Frequently As=
ked
Questions
Are co pays to be the same for=
each
visit or provision of services?
627.6686(5), F.S.
The coverage required pursuant to subsection (3) may not be subject to
dollar limits, deductibles, or coinsurance provisions that are less favorab=
le
to an insured than the dollar limits, deductibles, or coinsurance provisions
that apply to physical illnesses that are generally covered under the health
insurance plan, except as otherwise provided in subsection (4).
Are they to be the same as for other services und=
er
the health plan?
See above
What will happen for State of
Under PPO arrangements?
"Health insurance plan" means a group
health insurance policy or group health benefit plan offered by an insurer
which includes the state group insurance program provided under s. 110.123.=
The
term does not include any health insurance plan offered in the individual
market, any health insurance plan that is individually underwritten, or any
health insurance plan provided to a small employer.
What about city and county governm=
ents?
Are they covered?
Coverage would have to be provided if the city or county had 51 or =
more
employees.
Is there a listing of the insu=
rance
companies or group numbers that come in under the provisions of this act?
How can a family know if their current plan is covered?
The Office doesn’t have a list of specific
plans. The law only applies to large group plans that are issued or renewed=
on
or after 4/1/2009. The Office does have a list of carriers in the
large group market, however, we do not know if all these companies are acti=
vely
selling.
Who do parents contact if they feel
their rights under the Gellar act are being violated?
DFS Consumer services 1-800-342-2762
What about kids with Healthy Kids =
and
the other "uninsured" kid-coverage programs funded by the state or
pay-in? Do these plans come in under the Geller Act?
No.
Are PPOs and HMOs covered un=
der
this legislation?
Yes, the law only applies to large group p=
lans
that are issued or renewed on or after 4/1/2009.
What about services for medical
diagnostic and evaluative services? Will there be a set of procedures
that count as evaluative services and perhaps another that count as therape=
utic
services? What is the range of services that will be covered?
Other than the mandated services in the law, it will depend on what=
is
provided in the Insurance contract.
Can clinical psychologist’s services be covered if they are
providing diagnostic services? Will the services be covered if parent of a =
comprehensive
assessment being conducted by a physician?
If they provide covered services reference=
d in
627.6686(3), F.S. then yes.
Can any fees for social workers be covered if they are providing coordinati=
ng
services?
That will depend on t=
he
terms of the insurance contract.
Could physicians bill for hyperbaric oxygen therapy services?
We have a board array of alter=
native
medical treatments, are these going to be covered?
Can chelatio=
n therapy be covered? If pr=
ovided
by a physician would it be covered?
See above.
How do parents determine when and if their provid=
er
is obligated to provide services under the Geller Bill?
They must determine if they have a small or lar=
ge
group and when the plan renews. The law only applies to large group plans t=
hat
are issued or renewed on or after 4/1/2009.
Thank you to Eric Lingswil=
er,
Interim Director of the Life and Health Product Review at the Florida Offic=
e of
Insurance Regulation for providing this information.
Eric D. Lingswiler=
Interim Director<=
/span>
Life and Health P=
roduct
Review
Florida Office of Insurance
Regulation
850-413-5110
eri=
c.lingswiler@floir.com