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Your Online Guide » Guide to Insurance » Individual Health Insurance Coverage

[A734]Association Group Health Insurance
by Jonathon James, Jon

It is estimated that more than 60% of the U.S. population that has health insurance receives their coverage through an employer that offers a group health insurance plan. It's no secret that employees value health insurance benefits, perhaps above all other benefits. Employers, on the other hand, like to offer comprehensive group health insurance as it tends to attract and retain qualified employees as well as reduces the company's turnover rates.

In most states, group health insurance is available to companies with 2 or more employees. Often the number of employees covered under the group health insurance plan determines the types of coverage available as well as the premium costs.

For example, companies with between 2 and 50 employees are typically classified as a small business. Such businesses are eligible for small business health insurance; however, each state has its own set of regulations that determines what business can be classified as a "small business". It's interesting to note that some insurance companies will market a “group” health plan to a single individual that is self-employed. In such cases, it's important to realize that these “one-man” groups may not qualify for the same regulations that apply to larger groups.

Companies will thousands of employees may have their group health insurance plans customized for them by a health insurance carrier. Some large corporations will even choose to self-insure, with the health insurance carrier responsible for administering the health plans.

The primary difference between individual and group health insurance is that the plans offered to individuals (and “one-man” groups in some cases) are not “guaranteed issue”. This is a significant difference and means that the insurance company cannot deny coverage due to preexisting medial conditions of any of the eligible employees. The insurance company is allowed to ask medical questions, but can do so only for purposes of assessing the premium to charge for the group health insurance coverage.

The costs of group health insurance premiums is typically split 50/50, meaning the employer will cover 50% of the premium costs with the employee responsible for the remaining 50%. Even though minimum employer contribution varies by state, these percentages have changed in recent years due to the dramatic increase in health insurance costs, with employees bearing an ever-increasing share of the total costs.

There are tax incentives available to both employers who offer group health insurance and their employees. Business owners can generally deduct 100% of the premium costs and can reduce their payroll taxes by offering group health insurance as part of an employee's compensation package. Employees, on the other hand, can pay their share of the insurance premium with pre-tax dollars.

In an environment of ever-growing health care and health insurance costs, eligibility in a group health insurance is becoming critical for many employees. Even with paying a higher percentage of premium costs than in the past, employees still are better off financially (and receive greater choices) with group coverage than with an individual health plan. At the same time, business owners are fully aware that offering quality group health insurance creates a more satisfied, and therefore more productive, workforce.


Most health insurance policies offered by employers have an open enrollment period, in which dependents may be added or dropped. To make sure that you're getting the best coverage for your family's health care needs, you'll need to make an accurate comparison of what each plan offers. Have a copy of your current policy on hand, and when the next open enrollment period rolls around, get ready to perform a side-by-side comparison. You may find that when it comes to selecting the best family health insurance plan, one policy doesn't fit all.

Get the basics: What are the costs of premiums, yearly deductibles, benefits or services, and annual maximum benefit of each policy? What is the difference between the different service co-pays for each policy?

Take stock of your family's needs: Does your family have certain recurring yearly medical expenses, such as regular wellness checkups, physical therapy, chiropractic services, eye examinations, and eyeglasses? What is the difference between policies for this coverage, including co-pays?

Prescriptions: What provisions do your policies make for prescription drugs? Compare prescription co-pays. Do you have a choice between filling prescriptions with generic, formulary or non-formulary drugs, and if so, what is the difference in costs?

Mental health: Does your policy offer mental health coverage, and if so, what services are covered? Does your policy require a referral from a medical professional for counseling or therapy? Is there a limit to the number of appointments that may be made in a single fiscal year? How much does a co-pay cost for a visit to a mental health professional's office?

Women's health: What is the cost and provided coverage for yearly women's wellness exams such as mammograms and pap smears? Also, what are the coverage details for infertility treatments, hysterectomy, birth control, and other gynecological concerns?

Adding to the family: Be sure to consider what your covered health care conditions are and remember that services during pregnancy and childbirth vary from policy to policy. Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) health care plans cannot consider pregnancy a pre-existing condition during the open enrollment period. Changes in your family, such as the birth or adoption of a child, may prompt a new enrollment period in which you may add your new family member to your plan.

Older children: Most family health insurance plans will cover a full-time student under the age of 22, or until college graduation, although some plans may not cover dependent children after reaching their 18th or 21st birthday, regardless of student status. Should your child no longer be considered your dependent, he or she may be eligible to purchase Consolidated Omnibus Budget Reconciliation Act (COBRA) insurance coverage for a period of 18 to 36 months.
Article Source : Medical Care Insurance

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Both Jonathon James & Jim Waltrip are contributors for EditorialToday. The above articles have been edited for relevancy and timeliness. All write-ups, reviews, tips and guides published by EditorialToday.com and its partners or affiliates are for informational purposes only. They should not be used for any legal or any other type of advice. We do not endorse any author, contributor, writer or article posted by our team.

Jonathon James has sinced written about articles on various topics from Health Insurance. . Jonathon James's top article generates over 5400 views. to your Favourites.

Jim Waltrip has sinced written about articles on various topics from Health Insurance, Auto Insurance and Liability Insurance. US Insurance Online CEO Jim Waltrip is a self-taught software developer and entrepreneur with a passion for building things: teams of employees, software, and new systems. Jim started the company with business partner Ryan Patterson in May 2005. The recen. Jim Waltrip's top article generates over 12100 views. to your Favourites.
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