About the HMOCAP
The Florida Health Maintenance Organization Consumer Assistance Plan (“HMOCAP”) was created by statute to protect persons enrolled for coverage with HMOs, subject to certain limitations, against the failure of their HMO to perform its contractual obligations due to its insolvency. The HMOCAP only provides protection for “commercial” HMO members – those who have group HMO coverage, generally through their employer, or persons who purchase individual coverage directly through the HMO. Persons who are enrolled with an HMO for Medicaid or Medicare coverage are not covered by the HMOCAP. Rather, these persons must contact the Agency for Health Care Administration (for Medicaid) or the Center for Medicare and Medicaid Services (for Medicare), for their coverage questions.
Pursuant to Florida’s Insurer Insolvency statutes, the HMOCAP guarantees, reinsures, assumes, or provides coverage for members of the insolvent HMO subject to the terms and limitations provided in Florida law.
The HMOCAP will cover services that would have been covered by the subscribers’ contracts with the insolvent HMO from the date of insolvency until the date a subscriber attains replacement coverage with another HMO or other entity that provides health care coverage, or until the subscriber has reached the statutory limits of his or her HMOCAP coverage.