State RegulationsFL specificDifficulty 2/5
A Florida small employer applies for group health coverage, and one of its employees has a serious preexisting health condition. Under Florida's small employer requirements, the insurer:
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
Under Chapter 627, Florida Statutes, Florida's small employer health insurance requirements are built on guaranteed availability: a carrier offering coverage to small employers must accept a small employer group that applies, without using the group's health status or claims experience as a reason to refuse it. This is the cornerstone protection that keeps small businesses and their workers, including those with serious conditions, from being shut out of the insured market.
Why the other options are wrong
- B) Refusing the group because of an employee's condition is exactly the health-status discrimination the small employer rules prohibit.
- C) Individual medical-file rating of employees is not how small employer group coverage is underwritten under Florida's requirements.
- D) Using group acceptance as a vehicle to carve out and exclude the sick employee defeats the guaranteed availability protection.
Memory hook
Small employer coverage: the door must be open regardless of health.