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Florida - Compensation & Benefit Legislation

FLORIDA - AASHOWME

Demonstrates www.BenefitsReview.com™. Illustrates insurance carriers' coverages within the State.

 

FLORIDA - ADOPTED CHILD HEALTH CARE MANDATE

OBRA 1993 (Federal) requires group health plans to honor medical and child support orders. Also, plans must treat adopted children like biological children covered by the plan, and plans are precluded from applying pre-existing condition exclusions to an adopted child where no such exclusion applies to a newborn biological child. Health plans that covered the cost of pediatric vaccines as of May 1, 1993, and fail to continue that level of coverage, will be subject to an excise tax penalty applicable to plans that fail to meet the health care continuation coverage requirements under OBRA 1993.

 

Mandatory coverage of birth of adopted and foster children is included in state's newborn health care mandate.

 

Preventive care for children: yes, to age 16.

 

(Florida Stat. Ann. Sections 627.6406, 627.6562, 627.6575, 627.6578, 627.6579, 627.6615)

 

FLORIDA - ALCOHOLISM & DRUG ABUSE

Employer option. Minimum yearly inpatient coverage: No statutory requirements.

 

Minimum yearly outpatient coverage: No statutory requirements.

 

Minimum lifetime coverage: $2,000.

 

(Florida Stat. Ann. Section 627.69.)

 

FLORIDA - CAFETERIA PLAN TAX LAWS

State income tax, unemployment insurance tax on salary reduction: Florida has no personal income tax. State unemployment insurance law has no specific provision on cafeteria plans, but employer payments for health and accident and group term life insurance benefits are specifically excluded from wages under state Unemployment Insurance law and may be excluded even when provided through a cafeteria plan. However, employee salary reductions for such benefits still must be counted as wages for Unemployment Insurance taxes.

 

FLORIDA - CONTINUATION OF COVERAGE CONVERSIONS

Events Triggering Continuation of Coverage:

 

Death: No.

 

Job Termination: No.

 

Reduction of Hours: No.

 

Divorce or Legal Separation: No.

 

Medicare Eligibility: No.

 

Other Provisions: For total disability, policy must have "reasonable" continuation provision. If work place ceases to exist, employees are eligible for 12 months major medical and 90 days of other coverages.

 

Early Termination of Continuation of Coverage: The end of the 90-day extended coverage period (for dental coverage only) or when insured becomes covered under a similar dental policy.

 

(Florida Stat. Ann. Section 627.667)

 

FLORIDA - COORDINATION OF BENEFITS

Requires use of the birthday rule if coordinating benefits (effective 10/1/85), but uses different Coordination of Benefits (COB) rules for Medicare beneficiaries. COBRA amendment adopted in 1990. (Florida Stat. Section 627.4235

 

FLORIDA - COST-OF-LIVING

ERI's Relocation Assessor™ is a recommended source for U.S./Canadian cost-of-living data and U.S. Automobile Cost Survey.

 

FLORIDA - DRUG TESTING AND EMPLOYEE ASSISTANCE BENEFITS

Who is Covered by Statute: An agency within the state government.

 

Applicant Testing: Applicant testing is allowed. All positive tests must be confirmed by GC/MS.

 

Employee Testing: Employee testing is allowed where a reasonable suspicion of drug use exists, or where test is conducted pursuant to routine fitness testing or follow-up testing.

 

How Test Results are Used: Test results may be used as grounds for termination or disqualification of employment if a confirmation test is performed and if employee did not complete rehabilitation program. Test results may also be used as a basis for refusal to hire applicant.

 

Enforcement of Statutes: Enforcement is by civil suit.

 

Employee Remedies: Employees may seek back pay and benefits, attorney's fees, and injunctive relief.

 

Employer Penalties: None.

 

Who Pays for Testing: State has no statutory requirements.

 

Employee Assistance Benefits: State has no statutory requirements.

 

Other Requirements: Employer with not testing program in place must wait 60 days after providing employees one-time notice before implementing such a program.

 

(Florida Stat. Ann. Section 112.0455; City of Palm Bay v. Bauman, 475 So. 2d 1322 (Florida District Court of Appeals 1985). (Provisions are part of amendment to State Workers' Compensation statute.)

 

FLORIDA - GROUP HEALTH CODE ADDITIONS (MANDATED)

Adopted Children: Policies providing family coverage must cover adopted children --prior to the child's 18th birthday -- as of date of placement. Such policies may not exclude coverage for any pre-existing condition of the child. (Florida Stat. ch. 627.6415, .6578.)

