With daily reports of new information and proposed changes oncomprehensive health- care insurance reform, it may be time to lookat what is already available to Floridians. Florida is a large anddiverse state, and one size does not fit all when it comes tohealth-care coverage and costs. The state of Florida and insurancecarriers have recognized this and designed a wide array of group,individual, Medicaid, and Medicare health insurance plans to servethe needs of all. Listings of various plans and their healthinsurance carriers are available atwww.floridahealthfinder.gov.

Group Plans

Businesses with one life or more have access to guaranteed issuegroup plans. The group plans for employers with less than 100employees are available to businesses regardless of health claimsexperience. Carriers and benefit plans vary from county to county;some counties have regional HMO carriers that do excellent jobs inmeeting the specific needs of the county population. The coveragefor a one-life group (self-employed person with no other eligibleemployees) is only available for enrollment in August of each yearfor an effective date of October 1st.

While traditional health insurance and managed care plans are amajor part of our health care system, the larger employer may electa single employer, self-funded or partially self-funded plan. Theseplans fall under the guidelines of the federal Employee RetirementIncome Security Act (ERISA).

Employers participating in a self-insured plan assume thefinancial risks, rather than transferring the risk to an insurancecarrier. The employer pays the covered claims filed by theemployees as specified in the plan. The employer generally hires athird party administrator to administer the plan; however, theemployer is responsible for the claims.

Individual Plans

There are many reasons why a client may choose an individualplan, whether it is coverage for one person or all members of afamily. Many buy these plans because an insurance plan may not beavailable through their employer, they want to supplement theircurrent coverage, they are unemployed, or they have a life stylechange such as a death or divorce. Some insurance carriers offerindividual plans on a county-by-county basis and usually include anHMO, PPO or HSA. While all individual plans are medicallyunderwritten and an applicant may be rejected, the underwriting hasbecome simpler and easier to complete.

If a client is not medically eligible for an individual plan anddoes not qualify for a group plan, an alternative resource is theCover Florida Health Access Program. The Cover Florida plans areavailable to Floridians between the ages of 19-64 who have beenwithout health insurance for six months and may have pre-existinghealth conditions. Coverage is available in all 67 counties. Moreinformation on Cover Florida is available atwww.coverfloridaheathcare.com

Coverage for Children, Medicaid

Florida has three health-care programs for children throughFlorida KidCare: Medikids for children ages 1-4; Healthy Kids forchildren 5-18; and Medicaid for children birth-18 for families.Also, Children's Medical Services Network is a program for childrenfrom birth to age 18 who have special medical needs.

The eligibility for Florida KidCare depends primarily onhousehold size and family income. Coverage is offered for any childin Florida through the full-pay option for families who areover-income for the MediKids and Healthy Kids programs. Subsidizedcoverage is offered for child up to 200 percent of the federalpoverty level. More information on Florida Kidcare is available atwww.floridakidcare.org

Medicare Plans and Supplements

The Centers for Medicare and Medicaid (CMS) is part of the U.S.Department of Health and Human Services; 46 contractors administerthe Medicare program. Originally the Medicare program had two parts— A & B — known as the hospital insurance program and themedical insurance program. Today, Medicare also has Part C and PartD. Part C is the Medicare Advantage or managed care plans, and PartD is the prescription drug benefits program. These plans areoffered by private insurance companies and approved byMedicare.

Medicare supplements are available to offset deductibles andout-of-pocket expenses not covered by Medicare Parts A & B. Theplans E-J vary in pricing by county, but are standardized in thebenefits offered.

Offering Medicare to potential clients is a detailed,time-consuming process. Because of the rules, reporting, andenrollment processes involved, many carriers require that agentsrepresenting their products obtain special training andcertifications.

Timelines, materials and guidelines are strictly enforced byCMS. On October 1, approved marketing may begin. The annualelection period is November 15-December 31. New plan orcontinuation of current plan enrollment starts January 1. MedicareAdvantage Open Enrollment is January 1-March 31. During openenrollment, enrollees may join a new plan, switch plans, or returnto original Medicare. Changes made during this period will beeffective the first day of the month after the plan gets theperson's enrollment form. This enrollment time may be used toswitch to a different type of Medicare plan, but it cannot be usedto change whether or not a person is enrolled in Medicareprescription drug coverage. April 1 is the lock-in date — whicheverplan the person has elected is locked in for the rest of the year.More information on Medicare is available at www.medicare.gov.

Kimberly Auclair of Pineapple FinancialServices, LLC, in Melbourne, also is president-elect of the FloridaAssociation of Health Underwriters. She may be reached at321-259-8088 or [email protected].