If you wish to join a group health scheme you must first be eligible for memberships of the plan. For instance, in spite of the fact that an employer may run a group health plan, it does not have to be open to everybody, possibly being reserved for full-time but not part-time workers. In addition, the plan may be run by an HMO and you might find that you are living outside of the HMO's service area.



Should you be eligible to join the plan then you have to be allowed to join regardless of your state of health. In this case your state of health means your current health, including any disability that you may have, as well as your past medical history. It is also interesting to note that you may not be excluded from the plan on the grounds of genetic information.

It must be understood here that, despite the fact that an employer is permitted to exclude you from a plan because you do not for instance work enough hours, he cannot exclude you based solely on your present or prior medical history.

Most plans has an enrollment period during which you must join the scheme which may typically be within about 30 days or starting work. If however you decide not to enroll at that stage then an employer must give you the opportunity to join during what is frequently termed a special enrollment period if particular changes occur within your family. These changes may include things like marriage, the birth of a child and loss of other health insurance cover because of things like the cessation of cover being provided through another family member because of death, retirement, divorce, reduction in working hours, termination, legal separation and similar circumstances.

Vitually all plans also generally include a waiting period for membership that is typically anything from 30 days to about 3 months. This waiting period must be applied consistently for all employees and during this period an employee is not covered under the group plan.

If the group plan that you are joining is operated by an HMO then the HMO may also apply a waiting period (usually called an affiliation period) where you will again not be covered. HMO affiliation periods may not generally exceed 2 months and where such a waiting period is required the HMO may not then impose any pre-existing conditions exclusions.

Under Florida law any group health plan that provides cover for dependents also has to provide cover automatically for newborns, newly adopted children and children placed for adoption for 31 days after birth, adoption or placement. There may also be a requirement for parents to register these children with the plan within this 31 day period for cover to continue thereafter.

For parents with disabled children who are covered under a group plan cover will usually continue beyond the age when a child would no longer be classed as a dependent, as long as the parents can demonstrate that the individual concerned is incapable of supporting himself (or herself) because of physical or mental disability and that they are largely dependent upon the scheme member for support.

If you work for an employer with at least 50 employees then you can take a leave of absence without losing you health insurance for up to 12 weeks in certain circumstances. Such protection is guaranteed by the Family and Medical Leave Act (FMLA) to cover things like the birth of a child, sickness or the need to take care of a seriously ill family member.

Federal law permits states, county and local governments to exempt government employees from some coverage in self-insured group health insurance plans and a lot of public employers in Florida take advantage of this to a degree. Because exemptions vary widely between employers it is prudent to discover the precise nature of yourcoverage provided if you are a public employee. This information can also be found by getting in touch with The Center for Medicare and Medicaid Services (CMS) which has a list of employer exemptions.

Despite the fact that according to Florida law you may not be refused membership of a group health plan on the basis of health, there are certain circumstances where exclusion periods may be imposed for pre-existing conditions. However, this is a complicated topic and one that is therefore the subject of a further article.