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Florida Short-Term Health Plans

Residents of Florida are now eligible to apply for short-term health insurance that defaults to the new federal guidelines for the duration of the policies. However, there are state-specific regulations regarding preexisting conditions for renewals. Rules for Florida short-term health plans extend the initial term up to 364 days, with a total duration of up to 36 months.

Prior to the changes made by Washington, short-term healthcare plans were restricted to periods of up to 90 days. With the easing of restrictions under the Trump administration and a change in the Affordable Care Act (ACA), the federal government decided plans may be extended unless states pass their own regulations.

In addition to the changes promoted by the White House, Congress enacted the Tax Cut and Jobs Act, which had a revised ACA provision. The new law repealed the unpopular “individual mandate,” which required uninsured Americans to pay a fine unless they purchased health insurance, qualified for an exemption, or if they weren’t already covered by their employer or a program such as Medicare or Medicaid.

These changes in legislation and procedures have given consumers far more options for healthcare, especially for young and healthy consumers. Florida short-term health plans allow more residents to find affordable coverage outside of the ACA’s marketplace exchange.

Florida to Follow Federal Rules… Sort of

Florida follows the new federal rules in that it doesn’t limit the duration of temporary health plans. However, it has a statute in place that restricts excluding preexisting conditions on policies with terms longer than six months. The law, “Statute 627.6045 Insurance Rates and Contracts,” provides that health care must provide for preexisting conditions after 24 months, and insurers cannot consider health history earlier than two years prior when identifying preexisting conditions.

Individuals with policies who have had prior continuous creditable coverage during the 24 previous months won’t be subject to preexisting condition exclusions. It’s important to note that the above restriction doesn’t apply to nonrenewable plans of six-month terms.

Also, these short-duration plans don’t qualify as “continuous coverage,” meaning that if the insured is enrolled in a short-term plan, any conditions that arise during that timeframe can be deemed preexisting when applying for future insurance later.

Under a major medical policy of the ACA, coverage is guaranteed for preexisting conditions. Florida state doesn’t recognize temporary plans as healthcare coverage, which is the reason why Florida short-term health plans don’t have to follow ACA guidelines.

Surprisingly, some insurers in Florida are offering short-term plans with a duration in excess of six months. States that default to the federal guidelines may reject applicants who have any preexisting condition, limiting enrollment in the plans to only the youngest and healthiest applicants.

This is a significant change to the Obama-era regulations as to what constituted a short-term policy. Applicants should be aware that these temporary policies don’t meet federal guidelines for inclusion in the ACA, popularly known as Obamacare.

Under the ACA, plans must meet strict conditions to be considered “minimum essential coverage.” Shorter duration plans offer less coverage, but most of the time come with much lower premiums.

The greater number of choices for Florida consumers means that they can select a policy that more closely matches their needs for coverage. Floridians should consider that termination of a short-term plan doesn’t meet the standard for a “qualifying life event,” a situation that would allow consumers to seek insurance in marketplace exchanges under the Special Enrollment Period (SEP).

SEP differs from the ACA’s “open enrollment period,” which specifies several weeks at the end of the calendar year when individuals and families can sign up for government-compliant insurance. An SEP is triggered when situations or events outside of Open Enrollment qualify the individual to seek coverage such as losing a job, divorce, or the death of a spouse.

For example, losing a Medicare, Medicaid, employer-sponsored plan, or major medical coverage would be considered a qualifying event. However, losing short-term coverage isn’t a qualifying event, as defined by the federal government.

Florida Short-term Plans

There are nearly 70 short-term plans offered in Florida, with terms of six months to three years although some insurers have capped plans at six months. Deductibles range from $1,000 to $10,000 or above.

Florida short-term health plans are varied in the coinsurance provision from 10 percent up to 50 percent or higher. Policy maximums range from $500,000 to $2 million.

The structure differs based on the company. Insurers offer an Exclusive Provider Organization or EPO, which means that visits outside of the network aren’t covered.

There are also Preferred Provider Organizations or PPOs, which have negotiated pricing for in-network doctors and medical facilities. Out-of-network providers are available at a higher cost.

Indemnity plans are also offered. These short-duration policies basically cover a portion of eligible medical services.

Florida consumers should refer to their short-term health plan documentation for more details.

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