Requirements For Small Employers
Insuring small groups can be difficult and expensive because there are not enough employees to spread the cost around and make it more affordable per person. So, Florida created the Florida Employee Health Care Access Act to promote the availability of health insurance coverage to small employers regardless of claims experience or their employees' health status, and to improve the overall fairness and efficiency of the small group health insurance market.
Definitions
Dependent means the spouse or child of an eligible employee.
*****Eligible employee means an employee who works full-time, having a normal workweek of 25 or more hours. This includes a self-employed individual, a sole proprietor, a partner of a partnership, but does not include part-time, temporary, or substitute employees.
*****Guaranteed-issue basis means an insurance policy that must be offered to an employer regardless of health status, preexisting conditions, or claims history of the group, and if the policy is offered to the group then it must cover everyone within the group regardless of health status (no "carve outs").
*****Small employer means a person, any type of business, or association that is actively engaged in business, has its principal place of business in Florida, and employed an average of 1 to 50 eligible employees , the majority of who were employed in Florida.
Small employer carrier means an insurer that offers health benefit plans covering employees of small employers.
Special provisions
For employers who have fewer than two employees (so one employee), a late enrollee may be excluded from coverage for up to 24 months if he or she was not covered by creditable coverage to a date more than 63 days before the effective date of the new coverage.
The standards used to determine insurability of a small group must be used uniformly for all small groups having the same number of employees. The insurance company must offer coverage to all eligible employees and their dependents, which is what we stated earlier when we said that there are no "carve outs" allowed. A small employer carrier may not offer coverage limited to certain persons in a group except with respect to late enrollees, and the insurance company is not allowed to modify the plan.
The plan has to have an initial enrollment period of at least 30 days and an annual open enrollment period of 30 days.
Disclosure requirements
When offering of a health plan to a small employer, the insurance company must make a reasonable disclosure to the employer that information is available regarding:
- the provisions concerning an insurer's right to change premium rates and the factors that may affect premium rates;
- the provisions that relate to renewability of coverage;
- the provisions that relate to any preexisting condition exclusions; and
- the benefits and premiums available under all health insurance coverage for which the employer is qualified.
Denial/termination/nonrenewal
A small employer carrier does not have to offer coverage or accept applications from:
- a small employer not physically located in the service area of the insurance company, provided the service area be at least a county;
- an employee, if the employee does not work or reside within the service area of the small employer carrier; or
A small employer carrier may deny coverage in the small-group market if the carrier has demonstrated that:
- it does not have the financial reserves necessary to underwrite additional coverage; and
- it is applying this rule uniformly to all employers in the small-group market in the state.
If a small employer carrier denies issuing health insurance coverage then they will not be allowed to offer group plans in Florida for at least 180 days after the date of coverage was denied.
