Basic Differences Between Florida Individual and Group Health Insurance


The Florida insurance Commissioner sets the rules that every Florida health insurance company must abide by.

A small group is usually referred to as groups of less than 10 employees and a large group is usually 50 or more eligible employees.

Florida group health insurance plans are guaranteed issue, meaning you cannot be declined coverage behind because of any kind health issue, nor can they exclude coverage for condition if you have prior creditable coverage ( if you don’t have prior coverage there is usually a six to twelve month waiting period on any pre-existing conditions).

Also if you wanted maternity benefits, getting a group health insurance plan for your business actually is a viable solution because the only individual carrier in Florida that offers maternity benefits is Blue Cross and Blue Shield.

With most Florida group plans maternity expenses are covered the same as any other illness.

It’s also quite common for large group health insurance plans to have open enrollment.

So that’s where members can make a plan change once a year and during certain qualifying events such as marriage, divorce, and adoption, etc, etc.

This is an important matter for employees to consider after weighing the options of an individual health insurance plan versus their group medical benefits offered to their employer. A common situation is when an employee must decide whether to add his spouse and children to their group health plan and are only able to drop them once a year.

Usually, employers do not pay towards the cost of insurance for dependents, this can get quite expensive for the employee.

This is why it’s important to verify if your group health insurance plan has an open enrollment period.

if you’re contemplating starting up a group insurance plan for your business here are couple bullet points to keep in mind:

  • Florida health insurance groups require at least two eligible employees.
  • Most if not all Florida health insurance companies have participation requirements. It’s usually around 75%, which means if you have 10 employees that are eligible to enroll in the plan you must have at least seven enroll or you will be declined coverage or possibly lose your existing coverage because of being below the participation requirement level.

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