 

Alcoholism and Drug Abuse Treatment: Insurers must make available to group policyholders coverage for 4 outpatient visits at $35 per visit and at least equal to lifetime benefits of $2,000. (Florida Stat. ch. 627.669.)

 

Breast Conditions: Breast Reconstruction and Prostheses: Insurers must offer to policyholders coverage for mastectomy and coverage for breast reconstruction and prostheses. (Florida Stat. ch. 627.6417, 6612.) Fibrocystic Breast Conditions: Individuals who have been diagnosed as having fibrocystic breast conditions must not be denied issuance or renewal of policies (including HMOs); further, such individuals must not be canceled from policies, or subjected to exclusions or exemptions of benefits due to their conditions. (S548, 1995) (Florida Stat. ch. 627.6419.)

 

Cancer Treatment: An insurer may not exclude coverage for any drug prescribed for the treatment of cancer, in any individual or group insurance policy issued, amended, delivered, or renewed in the state, on the grounds that the drug is not approved by the U. S. Food and Drug Administration for a particular indication, if that drug is recognized for treatment of that indication in a standard reference compendium or recommended in the medical literature. Coverage for a drug required by this Section also includes the medically necessary services associated with the administration of the drug. (Florida Stat. ch. 627.4239(2).)

 

Child Health Services: Policies with family coverage must cover child health supervision services through age 16, including 18 visits at stated intervals. Benefits must be exempt from deductibles. (Florida Stat. ch 627.6416, 6579.)

 

Coverage Conversion: Policies must provide conversion rights to persons who cease to be eligible for coverage. (Florida Stat. ch. 627.646,  6675.)

 

Diabetes: Health insurers (including HMOs) must provide coverage for equipment, supplies, and outpatient self-management training and education for those with diabetes if a patients' physician certifies that such services are medically necessary. (H1239, 1996) (Florida Stat. ch 627.6408, 627.65745, 641.31.)

 

Disability: Any individual or group policy of disability which provides for the waiver of premiums or payment of claims upon total disability must, at a minimum, provide that for the first 12 months of the disability, a person is totally disabled if the person is unable to perform the material and substantial duties of the person's regular occupation, or must include a provision at least as favorable to the insured. (Florida Stat. ch.627.4233(1).) Group policies that provide coverage for loss of income due to a disability may contain a provision excluding coverage for pre-existing conditions may be excluded when the disability begins within 12 months following the effective date of an insured's coverage. ( Florida Stat. ch. 627.6561(2).)

 

Disclosure of Plan Terms: HMOs or exclusive provider organizations must provide prospective users with written information concerning the terms and conditions of a plan. However, specific information about an HMO such as where, in what manner, and from whom services may be obtained need be disclosed to a possible enrollee only upon request; marketing materials for an HMO must make clear in boldfaced type that such information is available upon request. (S910, 1996) (Florida Stat. ch. 627.6141.)

 

Enteral Formulas: Insurers must make available coverage for prescription and non-prescription enteral formulas for home use for individual through the age of 24. Enteral formulas must be prescribed as medically necessary for the treatment of inherited diseases of amino acid, organic acid, carbohydrate, or fat metabolism as well as malabsorption originating from congenital defects present at birth or acquired during the neonatal period. Individual coverage of these low protein food products must not exceed $2500 annually. (H1745, 1995) (Florida Stat. ch. 624.438, F.S.)

 

Handicapped Dependents: Coverage for dependent children cannot be terminated while a child is incapable of employment due to mental retardation or physical handicap and chiefly dependent on the insured. (Florida Stat. ch. 627.6055, .6615.)

 

Handicapped Persons: Insurers may not refuse coverage or charge different rates for persons solely because of a mental or physical handicap. (Florida Stat. ch. 627.644, 6576.)

 

Health Maintenance Organizations: Effective 10/1/96, HMOs may issue contracts which limit coverage to home health dare services. (H589, 1996) (Florida Stat. ch. 641.2018.) Pre-hospital and hospital care for trauma must be covered for HMO subscribers. (S910, 1996) (Florida Stat. ch. 641.513.)

 

Home Health Care: Group policies issued on an expense-incurred basis must cover home health care costs of up to $1,000 per year. (Florida Stat. ch. 627.6617.)

