Florida Individual Health Insurance
Florida Individual Health
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Health Insurance in
Florida for Individuals and Families:
Health insurance can be frustrating to fully understand
with seemingly random
underwriting rules; annual renewal rates increases, preexisting condition
clauses and policy
Exclusions and Limitations. Florida does not have a insurance pool like some other
States guaranteeing coverage at
affordable rates.
Individual
health insurance is health insurance not tied to a business, it has
nothing to do with the number of people on the application. A two parent
family with children or single mom, it's all considered Florida
individual health insurance. If
you are looking for
affordable
individual health insurance
rates,
you may be seeing numbers you are not quite comfortable with...particularly if you are
coming off a Group or Employer based insurance plan.
Individual health insurance is very different than Group or Employer health
insurance. The primary source of confusion to many is the issue of
pre-existing conditions...."you mean I have to pay that huge premium and they aren’t going to cover
my trick knee that had arthroscopic surgery? Another difference is
cost. Employer based plans
cost more and the reason is "mandated" benefits which must be included in the
policies:
maternity coverage;
substance-abuse treatment, mental and nervous disorder coverage etc. All
contributing to higher costs for Employer based health insurance plans
Underwriting allows an Florida health insurance company to "cherry-pick" who they want and what kind of coverage they are willing to offer.
When you apply for individual health insurance, the health insurance company uses a process called underwriting to look at your age, sex, and health history to decide whether it will cover you and how much they will charge you to offer coverage.
On an Individual Health Insurance Plan (unlike Guaranteed Issue States like New York, Massachusetts, Maine, Vermont and New Jersey), the insurance companies have the option of Accepting, Rating or Declining individual applications.
Rating up a policy is common when someone has a
preexisting
health condition in Florida, such as high blood pressure.
Obviously this is fairly common ailment and normally well controlled with
proper medication. With well controlled high blood pressure the insurance company is willing to
take on a little more risk and offer coverage. They "rate-up" that persons
premium by an amount, typically 25%, to help offset the additional costs of the
prescription medication taken to control the condition. But as the risk
increases at some point the application is a decline (for example if someone
smokes or is overweight).
Underwriting allows the carrier to "cherry pick" applicants based
on health. With
Employer Group health
insurance the person could be dieing of cancer
and the insurance company could not decline the individual so they charge more for it.
Florida health
insurance companies each have their own
underwriting guidelines for offering insurance?
However, insurance companies marketing and selling individual health insurance policies in Florida must file information with the Department of Insurance pertaining to their policies, procedures and underwriting guidelines for offering such insurance.
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Health conditions that would automatically not be approved;
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Health conditions that may not be approved;
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Height and weight standards;
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Health history, and lifestyle or behavior that may cause the insurance company to deny insurance, limit the products they offer, or charge more for the coverage.
Some common reasons for declination/deferrals of coverage
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currently pregnant or an expecting father
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multiple medications especially brand name
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recent (last 6 months including physical therapy) injury
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recent (last 2-3 years) treatment for heart disease, diabetes, cancer, immune system disorders, or any other serious medical condition
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height/weight outside guideline range
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multiple conditions/injuries/illnesses
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Health problems for which you have not seen a doctor;
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Health problems that a doctor cannot explain;
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Health problems for which you have not completed treatment.
Florida health insurance companies will decline you for Type 2 diabetes. But you may qualify for "Short Term" coverage lasting up to three years. Type I diabetics may qualify in August for guaranteed issue coverage if they are self employed.
If you're wondering whether there are any advantages in having an individual Florida health insurance plan instead of Employer health insurance there are several.
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Florida individual health insurance plan is cheaper because the insurance carrier can weed out individuals likely to file too many claims...people with preexisting conditions. By contrast, Guaranteed Issue or Group Health Insurance in Florida is more expensive because all employees of the business regardless of their preexisting conditions must be accepted. The average monthly premium for a family of four on a group plan is well over $1000/month.
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Plus the State of Florida requires or mandates that Group Health Insurance cover certain conditions, such as maternity, mental and nervous disorders and a list of other conditions.
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Also an individual health insurance plan is "portable", meaning that you can take it with you wherever you go (if you move out of State for example and switch employers) and there is no need to go on COBRA.
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individual plans normally have a greater choice of plans available and you can change plans at anytime. Use my Florida health insurance online quoting system to shop.
