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"We Believe Health Insurance is A Right Not A Privilege"

Florida health insurance is like an old time Western.  The law exists but it sure takes a long time to get there.  There is no 911, there is no great hero to help you fight.  The fact is that there is so many discount plans and health insurance companies that try to rip you off that unless you are with a well-known Florida health insurance comany you cannot be sure you are covered well.  This only pertains to Florida individual health insurance policies as the group health insurance policies are much more stable and reliable. We will discuss in this section the various laws that protect the Florida health insurance consumer (if we can ever find any!)  You are encouraged to email us your questions or submit them in our Florida health insurance contact section.

Florida Office of Insurance Regulation

The Florida Office of Insurance Regulation is responsible for regulating all types of insurance sold in the Florida – including health insurance policies. If you are looking for health insurance coverage, they have lists of insurance agents and insurance companies licensed to do business in Florida. Go here to find out if your insurance company is licensed to do business in Florida. You can also check for licensed agents here. If you are having trouble resolving a claims dispute with your insurer, you can file a complaint with the Office of Insurance Regulation. They have an online consumer complaint form here.

Florida Office of Insurance Regulation 200 East Gaines Street Tallahassee, FL 32399 Phone: 850.413.3140 http://www.floir.com/director/

U.S. Department of Labor If you get your insurance through your job, your plan is also regulated by the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA). They make and enforce the rules that your employer must follow when offering health insurance coverage to employees – for example, your employer cannot single out an individual employee to exclude her from the plan because she (or one of her dependents) has a costly illness. Also, if there are 20 or more employees at your job, you should be offered COBRA continuation coverage when you leave your job. The EBSA works to make sure that all of this happens and your rights are protected. If you have concerns about your employer’s practices in administering your job-based health coverage – for example, if you think you should have been offered COBRA continuation coverage, but were not, or if you feel that you were wrongly terminated from your health plan – contact your regional EBSA office.

U.S. Department of Labor Employee Benefits Security Administration Atlanta Regional Office (Northern Florida) 61 Forsyth Street, SW, Suite 7B54 Atlanta, GA 30303 Howard Marsh – Director Tel 404.562.2156 Fax 404.562.2168 http://www.dol.gov/ebsa/

U.S. Department of Labor Employee Benefits Security Administration Miami District Office (South Florida) 8040 Peters Road, Bldg H, Suite 104 Plantation, FL 33324 Isabel Colon – Supervisor Tel 954.424.4022 Fax 954.424.0548 http://www.dol.gov/ebsa/

Buying Individual Policies in Florida

As a general rule, insurers in Florida are allowed to reject your application for coverage based on your health status. There are several exceptions to this general rule:

  • If you have had at least 3 months of coverage under a group plan, you may be eligible to buy a conversion policy. This will convert your group plan into an individual policy.
  • If you had coverage under an individual policy or HMO, and your coverage was terminated because the insurer became insolvent, dropped all individual coverage in Florida, or you moved out of your policy’s service area, you may be eligible to buy an individual health insurance policy.
  • If you are HIPAA-eligible but do not qualify for a conversion policy, you are guaranteed the right to buy an individual health policy. This is a rare situation, as HIPAA-eligible individuals are those who have been covered under a group plan AND have exhausted all COBRA continuation coverage available to them.
If you are not sure whether you are eligible to buy an individual policy or a conversion policy, your insurance agent or the Office of Insurance Regulation can help you find out.

Florida KidCare – the state Children’s Health Insurance Program Florida KidCare provides health insurance coverage for children under age 19 whose family meets certain income guidelines.

Florida KidCare P.O. Box 980 Tallahassee, FL 32302-0980 Phone: 850.224.5437 http://www.floridakidcare.org/

Florida Serving Health Insurance Needs of Elders (SHINE) The Florida SHINE program provides free one-on-one counseling for Medicare beneficiaries with questions about any aspect of Medicare, including the new Part D prescription drug benefit, or Medigap coverage. Florida SHINE Program Phone: 1.800.963.5337 Florida Medicaid Medicaid is a government program designed to help the poor and indigent obtain health care services. Pregnant women and children under age 19 who meet certain income requirements may be eligible for Medicaid coverage, along with aged, blind, and disabled individuals. For more information about eligibility, contact the Department of Children and Families, Office of Economic Self Sufficiency.

Florida Medicaid Phone: 866.762.2237 http://www.fdhc.state.fl.us/Medicaid/index.shtml

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