19.13 Florida Health Insurance Plan
The Florida Comprehensive Health Association (FCHA) was created as a nonprofit legal entity to contract with preferred provider organizations and health maintenance organizations to provide high-risk individuals the most cost-effective quality health care, at rates up to 250% of standard rates. In 1991, Florida legislature made extensive changes in the law, one of which was to prohibit new enrollments after June 30, 1991. The plan had been operating at such a huge deficit that the legislature deemed it wise to close enrollments until the plan had been totally revised.
In 2004, the Florida Health Insurance Plan was created to replace the FCHA. Any individual who was covered under the FCHA will automatically be covered by the new plan once fully implemented and the FCHA has been legally abolished. The idea remains the same -- to ensure coverage to any Florida resident who, for health reasons, is otherwise deemed uninsurable by the private health insurance market.
The new plan is intended to be "the payor of last resort" whenever any other benefit or source of third-party payment is available. Benefits that are payable by the plan must be reduced by all amounts paid or payable through any other insurance coverage.
The Florida Health Insurance Plan makes coverage available to individuals who have no other option for similar coverage, at a premium that is commensurate with the risk and benefits provided, and with benefit designs that are reasonable in relation to the general market.
Separate schedules of premium rates based on age, sex, and geographical location may apply for individual risks. Initial rates for plan coverage are limited to no more than 300% of rates established for individual standard risks. All premium rates and schedules must be submitted to the Office of Insurance Regulation of the Financial Services Commission for approval prior to use.
Any person who is and continues to be a resident of Florida is eligible for coverage under the plan if the person has been denied coverage for health reasons from at least two health insurers or health maintenance organizations. In addition, each resident dependent of an eligible person is also eligible for coverage.
A person is not eligible for coverage under the plan if the:
- person has or obtains, or is eligible to obtain, health insurance coverage substantially similar to or more comprehensive than a plan policy;
- person is determined to be eligible for health care benefits under Medicaid, Medicare, the state's children's health insurance program, or any other federal, state, or local government program that provides health benefits;
- person voluntarily terminated plan coverage unless 12 months have elapsed since such termination;
- person is an inmate or resident of a public institution; or
- person's premiums are paid for or reimbursed under any government-sponsored program or by any government agency or health care provider.
Coverage will cease:
- on the date a person is no longer a resident of this state;
- on the date a person requests coverage to end;
- upon the death of the covered person;
- on the date state law requires cancelation or nonrenewal of the policy;
- at the option of the plan, 30 days after the plan makes any inquiry concerning the person's eligibility or place of residence to which the person does not reply; or
- upon failure of the insured to pay for continued coverage.
Usual and customary commissions are payable to agents for initial placement of coverage with the plan and for one renewal only. However, be aware that it is considered a violation of the Unfair Trade Practices Act for an agent to refer or arrange for an individual employee to apply to the plan for the purpose of separating that employee from group health insurance coverage provided by the employee's employer.
