Frequently Asked Questions
Are
copays 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
favorable 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 under the health plan?
See above
What
will happen for State of Florida employees under BCBS?
Under HMO arrangements?
Under PPO arrangements?
They should be covered at plan
renewal. 627.6686(3)(d), F.S.
"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 governments? 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 insurance 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
actively 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 under this legislation?
Yes, the law only applies to
large group plans 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 therapeutic 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 referenced in 627.6686(3), F.S. then yes.
Can
any fees for social workers be covered if they are providing coordinating
services?
That will depend on
the terms of the insurance contract.
Could physicians bill for hyperbaric oxygen therapy services?
We
have a board array of alternative medical treatments, are these going to be
covered?
Can chelation therapy be covered? If provided
by a physician would it be covered?
See above.
How
do parents determine when and if their provider is obligated to provide
services under the Geller Bill?
They must determine if
they have a small or large group and when the plan renews. The law only
applies to large group plans that are issued or renewed on or after
4/1/2009.
Thank you to Eric
Lingswiler, Interim Director of the Life and Health Product Review at
the Florida Office of Insurance Regulation for providing this information.
Eric D.
Lingswiler
Interim Director
Life and Health
Product Review
Florida Office of Insurance
Regulation
850-413-5110
eric.lingswiler@floir.com