Depending upon various needs and requirements, health insurance is offered to individuals, families, groups, small and medium businesses, etc. There are certain laws that go in favour of the consumers…
Depending upon various needs and requirements, health insurance is offered to individuals, families, groups, small and medium businesses, etc. There are certain laws that go in favour of the consumers and help them get the coverage; but at the same time, some rights are reserved for the companies to make their independent decision.
Indemnity plans are managed care plans are the basic categories in which health insurance is offered to the consumers. Indemnity plans provide reimbursement for claims made for receiving health care from any physician or doctor. Whereas, managed care programs have their own network of doctors, physicians, and hospitals. Some options are available in managed care plans to seek health care services from outside-network-doctors also, but the coverage provide would be less.
Types of health plans offered in Florida
Group health insurance offered by employers to the employees and the individual health insurance which can be used for the whole family are two major types of health plans used by the residents of Florida.
The rule that govern a group health plan states that an employee can’t be denied health insurance or charged more as premium costs depending on the individual’s health status. This protection is called non-discrimination. At the same time, certain changes in the family also entitle to you to be given a special chance to enrol in the group health insurance. These may include:
The birth, adoption, or placement for adoption of a child Marriage Involuntary loss of other coverage Loss of eligibility under Medicaid or SCHIP
If a health insurance plan covers the dependents of an individual, under Florida’s law, new-born’s, newly adopted children and children placed for adoption are automatically covered. The group health plan may require that the parent enrol the child within the 30 days in order to continue coverage beyond the 30 days.
A group health insurance is governed by state and federal law to impose a limit for pre-existing condition exclusion. Group health plans can exclude coverage for pre-existing conditions only for a limited time and the maximum period is twelve months. As a matter of fact:
The exclusion can be applied for those conditions for which a consumer actually received or were recommended to receive a diagnosis, treatment or medical advice within the 6 months immediately before you joined that plan. No exclusion period for pregnancy, newborns or newly adopted children, children placed for adoption, or genetic information.
In case of individual health insurance, just like any other state, the ability to buy a health plan in Florida depends directly on the health condition of an individual. Insurers are free to turn down the application based on health status and other factors. But consumers who have had at least 3 months of coverage under a fully insured group health plan and then lose it, the consumer is guaranteed the right to buy a conversion policy.
The health plans can be customized and different for individuals. It always makes sense to read them before buying any of the health insurance policy.
Tips to buy health insurance in Florida Usually, a comprehensive medical coverage is better than the basic coverage. If a consumer can afford to pay fair amount of premium, the first choice should be for a comprehensive health insurance plan providing complete financial security. It is very important to know how the reimbursement of claims would be done. It is also very important to know what are the benefits offered in a plan as well as the limitations or exclusions. Sometimes, pre-existing conditions are not covered in a plan-if a consumer has any pre-existing condition, he/she should take care of the same. While going for managed care programs like PPOs, it is necessary to check whether the personal or preferred doctor is in the network or not. If not, will the plan charge more or provide less coverage. By increasing the deductibles, it is better to lower the monthly premium costs. It works well if a consumer enjoys a fairly decent health status. The main driving force before finalizing any health insurance plan should not simply be the word “cheap”. Proper level of coverage, total understanding of the process involved and comfortable limits of the budgets should be the ruling factors.
Alen Lisa is an authority on Low Income Health Insurance Florida in the USA. he is currently expansing his expertise on the various Low Cost Health Insurance Florida options available in the country.