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Cover Florida Health Insurance Detail

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Please Read Our Opinion About Cover Florida Here

Message from Governor Charlie Crist

Dear Friends,



During the 2008 legislative session, my administration worked with legislators of both parties to secure unanimous approval of the Cover Florida Health Care Access Program. This legislation makes affordable health coverage available to 3.8 million uninsured Floridians through a comprehensive market-based strategy.



Cover Florida allows insurers to create innovative health insurance products that are affordable and guaranteed to Floridians who have been without insurance for at least six months, or who are recently unemployed – even if there are pre-existing health conditions. The coverage is voluntary for both individuals and for employers, and employees can even take their coverage with them if they change jobs.



Cover Florida gives uninsured Floridians the opportunity to take charge of their own preventive health care. Cover Florida benefit options include a robust set of benefits, such as coverage for preventive services, screenings, and office visits, as well as office surgery, urgent care, prescription drugs, durable medical equipment, and diabetic supplies.



No tax dollars were required to create the Cover Florida health insurance plans. Instead, six private insurance companies have partnered with the State of Florida to offer affordable health insurance coverage. If you have gone without insurance for at least six months – or have recently lost your employer-sponsored insurance – I encourage you to learn more about Cover Florida. It may be exactly the health insurance you have been looking for.

Cover Florida Health Access Program Summary

Cover Florida gives Floridians access to more affordable health insurance options. Created without tax dollars, it is voluntary for both individuals and employers.



Cover Florida plans were selected by the State of Florida through a competitive bidding process. Six private insurance companies were chosen based on their proposed robust, innovative and affordable health insurance products.



United Health Care and other health plans will be available in all 67 Florida counties. In addition, four counties will have further options. Broward County will have two additional options: Medica Health Plan of Florida and Total Health Choice.



Miami-Dade County will have three additional options: Medica Health Plan of Florida, Total Health Choice and JMH Health Plan.



Flagler and Volusia counties will have one additional carrier, Florida Health Care Plans.

Cover Florida Benefits





The six carriers have designed 27 creative health insurance products .



Each carrier offers at least two benefit options – one with catastrophic and hospital coverage, and one without. This flexibility gives Floridians more choices in selecting the plan that meets their needs.



Cover Florida plans have a robust set of benefits that include coverage for preventive services, screenings, office visits, as well as office surgery, urgent care, hospital coverage, emergency care, prescription drugs, durable medical equipment, and diabetic supplies.



Cover Florida gives Floridians the opportunity to choose primary and preventive care instead of costly visits to emergency rooms.





Eligibility for Cover Florida





Cover Florida plans are available to all Florida applicants ages 19 to 64 who have been without health insurance for at least six months – even if there are pre-existing health conditions. 



Floridians may also be eligible to purchase Cover Florida plans under the following conditions:



Loss of a job that provided employer-sponsored health benefits.



Loss of benefits under COBRA.



Death of, or divorce from, a spouse who has provided employer-sponsored health benefits.







Cover Florida plans are portable from one employer to another because they are individual policies. Employers may voluntarily share in the cost of the plan with their employees or may assist employees with a payroll deduction, providing a pre-tax benefit for the employee and a payroll tax break for the employer.





FAQs



When will Cover Florida plans be available? Cover Florida policies will be available to Floridians by January 5, 2009.





Who is eligible for Cover Florida? Cover Florida plans are available to all applicants age 19 to 64 who have been without health insurance for at least six months, and are not eligible for a public health insurance program such as Medicaid or Medicare.





Are there exceptions to the six-month exclusion? Yes. If you have had health insurance in the past six months, you can still participate in Cover Florida if you lost coverage due to any of the following reasons:

Loss of a job that provided an employer-sponsored health benefit plan.



Death of, or divorce from, a spouse who was provided an employer-sponsored health benefit plan.



Exhaustion of coverage that was continued under COBRA or continuation-of-coverage requirements under s. 627.6692, Florida Statutes.






Are there any mandates for participation in the Cover Florida plan? No, the Cover Florida plan is voluntary for both individuals and employers. There are no mandates on individuals or on employers to participate.





