Group health insurance is a type of health insurance policy often offered through employers to provide for employees and their families. Different policies may offer different benefits, however, so it is important that both employers searching for a policy and employees looking to get insured understand the coverage and limitations of group health insurance.
As a policy offered through employers, group health insurance does not generally have to be purchased directly from the employee. Instead, they can purchase a policy through their employer. This helps spread the risks between multiple employees and can often result in lower insurance premiums for the employees and their families.
Different Types of Group Health Insurance Plans
There are a few types of group health insurance plans an employer may offer. These plans include:
Preferred Provider Organization (PPO)
A PPO plan, or Preferred Provider Organization plan, is one of the most common types of group health insurance plans offered. This type of policy requires eligible employees to receive medical care from a list of approved or “preferred” health care providers as specified by the insurance company. Employees entering this type of plan should make sure that their health care provider accepts this type of insurance.
Health Maintenance Organization (HMO)
HMOs offer a network of providers that contract with the HMO in order to offer health care services. An employee may be required to choose a primary care physician for their HMO.
High Deductible Health Plan (HDHP)
HDHPs are unique because they can often be used along with a Health Savings Account, which allows employees to save pre-tax money to be later used for medical expenses.
Indemnity Health Insurance
Indemnity health insurance plans offer a more direct approach for employees when it comes to their health care needs. Employees may choose any doctor or hospital they desire and the insurer will pay a set amount of the total charges from the health care received. In some of these plans, employees may have to pay for services before filing for reimbursement through the insurance provider.
What Is Covered Under Group Health Insurance?
Group health insurance plans provide coverage for a wide range of medical bills that may also be offered under an individual health insurance policy, such as compensation for:
- Emergency services (ambulances, for example)
- Durable medical equipment
- Medically necessary surgery
- Doctor visits
- Preventive care
- Some specialty care
- Dental and vision care
- Lab tests
- Mental health care
- Prescription drugs
- Preventive services
What Is Not Covered Under Group Health Insurance?
Not all group health insurance plans are created equal and many have exclusions. Procedures that are considered cosmetic or deemed not medically necessary are generally not covered or have limited coverage under health insurance. This may include certain dental and vision care.
Employees should be sure to ask their employer if their plan offers additional coverage such as dental and vision. Although these coverages are commonly excluded, medical issues with your vision, mouth and teeth can be serious and lead to further medical complications if not cared for immediately.
Some employers have also started offering other benefits as part of their employee benefits package such as gym memberships, counselling and other health related services. These are important factors for prospective employees to consider when evaluating a potential career or a job offer.
Who Is Covered Under Group Health Insurance?
Qualification for group health insurance may vary per insurer and per state, but most full-time employees should be able to enroll in their employers’ group health insurance policies. At the time of enrollment, their dependents—such as spouses and children—may also be covered under their health insurance if the employee has that coverage option. This may also include coverage for retired family members or family members on Medicare.
If you have any questions about your employer’s group health insurance policy, be sure to ask your employer and your insurance representative. It is important that all individuals and families get the health insurance they deserve so that they can get the health insurance they need.
Is Group Health Insurance Expensive?
The cost of group health insurance varies depending on a variety of factors such as the coverage limits, claims history, location and more. In general, employees may save money on group health insurance through an employer rather than an individual policy through a private insurer. It is important to compare quotes and consider coverage limits when looking for a health insurance policy, however, especially when it comes to protecting yourself and your family from expensive medical bills.