A lot of Americans are members of group health plans and the rules governing such plans in Florida are similar to those seen in many of the other states, although there are some differences that could apply particularly to public employees.

In order to join a group health plan you need to first be eligible for memberships of the scheme. For example, although an employer may have a group health scheme, it does not have to be open to everyone, possibly being designed for full-time but not part-time workers. In addition, the scheme may be operated by an HMO and you might find that you live outside of the service area for the HMO.

If you are eligible for membership of the scheme then you must be allowed to join regardless of your state of health. Here your state of health refers to your present health, including any disability that you may be suffering from, together with your past medical history. It is also interesting to note that you cannot be refused membership as a result of genetic information.

It must be understood here that, despite the fact that your employer can exclude you from a scheme because you do not for example work sufficient hours, he cannot refuse you membership solely on your current or past medical history.

Virtually every scheme has an enrollment period during which you need to join the scheme which might typically be within 30 days or starting work. However, if you choose not to enroll at this stage then an employer is required to give you an opportunity to join during what is generally called a special enrollment period if particular changes come about within your family. Such changes might include such things as marriage, the birth of a child and the loss of other health insurance coverage as the result of such things as the cessation of coverage being provided through another family member because of death, reduction in working hours, legal separation, termination, retirement, divorce and similar circumstances.

Vitually all plans also normally have a waiting period for membership that will typically be anywhere from 30 days up to 3 months. An employer has to apply this waiting period consistently for all eligible employees and during this time you are not covered by the group scheme.

Where the group scheme that you are joining is being operated by an HMO then the HMO can also require a waiting period (often known as an affiliation period) where you will once again not be covered. Affiliation periods required by HMOs cannot normally exceed 2 months and where a waiting period is required the HMO may not then impose any pre-existing condition exclusion periods.

Under the provisions of Florida law any group plan that includes cover for dependents must also provide cover automatically for newborns, newly adopted children and children who are placed for adoption for 31 days after the date of birth, adoption or placement. There may also be a requirement for parents to register these children within this 31 day period for cover to continue thereafter.

For parents taking care of disabled children who are covered under a group plan cover will normally continue beyond the age at which a child would no longer be considered as a dependent, as long as the parents can demonstrate that the individual concerned cannot support himself (or herself) as a result of physical or mental disability and that they are principally dependent upon the plan member for support.

If you work for an employer with at least 50 employees then you will be allowed to take a leave of absence without loss of health insurance for up to 12 weeks in some circumstances. This protection is guaranteed by the Family and Medical Leave Act (FMLA) to cover such things as childbirth, sickness or the need to take care of a seriously ill family member.

Federal law allows states, county and local governments to exempt government employees from particular coverage in self-insured group health plans and many public employers in Florida make use of this to a degree. Because exemptions vary widely between employers it is a good idea to establish the precise nature of yourcoverage provided if you are a public employee. This information can also be found by contacting The Center for Medicare and Medicaid Services (CMS) which has a list of employer exemptions.

Despite the fact that under Florida law you cannot be refused membership of a group health plan for reasons of health, there are some circumstances in which exclusion periods may be imposed for pre-existing conditions. However, this is a complex topic and one that is thus the subject of a further article.

MedicalHealthInsuranceToday.com covers everything from Florida group health insurance to short term health insurance