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12 mandatory provisions of Florida health insurance.

Wednesday, February 27, 2008

Health insurance is one of the most important investments an individual can make for himself and his family members. With so many health insurance providers offering health insurance, states like Florida have 12 mandatory health insurance provisions that apply to all health insurance providers. The 12 mandatory Florida health insurance provisions are:
1) The contract

Anything apart from the signed application and attached policy riders cannot be considered a part of the health insurance contract. In essence, a customer must receive all the paperwork with the final contract and anything outside the paperwork provided is not considered a part of the contract. This provision has been enforced as a customer protection clause, and is designed to ensure that health insurance providers do not use any annexure to their advantage.
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2) Limiting the contestable time period

Any Florida health insurance policy can only be contested and question by the customer within a given time period. In essence, the customer is responsible for understanding all the details involved in the policy and Florida health insurance providers are required to provide their customers a time of around 2 years before the policy is considered ‘incontestable’.

3) Grace period

All Florida health insurance providers have to give their customers a grace period to renew their policy and only after the grace period has expired can a Florida health insurance provider null and void the insurance policy. The grace period is 7 days for industrial policies, 10 days for policies with a monthly premium and 31 days for other policies.

4) Reinstatement of defaulted health insurance payments

Florida health insurance providers are required to continue the health insurance if a customer defaults on the policy but pays the delinquent premium (If the Florida health insurance provider does not require a fresh application). This mandatory provision is ideal for people that might have defaulted on a payment but would like to continue the health insurance without any paperwork.

5) Notice of claim

The policy owner has to inform a Florida health insurance provider with a notification of loss within a stipulated time period of 20 days.

6) Health insurance provider has to provide claim forms

It is the duty of the Florida health insurance provider to provide the customer with the necessary claim forms within 15 days of receiving the notice of loss.

7) Submitting proof of loss

The claimant has 90 days to provide the Florida health insurance provider with the necessary proof of loss. This clause is not applicable when it is not possible to provide the Florida health insurance provider with the necessary documents.

8) Payment of claims

Any Florida health insurance provider has to pay the claimant in 45 days of receiving the necessary claim documents (like a notification and proof of loss).

9) Payment of claims

All Florida health insurance policies are required to mention clearly how the claims will be paid, and who will receive the payment of claims (irrespective of the nature of the Florida health insurance policy).

10) Examination and autopsy

Under Florida law, a Florida health insurance provider can carry out a physical examination/autopsy at its own expense. The claimant has zero liability, and all expenses involved in the examination/autopsy are borne by the Florida health insurance provider. Although this clause has come in for considerable criticism by various people, under Florida provisions a Florida health insurance provider can choose to conduct an autopsy before ‘entertaining and paying’ any claims. This rule has been enforced to rule out ‘foul play’ in deaths, but most health insurance providers usually let law enforcement take care of any autopsies. In fact, Florida health insurance providers usually make payment of claims once the local law enforcement has termed a death as natural. In addition, Florida health insurance providers can also carry out multiple physical examinations of a patient if need be.
11) Legal action

Although claim disputes are rather rare, a claimant can choose to pursue legal action against a Florida health insurance provider. It is important to note that the law prohibits any legal action within 60 days of submitting proof of loss. This clause has been introduced so that Florida health insurance provider and the claimants have sufficient time to resolve their disputes before entering into litigation. In addition, the 60 day ‘cooling off’ period also allows the Florida health insurance company to validate the authenticity of the claim and also to request any additional paperwork.

12) Change of beneficiary

The benefactor of a policy can choose to change the policy’s beneficiary at any given time (unless the beneficiary is irrevocable and such a condition is mentioned in the contract).

Understanding the 12 mandatory health insurance provisions

The most prominent feature of the 12 mandatory Florida health insurance provisions is that they are essentially designed to protect the policy holder. Almost all provisions are designed to give the policy holder greater flexibility and the opportunity for legal recourse if required. In fact, the only provision that is designed to protect the best interests of the Florida health insurance provider is the one that allows a Florida health insurance provider the opportunity to inspect the claimant before making payments. In addition, the 12 mandatory health insurance provisions are designed to streamline basic processes like making claims, and to make it simpler for the consumer to interact with Florida health insurance providers. In essence, the 12 mandatory health insurance provisions are essential for smooth flow of operations.
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