How Am I Protected?

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In Florida, as in many other states, your health insurance options are somewhat dependent on your health status. Even if you are sick, however, the laws protect you in the following ways.

· Coverage under your group health plan (if your employer offers one) cannot be denied or limited, nor can you be required to pay more, because of your health status. This is called nondiscrimination. (see Group Health Plans)

· All group health plans in Florida must limit exclusion of pre-existing conditions. There are rules about what counts as a pre-existing condition and how long you must wait before a new health plan will begin to pay for care for that condition. Generally, if you join a new group health plan your old coverage will be credited toward the pre-existing condition exclusion period, provided you did not have a long break in coverage. (see Group Health Plans)

· Your health insurance cannot be canceled because you get sick. Most health insurance is guaranteed renewable. (see Individual Health Plans for Individual Coverage, and Small Employer or Self-Employed Person for Small Group Coverage)

· If your son or daughter is in college and covered as a dependent under your group, but cannot maintain student status due to illness, he or she may still be able to remain covered as your dependent for up to one year. (see Group Health Plans)

· If you leave your job, you may be able to remain in your old group health plan for a certain length of time. This is called COBRA continuation coverage or state continuation coverage. It can help when you are between jobs or waiting for a new health plan to cover your pre-existing condition. There are limits on what you can be charged for this coverage. (see Individual Health Plans)

· If you lost your group health plan because of involuntary termination of employment that occurred between September 1, 2008 and December 31, 2009, you may be eligible for a federal tax credit that can help you pay for your COBRA or state continuation coverage premiums for up to nine months.(see Individual Health Plans)

· If you lose coverage under a fully insured group health plan in Florida, you may be able to buy a conversion policy. This is an individual policy from the company that insured your former group plan. You will not face a new pre-existing condition exclusion period. There are limits on what you can be charged for a conversion policy. (see Individual Health Plans)

· If you lose your group health plan and meet other qualifications, you will be HIPAA eligible. If so, and you do not qualify for a conversion policy, you are guaranteed the right to buy an individual health insurance policy from any insurance company that sells such plans in Florida. Insurers that sell individual health insurance must offer you a choice of at least two policies. You will not face a new pre-existing condition exclusion period. (see Individual Health Plans)

· When you apply for an individual health insurance policy, insurance companies may not turn you down, charge you more or impose a pre-existing condition exclusion period because of your genetic information. In addition, insurance companies are not allowed to even ask about your genetic tests or family history when you apply for coverage. (see Individual Health Plans)

· If you have been uninsured for 6 months or recently lost health coverage, you may be eligible to buy a limited health benefit plan through Cover Florida. (see Individual Health Plans)

· You may be eligible to buy a guaranteed-issue policy if your individual health insurer or HMO terminated your coverage due to insolvency, dropped all individual coverage in Florida, or if you moved out of your individual health insurer’s service area. (see Individual Health Plans)

· If you are a small employer buying a group health plan, you cannot be turned down because of the health status, age, or any factor that might predict the use of health services of those in your group. All health plans for small employers must be sold on a guaranteed issue basis. (see Small Employer or Self-Insured Person)

· If you are a small employer buying a group health plan policy, you can be charged more, within limits, based on the health status of those in your group. Even with these limits, however, premiums can be significantly higher if someone in your group has a serious health condition. (see Small Employer or Self-Insured Person)

· As a small employer, you may not be turned down or charged more because of the genetic information of a member of your group. In addition, insurance companies are not allowed to even ask about genetic tests or family history of people in your group when you apply for coverage. (see Small Employer or Self-Insured Person)

· If you have low or modest household income, you may be eligible for free or subsidized health coverage for yourself or members of your family. The Florida Medicaid program offers free health coverage for pregnant women, families with children, medically needy, elderly, and disabled individuals with very low incomes. (see Financial Assistance)

· The Florida KidCare Program provides health coverage to low-income Florida children under the age of 19 who are not eligible for Medicaid and currently uninsured or underinsured. (see Financial Assistance)

· If you believe that you have or are at risk for breast or cervical cancer, you may be eligible for free screening and treatment. The Florida Breast and Cervical Cancer Program provides qualified women with free breast and cervical cancer screening. In addition, women diagnosed with cancer may be eligible for treatment through the Florida Medicaid Program. (see Financial Assistance)

· If you have lost your health insurance and are receiving benefits from the Trade Adjustment Assistance (TAA) Program then you may be eligible for a federal income tax credit to help pay for new health coverage. This credit is called the Health Coverage Tax Credit (HCTC), and it is equal to 80% of the cost of qualified health coverage, including COBRA, state continuation coverage, and a specific policy offered through Blue Cross and Blue Shield of Florida. (see Financial Assistance)

· If you are a retiree aged 55-65 and receiving pension benefits from Pension Benefit Guarantee Corporation (PBGC), then you may also be eligible for the HCTC. (see Financial Assistance)


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