Group Health Insurance

Group health insurance is a type of insurance for employees and members of some company or organization. It provides coverage to its members at a lower cost. Only groups can buy this type of coverage, so you cannot purchase it as an individual.

What is group health insurance?

If you are employed you may get group health insurance. Businesses and organizations buy health insurance plans for their employees or members. It is usually a type of insurance for small businesses (from 2 to 50 people). This insurance provides a lower cost than individual insurance because the risks are divided among the group itself. Just like individual plans, group plans are also divided by plan type or by metal level. The good thing about group health insurance is that if your employer chooses it then it’s available for everyone. This means that you will be insured regardless of any health issues you might be having.

Types of Group Health Insurance

There are 4 main types of group plans:
  • HMOs: with this plan, every insurer must choose their primary care doctor and they must visit doctors within the HMOs network. Visiting out-of-network doctors may result in no coverage at all. Also, your PCP must get you a referral for specialists.
  • PPOs: with this plan, there is no need for primary care doctor, so you can choose any doctor you want. However, it is recommended to see a doctor within the PPOs network because if you go to an out-of-network doctor you’ll have higher costs
  • EPOs: you don’t need PCP with this plan, but you’ll maybe don’t get coverage if you visit an out-of-network doctor
  • POS: this type is usually a combination of HMO and PPO plans and in this category are also plans that may be used with Health Savings Accounts
Also, there are 4 types of metallic levels for plans:
  • Bronze: those are paying the least amount of health expenses, just 60%. But they have more affordable premiums
  • Silver: those are covering 70% of the average costs of the policyholders and have less expensive premiums
  • Gold: their coverage is 80%  with higher copays and premiums
  • Platinum: those have the highest level of coverage, 90%. They have higher monthly premiums but lower out-of-pocket costs
However, the most common health insurance group plans are High Maintenance Organization (HMO) and Preferred Provider Organization (PPO).  

What costs are shared between group members?

Cost can vary due to group health insurance plans plan types, but in general, things that are shared among the group members are:
  • Premiums are shared between the company and their members
  • 70% of the participation rate
  • Family members can be added to the group plan at an additional cost
  • out-of-pocket maximums: annual limit of shared costs you are responsible for 
  • Also, there are out-of-pocket costs that you make personally for the medical services. Once you meet your out-of-pocket cost companies’ health insurance will pay for 100% of costs for the rest of the calendar year. However, there is a specific cost known as copay that may pay for medical services or supplies like: er, specialists visits, and some types of therapy.

    Do I need to enroll in this plan?

    No, you don’t need to enroll in the group health insurance plan. You can choose if you want to enroll in it or not. However, if a business or organization wants to enroll in the plan it must have at least one full-time employee or equivalent full-time employee. It is important t know that small business under 50 full-time employees isn’t required to provide group health insurance. On the other hand, larger providers are required to do so.

    Advantages of Group Insurance Plan

    Group health insurance plan advantages are:
  • Extensive coverage
  • Chance to get dental and vision coverage if not included
  • Chance to  add family members
  • Coverage regardless of pre-existing conditions
  • Lower costs due to sharing among the employees 
  • It involves more people which means better plans are offered
  • Tax incentives for employers: employers can qualify for tax repayment as compensation for the money they  are paying toward insurance premiums
  • Happy employees 
  • Call Now ButtonCall & Get Help Skip to content