Florida Health Insurance
Health Insurance Plans for Everyone and Every Situation

There is no charge to the individual for using the services of a licensed health insurance agent.  The commission is entirely paid by the carrier. The carrier is prohibited from selling the policy any cheaper if an individual does not use an agent.

Please be aware that I never share contact numbers or email addresses with anyone and all personal information is kept absolutely confidential.  No one will call you unless you ask to be called and the only person you would talk with is me.  Thanks for visiting.  Please let me know how I can help you.  John K Arnold

What it is, what to think about and what to expect.

Individual health insurance means health insurance plans or HMO plans that are not attached to a business. The insurance is issued to the person not as an employee of a business, a business owner or self-employed person. It is issued to the person as an individual person.

There are advantages to having an individual health insurance even instead of business health insurance.  Insurance companies offering group health insurance in Florida to businesses having 2 to 50 employees are required to accept the business if it meets the underwriting guidelines (for more information see Florida Small Group Health Insurance). The insurance company has to accept persons with health conditions.  These conditions can be costly to the insurance company.  Health insurance rates have been rising rapidly.  The insurance companies have the option of accepting, rating or declining individual applications. This means they have better control of losses and can offer better rates. Individual PPO plans can be designed to fit the person or family.  All business plans include maternity which is costly.  Individual plans usually do not cover maternity or have this as an option.

There is an often overlooked benefit of having an individual PPO.  These plans usually have very large networks of doctors and hospitals. These providers are on contract for services.  The contracted amount can be considerably less than the amount charged to persons not insured on a PPO.  It is a very good idea to have health insurance even with a high deductible. You would receive the discounted PPO contracted rates and would not be uninsured.  These things can be worth thousands of dollars.

Individual plans are covered by different laws than health insurance for self-employed people or businesses.  In a very general way the laws can be divided into statutes covering individuals, statutes covering self-employed persons, statutes covering businesses from 2 to 50 employees and statutes covering businesses having 50 or more employees.  The federal government refers to small businesses as having from 2 to 50 employees. The federal laws do not include businesses of one or self employed persons.  Florida has included these one person businesses, but this is almost always in dispute.

Individual health insurance is medically underwritten.  This means the company gathers the health information on the proposed insured.  The information is obtained from the answers to questions on the application, doctor and hospital records, and field paramed exams.  Most companies also increase rates for people that smoke or use tobacco.

Individual health insurance also considers the type of job or occupation as person has. A person can be rated for their occupation.

The company underwriter has guidelines on whether the person will be approved, declined, rated up for more premium or have conditions waived or riders applied. There can be a combination of these such as a rider and an increased rate.  The guaranteed issue provisions that apply to health insurance for small businesses do not apply to individual health insurance.  Companies do not have the same underwriting standards. I now have plans that have the philosophy

After the underwriter has reviewed the information, a decision is made on how the policy will be offered to the insured.  It may be offered as applied.  In that case it is usually issued and made effective.  If any changes are to be made the insured will be notified of the proposed changes.  If the insured accepts these she/he would usually sign a form, stating acceptance of the proposed changes and the policy would be issued.  If the person does not want to accept the policy with those conditions, the policy would not go into effect.  Any moneys sent with the application would be returned. No moneys can be charged or any fees kept.  The refund would come directly from the insurance company to the person.

If you have been declined in the past, it may be possible for you to get health insurance.  Please provide me with complete information as requested on the quote form.  Be sure to give me specifics on health conditions.  I will check to see if individual health insurance will work for you.

Maternity on Individual Plans

Maternity benefits on individual health insurance varies, by insurance company and by plan.  No individual plan offers maternity benefits in the same way as group health insurance does.  Many companies do not offer maternity at all on individual plans.  All insurance companies will decline to offer individual health insurance to someone that is currently pregnant and in general will decline her husband and children as well until after the baby is born.

