A lot of Americans are enrolled in group health insurance plans and the regulations governing group plans in the state of Florida are similar to those in many other states, although there are several differences that could apply in the case of public employees.
To join a group health insurance scheme you must first be eligible for memberships of the scheme. For example, in spite of the fact that an employer may run a group health insurance scheme, it may not be open to all employees, perhaps being designed for full-time and not part-time workers. In addition, the scheme may be run by a Health Management Organization (HMO) and you may find that you are living outside of the service area for the HMO.
If you are eligible to participate in the scheme then you have to be allowed to join regardless of your state of health. Here your state of health refers to your current health, taking into account any disability that you may have, as well as your prior medical history. It should also be noted that you cannot be excluded from the plan on the grounds of genetic information.
It is also important to note here that, despite the fact that an employer is allowed to exclude you from a scheme because you do not for example work sufficient hours, he in not allowed to refuse you membership solely on your present or past medical history.
Virtually every scheme has an enrollment period during which you must join the scheme which might typically be within about 30 days or joining the company. If however you decide not to enroll at that stage then an employer must give you an opportunity to join during what is generally called a special enrollment period where particular changes occur within your family. Such changes might include such things as marriage, the adoption of a child and the loss of other medical insurance cover because of such things as the cessation of cover being provided through another family member as a result of death, termination, retirement, legal separation, divorce, reduction in working hours and similar changes.
The majority of plans will also normally have a waiting period for membership that is typically anywhere from 30 days up to about 3 months. This waiting period has to be applied consistently across all employees and during this period an employee will not be covered under the group scheme.
Where the group scheme that you are joining is operated through an HMO then the HMO may also require a waiting period (frequently referred to as an affiliation period) during which you will again not be covered. Affiliation periods required by HMOs cannot normally exceed 2 months and if such a waiting period is applied the HMO is not allowed to then impose any pre-existing conditions exclusions.
Under Florida law any group health plan that includes cover for dependents also has to provide cover automatically for newborn babies, newly adopted children and children who are placed for adoption for a period of 31 days from birth, adoption or placement. There may also be a requirement for parents to register such children during this 31 day period for cover to continue beyond this point.
For parents taking care of disabled children who are covered under a group plan cover will normally continue beyond the age at which a child would no longer be considered as a dependent, provided the parents can demonstrate that the individual concerned cannot support himself (or herself) as a result of mental or physical disability and that they are mainly dependent upon the scheme member for support.
If you are employed by an employer with more than 50 employees then you will be allowed to take a leave of absence without losing you health insurance for a period of up to 12 weeks in certain circumstances. Such protection is guaranteed under the Family and Medical Leave Act (FMLA) to cover such things as the birth of a child, illness or the need to take care of a seriously ill family member.
Federal law allows states, county and local governments to exempt government employees from particular coverage in self-insured group plans and a lot of Forida's public employers take advantage of this to a greater or lesser degree. Because exemptions vary widely from one employer to the next it is wise to ascertain the exact nature of yourcoverage provided if you have a public employer. This information may also be found by getting in touch with The Center for Medicare and Medicaid Services (CMS) which has a list of employer exemptions.
Although according to Florida law you cannot be excluded from membership of a group health insurance plan on the basis of health, there are some circumstances where exclusion periods can be imposed for pre-existing conditions. However, this is a complicated area and one that is therefore the subject of another article.
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