The FloridaInsurance Exchange (Marketplace) is the Federally-Facilitated Marketplace.
The Federally-facilitated Marketplace is administered by the federal government, under the Department of Health and Human Services (HHS).
General information about the Federally-facilitated Marketplace can be found at: https://www.healthcare.gov/marketplace/individual/#state=florida
Learn more: Background
PATIENTS
The Federally-facilitated Marketplace is essentially a marketplace for individuals to shop for health insurance if they do not already have insurance coverage from another source. If individuals have insurance from another source such as employment, retirement benefits, or spousal benefits, they do not need to obtain it from the Marketplace.
HIV PROVIDERS
Providers must contract with each of the Qualified Health Plans offered in the marketplace individually to participate fully in the Federally-facilitated Marketplace.
This process is similar to enrolling in insurance or managed care organization provider networks. See below the list of insurers participating in the Federally-facilitated Marketplace, and information about contacting them.
As an HIV provider, you may qualify for designation as an “ Essential Community Provider (ECP).” The Qualified Health Plans participating in the Insurance Exchange (Marketplace) are required to contract with a minimum number of ECPs and Specialists to ensure network adequacy.
Visit our Provider Resources Section for more specific instructions to assist you in contacting health plans.
REPORTING PROBLEMS
The state office of insurance is primarily responsible for examining and addressing issues with the plans offered within the state Exchange (Marketplace), and the companies that offer them. If you are experiencing problems as a medical provider with the plans or companies in the state exchange, or if your patients are experiencing problems with the plans or companies in the state exchange, including trouble with access to medications, access to preferred providers, navigating the appeals process, excessive costs, or possible discriminatory policies, or any other problems related to the Affordable Care Act, please report these problems to the state office of insurance:
Office of Insurance Regulation’s Long Range Program Plan
200 East Gaines Street
Tallahassee, FL 32399
www.floir.com/
Additionally, if you are experiencing these or other problems, please report these problems to AAHIVM, so that we may track issues affecting our members, and seek additional policies remedies.
QUALIFIED HEALH PLANS PARTICIPATING IN THE EXCHANGE
Below is a list of the Qualified Health Plans that have publically announced that they will offer plans in the Federally-facilitated Marketplace.
Florida has established Florida Blue as the “benchmark” plan.
This list is being routinely updated, and may change as insurers join or drop out of the exchange. Please check back for updates.
Aetna
Plan Website: http://www.aetna.com/
Provider Enrollment: http://www.aetna.com/healthcare-professionals/join-aetna-network/join-provider-network.html
Plan types offered: Individual
Ambetter from Sunshine Health
Plan Website: http://ambetter.sunshinestatehealth.com/
Provider Enrollment: http://www.sunshinestatehealth.com/for-providers/become-a-provider/
Plan types offered: Individual
Assurant Health
Plan Website: http://www.assuranthealth.com/corp/ah/AHHome.htm
Provider Enrollment: http://www.assuranthealth.com/corp/ah/Providers/health-care-provider.htm
