Coverage for mammograms
All health insurance issued in Florida must provide coverage for at least the following:
- A baseline mammogram for any woman age 35 to 39
- A mammogram every two years for any woman age 40 to 49 or more frequently if a doctor recommends it
- A mammogram every year for any woman age 50 or older
- Women of any age who are at risk for breast cancer because of a personal or family history must be allowed at least one mammogram a year if recommended by a doctor
Coverage for cleft lip and cleft palate of children
Group and individual health insurance policies in Florida must provide coverage for treatment of cleft lip and cleft palate for the child while the child is under the age of 18. The coverage must include:
- dental,
- medical,
- speech therapy,
- audiology, and
- nutrition services
if they are prescribed by the treating physician or surgeon and such physician or surgeon certifies that such services are medically necessary for treatment of the cleft lip or cleft palate. This section does not apply to accident, disease, hospital indemnity, limited benefit disability income, or long-term-care insurance policies.
Rebates for participation in wellness program
Insurance companies may encourage maintaining good health or improvement of issues like body mass index and smoking with annual rebates to the insured. The individual will have to show that their health status is the same or better than it was for example by showing weight loss or stopped smoking.
The rebate may not exceed 10% of paid annual premiums. The premium rebate will be paid on an annual basis while the individual is participating in the wellness program.
Emergency Services
Network plans, such as HMOs and PPOs, are required to provide the same coverage when the patient is out-of-network (“nonparticipating provider”) as when he/she is in-network (“participating provider”) for emergency services. Any co-payments or co-insurance amounts must be the same as those that apply to a participating providers, meaning that out-of-network emergency claims must be treated like any other claim.