Pre-existing conditions in Florida health insurance is an area of health insurance that seems to suffer from a murky cloud of confusion. What is a pre-existing condition? How are pre-existing conditions handled in Florida? Are there differences in how pre-existing conditions are handled depending on whether it is a Florida group health insurance plan or a Florida individual health insurance plan? All of these are valid questions concerning pre-existing conditions and their effect on obtaining health insurance coverage in the state of Florida.

The obvious first question is, “What is considered a pre-existing condition in Florida?” Typically, most health insurance companies in Florida will look at an applicant’s health history going back as far as 10 years to determine an applicant’s health status (in the case of an application for individual health insurance; group health insurance in Florida will not levy quite as much scrutiny towards a pre-existing condition). Therefore, in the strictest type of scenario; any adverse medical conditions or medical issues within the 10 years prior to the application being submitted is considered a pre-existing condition. (This is not the case for all areas of pre-existing conditions as in the case of certain conditions the health insurance company is only concerned with say high cholesterol [just an example] or nicotine use [just an example] in the past 5 years or 2 years rather than the full 10 years). Generally speaking, any type of medical condition or issue that happened further back than 10 years ago does not exist for the sake of the Florida health insurance application.

The obvious follow up question is, “How are these pre-existing conditions handled by the health insurance company that one is applying with?” The classic attorney answer happens to fit in this instance, “That depends.” The way that a specific pre-existing condition is handled in an application for individual health insurance in the state of Florida is solely at the discretion of the underwriting department of the health insurance company. Of course, common sense would tell us that a pre-existing condition of cancer will be treated much differently than a pre-existing condition of the tendency to develop a cold: just as Diabetes will be treated much differently from hay fever.

There are probably 3 main general groupings of pre-existing conditions in the state of Florida when it comes to individual health insurance. There are the pre-existing conditions that will signal an automatic decline by the health insurance company such as diabetes, cancer, extreme obesity, and rheumatoid arthritis (only a few examples), those that will prompt the insurance company to either not cover the particular pre-existing condition (exclude that specific condition but cover everything else - a “rider”) or charge an additional premium (”rate - up” or rate increase) such as asthma/allergies, back disorders, and high cholesterol (only a few examples), and then there are those pre-existing conditions that present a risk so minor that the health insurance company will cover everything and not charge an additional premium (such as infections, disorders, or surgeries where there has been a Doctor certified 100% recovery, common cold, common childhood ailments, etc) (again, only a few possible examples).

The important thing to do if you have a serious pre-existing condition and have health insurance is to NOT cancel your health insurance coverage! There may still be other options available to you such as a HIPAA guaranteed issue plan (cannot be declined due to pre-existing conditions) or a group health insurance plan. There are a number of criteria that you must meet in order to be eligible under HIPAA. Consult with a knowledgeable Florida independent health insurance agent that will be able to assist you in finding appropriate Florida health insurance coverage.

Joel Ohman