Florida Health Insurance Consultation
Do I have a pre-existing condition? Am I insurable? How do I know?
Many Floridians searching for Florida health insurance get quite confused when inquiring about pre-existing conditions. You mean I have to pay that huge premium and they aren’t going to cover my bum knee that has had surgery 50 times? Most likely the insurance company will not with an individual health insurance plan. What is a pre-existing condition? And how do I know if my Florida health insurance plan will cover it?
First you must understand that there is a huge difference between a Florida group health insurance plan that many are used to through their previous employer from that of a Florida individual health insurance plan. Understanding the difference between group and individual health insurance is the starting point in figuring out how your pre-existing conditions will be covered.
Florida group health insurance that entails two or more employees on the group certificate will cover pre-excising conditions if you have had credible coverage within 63 days of applying for your new coverage. If you are outside the 63-day window and are now obtaining group health insurance coverage you will most likely have to wait 12 months until your condition is covered.
The other type of coverage you could obtain if you do not have access to employer group, Medicare, or Medicaid health plans is better known as individual health insurance coverage. Individual health plans in Florida are medically underwritten based on your medical history. An individual health insurance carrier can do the following when they underwrite your policy.
- Accept you with a preferred rate
- Accept you with a rate increase
- Accept you with a rider on your policy
If you are lucky enough to obtain a preferred insurance rate you are in the clear. If you accepted with a rate increase there has to be a reason based on your medical history. If you obtain insurance with a rider most likely they will not cover any claims due to your pre-existing condition. This can sometimes be reviewed and taken off after 12 or 24 months depending on the individual insurance carrier.
Do I have a pre-existing condition? Ask yourself the following questions:
- Do I take a medication for an injury or illness?
- Have I had a major surgery or illness in the past 10 years that still needs medical attention?
- Have I had one of the big medical issues, cancer, hear attach, stroke, or renal failure?
If you answered yes to any of the above questions, most likely you have a pre-excising condition.
Common pre-existing conditions that are not covered by the Florida individual health insurance market would be:
- Type 1 Diabetes
- Cancer within the past 2 years
- Any heart attaches, stints, or strokes
- Renal Failure
Every insurance carrier follows state guidelines on accepting or declining based on pre-existing conditions. Make sure your insurance agent, broker, or web portal educates you before applying for an individual medical plan in Florida
Common pre-existing conditions that are covered with a rate increase or rider in the Florida individual health insurance market would be:
- High Blood Pressure
- High Cholesterol
- Attention Deficit Disorder (ADD)
Every single case is underwritten on a case-by-case basis. Make sure to check with a few insurance carriers. Many companies offer different underwriting guidelines, so be sure that you are getting the correct policy for yourself or family based on pre-existing conditions. The mentioned conditions are just a few known ailments considered as pre-existing conditions. Be sure to consult with your insurance professional to understand what the insurance carrier will do before you complete an application for insurance.
HMO & PPO PLANS EXPLAINED
Do you know what category your group health insurance plan falls under? There are three major types of group health insurance plans in the market place. Make sure you have the facts and choose a plan that meets your philosophical ideals:
The first plan is called an HMO (Health Maintenance Organization). HMO’s are highly focused on managing your health care and telling you what Dr.’s and hospitals you can choose. They believe that preventive care should be used to keep individuals on the plan healthy. Many HMO polices cover your preventive bookwork, mammograms, and all items associated with annual physicals. They try to keep these types of plans cost effective by offering a much smaller network than some traditional plans. They tend to negotiate very good contracts with the medical industry, thus they can keep their costs low. In many cases over the past few years HMO’s have caught a bad wrap. With new technological advances in healthcare many of the new types of treatment are not covered under HMO certificates. If you want choices when it comes to making serious decisions regarding your health in a time in need an HMO is probably not the plan for you. HMO health claims are paid on reasonable and customary charges.
The second type of plan is called a PPO (Preferred Provider Organization). Insurance plans that are PPO certificates allow participants some choice in their personal providers. Most PPO’s offer you benefits that will be covered as in or out of your network. Although you will get the greatest benefits going to providers in your network, it is nice to have that option of a higher copay or deductible, out of your network. PPO health plans are the most popular. Having the option to go in network and out of network makes PPO’s very attractive. PPO health claims are paid on usual and customary charges.
The third plan is called a fee-for service plan. Fee for service plans are the best in the industry. The carrier pays the provider directly for the balance of fees due after the participant pays his/her required portion. Individuals can choose whatever Dr. or hospital they would like to use. In many instances you will have to pay out of pocket fees up to the limit of a set deductible before the insurance carrier pays for everything else. These are a more traditional way of thinking about health insurance. Fee for service health claims are paid on regular charges.
