Health Insurance Definitions that Florida Subscribers Need to Know

‘Annual Limit’ is the yearly cap on the amount of funds that the subscriber can make use of. Once this limit is exceeded, the health insurance subscriber in Florida needs to bear the full expenditure on health care treatments. Owing to the health care reforms, no health insurance firm in Florida can impose a yearly cap below $1.25 million.


‘Catastrophic coverage’ is the amount that the health insurance carrier in Florida will pay for medical care that exceeds above the high deductible. This can usually go up to several thousands of dollars. Laws have mandated that health insurance policies issued in Florida must bear the cost of some specified preventive services including immunizations and diagnostic procedures for high blood pressure and depression.

‘Coinsurance’ refers to the amount the subscriber needs to pay for medical care after paying for the deductibles. While a typical health insurance plan in Florida might pay about 75% to 80% of the bill for medical services, the remaining amount can be understood as the coinsurance.

‘Copay’ is the pre-defined fee that the subscriber needs to pay every time he receives a health care. For instance, this can be something like $25 which a health insurance subscriber in Florida needs to pay while meeting a doctor. The amount exceeding this will be borne by the insurance policy.

‘Deductible’ is the amount that the subscribers needs to pay from their pockets before the coverage comes in.

‘Exclusions’ refers to treatments, medical services and conditions that will not be covered by the particular health insurance policy in Florida. Usually, it is mandated that the complete details of exclusions are spelt out in the policy document.

‘Fee for service’ is the coverage that bestows complete freedom to the health insurance subscriber in Florida with respect to the choice of the health care provider.

‘Group health insurance’ is the health insurance coverage offered by the employers or affinity groups like an employee Union or a student organization.

‘Health maintenance organization’ is a type of managed health care in Florida consisting of participating providers under which the subscribers of health insurance can receive medical care and treatments. Generally, the primary care physician will give a referral to the subscribers helping them to choose the right specialist to offer the required treatment.

‘Health reimbursement arrangement’ is an account maintained by the employers to save the amount towards medical expenses. In this arrangement, the balance remaining after a year on the subscriber’s account will be automatically carried over to the next year.

‘High-risk pool’ is a state sponsored health insurance plan in Florida that offers coverage for those who cannot qualify for a health insurance plan offered by a private buyer on account of pre-existing health conditions.

‘Individual health insurance’ is the health insurance coverage in Florida directly purchased by a subscriber from a health insurance provider.