State RegulationsFL specificDifficulty 1/5
A consumer with a preexisting heart condition applies for a NON-grandfathered individual health policy in Florida. What may the insurer do regarding the condition?
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Answer & full 3-part explanation (select an option above, or peek)
Why C is correct
Non-grandfathered health plans may not impose preexisting condition exclusions, and applicants cannot be declined or charged unlimited surcharges solely because of a health condition. Under the minimum benefit standards reflected in Chapter 627, Florida Statutes, and enforced by the Florida Office of Insurance Regulation, coverage is available regardless of health status, so the insurer cannot exclude the heart condition, surcharge it without limit, or deny the application because of it.
Why the other options are wrong
- A) Permanent exclusions for a preexisting condition are not permitted in non-grandfathered coverage.
- B) Unlimited premium surcharges based solely on a health condition are prohibited; rating must rest on the allowable factors.
- D) Declining an applicant solely because of a preexisting health condition is prohibited for non-grandfathered plans.
Memory hook
Preexisting condition? Not in THIS plan.