The Principles Of Group Health Insurance Schemes In Florida

A lot of Americans are members of group health insurance plans and the rules governing such plans in Florida are similar to those seen in most other states, although there are several differences which might apply in particular to public employees.

To join a group health insurance scheme you need to first be eligible for the scheme. For instance, in spite of the fact that an employer may have a group health insurance scheme, it might not be open to everyone, possibly being meant for full-time and not part-time workers. Also, the scheme may be run by a Health Management Organization (HMO) and you might find that you are living outside of the HMO's service area.

Should you be eligible for membership of the scheme then you have to be permitted to join whatever your state of health. In this case your state of health means your present health, including any disability which you may have, together with your prior medical history. It should also be noted that you cannot be excluded on the basis of genetic information.

It is also important to note here that, despite the fact that an employer is allowed to refuse you membership because you do not for instance work sufficient hours, he in not allowed to refuse you membership solely on your present or previous medical history.

Nearly every scheme has an enrollment period during which you need to join the scheme which might typically be within about 30 days or starting work. However, if you choose not to enroll at this stage then your employer has to give you a further opportunity to join during what is normally termed a special enrollment period if certain specified changes arise within your family. These changes might include such things as marriage, the birth or adoption of a child and loss of alternative health insurance cover because of such things as the cessation of cover being provided through another family member as a result of death, divorce, legal separation, retirement, termination, reduction in working hours and similar changes.

Most plans also usually include a waiting period for membership which is typically anywhere from 30 days to about 3 months. An employer must apply this waiting period consistently for all eligible employees and during this time you are not covered by the group scheme.

Where the group scheme which you are joining is run by an HMO then that HMO can also require a waiting period (frequently called an affiliation period) during which again you will not be covered. Affiliation periods applied by HMOs cannot usually be more than 2 months and where a waiting period is applied the HMO is not permitted to then impose any pre-existing conditions exclusions.

Under Florida law any group plan which includes dependent cover must also provide automatic cover for newborn babies, newly adopted children and children who are placed for adoption for 31 days from the date of birth, adoption or placement. The can also require parents to register such children with the scheme during this 31 day period for cover to continue beyond this point.

In the case of parents with disabled children who are covered under a group health plan cover will usually continue beyond the age when a child would no longer be considered as a dependent, provided the parents can demonstrate that the individual in question is incapable of supporting himself because 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 can take a leave of absence without losing you health insurance for up to 12 weeks in some circumstances. This protection is guaranteed by the Family and Medical Leave Act (FMLA) which is intended to cover such things as childbirth, illness or the need to care for a seriously ill member of your family.

Federal law allows states, county and local governments to exempt government employees from specific coverage in self-insured group plans and many Forida's public employers take advantage of this to a greater or lesser degree. Because exemptions vary widely between employers it is a good idea to find out the exact coverage provided if you have a public employer. This information can also be found by getting in touch with The Center for Medicare and Medicaid Services (CMS) which has a list of employer exemptions.

Although under Florida law you cannot be excluded from membership of a group health insurance plan on the basis of health, there are various circumstances in which plans are permitted to impose exclusion periods for pre-existing conditions. However, this is a complex area and one which is thus the subject of another article.

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