Preexisting Conditions and Rules of Blue Cross Blue Shield of Florida

Obtaining quality health insurance coverage for Floridians with preexisting conditions can be a challenge. Insurance companies have an obligation to shareholders and existing policyholders not to take poor risks into the risk pool, but even those with preexisting conditions need coverage, if not for their preexisting condition, then for other conditions that may occur that need treatment.



Florida preexisting conditions provisions at Blue Cross/Blue Shield of Florida are in line with the requirements set forth by the Health Insurance Portability and Accountability Act (HIPAA) of 1996.

Federal Law

• HIPAA required insurance companies to provide coverage to those with preexisting conditions, subject to the following provisions:

  Group plans cannot deny coverage to individuals with preexisting conditions who otherwise qualify for membership in the risk pool.

  If you have had no gap in creditable coverage lasting 63 days or longer, you can convert a group plan to a comparable individual plan, paying no more than 115 percent of the total premium of the group plan (including the employer-paid portion of the premium).

  If you have a gap in coverage longer than 63 days, or have never had coverage, then insurance companies are not required to cover expenses arising from preexisting conditions for the first 12 months the policy is in force.

Applicability of Florida Law

• Florida law requires insurers to cover pregnancy-related claims, regardless of prior coverage status. In this way, Florida law provides more generous guarantees to consumers than Federal law requires. Newborns are also covered, provided they are enrolled in the plan within 30 days of birth. If they are not enrolled after 30 days, then preexisting conditions exclusions apply in the state of Florida.

  Individuals who cannot get coverage in Florida because of a preexisting condition may apply to the Florida Preexisting Condition Insurance Plan, or CoverFlorida initiatives.

Blue Cross/Blue Shield

• Blue Cross/Blue Shield of Florida's policies are in compliance with both state and federal requirements. They offer maternity benefits and plans for pregnancy as well as mental illness.