An Introduction To Group Health Insurance Plans In Florida

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

In order to join a group health plan you have to first be eligible for the plan. For example, though an employer may have a group health plan, it does not have to be open to everybody, perhaps being reserved for only full-time workers. In addition, the plan may be run by an HMO and you might find that you live outside of the HMO's service area.

If you are eligible to join the plan then you have to be allowed to join whatever your state of health. In this case your state of health means your present health, including any disability that you may have, and to your prior medical history. It is also interesting to note that you cannot be excluded as a result of genetic information.

It is also important to note here that, in spite of the fact that an employer is allowed to refuse you membership because you do not for example work sufficient hours, he is not permitted to exclude you based solely on your current or prior medical history.

Virtually every plan will have an enrollment period during which you have to elect to join the scheme which might typically be within 30 days or starting work. If however you decide not to enroll at that stage then an employer has to give you the opportunity to join during what is normally termed a special enrollment period when certain specified changes happen within your family. These changes might include such things as marriage, the birth or adoption of a child and the loss of other medical insurance coverage because of such things as the cessation of coverage provided through another family member as a result of death, retirement, reduction in working hours, divorce, legal separation, termination and similar circumstances.

Almost all plans will also generally 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 to all employees and during this period an employee is not covered under the group plan.

Where the group plan that you are joining is being operated by an HMO then that HMO may also require a waiting period (generally known as an affiliation period) during which you will again not be covered. Affiliation periods required by an HMO cannot generally exceed 2 months and if such a waiting period is applied the HMO cannot then impose any pre-existing conditions exclusions.

Under the provisions of Florida law any group plan that includes dependent cover must also provide cover automatically for newborn babies, newly adopted children and children placed for adoption for 31 days after birth, adoption or placement. The may also require parents to register these children with the plan within this 31 day period for cover to continue thereafter.

In the case of parents with disabled children who are covered under a group health insurance plan cover will usually continue beyond the age at which a child would cease to qualify as a dependent, as long as the parents can demonstrate that the individual concerned is incapable of supporting himself (or herself) because of physical or mental disability and that they are principally dependent upon the plan member for support.

If you are employed by 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 certain circumstances. This protection is guaranteed by the Family and Medical Leave Act (FMLA) to cover such things as childbirth, illness or the need to take care of a seriously ill family member.

Federal law allows states down to local government level to exempt government employees from specific areas of coverage in self-insured group health insurance plans and a lot of public employers in Florida make use of this to a degree. Because exemptions vary widely between employers it is a good idea to discover the precise nature of yourcoverage provided if you are a public employee. These details can also be found by contacting The Center for Medicare and Medicaid Services (CMS) which maintains a list of exemptions for individual employers.

Although under Florida law you cannot be excluded from membership of a group health plan on the basis of health, there are certain circumstances in which exclusion periods may be imposed for pre-existing conditions. However, this is a complicated topic and one that is thus the subject of a further article.

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