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Self-employed Floridians Qualify for Guaranteed-issue Health Coverage during August

7/31/2002

TALLAHASSEE - Self-employed Floridians in need of health insurance can obtain it during an open enrollment period beginning tomorrow and lasting through the month of August, Treasurer and Insurance Commissioner Tom Gallagher said today.

The open enrollment period, established by the 2000 Legislature, requires insurers to offer applications for coverage to the self-employed on a guaranteed-issue basis from August 1 to August 31 each year, with a plan start date of October 1. The open enrollment period is also the time when the self-employed currently covered by a small business plan may switch to another company's plan.

"We need to get the word out that the window of opportunity only comes once a year for the self-employed seeking guaranteed-issue coverage," Gallagher said.

Guaranteed-issue means that insurers must offer coverage without regard to health status. While small businesses having only one employee, often referred to as "one-life groups," cannot be refused coverage during the open enrollment period, small employer carriers are required to offer only "basic" and "standard" plans to the self-employed.

The basic and standard small business plans are generic or standardized plans, meaning all small employer carriers must offer these exact plans in the marketplace. The current standard plan provides drug coverage and a $1,000,000 lifetime limit on hospital and physician services. The less expensive basic plan does not provide drug coverage, has higher out-of-pocket charges, and has a $500,000 lifetime limit. Both plans are currently under review for possible alterations, but any changes to current benefit levels will not likely take place until 2003.

The department may conduct onsite investigations of small group carriers to assure compliance with open enrollment requirements. If sole proprietors attempting to apply for coverage experience difficulty during this enrollment period, they should contact the department's toll-free consumer helpline at 1-800-342-2762 for assistance.

Consumers may also contact our helpline to ask questions or request a free copy of our health insurance consumer guide. In addition, the department's website, www.fldfs.com, features an online version of the guide.