Florida, like most states, gives limited guarantees to anybody who wants to buy individual health insurance and, although your ability to buy health insurance is dependent to some extent on your current state of health, there are certain circumstances where health insurers in Florida must offer you insurance.
In general, health insurance companies are allowed to ask questions concerning your past medical history and to refuse to insure you if you have a current medical problem or have a history of particular conditions. However, more usually, insurance companies will cover you, but they will either exclude particular conditions from your plan or increase your premium and permit cover for these conditions. In Florida however one exception to the rule applies in the case of a history of breast cancer as long as you have had a course of treatment for the condition a minimum of two years prior to your current request for cover. In cases where this applies an insurance company is not allowed to refuse to cover you.
If you have been insured under a group insurance plan for a period of at least three months and then lose your cover then, in Florida, you can purchase a conversion plan and an insurance company have to offer you the choice of a minimum of two plans. In addition, companies are not permitted to inflict any new exclusion for pre-existing conditions. However, they can enforce an exclusion clause if you have not reached the end of any previously imposed qualifying period.
Where you cannot qualify for a conversion plan but are nonetheless HIPAA eligible then once again an insurance company cannot refuse to insure you and must once again offer you a choice of a minimum of two plans. HIPAA eligibility means that have had a minimum of 18 months of creditable continuous coverage (the final day of which has to have been under a group insurance policy) and have used up any continuation or COBRA coverage for which you were eligible. Further, you must not currently have health insurance (or your current group plan cover must be about to expire) and must not be eligible for a further group policy or for Medicare or Medicaid. An application for insurance coverage under HIPAA eligibility needs to be submitted within 63 days of losing your previous coverage.
Where an insurance company or HMO is no longer able to offer cover, because they have for example ceased trading or you have moved outside of their service area, then other insurance companies are required to offer to provide you with health coverage whatever your state of health.
Newborns, newly adopted children and children who are placed for adoption have to be automatically covered under a parent's individual health insurance plan for a period of 31 day from the date on which the child is born, adopted or placed.
Under Florida law a disabled child is to continue to enjoy the benefit of cover when dependent coverage has previously been in issue beyond the age at which cover would generally be ended, provided the child is unable to support himself or herself as a result of mental or physicall disability and is dependent on the policyholder for support.
In Florida the cover afforded by an individual health insurance plan will be largely dependent on the particular plan that is purchased but it is a requirement of Florida law that all plans cover specific benefits such as diabetes treatment, childhood immunizations and mammograms. The full list of required benefits is updated every now and again and a current list is available from the Florida Department of Financial Services.
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