Individual & Family Health Insurance
In the state of Florida, there are many options to choose from when it comes to picking the right health insurance plan. We act as consultants on your behalf to make sure you get a health plan that satisfies your needs in terms of coverage and price.
At Florida Health Insurance Center we have access to the major health insurance companies in Florida including United Healthcare, Golden Rule, Aetna, Humana, Cigna, Assurant Health, and others. Whether you live in Miami, West Palm Beach, Fort Lauderdale, Tampa, Orlando, Jacksonville, Daytona Beach, Fort Myers or any other location in Florida, you can rest assured you are getting the best possible rates and benefits direct from top notch companies.
We offer every health insurance product line available including traditional Doctor Co-Pay plans, Health Savings Account plans (H.S.A.), Small Business Group plans, Short Term medical plans, Catastrophic plans, and Special Risk plans.
Florida health insurance usually provides either direct payment or reimbursement for expenses associated with illnesses and injuries. The cost and range of protection provided by your health insurance will depend on your insurance provider and the particular policy you purchase. If your employer does not offer a Health Insurance plan, you may wish to purchase Health Insurance on your own.
Individual vs. Group Health Insurance Plans
When you purchase an Individual Florida Health Insurance plan it now belongs to you and will follow you regardless of employment status. Employer Group Plans belong to the employer and will be lost if you change employment.
The biggest difference between Individual / Family Plans and Employer Group Health Plans are that Employer Group Plans are guaranteed issue (you can be insured regardless of medical conditions) while Individual / Family Plans go through what is called a medical underwriting process. During medical underwriting, everyone listed on the application will have their health condition evaluated and the insurance company can choose to do one of four things.
- First, you can be issued a policy with no changes with full coverage up to the policy limits.
- Second, the insurance company may uncover a condition that will add additional cost to them. This is known as a pre-existing condition and they will most likely increase the monthly premium to cover that additional cost (called a rate up) or move you to a different rate class.
- Third, they can find a condition that they feel is too risky for them to cover and put an exclusion rider on that condition. A rider means they will cover everything up to the policy limits except the condition the rider was issued for.
- Forth, the insurance company can decline your application and not issue you a policy.
Once the underwriting process takes place on an Individual or Family plan, the Insurance Company has a good understanding of the insured's current health conditions. This identifies the claims risk for the insurance company and may result in a much lower monthly premium.
The opposite is true with Employer Group plans. Since the Insurance Company doesn't know the current health conditions of the employees they will be insuring under a Group Health plan, their claims risk will be much higher therefore the monthly premium can be as much as 2-1/2 times more expensive for the employer who is sponsoring the plan.
A popular option that can reduce cost for both the employer and their employees is to offer lower cost high deductible Health Savings Account Plans (H.S.A.). These plans generally have either a single individual deductible or single family deductible. Once deductible has been met the plan covers 100% of covered expenses. It also incorporates limited income tax deferred benefits.
In the State of
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They can elect to have the payments for individuals deducted from payroll through something called "List Bill". Many employees prefer this because they can pay weekly or by-weekly instead of monthly or quarterly.
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The employer can also elect to direct funds to the employee's Health Savings account to help pay some of the out of pocket expenses before the calendar year deductible has been met. This is a popular option because the monthly premiums are usually lower for these types of plans and at the same time gives the employee the use of a debit card to purchase day to day services until the deductible has been reached. Money that accumulates in the employee's health savings account can also be used tax deferred to pay for over the counter medication, Dental, Vision and a host of other medically related items not usually covered on a health Insurance plan.
The Problem
Generally speaking employers want to provide Health Insurance to their employees as a benefit to retain them. In order for the employer to qualify to offer Group insurance, they first must guarantee employee participation of 75% to 50% and have at least 2 or more employees on their payroll. The participation rate will depend on the insurance company they choose. Maintaining participation percentage has become more difficult and a growing concern for both the employers and the employees due to the increasing cost of Group Health Insurance.
The average cost for the employer in 2009 at the rate class of "Family" (employee, spouse and 1 or more children) is about $1,200 per month.
A similar plan for individual / family coverage may only cost $400 to $500 per month or even less if it just includes the spouse and children. The employee's cost on a group plan depends on what portion of the premium the employer is willing or able to pay.
Employer Group plans are great if the employer is able to cover a majority of the entire family premium but we are seeing more & more cases where the employers have been forced to only contribute to the cost of the employee's portion with little or no contribution to the rest of the family. The family portion represents about 75% of the full cost of the policy. The law only requires that the employer pay 50% of the employee's portion and the employer doesn't have to share in the cost for the rest of the family. We have seen an increasing amount of clients come to us just to cover spouses and children and the employee will remain covered by their employerıs group plans.
So what do we recommend?
- First find yourself a Broker that you feel comfortable with. We hope you will choose us. We represent all of the major insurance companies that offer quality plans in the state of
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We know that all plans work differently depending on where you live. There are network differences and prices vary as much as 30% by zip codes. Don't be fooled, no the facts. Make sure you talk with a Broker before you buy. We don't charge for our services because we are compensated by the insurance companies that have appointed us to representatives them. Remember, rates are established through the State of Florida Insurance Commissioner. Each company must submit rates and plan designs periodically before they can be approved. Once a plan is approved that is the only rate that can be charged by any Agent, Broker or even the Insurance Company.
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If you are already on an Employer Group sponsored plan and your employer is able to contribute enough to offer a decent plan with reasonable rates, stay where you are.
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If you are in a situation where your employer group sponsored plan is costing your family too much and your family members are fairly healthy, consider applying for Individual / Family coverage for just your spouse and children. This will place the one in your family that is the employee into the "employee only" rate class and the law requires that the employer pay at least 50% of that cost which will substantially reduce the current rate or even totally remove any premium for the single employee. This will lower your combined cost by as much as 65% and satisfy the employer as well because as long as the employee remains on their company plan it doesn't hurt the company's participation rate.
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You may have a situation where your spouse or other members of your family have pre-existing conditions. These members are most likely going to have to stay on the employer group plan. Look for anyway that you can change the rate class on the Employer Group plan and then cover the healthy family members on individual plans. Group plans get very expensive when children are involved. For instant, as soon as you add one child to either a husband and wife class or single parent class you instantly will take a giant leap in your monthly premium. This is because you are now paying the rate of this new class where some people could have 5 or more children and you are going to pay the same rate as if you had that many children. To put it another way you are paying for everyone.
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If you are self employed or just not covered you can give us a call and in a few minutes we will be able to tell you what your situation will be. Then find the best plan to meet your personal needs. Service doesn't end there. We will then help you through the enrollment process and year after year we will be looking for opportunities to continually lower your premiums or find even better coverage if it should come along.
For an instant online health insurance quote for you or your family, please fill out our online form.
