As is the case in the majority of states, Florida gives limited guarantees to individuals who wish to purchase individual health insurance and, while your capacity to purchase medical insurance will depend to a certain degree on your present state of health, there are situations in which health insurers in Florida have to offer to insure you.
Usually, health insurers are allowed to ask questions about your medical history and to refuse to insure you if you have a current medical problem or have a history of particular conditions. However, more commonly, insurers will insure you, though they will either exclude particular conditions from your insurance policy or increase your premium and allow cover for such conditions. In Florida however there is an exception to the rule in the case of a history of breast cancer as long as you have finished a course of treatment for the condition at least two years prior to your present application for insurance. In this case insurance companies are not allowed to deny you insurance.
As long as you have been covered by a group insurance plan for at least three months and then lose your cover then, according to Florida law, you have the right to buy a conversion plan and an insurer have to offer you the choice of at least two plans. Additionally, companies must not inflict any new exclusion for pre-existing conditions. They are permitted to however enforce such an exclusion when you have not completed any previous qualifying period.
If you are not able to meet the qualifications for a conversion plan but are HIPAA eligible then once again an insurer cannot deny to cover you and must once again offer you a choice of at least two plans. HIPAA eligibility means that have had at least eighteen months of creditable continuous coverage (the last day of which has to have been under a group insurance policy) and have used up any COBRA or continuation coverage for which you were eligible. Further, you must not presently have health insurance (or be covered by a group policy which is about to expire) and must not be eligible for another group insurance policy or for either Medicaid or Medicare. Finally, an application for health insurance under HIPAA eligibility needs to be completed within 63 days of the loss of your previous cover.
If an insurer or HMO can no longer give you cover, because they have for example become insolvent or you have moved to a location outside of their service area, then other insurers are required to offer to provide you with health insurance cover whatever your state of health.
Newborn children, newly adopted children and children placed for adoption must be covered under the terms of a parent's individual health insurance plan for 31 day from the date of birth, adoption or placement.
Under Florida law a disabled child will remain covered when dependent coverage has been in issue past the age at which cover would normally be terminated, as long as the child is unable to support himself (or herself) as a consequence of either mental or physicall disability and is dependent on the policyholder for support.
The cover provided by an individual health insurance plan in Florida will depend to a large degree on the particular plan which is bought but Florida law requires that all plans cover a number of benefits such as mammograms, childhood immunizations and diabetes treatment. The full list of required benefits is updated every now and again and an up-to-date list may be obtained from the Florida Department of Financial Services.
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