 

Mammography Screening: Insurers including HMOs must provide benefits for a baseline mammogram for women 35 years of older, but younger than age 40. Mammograms also must be covered every two years for women 40 years of age or older, but younger than age 50; benefits must be provided for yearly mammograms for women age 50 or older. Insurers must cover more frequent mammograms for patients with physician's recommendations, for women at greater risk of developing breast problems due to their personal family history, for women with a history of biopsy-proven benign breast disease, or for women who have not given birth prior to the age of 30. (S548, 1995) (Florida Stat. ch. 627.6418.)

 

Maternity: Effective 10/1/96, health insurers (including HMOs) that provide coverage for maternity or newborn care also must cover post delivery care for a mother and her newborn baby. Also, policies that cover maternity care must cover the services of certified nurse-midwives and birthing centers. Insurers providing maternity and newborn care must not limit the length of hospital and follow-up care for mother and baby to a period of time that is shorter than that determined to be medically necessary. (S1860, 1996) (Florida Stat. ch. 627.6406, 627.6574, 641.31.)

 

Mental Health: Insurers must make available to group policyholders coverage under terms not less favorable than for physical illness generally that includes 30 days of inpatient or partial hospitalization treatment per year and up to $1,000 in outpatient treatment per year. (Florida Stat. ch. 627.668.)

 

Newborns: Policies providing family coverage must provide benefits for newborns from the moment of birth for injury or sickness, including treatment of medically diagnosed congenital defects, birth abnormalities, prematurity, and transportation costs to and from a facility necessary to protect the health and safety of the newborn. Transportation cost coverage can be limited to $1,000. (Florida Stat. ch. 627.641, .6575.)

 

Osteoporosis: Effective 10/1/96, group policies, including HMOs, must cover diagnosis and treatment of osteoporosis for high-risk individuals. High-risk individuals include, but are not limited to, persons who are estrogen deficient, those receiving long-term steroid treatments, and those with primary hyperparathyroidism, vertebral abnormalities, or those with a family history of osteoporosis. (H397, 1996) (Florida Stat. ch. 402.475, 627.6409, 627.6691, 641.31.

 

Policies for Small Employers: Effective 1/1/97, small employer carriers which issue new health benefit plans to small employers (companies with 3 - 50 employees) must offer them a standard health benefit plan and a basic health benefit plan. Continuation of Coverage: Plans issued to small employers must provide that each beneficiary who would lose coverage due to a qualifying event - death, termination or reduction in working hours, divorce or legal separation, eligibility for Medicare, loss of dependent status, or retirement - be entitled to an 18 month period of continuation of coverage. Effective 2/1/97, small employer health insurers must include statements of the right to continue coverage and procedures for establishing such continuation in policies, contracts, certificates, and plan booklets. (S14, 1996) (Florida Stat. ch. 627.6691, 627.6699.)

 

Pre-existing Conditions: Effective 10/96, health policies must not exclude coverage for previously manifested ailments for a period beyond 24 months prior to an individual's effective date of coverage. In determination of pre-existing conditions, consideration must be given for the time an individual may have been covered under a preceding policy if coverage under such policy was similar to or exceeded the coverage provided under a new plan. (S910, 1996) (Florida Stat. ch. 627.6045.)

 

Providers: Ambulatory surgical centers: Costs for services must be covered if policy covers such services rendered on an inpatient basis. (Florida Stat. ch. 627.6056, 6616.) Nurse midwives: Policies covering maternity care must cover services of certified nurse midwives. (Florida Stat. ch. 627.6406, 6574.) Acupuncturists: Costs for services must be covered if the provider is licensed, the service is within the provider's scope of services, and the service is covered by the policy. (Florida Stat. ch. 627.6403, 6618.) Podiatrists, optometrists, and chiropractors: Services are covered when done within scope of license. (Florida Stat. ch. 627.419(3)-(4). HMOs must cover optometrists, ophthalmologists, certified nurse anesthetists, and acupuncturists. (Florida Stat. ch. 627.6618, 641.31(18)-(20). Psychotherapeutic Services: Under plans covering psychotherapeutic services, health insurers must establish eligibility criteria for treatment by each category of provider, such criteria must be included in an insurer's criteria for selection of network providers. (S412, 1996) (Florida Stat. ch. 627.6471, 627.6472.

