19.11 Types of Health Plans
A group health insurance policy issued or delivered outside the State of Florida that covers a Florida resident is required to comply in the same manner as if the policy was issued in Florida. The policy must contain the following statement in contrasting color and 10-point or larger type:
"The benefits of the policy providing your coverage are governed by the law of a state other than Florida."
HMO
- Health Maintenance Organization - Group insurance, stresses preventive medicine and early treatment, physician services paid in advance, contracted physicians and treatment facilities.
PPO
- Preferred Provider Organization - Group insurance, discounted health care costs due to volume of participants.
EPO
- Exclusive Provider Organization - Written agreement with providers for certain services for certain insureds.
PLHSO
- Prepaid Limited Health Service Organization - Provider panel, limited health services, ambulance, dental care, vision, mental health, substance abuse, chiropractic, podiatric care, and pharmaceutical services provided; no coverage for inpatient, hospital surgical, or emergency services.
Group Accident and Health Insurance
- Coverage for groups of persons under a master policy, provides basic medical expenses, major medical, comprehensive medical, accidental death and dismemberment, and disability income. Types of eligible groups are employer/employee groups, labor unions, association groups, and debtor groups.
Noncontributory Plans
- Employer pays entire premium costs; employees do not contribute; allows employer control and 100% participation.
Extension of Benefits
- Provides continued benefits in the event of total disability at the date of discontinuance of the policy whether or not the covered person secures replacement coverage from a new insurer.
Exclusions
- Coverage typically not provided under typical health insurance contracts are intentional self-inflicted injury, act of war, military service, injuries in private aviation as pilot or crew member, losses due to preexisting conditions, cosmetic surgery, expenses not associated with treatment of injury or sickness, and mental disorders.
Noncancelable Policy
- Continued coverage at the policyowner's option with fixed premiums.
