Florida, like the majority of states, grants limited guarantees to anyone who wishes to buy individual health insurance and, whilst your capacity to buy health insurance will depend to a certain extent upon your current state of health, there are situations where health insurers in Florida have to offer you insurance.
Usually, health insurance companies are permitted to ask questions about your past medical history and to refuse you cover if you are currently suffering from a medical problem or have a poor medical history. More usually however insurance companies will insure you, although they will either exclude specific conditions from your insurance policy or raise your premium and permit cover for such conditions. In Florida however there is an exception to this rule in the case of a history of breast cancer where you have had a course of treatment for the condition a minimum of two years prior to your current request for insurance. In this instance insurance companies are not permitted to refuse to cover you.
When you have been covered by a group insurance plan for at least three months and then lose your cover then, according to Florida law, you can purchase a conversion policy and an insurer have to offer you the choice of a minimum of two policies. Also, companies cannot impose any new pre-existing condition exclusion. They can however enforce an exclusion clause if you have not completed any previously imposed qualifying period.
When you cannot meet the qualifications for a conversion plan but are nonetheless HIPAA eligible then once again an insurer may not deny to insure you and must once again offer you a choice of a minimum of two policies. HIPAA eligibility requires that have had a minimum of 18 months of creditable continuous coverage (the final day of which must have been under a group health policy) and have used up any COBRA or continuation coverage for which you were eligible. Further, you cannot currently have any health insurance (or your current group plan cover must be about to expire) and cannot be eligible for another group insurance policy or for either Medicaid or Medicare. Finally, an application for health insurance on the basis of HIPAA eligibility must be submitted within 63 days of losing your prior cover.
Where an insurer or HMO is no longer able to offer cover, because they have for example become insolvent or you have moved outside of their service area, then other insurance companies must offer to provide you with insurance cover regardless of your state of health.
Newborn children, newly adopted children and children who are placed for adoption must be covered under a parent's individual insurance policy for 31 day from the date of birth, adoption or placement.
Under Florida law a disabled child is to continue to enjoy cover when dependent coverage has been in issue beyond the age when cover would usually be terminated, as long as the child is unable to support himself (or herself) because of either physical or mental disability and is dependent upon the policyholder for support.
In Florida the cover afforded by an individual health insurance policy will be largely dependent upon the policy which is bought but it is a requirement of Florida law that all policies cover certain benefits such as mammograms, childhood immunizations and diabetes treatment. The full list of required benefits is updated occasionally and a current list may be obtained from the Florida Department of Financial Services.
MedicalHealthInsuranceToday.com provides information on affordable health insurance and on buying a Florida individual health insurance plan
HealthLeaders-InterStudy, the leading provider of managed care market intelligence, reports that smaller Florida health plans are looking to make inroads in state's health plan marketplace through acquisitions and stronger networks. According to the latest Florida Health Plan Analysis, Coventry Health Care and Great-West Healthcare are poised to move up the ranks of Florida's largest insurers, showing two successful ways to gain share in a hyper-competitive market.
"Florida is the third-largest state with more than 18 million residents, so its population size is attractive to insurers," states Roy Moore, market analyst for HealthLeaders-InterStudy and author of the report. "Carriers see the state as full of opportunity."
Coventry Health Care's recent purchase of Florida Health Plan Administrators has made Coventry the state's fourth-largest commercial HMO provider. Through Vista, the product name of Florida Health Plan Holdings, the insurer will bring additional products to the market, boosting its competitive strength and expand in the small-group and individual business. The company's national infrastructure will also allow Vista to better compete against the giant Florida insurers Blue Cross, UnitedHealthcare, Humana and Aetna.
After realizing they were behind the competition, new leadership for Great-West Healthcare placed a major focus on expanding the company's provider networks and boosting membership. The insurer's has expanded its networks significantly with the addition of 30 new hospitals and 4,000 physicians, providing access to more than 30,000 network providers.
In January 2008, Great-West will roll out a program called Level Funded. Instead of paying the actual claims cost each month, employers in this model pay a fixed monthly maximum claim liability. At the end of the year, Great-West reconciles the difference between the total monthly payments and actual claim costs. If actual claim costs are less than the total monthly payments, the employer retains two-thirds of the claims savings. With a large number of small businesses in the state that need insurance and for companies looking for a self-funded insurance approach, Great-West could offer an alternative to the market leaders and give smaller employers a break on healthcare costs by using a self-funded model. This week's announcement by CIGNA to acquire Great-West further consolidates this dynamic market and will help the insurer to gain additional market share.
Most individuals do not fully understand how their health insurance works. In Florida, almost every plan is a PPO and you can visit any provider in the network without a referral.
