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Individual Insurance

 

Individual health insurance is purchased independently of an employer or a government program.  Unlike group health insurance, applicants generally must complete a medical questionnaire and companies can decide not to cover people with pre-existing medical conditions, such as cancer.

Individual Insurance Options

  • Basic and Essential Medical Insurance
    Covers a portion of hospital, medical, and surgical expenses.  Payments are based on what is deemed usual and customary by the insurance company.  Premiums are based on your health status, occupation, and geographic location.
  • Major Medical Insurance
    Costs extra and provides more benefits than basic insurance.  Usually pays 80% of covered expenses after you pay a deductible.
  • High-Deductible
    Also referred to as catastrophic insurance, this is an inexpensive plan that pays after a high deductible is met of at least $1000 for an individual and $2000 for a family.
  • Tax-Favored Plans (HSAs, MSA, FSAs, etc)
  • Group Options
    You may be able to join a group health plan through a professional or trade association, charitable organization, or alumni group.  For people over 50, the Association of Retired Persons offers health coverage.
  • Limited Benefit Plan (example:  Cover Florida, see below)

    Coverage does not include all required benefit mandates required by Florida law.  Plans have limitations and exclusions and a reduced number of covered services and benefits as compared to comprehensive benefit plans.

Cover Florida

Private insurance companies have collaborated with the State of Florida to offer health insurance coverage. You do not loose your Cover Florida coverage when you change employers or are unemployed.  Cover Florida offers limited benefit plans to any Florida resident between the ages of 19 and 64 who has been without health insurance for at least six months, or if:

  • coverage was terminated due to any of the following:
  • lost a job that provided employer-sponsored health benefits;
  • benefit time ended under COBRA;
  • not eligible for any public health coverage program such as Medicaid or KidCare;
  • coverage  as a dependent child or through KidCare ended due to age; or
  • lost benefits due to a death of, or divorce from, a spouse with employer-sponsored health benefits

Cover Florida is a guaranteed issue plan, meaning that you cannot be denied coverage due to pre-existing medical conditions or health status.  Exclusions apply for a 12- month period for pre-existing conditions. 

  

Cover Florida offers two types of benefit plans.  Plan I is a limited benefit plan that provides preventive coverage such as routine office visits, lab services, specialist services, screenings such as mammograms, immunizations, annual health assessments, and some level of  prescription coverage and preventive dental care. 

  

Plan II is a limited benefit plan that adds hospital and surgical coverage to the routine and preventive coverage of Plan I. 

  

Sarasota County residents may choose from two insurance providers that offer Cover Florida: 

  1. BlueCross BlueShield  1-877-872-6580
  2. United HealthCare     1-800-809-9831

 

In certain situations, individuals may qualify for guaranteed-issue policies.  This means that coverage must be issued regardless of a person's health status.  You  may qualify for a guarantee-issue policy under HIPPA.

 

For more information on health insurance, go online to the National Association of Health Underwriters:  www.nahu.org/consumer

 


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