The Principles Of Group Health Insurance Plans In Florida

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A significant number of Americans are members of group health plans and the regulations governing group health insurance in Florida are similar to those in most other states, although there are several differences that may apply in particular to public employees.

To join a group health scheme you have to first be eligible for the scheme. For instance, although an employer may operate a group health scheme, it does not have to be open to all employees, perhaps being aimed at only full-time workers. Additionally, the scheme may be operated by an HMO and you may find that you are living outside of the HMO's service area.

If you are eligible to join the scheme then you have to be allowed to join regardless of your state of health. In this context your state of health means your current health, including any disability that you may be suffering from, together with your past medical history. It should also be noted that you may not be excluded on the grounds of genetic information.

It is also important to note here that, although an employer can exclude you from a scheme because you do not for instance work enough hours, he is not permitted to refuse you membership solely on your current or previous medical history.

Virtually all plans will have an enrollment period during which you have to join the scheme which could typically be within about 30 days or starting work. However, if you choose not to join at that stage then your employer is required to give you an opportunity to join during what is often called a special enrollment period if certain specified changes come about within your family. These changes could include such things as marriage, the birth or adoption of a child and loss of alternative health insurance cover because of such things as the cessation of cover provided through another family member because of death, retirement, reduction in working hours, divorce, termination, legal separation and similar circumstances.

Almost all plans also normally include a waiting period for membership that is typically anywhere from 30 days to about 3 months. Employers have to apply this waiting period consistently to all employees and during this period an employee will not be covered by the group scheme.

If the group scheme that you are joining is operated by an HMO then the HMO may also require a waiting period (generally known as an affiliation period) where again you will not be covered. HMO affiliation periods may not normally be greater than 2 months and where such a waiting period is applied the HMO is not allowed to then impose any pre-existing condition exclusion periods.

Under Florida law any group health plan that includes dependent cover must also provide cover automatically for newborn babies, newly adopted children and children placed for adoption for a period of 31 days after the date of birth, adoption or placement. The may also require parents to register these children during this 31 day period if cover is to continue beyond this point.

For parents caring for disabled children who are covered under a group health plan cover will normally continue beyond the age at which a child would cease to qualify as a dependent, as long as the parents can show that the individual concerned cannot support himself (or herself) as a result of physical or mental disability and that they are mainly dependent upon the scheme member for support.

If you are working for an employer with at least 50 employees then you will be allowed to take a leave of absence without loss of health insurance for a period of up to 12 weeks in certain circumstances. This protection is guaranteed under the Family and Medical Leave Act (FMLA) to cover such things as childbirth, sickness or the need to care for a seriously ill family member.

Federal law permits states, county and local governments to exempt government employees from particular areas of coverage in self-insured group health insurance plans and many public employers in Florida make use of this to a degree. As exemptions vary widely between employers it is a good idea to find out the precise nature of yourcoverage provided if you are a public employee. This information may also be found by getting in touch with The Center for Medicare and Medicaid Services (CMS) which has a list of employer exemptions.

In spite of the fact that according to Florida law you may not be refused membership of a group health plan on the basis of health, there are some circumstances in which exclusion periods are allowed to be imposed for pre-existing conditions. However, this is a complex topic and one that is therefore the subject of a separate article.

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