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


CONTACT: Nina Banister
(850) 413-2842

TALLAHASSEE - Self-employed Floridians in need of health insurance can obtain it during an open enrollment period during the month of August, Florida's Chief Financial Officer Tom Gallagher said today.

The open enrollment period requires insurance companies and Health Maintenance Organizations (HMOs) 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 now covered by a small business plan may switch to another company's plan.

"The opportunity comes only once a year for the self-employed seeking guaranteed-issue health coverage," Gallagher said. "It's a good time to review current coverage and to consider new additional options, such as tax-advantaged health savings accounts and health reimbursement arrangements."

The Small Group Market Carrier list is posted on the Department of Financial Services' website at . For available benefits, go to .

Guaranteed-issue means insurers and HMOs must offer coverage without regard to health status. While small businesses with only one employee, often referred to as "one-life groups," cannot be refused coverage during the open enrollment period, companies that write coverage for these groups are required to offer only "basic" and "standard" plans. Redesigned last year by a Small Employer Benefit Committee appointed by Gallagher, the plans feature adjustments to benefits intended to reduce premium costs, such as raising co-pays for emergency room admissions, physician office visits and prescription drugs, as well as allowing higher deductibles and out-of-pocket maximums.

HMOs are now also able to offer "co-insurance" type standard and basic plans as an alternative to traditional co-pay type plans. In these insurance-like options, HMOs pay
60 to 80 percent of typical charges for services, depending on the plan, as opposed to charging co-pays. Employers can choose different out-of-pocket maximums to further adjust premiums.

All basic plans are now required to provide prescription drug coverage, and lifetime maximums for basic insurance plans were raised from $500,000 to $2 million. Standard insurance plan lifetime maximums were raised from $1 million to $5 million. HMO standard and basic plans previously carried no lifetime limits but now have the same maximum limits as the insurance plans.

With the passage of the Affordable Healthcare for Floridians Act this year, new coverage options for employers include health savings accounts (HSAs) and health reimbursement arrangements (HRAs) for employers. HSAs, which operate like Individual Retirement Accounts (IRAs), allow people to save their own money in a tax-free account for use on health related expenses. If the money is not spent, it rolls over and continues to accumulate until age 65 at which time the money can be used for any purpose.

"These accounts will help Floridians pay for out-of-pocket health costs with pre-tax dollars and empower them to make wise financial decisions about their medical care," said Gallagher, who co-chaired the Governor's Task Force that suggested many of the new choices. "In addition to offering another option for Floridians seeking health care coverage, these accounts will be attractive to young, healthy individuals who so often choose to go without insurance and will help lower overall costs in the market."

Self-employed Floridians who apply for coverage must show certain documentation verifying that they are operating an active business. For assistance, they should contact the department's toll-free consumer helpline at 1-800-342-2762 or visit

Consumers may also contact our helpline to request a free copy of our health insurance consumer guide. Previous releases and a copy of the Small Employer Benefit Committee's report are also available on the department's website.