Florida insurance law and regulation
News that affects your health insurance and planning
April 11, 2020 – Florida Blue, the association of Blue Cross and Blue Shield companies, will waive cost-sharing through June 1 for its members who must undergo treatment for COVID-19, including in-patient hospital admissions. The company will also extend the reinstatement period through May 31 to accommodate members who have trouble paying their premiums.
The announcement impacts all Florida Blue members with Affordable Care Act, Medicare Advantage (excluding Part D drug plans) and other individual plans, as well as all fully insured employer group health plans.
May 26, 2019 – Status of alternative non-ACA health plans: Florida does not require individuals to maintain adequate health coverage. The state provides no premium or cost-sharing subsidies for individual market coverage, permits insurers to sell non-compliant transitional policies in the individual market and does not limit the sale of short-term coverage more strictly than the federal government.
May 8, 2019 – Oscar Health, a New York Company owned by the Kushner Family, teamed up with the U.S. Department of Justice in challenging Florida’s health insurance system that is dominated by Blue Cross. Oscar Health offers limited benefit health plans like those listed at Freedom Benefits.
March 19, 2019 – Bay Medical Sacred Heart announced plans to reopen 144 beds and enhance patent services in Bay County this year as part of a $47 million investment to rebuild after Hurricane Michael.
The history of health care planning in Florida (Information is outdated and links may be expired)
2/15/2016 Floridians covered by Humana and CarePlus health plans will be switched to Aetna More than a million Florida residents are affectedby Humana’s sale to Aetna as part of a corporate merger between two of the nation’s four largest health insurance companies. In Florida, the merger gives Aetna ownership of Humana’s large stake in government-sponsored insurance programs, including Medicare Advantage and Medicaid managed care plans.
12/31/2015 Cigna Inc. says that it has discovered two separate types of insurance fraud by Florida medical treatment facilities in conjunction with health insurance brokers that caused it to lose money and eventually pullout of the Florida health insurance marketplace. Apparently the providers promised free airfare to Florida and free treatment to out-of-state residents for drug treatment at facilities within the state. The scam used brokers to enroll the addicts in Florida health insurance at the expense of Cigna and others. Palm Beach Post published a series of investigative articles on this scam and related topics throughout the past year.
10/22/2015 Cigna Insurance will not be offering health insurance through the state insurance exchange in 2016.
2/20/2015 The Florida state health insurance exchange called Florida Health Choices cost $2.4 million and succeeded in enrolling only 42 people for 2015. That cost works out to about $60,000 per applicant. The federal health insurance exchange in Florida (Healthcare.gov) was far more successful and signed up many more applicants.
12/21/2014 The federal government stopped promoting the subsidized health insurance plans offered in Florida through its web site. The state exchange and private exchanges offer the same health insurance but without tax subsidies to lower the premium. Residents who purchase insurance without a premium subsidy can still claim a refund on their federal income tax return.
2/11/ 2014 Professional support for any health care reform issue is available free of charge through an arrangement with OnlineNavigator. All online inquiries are handled personally by Tony Novak, CPA. Online support is available through a number of popular social media channels including Facebook and Google+ as well as e-mail. Telephone support for insurance enrollment is available through Members Insurance Exchange at (800) 609-0683.
8/13/2013 The Florida Office of Insurance Regulation released information last week projecting that individual monthly health insurance premiums will rise 30 to 40 percent next year. The rate increases are attributed to insurance changes required by the Affordable Care Act of 2010 known as Obamacare.
7/26/2013 Affordable Smart Term Life Insurance is now available to most Florida residents from age 20 through 60 directly online with no physical exam, agent appointment or telephone verification. Most policies are issued on the same day with coverage amounts of $25,000 up to $350,000. The level premium life insurance is available for terms of 10, 15, 20 and 30 years. Sample rates for $150,000 coverage for a preferred risk male age 30, non-tobacco $30.85 per month; tobacco user $49.55 per month. A preferred risk female age 30 non-tobacco user would be $26.49 per month and a tobacco user would be $40.96 per month. Rates are higher for older applicants and lower health risks as described online. Pricing is based on input you provide about your medical history but, unlike most other life insurers, does not consider family medical history. Coverage is issued by innovative National Life Group, rated “A” by A.M. Best Company for 2013.
4/2/2013 Palm Beach County reports that a cost-subsidized health insurance program offered at a premium of $52 per month to low income residents who were not eligible for Medicaid enrolled less than 500 people over the past year.
3/6/2013 This page was updated to include a link to the insurance plan that will be used to determine specific “essential health benefits” for insurance that qualified for 2014 federal tax purposes. Also, a link to additional covered benefits required by state law. Non-qualified insurance is likely to continue to be available at a lower cost that does not include these benefits nor qualify for federal tax purposes.
