What Is An Example Of A Group Health Plan?

Sunday, March 19, 2023 06:26 Posted by Admin

Are you looking to buy group health insurance and you are wondering what its examples are? However, due to the difference in coverage that most companies are looking to provide for their employees, there are various examples of group health insurance plans that exist.

All the examples of group insurance health plans are under the affordable care act. However, the affordable care act requires coverage for large companies, but there are also small business health plans that small employers can choose from.

These examples include; Union-sponsored health insurance coverage, Employer-sponsored health insurance coverage, Government-sponsored health coverage, and Health insurance for students of an institution.

Also, Health insurance offered to a professional association or trade group health plans, and Health insurance offered to employees of a non-profit organization are available choices as well.

What Does Group Health Insurance Mean?

Group Health Insurance refers to the type of insurance you enjoy from being a member of a group. Under this, the participants get to enjoy group health benefits. Also, group health plan includes various medical coverage and preventive care that applies as well.

However, the opposite of group health insurance plans, are individual coverage plans. Here, the health insurance policies, are self-insured health plans. They only cater to individuals, rather than group members collectively.

Also, group health insurance plans, whether group plans or individual plans, all need premiums to function. However, higher premiums or lower premiums may apply depending on the plan being used. Full-time equivalent employees are determinant for whether health insurance will be offered at all.

A group plan is a type of attractive benefit that full-time employees enjoy. Individual health plans are also referred to as supplemental health plans. A major characteristic of a group health insurance plan is medical care. Below are some examples of group health insurance plans.

Employer-sponsored Health Insurance Coverage

An employer-sponsored group health plan is a type of insurance offered to the employees of a company as a benefit of working with the company.

Here, a portion of the monthly premium is paid by the business owner, however, the employees are also required to pay the other portion through payroll reduction. Typically, this type of group health insurance coverage covers an extensive range of healthcare costs that employees have been required to pay. However, employees can decide to decline coverage.

As much as group health plans benefit both you and your employees, therefore, both you and your employees will contribute to the premiums.

Medical services such as; hospital stays, doctor’s visits, prescription drugs, and preventive care, all gotten from the hospital are mostly catered for. However, terms and conditions may vary, depending on the plan chosen by the business owner.

Terms and conditions of medical coverage such as copays, types of services covered, tax-deductible, and coinsurance amounts, will all vary from company to company depending on the type of plan chosen by the employer.

Union-sponsored Health Insurance

Labor unions provide this type of insurance to their members. Here, these labor unions reach out to health insurance companies for the best possible plan for their members. As a result, the terms and conditions of the insurance are typically negotiated among the union as a whole and the employers.

Also, the terms and conditions of the insurance are provided as part of the bargaining agreement between the union and the employer. These agreements provide group coverage for members of the union, while also putting the employer into consideration.

This example of health insurance is designed to typically provide workers access to affordable but comprehensive healthcare coverage. Also, it functions as a group health insurance plan that caters to the health of workers.

However, the benefit of union-sponsored health insurance varies according to the collective needs of members of the union. Nevertheless, union-sponsored group health generally covers prescription drugs, the cost of medical care, and all other health-related expenses. It is a good example of group health insurance.

Government-sponsored Health Insurance

This example of group health insurance is not only provided by the government but also funded by the government as well. The main purpose of this group health plan is for all citizens to get access to affordable and extensive group medical insurance plans.

There are examples of government-sponsored group health insurance. They include Medicare and Medicaid. However, these two offer group health insurance differently. Medicare provides health coverage for people between the ages of 60 and above. While Medicaid provides health coverage for people with low income.

The government mostly works with one health maintenance organization at a time for each company to provide extensive group coverage. Group health plans are very government-based.

How To Enroll In A Group Health Insurance Plan

To enroll in any type of group health plan, regardless of the one you are enrolling in, there are specific steps that cut across all of these types. A group health plan refers to the kind of plan that caters to all employees collectively, while the employer caters to the premium.

As an employee, before you enroll in any group health insurance plan, there are steps to go through that give you an analysis of what group health plan works for you. Therefore, the universal steps for every group health plan that exists include-

Identify the Insurance Plan Offered by Your Employer or the Organization You Work

For employees to identify the plans offered by the company they work for, there are specific steps to follow. Most companies put this sort of information in three major places.

First is the employee’s handbook, second is the company’s website, and the last is asking HR.

Detailed Review

Some steps make reviewing a plan very easy to go about. Also, you need to review the details of a plan before you enroll in any plan. These steps include:

• Read the plan’s documentation
• Contact the insurance company
• Check out the insurance company’s website
• Reach out to licensed insurance agents

Choose Your Desired Coverage Plan

At this stage, you finally have gone through all the previous stages, now is the time for you to choose your desired coverage plan. However, there are still steps that will help make that choice well-tailored.

Therefore, if you decide to go with a self-insured health plan or level-funded plan, it is also important for you to note that insurance companies are the ones to provide healthcare for employees of a company.

Where To Find Group Health Insurance Plans

Most employees can find group health coverage plans through various channels. The most common channel is the employer, however, membership programs such as the freelancers Union also serve as another channel that works.

Trade or professional associations, unions, and other organizations are also channels to find suitable group health insurance plans. However, in a case where you are self-employed, look out for group insurance plans that cater to small businesses, or you could even consider individual health insurance plans.

For small businesses, the number of insured persons is very very dependent on how many employees such businesses have. Many employers, especially small business owners seek policy advice by various means.

Also, they mostly do that to find the preferred provider organization (PPO Plans) that gives group members more flexibility as regards healthcare costs. Additionally, the company’s tax credit, employees’ satisfaction, insurer’s risk, reduced cost, and additional cost may apply, all at a moderate price.

Benefits Of A Group Health Insurance Plan

Generally, group health insurance plans are very advantageous. Therefore, some of its benefits include; providing group healthcare coverage and enabling groups to enjoy low premiums. Also, insurance companies get the chance to reduce risk, by knowing who covers them, and insurers’ risk is also controlled through HMO contracts.

HMO contracts are contracts where members pay for specific healthcare expenses. Therefore, the HMO helps in keeping costs at a lower price range, but the flexibility for individual health insurance is restricted.

A health savings account is an insurance product that functions as a type of savings account. Health savings accounts are usually paired with high-deductible health plan.

Group health insurance plan offers several benefits, however, there are still benefits that are specific to the type of group health plan in question. These general benefits include:

• Lower premiums
• Extensive range of options
• Simplicity when compared to Individual health insurance
• Inclusion of preventive care services
• The ability of employees to afford individual health insurance collectively
• Sometimes covers family members i.e group health plans provide family coverage