A Basic Introduction To Florida Group Health Insurance

By Author: Donald Saunders
Total Articles: 84
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A lot of Americans are enrolled in group health insurance plans and the rules governing group health insurance in the state of Florida are similar to those in most of the other states, although there are various differences that could apply in the case of public employees.

If you want to join a group health insurance plan you have to first be eligible for memberships of the scheme. For example, while an employer may operate a group health insurance scheme, it may not be open to everyone, perhaps being designed for full-time and not part-time workers. Additionally, the scheme may be run by a Health Management Organization (HMO) and you may discover that you are living outside of the HMO's service area.

Assuming that you are eligible for membership of the scheme then you must be permitted to join whatever your state of health. In this context your state of health means your present health, taking into account any disability that you may have, and to your past medical history. It should also be noted that you may not be excluded from the scheme as a result of genetic information.

It is also important to note ...
... here that, although your employer can refuse you membership because you do not for example work enough hours, he is not permitted to exclude you based solely on your current or past medical history.

Nearly all plans has an enrollment period during which you have to join the scheme which could typically be within about 30 days or starting work. If however you choose not to join at that stage then your employer must give you an opportunity to join during what is usually termed a special enrollment period if certain specified changes come about within your family. Such changes could include things like marriage, the adoption of a child and the loss of other health insurance coverage because of things like the cessation of coverage being provided through another family member as a result of death, retirement, termination, divorce, reduction in working hours, legal separation and similar changes.

Most plans also normally include a waiting period for membership that is typically anything from 30 days to about 3 months. Employers must apply this waiting period consistently to all employees and during this time you will not be covered under the group scheme.

If the group scheme that you are joining is operated by an HMO then the HMO can also require a waiting period (generally called an affiliation period) during which you will again not be covered. Affiliation periods required by an HMO may not normally be more than 2 months and where a waiting period is applied the HMO may not then impose any pre-existing condition exclusion periods.

Under the provisions of Florida law any group plan that includes dependent cover also has to provide cover automatically for newborns, newly adopted children and children who are placed for adoption for a period of 31 days from the date of birth, adoption or placement. The can also require parents to register these children with the scheme during this 31 day period for cover to continue thereafter.

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

If you are employed by an employer with at least 50 employees then you will be permitted to take a leave of absence without loss of health insurance for a period of up to 12 weeks in some circumstances. Such protection is guaranteed by the Family and Medical Leave Act (FMLA) to cover things like childbirth, sickness or the need to take care of a seriously ill member of your family.

Federal law permits states, county and local governments to exempt government employees from specific areas of coverage in self-insured group plans and a lot of Forida's public employers make use of this to some extent. As exemptions vary widely between employers it is wise to discover the precise coverage provided if you have a public employer. This information may also be found by getting in touch with The Center for Medicare and Medicaid Services (CMS) which keeps a list of employer exemptions.

Although according to Florida law you may not be excluded from membership of a group health insurance plan for reasons of health, there are certain circumstances in which exclusion periods are allowed to be imposed for pre-existing conditions. However, this is a complicated area and one that is thus the subject of a further article.