Florida Health Insurance Buyers Guide

When evaluating options for an individual health insurance in Florida there are important features of Florida health insurance regulations that will apply to yourself and family. Please learn how to purchase quality health insurance by gaining a better understanding in how our health care system works. 

What Considered Pre-existing Health Conditions?

Florida is like most states in that health insurance companies may deny an application if the applicant has a history of pre-existing conditions.  This applies in cases where individuals are applying for health insurance coverage on their own, directly to an insurer.  This can be avoided by applying for health insurance as a member of a group plan, with some restrictions.  The group must have had coverage for at least 12 months with no significant lapse.

Florida health insurance policies are fully underwritten based on prior medical history.  Currently only five states do not allow an application to be declined due to preexisting conditions.  These states include Maryland, Massachusetts, New Jersey, New York and Vermont.

Need Eligibility Requirements? – A Conversion Policy?

A conversion policy is an individual health insurance policy that can be sold to an individual that leaves a group plan or loses coverage from a group plan.  The policy is actually sold by the group that provided coverage under the former group health insurance plan.

In Florida, you can purchase a conversion policy if you lose coverage if you had at least 3 months of coverage through group before losing coverage.

The cost of a conversion policy cannot be more than 200% of the cost of a standard rate for an individual policy.

Learn About Portability Health Insurance In Florida

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) allows a person who leaves their job health insurance on a guaranteed basis.  There is a requirement however that the person must have had been insured for at least 12 months prior to leaving, and then have fully utilized and exhausted benefits available under a COBRA group continuation plan. 

Do I Have Exclusion Periods?

As stated, Florida health insurance law allows a company to reject an applicant for preexisting medical conditions.  If an applicant is accepted for coverage, the health insurance company is still exempt from paying for treatment of preexisting conditions during the exclusionary period.  In Florida, the period applies in these cases of up to two years.  The carrier may obtain a special rider to exclude coverage on certain conditions indefinitely.

Florida Health Insurance Cancellation Restrictions

Health insurance companies in Florida may not cancel or rescind coverage when a policyholder becomes sick.  They can however cancel or rescind coverage when an applicant misrepresents important medical information on an application. 

Health insurance premiums are increasing by double digits every year, and every policy is open for rate adjustments at least once per year.  Customers who face large premium increases may be faced with the prospect of finding new health insurance coverage, but it is never recommended that a policy is cancelled by a policyholder until a replacement policy has been procured.  The reason for this is that it may be difficult or impossible for the applicant to actually find a replacement health insurance policy.

For those with concerns over group health insurance increases a qualified agent or broker should be consulted before any major decisions are made.  The current climate for health insurance options is rapidly changing and consumers should educate themselves when making major decisions affecting their medical care.