Know More About Types of Health Insurance Plans in Florida

Individual, families, groups, and businesses need customized health insurance plans to ensure that they have to spend minimum out-of-the-pocket money for their healthcare needs. With the implementation of healthcare reforms, the options for buying health insurance are widened.

With the advent of internet technology, the concept of transparency of price is gaining momentum. Insurers in Florida health insurance are facing a compelling need of price transparency when they offer health insurance quotes to their clients. At the same time, application time and waiting time for health insurance has reduced significantly as compared to earlier times.

Types of health insurance plans offered in Florida
Apart from State and Federal governments’ sponsored program including Medicare, Medicaid, etc., there is an option of buying health insurance from private companies. Like many other states, health insurance plans in Florida are offered to the residents in traditional format. These could be classified as:

1. Individual health coverage
2. Family health coverage
3. Group insurance
4. Student health coverage
5. Dental health insurance
6. Low cost insurance
7. Low-income families insurance
8. Short-term insurance
9. Small business insurance

Companies offering health insurance Florida
Below is the list of health insurance companies offering health insurance to the residents of Florida:
• Aetna
• AMS
• Assurant
• Avalon Healthcare
• AvMed Health Plans
• Blue Cross and Blue Shield
• Celtic
• Cigna
• Coventry
• Golden Rule
• Humana One
• IAC
• Solera Dental
• Vista

Types of health plans offered in Florida

A lot of consumer end up having discount coupons, which sometimes are termed as health plans; however, it needs to be understood that these discount coupons are not insurance. To buy affordable health plans in Florida, consumers need to equip themselves with proper knowledge about the same.

Traditional categorization of health coverage in Florida offers indemnity and managed care health plans. Indemnity health plans have the insured file claims for reimbursement. While managed care health plans allow the providers to file claims for the insured person.

Managed care health plans are further categorized as HMO, PPO, and POS.

Impact of the Affordable Care Act on insurance in Florida
• 290,000 small businesses in Florida will be offered tax credits for offering health coverage to their employees.
• Medicare beneficiaries in Florida will be automatically mailed a check of $250 to defray the cost of their prescription drugs.
• Early retirees will be offered reinsurance options.
• Uninsured Floridians with pre-existing condition will have a huge boost with $351 million federal dollars made available to Florida starting July 1 to provide coverage.
• Like many other states, for the first time ever, Florida will have the option of Federal Medicaid funding for coverage for all low-income populations, irrespective of age, disability, or family status.
• 8.8 million Floridians will no longer have to worry about lifetime limits on the coverage.
• Around 1.1 million individuals will not have to worry about getting dropped from coverage when they get sick.
• Children in Florida will be able to stay with their family insurance policy till the age of 26 years.

Costs involved in a health coverage plan in Florida

It is important to understand types of costs involved in a health coverage plan to make sure that Floridians have assessed everything before they finalize a health plan. We talk about the types of costs involved in a health coverage plan:

Premium-premium is the amount of money to be paid on monthly basis. Premium is the main cost that a health plan constitutes. It could vary from person to person and in plan to plan. It mainly depends on the age, gender, and health status of a consumer applying to get health coverage.

Deductible-deductible is the second major cost involved in a health plan. It is the amount of money that a consumer pays before the insurer actually begins to pay for the coverage. With higher deductibles, premium costs are reduced.

Coinsurance – coinsurance, as the name explains itself, is the amount of money that the consumer agrees to pay in percentage of the total cost of medical service after the deductible has been paid. Generally, it is usually 80/20 of the total value where 80% of the cost is paid by the insurance companies while the 20% is by the consumer.

Copay – copay is like coinsurance but it is not represented in percentage but in real value. Moreover, there is no consideration of deductibles in copays. Supposing a consumer needs to pay $70 per visit for the doctor: with copay, consumer will be paying $40 and the remaining $30 will be paid by the insurer. However, this copay facility will have some impact on the premium costs.

What to Do If You Were Turned Down For Health Insurance

If you’ve been living without health insurance, you’re not alone. 15.9 percent of all Americans are uninsured as reported by the UHF (United Health Foundation). Sadly, sometimes even when people are trying to be financially and socially responsible they’ll find that they’re unable to qualify for a health insurance policy.

According to survey by U.S. Census Bureau, nearly 60 percent of the population gets health insurance in the form of group policies through their employer. There are other people who get covered by government-sponsored health care, such as children, the elderly, and those with low incomes. Until recently, however, those outside of these groups were largely at the mercy of the policies of for-profit insurance companies when it came to whether they could get coverage.

If initially turned down, ask again or apply with another insurance provider

If you find that you’re in this group that has difficulty getting coverage, the first thing you should do is to try to find out what happened. In some cases, you may be rejected due to an error on the part of the company. If the reasons for your rejection were minor, you may also still be able to get individual insurance through another company. However, if you have a major pre-existing condition such as Cancer or Diabetes, it’s unlikely that any insurance company will consider you a good risk and you’ll have to seek out other options.

