There are some attractive group health insurance schemes that are beneficial to employees. Their employers and professional groups often offer these to the employees. There are also some plans - designed by medical service providers - for healthcare coverage that usually proves to be economical to the employees because they help them save their own money for incurring on medical expenses. But some of these schemes, in order to make them save costs, have certain limitations that must be brought to the notice of employees and sorted out first before finalizing the deal.

The normal practice with group health insurance is that the administrator of the plan negotiates prices for specific services with providers for their agreement to charge a lower fee for professional services rendered to group health insured people. These fees are often considerably lower than what the patients pay if they are not members of group health insurance plan. These patients get quality healthcare treatment from healthcare providers while usually paying a per office visit co-payment.

They can also save if they visit a network physician for procedures not covered under their group health insurance, as many doctors will also offer similar discounts for uncovered services as they do for covered services. The difference is that the patients are required to pay the balance, usually up front when services are rendered.

Options and choices

Most group health insurance plans will only pay the amount they negotiated with member service providers, and if a plan member visits a physician not in the plan, the difference between what the plan typically pays for the service and the cost by the physician will be the responsibility of the patient. For example, if the plan pays $100 for an office visit plus the patient's $20 co-payment and the out of plan physician charges $200, the patient will be charged the $20 co-pay plus the difference of $100 per visit.

An insured patient should be able to save money by visiting physicians on the plan. But the problem arises when employers switch group health insurance plans and when the family physician does not belong to the new plan. Patients usually dislike the idea of being forced to switch over to a new primary care physician. They prefer to continue to consult their old trusted doctor that they are used to. But they themselves have to bear the additional costs.

Prescription drugs are also permissible in most group health insurance plans against a co-payment for each prescription. There are plans that allow supply for up to 90 days to be obtained from mail-order pharmacies without incurring any additional co-payment for their monthly supply from their regular pharmacy. That helps patients financially by not being required to pay the co-payment for each prescription once every three months instead of monthly on maintenance drugs.