Health Insurance

The Florida House Policy & Budget Council prepared an excellent overview of health insurance and the uninsured problem in Florida as part of an analysis of HB 7081, the big House bill during the 2008 regular session on expansion of health insurance and health care.

The overview, "Current Situation," begins on page 2 of the bill staff analysis and is available from the link below.

Sections of the overview include:

Financial Basis of Health Care

  • Access to Health Care
  • Accident & Health Report: Summary by Major Medical Lines of Business
  • Cost of Insurance
  • Quality
  • Health Flex Plans
  • Retiree Health Insurance Subsidiary
  • Florida Kidcare Program
  • Nonprofit Religious Cost Sharing  Organizations
  • Employee Election of Health Coverage
  • Dependent Coverage
  • Limited Benefit Plans

Florida Health Insurance Overview - April 9, 2008



Coverage for mental, nervous and substance-related disorders is a "mandatory offer" under Florida law; that is, insurers and HMO's must offer it in small group health plans and it must be offered through government employee insurance programs. The coverage is limited. Major legislation considered during the 2008 session would significantly expand this mandatory offer.

Excellent background is available on the bill and health insurance coverage for mental and nervous disorders generally from the Senate Banking & Insurance Committee analysis on SB 164, dated February 26, 2008.

Mental Health & Nervous Disorder Coverage

From the House Committee on Health Innovation, analysis of HB 71, January 22, 2008. 

The average cost of health insurance in the United States has increased by 87 percent since 2000. In 2006, premiums for family coverage increased 7.7 percent nationally. This is less than the 9.2 percent increase for 2005, but exceeds the overall inflation rate, which was 3.5 percent, and the increase in workers’ earnings, which was 3.8 percent.

The average premium cost of single coverage for covered workers in 2006 is on average $354 per month or $4,242 per year, while the average cost of family coverage is $957 per month or $11,480 a year. Premiums further vary based on the type of policy workers are covered under. Preferred Provider Organizations plans have the highest enrollment and face higher average premiums for both single and family coverage than Health Maintenance Organizations, Point of Service, and High Deductible Health Plans with Savings Options plans.

From the Senate Banking & Insurance Committee, February 28, 2008, analysis of SB 164:

In Florida, the average cost of family coverage (for health insurance) is about $1,000 a month, or $12,000 a year.


Individual Coverage: State by State Regulation

From Florida Insurance Council Researchers

An increased number of Floridians with health insurance and lower loss ratios for the health care industry were some of the positive trends cited in a report from The Florida Health Insurance Advisory Board (FHIAB).

The report focused on specific segments of the Florida health care market including in-state and out-of-state group markets, the small-group market, large group market and individual market for the years 2001-2006.

The most important development the report discovered was the increase in the small group market (58,000 more covered lives) and individual market (111,000 more covered lives) from 2005-2006.

Other results were mixed. As the number of people covered in the commercial health insurance market has increased, the number and percentage of Floridians without health insurance coverage has also increased.

Citing data from the U.S. Census Bureau, the report found that a fourth of all Floridians (more than 3.8 million) under the age of 65 are without health insurance. This represents an increase of 37.7% since 1999. The report also showed a decrease of 11.8% in covered lives in the commercial health insurance market from 2001 (5.1 million) to 2006 (4.5 million).

Despite this overall trend, markets did see the first yearly increase in total enrollment for the reporting period. There was a 7.1% increase in covered lives from 2005 to 2006 (from 4.2 to 4.5 million), partly due to the continued growth of the individual health market, up 32% since 2001.

From 2005 to 2006, enrollment increased in all market segments except for the out-of-state group (both large and small)which saw a decrease of 19,799 or 8%.

The instate large group market (groups with 51 and more members) enrollment increased for the first time in the reporting period, up 3.7% or 82,477 covered lives from 2005 to 2006.

Total enrollment in the small group market increased once again from 1,060,562 covered lives in 2005 to 1,124,909 covered lives in 2006, or 6.1%. This market has shown growth every year since 2003.

 The impact of three new insurers to the individual health insurance market last year drove enrollment numbers from 453,976 in 2005 to 547,241 in 2006, an increase of 20.5.%  The individual market in Florida also has had a significant presence of  out-of-state group or association group policies. These policies have increased covered lives 53.6%, from 158,066 in 2001 to 242,767 in 2006. These policies now represent 30.7% of the individual market compared to only 26.5% in 2001.

Another finding of the report was that instate insurers are bearing a disproportionate share of the percentage of guarantee issue covered lives. Guarantee issue policies cover people who are not able to obtain coverage through an employer or other alternative. These persons generally have higher claims costs. While insurers issuing instate policies cover 69.3% of covered
lives in the individual market, they cover 97.8% of the guarantee issue individual covered lives.

Out-of-state insurers bear only 2.2% of these policies.

While total premium revenue increased 40.2% from 2001 to 2006, it showed a decrease of 3% from 2005 to 2006. This decrease  was primarily caused by a decrease of 8.7% in premium revenue for the instate large group market. The decrease occurred  despite enrollment increasing by 3.7%. The factors causing these decreases could not be determined.

The direct incurred loss ratio (direct incurred losses as a percent of direct earned premium) for all market segments showed general decline from 2005 to 2006 with the percentage for all insured declining 78.8% to 78.4%. Market segments that showed  an increase in direct incurred loss ratio were instate small group from 72.2% to 73.4% and the out-of-state group markets
which saw an increase from 76.8% to 80.8%.