State high risk health insurance pools as an option

It is for this reason that a national high-risk insurance pool will be created within 90 days following the passage of the March 2010 Health Care Reform Act for people with existing medical conditions. The pool is backed by $5 billion in federal subsidies, and will offer subsidized premiums to people who have been uninsured for at least six months and have medical problems that have resulted in their being rejected from other insurance options. In some cases these risk pools will be run through the state governments. Either way, the law says that these pools will remain available until the new health care reforms have fully taken effect in 2014.

Prior to this legislation, high risk pools were already available in 34 states and covered 183,000 citizens. From the perspective of someone who wants a policy, the important thing to note is that the quality of coverage offered can vary widely depending on the attitude and policies of the state offering them. Some states are just more generous than others in programs like this, and if you believe that you’re likely to need to use your health care policy regularly, it’ll be worth your while to get a sense of the kind of coverage that your state offers. You should also remember that even though you’ll already be paying higher premiums than a typical insurance plan, you’ll still have to make sure you have enough money in reserve to cover deductibles and co-payments or health care will be as unattainable to you as ever.

In extreme cases, if you find your state’s high risk pool to be a completely unacceptable option, you still have choices but none of them are easy. If you’ve been working at running your own business or at a small business, you may be able to get into a group plan if you can find employment at a large company. In an extreme case, if you know that another state offers a high risk pool option that would work for you, and you have the means to do it (such as family in that area), you could even consider relocating.

State risk pools and where to contact them

Alabama Insurance Plan

Toll-free 1-800-513-1384 or (334) 353-8924

Alaska Comprehensive Insurance Association

Toll-free 1-888-290-0616

Arkansas Comprehensive Insurance Plan

Toll-free 1-800-285-6477

California Major Risk Medical Insurance Program

Toll-free 1-800-289-6574 or (916) 324-4695

CoverColorado

(303) 863-1960 or toll-free 1-866-787-9129 (M-F 8am-5pm)

Connecticut Health Reinsurance Association

Toll-free 1-800-842-0004 (M-F 9am-4pm EST)

Florida Comprehensive Health Association (closed to new enrollees since 1991)

(850) 309-1200

Idaho Individual High Risk Reinsurance Pool

(link is to a PDF on program)

Toll-free 1-800-721-3272 (In-state only)

Illinois Comprehensive Insurance Plan

Toll-free 1-866-851-2751 (in-state only) or (217) 782-6333

Indiana Comprehensive Health Association (click “guest” for access, then choose “ICHIA”)

Toll-free 1-800-552-7921 or (317) 614-2000

Health Insurance Plan of Iowa

Toll-free 1-877-793-6880 (M-F 8am-5pm CST)

Kansas Insurance Association

Toll-free 1-800-362-9290 (M-F 8am-5pm)

Kentucky Access

Toll-free 1-866-405-6145

Louisiana Health Plan

Toll-free 1-800-736-0947 or (504) 926-6245

Maryland Insurance Plan

Toll-free 1-888-444-9016 (M-F 8am-5pm)

Minnesota Comprehensive Health Association

Toll-free 1-866-894-8053

Mississippi Comprehensive Health Risk Pool

Toll-free 1-888-820-9400

Montana Comprehensive Health Association

Toll-free 1-800-447-7828

Nebraska Comprehensive Insurance Pool

(402) 343-3574 or toll-free 1-877-348-4304 (M-F 8am-4:30pm)

New Hampshire Health Plan

Toll-free 1-877-888-6447

New Mexico Medical Insurance Pool

(505) 622-4711

North Carolina Health Insurance Risk Pool (NCHIRP)

Toll-free 1-866-665-2117

Comprehensive Health Association of North Dakota (North Dakota health insurance risk pool)

Toll-free 1-800-737-0016 or (701) 277-2271

Oklahoma Health Insurance High Risk Pool

Toll-free 1-800-255-6065 or (913) 362-0040

Oregon Medical Insurance Pool

Toll-free 1-800-848-7280 or (503) 225-6620 (M-F 8am-5pm)

South Carolina Insurance Pool

Toll-free Phone 1-800-868-2500, ext. 42757, or 1-803-788-0500, ext. 42757

South Dakota Risk Pool

605-773-3148 (ask for a Risk Pool representative)

Tennessee’s Tenncare Program

1-888-486-9355

Texas Health Insurance Risk Pool

1-888-398-3927

Utah Comprehensive Health Insurance Pool

Toll-free 1-800-705-9173 or (801) 442-6660

Washington State Health Insurance Pool

Toll-free 1-800-877-5187

West Virginia Health Insurance Plan

1-866-445-8491

Wisconsin Health Insurance Risk Sharing Plan

Toll-free 1-800-828-4777

Wyoming Health Insurance Pool

(307) 634-1393

Mark Anderson is a serial entrepreneur and a self-studied expert in buying individual health insurance [http://www.buyingindividualhealthinsuranceblog.com] and small business health insurance plans. Mark has started, operated and sold several businesses ranging from being a solo-entrepreneur to building a small businesses into a 35 person organization. Through this process Mark has become an expert in the field of medical health insurance for individuals and small business.