If a plan offers maternity benefits, it generally will have some or all of these features:

1. There is a waiting period before a person would be eligible for benefits from the maternity benefit but could become pregnant during that waiting period.  For example, no benefits are paid during the first 12 months the insured is on the policy and has the maternity benefit, then plan starts paying benefits. 
2. Another option is conception must have occurred after a set amount of time the person has had the maternity benefit, 270 days is a common time period.  You must have been insured and had the maternity benefit at least 270 days before you became pregnant.  Any pregnancy prior to that time would not be covered.
3. The benefit is stepped over a period of time. There might be some small benefit payable if the insured becomes pregnant in the first year, a larger benefit payable if the insured becomes pregnant in the second year, larger in the third year and so forth.
4. A flat amount is paid for maternity such as $1000 after a $500 maternity deductible.  No more is paid no matter what the cost of the pregnancy.
5. Maternity is paid as a separate benefit with its own deductible and coinsurance amount, but without a benefit limit. 

You can check the plans below for details.  Fortis and Humana are the only companies on the list below that offers maternity benefits.  If you are already pregnant then all plans will decline to insure anyone on the family until after the baby is born.

Detailed Plan Descriptions and Florida Health Insurance Quotes:.

For quotes on individual PPO plans please go to Quote Information. E-mail the requested information.

Some more buying tips:

(1.) You’ll want to understand the difference between a "Major Medical" health plan and other types of health insurance, such as a "Basic Medical" or a "Hospital/Surgical". 

In general, a "Major Medical" or "Comprehensive Major Medical" health plan covers medically necessary treatment unless specifically excluded in the policy. On the other hand, a "Basic Medical" or "Hospital/Surgical" typically covers only treatment that is specifically included in the policy. 

Look carefully at the difference. "Basic Medical" plans serve a purpose. However, some are designed to look like a "Major Medical" plan and are aggressively marketed. If you qualify and you want the most comprehensive protection, look for the phrase "Major Medical" or "Comprehensive Major Medical" on the offering brochure or policy.

(2.) When comparing health plans, check the exclusions carefully. A list of plan exclusions should be clearly stated in the sales brochure - almost always at the very end. 

Many exclusions are typical (i.e. acts of war, self-inflicted injuries, custodial care, etc.), while others are not and should be carefully considered when comparing plans. For example, does the plan have a waiting period for certain conditions? Also, watch for the typical exclusion of a "Basic Medical" plan - "anything not specifically listed in the policy".

(3.)  A "stop-loss-limit" restricts the amount of medical charges you pay. NOT all policies include such a limit.

After you pay the deductible, major medical insurance normally pays a portion of the covered charges (i.e. 80%) and you pay the other portion, known as "co-insurance", until your out-of-pocket expense equals the policy stop-loss-limit. Once you've paid your limit, the policy then pays 100% of the covered charges up to the policy maximum.

Be sure you're protected with a stop-loss-limit. In a PPO, you should check for a stop-loss-limit on both "in-network" and "out-of-network" charges. 

(4.)  "Test the waters" by calling customer service. This is a great tiebreaker. 

Unlike your life insurance, your health insurance is an asset you are likely to use more than once, in good health as well as with possible injury or illness. So when a need arises, how difficult will it be to get an answer? 

Is it worth paying a few dollars more for a company that answers your call within a minute or two, rather than waiting on hold for 20 minutes or longer? In any case, it’s good to know what to expect before making your decision.

(5.) The assistance of a top-notch, independent insurance professional can be invaluable – and probably costs you nothing! 

So, no matter whether it's you, an insurance company employee, or an independent agent who completes your insurance application, your monthly premium is exactly the same. 

And since health insurance can be complicated and expensive, find the best independent agent you can to help you get the most for your money? Here are some sample questions when interviewing an agent: "How do you keep up with changes in the health insurance marketplace?", "How many health insurance companies do you represent?", "How readily available are you should I have a question or encounter a problem?" 

Don’t worry about offending someone’s fragile ego. It’s your family, your health, and your pocketbook that you are looking after. A good insurance professional will understand this fact and will welcome your sensible inquiry.

(6.)  Activate your best memory when completing the health questionnaire. Here’s why: 

The final step in obtaining health insurance is qualifying through the health questionnaire. Here it’s important to remember that by nature, the human mind tends to forget or minimize past or present illness. A positive attitude can be a benefit in the healing process. However, failing to disclose a material health condition, past or present, could jeopardize your coverage entirely. 

Medical audits are often done when there is a major claim. By law, the insurance company can revoke coverage and return all premiums paid, if it is discovered that the policyholder failed to disclose a material medical condition on the application. 

Never give the insurance company a potential way out of paying a major claim. Even though this is the last step in the process, don’t be hurried. It is wise to pause and think carefully when completing your health questionnaire.