| The principles of Florida group health schemes can be | | | | being run by an HMO then that HMO may also apply |
| confusing until you are taken through the regulations | | | | a waiting period (often referred to as an affiliation |
| one at a time. | | | | period) where again you will not be covered. |
| A lot of Americans are covered by group health | | | | Affiliation periods applied by HMOs cannot normally be |
| plans and the rules governing group plans in Florida | | | | greater than 2 months and when a waiting period is |
| are similar to those seen in most of the other states, | | | | required the HMO may not then impose any |
| although there are various differences which might | | | | pre-existing conditions exclusions. |
| apply for public employees. | | | | Under the provisions of Florida law any group health |
| If you want to join a group health plan you have to | | | | plan which includes dependent cover also has to |
| first be eligible for memberships of the scheme. For | | | | provide cover automatically for newborn babies, |
| instance, despite the fact that an employer may run | | | | newly adopted children and children who are placed |
| a group health scheme, it does not have to be open | | | | for adoption for 31 days after birth, adoption or |
| to all employees, possibly being aimed at full-time and | | | | placement. There may also be a requirement for |
| not part-time workers. Alternatively, the scheme may | | | | parents to register these children with the scheme |
| be operated by a Health Management Organization | | | | within this 31 day period if cover is to continue |
| (HMO) and you may discover that you are living | | | | beyond this point. |
| outside of the service area for the HMO. | | | | For parents taking care of disabled children who are |
| Should you be eligible for membership of the scheme | | | | covered under a group health insurance plan cover |
| then you must be permitted to join regardless of | | | | will often continue beyond the age when a child |
| your state of health. In this case your state of health | | | | would no longer be classed as a dependent, as long |
| refers to your present health, taking into account | | | | as the parents are able to demonstrate that the |
| any disability which you may have, as well as your | | | | individual in question cannot support himself (or |
| past medical history. It is also interesting to note that | | | | herself) because of mental or physical disability and |
| you cannot be excluded from the scheme on the | | | | that they are mainly dependent upon the plan |
| grounds of genetic information. | | | | member for support. |
| It is also important to note here that, in spite of the | | | | If you work for an employer with more than 50 |
| fact that an employer can refuse you membership | | | | employees then you can take a leave of absence |
| because you do not for instance work sufficient | | | | without losing you health insurance for up to 12 |
| hours, he is not permitted to refuse you membership | | | | weeks in some circumstances. This protection is |
| solely on your present or previous medical history. | | | | guaranteed under the Family and Medical Leave Act |
| Nearly every scheme has an enrollment period during | | | | (FMLA) which is designed to cover such things as |
| which you have to elect to join the scheme which | | | | childbirth, illness or the need to take care of a |
| may typically be within 30 days or joining the | | | | seriously ill member of your family. |
| company. However, if you choose not to join at that | | | | Federal law allows states, county and local |
| stage then an employer must give you the | | | | governments to exempt government employees |
| opportunity to join during what is normally called a | | | | from some coverage in self-insured group health |
| special enrollment period if certain specified changes | | | | plans and a lot of Forida's public employers make use |
| arise within your family. Such changes may include | | | | of this to some extent. Because exemptions vary |
| such things as marriage, the birth or adoption of a | | | | widely between employers it is prudent to find out |
| child and loss of alternative medical insurance | | | | the exact coverage provided if you have a public |
| coverage because of such things as the cessation of | | | | employer. This information may also be found by |
| coverage being provided through another family | | | | contacting The Center for Medicare and Medicaid |
| member as a result of death, divorce, retirement, | | | | Services (CMS) which maintains a list of employer |
| legal separation, reduction in working hours, | | | | exemptions. |
| termination and similar things. | | | | Despite the fact that according to Florida law you |
| Nearly all plans will also normally have a waiting period | | | | cannot be excluded from membership of a group |
| for membership which will typically be anywhere from | | | | health plan for reasons of health, there are some |
| 30 days to 3 months. Employers must apply this | | | | circumstances in which exclusion periods may be |
| waiting period consistently to all eligible employees | | | | imposed for pre-existing conditions. However, this is a |
| and during this time you are not covered by the | | | | complicated area and one which is therefore the |
| group scheme. | | | | subject of another article. |
| Where the group scheme which you are joining is | | | | |