Private Health Insurance and Publicly Sponsored Programs For Florida Health Insurance Coverage
Small businesses
(1-50 employees)
U.S. Uninsured Help Line
800-234-1317
Group Health
Florida Association of Health Underwriters www.fahu.org
Up to $5M lifetime maximum, assorted deductibles
If uninsured for previous 1-6 months, a waiting period for coverage of pre-existing conditions may apply
Pre-Existing Health Conditions Covered
GUARANTEED COVERAGE Company size 1-50 employees Two employees must work for
at least 6 months out of the year, and work 20 hours per week for coverage
Individuals recently covered by an employer
COBRA and Mini-COBRA
And then
HIPAA
Health Insurance Portability and Accountability Act
866-4-USA-DOL www.dol.gov
Cobra Subsidy: 9 months of partially subsidized COBRA premium
COBRA /Mini-COBRA coverage is available for up to 18 months depending on qualifying events
COBRA benefts are the same as what you had in your group coverage
After COBRA expires, HIPAA individual plan conversion benefts are based on the program selected, no expiration
Pre-Existing Health Conditions Covered
GUARANTEED COVERAGE Cobra Subsidy: If you were involuntarily terminated between Sept 1, 2008 and Dec 31, 2009, you are eligible for a COBRA subsidy from the Federal Government. If you become eligible for other insurance, you will no longer be eligible for the subsidy. If you turned down COBRA from Sept 1, 2008 to Feb 17, 2009, you are eligible for the subsidy. Must have an income at or below $125,000 for individuals or $250,000 for couples.
Individuals and Families in Florida
U.S. Uninsured Help Line
800-234-1317
Individual Plans
Florida Association of Health Underwriters www.fahu.org
Assorted plans depending on medical needs
There is a 24-month look-back and exclusionary period limit for pre-existing conditions in traditional individual market health insurance products in Florida
Pre-existing conditions may not be considered for HIPAA-eligible population
Limits on pre-existing health conditions may apply
Eligibility is subject to medical underwriting
If you are denied coverage for a medical condition, you may be eligible for FCHA, see next column
Individuals with pre-existing,
severe or chronic medical conditions
Cover Florida
877-872-6580 www.coverforidahealthcare.
com
Six carriers have designed 27 creative health insurance products. Each carrier ofers at least two beneft options – one with catastrophic and hospital coverage, and one without. Benefts include preventive services, screenings, ofce visits, as well as ofce surgery, urgent care, hospital coverage, emergency care, prescription drugs, durable medical equipment, and diabetic supplies.
Pre-Existing Health Conditions Covered
GUARANTEED COVERAGE Ages 19 to 64 who have been
without health insurance for at least six months – even if there are pre-existing health conditions. May also qualify if you lost your job that provided employer-sponsored health benefit, lost of benefits under COBRA; death of, or divorce from, a spouse who has provided employer-sponsored health benefit.
Low-income individuals & families
Medicaid
850-488-3560 Medicaid Options Help Line
888-367-6554 www.fdhc.state.f.us/Medicaid
Among some of the services: ambulatory surgical center birth center services, child health check up chiropractic care, durable medical equipment and supplies, federally qualifed health centers, home health hospital inpatient/outpatient care, laboratory, licensed midwives, physician, podiatry prescriptions, rural health clinics, therapy, X-rays
Pre-Existing Health Conditions Covered
GUARANTEED COVERAGE Pregnant Women: 185% FPL Children (Ages 0-1): 200% FPL
Children (ages 1-5): 133% FPL Children (ages 6-19): 100% FPL
Aged, Blind and Disabled: 90% FPL Supplemental Security Income Recipients: 74% FPL
Children
Florida KidCare
MediKids, Healthy Kids, Children’s Medical Services and Medicaid 888-540-5437 877-316-8748 TTD www.foridakidcare.org
Comprehensive health insurance coverage
Benefts vary based on the segment of the program in which a child participates— MediKids, Healthy Kids, or the Children’s Medical Services (CMS) Network for children with special health care needs
Pre-Existing Health Conditions Covered
GUARANTEED COVERAGE Under age 19 and uninsured Have an income at or below
200% of the FPL Be a U.S. citizen or qualifed
non-citizen Cannot be eligible for Medicaid Not be the dependent of a state
Women In Florida
Breast and Cervical Cancer Prevention
800-227-2345 www.doh.state.f.us/Family/bcc
(Pregnant women see Medicaid)
Breast and cervical cancer screening exams (mammograms, pap smears and clinical breast exams) are provided to diagnostic exams are provided as necessary case management is provided to all clients
Outreach, public education and professional education is provided
Treatment for eligible women may be paid by Medicaid
GUARANTEED COVERAGE Uninsured and underinsured
women 50 to 64 years of age, at or below 200% of FPL
Seniors and Disabled
Medicare
800-952-5253 800-MEDICARE www.medicare.gov
Medicare Prescription Drug Program
800-633-4227
Medicare ofers two standard plans, A: Hospital Insurance and B: Medical Insurance, as well as several supplemental and advantage plans
Pre-Existing Health Conditions Covered
GUARANTEED COVERAGE Disabled or age 65 and older
or people under age 65 with certain disabilities, and people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).