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Most employer groups are too small to absorb the cost of a few catastrophic illnesses. For example, if someone has a $500,000 claim one year that means the next year the cost of insurance for that employer increases by $500,000. That would have devastating consequences and mean that the Employer has to drop coverage because he is unable to distribute the premium cost increase over a large enough employee base. Hence, the employee is stranded, particularly the one with the catastrophic illness. Florida health insurance is Guaranteed Renewable.
Florida health insurance and maternity coverage.
Maternity benefits on individual health insurance varies, by insurance company and by plan. No individual plan offers maternity benefits in the same way as group health insurance does. Many companies do not offer maternity at all on individual plans. Be aware that if someone is currently pregnant they will decline her, her spouse and children as well until after the baby is born.
If a plan offers maternity benefits, it generally will have some or all of these features:
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There is a waiting period before a person would be eligible for benefits from the maternity benefit but could become pregnant during that waiting period. For example, no benefits are paid during the first 12 months the insured is on the policy and has the maternity benefit, then plan starts paying benefits.
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Another option is conception must have occurred after a set amount of time the person has had the maternity benefit, 270 days is a common time period. You must have been insured and had the maternity benefit at least 270 days before you became pregnant. Any pregnancy prior to that time would not be covered.
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The benefit is gradational over a period of time. In other words, if delivery of the child occurs within the first twelve months of the policy benefits might be reduced 50%.
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A flat amount is paid for maternity such as $4000 after a $500 maternity deductible. No more is paid no matter what the cost of the pregnancy. We do now have plans that cover all expenses associated with the pregnancy after a separate deductible is met ($1,000)...call for details (407) 425-9347.
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Insurance brokers fees are built into all quoted premiums by the insurance company. Whether you use a broker or not the premiums will be the same. Premiums are filed each year by each Florida health insurance company with the Florida Department of Insurance. You will not receive a lower quote for a particular plan by "shopping". If you do, you are being misled!
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Insurance brokers can use their experience to find you the best deal. It's only natural that since you're not in the business that you aren't aware of the changes that are constantly made, or the companies that are offering the best deals. This is exactly the kind of thing that brokers stay current with. When they pass this knowledge to you it will result in plenty of savings.
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Just because you were declined by one Florida health insurance carrier doesn't necessarily mean that all health insurance companies will decline you, the trick is figuring out which companies will work with you...one more reason to be working with an Independent Agent.
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Ask your agent if you have an out-of-state policy. Read everything carefully and make sure it has all the coverage you have requested. Typically these are called "Association Plans" and membership in the Association is a prerequisite to getting the coverage.
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Don't be afraid to mix and match plans. If you have young children that probably are going to use a doctor visit copay, place them on a separate plan with co-pays. Adults could go on a separate higher deductible plan. You will come out way ahead.
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Pay careful attention to filling out the application for health insurance completely and accurately. Pay particular attention to accurate medical history information...don't give the insurance company an opportunity not to pay claims.
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If at all possible, stay in network! Going out of network with a hospital can be very costly. Ask the agent to check the hospitals in the network that are of interest to you.
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If you are coming off COBRA onto an individual health insurance plan in Florida, make sure you are approved and satisfied with the offer of coverage before canceling your COBRA coverage. There is no going back once you have canceled COBRA and there is no "Grace Period" to send in payments. Make sure you are on automatic monthly debit (electronic debit of a checking account)....don't give the insurance company an opportunity to say they never received your payment.
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If you can manage to stay healthy you can switch health insurance plans as your renewal premiums become higher then premiums offered to new enrollees. Insurance companies penalize you the longer you stay with them, they figure you are going to switch companies if you are healthy unless you are with an insurance company domiciled in Florida .
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Check the Exclusions and Limitations Section carefully (usually located in the very back of the brochure). Most often the Exclusions are fairly standard, i.e. injury during acts of war, self-inflicted injuries, cosmetic surgery, experimental procedures.
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Florida health insurance - working with an Independent Broker.
Using an instant quoting system does not provide access to all the Florida health insurance plans available to you and there is a high probability that you are not getting the coverage that you think you are purchasing. Speaking to me personally will guarantee the lowest premium available to you and that you will fully understand the coverage. And when renewal comes around in 12 months you will have a personal agent that will shop for the cheapest plan out there for you.
If you haven't already you should start reviewing some Florida health insurance quotes. Make sure you understand the terminology and remember there will be a test afterward...you pass by choosing the right plan at the right price for you! Choosing a Florida health insurance plan is perhaps the single most important financial decision you will ever make.