Everything You Need To Know About Group Health Insurance

Health insurance can be confusing, even if you have used it for years. Here's what you need to know to navigate group health insurance.

What is group health insurance?

Group health insurance is a type of insurance that covers a group of people, usually those who work for the same employer. The employer pays for part or all of the premium, and the employees are usually able to get coverage at a lower rate than if they bought an individual policy.

Is health insurance cheaper if purchased as a group?

Yes, group health insurance is usually cheaper than buying an individual policy. This is because the insurance company spreads its risk over a larger pool of people.

What are the benefits of group health insurance?

There are many benefits to having group health insurance, including:

  • Cost. As mentioned above, group health insurance is usually cheaper than individual health insurance.
  • Coverage. Group health insurance plans are required to cover certain essential health benefits, like preventive care, hospitalization, and prescriptions.
  • Choice of providers. Group health insurance plans often have a network of providers that you can choose from.
  • Convenience. Group health insurance plans are often easy to enroll in and make payments for.

What are key terms to know about group health insurance?

There are a few key terms to know about group health insurance:

Premium. This is the amount you pay monthly for your health insurance coverage. Your employer may pay part or all of your premium.

Deductible. This is the amount you have to pay for medical care before your insurance plan starts to pay.

Co-pay. This is the amount you have to pay for each doctor's visit or prescription at the time of service.

Co-insurance. This is the percentage of your medical bills that you have to pay after you've met your deductible. If you have an 80/20 co-insurance, it means that after your deductible is met for the year, you pay 20 percent of all remaining medical bills and your insurance provider pays 80 percent. There is typically a cap on the amount you pay annually.

Out-of-pocket maximum. This is the most you'll have to pay for medical care in a year, including your deductible and co-insurance. Once you reach this amount, your insurance will pay 100 percent of all covered medical expenses for the rest of the year.

Network. This is the group of doctors, hospitals, and other healthcare providers that your insurance plan has contracted with to provide care at a discounted rate.

Additionally, it is important to note that insurance companies can't deny you coverage or charge you more because of pre-existing conditions.

Talk to your benefits coordinator or human resource department about your group health insurance policy today.

A company like SCI & Associates can offer more information. 

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