Capital Health Partnership


frequently asked questions

What is Capital Health Partnership?

Capital Health Partnership is a premium subsidy program for qualified uninsured, small businesses administered by the Capital Area Health Access Foundation, a non-profit organization created by Capital Health Plan.

How is Capital Health Partnership different from Capital Health Plan?

Capital Health Partnership is not an HMO or a health insurance plan. It is a Tallahassee area subsidy program applied toward Capital Health Plan premiums for eligible small businesses and their eligible employees. Capital Health Plan benefit plans and rates remain the same whether a Capital Health Partnership subsidy is applied to the premium or not.

What businesses and employees are eligible for the premium assistance?

Eligible employers must have not offered commercial HMO or health insurance coverage to their employees for at least the past 12 months, must pay average wages to their workforce of $12/hr or less, must have fewer than 25 employees and must be located in the Tallahassee area (Leon, Gadsden, Jefferson or Wakulla County). Eligible employees must have not been covered in an employer-based health plan for at least the past 12 months, and work full-time (at least 25 hours / week).

How many businesses and individuals can be covered by Capital Health Partnership?

Funding is sufficient to initially assist approximately 600 businesses and 3,000 individuals.

Must all eligible employees be based in Gadsden, Leon, Jefferson or Wakulla Counties?

Yes.

If an employee works for an eligible employer but does not reside in Gadsden, Leon, Jefferson or Wakulla Counties, can they be eligible?

Yes, if they work full-time (at least 25 hours / week) in this four county area and have been uninsured for at least the past 12 months.

Is a business owner eligible for the Capital Health Partnership subsidy?

Yes, if all other employee criteria are met when the owner’s income is incorporated in the average wage criteria for the business.

Is group health coverage in Florida “guarantee issue” for small business and are pre-existing limitations applied?

Yes. Florida law guarantees a small group (1-50 employees) issuance of coverage. Groups must be legitimate companies actively engaged in business in Florida and not formed strictly for purposes of obtaining group insurance (examples of the latter are clubs, fraternal organizations and consortia). Pre-existing limitations are applied and vary based on the size of the group.

How much is the subsidy and how long will it be paid?

The premium subsidy from Capital Health Partnership has been set at 40% of the total premium and will continue for the first consecutive two years of coverage.

What is the minimum contribution an employer must make toward his or her employees’ health plan premiums?

Employers must pay at least 50% of the premium balance after the subsidy is applied. The employee pays the rest.

Are a minimum number of employees required to participate if Capital Health Partnership subsidizes a group?

Yes, 75% of eligible employees in a group must enroll.

I am a self-employed uninsured individual. Am I eligible?

Yes, if you meet the income and other eligibility requirements for your business. Under Florida law, one life groups are eligible to enroll once each year in August for an October 1st effective date.

Does the requirement of no employer group insurance or HMO coverage in the previous 12 months apply only to employees or also to spouses and dependents?

The requirement applies only to employees. However, the subsidy is for uninsured employees and their dependents and is not available to employees who are currently covered through a spouse’s coverage with another employer.

How does an employer and employees prove lack of health insurance or HMO coverage during the previous 12 months?

The employer provides a self-certification and declaration on the Capital Health Partnership application. Statements will be audited.

Does an employer receiving a premium subsidy need to be re-evaluated for continued eligibility and if so, when does this occur?

Yes. The Capital Health Partnership’s premium assistance is available for eligible employers and employees for a maximum of 24 consecutive months. Employers will be re-evaluated for continued eligibility (# of employees and average wage base) at their first 12 month anniversary.

How are brokers and agents compensated for enrolling eligible small businesses that qualify for premium subsidy from Capital Health Partnership?

Agents and brokers will receive the same commission they would receive on any other small group covered through Capital Health Plan.

Once paperwork has been submitted, how long does it take to hear back on premium subsidy eligibility? When could group coverage be effective?

If all paperwork is complete, subsidy eligibility and premium calculation can be completed in 10 business days. Premiums are due by the 10th day of the month preceding coverage. For example, if complete paperwork is forwarded in May and premium paid by June 10th, group coverage would be effective July 1st.

How do I find out more about Capital Health Partnership?

Please call Capital Health Partnership at 523-7333.