 

FLORIDA - GROUP HEALTH FOR SMALL EMPLOYERS

For insurance plans offered to small employers:

Eligibility Criteria: 2 - 50 employees; the majority within the state.

Restrictions on premiums: Yes.

Restrictions on cancellation: Yes.

Pre-existing Conditions: Provisions may not exclude coverage for more than 12 months following the effective date of coverage.

Other: Standard and basic health benefit plans must contain inpatient and outpatient coverage, subject to cost containment measures. Plans must include coverage for newborn children, child care services, and adopted children, mammograms, handicapped children, and emergency care out of geographic service area. Plans must exclude coverage for services not medically necessary and must provide for pre-authorization. (Florida Stat. Ann. Section 627.6699)

 

FLORIDA - GROUP LIFE CODE ADDITIONS

Employer required to pay part of premium: No.

 

Percent of employees who must elect coverage (if employees pay part of premium): No statutory requirements.

 

Percent of employees who must be covered if employer pays all of premium: 100%. Minimum number of employees in group plan: 2.

 

Employer prohibited as beneficiary: Yes.

 

Grace period (days): 31.

 

Mandatory conversion: Yes.

 

Other provisions: Insurer may not deny benefits based on fact that death was caused by exposure to HIV infection.

 

(Florida Stat. Ann. Sections 627.411, 627-552, 627-559, 627-566, 627-567)

 

FLORIDA - HOLIDAYS

January 1, Washington's Birthday (or 3rd Monday in February), Memorial Day (or last Monday in May), July 4, Labor Day (or 1st Monday in September), Veterans Day, and December 25 are state holidays in all 50 states and in the District of Columbia. Other holidays under State law include: Martin Luther King's birthday (or 3rd Monday in January), Lincoln's Birthday, Columbus Day (or 2nd Monday in October), Thanksgiving, Sunday. Other: If any holiday falls on a Sunday, following Monday is a holiday. (Florida Stat. Ann. Sections 683-01-683.21)

 

FLORIDA - IMMIGRATION (PREVAILING WAGE POLICY)

See U.S. Federal General Administrative Letter 1-2000

 

FLORIDA - JURY DUTY & WITNESS TIME OFF

Employer Restriction For Discharging Employee For Taking Leave For Jury Service: Yes.

 

Remedies and Penalties: Employer may be subject to contempt of court for threats or dismissal. Employee can bring civil action for lost wages, reinstatement and reasonable attorney fees.

 

Other Requirements: None reported. (Florida Stat. Ann. Section 40.271.)

 

Employer Restriction For Discharging Employee For Taking Leave to be a Witness: Yes, if subpoena is served.

 

Remedies and Penalties: Employee may bring civil action for actual damages and reasonable attorney fees.

 

Other Requirements: State reports no statutory provisions.

 

FLORIDA - LEAVES OF ABSENCE

Employers Subject to Leave Laws: All state agencies. (Note: Dade County has a family and medical leave ordinance that covers some private employees, as well as public employees.)

 

Criteria for Eligibility: Must have a career service status.

 

Maximum Length of Leave: Up to 6 months.

 

Paid Leave: State does not require paid leave.

 

Acceptable Reasons for Leave: Birth/adoption of child, serious family illness.

 

Employment Guarantees After Leave: Entitled to reinstatement in the position held prior to the leave or equivalent position.

 

Use of Vacation or other Time-off Benefits: Employee may use accrued sick leave or annual leave to extend leave benefits.

 

Certification Required: Employer may require certification of illness if leave is taken to care for an ill family member or for employee illness.

 

Effect Of Leave on Other Benefits: All benefits continue while on paid leave.

 

Effect of Seniority Accrual During Leave: Seniority benefits do not accrue while on leave.

 

Minimum Requirements for Notification to Employer: Notice is required.

 

Conditions for Denial of a Request For Leave: State reports no statutory requirements.

 

(Florida Stat. Ann. Section 110.221.)

 

See U.S. Federal Family and Medical Leave Act

 

FLORIDA - LONG TERM DISABILITY CODE ADDITIONS

State does not require employer to provide long term disability benefits; although many employers do in order to remain competitive in hiring/retention of employees.

 

See LEAVES OF ABSENCE (above), WORKERS' COMPENSATION (below) and U.S. Federal Americans With Disabilities Act

 

FLORIDA - MANDATED PROVIDERS

Optometrists, chiropractors, dentists, podiatrists, and nurse midwives. Mandatory coverage for acupuncturists, nursing assistants, physician assistants, and massage therapists. (Florida Stat. Ann. Sections 627.419, 627.6406, 627.6472, 627.6574, 627.6618, 627.6619)

 

FLORIDA - MENTAL HEALTH CARE

Employer option.

