The Principles Of Florida Group Health Insurance

A significant number of Americans are covered by group health plans and the rules governing group health insurance in Florida are similar to those in many other states, although there are some differences that could apply particularly to public employees.

To join a group health scheme you have to first be eligible for the scheme. For example, in spite of the fact that an employer may have a group health scheme, it does not have to be open to all employees, perhaps being designed for full-time and not part-time workers. Additionally, the scheme may be run by an HMO and you might discover that you are living outside of the HMO's service area.

If you are eligible to participate in the scheme then you must be allowed to join regardless of your state of health. Here your state of health refers to your present health, taking into account any disability that you may be suffering from, as well as your prior medical history. It should also be noted that you may not be excluded from the plan on the basis of genetic information.

It must be understood here that, while your employer may exclude you from a scheme because you do not for example work sufficient hours, he is not permitted to refuse you membership solely on your current or past medical history.

Virtually all schemes will have an enrollment period during which you have to join the scheme which could typically be within 30 days or joining the company. If however you choose not to enroll at this stage then an employer has to give you the opportunity to join during what is normally termed a special enrollment period where certain specified changes take place within your family. These changes could include such things as marriage, the birth of a child and the loss of alternative health insurance cover as the result of such things as the cessation of cover provided through another family member as a result of death, termination, divorce, retirement, reduction in working hours, legal separation and similar changes.

Vitually all plans will also normally have a waiting period for membership that is typically anything from 30 days up to 3 months. An employer must apply this waiting period consistently for all employees and during this time you will not be covered by the group scheme.

Where the group scheme that you are joining is operated by an HMO then the HMO may also apply a waiting period (usually referred to as an affiliation period) during which again you will not be covered. HMO affiliation periods may not normally be more than 2 months and where a waiting period is required the HMO may not then impose any pre-existing conditions exclusions.

Under Florida law any group health plan that includes dependent cover also has to provide automatic cover for newborn babies, newly adopted children and children who are 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 scheme within this 31 day period for cover 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 classed as a dependent, provided the parents can demonstrate that the individual concerned cannot support himself because of mental or physical disability and that they are largely dependent upon the scheme member for support.

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

Federal law allows states down to local government level to exempt government employees from certain areas of 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 amongst employers it is wise to discover the precise coverage provided if you are a public employee. This information can also be found by contacting The Center for Medicare and Medicaid Services (CMS) which has a list of employer exemptions.

In spite of the fact that under Florida law you may not be excluded from membership of a group health plan on the basis of health, there are some circumstances in which exclusion periods may be imposed for pre-existing conditions. This is however a complicated area and one that is thus the subject of a separate article.

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