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GROUP HEALTH INSURANCEGroup Health Insurance is offered by many employers and associations and offer health insurance coverage to their employees, members and eligible dependents. There are different types of Group Health Insurance plans that an employer or association can offer, as well as different cost sharing options. A group health insurance policy may cover thousands of people but it is still only one policy. It's called a master policy and the employer or association is the master policyholder. The master policyholder negotiates the terms of a group policy with the group health insurance company. Group health insurance rates for large groups are negotiable and are not regulated by the state. The policy must include specific minimum benefits required by state law. Others are negotiated by the master policyholder. The group health insurance master policyholder does not need consent of certificate holders to change companies or policies, cancel the policy, or agree to new premiums or benefits. If an employee or member leaves the group health insurance plan, they may have the right to convert to an individual health insurance policy or continue group coverage for a temporary period of time.Most group health insurance plans are available through health maintenance organizations (HMOs), point of service (POS) plans, and preferred provider organizations(PPOs). A managed care plan determines whether your preferred doctors and hospitals (also known as "providers") are in the plan's network. Typically, in a managed care group health insurance plan, care is received from a network of providers. To confirm the availability of preferred doctor and hospital, check the health plan's provider directory, or call the provider's office. Check to see if there are any restrictions to whom and where a primary care physician (PCP) can make referrals if you anticipate employees/members needing a specialist. If a doctor in a medical group as the PCP, employees/members may be limited to specialists and hospitals affiliated with that medical group. A health maintenance organization (HMO) offers lower co-payments and may cover the costs of more preventative care. Your choice of service providers, if there is a choice, is limited. A preferred provider organization (PPO) offers lower co-payments like an HMO, but it usually gives you more flexibility selecting a provider. A PPO gives you a list of providers you can choose from. If you go outside the HMO or PPO network of providers, you may have to pay a portion or all of the costs. Insured Plan:In this type of plan, an employer contracts with a licensed group health insurance company or HMO to provide coverage for its employees. Such coverage is subject to all state insurance laws, protections and required covered benefits.Self-Insured Plan:In this type of plan, an employer pays for employees’ health care costs out of a fund that the company has set aside for medical expenses. Employers may contract with an outside party to administer health benefits, which is often a group health insurance company. Under a federal statute known as ERISA, the U.S. Department of Labor has authority over self-insured employer health plans.Professional Association:In this type of plan, an association offers its members group rates on group health insurance plans that are generally less expensive and easier to apply for than individual health plans. These plans are typically offered through a licensed group health insurance company.WHAT GROUP HEALTH INSURANCE COVERAGE DO I NEED?Compare the monthly premium as well as the out-of-pocket expenses such as deductibles, coinsurance and copayments of different group health insurance plans. Search for the group health insurance plan that offers the benefits employees/members will want. Think about your employees'/members' health care needs and choose a group health insurance company that best covers the services needed most. Try to estimate your needs for prescription drugs, well-child care and mental health services.COMPARISON SHOP ONLINE FOR GROUP HEALTH INSURANCERates for group health insurance can vary by hundreds, even thousands of dollars, so it pays to shop around. You can compare hundreds of group health insurance companies' rates conveniently on the internet.Once you've completed your online comparison of several group health insurance providers, eliminate the insurers that do not meet your group's basic requirements. Then, choose the insurer that offers the features most important to your organization, as well as reasonable rates. The group health insurance company you select should offer both fair prices and excellent service. Quality service may cost a bit more, but provides added conveniences, so compare a number of insurers to get a feeling for the quality of their service. Check for any special discount programs theses group health insurance companies might offer to lower your costs. Get at least four or five competitor's rate quotes before making a decision. ![]() |
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