Health Coverage for Your Employees
While not required by law, employers sometimes offer benefits, such as group life and health coverage, to attract and keep good employees. The next few pages address health care coverage. If you want to learn more about life insurance, please request a free copy of our Life Insurance and Annuities guide for consumers by calling the Consumer Helpline toll-free at
1-800-342-2762. Or, you can download it from the Department’s Web site at www.myfloridacfo.com.
Types of Health Coverage
Traditional health insurance, managed care plans, and dental, vision and disability insurance are among the types of health coverage available to small employers.
Traditional Health Insurance
With traditional health insurance, employers usually offer health benefits to their employees by purchasing coverage through an insurance company at group rates.
Managed Care
Managed health care combines the delivery and financing of health care services. The most popular form of managed care is the health maintenance organization (HMO). Your employees choose physicians and medical service providers from a list of HMO contract providers (hospitals, physicians, specialists, medical services, etc.).
The Office of Insurance Regulation regulates HMOs financially, reviewing and approving HMO contracts and rating methods, and monitoring HMOs for financial solvency. The Florida Agency for Health Care Administration regulates the quality of care offered by HMOs. If you have questions or complaints regarding quality of care issues, contact the Agency for Health Care Administration’s toll-free Consumer Hotline at 1-888-419-3456.
The advantage of an HMO is that, in return for the limited choice of doctors and hospitals, HMO members usually pay less out of their own pockets than people with traditional insurance. There is also little or no paperwork for HMO members to complete when they receive care.
The main disadvantage of an HMO is that employees cannot always visit the physician or medical facility of their choice. They must choose from a group of physicians that contracts with the HMO, except in an emergency situation. For more information on HMOs, health insurance or other health coverage concerns, please request a free copy of our Health Maintenance Organizations or Health Insurance guides for consumers by calling the Department of Financial Services Consumer Helpline toll-free at 1-800-342-2762. You may also download them from the Department’s Web site at www.myfloridacfo.com.
Association-Based Coverage
An insurance company that markets an association-based certificate to a Florida resident must obtain a license from the Florida Department of Financial Services. However, the insurer may keep the master policy in the name of an association or trust based outside of Florida. In addition, the insurer may file its policy forms and rates for approval in the association’s home state.
Please be aware that this means some of Florida’s most important insurance laws covering benefits and rate increases may not apply to out-of-state, association-based coverage, even though the insurance is sold to Florida residents. In particular, the government of the home state (the state where the policy was issued) may not closely review or approve the rates involved. For more information about association-based coverage, you may request a free copy of Health Insurance: A Guide for Consumers by calling the Consumer Helpline toll-free at 1-800-342-2762, or you may download it from the Department’s Web site at www.myfloridacfo.com.
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