Group Health Insurance

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Florida Group Health Insurance Plans

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What is Florida Group Health Insurance?

Florida group health insurance provides medical coverage for individuals who are part of their employer’s insurance plan. These plans give you and your family the ability to receive treatments and preventative check-ups for a lower cost than if you were covered under an individual health insurance plan or have no coverage whatsoever.

Who is Eligible
In order to qualify for a group health insurance plan in Florida, a business must first meet certain conditions. The State of Florida defines small business group health insurance as any business that employes between 2 and 50 employees. In order for an employee to be eligible they will need to be classified as a full-time employee working at least 25 hours per week. You may also need to have worked at your company for a certain amount of time, such as three months, before being eligible for benefits.

Group health insurance plans typically assess the risk of an entire group – everyone in your company – rather than that of an individual when determining insurability. This means that you are not required to take a physical examination or answer medical questions in order to qualify for coverage.  In the State of Florida group health insurance is guaranteed issue.  This means that you cannot be turned down regardless of your medical history.  However, in order to qualify for group health insurance a company must first meet certain conditions.

Types of Group Health Insurance Plans in Florida

Group health insurance in Florida is typically offered as managed care or indemnity plans, with managed care plans being the most commonly offered type of plan. Indemnity plans, also referred to as fee-for-service plans, specify a maximum amount of coverage for each type of service after you have paid your deductible and/or co-pay amount.

Managed care group health plans typically cost less than indemnity plans by offering affordable deductibles and/or co-pays without having to handle your own claims. These plans include:

  • Preferred Provider Organizations (PPO) – In this type of plan, the insurance company works with participating health care providers to render services at discounted rates. You are encouraged to use a physician within the network but have the freedom to choose an out-of-network provider for a higher deductible and/or co-pay. Additionally, most PPOs allow you to see specialists without having a referral from your primary physician.
  • Health Maintenance Organizations (HMO) – These plans provide coverage at a predetermined or fixed fee that often pays for services performed by participating health care providers for a small deductible or co-pay. In some instances, you may have no deductible or co-pay whatsoever. Also, some HMOs may allow you to choose your own physician but at a higher deductible and/or co-pay. Generally, your primary physician – also referred to as a gatekeeper physician – determines if you need to see a specialist.
  • Point-of-Service (POS) – A POS plan is similar to an HMO; however, you have more freedom to choose a health care provider outside of a network and generally do not need a gatekeeper physician for a referral to see a specialist.

Covered Conditions
Each plan specifies which conditions and procedures are covered, along with the amount of any co-pays or deductibles. Florida group health insurance plans usually cover:

  • Routine check-ups and physicals
  • Broken bones
  • Diseases
  • Surgery

Pre-existing conditions
Under certain conditions, group health insurance plans will cover pre-existing conditions that were previously treated if you were part of another group health insurance plan or if you have been covered by your current plan for a period of 12 months without a break of more than 63 days. Additionally, group health insurance plans guarantee portability of coverage. This means that should you change employers and meet certain criteria, you can continue receiving full coverage even though you may have a pre-existing condition.

Group health insurance plans may or may not be paid entirely by your employer. In some cases, you may be responsible for paying a portion of a monthly premium; however, your payment is typically made with pre-tax money from your earnings. If you have dependents listed on your policy, your premiums generally will be more expensive than single coverage.

Choosing a Plan
Having medical coverage is essential. As you choose a Florida group health insurance plan for yourself or for your employees, read the policies carefully and review everything from the premium costs to the list of available providers. Take into consideration co-pays and deductibles and how often you and your dependents may need to visit health care facilities.

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