group health insurance
Health Insurance Net
Most people have a general idea of the nature of ‘group’ coverage. The most
common type of group coverage is provided via employment. Many employers provide
group health coverage as a benefit to their employees, either by paying the
entire premium or sharing in the premium.
In a group situation, a single policy covers a specific group of people as
opposed to a single person as individual policies do. Because of this special
nature, insurance companies have to make certain that the number of people
covered by a group policy stays at or above a certain level. Some states also
have their own regulations that control the minimum number of people required
under a group plan. The number can differ from state to state so check local
regulations. In order to be considered a group, the entity must have the same
employer or other commonality. As we discussed above, there are many different
types of groups that may be considered, but for our purposes we will consider an
employer/employee group.
A single master policy is issued to an individual or entity representing the
group of people. As we stated, for our purposes we will call this the employer.
It is the employers responsibility to apply for coverage for the group, own and
hold the master policy and collect and make premium payments to the insurer when
due.
Eligibility and eligibility period. In an individual policy situation where each
person is evaluated separately in terms of risk, the normal practice in a group
situation is to include all eligible employees regardless of physical condition
or age.
On condition must be met, however, for all people regardless of their physical
condition before they may be included in a group plan. That condition is that
they must apply for coverage during a specified eligibility period. Failing to
enroll in that time period will result in a requirement to take a physical
examination and they will be selected on an individual basis just as if the
policy were an individual policy.
An initial 90 day employment period is typical for group coverage, after which
the employee has a 31 day eligibility period. If the employee fails to apply
during that eligibility period, then the employee will be required to take a
physical examination and must qualify as if on an individual basis.
This is how an insurer can afford to cover a group of people without individual
selection. Otherwise some people might choose not to enroll until they discover
they have an illness or they become disabled, and requiring a physical exam
after the eligibility period helps to preclude this event.
This same concept also applies to determining who receives specific benefits.
For example, an employer may choose to offer certain groups of people within the
total employee group, a different set of benefits.
For instance, this can award certain benefits for those employed less than 5
years and a different set of benefits for those employed over 5 years. read more »
group health insurance
health insurance preffered provider
health insurance summary
health insurance deal
health insurance disability
indemnity plans
health insurance policy
index
locating a provider
health insurance providers
health insurance domestic
health insurance comprehensive
health insurance maintenance
health insurance coverage
health insurance no cover
health insurance standard
keeping costs low
health insurance glossary 