Florida individual health insurance

Florida Health Insurance for Individuals

If you're coming off an Employer-sponsored or Group health insurance plan, you may think you've entered the twilight zone. Soaring premiums, preexisting condition limitations and slow Underwriting procedures are but a few of the many problems you are about to encounter.

Employer sponsored health insurance is becoming increasingly rare as higher premiums have placed such coverage beyond the reach of most small employers. If such a plan is not available to you or you find yourself becoming self employed you may want to buy an individual health insurance policy from a private insurer.

In Florida - as in most other states - you have limited guaranteed access to individual health insurance. Whether you can buy an individual health policy will depend on your health status, the kind of coverage you want to buy, and other circumstances. There are alternatives to individual health insurance coverage - such as COBRA coverage and Conversion policies.

What characterizes Florida health insurance plans?

If you have preexisting conditions when you apply for an individual health insurance plan, those preexisting conditions may not be covered and in fact may cause you to be declined. This is regardless of whether you have had continuous coverage or not and whether you are coming off an employer sponsored plan or not.

Your Florida individual health insurance plan is non-cancelable based on the number of claims you submit or how sick you get. The only way it can be canceled is for failure to pay your premium or lying on your application...an intent to mislead or misrepresent your medical history.

Your rates are usually fixed for the first 12 months of a policy. Some policies we offer come with a 24 month rate guarantee. But 12 months is the industry norm here in Florida. After that you can expect to see rate increases annually. Rate increases must be approved by the Florida Department of Insurance as well.

Since your policy is not guaranteed issue it will be subject to medical underwriting. Florida insurers can issue policies with Riders anywhere from 1 year to 2 years or the life of the policy depending on the carrier and depending on the condition. You can also be declined for coverage.

After one year without treatment of a preexisting condition excluded from coverage by a Rider, the insurer is required to consider removing it upon written request of the insured.

On an individual Florida health insurance plan you will generally see lower rates because the insurance company is allowed more flexibility in who they choose to accept (unlike guaranteed issue States like New York, Massachusetts, Maine, Vermont and New Jersey) and what benefits they offer (as opposed to mandated benefits the State requires insurers to offer in employer-group plans...maternity insurance is an example of a mandated benefit.

Licensed insurance agents can be a helpful starting point when shopping for insurance. Some agents, called Captive Agents, only represent one health insurance company. Other agents, called independent agents, represent several companies and can offer you more objective advice when selecting a plan then a Captive Agent. So it is wise to seek out the services of an independent agent where possible.

What will my individual health insurance policy cover?

It depends on what you buy. Florida does not require health insurers in the individual market to sell standardized policies. Insurers can design different policies and you will have to read and compare them carefully. However, Florida does require all health insurers to cover certain benefits - such as childhood immunizations, mammograms, and diabetes treatment (these are more examples of mandated benefits more prevalent in employer insurance). Check with the Florida Department of Financial Services for more information about mandated benefits.

What questions should I be asking when I am comparing plans?

Every situation is a little different but in general, you are comparing benefit levels so pay close attention to deductibles, co-insurance, maximum out-of-pocket expenses and dollar or day limits on certain medical treatments. Also, you should review exclusions in the policy and any cost containment features such as only paying for usual, customary and reasonable charges. If an agent only shows you one plan and it places dollar limits on important items in a hospital bill like miscellaneous expenses, anesthesia, surgical fees etc....TASER him and ask questions later!

These are called "Scheduled Benefit Plans" and they are a ticking time bomb. You have no idea what you will end up paying on a claim. Work with an Independent Agent that truly represents more then one company from at least the top carriers.

Some guidelines if you intend to purchase a Florida individual health insurance plan.

Individual health insurance plans are non-cancelable and you can not be singled out for rate increases based on claims.
Price: We all have budgets. A good independent agent, can help you quickly shop apples-to-apples between the major insurance providers. You can also use online quoting and comparison systems such as those found here at instant, online Florida health insurance quotes. No one insurance provider, at this time, is the low cost leader for every situation.
Normally you have to go 12 months with no treatment (including seeing a doctor for the condition or being prescribed a medication for it, before a health insurance company considers it not to be preexisting. In certain situations where a doctor hasn't been seen recently you may be asked to undergo a paramed exam.
Prescription Drug Card Benefits - Policies with Brand Rx coverage can get costly. Generic Rx is cheap and costs the insurance company very little. Adding Brand Rx coverage with a $500 or $1,000 deductible can really bring you total monthly premium costs down.
Preventive (Wellness) Benefits – Many co-pay plans (not all) will have some level of preventative benefits. Many times these plans have a dollar limit to be used toward preventative benefits. An important thing to understand with this benefit is that the money can only be used towards certain benefits:

Women – benefits can typically only be used to cover cost of pap smears and after a certain age (or younger if family history) mammography's for women. Any blood work or other routine labs or tests are typically out-of-pocket.

Men – the benefit is usually limited to PSA (prostate screening) tests and colorectal screenings and at older ages could help pay for such things as a colonoscopy. There are often, however, often benefit limitations. Thoroughly review your benefits to understand what is covered by the plan and what isn't.

Oh to be young and uninsured! Bad idea...a serious case of pneumonia can run you more then $175,000, a head injury from a car accident could set you back $45,000. Bills from a spinal cord injury could exceed $650,000. People without health insurance or underinsured are less likely to get preventive screenings and more likely to be diagnosed at an advanced stage of a life threatening illness...according to the American Cancer Society.
Ask your agent if you have an out-of-state individual health insurance policy. Read everything carefully and make sure it has all the coverage you have requested. Typically these are called "Association Plans" and membership in the Association is a prerequisite to getting the coverage.
Consider mixing and matching plans. If you have young children that probably are going to use a doctor visit copay, place them on a separate plan with co-pays. Adults could go on a separate higher deductible plan. You will come out way ahead.

Even getting a high deductible individual health insurance plan is far less risky then going without health insurance entirely. And remember you receive instant benefits with PPO discounts...those discounts are nothing to sneeze at and can save you thousands depending on the carrier!