Why You May NOT Want to Use Your Health Insurance for Counseling

Why not use your health insurance for counseling? Isn’t that what it is for?

Perhaps.

But using health insurance for mental health services is a little different than other medical issues. Sometimes mental health issues are not covered by your health insurance. Once you use your health insurance for mental health, you will have a mental health diagnosis on file – a mental health disorder/mental health illness must be on the insurance claim in order for insurance to pay for treatment. This will be in your permanent medical record.

Of course you want to consider using your health insurance for counseling, but there are some good reasons for you to consider why you may not want to use your insurance for counseling services.

Why doesn’t my counselor accept my health insurance?

Many counselors choose not to accept health insurance for very good reasons. They want to focus 100% of their time in treating you. If they accept health insurance, there is a lot of extra work involved in accepting insurance, in addition to agreeing to work for a discounted fee. The counselor may spend hours on the phone getting benefit information, authorizations, or following up on claims payments. The counselor has to wait a month for payment from the insurance company. The counselor has to file progress reports with the insurance company. The counselor is required to submit treatment reports and other details about your medical history with the insurance company.

It’s not that counselors don’t like insurance companies, or don’t want you to use your insurance (we have health insurance too!), but many counselors prefer to focus 100% of their time and energy in helping clients, rather than doing paperwork for insurance companies.

But this isn’t the only reason counselors may not be in network with your health insurance company.

The other reasons are more compelling, and you need to consider them BEFORE you decide to use your health insurance.

Many counselors prefer not to work in network with health insurance companies so that they can better protect your confidentiality. Any information (claims, reports, or treatment plans) filed with health insurance leaves the protection of their office and their locked files and your personal, private, emotional information is outside of your counselor’s office. In order for any insurance company to reimburse or pay for counseling (both in network and out of network), you must be considered “ill”. You must be diagnosed with a mental health illness or disorder. If you are not ill enough to warrant a diagnosis, then insurance will not pay for counseling services. If you do qualify for a mental health diagnosis, your illness will be listed in your permanent medical record. Many counselors don’t like this “medical model” of declaring someone ill, so they choose not to accept insurance because they want to focus on their client’s strengths, and not label them as mentally ill.

Do you want to be considered mentally ill? If you have a mental health diagnosis already, because you have been to counseling or psychiatric appointments in the past, find out what your diagnosis on file is. If you already have a mental health diagnosis, this may not be a concern to you, but if not, you may not want this in your medical record.

Counselors also do not like releasing information to others to protect your confidentiality. Once a claim is submitted to the insurance company, who knows how many people take a look at it and rubber stamp it while it travels through the system? If insurance pays for any counseling sessions (in network or out of network), then the insurance company has the right to audit your complete file. They can request copies of counseling notes, assessments, and other personal emotional information to determine if you really are “sick enough” to warrant their payment. They can deny services to you if they think you aren’t sick enough or if they think your counseling is not “medically necessary”.

Additionally, there are many counseling issues that are not even covered by insurance at all. Stress management and anger management are usually not covered. Marriage counseling is usually not covered. Certain medical conditions/mental health conditions may be excluded (such as attention deficit disorder or adjustment disorder). Even if your illness or disorder is covered by your insurance plan, they may limit the number of visits they will cover (sometimes only 20 per year), and they will set a maximum amount they will pay per calendar year or in your lifetime.

Additionally, counselors prefer not to have someone in the insurance company telling them how to treat their clients. Insurance companies can decide what type of counseling is covered, what diagnoses are allowed, and how many times the client needs to come before they are cured. Many counselors prefer to work directly with clients to serve their needs, without interference from an insurance company.

Using your health insurance for counseling services can also affect your security clearance, life insurance rate, employment, or future health insurance coverage.

For the above reasons, I recommend that you be informed about using health insurance for counseling. You may choose to file anyway, but be an informed consumer.

Be an informed consumer.
Know your mental health diagnosis.
Talk to your counselor about the diagnosis.
Ask your counselor about your treatment reports.
Decide if you have, or want to have, a psychiatric illness.

If you have clinical, severe depression, anxiety, or other issues, then you probably already have a diagnosis.

But if you are stressed, having relationship problems, or trying to figure out your purpose in life, your symptoms may be minor, and you may not want to have a mental health diagnosis in your records.

