Group Health Insurance Information Overview

Reportedly, 60% of the population in the U.S. gets their health care coverage through an employer-sponsored group medical insurance plan. There are definite advantages of obtaining this type of medical insurance coverage, as it is generally less expensive to get health insurance coverage through a group insurance program. In recent years, however, companies have found that it is costing more and more to provide health care for their employees. Mainly this is due to the increasing cost of healthcare and prescription drugs. Still, for those companies that can afford it, providing group health insurance to employees is the least expensive option for all involved.

What are Group Plans?

Group insurance is a healthcare plan in which individual employees or members are included under one policy that is owned by their employers. Because the group insurance plan includes many people, the policy often covers more services at a much lower rate for those in the plan. Group insurance is not just for companies that make a profit. Labor unions, churches and other service groups can also obtain this coverage.

How does the Coverage Work?

Members of a plan receive insurance certificates, which are used to determine their eligibility for benefits. Group polices are associated with various systems such as HMO's or they may be part of other policies with major insurance providers such as Blue Cross/Blue Shield.

These polices are usually paid by a flexible payroll deduction, but some companies will pay the entire cost of the policy. As with many insurance policies, the cost of premiums can increase without warning. For example, if some members in the group receive costly treatments for serious medical conditions then the rest of the group may have to pay the higher premium costs.

What are the Benefits?

Group benefits vary from company to company. The majority of policies do cover normal medical procedures such as routine doctor visits, emergencies and long term care in hospitals, but spouses and/or dependents are not always covered. Some policies offer assistance for eye care or dental work, but coverage may be limited. Also group insurance may not include mental health coverage.

Prescription drug costs are most likely covered under group insurance benefits, but there is usually a co-payment condition. Under a co-payment plan the policy holder must pay a determined out-of-pocket amount for both name brand and generic medications.

Group insurance is way more affordable than most individual policies, but there are some drawbacks. The choices of physicians and treatments are very limited under HMO group plans and even major medical plans can limit the list of approved physicians. Also employers may put some of their own restrictions on polices such as a no smoking clause which some group policy holders may find invasive.

All in all these polices are viewed by employees as being a major bonus because their policy has numerous medical benefits and perks that may not be obtainable for certain individuals if they were to seek their own coverage.

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