7/28/2012 Economic recovery data – Florida’s unemployment rate is now 8.6%, the lowest level since December 2008. While a shrinking labor force has contributed to this decline, a number of metrics confirm that Florida’s labor market is improving. This includes total nonfarm payroll employment in Florida, another yardstick for job creation, which has expanded by 70,900 jobs in the last twelve months. Florida lost about 750,000 in the recession since 2009 and only part of these have been recovered so far. Florida’s small and medium-sized businesses are a major driving force in the Florida economy, accounting for nearly 62% of new job growth in the state in 2010-2012. Freedom Benefits is focused on providing affordable flexible benefit plan solutions for Florida’s small businesses.
7/3/2012 Florida Governor Rick Scott said that the Affordable Care Act is “devastating for patients” and will not implement portions of the law. The recent Supreme Court ruling allows states to decline expansion of Medicaid programs and the Governor intends to prevent that expansion. On Fox News the Governor added “Government health care programs, everywhere in the world, do three things: They promise you the world, they say, ‘Oh, we’re going to cover everything.’ Then what they do is they run out of money and they underpay hospitals, doctors and guess what happens? They don’t want to take care of you. … If you care about patients, this is devastating for you.”
6/25/2012 Last week Michigan State University dropped its requirement that students maintain a specific type of health insurance after opposition from state lawmakers. We expect that University of Florida will eventually follow in the same manner. Freedom Benefits has previously voiced the opinion that the current requirement goes beyond the limits of law or common sense financial planning. Current Florida law requires that students maintain specific insurance benefits that are not available in the state’s commercial insurance market except through the policy sold through the University. This effectively creates a monopoly in student health insurance. Some opponents of the University’s policy believe that the conflict of interest created by the student insurance mandate generating insurance marketing revenue to the University may be a violation of federal education funding rules.
2/24/2012 The federal government announced that enrollment in the state’s Pre-existing Condition Insurance Plan (PCIP) grew to almost 4,000 after the premium rates were reduced in July 2011. The federal government reported that only 770 Florida residents were reported enrolled in the PCIP as of July 1 2011 but the year-end report shows that 3,736 had now joined the plan. The federal government pays most of the cost of this insurance; individuals contribute up to $505 per month. The federal government is expected to pay an average of $28,994 for each person enrolled in the PCIP plan in 2012 out of a $5 billion dollar budget established by the 2010 federal health reform law. More than 75% of this expense is expected to be for cancer care including surgery and chemotherapy. An average premium for an adult is only $363 per month; less than most commercial insurance plans. The maximum you will pay out-of-pocket for covered services in a calendar year is $5,950 in-network/$7,000 out-of-network. This plan covers the sickest of the state’s residents representing 1/10 of 1% of the state’s 3.8 million uninsured residents. Freedom Benefits supports enrollment in the PCIP through its OnlineNavigator service for those who want professional help. There is a fee of $50 for this service but individuals may enroll in the PCIP without charge online at www.pcip.gov.
2/1/2012 The Center for Consumer Information and Insurance Oversight, a division of the Center for Medicare and Medicaid Services (CMS)reported that as of June 30, 2011 Blue Cross and Blue Shield of Florida, UnitedHealthcare and Aetna are the state’s largest health insurance providers and as such, earn the right to set the benchmark for the development of the state’s essential benefit plans to debut in 2014 under health reform law.
10/28/2011 American Republic Insurance Company and World Insurance Company are leaving Florida and will no longer issue or renew individual insurance policies in the state. According to a source at the Office of Insurance Regulation policyholders will be able to convert their coverage to a policy issued by Celtic Insurance Company under similar terms and conditions.
2/12/2011 With dozens of health plans choices available online offering a wide range of pricing and benefits, how do you find the best combination of price and benefits? Celtic Insurance realizes that the choices can be overwhelming; the company offers more than 40 possible health plan designs in many parts of the United States. A new feature called “Help Me Choose” lets users easily and quickly select the benefits they value most and narrows the list down to a few of the best choices. No personal information is required other than zip code and date of birth.
2/7/2011 (Editor’s Note: These rates were reduced in July 2011). The state’s pre-existing condition insurance plan (PCIP) monthly premium rates (per person) for January 2011:
PCIP will cover a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. All covered benefits are available for you, beginning on your coverage effective date, even if it’s to treat a pre-existing condition – there are no waiting periods. PCIP applicants who are approved to participate in PCIP can choose from three plan options, with different levels of premiums, calendar year deductibles, prescription deductibles and prescription copays. The HSA Option provides an opportunity to open a Health Savings Account, a tax-exempt account where you can deposit funds for eligible medical expenses. Each of the three PCIP plan options provides preventive care (paid at 100%, with no deductible) when you see an in-network doctor and the doctor indicates preventive diagnosis. Included are annual physicals, flu shots, routine mammograms and cancer screenings. For other care, you will pay a deductible before PCIP pays for your health care and prescriptions. After you pay the deductible, you will pay 20% of medical costs in-network. The maximum you will pay out-of-pocket for covered services in a calendar year is $5,950 in-network/$7,000 out-of-network. There is no lifetime maximum or cap on the amount the plan pays for your care. If you apply for PCIP coverage on the government Web site, you will be billed for the premium once your application is approved. You will need to send in your payment in order for your coverage to be effective. Please do not send in the premium before you are billed. Note that your premium may increase if you age into a higher rate tier, or if PCIP adjusts its premiums to any changes in the commercial market.
