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The Basics Of Florida Group Health Insurance Schemes

Many Americans are members of group health plans and the regulations governing group plans in the state of Florida are similar to those seen in most other states, although there are a number of differences which may apply for public employees.

If you wish to join a group health plan you must first be eligible for the scheme. For example, although an employer may operate a group health scheme, it may not be open to all employees, possibly being aimed at only full-time workers. In addition, the scheme may be operated by an HMO and you could discover that you live outside of the HMO's service area.

Should you be eligible for the scheme then you must be allowed to join regardless of your state of health. In this case your state of health refers to your present health, taking into account any disability which you may have, as well as your past medical history. It is also interesting to note that you cannot be refused membership as a result of genetic information.

It is important to understand here that, while an employer is permitted to refuse you membership because you do not for example work enough hours, he in not allowed to exclude you based solely on your current or previous medical history.

The vast majority of plans will have an enrollment period during which you must join the scheme which might typically be within about 30 days or joining the company. However, if you decide not to join at this stage then an employer is required to give you a further opportunity to join during what is often called a special enrollment period if certain specified changes occur within your family. These changes might include things like marriage, the adoption of a child and the loss of alternative health insurance coverage as the result of things like the cessation of coverage provided through another family member as a result of death, legal separation, divorce, reduction in working hours, retirement, termination and similar things.

Almost all plans will also generally include a waiting period for membership which is typically anything from 30 days up to about 3 months. An employer has to apply this waiting period consistently to all employees and during this time you will not be covered under the group scheme.

If the group scheme which you are joining is operated through an HMO then that HMO may also require a waiting period (usually called an affiliation period) during which you will once again not be covered. Affiliation periods applied by an HMO cannot generally be greater than 2 months and when such a waiting period is applied the HMO is not allowed to then impose any pre-existing conditions exclusions.

Under the provisions of Florida law any group plan which includes cover for dependents also has to provide automatic cover for newborns, newly adopted children and children placed for adoption for 31 days after the date of birth, adoption or placement. The may also require parents to register such children with the scheme during this 31 day period if cover is to continue thereafter.

In the case of parents caring for disabled children who are covered under a group plan cover will generally continue beyond the age at which a child would no longer be classed as a dependent, as long as the parents can demonstrate that the person in question cannot support himself (or herself) as a result of mental or physical disability and that they are largely dependent upon the plan member for support.

If you are working for an employer with at least 50 employees then you may take a leave of absence without loss of health insurance for up to 12 weeks in some circumstances. This protection is guaranteed under the Family and Medical Leave Act (FMLA) to cover things like childbirth, sickness or the need to take care of a seriously ill member of your family.

Federal law allows states down to local government level to exempt government employees from some areas of coverage in self-insured group plans and a lot of public employers in Florida make use of this to a greater or lesser degree. As exemptions vary widely between employers it is wise to discover the exact coverage provided if you are a public employee. These details may also be found by getting in touch with The Center for Medicare and Medicaid Services (CMS) which keeps a list of exemptions for individual employers.

In spite of the fact that according to Florida law you cannot be refused membership of a group health plan on the basis of health, there are some circumstances in which exclusion periods may be imposed for pre-existing conditions. However, this is a complex topic and one which is therefore the subject of a further article.