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Florida Health Insurance Preexisting Conditions: COBRA, HIPAA Laws

Unfortunately Florida health insurance law allows insurance companies to place Riders on a policy; decline coverage, or rate up (increase) your base premiums based on preexisting conditions. If you are declined in Florida there are no health insurance pools that will take you as in some other States. However, there are consumer protections in Florida health insurance law that guarantee that policies are renewable as long as the policyholder did not give any false information on the application, and all premiums are paid on time. False information on an application constitutes fraud (intentional deception or concealing of facts that results in an injury to another) and could include failure to inform the Florida health insurance company of any pre-existing conditions. Policies can be "rescinded" or terminated back to the effective date of coverage for failure to disclose health history on the application.

Just because you were declined by one company doesn't mean you're done.  I may be able to find you coverage for your preexisting conditions depending on how well they're controlled...call (407) 425-9347 and let us help you.

If you are in need of Guaranteed Issue Health Insurance that is HIPAA compliant go to this page.

As in most other most states, Florida health insurance law sets out legislative guidelines as to how Florida health insurance companies can deal with a customers pre-existing conditions. In Florida health insurance law, a pre-existing condition is deemed a health issue that might require coverage that you have been treated for or diagnosed with in the two years prior to the beginning of your new policy. Florida law gives companies the right to exclude coverage of pre-existing conditions. This exclusion period means that the health insurance companies do not have to pay for treatment of the pre-existing condition.

Questions on Preexisting Conditions go to our Frequently Asked Questions page.

Florida health insurance companies have the right to extend exclusion periods temporarily or even permanently. There is no limit to the length of an exclusion period in Florida health insurance law.

Generally, a "pre-existing condition exclusion" is a limitation or exclusion of health insurance benefits based on the fact that a physical or mental condition was present before the first day of coverage.  Most Florida health insurance plans will have a period of at least 12 months sometimes 24 months before any benefits are paid on preexisting conditions and many plans place permanent or indefinite Riders on those conditions in the place of a preexisting clause.

Florida Health Insurance companies try to discourage people from waiting until they get sick in order to purchase health insurance. One way in which they do this is to impose pre-existing condition exclusion periods. This means that if you have a medical problem  which exists at the time you enroll in or purchase your health insurance, the insurance company will deny all claims pertaining to this medical problem for a certain period of time or deny coverage to you entirely.

If you have a job-based Florida health insurance plan, the pre-existing condition exclusion period is limited to 12 months (18 months if you are a late enrollee) and only applies to conditions for which you sought treatment in the 6 months leading up to enrollment. You may be able to apply creditable coverage to offset your pre-existing condition exclusion period if you are coming off either an Florida individual or group health insurance plan. (It doesn't work the other way around however: going from a Group Employer Plan to an Individual Health Insurance Plan - you will not receive credit on preexisting condition waiting periods on most plans.)   A lot of people we talk to either don't hear this or refuse to believe it because they are familiar with group employer coverage, but trust me, in the State of Florida anyway, coming off a group plan in no way offsets any Preexisting Condition Clause Waiting Period in your Individual Plan if they have such Clauses.

Several Florida health insurance carriers cover certain pre-existing conditions. And some plans will place Temporary/Permanent Riders on the condition for a period of a year or two and perhaps indefinitely. While other companies will rate up your base premium to offset the risk associated with your preexisting condition and cover the medical condition. While others we sell will not rate up but may decline you if the medical condition is too serious in which case we have a Guarantee Health Insurance where the only requirement is you are working. But PLEASE don't be tempted to lie on your health insurance application. One way or another the health insurance company will find out about it.  Either during a phone interview to verify application information you might, or a spouse, might give conflicting information or during a preexisting condition review when processing a claim (where they ask for your medical records before they consider paying medical claims). In which case if you are found out, the claim will be not be paid and or benefits will be rescinded to the effective date of the policy.  

Florida COBRA, HIPAA Health Insurance

If you are coming off a COBRA Plan (Consolidated Omnibus Budget Reconciliation Act) you may qualify for Florida HIPAA Health Insurance was enacted by the U.S. Congress in 1996).  To qualify for HIPAA you must be able to answer "yes" to six questions, click above to learn what those conditions are:

There are also Guaranteed Issue health insurance plans available if you qualify as a group of one. Once again, on these plans there is no medical underwriting. Your premium will be rated-up based on medical history and underwriting. However, these rate ups are usually within 15% of the standard Community Base Rates Underwriters use to calculate ordinary Group Health Insurance premiums. To apply as a group of one if you meet the guidelines of being self employed, you need to make application in August for an October 1st effective date. Talk to us and we can explain your options and details for filing an application.   

Florida health insurance - working with an Independent Broker.
There's plenty of reasons why it's not only important which plan you select but also who you choose to have help you with that selection. Anyone can quote a low premium. The question is, is it the right one for you and one that you will be happy with for years to come?  Don't be fooled into working with any ol' agent that quotes a low premium.

How to avoid having claims denied if you have a health insurance policy in Florida
Be careful completing your application for health insurance. Maybe claims are denied, even rescinded back to the original issue date with all premiums refunded, because you misstated some pertinent information about your medical history in the last ten years. Don't be fooled by any agent that tells you "it doesn't matter if you stretch the truth a little". Because in the end its' your money on the line not his.

Florida Health Insurance - maternity insurance
If you are already pregnant there's no insurance company in the State of Florida that will issue you, or anyone in your family for that matter, on a traditional Florida health insurance policy. If you are not already pregnant there are various optional Riders you can add onto a base plan that will cover the pregnancy. Beware however that there will be "waiting-periods". If there are no waiting periods then expect to see high deductibles and limited benefits...50%.