The Effect of Hypertension/High Blood Pressure on Floridas Health Insurance Premiums and Pre-Existing Conditions
As requested, below you will find the Florida statute pertaining to Florida Health Preexisting Condition Law and which I believe will be able to best answer your question. The first snap shot is an excerpt from the benefit summary. Essentially, with all medically underwritten Individual insurance plans in Florida (the one that we’re discussing not the guaranteed issue, or HIPAA, etc. scenarios), you are subject to a maximum of 24 months waiting period before a preexisting condition is covered unless you have had creditable coverage within 62 days of obtaining the new coverage in which case that 24 month waiting period would then be waived.
Please note that a PPO in Florida can issue exclusionary riders and/or rate modifications to a policy and does not relate to this preexisting clause. For instance, in your mother’s case, she will have the preexisting clause apply and for the first 24 months of coverage she would not be covered for any preexisting condition in which she has obtained treatment for or should have received treatment for as is further explained below, for the preceding 24 months before her effective date with this new coverage.
Furthermore, an example of this would be if she were to have generalized anxiety disorder at the time she was submitting her application, the underwriting department could decide to issue a permanent exclusionary rider on that condition and never cover any medical benefits related to that specific condition. If she were to develop Generalized Anxiety Disorder within the first 24 months of coverage and had no prior treatment or indications of the condition, all benefits would be covered according to the contract and terms of her policy since it would be deemed as a medical condition in which was not present 24 months prior to her effective date. The medical underwriting team and/or the claims department would have the right within the first 2 years of coverage to obtain your medical records and review accordingly to ensure that said condition manifested itself as a new condition and not apparent during those 24 months immediately preceding her effective date with the new policy.
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