Florida Statutes, Rules and Regulations Pertinent to Health Insurance 18% Exam With Complete Solutions

Florida Statutes, Rules and Regulations Pertinent to Health Insurance 18% Exam With Complete Solutions Minimum Benefit Standards - answerFlorida law regulates the minimum standards for coverage. Grandfathered Health Plan - answerSection 42&18011 of the US Code says that any group health plans participants have the right to maintain coverage when the insured's changes plans and to have creditable coverage count toward HIPAA eligibility relating to pre-existing conditions exclusions. Non-grandfathered health plans - answerPlans or policy contracts that do to have to provide the creditable coverage benefits. Individual Health Insurance Policies - answerCannot exclude coverage for pre-existing conditions for longer than 24 months following the effective date of coverage. Insurer are required to credit to provide credit for pre-existing conditions for the time their person was covered under the previous coverage in the new policy. If previous coverage was effective 63 days prior to the new coverage . *The application must clearly request information about p[re-existing conditions if the provision is to apply.* Group Health Insurance Polcies - answerMust make available to policy holders coverage for mental and nervous disorders. These benefits must meet minimum standards Individual and Group Health Coverage: Minimum Standards - answerBOTH MUST • Provide coverage for handicapped children • Provide coverage for a newly born child for the 1st 18 months • Must be renewable at the option of the individual Coverage Exceptions or Exclusions - answerExceptions: Florida Law provides that individual and group health insurance policies and HOM contracts must be renewable at the option of the policy holder UNLESS: • Failure to pay premiums in a timely manner • Fraud or misrepresenting of material fact • Failure to meet minimum participation or minimum contribution requirements of a group policy. • Insurer ceases offering that coverage in a market • For network plans or bonfire assoc. there isn't an individual or group enrollee resides or works in the service area, provided that this requirements is applied uniformly. Health Insurers may exclude payment of benefits under a health plan that are covered under Workers Compensation or are services rendered by the Veterans Administration. Coordination of Benefits - answerInsurance companies may work together between group insurance and ind. health insurance benefits. Does not include Indemnity plans. HMO's FLorida Statues and Regulations: - answerHMO's: • Can only offer plans approved by the Department and cannot engage in any other activity. • An insurance company can own or sponsor an HMO • Required to file a report of its activities within 3 months of the end of each fiscal year. • Department can and may conduct on-site visits. • Can operate their own hospitals and clinics • Enter into volume discount arrangements with physicians to provide service on a prearranged per capita basis. Called (Capitation) • Operate on EITHER the closed-panel or open-panel basis. HMO's Requirements For Providers - answerHMO Requireme