Trade Dislocated Workers (TAA recipients)
Health Coverage Tax Credit
866-628-HCTC www.irs.gov (key word HCTC)
Will cover 80% of your COBRA premium if employer contributes less than 50% (or spouses’ employer)
Will cover individual insurance in which you were enrolled for last 30 days before TAA benefts
Pre-Existing Health Conditions Covered
GUARANTEED COVERAGE Must be receiving TAA (Trade
Adjustment Assistance) Must not have access to
employer plan that pays 50% of coverage cost
Age 55 and older
20% of the insurance premium
Veterans
VA Medical Benefts Package
877-222-8387 www.va.gov
Comprehensive preventive and primary care, outpatient and inpatient services
Pre-Existing Health Conditions Covered
GUARANTEED COVERAGE ”Veteran status” = active duty
in the U.S. military, naval, or air service and a discharge or release from active military service under other than dishonorable conditions
$0 and share of cost and co-pays depending on income level
Other Programs In Florida
Women-InfantChildren (WIC)
800-342-3556 http://www.doh.state.f.us/ family/wic/
Partnership for Prescription Assistance
888-4PPA-NOW (888-477-2669) www.pparx.org
Florida Alzheimer Disease Initiative
850-414-2000
Florida AIDS Insurance Continuation Program
305-592-1452 http://www.doh.state.f.us/ disease_ctrl/aids/care/aicp.html
NOTE: Government programs look at each family’s circumstance to determine eligibility.
Income and assets tests may be required to determine eligibility for publicly sponsored programs.
Guaranteed Coverage means you cannot be turned down due to your health conditions.
Programs and plan availability, eligibility requirements, costs, and coverages are subject to change.
For additional assistance and to learn more about these programs, please call the u.s. uninsured Help line at 800.234.1317 <!–[if !vml]–><!–[endif]–><!–[if !vml]–><!–[endif]–> <!–[if !vml]–><!–[endif]–><!–[if !vml]–><!–[endif]–> <!–[if !vml]–><!–[endif]–><!–[if !vml]–><!–[endif]–> <!–[if !vml]–><!–[endif]–><!–[if !vml]–><!–[endif]–> <!–[if !vml]–><!–[endif]–><!–[if !vml]–><!–[endif]–>
Financial aid and free or low-cost benefits
Government Benefits Finder 800-FED-INFO www.benefits.gov
(Search tool for grants, loans and other benefits)
Catalog of Federal Domestic Assistance www.cfda.gov
(Search tool for grants, loans and other benefits)
Finding local health care options
Bureau of Primary Health Care 888-ASK-HRSA www.ask.hrsa.gov/pc
(Search tool by zip code)
Self Help Clearing House www.mentalhelp.net/selfhelp
(Search tool for people sharing information on hundreds of diseases, health conditions and other health care related situations)
Laws and regulations
Florida Office of Insurance Regulation 800-342-2762 www.floir.com
(General information on all types of insurance)
Department of Health and Human Services www.hhs.gov
(Various health care search tools)
Florida Health and Human Services www.dcf.state.fl.us/ess www.doh.state.fl.us
(State program information)
Employee Benefits Security Administration www.dol.gov/ebsa
( Official information and rules from the U.S. Department of Labor)
Help with this Matrix or finding a broker or agent
Florida Association of Health Underwriters www.fahu.org
(State organization of insurance brokers)