Plan types offered: Individual
Cigna Health and Life Insurance Company
Plan Website: http://www.cigna.com/individuals-families/florida
Provider Enrollment: http://www.cigna.com/healthcare-professionals/join-our-network
Plan types offered: Individual
Cigna Healthcare
Plan Website: http://www.cigna.com/individuals-families/florida.page?fpl=
Provider Enrollment: https://cignaforhcp.cigna.com/web/public/guest/!ut/p/b1/04_Sj9CPykssy0xPLMnMz0vMAfGjzOKDnMyMDA0sHL0dA92MDDwtjTx8zbw9DQ08zYEKIoEKDHAARwNC-
Plan types offered: Individual
CoventryOne
Plan Website: http://coventryhealthcare.com/products-and-services/state-serv-overviews/Florida/index.htm?selectSubCareMgmtSubmit=
Provider Enrollment: http://coventryhealthcare.com/providers/network-participation/index.htm
Plan types offered: Individual
Florida Blue (BlueCross BlueShield FL)
Plan Website: http://www.bcbsfl.com/wps/portal/bcbsfl/w/home/!ut/p/b1/jZDdboJAEEafhQfQXVhg10s2bBbUghBA3RuDBBERRPmrPr3W9KJNWtu5m-ScbzIfEGAFRBX3eRa3-amKjx-70DcUujKERmCwCBFoz6mGfI8hCOEDWH8FwiiaQFsNvIXGLMSR9j8f_jIGfPoqsWRMCWN0MXvEO5SbkctlztGn_wL44_4UiHxbjoekHMMxxjpSZIhUBeqaQgiIzKR4NzN7z5jpN_Le6wqnbeVaNcyI8tu8ORT2deCBoS74cdRUWHUNkWpp0CSx-ybWIbnMo6079IlS8bwVEyurHTs_Omfn7As8ovAan0raEWo1pO5nncr1Sy_be98TqNt1FnYO0wovXT-7kKU32YyELspBksASiO-v_dD8E3hRrWOdyhTUZRiubmmxMyTpDhK-vV0!/dl4/d5/L2dJQSEvUUt3QS80SmtFL1o2XzQ4SDE3QjhFRUIyTDQwSUZPUzNVTFQzS0U1/
Provider Enrollment: http://providermanual.bcbsfl.com/ab/on/join/pages/joinournetworks.aspx
Plan types offered: Individual, SHOP
Florida Blue HMO (a BlueCross BlueShield FL company)
Plan Website: http://www.bcbsfl.com/wps/portal/bcbsfl/w/home/!ut/p/b1/jZDdboJAEEafhQfQXVhg10s2bBbUghBA3RuDBBERRPmrPr3W9KJNWtu5m-ScbzIfEGAFRBX3eRa3-amKjx-70DcUujKERmCwCBFoz6mGfI8hCOEDWH8FwiiaQFsNvIXGLMSR9j8f_jIGfPoqsWRMCWN0MXvEO5SbkctlztGn_wL44_4UiHxbjoekHMMxxjpSZIhUBeqaQgiIzKR4NzN7z5jpN_Le6wqn
Provider Enrollment: http://providermanual.bcbsfl.com/ab/on/join/pages/joinournetworks.aspx
Plan types offered: Individual, SHOP
Florida Health Care Plans
Plan Website: http://www.fhcp.com/individual-plans
Provider Enrollment: http://www.fhcp.com/providers/services/contracting-with-fhcp
Plan types offered: Individual, SHOP
Health First Health Plans, Inc.
Plan Website: http://www.health-first.org/health_plans/individual/index.cfm
Provider Enrollment: http://www.health-first.org/health_plans/contact_us.cfm
Plan types offered: SHOP
Health First Insurance, Inc.
Plan Website: http://www.health-first.org/health_plans/individual/index.cfm
Provider Enrollment: http://www.health-first.org/health_plans/contact_us.cfm
Plan types offered: Individual, SHOP
Humana Medical Plan, Inc.
Plan Website: https://www.humana.com/ads/explore-health-and-dental-coverage
Provider Enrollment: https://www.humana.com/provider/medical-providers/network/
Plan types offered: Individual
Molina Marketplace
Plan Website: http://www.molinahealthcare.com/members/fl/en-US/hp/marketplace/Pages/marketplace.aspx
Provider Enrollment: http://www.molinahealthcare.com/members/common/en-us/abtmolina/compinfo/pages/contactus.aspx#
Plan types offered: Individual
Preferred Medical Plan
Plan Website: https://www.pmphmo.com/
Provider Enrollment: https://www.pmphmo.com/providers.php
Plan types offered: Individual
UnitedHealthcare
Plan Website: http://www.uhc.com/health_reform_guide.htm
Provider Enrollment: http://www.uhc.com/physicians/join_our_network.htm
Plan types offered: Individual