Florida Medical Insurance

Florida medical insurance is comprised of two main categories: Florida individual medical insurance and Florida group medical insurance. These two categories have many similarities but yet many important differences as well.

Many Florida residents are quite familiar with large group medical insurance through their employer if they have ever worked for a large corporation (in Florida a large group is considered a company or group that has more than 50 employees). However, when it comes to understanding individual medical insurance in Florida and how it works or even understanding small group medical insurance in Florida and how that works it turns out to be somewhat different than the large group medical insurance plan that most have known so well for so long.

Individual medical insurance in Florida is different from group medical insurance in Florida because of the fact that the underwriting departments at each Florida insurance company will scrutinize very closely any pre-existing conditions that an applicant has in their health history (going back up to 10 years) if they are applying for an individual policy.

This scrutiny is geared towards finding any adverse health conditions or precursors to health conditions such as diabetes, high cholesterol, heart disease, obesity, cancer, etc. Conditions such as diabetes, cancer, heart disease and severe obesity will cause a Florida health insurance company to automatically decline an application for coverage with an individual medical insurance policy.

Less severe pre-existing health conditions such as high cholesterol, high blood pressure, mild obesity, and heartburn/acid reflux will generally result in a rider being placed on the accompanying policy that will exclude coverage for anything related to that specific pre-existing condition. Riders are generally levied on an indefinite basis or a temporary basis (12-24 months in most cases).

There are a few insurance companies in Florida (one of them presently being Aetna) that do not issue riders on the individual medical insurance side as is most common but will instead “rate up” an applicant they deem presents excess risk due to pre-existing conditions. This “rate up” simply means that they will offer to cover the mild pre-existing conditions but they will offer you a rate increased premium amount that can be 10% more than was initially quoted you, 25% more, 50% more; it all depends on the underwriting department at the insurance company as to what premium amount that they will offer you if they decide to accept you.

Florida group medical insurance is much simpler in that generally there is not as much scrutiny towards an applicant’s health history and pre-existing conditions. This is good or bad depending on your present health condition. It is good if you are an unhealthy person with some major pre-existing conditions because it allows you to obtain group medical insurance when you would be declined if you tried to obtain individual medical insurance (due to your pre-existing conditions). However, it is bad from a financial sense if you are a generally healthy person because you are paying a higher premium cost for group medical insurance (as opposed to individual medical insurance) – that is unless your employer is paying the cost for all of your group medical insurance: then you are quite happy (unless you have a family and your employer is not so kind as to pay for them to be on the group medical coverage as well!)

Just from what you have learned so far; which do you think would be more expensive – group medical insurance or individual medical insurance? If you said group medical insurance then you are on the right track to understanding the main difference between the two. Think of the cost of group medical insurance versus the cost of individual medical insurance like this: if your new co-worker at the cubicle next to you has cancer then guess what? They will be able to obtain group coverage on your group plan even though they never would be approved for an individual medical insurance policy. You as a healthy person are in a sense subsidizing the cost of your unhealthy co-worker (and all of the other unhealthy people) in paying their premiums. It follows of course that the premiums will be higher for a group medical insurance plan in Florida where the insurance company has to take on both healthy and unhealthy people as opposed to an individual medical insurance plan in Florida where the insurance company can pick and choose who they will accept.

Be sure to research your Florida medical insurance options thoroughly by consulting with an independent agent who can represent multiple health insurance companies and by comparing Florida medical insurance quotes from multiple companies side by side. (Be sure not to believe any Florida insurance agent who tells you that you will be approved for an individual medical insurance policy whether you have pre-existing conditions or not – chances are they are just trying to unload a close to worthless medical discount plan – not medical insurance).

Joel J. Ohman
Florida Health Medical Insurance