your employer, through your spouse or partner’s employer plan, via coverage provided to members of associations such as trade unions or you may purchase health insurance in Florida as an individual.
Under Florida law you have a 10-day free-look provision on individual plans purchased that allows you to return any policy and receive a full refund. Individual policies must include a grace period provision of from 7 to 31 days, depending on how you pay the premium. Individual HMOs must offer a 10-day grace period.
Individual health insurance policies are not guaranteed issue under Florida state health insurance laws. This allows companies to decline your application for an individual health insurance policy based on your medical history or pre-existing conditions for up to 24 months. Pre-existing conditions, however, can’t be considered when you apply for health insurance under HIPPA.
There are many types of health insurance
coverage plans that are sold in Florida. Many plans provide coverage benefits for routine visits to
health care providers, prescription drugs and hospitalization.
Major Medical or Comprehensive Care Coverage
This category includes most group health insurance plans. They are typically the most policies because they provide a comprehensive range of benefits and services. They typically pay 80% of expenses covers under the plan after you meet your deductible. Fees paid under Florida major medical insurance plan use a schedule based on the average cost of a procedure. Because individual situations vary, what you actually are charged may be more or less than the average.
The State of Florida limits your maximum out-of-pocket co-insurance payments. You may have a policy that doesn’t have limits, however, if your policy does, it must pay 100% of all remaining covered expenses after you have met the stated amount of coinsurance.
Managed Care Coverage
This category of policies limits your choice of doctors and hospitals in an effort to control costs. Premiums can be significantly lower than major medical policies. Your co-pay for office visits, hospitalization, prescription drugs and other covered services will be less, as well, as long as you stay within your plan’s network. Managed care services in Florida include:
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PPO's (also called Preferred Provider Organizations)
You choose from a
network of health care professionals and hospitals, who in turn charge the
plan’s carrier less for services (in exchange for prompt payment and volume of
patients). Your plan may allow you to go outside the network, but your co-pay
will be more.- POS's plans (also called Point of Service)
Similar to a PPO, in that you have a network of preferred providers and will pay more if you go outside the network. You will also be expected to pay deductibles and co-pays on services received outside the network.-
HMO's (also called Health Maintenance Organizations)
You must use the plan’s provider network, except in certain emergency situations (these will vary depending on plan). Co-pays are predetermined and paid at the time services are rendered.-
EPO's (also called Exclusive Provider Organizations)
Your insurance provider contracts with specific hospitals and health care professionals and you must use their services to receive coverage under the plan.
Limited Benefit Coverage
This category of health insurance coverage typically includes:
- Plans that cover basic hospitalization expenses
- Plans that cover basic surgical expenses
- Plans that cover specific diseases
- Hospital indemnity plans
The State of Florida also has plans that provide affordable coverage to residents ages 19 to 64 who haven’t had health insurance coverage for at least six months and are not eligible to public health insurance programs.
The Florida Office of Insurance Regulation is the regulatory body that supervises legislation regarding the sales of private health insurance to families and individuals.
The Florida Agency of Health Care Administration licenses and regulates health care facilities and HMOs in Florida. It also administers Florida’s Medicaid program.
Request a free Florida health insurance quote
Florida Medicaid
The Florida Medicaid program offers some low-income adults and children with health insurance coverage. Families who have high medical bills may also qualify for Medicaid in Florida. Visit http://www.fdhc.state.fl.us/Medicaid/index.shtml
Florida KidCare
Through Florida KidCare, the state of Florida offers health insurance for children from birth through age 18, even if one or both parents are working. It includes four different parts. When you apply for the insurance, Florida KidCare will check which part your child may qualify for based on age and family income. MEDIKIDS: children ages 1 through 4. HEALTHY KIDS: children ages 5 through 18. CHILDREN’S MEDICAL SERVICES NETWORK: children birth through 18 who have special health care needs. MEDICAID: children birth through 18. A child who has other health insurance may still qualify for Medicaid.
http://www.doh.state.fl.us/AlternateSites/KidCare/
(NAIC) National Association of Insurance Commissioners
The National Association of Insurance Commissioners (NAIC) is the organization of insurance regulators from the 50 states, the District of Columbia and the five U.S. territories. The NAIC provides a forum for the development of uniform policy when uniformity is appropriate. NAIC members are the elected or appointed state government officials who along with their departments and staff regulate the conduct of insurance companies and agents in their respective state or territory.
http://www.naic.org/
Insurance Information Institute (I.I.I)
The mission of the Insurance Information Institute (I.I.I.) is to improve public understanding of insurance -- what it does and how it works.
Contact info:
110 William Street
New York, NY 10038
212-346-5500
http://www.iii.org/