A PPO is essentially an arrangement between the health insurance carrier or network and the provider of services (physician, lab, hospital, etc.). The provider has agreed to charge a fixed, discounted rate for all of the services they perform.
For example, a physician might send an office visit claim to the insurance company for $100. The carrier or network will look up the contracted rate that the provider has and "re-price" the claim. The contracted rate might realistically be $55. This is the amount you will be charged for the office visit. If you have a co-pay feature in your plan, you might only pay $25 or $30. But, even without this feature, you would still only be responsible for the discounted, contracted rate of $55.
At this point, you should ask yourself two questions. "How many times did I see a physician last year?' "How much extra am I paying for the privilege of paying $30 for an office visit instead of $55 or $60?"
If you went to the doctor twice last year, the difference between having a co-pay and not having a co-pay is less than $60 in extra cost. While at the same time, this co-pay feature might have added $800 a year to your premiums. You would literally need to be in your doctor's office almost every week before the co-pay benefit made any sense.
Co-pays often add an unnecessary cost to your health insurance premiums. You need to examine how much extra you are paying every month for this feature.
Deductibles are also a misunderstood concept on most health insurance plans in Florida and elsewhere. Clients typically ask for a low deductible, thinking that the plan will provide no coverage until the deductible is met. Of course, we now know that the PPO feature of re-pricing and discounting all services is available as soon as the plan begins, and you do not have to first meet a deductible.
Keep in mind that less than 5% of you will ever have more than $5,000 in medical expenses in one year. Why, you might ask, am I paying a small fortune to maintain a $1,000 deductible?
If you ask your agent to give you the premiums for $1,000, $2,500 and $5,000 deductibles, you will discover that the difference in benefit is very small.
For example, a healthy, 40 year old male in Fort Lauderdale might pay $60 a month or $720 a year less by raising their deductible from $1,000 to $2,500. After they have been on the plan for about two years, they have already saved the $1,500 difference. If this individual saved the difference and put it into a high yield savings account, they would have about $25,000 after twenty years.
The money is much better off in your pocket as opposed to the insurance company's pocket. Yet, the insurance companies make millions each year because you are giving them extra premium for an event that has a very low likelihood of ever occurring.
Let me try to summarize what we are telling you.
You need to do the math (it is only simple arithmetic) when purchasing health insurance or any type of insurance for that matter. You are performing what business school graduates call a "cost benefit analysis". That is, how much extra am I paying for each additional benefit?
Now that you realize that high deductibles are nothing to be afraid of, and co-pays for office visits and even prescriptions can add thousands a year to your premiums for very little benefit in return, you are in better position to intelligently select a health insurance plan.
If you live in Florida and would like to speak with an agent who understands the aforementioned concepts, or, if you want to learn more about Florida health insurance, we can recommend a few links.
Finding low cost Florida Health Insurance
Guaranteed Issue Health Insurance
Martin Unger has been selling health insurance for more than twenty years. He is a pioneer of Internet based health insurance and his web site www.flquote.com is one of the most highly regarded sites on the subject of Florida health insurance.
Affordable Health Insurance
How To Buy Affordable Low Cost Health Insurance And Save $7,000 Or More Every
Year Starting Now!
Anthem Blue Cross Blue Shield
Ppo vs hmo
HSA Health Plans
Dental PPO
Excellus PPO insurance plan
Kentucky PPO POS HMO
Insurance saving the Right Insurance plan
No Premium reduction to N.C. Students opting out of Abortion Coverage in Campus Health Plan
The students of North Carolina University are now required to purchase a private insurance coverage plan or enroll in the campus plan which offers abortion coverage from this year. Even though the UNC administration had agreed although under the pressure from pro-lifers to let students in the 16 cam
What is Annual Maximum Rollover on PPO Dental Insurance Plans
Many people are familiar with the term rollover but few can associate it with health insurance. Most only apply the term to cell phone use. In this case used time for a month of service in rollover to the subsequent month. In a rollover
Independence Blue Cross Student PPO plan
Independence Blue Cross of Philadelphia has introduced a new PPO plan targeting students in the Philadelphia area in particular and the entire USA in general. The Independence Blue Cross Student PPO plan will increase Blue Cross coverage of Colleges and Universities in the area.
Independence B
Aetna North Carolina Small Business PPO HMO POS
Aetna has recently announced that it will offer 26 types of PPO, HMO and POS insurance plans for small-group or small business owners in the state of North Carolin
How to Dispute Balance Billing From Out-Of-Network PPO HMO
The patient visit the doctor. The doctor issues a bill to the insurance company. The insurance company pays the doctor a discounted payment and send you are copy of the bill. The doctor sends an additional bill to you. This controversial and, yes, illegal practice is called Balance Bill