2/3/2011 Florida halted the development of a public health insurance exchange following the recent federal court decision to nullify the Patient Protection Affordable Care Act of 2010 in its entirety. In a statement issued yesterday, Florida’s insurance commissioner did not say what use would be made of federal funds already received for the development of the insurance exchange. This announcement is not expected to affect the development of commercial insurance exchanges like Freedom Benefits that are not dependent on the federal grant for development or implementation. Consumers will likely be affected by the lack of uniformity in interpretation of the health reform law’s provisions while an appeal of the decision is pending before the Supreme Court.
1/30/2011 Patients with health insurance and a credit card now have access to VIP treatment when care is needed at a hospital emergency room. University Community Hospital-Carrollwood in Tampa, Parrish Medical Center in Titusville, and MedFast Urgent Care Center in Port St. John joined the growing list of hospitals that allows patients to use InQuickER, a reservation system that books appointments and reduces waiting time in the emergency room. The reservation system makes check-in easier by recording your insurance and payment information in advance. The service costs $15 to $25. Of course the nature unpredictable medical emergencies mean that the service cannot absolutely guarantee that you’ll be seen immediately at your appointment time, but you get a full refund if not treated within 15 minutes after arrival. The InQuickER service works in conjunction with any of the private health insurance plans listed here at FreedomBenefits.net but is not available to uninsured patients.
12/16/2010 Florida Agency for Health Care Administration officials met representatives of 44 other states and numerous employees of the federal Health and Human Services Department in Washington DC this week for a two-day working meeting to discuss the next steps in establish a government-run health insurance exchange under the American Health Benefit Exchange Model Act. Their attendance at this meeting was paid for by a $1 million federal grant awarded by HHS in September to the state for research how to set up an insurance exchange. Two states (Alaska and Minnesota) declined to participate, saying that it was a waste of taxpayer money. Four other states (not identified in press reports) that received federal grants did not send representatives to the meeting. Attendees included representatives of 16 states that are suing the federal government in an attempt to overturn the federal health reform law; specifically the requirement that forces individuals to buy health insurance on the insurance exchange or pay a hefty tax fine.
In its initial federal grant request for the insurance exchange project, the Agency for Health Care Administration said that it would: 1) Research the estimated number of currently uninsured individuals as well as those entitled to tax credits, cost sharing through the Exchange, those eligible for Medicaid or employer-sponsored coverage, 2) Create a Technical Advisory Work Group to assist the implementation of the Exchange and how it will build upon current State and Federal programs, 3) Address whether Florida should have its own Exchange, join a regional Exchange or elect to have a Federal Exchange, and 4) Identify legislative and regulatory needs.
The meeting reportedly did not address the role of the commercial health insurance exchanges on the implementation of new competing government systems. The model act does not address inter-state insurance exchange proposals nor insurance sales across state lines. Federal officials admitted that they may not be able to provide further guidance until 2012. Meanwhile, most states are motivated to continue to meet requirements to obtain additional funding promised by the federal government for the establishment of insurance exchange by 2014. Freedom Benefits has previously voiced the opinion that the huge amount of money being spent to set up alternate insurance sales system technologies could be better used providing health benefits to the public. We proposed on the Universal Health Insurance blog that adequate commercial insurance sales systems are already in place that could be modified in a public/private partnership to make health insurance more affordable.
12/5/2010 Fifteen commercial insurance companies recognized by the state to provide individual major medical health insurance plans in Florida in 2011. These are Aetna Life Insurance Company, American Republic Insurance Company, Best Life and Health Insurance Company, Celtic Insurance Company, Continental General Insurance Company, Fidelity Security Life Insurance Company, Freedom Life Insurance Company of America, Golden Rule Insurance Company, Humana Health Insurance Company of Florida, John Alden Life Insurance Company, Mega Life & Health Insurance Company, Mid-West National Life Insurance Company of TN, Time Insurance Company, United American Insurance Company, and World Insurance Company. Most individual policies are medically underwritten through an out-of-state group master policy and may not be included on any insurance exchange. Contact the Department of Financial Services Consumer Services Division at 1-877-693-5236 to confirm whether a company is licensed to issue any other type of coverage.
9/14/2010 A new blog post titled “Fast Facts on Florida KidCare Insurance” summarizes the four programs available and explains how it can be supplemented to improve overall coverage to address a common concern with these public insurance programs.
5/14/2010 Diabetes Coverage: A new resource to help find health insurance for diabetics in Florida is now available at Freedom Benefits.
3/23/2010 Florida is leading ten other states including Alabama, Michigan, Nebraska, North Dakota, Pennsylvania, South Carolina, South Dakota, Texas, Utah and Washington in a joint legal challenge to the federal health reform bill on the basis that it improperly usurps state sovereignty over health insurance and that requiring health insurance is an illegal and improper government action.