Florida Statutes, Rules, and
Regulations Pertinent To Health
Insurance
Grandfathered health plan - ANSWER-is any group health plan to which a plans
participant's right to maintain existing coverage when the insured changes plans, and
to have creditable coverage count toward HIPAA eligibility relating to pre-existing
conditions exclusions.
Nongrandfathered health plans - ANSWER-are health insurance policies or HMO
contracts that do not provide the credible coverage benefits.
Exclusive Provider Organization (EPO) - ANSWER-is a type of preferred provider
organization in which individual members use particular preferred providers rather
than having a choice of a variety of preferred providers.
Multiple Employer Welfare Associations (MEWAs) - ANSWER-can be any, other
than a duly admitted insurer, that establishes an employee benefit plan for the
purpose of offering or providing accident and sickness or death benefits to the
employees of at least 2 employers, including self-employed individuals and their
depndents.
Multiple-Employer Trust (MET) - ANSWER-is made up of two or more employers in
similar or related businesses who do not qualify for group insurance on their own.
fee-for-service - ANSWER-where providers receive a payment for their billed
charges for each service provided.
Prepaid plans - ANSWER-provide medical and hospital benefits in the form of
service rather than dollars.
Indemnity-based plans - ANSWER-pay health policy benefits to the insured based
on a predetermined, fixed rate, regardless of the actual expense incurred.
Expense-based plans - ANSWER-pay health policy benefits as a reimbursement of
actual expenses.
Discount medical plans - ANSWER-means a business arrangement or a contract
(not insurance) in which a person, for a fee, provides access for plan members to
providers of medical services and the right to receive those services at a discount.
Shopper's Guide - ANSWER-must be provided in the format developed by the
National Association of Insurance Commissioners (NAIC) and must be presented to
the applicant prior to completing the application.
Regulations Pertinent To Health
Insurance
Grandfathered health plan - ANSWER-is any group health plan to which a plans
participant's right to maintain existing coverage when the insured changes plans, and
to have creditable coverage count toward HIPAA eligibility relating to pre-existing
conditions exclusions.
Nongrandfathered health plans - ANSWER-are health insurance policies or HMO
contracts that do not provide the credible coverage benefits.
Exclusive Provider Organization (EPO) - ANSWER-is a type of preferred provider
organization in which individual members use particular preferred providers rather
than having a choice of a variety of preferred providers.
Multiple Employer Welfare Associations (MEWAs) - ANSWER-can be any, other
than a duly admitted insurer, that establishes an employee benefit plan for the
purpose of offering or providing accident and sickness or death benefits to the
employees of at least 2 employers, including self-employed individuals and their
depndents.
Multiple-Employer Trust (MET) - ANSWER-is made up of two or more employers in
similar or related businesses who do not qualify for group insurance on their own.
fee-for-service - ANSWER-where providers receive a payment for their billed
charges for each service provided.
Prepaid plans - ANSWER-provide medical and hospital benefits in the form of
service rather than dollars.
Indemnity-based plans - ANSWER-pay health policy benefits to the insured based
on a predetermined, fixed rate, regardless of the actual expense incurred.
Expense-based plans - ANSWER-pay health policy benefits as a reimbursement of
actual expenses.
Discount medical plans - ANSWER-means a business arrangement or a contract
(not insurance) in which a person, for a fee, provides access for plan members to
providers of medical services and the right to receive those services at a discount.
Shopper's Guide - ANSWER-must be provided in the format developed by the
National Association of Insurance Commissioners (NAIC) and must be presented to
the applicant prior to completing the application.
