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More Information on Florida Health Insurance Coverage Continuation

Who Qualifies For A "Guaranteed-Issue" Policy?

There are important requirements that determine whether you qualify for a guaranteed-issue, individual health insurance policy:

• You previously held membership under an employer group health, governmental or church plan, and no longer qualify for that plan or any other group plan;
• You exhausted any available COBRA or similar continuation of coverage periods;
• You have had 18 months of coverage with no "break in coverage" for a period greater than 63 days in which you lacked group or COBRA insurance; or
• You were issued individual medical coverage in Florida because your insurer withdrew from your area and you lost coverage, or you moved to another county in Florida where your current medical plan is no longer applicable.

What do I qualify for?

If your prior group coverage was an insured medical plan governed by Florida law, you qualify for a choice of plans that "convert" you to individual coverage, called a "conversion" plan.

If your prior group coverage was through a self-insured group plan, or from an employer group insurance plan governed by the laws of another state, or you lost your individual coverage as mentioned above, then you are entitled to apply to receive a guaranteed-issue individual plan from any carrier marketing to individuals in the state. Such a carrier must offer you the two most popular products it is currently offering.

An exception applies when the administrator of a self-insured group health plan offers a conversion option that complies with Florida law. In this case, you will not qualify for any other guaranteed-issue plan except for a choice between the conversion options above.

Guaranteed-issue individual policies include the following protections:

Credit for prior coverage

If you have 18 months of previous coverage without a break of 63 days or greater, you will not have a pre-existing condition waiting period for your individual policy to begin. Your previous coverage acts as a "credit" against the longest of such periods (24 months) that an insurer may require for a guaranteed-issue policy. Any previous coverage of your spouse or dependents also acts as a credit.

Coverage for a pre-existing condition

The policy may not completely exclude coverage for pre-existing conditions for you, your spouse or dependents by issuing a rider to the policy.

Coverage for a newborn or newly adopted child

If your child was born or adopted within the last 18 months, the child does not have to meet a "prior coverage" requirement. The child qualities for benefits as soon as the policy begins.

DFS is ready to help you understand your HIPAA or health care continuation questions. If you or your insurance agent has a question, call the Consumer Helpline toll-free at 1-877-MY-FL-CFO (1-877-693-5236). You may also call the Helpline to find out if a company sells individual health insurance in Florida.