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Getting To Grips With Florida Group Health Insurance
A lot of Americans are covered by group health plans and the rules governing group in Florida are similar to those seen in many of the other states, although there are some differences which may apply in particular to public employees.
If you wish to join a group health plan you have to first be eligible for memberships of the scheme. For instance, despite the fact that an employer may operate a group health scheme, it does not have to be open to all employees, possibly being reserved for only full-time workers. In addition, the scheme may be operated by an HMO and you might discover that you are living outside of the service area for the HMO.
Should you be eligible to participate in the scheme then you have to be allowed to join whatever your state of health. Here your state of health means your present health, including any disability which you may be suffering from, and to your prior medical history. It should also be noted that you may not be excluded as a result of genetic information.
It must be understood here that, despite the fact that your employer is permitted to 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 every scheme will have an enrollment period during which you have to elect to join the scheme which might typically be within 30 days or joining the company. However, if you decide not to join at this stage then your employer must give you the opportunity to join during what is generally called a special enrollment period when certain specified changes happen within your family. These changes might include things like marriage, the adoption of a child and loss of alternative medical insurance coverage because of things like the cessation of coverage provided through another family member because of death, retirement, termination, reduction in working hours, legal separation, divorce and similar circumstances.
Most plans will also usually include a waiting period for membership which will typically be anything from 30 days up to 3 months. This waiting period has to be applied consistently for all eligible employees and during this period an employee is not covered by the group scheme.
Where the group scheme which you are joining is being run by an HMO then that HMO may also require a waiting period (frequently referred to as an affiliation period) during which you will once again not be covered. HMO affiliation periods may not usually
be greater than 2 months and where such a waiting period is applied the HMO cannot then impose any pre-existing condition exclusion periods.
Under the provisions of Florida law any group plan which provides cover for dependents must also provide automatic cover for newborns, newly adopted children and children who are placed for adoption for a period of 31 days after the date of birth, adoption or placement. The may also require parents to register such children with the scheme within this 31 day period for cover to continue beyond this point.
In the case of parents taking care of disabled children who are covered under a group plan cover will generally continue beyond the age when a child would cease to qualify as a dependent, as long as the parents are able to show that the person concerned is incapable of supporting himself because of physical or mental disability and that they are chiefly dependent upon the plan member for support.
If you are employed by an employer with more than 50 employees then you are allowed to take a leave of absence without losing you for a period of up to 12 weeks in certain circumstances. This protection is guaranteed by the Family and Medical Leave Act (FMLA) to cover things like the birth of a child, sickness or the need to care for a seriously ill member of your family.
Federal law allows states down to local government level to exempt government employees from particular coverage in self-insured group plans and many public employers in Florida make use of this to some extent. As exemptions vary widely amongst employers it is wise to establish the precise nature of yourcoverage provided if you are a public employee. These details may also be found by contacting The Center for Medicare and Medicaid Services (CMS) which maintains a list of exemptions for individual employers.
Despite the fact that according to Florida law you may not be refused membership of a group health plan for reasons of health, there are certain circumstances where plans are allowed to impose exclusion periods for pre-existing conditions. However, this is a complex topic and one which is thus the subject of another article.
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