Key Takeaways
- Florida requires group life insurance policies to include a conversion privilege within 31 days of coverage termination
- Small group health insurance in Florida applies to employers with 1-50 employees
- Florida law requires mental health parity in group health insurance plans
- Group health plans must provide certificates of insurance to covered employees
- Florida follows federal ACA requirements for essential health benefits in small group plans
Florida Group Life and Health Insurance Requirements
Florida regulates group life and health insurance to protect employees and ensure access to coverage.
Group Life Insurance Requirements
Conversion Privilege
Florida requires group life policies to include a conversion privilege:
| Requirement | Details |
|---|---|
| Who Qualifies | Employees losing group coverage |
| Conversion Period | 31 days from termination |
| No Underwriting | Cannot require proof of insurability |
| Premium | Standard individual rates for age |
| Coverage Amount | Up to amount of group coverage |
When Conversion Rights Apply
Conversion rights apply when:
- Employment terminates
- Employee retires
- Employee's class is eliminated
- Group policy terminates
- Dependent loses coverage
Exam Tip: The 31-day conversion period is key. During this period, employees remain covered under the group policy.
Death During Conversion Period
If an employee dies during the 31-day period:
- Group coverage still applies
- Death benefit paid as if coverage continued
- Conversion application status irrelevant
Small Group Market Definition
Florida Small Group
| Market | Employee Count |
|---|---|
| Small Group | 1-50 employees |
| Large Group | 51+ employees |
Small Group Protections
Florida small groups enjoy:
- Guaranteed issue
- No pre-existing condition exclusions
- Essential health benefits
- Community rating
- Guaranteed renewal
Certificate of Insurance Requirements
Florida requires certificates for covered employees:
Required Contents
| Element | Description |
|---|---|
| Benefits Summary | What the plan covers |
| Eligibility | Who is covered |
| Effective Dates | When coverage begins/ends |
| Conversion Rights | How to convert |
| Continuation Rights | COBRA options |
| Claims Procedures | How to file claims |
| Appeal Rights | How to appeal |
| Contact Information | Insurer info |
Certificate Timing
- Provided within reasonable time of coverage
- Updated for material changes
- SBC also required
Mental Health Parity
Florida requires mental health parity in group plans:
Parity Requirements
| Requirement | Details |
|---|---|
| Coverage Level | Same as medical |
| Cost Sharing | Same copays, deductibles |
| Visit Limits | Cannot be more restrictive |
| Prior Authorization | Same as medical |
Covered Conditions
- Mental illness
- Substance use disorders
- Behavioral health
- Same as physical illness coverage
Dependent Coverage
Age 26 Rule
Florida follows federal requirements:
| Requirement | Details |
|---|---|
| Age Limit | Coverage to age 26 |
| Marital Status | Doesn't matter |
| Student Status | Doesn't matter |
| Financial Dependence | Doesn't matter |
Extended Coverage
Florida provides extended dependent coverage for:
- Disabled dependents
- Full-time students (some plans)
Coordination of Benefits
When employees have multiple coverage:
Florida Coordination Rules
| Situation | Primary Plan |
|---|---|
| Employee's own plan | Primary for employee |
| Employee as dependent | Primary pays first |
| Children (birthday rule) | Earlier birthday primary |
| Divorced parents | Court order or rules |
Birthday Rule
Uses parent's birthday month and day:
- Earlier birthday = primary
- Same birthday = longer coverage primary
Employer Contribution Requirements
Participation Requirements
| Contribution | Minimum Participation |
|---|---|
| Employer-paid | 100% eligible |
| Contributory | Typically 75% |
Small Employer Flexibility
Small employers may have:
- Lower participation requirements
- Guaranteed issue
- Cannot be charged more
Florida Healthy Kids
Florida's CHIP program (Children's Health Insurance Program):
Who's Eligible
| Requirement | Details |
|---|---|
| Age | Under 19 |
| Income | Above Medicaid limits |
| Residency | Florida resident |
Benefits
- Comprehensive health coverage
- Doctor visits
- Hospital care
- Prescription drugs
- Dental and vision
Exam Tip: Florida Healthy Kids is Florida's CHIP program for children whose families have income too high for Medicaid but who cannot afford private insurance.
How long do employees have to convert group life insurance in Florida?
What is the small group market size in Florida?
Under the birthday rule, which parent's plan is primary?
What happens if an employee dies during the 31-day conversion period?
What is Florida Healthy Kids?