 

Minimum yearly inpatient coverage: 30 days.

 

Minimum yearly outpatient coverage: $1,000.

 

Minimum lifetime coverage: No statutory requirements. (Florida Stat. Ann. Section 627.668)

 

FLORIDA - MINIMUM WAGE

Refer to the Federal minimum wage: $5.15 per hour (effective September 1, 1997).

 

State reports no statutory requirements.

 

See U.S. Minimum Wage

 

FLORIDA - NEW HIRE REPORTING

Who is required to report: All employers.

 

Who must be reported: All new employees.

 

Exempt from reporting: No exemptions.

 

Form(s) to file: LES Form UCT-6NH Florida Unemployment Compensation New Hire Report or LES Form UCT-1NH Application For Diskette Or Magnetic Media Reporting.

 

Filing deadline: Within 20 day of hire.

 

Employer information to be included: Name, address, unemployment compensation identification number, and EIN.

 

Employee information to be included: Name, address, SSN, and date employee began work.

Penalty for failure to report: N/A.

 

 (Florida Stat. Ann. Section 409.2557)

 

FLORIDA - NEWBORN CARE MANDATE

Mandated coverage.

 

Preventive care for children: Yes, to age 16. (Florida Stat. Ann. Sections 627.6406, 627.6562, 627.6575, 627.6578, 627.6579, 627.6615)

 

FLORIDA - PARENTAL LEAVE

See U.S. Federal Family and Medical Leave Act

 

FLORIDA - PRE-EXISTING CONDITIONS

For insurance plans offered to small employers, pre-existing conditions must not exclude coverage more than 12 months following effective date of coverage. (Florida Stat. Ann. Sections 627.6692, 627.6699)

 

See U.S. Federal Health Insurance Portability & Accountability Act

 

FLORIDA - PROTECTED CLASSIFICATIONS

Age:  Yes.

Race:  Yes.

Color:  Yes.

National Origin: Yes.

Ancestry:  Yes.

Religion:  Yes.

Sex:   Yes.

Pregnancy:  No specific law. State has expressed policy against discrimination.

Sexual Harassment:  No specific law. State has expressed policy against discrimination.

 

(Fla. Stat. Ann. Sections 110.105, 760.02, 760.10.)

 

FLORIDA - SALARY SURVEY

ERI's Relocation Assessor™ is a recommended source for U.S./Canadian wages & salaries (covering 3,000 positions).

 

FLORIDA - SHORT TERM DISABILITY CODE ADDITIONS

State does not require employer or employee participation in short term disability plans.

 

FLORIDA - TERMINATION & SEVERANCE PAY

State reports no statutory requirements.

 

FLORIDA - UNEMPLOYMENT TAX

Employer Contributions:

 

 

Voluntary Contribution Provision: No. State reports no statutory requirements.

 

(Florida Stat. Ann. Sections 443.131, 443.141.)

 

FLORIDA - VACATION PAY

State reports no statutory requirements.

 

FLORIDA - VOTING TIME OFF

State reports no statutory requirements.

 

FLORIDA - WORKERS' COMPENSATION

Private Employers: Mandatory as to all employers of 4 or more employees, 1 or more in construction or construction-related trades. Elective as to corporate officers, partners, and sole proprietors, but officers of a construction or construction-related company may elect exemption from coverage for up to 3 officers, otherwise must maintain coverage.

 

Public Employers: Separate act is state and political sub-divisions (includes volunteers), except elected officials.

 

Exceptions: Domestic servants, casual employees, 12 or fewer casual or 5 or fewer regular farm labor, professional athletes, owner/operator of a motor vehicle who is under written contract with a motor carrier and assumes all responsibility for carrying out that contract, and volunteers (except government entities but including volunteer firefighters).

 

Special Coverage Provisions: Voluntary as to excepted employments. Excludes real estate salespersons, solely on commission. Numerical exemption inapplicable to employees of sub-contractors. When a contractor sublets part of his contract, the contractor is responsible for securing and paying coverage for sub-contractor.

 

(U.S. Chamber of Commerce, 1994 Analysis of Workers' Compensation Laws.)