Cover Florida

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The Cover Florida Health Access Program offers certain qualified residents access to limited benefit private health insurance policies on a guaranteed issue basis. This program is administered by the State of Florida in cooperation with private health insurers.

When am I eligible for a Cover Florida policy?

· You must meet certain eligibility criteria. You must be between the ages of 19-64, and not covered by covered by a private plan or eligible for a public health insurance program. In addition, you must be not have been covered under any health insurance program within the last six months, unless you lost employer sponsored due to job loss, death, divorce, exhaustion of COBRA or state continuation coverage or you aged off a private health insurance policy or health insurance program, such as Medicaid or SCHIP.

What does a Cover Florida policy cover?

· Cover Florida requires insurers to offer policy options with limited benefits. Insurers must offer two types of policy options: “catastrophic” and “non-catastrophic”.

All Cover Florida policies must cover at least some preventative care, some physician office visits, some outpatient surgery, some mental health benefits, and diabetic supplies. For example, Cover Florida plans must cover physician office visits, however a plan may limit the benefit up to $450 in office visits per year.

In addition, all Cover Florida policies either have to provide some coverage for prescription drugs, or they might just offer a prescription drug discount plan. A drug discount plan is not the same thing as having prescription coverage. Under a discount plan, when you fill your prescription at a participating pharmacy, the pharmacy might discount the price of your drug, but you must pay the entire discounted price yourself – your Cover Florida plan will not pay anything. Cover Florida plans that cover prescription drugs usually cap coverage, for example, the plan might pay up to $500 per year of your prescription expenses.

Cover Florida plans designated as “catastrophic” must also include limited coverage for inpatient hospital services, hospital emergency care services, urgent care services and outpatient facility services. For example, a plan might cover up to 10 days of inpatient hospital stays per year. Cover Florida policies are not required to cover most of Florida’s mandated benefits.

Cover Florida policies generally cover limited benefits and enrollees may encounter significant limitations in getting their medical needs covered when faced with an illness or injury. Before you purchase a Cover Florida policy, it is important to determine exactly what benefits are covered. A summary of Cover Florida policies and what they cover is available at

What about coverage for my pre-existing condition?

· Cover Florida plans are not allowed to impose elimination riders, which permanently exclude coverage for a health condition, body part, or body system.

However, Cover Florida plan can impose a pre-existing condition exclusion period. Pre-existing condition exclusion periods cannot exceed 12 months.

Pre-existing conditions are conditions for which medical advice, diagnosis, or treatment was recommended or received within the six-month period prior to the effective date of the policy. Pregnancy can count as a pre-existing condition but genetic information cannot.

· You will get credit for prior continuous coverage that was not interrupted by a break of 63 or more days in a row. If you have at least twelve months of prior continuous coverage, no pre-existing condition exclusion period can be imposed on your coverage.

How much can I be charged for my Cover Florida policy?

· You cannot be charged more based on your health status. However, premiums for the Cover Florida policies will vary depending on your age, gender and the plan you buy.

· As you compare the price of Cover Florida plans to other individual health insurance policies, pay attention to the differences. Cover Florida policies tend to provide less coverage compared to other individual policies. On the other hand, Cover Florida policies can’t turn you down if you are sick while other individual policies can do that. You will need to carefully compare the protection offered by different policies as you compare prices.

Can my Cover Florida policy be canceled?

· Your coverage cannot be canceled because you get sick. This is called guaranteed renewability. You have this protection provided that you do not lose your prior coverage because of failure to pay the premiums.

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