Once an insurance claim is submitted to your health insurance company, your diagnosis becomes part of your permanent medical record, and can affect future life insurance, preexisting conditions, or the cost of private health insurance.

Jama Thurman is a Licensed Professional Counselor in Manassas, VA. She helps teens and adults who are stressed and anxious find peace and purpose.

You can get a FREE download of her book, How to Find a Counselor at [http://www.howtofindacounselor.com]. This book will help you figure out if you need professional help, how to find it, and whether you want to use your health insurance for payment for counseling services.

The Pros and Cons of Group Health Insurance

The health insurance marketplace is certainly challenging, but count your lucky stars that at least you have choices. To that end, this article is going to explore the pros and cons of group health insurance.

Group Health Insurance Pros

Group health premiums are subsidized by the employer. Generally, an employer must contribute at least 50% of the “employee only” premium. As such, if you are the employee, you can likely get a richer health plan for less premium than you would pay in the individual health marketplace. However, the cost to add your dependents to the employer’s plan, may be cost prohibitive. In this case, and assuming that your dependents can qualify, then you may want to put them on an individual health plan.
Group health premiums for large families are the same as for small families; whereas in the individual market, you pay a separate premium for every family member. So, if you have a large family, you may be able to get a better deal by adding them to your employer’s plan. As with any insurance change though, don’t make any changes without consulting with an experienced insurance advisor in your state.
Group health insurance in most states is guaranteed issue – meaning that you can’t be turned down because of pre-existing health conditions. This is a real blessing if you or a family member has a medical condition that prevents you from qualifying for a individual plan. But, this is a double-edged sword. While being guaranteed issue is a huge benefit for those with pre-existing medical conditions, it does come at a price. This one feature alone accounts for most of the disparity between group and individual insurance premiums. Yes, that is right – in most states, individual health premiums are almost always less expensive than group health premiums.
Most group plans cover maternity. So, if you are planning on having more children, you should definitely consider hopping on to a group plan. While you can add a “maternity rider” to individual plans, these riders tend to be expensive, restrictive, and otherwise provide less value than the coverage you can get in a group health plan. That being said, if you are considering having more children, we recommend that you contact a health insurance advisor in your state for advice about what is best for your family. The right answer is different for each unique family.
Economies of scale can benefit employees of large employers. It is true that the larger the group, the larger the risk pool is in which to share the risk which CAN result in lower premiums than are available in the individual health market. However, the guaranteed issue “issue” CAN wreak havoc on this type of plan. For example, a large employer with good benefits tends to retain employees for long periods of time. Eventually, the average age of the group starts to creep up and so do premiums. In addition, people with large medical needs (expensive medical conditions) tend to be attracted to large plans because they are guaranteed issue with good coverage. And so, over time, not only is the group’s average age increasing, but the group is also attracting employees with large expected health costs. This is the dilemma that we see with large health plans like the U.S. auto-makers and even government plans. Eventually, those with lots of medical needs begin to outnumber those with little or no needs and so premiums are driven higher and higher.

Group Health Insurance Cons

Group health insurance can be more expensive than individual health insurance. ln fact, if you don’t factor in the employer’s contribution towards premiums, then individual plans are almost always more affordable than group plans. However, as we discussed earlier, not every one can qualify for an individual plan.
What happens if your employment is terminated (by you or your employer)? Yes, you will likely have some benefit continuation rights (through COBRA or state continuation programs), but these benefits can be very expensive and the term limited. So, eventually, you either have to secure another job with benefits, an individual health plan (assuming you are insurable), or possibly join a government health insurance program for the uninsured (if you are not insurable). Let me emphasize, that you should NEVER be without some form of major medical health insurance. Being without this insurance puts you and your family in serious financial jeopardy. In fact, a recent Harvard University study found that 50 percent of all bankruptcy filings were partly the result of medical expenses.¹ To the same point, every 30 seconds in the United States, someone files for bankruptcy in the aftermath of a serious health problem. Don’t let this happen to you.
Group health insurance premiums are rising faster than individual health insurance premiums. Why? Because most group plans are guaranteed issue and since they accept “all comers”, they tend to attract those with high medical costs. On the other hand, most individual health insurance plans are medically underwritten. This means that the insurance company can say “no thanks” to any application that it deems to not be in its interest. Put yourself in their shoes – would sign a contract to provide $30,000 in annual benefits to someone that was only going to pay $3,000 in premiums (for a net loss of $27,000) if you didn’t have to? Hmm…let me me think about that one. The answer is a resounding “NO!”. Because of this underwriting process for individual health insurance, insurance companies can control their risk and more effectively manage their profitability, resulting in more stable prices.

As you can see, there is no clear cut answer as to which type of insurance is the best. The answer depends on a number of factors and is different for every unique situation. The best advice I can give you as you consider your health insurance options — get good advice from an experienced health insurance advisor.