Has this helped you figure out what type of group health plan fits for you and your employees? Within these three types of plans the benefits with each certificate will very a great deal. In addition to figuring out what plan type you need to services your needs. You must also make sure you find out how responsive the carrier's customer service department is, how they rate with AM Best in ability to pay claims, and lastly check their complain ratio with the NAIC. This is a very good start to narrowing down what group health plan fits for you. Make sure to consult your broker, web portal, or risk manager before signing on the dotted line.
Health Insurance For America
How do we insure America? The gap between high medical costs and affordable health insurance seems to be widening. It seems the solution for many government policy experts and corporate America officials would be to start with the younger population and work up from there. Although they believe that the 57 million people in this country without health insurance is not a good thing, that we must start with the more than 10million uninsured children.
You could then add the four million college students, who do not have insurance, but they are usually not the individuals using health insurance, they tend to be young and healthy. Do they really need health insurance?
Follow that idea up with the 1.5 million or so uninsured people in households with total income at least $80,000, who are perhaps in a position to purchase insurance, but seem to think the big car payment is a better choice. Health insurance should be mandatory just as your car insurance -- if insurance became mandatory and if a market for affordable personal policies were created, we would then have something else to complain about.
These are some of the different ideas arising from corporate America, as change in the nation's health insurance system seems increasingly to become a political objective. The insurance marketplace is a huge industry in America and comprises a large part of our economy. Would universal healthcare make everything better? Or would millions of people lose their jobs?
Big Employers are much of what is holding the nation's piecemeal health care system together and have been very standoffish to having the government take a bigger role in medical coverage. The rise in costs for providing health insurance -- partly because of the costs imposed on the medical system by individuals with no insurance at all – have many people and their colleagues thinking that they are starting to overhaul the system.
Will these frustrations become larger? Will we have universal healthcare? What is the solution to this ever-growing problem? We can ask these types of questions all day long… Does the current system work for individuals and employers? Only time will tell as this has turned into the largest domestic issue on the table for our country.
How To Get Low-Cost Health Insurance
NEW HEALTH INSURANCE ADVICE
Purchasing health insurance can be a tricky affair. There are many kinds of insurance policies in Florida, Individual Florida Health Insurance, Florida Group Health Insurance, Florida Dental Insurance, Florida Maternity Insurance, Florida Health Savings Accounts, Florida Temporary Health Insurance, and Florida Child-Only Health Insurance.
Individual Florida Health Insurance is deemed to be expensive which makes it unaffordable to most people. Also, relatively healthy applicants alone are accepted. Some of the illnesses that are given an automatic decline are cancer, colitis, some diseases of the heart, Hepatitis C, etc…
Florida Group Health Insurance plans have premiums that have been increasing every year. Group health insurance costs a lot because it is usually sold to a group of less than 50 which means that coverage cannot be denied no matter how many people really claim it. This is the case when insurance is sold to small groups.
Dental Insurance is offered in the form of a discounted fee for a particular service plan. This means that while you pay premiums every month each of the dental procedures is offered on a discounted basis. 20% - 25% discount is normally offered on each procedure. Some of the Dental Insurance providers are Preferred Provider Organization, Dental Health Maintenance Organization, and Combo Preferred Provider Organization (PPO) & Indemnity Plans.
Florida Maternity Insurance is an insurance that is quite affordable. A flat fee is available for c-section and normal deliveries. $2200 and $3500 are offered for vaginal deliveries. All insurance plans have a waiting period of 9 to 15 months. Florida Maternity Insurance Plan offers a full coverage of pre-natal and delivery charges. Co-insurance is not available but there is full coverage after the deductibles.
Florida Health Savings Accounts (HSA) offer tax-exemption and the insurance premium fall in the lower range. HAS is a custodial or trust account. Health care expenses and medical insurance are both covered under HSA. A conforming health insurance plan is all what one needs to avail the services of HSA. Even the unemployed class can have an HSA.
Florida Short-term or Temporary Insurance Plans are complete medical plans. They can even be issued within 24 hours. They cannot be used in case of prolonged illness or hospitalization and any uninsured condition cannot be claimed for.
Florida Health Insurance for Children is a good option for people from low income groups. The parent or guardian is the applicant. This is applicable even for the new born as long as at least one member of the family is insured. Some of the common insurance plans for children are KidCare Medicaid, MediKids, Florida Healthy Kids, and Children's Medical Services Network.
Affordable Health Insurance Plans
Low-Cost Florida Health Insurance