Enrollment in small group health insurance in Florida is available only once a year, in the month of August. Coverage would then commence in October.

‘Available’ is a misleading term, as the insurance companies have the legal right to apply strict underwriting guidelines. This law went into effect on July 1, 2000. ‘Strict underwriting guidelines’ includes a close scrutiny of the applicant’s health for possible future health conditions, along with limiting the length of coverage. They may even require that the premium payment for their insurance be submitted on a business check. Many people in business for themselves do not need or want a business account.

Small businesses create the most new growth in employment in the US, as more well trained and well educated people go into business for themselves. The freedom they desire to direct their own work lives is strong. Sometimes the price of this freedom includes not being able to obtain health insurance at all.

Health insurance in Florida is guaranteed issue under the law for self employed persons. There are very few insurance carriers for this type of small group health insurance. Usually it is a business loss for them. Guaranteed issue means that health insurance coverage is mandatory if the applicant can fulfill the underwriting guidelines. Insurance companies and HMO’s would prefer that they be allowed to select only the applicants most likely to stay healthy. Since they are not allowed to do this, they require information such as 2 years of business tax returns as part of the underwriting guidelines. In 2003 the legislature allowed insurance carriers to charge self employed persons an additional 50% on their insurance premium. In many cases this increased the monthly premium from $1,000.00 to $1,500.00 for their Florida group health insurance.

A person who is self employed may be better off financially to try for individual health insurance, if they can qualify for it. Under individual health insurance rules, the insurance carrier can examine the health of the applicant and if found suspect, deny coverage. Those applicants with Type 2 diabetes, over 50, overweight, or with a family history of chronic health conditions such as high blood pressure, will probably not be able to obtain individual health insurance at any price.

As a consequence of these issues, some self employed persons elect to establish Health Savings Accounts. Under a health savings account, the person may contribute to a fund that is used to pay for health care. It is tax protected and the balance can be carried forward to the next year. This fund would be established by an insurance carrier as another Florida group health insurance option. The insurance carrier would administer the fund to maintain the tax protected (before tax income) status. Depending on how the fund is set up, the person may be viewed as self insured. Finding a physician who will accept a patient with this type of coverage is just another stumbling block in the health care system.