Hegeman Insurance Brokerage
An Orlando, Fl Health & Life Insurance Agency Since 1996
400 E. Colonial Dr. Suite #1302 | Orlando, Fl   32803
ph: (407) 425-9347 | (407) 342-9945  | fax: (407) 423-7483
Florida Health & Life Insurance License # A115384
email: info@HegemanInsurance

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Florida health insurance and preexisting conditions:

Are you uninsurable or just having difficulty getting your preexisting conditions covered?  Are you on COBRA and it's ending?  Do you have to go on COBRA?  Are you self employed? What preexisting conditions are no big deal and which ones should you be justifiably worried over?   Some people do have options they may not be aware of....

Using an Independent Florida Health Insurance Agent is a smart move!

Be cautious when applying directly with an insurance company.  You are dealing with captive agents that are trained to take in applications first and answer the tough questions about your medical history later; are you listening Blue Cross Blue Shield?  If you are declined it diminishes your chances of getting approved with another company that might have more liberal criteria for your particular medical condition.  Also be aware that the language used in Exclusionary Riders is very important and can vary from insurer to insurer. For example a company might issue a Rider which excludes a certain specific portion of the spine (in the case of a slipped disk).  There are some insurers out there who would exclude from coverage the entire back or any disorders of the back...simply because you had a slipped disk at some point! Are you willing to invest the time and savvy enough to know which carriers will give you a better deal on how they word their Exclusionary Riders? This is where the services of an independent Broker come in real handy, yes like ourselves.  We can level the playing field in your favor because, quite frankly, we want to retain you as clients by getting you the best deal out there so that we don't have to worry about some agent coming in behind us with a better deal.  We know the market and study it everyday.

Riders can also vary for the time periods they cover. They can be Temporary Riders for one year, two years or Permanent over the life of the policy.  You can request that a temporary rider be removed if more then one year (depending on the condition) has elapsed with no treatment. Treatment meaning taking any medications for that condition; seeing a doctor for it or taking a test to see if it is still present in your system. Again it is helpful to have an agent working with you to help you in the Appeal Process once your policy is issued. Frequently people work directly with the insurance company and soon realize that they no longer are a high priority item like they were when they were applying for coverage and feel somewhat abandoned and at the mercy of the insurance Claims Dept.

Florida Temporary Health Insurance- the other, less expensive option...it's more likely they will accept you then a Traditional Health Insurance company while offering nearly identical benefits.

Even if you were declined by a traditional PPO plan, a Temporary health insurance plan might work. The Underwriting is much more liberal, but here again, if you were previously declined it greatly reduces the number of Short Term Health Insurance carriers that will take you.  Height and weight issues, smoking, blood pressure and even adult onset diabetes etc.; which will greatly effect your chances of getting an individual plan, are not so critical when you are applying for Short Term Coverage. 

Let us help find you coverage for your preexisting conditions...call our Orlando office at: (407) 425-9347, or visit our HOMEPAGE

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.

If you have a job-based Florida health insurance plan, the pre-existing condition exclusion period is limited to 12 months 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.

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 of course others will not rate up but may decline you if the medical condition is too serious. There is a myriad of solutions to how Florida health insurance companies deal with preexisting conditions.  That's why we emphasize how important it is to get the perspective of an independent agent and be especially wary of getting advice from an agent or someone that answers the phone at an insurance company. You want an overview of your situation and how the various carriers will cover your conditions so you can pick and choose from many possibilites...this is no time for a narrow minded perspective of one carrier.

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). Coverage can be rescinded to the effective date of the policy.  

If you previously belonged to an employer sponsored health plan and fewer then 63 days have elapsed you may be eligible to continue benefits under COBRA.

What is COBRA ?

Congress passed the landmark Consolidated Omnibus Budget Reconciliation Act (COBRA) health benefit provisions in 1986.  The law provides for the continuation of group health coverage that otherwise might be terminated.

COBRA provides former employees and their dependents the right to temporary continuation of health coverage at group rates.  Usually for 18 months.  This coverage, however, is only available when coverage is lost due to certain specific events.  COBRA is more expensive than health coverage for active employees, since usually the employer pays a part of the premium for active employees while COBRA participants generally pay the entire premium themselves.  It is more expensive, though, than individual health coverage.

Under COBRA, if you voluntarily resign from a job or are terminated for any reason other than "gross misconduct," you are guaranteed the right to continue your former employers group plan for individual or family health insurance for up to 18 months at your own expense. In many cases, your spouse and dependent children are also eligible for COBRA coverage, sometimes for as long as three years. However, individual plans — that is, plans you buy on your own, rather than through work or an association — are not subject to COBRA law, and once you lose that coverage, you won't be able to get an extension under COBRA.

You must be covered under an employer health plan to be eligible for COBRA. If your employer has more than 20 workers but doesn't offer health coverage, or offers coverage only to certain groups of employees and you're not one of them, you won't be eligible for COBRA even if one of the qualifying events occurs — nor will your spouse or children be eligible.

Your COBRA coverage ends when:

• You reach the last day of maximum coverage.

• Premiums are not paid on a timely basis.

• The employer ceases to maintain any group health plan.

• The employer goes out of business.

• You obtain coverage through another employer group health plan that does not contain any exclusion or limitation with respect to pre-existing conditions. (Eligibility under a spouse's group health plan does not count.)

• A beneficiary is entitled to Medicare benefits.

What happens after COBRA expires?  One of two things....either your COBRA health insurance company will offer you a Conversion Plan (call your former HR Dept. to inquire, or roll the dice and try and get a hold of someone yourself at the health insurance company that will help you)  If a Conversion Plan is available to you then that disqualifies you from applying for a Guaranteed Issue HIPAA plan. Actually there is also a 3rd option if you are self employed....

Guaranteed Issue health insurance plans are also available if you qualify as a group of one, that is you are Self Employed. 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, or visit our Homepage for more useful information at your convenience.