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Individual Health Insurance In Florida
Florida, like most states, gives limited guarantees to individuals who wish to purchase individual health insurance and, despite the fact that your capacity to purchase health insurance will depend to a certain extent on your present state of health, there are circumstances in which health insurers in Florida are required to offer to insure you.
When You Have a Pre-Existing Condition
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Usually, health insurance companies are permitted to ask questions about your medical history and to refuse to insure you if you are currently suffering from a medical problem or have a history of particular conditions. However, more commonly, insurance companies will cover you, but they will either exclude specific conditions from your policy or increase your premium and allow cover for such conditions. However, in Florida one exception to the rule applies in the case of a history of breast cancer where you have finished a course of breast cancer treatment at least two years prior to your present request for insurance. In this instance insurance companies are not permitted to deny you insurance.
When You Lost a Group Insurance Cover
When you have been covered by a group insurance plan for a period of at least three months and later lose your cover then, in Florida, you have the right to purchase a conversion policy and an insurer is required to offer you the choice of at least two policies. Also, companies are not permitted to impose any new exclusion for pre-existing conditions. They can however enforce an exclusion clause if you have not reached the end of any previously imposed qualifying period.
When You Don’t Qualify for a Conversion Plan
When you are not able to meet the qualifications for a conversion plan but are nevertheless HIPAA eligible then once again an insurer must not deny to cover you and must once again offer you a choice of at least two policies.
HIPAA eligibility means that:
- You have had at least 18 months of creditable and continuous coverage (the last day of which must have been under a group insurance plan).
- You have used up any COBRA or continuation coverage for which you were eligible.
- You must not currently have any health insurance (or your present group cover must be about to expire).
- You are not eligible for another group plan or for either Medicaid or Medicare.
- An application for cover under HIPAA eligibility must be submitted within 63 days of the loss of your prior cover.
When Your Insurer Folds
In cases where an insurance company or HMO can no longer give you cover, because they have for instance become insolvent or you have moved outside of their service area, then other insurance companies are required to offer to provide you with health cover regardless of your state of health.
Health Insurance for Newborn, Adopted or Disabled Kids
Newborn children, adopted children and children who are placed for adoption must automatically be covered under a parent’s individual health insurance policy for a period of 31 days from the date on which the child is born, adopted or placed for adoption.
In Florida a child who is disabled will continue to enjoy cover where dependent coverage has been in issue past the age when such cover would usually be ended, providing the child is unable to support himself or herself as a result of either physical or mental disability and is dependent on the planholder for support.
In Florida the cover given by an individual health insurance policy will depend to a large degree on the particular policy that is purchased but it is a requirement of Florida law that all policies provide cover for certain benefits such as childhood immunizations, mammograms and diabetes treatment. The list of required benefits is updated occasionally and a current list can be obtained from the Florida Department of Financial Services.
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