Florida 2-15 Life, Health and Variable Annuity AgentFlorida Laws and Regulations Specific to Health InsuranceHard
A Florida resident is purchasing a new individual medical expense policy. The policy includes a provision that restricts coverage for conditions for which treatment or advice was received within 6 months prior to the effective date of coverage. What is the maximum period this pre-existing condition exclusion can apply under Florida law for an individual health policy?
- A12 months
- B9 months
- C3 months
- D6 months
Show answer & explanationAnswer & explanation
Correct answer: A. 12 months
While the scenario describes a 6-month look-back period, Florida law allows a maximum pre-existing condition exclusion period of 12 months for individual health insurance policies. The insurer can choose a shorter period, but cannot exceed 12 months.
Why the other options are wrong
- B. 9 months is not the standard maximum period defined by Florida law for individual policies.
- C. 3 months is often a shorter period offered by some plans, but not the maximum allowed.
- D. 6 months is a common look-back period, but not the maximum exclusion period allowed by Florida law.
FL Individual Health Pre-existing Max
Under Florida law, for individual health insurance policies, a pre-existing condition exclusion period cannot exceed 12 months.
- Maximum 12-month exclusion period
- Look-back period typically 6 months
- Applies to individual policies (ACA eliminated for most new plans, but still relevant for certain grandfathered or specific policy types for exam purposes)
Memory trick: Florida's pre-existing exclusion is MAX 12 months, like a full year of waiting.