Florida is a state with an historically complicated insurance landscape due both to its geographic location in terms of property and disaster insurance, and the diversity of its population with a high percentage of retirees in the realm of health insurance. As health care reform in the United States moves forward under the provisions of the 2010 Patient Protection and Affordable Care Act, there will be changes to state regulations to comply with federal statutes.
Under the provisions of the Affordable Care Act, children can no longer be excluded from health insurance policies due to pre-existing conditions and may remain on their parents’ policies up to age 26 even if they are not in school and have married. The protection against pre-existing condition exclusion will be afforded adults by 2014. In the meantime, the major responsibilities of the states in regard to health care reform involve the formation of high risk insurance pools and the implementation of health insurance exchanges.
General Insurance Regulations
In Florida, there are no coverage denials or limitations for group plans, and insurance companies cannot charge additional rates based on a health condition as long as there has been continuous coverage. Insurance companies can make group rates higher if a large number of employees are considered high risk. Guaranteed renewability ensures that once a policy is in place, it cannot be cancelled due to a medical condition as long as the terms of the contract are met.
In addition to the guaranteed renewability clause, Florida insurance companies can currently require that applicants meet a pre-existing clause. There is no limit to the exclusion period, but most Florida insurance companies fix it at two years. There is also temporary coverage available for people who are in-between jobs or need health insurance for a temporary time.
Creation of Health Care Exchanges
There has been no significant activity in the state toward the formation of a health care exchange and Florida is, in fact, the primary plaintiff in a lawsuit brought by 26 states seeking to have large portions of the Affordable Care Act declared unconstitutional.
Florida did enact a law on June 2, 2011, however, stipulating that any health care coverage purchased through an insurance exchange cannot cover abortions unless the case is an instance of incest, rape, or life endangerment. Separate coverage for abortions may be purchased from entities not supported by state or federal funds.
Pre-Existing Condition Insurance
The Florida high-risk pool or Pre-Existing Condition Insurance Plan program is administered by the U.S. Department of Health and Human Services. Covered benefits include hospital care and prescription drugs as well as specialty and primary care. Depending on age and option status, monthly premiums range from $118 to $505. Deductibles fall in a range of $1000 to $3000 and there may be a separate drug deductible. Copays for doctor’s visits are $25 and out-of-pocket expenses cannot exceed $7000 annually.
Florida Healthy Kid Program and Cover Florida
The Florida Healthy Kid Program (Kidcare) was created to help uninsured children and is supported by a variety of tax funds. The coverage protects children who otherwise would not have insurance.
The Cover Florida program accepts policyholders age 19-64 who have been without health insurance for at least 6 months and who do not qualify for Medicare or Medicaid.
Medicaid
All Medicaid eligibility is determined as a percentage of the Federal Poverty Level as are benefits derived from CHIP-funded Medicaid Expansions. In Florida, infants under the age of 1 qualify at 185% FPL, those 1-5 at 133%, and 6-19 at 100%. CHIP funds are available for infants under 1 year of age at 200% FPL.
Pregnant women can draw Medicaid benefits at 185% FPL, parents at 22%, and non-elderly disabled Social Security recipients at 75%.