Health Insurance

Office of Insurance Regulation snapshot of Florida market,  including insured and uninsured for health insurance. 

Macro-Trends in Florida Health Insurance Market

July 16, 2007

A Florida Insurance Council White Paper 

Contact Sam Miller, Executive Vice President, (850) 386-6668, ext. 223

A recent editorial in a major Florida newspaper was entitled: “Insurers are preventing prevention”. It criticized the health insurance members of the Florida Insurance Council for opposing during the 2007 regular session bills that mandated coverage of specific health benefits.  Unfortunately, the editorial, as similar articles or opinion pieces in recent years, ignored the reasons why health insurance companies oppose such mandates.

The Florida Insurance Council is comprised of health plans that compete to sell policies that individuals and employers want - and can afford - to purchase.  These insurers try to meet the needs of Florida customers by offering policies that will best meet their needs. 

There are two major reasons why health plans oppose mandates.  First, mandates increase the cost of a policy.  Many customers already find it difficult to afford their health care coverage and will not be able to retain coverage if their costs continue to rise.  Second, customers may not wish to purchase coverage for certain benefits.  If mandated, they would be required to do so regardless of whether those benefits are needed.

It is also important to point out that health plans in Florida currently offer a multitude of product options that include coverage of benefit choices that are not mandated.  If a benefit is important to the consumer and they are willing to pay for it then it is in the best interest of the health plans to cover that benefit, regardless of whether it is required by law. 

To imply that health plans cover only what is absolutely necessary and have no interest in preventative coverage is completely untrue.  In 2006 Blue Cross and Blue Shield of Florida covered more than 870,000 child and adult immunizations, performed more than 45,000 child health checkups and filled approx. 13.5 million prescriptions.  BCBSF and other FIC health plans care about their members and encourage them to take advantage of the preventative services offered to them.

The home health care mandate offers a perfect example of the negative impact that mandates can have on coverage.  Most health plans covered home health services before the Florida Legislature mandated them.  Home health care was cost effective and convenient for plan members. What impact did the decision to mandate home care have?  Instead of contracting with the highest quality home health providers of their own choosing and negotiating with those providers to keep costs down, health plans were forced to contract with lesser-quality home health providers in order to meet mandated requirements.  Forcing health plans to contract with home health agencies also took away any negotiating leverage that health plans had, resulting in higher costs and lower quality for plan members. 

Choosing home health care was not by chance, as it is the rarest of mandates – a cost-effective one our customers value.  It shouldn’t be mandated for those reasons cited, but likely would be included in policies even if repealed.  Most mandates - current and proposed - are neither cost-effective nor demanded by customers, and therefore should not be required.

FIC health plan members will work to continue to offer what our customers want: high quality network products at affordable prices.  We will continue to find ways to market lower cost products to cover the uninsured.  Mandates impede accomplishment of those objectives by raising costs and limiting access options for individuals and groups that must absorb continued health cost increases.

 

This informational memorandum was posted by the Office of Insurance Regulation on its Internet site on July 12.

OIR Informational Memo on HMO Legislation


Florida Guaranty Funds & Associations

July 12, 2007

Much of this information came from the Department of Financial Services Internet Site.

Florida Insurance Guaranty Association (you are leaving the FIC site and opening a new browser window)
FIGA

The Florida Insurance Guaranty Association handles the claims of insolvent property and casualty insurance companies.

Florida Workers' Compensation Insurance Guaranty Association (you are leaving the FIC website and opening a new browser window)
FWCIGA

The purpose of the Florida Workers' Compensation Guaranty Association, Inc. ("FWCIGA") is to implement Florida Statute Sections 631.902 - 631.927, to provide a mechanism for the payment of covered claims, to avoid excessive delay in payment and to avoid financial loss to claimants in the event of the insolvency of a member insurer.

Florida Life and Health Insurance Guaranty Association (you are leaving the FIC website and opening a new browser window)
FLAHIGA

Florida Health Maintenance Organization Consumer Assistance Plan
(Note: This organization does not currently have a website but may be contacted using the below contact information)
Phone: 850-893-6686
Fax: 850-422-3737
Mailing Address
HMOCAP
P. O. Box 16459
Tallahassee, FL 32317-6459