Will I be denied coverage for a pre-existing condition? No, Florida applicants with pre-existing health conditions will not be denied enrollment in a Cover Florida plan. However, Cover Florida plans can exclude payment for treatment of a specific pre-existing condition for one year. After one year, the plan must cover for treatment of pre-existing conditions. During the one-year period, however, you are covered for services that are not related to your pre-existing condition.





How do I enroll in Cover Florida plans? After Cover Florida plans become available for purchase on January 5, 2009, applicants can purchase plans directly through one of the six authorized Cover Florida providers.



At least two carriers are available in every county. See the “Available Plans” section of the www.echealthinsurance.com Web site to learn which plans are available in your area. Interested individuals and employers can learn more by contacting each company directly.



The State of Florida will not be involved in the purchasing process. Each insurance company will have a Web page and a toll-free telephone number where you can learn about available Cover Florida plan benefit options.







What are the rates for Cover Florida plans? Cover Florida plans can be purchased for as low as $23.70 per month. However, the rates for Cover Florida plans vary depending on the applicant’s age, gender and chosen benefit options. Typically, preventive plans do not cover hospitalization; however, have lower monthly premiums than catastrophic hospitalization benefit plans. See the plan details in the Web site to see examples of rates.





Is the state subsidizing any of the premiums for Cover Florida? No, there are no subsidies for Cover Florida premiums. However, employers may voluntarily share in the cost of the plan with their employees or may assist employees with a payroll deduction, providing a pre-tax benefit for the employee and a payroll tax break for the employer.





Will Cover Florida plans include all of Florida’s mandated benefits? No, Cover Florida plans will not be required to include all of Florida’s mandated benefits, nor will they be “bare-bones.” Instead of limiting the types of benefits offered, Cover Florida plans contain costs through the quantity of services, such as number of office visits or number of days in the hospital that policyholders may use each year.



All approved insurance plans offer consumers at least two plans, one with catastrophic and hospital coverage, and one without. All Cover Florida plans benefit options include – at a minimum – coverage for preventive services, screenings, office visits, as well as office surgery, urgent care, hospital coverage, emergency care, prescription drugs, durable medical equipment, and diabetic supplies.







Do Cover Florida plans cover diabetic supplies? Yes, all Cover Florida plans include coverage for diabetic supplies.





Are there coverage options for children under age 19, or for children of policyholders in the existing insurance market? Yes. The Cover Florida legislation also expands coverage options for children. First, Cover Florida policyholders may also purchase individual plans for their spouses and children. Further, the legislation permits all Florida families to pay full premiums and “buy in” to the Florida Kid Care Program. The legislation also requires all insurance carriers – not just Cover Florida carriers – to offer families the option of keeping children enrolled on the family policy up to age 30, as long as the child is unmarried and does not have any dependents of his or her own.





Are Cover Florida plans portable? Yes. Cover Florida consumers can take their coverage with them if they change jobs or become unemployed. This portability is possible because Cover Florida plans are designed to cover the individual, regardless of employment status or employer participation.





What is the Florida Health Choices Corporation, and how does this “clearinghouse” differ from Cover Florida? The legislation that created the Cover Florida plan also created the Florida Health Choices Corporation. The corporation will oversee a centralized “marketplace” where small businesses with fewer than 50 employees may offer employees a chance to choose from a variety of new health care plans and services. These products will be overseen by a Board of Directors, comprised of appointees of the Governor, President of the Senate and Speaker of the House.



While Cover Florida plans will be available to individual Floridians regardless of employment, plans and services offered through the “marketplace” will be available to employees of small businesses that have chosen to enroll in the “marketplace.”







Can I see my own doctor? Once plans begin enrolling consumers, you will need to contact the Cover Florida plan for which you wish to enroll to see if your current physician is included in their network. 





Is there prescription coverage? Every plan offers at least one of the following: prescription drug benefit coverage, use of a prescription drug manager, or a discount drug card. Each plan will vary.





I am an employer. Are there group plans available for my employees? Group plans may be offered by the participating plans. Once plans begin enrolling consumers, you will need to contact the Cover Florida plans offered in your area to learn specific details. All plans are portable, meaning that the enrollee remains covered regardless of the status of employment or the employer’s cost-sharing of premiums, as long as premiums are paid in a timely manner.










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